1

SEMINAR ON
METHODS OF COLLECTION, ANALYSIS AND UTILIZATION OF DATA RELAVANT TO NURSING PROCESS
SUBMITTED TO: Mrs. FELICIA CHITRA READER IN NURSING MTPG&RIHS SUBMITTED BY: A.JALAJARANI M.SC (N), I YEAR SUBMITTED ON: !! "##$

'

!.INTRODUCTION
Assessment is the first step in the nursing process and includes systematic collection, verification, organization, interpretation and documentation of data for use by health care professionals. Effective planning of client care depends on a complete database and accurate interpretation of information. Incomplete or inadequate data may result in inaccurate conclusions and incorrect nursing assessment. Proper collection of assessment data directs decision making activities of professional nurse. Assessment is the collection and analysis of data that are used in formulating nursing diagnosis, identifying outcomes and planning care and developing nursing intervention.

TERMINOLOGIES:
Ass%ss&%'(: Assessment is the first step in the nursing process and includes systematic
collection, verification, organization, interpretation and documentation of data.

V)*+,)(+-': hecking the accuracy and adequacy Or.)'+/)(+-': Arranging in such a !ay to analyze strength and !eakness of the data I'(%r0r%()(+-': "he process of understanding and utilization of data D-12&%'()(+-': #ecording and reporting S-2r1%$ !here the data being collected M-,%*$ %chematic representation of some aspect of reality N%%,$ &ecessary or requirement

CRITICAL THIN3ING AND THE ASSESSMENT PROCESS

3NO4LEDGE: *nderlying disease process &ormal gro!th+development &ormal psychology &ormal assessment findings ,ealth promotion Assessment skills ommunication skills

E5PERIENCE: Previous client care e.perience /alidation of assessment findings 0bservation of assessment techniques A%%EE)E&"

STANDARDS %pecialty standards of practice and Intellectual standards of measurement

ATTITUDE: Perseverance -airness Integrity onfidence reativity

6.PURPOSE OF ASSESSMENT
An assessment may have a comprehensive focus or a specific, narro! focus. Establish a data base !ith !hich to plan and evaluate comprehensive care Identify the actual and potential problem to make nursing diagnosis -ocus on a specific problem 1etermine immediate needs to establish a priorities 1etermine the causes of problem 1etermine related factor Identify strength as a basis for changing behavior Identify the risk for complications #ecognize complication

7.TYPES OF ASSESSMENT
7.!. C-&0r%8%'s+9% Ass%ss&%'(:
*sually performed upon admission to a health care agency and includes a complete health history to determine current needs of the client. "his database provides a baseline against !hich changes in the client2s health status can be measured and should include assessment of the physical and psychological aspects of the client2s health, the client2 perception of health , the presence of health risk factors and the client2s coping pattern.

7.". F-12s%, Ass%ss&%'(:

Is an assessment that is limited in scope in ordered to focus on a particular need or health care problem or potential health care risk3 It is mostly used in speciality areas such as labor and delivery, mental health settings or for screening purpose in specific problems. E.ample$ 4oman during labor 4hen your contraction did begin3

9 ,o! far apart are the contractions3 Are they getting stronger3 4hen did your !ater break3

7.6. O'.-+'. Ass%ss&%'($

%ystematic follo!6up is required !hen problem are identified during a comprehensive or focused assessment. It is an assessment that includes systematic monitoring and observation related to specific problems. "his type assessment allo!s the nurse to broaden the data base or to confirm the validity of the data obtained during the initial assessment. It is important !hen problem have been identified and a plan of care has been implemented to address these problem. %ystematic monitoring and observation allo! nurse to determine client response to nursing intervention and to identify any emerging problems.

:. ELEMENTS OF ASSESSMENT PROCESS

17 1ata collection '7 1ata /alidation8/erification (7 1ata 0rganization 57 1ata Interpretation 97 1ata 1ocumentation

:.!.DATA COLLECTION
:.!.! TYPES OF DATA %ub:ective 1ata$
1ata from the clients point of vie! and includes feelings, perception, and concerns.

= Also referred to as symptom

0b:ective 1ata$
0bservable and )easurable Also referred as sign omprehensive and accurate %tandard assessment technique is used by e.perienced person

:.!.". SOURCES OF DATA (+)C*+%'(

"he client is the best source of information. "he client !ho is oriented and ans!ers questions appropriately can provide the most accurate information about health care needs, lifestyle patterns, present and past illnesses, perception of symptoms, and changes in activities of daily living. It is important, ho!ever, to consider the setting !here the nurse interacts !ith a client.

(++) F)&+*;
-amilies and significant others can be intervie!ed as primary sources of information about infants or children and critically ill, mentally handicapped, disoriented or unconscious clients. In cases of severe illness or emergency situations, families may be the only available sources of data about a client2s health6illness patterns, current medications, allergies, onset of illness and other information needed by nurses and physicians.

(+++) H%)*(8 C)r% T%)& M%&<%rs

"he health care team consists of physicians, nurses allied health processionals, and non6professional employees !orking in a health care setting. ;ecause assessment is an ongoing process, the nurse must communicate !ith other health care team members, including physical therapists, social !orkers, community health !orkers and spiritual advisers !henever possible. ,ealth care team members can provide information about the !ay the client interacts !ithin the health care environment< the client2s reaction to information about diagnostic tests< and in acute and restorative care

A settings, ho! the client responds to visitors. Every member of the health care team is a potential source of information, and the team can identify and communicate data and verify information from other sources.

(+9) M%,+1)* R%1-r,s

"he present and past medical records of the client can verify information about past health patterns and treatments or can provide ne! information. and past methods of coping. ;y revie!ing medical records, the nurse can identify patterns of illness, previous responses to treatment

(9)O(8%r R%1-r,s
0ther records such as educational, military and employment records may contain pertinent health care information >e.g., immunizations, prior illnesses7. If the client received services at a community health center or day care clinic, the nurse should obtain data from these records but must first obtain !ritten permission from the client or guardian to see them.

(9+) L+(%r)(2r% R%9+%=

#evie!ing nursing, medical and pharmacological literature about an illness helps the nurse complete the database. "he revie! increases the nurse2s kno!ledge about the symptoms, treatment and prognosis of specific illnesses and established standards of therapeutic practice.

