HESI Review- Health Assessment
Past Health questions
Childhood Illnesses, Accidents or Injuries, Serious or Chronic Illnesses, Hospitalizations, Operations, Obstetric History, Immunizations, Last examination date, Allergies, Current Medications
Nonverbal communication
Communication using body movements, gestures, and facial expressions rather than speech
Complete database
Complete health history and physical examination. It describes current and past health state and forms a baseline against which all future changes can be measured. Yields first diagnoses
What is the yin/yang theory of health?
Health exists when all aspects of the person are in perfect balance.
Which theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage?
Heritage consistency
Phases of the Interview
Introduction, working phase, and conclusion
Purpose of the assessment
Is to make a judgement or diagnosis
Folk Healer
Lay healer in the person's culture apart from the biomedical/ scientific healthcare system.
Internal Factors of the interview
Liking others, empathy, and the ability to listen
Interpretation
Links events, makes associations, or implies cause
8 Critical characteristics of a symptom
Location, Quality, Severity, Timing, Setting, Relieving Factors, Associated Factors, Patients Perception
Biographic data
Name, address, phone number, age, birthdate, gender, marital status, race, ethic origin, occupation, primary language
Interview with infant
Nonverbal communication is the primary method of communicating with infants. They respond best to firm, gentle handling and a quiet, calm voice.
Sign
Objective abnormality that you as an examiiner could detect on physical examination or in laboratory reports
What symptom is greatly influenced by a person's cultural heritage?
Pain. Pain is a very private, subjective experience that is greatly influenced by cultural heritage. Expectations, manifestations, and management of pain are all embedded in a cultural context.
Nonverbal skills
Physical appearance, Posture, Gestures, Facial Expressions, Eye Contact, Voice, Touch
Vocal cues
Pitch, tone, quality, loudness, intensity, rate & rhythm, sounds such as groans, laughs, coughs, "um", "uh"
Past Health for children (extra)
Prenatal status, Labor and delivery, Postnatal status, are to be asked of the mother
Diagnostic reasoning
Process of analyzing health data and drawing conclusions to identify diagnoses.
Cultural Care Nursing
Professional health care that is culturally sensitive, appropriate, and competent.
What is a person's mood?
Prolonged display of a pt's feelings
10 traps of interviewing
Providing false assurance or reassurance, giving unwanted advice, using authority, using avoidance language, engaging in distancing, using professional jargon, using leading or biased questions, talking too much, interrupting, using "why" questions
(P)QRSTU
Provocative or palliative- what brings it on? what were you doing when you first noticed it? what makes it better or worse?
P(Q)RSTU
Quality or Quantity- How does it look, feel, sound? How intense/severe is it?
Emergency database
Rapid collection of the database, usually compiled concurrently with life-saving measures
Source of History
Record who furnishes the information, judge how reliable the informant seems and how willing, note any special circumstances
PQ(R)STU
Region or radiation- Where is it? Does it spread anywhere?
Reflection
Response echos patient's words, is repeating part of what the person says
Confrontation
Response in which examiner gives honest feedback about what he or she has seen or felt after observing a certain patient action, feeling, or statement
Facilitation
Response that encourages patient to say more, continue with story, shows person you are interested and will listen further
Functional Assessment
Self esteem, Self concept, Activity/exercise, Sleep/rest, Nutrition/elimination, Interpersonal relationships/resources, Spiritual resources, Coping and stress management, Personal Habits, Alcohol, Illicit or street drugs, Environment/hazards, Intimate partner violence, Occupational health
PQR(S)TU
Severity scale- How bad is it (on a scale of 1 to 10)? Is it getting better, worse, or staying the same?
When interviewing a person currently under the influence of alcohol or illicit drugs ask what?
Simple and direct questions
Symptom
Subjective sensation that the person feels from the disorder
What is affect?
Temporary expression of feelings or state of mind
Ethnocentrism
Tendency to view your own way of life as the most desirable, acceptable, or best and to act superior to another culture's lifestyle.
