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Study sets matching "nursing physical assessment"

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Study sets matching "nursing physical assessment"

51 terms
Nursing Foun, Physical assessment
Assessment
Disease
Acute
Chronic
evaluation or appraisal of a condition; includes observing, g…
Any disturbance of a structure or function of the body; a pat…
Having a short and relatively severe course; a disease proces…
Developing slowly and persisting for a long period, often for…
Assessment
evaluation or appraisal of a condition; includes observing, g…
Disease
Any disturbance of a structure or function of the body; a pat…
192 terms
Fundamentals Nursing PHYSICAL ASSESSMENT
health assessment
nursing assessments focus on....
what are the purposes of a physical as…
where would you do a comphrehensive as…
comprehensive assessment of the physical, mental, spiritual,…
the clients functional abilities and physical responses to il…
to obtain base line data, to identify collaborative problems,…
annual physical, outpatient appointment, inpatient setting, a…
health assessment
comprehensive assessment of the physical, mental, spiritual,…
nursing assessments focus on....
the clients functional abilities and physical responses to il…
69 terms
Nursing: Physical Assessment
Objectives
Purpose of physical exam
Types of data
Subjective data
-Identify the purpose of obtaining a patient's health history…
-Obtain baseline data about patient's functional abilities... -S…
Subjective and Objective
- Referred to as symptoms... - Only patient can tell you... - Ex: i…
Objectives
-Identify the purpose of obtaining a patient's health history…
Purpose of physical exam
-Obtain baseline data about patient's functional abilities... -S…
192 terms
Fundamentals Nursing PHYSICAL ASSESSMENT
health assessment
nursing assessments focus on....
what are the purposes of a physical as…
where would you do a comphrehensive as…
comprehensive assessment of the physical, mental, spiritual,…
the clients functional abilities and physical responses to il…
to obtain base line data, to identify collaborative problems,…
annual physical, outpatient appointment, inpatient setting, a…
health assessment
comprehensive assessment of the physical, mental, spiritual,…
nursing assessments focus on....
the clients functional abilities and physical responses to il…
72 terms
Nursing 101- physical assessment
Accommodation
Affect
aneurysm
anosmia
adjustment, especially that of the lens of the eye for variou…
he external expression of emotion attached to thoughts, mood,…
a fluid- or blood-filled sac formed by the dilation of the wa…
absence of the sense of smell
Accommodation
adjustment, especially that of the lens of the eye for variou…
Affect
he external expression of emotion attached to thoughts, mood,…
49 terms
Nursing Physical Assessment
Vital signs
Temperature
Afebrile
Fever
temperature, pulse, respiration, blood pressure, pain
the difference between the amount of heat produced by the bod…
without fever
(pyrexia) an increase above normal in body temperature. Febri…
Vital signs
temperature, pulse, respiration, blood pressure, pain
Temperature
the difference between the amount of heat produced by the bod…
79 terms
Foundations of Nursing: Physical Assessment
Signs
symptoms
drainage
exudate
-objective data... - what you see, hear, measure or feel.... exampl…
- subjective data... - illness that patient perceives... example: p…
refers to the passive or active removal of fluids from a body…
refers to fluids, cells, or other substances that are slowly…
Signs
-objective data... - what you see, hear, measure or feel.... exampl…
symptoms
- subjective data... - illness that patient perceives... example: p…
21 terms
Nursing Assessment~ Physical Assessment Equipment
Audiometer
Calipers
Doppler
Nasal Speculum
Performs basic screening for hearing acuity
Measures the thickness of subcutaneous tissue to estimate the…
Amplifies sounds
Spread the opening of the nares so the internal surfaces of t…
Audiometer
Performs basic screening for hearing acuity
Calipers
Measures the thickness of subcutaneous tissue to estimate the…
40 terms
Nursing 110 Physical Assessment
Steps in an assessment
Obtaining a history
Health history
Physical assessment
-Use the nursing process to identify patient needs... -Gathering…
-Reason for accessing health care... -Past Medical problems- PMH…
-Family History- diseases - especially heart disease, cancer,…
-Head to Toe approach vs. system approach... -Positioning/drapin…
Steps in an assessment
-Use the nursing process to identify patient needs... -Gathering…
Obtaining a history
-Reason for accessing health care... -Past Medical problems- PMH…
135 terms
Foundations of Nursing Physical Assessment
Acute
Assessment
