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Nurs 125 Health assessment and
symptom analysis
Describe how you take a present illness report? - answe record the health history chronologically and complete a symptom analysis. These include the 10 specific attributes of the symptom. Describe the M in a SMART nursing goal. - ansmeasurable: how will you know when have reached the goal? differentiate between subjective and objective data - anssubjective data is the patients perceptions on what they feel such as pain and dizziness. Objective data is measurable such as blood pressure and breaths per minute. differentiate primary from secondary data - ansprimary data comes from the patient and secondary data comes from any other source than the patient such as previous health records and family members How do we choose which pain assessment tool to use? - answe choose based on age and use such as we may want to use a picture diagram if the patient does not speak English. How do we communicate with a patient who has cognitive impairment? - answe allow the patient sufficient time to answer and help them find the right words to describe their symptoms. We do not want to put words in their mouth however. It is easy to confuse cognitive impairment with anxiety or agitation. We must monitor these patients for basic needs such as water, food, and ensure their pain is properly managed. How do we communicate with school age children? - ansWe address them so they feel like they are the most important thing in the room. We collect most of the data from the parents but we do not ignore the child. We want the child to answer if they have the cognitive ability, and the parent to fill in any blanks. How do we communicate with someone who has a hearing impairment? - ansWe ensure their hearing aid is on and they can hear us, we can therapeutically touch the patient and use visual signs before interacting with them. We need them to hear everything so we need to ensure the environment is quiet. We ask open ended questions so we know they are listening. If a patient is deaf, we should sit close to the patient and let them read our lips, we must speak slower. How do we do a pain assessment? - answe use a one dimension scale such as 1-10.
How do we interview adolescents? - ansWe interview them alone to ask about sensitive topics like sexuality, drugs, and alcohol. We want to allow these patients privacy and we must treat them like an adult in order for them to feel comfortable and relaxed. We may ask them about school activities and hobbies to warm up the conversation. how do we speak in a therapeutic verbal way? - answe use a calm tone, we are relaxed, we introduce ourselves to build familiarity and trust, we ask what they would like to be called. We actively listen by making eye contact, having an open posture, leaning forward, being eye level with them, asking open ended questions. How do we use therapeutic communication for adults? - answe create a relaxing environment by closing a door so there is less noise, we turn up the temperature a bit, we also avoid rushing so they are able to tell their story and feel that they have been heard. We need to prioritize questions so we do not tire and stress the patient out. How do we use therapeutic communication when there is a language barrier? - ansWe should use a interpreter that can be found in the hospital. we should meet with them before patient interaction and cannot use them for the entire treatment of the patient. Nurses can use charts, diagrams, and simple sentences to communicate after the health assessment is completed. A nurse must understand that the patient's level of English speaking does not determine their intelligence level, and we must allow more time for the patient to respond because they think in their native language and translate in english. We must speak to the patient, not the interpreter, when communicating. How do we use therapeutic communication with a patient who is angry? - ansWe listen to the patients and search for themes of their anger. We do not become defensive and personalize the situation because it may be from a previous experience, not our own. These patients are triggered by the feeling they have lost control over the situation which leads to feelings of helplessness and anxiety. Nurses must acknowledge their feelings by saying: "I understand that you are upset about being asked this question, or, I am sorry you are upset" The nurse must validate the patients concern and attempt to connect their feelings with related events. Nurses are encouraged to call hospital security if the situation is seen to become physical. How do we use therapeutic communication with a patient who is crying? - ansWe address the situation instead of ignoring the patient and moving onto another topic. We can say "You look sad when talking about your prognosis, can I offer a tissue and address why you are upset?" We must show empathy, not sympathy and we can support the patient through silence. We do not give false reassurance and we must allow the patient to cry and show their grief rather than let them bottle it up. We must create a safe place for the patient to feel comfortable. How do we use therapeutic communication with infants and young children? - answe use a calm tone and are relaxed because they easily pick up on non verbal behaviours. We do not enter the room if we are anxious. We smile to show friendliness.
What are 3 distinguishing features between chronic and acute pain? - ansvital signs, protective, seek help and cure. What are 5 subtypes of pain? Give examples. - ansvisceral(cramps in the abdomen), somatic(patient trips and there is a sharp pain in the ankle), cutaneous(tenderness of the skin due to back pain), referred pain(pain in the neck, shoulder, and the arms), phantom pain(pain in a leg that is no longer there). What are some components collected in demographic data? - ansname, birthday, primary language, health care number, marital status, address, numbers, if the patient was accompanied, religious preference, allergies, etc. What are some components of the data we collect in a comprehensive health history? - ansdemographic data, chief concern, present illness, past health history, medications, family history, personal and social history, review of systems. What are some considerations we must make when assessing the pain of an older adult? - ans- They are the age group with the most pain, typically chronic. -They may under report pain because they think it is a normal process of aging and they do not want to be a bother. -The may be reluctant to take pain medication because they have a fear about addiction -Monitor if the pain medication is working because we know there are a variety of pain relievers that we can use to help them. what are some environmental factors we ask for a symptom analysis? - ansif the patient's surroundings can be related to the illness What are some questions to ask and assess in the growth and development of children? - ans-We look at the genetic background to see if the stature of the child matches that of the parents.
