need help

[sishu]

please help......this is my first semester in nursing so far i am so 0verwhelmed by everything. our fundamental instructor gives us these questions to prepare for the exam...i just do not know how to start these questions......i would really appreciate any help...........here are the questions.........

1) you find mrs. brown's pulse (radial) is 88 and irregular, her respirations are regular at 16/min, and her temperature is 98.2f. you also interview mrs. brown as to whether she has concerns about her health and you ask questions related to gordon's functional assessments. you learn from mrs. brown that she has recently quit walking because she gets a "cramping" in her right lower leg after walking abut two to three blocks as well as becoming tired. she tells you "if i stop and rest a bit, the pain and the tiredness go away and i can start walking again--but then after a couple more blocks, the pain and fatigue return." this is beginning to concern her because about a month ago she was able to walk two miles without any symptoms. when you check the pulses in her feet, you find that the right foot is cooler than the left and the dorsalis pedis and posterior tibial pulses in the right foot are very weak. they are easily palpated and strong in the left foot. there is no obvious swelling in either foot.

• please outline further and exams you need to assess mrs. brown. please note whether the information you receive will be subjective or objective:
  

• which of gordon's functional assessments have the greatest bearing on this case and why? give your rationale to defend your responses.
  

2) you are watching 2nd graders in their pe class run a mile. you notice one child is running far behind and stops regularly to rest and to cough. how do you decide if this child is experiencing heart or respiratory problems?

• what history questions would you ask to determine a cardiovascular versus pulmonary problem? list the specific questions.
  

• which gordon's functional assessment questions would be useful? how would you ask these questions--list specific questions:
  

• what past history questions would be helpful? again list specific questions:
  

• what exams would you perform? list the components of the physical exam:
  

• in outline form list five key decisional points would you use in your assessment (subjective and objective) to make your nursing diagnosis?
  

[pharmgirl]

Can you post what you have come up with so far, that way we can direct you in one way or another?

[Daytonite, BSN, RN]

i can understand your dilemma. you are being asked to critically think and do some initial problem solving of these two situations. we use the nursing process to do that. the nursing process is a problem solving technique that helps is to think critically and rationally. it consists of 5 steps:

1. assessment
   
2. problem determination (nursing diagnosis)
   
3. planning
   
4. implementation
   
5. evaluation
   

which over the course of lectures your instructors will expand on. in your program it seems that your instructors wish for you to use gordon's functional health needs (there are 11 of them) when performing assessments of your patients/clients. it is merely one way to organize how you question and examine the patient before moving on to step 2 of the nursing process which is determining what their nursing problems are. an assessment is designed to help you get as much helpful information about what is going wrong for the patient in an educated way. marjory gordon some years ago identified 11 areas that she felt were important that nurses needed to explore and examine a person's health history. here are the 11 areas:

1. health perception - health management pattern
   
2. nutrition - metabolic pattern
   
3. elimination pattern
   
4. activity - exercise pattern
   
5. sleep - rest pattern
   
6. cognitive - perceptual pattern
   
7. self-perception pattern
   
8. role - relationship pattern
   
9. sexuality - reproductive pattern
   
10. coping - stress tolerance pattern
    
11. value - belief system pattern
    

now, somewhere during lectures you might have gotten handouts, some guidelines or examples of the types of questions or the things you should be asking patients about for each of these 11 areas. the questions above have already given you some assessment information, but the questions are also asking if you think you need more information (you can never know too much) and which of gordon's function need assessment areas you would need to focus on. so, this test is clearly testing your knowledge of gordon's way of assessing and what each area of gordon's covers.

and in question #2, a statement says, list the components of the physical exam. that tells me that you must have also had lectures or handouts regarding how to do a physical examination on a human being. physical examination is also part of the assessment process. so, you need to know the components of either a head-to-toe or body system type physical exam where you go in and look at the patient and do things like inspect, palpate, percuss and auscultate parts of their body.

the remainder of the questions being asked about the patients in the scenarios above pertain to the symptoms these patients are having and what assessments you want to be sure to make sure you focus on because of these symptoms. all problems consist of symptoms. and in order to get to nursing problems and nursing diagnoses eventually we will need to assemble a list of the patient's symptoms, or abnormal data which we find during all this assessment we do. that is the purpose of assessment.

in outline form list five key decisional points would you use in your assessment (subjective and objective) to make your nursing diagnosis? this is your first movement into step #2 of the nursing process. you are being asked to list 5 abnormal assessment items that you would discover from your assessment of the patient that would indicate a definite nursing problem existed. this could be subjective or objective data and it will be assessment data that you create. the scenario only gives you a few pieces of information to work with: "one child is running far behind and stops regularly to rest and to cough. how do you decide if this child is experiencing heart or respiratory problems?". you will need to assess this child find a number of abnormal data from assessing to support at least 5 nursing problems.

for information on gordon's 11 functional health patterns including the questions to ask, see post #4 on the following sticky; physical exam weblinks are on post #3:

• https://allnurses.com/nursing-student-assistance/health-assessment-resources-145091.html - health assessment resources, techniques, and forms
  

this should get you started. review your lecture notes on assessing using gordon and how to do a physical exam. these 2 questions are a practical application of them. if you are still having trouble figuring out how to apply that information i will give you a bit more help.

[sishu]

thank you so much daytonite...these is really a good guide....i will start working on it and if i get stake i might need a rescue…. thanks’ a lot……..