PCC1__Final_Review from Ears On
CH 16 – Ears (Jarvis)
Assessment of the Ears: To evaluate ear health, one must distinguish between types of hearing loss.
Conductive Hearing Loss: Loss of hearing that occurs when sound cannot efficiently travel through the outer ear canal to the eardrum and the tiny bones of the middle ear.
Sensorineural Hearing Loss: Results from damage to the inner ear (cochlea) or the auditory nerve pathways that lead to the brain.
Developmental Competencies: Different methods may be used to assess individuals based on age.
Subjective Data: Gather patient history regarding ear problems, including any hearing loss, pain, or discharge.
Objective Data:
For Adults: Pull the pinna (outer ear) up and back before inspection.
For Children under Three: Pull the pinna straight down to properly align the ear canal for examination.
Otoscope Examination: It is crucial to perform an otoscopic examination to visualize the ear canal and tympanic membrane.
Normal Variations: Clear ear canal with healthy tympanic membrane.
Abnormal Variations: Redness, bulging tympanic membrane, or ear canal obstructions should be acknowledged.
Health Promotion: Encourage regular hearing evaluations, especially for those in high-risk environments.
CH 17 – Nose, Mouth, and Throat (Jarvis)
Assessment of Nose, Mouth, and Throat: Essential for diagnosing conditions affecting these areas.
Subjective Data: Collect information regarding nasal congestion, sore throat, and oral hygiene practices.
Objective Data: Evaluate for any physical signs of disease or disorders in these areas.
Developmental Considerations: Assessments should be adapted for age-appropriateness and developmental stage.
Health Promotion: Emphasize the importance of smoking cessation to prevent diseases of the mouth and throat.
CH 18 – Breast, Axillae, and Regional Lymphatics (Jarvis)
Assessment Techniques: Comprehensive evaluation of breast and axillary regions, including lymphatic drainage.
Developmental Competencies: Changes in breast tissue with age, gender, and hormonal influences should be considered.
Subjective Data: Investigate personal and family history of breast disease, including discomfort and changes in breast tissue.
Objective Data: Physically examine the breasts and axillae to check for asymmetry, lumps, or other abnormalities.
Normal vs Abnormal: Ensure recognition of typical breast morphology vs any signs of pathology.
Health Promotion: Encourage regular self-examinations and mammograms as age-appropriate for breast health.
CH 19 – Thorax and Lungs (Jarvis)
Lung Assessment Protocol:
Emphasize the importance of not auscultating through clothing, as it can muffle lung sounds.
Developmental Competencies: Recognize respiratory variations based on the patient's age and chronic health conditions.
Subjective Data: Document any patient-reported respiratory conditions or symptoms, such as cough or shortness of breath.
Objective Data: Inspect, palpate and auscultate the thorax and lungs systematically.
Normal vs Abnormal Findings: Compare findings against established norms.
Altered Respiratory Patterns:
Bradypnea: Respiratory rate (RR) less than 12 breaths per minute.
Tachypnea: RR greater than 20 breaths per minute.
Dyspnea: Difficulty or distress while breathing.
Hemoptysis: Expectoration of blood from the respiratory tract.
Health Promotion: Promote regular lung function testing and smoking cessation initiatives.
CH 20 – Heart and Neck Vessels (Jarvis)
Assessment of Heart: Evaluate the heart through auscultation at all five heart locations to accurately assess heart sounds.
Developmental Competencies: Recognize variations in heart sound patterns across different age groups.
Subjective Data: Gather history of cardiovascular health, including symptoms like chest pain or palpitations.
Objective Data: Document vital signs and heart sounds.
Normal Heart Sounds: Identify normal S1 and S2 heart sounds.
Murmurs: Describe as gentle blowing or swooshing sounds, indicating possible valvular heart issues.
Pulse Assessment:
Bradycardia: Heart rate less than 60 bpm.
Tachycardia: Heart rate greater than 100 bpm.
Chronic Conditions: Assess for heart failure signs, and understand their implications on the patient's health.
Health Promotion: Advise on maintaining a heart-healthy lifestyle.
CH 21 – Peripheral Vascular and Regional Lymphatics (Jarvis)
Assessment of Peripheral Vascular System: Important to assess the most distal pulse to ensure adequate blood flow.
Distal Pulse Assessment: If peripheral pulses are nonpalpable, this requires investigation using Doppler ultrasound for verification.
Normal Pulse: Documented as +2 on a scale of +0 to +4, indicating a normal, easily palpable pulse.
Developmental Competencies: Adapt assessments for age and overall health of the patient.
Subjective Data: Document history related to vascular issues like claudication or swelling.
Objective Data: Physical examination of distal pulses and capillary refill.
Chronic Conditions: Consider conditions like Peripheral Vascular Disease (PVD) and Deep Vein Thrombosis (DVT).
Health Promotion: Encourage active living to improve vascular health.
CH 22 – Abdomen (Jarvis)
Abdominal Assessment Protocol: Note that the order of assessment differs, with auscultation performed before palpation and percussion to prevent false results.
