NUR 2092 SECTION 03 HEALTH ASSESSMENT TEST 1 STUDY GUIDE

(DOWNLOAD FOR COMPLETE AND USEFUL RESOURCES) HEALTH ASSESSMENT EXAM 1 CHAPTER 2 • FOUR TYPES OF ASSESSMENT DATABASES o COMPLETE (TOTAL HEALTH)  COMPLETE HEALTH HISTORY AND FULL PHYSICAL EXAMINATION • DESCRIBES CURRENT AND PAST HEALTH STATE • FORMS A BASELINE AGAINST WHICH ALL FUTURE CHANGES CAN BE MEASURED  THIS WOULD BE DONE IN A PHYSICIAN’S OFFICE/FIRST PATIENT  TAKES ABOUT HALF AN HOUR TO GET ALL THIS INFO o FOCUSED OR PROBLEM-CENTERED DATABASE  USED FOR A LIMITED OR SHORT-TERM PROBLEM  COLLECT A MINI DATABASE • SMALLER IN SCOPE AND MORE TARGETED  COLLECT INFORMATION REGARDING THAT ACUTE INCIDENT o FOLLOW-UP DATABASE  COMPLICATIONS?  ARE MEDICATIONS WORKING?  BLEEDING? STILL HURT? ANY BETTER? o EMERGENCY DATABASE  URGENT, RAPID COLLECTION OF CRUCIAL INFORMATION  NAME?  AS MUCH INFO AS YOU CAN? • CAB o CIRCULATION – MOST IMPORTANT o AIRWAY o BREATHING o WHAT’S HAPPENING?  CALL 911 AND EXPLAIN • EVIDENCE-BASED ASSESSMENT o CLINICAL DECISION MAKING DEPENDS ON ALL FOUR FACTORS  BEST EVIDENCE FROM A CRITICAL REVIEW OF RESEARCH LITERATURE  THE PATIENT’S OWN PREFERENCES  THE CLINICIAN’S OWN EXPERIENCE AND EXPERTISE  PHYSICAL EXAMINATION AND ASSESSMENT • ASSESSMENT SKILLS MUST BE PRACTICED WITH HANDS ON EXPERIENCE AND REFINED TO A HIGH LEVEL • CULTURAL COMPETENCY QUESTIONS o WHEN MEETING A PATIENT FOR THE FIRST TIME  WHERE DOES THE PATIENT COME FROM?  WHAT IS HIS/HER HERITAGE?  WHAT IS HIS/HER CULTURAL BACKGROUND?  WHAT LANGUAGE IS THE PATIENT FAMILIAR WITH?  WHAT ARE HIS/HER HEALTH AND ILLNESS BELIEFS AND PRACTICES? • HEALTH o BALANCE OF A PERSON IS A COMPLEX, INTERRELATED PHENOMENON  WITH ONE’S BEING: PHYSICAL, MENTAL, AND SPIRITUAL  IN OUTSIDE WORLD: NATURAL, COMMUNAL, AND METAPHYSICAL • ILLNESS o LOSS OF A PERSON’S BALANCE • ALMOST 40% OF US RESIDENTS IDENTIFY AS OTHER THAN NON-HISPANIC WHITES • EMERGING MINORITY GROUPS o YOUNGER WITH LOWER MEDIAN AGES o HIGHER PROPORTIONS UNDER 18 YEARS OLD o HOUSEHOLDS WITH MULTIPLE GENERATIONS o POVERTY LEVEL  TRANSPORTATION  ACCESS TO CARE  LITERACY • IMMIGRATION AND HEALTH CARE CONCERNS o MANY NEW IMMIGRANTS HAVE ONLY MINIMAL UNDERSTANDING OF THE FOLLOWING  MODERN HEALTH CARE DELIVERY SYSTEM  MODERN MEDICAL AND NURSING PRACTICES AND INTERVENTIONS  ENGLISH LANGUAGE o IMPERATIVE THAT THE NURSE’S CARE IS TAILORED TO MEET THE PERSON’S PERCEIVED NEEDS • NATIONAL CULTURAL AND LINGUISTIC STANDARDS o FIRST AND LANDMARK STANDARD  HEALTH CARE ORGANIZATIONS ARE LEGALLY