Bedside Assessment UPDATED Exam
Questions and CORRECT Answers
objectives of bedside assessment - Correct Answer- obtain hospitalized pt medical history
perform problem based physical assessment on hospitalized pt
recognize normal/abnormal
what is up with my pt - Correct Answer- get the scoop on your pt
obtain from: report from off going nurse, what was the last few hours like, from chart: last
few days especially
outside pt room - Correct Answer- note signs: correct??
high risk for falls, isolation precaustions, latex allergies?
meet and greet pt - Correct Answer- make eye contact
introduce yourself
acknowledge patient first
focus questions on info recieved in report
patient contact guidelines - Correct Answer- wash hands, verify armband, equiptment set up,
anything missing or incorrect
general appearance - Correct Answer- facial expression, body postion, level of consciousness
(A/O x 3), skin color, nutritional status, speech, hearing, hygeine
measurement - Correct Answer- vital signs
pulse oximetry: >92% is goal
copd: 88-92% so they can keep drive to breath
pain level and tolerance
pain reassessment - Correct Answer- always re-assess pain and document new #/10
, give meds time to work
general rule is to reassess in 30 min
IV reassessment - Correct Answer- within 15 min (intravenous)
PO - Correct Answer- by mouth within 1 hour
neuro - Correct Answer- stimuli, motor response, verbal resonse
perrla
muscle strength (grips hands, push your feet into my palms)
ptosis (facial droop)
sensation if indicated
communication
swallowing ability if patient isn't NOP (nothing by mouth : latin)
respiratory - Correct Answer- oxygen (filtered correctly, actually on, oxygen percentage
patient is recieveing:FiO2)
resp effort
ascultate
cough: check for mucose
incentive spirometer: exhale, then breath in using mouthpiece and hold
cardio - Correct Answer- under gown, inspect cap refill and edema
take note: fluid overload, dehydration, iv fluids may need to be adjusted by providor
skin - Correct Answer- braden risk assessment
inspect: don't forget the iv site
braden risk assessment - Correct Answer- Tool used by nurses to measure risk for pressure
ulcers in patients. Score range 6-23. Low indicates higher risk for pressure ulcer. 18 is cut off
score for onset of pressure ulcer risk.
Questions and CORRECT Answers
objectives of bedside assessment - Correct Answer- obtain hospitalized pt medical history
perform problem based physical assessment on hospitalized pt
recognize normal/abnormal
what is up with my pt - Correct Answer- get the scoop on your pt
obtain from: report from off going nurse, what was the last few hours like, from chart: last
few days especially
outside pt room - Correct Answer- note signs: correct??
high risk for falls, isolation precaustions, latex allergies?
meet and greet pt - Correct Answer- make eye contact
introduce yourself
acknowledge patient first
focus questions on info recieved in report
patient contact guidelines - Correct Answer- wash hands, verify armband, equiptment set up,
anything missing or incorrect
general appearance - Correct Answer- facial expression, body postion, level of consciousness
(A/O x 3), skin color, nutritional status, speech, hearing, hygeine
measurement - Correct Answer- vital signs
pulse oximetry: >92% is goal
copd: 88-92% so they can keep drive to breath
pain level and tolerance
pain reassessment - Correct Answer- always re-assess pain and document new #/10
, give meds time to work
general rule is to reassess in 30 min
IV reassessment - Correct Answer- within 15 min (intravenous)
PO - Correct Answer- by mouth within 1 hour
neuro - Correct Answer- stimuli, motor response, verbal resonse
perrla
muscle strength (grips hands, push your feet into my palms)
ptosis (facial droop)
sensation if indicated
communication
swallowing ability if patient isn't NOP (nothing by mouth : latin)
respiratory - Correct Answer- oxygen (filtered correctly, actually on, oxygen percentage
patient is recieveing:FiO2)
resp effort
ascultate
cough: check for mucose
incentive spirometer: exhale, then breath in using mouthpiece and hold
cardio - Correct Answer- under gown, inspect cap refill and edema
take note: fluid overload, dehydration, iv fluids may need to be adjusted by providor
skin - Correct Answer- braden risk assessment
inspect: don't forget the iv site
braden risk assessment - Correct Answer- Tool used by nurses to measure risk for pressure
ulcers in patients. Score range 6-23. Low indicates higher risk for pressure ulcer. 18 is cut off
score for onset of pressure ulcer risk.