Developmental Considerations: Account for age and individual health status in assessment methods.
Subjective Data: Collect patient-reported symptoms including pain, nausea, and appetite.
Objective Data: Physical examination of abdomen, including inspection, auscultation for bowel sounds.
Assessing Bowel Sounds:
Normoactive: Normal bowel sounds indicating proper function.
Hyperactive: Increased peristalsis, indicating possible gastrointestinal distress.
Hypoactive: Decreased peristalsis, possibly suggesting bowel obstruction or inactivity.
Important Note: Listen for bowel sounds for at least five minutes before documenting them as absent.
Chronic Conditions: Acknowledge chronic gastrointestinal disorders and their management.
Health Promotion: Foster healthy eating and lifestyle to support digestive health.
CH 23 – Musculoskeletal (Jarvis)
Assessment of Musculoskeletal System: Evaluate overall musculoskeletal health including structural integrity and functional capability.
Developmental Considerations: Acknowledge changes throughout different life stages, particularly in childhood and old age.
Subjective Data: Document history related to musculoskeletal pain, injuries, or limitations.
Objective Data: Physical examination focusing on joints, muscles, and overall mobility.
Abnormal Variations: Types of abnormal curvature include:
Kyphosis: Abnormal curvature of the thoracic spine, which may cause a hunching appearance.
Lordosis: Abnormal curvature of the lumbar spine, often noted during pregnancy.
Age-Related Changes:
Decrease in height is common with aging due to vertebral changes.
Gait changes and loss of muscle mass may be observed with age,
Changes in bone density are associated with osteoporosis.
Health Promotion: Encourage impact exercises to maintain bone health, particularly for at-risk populations.
CH 24 – Neuro (Jarvis)
Neuro Assessment Procedures: Comprehensive evaluation to assess neurologic function and integrity.
Developmental Competencies: Adjust assessment methods according to age-related changes.
Subjective Data: Collect history of neurological events, including seizures, headaches, or dizziness.
Objective Data: Consider assessments of consciousness levels and neurologic reflexes.
Level of Consciousness: Assessment documented as "AAOx4" (alert and oriented x 4) should include:
Identity: Who they are
Location: Where they are
Time: Month, day, year
Situation: What is happening
Cranial Nerve Assessment: Evaluate individual cranial nerves through specialized tests.
Deep Tendon Reflexes: Documented reflexes on a scale of +0 to +4 to assess neurological function.
Health Promotion: Encourage regular physical and mental health monitoring to mitigate risks for neurological decline.
CH 25 – Male Genitourinary (Jarvis)
Assessment of Male Genitourinary System: Conduct a thorough evaluation of male reproductive and urinary systems.
Developmental Competencies: Address developmental changes from childhood into adulthood.
Subjective Data: Discover any urinary difficulties, pain, or reproductive health concerns.
Objective Data: Perform physical examinations as appropriate based on health history.
Chronic Conditions: Take existing health issues into account, including prostatitis or urinary incontinence.
Health Promotion: Promote regular check-ups for urological health, particularly in older adults.
CH 26 – Anus, Rectum, and Prostate (Jarvis)
Assessment Procedures: Execute a thorough examination of the anal, rectal, and prostate areas.
Developmental Competencies: Tailor assessment methods based on patient age and previous health history.
Subjective Data: Gather patient complaints related to stools, discomfort, or changes in bowel habits.
Objective Data: Conduct physical examinations focusing on the condition of the anal area and prostate.
Labs Indicative of Prostate Issues: Ensure availability of Prostate-Specific Antigen (PSA) tests to evaluate prostate health.
Chronic Conditions:
Consider symptoms related to hemorrhoids and decide treatment utilization.
Enlarged Prostate Symptoms: Urinary difficulties and potential discomfort during intercourse.
Colorectal Cancer: Early signs include blood in stools; confirmed via colonoscopy.
Screening Age: Determine appropriate screening timelines for colorectal health assessments.
Tests for Hidden Blood: Hemocult tests to identify occult blood in stools.
Health Promotion: Emphasize awareness of symptoms and encourage regular screenings for colorectal cancer.
CH 27 – Female Genitourinary (Jarvis)
Assessment of Female Genitourinary System: Comprehensive assessment methods for female reproductive health.
Developmental Competencies: Adapt assessments according to a woman's life stages and hormonal changes.
Subjective Data: Document complications such as menstrual irregularities, discomfort, or reproductive concerns.
Objective Data: Physical examinations should be performed as indicated by patient history.
Menopause: Acknowledged as a common phase characterized by decreased estrogen production, leading to:
Uterus reduction in size
Vaginal dryness
Decrease in pubic hair growth
Chronic Conditions: HPV vaccination as a preventive measure, noting it does not cure existing infections.
Health Promotion: Educate on urinary health and promote awareness of reproductive health at different life stages.
CH 27 – Patient Safety and Quality (P&P)
Patient Safety Protocols (RACE):
RACE: Rescue, Alarm, Contain, Extinguish. Steps to respond during a fire emergency.
