Exam Study GuideGeneral: Review terminology from the terms presented under each class moduleClass 1: Chapters 1 and 2 (Evidenced Based Assessment and Cultural Care):1. Be able to prioritize problems: see Table 1-1, page 5. Principles of Setting Priorities - Make a complete list of medications, medical problems, allergies, and reason for seeking care. - Determine relationships among problems: If problem a patient is rendered immobile due to pain, then treating the pain is the priority. - Setting Priorities is a dynamic, changing process, at time the order of priority changes, depending on the seriousness and relationship of the problemsSetting Priorities- Assign high priority to all first-level priority problems: Airway problems, Breathing problems, Cardiac, Circulation problems and vital sign concerns (ex: High fever)- Next assign priority to second-level priority problems:o Mental status change (eg: confusion, decreased alertness)o Untreated medical problems requiring immediate attention(ex: a diabetic who has not had insulin)o Acute Paino Acute urinary elimination problemso Abnormal laboratory valueso Risks of infection, safety, or security (for the patient or for others)- Address third-level priority problems (later priorities):o Health problems that do not fit into the above categories (ex: problems with lack of knowledge, activity, rest, family coping) 2. In emergency situations it is important to address first the problems that relate to cardiac and respiratory systems (i.e. prioritize the assessments of presenting signs that may indicate cardiac/respiratory distress).3. Know the types of data bases for assessment: see page 7 & 8.Complete Data base: A complete health history and full physical examination. It describes current and past health state and forms a baseline against which all future changes can be measured. Collected carried out in primary care settings; generally upon the first visit if the client is not presenting with a high priority problemFocused or Episodic Data Base: This is for a limited or short term problem. You collecta “mini” database, smaller in scope and more targeted than a complete database. It concerns one problem, one cue complex, or one body system. This can be collected anywhere. EX: A patient presents with a rash in an outpatient clinic. The history andexamination follow the direction of this presenting concern, such as whether the rash had an acute or chronic onset, was associated with fever, and was localized or generalized. History and examination must include a clear description of the rash.Follow-Up Database: The status of any identified problems should be evaluated at regular and appropriate intervals. What change has occurred? Is the problem getting better or worse? This type of database is used in all settings to follow up short-term or chronic health problems. Emergency Data Base: This calls for a rapid collection of data, often complied concurrently with lifesaving measures. Diagnosis must be swift and sure. For example, in a hospital ER, a person brought in with a suspected substance overdose. The first history questions are, “What did you take?” and “When?” The person is questioned simultaneously while his or her airway, breathing, circulation, level of consciousness, and disability are being assessed.4. Know the importance of having another qualified health care provider validate assessment findings with which one is unfamiliar.It is important to always validate the data that you collect to make sure they are accurate. As you validate your information, look for gaps in data collection (i.e., missing pieces of information). How you validate data depends on experience. Some things, likevital signs, can be validated by you by repeating the process as well as eliminating any extraneous variables that could influence the data (e.g., recent exercise or cigarette smoking if you need to take BP). If you are still unsure, get another nurse to help you. However, some information, no matter how experienced you are, should be validated byanother healthcare provider (e.g., a breast lump). If you report erroneous patient data, the patient will not receive the care they need (e.g., diabetic not getting insulin when it isneeded because of erroneous glucose testing). The consequences could be deadly andcould cost you your license/job.5. Know the differences between first, second and third-level priorities.1st- Emergent, life threatening, and immediate like establishing an airway, or supportingbreathing ABC’s + V .Airway ProblemsBreathing ProblemsCardiac/circulation ProblemsVital Sign Concerns (Ex: High Fever)2nd- Those next in urgency- they require prompt intervention to forestall further deterioration.Mental Status Change, Acute Pain, Acute Urinary Elimination Problems, Untreated Medical Problems, Abnormal Lab Values, Risks of Infections, Safety, or Security (to PT or others)3rd- Those that are more important to the PT’s health but can be addressed after more urgent health problems are addressed. Interventions to treat is more long-term and the response to treatment is expected to take more time.Ex: Problems with lack of knowledge, activity, rest, family coping6. Review the nursing process and the order in which the phases occur. It is important for the nurse to begin with assessment.Begin with Assessment- Collect data –both subjective & objectiveDiagnose actual problems and predict potential problems- Identify risk factors- Identify strengths- Formulate nursing diagnosesPlanning – OUTCOMES!- Determine specific outcomes- Decide what interventions would be most effectiveImplementation- Intervene with specific nursing activities- Reassess and modify, if indicated- Determine appropriateness of interventionsEvaluation- How are we doing as far as achieving desired outcomes?- Do we need help?- How can we do this better?- Do we need to terminate or modify plan?7. Know general growth changes associated with infancy, early childhood, middle childhood, adolescence, early adulthood, middle adulthood and late adulthood.8. Review the Denver II developmental screening test and the Ages and Stages Questionnaire as to what these are designed to detect and what age group they are supposed to assess.Denver II screening test – designed to detect developmental delays in infants and preschoolers within four functions: gross motor, language, fine-motor adaptive, and personal-social skills. For