intro to physical assessment

Question 1

what is the purpose of physical assessments

Answer 1

to gather baseline data, supplement; confirm; or refute previous data, confirm and identify nursing diagnosis, evaluate physiological outcomes of care

Question 2

the 2 types of data

Answer 2

subjective, objective

Question 3

the 2 sources of data

Answer 3

primary, secondary

Question 4

3 phases of the interview process

Answer 4

Orientation, working, termination

Question 5

4 types of physical assessment

Answer 5

comprehensive, focused, system specific, ongoing

Question 6

what are the elements of the history assessment

Answer 6

baseline history, problem based history

Question 7

what are the elements of the examination assessment

Answer 7

vital signs, inspection, auscultation, palpation

Question 8

what are the 4 used techniques for assessment

Answer 8

inspection, palpation, auscultation, olfaction

Question 9

what sense is not used in assessments

Answer 9

taste

Question 10

what are 3 things to remember when doing an inspection

Answer 10

have good lighting, drape or cover parts not being examined for privacy, use additional lighting devices when needed

Question 11

what are you observing for when doing an inspection

Answer 11

color, shape/symmetry, movement, position

Question 12

light palpation

Answer 12

1 cm or 1/2 in deep

Question 13

deep palpation

Answer 13

4 cm or 2 in deep

Question 14

what are 8 things you are observing when doing a palpation assessment

Answer 14

texture, resistance, resilience, mobility, temperature, thickness, shape, moisture

Question 15

frequency

Answer 15

of oscillations per second generated by a vibrating object

Question 16

loudness

Answer 16

amplitude of a sound waves

Question 17

quality

Answer 17

descriptive

Question 18

duration

Answer 18

length of time that sounds lasts

Question 19

where do you place the stethoscope

Answer 19

directly on the skin

Question 20

bell of stethoscope

Answer 20

best for low pitched sounds

Question 21

diaphragm of stethoscope

Answer 21

best for high pitched sounds

Question 22

what do you look for in an olfactory assessment

Answer 22

abnormal vs normal smells

Question 23

what are 3 special considerations for age?

Answer 23

adjust position, allow more time, allow more space

Question 24

what do you begin the assessment with

Answer 24

a general survey

Question 25

4 signs of abuse

Answer 25

Inconsistency, bruises/lacerations/burns/bites, x-ray shows various stages of healing, behavioral issues