PASS: Pull, Aim, Squeeze, Sweep. Procedures for using a fire extinguisher.
Seizures: Recognize and respond appropriately to seizure episodes in patients.
Restraints: Proper usage of restraints to ensure patient safety and comfort.
Fall Prevention: Implement measures to minimize fall risks while hospitalized.
Objective: Aim to keep patients safe in hospital settings.
CH 28 – Infection Control (P&P)
Chain of Infection: Review principles involved in the transmission of infections.
Preventing Infection Spread:
Emphasize that the number one way to control infections is through hand hygiene.
Implement standard precautions to manage infection risk.
Understand transmission-based precautions:
Airborne: Used for pathogens that are transmitted through the air.
Droplet: Used for pathogens spread via respiratory droplets.
Contact: For pathogens spread through direct or indirect contact.
Personal Protective Equipment (PPE): Understand the correct order for donning (putting on) and doffing (removing) PPE.
Medical vs Surgical Asepsis: Review the principles of maintaining aseptic techniques.
CH 38 – Activity and Exercise (P&P)
Assessment Before Exercise Regimen: Evaluation of patient’s mobility, gait, and range of motion (ROM).
Differentiate between active (patient performs movement) vs passive (healthcare providers assist).
Activity Tolerance: Assess how well patients can handle physical activity.
Early Ambulation: Highlight the importance of getting patients moving early post-operatively or during hospitalization.
Precautions During Ambulation:
Allow the patient to sit for a minute before standing to prevent dizziness.
Monitor while ambulating to prevent falls; fall prevention strategies are vital.
In case of a fall, position yourself to catch the patient and ease them to the ground safely.
Assistive Devices: Teach proper use of devices like canes, walkers, and crutches for enhancing mobility.
CH 40 – Hygiene (P&P)
Hygiene in Hospital Setting: Emphasize respect for patient preferences while helping with hygiene maintenance.
Types of Baths:
Partial Bed Bath vs Complete Bed Bath: Determine the level of care required based on patient status.
Encourage patient participation in hygiene to the extent possible based on their abilities.
Oral Care: Ensure consistent oral hygiene; understand special considerations for unconscious patients, like turning on their side during care.
Skills Review: Refer to practical skills in the yellow pages for specific procedures.
Health Promotion: Educate patients on hygiene relative to specific diseases, particularly for diabetes regarding foot care, ensuring adaptation of hygiene practices to functional capabilities.
CH 41 – Oxygenation (P&P)
Understanding Perfusion:
Left/Right-Sided Heart Failure Symptoms: Knowledge of common presentations in heart failure patients.
Treatment of Heart Failure Patients: Conduct thorough assessments of respiratory functions.
Respiratory Assessments:
Dyspnea: Shortness of breath.
Tachypnea: Increased respiratory rate.
Bradypnea: Decreased respiratory rate.
Ventilation Concepts:
Definitions of hypoventilation and hyperventilation, focusing on controlling rates for optimal patient care.
Hypoxia: Early signs include restlessness; late signs involve cyanosis (a bluish tint indicating severe oxygen deprivation).
Management of Dyspnea:
Focus on airway management and possible interventions such as mobilization of secretions, humidification, hydration, and suctioning.
Differentiate between open and closed suctioning methods and indications.
Methods of Oxygen Delivery: Understand various devices and their appropriate usage for maintaining oxygenation in patients.
CH 46 – Urinary Elimination (P&P)
Urinary Tract Infections (UTIs): Identify causes and prevention strategies.
Common Problems:
Incontinence: Document assessments related to urinary control issues.
Urinary Retention: Assess contributing factors and interventions required.
Patient Care in Hospital Settings: Ensure clear pathways to bathrooms for patients needing assistance during urinary episodes.
Proper Patient Positioning: Understand techniques for using bedpans and bedside commodes to facilitate urination.
Interventions: Always perform the least invasive methods prior to considering catheterization.
Catheterization: Review the proper technique for catheter insertion, emphasizing sterile practices and indications for use.
CH 47 – Bowel Elimination (P&P)
Common Bowel Issues: Awareness of conditions such as diarrhea, constipation, impaction, and hemorrhoids.
Patient Care: Ensure a clear path for patients needing the restroom, monitoring for any physical barriers.
Proper Positioning: Obtain appropriate positioning for bowel movements using bedpans and commodes.
Interventions: Always initiate the least invasive techniques before more aggressive management.
Ostomy Care: Guidelines for managing ostomy care, including emptying the bag when 2/3 full and assessing the stoma for health indicators.
CH 48 – Skin Integrity and Wound Care (P&P)
Pressure Injuries: Understand the importance of assessing for pressure ulcers in hospital patients.
Assessment Strategies:
Employ the Braden Scale for risk assessment and staging of pressure injuries.
Prevention Techniques: Document risk factors and preventive strategies such as turning patients every two hours.
Risk Factors: Include considerations like immobility, decreased level of consciousness (LOC), and impaired sensory perception in assessments.