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N305 Health Assessment 9/5/2014 7:31:00 PM
Introduction to health assessment:
What is health?
• “a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.” –WHO (1946)• 1986-Ottawa Charter affirms social, economic and environmental
aspects of “health”
• A relative state where a person lives to their potential and includes 6
facets: physical, emotional, social, cultural, spiritual, developmental.
Health is the summation of these 6 facets and is simply not the
absence of disease.
• Our health is also determined by how well we can adapt to changes in
our environment
◦ How well we adapt
-immune system, stress relief techniques, support systems
ADL (activities of daily living)
Health is not a constant. A healthy person feels good on all levels.
What contributes to health:
Lifestyle, family history, genetics, environment, socioeconomic, occupation,
education, culture, spirituality, age, access to health care, nutrition, RNs!!!!!!
Determinants of Health:
1. income and social status
2. social support networks
3. education and literacy
4. employment/working conditions
5. social environments
6. physical environments
7. personal health practices and coping skills
8.
healthy child development
9. biology and genetic endowment
10. health services
11. gender
12. culture
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Diet is embedded in many of the 12 determinants of health.
Age isn’t part of it.
Florence Nightingale
1860/1969 (individual/environment)
“what you want are facts, not opinions…the most important practical lesson
that can be given to nurses is to teach them what to observe and how to
observe…” (p.105)
“And nothing but observation and experience will teach us the way…”
Why Health Assessment?-information about patient, knowledge that leads to best course of action for
patient care
-health promotion makes RNs different
How are you?
-illness, injury, disease, alterations in health, health, wellness, wellbeing
- interested in both ends of the spectrum of health and illness
Professional LensProfessional and Practice Considerations
- situational awareness’
- context dependent
- general survey
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clinet assessment
- priority setting
- nursing knowledge and judgment
- nursing process
-
clinical reasoning- interprofessional collaboration
The Nursing Process
The information obtained throughout the health assessment should be doc-
umented in a clear, concise manner. This information is collated in the
patient’s medical records. The ability of the nurse to extrapolate the
findings, prioritize them, and finally formulate and implement the plan of
care is the overall goal. This is called “the Nursing Process.”
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Client Assessment strategies and scopes vary significantly.
Individual Depends on the client, purpose, context, setting etc.
Family Determines nursing care plan and interventionsAggregate Contributes to interprofessional plan and strategies.
Population
Community
Also need to consider:
- professional approach
o with clients and team members
- communication
o empathy, caring, effective
o therapeutic
- Professional relationship
o Boundaries
o Touch, space, dignity, respect, comfort, safety, privacy
Three effective verbal communication skills
- Active listening
o
The ability to focus on patients and their perspectives- Restatement
o The content of communication
- Reflection
o Identify the themes of communication and what the patient may
be feeling.
Individual Assessment: assessing social, env, econ, health, physical,
mental, social, family, community
60-sec assessment
- purpose, directions
ABC without touching the patient
Tubes and lines
Respiratory equipment
Patient safety survey
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Environmental survey
Sensory
Additional…
Lab and Diagnostic Examples: blood work (CBC), x-rays, angiogram
Role and responsibility of RN
o Understand or clarify purpose of test
o
Inform client or others
o Prepare client or others
o Understand or report pertinent findings
o Discuss or relay information with client.
Health Hx: Components
Interview: Phases and Process
Preparation/Preinteraction phase
o Collect data (if possible)
o Create setting: private, comfortable, safe
Initial/ Introductory phase
o Introduce: name, role and purpose
Working phase
Summarizing phase
Client Considerations
- Age
- growth and development
- sensory
- language
- culture
- gender
- emotional state
Perceptions and Concerns
- subjective
- “self -report”
- what does client perceive?
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What is of concern?
- Attend to statements, inferences, possibilities, lead, cues
- Consider potentially sensitive topics and vulnerability
o What might they be?
o
What might they depend on… gender, age, culture
Assessnebt types, Depth, Scope
- emergent/urgent
-
unstable, life threatening, at risk
comprehensive
- health history, phys exam, lab/diag
-head to toe regions and sustems
-systems: CNS, CVS, Resp, GI/GU, MSK/Integ
- focused. Issue-oriented
-narrow scope
-in depth relationto concets of client, rn
- functional
health patterns/aspects
Organizing Frameworks
functional head-to-toe
body systems
Individual Assessment
Findings
o Normal
o Abnormal
o Expected
o
Unexpected
Ongoing
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Communication of Findings
-among and between team members
SBAR
S: situation (name, role, overview of issues)
B: background (pertinent history)
A: assessment (summary of facts and assessment)
R: recommendation (actions asking for, what do you need or
want to happen next)
Health Care Team (interactions with certain professionals)
What is health assessment?
