NU 325 Health Assessment – Final Exam Study Guide University of
Pennsylvania Complete Review with Questions and Answers
medical |dx |- |answersonly |made |by |doctors
nursing |dx |- |answersused |to |evaluate |the |response |of |the |whole |person |to |actual |or |potential |health |
problems
nursing |process |- |answers- |iterative |process |allowing |practitioners |to |move |back |and |forth |while |
caring |for |the |needs |of |complex |pts. |
- |Includes |six |phases: |assessment, |diagnosis, |outcome |identification, |planning, |implementation, |
evaluation
"A |Delicious |Orange |PIE" |- |answersAssessment- |collect |data
Diagnosis- |interpret |data
Outcome |identification- |identify |the |expected |outcomes
Planning
Implementation- |doing |what |you |planned
Evaluation- |was |the |outcome |we |wanted |achieved?
inspection |phase |- |answersconcentrated |watching. |Checking |for |abnormalities |before |continuing. |
Inspection |begins |the |moment |you |first |meet |a |person |and |develop |a |"general |survey"
purpose |of |percussion |- |answers- |mapping |out |the |location |and |size |of |an |organ |by |exploring |where |
the |percussion |note |changes |b/n |the |borders |of |an |organ |and |its |neighbors
- |signaling |the |density |(air, |fluid, |or |solid) |of |a |structure |by |a |characteristic |note
- |detecting |an |abnormal |mass |if |its |fairly |superficial; |the |percussion |vibrations |penetrate |a/b |5 |cm |
deep---a |deeper |mass |would |give |no |change |in |percussion |
- |eliciting |a |deep |tendon |reflex |using |the |percussion |hammer
diaphragm |- |answersused |for |high-pitched |sounds |→ |breath, |bowel, |and |normal |heart |sounds. |Hold |
the |diaphragm |firmly |a/g |the |person's |skin, |firm |enough |to |leave |a |slight |ring |afterwards
bell |- |answersused |for |soft,low-pitched |sounds |such |as |extra |heart |sounds |or |murmurs. |Hold |it |lightly |
a/g |the |person's |skin, |just |enough |that |it |forms |a |perfect |seal
1st |level |priorities |- |answersemergent, |life |threatening
airway, |breathing, |circulation, |vital |signs
, 2nd |level |priorities |- |answersrequires |prompt |intervention |to |forestall |further |deterioration |
acute |pain, |mental |status |change, |abnormal |labs, |risk |of |infection
3rd |level |priorities |- |answersthose |that |are |important |to |the |pt's |health |but |can |be |addressed |after |
more |urgent |problems. |Interventions |to |treat |these |problems |are |more |long |term, |and |the |response |
to |treatment |is |expected |to |take |more |time
subjective |data |- |answerswhat |the |pt |says, |biased
objective |data |- |answersunbiased, |what |the |pt |cannot |see, |labs
how |do |you |prioritize |patient |problems/diagnosis? |- |answersairway |→ |breathing |→ |circulation |→ |
perfusion
spirituality |- |answersbroader |term |focused |on |a |connection |to |something |larger |than |oneself |and |a |
belief |in |transcendence
religion |- |answersorganized |system |of |beliefs |concerning |the |cause, |nature, |and |purpose |of |the |
universe, |as |well |as |the |attendance |of |regular |services
role |of |nurse |with |DM |- |answersfor |neglect |in |the |elderly |and |children, |report |your |suspicions |to |the |
proper |authorities. |No |evidence |is |needed, |when |in |doubt, |REPORT
BMI |- |answersweight |(lbs.) |/ |height |(in.) |* |703
- |normal |= |18.5-24.9
- |<18.8 |→ |underweight |
- |want |to |be |less |than |25 |> |30 |= |obese
negative |effects |on |elderly |nutritional |status |- |answerslack |of |taste, |medications, |teeth |issues, |
decreased |GI |motility, |decrease |visual |acuity, |decreased |saliva |production
how |long |would |you |monitor |a |heart |rate |if |it |is |irregular |- |answers1 |full |minute
proper |way |to |take |a |BP |- |answerspalpate |pulse |in |radial |artery,
Let |air |out |2-4 |mmHg/second.
