WGU HEALTH ASSESSMENT
Subjectivebgdatabg-bganswers--Saidbgbybgthebgclientbg(S)
Obejectivebgdatabg-bganswers--Observedbgbybgthebgnursebg(O)
AssessmentbgTechniquesbgisbgasbgfollowsbg-bganswers--Inspect-Palpation-Percussion-Auscultation
OrderbgofbgAbdomenbgAssessmentbg-bganswers--Inspect-Auscultation-Percuss-Palapate
Inspectionbg-bganswers--*alwaysbgfirst*
1.bgTakebgtimebgtobgobservebgwithbgeyesbgearbgnosebg
2.Usebggoodbglighting
3.Lookbgatbgcolorbgshapebgsymmetrybgposition
4.Observebgforbgodorsbgfrombgskinbgbreathbgwound
5.bgDevelopbgandbgusebgnursingbginstincts
6.Inspectionbgisbgdonebgalonebgandbginbgcombinationbgwithbgotherbgassessmentbgtechniuqes
Backbgofbghandbg-bganswers--Tobgassessbgskinbgtemperaturebguse
DeepbgPalpationbg-bganswers--5-8cmbgorbg(2-3")bgdeepbgisbgconsidered
LightbgPaplpationbg-bganswers--1cmbgdeepbgisbgconsidered
,Percussionbg-bganswers--soundsbgproducedbgbybgstrikingbgbodybgsurface
soundsbgarebgdullbgresonantbgflatbgtympanic
actionbgisbgperformedbginbgthebgwrist
Ausculationbg-bganswers--listeningbgtobgsoundsbgproducedbgbybgthebgbody
Bellbg-bganswers--picksbgupbglowbgpitchedbgsoundsbgsuchbgasbgheartbgmurmurs
GeneralbgSurveybg-bganswers--
isbganbgoverallbgreviewbgorbgfirstbgimpressionbgabgnursebghasbgofbgperson'sbgwellbgbeing.
Appearancebg-bganswers--appearsbgtobgbebgreportedbgage
sexualbgdevelopmentbgappropriate
alertbgandbgoriented
facialbgfeaturesbgsymmetric
nobgsignsbgofbgacutebgdistress
BodybgStructure/mobiltybg-bganswers--weightbgandbgheightbgWNLbgBMIbgguidelines
bodybgpartsbgequalbgbilaterally
standsbgerect
sitsbgcomfortably
gaitbgisbgcoordinated
walkbgisbgsmoothbgandbgwellbgbalanced
fullbgmobilitybgofbgjoints
Behaviorbg-bganswers--maintainsbgeyebgcontactbgwithbgappropriatebgexpressions
comfortablebgandbgcooperative
speechbgclear
clothingbgisbgcorrectbgforbgclimate
, looksbgcleatbgandbgfit
appearsbgcleanbgandbgwellbggroomed
Comprehensivebghistorybg-bganswers--
whichbgincludesbgchiefbgcomplaintbgorbgreasonbgforbgthebgvisitbgabgcompletebgreviewbgofbgsystemsbgand
bgcompletebgpastbgfamilybgandbgsocialbghistorybgshouldbgbebgobtainedbgonbgthebgfirstbgencounterbgwithb
gabgpatientbgregardlessbgofbgsettingbgandbgbybgabgRN
FamilybgHealthbgHxbg-bganswers--
Arebgcompletedbgacrossbgthreebggenerationsbglookingbgspecificallybgforbgpatternsbginbggeneticbgissuesbgt
hatbgnegativelybgimpactbgqualitybgofbglife
HealthbgHxbg-bganswers--
givesbgabgpicturebgofbgpatient'sbgcurrentbghealthbgandbgdocumentationbgmustbgbebgcompletedbgforbgeac
hbgvisitbgandbgorbgassessment
Howbgtobgmeasurebgheightbglessbgthanbg2bgyearsbgofbgagebg-bganswers--
Obtainbgheightbgbybgmeasuringbgthebgrecumbentbglengthbgofbgchildrenbglessbgthanbg2bgyearsbgofbgagebg
and
childrenbgbetweenbg2bgandbg3bgwhobgcannotbgstandbgunassisted.bgAbgmeasuringbgboardbgwithbgabgstati
onarybgheadboardbgandbgabgslidingbgverticalbgfootbgpiecebgisbgideal,bgbutbgabgtapebgmeasurebgcanbgalsob
gbebgused
a)bgLaybgthebgchildbgflatbgagainstbgthebgcenterbgofbgthebgboard.bgThebgheadbgshouldbgbebgheldbgagainstb
gthe
headboardbgbybgthebgparentbgorbganbgassistantbgandbgthebgkneesbgheldbgsobgthatbgthebghipsbgandbgkne
esbgarebgextended.bgThebgfootbgpiecebgisbgmovedbguntilbgitbgisbgfirmlybgagainstbgthebgchild'sbgheels.bgRe
adbgandbgrecordbgthebgmeasurementbgtobgthebgnearestbg1/8bginch.