REQUIRED TO ENSURE THAT PATIENTS RECEIVE EFFECTIVE, UNDERSTANDABLE, AND RESPECTFUL CARE THAT IS PROVIDED IN A MANNER COMPATIBLE WITH THEIR CULTURAL HEALTH BELIEFS AND PRACTICES AND PREFERRED LANGUAGE o EFFECTIVE CARE  POSITIVE OUTCOMES AND SATISFACTION FOR PATIENT o RESPECTFUL CARE  CONSIDERS VALUES, PREFERENCES, AND EXPRESSED NEEDS OF PATIENT o CULTURAL AND LINGUISTIC COMPETENCE  CONGRUENT BEHAVIORS, ATTITUDES, AND POLICIES THAT COME TOGETHER IN A SYSTEM AMONG PROFESSIONALS THAT ENABLES WORK IN CROSS-CULTURAL SITUATIONS • LINGUISTIC COMPETENCE o TITLE VI OF CIVIL RIGHTS ACT OF 1964  SERVICES CANNOT BE DENIED TO PEOPLE OF LIMITED ENGLISH PROFICIENCY o MOST COMMON NON-ENGLISH LANGUAGE IS SPANISH o PATIENTS WHO HAVE LIMITED ENGLISH PROFICIENCY (LEP) ARE AT RISK FOR POOR HEALTH CARE OUTCOMES DUE TO THE BARRIER THAT LANGUAGE PRESENTS DURING HEALTH CARE DELIVERY INTERACTIONS • CULTURAL COMPETENCE o CULTURALLY SENSITIVE  POSSESSING BASIC KNOWLEDGE OF AND CONSTRUCTIVE ATTITUDES TOWARD DIVERSE CULTURAL POPULATIONS o CULTURALLY APPROPRIATE  APPLYING UNDERLYING BACKGROUND KNOWLEDGE NECESSARY TO PROVIDE THE BEST POSSIBLE HEALTH CARE o CULTURALLY COMPETENT  UNDERSTANDING AND ATTENDING TO TOTAL CONTEXT OF PATIENTS SITUATION INCLUDING THE FOLLOWING • IMMIGRATION STATUS • STRESS AND SOCIAL FACTORS • CULTURAL SIMILARITIES AND DIFFERENCES • STEPS TO CULTURAL COMPETENCE o UNDERSTAND ONE’S OWN HERITAGE-BASED VALUES, BELIEFS, ATTITUDES, AND PRACTICES o IDENTIFY MEANING OF “HEALTH” TO PATIENT o ACQUIRE KNOWLEDGE ABOUT SOCIAL BACKGROUNDS OF PATIENTS o BECOME FAMILIAR WITH LANGUAGES, INTERPRETIVE SERVICES, AND COMMUNITY RESOURCES AVAILABLE TO NURSES AND PATIENTS • FOUR BASIC CONCEPTS OF CULTURE o LEARNED o SHARED o ADAPTED o DYNAMIC • RACE AND ETHNICITY o SELF-IDENTIFICATION o SOCIAL GROUP • ACCULTURATION o ASSIMILATION IS ONE DIMENSIONAL o BICULTURALISM/INTEGRATION IS DIMENSIONAL • CULTURE o THOUGHTS, COMMUNICATIONS, ACTIONS, BELIEFS, VALUES, AND INSTITUTIONS OF RACIAL, ETHNIC, RELIGIOUS, OR SOCIAL GROUPS • RELIGION o BELIEF IN DIVINE OR SUPERHUMAN POWER, OR POWERS TO BE OBEYED AND WORSHIPPED AS CREATOR/RULER OF UNIVERSE o SYSTEM OF BELIEFS, PRACTICES, AND ETHICAL VALUES o SHARED EXPERIENCE OF SPIRITUALITY o PEOPLE HOLD RELIGION VERY DEAR  YOU CANNOT DISCREDIT THEIR RELIGION OR THE IMPORTANCE OF THEIR SPIRITUALITY • SOCIALIZATION o PROCESS OF BEING RAISED WITHIN A CULTURE AND ACQUIRING CHARACTERISTICS OF THAT GROUP • ACCULTURATION o PROCESS OF ADAPTING TO AND ACQUIRING ANOTHER