NUR2180 Module 3 Quiz Focused Review
Subjective vs objective data
o Subjective
Health history
o Objective
Physical assessment
Components of a health history
o Chief complaint
o Present health status
o Past health history
o Current lifestyle
o Psychosocial status
o Family history
o Review of symptoms
Types of databases
o Complete total health database
Includes complete health history and full physical examination
Describes current and past health state and forms baseline to measure all
future changes
Yields first diagnoses
o Episodic or problem-centered database
For limited or short-term problems
Collect “mini” database, smaller scope and more focused than complete
database.
Concerns mainly one problem, one cue complex, or one body system
History and examination follow direction of presenting concern
o Follow-up database (found in doctors office)
Status of all identified problems should be evaluated at regular and
appropriate intervals
Note changes that have occurred
Evaluate whether problem is getting better or worse
Identify coping strategies being used
o Emergency database (usually ER or Trauma)
Rapid collections of data, often compiled concurrently with lifesaving
measures
Diagnosis must be rapid and comprehensive in nature
Therapeutic vs non-therapeutic communication
o Therapeutic
Active listening
Sharing observations
Sharing empathy
Sharing hope
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, Sharing humor
Sharing feelings
Using touch
Silence
Providing Information
Clarifying
Focusing
Paraphrasing
Asking relevant questions
Summarizing
empathy
o Non-Therapeutic
Asking personal questions
Giving personal opinions
Changing the subject
Automatic responses
False reassurance
Self-Disclosure
Confrontation
Sympathy
Asking for Explanations
Approval or Disapproval
Defensive Responses
Passive or Aggressive Responses
Arguing
Characteristics of a culture
o Immigrants commonly maintain traditional eating customs long after language
and manner of dress of adopted country become routine
o Newly arriving immigrants may be at higher nutritional risk
Often coming from countries with poor resources and nutrition related
problems
o Unfamiliar with foods, food preparation, food buying habits and food storage
o Standard tables for weight and height may not be appropriate
o Need to know food habits in regard to religion and culture
Types of Nutritional assessments
o Anthropometric measurements
o Swallowing assessment prn
o Lab test
Risk factors for a poor nutritional intake
Questions re weight loss? Wt gain?
How does age factor into nutritional intake?
Food habits and customs
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