Week 12 - Week 12 outline. PDF

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FANSHAWE COLLEGE NRSG 1013 PRACTICAL NURSING PROGRAM LABORATORY PRACTICE 1 LEARNING ACTIVITIES LABORATORY GUIDE: MENTAL STATUS

PNG5-1 LEVEL 1, TERM 1

OVERVIEW Holistic nursing involves caring for the client physically, psychologically, socially and spiritually. When we assess a client we, therefore, need to assess these four components of a person’s health history. The psychological assessment helps determine the client’s mental status. ENDS IN VIEW The learner will 

identify how a client’s appearance and movement, mood, thought process and perceptions, cognition and coping strategies assess a person’s mental status.



discover ways of assessing the above mentioned components of mental status.



discuss the impact of a client’s mental status on their overall health.



be able to document their mental status assessment of the SPE using the MoCa tool

PREPARATION The learner will 1. Read the appropriate pages in => Canadian fundamentals of nursing textbook – Chapter 31 => Jarvis - Chapter 2 (Mental Health Assessment)

IN LAB The learner will 1.

work with a partner to practice the assessment of Mental Status by interviewing a SPE

2.

compare assessment findings with normal findings for age.

3.

problem-solve how to carry out a mental status assessment for a client with a communication barrier.

4.

discuss the difference between short term and long term memory

© Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE PRACTICAL NURSING PROGRAM

NRSG 1013 LABORATORY PRACTICE 1

PNG5-1 LEVEL 1, TERM 1

AN APPROACH TO ASSESSING MENTAL HEALTH When nurses assess mental health, we assess an individual’s abilities to meet his/her psychosocial needs. Nurses seek to determine whether an individual is experiencing a stable emotional state, is capable of understanding and making choices about health and healing, and whether caring relationships and a positive self-concept are being preserved. 1.

Need for Emotional Security The individual who is emotionally secure  usually feels emotionally stable  is able to tolerate occasional episodes of anxiety  usually feels confident in his or her ability but may experience uncertainty in an unfamiliar situation  is able to deal with frustration and stressful situations but will sometimes need support  is able to acknowledge the need to know and learn  adapts and adjusts to change using a variety of coping mechanisms  after progressing through the initial stages of adaptation, solves problems by exploring options and their consequences, and then making realistic choices  when unable to modify the situation, modifies his or her expectations

2.

Communication and Cognitive Needs The individual who is meeting his or her communication and cognitive needs  articulates clearly without stuttering or slurring, is audible, speaks at a moderate rate  maintains continuity of phrases, and makes no inappropriate grimacing  maintains eye contact as appropriate to culture, initiates conversation, expresses concerns clearly, and can substitute nonverbal communication effectively if necessary  has a realistic understanding of normal structure and function of the body, asks questions and seeks information as needed about risk factors, preventative measures, own diagnosis, and possible treatments

3.

Need for Love and Belonging The individual whose need for love and belonging is fulfilled  gives and receives affection  relates sympathetically toward other human beings  expresses caring and tenderness toward the significant persons in his or her life  is capable of sexual expression in a relationship with a significant other  is able to tolerate loss by working through the process of grieving but will sometimes need the support of a caring person.

4.

Need for Self-esteem and Self-actualization The individual whose self-esteem and self-actualization needs are fulfilled  accepts him or herself as an individual with physical and emotional needs, strengths, and limitations  accepts both positive and negative feelings and reactions in self and others  is satisfied with, and respected by others in, usual family and work roles  anticipates successful adaptation to changes in lifestyle imposed by physical limitations  is spiritually comfortable while searching for spiritual meaning. Adapted from Merchant Lyke “Assessing for Nursing Diagnosis: a human needs approach.”

© Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE PRACTICAL NURSING PROGRAM

NRSG 1013 LABORATORY PRACTICE 1

PNG5-1 LEVEL 1, TERM 1

OBSERVATIONS NECESSARY FOR MENTAL STATUS ASSESSMENT NOTES 1. Observe appearance and movement: - posture - gait - motor movements & gestures - dress (clothing) - hygiene - facial expression - speech 2. Observe mood: - feelings - expressions - congruency of verbal & non-verbal 3. Observe thought process and perceptions: - clarity and content - perceptions 4. Observe cognition: - level of consciousness - length of concentration - memory - recent - remote - abstract reasoning - ability to make sound judgements - sensory perception and co-ordination - orientation to person, time, place 5. Coping strategies

LEARNING ACTIVITIES LABORATORY GUIDE: INTEGRATED PHYSICAL ASSESSMENT GUIDE OVERVIEW Clients are admitted to health care agencies to receive care and treatment for acute and/or chronic illness or concern © Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE NRSG 1013 PNG5-1 PRACTICAL NURSING PROGRAM LABORATORY PRACTICE 1 LEVEL 1, TERM 1 about real or imagined health symptoms. The admission procedure and the physical assessment is the first contact between nursing personnel and the client. Students should hone their interpersonal skills to ensure that the initial greeting and interaction will be positive and therapeutic. If the first contact engenders favourable impressions then the attitude of the clients will be co-operative during their stay in health care. ENDS IN VIEW The learner will 

establish a positive initial relationship with the client, his relatives, or close friends.



inform the client about the immediate environment and the services that are available.



acquire a data base of information which includes a health history and a physical assessment.



collaborate with the client to discuss his/her needs and to begin an individualized nursing case plan; identifying problems and strengths

PREPARATION The learner will 1.