Listen |for |first |and |last |sounds, |Pt |shouldn't |cross |legs, |chew |gum, |drink |caffeine, |etc |in |the |past |30 |
minutes |or |smoked |in |the |past |5 |minutes.
best |indicator |of |pain |- |answerspt |report |of |pain, |subjective |data
systolic |number |(top |#) |- |answersindicates |how |much |pressure |your |blood |is |exerting |a/g |your |artery |
walls |when |the |heart |beats
diastolic |number |(bottom |#) |- |answersindicates |how |much |pressure |your |blood |is |exerting |a/g |your |
artery |walls |while |the |heart |is |resting |b/n |beats
uvula |- |answersrises |on |phonation, |midline |to |soft |palate, |CN |9 |(glossopharyngeal)
Pennsylvania Complete Review with Questions and Answers
medical |dx |- |answersonly |made |by |doctors
nursing |dx |- |answersused |to |evaluate |the |response |of |the |whole |person |to |actual |or |potential |health |
problems
nursing |process |- |answers- |iterative |process |allowing |practitioners |to |move |back |and |forth |while |
caring |for |the |needs |of |complex |pts. |
- |Includes |six |phases: |assessment, |diagnosis, |outcome |identification, |planning, |implementation, |
evaluation
"A |Delicious |Orange |PIE" |- |answersAssessment- |collect |data
Diagnosis- |interpret |data
Outcome |identification- |identify |the |expected |outcomes
Planning
Implementation- |doing |what |you |planned
Evaluation- |was |the |outcome |we |wanted |achieved?
inspection |phase |- |answersconcentrated |watching. |Checking |for |abnormalities |before |continuing. |
Inspection |begins |the |moment |you |first |meet |a |person |and |develop |a |"general |survey"
purpose |of |percussion |- |answers- |mapping |out |the |location |and |size |of |an |organ |by |exploring |where |
the |percussion |note |changes |b/n |the |borders |of |an |organ |and |its |neighbors
- |signaling |the |density |(air, |fluid, |or |solid) |of |a |structure |by |a |characteristic |note
- |detecting |an |abnormal |mass |if |its |fairly |superficial; |the |percussion |vibrations |penetrate |a/b |5 |cm |
deep---a |deeper |mass |would |give |no |change |in |percussion |
- |eliciting |a |deep |tendon |reflex |using |the |percussion |hammer
diaphragm |- |answersused |for |high-pitched |sounds |→ |breath, |bowel, |and |normal |heart |sounds. |Hold |
the |diaphragm |firmly |a/g |the |person's |skin, |firm |enough |to |leave |a |slight |ring |afterwards
bell |- |answersused |for |soft,low-pitched |sounds |such |as |extra |heart |sounds |or |murmurs. |Hold |it |lightly |
a/g |the |person's |skin, |just |enough |that |it |forms |a |perfect |seal
1st |level |priorities |- |answersemergent, |life |threatening
airway, |breathing, |circulation, |vital |signs
, 2nd |level |priorities |- |answersrequires |prompt |intervention |to |forestall |further |deterioration |
acute |pain, |mental |status |change, |abnormal |labs, |risk |of |infection
3rd |level |priorities |- |answersthose |that |are |important |to |the |pt's |health |but |can |be |addressed |after |
more |urgent |problems. |Interventions |to |treat |these |problems |are |more |long |term, |and |the |response |
to |treatment |is |expected |to |take |more |time
subjective |data |- |answerswhat |the |pt |says, |biased
objective |data |- |answersunbiased, |what |the |pt |cannot |see, |labs
how |do |you |prioritize |patient |problems/diagnosis? |- |answersairway |→ |breathing |→ |circulation |→ |
perfusion
spirituality |- |answersbroader |term |focused |on |a |connection |to |something |larger |than |oneself |and |a |
belief |in |transcendence
religion |- |answersorganized |system |of |beliefs |concerning |the |cause, |nature, |and |purpose |of |the |
universe, |as |well |as |the |attendance |of |regular |services
role |of |nurse |with |DM |- |answersfor |neglect |in |the |elderly |and |children, |report |your |suspicions |to |the |
proper |authorities. |No |evidence |is |needed, |when |in |doubt, |REPORT
BMI |- |answersweight |(lbs.) |/ |height |(in.) |* |703
- |normal |= |18.5-24.9
- |<18.8 |→ |underweight |
- |want |to |be |less |than |25 |> |30 |= |obese
negative |effects |on |elderly |nutritional |status |- |answerslack |of |taste, |medications, |teeth |issues, |
decreased |GI |motility, |decrease |visual |acuity, |decreased |saliva |production
how |long |would |you |monitor |a |heart |rate |if |it |is |irregular |- |answers1 |full |minute
proper |way |to |take |a |BP |- |answerspalpate |pulse |in |radial |artery,
Let |air |out |2-4 |mmHg/second.
Listen |for |first |and |last |sounds, |Pt |shouldn't |cross |legs, |chew |gum, |drink |caffeine, |etc |in |the |past |30 |
minutes |or |smoked |in |the |past |5 |minutes.
best |indicator |of |pain |- |answerspt |report |of |pain, |subjective |data
systolic |number |(top |#) |- |answersindicates |how |much |pressure |your |blood |is |exerting |a/g |your |artery |
walls |when |the |heart |beats
diastolic |number |(bottom |#) |- |answersindicates |how |much |pressure |your |blood |is |exerting |a/g |your |
artery |walls |while |the |heart |is |resting |b/n |beats
uvula |- |answersrises |on |phonation, |midline |to |soft |palate, |CN |9 |(glossopharyngeal)