CULTURE • ASSIMILATION o PROCESS OF DEVELOPING A NEW CULTURAL IDENTITY AND BECOMING LIKE MEMBERS OF DOMINANT CULTURE • BICULTURALISM o DUAL PATTERN OF IDENTIFICATION AND OFTEN OF DIVIDED LOYALTY • HEALTH-RELATED BELIEFS AND PRACTICES o BALANCE AND BELIEFS ABOUT CAUSES OF ILLNESS o BIOMEDICAL OR SCIENTIFIC THEORY  BIOMEDICAL • ASSUMES CAUSE AND EFFECT • VIEWS THE BODY AS A MACHINE • LIFE CAN BE DIVIDED INTO PARTS • ENDORSES GERM THEORY o NATURAL OR HOLISTIC THEORY  NATURALISTIC • FORCES OF NATURE MUST BE KEPT IN BALANCE • EMBRACES IDEAS OF OPPOSING CATEGORIES OR FORCES o YIN AND YANG o HOT AND COLD o MAGICORELIGIOUS PERSPECTIVE  SUPERNATURAL POWERS PREDOMINATE IN AREA OF HEALTH AND ILLNESS • VOODOO ETC o TRADITIONAL BELIEFS AND HEALTH HEALERS  SOME CULTURES JUST GO TO THEIR LOCAL “DESIGNATED NOT OFFICIAL” HEALTH CARE PROVIDER  SOME ETHNIC GROUPS BELIEVE THAT CURE IN INCOMPLETE UNLESS HEALING IS CARRIED OUT FOR THE BODY, MIND, AND SPIRIT • HEALTH-RELATED BEHAVIORS AFFECTED BY RELIGION o MEDITATING o EXERCISE o SLEEP o VACCINATIONS o STRESS o GENETIC SCREENING o CARE FOR CHILDREN • FOLK HEALERS o HISPANIC  HERBALISTS  SPIRITUALISTS o BLACK  VOODOO PRIEST  SPIRITUALIST o AMERICAN INDIAN  SHAMAN  MEDICINE WOMAN/MAN o ASIAN  HERBALISTS  ACUPUNCTURE  BONE SETTERS o AMISH  HERBALISTS • DEVELOPMENTAL COMPETENCE o CULTURE AFFECTS CHOICES PARENTS MAKE FOR CHILDREN REGARDING THE FOLLOWING  PRESUMED CAUSE OF ILLNESS  FIRST TREATMENT TRIED  ACCEPTABILITY OF TREATMENTS OFFERED BY CLINICIANS o OLDER PATIENTS, CULTURE IS LIKELY TO DO THE FOLLOWING  DEFINE THEIR FAMILY RESPONSIBILITIES  AFFECT THEIR VIEW AND KNOWLEDGE OF HEALTH CARE SYSTEMS USED BY DOMINANT CULTURE • TRANSCULTURAL EXPRESSION OF ILLNESS o EXPRESSION OF PAIN  EXPECTATIONS, MANIFESTATION, AND MANAGEMENT OF PAIN ARE ALL EMBEDDED IN A CULTURAL CONTEXT  PAIN HAS BEEN FOUND TO BE A HIGHLY PERSONAL EXPERIENCE • UNIQUE FOR EACH PERSON  SILENT SUFFERING HAS BEEN IDENTIFIED AS THE MOST VALUES RESPONSE TO PAIN BY HEALTH CARE PROFESSIONALS • CULTURE-BOUND SYNDROMES o CONDITION THAT IS CULTURALLY DEFINED  SOME HAVE NO EQUIVALENT BIOMEDICAL, SCIENTIFIC PERSPECTIVE  ANOREXIA NERVOSA AND BULIMIA ARE EXAMPLES OF CULTURAL ASPECTS OF ILLNESS IN DOMINANT CULTURAL POPULATION IN NORTH AMERICA • HERITAGE CONSISTENCY o DEGREE TO WHICH A PERSON’S LIFESTYLE REFLECTS HIS/HER TRADITIONAL HERITAGE • HERITAGE CONSISTENCY CONTINUUM o TRADITIONAL  LIVING WITHIN NORMS OF TRADITIONAL CULTURE o MODERN  ACCULTURATED TO NORMS OF DOMINANT SOCIETY • INDICATORS OF HERITAGE CONSISTENCY o CHILDHOOD OCCURRED IN COUNTRY OF ORIGIN OR IMMIGRANT NEIGHBORHOOD OF LIKE ETHNIC GROUP o EXTENDED FAMILY SUPPORT OF TRADITIONAL ACTIVITIES o FREQUENT VISITS TO OLD COUNTRY OR OLD NEIGHBORHOOD o FAMILY HOME WITHIN ETHNIC COMMUNITY TO WHICH THEY BELONG o PARTICIPATION IN ETHNIC CULTURAL EVENTS o RAISED IN EXTENDED FAMILY SETTING o REGULAR CONTACT WITH EXTENDED FAMILY o NAME NOT ANGLICIZED o EXPRESSES PRIDE IN HERITAGE ETC • CULTURAL TREATMENT o FIRST EFFORT AT TREATMENT IS OFTEN SELF-CARE o HOME TREATMENT MAY MOBILIZE PERSON’S SOCIAL SUPPORT NETWORK AND PROVIDE A CARING ENVIRONMENT IN WHICH TO CONVALESCE o ALTERNATIVE OR COMPLEMENTARY INTERVENTIONS ARE GAINING RECOGNITION FROM HEALTH CARE PROFESSIONALS IN HEALTH CARE SYSTEM • DISPARITY CONTINUES IN DEATHS AND ILLNESSES EXPERIENCED BY RACIAL AND ETHNIC POPULATIONS o DISEASES ARE NOT DISTRIBUTED EQUALLY AMONG ALL SEGMENTS OF POPULATION • ABNORMAL BIOCULTURAL VARIATIONS MAY BE GENETIC OR ACQUIRED o INFORMATION ABOUT DISEASE PREVALENCE FOR RACIAL AND ETHNIC GROUPS PROVIDES FOCUS FOR ASSESSMENT REGARDING INCREASED PROBABILITY THAT PARTICULAR CONDITIONS MAY OCCUR o NURSES MUST BE CERTAIN THAT THEY HAVE GATHERED DATA NEEDED TO SUPPORT OR REFUTE SUSPICIONS • TOUCH PATIENT WITHIN BOUNDARIES OF HIS OR HER HERITAGE o KEEP MIND OF YOUR BODY LANGUAGE AND INFORM PATIENTS IF YOU NEED TO TOUCH THEM CHAPTER 3 – THE INTERVIEW • THE INTERVIEW o SUBJECTIVE DATA COLLECTION  PATIENT DATA o OBJECTIVE DATA  DATA THAT PROVIDERS OBTAIN o PATIENT PERCEPTION OF HEALTH o FIRST STEP IN THERAPEUTIC RELATIONSHIP o INTERVIEW GOAL IDENTIFICATION  IDENTIFY HEALTH STRENGTHS AND PROBLEMS AS BRIDGE TO PHYSICAL EXAMINATION • FIRST AND MOST IMPORTANT PART OF DATA COLLECTION • COLLECTS SUBJECTIVE DATA; WHAT PERSON SAYS ABOUT HIS/HER PERCEIVED HEALTH STATE • INDIVIDUAL KNOWS EVERYTHING ABOUT HIS/HER HEALTH STATE, AND NURSE KNOWS NOTHING • SUCCESSFUL INTERVIEW CHARACTERISTICS o GATHER COMPLETE AND ACCURATE DATA ABOUT PERSON’S HEALTH STATE, INCLUDING DESCRIPTION AND CHRONOLOGY OF ANY SYMPTOMS OF ILLNESS o ESTABLISH RAPPORT AND TRUST SO PERSON FEELS ACCEPTED AND FREE TO SHARE ALL RELEVANT DATA o TEACH PERSON ABOUT HEALTH STATE SO THAT HE OR SHE MAY PARTICIPATE IN IDENTIFYING PROBLEMS o BUILD RAPPORT TO CONTINUE THE THERAPEUTIC RELATIONSHIP AND TO FACILITATE FUTURE DIAGNOSIS, PLANNING, AND TREATMENT o BEGIN TEACHING FOR HEALTH PROMOTION AND DISEASE PREVENTION • CULTIVATING YOUR SENSES o THE EXAMINER WILL USE THE SENSES