1) General Survey Flashcards

1
Q

When does the general survey begin?

A
  • When the nurse first meets the patient
  • Observing behavior, appearance, and mobility
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2
Q

What is the general survey?

A
  • The first step in physical examination
  • Provides information about illness characteristics, hygiene, body image, emotional state, weight changes, developmental status
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3
Q

What should the nurse do if abnormalities are noted in the general survey?

A
  • Closely assess the affected body system later during physical examination
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4
Q

What should be assessed when interacting with the patient?

A
  • General appearance
  • Behavior
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5
Q

How do age and gender affect the examination?

A
  • They affect the type of examination performed
  • They affect the manner assessments are made
  • Certain conditions are more likely based on gender/characteristics
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6
Q

What signs of distress should be noted?

A
  • Signs indicating pain (grimacing, splinting area)
  • Signs of breathing difficulty (shortness of breath, retractions)
  • Signs of anxiety (fidgeting, pacing)
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7
Q

What should be observed about the patient’s body type?

A
  • If they appear trim/muscular, obese, or excessively thin
  • Body type reflects health level, age, and lifestyle
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8
Q

How should normal standing and sitting posture be observed?

A
  • Standing: upright, parallel hips/shoulders
  • Sitting: some shoulder rounding
  • Note if slumped, erect, or bent posture
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9
Q

What should be noted about an older person’s posture?

A
  • May have stooped, forward-bent posture
  • Hips/knees flexed, arms bent raising arm level
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10
Q

How should gait be observed?

A
  • If ambulatory, observe walking into room/bedside
  • Note if movements coordinated or uncoordinated
  • Arms normally swing freely, head/face lead body
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11
Q

What body movements should be observed?

A
  • If movements purposeful
  • Any tremors in extremities
  • Any body parts immobile
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12
Q

How should hygiene and grooming be assessed?

A
  • Note cleanliness of hair, skin, nails
  • If clothes are clean
  • Amount/type of cosmetics used
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13
Q

What factors affect the type of clothes a person wears?

A
  • Culture
  • Lifestyle
  • Socioeconomic level
  • Personal preference
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14
Q

How should clothing appropriateness be assessed?

A
  • Note if clothing is appropriate for temperature/weather conditions
  • Depressed or cognitively impaired may not choose proper clothing
  • Older persons tend to wear extra layers due to cold sensitivity
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15
Q

What can cause an unpleasant body odor?

A
  • Physical exercise
  • Poor hygiene
  • Certain disease states
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16
Q

What is affect?

A
  • A person’s feelings as they appear to others
  • Expressed verbally and nonverbally
17
Q

How should mood be assessed?

A
  • Note if verbal expressions match nonverbal behavior
  • Observe if mood is appropriate for the situation
  • Observe facial expressions while asking questions
18
Q

How should speech be assessed?

A
  • Normal speech is understandable and moderately paced
  • Associated with the person’s thoughts
  • Note if abnormally rapid or slow
  • Note tone and clarity of word inflection
19
Q

What are signs of possible violence/intimidation?

A
  • Obvious physical injury or neglect
  • Evidence of malnutrition
  • Presence of bruising on extremities or trunk
20
Q

What should be assessed regarding potential abusers?

A
  • Patient’s fear of spouse/partner/caregiver
  • History of violence, alcoholism, drug abuse in partner/caregiver
  • If partner/caregiver is unemployed, ill, or frustrated as caregiver
21
Q

What should be done if violence is suspected?

A
  • Most provinces mandate reporting to social services
  • Interview patient privately without suspected abuser
  • Victims often don’t report abuse
22
Q

What safety precaution should be taken for victims of violence?

A
  • The risk for further violence is high once reported or trying to leave
  • Provide counseling options for these individuals
23
Q

What groups does substance use and misuse affect?

A
  • It affects all socioeconomic groups
  • A single clinic visit may not reveal the problem
  • Several visits can reveal behaviors to confirm with history/exam
24
Q

How should patients with suspected substance misuse be approached?

A
  • In a caring and non-judgmental way
  • Issues involve emotional and lifestyle factors
25
What are the CAGE questions to assess for substance misuse?
- Cut down: Need to cut down on drinking/drug use? - Annoyed: People annoyed by criticizing your use? - Guilty: Felt guilty about your use? - Eye-opener: Used first thing in morning to steady nerves?
26
What are physical indicators of child sexual abuse?
- Vaginal or penile discharge - Blood on underclothing - Pain, itching, or unusual odor in genital area - Genital injuries - Difficulty sitting or walking - Pain while urinating; recurrent UTIs - Foreign bodies in rectum, urethra, or vagina - Sexually transmitted infections - Pregnancy in a young adolescent
27
What are behavioral indicators of child sexual abuse?
- Difficulty sleeping or eating - Fear of certain people or places - Play activities recreating the abuse - Regressed behavior - Sexual acting out - Knowledge of explicit sexual matters - Preoccupation with genitals - Profound personality changes - Declining school performance - Poor peer relationships
28
What are physical indicators of intimate partner violence?
- Injuries inconsistent with reported cause - Multiple injuries to head, face, neck, breasts, abdomen, genitalia - X-rays showing old and new fractures - Abrasions, lacerations, bruises/welts - Burns - Human bites - Attempted suicide
29
What are behavioral indicators of intimate partner violence?
- Eating or sleeping disorders - Anxiety - Panic attacks - Substance abuse following abuse - Low self-esteem - Depression - Helplessness - Guilt - Forgetfulness - Stress symptoms like headaches
30
What are physical indicators of elder abuse?
- Injuries inconsistent with reported cause - Hematomas - Bruises at various stages - Bruises from restraints - Burns - Fractures inconsistent with cause - Dried blood - Prolonged delay in treatment
31
What are behavioral indicators of elder abuse?
- Dependent on caregiver - Physically or cognitively impaired - Combative - Wandering - Verbally aggressive - Minimal social support
32
What are red flags for suspecting substance use/misuse?
- Frequently missing appointments - Frequently requesting work excuse notes - Complaints of insomnia, "bad nerves," or atypical pain - Reporting lost prescriptions or requesting early refills - Frequent emergency department visits - Changing healthcare providers frequently - History of medication bottles from multiple providers
33
What medical histories suggest substance use/misuse?
- Gastrointestinal bleeds, ulcers, pancreatitis, cellulitis - Frequent pulmonary infections - Frequent STIs, complicated pregnancies, abortions, sexual dysfunction - Chest pains, palpitations, admissions to rule out MI - Activities placing patient at risk for HIV (multiple partners, rapes)
34
What personal histories suggest substance use/misuse?
- Family history of addiction - History of childhood abuse (sexual, physical, emotional) - Social, financial or marital problems
35
How can the CAGE questionnaire identify substance use disorder?
- If 2 or more CAGE questions are positive, strongly suspect substance use disorder - Consider motivating patient to seek treatment