HA WEEK 5 PVS
Health History and Analysis
Structure and purpose
Begin with a review of systems, then move to a narrative paragraph form covering self-concept and patient-centered context before the analytic section.
Analysis ( Nathaniel’s focus in the transcript): write a paragraph that explains the problems, cues, and rationale for prioritization based on the complete health history.
Prioritizing problems (risk and urgency)
Identify life-threatening or top-priority concerns first.
Example discussed: patient with shortness of breath and chest pain; nutrition would be a lower priority than respiratory status and chest pain.
If the primary problem is diabetes (or another chronic condition), determine what symptom or deficit to address first (e.g., wound, nutrition, or glucose management).
Evidence-based goal setting for patient education
Use current, reputable sources (within the last 5 years) from text, eBooks, or journal articles; avoid non-viable sources (e.g., random social media links).
Cite sources using APA style; know where to find APA seventh edition guidelines in Blackboard via Course Resources -> APA Seventh Edition.
Example: for nutrition-related goals in diabetes, cite a recognized organization (e.g., American Diabetes Association) or current nutrition guidelines and translate into a specific, measurable goal.
Measurable, realistic goals
Make goals specific and realistic given the patient’s age and socioeconomic context.
Example goals:
Diabetes nutrition goal: lose pounds over months rather than pounds in weeks.
Nutrition plan may use tools like MyPlate or a nutrition app, tailored to the patient’s access (e.g., older adults may not use apps; alternatives like journals or simple plate-based guidance).
Personalization and feasibility
Tailor goals to patient factors: age (e.g., -year-old mother with a pacemaker), technology access, health literacy, and socioeconomic status (ability to afford an app or journal).
Do not assume the patient can perform activities they cannot (e.g., not every elderly patient can use a smartphone app).
History-to-risk factor alignment
Ensure the chosen risk factors and goals align with the patient history and literature.
Example: if nutrition is a concern due to diabetes, align dietary goals with evidence-based guidelines.
Genogram inclusion (family history footprint)
A genogram is required as part of the analysis; see separate section.
Citations and sources list
Include a sources/bibliography list at the end of the analysis.
Use credible sources (textbooks, ebooks, peer-reviewed journals). Avoid random online sources; cite via APA format.
Documentation and submission logistics
The analysis section should be one cohesive paragraph with citations.
Use the appropriate course resources (Blackboard) for APA formatting guidance.
Genogram and family history (intro to its use in analysis)
You will discuss the family history in a genogram: three generations, both sides, with a key, and markers for uncertain information (Unknown).
Genogram and Family History
Purpose and scope
A genogram visually maps family relationships and health history across at least three generations on both sides.
Features to include
Each generation on both sides of the family with a clear key.
Indicate known conditions (e.g., hyperlipidemia, diabetes, hypertension), and when unknown, mark as Unknown rather than omitting.
Show patterns of inherited or familial conditions when relevant to the patient's risk (e.g., cardiovascular disease, cancer).
Practical considerations
Create a separate page for the genogram with space for the key; it should be legible and easy to interpret.
If information is missing, note it (e.g., Aunt Sally unknown, Grandfather unknown) rather than guessing.
Generations to include
Ideally, three generations on each side (two parental lines), but include more if data is available.
How to use in assessment
Correlate genogram findings with risk factors and potential genetic predispositions in the analysis and care planning.
Lymphatic System and Nodes
What the lymphatic system does
Drains excess interstitial fluid and returns it to the bloodstream.
Plays a crucial role in immune defense (filters bacteria and foreign substances via lymph nodes).
Involved in lipid absorption from the small intestine via lymphatic vessels.
Lymph nodes and infection signaling
Enlarged nodes can indicate infection, inflammation, or malignancy; nodes should be assessed for size, mobility, tenderness, and consistency.
Node size and mobility thresholds
Generally, nodes are mobile and small; fixed nodes ≥ are a red flag.
Fixed, hard nodes with systemic symptoms warrant urgent follow-up.
Nodes to palpate and technique
Palpate epitrochlear nodes (at the elbow region) and other common sites (cervical nodes) using the pads of the fingers.
Nodes should be non-tender and movable; in adults, persistent or fixed enlargement is abnormal.
The spleen, thymus, bone marrow, tonsils
Spleen: left upper quadrant; functions include destruction of old red blood cells, antibody production, red blood cell storage, and filtration of microorganisms.
Thymus, tonsils, and bone marrow are also part of lymphatic/immune function.
Special cases and teaching points
Lymphadenopathy in children is more common and often benign; in adults, persistent lymphadenopathy should be evaluated.
Breast tissue and axillary lymph nodes: tail of the breast tissue extends into the axilla; changes there can relate to breast pathology (e.g., cancer) in both men and women.