(9++) N2rs%>s E?0%r+%'1%

;enner >1?@57 notes that a nurse2s e.pertise develops after testing and refining propositions, questions and principle6based e.pectations. -or e.ample, after a nurse has cared for a client !ith abdominal pain there are lessons learned. "he nurse !ill recognize more quickly the behavior the client sho!ed !hile in acute pain. A nurse2s ability to make an assessment !ill improve from using past e.perience, applying relevant kno!ledge and focusing on data collection that avoids !asteful consideration of unnecessary information.

CLIENT DATABASE$

@ It includes sub:ective >Bmay reportC7 and ob:ective >Bmay e.hibitC7 data that !ould likely be collected through the history taking intervie!, physical assessment, diagnostic studies and revie! of prior records.

:.!.6 METHODS OF DATA COLLECTION: OBSERVATION:

It is a technique for collection the data through occurrences that can be observed though senses !ith or !ithout mechanical devices. 0bservations are a t!o6part process. %omeone is observing6observer, and there is something to observe the observed. It is primarily centered on naturalistic conditions. In observation, there are four broad questions they are

4hat should be observed3 ,o! should observation be recorded3 4hat procedures should be used to try to assure the accuracy of observation3

? 4hat relationship should e.ist bet!een the observer and the observed3 4hat is to be observed "he nurse uses the skill of observation to carefully and attentively note the general appearance and behavior of the client. "hese observations occur !henever there is contact !ith clients and include factors such as client mood, interaction !ith others, physical and emotional response and any safety considerations. 0bservation helps the nurse determine the client2s status, both physical mental. ;y carefully !atching the client, the nurse can detect nonverbal cues that indicate a variety of feeling, including presence of pain, an.iety, and anger. 0bservational skills are essential in detecting the early !arning sign of physical changes.

T8%r% )r% 9)r+-2s 08%'-&%') (8)( 1)' <% -<s%r9%, +' '2rs+'., F-r %?)&0*%
o haracteristics and conditions of individuals, such as physiological conditions

o /erbal communication behavior, such as linguistic behavior, people2s conversation o &on6verbal communication behavior, such as facial e.pressions, touch, posture, body movements o Activities for e.ample actions that serve as an inde. performance activity of nurses, performances of procedure o Environment characteristics, such as noise levels cleanliness that have profound effect on health or individual2s behavior. of health status,

INTERVIE4
Intervie! is a therapeutic interaction that has a specific purpose. "he intervie! for a variety of reasons throughout the nurse6client relationship, including data collection, teaching, e.ploration of client feelings or concern, and provision of support.

1E

!) I'(%r9+%= 0r%0)r)(+-':
#evie! client medical record, conservation !ith other health care team members and research of the presenting medical diagnosis. %hould kno! !hat data to be collected Preparing the intervie! environment includes Ensure lighting )aintain a comfortable room temperature -ree from noise lient privacy

") I'(%r9+%= S().%:

Assessment intervie! often occurs at the beginning of a nurse Dclient relationship, it is helpful in begin the process !ith an orientation. 1uring this period introduction are made, rapport is established, and roles are defined. "he first fe! minutes meeting may give an indication of the type of intervie!ing needed, so it is important that the nurse employ active listening skills. "here are three phases of intervie! Introduction phase 4orking phase losure phase

I'(r-,21(+-' 08)s%: Establish the goal for interaction6primary goal is collection of client data 1iscuss the uses of data collection Egg< I need to talk to you for a fe! minutes about your health so that, !e can better plan your care Adequate time and privacy should be provided &urse should inform appro.imate duration of intervie! Establish eye contact !ith client and listen attentively and note nonverbal communication 4-r@+'. 08)s%:

11

-ocus on detailed data collection %cope of intervie! depends upon the type of assessment Intervie! may be structured >!hen large amount of information needed7 and formal or unstructured and informal >information regarding specific area concern7 Intervie! starts !ith question about biographical and other no threatening information 1epth of information to be collected !ith help of format !hich is used by the hospital Information should be obtained from specific to general "echnique used in intervie! depends upon the type of assessment Egg$ omprehensive type60pen ended question 4hat led to your coming today3 -ocused type6direct closed question ,ave you been in the hospital before3 "he nurse should have reflective thinking !hile intervie!ing

C*-s2r% P8)s%
heck !hether all the relevant information are gathered %hould summarize !hat !as covered and request validation of perceptions !ith the client %hould not close the intervie! suddenly If the nurse or client feel additional time is needed for further e.ploration of specific points discussed during this session, plan can be made for future intervie!.

H%)*(8 H+s(-r;

1' A primary focus of the data collection intervie! is the health history. "he health history is a revie! of the client2s functional health patterns prior to the current contact !ith a health care agency.

D%&-.r)08+1 I'A-r&)(+-': Personal data include name, address, date of birth, gender, religion, race and ethnic origin, and occupation. "his information may be useful in helping to foster understanding of a client2s perspective. R%)s-' A-r S%%@+'. H%)*(8 C)r%: "he client2s reason for seeking health care should be described in the client2s o!n !ords. -or e.ample, the statement Bfell off four6foot ladder and landed on right shoulder< unable to move right armC is the client2s actual report of the event that precipitated the need for health care. P%r1%0(+-' -A H%)*(8 S()(2s: Perception of health status refers to clients2 opinions of their general health. Pr%9+-2s I**'%ss%s, H-s0+()*+/)(+-'s, )', S2r.%r+%s: "he history and timing of any previous e.periences !ith illness, surgery, or hospitalization are helpful in order to assess recurrent conditions. It is also helpful to anticipate responses to illness, since prior e.periences often have an impact on current responses. C*+%'( )', F)&+*; M%,+1)* H+s(-r;:

1( "he nurse needs to determine any family history of acute and chronic illnesses that tend to be familial. ,ealth history forms !ill frequently include checklists of various illnesses that can be used as the basis of the questions about this aspect.

I&&2'+/)(+-'s )', E?0-s2r% (- C-&&2'+1)<*% D+s%)s%:

Any history of childhood or other communicable disease should be noted. In addition, a record of current immunizations should be obtained. "his is particularly important !ith children< ho!ever, records of immunizations for tetanus, influenza, and hepatitis ; can also be important for adults. A**%r.+%s: Any drug, food, or environmental allergies should be noted in the health history. In addition to the name of the allergen, the type of reaction to the substance should be noted. -or e.ample, a client may report developing a rash or becoming short of breath. "his reaction should be recorded. C2rr%'( M%,+1)(+-'s: All medications currently taken, both prescription and over6the6counter, are to be recorded by name, frequency, and dosage. *se of alternative or complementary treatment methods, including herbals, is often not shared by health care consumers. D%9%*-0&%'()* L%9%*: Fno!ledge of developmental level is essential for considering appropriate norms of behavior and for appraising the achievement of relevant developmental tasks. Any recognized theory of gro!th and development can be applied in order to determine !hether clients are functioning !ithin the parameters e.pected for their age group. Ps;18-s-1+)* H+s(-r;: Psychosocial history refers to assessment of dimensions such as self6concept and self6esteem as !ell as usual sources of stress and the client2s ability to cope. %ources of support for clients in crisis >such as family, significant others, religion, or support groups7 should be e.plored. S-1+-12*(2r)* H+s(-r;:

15 It is important to inquire about the home environment, family situation, and client2s role in the family. -or e.ample, the client could be the parent of three children and the sole provider in a single6parent family.

