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Study sets matching "nursing 314 assessment"

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Study sets matching "nursing 314 assessment"

56 terms
Nursing 314 Musculoskeletal Assessment
What are 5 subjective observations abo…
What are three subjective observations…
What components make up a functional a…
What are examples of ADLs
- Pain ... - stiffness... - swelling... - heat... - limitation of movement
- pain ... - deformity ... - trauma
- ADLs ... - mobility
- bathing ... - toileting... - Dressing ... - grooming ... - eating
What are 5 subjective observations abo…
- Pain ... - stiffness... - swelling... - heat... - limitation of movement
What are three subjective observations…
- pain ... - deformity ... - trauma
36 terms
Breasts & Lymph - Nursing 314 - Health Assessment
Areola
Colostrum
Gynecomastia
Mastalgia
Darkened area surrounding nipple
thin, yellow fluid, precursor of milk, secreted for a few day…
excessive breast development in the male
pain in breast
Areola
Darkened area surrounding nipple
Colostrum
thin, yellow fluid, precursor of milk, secreted for a few day…
69 terms
Nurse 314 Exam 1
What does the nurse taking into accoun…
What are the steps of the nursing proc…
Assessment
What are the components of health asse…
The patient's age, gender, culture, ethnicity, physical & psy…
Assess, diagnose, plan, implement, evaluate
the collection of comprehensive data pertinent to the patient…
1. Conducting a health history/interview (subjective data)... 2.…
What does the nurse taking into accoun…
The patient's age, gender, culture, ethnicity, physical & psy…
What are the steps of the nursing proc…
Assess, diagnose, plan, implement, evaluate
64 terms
nursing 314 final
anticipatory grief
bereavement
ambiguous loss
disenfranchised grief
the unconscious process of disengaging before the loss/death…
captures grief and mourning, emotional responses, and behavio…
difficult to process because of the lack of finality and unkn…
marginal or unsupported grief; the relationship may not be so…
anticipatory grief
the unconscious process of disengaging before the loss/death…
bereavement
captures grief and mourning, emotional responses, and behavio…
75 terms
Assessment 314
95 bpm
90 bpm
80 bpm
70-75 bpm
Child
Preteen
Teen
Adult
95 bpm
Child
90 bpm
Preteen
10 terms
Nursing 314 Test 4
Body Fluid Function
Fluid deficit Causes
Manifestations of fluid volume deficit
Causes of fluid volume excess
Maintain blood volume... transports substances to and from cells…
decreased intake... loss of plasma or blood... diarrhea, vomiting,…
weight loss (2.2 lbs = 2,000 ml)... dry skin or dry mucus membra…
excessive sodium intake... excessive IV fluids containing sodium…
Body Fluid Function
Maintain blood volume... transports substances to and from cells…
Fluid deficit Causes
decreased intake... loss of plasma or blood... diarrhea, vomiting,…
149 terms
Nursing 314 Exam 1
Vital Signs
Adult Ranges for Temperature:
Adult Ranges for Pulse
Adult Ranges for Respirations
Temperature, Pulse, Respirations, BP, Pain and [oxygen satura…
96.8 to 100.4 F
60 - 100 beats/min
12 - 20 breaths/min
Vital Signs
Temperature, Pulse, Respirations, BP, Pain and [oxygen satura…
Adult Ranges for Temperature:
96.8 to 100.4 F
NURSING 314: VITAL SIGNS
Normal range for adult heart rate?
Normal range for adult respiration rate?
Normal body temperature?
Normal adult BP?
60-100 bpm
12-20/ min
96.8-100.4 degrees Fahrenheit
120 / 80 mmHg
Normal range for adult heart rate?
60-100 bpm
Normal range for adult respiration rate?
