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    NCM 101 RLE 1A

    Uploaded by

    Karl Estrada
    This document provides an assessment guide for a normal client that includes 14 sections covering personal data, family background, general health status assessments of various body systems, identified health problems, and recommendations. The personal data section includes biographical information, contact details, medical history, and insurance. The family background section covers family structure, the client's role, ethnic group, hereditary diseases, and immunization history. The guide aims to identify current and potential health issues.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    NCM 101 RLE 1A

    Uploaded by

    Karl Estrada
    291 views9 pages
    This document provides an assessment guide for a normal client that includes 14 sections covering personal data, family background, general health status assessments of various body systems, identified health problems, and recommendations. The personal data section includes biographical information, contact details, medical history, and insurance. The family background section covers family structure, the client's role, ethnic group, hereditary diseases, and immunization history. The guide aims to identify current and potential health issues.

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    ncm-101-RLE-1A

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    This document provides an assessment guide for a normal client that includes 14 sections covering personal data, family background, general health status assessments of various body systems, identified health problems, and recommendations. The personal data section includes biographical information, contact details, medical history, and insurance. The family background section covers family structure, the client's role, ethnic group, hereditary diseases, and immunization history. The guide aims to identify current and potential health issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    291 views9 pages

    NCM 101 RLE 1A

    Uploaded by

    Karl Estrada
    This document provides an assessment guide for a normal client that includes 14 sections covering personal data, family background, general health status assessments of various body systems, identified health problems, and recommendations. The personal data section includes biographical information, contact details, medical history, and insurance. The family background section covers family structure, the client's role, ethnic group, hereditary diseases, and immunization history. The guide aims to identify current and potential health issues.

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    © All Rights Reserved
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    NCM 101 RLE

    ASSESSMENT GUIDE OF A NORMAL


    CLIENT
    I.  Personal Data
    II.  Family Background
    III.  General Assessment
    IV.  Motor Ability Status
    V.  Nutrition Status
    VI. Elimination Status
    VII. Reproductive Status
    VIII. Circulatory Status
    ASSESSMENT GUIDE OF A NORMAL
    CLIENT
    IX. Respiratory Status
    X. State of Physical Rest and Comfort
    XI. Emotional Status
    XII. State of Skin Appendages
    XIII. Health Maintenance Activities
    XIV. List of Problems Identified
    I. Biographical/Personal Data
    •  provide you with direct information related
    to a current health problem, alert you to
    risk factors for health problems, and
    point out the need for referrals.
    •  Y o u r p a t i e n t ’ s a b i l i t y t o p r o v i d e
    biographical data accurately reflects his or
    her mental status.
    I. Biographical/Personal Data
    •  Patient’s name •  Educational level
    •  Address, •  Occupation
    •  Phone number •  S o c i a l s e c u r i t y
    •  Contact person number/ health
    •  Age/birth date insurance.
    •  Place of birth
    •  Gender
    •  Religion
    •  Marital status
    I. Biographical/Personal Data
    •  Person who provided the history and her or his
    reliability as well as the person who referred the
    patient.
    •  Information on advance directives may also be
    obtained for hospital admissions. Also note any
    special considerations, such as the use of an
    interpreter.
    II. FAMILY BACKGROUND
    A.  Family Structure •  Grandparent Family
    •  Nuclear •  Adolescent Family
    •  Extended •  Foster Family
    •  Single Parent •  Cohabiting Family
    Family
    •  Gay and Lesbian
    •  Childless Family Family
    •  Two Career Family •  Cohabiting Family
    •  Step/blended •  Single Adults living
    Family Alone
    II. FAMILY BACKGROUND
    B. Role in Family
    •  A family role is the position one has
    within the family household.
    •  One's role encompasses how much
    power the individual holds within
    the family system and their
    responsibilities, as well as their impact on
    other family members.
    II. FAMILY BACKGROUND
    c. Ethnic Group
    •  the ties are reckoned by blood and traced
    through the family tree.
    d. Herido-familial disease
    •  A familial disease is hereditary, passed on
    from one generation to the next.
    e. Immunization History

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