Chp 6 - Nur 216
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Created by:
mikerizz69 on February 9, 2012
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103 terms
Terms | Definitions |
|---|---|
 What is Nursing Assessment | Dynamic, ongoing process that uses observations & interactions to: collect information, recognize changes, analyze needs, and plan care |
| What is Subjective Data | what client says, interview and health history |
| What is Objective Data | observations, exam, lab/test results |
| 2008 physical activity guidelines for adult and the us department of health and human services is | is 30 minutes of physical activity five times a week |
| Nursing Assessment has 4 parts | Subjective data Objective data Reflects "whole person" with environment Systematic approach Goal |
| What does FITT stand for | Frequency - how long workout Intensity - how hard workout Type - Type of exercise Time - how long they workout |
| Healthy People Examples of National Health-Promotion & Disease Prevention Objectives for Individuals 3 | Increase the proportion of sexually active people who use condoms. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per session. Reduce cigarette smoking by adults. |
| What is Gordon 2007 Framework | concept of functional patterns and pattern interaction Depicts individuals lifestyle |
| What is the Definition of Functional Health Pattern Framework | Individual viewed as whole being used interrelated behavioral areas |
| 11 functional areas of typology serve as | useful tool to collect and organize assessment data to create a structure for validation and communication among health care providers |
| 5 Functional Health Pattern Framework by focus | Pattern: Examine patterns over time (e.g., blood pressure) Individual-environmental: Environmental influence within patterns Age-developmental: Individual developmental task fulfillment Functional: Individual performance levels on tasks (e.g., activities of daily life [ADLs]) Cultural: Influence developmental health patterns |
| why use functional health pattern framework | Centers on health; focus on nursing knowledge; provides structure/ flexibility |
| The Patterns reflect a expression of the individuals lifestyle or life processes, this expression 3 | Pattern/sequencing of behaviors Role of environment (physical surroundings, family, societal, cultural influences) Developmental influences |
| The assessment of each pattern as ..?3 | Functional (strength) Dysfunctional (nursing diagnosis) Potentially dysfunctional |
| An Important goal in assessing is to determine | the individual knowledge, ability to manage health promotion, and value placed on health promotion |
| Problem in one area is a | Problem in one area clue to dysfunction in other patterns |
| Gordan 11 Functional Health Patterns | Health Perception-Health Management Nutritional-Metabolic Elimination Activity-Exercise Sleep-Rest Cognitive-Perceptual Self Perception-Self Concept Roles-Relationships Sexuality-Reproductive Coping-Stress Tolerance Values-Beliefs |
| An individual's perceived health and well-being affect what | lifestyle and ability to function |
| Health promoting activities pattern clues to | improve or maintain optimal quality of health |
| Asssesment of Health-Perception-Health-Management Pattern parameters are | parameters such as current health safety practices, previous patterns adherence, use of health care systems, health care access, health perceptions/beliefs |
| Past Health management predictor in the health perception health management pattern? | Nurse needs to identify/address reason for past failures to promote success for interventions (e.g., belief systems, finances, literacy) |
| What is a nutritional metabolic pattern | Individual's typical food and fluid consumption in relation to metabolic needs and perceived problems |
| Nutritional Metabolic Pattern Indicators of Nutritional Adequacy | Nutritient Intake Metabolic demand |
| What two things may indicate the need for further exploration within the nutrition area | frequent eating out issues Finances and meal preparation |
| What does metabolic demand vary between? | Varies between individuals and with different activity levels stress |
| Objective indicators in the Nutritional Metabolic Pattern is | mucuous membranes, Dentition, teeth, hair |
| Elimination pattern is | Adequacy, control, and regularity of an individual's bowel, bladder, and skin excretion of waste |
| How does the normal elimination pattern vary | Normal pattern varies between individuals |
| Elimination pattern could be how often you | urinate |
| Prolonged time without elimination means | UTI |
| Elimination pattern dysfunction affects? | interpersonal interactions |
| Elimination pattern Assessment Data | includes data about regularity and control of exreta |
| what is child ml per day of exerta | Child - 800 to 1000ml |
| Elimination pattern is closely related to | Closely related to nutrition pattern assessment |
| Activity-exercise pattern parameters are | SELECTED PARAMETERS; movement capability, activity tolerance, self care activities use of assistive devices |
| Activity level limitations in movement will | alter lifestyle and may affect every other functional health pattern |
| What is linked to obesity, being overweight? | Sedentary lifestyle |
| Environment can limit movement how? | if living alone in high crime area may limit activity for fear of harm |
| Assessment of Activity exercise pattern? | Pattern of activities requiring energy and adequacy of pattern |
| 4 types of exercise patterns | Type, frequency, duration, intensity |
| What also must be assessed during exercise patterns | modes of transportation (how get there) barriers to exercise Response/Subjective complaints Objective measures to assess functions |
| Sleep Rest pattern is | Adequacy of an individual's sleep and relaxation |
| Subjective to Sleep rest pattern reports what | reports of fatigue energy levels |
| Problems to sleep rest pattern reports what | cause stress response, decreased immune system response, unhealthy relationships |
| Data to sleep rest pattern reports what | difficulities in sleep onset, interruptions, sleep disturbances |
| Assess to sleep rest pattern reports what | sleep quality and quantity |
| Intervention focus to sleep rest pattern reports what | counseling, medical, referral, development bedtime routine, relaxation techniques |
| what is the cognitive perceptual pattern | Individual's ability to understand and follow directions, retain information, make decisions, solve problems, use language appropriately |
| What patterns analyzed here | Perceptual and sensory patterns, including pain |
