Sub vs Obj
Assessments
Grab Bag
Definitions
Age
100
Tachycardia 165BPM
Objective
100
A problem centered database is used for
a limited or short-term problem. It is smaller in scope
and more targeted than the complete database
Focused
100
Delirium vs Dementia
Acute confusional change or loss of consciousness - can accompany acute illness ( PNA, ETOH/Drug intoxication)
Dementia is gradual/progressive process causing decreased cognitive function
100
ADPIE
ADPIE is an acronym used in nursing to remember the five steps of the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation. It's a systematic, organized approach nurses use to provide individualized patient care.
100
Elderly
- May require additional time to change positions
-Consider cognitive/hearing/vison functions
-May want same gender provider
200
" I have been vomiting for 6 days"
Subjective
200
A nurse is performing percussion while
examining a client. Which body organ would the
examiner expect to hear tympany?
Tympany is heard
over the gastric bubble in the
stomach.
Dull sounds are heard over
organs such as the liver,
pancreas and kidneys.
200
the single-most important component to reduce
infection transmission
Hand Hygiene
200
PQRST
PQRST is a way to assess pain.
P= What makes your pain worse? What is the place?
Q= Can you describe the pain. Is it dull sharp, throbbing, achy, ?
R= Does it radiate or go to other parts of your body. Point to area of pain. Does anything relieve the pain?
S= What is your pain scale 0-10. Also setting= does pain occur in specific place or doing something.
T= Has pain changed over time?
200
Toddlers/ Children
-Acceptable to sit in parents lap
-Show examples on yourself or toy
-Include in care (Yes/No questions)
300
" My son refuses to take a bottle, I am worried he will become dehydrated"
Subjective
300
A patient is brought by ambulance to the emergency
department with multiple traumas received in an
automobile accident. He is alert and cooperative, but his injuries are quite severe. How would the nurse proceed with data collection?
What type of assessment should be used?
The emergency data base calls for a rapid collection of the data base, often concurrently compiled with life- saving measures.
300
An otoscope is used to visually inspect the ear canal and eardrum, while an ophthalmoscope is used to examine the internal structures of the eye, including the retina and optic nerve
Allows examination of the retina, optic nerve, and blood vessels within the eye.
300
What is a healthy BMI
19-25
300
Teens
-May not be forthcoming with parents in room
- Sexuality/ Smoking/ Drinking/ Peer pressure
400
+3 Edema noted to BLLE
Objective
400
These patients require prompt intervention to prevent further deterioration and may include mental status change, acute pain, or abnormal laboratory values
Second-level priority problems
400
What are SDOH
Economic stability
Education
Healthcare Literacy
Social and community context
400
IPPA
• Head to Toe order = IPPA
•Inspection: concentrated watching (what am I looking at?)
• Palpation: sense of touch (ex. checking pulse)
•Percussion: assessing underlying structures
•Auscultation: listening to sounds produced by the body