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Biomedical "Medical" Model
(concept of health)
- -Used by Dr's physicians
- -Focus is on dx & treatment of disease
- -Assessment factors (S&S of disease)
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Holistic Model
(concept of health)
- -Used by nurses (not just S&S)
- -Expanded focus: views the body, mind, & spirit as interdependent & functioning as a whole w/in the enviro.
- -Individuals are considered active participants in their health care (must believe in treatment in order for it to work)
- -Assessment factors (not just S&S--include culture&values, family&social roles, self-care behaviors, enviro stress, developmental tasks)
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Health Promotion/Disease Prevention
- *Forms core of nursing practice
- -1° Prevention: promote optimum health prior to the onset of problems; vaccines, wash hands, exercise, diet)
- -2° Prevention: early ID and treatment of existing health problems; pap smear, mammogram, TB test; (it identifies but doesn't prevent)
- -3° Prevention: rehabilitation & restoration of health
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Assessment
- *collection of subjective and objective data
- -starts w/ first pt contact
- -forms the data base
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Subjective/Objective
- S: statments, sypmtoms
- O: observations, signs
- ex: inspection; palpation: touch skin for warmth; percussion: tap chest for sounds; auscultation: stethoscope to listen to lungs or heart; Lab values/diagnostic test results; pt records: readable, can include subjective data
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Diagnosis
- -Judgement regarding an individual's state of health
- -Derived from the subjective and objective data base
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Medical Diagnosis
- -Assessment data (used to diagnose disease)
- -Can't be made by nurses but nurse practitioner's can
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Nursing Diagnosis
- -Assessment data (used to dx pt's response to actual or potential health problems)-pain, altered skin integrity, ineffective coping, etc.
- -Pts response to illness or disease
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Types of Data
- -COMPLETE: health history & physical exam. Ex: 1st appt in primary care, hospital admission
- -EPISODIC: mini data base concerning one problem. Ex: acute illness (common cold)
- -FOLLOW-UP: to assess progress
- -EMERGENCY: rapid & focused data collection. Ex: chest pain (h/o of heart trouble, MI, PUD, hiatal hernia?); The type of data may quickly inc/dec level of suspicion for a certain type of problem
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Personal Distance
- -1.5-4 ft
- -Distance for most physical assessment
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Intimate Zone
- -0-1.5 ft
- -Some physical assessment
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Interview
- -To collect subjective data (health history, symptoms)
- -Assist pt to ID areas of concern & perceptions of health status
- -ID person's problems & strengths
- -Establish trust for ongoing working relationship
- -Provide comfortable bridge to physical exam
- -Provide opportunity for education
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Terms of Interview
- -Purpose
- -Time (set time limits in beginning)
- -Presence of others: (may be unable to speak freely, may help w/ info acquisition, interpreter violates confidentiality, risk of misinterpretation)
- -Confidentiality: (or limits of; avoid convo in public places, don't discuss w/ friends/family, don't refer to pt by name, builds pt trust/dec litigation
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Verbal & Nonverbal Comm.
- V: tone, words, speed, vocalizations, what you don't say
- NV: posture, gestures, facial expression, eye contact, body position, location in room
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Communication
- -Is 2 way (sending and receiving messages)
- -Emotional impact of illness can affect interpretation of msgs. Ex: may not be able to process info, pt teaching may have minimal impact in hospital setting
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