Nursing 3rd ed. Varcarolis EXAM 2
1. Patient centered care:
The patient is the full partner in providing care based on patients preferences, values, and
needs
2.Quality Improvement:
3. Safety
4. Information
5.Teamwork and Collaboration
6.EBP - ANSQSEN
Personal information:
Relationship, Religion, Living,
Appearance:
Grooming, Pupil, Ht, Wt, tattoos/piercing, relationship between appearance and age
Behavior:
Body movements, eye contact
Speech:
Rate, volume, disturbance, cluttering
Affect and mood:
Ex: flat, bland, animated, angry, withdrawn, appropriate; sad, labile, euphoric
Thought:
Process and content
Perceptual disturbances:
Hallucinations, Illusions
Cognition:
, Orientation, LOC, memory, attention, abstraction, Judgement - ANSMental Status Examination
1. WHat day of the week is it?
2. What is the year
3. What state are we in
4. Please remember there five objects, I will ask about them later
5.You have $100 and buy a dozen apple for $3 and a bike for $20
-How much did you spend
-How mush do you have left
6.Please name as many animals in 1 min
0-0-5, 1-5-10, 2-10-15, 3-15+
7.What were the 5 object I asked you to remeber
(1pt for each)
8.I am going to give you a series of number and I would like you to give them back to me
0 - 87, 1 - 649, 2 -8537
9. Place the time on this clock
2 - Hrs
2 - time
10. X marks the triangle
11. Story and response - ANSSLUMS
1. Does the patient have a spiritual or religious affiliation
2. what gives the patient strength and hope
3. Participation in any activities
4. What role dose the practice play in the patient life
5. Dose the religion help in stressful situations
6. Are there any restrictions, diet, medical interventions - ANSSpiritual Assessment
1. Interpreter?