b)bgAbgmodifiedbgtechniquebginbghomebgsettingsbgisbgtobglaybgthebgchildbgflatbgandbgstraightbgwherebgth
ebgheadbgshouldbgbebgheldbgbybgthebgparentbgandbgthebgkneesbgheldbgsobgthatbgthebghipsbgandbgkneesb
garebgextended,bgmarkbgthebgflatbgsurfacebgatbgthebgtopbgofbgthebgheadbgandbgtipbgofbgthebgheels.bgMov
ebgchildbgandbgmeasurebgthebgdistancebgbetweenbgthebgmarksbgwithbgabgtapebgmeasure.bgReadbgandbgr
ecordbgthebgmeasurementbgtobgthebgnearestbg1/8bginch
2.bgWhenbgabgrecumbentbglengthbgisbgobtainedbgforbgabgtwobgyearbgold,bgitbgshouldbgbebgplottedbgonbgt
hebgbirthbgtobg36bgmonthsbggrowthbgchart.bgWhenbgabgstandingbgheightbgisbgobtainedbgforbgabgtwobgye
arbgold,bgplotbgthebgfindingbgonbgthebg2bgyearbgtobg18bgyearbgchart.bgAfterbgplottingbgmeasurementsbgfo
rbgchildrenbgonbgagebgandbggenderbgspecificbggrowthbgcharts,bgevaluate,bgeducatebgandbgreferbgaccordin
gbgtobgfindings.
Subjectivebgdatabg-bganswers--Saidbgbybgthebgclientbg(S)
Obejectivebgdatabg-bganswers--Observedbgbybgthebgnursebg(O)
AssessmentbgTechniquesbgisbgasbgfollowsbg-bganswers--Inspect-Palpation-Percussion-Auscultation
OrderbgofbgAbdomenbgAssessmentbg-bganswers--Inspect-Auscultation-Percuss-Palapate
Inspectionbg-bganswers--*alwaysbgfirst*
1.bgTakebgtimebgtobgobservebgwithbgeyesbgearbgnosebg
2.Usebggoodbglighting
3.Lookbgatbgcolorbgshapebgsymmetrybgposition
4.Observebgforbgodorsbgfrombgskinbgbreathbgwound
5.bgDevelopbgandbgusebgnursingbginstincts
6.Inspectionbgisbgdonebgalonebgandbginbgcombinationbgwithbgotherbgassessmentbgtechniuqes
Backbgofbghandbg-bganswers--Tobgassessbgskinbgtemperaturebguse
DeepbgPalpationbg-bganswers--5-8cmbgorbg(2-3")bgdeepbgisbgconsidered
LightbgPaplpationbg-bganswers--1cmbgdeepbgisbgconsidered
,Percussionbg-bganswers--soundsbgproducedbgbybgstrikingbgbodybgsurface
soundsbgarebgdullbgresonantbgflatbgtympanic
actionbgisbgperformedbginbgthebgwrist
Ausculationbg-bganswers--listeningbgtobgsoundsbgproducedbgbybgthebgbody
Bellbg-bganswers--picksbgupbglowbgpitchedbgsoundsbgsuchbgasbgheartbgmurmurs
GeneralbgSurveybg-bganswers--
isbganbgoverallbgreviewbgorbgfirstbgimpressionbgabgnursebghasbgofbgperson'sbgwellbgbeing.
