Health Assessment Exam 2

What are the phases of interviewing?

What are the phases of interviewing?

Introduction, Working, Closing

What's the introduction phase?

-let pt know why we're there and introduce self...duh
- establish rapport w/ pt
ex: make sure they're comfortable

Interview Introduction components

purpose
length/ expectations
time/place, introduction
Prescence of others/confidentiality

What's the working phase

asking questions (open/ closed ended questions)
and gathering sub/ obj. data

Working Phase components

data-gathering phase
verbal skills include questions to patient and ur responses to what's said

What's open-ended questions?

-from pt's narrative
- allows for full expressions from pt

Open ended ex.

What brings you in today?

What's closed ended questions?

more direct; yes, no word answers

What's the Closing Phase?

-Summarize what's pts told us
- let pt know what'd be happening next

What's the process of communication?

1. sending
2. receiving
3. internal factors
4. external factors

The sending process of comm.

verbal
- ex: words
and Nonverbal communication
- ex: facial expressions

Whats receiving phase of comm?

active listening

What are internal factors in comm?

liking others, empathy, self-awareness, ability to listen (pertains to nurse)

What are external factors in comm.?

privacy, interruptions, environment
-documentation!

Ten Traps of Interviewing

1. Providing false assurance or reassurance
2. Giving unwanted advice
3. Using authority
4. Using avoidance language
5. Engaging in distancing
6. Using professional jargon
7. Using leading or biased questions
8. Talking too much
9. Interrupting
10. Using "why" questions

Interviewing 1-10 year olds

talk to parent
-bc children are careful to trust, and nurses non-verbal cues are very important!

How should you approach interviewing adolescents aged 12-17?

Talk to them and engage in friendly conversation to make them feel relaxed.

Why is it important to create a relaxed atmosphere when interviewing adolescents?

To encourage them to be forthcoming and trustful by avoiding judgment.

What to do when obtaining health history?

-record who furnishes info, usually the person, although source may be relative or friend
- judge reliability of informant and how willing they are to communicate
- note any use of interpreter

Name parts of the complete health history

1. biographical data
2. reason for seeking care
3. present health or history of present illness
4. past health
5. fam. history
6. review of systems
7. functional assessment of ADLs

give examples of biographic data

name
addy
age/ Bday
sex
marital status
race
ethnic origin
occupation (hazards)

What is a brief spontaneous statement in a person's own words describing the reason for their visit?

Chief complaint-- use quotes

What term is used to describe a subjective sensation that a person feels from a disorder?

Symptom

What is an objective finding that can be detected on physical examination or in lab reports?

Sign

whats that mnemonic used for history of present illness?

OLD CARTS (PQRST basically)

O in Old Carts

Onset (when did the symptoms begin?)
- acute ( < 6 months)
- chronic ( > 6 months)

L in Old Carts

Location: Where symptoms occur

D in Old Carts

Duration: How long symptoms last
- does it come and go?

C in Old Carts

characteristics (quality)
- what's it feel like? (dull, sharp, tingly etc)

A in Old Carts

aggravating factors
- what makes it worst?

R in Old Carts

Relieving factors
- what makes it better?

T in Old Carts

Treatments (and response)

S in Old Carts

Severity: How severe symptoms are
- use pain scale

What are some examples of Past med. history?

-childhood illness
-accidents/ injuries
-serious/ chronic
-operations
-hospitalizations
-obstetric history
- immunizations
- last examination date
-. allergies
- current meds.

What do you look for in obstetric history?

- How many pregnancies v. births
-ex: 5 pregnancies but 2 births...miscarriage

Whats the MOST important thing you look at for past med. history?

Allergies

What information should be included in the family history section of a complete health history?

- Age and health or cause of death of relatives
- fam. tree
- Health of close family members
- Family history of heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, allergies, arthritis, mental illness, seizures, kidney diseases, TB, obesity, alcoholism, etc.

Why is it important to include family history in a health history?

Family history can provide valuable insights into potential genetic predispositions and risks for various health conditions.

Episodic

focuses on 1 system

What's Review of Symptoms?

- general overall health state
- skin/hair/ nails
- head/eyes/ears
- nose/ sinuses
- mouth/ throat
- neck
- breast
- respiratory system
- cardiovascular
- peripheral vascular
- GI
- urinary system
- M/F genital system
- sexual health
- musculoskeletal system
- Neurological system
- endocrine system

What aspects are considered in a functional assessment related to self?

Self-esteem, self-concept

What factors are evaluated in a functional assessment related to physical well-being?

Activity and exercise (based on occupation), sleep/rest, nutrition and elimination

What social factors are examined in a functional assessment?

Interpersonal relationships (support system), domestic violence (DV)

What other elements are included in a functional assessment?

Coping/stress management, alcohol/tobacco/substance use, environment and work hazards, occupational health

What is gout?

the buildup of uric acid in the blood (hyperuricemia).

Name some pediatric abnormalities

• congenital dislocated hip

• spina bifida

• Talipes Equinovarus (clubfoot)

Whats congenital dislocated hip?

head of femur becomes displaced out of acetabulum

Whats spina bifida?

incomplete closure of posterior part of vertebrae

• results in neural tube defects (paralyzed)

• mom needs to consume folic acid to prevent this

Whats Talipes Equinovarus?