Borborygmi
Bruits
-begins abruptly with marked intensity of sever signs and sym…
-evaluation or appraisal of the patients condition... -involves…
high-pitched, loud, gurgling sounds that accompany increased…
-abnormal swishing sounds heard over organs, glands and arter…
Acute
-begins abruptly with marked intensity of sever signs and sym…
Assessment
-evaluation or appraisal of the patients condition... -involves…
98 terms
The Nursing Physical Assessment
Health/Medical History
Nursing Health History
Nursing Health History
Gordon's Functional Health Patterns
Provides guidence for care; Includes subjective and objective…
Biographical information;chief complaint/ reason for seeking…
Family history; Social history; Medications; Complementary th…
Health Perception- Health Promotion; Elimination- Bowel/Bladd…
Health/Medical History
Provides guidence for care; Includes subjective and objective…
Nursing Health History
Biographical information;chief complaint/ reason for seeking…
40 terms
Physical Assessment Techniques - Nursing
palpation
best suited for fine tactile discrimin…
measure position, consistency and tugor
measuring temperature
uses the sense of touch as part of the assessment
fingertips
grasping action of thumb and fingers
dorsa (back of hands)
palpation
uses the sense of touch as part of the assessment
best suited for fine tactile discrimin…
fingertips
19 terms
Nursing Physical Assessment
Introduction (3)
Patient ID
Vitals (5)
Pain (3)
Communication... Privacy/comfort... Handwashing/alcohol stethescope…
Verbal ID/wristband
BP, pulse, RR, temp, pulse ox
Location, quality, rating
Introduction (3)
Communication... Privacy/comfort... Handwashing/alcohol stethescope…
Patient ID
Verbal ID/wristband
334 terms
Nursing 612 Physical Assessment Vocabulary
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
192 terms
Fundamentals Nursing PHYSICAL ASSESSMENT
health assessment
nursing assessments focus on....
what are the purposes of a physical as…
where would you do a comphrehensive as…
comprehensive assessment of the physical, mental, spiritual,…
the clients functional abilities and physical responses to il…
to obtain base line data, to identify collaborative problems,…
annual physical, outpatient appointment, inpatient setting, a…
health assessment
comprehensive assessment of the physical, mental, spiritual,…
nursing assessments focus on....
the clients functional abilities and physical responses to il…
40 terms
Physical Assessment Techniques - Nursing
palpation
best suited for fine tactile discrimin…
measure position, consistency and tugor
measuring temperature
uses the sense of touch as part of the assessment
fingertips
grasping action of thumb and fingers
dorsa (back of hands)
palpation
uses the sense of touch as part of the assessment
best suited for fine tactile discrimin…
fingertips
13 terms
Nursing Physical Assessment
K WIPES throughout procedure.
Allergies
Vital Signs
Neuro
Any miss of bolds is automatic fail. 5 or more non-critical i…
Food;... Medicine;... Other.
Temperature;... Pulse;... Respirations;... Blood Pressure;... SpO2: RA, O…
PERRLA;... Orientation times 4: Person, Place, Situation, Time;…
K WIPES throughout procedure.
Any miss of bolds is automatic fail. 5 or more non-critical i…
Allergies
Food;... Medicine;... Other.
Nursing principals physical assessment
Accomodation
Affect
Aneurysm
Anosmia
Adjustment, especially that of the lens of the eye for variou…
The external expression of emotion attached to thoughts, mood…
A fluid or blood-filled sac formed by the dilation of the wal…
Absence of the sense of smell
Accomodation
Adjustment, especially that of the lens of the eye for variou…
Affect
The external expression of emotion attached to thoughts, mood…
30 terms
Physical Assessment Nursing 108
Musculoskeletal Physical - TASK ONE
Musculoskeletal Physical - TASKTWO
Musculoskeletal Physical - TASKTHREE
Musculoskeletal Physical - TASKFOUR
STRENGTH - inspect muscles and strength
SKELETAL - have pt touch toes and check spine alignment
JOINTS - palpate joints
ROM - go through range of motion exercises
Musculoskeletal Physical - TASK ONE
STRENGTH - inspect muscles and strength
Musculoskeletal Physical - TASKTWO
SKELETAL - have pt touch toes and check spine alignment
192 terms
Fundamentals Nursing PHYSICAL ASSESSMENT
health assessment
nursing assessments focus on....
what are the purposes of a physical as…
where would you do a comphrehensive as…
comprehensive assessment of the physical, mental, spiritual,…
the clients functional abilities and physical responses to il…
to obtain base line data, to identify collaborative problems,…
annual physical, outpatient appointment, inpatient setting, a…
health assessment
comprehensive assessment of the physical, mental, spiritual,…
nursing assessments focus on....
