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Health Assessment Lecture > Objective Data > Flashcards

Objective Data Flashcards

1
Q

Its a type of data that is reproducible, true for the patient and the nurse, and its a fact.

A

Objective Data

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2
Q

Purposes of Physical Examination

A
  • obtain baseline data about clients functional abilities
  • supplement, confirm, or refute data obtained from nursing history
  • obtains data that will establish nursing diagnosis and plan
  • Evaluate physiological outcomes of healthcare
  • Make clinical judgements
  • Identify areas of health promotion and disease prevention
  • dicover patient’s strenghts
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3
Q

Two types of physical assessment

A

Focused and Complete

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4
Q

Establish or monitors health status. Assess from head to toe

A

Complete Physical Assessment

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5
Q

This type of assessment focuses on a particular part of the body. This is done when patient is unstable, episodic follow up and time constraint situations

A

Focused Physical Assessment

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6
Q

What to prepare when conducting physical assessment.

A
  • yourself
  • The environment
  • The patient
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7
Q

How to prepare yourself before physical assessment

A
  • identify yourself
  • appear calm and organized
  • avoid interpreting your findings
  • observe standard and universal precaution
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8
Q

How to prepare your patient before physical assessment

A
  • explain where and where and when the examination takes place
  • explain what will happen during examination
  • determine contradicted positions
  • empty the bladder of client
  • start with least invasive aspect of examination if its with child
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9
Q

Preparing the environment before physical assessment

A
  • Temp
  • Lighting
  • Privacy and noise
  • Positioning
  • Draping
  • Instrumentation
  • Methods of Examining
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10
Q

What to consider when positioning the client

A
  • clients ability to assume position
  • Physical condition
  • energy level
  • age
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11
Q

A seated position, unssuported back, leg hanging freely

A

Sitting Position

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12
Q

Back lying position with legs extended, with or without pillow under the head

A

Supine Position

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13
Q

Back lying position, with knees flexed and hips externally rotated, has small pillow under the head, soles of feet on the surface

A

Dorsal Recumbent

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14
Q

Back lying position with feet supported on stirrups, hips should be in line with the edge of the table

A

Lithotomy

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15
Q

Lies on abdomen with head turned to the side with or without small pillow

A

Prone

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16
Q

lower most arm behind the body, uppermost leg flexed at hip and knee, upper arm flexed at shoulder and elbow

A

Sim’s Side lying position

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17
Q

knees and chest with head is turned to one side, arms extended on the bed, and elbows flexed and resting

A

Knee chest position

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18
Q

It provides privacy and warmth. Exposes only the area that is going to be assessed

A

Draping

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19
Q

Used to assess internal structure of the eyes. used in a dark room.

A

Ophthalmososcope

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20
Q

What equipment is being described?
▪ Assess hearing and vibratory sensation
▪ Low frequency fork (256Hz): testing
vibratory sensation
▪ High frequency fork (512Hz): assessing
hearing

A

Tuning fork

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21
Q

What equipment is being described?
To view the ear and nose cavities

A

Otoscope/Nasoscope

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22
Q

What equipment is being described?
▪ Lengths and circumferences
▪ Abdominal girth
▪ Fundal height

A

Tape measure/ pocket ruler

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23
Q

What equipment is being described?
▪ To assess range of motion exercisesr

A

Goniometer

24
Q

What equipment is being described?
▪ Used to measure body fat

A

Triceps skin fold calipers

25
Q

What equipment is being described?
▪ Used to measure weight
▪ If obtaining daily weights, weigh the patient
at the same time with the same scale

A

Scale

26
Q

What equipment is being described?
Used to….
▪ Better visualize the pharynx
▪ Assessing gag reflex
▪ broken after use

A

Wooden tongue depressor

27
Q

What equipment is being described?
▪ Used during neurological examination:
▪ Light touch
▪ Corneal reflex