12-20/ min
111 terms
Nursing 314 test 1
what is assessment
why do we need to assess
define nursing according to the ANA
what is the law that we are required t…
-gathering info about the health status of the patient... -analy…
required by ANA
the protection, promotion, and optimization health and abilit…
standards of nursing practice
what is assessment
-gathering info about the health status of the patient... -analy…
why do we need to assess
required by ANA
111 terms
Nursing 314 Exam #1
temperature, pulse, respirations, BP,…
after surgery, after medication admini…
96.8 to 100.4
hypothalamus
what are the 6 basic vital signs?
when should the checking of vital signs increase in frequency?
what is the range of normal temperature?
where is the patient's internal thermostat?
temperature, pulse, respirations, BP,…
what are the 6 basic vital signs?
after surgery, after medication admini…
when should the checking of vital signs increase in frequency?
24 terms
MWSU Nursing Statistics Brooks 314
Level 7 Evidence
Level 6 Evidence
Level 5 Evidence
Level 4 Evidence
From the opinion of authorities and/or reports of expert comm…
From a single descriptive or qualitative study (aka., trian…
From systematic reviews of descriptive or qualitative studies…
From well-designed case-control or cohort studies
Level 7 Evidence
From the opinion of authorities and/or reports of expert comm…
Level 6 Evidence
From a single descriptive or qualitative study (aka., trian…
14 terms
314 Holistic Nursing Giddens Concept 14 Conditions
Urinary Tract Infection
Pyelonephritis
Renal Calculi
Hemorrhoids
o Pathophysiology... Alteration of defenses (normal voiding, co…
o Pathophysiology... Inflammation of renal parenchyma and colle…
o Pathophysiology ... Factors for stone formation: metabolic, d…
o Pathophysiology... Develop from increased anal pressure and w…
Urinary Tract Infection
o Pathophysiology... Alteration of defenses (normal voiding, co…
Pyelonephritis
o Pathophysiology... Inflammation of renal parenchyma and colle…
12 terms
Nursing assessment
Assessing
database
database
assessment
systematic and continuous collection ,analysis, validation, a…
includes all the pertinent patient info collected by the nurs…
also helps and develops comprehensive and effective plan of c…
first step in ADPIE, gather info
Assessing
systematic and continuous collection ,analysis, validation, a…
database
includes all the pertinent patient info collected by the nurs…
38 terms
314: CH 1 Community-Oriented/Based Nursing
Professional Nurses must provide what?
Community-based Nursing
community-based nursing aims to ?
Community-oriented nursing focuses on?
evidence-bsed, cost-effective, high-quality, innovative, and…
focuses on "illness care" of individuals and famiies across t…
manage acute and chronic health conditions in the community.
health care of the community or populations
Professional Nurses must provide what?
evidence-bsed, cost-effective, high-quality, innovative, and…
Community-based Nursing
focuses on "illness care" of individuals and famiies across t…
16 terms
CSD 314: Assessment
appraisal; diagnosis
appraisal
diagnosis
separate clients into those who need t…
Components of assessment
collecting information about individuals' speech sound disord…
interpreting information to determine whether a disorder exists
Goal of a screening
appraisal; diagnosis
Components of assessment
appraisal
collecting information about individuals' speech sound disord…
20 terms
N314 Physical Assessment
Techniques for obtaining physical asse…
Inspection
Sensory perception of the hand
Types of palpations
" Inspection - see... Palpation - touch... Percussion - tapping l…
"Done first, you must look at the patient to inspect... Occurs d…
" Palmar surface of fingers and finger pads... ◦ Pulsations, tex…
" Light - 1 cm... Moderate palpation - 1-2 cm... ◦ Determines pain…
Techniques for obtaining physical asse…
" Inspection - see... Palpation - touch... Percussion - tapping l…
Inspection
"Done first, you must look at the patient to inspect... Occurs d…
189 terms
exam 2- nurse 314