Review previous assessment labs.

2.

Read Jarvis - Chapter 20 (Complete health assessment: putting it all together)

3.

Read Jarvis - Chapter 21 (Bedside Assessment of the Hospitalized adult)

4.

Watch video by Carolyn Merriman RN – East Tennessee State University Head to Toe Exam – 21 minutes https://www.youtube.com/watch?v=BGxjSb_HT6U

5.

Complete the curriculum study questions

IN LAB The learner will 1.

2.

3. 4.

with a laboratory partner, demonstrate a method of client assessment from head to toe using the following techniques: a. Inspection b. Palpation c. Percussion d. Auscultation discuss the priority problems with the following case study: A 45-year-old male presented with chest pain or pressure that started 12 hours ago. No abnormal heart sounds detected, B/P - 130/90, temperature - 37oC, pulse - 82, respirations - 22. Bedside monitor displays normal sinus rhythm. He had some shortness of breath 4 hours ago. No jugular venous distention. complete the health history in Jarvis 2009 Chapter 1 use case studies distributed in lab, with a partner, will perform a focus assessment.

© Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE PRACTICAL NURSING PROGRAM

NRSG 1013 LABORATORY PRACTICE 1

PNG5-1 LEVEL 1, TERM 1

INTEGRATED PHYSICAL ASSESSMENT STUDY QUESTIONS Matching - Match the terms in the left column with the correct description in the right column ______1. Biographical data

A. complains of fatigue and general malaise

______2. Reason for seeking healthcare

B. no chest pain or shortness of breath, no leg cramping or pain, no indigestion or burning, no dizziness or change in cognition

______3. History of present concern

C. Breast cancer 20 years ago, hypertension hypertension controlled by diuretics, cataract surgery 1990

______4. Past Health History

D. older adulthood; ego integrity vs despair

______5. Family Health History

E. decreased appetite and inability to engage in usual activities, complains of fatigue

______6. Review of Body systems

F. 80 year old widow with four daughters resident of retirement community for 8 yr

______7. Lifestyle and health practices

G. Both parents dies of heart disease in their 70's, no known family history of cognitive problems

______8. Developmental level

H. Doesn’t smoke and rarely drinks a glass of wine, performs all personal care independently, walks independently with rolling walker

9. List the five steps in performing a 5-minute head to toe assessment

10. Give examples of both subjective and objective findings in adult clients.

LEARNING ACTIVITIES LABORATORY GUIDE: REPRODUCTIVE ASSESSMENT © Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE NRSG 1013 PNG5-1 PRACTICAL NURSING PROGRAM LABORATORY PRACTICE 1 LEVEL 1, TERM 1 OVERVIEW Female breast examination and male testicular examination assist in the early detection of cancers of the breast and testicles. These examinations involve physical assessment, psychological support of clients, and teaching of self examination. ENDS IN VIEW The learner will 

identify how to perform a breast examination and a testicular examination.



know when to start teaching clients to do self examination.



identify on the models a tumour in breast and testicles.

PREPARATION The learner will 1. Read the appropriate pages in => Canadian fundamentals of nursing textbook – Chapter 31 => review Jarvis – Chapter 17 (male) & 18 (female) GU 2.

Complete the study questions in the curriculum guide and the FOL online Quiz #6

IN CLASS View video – Breast Self Exam and Testicular Exam IN LAB The learner will 1.

palpate the models and differentiate between normal and abnormal findings.

2.

work with a partner and explain how to perform a BREAST SELF EXAMINATION (BSE) and TESTICULAR SELF EXAMINATION (TSE).

3.

discuss with your partner your thoughts and feelings regarding these examinations

4.

discuss how you would promote patient privacy and patient respect and dignity during these examinations.

5.

Role model a “communication dialogue” between a client and a nurse for this assessment.

IN REFLECTION Consider your own practice in regard to BSE or TSE as appropriate.

© Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE NRSG 1013 PRACTICAL NURSING PROGRAM LABORATORY PRACTICE 1 BREAST EXAMINATION STUDY QUESTIONS

PNG5-1 LEVEL 1, TERM 1

1.

When should women start doing monthly breast examinations.

2.

Before menopause, when is the best time to tell women to examine their breasts and why?

3.

Describe the normal changes in the breast during a woman’s life span.

4.

Describe the difference between a cyst and a tumour.

5.

Why is it important that a woman do a systematic examination of each breast and under each arm?

© Fanshawe College, Practical Nursing Program

FANSHAWE COLLEGE NRSG 1013 PRACTICAL NURSING PROGRAM LABORATORY PRACTICE 1 TESTICULAR EXAMINATION STUDY QUESTIONS 1.

When should men start doing testicular examination.

2.

Explain what a normal testicular exam should reveal.

3.

What is the most common symptom of testicular cancer?

4.

During inspection, what would be normal findings?

5.

When palpating the scrotum, why must the nurse use only light palpation.

© Fanshawe College, Practical Nursing Program

PNG5-1 LEVEL 1, TERM 1...