health assessment - Answers gathers data about the whole person so you can identify their
general state of health
health history - Answers a questionnaire or interview process that gathers historical data about
the patient's health (family history, social history, previous hospitalizations, literacy/education)
physical examination - Answers lay hands, lay eyes on, all present oriented. should be
purposeful. health history helps you decide what 25-40 skills you will use out of the 200 you
should know how to do
where is the first place a nurse makes a mistake in a bad physical exam? - Answers an
incomplete health history
What are the types of physical exams? - Answers -well, comprehensive intake physical exam
-ill, comprehensive intake physical exam
well comprehensive intake physical exam - Answers -sports physical or for a job
-this person is in a healthy state
-sample each system (looking for anything gross/obvious)
-if something is found, patient is referred
gross - Answers obvious
ill comprehensive intake physical exam - Answers -focus on problem and related areas
(admin/transfer)
-then sample the other systems
-once per episode
-looking for subtle, pick up any info no matter how slight
-cc and hpi
CC - Answers -chief complaint, always put in the patients words. Their reason for seeking health
care and write it in quotes
HPI
* be able to do this well - Answers -history of present illness
-taking the cc and making it professional in a paragraph
,(location, on set, duration, quantity, aggravating/relieving factors, associated signs and
symptoms, actions taken)
-goal is to come up with treatment
What is the most common daily basis physical for RN's? - Answers - a focus/problem based
physical exam
-done in emergencies
Focus/problem based physical exam - Answers -2-3 minutes
-short, succinct, focused, purposeful
-immediate remedy
1. know what you're doing and why
2. gather data
3. take action
4. perform communicate it
IPPA - Answers -inspection
-palpation
-percussion
-auscultation
Inspection - Answers -eyes- visual data, observable
-can be done in the interview
-will guide what you do
-be honest about inspection, don't be uncomfortable
palpation - Answers -tactile- gather tactile, somatic sensation
-moisture, texture, vibration, temperature, pain
-always head to toe, proximal to distal
percussion - Answers -use of tactile to gain auditory information
-telling you the relative density of tissues
, ausculation - Answers -using auditory for auditory
-usually using a stethoscope
Will you follow the order of IPPA with kids? - Answers - probably not, get the most important
information first
Why is IPPA in this order? - Answers - least invasive to most invasive
You will always pay for the________ _________ in the _________ _______ - Answers short cut, long
run
You don't have time _____ to inspect - Answers not
What side of your hand do you use for vibration? - Answers ulnar surface
what side of your hand do you use for temperature? - Answers dorsal back of hand
what side of your hand do you use for moisture? - Answers back of hand
what side of your hand do you use for texture? - Answers finger pads, fine point discrimination
Why do we test bilaterally simultaneously? - Answers to use the patient as their own control, to
tell if one side is acting differently than the other
vibrations on the back - Answers - should feel less as you go down and less as you leave the
middle
- you're feeling vibrations from their vocal chords
temperature - Answers - getting info about peripheral vascular
-warm= good circulation
-cold= poor circulation
Moisture: wet vs dry - Answers -hydration vs inadequate hydration
-dry skin is more of a concern
-wet- warm core body temp (can be due to some drugs and glandular problems, thyroid)
texture: smooth vs rough - Answers -health of skin and any metabolic and nutritional status
pain - Answers -where might a problem exist
-tender means painful
-palpate their tender areas last (except in children, do the most essential one first)