Nursing 210 Exam 1 2024 Questions & Answers Solved 100% Correct!!
Maslow's Hierarchy of Needs - physiological, safety, love/belonging, esteem, self-actualization Nursing Process: Assessment - ongoing collection of essential data variety of sources & methods used determines health status consider: patient characteristics(age/gender/religion) 4 types of assessment - 1)comprehensive/complete 2)focused/episodic 3)time lapsed-follow up 4)emergency step 1 of health assessment - collection of data health history, interview, physical exam, lab tests types of data: subjective & objective primary source of data - patient secondary source of data - family members, significant others, medical records, diagnostic procedures, and nursing literature step 2 of health assessment - Evaluation of Datareview any relevance, contradictions, gaps present data organized, legal, precise step 3 of health assessment - Comparison of Datapatient's "normal!", standards, your own experienceANA Professional standards of data collection - do shit right fam! collection involves everyone, using appropriate techniquesrelevant data documented health history - 1st step in health assessment: collection of data record of subjective data includes:patient profiledemographic/biological data(family history, culture, level of development) description of current health statusreason for coming in etc health history INTERVIEW - therapeutic communication techniques facilitate data gathering open-ended short ?s, don't ask why, move from general to specificCOLDSPA COLDSPA - C-characterdescribe sign/symptom! O- onsetwhen did it begin? L- locationwhere? D-durationhow long does it last? S- severity how bad ? P-patternwhat makes it better/worse? A- Associated factors other signs/symptoms at same time? phase 1 of health history interview - preparatory phase determine need for translator, therapeutic env., time interview consider anxiety levels, pain levels phase 2 of health history interview - introductory phase explain HIPAA, introduce self, prepare patientphase 3 of health history interview - working phase-body of interview observe verbal& non verbal cues, use therapeutic techniques phase 4 of health history interview - summary/closing/termination "is there anything else you would like to mention?" summarize& validate(recap) discuss plan General Survey - study of the whole person general health state and any obvious physical characteristics General Survey: Physical Appearance - hygiene, dress, skin color/condition, facial features, nutritional status, body structure overall behavior:eye contact, cooperation, speech, level of conciousness General Survey: Mobility - gaitwalk balanced, accurate foot placement range of motionfull mobility of joints, movements deliberate & coordinated Physical Examination (PE) - objective processdoctor evaluation inspection, auscultation, palpation, percussion head to toe, most common except for children & infants Inspection (Physical Exam) - use of hearing, smell, vision Auscultation (physical examination) - use of instrument(stethescope, doppler)Bell of stethoscope - soft, low pitched sounds for extra sounds/ heart murmurs Diaphragm of stethoscope - flat endpiece for relatively high-pitched heart sounds(breath/bowel/normal heart)
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