N3314: Health Assessment Midterm

How do you increase understanding of culture diversity in patients?

by being self aware and knowledgable

Definition: health outcome lower in one group than other. This has nothing to do with genetics or patho of disease

Healthcare disparity

4 basic characteristics of culture

learned, shared, adapted, dynamic

4 basic characteristics of culture: __________ FROM BIRTH THROUGH PROCESS OF LANGUAGE QCQUISITION AND SOCIALIZATION

Learned

4 basic characteristics of culture: ______ by all members of the same cultural group

Shared

4 basic characteristics of culture: ____________ to specific conditions environmental and technical factors in the context of available resources

Adapted

4 basic characteristics of culture: _____ interphase that is ever changing

Dynamic

Maintain old and integrate new culture

Biculturalism

social group with shared traits

ethnicity

process of adopting culture and behavior of the majority culture

acculturation

broader term that encompasses something larger than one's own existence with a belief in transcendence

spirituality

an organized system of beliefs asa shared experience that can assist in meeting one's individual spiritual needs

religion

social construct for group who shares smilier bio or genetic trait

race

disease causation theories: cause and effect

biomedical or scientific

disease causation theories: forces in nature must remain in balance

naturalistic or holistic

disease causation theories: supernatural forces dominate resulting in good versus evil

magicoreligious

Possessing basic knowledge of and constructive attitudes toward diverse cultural populations

culturally sensitive

Applying underlying background knowledge necessary to provide the best possible health care

culturally appropriate

implies that the caregivers understand and attend to the total context of the individual's situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences

culturally competent

professional health care that is culturally sensitive, appropriate, and competent

cultural care

information said by the patient

subjective

information observed by the nurse

objective

begins when you first meet patient. Comes first. Requires good lighting, adequate exposure, occasional use of instruments (penlight, etc)

Inspection

When you're inspecting a patient you start off with the _____________ invasive

least

applies sense of touch to assess temperature, moisture, texture, presence of tenderness or pain

Palpation

When palpating a patient, pain area is assessed in what order?

pain area last

When palpating a patient what is the best way to do so?

interminnet pressure rather then one long continuous

tapping person's skin with short sharp strokes to assess underlying structures

percussion

listening to sounds produced by body

auscultation

caused by prolonged exposure to high levels of cortisol (stress hormone).Moon face, striae, cervical neck obesity, weight gain

Cushing's syndrome

Excessive bruises above knees and elbows are signs of

physical abuse

capillary refill

depress nail edge to blanch and then release, noting return if color. If it takes more than 1-2 seconds concern is blood

Normal nail curve

160 degrees

Early nail clubbing

180 degrees

What does early nail clubbing indicate

chronic low oxygenation in the body

ABCDEF Skin assessment

A- asymmetry

B- border

C- color

D0 diameter

E- elevation and enlargement

F- funny looking ugly duckling (different from others)

Pregnancy skin shows what?

-Striae

-Linea nigra (brownish black line down the midline

-Chloasma (hyperpigmentation on the face)

-Vascular spiders

Aging skin shows what?

- Liver spots

- Keratoses (spots lightly raised)

- Xerosis (rough dry skin)

- skin tags

- thin parchment

- decreased hair growth

- decreased nail growth and brittle nails

Aging adult, what happens to skin?

loses elasticity, sags and skin folds

Aging adult: what happens to sweat and sebaceous glands?

decrease in number and function, leaving skin dry

Aging adult: senile purpura

discoloration due to increasing capillary fragility

Aging adult: skin breakdown

cell replacement is slower and wound healing is delayed

Aging adult: hair

functioning melanocytes decrease leading to gray fine hair

Increases pigmentation of midline abdomen

linea nigra

discoloration changes on face representing the "mask of pregnancy"

chloasma

palor

paleness, white

cyanosis

blueing

erythema

redness

jaundice

yellow

What is the most important environmental risk factor for skin cancer?