three main behaviors of ADHD
behaviors for oppositional defiant dis…
what is the most important factor in t…
Attention-deficit hyperactivity disord…
inattention, impulsivity, hyperactivity
hostility, negativism, deviant, difficulty controlling temper
home environment
genetic etiology, child neglect, lead poisoning, drug exposur…
three main behaviors of ADHD
inattention, impulsivity, hyperactivity
behaviors for oppositional defiant dis…
hostility, negativism, deviant, difficulty controlling temper
49 terms
314 Neuro Assessment
Aphasia
Spatial Perception
How to asses higher intellectual funct…
How to assess judgement
Word comprehension, reading, writing
Pt can copy simple drawings of objects
Proverb interpretation/Abstract meaning
Long term goals, unrealistic and impulse decisions
Aphasia
Word comprehension, reading, writing
Spatial Perception
Pt can copy simple drawings of objects
30 terms
Nursing Assessment
Activities of Daily Living (ADLs)
Adventitious Breath Sounds
Auscultation
Body Mass Index (BMI)
the activities of daily living needed for independent living
abnormal breath sound heard over the lungs
listening for sounds within the body
ratio of height to weight
Activities of Daily Living (ADLs)
the activities of daily living needed for independent living
Adventitious Breath Sounds
abnormal breath sound heard over the lungs
36 terms
314 ear assessment
external ear extends from the
parts of the external ear
vibrations from the tympanic membrane…
anatomy of ear
auricle through the external auditory canal to the tympanic m…
helix, antihelix, tragus, antitragus, concha, lobule
the middle ear
external ear, middle ear, and inner ear
external ear extends from the
auricle through the external auditory canal to the tympanic m…
parts of the external ear
helix, antihelix, tragus, antitragus, concha, lobule
314 Exam1 Critical Thinking/Nursing Process
Know difference between objective & su…
Describe diagnostic reasoning
What are the 4 major components of dia…
What are the 6 phases of the nursing p…
Objective data is what the health care provider learns throug…
Diagnostic reasoning is the process of *analyzing health data…
o Attending to initially available cues, which are pieces o…
The nursing process includes six phases: assessment, diagno…
Know difference between objective & su…
Objective data is what the health care provider learns throug…
Describe diagnostic reasoning
Diagnostic reasoning is the process of *analyzing health data…
27 terms
314 cardiovascular assessment
Congenital heart disease
Diaphoresis
Nocturia
Jugular vein distention
once a defect occurs in a family, the likelihood of recurrenc…
excessive sweating
has to get up during the night to use the bathroom
Pressure going to the heart is increased in right side of heart
Congenital heart disease
once a defect occurs in a family, the likelihood of recurrenc…
Diaphoresis
excessive sweating
38 terms
314 eye assessment
Function of extraocular structures
extraocular structures
intraocular structures has how many la…
outer layer consists of
support and protect
eyebrows, eyelashes, eyelids, conjuctiva (bulbar and palpebra…
3: outer, middle, and inner layer
sclera and cornea (fibrous layer)
Function of extraocular structures
support and protect
extraocular structures
eyebrows, eyelashes, eyelids, conjuctiva (bulbar and palpebra…
9 terms
CSD 314: Assessment
appraisal; diagnosis
appraisal
diagnosis
separate clients into those who need t…
Components of assessment
collecting information about individuals' speech sound disord…
interpreting information to determine whether a disorder exists
Goal of a screening
appraisal; diagnosis
Components of assessment
appraisal
collecting information about individuals' speech sound disord…
NURSING 314: MENTAL STATUS AND SENSATION
Affect
Mental status check: ABCE
MMSE
Glasgow Coma Scale
Emotional reaction associated with a situation
-Appearance... - Behavior... - Cognition... - Emotions
Mini mental status exam; the maximum score is 30 and any scor…
Test administered during altered LOC; tests for eye opening a…
Affect