TO GATHER DATA DURING PHYSICAL EXAMINATION o SKILLS PERFORMED ONE AT A TIME IN THIS ORDER  INSPECTION • GENERAL EYE SURVEY HEAD TO TOE  PALPATION • TOUCHING THEM  PERCUSSION • FINDING SOUNDS THROUGH TAPPING  AUSCULTATION • LISTENING TO SOUNDS  WHEN IT COMES TO ABDOMEN, PERCUSS BEFORE PALPATE TO AVOID CAUSING PAIN o INSPECTION  CLOSE, CAREFUL SCRUTINY, FIRST OF WHOLE INDIVIDUAL AND THEN EACH BODY SYSTEM  BEGINS WHEN YOU FIRST MEET PERSON  INSPECTION ALWAYS COMES FIRST • GOOD LIGHTING • ADEQUATE EXPOSURE o PALPATION TECHNIQUES  DIFFERENT PARTS OF HANDS ARE BEST SUITED FOR ASSESSING DIFFERENT FACTORS • FINGERTIPS o BEST FOR FINE TACTILE DISCRIMINATION OF SKIN TEXTURE o SWELLING o PULSATION o PRESENCE OF LUMPS • FINGERS AND THUMB o DETECTION OF POSITION o SHAPE o AND CONSISTENCE OF ORGAN OR MASS • DORSA OF HANDS AND FINGERS o BEST FOR DETERMINING TEMPERATURE BECAUSE SKIN HERE IS THINNER THAN ON PALMS • BASE OF FINGERS OR ULNAR SURFACE o BEST FOR VIBRATION o PERCUSSION  TAPPING A PERSON’S SKIN WITH SHORT, SHARP STROKES TO ASSESS UNDERLYING STRUCTURES • PERCUSSION HAS THE FOLLOWING USES: o DETECT UNDERLYING TISSUES o MAPPING LOCATION AND SIZE OF ORGANS o SIGNALING DENSITY OF STRUCTURE BY A CHARACTERISTIC NOTE o DETECTING A SUPERFICIAL ABNORMAL MASS  PERCUSSION VIBRATORS PENETRATE ABOUT 5CM DEEP  DEEPER MASS WOULD GIVE NO CHANGE IN PERCUSSION o ELICITING PAIN IF UNDERLYING STRUCTURE IS INFLAMED o ELICING DEEP TENDON REFLEX USING PERCUSSION HAMMER o DIRECT AND INDIRECT PERCUSSION  DIRECT • HAND STRIKING DIRECTLY  INDIRECT • HAND ON STRUCTURE THEN STRIKE YOUR HAND • PERCUSSION o DULL  ORGANS, KIDNEY o RESONANT  LUNGS • AIR o AUSCULTATION  LISTENING TO SOUNDS PRODUCED BY THE BODY • MOST BODY SOUNDS ARE SOFT AND MUST BE CHANNELED THROUGH A STETHOSCOPE o BLOCKS OUT EXTRANEOUS SOUNDS • ONE YOU CAN RECOGNIZE NORMAL SOUNDS, YOU CAN DISTINGUISH THE ABNORMAL SOUNDS o VITAL SIGNS  TEMPERATURE • ORAL TEMP IS 98.6 F • WITH A RANGE OF 96.4 TO 99.1 F  PULSE • PUSH UNTIL STRONGEST PULSATION IS FELT • ASSESING PULSE FOR o RATE o RHYTHM  PULSE USUALLY HAS AN EVEN TEMPO  SINUS ARRHYTHMIA • ONE IRREGULARITY COMMONLY FOUND IN CHILDREN AND YOUNG ADULTS o FORCE  STRENGTH OF ONES HEART STROKE VOLUME  WEAK, THREAD PLUS REFLECTS A DECREASED STROKE VOLUME  THREE POINT SCALE • 3+ FULL, BOUDING • 2 + NORMAL • 1+ WEAK , THREAD • ABSENT o ELASTICITY  BLOOD PRESSURE • THE FORCE OF BLOOD PUSHING AGAINST SIDE OF ITS VESSEL WALL o SYSTOLIC PRESSURE  MAXIMUM PRESSURE FELT ON ARTERY DURING LEFT