A1(+9+(+%s -A D)+*; L+9+'.: "he activities of daily living is a description of the client2s lifestyle and capacity for self6care and are useful both as baseline information and as a source of insight into usual health behaviors. "his database should include the follo!ing areas$ N2(r+(+-'$ Includes type diet and foods eaten and fluids consumed regularly, food preparation, the size of portions, and the number of meals per day. preparation or eating, should also be determined. E*+&+')(+-': Includes both urinary and bo!el elimination frequency and patterns. Any recent changes or problems in these patterns should be noted. R%s( )', s*%%0$ Includes the usual number of hours of sleep, number of hours of sleep needed to feel rested, sleep aids used, and the time !ithin the day or night !hen sleep usually occurs. Any bedtime rituals >especially !ith children7 should also be noted. A1(+9+(; )', %?%r1+s%$ Includes types of e.ercise and patterns in a typical day or !eek. If assistance is needed !ith activities such as !alking, standing, or meeting hygienic needs, this information should be noted. R%9+%= -A S;s(%&s: "he revie! of systems >#0%7 is a brief account from the client of recent signs of symptoms associated !ith any pf the body systems. "his allo!s the client an opportunity to communicate any derivations from normal that have not been other !ise identified. #elevant data include$ -ood preferences and dislikes, as !ell as the client2s need for assistance in food

L-1)(+-': the area of the body in !hich the symptom >such as pain7 can either be pointed to or described in detail.

19 C8)r)1(%r: "he quality of the feeling or sensation >e.g., sharp, dull, stabbing7. I'(%'s+(;$ "he severity or quantity of the feeling or sensation and its interference !ith functional abilities. "he sensation can be rated on a scale of 1 >very little7 to 1E >very intense7. T+&+'.: "he onset, duration, frequency, and precipitating factors of the symptom. A..r)9)(+'. )', )**%9+)(+'. A)1(-rs$ "he activities or actions that make the symptom !orse or better.

P8;s+1)* E?)&+')(+-'
"he purpose of the physical e.amination is to make direct observations of any deviations from normal and to validate sub:ective data gathered through the intervie!. ;aseline measurements are obtained, and physical e.amination techniques are used to gather ob:ective data.

B)s%*+'% D)():
)easurements of height, !eight, and vital signs >temperature, pulse, respirations, and blood pressure7 are important for comparison !ith future measurements in order to :udge the significance of any changes >progress or regression7 over the time.

Ass%ss&%'( T%18'+B2%:
"he physical e.amination incorporates the use of visual, auditory, tactile and olfactory senses and the use of systematic assessment techniques.

PHYSICAL E5AMINATION TECHNICUES

-our basic techniques must be mastered before you can perform a thorough and complete assessment of the client. "hese techniques are inspection, palpation, percussion, and auscultation. "his chapter provides descriptions of each technique along !ith guidelines on ho! to perform the basic technique. *sing each technique for assessing specific body systems is described in the appropriate chapter. After performing each of the four assessment techniques, the e.aminer should ask herself questions that !ill

1= facilitate analysis of the data and determine areas in !hich more data may be needed. "hese questions include 1id I inspect, palpate, percuss, or auscultate any deviations from the normal findings3 >&ormal findings are listed in the second column of chapters.7 the Physical Assessment sections in the body systems

If there is a deviation, is it a normal physical, gerontologic, or cultural finding< an abnormal adult finding< or an abnormal physical, gerontologic, or cultural finding3 >&ormal gerontologic and cultural findings are in the second column of the Physical Assessment sections in the body systems chapters. Abnormal adult, genertologic, and cultural findings can be found in the third column of the Physical Assessment sections.7

;ased on my findings, do I need to ask the client more questions to validate or obtain more information about my inspection, palpation, percussion, or auscultation findings3

;ased on my observations and data, do I need to focus my physical assessment on other related body systems3

%hould I validate my inspection, palpation, percussion, or auscultation findings !ith my instructor or another practitioner3

%hould I refer the client and data findings to a primary care provider3

"hese questions help ensure that data is complete and accurate and facilitate analysis.

I's0%1(+-'

1A

Inspection involves using the senses of vision, smell, and hearing to observe and detect any normal or abnormal findings. "his technique is used from the moment that you meet the client and continuous throughout the e.amination. Inspection precedes palpation, percussion, and auscultation because the latter techniques can potentially alter the appearance of !hat is being inspected. Although most of the inspection involves the use of the senses only, a fe! body systems require the use of special equipment >e.g., ophthalmoscope for the eye inspection, otoscope for the ear inspection7.

Guidelines to practice the technique of inspection$

)ake sure the room is a comfortable temperature. A too6cold or too6hot room can alter the normal behavior of the client and the appearance of the client2s skin. *se good lighting, preferably sunlight. -luorescent lights can alter the true color of the skin. In addition, abnormalities may be over looked !ith dim lighting.

Hook and observe before touching. "ouch can alter appearance and distract you from a complete, focused observation.

1@ ompletely e.pose the body part you are inspecting !hile draping the rest of the client as appropriate. &ote the follo!ing characteristics !hile inspection the client$ color, patterns, size, location, consistency, symmetry, movement, behavior, odors, or sounds. ompare the appearance of symmetric body parts >e.g., eyes, ears, arms, hands7 or both sides of any individual body part.

P)*0)(+-'
Palpation consists of using parts of the hand to touch and feel for the follo!ing characteristics$ "e.ture >rough8smooth7, temperature >!arm8cold7, moisture >dry8!et7, mobility >fi.ed8movable8still8vibrating7, consistency >soft8hard8fluid filled7, strength of pulses >strong8!eak8thread8bounding7, size >small8medium8large7, shape >!ell defined8irregular7, and degree of tenderness. "hree different parts of the hand6the finger pads, ulnar8palmar surface, and dorsal surface6are used during palpation. Each part of the hand is particularly sensitive to certain characteristics.