Emotional reaction associated with a situation
Mental status check: ABCE
-Appearance... - Behavior... - Cognition... - Emotions
16 terms
ear assessment 314 kerner
Three bones that are within the middle…
Inner ear (labyrinth) does what
Vestibule
Cochlea
Incus, malleus, and stapes
responsible for translation of sound to CN VIII
where oval window is housed
contains the organ of corti, transmits impulses to CN VIII
Three bones that are within the middle…
Incus, malleus, and stapes
Inner ear (labyrinth) does what
responsible for translation of sound to CN VIII
NURSING 314: MEDICAL ADMINISTRATION AND SAFETY
Nurse Practice Acts
PRN
What are the five rights of medical ad…
What is the 6th right of med administr…
Defines the nurses' scope of work; varies state by state
Administer as needed
1. right patient... 2. right drug... 3. right dosage... 4. right time…
Documentation
Nurse Practice Acts
Defines the nurses' scope of work; varies state by state
PRN
Administer as needed
15 terms
Nursing Assessment
Order of assessment
ABCD for assessing carcinomas
CAGE ASSESMENT
Nail clubbing
1 inspection, 2 palpation, 3 percussion, 4 auscultation
Asymmetry, border color, diameter
cut down, annoyed, guilty and eye-opener
angle between nail and base greater than 180 degrees
Order of assessment
1 inspection, 2 palpation, 3 percussion, 4 auscultation
ABCD for assessing carcinomas
Asymmetry, border color, diameter
26 terms
nursing assessment
nursing assesment
potential needs
Data collection
objective data
-is the systematic and continuous collection and analysis of…
are often listed as "at risk for"
Best sources of information about the client are the client a…
-means that only precise, accurate measurements or clear desc…
nursing assesment
-is the systematic and continuous collection and analysis of…
potential needs
are often listed as "at risk for"
9 terms
314 Exam1 Critical Thinking/Nursing Process
Know difference between objective & su…
Describe diagnostic reasoning
What are the 4 major components of dia…
What are the 6 phases of the nursing p…
Objective data is what the health care provider learns throug…
Diagnostic reasoning is the process of *analyzing health data…
o Attending to initially available cues, which are pieces o…
The nursing process includes six phases: assessment, diagno…
Know difference between objective & su…
Objective data is what the health care provider learns throug…
Describe diagnostic reasoning
Diagnostic reasoning is the process of *analyzing health data…
119 terms
314 Assessment of Peripheral Circulation and lymphatics
What is the innermost layer of the vei…
What is the middle layer of the veins…
What is the tunica externa
How do artery walls differ than those…
Tunica intimal (internal) also known as the endothelium
- Tunica Media... - elastic fibers and smooth muscle
the outermost layer of veins and arteries, made of a thin lay…
thicker than veins
What is the innermost layer of the vei…
Tunica intimal (internal) also known as the endothelium
What is the middle layer of the veins…
- Tunica Media... - elastic fibers and smooth muscle
120 terms
Ch 13 - NUR314 - Health Assessment
Ch13: ... Thyroid Gland
Ch 13: ... Thyroid Assessment: Objective…
Ch 13: ... Thyroid Assessment: Inspection
Ch 13: ... Thyroid Assessment: Palpation
The thyroid gland straddles the trachea in the middle of the…
Questions to ask your client:... - Have you ever had a thyroid p…
As the client moves the head, note any enlargement of they th…
The thyroid gland is difficult to palpate; arrange your setti…
Ch13: ... Thyroid Gland
The thyroid gland straddles the trachea in the middle of the…
Ch 13: ... Thyroid Assessment: Objective…
Questions to ask your client:... - Have you ever had a thyroid p…
53 terms
Nursing Assessment
Graphesthesia
Stereognosis
What does the tympanic membrane look l…
What response do you expect a healthy…
the ability to recognize writing on the skin purely by the se…
ability to perceive and recognize the form of an object in th…
Shiny, pearly gray, intact and mobile.
Knee-jerk reflex or sudden kicking of the lower leg.