VENTRICULAR CONTRACTION OR SYSTOLE o DIASTOLIC PRESSURE  ELASTIC RECOIL, OR RESTING, PRESSURE THAT BLOOD EXERTS CONSTANTLY BETWEEN EACH CONTRACTION • PULSE PRESSURE o DIFFERENCE BETWEEN SYSTOLIC AND DIASTOLIC  REFLECTS STROKE VOLUME • MEAN ARTERIAL PRESSURE (MAP) o PRESSURE FORCING BLOOD INTO TISSUES, AVERAGED OVER CARDIAC CYCLE • AVERAGE BP IS 120/80 • LEVEL OF BP DETERMINED BY 5 FACTORS o CARDIAC OUTPUT  IF HEART PUMPS MORE BLOOD INTO BLOOD VESSELS, PRESSURE ON CONTAINER WALLS INCREASES o PERIPHERAL VASCULAR RESISTANCE  OPPOSITION TO BLOOD FLOW THROUGH ARTERIES  WHEN VESSEL BECOMES SMALLER OR CONSTRICTED PRESSURE NEEDED BECOMES GREATER o VOLUME OF CIRCULATING BLOOD  REFERS TO HOW TIGHTLY BLOOD IS PACKAGED INTO ARTERIES • INCREASING CONTENTS IN VESSELS INCREASES PRESSURE o VISCOSITY  “THICKNESS” OF BLOOD DETERMINED BY ITS FORMED ELEMENTS, BLOOD CELLS, WHEN CONTENTS THICKER, PRESSURE INCREASES o ELASTICITY OF VESSEL WALLS  WHEN VESSELS ARE STIFF AND RIGID, PRESSURE NEEDED TO PUSH INCREASES • TEMPERATURE o CHANGES IN BODY TEMP • PULSE o NORMAL RANGE OF HEART RATE IS 60 TO 100BPM • INCREASINGLY RIGID ARTERIAL WALL NEEDS FASTER UPSTROKE OF BLOOD SO PULSE IS ACTUALLY EASIER TO PALPATE • RESPIRATION IS AFFECTED • MEASUREMENT OF OXYGEN SATURATION o PULSE OXIMETER  A NON INVASIVE METHOD TO ASSESS ARTERIAL OXYGEN SATURATION (SPO2)  SENSOR ATTACHED TO PERSONS FINGER  DIODE EMITS LIGHT  DETECTOR MEASURES RELATIVE AMOUNT OF LIGHT ABSORBED BY OXYHEMOGLOBIN AND UNOXYGENATED HEMOGLOBIN  HEALTH SPO2 OF 97-98% • ASSESSMENT TECHNIQUES o PALPATION  ASSESSES THE FOLLOWING • TEXTURE • TEMPERATURE • MOISTURE • ORGAN LOCATION AND SIZE • SWELLING, VIBRATION, PULSATION • RIGIDITY OR SPASTICITY • CREPITATION • PRESENCE OF LUMPS OR MASSES • PRESENCE OF TENDERNESS OR PAIN  PALPATION SEQUENCE • START WITH LIGHT PALPATION TO DETECT SURFACE CHARACTERISTICS AND ACCUSTOM PERSON TO BEING TOUCHED • THEN PERFORM DEEPER PALPATION WHEN NEEDED o INTERMITTENT PRESSURE BETTER THAN ONE LONG CONTINUOUS PALPATION • AVOID ANY SITUATION IN WHICH DEEP PALPATION COULD CAUSE INJURY OR PAIN • BIMANUAL PALPATION REQUIRES BOTH HANDS o PERCUSSION  TWO METHODS OF PERCUSSION • DIRECT • INDIRECT o AUSCULTATION  LISTENING NUTRITION - KNOW 24HR RECALL - FOOD QUESTIONNAIRE - HEIGHT/WEIGHT – BASELINE ASSESSMENT o BMI - DYSPHAGIA – TROUBLE SWALLOWING, CANT EAT, LOSING WEIGHT - KNOW OPTIMAL NUTRITIONAL STATUS o DAILY REQUIREMENT - FOCUS ON OLDER ADULTS pain - chronic is 6 months know the entire mental status PowerPoint