Roles & Responsibilities of a Nurse

”
1. Caregiver/ Care provider - the traditional and most essential role

functions as nurturer, comforter, provider
“mothering actions” of the nurse
provides direct care and promotes comfort of client
activities involves knowledge and sensitivity to what matters and what is important to clients
shows concern for client welfare and acceptance of the client as a person

Head-To-Toe Assessment (S. Extremities)

Inspection

Observe for size, contour, bilateral symmetry, and involuntary movement.
Look for gross deformities, edema, presence of trauma such as ecchymosis or other discoloration.
Always compare both extremities.

Palpation

Feel for evenness of temperature. Normally [...]

Head-To-Toe Assessment (R. Abdomen)

In abdominal assessment, be sure that the client has emptied the bladder for comfort. Place the client in a supine position with the knees slightly flexed to relax abdominal muscles.
Inspection of the abdomen

Inspect for skin integrity (Pigmentation, lesions, striae, scars, veins, and umbilicus).
Contour [...]

Head-To-Toe Assessment (Q. Breast)

Inspection of the Breast
There are 4 major sitting position of the client used for clinical breast examination. Every client should be examined in each position.

The client is seated with her arms on her side.
The client is seated with her arms abducted over the head.
The [...]

Head-To-Toe Assessment P. Thorax (Cardiovascular System)

Inspection of the Heart
The chest wall and epigastrum is inspected while the client is in supine position. Observe for pulsation and heaves or lifts
Normal Findings:

Pulsation of the apical impulse maybe visible. (this can give us some indication of the cardiac size).
There [...]

Head-To-Toe Assessment (O. Neck)

The neck is inspected for position symmetry and obvious lumps visibility of the thyroid gland and Jugular Venous Distension.
Normal Findings:

The neck is straight.
No visible mass or lumps.
Symmetrical
No jugular venous distension [...]

Head-To-Toe Assessment N. Cranial Nerve I (olfactory Nerve)

To test the adequacy of function of the olfactory nerve:

The client is asked to close his eyes and occlude.
The examiner places aromatic and easily distinguish nose. (e.g. coffee).
Ask the client to identify the odor.
Each side [...]

Head-To-Toe Assessment (M. Nose and Paranasal Sinuses)

The external portion of the nose is inspected for the following:
1.     Placement and symmetry.
2.    Patency of nares (done by occluding nosetril one at a time, and noting for difficulty in breathing)
3.    Flaring of alaenasi
4.    Discharge
The external nares are palpated for:
1.    Displacement of bone and cartilage.
2.    For tenderness and masses
The internal nares are inspected by heperextending [...]

Head-To-Toe Assessment (L. Ears)

1. Inspect the auricles of the ears for parallelism, size position, appearance and skin color.
2. Palpate the auricles and the mastoid process for firmness of the cartilage of the auricles, tenderness when manipulating the auricles and the mastoid process.
3. Inspect the auditory meatus or the [...]

Head-To-Toe Assessment K. Cranial Nerve III, IV & VI (Oculomotor, Trochlear, Abducens)

All the 3 Cranial nerves are tested at the same time by assessing the Extra Ocular Movement (EOM) or the six cardinal position of gaze.
Follow the given steps:
1.     Stand directly in front of the client and hold a finger or a penlight about 1 ft from the client’s eyes.
2.    Instruct the client to follow the [...]