Graphesthesia
the ability to recognize writing on the skin purely by the se…
Stereognosis
ability to perceive and recognize the form of an object in th…
40 terms
Carido-Pulmonary Assessment 314
Deoxygenated Blood
Oxygenated Blood
Right Ventricle
Left Ventricle
blood high in carbon dioxide and low in oxygen
blood high in oxygen and low in carbon dioxide
pumps blood through the pulmonary circulation
pumps blood through the systemic circulation
Deoxygenated Blood
blood high in carbon dioxide and low in oxygen
Oxygenated Blood
blood high in oxygen and low in carbon dioxide
88 terms
Nursing assessment
Alert
Lethargic
Obtunded
stuporous
Awake, responds appropriately to auditory, tactile, and visua…
Sleeps often, arouses easily; responds appropriately
Aroused by shaking or shouting; responds appropriately then r…
responds only to painful stimulus, withdraws finger or pushes…
Alert
Awake, responds appropriately to auditory, tactile, and visua…
Lethargic
Sleeps often, arouses easily; responds appropriately
19 terms
314 - Ch. 10 Pain Assessment
Pain
JCAHO standards of pain
Acute pain
Chronic pain
Pain is an unpleasant sensory and emotional experience associ…
Pain is assessed in all clients.... Initial assessment and regul…
Short term... Self-limiting... Follows a predictable trajectory... Dis…
Continues for 6 months or longer... Types are malignant (cancer…
Pain
Pain is an unpleasant sensory and emotional experience associ…
JCAHO standards of pain
Pain is assessed in all clients.... Initial assessment and regul…
66 terms
Nursing Assessment
when is the best time to assess the pt?
By who is the intial assessment perfor…
the ongoing assessment is the responsi…
what is a focused assessment?
as soon after admission as possible ... in some facilities it's…
by the RN
both the registered nurse and the LPN
when an assessment is performed when the nurse observes a cha…
when is the best time to assess the pt?
as soon after admission as possible ... in some facilities it's…
By who is the intial assessment perfor…
by the RN
66 terms
Nursing Assessment
when is the best time to assess the pt?
By who is the intial assessment perfor…
the ongoing assessment is the responsi…
what is a focused assessment?
as soon after admission as possible ... in some facilities it's…
by the RN
both the registered nurse and the LPN
when an assessment is performed when the nurse observes a cha…
when is the best time to assess the pt?
as soon after admission as possible ... in some facilities it's…
By who is the intial assessment perfor…
by the RN
54 terms
Nursing Assessment
Assessment
First step of assessment
Primary source
Secondary source
the gathering and analysis of information about the patient's…
colletion of information from primary and secondary sources
the patient
family members, health professionals, medical records
Assessment
the gathering and analysis of information about the patient's…
First step of assessment
colletion of information from primary and secondary sources
143 terms
Nursing Assessment
Emergency
Baccalaureate
Objective
Physician
A very rapid assessment performed in life-threatening situati…
Nursing health courses with informatics content are becoming…
Body functions are what type of data?
Performs a total physical examination when the client is admi…
Emergency
A very rapid assessment performed in life-threatening situati…
Baccalaureate
Nursing health courses with informatics content are becoming…
47 terms
Nursing Assessment
Bradypnea
Tachypnea
Adult respiration
Adult blood pressure
: respirations below 12 bpm
: respirations above 20 bpm
: normal range 12-20 bpm
: 100-120 systolic and 60-80 diastolic
Bradypnea
: respirations below 12 bpm
Tachypnea
: respirations above 20 bpm
131 terms
NUR314 - Health Assessment Exam 1
Assessment
Subjective data
Objective data
The database
Assessment is the collection of subjective and objective da…
Subjective data consist of information provided by the affe…
Objective data include information obtained by the health c…
The database is the totality of information available about…
Assessment
Assessment is the collection of subjective and objective da…
Subjective data
Subjective data consist of information provided by the affe…
26 terms
Nursing Assessment
Discuss the relationship between criti…
Explain the process of data collection…
Explain the process of data collection…
Explain the process of data collection…
Discuss the relationship between critical thinking and nursin…
Interview, observations, and physical examination
Report and response to interviews
...
