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Flashcards in nurse assessment Deck (21)
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1
Q

look at patient obtain data organize document data

A

assessing

2
Q

analyze data, identify health problem give name for problem

A

diagnosing

3
Q

prioritize problems/ diagnoses select nursing interventions independent things you can do for yourself, goal setting for patient

A

planning

4
Q

put hands on patient what needs to be done supervise delegated care

A

implementing

5
Q

collect data outcome, compare data outcomes, see if implementation was successful

A

evaluating

6
Q

what is nurse assessment

A

physical most important head to toe, listen feeling, smelling.
mental, spiritual, economic, cultural status

7
Q

what are skills for nurse assessment

A

IPPA- inspection, palpation, percussion, auscultation

8
Q

seated position

A

sitting

9
Q

flat on back-lying position with legs extended

A

supine

10
Q

60 degree angle sitting with head up

A

fowlers

11
Q

30-40 degree angle sitting with head up

A

semi-fowlers

12
Q

laying on back with knees flex

A

dorsal recumbent

13
Q

legs open getting pap smear, legs in stirrup

A

lithotomy

14
Q

laying on side with top knee toward chest

A

sims

15
Q

lies on abdomen with head to the side

A

prone

16
Q

linear crack with sharp edges extending into dermis ex: cracks at corners of mouth hand athlete’s foot

A

fissure

17
Q

translucent, dry, paper like wrinkled skin, thinning or wasting of skin due to loss of collagen ex: striae, aged skin

A

atrophy

18
Q

rough thick hard epidermis ex: chronic dermatitis

A

lichenification

19
Q

deep irregular shape area of skin may bleed ex: pressure ulcers, stasis, ulcers chancres

A

ulcer

20
Q

elevated irregular darkened area of excess scar tissue ex: keloid from ear piercing or surgery

A

keloid

21
Q

Linear erosion ex: scratches some chemical burns

A

excoriation