NRSG139 Lecture Notes - Lecture 7: Vital Signs, Shortness Of Breath, Sexual Dysfunction
Assumed understandings on assessment
Techniques
● Health interview - emergency, focused, comprehensive
● Physical assessment - IPPA
Accounting for:
● Lifespan variations
● Cultural variations
● Individual beliefs on health, illness, healthy ageing…
Maintaining a safe environment
● Model of living
○ Maintaining a safe environment in health and illness...
○ Dependence/independence in the activity of...
○ Factors influencing maintenance of…
● Model of nursing
○ Nursing care of individuals with health problems affecting their ability to…
○ Healthcare environment is in itself a hazard
Assessing for safety
● Presence of current injuries
● Risk of future injuries
● Presence of known medical issues
○ Eg stroke R) side hemiplegia
○ Eg peripheral neuropathy
● Environment
○ Current (likely healthcare)
○ Home
○ Workplace
Communicating
● Model of living
○ What you say, the words you choose, tone of voice
○ Facial expressions and body language
○ What you write, vocabulary you use
● Model of nursing
○ Nursing care of people with conditions affecting their ability to communicate
effectively and appropriately
○ Recognising a power imbalance exists which will often affect communication
with you and the health system
Assessing communication
● Verbal - speech
● Hearing capacity
● Non-verbal
● Touch and visual cues
● Vision and hearing assessment
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● Language assessment
● Translators where needed
● Literacy/health literacy
● Consider psychological health
Breathing
● Model of living
○ How do we breathe?
■ Inspiration
■ Expiration
■ No abnormal effort
■ Normal gas exchange
○ Breathing activity in health and illness across the lifespan
○ Dependence/independence in relation to…
○ Factors which influence the activity of…
● Model of nursing
○ Nursing care of individuals with health problems which affect their activity of
breathing
Assessing breathing
● Vital signs
○ Respiratory rate
○ Respiratory depth
○ Oxygen saturations
● Peripheral oxygenation (inspection)
● Respiratory assessment
○ Auscultation
○ Inspection symmetry and work of breath
○ Dyspnea, cough, sputum
● Exercise tolerance
● Health history
○ Inhaled toxins
○ Respiratory illness e.g emphysema, asthma
○ Travel history e.g exposure to TB
○ Occupational exposure
Eating and drinking
● Model of living
○ Eating and drinking in health and illness
○ Dependence/independence
○ Factors influencing…
● Model of nursing
○ Nursing care of individuals with health problems affecting the AL of eating and
drinking
Assessing eating and drinking
● Ability to eat and drink
● Knowledge of nutrition and healthy choices
● Access to food and drink
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Document Summary
Maintaining a safe environment in health and illness Nursing care of individuals with health problems affecting their ability to . Healthcare environment is in itself a hazard. What you say, the words you choose, tone of voice. Nursing care of people with conditions affecting their ability to communicate effectively and appropriately. Recognising a power imbalance exists which will often affect communication with you and the health system. Breathing activity in health and illness across the lifespan. Nursing care of individuals with health problems which affect their activity of. Eating and drinking in health and illness. Nursing care of individuals with health problems affecting the al of eating and drinking. Knowledge assessment [view to health promotion/health education] Personal cleansing and dressing in health and illness across the lifespan. Nursing care of individuals with health problems affecting the al of personal cleansing and dressing. Consider the role" of clothing, not just the physical capacity to undertake the task.
