Week 1 - Class 2 (Introduction to Health Assessment)

Question 1

What does health mean to you? Is there a universal definition / Does everyone define health the same way? What influences peoples definition of health?

Answer 1

Complete physical, mental, and social well-being
- Not only the absence of disease

No
- Many people have a different perspective of “health”

There are many factors:

• Social
• Cultural
• Religion
• Environmental
• Social
• Financial

Question 2

What does holism mean to you?

Answer 2

• Including all entities and perceptions

Question 3

What is Holistic Health Assessment? What does it examine? What does it address?

Answer 3

It is about addressing the whole person - mind, body, and spirit

• Examines: Interactions with one’s values, goals, and motivations
• Addresses: Physiological, psychological, sociological, developmental, spiritual, and cultural needs of the client

Question 4

How does holism make the assessment/treatment/relationship client focused?

Answer 4

It tailors to the patient rather than having a “one-size-fits-all” approach.

Question 5

What is a good approach for nursing and decision making?

Answer 5

The Holistic Health Assessment Model because it considers various dimensions of the patient - you see all parts of them.

Question 6

For the patient, what are three contexts for health?

Answer 6

1) Social determinants
2) Family context
3) Community context

Question 7

For a nurse, what are the two contexts of health?

Answer 7

1) Positionality

2) School of Nursing Core Tenets

Question 8

What is positionality?

Answer 8

Positionality is the context you bring to an interaction

• It asks ‘where you are coming from as you approach a situation’ and ‘what kind of effect does that have on how you see this person, how you understand their circumstances, how you offer help/care, what you notice and what you don’t, what you look for and what you don’t’, etc.
• Ex. If you come from a privileged orientation, you may miss certain aspects about your patient or how you view them may affect your relationship

Question 9

What is the ‘School of Nursing Core Tenets’? Why do we view our work with a critical lens? What is the stance on social justice?

Answer 9

The School of Nursing Core Tenets are about looking at health, people, conditions, environments, etc. through and equity lens

• We view our work critically because we question and examine structures
• Social justice is our stance on equity - we seek to improve the progression of health for all

Question 10

What are two distinct phases of the nursing process? What does the nursing process do?

Answer 10

History and physical assessment.

The nursing process is a method that assists nurses in collecting info, determining appropriate interventions, and evaluating outcomes.

Question 11

What is OLDCARTSS?

Answer 11

A framework for ensuring that the collection of data from a physical assessment, and even the collection of data about an occurrence or health event, is as complete as possible.

• Past medical history
• Family history
• Medications
• Immunizations
• Allergies
• Lifestyle
• Psychosocial
• Impact on function

Question 12

What is a physical assessment used for?

Answer 12

Obtaining baseline data

• Supplementing, confirming, or refuting data obtained in the nursing history
• Helps to establish nursing diagnosis and plan client care
• Evaluating physiological outcomes of care and therefore the progression of the clients health status
• Making clinical judgments about the clients health
• Assess the outcomes

Question 13

Who orders physical assessments?

Answer 13

Physicians or other care providers for specific issues

Question 14

When would a nurse perform a physical assessment?

Answer 14

Nurses are performing PA based on info they gathered from the PT, as well as their own observations and clinical reasoning.

Question 15

What is a Review of Systems?

Answer 15

All of the body systems for a comprehensive assessment

- Not many instances where you need to review each body system

Question 16

What is important in a Review of Systems?

Answer 16

How all the body systems interact with one another

Question 17

What is a HEAD TO TOE examination? Why do we do this?

Answer 17

Actual action of examining the PT - Looking at more than one problem

• We do this to avoid missing anything
• Ex. Painful hip and anything that relates to it
• Ex. Annual physical

Question 18

What are the 4 basic techniques of physical assessments?

Answer 18

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

Question 19

What is the one exception to the order of a physical assessment?

Answer 19

Abdominal Assessment
- If we palpate, we may create activity in the bowel that can be artificial and these sounds may not be what the PT is actuall experiencing

Question 20

During a physical assessment, how does one proceed with inspection? What do you do first? What are some good techniques?