the clients functional abilities and physical responses to il…
192 terms
Fundamentals Nursing PHYSICAL ASSESSMENT
health assessment
nursing assessments focus on....
what are the purposes of a physical as…
where would you do a comphrehensive as…
comprehensive assessment of the physical, mental, spiritual,…
the clients functional abilities and physical responses to il…
to obtain base line data, to identify collaborative problems,…
annual physical, outpatient appointment, inpatient setting, a…
health assessment
comprehensive assessment of the physical, mental, spiritual,…
nursing assessments focus on....
the clients functional abilities and physical responses to il…
9 terms
General Physical Assessment Nursing
Do Initial Steps and ID PT with two id…
Patient's Overall Hygiene and Appearance
Mental Status
Cranial Nerves
...
Observe skin color. Note respirations. Labored? Noisy? O2 Sat…
Orientation to person place and time. Level of consciousness.…
Assess SMELL: Pt close eyes, occlude one nostril. Ask them to…
Do Initial Steps and ID PT with two id…
...
Patient's Overall Hygiene and Appearance
Observe skin color. Note respirations. Labored? Noisy? O2 Sat…
25 terms
Nursing Health assessment & physical examination
Explain a few purposes of physical exa…
Should you be culturally sensitive dur…
During inspection Should you compare l…
When you palpate skin what are you loo…
-Gather baseline data... -Make clinical judgments... -confirm and i…
Yes!!
YES
Temperature, moisture, and texture
Explain a few purposes of physical exa…
-Gather baseline data... -Make clinical judgments... -confirm and i…
Should you be culturally sensitive dur…
Yes!!
22 terms
Nursing 1023-Health/Physical Assessment
Neuro: General
Neuro: Mental Status (SOME JC)
Neuro: Cranial Nerves
Neuro: Motor
Grooming, hygiene, dress, LOC
Speech (appropriate, clear) ... Orientation (alert x3) ... Memory (…
Olfactory (1): smell each nostrile... Optic (2): snellen and per…
General: gait, tremors, involuntary movements... muscle mass: bi…
Neuro: General
Grooming, hygiene, dress, LOC
Neuro: Mental Status (SOME JC)
Speech (appropriate, clear) ... Orientation (alert x3) ... Memory (…
202 terms
Nursing Exam 2 - Physical Assessment
When does a physical assessment begin
What is the purpose of a physical asse…
What is the complexity of the physical…
What are the components of a health as…
as soon as you walk in the room
to establish baseline, focused assessment, assess for progres…
Expertise of the nurse
Health history and physical examination
When does a physical assessment begin
as soon as you walk in the room
What is the purpose of a physical asse…
to establish baseline, focused assessment, assess for progres…
23 terms
Chapter 1 Nursing Physical Assessment
Assessment
Subjective Data
Objective Data
Database
the collection of subjective and objective data about a patie…
information provided by the affected individual (SIGNS)
information obtained by the health care provider through obse…
totality of information available about the patient, includin…
Assessment
the collection of subjective and objective data about a patie…
Subjective Data
information provided by the affected individual (SIGNS)
12 terms
Facts about Physical Assessment in Nursing
The systematic collection and analysis…
Assessment
Primary source of patient?
Other sources of patient?
