Introduction to the Nursing Assessment

Comprehensive vocabulary flashcards covering the fundamentals of nursing assessment, communication techniques, and disease prevention levels based on PN228 lecture notes.

PN228

The course code for Nursing Assessment taught by Pat Molcan in Spring 2026.

Required Lab Equipment

Includes a stethoscope, blood pressure cuff, pencil, Jarvis Physical Examination and Health Assessment text ($3^{RD}$ Ed.), and NANDA Nursing Diagnosis Handbook.

CLO #1

The course learning outcome that examines how the nursing assessment establishes the nursing process and initiates the therapeutic nurse-client relationship.

Gordon’s Functional Health Patterns

A conceptual framework developed by Marjorie Gordon in $1987$ used to organize, guide, and cluster nursing assessment data into $11$ standardized categories.

Inlow’s 60-second diabetic foot screen

An assessment tool used in diabetic foot screening aimed at preventing diabetic foot ulcers.

PODS

The Patient Oriented Discharge Summary used when individuals transition from hospital to home.

PAINAD

The Pain Assessment in Advanced Dementia Scale used to measure a client's pain level.

Subjective Data

Information collected during the assessment phase based on what the patient states (e.g., "I have a sore back").

Objective Data

Information collected from what the nurse observes, measures, and assesses (e.g., Vital Signs, Braden Score).

Therapeutic Nurse-Client Relationship

A CNO Practice Standard emphasizing skills such as empathy, active listening, and unconditional positive regard.

Power Differential

The dynamic where nurses and healthcare providers often have more knowledge about the healthcare system than patients and families.

NOD

An acronym used to start the introduction of an interview with a patient.

Open-Ended Questions

Questions used during the working phase of an interview that encourage the patient to respond and express themselves freely.

Closed or Direct Questions

Questions that ask for specific information and elicit short one or two-word answers, such as "yes" or "no".

Ten Traps of Interviewing

A list of avoidable behaviors including providing false assurance, giving unwanted advice, using avoidance language, and using "Why" questions.

ADPIE

The acronym for the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation.

Focused Assessment

A nursing assessment that narrows in on specific areas of concern after a full head-to-toe assessment is completed.

Episodic Assessment

An assessment conducted when there is a change in the patient's condition, such as new abdominal pain.

Primary Prevention

Refers to the promotion of health and prevention of illness or injury before it occurs, such as immunizations or sanitation.

Secondary Prevention

The early detection of disease before symptoms emerge, such as Pap tests or mammography.

Tertiary Prevention

The prevention of complications when a condition or disease is already present, such as daily foot inspections for a diabetic patient.

Health Promotion

Defined by the WHO as the process of enabling people to increase control over, and to improve, their health.

Social Determinants of Health

Factors such as socioeconomic environment, physical environment, gender, and culture that influence a patient's health care experiences.

Braden Scale

A screening tool used to assess a patient's risk for pressure injuries; a score of $12$ indicates high risk.

Morse Fall Scale

A screening tool used to assess a patient's risk for falls; a score of $45$ indicates a high risk.