Istinye University & Patient Surveys

Istinye University Overview

• Istinye University was established in 2015 by the 21st Century Anatolian Foundation as a continuation of the MLPCare Group's 25-year knowledge and experience, uniting three separate hospital brands: Liv Hospital, Medical Park, and VM Medical Park.
• The university aims to be among Turkey's and the world's distinguished universities by empowering students and contributing to the production of new knowledge through education and research.
• Istinye University aims to broaden the boundaries of science, implement scientific findings for the welfare of society, and provide accessible health services, while offering a learning environment encompassing technology and art.

General Survey

• The general survey starts during the patient interview and history taking.
• Healthcare professionals observe patients while collecting subjective data to form initial impressions and plan for objective data collection.
• Vital signs serve as key indicators of a patient's physiological status and response to their environment.

Acute Assessment Indicators

• Indicators include extreme anxiety, acute distress, pallor, cyanosis, and changes in mental status.
• The nurse should begin interventions while continuing assessment, obtain all vital signs, and request help.
• A rapid response team is called if the nurse senses something is wrong; rapid breathing less than 10 breaths/min or greater than 32 breaths/min, increased breath effort, oxygen saturation less than 92%
• Pulse less than 55 beats/min or greater than 120 beats/min, systolic BP 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 require rapid response

Objective Data Collection Equipment

• Essential equipment includes a scale, tape measure (for infants), height bar, stethoscope, pulse oximeter, watch with a second hand, and thermometer.

Key Aspects of General Survey

• The general survey is the initial part of the assessment and includes mental notes on overall behavior, physical appearance, and mobility to form a global impression.

Physical Appearance Observations

• Note if the patient appears to be the stated age and if the face and body are symmetrical, also check obvious deformities.
• Facial features, movements, and body should be symmetrical.
• Observe clothes, hair, nails, and skin, and assess appropriateness for age, gender, culture, and weather.
• Hygiene should be noted including breath or body odors.

Skin Color Considerations

• Observe skin tones, symmetry, redness, pallor, cyanosis, lesions, pigmentation variations, hair amount, texture, quality, and distribution.
• Skin color should be even with pigmentation appropriate to genetic background, without obvious lesions or color variations, and hair should be thick, smooth, and evenly distributed.

Body Structure Evaluation

• Check physical and sexual development consistency with stated age, obesity, height, symmetry, fingertips, and joint abnormalities.
• Physical and sexual development should be appropriate for age, culture, and gender, with no joint abnormalities.

Behavioural Assessment

• Assess facial symmetry, note expressions at rest and during speech, noting symmetrical movements, and appropriate eye contact.
• Facial expression should be relaxed, symmetrical, and appropriate for circumstances with maintained eye contact.

Level of Consciousness Assessment

• Assess if the patient can state name, location, date, month, season, and time, and if they are awake, alert, and oriented.
• Note any agitation, lethargy, or inattentiveness.
• The patient should be awake, alert, oriented to person, place, and time, and responsive to questions.

Speech Evaluation

• Listen to speech patterns, speed, clarity, appropriateness, vocabulary, and sentence structure.
• Assess language fluency and the need for an interpreter.
• Patients should respond quickly and easily, with appropriate volume, pitch, rate, and word choice, and speech should be clear, articulate, and fluent.

Posture Assessment

• Note how the patient sits and stands, ensuring they sit upright and that the body is straight and aligned when standing.
• Posture should be upright while sitting, with limbs and trunk proportional to body height, and the patient should stand erect without discomfort, arms relaxed.

Range of Motion Assessment

• The patient moves freely in the environment.
• Note if the patient moves all limbs equally without limitations.

Ambulatory Gait Observation

• The patient must be ambulatory and movements must be observed to see if they are coordinated
• Note any tremors or tics, check body parts that do not move and assistive devices.
• Gait should be steady, balanced, with even heel-to-toe foot placement and smooth, purposeful, effortless, and symmetrical movements.

Anthropometric Measurements

• Height and weight are key assessments.
• Body mass index is another key assessment.

Vital Signs Overview

• Vital signs indicate health status, cardiopulmonary function, body function
• The goal is to establish a baseline, monitor a condition, evaluate a treatment, identify problems, and monitor for changes.

Temperature Measurement and Normal Ranges

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

Pulse Characteristics

• The heart's contraction causes forward blood flow, creating a pressure wave known as a pulse.
• A normal adult heart rate is between 60 and 100 beats per minute
• Apical pulse is 60 to 100 beats/min and regular

Respiration

• Breathing supplies oxygen, eliminates carbon dioxide, should be 12 to 20 breaths/min and regular
• Inspiration and expiration must be observed individually.
• Breaths can be observed from 30 seconds and multiplied by two for a total count.

Oxygen Saturation Measurement

• Pulse oximetry is used to measure oxygen saturation.
• Pulse oximetry provides the percentage of hemoglobin filled with oxygen in arterial blood.
• Readings are obtained from a finger; a pulse oximetry of 95% to 100% is necessary for healthy people.
• Oximetry readings do not replace arterial blood.

Blood Pressure Dynamics

• Blood pressure measures the force of blood against artery walls, changing during the phases of heart contraction and relaxation.
• Systolic pressure is the maximum pressure exerted on arteries during contraction from the left ventricle.
• Diastolic pressure is the lowest pressure measured when the left ventricle relaxes between beats.

Blood Pressure Values for Adults

• Hypotension is less than 90 systolic, less than 60 diastolic
• Normal is less than 120 systolic, less than 80 diastolic
• Prehypertension is 120-139 systolic, 80-90 diastolic
• Stage 1 hypertension is 140-159 systolic, 90-99 diastolic
• Stage 2 hypertension is greater than 160 systolic, greater than 100 diastolic

Important Pain Considerations

• Measuring pain is the fifth vital sign and includes assessment of location, duration, severity, quality, and alleviating/aggravating factors
• Pain can indicate a health problem
• It can be recorded using a scale of zero to ten with zero being no pain and ten being the worst; indicate pain severity with this method
• The number selected indicates pain severity; the higher the number the more pain

Questions for Symptom Assessment

• "Where is the pain? Point to the painful area, what area hurts the most?", "When did you first become aware of the pain? How long have you had it?"
• "How much pain do you have on 0-10 scale?","Is the pain worse or better?", "Does current pain medication work?"

Alleviating Aggravating Factors related to Pain Symptoms

• The goal is to determine factors that can help relieve or improve the patient's experience of pain
• "What does your pain feel like?", "does applying heat or a cold pack help?"
• "What have you used to manage it?", "Does what makes the pain feel worse or better?", "Does sitting work?"