1?

%everal types of palpation can be used to perform an assessment< they include

'E

Hight, )oderate, 1eep, or ;imanual palpation. "he depth of the structure being palpated and the thickness of the tissue overlying that structure determine !hether you should use light, moderate, or deep palpation.

;imanual palpation is the use of both hands to hold and feel a body structure.

In general, the e.aminer2s fingernails should be short and the hands should be a comfortable temperature. %tandard precautions should be follo!ed if applicable. Proceed from light palpation, !hich is safest and the most comfortable for the client, to moderate palpation and finally to deep palpation. %pecific instructions on ho! to perform the four types of palpation follo!$ L+.8( 0)*0)(+-'$ "o perform light palpations place your dominant hand lightly on the surface of the structure. "here should be very little or no depression >less than 1 cm7. -eel the surface structure using a circular motion. *se this technique to feel for pulses, tenderness, surface skin te.ture, temperature, and moisture. M-,%r)(% 0)*0)(+-'$ 1epress the skin surface 1 to ' cm >E.9 to E.A9 inch7 !ith your dominant hand, and use a circular motion to feel for easily palpable body organs and masses. &ote the size, onsistency, and mobility of structures you palpate. D%%0 0)*0)(+-'$ Place your dominant hand on the skin surface and your nondominant hand on top of your dominant hand to apply pressure ."his should result in a surface depression bet!een '.9 and 9 cm >1 and ' inches7. "his allo!s you to feel very deep organs or structures that ate covered by thick muscle.

'1 B+&)'2)* 0)*0)(+-'$ *se t!o hands, placing one on each side of the body part >e.g., uterus, breasts, spleen7 being palpated >-ig. 56(7. *se one hand to apply pressure and the other hand to feel the structure. &ote the size, shape, consistency, and mobility of the structures you palpate.

P%r12ss+-'

Percussion involves tapping body parts to produce sound !aves. "hese sound !aves or vibrations enable the e.aminer to assess underlying structures. Percussion has several different assessment uses, including E*+1+(+'. 0)+'$ Percussion helps to detect inflamed underlying structures. If an inflamed area is percussed, the client2s response may indicate or the client !ill report that the area feels tender, sore, or painful.

'' D%(%r&+'+'. *-1)(+-', s+/% )', s8)0%$ Percussion note changes bet!een borders of an organ and its neighboring organ can elicit information about location, size, and shape. D%(%r&+'+'. ,%'s+(;$ Percussion helps to determine !hether an underlying structure is filled !ith air or fluid or is a solid structure. D%(%1(+'. )<'-r&)* &)ss%s: Percussion can detect superficial abnormal structures or masses. Percussion vibrations penetrate appro.imately 9 cm deep. 1eep masses do not produce any change in the normal percussion vibrations. E*+1+(+'. r%A*%?%s$ 1eep tendon refle.es are elicited using the percussion hammer.

T;0%s -A 0%r12ss+-'
1irect, ;lunt, and Indirect. D+r%1( 0%r12ss+-' is the direct tapping of a body part !ith one or t!o fingertips to elicit possible tenderness >e.g., tenderness over the sinuses7. B*2'( 0%r12ss+-' is used to detect tenderness over organs >e.g., kidneys7 by placing one hand flat on the body surface and using the fist of the other hand to strike the back of the hand flat on the body surface. I',+r%1( -r &%,+)(% 0%r12ss+-' is the most commonly used method of percussion. "he tapping done !ith this type of percussion produces a sound or tone that varies !ith the density of underlying structures. As density increases, the sound of the tone becomes quieter. %olid tissue produces a soft tone, fluid produces a louder tone, and air produces an even louder tone. "hese tones are referred to as percussion notes and are classified according to origin, quality, intensity, and pitch. "he follo!ing techniques help to develop proficiency in the technique of indirect percussion$ Place the middle finger of your nondominant hand on the body part you are going to percuss.

'( Feep your other fingers off the body part being percussed because they !ill damp the tone you elicit3 *se the pad of your middle finger of the other hand >ensure that this fingernail is short7 to strike the middle finger of your nondominant hand that is placed on the body part. 4ithdra! your finger immediately to avoid damping the tone. 1eliver t!o quick taps and listen carefully to the tone. *se quick, sharp taps by quickly fle.ing your !rist, not your forearm.

Practice percussing by tapping your thigh to elicit a flat tone and your puffed6 out cheek to elicit a tympanic tone. A good !ay to detect changes in tone is to fill a carton half!ay !ith fluid and practice percussing on it. "he tone !ill change from resonance over air to a duller tone over the fluid.

%0*&1% >"0&E%7 EHI I"E1 ;I PE# *%%I0&

%ound #esonance >heard over Houd part air part solid7 ,yper6 resonance >heard over mostly air7 "ympany >heard over Houd air 1ullness >heard over )edium )edium )oderate "hudlike ,igh )oderate 1rumlike /ery loud Ho! Hong ;ooming Hung !ith emphysema Puffed6out cheek, gastric bubble 1iaphragm, pleural Ho! Hong ,ollo! &ormal lung Intensity Pitch Hength Juality E.ample of 0rigin

'5 more solid tissue7 -latness >heard over %oft very dense tissue7 ,igh %hort -lat effusion, liver )uscle, bone, sternum, thigh

A2s12*()(+-'

'9

'=

Auscultation is a type of assessment technique that requires the use of a stethoscope to listen for heart sounds, movement of blood through the cardiovascular system, movement of the bo!el, and movement of air through the respiratory tract. A stethoscope is used because these body sounds are not audible to the human ear. "he sounds directed using auscultation are classified according to "he intensity >loud or soft7, Pitch >high or lo!7, 1uration >length7, and Juality >musical, crackling, raspy7 of the sound

"he follo!ing guidelines should be follo!ed as you practice the technique of auscultation$

'A

Eliminate distracting or competing noises from the environment >e.g., radio, television, machinery7. E.pose the body part you are going to auscultate. 1o not auscultate through the client2s clothing or gro!n. #ubbing against the clothing obscures the body sounds. *se the diaphragm of the stethoscope to listen for high6pitched sounds, such as normal heart sounds, breath sounds, and bo!el sounds, and pres the diaphragm firmly on the body part being auscultated. *se the bell of the stethoscope to listen for lo!6pitched sounds such as abnormal heart sounds and bruits >abnormal loud, blo!ing, or murmuring sounds heard during auscultation7. ,old the bell lightly on the body part being auscultated.