Appearancebg-bganswers--appearsbgtobgbebgreportedbgage
sexualbgdevelopmentbgappropriate
alertbgandbgoriented
facialbgfeaturesbgsymmetric
nobgsignsbgofbgacutebgdistress
BodybgStructure/mobiltybg-bganswers--weightbgandbgheightbgWNLbgBMIbgguidelines
bodybgpartsbgequalbgbilaterally
standsbgerect
sitsbgcomfortably
gaitbgisbgcoordinated
walkbgisbgsmoothbgandbgwellbgbalanced
fullbgmobilitybgofbgjoints
Behaviorbg-bganswers--maintainsbgeyebgcontactbgwithbgappropriatebgexpressions
comfortablebgandbgcooperative
speechbgclear
clothingbgisbgcorrectbgforbgclimate
, looksbgcleatbgandbgfit
appearsbgcleanbgandbgwellbggroomed
Comprehensivebghistorybg-bganswers--
whichbgincludesbgchiefbgcomplaintbgorbgreasonbgforbgthebgvisitbgabgcompletebgreviewbgofbgsystemsbgand
bgcompletebgpastbgfamilybgandbgsocialbghistorybgshouldbgbebgobtainedbgonbgthebgfirstbgencounterbgwithb
gabgpatientbgregardlessbgofbgsettingbgandbgbybgabgRN
FamilybgHealthbgHxbg-bganswers--
Arebgcompletedbgacrossbgthreebggenerationsbglookingbgspecificallybgforbgpatternsbginbggeneticbgissuesbgt
hatbgnegativelybgimpactbgqualitybgofbglife
HealthbgHxbg-bganswers--
givesbgabgpicturebgofbgpatient'sbgcurrentbghealthbgandbgdocumentationbgmustbgbebgcompletedbgforbgeac
hbgvisitbgandbgorbgassessment
Howbgtobgmeasurebgheightbglessbgthanbg2bgyearsbgofbgagebg-bganswers--
Obtainbgheightbgbybgmeasuringbgthebgrecumbentbglengthbgofbgchildrenbglessbgthanbg2bgyearsbgofbgagebg
and
childrenbgbetweenbg2bgandbg3bgwhobgcannotbgstandbgunassisted.bgAbgmeasuringbgboardbgwithbgabgstati
onarybgheadboardbgandbgabgslidingbgverticalbgfootbgpiecebgisbgideal,bgbutbgabgtapebgmeasurebgcanbgalsob
gbebgused
a)bgLaybgthebgchildbgflatbgagainstbgthebgcenterbgofbgthebgboard.bgThebgheadbgshouldbgbebgheldbgagainstb
gthe
headboardbgbybgthebgparentbgorbganbgassistantbgandbgthebgkneesbgheldbgsobgthatbgthebghipsbgandbgkne
esbgarebgextended.bgThebgfootbgpiecebgisbgmovedbguntilbgitbgisbgfirmlybgagainstbgthebgchild'sbgheels.bgRe
adbgandbgrecordbgthebgmeasurementbgtobgthebgnearestbg1/8bginch.
b)bgAbgmodifiedbgtechniquebginbghomebgsettingsbgisbgtobglaybgthebgchildbgflatbgandbgstraightbgwherebgth
ebgheadbgshouldbgbebgheldbgbybgthebgparentbgandbgthebgkneesbgheldbgsobgthatbgthebghipsbgandbgkneesb
garebgextended,bgmarkbgthebgflatbgsurfacebgatbgthebgtopbgofbgthebgheadbgandbgtipbgofbgthebgheels.bgMov
ebgchildbgandbgmeasurebgthebgdistancebgbetweenbgthebgmarksbgwithbgabgtapebgmeasure.bgReadbgandbgr
ecordbgthebgmeasurementbgtobgthebgnearestbg1/8bginch
2.bgWhenbgabgrecumbentbglengthbgisbgobtainedbgforbgabgtwobgyearbgold,bgitbgshouldbgbebgplottedbgonbgt
hebgbirthbgtobg36bgmonthsbggrowthbgchart.bgWhenbgabgstandingbgheightbgisbgobtainedbgforbgabgtwobgye
arbgold,bgplotbgthebgfindingbgonbgthebg2bgyearbgtobg18bgyearbgchart.bgAfterbgplottingbgmeasurementsbgfo
rbgchildrenbgonbgagebgandbggenderbgspecificbggrowthbgcharts,bgevaluate,bgeducatebgandbgreferbgaccordin
gbgtobgfindings.