Who has a developmental task of finding the meaning of life and the purpose of his or her own existence, and adjusting to the inevitability of death?
The aging adult
Health/Illness
The balance/imbalance of a person, both withing one's being (physical, mental, and or spiritual) and in the outside world, ( natural, communal, and/or metaphysical)
Religion
The belief in a divine or superhuman power or powers to be obeyed and worshiped as the creator(s) and ruler(s) of the universe; and a system of beliefs, practices, and ethnic values.
Working phase
The data-gathering phase, includes two question types: open and closed
Heritage Consistency
The degree to which a person's lifestyle reflects his or her traditional heritage, whether it is American Indian, European, Asian, African, or Hispanic.
While evaluating the health history, the nurse determines that the patient subscribes to the hot/cold theory of health. Which of the following will most likely describe this patient's view of wellness?
The humors must be balanced.The hot/cold theory of health is based on humoral theory; the treatment of disease is based on the balance of the humors.
Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand
The logic of the traditional belief systems
Socialization
The process of being raised within a culture and aquiring the characteristics of that group.
Avoidance language
The use of euphemisms to avoid reality or hide feelings - ex: saying someone "passed on" instead of "died"
First level priority problems
Those that are emergent, life threatening, and immediate(establishing and airway, breathing)
Third level priority problems
Those that are important to the patient's health but can be addressed after more urgent health problems are addressed. (Knowledge deficit, altered family processes, and low self esteem)
Second level priority problems
Those that are next in urgency requiring your prompt intervention to forestall further deterioration. (mental status change, acute pain, acute urinary elimination problem, untreated medical problems, abnormal lab test results
PQRS(T)U
Timing- Onset, exactly when did it first occur? Duration, How long did it last? Frequency, How often does it occur?
PQRST(U)
Understanding Patient's Perception of the problem- What do you think it means?
Engaging in distancing
Using impersonal speech to put space between a threat and the self by using "the" instead of "my" or "your"; blunt specific terms in preferable to defuse anxiety
Jargon
Using medical vocabulary with patient in an exclusionary and paternalistic way
Empathy
Viewing the world from the other person's inner frame of reference while remaining yourself; recognizing and accepting the other person's feelings without criticism
Holistic health
Views the mind, body, and spirit as interdependent and functioning as a whole within the enviroment
Five types of nonverbal behaviors that convey information about the person
Vocal cues (crying & moaning), action cues(posture facial expression), object cues (clothes), use of personal and territorial space, touch
Objective data
What the health professional observe by inspecting, percussing, palpating, and auscultating during the physical exam
Subjective data
What the person says about himself or herself during history taking
Explanation
You inform the patient, you share factual and objective information
Each culture has its own healers who usually
Cost less than traditional or biomedical providers.
What should be avoid in speaking with elders?
Elder speak, inappropriate plural pronouns, tag questions, shortened sentences, slow speech rate
External Factors of the interview
Ensure privacy, refuse interruptions, physical environment, dress, note taking, tape and video recording
Clarification
Examiner's response used when the patient's word choice is ambiguous or confusing
Verbal communication
Expressing ideas to others by using spoken words
How do we interview with hearing impaired individuals?
Face directly so mouth and face are visible, do not shout, speak slowly, use hand gestures
Respones-assisting the narrative
Facilitation, silence, reflection, empathy, clarification, confrontation, interpretation, explanation, summary
Summary
Final review of what the person has said, condenses the facts and presents a type of survey of how you percieve the health problem or need
Conclusion
Final statement of what you and the patient agree his or her health state to be. a summary or recap of what you have learned during the interview
What is top priority during drug consumption?
Finding out the time of the person's last drink or drug and how much
Focused or problem-centered database
For limited or short term problem. Collect "mini" database, smaller in scope, concerns mainly one problem, one cue complex, or one body system
What is delirium?
