ST.

LUKE’S COLLEGE OF NURSING

2nd Semester
School Year: 2020-2021

GENERAL DISCUSSION SCHEDULE

COURSE CODE : NCM 101

COURSE TITLE : Health Assessment
LESSON NUMBER : 01
TIME ALLOTMENT : 4.5 Hours
PRESCRIBED FLO : Preferred: e-Learning (E1, E4)
Alternative: Modular (M2)

TOPIC LEARNING OUTCOMES:

After the end of the lesson, the student should be able to:

1. Comprehend and accept the guidelines, requirements, and grading system for their success in the course.
2. Comprehend the significance of the course to the Nursing profession.
3. Participate in the interactive discussions.
4. Use critical thinking skills to assess client.
5. Familiar to data collection and analysis as part of the nursing process

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 Activities Strategies TA Remarks
1 ATTENTION Classroom Orientation with icebreaker 15 minutes

2 OBJECTIVE Discussion of the learning objectives for the day 5 minutes

3 RECALL Conduct a 10-items Pre-test 10 minutes

4 STIMULUS Do a 30-minute lecture 30 minutes Focusing on the highlights and the

essentials
5 GUIDANCE Conduct SGDs to expound on the topic 30 minutes Question for discussion will be posted
in the chat box
6 PERFORMANCE Do a group presentation on the highlights of the topic 30 minutes

7 FEEDBACK Provide Immediate feedback at the end of the 15 minutes

presentation
8 ASSESSING Conduct a 10-item post-test with discussion afterwards 10 minutes

9 RETENTION Summarize the main points of the lecture and encourage 15 minutes
Q&A before synthesis

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 LESSON/TOPIC DISCUSSION

Learning Resources: (Citation following APA Method)

1. Textbook
o Weber, J. (2017). Health Assessment in Nursing 6th Edition. Wolters Kluwer/ Lippincott Williams and Wilkins
o Potter, P. (2016). Fundamentals of Nursing Practice 5th Edition. Elsevier

LESSON 1 TOPICS:

A. General Impression on General Status Assessment

a. Physical development, body build and Fat distribution
b. Gender and sexual Development
c. Skin condition and color
d. Posture and gait
B. Overview of vital signs
a. Temperature
b. Pulse
c. Respirations
d. Blood pressure
e. Pain

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ACTIVITY 1: INTRODUCTION

OVERALL IMPRESSION OF THE CLIENT:

The first time you meet a patient, we remember a specific attribute. To have an overall impression, initially we observe and note the environment of the patient
to know the discrepancy or similarity of the attitude/characteristics of the patient in the presence or absence of a healthcare provider. For example, the patient in
pain shows facial grimacing, guarding behavior of the part of the body in pain before the assessment, during the nurse’s examination the patient may manifest the
same signs and symptoms.

Next, we can perform systematic examination and recording of the observable characteristics of the patient. Obvious abnormalities in the patient’s skin color,
dress, hygiene, posture and gait, physical development, body build, apparent age and gender may warrant in depth assessment of that body area.

Other area of assessment may include client’s level of consciousness, comfort, behavior, body movements, affect, facial expression, speech and mental acuities.
Again, if you have recorded abnormalities, then you should perform in depth examination of the body part.

Complete and correct health assessment is very helpful to healthcare professional especially nurses to come up with good nursing diagnosis, intervention and
eventually improved outcome.

ACTIVITY 2: PRE-TEST

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ACTIVITY 3: CONCEPTS 1

GENERAL STATUS ASSESSMENT

1. Physical development, body build and fat distribution.

NORMAL: Body proportions are normal. Arm span (distance between fingertips with arms extended) is approximately equal. The distance from the head
crown to the symphysis pubis is approximately equal to the distance from the symphysis pubis to the sole of client’s foot.
ABNORMAL: Malnutrition is lack of subcutaneous fat with prominent bones, Obesity on the other hand has abundant fatty tissue. Dwarfism manifests
decreased height, delayed puberty, and chubbiness. Opposite to that, Gigantism is increased in height, weight, and delayed sexual development.