exposure to UV radiation both from sun and indoor taking source

begins in center and spreads to periphery

Annular or circular lesions

Run together (ex. hives)

confulent lesions

distinct, individual lesions that remain separate (ex. acne)

discrete lesions

twisted, coiled spiral, snakelike

gyrate lesion

clusters of lesions

grouped lesions

a scratch, streak, line, or stripe

linear lesion

A roughly circular lesion with red edges and central blanching (ROS Skin). Bullseye

target lesion

linear arrangement along a unilateral nerve route

Zosteriform lesion

annular lesions grow together

polycyclic lesion

(Flat)

Freckle

macule

mole, wart, elevated<1 cm

papule

solid, hard, elevated >1cm

nodule

raised mosquito bite

Wheal

filled with fluid

cyst

acne, elevated

pustule

small 1-3mm, red nonblanchung macular lesions caused by intradermal capillary bleeding

petechiae

larger raised lesions resulting from bleeding within the skin

purpura

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising. purple patch

Echymosis

Scales—hyperpigmented in whites, depigmented in dark-skinned people; on chest, abdomen, back of arms forming multiple circular lesions with clear centers. Ringworm of th body

Tinea Corporis

a common vascular cancer in HIV-infected persons. Considered an AIDS-defining illness, KS can occur at any stage of HIV infection. Here multiple patch-stage early lesions are faint pink on the temple and beard area. They easily could be mistaken for bruises or nevi and be ignored. The use of highly active antiretroviral therapy has decreased the risk of this cancer.

Kaposi sarcoma

Inner edge of nail elevates; nail bed angle is greater than 180 degrees. Distal phalanx looks rounder, wider, and shiny.

Chronic lung inflammation, lung cancers, heart defects with right-to-left shunts may cause release of growth factors (e.g., platelet-derived growth factor) and promote growth of vessels. Clubbing usually develops slowly over years; if the primary disease is treated, clubbing can reverse

Late clubbing of nails

Local inflammatory reaction to an irritant in the environment or an allergy. Characteristic location of lesions often gives clue. Often erythema shows first, followed by swelling, wheals (or urticaria), or maculopapular vesicles, scales. Frequently accompanied by intense pruritus. Example here: poison ivy.

Primary Contact Dermatitis

Interview process for patients allows a nurse to compile ________ data and awareness of ________ data

subjective

objective

Give an example of physical environment in regards to interviewing a pt

being on the same physical level (sitting etc) with pt

What kid of question do you start with when interviewing a pt?

Open ended to get them talking

Nurse's reaction tp what patient communicates

Client's perspective

Client's perspective

facilitation

silence

reflection

empathy

clarification

Examiner's perspective

confrontation

interpretation

explanation

summary

Nurse's own thoughts and feelings

Examiner's perspective

encourages patient to say more

facilitation

directed attentiveness

silence

echoes to help express meaning

reflection

names a feeling and allows its expression

empathy

asking for confirmation, repeat back

clarification

clarifying inconsistent information, what pt tells nurse is inconsistent with what the nurse observes (surgery example)

confrontation

makes association to identify cause or conclusion

interpretation

informing person by sharing factual and objective information

explanation

provides conclusion based on verified information which in turn identifies that the interview process is closing

summary

Nonverbal Cues

Posture

Physical apperance

Gestures

Face Expression

Eye contact

Voice

Touch

How do you interview a pt with a hearing impairment?

Look directly at pt so they could read lips. If interpreter is needed LOOK AT PT

Three Questions to ask for drug/acohol use?

When did you take?

What did you take?

How much did you take?

a person's emotional and cognitive functioning

Mental status

how a patient is feeling in general

mood

how a patient is feeling temporarily

affect

Mental disorder with a known cause (intoxication, withdrawal)

organic disorder

Mental disorder with no organic cause

psychiatric mental illness

Components of mental status assessment

Appearance

Behavior

Cognition

Thought processes

Mental Status Assessment: Appearance

Posture

Body movements

Dress

Grooming and Hygiene

Mental Status Assessment: Behavior

Level of consciousness

Facial expression

Speech

Mood and Affect

When is a full mental status exam necessary?

Patients whose initial screening suggests an anxiety disorder or depression

Behavioral changes, such as memory loss, inappropriate social interaction

Brain lesions: trauma, tumor, cerebrovascular accident or stroke

Aphasia: impairment of language ability secondary to brain damage

Symptoms of psychiatric mental illness, especially with acute onset