Discuss the relationship between criti…
Discuss the relationship between critical thinking and nursin…
Explain the process of data collection…
Interview, observations, and physical examination
10 terms
Nursing assessment
General Assessment
HEENT
Neuro
Pulmonary
Mental Status, Appearance, Body Movement
Palpate head, facial bones, inspect eyes, visual acuity... Inspe…
LOC, orientation, GCS, pupils, speech
Inspect chest for symmetry/expansion, rate... Palpate for deform…
General Assessment
Mental Status, Appearance, Body Movement
HEENT
Palpate head, facial bones, inspect eyes, visual acuity... Inspe…
12 terms
Nursing Assessment
assessment
auscultation
cues
inspection
first phase of the nursing process in which data are gathered…
technique of listening to body sounds with a stethoscope
piece of data, subjective or objective, about a client
systematic visual examination of the client
assessment
first phase of the nursing process in which data are gathered…
auscultation
technique of listening to body sounds with a stethoscope
85 terms
Nursing Assessment
Domestic Violence Effects on Health
Abused Women
Abused OA
Child Maltreatment
Most women are assaulted by former or current partners.... Of th…
More chronic health problems, depression, suicidality, PTSD,…
Minor pain and discomfort, life threatening injuries, changes…
Physical injuries - bruises, fractures, lacerations, burns, b…
Domestic Violence Effects on Health
Most women are assaulted by former or current partners.... Of th…
Abused Women
More chronic health problems, depression, suicidality, PTSD,…
120 terms
Ch 13 - NUR314 - Health Assessment
Ch13: ... Thyroid Gland
Ch 13: ... Thyroid Assessment: Objective…
Ch 13: ... Thyroid Assessment: Inspection
Ch 13: ... Thyroid Assessment: Palpation
The thyroid gland straddles the trachea in the middle of the…
Questions to ask your client:... - Have you ever had a thyroid p…
As the client moves the head, note any enlargement of they th…
The thyroid gland is difficult to palpate; arrange your setti…
Ch13: ... Thyroid Gland
The thyroid gland straddles the trachea in the middle of the…
Ch 13: ... Thyroid Assessment: Objective…
Questions to ask your client:... - Have you ever had a thyroid p…
45 terms
314 Neurological Assessment Exam 1
mental status is evaluated by noting
what is affect
Mental Status: ABCE
MMSE
alertness, facial expressions, tone of voice, and affect
an emotional reaction associated with a situation (blunted af…
A: appearance (posture, body movements, dress/grooming)... B: B…
Mini mental status exam... -measures orientation & cognitive fun…
mental status is evaluated by noting
alertness, facial expressions, tone of voice, and affect
what is affect
an emotional reaction associated with a situation (blunted af…
25 terms
Nursing Assessment
Five Step Nursing Process includes: ... 1…
Gather info about the patient's condit…
Identify the patient's problem
Set goals of care and desired outcomes…
Assess... Evaluate
Assess
Diagnose
Plans
Five Step Nursing Process includes: ... 1…
Assess... Evaluate
Gather info about the patient's condit…
Assess
273 terms
NUR314 - Health Assessment - Exam 2
Ch 13:... Bleeding into the periosteum du…
Ch 13: ... Craniosynostosis is a severe d…
Ch 13: ... Narrow palpebral fissures, epi…
Ch 13: ... Kyphosis of the spine is commo…
D) cephalhematoma.... A cephalhematoma is a subperiosteal hemor…
A) premature closure of the sutures.... Craniosynostosis is mar…
B) fetal alcohol syndrome.... Facial characteristics of fetal a…
B) extend their heads and jaws forward.... The older adult may…
Ch 13:... Bleeding into the periosteum du…
D) cephalhematoma.... A cephalhematoma is a subperiosteal hemor…
Ch 13: ... Craniosynostosis is a severe d…
A) premature closure of the sutures.... Craniosynostosis is mar…
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