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 Acromegaly is overgrowth of bones in the face, hands, head, and feet with normal height. Anorexia Nervosa is extreme weight loss. Marfan Syndrome has
a long arm span. Cushing syndrome has excessive cervical obesity.

OLDER ADULT CONSIDERATION: Sarcopenia is the loss of muscle mass and strength with age. Sarcopenia is a part of normal aging, and occurs even in
master athletes, although it is clearly accelerated by physical inactivity. Sarcopenia affects all muscles including, for example, the respiratory muscles (reduced
efficiency of breathing) & GI tract (constipation). Sarcopenia contributes to disability, reduced ability to cope with the stress of a major illness, and to mortality
in the elderly.

2. Gender and sexual development

NORMAL: Appropriate for gender age, client appears to be her stated age
ABNORMAL: Delayed puberty, male with female characteristics and vice versa. Client appears older than actual age may be due to hard life.
OLDER ADULT CONSIDERATION: observe for signs and symptoms of Menopause (hot flashes, thinning hair, thinning skin/wrinkles and others) and
Andropause (Lack of energy, irritability, thinning skin/wrinkles etc)

3. Skin condition and color

NORMAL: Color is even without obvious lesions. Light skinned client has light to dark beige-pink color. Dark skinned client has light tan to dark brown or
olive color.
ABNORMAL: Extreme pallor, flushed skin, yellow skin in light skinned client. Loss of red tones and ashen gray cyanosis in dark skinned client
OLDER ADULT CONSIDERATION: Decreased vascularity of dermis (pallor), decreased amount of melanin (graying hair), loss subcutaneous fat (increased
wrinkling), increased localized pigmentation (brown spots)

4. Posture and gait

NORMAL: Posture and comfortable for age. Gait is rhythmic and coordinates with arms swinging at side.
ABNORMAL: Curvatures of spine (lordosis, kyphosis or scoliosis) may indicate musculoskeletal disorder. Parkinsons or arthritis show stiff, rigid
movements. Slumped shoulders may indicate depression. COPD patients tend to lean forward and brace themselves with their arms.

VITAL SIGNS

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 1. TEMPERATURE
The core body temperature is 36.5°C – 37.7°C (96.0°F – 99.9°F), this is necessary for the body to function properly. Temperature can be taken in different
part of the body like under the tongue, axilla and rectally to get an approximate core body temperature. There are factors that can cause normal variations
in body temperature like strenuous exercise, stress, ovulation and time of the day. Hypothermia or temperature lower than normal may be cause by
exposure to cold, hypoglycemia, hypothyroidism and starvation. Hyperthermia or temperature higher than 38°C or 100°F can be cause by infection, e
inflammation, malignancy, trauma, blood disorders, endocrine disorders and immune disorders
OLDER ADULT CONSIDERATION:
Temperature of older adults is lower than normal adults because of many reasons like loss of subcutaneous fats, muscle atropy, decreased function of sweat
glands and changes in the functioning of hypothalamus, their temperature may range from 95.0°F – 97.5°F. This puts them at risk of heat stroke, afebrile
in the presence of infection and they may need layers of clothing to feel warm

2. PULSE
A shock wave is produced when the heart contracts and forcefully pumps blood out of the ventricles into aorta. The shock waves travel along the fibers of
the arteries and is commonly called arterial or peripheral pulse. The normal pulse rate is 60-100 beats per minute for adults. The body has several
arterial pulse sites: carotid, brachial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis, and radial pulse which is commonly use in adult clients. In
pediatric patients, it is best to use stethoscope and count the apical pulse in full minute. It is not enough to count the pulse in full minute, several
characteristics should also be assessed in taking the pulse: rate, rhythm, amplitude, contour and elasticity.
It is best to perform auscultation of the apical pulse if the clients exhibits irregular intervals between beats.
OLDER ADULT CONSIDERATION:
The older client’s artery may feel more rigid, hard and bent because of atherosclerosis