- We assess the child's motor skills to see if they are learning at the average pace of most other children. -We ensure their speech is appropriate for their age. -We assess if they have met their developmental milestones
- If we can detect an issue early on, there is a better success rate. What are the 4 main themes in personal and social history? - ansdevelopment, psychological, spiritual, sociocultural. What are the 4 one dimension pain scales? - ansa. verbal rating scale b. visual analogue scale c. numeric pain intensity scale d. faces pain rating scale what are the 4 phases in the interview process? - ans- preinteractive
-beginning -working -closing What are the 4 phases of the interview process? - ans1. pre-interaction
- Beginning phase
- Working phase
- Closing phase What are the 10 main attributes of a symptom? - anslocation, quality or nature, severity or quantity, timing, aggravating factors, alleviating factors, associated signs and symptoms, environmental factors, significance to the patient, and the patient perspective. What are the difference in vital signs in chronic and acute pain? - ansacute has increased vital signs and chronic has normal vital signs. what are the thoughts and ideas questions we ask when evaluating an illness? - answhat the patient believes the disease is based on their feelings and what other information they have provided What do we ask in a family history? - ans-family conditions, some are genetic such as heart disease, cancer and depression.
- Identify areas for health promotion -Can include a genogram What do we look for between the parents and child's interactions in an interview? - answe look to see who is answering the questions. We typically want the child to answer first and the parent to fill in any gaps. What do we observe in families with newborns? - ansWe observe how they interact with the baby, whether they encourage happy behaviour or if their behaviour is appropriate for the situation. We do not want a irritable patient because this is a reason for concern such as post partum. We also must keep in mind families are often sleep deprived and this can manifest anxiety and depression. what does a comprehensive assessment consist of? - ansphysical exam and health history of the entire body system. health promotion is included. these are needed for when someone is admitted into a hospital or before a surgery What does the history of present illness include? - anssymptom analysis. what does the nursing practice revolve around? - ansthe nurse-patient relationship what happens in the beginning phase of the interview process? - ansthe nurse will introduce themselves and state the purpose of the interview.
What is chronic pain? - anslasts 3 months and longer, can start as acute, builds gradually, not protective, can have no cause, changes how the body perceives the pain signal. ex: lower back pain. What is in the developmental variable of social history? - ansmarital status, children, significant life experiences, occupation, housing, and safety at work and home. What is in the psychological variable of social history? - ansmental processes, memory and cognition, self perception What is in the spiritual variable of social history? - ansreligion(jehova witness blood product example), Belief and purpose in life, death and dying, meaning giving to personal existence. what is included in a focused health history? - ansclinic based which typically focuses on 2 body systems such as a cough so you assess the respiratory system What is included in the sociocultural variables? - ansculture(indigenous gathering around a dying member), language(s) spoken, recreation and hobbies. What is neuropathic pain caused by? What are some examples? - ansa lesion or disease of the somatosensory nervous system. Some examples are herpes zoster, spinal cord injury, stroke, MS, etc. What is objective data? - ansmeasurable/verifiable data. This is collected when completing a physical exam. This part requires the application of nursing skills/techniques. What is pain? - anssubjective so every individual interprets it individually. Therefore pain is what the patient says it is. What is recurrent acute pain? - ansbrief painful episodes that recur at intervals: migraine headaches. Result of inflammation and has a protective role. What is subjective data? - anspersonal perceptions and opinions, these are symptoms. To acquire accurate answers, this requires skillful interviewing. what is the A in a smart goal? - ansIs it in our power to reach the goal? what is the aggravating and alleviating questions we ask for a symptom? - answhat makes it worse or better such as any medications, positions, activities, what time of the day, foods, etc. what is the difference between primary and secondary sources of information? - ansPrimary data is collected directly from the patient.
Secondary data is collected from health records or family members, etc. What is the fifth vital sign? - anspain What is the goal of a patient with chronic and acute pain? - anschronic patients want a diagnosis/cure, whereas acute patients seek help and relief. What is the gold standard for pain assessment? - anspatient self report of pain. What is the guiding principle of painful procedures and conditions? - ansif it is painful for an adult, it is also painful for a child. what is the location attribute of a symptom? - ansthe area of the body that is affected. this includes localized, generalized, it includes radiating and shooting pain and we ask the patient to point towards the affected area what is the mnemonic we use for remembering the elements of assessing a present symptom? - ansOLDCART: onset, location, duration, character, associated or aggravating/alleiviating factors, timing and severity. What is the primary reason patients access healthcare in Canada? - ansthey are experiencing pain. What is the purpose of reviewing systems? - ans1. to reveal the health concerns in relation to all of the body systems.
- Health promotion practices
- patient education
- use lay language at varying levels
- data should be clustered what is the quality or nature attribute of a symptom? - answhat the symptom is like such as if the pain is crushing, aching, gnawing, or stabbing. there are also things such as thick sputum, dry cough, purple spots, and tingling weakness. what is the severity or quantity of a symptom? - anshow bad the concern is. such as asking them to rate the pain on a scale. if there is sputum or blood we ask how much there is. what is the significance questions we ask when evaluating a symptom? - ansthe effects on the patient's daily life, behaviour and well being what is the timing of a symptom? - answhen the symptom or sign began. this is also known as onset. when the condition began, what the speed was as the duration of the symptom. we also ask if it has been continuous or if there are patterns of ocurrence
