Patient Assessment

Upon evaluating the effect of past five week’s classes and course material encounters each week was enchanting for me. I have had great impact on my practice with those new gained and reinforced knowledge .While reading some of the materials I realized how important the legal value of our documentation .As nurses often we do give priority to our patients care and charting as our last priority .Whatever care we give if we are not documenting its considered as not done .when it reaches court of judgement our documentation is our proof .Other impact was on the focused assessment .As our patient population mostly belong to the repeated visit for chemo therapy ,focus is mainly on the focused assessment ,my new knowledge assisting me to do focused assessment in a more systematic way. Acronyms like VINDICATE was new to me even though familiar with SOAP I never used SOAPIE before.

Hospitals regularly measure patient care, which is defined as any health care service provided to an individual. It is measured in different ways according to the type of health care service provided. However, there are basic principles that guide how all patient hospital care is measured.

Excruciating jaw pain can be extremely hard to deal with on a daily basis. If you notice any pain, clicking, or popping in your jaw when you talk, chew, or yawn, you may be suffering from Temporomandibular Joint Syndrome, or TMJ. Gregory T. Grubba, DDS, understands how to treat TMJ symptoms. Their highly-trained staff in Anchorage, AK is committed to providing comfortable, affordable dental care for their patients. Whether you’re coming in for a filling or a routine teeth cleaning, you’ll always receive the highest quality treatments for your teeth at their practice!

To diagnose and rule out other causes of the pain, your dentist will perform a thorough oral examination. For immediate and long-term relief from pain caused by TMD, your dentist may recommend behavior modification, eating soft foods for a few days to reduce stress on the jaw joints, gentle stretching exercises, anti-inflammatory medications, muscle relaxants, biofeedback, stress management, and other conservative therapies. Surgery is usually performed when all other treatments have

The Sarah self-referred for assessment at am outpatient clinic. She subsequently requested a referral to a psychologist in Chicago, IL. Sarah is a 24-year-old adult Caucasian female who identified as a lesbian. She reported a history of depressive symptoms that have worsened in the last few months. She is seeking treatment for these intensified depressive symptoms. She described having “depression” many years ago, but became evasive when asked to clarify. In addition, she noted a concern with experiencing anger and hostility towards others; she stated that these emotions are “uncomfortable” for her. She clarified that in the past three months she has perceived herself as “grumpier than usual.” She reported having experienced anhedonia, fatigue, and insomnia.

The tympanic membrane and thyroid gland are two of the many features that will assessed on a patient. When abnormalities or disruption in the normal function of either of these persist, permanent damage can occur. To know if there is a disruption in the normal function, we must know what the normal function and purpose is. This paper will review possible finding for the tympanic membrane, how to examine the thyroid gland, and give an assessment note using the subjective, objective, assessment, and plan (SOAP) note format.

If you suspect you have a hearing loss, your doctor can refer you to an Otorhinolaryngology’s, more commonly referred to as Ear, Nose and Throat specialists or ENT’s. This physician will examine your ears to see if there is any underlying disease, abnormality or possible undiagnosed condition that is causing your hearing loss and needs to be treated.

Strengths of the evaluation tool is strong because it is given to all new hires, it has many subdivisions, includes other health care providers interactions, along with critical care thinking in reference to knowing limits and how they evaluate situations. Before a preceptor is given a new nurse to precept, they must attend a series of classes. These classes elaborate the teaching and evaluation concepts of checklist for evaluation. This brings consistency, that everyone is educated in the same manner as how to approach and evaluate a new RN. The focus is on approachable nurses and also on those individuals that are strong and difficult to teach. A weakness that is obvious, is that the evaluation is subjective in nature. After all, we

This assignment will critically discuss the nurse’s role in assessment and care planning for a patient in a case study. Confidentiality which is required by the NMC (Nursing Midwifery Council, 2008) and the Data protection Act (1998) will not be broken through out the assignment because the case study used is a scenario not a fictional character. The care plan will focus on Jean’s incontinence needs using The Roper, Logan and Tierney model (2000).

Assessment is the first part of the nursing process and thus forms the basis of the care plan. The essential requirement of accurate assessment is to view the patients holistically and thus identify their real needs. The general survey of an assessment gives a broad range of impression of the individual.

The goal of the patient gaining more confidence in health care professionals transferring him by 02/10/16, was partically met, however, he still gets anxiety and will occasionally move too quickly, therefore, he is still at risk for the patient falling. The patient met the goal of notifying the nurse or the nursing assistant when he needed to use the restroom. He would properly notify us as the healthcare providers by pushing his call light.

The purpose of this research group is to evaluate the effectiveness of bed/chair alarms in the prevention/intervention of adults 65 years and older in inpatient settings. The majority of the articles that were reviewed were conducted on inpatients, while the age of adults 65 years and older was not adhered to in every inclusion article.

According to Smeltzer, Bare, Hinkle and Cheever (2010), “the ear is a sensory organ with dual functions – hearing and balance. The delicate structure and function of the ear make early detection and accurate diagnosis of disorders necessary for preservation of normal hearing and balance.” (p. 1802). For infants and children, during regular check-ups, the inner and outer ear are examined and hearing tests are incorporated to identify any abnormalities, for example, watery or bloody discharge. Otitis media (OM) is commonly identified in children.

Pain is an internal and subjective experience that cannot be directly observed, assessed and measured by others. Hence, an assessment of a patient’s pain is critical to optimal pain management interventions. A systematic process of pain assessment, measurement and re-evaluation would help to achieve a reduced experience of pain, increased comfort, improved physiological, psychological and physical function, and lastly increased the satisfaction with pain management in the patients with arthritis (Sharon Wood, 2008).

Mr. Douglass was advised to cut back on red meat intake and try to eat leaner meats such as chicken, fish and nuts.