Module 1 Introduction to Adult Health Assessment Student Notes PDF

Module 1: Introduction to Adult Health Assessment Objective Discuss the use of the nursing process in clinical judgement Notes “ADPIE” From Information/database, make a clinical judgement about individual's health state or response to actual health problems or risk factors and life processes. • •...

Module 1: Introduction to Adult Health Assessment Objective Discuss the use of the nursing process in clinical judgement Notes “ADPIE” From Information/database, make a clinical judgement about individual's health state or response to actual health problems or risk factors and life processes. • • • • • • • • • • • Identify assumptions Identify an organized and comprehensive approach to assessment. Validate or check the accuracy and reliability of data. Distinguish normal from abnormal when signs and symptoms are identified. Make inferences or hypotheses. Cluster related cues, which helps you see relationships among the data. Distinguish relevant from irrelevant. Recognize inconsistencies. Identify patterns. Identify missing information, gaps in data, or a need for more data to make a diagnosis. Promote health by identifying priorities with the patient, assessing risk factors, and considering a patient's social context. • Diagnose actual and potential (risk) problems from the assessment data. • Set priorities when a patient has more than one health or illness issue occurring concurrently (see next objective) Distinguish o First-level priority problems - emergencies, life-threatening, and immediate, such as first-level, establishing an airway or supporting breathing. second-level, o Second-level priority problems- next in urgency: those necessitating your prompt and thirdintervention to forestall further deterioration, such as mental status change, acute pain, acute level priority urinary elimination problems, untreated medical problems, abnormal laboratory values, risks problems of infection, or risk to safety or security. o Third-level priority problems those that are important to the patient's health but can be addressed after more urgent health problems are addressed. o Collaborative problems are those in which the approach to treatment involves multiple disciplines, and nurses often have the primary responsibility to diagnose the onset and monitor the changes in status. Pg. 4 (e-text) Differentiate “A medical diagnosis deals with disease or medical condition. A nursing diagnosis deals with human medical response to actual or potential health problems and life processes. For example, a medical diagnosis with diagnosis of Cerebrovascular Attack (CVA or Stroke) provides information about the patient’s nursing pathology. The complimentary nursing diagnoses of Impaired verbal communication, risk for falls, diagnosis interrupted family processes and powerlessness provide a more holistic understanding of the impact of that stroke on this particular patient and his family – they also direct nursing interventions to obtain patient-specific outcomes” http://nanda.host4kb.com/article/AA-00266/0/What-is-thedifference-between-a-medical-diagnosis-and-a-nursing-diagnosis-.html Discuss the use of a relational approach to nursing practice NOT ABOUT RELATIONSHIPS. Think reflectivity. • A relational approach in nursing practice accounts for the fact that health, illness, and the meanings they hold for a person are shaped by the person's social, cultural, family, historical, and geographical contexts, as well as the person's gender, age, ability, and other individual contexts. • Relational approaches focus nurses' attention on what is significant to people in the context of their everyday lives and how capacities and socioenvironmental limitations shape people's choices. One of the central skills of relational practice is reflectivity, a process of continually examining how you view and respond to patients on the basis of your own assumptions, cultural and social orientation, past experiences, and so on. • Approaching nursing practice relationally promotes (a) understanding across differences rather than defensiveness and (b) responsiveness rather than a sense of frustration or powerlessness. • Pg. 7 (etext) Describe the “the application of knowledge, skills, attitudes or personal attributes required by nurses to basic maximize respectful relationships with diverse populations of clients and co-workers.” The CNA also characteristics recognizes “that cultural issues are intertwined with socioeconomic and political issues” and “is of culture and committed to social justice as central to the social mandate of nursing.” the steps to cultural Cant develop competence through simple cross-culture training, several develop areas: competence 1. Your own personal ethnocultural and social background 2. The culture of nursing and related professions 3. The culture of the health care system 4. The significance of social, economic, and cultural contexts 5. Your ability to critically examine your assumptions about each of these areas Pg. 32 (e-text) Explain the concept of ethnicity Discuss Indigenous people’s history and its impact on the health status of this population • Ethnicity is also not synonymous with culture. • Ethnicity is a complex concept that can encompass multiple different aspects such as one's country of origin or ancestry, identity, and family history, languages spoken, and, in some cases, religious identity. However, how individuals identify their ethnicity often changes as a result of new immigration flows and the changing nature of identity politics and nationalism. Pg. 29 (e-text) Indigenous Peoples of Canada: 3.8% of population First Nations Métis Inuit Policies Affecting Indigenous Peoples in Canada  Indian Act  Reserves  Residential schools  Geography  Inequities in health status Reserves • 44.2% live on-reserve. More are moving to major cities for work. • Access to health care can be hard, policies have contributed to lack of employment, education, housing, high levels of poverty. Residential Schools • indoctrination into dominant culture. • Last school