E5AMPLE G%'%r)* 0r%s%'()(+-' -A s;&0(-&s: -ever, chills, malaise, pain, sleep patterns, fatigability. D+%(: Appetite likes and dislikes, restrictions, !ritten diary of food intake. S@+', 8)+r )', ')+*s$ #ash or eruption, itching, color or te.ture change, e.cessive s!eating, abnormal nail or hair gro!th. M2s12*-s@%*%()*$ Koint stiffness, pain, restricted motion, s!elling, redness, heat, deformity. H%), )', '%1@$ E;%s: /isual acuity, blurring, diplopia, photophobia, pain, recent change in vision E)rs: ,earing loss, pain, discharge, tinnitus, vertigo N-s%: %ense of smell, frequency of colds, obstruction, epista.is, sinus pain, or postnasal discharge

'@ T8r-)( )', &-2(8$ ,oarseness of change in voice, frequent sore throat, bleeding or s!elling of gums, recent tooth abscesses or e.tractions, soreness of tongue or mucosa

E',-1r+'% )', .%'+()*Dr%0r-,21(+9%: thyroid enlargement or tenderness, heat or cold intolerance, une.plained !eight change, polyuria, polydipsia, changes in distribution of facial hair< )ales6 Puberty onset, difficulty !ith erections, emissions, testicular pain, libido, infertility< -emales6 )enses >onset, regularity, duration, and amount7, dysmenorrheal, last menstrual period, date of last Pap smear, frequency of intercourse, age at menopause, pregnancies >number, miscarriages, abortions7, type of delivery, complications, use of contraceptives< breasts > pain, tenderness, discharge, lumps7 C8%s( )', *2'.s$ Pain related to respiration, dyspnea, cyanosis, !heezing, cough, sputum >character and quantity7, and e.posure to tuberculosis >";7, last chest L6 ray. H%)r( )', <*--, 9%ss%*s$ hest pain or distress, precipitating causes, timing and duration, relieving factors, dyspnea, orthopnea, edema, hypertension, e.ercise tolerance G)s(r-+'(%s(+')*: Appetite, digestion, food intolerance, dysphagia, heartburn, nausea or vomiting, bo!el regularity, change in stool color or contents, constipation or diarrhea, flatulence, hemorrhoids. G%'+(-2r+')r;: 1ysuria, flank or suprapubic pain, urgency, frequency, nocturia, hematuria, polyuria, hesitancy, loss in force of stream, edema, se.ually transmitted disease N%2r-*-.+1)*: %yncope, seizures, !eakness or paralysis, abnormalities of sensation or coordination, tremors, loss of memory. Ps;18+)(r+1: 1epression, mood changes, difficulty concentrating, nervousness, tension, suicidal, thoughts, irritability.

D+).'-s(+1 S(2,+%s

'? o Interpretation of diagnostic test results is integrated !ith the history and physical findings as part of ob:ective findings. %ome tests are used to diagnose disease, !hereas others are useful in follo!ing the course of a disease or in ad:usting therapies. o "he nurse needs to be a!are of significant test results that require reporting to the physician and8or initiation of specific nursing interventions. In many cases, the relationship of the test to the pathological physiology is clear, but in other cases it is not. "his is the result of the inter6relationship bet!een various organs and body systems.

:.". DATA VERIFICATIONDVALIDATING DATA

/alidation of data is the process of confirming or verifying that the sub:ective and ob:ective data you have collected is reliable and accurate. "he steps of validation include 1eciding !hether the data require validation, 1etermining !ays to validate the data, and Identifying areas !here data are missing.

F)+*2r% (- 9)*+,)(% ,)() &); r%s2*( +'

Premature closure of the assessment or collection of inaccurate data. Errors during assessment cause :udgments to be made on unreliable data, !hich result in diagnostic errors during the second part of the nursing process6analysis of data >determining nursing diagnoses7. "hus validation of the data collected during assessment of the client is crucial to the first step of the nursing process.

(E

D)() R%B2+r+'. V)*+,)(+-'

&ot every piece of data you collect must be verified. -or e.ample, you !ould not need to verify or repeat the client2s pulse, temperature, or blood pressure unless certain conditions e.ist. onditions that require data to be rechecked and validated include 1iscrepancies or gaps bet!een the sub:ective and ob:ective data. -or e.ample, a male client tells you that he is very happy despite learning that he has terminal cancer. 1iscrepancies or gaps bet!een !hat the client says at one time then at another time. -or e.ample, your female patient says she has never had surgery but later in the intervie! she mentions that her appendi. !as removed at a military hospital !hen she !as in the &avy. -indings that is very abnormal and8or inconsistent !ith other findings. -or e.ample, the follo!ing are inconsistent !ith each other$ the client has a temperature of 1E5 degrees -ahrenheit is resting comfortably, and her skin is !arm to the touch and not flushed.

M%(8-,s -A V)*+,)(+-'
"here are several !ays to validate your data$ #echeck your o!n data through a repeat assessment. -or e.ample, take the client2s temperature again !ith a different thermometer. larify data !ith the client by asking additional questions. -or e.ample, if a client is holding his abdomen the nurse may assume he is having abdominal pain, !hen actually the client is very upset about his diagnosis and is feeling nauseated. /erify the data !ith another health care professional. -or e.ample, ask a more e.perienced nurse to listen to the abnormal heart sounds you think you have :ust heard. ompare your ob:ective findings !ith your sub:ective findings to uncover discrepancies. -or e.ample, if the client states that she Bnever gets any time in the

(1 sun,C yet have dark, !rinkled, suntanned skin, you need to validate the client2s perception of never getting any time in the sun.

I,%'(+A+1)(+-' -A Ar%)s 48%r% D)() Ar% M+ss+'.

0nce you establish an initial database, you can identify areas !here more data are needed. Iou may have overlooked certain questions. In addition, as data are e.amined in a grouped format, you may realize that additional information is needed. -or e.ample, if an adult client !eighs only ?@ 1b, you !ould e.plore further to see if the client recently lost !eight or this has been the usual !eight for an e.tended time. If a client tells you he lives alone, you may need to identify the e.istence of a support system, his or her degree of social involvement !ith others, and his ability to function independently.