Post-surgical or oncologic patients may have altered lymphatic drainage leading to lymphedema; observe swelling and mobility of nodes.
Vascular System: Arteries vs Veins (anatomy refresher)
Core difference
Arteries carry blood away from the heart; Veins carry blood toward the heart.
Note: There is a common anatomical exception taught historically: pulmonary artery carries deoxygenated blood away from the heart to the lungs, and pulmonary veins carry oxygenated blood from the lungs to the heart.
The transcript includes a misstatement about the pulmonary artery; correct physiology is: Pulmonary artery carries deoxygenated blood; Pulmonary veins carry oxygenated blood.
Vessel function and signs of insufficiency
Arterial problems: diminished or absent pulses, cool and pale skin, hair loss, thick/rigid nails, dependent rubor, intermittent claudication (pain with walking relieved by rest).
Venous problems: edema, brownish pigmentation, venous stasis changes, relatively normal pulses, ulcers typically at the ankle region, often irregular edges.
Pulses to know (locations)
Carotid, radial, brachial, ulnar; femoral; popliteal; posterior tibial; dorsalis pedis.
Technique tip: start from head to toe; assess bilaterally and compare sides.
Pulse quality and grading (example scale discussed in class)
Regular vs irregular rhythm; amplitude scale commonly described as 0, 1+, 2+, 3+, 4+ with 0 = absent and higher numbers indicating stronger pulses.
Doppler use
Portable Doppler can identify weak or non-palpable pulses and help detect DVT by assessing blood flow.
Artery vs vein cues (quick mental checks)
Arterial problem cues: cool, pale skin; hair loss; diminished pulses; pain with activity; ulcers at toes/feet; hair absence.
Venous problem cues: edema; skin brownish pigmentation; ulcers near ankles; normal or present pulses; pain may occur with standing or prolonged sitting.
Nail and skin changes
Arterial disease: thin, shiny skin; loss of hair; nails thickened and brittle.
Venous disease: skin changes around ankles with edema and brownish staining due to red cell breakdown.
Peripheral Vascular Disease (PAD) and Peripheral Venous Disease (PVD)
Key definitions
PAD: arterial insufficiency in the limbs leading to reduced blood flow; often causes claudication.
PVD: broader term often used to describe venous insufficiency and related venous problems.
Risk factors for PAD/DVT/PVD
Modifiable: smoking, obesity, poor diet, physical inactivity, diabetes, hypertension, hyperlipidemia.
Non-modifiable: age, family history.
Intermittent claudication (definition and significance)
Pain in the leg with walking that is relieved by rest; a hallmark symptom of PAD due to arterial insufficiency.
Arterial ulcers vs venous ulcers
Arterial ulcers: usually on toes/feet; round and well-defined; pale/pale-blue skin; cool; painful; minimal edema.
Venous ulcers: usually around the ankles; irregular shape; brown pigmentation; edema; more superficial.
DVT (deep vein thrombosis)
Risk factors include prolonged immobility (long flights/trips), pregnancy, birth control pills, smoking, obesity, prior DVT.
Homan’s sign (calf pain with forced dorsiflexion) described but not highly reliable; not a sole diagnostic criterion.
Complications: pulmonary embolism if clot dislodges.
Special population considerations
Pregnant patients: edema common; monitor for preeclampsia signs (hypertension, edema); risk for DVT increases with pregnancy.
Long airplane or car trips: encourage movement and ambulation to reduce DVT risk.
Aging adults: assess for PAD/PVD due to cumulative risk factors and reduced mobility; ensure vascular assessments are thorough.
Raynaud’s phenomenon (brief mention)
Episodic vasospasm of digital arteries causing color changes (white to blue to red) in response to cold or stress.
Hormonal therapy and clots
Hormone replacement therapy and estrogen-containing birth control pills increase thrombotic risk, especially with smoking; evaluate risks vs benefits for each patient.
Clinical Assessment Techniques and Findings
Palpation and inspection sequence
Inspect skin, hair, nails first, then palpate pulses; compare bilaterally; assess symmetry.
Check capillary refill time: normal is typically ; longer times suggest perfusion issues.
Capillary refill and color changes
Color-change tests: raise legs to drain venous blood for about , then have patient sit and dangle; normal return to pink within roughly if circulation is intact.
Edema grading (pitting edema)
Indentation depth and time to rebound:
1+ slight indentation
2+ indentation of roughly ; rebounds in about
3+ indentation persists about
4+ indentation persists longer (severe edema)
Lymph node assessment and signs
Abnormal lymph nodes: nodes that are enlarged (> ) or fixed/hard indicate possible pathology; fixed nodes are more concerning.
