Study Guide Objectives: Lessons 1 and 2 Flashcards
Name situations in which a nurse’s assessment of a client is crucial:
- Giving/holding meds
- Calling for help
- Communicating
- Charting
- Identifying “watchers”
- Assigning patients
When was physical assessment incorporated into the nursing curriculum?
1970’s
Name 3 problems in incorporating physical diagnosis techniques from the medical profession into nursing curriculum in al almost identical format:
- Nursing curriculum is the same as medical curriculum and nurses are expected to learn it in less time.
- Technology
- Evidence based assessment
What positive impact has technology had on nursing?
Technology has allowed us a means of measuring the effectiveness of a particular physical assessment to determine its accuracy and usefulness.
What negative impact has technology had on nursing?
There may be an over-reliance on technology for answers when simple physical assessment may be as accurate and less invasive.
What is meant by evidence based assessment?
- The use of research and theory is used to guide the selection of assessments to be used.
- The decision to use an assessment is based on information and data and does not rely on gut instinct
- Optimize decision-making by emphasizing the use of evidence from well designed and conducted research.
What are Health Assessment’s 2 mottos?
- Begin with the end in mind
2. Mind like water
What is meant by “Begin with the end in mind”?
Determine the goal and then develop a plan to get there.
What is meant by “Mind like Water”?
Be flexible.
Regarding evidence based assessments, fill in the blanks:
- No ____ is perfect
- _______ always takes precedence
- ___________ ratios are the key
Test
Context
Likelihood
In a sensitive test, _______ results are the most meaningful.
Negative
What does a sensitive test detect?
- Tends to detect all people WITH a disease
2. May also identify people as having a disease when they do not (false Positive).
In a specific test, ________ results are the most meaningful.
Positive
What does a specific test detect?
- Tends to detect all people WITHOUT a disease
2. May also identify people as not having disease when they actually do (false Negative)
Which test, sensitive or specific, can give a false negative?
Specific
Which test, sensitive or specific, can give a false positive?
Sensitive
Give an example of a disease in which a sensitive test is the most beneficial for detection. Why?
HIV
Why? We do not want to miss a patient with the disease (and thus risk infecting others).
Give an example of a disease in which a specific test is the most beneficial for detection? Why?
Pancreatic Cancer
Why? Do not want to inform someone they have pancreatic cancer when they do not.
Why is a test’s likelihood ration important to know?
Likelihood ratios take into account sensitivity and specificity.
What likelihood ratio has no value?
1
What is an example of an assessment skill with strong research support?
What is the test for this called?
Why is it strong?
ACL Tear
Strong: Lachman Test (+ LR: 9.6 and - LR: 0.15)
This method is strong, because both the positive and negative are both useful, and close to a diagnostic level
What is the Lachman test?
Test where the examiner flexes the patients leg in a certain way to test for ACL deficiency.
What is an example of an assessment skill with weak research support?
What is a better test?
Right upper quadrant pain for cholecystitis
Lab result of white blood count is a WEAK predictor of cholecystitis (+LR=1.8)
Murphy’s sign
What is Murphy’s sign?
Fingers will bump gallbladder if it is inflamed
