Lessons 1-3

Question 1

Give examples of situations in which a nurse’s ability to assess a client is critical.

Answer 1

• Giving/holding meds
• Calling for help
• Communicating
• Charting
• Identifying “watchers”
• Assigning patients

Question 2

Describe how nursing practice and education has evolved starting in the 1970s

Answer 2

• 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

Question 3

What are the 3 problems with incorporating physical diagnosis techniques from the medical profession into nursing curriculum in an essential identical format?

Answer 3

• 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.

Question 4

What are some positive aspects of technology in regards to physical assessment?

Answer 4

Measuring the effectiveness of particular physical assessment to determine its accuracy and usefulness..so basically accuracy and usefulness

Question 5

What are some negative aspects to technology in regards to physical assessment?

Answer 5

There may be over-reliance on technology for answers when simple physical assessment may bas as accurate and less invasive

Question 6

Evidence-based assessment

Answer 6

• 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

Question 7

Begin with the end in mind

Answer 7

Determine the goal and develop a plan to get there. Helps keep you heading in the right direction

Question 8

Mind like water

Answer 8

Respond to situations accordingly

Be willing and flexible and adapt to changes as they occur

Question 9

Why is it essential to understand the purpose and value of physical examination techniques?

Answer 9

• 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?

Question 10

What are 3 points about physical examination techniques?

Answer 10

• No test is perfect
• Context always takes precedence
• Likelihood ratios are the key

Question 11

Sensitive tests

Answer 11

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

Question 12

What does it mean when a test identifies people as having a disease when really they do not have it?

Answer 12

False positive

Question 13

Specific test

Answer 13

Positive results are most meaningful

• Tends to detect all people without disease
• May also identify people as not having disease when they actually do

Question 14

What does it mean when a test identifies people as not having a disease when they actually do have it?

Answer 14

False negative

Question 15

Why is an HIV test a sensitive test?

Answer 15

We do not want to MISS SOMEONE THAT MAY POSSIBLY HAVE HIV (and thus risk of infecting others)

Question 16

What is pancreatic cancer a specific test?

Answer 16

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.

Question 17

Likelihood ratios: 
LR value given. What is the interpretation?
10
2
1
0.5
0.1

Answer 17

10- diagnostic (rules in) GREAT TEST
2- Useful
1- No value
0.5- Useful
0.1- diagnostic (rules in) GREAT TEST

Question 18

What is the chief complaint?

Answer 18

Part of the doctors history and physical; what brings them in today?
-In a patients own words

Question 19

What is the HPI?

Answer 19

Part of doctors history and physical; History of present illness
-Clients story of what is going on

Question 20

What is PMH

Answer 20

Part of doctors history and physical; Past medical history

-Overview of client’s health prior to the present illness

Question 21

Family history

Answer 21

Part of doctors history and physical; age, health/death of family

Question 22

Psychosocial history

Answer 22

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

Question 23

What is the ROS?

Answer 23

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…

Question 24

What is the physical exam?

Answer 24

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.

Question 25

What are the 3 other parts of the doctors history and physical?

Answer 25

Lab and radiographic studies
Differential diagnosis
Assessment/plan

Question 26

What is the most important tool doctors use to determine a diagnosis?

Answer 26

History

-Listening to the patient’s story

Question 27

What is the role of diagnostic tests?

Answer 27

-Labs are used to confirm/disprove the suspected diagnosis

Question 28

Are diagnostic tests used for “hunting expeditions”?

Answer 28

No. We do the labs to confirm/disprove the suspected diagnosis…not to run a bunch of random labs to find the problem.

Question 29

What are some tools a nurse needs for a typical bedside assessment?

Answer 29

Stethoscope
Penlight
BP cuff
Thermometer
Watch with a second hand

Question 30

What’s the difference between a medical diagnosis and a nursing diagnosis?

Answer 30

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

Question 31

What is the daily routine of a bedside nurse?

Answer 31

Daily routine:

• Beginning report
• Bedside assessment
• Fluid intake and output every 2 hours
• Mid-day focused assessment
• Final report

Question 32

When is health history done?

Answer 32

Health history

Question 33

What is the difference between a head to toe assessment and focused assessment?

Answer 33

Head to toe: Whole/body comprehensive

Focuses: Specific/focusing on the system affected by their diagnosis

Question 34

Nursing surveillance (as it relates to health assessment)

Answer 34

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)

Question 35

Quote: What does surveillance involve?

Answer 35

Surveillance involves frequent patient assessment and recognizing subtle and overt cues