Palpation sites: epitrochlear nodes (elbow area), cervical nodes, axillary nodes, and inguinal nodes as appropriate.
Pulses and gradient assessment (step-by-step)
Palpate carotid pulses one at a time; avoid simultaneous compression of both carotids.
Move head-to-toe: carotid -> brachial -> radial -> femoral -> popliteal -> posterior tibial -> dorsalis pedis.
Evaluate rhythm (regular vs irregular) and amplitude (0–4+ scale) for each site; compare bilaterally.
Special bedside tests and tools
Doppler for non-palpable pulses or to assess venous flow and DVT suspicion.
Modified Adams test (Allen test) for arterial patency: compress both radial arteries, release one at a time to observe refill; assesses collateral circulation.
Critical signs and red flags
Fixed, hard lymph nodes or nodes ≥ with systemic symptoms require prompt evaluation.
Acute limb ischemia signs: sudden severe pain, pallor, pulselessness, paresthesias, paralysis (not detailed in transcript but students are taught to recognize these in practice).
DVT signs: unilateral leg swelling, tenderness, warmth, and sometimes erythema; positive Homan’s sign indicates dorsiflexion pain (recognize limitations of this sign).
Color and temperature cues in vascular problems
Arterial insufficiency: skin is cool, pale, hair loss; nails thick and brittle.
Venous insufficiency: skin may be warm but edematous; brownish discoloration; edema and stasis changes.
Important anatomical recall for exam
The major pulses and their anatomical landmarks: carotid, brachial, radial; femoral (mid-inguinal), popliteal (behind knee), posterior tibial (behind medial malleolus), and dorsalis pedis (on the dorsum of the foot).
Lateral vs medial approach and consistency for palpation with the pads of the fingers; light touch vs deep palpation as appropriate.
Practical Considerations for Exam and Paper Preparation
Exam format and rules (from the transcript)
Duration: about per session; maximum four students at a time to minimize disturbance.
Equipment: whiteboard and laptop only; no Apple Watch or personal notes; no drinks or phones during exam.
After the exam, there may be a posting of a recording; this is for week 5 content and should be reviewed.
Test subject emphasis
Peripheral vascular topics are covered; nutrition and vital signs are not tested on this exam (though nutrition content appears later; vital signs may be referenced as a resource for practicum rather than exam).
Pain assessment is included as a resource; nutrition and vital signs are deferred.
Study resources and navigation tips
Use Jarvis checklist for vascular and other health assessment skills.
Go to the lab section in course materials for Jarvis pictures and checks; verify arterial pulse sites and Doppler use.
Check the course resources for APA Seventh Edition guidance and citations; use the library for credible sources.
The 527 chapter in the provided materials (and associated images) can help locate pulses and anatomy references.
Documentation and submission tips
For the health history paper: a separate genogram page is preferred; ensure a clear key and three generations on both sides; mark unknowns when information is unavailable.
Ensure your team submits only one copy with clearly identified contributors.
When composing the analysis, cite current sources and place citations in the narrative with a corresponding references list.
Practical clinical reasoning guidance
In analysis, separate risk factors from health assessment priorities; prioritize factors that are life-threatening and supported by history.
Align risk factors with literature-based interventions (e.g., for hyperlipidemia: dietary changes, physical activity, medications when indicated).
Use clinical cues to determine priority order (e.g., oxygenation status for shortness of breath before other concerns).
Ethical and professional considerations
Cite sources to support patient teaching goals; avoid unsupported claims.
Be mindful of the patient’s cultural, linguistic, and socioeconomic context when setting goals and recommending interventions.
Quick Reference: Key Concepts, Symbols, and Thresholds
Lymph nodes
Abnormal: ≥ or fixed/hard lymph node
Edema grading
1+: slight indentation
2+: indentation of ; rebound in about
3+: rebound in about
4+: indentation persists longer; severe edema
Capillary refill
Normal: ≤ ; borderline: ; abnormal: >
Intermittent claudication (PAD indicator)
Pain with walking relieved by rest
Arterial vs venous ulcers (location cues)
Arterial: toes/feet; round, smooth; cool, pale skin; diminished pulses
Venous: ankles; irregular edges; edema; brown pigmentation
Pulses and landmark guide (typical order)
Carotid → brachial → radial → femoral → popliteal → posterior tibial → dorsalis pedis
Age-related risk note (PAD)
Higher risk with age, particularly ext{men} > 55 and ext{women} > 70, in combination with risk factors
Doppler uses
Pulse detection, DVT assessment, fetal heart monitoring (portable)
Vitamin/medication risk signals (discussion examples)
Hormone replacement therapy and birth control pills increase clot risk, especially with smoking; assess risk–benefit balance for each patient