• clubfoot

• congenital rigid fixture of feet

• inverted

What's rheumatoid arthritis?

chronic inflammation disorder; autoimmune

what's ankylosing spondylitis?

chronic inflamed vertebrae- squares

Whats considered degenerative joint conditions?

-osteoarthritis
- osteoporosis

Whats osteoarthritis?

asymmetric; “wear and tear”

Whats osteoporosis?

decrease in skeletal bone mass

• low bone mineral density (wrist, hips, vertebrae)

How do you grade muscular response?

0-5

0 on the muscular response scale

No contraction detected (aka very bad… no mobility)

1 on the muscular response scale

Barely detectable flicker or trace of contraction

2 on the muscular response scale

Active mvmt w/ Gravity eliminated

3 on the muscular response scale

Active mvmt against gravity

4 on the muscular response scale

active mvmt against gravity and some mvmt

5 on the muscular response scale

Active mvmt against resistance w/o evident fatigue —”normal”

The nurse grades the left upper extremity strength as 2/5 meaning the client can:
a. Perform full ROM and active movement against resistance.
b. Has no movement against resistance
c. Perform active movement against gravity and some resistance
d. Perform active movement with gravity eliminated

d. Perform active movement with gravity eliminated

What's the Phalen's test?

tests for carpel tunnel syndrome.
- hold both hands back to back, flexing wrists at 90-degree angle

What's tinel's sign?

when media nerve in wrist is percussed and produces burning/ tingling sensation, testing positive for carpal tunnel.

What degree of spine indicates its normal?

75-90 degrees, and symmetrical

Good sign of temporomandibular test

audible and palpable click or snap occurs

What do you look for during inspection phase of OBJ. musculoskeletal assessment?

-size and contour
-skin and tissues over joints

What to look for when palpating musculoskeletal assessment?

-skin temperature
- joint areas

What' active ROM in Musculoskeletal assessment?

pt can do it themselves

What' passive ROM in Musculoskeletal assessment?

nurse has to help/ do it for pt

Why would a pt need passive rom?

- When they had a stroke and you don’t want their muscles to atrophy
- to prevent clots/ or contractures

What's muscle testing in Musculoskeletal obj. assessment?

- applying opposing force and grading muscle strength 0-5 (ROM)

What are abnormalities regarding muculoskeletal palpation?

- dislocation
- subluxation
- contracture
- kyphosis
- lordosis

Define dislocation

complete disruption or "coming apart" of a joint

Define Subluxation

partial dislocation of a joint

Whats a contracture?

when a muscle or tendon shortens, becomes inflexible, and "freezes" in position causing permanent disability of the limb

When observing the eyebrows what should you observe?

- symmetry all around

When observing eyelids and eyelashes, what should you observe?

- symmetrical and lids should close fully
- if not, then its ptosis

What do you look for when observing eyeballs?

- no protrusions (exophthalmos) or sunken (enophthalmos) appearance

What should sclera look like?

White; though there's some normal variations

What to do when observing conjunctiva?

- have pt look up and down while pulling back opp. lid for good visualization
- assess for discharge, edema, erythema, hemorrhage, lesions or foreign bodies

What does cyanosis of the lower lids when looking at the conjunctiva mean?

lack of O2

What if there's pallor near the out canthus of the conjunctiva?

pt has anemia

What's normal when you assess an elderly pt's eyeball?

- grey, white arc or circle around the limbus due to deposits of lipids
- opacities

What stimulates the pupil?

para and sympathetic nervous system

What should you make note of when looking at the pt's pupil?

- flat w/ round, reg. shape
- note size, shape, and equality of the pupils (round, reg. and equal)

what's corneal light reflex?

- light should be shining in same spot in both eyes

When testing infants with corneal light reflex, if the light is not in the same spot in both eyes, should it be a concern?

NO; still developing

If testing for corneal light reflex in 6moths and older, and the light is NOT in the same spot in both eyes, should it be a concern?

YES-- refer to specialist

What's PERRLA?

pupils are,
equal,
round,
reactive to light
accommodation

What's a big indicator of the nervous system?

Pupils

If one pupil's at 5mm and the other's at 3mm, what does this indicate?

brain bleed/ hemorrhage

What's the resting pupil size at?

3mm -5 mm

How do you want your pupils to react to light? brisk or delayed?

Brisk

What's direct light reflex when testing for light in PERRLA

- noticing brisk constriction mvmt in the eye the light's pointing at

What's consensual light reflex?

- when the opposing eye the light is pointing at also reacts to the light

What's the Accommodation part of PERRLA

-have pt look off into distance--dilates pupil and then put a finger in front of nose and watch pupil adjust/ constrict to see objects far away and close up

Whats the Snellen Chart used for?

Far vision
- determines 20/20 vision
- numerator is the distance the pt stands at (20ft)
- denominator is the distance the normal eyes could've read the line (the bigger the number, the poorer the vison)

What's the Jaeger Chart used for?

Near vision

What's EOM?

- 6 muscles attaches eye to orbit
- mvmt stimulated by 3 cranial nerves (III, IV, VI)