Exam 1

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Health Assessment Flashcards on Exam 1, created by claire.m.sm on 23/02/2014.
claire.m.sm
Flashcards by claire.m.sm, updated more than 1 year ago
claire.m.sm
Created by claire.m.sm about 10 years ago
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Question Answer
Ataxia Loss of muscle control; drunken walk
2 pt discrimination ability to determine between 2 stimuli on the skib
Dysphagia trouble swallowing, gluglug
Dysphasia difficulty with motor speech
graphesthesia inability to recognize #/letter drawn on hand
stereognosis inability to recognize object placed in hand
tinnitus ringing in ear
vertigo room is spinning
Interview Process 1) Bio Date 2) Chief Complaint 3) HPI 4) Allergies and Meds 5) Past History 6) Family History 7) ROS 8) Functional asessment of ADL
For children what is their subjective data? The same as adult + Developmental Status Nutritional Status
Psychosocial Interview for Adolescents Home Education Eating Activities Drugs Sexuality Suicide and Depression Safety
ADPIE nursing process Assessment Diagnosis Planning Intervention Evaluation
Assessment Collection of data
Diagnosis Problem NANDA approved r/t Etiology AEB Sx/S ( could be at actual, at risk or wellness)
Nursing Care Plan 1) Identify most important problem 2)Goals (nurse's approach to problem) 3) Outcomes (pt centered) 4) Evaluate pt's response to care plan
BMI weight (kg)/ height (m^2)
BMI interpretation <18.5 underweight 18.5- 25 healthy 25-30 overweight 30-39.9 obesity >40 extreme obesity
MAP Diastolic + 1/3 PP PP= systolic-diastolic
Physical Examination Techniques 1) Inspect 2) Palpate 3)Percussion 4) Ausculate
Inspect Look
Palpate Touch feel for temperature or abnormalities
Percussion Tap to hear for abnormalities 1)Lungs- resonant 2) Spleen/liver-thud 3)
Ausculation Listen 1) Bell=low sounds 2) diaphragm= high sounds
Normal Blood Pressure 120/80
Pre hypertension 120-139 8-89
Hypertension 140-159 90-99
Stage 2 Hypertension Above 160 Above 100
Componnts of Mental Status Exam Appearance behavior Cognition Thought process
Appearance Dress Body movement Hygiene
Behavior Level of Conciousness Facial Expression Speech Mood and Affect
Cognition Orientation (person, place, time) Attention span Recent Memory Remote memory New learning Judgment Higher Intellectual Fx
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