NURS 301 Health Assessment Exam 1 Focus Topics to Review Exam 1 will cover Chapters 1 to 5, Chapters 8, 9, 13, 14, 19, 23 Exam Items: 50 multiple choice, True or False

NURS 301 Health Assessment Exam 1 Focus Topics to Review Exam 1 will cover Chapters 1 to 5, Chapters 8, 9, 13, 14, 19, 23 Exam Items: 50 multiple choice, True or False Topics: Explain the purpose of a nursing health assessment Purpose of nursing health assessment = collect holistic subjective and objective data to determine a client’s overall level of functioning to professional clinical judgment. the main idea is something we should understand. This was a question about the test. Clinical judgment. *Holistic data collected* by the nurse from the client during a nursing health assessment = - Physiologic - Psychological - Sociocultural - Developmental - spiritual data Compare and contrast medical assessment from nursing health assessment. Holistic nursing assessment = Collects holistic subjective and objective data to determine a client’s overall level of functioning in order to make a professional clinical judgment the nurse assesses during nursing health assessments = how clients interact within their family and community, and how the clients’ health status affects the family and community. Ex. a diabetic client may not be able to eat the same foods that the rest of the family enjoys Physical medical assessment = Focuses primarily on the client’s physiologic development status - there is a question that in which you are doing a physical on a patient and she tells you that “the doc already did this”, what would you tell her? It’s not that both the nurse and the doc are just as important and we will collaborate together to determine your order. It is literally the highlighted above just put into one sentence. Physical medical assessment focuses less on = psychological, sociocultural, or spiritual well-being. Ex. a physical therapist would focus primarily on the client’s musculoskeletal system and the effects on ability to perform ADL Describe the phases of the nursing process involved in health assessment by the nurse. Nursing Process: Assessment: Collecting subjective and objective data, gathering info about patient health status, analyzing and synthesizing data, making [clinical] judgments about interventions and evaluation of care outcomes Most critical phase during the nursing process = assessment; if the data is not correct or inaccurate, nursing judgements affect the other phases in the process. The assessment phase of the nursing process has four major steps = - Collection of subjective data - Collection of objective data - Validation of data. There were questions about this. Know when you should do this. - Documentation of data// Compare and contrast the four basic types of nursing assessment: (a) initial comprehensive, (b) ongoing or partial, (c)focused/problem oriented, (d) emergency. The four basic types of assessment are = - *Initial comprehensive* assessment; admitted to ER. - *Ongoing or partial* assessment; flowsheet, nurse comes to check vitals routinely. - Focused or problem-oriented assessment; like quick care visits. - Emergency assessment; like SOB, chest pain. Initial comprehensive assessment = - collection of subjective data about the client’s perception of his or her health of all body parts or systems. - past health history. - family history, and lifestyle and health practices (which include information related to the client’s overall functioning) . - objective data gathered during a step-by-step physical examination. Ongoing or partial assessment = - after the comprehensive visit; patient is established. - Follow up on health status to detect any changes from the baseline data in the patient’s body system or holistic health patterns. - Reassessment on any of the changes. Question asks about a patient who has been evaluated already, what is the purpose of going back to check on the patient again? It would be this answer. The other answeres were to go back and check anything that was omitted, for documentation purposes Focus or Problem-Orientated Assessment = - Does not replace the comprehensive health assessment. - Patient comes to office for specific health concern and that concern is assessed accordingly. I think there was a question about this asking what assessment would be done if there was a patient who had a problem with a specific part of their body. Emergency Assessment = - Rapid assessment performed in life-threatening situations; evaluate ABC’s. - Assesses the client’s life sustaining physical functions. Preparing for the assessment = - Review *client’s record*. - Review client’s status with other health care team members; *collaborate*. - *Educate* about client’s diagnosis and tests performed. Reviewing the clients record to prepare for the assessment = - Biographical data (age, sex, religion, education, occupation). - Personal medical history to gather information in how it affects ADLs. - Past med history and current gives a better guided interaction and care. Nursing Process: Diagnosis: Analyzing subjective and objective data to make a professional nursing judgment (nursing diagnosis, collaborative problem, or referral) Nursing Process: Planning: Determining outcome criteria and developing a plan Nursing Process: Implementation: Carrying out the plan Nursing Process: Evaluation: Assessing whether outcome criteria have been met and revising the plan as necessary Compare and contrast subjective from objective data Subjective data include = - Biographical information. - History of present health concern; physical symptoms related to each body part or system. - Past health history. - Family history. - Health and lifestyle practices