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The purpose of the nursing health assessment is to determine a
patient’s health status, risk factors, and need for health education
as a basis for developing a nursing plan of care.
Three types: emergency, comprehensive (physical), patient history
The extent of health assessment depends on the acuity of the
patient’s condition.
Nursing and medicine both perform health assessments but they
differ! Medicine focuses on diagnoses and treatment of the disease.
Nursing focuses on diagnoses and treatment of the actual or
potential human responses. The nursing assessment identifies many
contributing factors to the individual’s health and wellness. These
include the 6 facets. Deviation or changes in response is noted.
For nurses it is a comprehensive health history and a physical
examination which aids in the health evaluation to determine the
health status of a person. This aids in how care should be executed
which is unique to each person.
i. Health History: A series of pertinent questions about the
patient and/or family. Use of past medical records. Knowledge
of physical, psychological, social issues, spiritual, culturalbeliefs. The identification of important data is a
systematic process.
ii. Physical Examination: A structured head-to-toe examination
to identify changes in the patient’s body systems. Findings may
support history data or trigger more questions.
General Survey
- height, weight, vital signs
- body frame
- body mass index (BMI)
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Situational Awareness
- is the ability to identify, process, and comprehend the critical elements
of information about what is happening to the team with regards to the
mission. More simply, it's knowing what is going on around you
Health Assessment
o curiosity
o observation skills
o
knowledge and intellect
General survey
behaviour, physical appearance, mobility
Questions: Ask how he is, ask about why he is in today,
Notice from health assessment:nutrition, occupation, relaxed, good posture
Man on street: smoking, hygiene poor?, unkempt,
Questions: how long have you been smoking? When did you start smoking?
What are you reading today? Are you feeling comfortable? Do you live
closeby? Note grooming, nutrition, safety.
Health History
When is one anticipated? On admission to hospital, patient coming into
clinic for first time, long-term care, employment physical, before surgery,
admission to medical unit, clinic, surgery
What do we obtain?
Past and present illnesses, chief concern, drinking, drugs, smoking,
sexual health, occupation, family history,
Why do/ would RNs complete one? For plan of care. To inform and
work with other disciplines for plan of care.
Health Hx: Personal Data
Subjective: information
Objective
Primary from the client themselves
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Secondary from the secondary source
Reliable
Inaccurate
Do own assessment
Get reports
Test-rest validity
EG redo vitals if not sure
Ask what they know –get 2nd opinion
Subjective pain- most important
Sometimes subjective is the most important.
Reliability is important- know what they are saying
- information getting, need to know is correct, hiding, making up
- clarify, see if misunderstanding
Primary data might not be reliable, e.g., patient with dementia
First language not English might need to clarify
If person insists they have tumor? How do we handle?
Syllabus pp 79-87
Health Hx: Components
E.g., phone number, contacts, address, male/fem, chief concern, sign
sensation symptoms, personal family, social, cultural, medical
Signs- can see
Symptoms- can’t
sensations
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CLPD
Refer to pdf from email
Short form mcgill can be used anywhereEdmonton- more dimensional in terms of symptoms
Sim to ESR but includes distress
Vital Signs:
Bp, pulse, o2 sat
Temp
Expected findings: why do numbers vary?
Hypothermia
Hyperthermia
Comment Jensen, p.99
Interventions for fever are dependent on the patient and cause. Most often
rapid cooling is not beneficil or required.
Pulse
Sites- Adults
Radial, carotid, apical, brachial, femoral, popliteal, dorsalis pedis, posterior
tibial
Expected findings
Rate
60-100
Expected (60-100 sinus rhythm)
Tachycardia- rate over 100
Bradycardia- less than 60
Rhythm
Regular or irregular
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Strength/ amplitude
Weak pulse due to blood loss
Respirations
Rate: expected
Tachypnea
Bradypnea/apnea
Rhythm
REGULAR
IRREGULAR
QUALITY/DEPTH
Blood Pressure: sys, diastolic, MAP
An increase in volume will
An increase in resistance (called vasoconstriction) will
Normotensive
-
sys, diastolic, MAPHypotensive
MAP should always be over 65
BP: influenced by age, gender, genetics, weight,
exercise, smoking, diet, emotions, medications, position
pulse oximeter
SpO2
Widely used
Arterial blood gases
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SaO2
More accurate
But more invasive.