A

Cotton balls

28
Q

To Assess hot and cold sensation

A

Test tubes

29
Q

To Assess the sense of smell

A

Coffee

30
Q

To Assess sense of taste

A

Sugar and lemon

31
Q

To Assess Swallowing ability and thyroid

A

Cup of water

32
Q

To Assess for stereognosis

A

Paper clip

33
Q

What equipment is being described?
▪ Assess light touch and pain
▪ Discard after use

A

Safety Pin

34
Q

What equipment is being described?
▪ Use when there is risk for exposure to blood
or body fluids

A

Gloves

35
Q

What is being described?
▪ Visual examination
▪ Assessing using sense of sight
▪ Moisture
▪ Color
▪ Texture of the body surface
▪ Shape, size, position, color and symmetry
of the body
▪ Also use sense of hearing and smell
▪ Use your patient as a comparative

A

Inspection

36
Q

General guidelines for Inseptecting a Patient

A

▪ Be systematic
▪ Use you patient as a comparative
▪ Always consider your patient’s growth and
developmental stage

37
Q

Types of Inspection

A

▪ Direct inspection
▪ Indirect inspection

38
Q

What is being described?
▪ Use of sense of touch
▪ Surface characteristics, texture,
consistency, temperature
▪ Masses, organs, pulsation, muscle rigidity,
chest excursion
▪ Able to differentiate areas of tenderness
from pain

A

Palpation

39
Q

what are the types of palpation

A

Light and Deep Palpation

40
Q

What Type of Palpation to Assess
- Temp, texture, mobility, shape, size
- Pulses
- Areas for edema
- Tenderness

A

Light Palpation

41
Q

What Type of Palpation to Assess
- Organ size, masses
- Rebound Tenderness
- Voluntary Guarding
- ballotment

A

Deep Palpation

42
Q

Striking a body surface with quick, light
blows and eliciting vibrations and sounds

A

Percussion

43
Q

Percussion assesses what?

A
  • Density of underlying structure
  • Areas of tenderness
  • Deep tendon reflexes
44
Q

Types of Percussion

A
  1. Direct/immediate Percussion
  2. Indirect Percussion
  3. Fist or Blunt Percussion
45
Q

Identify the type of percussion
- Directly tapping your hand over a body surface

A

Direct/immediate Percussion

46
Q

Identify the type of percussion

Uses plexor, pleximeter technique. Uses Percussion hammer

A

Indirect Percussion

47
Q

Identify the type of percussion
- assess organ tenderness
- can be direct and indirect

A

Fist or Blunt Percussion

48
Q

This technique uses
▪ Use of sense of hearing
▪ Assess heart sounds, lung sounds, bowel
sounds, vascular sounds
▪ Pitch (medium, high or low) oIntensity (soft
or loud)
▪ Duration (short or long)
▪ Quality

A

Auscultation

49
Q

Type of Auscultation

A

Direct and Indirect Auscultation

50
Q

This type of Auscultation is
- no stethoscope
- Respiratory congestion

A

Direct Auscultation

51
Q

This type of Auscultation is uses a stethascope

A

Indirect Auscultation

52
Q

Patients with special needs
- Children

A
  • Adopt an age appropriate approach
  • Look for normal growth and developmental
    changes
53
Q

Patients with special needs
- Pregnant Patients

A

▪ Assess both mother and fetus
▪ Include fundal heights and fetal heart tones
▪ Assess for physiologic changes
▪ Include nutritional assessment
▪ Remember that patients may have difficulty
changing positions
▪ Patients may have mood swings

54
Q

Patients with special needs
- Elderly patients

A

▪ Do not rush
▪ Look for developmental changes
▪ Conserve your patient’s energy
▪ Allow enough time to respond

55
Q

Patients with special needs
- Disabled patients

A

▪ Identify the disability
▪ Focus on patient’s functional ability and
mental capacity
▪ Modify as necessary

Health Assessment Lecture (17 decks)

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