3. RESPIRATION
Respiration is the mechanism the body uses to exchange gases between the atmosphere and the blood and the blood and the cells. Normal value for adult
patient is between 12-20 breaths per minute. Fewer than 12 breats /minute or more than 20 breaths per minute are abnormal for adult patients
OLDER ADULT CONSIDERATION:
Respiratory rate may range from 15-22. The rate may increase with a shallower inspiratory phase because vital capacity and inspiratory reserve volume
decrease with aging.

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 4. BLOOD PRESSURE
Blood pressure reflects the pressure exerted on the walla of the arteries. This pressure varies with the cardiac cycle, reaching a high point with systole and
a low point at with diastole. Systolic blood pressure is the measurement of the pressure of the blood in the arteries when the ventricles are contracted.
Diastolic blood pressure is the measurement of the pressure of the blood in the arteries when the ventricles are relaxed. A client’s blood pressure is affected
by: cardiac output, distensibility of arteries, blood volume, blood viscosity and others. Blood pressure may also change depending on the position of body
and arm. Normal blood pressure is : systolic <120mmHg and diatolic <80mmHg, a pressure difference of 10mmHg between arms is normal. Pulse pressure
is the difference between your systolic blood pressure and diastolic blood pressure, the normal pulse pressure is 30-40mmHg.
Abnormal blood pressure may be seen in patients with orthostatic hypotension wherein a drop of 20mmHg or more from the recorded sitting blood
pressure. Widened pulse pressure can be caused by problems in the heart or aorta.
OLDER ADULT CONSIDERATION:
Widening of the pulse pressure is seen with aging due to less elastic peripheral arteries

5. PAIN
Pain is the fifth vital signs, giving it equal status with temperature, pulse, respiration and blood pressure. There are many ways to classify pain, first
according to duration and etiology which are acute pain, chronic pain and cancer pain, second classification is according to pain location which are
cutaneous pain, visceral pain and deep somatic pain, another aspect of pain location is whether it is perceived at the site of the pain stimuli which is
radiating or referred pain. Lastly other classification of pain may be neuropathic pain or intractable pain. There are 7 dimensions of pain: physical, sensory,
behavioral, cognitive affective, spiritual and sociocultural.
Many Assessment Tools available are available and easy to use such as Visual Analogue Scale (VAS), Numeric Rating Scale (NRS) Numeric Pain Intensity.
Scale (NPIS), Verbal Descriptor Scale, Simple Descriptive Pain Intensity Scale, Graphic Rating Scale, Verbal rating Scale and Faces Pain Scales. The nurse
may assess pain deeper using PQRST or COLDSPA mnemonics. PQRST means Provocation, Quality, Radiation, Severity and Timing while COLDSPA means
Character, Onset, Location, Duration, Severity, Pattern and Associated Factors.

ACTIVITY 4: DISCUSSION / EXERCISE

HEALTH ASSESSMENT INDIVIDUAL ACTIVITY

1. Collect Subjective Data: Nursing Health History

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 Interview and record health history of any member in your household (or a relative thru phone) with health issues example arthritis, diabetes,
hypertension using INITIAL HEALTH HISTORY form in your book page 126-127.

ACTIVITY 5: POST TEST

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ACTIVITY 6: SYNTHESIS / EXERCISE

Comprehensive patient health assessment is a tool to learn about patient’s overall health: concerns, issues, signs and symptoms of the disease. Gathering
information provides a comprehensive description of patient and it will be a tool to assess the progress of the patient, it can also be use as communication tool
among health care team to address the needs of the patient. It is very important process in developing a nursing diagnosis to the patient and to have an effective
plan of care and intervention.

Prepared by Edited by Reviewed by

Ms. Edna U. Robles, MAN, RN

SLCN Faculty

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