SCHEMATIC DIAGRAM DATA VALIDATION Assessment of client2s health status lient, family, health care resources comprise database

&urse clarifies inconsistent or unclear information ritical thinking guides and directs line of questioning and e.amination to reveal detailed and relevant database

/alidate data !ith other sources

Is additional data needed3 &o Ies

('

Interpret and analyze meaning of data

luster data Group signs and symptoms lassify and organize

;egin formulation of nursing diagnosis

:.6. DATA ORGANIZATION

After data collection is completed and information is validated, the nurse organizes, or clusters, the information together in order to identify areas of strengths and !eaknesses. "his process is kno!n as data clustering. A cluster is a set of signs or symptoms that are grouped together in a logical order. 1uring data clustering the nurse organizes data and focuses attention on client functions needing support and assistant for recovery. 1uring data clustering certain cues alert the nurse2s thinking processes more than others. "hese cues help to generate nursing diagnosis.

Ass%ss&%'( M-,%*s:
An assessment model is a frame!ork that provides a systematic method for organizing data. "he use of a model helps to ensure comprehensive and organized data collection.

9.(.1&ursing )odels$
&ursing models have been developed to focus on a !ide range of human responses to alterations in health status. "hese models typically include psychosocial, %ociocultural, and behavioral data as !ell as biophysical data. &ursing models may offer

(( the advantage of organizing information in a mode that more easily allo!s transition from data collection to nursing diagnoses.

F2'1(+-')* H%)*(8 P)((%r's:

H%)*(8 0%r1%0(+-' 8%)*(8 &)').%&%'( 0)((%r'$ 1escribes client2s perceived pattern of health and !ell6being and ho! health is managed. N2(r+(+-')* &%()<-*+1 0)((%r'$ 1escribes pattern of food and fluid consumption relative to metabolic need and pattern indicators of local nutrient supply. E*+&+')(+-' 0)((%r'$ 1escribes patterns of e.cretory function >bo!el, bladder, and skin7. A1(+9+(; %?%r1+s% 0)((%r'$ 1escribes pattern of e.ercise, activity, leisure, and recreation. C-.'+(+9% 0%r1%0(2)* 0)((%r'$ 1escribes sensory6perceptual and cognitive patter. S*%%0 r%s( 0)((%r'$ 1escribes pattern of sleep, rest, and rela.ation. S%*A 0%r1%0(+-' s%*A 1-'1%0( 0)((%r'$ 1escribes self6concept pattern and perceptions of self. R-*% r%*)(+-'s8+0 0)((%r'$ 1escribes pattern of role engagements and relationships. S%?2)*+(; r%0r-,21(+9% 0)((%r': 1escribes patterns of satisfaction or dissatisfaction !ith se.uality< describes reproductive patters. C-0+'. s(r%ss (-*%r)'1% 0)((%r'$ 1escribes coping pattern and its effectiveness in stress tolerance. V)*2% <%*+%A 0)((%r'$ 1escribes goals and value and belief patterns that underlie decision making.

E?)&0*% A-r F2'1(+-')* H%)*(8 P)((%r' F-r&)(

A1(+9+(; )', E?%r1+s% P)((%r' %tatement of increased fatigue !hen !alking 1emonstration of ability to perform activities of daily living A1Hs Increased pulse from ?E to 1'= beats per minute during A1Hs S*%%0 )', R%s( P)((%r'

(5 #eport of difficulty in falling and remaining asleep 1enial of use of sleeping aids C-0+'. S(r%ss T-*%r)'1% P)((%r' An.iety about illness Pain

M%,+1)* R%1-r,
Previous history of decreased activity tolerance and poor sleeping. 1iagnosed !ith emphysema 1 year ago. hest L6ray film sho!ing pulmonary congestion

H2&)' R%s0-'s% P)((%r':

"he &orth American &ursing 1iagnosis Association >&A&1A7, in an effort to standardize terminology related to client problems, has developed ta.onomy of nursing diagnoses >&A&1A, 'EE97. "he first ta.onomy !as completed in 1?A( and consisted of (1 diagnostic categories. "his ta.onomy has developed into over 1EE diagnostic categories arranged in a hierarchical structure organized according to nine human response patterns. "his frame!ork suggests that a person2s health status is evidenced by observable phenomena that can be classified into one of these response patterns. "hese human response patterns can then be used a model for organizing data

collection.

T8%-r; -A S%*A C)r%:

*niversal %elf6 are #equisites 1. "he maintenance of a sufficient intake of air. '. "he maintenance of a sufficient intake of !ater. (. "he maintenance of a sufficient intake of food. 5. "he provision of care associated !ith elimination processes and e.crement. 9. "he maintenance of a balance bet!een activity and rest. =. "he maintenance of a balance bet!een solitude and social interaction.

(9 A. "he prevention of hazards to human life, human functioning, and human !ell6 being. @. "he promotion of human functioning and development !ithin social groups in accord !ith human potential, kno!n human limitations, and human desire to be normal. >&ormalcy is used in the sense of that !hich is essentially human and that !hich is in accord !ith the genetic and constitutional characteristics and the talents of individuals.7

R-;>s A,)0()(+-' M-,%*:

Adaptive )odes 1. Physiologic needs Activity and rest &utrition Elimination -luid and electrolytes 0.ygenation Protection #egulation$ temperature #egulation$ the senses #egulation$ endocrine system Physical self Personal self

'. %elf6concept

(. #ole function 5. Interdependence

N-' N2rs+'. &-,%*:

B-,; s;s(%&s &-,%*:
"he body systems model focuses on abnormalities of the follo!ing anatomic systems$

(= Integument system #espiratory system ardiovascular system

&ervous system )usculoskeletal system Gastrointestinal system Genitourinary system #eproductive system Immune system

E?)&0*% A-r F-12s%, D)() C*2s(%r+'. )11-r,+'. (- s;s(%& &-,%*:

S;s(%& Or+%'(%, F-r&)( I'(%.2&%'( s;s(%& Intact, flushed skin that is hot and dry to touch 1ry oral mucosa, coated tongue, and cracked lips G)s(r-+'(%s(+')* s;s(%& 1istended, firm abdomen that is tender to palpation in lo!er quadrants ,yperactive bo!el sounds in all quadrants ,istory of diarrhea and cramping for ( !eeks Poor nutritional intake over last !eek. M%,+1)* R%1-r, Haboratory tests indicating elevated !hite blood cell >4; 7 count and hematocrit level$ hypernatremia Abdominal L6ray e.amination sho!ing gas6filled loops of bo!el Admitting diagnosis of gastroenteritis

M)s*-=>s H+%r)r18; -A N%%,s:

)aslo!2s hierarchy of needs clusters data pertaining to follo!ing$ Physiologic needs >survival needs7 %afety and security needs

(A Hove and belonging needs %elf6esteem needs %elf6actualization needs

D%9%*-0&%'()* T8%-r+%s
%everal physical, psychosocial, cognitive, and moral developmental theories may be used by the nurse in specific situation. E.amples include the follo!ing$ ,avighurst2s age periods and developmental tasks -reud2s five stages of development Erickson2s eight stages of development Piaget2s phases of cognitive development Fohlberg2s stages of moral development

:.7 DATA INTERPRETATION:

1ata clustering facilitates recognition of patterns, and determination of further data that are needed. 1ata interpretation is necessary for identification of nursing diagnoses. "hrough data interpretation, the nurse e.amines all the information collected and seeks to make it meaningful in order to correctly determine pertinent client problems. After the data collection and validation the collected data should undergo interpretation through the process of inferential reasoning and :udgment. "he nurse interprets the data to decide !hat information has meaning in relation the client2s health status. Inferential reasoning involves the process of attaching ne! meaning to kno!n clinical data. E..$ !hen entering the client2s room at = A) the nurse notices the client is out of bed , and bed linen is pulled do!n to the end of the bed and t!isted in a lump ,!ith the blanket on the floor.>inference$ the bed linen is in disarray7. "he closer inspection finds the client sitting up in the chair, holding is his incision firmly, breathing slo!ly, and stating, BI didn2t get much sleep at nightC >Inference$ client has inadequate sleep7

(@ Interpretation of data summarizes the data and provides a focus for attention. ritical thinking in a client assessment enables a nurse to fully understand a client2s problems more carefully, and discover possible relationships bet!een problems

:.: DATA DOCUMENTATION:

1ocumentation of assessment data is another crucial part of the first step in the nursing process. "he significance of this aspect of assessment is addressed specifically by various state nurse practice acts, accreditation and8or reimbursement agencies >e.g., "he Koint ommission on Accreditation of ,ealthcare 0rganizations MK A,0N, )edicare, )edicaid7, professional organizations >local, state, and national7, and institutional agencies >acute, transitional, long6term, and home care7. K A,0, for e.ample, has specific standards that address documentation for assessments. ,ealth care institutions have developed assessment and documentation policies and procedures that provide not only the criteria for documenting but also assistance in completing the forms. "he categories of information on the forms are designed to ensure that the nurse gathers pertinent information needed to meet the standards and guidelines of the specific institutions mentioned previously and to develop a plan of care for the client. I'A-r&)(+-' R%B2+r+'. D-12&%'()(+-' Every institution is unique !hen it comes to documenting assessments. ,o!ever, t!o key elements need to be included in every documentation$ nursing history and physical assessment, also kno!n as sub:ective and ob:ective data. )ost data collection starts !ith sub:ective data and ends !ith ob:ective data. PURPOSES OF ASSESSMENT DOCUMENTATION Provides a chronologic source f client assessment data and a progressive record of assessment findings that outline the client2s course of care. Ensures that information about the client and family is easily accessible to members of the health care team< provides a vehicle for communication< and prevents fragmentation, repetition, and delays in carrying out the plan of care.

(? Establishes a basis for screening or validating proposed diagnoses. Acts as a source of information to help diagnose ne! problems. 0ffers a basis for determining the educational needs of the client, family, and significant others. Provides a basis for determining eligibility for care and reimbursement. reimbursement for transitional or skilled care needed by the client. onstitutes a permanent legal record of the care that !as or !as not given to the client. -orms a component of client acuity system or client classification systems &umeric values may be assigned to various levels of care to help determine the staffing mi. for the unit. Provides access to significant epidemiologic data for future investigations and research and educational endeavors.
Promotes compliance !ith legal, accreditation, reimbursement, and professional standard requirements.

areful

recording of data can support financial reimbursement or gain additional

G2+,%*+'%s A-r D-12&%'()(+-'

"he !ay that the nursing assessments are recorded varies among practice settings. ,o!ever, several general guidelines apply to all settings. "hey include D-12&%'( *%.+<*; -r 0r+'( '%)(*; +' '-' %r)s)<*% +'@ . Errors in

documentation are usually corrected by dra!ing one line through the entry, !riting Berror,C and initialing the entry. &ever obliterate the error !ith !hite paint or tape, an eraser, or a making pen. Feep in mind that the health record is a legal document.

5E Us% 1-rr%1( .r)&&)r )', s0%**+'.. *se only abbreviations that are acceptable and approved by the institution. Avoid slang, :argon, or labels unless they are direct quotes. A9-+, =-r,+'%ss (8)( 1r%)(%s r%,2',)'1;. -or e.ample, do not record$ BAuscultated gurgly bo!el sounds in right upper, right lo!er, left upper, and left lo!er abdominal quadrants. ,eard (= gurgles per minute.C Instead record$ B;o!el sounds present in all quadrants at (=8minute.C Us% 08r)s%s +'s(%), -A s%'(%'1%s (- r%1-r, ,)(). -or e.ample, avoid recording$ B"he client2s lung sounds !ere clear both in the right and left lungs.C Instead record$ B;ilateral lung sounds clear.C R%1-r, ,)() A+',+'.s, '-( <-= (8%; =%r% -<()+'%, . -or e.ample, do not record$ B lient !as intervie!ed for past history of high blood pressure, and blood pressure !as taken.C Instead record$ B,as (6year history of hypertension treated !ith medication. ;P sitting right arm 15E8@=, left arm 1(=8@=.C 4r+(% %'(r+%s -<E%1(+9%*; =+(8-2( &)@+'. 0r%&)(2r% E2,.&%'(s -r ,+).'-s%s. *se quotation marks to identify clearly the client2s responses. -or e.ample, record$ B lient crying in room, refuses to talk, husband has gone homeC instead of Bclient depressed due to fear of breast biopsy report and not getting along !ell !ith husband.C Avoid making inferences and diagnostic statements until you have collected and validated all data !ith client and family. R%1-r, (8% 1*+%'( 2',%rs()',s )', 0%r1%0(+-' -A 0r-<*%&s . -or e.ample, record$ B lient e.pressed concern regarding being discharged soon after gallbladder surgery because of inability to rest at home !ith si. children.C A9-+, r%1-r,+'. (8% =-r, F'-r&)*G A-r '-r&)* A+',+'.s . -or e.ample, do not record$ Bbody temperature is normal.C Instead record$ Bthe body