Answer 20

Inspection begins by using the senses (i.e. hear, smell) to observe body parts and note deviation from normal
- Use your eyes

Techniques:

• Expose body part
• Look before touching
• Use good lighting
• Warm, private room
• Observe colour, size, location, symmetry, movements, odours, and sound

Question 21

During a physical assessment, how does one proceed with palpation? To determine what?

Answer 21

Palpation begins with touching and feeling the body part with your hands to determine:

• Texture
• Temperature
• Moisture
• Motion
• Consistency of structures (i.e. solid/fluid/liquid)

Question 22

What is palpation an important part of?

Answer 22

Abdominal assessment

Question 23

What are 2 types of palpation?

Answer 23

1) Light palpation
- Pain
- Distention
- Superficial Masses

2) Deep palpation
- Advanced skill (NP or physician)

Question 24

During a physical assessment, how does one proceed with percussion? Used to determine? What are some techniques?

Answer 24

Tapping a portion of the body to elicit tenderness or sounds that vary with the density of underlying structure due to pair, fluid or solids - used to determine:

• Size & location of body organs
• Stimulate reflexes

Technique

• Direct Percussion = Directly tap on body part
• Indirect Percussion = Press middle finger on non-dominant hand firmly on the body part then use middle finger of dominant hand to tap joint of finger resting on body surface

Question 25

During a physical assessment, how does one proceed with auscultation? Used for what type of assessments? Techniques?

Answer 25

Listening for various breath, heart, vascular, and bowel sounds - listen for pitch, intensity, duration, and quality with a stethoscope
- Cardiac, respiratory, and abdominal assessments (also a part of BP)

Techniques:

• Use stethoscope with snug fitting ear pieces
• Diaphragm used to detect high pitched sounds (i.e. breath, heart, bowels)
• Bell used to detect low pitched sounds (i.e. cardiac)
• Good contact with body and keep hand still

Question 26

What is the clinical judgment model?

Answer 26

Explains how a nurse goes from raw data, to making sense of it, to taking action, to evaluating whether that action was successful or not.

Question 27

What are the 4 phases of the clinical judgment model?

Answer 27

1) Noticing
- The PT, environment, and your past experiences influences decision making of the PT
2) Interpreting
3) Responding
4) Reflecting
- In action
- On action

Question 28

Is healthcare black and white? What is the biggest challenge?

Answer 28

No - Nursing is grey

- Everything does not have an answer

Question 29

What is the general survey? How does it help the next clinician? Why is it important?

Answer 29

“Organized Noticing”

• When you walk into the PT room and throughout the PT interaction
• Can be used by the next clinician to determine if there is any change without previously seeing the client
• It is important to know what is normal for the PT before an assessment = normal is a complex word

Question 30

What are the components of the general survey?

Answer 30

ASEPTIC

• Appearance and behaviour
• Speech
• Emotion
• Perception
• Thought process
• Insight
• Cognition

Question 31

What are the 7 takeaways of this lesson?

Answer 31

1) Health’ is defined differently by different people
2) Health assessment is holistic when it takes into consideration all of those factors that make up the client’s context
3) Physical assessments are performed routinely by nurses and involve particular techniques for gathering information
4) The physical assessment is informed by the health history
5) Nurses work together yet autonomously and must exercise clinical judgment when caring for clients
6) Tanner’s clinical judgment model is a framework for understand how nurses make decisions
7) Noticing is the first phase of the CJM and includes subjective data, general survey, assessment findings, environmental factors, and data/input from other sources

Question 32

What is the relevance of everything in this lesson (5)?

Answer 32

1) Health assessment is one of the primary functions of the professional nurse.

2) The 4 techniques used for physical assessment will only improve with continued practice.
Learn now, before working with vulnerable people.

3) Nurses work autonomously to conduct holistic assessments. You need to be competent to do this independently.
4) The autonomous nature of nurses’ work means that using sound clinical judgment is paramount to safe and effective care.
5) Nurses use clinical judgment everyday in their practice, from minor tasks to major assessments & interventions. This also improves with practice and experience.

Question 33

Understand the following terms, concepts, and acronyms.

Answer 33

• HHA
• CJM
• SDoH
• Nursing process (slide 14)
• Context
• Positionality
• EVERYTHING in the notes on SLIDE 9
• OLDCARTSS
• Nursing diagnosis
• Head-to-toe assessment
• General survey
• Palpation, percussion, auscultation

-Noticing*