NUR 2180 Physical Assessment Module 1
- Subjective Information
Answer
What the client tells you
- Objective Information
Answer
What you measure or observe
- Open Ended Questions
Answer
Allows for the collection for more information for the client to elaborate on their symptoms or concerns.
- Closed Ended Questions
Answer
Allows for a yes or no answer only
- Genogram
Answer
Method of visually portraying family relationships and medical history to see trends 1 / 3
- Therapeutic Communication
Answer
a way to communicate with patients and staff while respecting values
- Databases
Answer
helps us assess, track, see labs and notes, and give medications. allows nurses to make clinical judgments and be organized
- Cultural Competency
Answer
respecting all areas of culture and respecting values of patients specific to culture
- Steps of the Nursing Process
Answer
Assessment Diagnosis
Outcome Identification Planning Implementation Evaluation
- Assessment
Answer
Collecting data from medical record, health history, physical exam, functional assessment, risk assessment while using evidence based practice
- Diagnosis 2 / 3
Answer
Compare clinical findings with normal and abnormal variations and developmental events.interpret data and create hypothesis and nursing diagnosis
- Outcome Identification
Answer
Identify expected outcomes, individualize to the per- son, culturally appropriate, realistic and measurable, include a timeline
- Planning
Answer
Establish priorities, develop outcomes, set timelines for outcomes, identify interventions, integrate evidence based practice
- Implementation
Answer
Must be done in a safe and timely manner using evidence based practice. Coordinate care and collaborate with other while giving treatment.
- Evaluation
Answer
Progress towards outcomes. Must be systemic and ongoing. Can be revised and must include patient and family.
- Novice Nurse
- / 3