Lessons 1-3 Flashcards
Give examples of situations in which a nurse’s ability to assess a client is critical.
- Giving/holding meds
- Calling for help
- Communicating
- Charting
- Identifying “watchers”
- Assigning patients
Describe how nursing practice and education has evolved starting in the 1970s
- Physical assessments added to nursing curriculum (but in the same format as medical students)
- Nursing from task to profession
- Integrated as part of a health care team
What are the 3 problems with incorporating physical diagnosis techniques from the medical profession into nursing curriculum in an essential identical format?
- Nursing as a profession: Nursing curriculum is the same as medical curriculum, but nurses training is only 1-2 years whereas physicians are 4+ years training. There is overlap between nurses and doctors.
- Technology: Technology makes up more than 50% of the assessment. Traditional exams have been rendered obsolete and do not yield accurate results.
- Evidence based assessment: Compare physical signs with modern diagnostic standards.
What are some positive aspects of technology in regards to physical assessment?
Measuring the effectiveness of particular physical assessment to determine its accuracy and usefulness..so basically accuracy and usefulness
What are some negative aspects to technology in regards to physical assessment?
There may be over-reliance on technology for answers when simple physical assessment may bas as accurate and less invasive
Evidence-based assessment
- The use of research and theory is used to guide the selection of assessments to be used
- Decision of assessment based on info and data does not rely on gut instinct
- Optimize decision-making by emphasizing the use of evidence from well designed and conducted research
Begin with the end in mind
Determine the goal and develop a plan to get there. Helps keep you heading in the right direction
Mind like water
Respond to situations accordingly
Be willing and flexible and adapt to changes as they occur
Why is it essential to understand the purpose and value of physical examination techniques?
- You should have a purpose for performing the test
- You should be able to properly interpret the results of a given test and be able to make appropriate decisions
- If you don’t understand the above, then there is no way to make a proper decision. If you don’t know the meaning or value of the test, why are you even doing it?
What are 3 points about physical examination techniques?
- No test is perfect
- Context always takes precedence
- Likelihood ratios are the key
Sensitive tests
Negative results are most meaningful
- Tends to detect all people with a disease
- May also identify people as having a disease when they do not
What does it mean when a test identifies people as having a disease when really they do not have it?
False positive
Specific test
Positive results are most meaningful
- Tends to detect all people without disease
- May also identify people as not having disease when they actually do
What does it mean when a test identifies people as not having a disease when they actually do have it?
False negative
Why is an HIV test a sensitive test?
We do not want to MISS SOMEONE THAT MAY POSSIBLY HAVE HIV (and thus risk of infecting others)
What is pancreatic cancer a specific test?
Pancreatic cancer is a type of cancer that unfortunately does not give you much hope. We do not want to inform someone they have pancreatic cancer when they do not.
Likelihood ratios: LR value given. What is the interpretation? 10 2 1 0.5 0.1
10- diagnostic (rules in) GREAT TEST 2- Useful 1- No value 0.5- Useful 0.1- diagnostic (rules in) GREAT TEST
What is the chief complaint?
Part of the doctors history and physical; what brings them in today?
-In a patients own words
What is the HPI?
Part of doctors history and physical; History of present illness
-Clients story of what is going on
What is PMH
Part of doctors history and physical; Past medical history
-Overview of client’s health prior to the present illness
Family history
Part of doctors history and physical; age, health/death of family
Psychosocial history
Part of doctors history and physical; clients birthplace, education, employment, religion, use of alcohol, tobacco, diets, exercise, hobbies, living accommodations, client’s sexual history, etc
What is the ROS?
Part of doctors history and physical; Review of systems
-SUBJECTIVE data
-Thorough review of each body system based on what the patient is describing so the doctor as an idea of what is going on..It narrows down so during the physical assessment the doctors has an idea of what to look for.
EX: I have this weird mole on my back…
What is the physical exam?
Part of doctors history and physical
-OBJECTIVE data
-Thorough assessment of different systems to see what findings they may have
-Measurable
EX: This mole is discolored and abnormally shaped. We should run a test on this.
What are the 3 other parts of the doctors history and physical?
Lab and radiographic studies
Differential diagnosis
Assessment/plan
What is the most important tool doctors use to determine a diagnosis?
History
-Listening to the patient’s story
What is the role of diagnostic tests?
-Labs are used to confirm/disprove the suspected diagnosis
Are diagnostic tests used for “hunting expeditions”?
No. We do the labs to confirm/disprove the suspected diagnosis…not to run a bunch of random labs to find the problem.
What are some tools a nurse needs for a typical bedside assessment?
Stethoscope Penlight BP cuff Thermometer Watch with a second hand
What’s the difference between a medical diagnosis and a nursing diagnosis?
Medical diagnosis, the assessment is used to supply and underlying cause. More abstract
Nursing diagnosis: Assessment is more holistic, focusing on the client’s experience of the medical problem. More concrete
What is the daily routine of a bedside nurse?
Daily routine:
- Beginning report
- Bedside assessment
- Fluid intake and output every 2 hours
- Mid-day focused assessment
- Final report
When is health history done?
Health history
What is the difference between a head to toe assessment and focused assessment?
Head to toe: Whole/body comprehensive
Focuses: Specific/focusing on the system affected by their diagnosis
Nursing surveillance (as it relates to health assessment)
The thing nurses can do that no one else can do
- Our main role in the healthcare team
- Keeping a close eye on the patient the whole-time they are in the hospital (ongoing surveillance)
Quote: What does surveillance involve?
Surveillance involves frequent patient assessment and recognizing subtle and overt cues