Acute confusional change or loss of consciousness and perceptual disturbance
Follow up database
Used in all settings to monitor progress on short-term or chronic health problems
Review of Systems
General overall health state, Skin, Hair, Head, Eyes, Ears, Nose and Sinuses, Mouth and throat, Neck, Breast, Axilla, Respiratory system, Cardiovascular, Peripheral vascular, Gastrointestinal, Urinary System, Male genitals, Female genitals, Sexual Health, Musculoskeletal system, Neurologic system, Hematologic system, Endocrine system
What is dementia?
Gradual progressive process, causing decreased cognitive function
Pedigree or genogram
Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least three generations, also highlights health issues and diseases of family members
Developmental History for children
Growth, Milestones, Current development (children 1-preschool)
Assessment
*Collect data -review of the clinical record -health history -physical examination -functional assessment -risk assessment -review of the literature *Use evidence-based assessment techniques *Document relevant data
Culture is
*Learned from birth through the process of language acquisition and socialization *shared by all members of the same cultural group *adapted to specific conditions related to environmental and technical factors and to the availability of natural resources * dynamic and ever changing
Interview with Preschooler
2-6 yr old is egocentric. Sees the world mostly from his or her own point of view. can have animistic thinking about unfamiliar objects. May imagine unfamiliar inanimate objects can come alive and have human characteristics
Interview with School-age child
A child 7-12 years can tolerate and understand others viewpoints. Is more objective and realistic. He or she wants to know functional aspects--how things work and why things are done.
Values
A desirable or undesirable state of affairs and a universal feature of all cultures.
Title VI of the Civil Rights Act of 1964
A federal law that mandates that when people with limited English proficiency (LEP) seek health care in health care settings such as hospitals, nursing homes, clinics, daycare, and mental health centers, service cannot be denied.
Spirituality is defined as
A personal effort to find meaning and purpose in life
Leading question
A question that implies that one answer would be better than another
Ad hoc
A relative or friend used as an interpreter
Cultural and Linguistic Competence
A set of congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations.
Ethnicity
A social group within the social system that claims to possess variable traits such as common geographical origin, migratory status, and religion.
When considering cultural competence, there are discrete areas that the nurse must develop knowledge of to understand the health care needs of others. These discrete areas include understanding of
A) the heritage of the health care system. B) the heritage of the nursing profession. C) the heritage of the patient. D) his or her own heritage. E) cultural and ethnic values.
Introduction
Address the patient using his or her surname. Introduce yourself and state your role in the agency. Give reason for the interview
Interview with adolescent
Adolescence begins with puberty which is a time of dramatic physiological change. Adolescents want to be adults but lack cognitive ability. Must consider attitude...needs to be one of respect. Adolescent needs to feel validated as a human being. Communication must be honest.
Silence
After open ended questions, communicates that the patient has time to think and organize what he or she wishes to say
ABC's
Airway, breathing, cardiac
The ability to listen
An internal factor that is essential for a successful interview. it is an active and demanding communication process and requires your complete attention. It is the route to understanding.
Open ended questions
Asks for narrative information, is unbiased, states the topic to be discussed but only in general terms, ex. Tell me how can I help you?
Closed or direct questions
Asks for specific information, usually illicit a short 1 or 2 word answer, limits the patient's answer, use to fill in details after open ended questions
Nursing process
Assessment, diagnosis, planning, implementation, evaluation
What is consciousness?
Being aware of one's own existence, feelings, and thoughts and being aware of the environment
Components of Health History
Biographic data, reason for seeking care, present health or history of present illness, past history, family history, review of systems, functional assessment or activities of daily living
Equal-status seating
Both you and the patient should be comfortably seated at eye level, about 4-5 feet apart. Avoid standing which communicates haste and superiority
Reason for seeking care
Brief, spontaneous statement in the person's own words that describes the reason for the visit
Action cues
body movements automatic reflexes posture, facial expression, gestures, mannerisms