closed in 1996. • Discuss effect on their culture now. Health status continues to be behind the overall Canadian standard in almost every measure. • (P. 36) Truth and Reconciliation – Report has 94 action items. • #5 calls for health care to recognize aboriginal healing practices where requested. Watch the following short film titled : Canada's Dark Secret | Featured Documentary https://youtu.be/peLd_jtMdrc 47 min long Consider the following as you watch this film: What are some of the negative lasting results of the residential school system for Indigenous peoples in Canada? Identify health disparities that exist for older Indigenous Canadians Identify health disparities commonly faced by members of a visible minority Discuss health, social, and gender inequities and their impact on health status Discuss the influence of religion and spirituality on health and illness perception Completing the Circle: End of Life Care with Aboriginal Families 20min https://www.youtube.com/watch?v=XbUGMIKId0c In this video, Saskatchewan Elders share their experiences and beliefs about death and dying in the Aboriginal World. They send messages to health care providers that help to create understanding of the end of life health care needs of Aboriginal families when a family or community member is dying. We welcome you into the circle to join the journey through the end of life health experience. Follow-up video: https://www.youtube.com/watch?v=LX_RYoQq1yk Pg. 34 (e-text)  Health inequality ➢ Differences, variations, and disparities in the health status of individuals and groups  Health inequity ➢ Inequalities in health that are unnecessary and avoidable and differences that are considered unfair and unjust  Poverty ➢ Relative poverty: the situation in which individuals are unable to carry out or participate in the activities expected in a wealthy developed nation  Lone-mother families ➢ Main causes of female poverty: labour market inequities, family circumstances (marriage breakdown, lone parenting), cutting of welfare payments, and wage disparities Thoughts will vary significantly here. It is important to be open and reflect on your own thoughts/beliefs. Your textbook has this: Spirituality and Health The significance of spirituality in people's health and healing has long been recognized. Although spirituality commonly tends to be perceived as an offshoot of religion, it is important to distinguish between religion and spirituality. Spirituality has always been more central to the human experience than religion. Religions are often established by formal institutional structures, rituals, and beliefs, whereas spirituality may refer more generally to the search for meaning. Both religion and spirituality can play a significant role in the ways people deal with health and illness. As a health care provider, you do not need to know the specifics of various religious and spiritual traditions. However, it is important to convey openness, interest, and acceptance. First, you must check your own assumptions and biases. If you call places of worship “churches” in your work with patients, you are conveying a Christian bias that may discourage communication by patients who call their places of worship by other names (e.g., “temples,” “mosques,” or “synagogues”). Second, you need to avoid making assumptions about particular people. A person may be part of an ethnocultural group but not part of an associated religion. During the health assessment, conveying openness and inviting patients to identify what is important to them is most effective in eliciting data. For example, you might ask, “Do you have any religious beliefs or practices that you would like me to know about in relation to your health?” Describe the use of inspection as a physical examination technique Describe the use of palpation as a physical examination technique Differentiate between light and deep palpation      Concentrated watching, close/careful scrutiny Compare patient’s right and left sides (symmetrical) Use good lighting Ensure adequate patient exposure Will include instruments for specific body systems: ➢ Otoscope ➢ Ophthalmoscope ➢ Specula: vaginal, nasal ➢ Penlight  Using sense of touch can confirm points noted during inspection  Slow and systematic: if patient stiffens, warm hands, (identify) palpate tender areas last  Light versus deep palpation (Start with Light) → sense of touch is hindered with deeper pressure. Avoid deep palpation which could result in injury or pain  Intermittent pressure → use vs continuous Characteristics:  Texture  Temperature  Moisture  Organ location and size  Swelling  Vibration or pulsation  Rigidity or spasticity  Crepitation  Presence of lumps or masses  Presence of tenderness or pain Techniques:  Use particular parts of the hand: ➢ Fingertips—best for fine tactile discrimination, for example, of skin texture, swelling, pulsation, and determining presence of lumps ➢ A grasping action of the fingers and thumb—to detect the position, shape, and consistency of an organ or mass ➢ The dorsa (backs) of hands and fingers—best for determining temperature because the skin is thinner here than on the palms ➢ Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—best for detecting vibration Pg. 141 Note* Deep palpation is not within LPN scope of practice at this time. Be mindful of this during palpation assessments. Start with light palpation, using the pads of your fingertips to detect surface characteristics and accustom the patient to being touched. Then perform deeper palpation, perhaps by helping the patient use relaxation techniques such as imagery or deep breathing. Your sense of touch becomes blunted with heavy or continuous pressure. When deep palpation is needed (as for abdominal contents), intermittent pressure is better than one long, continuous palpation. Avoid deep palpation in situations in which it could cause internal injury or pain. Also avoid “digging in” with the ends of your fingers; it will cause pain or discomfort to your patient and may result in increased guarding, by the patient, of the affected areas. Pg. 141 (e-text)