Advanced Patient Assessment (Exam 1) Solved 100%

Diagnostic Reasoning - Answer A. Cognitive skills in communicating B. Selecting assessment testing C. Interpreting results D. Formulating solutions E. Evaluating treatment plans Critical Thinking Steps - Answer 1. Identify the patients problem(s) Ex: Patient complains of dyspnea 2. Clarify the problem(s) Ex: Dyspnea only occurs during exercise 3. Perform additional assessment procedures Ex: Auscultation reveals wheezes 4. Formulate list of possible causes Ex: Asthma, CHF, Bronchitis 5. Obtain specialized test(s) Ex: PFT's shows obstructive lung disease 6. Determine potential solutions Ex: Bronchodilators before exercising 7. Evaluate solutions and monitor patient Ex: Patient states "Shortness of breath has been resolved with bronchodilators Stages of Patient and Clinician Interaction - Answer • Preinteraction Stage • Social Space • Personal Space • Intimate Space Preinteraction Stage - Answer Review patients chart to identify details: 1. Patients Name 2. Age 3. Gender 4. Chief complaint 5. Hx of present illness 6. Physicians initial orders Use this information to introduce yourself: 1. To make initial assessment 2. Clarify in your mind what your role will be in caring for the patient. Social Space - Answer A. Introduction space B. 4-12 feet C. Get the big picture D. Introduce self E. Greet patient by their formal name F. Start to establish rapport G. Confirm patient's identification 1. Address them by name 2. Check ID band H. Be warm and friendly but not irritating Personal Space - Answer A. 18 inches to 4 feet B. Interviewing - Make patient feel secure 1. Draw curtain around 2. Ask to pull up a chair C. Be aware of personal appearance D. Appropriate eye contact Intimate Space - Answer A. 0 to 18 inches B. Move into intimate space only after social and personal spaces have been done. C. Request permission to invade their space Example: Permission to listen to BS D. Limit eye contact E. Limit questions to simple commands Ex: "Please take a slow deep breath in" F. Point to ponder: Invasion of patient's intimate space is often met with a variety of different responses: 1. Gender 2. Age 3. Race 4. Physical appearance 5. Health status 6. Cultural background Expression of Genuine Concern - Face the patient squarely - Answer 1. Simple maneuver used during all conversations with the patient 2. It tells the patient that he/she has your undivided attention 3. It suggest you are interested in what they are saying 4. It allows you to visualize the patient better Expression of Genuine Concern - Maintain an open posture - Answer 1. Sit or stand in a relaxed manner with your arms at your side 2. A relaxed position creates a more comfortable setting for the patient 3. Represents nonverbal communication that you care and want to help Expression of Genuine Concern - Consider appropriate use of touch - Answer 1. Touch is a powerful tool for communicating genuine concern for the patient. 2. It is the most difficult technique to use appropriately. 3. To communicate empathy with touch should be limited to patients with whom you have a solid rapport. a. Used with patients who would receive it positively 4. Appropriate sites include a. Hands b. Arms c. Shoulders Expression of Genuine Concern - Be an active listener - Answer 1. Listening carefully to what the patient has to say shows true concern 2. Active listening take practice to become proficient. 3. Active listening includes: a. Good eye contact b. Asking for clarification on certain points c. Brief note taking Conversational Interviewing - Answer A. Open ended B. Closed ended C. Direct D. Indirect E. Neutral questions F. Reflecting G. Facilitating phrases H. Communicating empathy and support I. Complete Health History Open Ended - Answer The patient describes an event Ex: "What prompted you to come to the hospital?" "My tonsils felt like they were on fire" Closed Ended - Answer Focus on specific information Ex: "When did it start?" "Yesterday, early afternoon" Direct - Answer Either open ended or closed ended, always ends with a question to obtain specific information. - Too many "whys" may be intimidating Indirect - Answer Less threatening Ex: "I gather your doctor has ordered your treatments every six hours." Neutral Questions - Answer are preferred for all interactions with patients. Ex: "What happened next?" Reflecting - Answer (echoing) - Repeating words, thoughts or feelings the patient has just stated. Facilitating Phrases - Answer "yes" "umm" or "I see" should be used while establishing good eye contact Communicating Empathy and Support - Answer Ex: "That must have been very hard for you" Complete Health History - Answer (see page 19 - box 2-1 and page 20 in Wilkins) Assessing the patient - Answer • Look at patient/Body types • Vital signs - Temperature, Pulse Rate, Respiratory Rate, Blood Pressure • Level of Sensorium • Chest Physical Assessment • Auscultation/Breath Sounds Body Types - Answer Ectomorphoric, Endomorphic, Mesomorphic Ectomorphoric - Answer Slight development, body linear and with sparse muscular development (thin) Endomorphic - Answer Soft, roundness throughout the body, large trunk and thighs with tapering extremities (overweight) Mesomorphic - Answer Preponderance of muscle, bone, and connective tissue, with heavy hard physique of rectangular outline (fit) Vital Signs - Answer Temperature, Pulse Rate, Respiratory Rate, Blood Pressure Temperature - Answer A. Normal body temperature range is from 97.0 F to 99.5 F (36.5 C to 37.5 C) B. Daily variations of 1 to 2 degrees throughout the day. C. Body temperature lower in the morning and higher. D. Sites include: 1. oral 2. axillary 3. rectal 4. ear Fever - Answer Also known as Pyrexia Abnormally high body temperature 97 F Intermittent - Answer Daily elevation with a return to normal or subnormal between spikes. Remittent - Answer Continuously elevated with wide diurnal variations Relapse - Answer Recurring in bouts of several days interspersed with periods of normal temperatures. Hyperthermia - Answer Elevation of core body temperature above normal