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N301- Nursing Research 9/5/2014 7:31:00 PM
First paper due September 29th 8:00am
- APA format
3-4 pages
1. Who are the subjects (quantitative researchers)? OR who are the
participants (qualitative researchers)?
-The students
2. Was any theory building or theory development done (qualitative) OR was
a developed theory or existing model being tested (quantitative)?
Both. Some kids already know how to make their favourite food
3. Was data collected? (quantitative - data that can be summarized or
reported as one or more numbers) OR (qualitative - information gathered for
an improved understanding of the topic or phenomenon of interest)
Yes. Measurements, favourite foods/ recipes/ food types, sweet/salty,
preparation time, ingredient amounts
4. What were the variables (concepts that could have information
counted on each one - quantitative researchers) OR what may be thekey points of understanding gained from reading this booklet with these key
points actually called "codes" which would be grouped together to
form categories and with these categories then grouped into a theory that
would hopefully increase our understanding of the topic or phenomenon of
interest - qualitative researchers)?
Dessert, main meal, side, snack
Ingredient availability
5. What did you find? (qualitative researchers AND quantitative
researchers)
Measurements were not exact and exact amounts of ingredients and yield
was not provided. Children don’t have a good concept of time.
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6. Was this a "good" study (quantitative - random selection of subjects,
objective researcher so no researcher bias, the findings from these children
can be generalized to all children OR qualitative - was this a trustworthy
research process that generated meaningful information that may be used
sometime and/or transferred into practice somewhere)random selection was not good, objective researcher (biased due to teacher)
bias due to age and preferences, not generalized to all children in the world
7. Which type of study was best at answering the question on page 1 of the
booklet - qualitative or quantitative?
Qualitative- theoretical thinking
Both
Chapter One Review
Overview of Nursing Research
On completing this chapter, you will be able to:
Describe why research is important to nursing and discuss evidence-
based practice
Research is important to nursing because it answers questions, solves
problems and builds upon knowledge.
All this knowledge acquired by the nurse (clinical evidence) helps in the bestcourse of action for care.
Describe historical trends and future directions in nursing research
Historical trends: Nightingale founded nursing research in 1859 Notes on
Nursing. Focus of paper on environmental factors that influence emotional
and physical well-being.
Describe alternate sources of evidence for nursing practice
Describe the main characteristics of the positivist and naturalistic paradigms,
and discuss similarities and differences between quantitative and qualitative
research
Identify several purposes of qualitative and quantitative research
Define new terms in the chapter
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Research: a systematic inquiry that uses rigorous methods to answer
questions or solve problems. The ultimate goal of research is to develop,
refine, and expand knowledge.
Nursing research: is designed to develop evidence about issues of
importance to various stakeholdersEvidence-based practice (EBP): EBP is broadly defined as the use of the
best clinical evidence in making care decisions.
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N303- Nursing Theory 9/5/2014 7:31:00 PM
1. Religious Nursing
2. Florence Nightingale
3. Schools or Nursing
4. Rise of Professional Nursing
5. Public Health Nursing 1920s-1950s6. Hospital Nursing 1965
7. 1980s
pine needle drink from natives to fight survey
Jeanne Mance
- nurse, not a sister
- considered a founder of Quebec
- founded L’hotel dieu
- Grey Nuns not Cloistered
- Grey means colour and tipsy
ferry, brewery money for hospital and for employment for handicapped
Surgeons
barbersGrey Nuns in Quebec City, Winnipeg, Edmonton. Followed colonization and
fur trade. Not in Ontario or New England due to English.
First school of nursing in St. Catherines. First school of nursing in Alberta
(Medicine Hat). Properties of hospital. Lectures in evening.
Hospitals owned by mining companies in Alberta.
Nurse groups
- organizations (international)
Victorian Order of Nurses
Yukon- gold rush VONs and sisters went too!
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Edith Cavell
- angel glacier
- nurses were viewed as “angels of mercy”
Health Insurance
- started in Saskatchewan
McGill model of nursing
Int council of nursing 1989
Robert Calman
Roberta McAdams
Lpn after WWII
RPN
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N113- Pathophysiology 9/5/2014 7:31:00 PM
Amy- TA
or post on E-class
For games use the two diagrams for pathogen and pathophys.
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N305 lab 9/5/2014 7:31:00 PM
Instructor
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N303 Lab 9/5/2014 7:31:00 PM
7804929066