Istinye University Overview

• İstinye University was established in 2015 by the 21st Century Anadolu Foundation.
• The university belongs to the MLPCare Group, which unites three hospital brands: Liv Hospital, Medical Park, and VM Medical Park.
• İstinye University aims to be among Turkey's and the world's top universities.
• It strives to contribute to new knowledge production through education and research performance.
• The university aims to contribute to society's well-being by translating scientific findings into practice.
• It aims to provide accessible healthcare services and a broad learning environment.
• Students are offered a learning and advancement environment covering technology and art.

General Survey

• The general survey begins with interviewing and obtaining the patient's history.
• Healthcare professionals observe patients, form initial impressions, and plan for objective data collection while collecting subjective data.
• Vital signs serve as key indicators of a patient's physiological condition and their response to their environment.
• Indicators of an acute situation include extreme anxiety, acute distress, pallor, cyanosis, and changes in mental status.
• In acute situations, nursing interventions starts while continuting assessment.
• In acute situations, vital signs are obtained and help is requested.
• A rapid response team may be called if the nurse senses something is wrong.
• Conditions that may warrant a rapid response team include:
  • Respirations less than 10 or greater than 32 breaths/min
  • Increased breathing effort
  • Oxygen saturation less than 92%
  • Pulse less than 55 or greater than 120 beats/min
  • Systolic blood pressure less than 100 or greater than 170
  • Temperature less than 35°C or greater than 39.5°C
  • New onset of chest pain
  • Agitation or restlessness
• Equipment that is needed for objective data collection include:
  • Scale
  • Tape measure (for infants)
  • Height bar
  • Stethoscope
  • Pulse oximeter
  • Watch with a second hand
  • Thermometer
• The general survey is the initial part of the assessment.
• Mental notes on the patient's behavior, appearance, and mobility create a global impression.
• Physical appearance includes overall appearance, hygiene, dress, skin color, and body structure and development.
• Mobility includes posture and gait and range of motion.
• Behavior includes facial expressions, level of consciousness, and speech.

Physical Appearance

• Note whether the patient appears their stated age, if their face and body are symmetrical, and any deformities, observing if they are well, ill, or in distress.
• Facial features, movements, and body should be symmetrical.
• Assess appropriateness of clothing to age, gender, culture, and weather, and if clothing is clean.
• Checks for breath/body odors, and the cleanliness/condition of skin, nails, and hair.
• Skin tones, symmetry, lesions, variations in pigmentation, and hair distribution should be observed.
• Physical and sexual development should be consistent with the stated age, noting features such as obesity or joint abnormalities.

Behavior

• Assess the face for symmetry, noting expressions.
• Assess symmetry of movements and the appropriateness of eye contact.
• Check if awake, alert, oriented to person, place, time, and assess agitation, lethargy, or inattentiveness.
• Assess speech pattern, clarity, word appropriateness, vocabulary, fluency, and need for interpreter.

Mobility

• Note how the patient sits and stands, and if the body is straight and aligned.
• Posture should be upright while sitting, with the limbs and trunk proportional to body height.
• The patient should stand erect with no signs of discomfort, with arms relaxed.
• Assess if the patient can move all limbs equally and if there are any limitations.
• Observe coordination, tremors, tics, affected body parts, and use of assistive devices during ambulation.
• Gait should be steady, balanced, smooth, purposeful, effortless, and symmetrical.

Vital Signs

• Vital signs reflect health status, cardiopulmonary function, and overall body function.
• The purpose of checking vital signs are to:
  • Establish a baseline
  • Monitor a patient's condition
  • Evaluate responses to treatment
  • Identify problems
  • Monitor risks
  • Monitor for alterations in health
• Seven key vital signs include: temperature, pulse, respiration, oxygen saturation, blood pressure, and pain.

Temperature

• Oral temperature normal range is 35.8°C to 37.3°C.
• Axillary temperature is approximately 1°C lower than oral.
• Tympanic temperature is approximately equal to oral.
• Temporal temperature is approximately equal to oral.
• Rectal temperature is approximately 1°C warmer than oral.

Pulse

• Heart contraction causes blood to flow forward, creating a pressure wave or pulse.
• A normal adult heart rate is 60 to 100 beats/min (bpm).
• The normal apical pulse is 60 to 100 beats/min and regular.

Respiration

• Breathing supplies oxygen and eliminates carbon dioxide.
• Inspiration (breathing in) and expiration (breathing out) should be discreetly observed.
• Breaths should be counted for 30 seconds and multiplied by two to get breaths per minute.
• Normal respiratory rate in adults in 12 to 20 breaths/min and regular.

Oxygen Saturation

• Pulse oximetry is a noninvasive technique to measure oxygen saturation.
• Oximetry measures the percentage to which hemoglobin is filled with oxygen, and is obtained from arterial blood.
• Pulse oximetry does not replace arterial blood gas measurements.
• Measurement is performed by placing a pulse oximeter on the patient's finger.
• Normal pulse oximetry is SpO2 of 95% to 100.

Blood Pressure

• Blood pressure (BP) is the force exerted by blood flow against arterial walls, which changes during contraction and relaxation of the heart.
• Systolic blood pressure is the maximum pressure performed on the arterial walls from contraction of the left ventricle.
• Diastolic blood pressure is the lowest pressure when the left ventricle relaxes between beats.
• Blood pressure in adults is categorized as:
  • Hypotension: <90 systolic / <60 diastolic
  • Normal: <120 systolic and <80 diastolic
  • Prehypertension: 120-139 systolic or 80-90 diastolic
  • Stage 1 hypertension: 140-159 systolic or 90-99 diastolic
  • Stage 2 hypertension: >160 systolic or >100 diastolic

Pain

• Pain is the fifth vital sign.
• The location, duration, severity, quality and alleviating/aggravating factors should be assessed.
• The numeric pain intensity scale ranked from 0 (no pain) to 10 (worst possible pain) is an indicator of pain severity.
• The higher the number selected, the more severe the pain.
• Questions to assess pain include:
  • Where is the pain?
  • When did you first become aware of the pain?
  • How long have you had the pain?
  • How much pain do you have on a 0 to 10 scale?
  • Is the pain worse or better at different times of the day?
  • Does current pain medication decrease the intensity?
  • What does your pain feel like? Describe the pain.
  • What makes the pain better/worse?
  • What have you used to manage the pain?
  • Does applying heat make pain better or worse?
  • Does a cold pack help?
  • Does activity increase the pain?
  • Does sitting make the pain better?