Quiz 1 Study Guide: Health Assessment Review

Subjective data: What the patient says about himself or herself during history taking Objective data: Observed when inspecting, percussing, palpating, and auscultating patient during exam Database: formed from these ^ elements, plus the patients record and laboratory studies Terminology: cyanosis: a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood. (chronic heart and lung disease ) Confluent: flowing together or merging. – The lesions run together Data types, -Complete total health database: complete health history and physical examination. Shows the pathophysiology and the patients response to it. Helps lead to the nursing diagnoses. (doctors office ) -Focused or problem centered database : limited or short term problem “mini database”. -Targeted – one problem, one cue complex, one body system. May occur in all kinds of settings (chest pains) -Follow up database – is evaluated at regular/appropriate intervals. Questions that may be asked – what has changed? Has it gotten worse or better? What coping strategies are being used? - may be used in all settings. Used for follow ups on short term and chronic health problems (diabetes , heart attack, sprain) -Emergency Database – its urgent, rapid collection of crucial information – goes by lifesaving measures. The diagnosis is swift and sure. Your questions and observation is being done at the same time. When your patient is stabilized a complete database is completed. (hospital)