51 temperature is ?@.= degree -ahrenheit.C In some health care settings, ho!ever, only abnormal findings are documented if the policy is to chart by e.ception only. In that case, no normal findings !ould be documented in any format. R%1-r, 1-&0*%(% +'A-r&)(+-' )', ,%()+*s A-r )** 1*+%'( s;&0(-&s -r %?0%r+%'1%s. -or e.ample, do not record$ B lient has pain in lo!er back.C Instead record$ B lient reports aching burning pain in lo!er back for ' !eeks. Pain !orsens after standing for several hours. #est and ibuprofen used to take edge off pain. &o radiation of pain. #ates pain as A on scale of 1 to 1E.C I'1*2,% ),,+(+-')* )ss%ss&%'( 1-'(%'( =8%' )00*+1)<*% >e.g., include information about the caregiver or last physician contact7. S200-r( -<E%1(+9% ,)() =+(8 s0%1+A+1 -<s%r9)(+-'s -<()+'%, ,2r+'. (8% 08;s+1)* %?)&+')(+-'. -or e.ample, !hen describing the emotional status of the client as depressed, follo! it !ith a description of the !ays depression is demonstrated such as Bdressed in dirty clothing, avoids eye contact, unkempt appearance, and slumped shoulder data

H.CONCLUSION.
Assessment does not e.ist in isolation from the other steps of the nursing process. ritical thinking is a necessary part of assessment to kno! !hat the question to ask and !hat the ans!ers mean, ho! to follo! up and ho! to recognize etiology of the problem. %o nurses should assess the client properly and adequately in order to provide better possible nursing care.

BIBLIOGRAPHY$
1. Achely Hauded, N2rs+'. D+).'-s+s H)',<--@, @th edition, )osby Publications 'EE@, Page '619 '. ;arbara herry, C-'(%&0-r)r; N2rs+'. Iss2%s Tr%',s & M)').%&%'(, )osby Publication, 'nd Edition.

5'

(. anal, N2rs+'. C)r% P*)''+'. Grudes, =th edition, %ounders Publications 'EE9, Page &o$ (61E 5. raven #uth, et.al, F2',)&%'()*s -A N2rs+'. IH2&)' 8%)*(8 &A2'1(+-', 'EEA, 9th edition, Hippincott 4illiams+4illiam, Philadelphia, pp '5(6'95 9. 1oenges, )arilynn E. A00*+1)(+-' -A N2rs+'. Pr-1%ss )', N2rs+'. D+).'-s+s: A' I'(%r)1(+9% T%?( A-r D+).'-s(+1 R%)s-'+'., -A 1avis Publications 'EE(, 5th edition, Page &o$ 1E6'E =. 1uGas, A C-&0r%8%'s+9% )00r-)18 (-'2rs+'.,'EE',5th edition,%aundes Publisher, &e! 1elhi A. Elkin Perry Potter, N2rs+'. I'(%r9%'(+-'s & C*+'+1)* S@+**s , 5th edition, )osley Publications 'EE5, Page &o$ '56'@ @. ,arkreader ,elen+ )ary Ann, F2',)&%'()*s -A N2rs+'. 1)r+'. )', 1*+'+1)* E2,.&%'(, 'EE=, (rd edition, Evolve publisher, )issouri, pp no ?96 11' ?. Fozier+ Erbs, F2',)&%'()*s -A N2rs+'., @th edition, Pearson Publications 'EE@, Page &o$ 1A=61?5 1E. Hinton, I'(r-,21(+-' (- M%,+1)* S2r.+1)* N2rs+'., 5th edition, %ounders Publication, 'EEA, Page &o$ 51659 11. Hong ;arbara. . et.al, M%,+1)* s2r.+1)* N2rs+'. A N2rs+'. 0r-1%ss A00r-)18, 1??(, (rd edition, )osby publication,pp 1''E61''A 1'. Hym, C*+'+1)* N2rs+'. S@+**s & N2rs+'. Pr-1%ss A00r-)18 , 'nd edition, Hippincott Publications, 'EE@ 1(. Potter + Perry, F2',)&%'()*s -A N2rs+'., 9th edition, /olume D 1 )osby Publications 'EE1, Page &o$ '?16'?A 15. %uzanne. &o$ '96(E. and ;renda. G, ;runner and %iddhartha2s "e.tbook of M%,+1)* S2r.+1)* N2rs+'., @th edition, Hippincott Publications 1??=, Page

5(

19. %ue. .1elaune+Patricia, F2',)&%'()*s -A N2rs+'., 'ndedition, 'EE@, "homson publisher, Australia, pp no ?=611' 1=. "aylor, F2',)&%'()*s -A '2rs+'., =th edition, Hippincott Publications 'EE9, Page &o$ (196('E 1A. "immy ;arbara2s., F2',)&%'()*s N2rs+'. s@+**& 1-'1%0(s, 'EE9, @th edition, Hippincott company, *%A, pp no ''56'(5 1@. 4hite Houis, F-2',)(+-' +' N2rs+'., 'EE9, 'nd edition, "homson publisher, *F, pp('(6((5

JOURNALS
1. &ightingale &ursing "ime, Pr-0%r R%1-r, @%%0+'. &)@%s ;-2 s&+*% )*=);s, -eb6'EE=, /olume61, Issue611,pp '16'(+9(695 '. &ightingale &ursing "ime, A s(2,; -' N2rs+'. 0r-1%ss +(s )00*+1)(+-', -eb6'EE=, /olume61, Issue611,pp (16(( 6. &ightingale &ursing "ime, EAA%1(+9% ,%1+s+-' &)@+'. &0r-<*%& s-*9+'. I' '2rs+'. 0r-1%ss )00*+1)(+-', oct 6'EEA, /olume6(, Issue6A, pp 9A69?

NETREFERENCE 1. http$88!!!.pubmed.com '. http<88!!!.nursingcenter.com (. http$88!!!.nursing!orld.com 5. http$88 !!!.googlesearch.com TABLE OF CONTEN %.&0 1 I&1E&"
Introduction

Page &0

55

' ( 5

"erminologies Purpose of Assessment "ypes of Assessment a. omprehensive b. -ocused c. 0ngoing

Elements of assessment Process 9.1 1ata ollection a. "ypes b. %ources c. )ethods of data collection 9.' 1ata /alidation 9.( 1ata 0rganization Assessment6&ursing model &on6nursing model 9.5 1ata Interpretation 9.9 1ata 1ocumentation

= A

onclusion ;ibliography