1. Subjective data... 2. Objective data... 3. Data Base
- used to establish a database for the patient... - the basis on…
Patient
- Patient's support persons... - Patient record... - Information fr…
The systematic collection and analysis…
1. Subjective data... 2. Objective data... 3. Data Base
Assessment
- used to establish a database for the patient... - the basis on…
30 terms
Exam 1 Nursing Physical Assessment
Which technique is used to auscultate…
What heart sound is associated with he…
Match the location on the thorax with…
Where is the point of maximal impulse…
Ask the client to take a breath and hold it briefly while you…
S3, indication of fluid overload
Aortic Valve area ~ Second right interspace... Pulmonic valve a…
5th intercostal space, mid-clavicular line
Which technique is used to auscultate…
Ask the client to take a breath and hold it briefly while you…
What heart sound is associated with he…
S3, indication of fluid overload
12 terms
Nursing Midterm - Physical Assessment Techniques
Physical Assessment Techniques
Inspection
Palpation
Percussion
Inspection... Palpation ... Percussion ... Auscultation
observation and visual examination of the client, as well as…
light touch, progressing to deeper touch, using the pads of t…
striking a body surface with the tip of a finger, which produ…
Physical Assessment Techniques
Inspection... Palpation ... Percussion ... Auscultation
Inspection
observation and visual examination of the client, as well as…
11 terms
6700: physical assessment and nursing process
Nursing process components
Steps of nursing process
Assessment
Nursing diagnosis
Subjective + objective + database = clinical judgement or dia…
ADOPIE
Medical record, physical exam, cultural/spiritual, health hx,…
Compare findings, cluster data/clues, validate data and form…
Nursing process components
Subjective + objective + database = clinical judgement or dia…
Steps of nursing process
ADOPIE
317 terms
Nursing 612 Physical Assessment: All Terms
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
67 terms
ACCC Nursing Physical Assessment Adult
accommodation
affect
aneurysm
anosmia
adjustment, especially that of the lens of the eye for variou…
the external expression of emotion attached to thoughts, mood…
a fluid- or blood-filled sac formed by the dilation of the wa…
absence of the sense of smell
accommodation
adjustment, especially that of the lens of the eye for variou…
affect
the external expression of emotion attached to thoughts, mood…
317 terms
Nursing 612 Physical Assessment: All Terms
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
47 terms
Nursing Physical Assessment Quiz 1
air embolism
speed shock
syncope, chock, and cardiac arrest
dizziness, facial flushin, h/a, tightn…
s/s: palpitations, lightheadedness, weakness, dyspnea, tachyp…
when foreign substance(med) is rapidly introduced to circulat…
what can speed shock cause?
s/s of speed shock
air embolism
s/s: palpitations, lightheadedness, weakness, dyspnea, tachyp…
speed shock
when foreign substance(med) is rapidly introduced to circulat…
9 terms
Physical Assessment Check Off - Nursing
Level of Consciousness... Oriented x4... Mood
Hair
Face
Eyes
Alert, lethargic, drowsy, comatose... Oriented x4 person, time,…
Hair Distribution... Thinning, alopecia, use of wigs?... Condition:…
Assess Facial Symmetry (symmetrical or drooping)
Pupil Size, Equal, Round ... Reactive to light, Direct & Indirec…
Level of Consciousness... Oriented x4... Mood
Alert, lethargic, drowsy, comatose... Oriented x4 person, time,…
Hair
Hair Distribution... Thinning, alopecia, use of wigs?... Condition:…
11 terms
Physical Assessment Data: Sample Nurses Notes
Vital Signs/ Pulse OX
Cognitive (neurological) / Psychosocia…
Perfusion (cardiac)
Oxygenation (Respiratory)
T: 98° orally P: 80 regular R: 20 moderate depth, regular BP…
Alert and oriented X3. Pleasant and able to verbally communic…
S1 and S2 Heart sounds auscultated at all cardiac locations.…
lungs clear anteriorly and posteriorly in all lobes. Respirat…
Vital Signs/ Pulse OX
T: 98° orally P: 80 regular R: 20 moderate depth, regular BP…
Cognitive (neurological) / Psychosocia…
Alert and oriented X3. Pleasant and able to verbally communic…
18 terms
Nursing 201 Physical Assessment Competency
basic physical assessment order
abdomen basic physical assessment steps
upper extremities basic physical asses…
lower extremities basic physical asses…
neurologic, respiratory, cardiac, abdomen, upper extremities,…
-inspect abdomen (don't stoop)... -auscultate for bowel sounds (…
-assess radial pulses (strength and rhythm and symmetry)... -ass…
-assess dorsalis pedis pulse (strength and rhythm and symmetr…
basic physical assessment order
neurologic, respiratory, cardiac, abdomen, upper extremities,…
abdomen basic physical assessment steps
-inspect abdomen (don't stoop)... -auscultate for bowel sounds (…
48 terms
NURSING 175 HEALTH AND PHYSICAL ASSESSMENT
List techniques to promote physical an…
Identify ways to incorporate health te…
The systematic gathering of informatio…
Head-to-toe approach... Assessment of eac…
Caring Interventions
Teaching / Learning
Assessment: The first step in the nursing process
Organization of the Assessment
List techniques to promote physical an…
Caring Interventions
Identify ways to incorporate health te…
Teaching / Learning
41 terms
Nursing Final Physical Assess Terms
accommodation
affect
aneurysm