| Where must cognitive perceptual pattern be asssesed | context of environment |
| Cognitive perceptual pattern affects capacity | for independent functioning |
| Assessing cognitive perceptual pattern includes evaluating | language capabilities, cognitive skills and perception |
| What assisted devices would this pattern use | hearing aids, glasses contact lenses |
| Self-Perception-Self-Concept Pattern defined as | Individual's sense of personal identity, goals, emotional patterns, feelings about self, self-image, self-worth |
| Developmental level affects/affected by | pattern |
| Assessment of Self perception self concept pattern makes 2 things | Clues to identity confusion, disturbed self-esteem Anxiety, fear, depression |
| Erickson had the ? | eight stages of human development |
| Havinghurst had a task for? | building wholesome attitudes |
| Bruhn and colleagues refer to? | self concept development |
| During assessment of Self perception self concept, what kind of data can we use to identify confusion, disturbed self esteem | Elicit data regarding cognitive, affective, psycho motor domains |
| Influences in care for self perception self concept | Affects individual-nurse interaction Information-sharing may help goal setting and intervention planning |
| Roles-relationship pattern assumed by | Position (s) assumed by an individual |
| How are associations engaged in roles relationship | Associations engaged in by the individual that are connected to the position (s) |
| Individual perception is a major component of the assessment, and exploration of the pattern includes | each individuals level of satisfaction |
| Assessment in roles relationship focuses on | family work and community roles and relationships |
| Assessment parameters include | family structure, tasks, communication, patterns, power, decision making, stress, social support |
| Relationships affect the whole person; therefore, problems in the roles-relationships pattern may be exhibited in other areas such as | sleep, appetite and sexuality |
| Sexuality reproductive pattern define | Individual's satisfaction and dissatisfaction with sexuality and reproduction |
| Sexuality reproductive related to | Related to self-perception and relationship patterns |
| sexual identity linked to | Sexual identity linked to body image, self-concept, role, gender identity |
| Individual development influences | reproductive capacity |
| Sexual expression influences | Environment Cultural |
| One objective of assessment in this pattern is to describe | behavioral problems or difficulties |
| Another assessment of this pattern is important of individual knowledge of ? | sex functioning and preventive health practices like breast and ball self examination |
| Sexual education important for | sexual understanding and increased satisfaction |
| Firm, trusting relationship needed for ?? in the sexual reproductive pattern | discussion |
| Coping-Stress Tolerance pattern define as | General coping and ability to effectively manage stress |
| Parameters on sexual reproductive pattern | Sexual self concept Sexual functioning Reproductive patterns Level of satisfaction |
| Stess is a ? | necessary part of life; without it there is no motivation to grow |
| Problem with stress | when tolerance is weak and daily activities are affected |
| Individual Perception of events related to? | development, amount of stress, current levels of stress, social support |
| define Coping: Learned behavior | Individual behavioral response to stress |
| assessment of coping learned behavior is | Objective: determine stress tolerance and past coping behaviors |
| Parameters of coping learned behavior is | Coping task Coping style Coping strategies Consider variety, flexibility, health promotion value Coping effectiveness |
| Stress interventions of coping learned behavior is | Replace unhealthy coping strategies Employ stress management techniques (time management, cognitive rehearsal, relaxation) |
| What is the value belief pattern defined as | describes Values, beliefs, and goals |
| What are the perceptions of value belief pattern | Perceptions of right and wrong |
| What is the objective of value belief pattern | Determine basis for health-related decision/actions |
| How to value clarification in value belief pattern | Value clarification by summarizing, verifying, obtaining information |
| Base interventions in the value belief pattern are on? | Base interventions on value system and health beliefs |
| Individual Health Promotion and the Nursing Process is? | Collection and analysis of data Problem identification/nursing diagnosis Planning the care Implementing the plan Evaluating effectiveness of plan |
| What is planning ? | proposal of diagnosis specific treatment to assist the individual toward the goal, or expected outcome of optimal health |
| What is implementing the plan | is the completion of the actions necessary to fulfill the goals for optimal health |
| The nurse is performing an initial antepartal assessment on a client who has missed two periods. Assessment of this woman for alcohol consumption is best determined by the: | T-Ace |
| The nurse, teaching a class on primary prevention at a women's health club, emphasizes participation in: | Recommended immunization schedules |
| Major goals in assessing each person's functional pattern are to determine (select all that apply): | A) Ability to manage health-promoting activities C) Knowledge of health promotion E) Value that the client ascribes to health promotion |
| The individual's perceived health and well-being and how health is managed describes: | Health-perception-health-management pattern |
| In assessing the nutritional-metabolic pattern, the nurse performs an examination of: | Mucous membranes |
| When teaching about proper nutrition to a client with congestive heart failure, which affective component should be included in the educational plan? | Value of adhereing to diet |
| The nurse is preparing education on prevention of urinary tract infections. A principle emphasized in the teaching plan would be: | Empty the bladder at the first sensation of fullness |
| A person reports his exercise pattern is one golf game per week. The nurse evaluates this pattern and teaches the individual that: | Exercises should be repetitive |
| When assessing the older adult for sleep quality, the nurse expects to find that the person will state: | "I experience difficulty returning to sleep." |
| The nurse is preparing a class on wellness and health promotion for a group of middle school students. Developmental tasks of early adolescence include a learning focus emphasis on: | Risk taking and its consequences |
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