Health assessment terms
Health assessment in nursing ppt
It can be difficult to keep up with the latest guidelines and standards. To ensure accuracy, count pulse for a full minute. For further information please see the Pain Assessment and Measurement clinical guideline Skin: Colour, turgor, lesions, bruising, wounds, pressure injuries. The depth of investigation and the frequency of the assessment vary with the condition and age of the client and the facility in which the assessment is performed. Tactile sensory functioning is assessed for the client's ability to have stereognosis, extinction, one point discrimination and two point discrimination. If there is a blockage, constriction or narrowing of your lung tubes, or fluid in your lungs, this can be heard by the examiner. Ocular apraxia: Ocular apraxia is the neurological deficit that occurs when the person is no longer able to rapidly move their eyes to observe a moving object. Plantar reflex: The plantar reflex is elicited when the person performing this assessment strokes the bottom of the foot and the client's toes curl down.
For more information see Engaging with and assessing the adolescent patient. In the adolescent patient it is important to consider completing psychosocial assessments as physical, emotional and social well-being are closely interlinked.
Optic ataxia: Optic ataxia is characterized with the client's inability to reach for and grab an object.
Pupil size, shape and reaction to light. Boston Diagnostic Aphasia Examination: The Boston Diagnostic Aphasia Examination is a standardized comprehensive assessment tool that assess and measures the client's degree of aphasia in terms of the client's perceptions, processing of these perceptions and responses to these perceptions while using problem solving and comprehension skills.
Focused Assessment A detailed nursing assessment of specific body system s relating to the presenting problem or other current concern s required.
Types of health assessment
Geographic agnosia: Geographic agnosia is the lack of ability of the client to recognize familiar counties, like Canada or Mexico, when viewing a world map. The four basic methods or techniques that are used for physical assessment are inspection, palpation, percussion and auscultation. Interventions to treat these problems are more long term, and the response to treatment is expected to take more time. Ocular apraxia: Ocular apraxia is the neurological deficit that occurs when the person is no longer able to rapidly move their eyes to observe a moving object. Biceps reflex: This reflex is assessed by placing the thumb on the biceps tendon while the person is in a sitting position and then tapping the thumb with the Taylor hammer. Patellar tendon reflex: This reflex, often referred to as the knee jerk reflex, is elicited by tapping the patellar area with the Taylor hammer. For infants, an assessment is made of their cry and vocalization. Patient assessment commences with assessing the general appearance of the patient. During a physical examination, testing reflexes helps to assess the status of the central nervous system, this indicates whether the pathway from the spinal cord to the area stimulated and back is intact. Diagnosis often includes laboratory studies, radiology studies to look at certain organs, and the physical exam itself. For example, the pediatric client will require that the nurse use a neonatal, infant or pediatric blood pressure cuff, respectively, and techniques such as the assessment of the vital signs which vary among the age groups.
Note for Cheyne Stokes, rapid, irregular, clustered, gasping or ataxic breathing. Ongoing assessment of vital signs are completed as indicated for your patient. Percussion This is when the examiner uses their hands to "tap" on an area of your body.
The general survey includes the patient's weight, height, body build, posture, gait, obvious signs of distress, level of hygiene and grooming, skin integrity, vital signs, oxygen saturation, and the patient's actual age compared and contrasted to the age that the patient actually appears like.
Pupils will normally dilate as the light is withdrawn and they will normally constrict when the light is brought close to the pupils.
For example, in the emergency room the focus is chief complaint and how to help that person related to the perceived problem.
Comprehensive health assessment nursing
The "tapping" produces different sounds. Some of the clues are based on the spoken information that you provide, or they may be based on physical examination findings. For example, does the patient appear to be older than their actual age? In healthcare, the assessment's focus is biopsychosocial but the intensity of focus may vary by the type of healthcare practitioner. Sucking reflex: The sucking reflex is demonstrated when the infant performs sucking actions when anything like a nipple or a finger tip comes in contact with the infant's mouth. For your reference, here is a summary of what has and has not changed for the edition. The client is prompted to report whether or not they feel the blunt item as the nurse touches the area. For example, the nurse may touch both knees and then ask the client if they felt one or two touches while the client has their eyes closed. Common areas that are inspected may include: Your skin - to look for bruising, cuts, moles or lumps Your face and eyes - to see if they are even and "normal" Your neck veins - to see if these are bulging, distended swollen Your chest and abdomen stomach area - to see if there are any masses, or bulges Your legs - to see if there are any swelling Your muscles- to check for good muscle tone Your elbows and joints - check for swelling and inflammation, if any deformities are present Palpation This is when the examiner uses their hands to feel for abnormalities during a health assessment.
The Lungs: Your doctor or healthcare provider may listen to your lungs with their stethoscope, anywhere on your back posterioror on the front of your chest wall anterior.
Blinking reflex: This reflex is elicited when the eyes are touched or they are stimulated a sudden bright light or an irritant.
Less than 6 months use digital thermometer per axilla.
based on 76 review