anosmia
adjustment, especially that of the lens of the eye for variou…
the external expression of emotion attached to thoughts, mood…
a fluid- or blood-filled sac formed by the dilation of the wa…
absence of the sense of smell
accommodation
adjustment, especially that of the lens of the eye for variou…
affect
the external expression of emotion attached to thoughts, mood…
102 terms
Nursing Lab: Physical Assessment and Pain
Accommodation
Affect
Aneurysm
Anosmia
adjustment, especially that of the lens of the eye for variou…
the external expression of emotion attached to thoughts, mood…
a fluid or blood filled sac formed by the dilation of the wal…
absence of the sense of smell
Accommodation
adjustment, especially that of the lens of the eye for variou…
Affect
the external expression of emotion attached to thoughts, mood…
33 terms
Nursing 3 Pediatric physical assessment
Rule #1 for children is that they are…
when dealing with children what approa…
As a nurse preparing to do a physical…
when doing an assessment what are our…
CHILDREN ARE NOT SMALL ADULTS
-Take time w/child & family before you give meds or procedure…
-always go prepared... -have all supplies on hand... -focused asses…
We assess respiration and H/R for 1 complete minute... Reason br…
Rule #1 for children is that they are…
CHILDREN ARE NOT SMALL ADULTS
when dealing with children what approa…
-Take time w/child & family before you give meds or procedure…
67 terms
Nursing Assessment of the Geriatric Cat and Dog: Physical Assessment
Physical Assessment
Vital signs- (especially blood pressur…
Hydration Status- Pet owners assume th…
Pain-Pain assessment (especially chron…
What to check
Temperature, Pulse, Respiration, blood pressure (if recommend…
Mucous membrane color and capillary refill time, skin turgor
Increased pulse rate; increased respiratory rate; changes in…
Physical Assessment
What to check
Vital signs- (especially blood pressur…
Temperature, Pulse, Respiration, blood pressure (if recommend…
19 terms
Health & Physical Assessment in Nursing Ch 1
assessment
client record
communication
confidentiality
Step 1 of the nursing process, is the collection, organizatio…
A legal document used to plan care, to communicate informatio…
Refers to the exchange of information, feelings, thoughts, an…
Means that information sharing is limited to those directly i…
assessment
Step 1 of the nursing process, is the collection, organizatio…
client record
A legal document used to plan care, to communicate informatio…
317 terms
Nursing 612 Physical Assessment: All Terms
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
317 terms
Nursing 612 Physical Assessment: All Terms
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
317 terms
Nursing 612 Physical Assessment: All Terms
Scotoma
Open Angle Glaucoma
Angle-Closure Glaucoma or Narrow Angle…
Amaurosis fugax
loss of vision in a part of the visual field; blind spot.
Most common 90% of cases-caused by slow clogging of the drain…
Angle-closure glaucoma, a less common form of glaucoma:... Is ca…
Sudden onset / temporary blindness that may resut from transi…
Scotoma
loss of vision in a part of the visual field; blind spot.
Open Angle Glaucoma
Most common 90% of cases-caused by slow clogging of the drain…
51 terms
Health and Physical Assessment in Nursing Chapter:1
Health
Wellness
Health assessment
Interview
state of complete physical, mental, and social well-being
a state of life that is balanced, personally satisfying, and…
systematic method of collecting data for the purpose of deter…
the gathering of subjective data (includes health history and…
Health
state of complete physical, mental, and social well-being
Wellness
a state of life that is balanced, personally satisfying, and…
12 terms
Health and Physical Assessment in Nursing Chapter 8
Health history
Components of Health History and Terms
Biographic data
Present health or illness
comprehensive record of the patients past and current health…
Electronic health record (EHR) - designed to be portable and…
includes patients name and address (first opportunity to asse…
includes information about all the patient's current health-r…
Health history
comprehensive record of the patients past and current health…
Components of Health History and Terms
Electronic health record (EHR) - designed to be portable and…
62 terms
Fundamentals of Nursing Chapter 5: Physical Assessment
A sign
A symptom
Drainage
Exudate
objective data; what you can see, hear, smell, feel, or measure
subjective data; illness that patient percieves such as nause…
passive or active removal of fluids from a body cavity, wound…
fluid, cells, or other substances that are slowly discharged…
A sign
objective data; what you can see, hear, smell, feel, or measure
A symptom
subjective data; illness that patient percieves such as nause…
Fundamentals of Nursing Chapter 16: Physical Assessment
Nursing process
Nursing Process Five Steps
Assessment
Database
A critical thinking process that professional nurses use to a…
Def. Fundamental blueprint for how to care for a patient. "St…
Def. The deliberate and systematic collection of information…
The purpose of assessment is to establish a database about th…
Nursing process
A critical thinking process that professional nurses use to a…
Nursing Process Five Steps
Def. Fundamental blueprint for how to care for a patient. "St…
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