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Health Assessment Exam 1 > Chapter 8-11: Initial Assessments > Flashcards

Chapter 8-11: Initial Assessments Flashcards

1
Q

Inspection

A

A concentrated watching that begins at the moment you meet, a close scrutiny first of the individual as a whole and then of each body system

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2
Q

What are you looking for while you inspect?

A

Consciousness, Skin color, Hygiene, Bruises, Redness, Injuries

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3
Q

Palpation

A

applies your sense of touch to assess (texture, temp, moisture, organ location and size, any swelling, vibration or pulsation, rigidity or spasticity, crepitation (sounds like hair rubbing together), presence of lumps or masses and presence of tenderness or pain.

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4
Q

Different methods when palpating

A
  • Fingertips: best for fine, tactile discrimination, as of the skin texture, swelling, pulsation and determining presence of lumps
  • A grasping action of the fingertips and thumb – to detect the position, shape, and consistency of an organ or mass
  • The dorsa (backs) or hands and fingers: best for determining temp because the skin here is thinner than on the palms
  • Base of fingers or ulnar surface of the hand —best for vibration
  • Bimanual palpation = using two hands
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5
Q

Percussion purpose

A

Mapping out location and size or organ, Signaling the density (air, fluid or solid), Detecting an abnormal mass and eliciting a deep tendon reflex using percussion hammer

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6
Q

Direct palpation

A

Using your fingers on one hand to directly tap the patient to feel vibration

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7
Q

Indirect Palpation

A

Using two hands and tapping your own finger, not tapping directly the patient

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8
Q

Amplitude

A

Intensity of sound

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9
Q

Pitch

A

Frequency or number of vibrations per second

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10
Q

Quality

A

A subjective difference by overtones of sounds

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11
Q

Duration

A

Length of time the note lingers

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12
Q

What has resonant sounds?

A

Lungs

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13
Q

What has hyper-resonant sounds?

A

Childs lung or lung with emphysema

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14
Q

What has Tympany sounds?

A

Stomach, Intestine

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15
Q

What makes a Dull Sound?

A

Liver or Spleen

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16
Q

What makes a Flat sound?

A

Thigh muscles or bone or tumor

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17
Q

Auscultation

A

Listening to sounds produced by the body like the heart, blood vessels, abdomen and lungs
DO NOT listen through gown

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18
Q

Diaphragm of stethoscope: purpose

A

used for high pitched sounds like breath, bowel, and normal heart sounds (press down firmly with this one)

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19
Q

Bell of a stethoscope: purpose

A

used for soft, low pitched sounds like murmurs and extra heart sounds (press lightly with this one)

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20
Q

Physical exam on Infant

A

Child should be on an exam table or parents lap, parent should be in view to the toddler, plan exam 1-2 hrs after feeding

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21
Q

Physical exam on the toddler

A

Toddler should be on parents lap sitting and nurse on a seat as well, child should have a security object

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22
Q

Physical exam with preschool child

A

Child can go on the exam table if comfortable, verbal communication with child is important at this point, do most invasion things at the end

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23
Q

Physical exam of the school aged child

A

The child should e sitting on the exam table, decide if they want parents in the office, make small talk and teach them what you’re doing and why, head to toe evaluation

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24
Q

Physical exam on the adolescent child

A

Have the child sitting on the exam table and communicate with care, treat adolescent not as a child and promote positive practices and attitude

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25
Q

Physical exam on the aging adult

A

On exam table, give feedback, dont rush, break up the exam into parts if needed, use physical touch, don’t mistake diminished vision and hearing for confusion

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26
Q

The ill person

A

Alter positions during exam based on patient and their distresses if present , just do what you need to do

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27
Q

What general observations should you make when the patient walks in?

A

Physical appearance, Body structure, Mobility, Behavior

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28
Q

Normal BMI

A

Between 19 - 25

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29
Q

BMI between 25 - 29.9

A

Overweight

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30
Q

BMI between 30 - 34.5

A

Obese

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31
Q

BMI between 35 +

A

Extremely obese

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32
Q

BMI below 18.9

A

Underweight

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33
Q

Normal Temperature

A

97F - 99.8F (Average is 98.6F or 37C)

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34
Q

What should you keep in mind when taking rectal temp?

A

it is usually .1 or 1 greater

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35
Q

Stroke volume

A

Every beat the heart pumps an amount of blood into aorta

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36
Q

Pulse

A

the force flares of the arterial walls and generates a pressure wave that is felt in the periphery

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37
Q

What is considered a normal rate for an adult

A

60 - 100 bpm

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38
Q

Bradycardia

A

abnormally slow heart rate below 50

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39
Q

Tachycardia

A

Abnormally high heart rate higher than 100

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40
Q

Sinus Arrhythmias

A

the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration

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41
Q

3 pt scale for pulse

A

3+ - Full, bounding
2+ - Normal (most common)
1+ - weak, thready
0 - absent

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42
Q

Respirations normal value for neonate

A

30 - 60

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43
Q

Respirations normal for 1 yr old

A

20 - 40

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44
Q

Respirations normal for 2 yr old

A

25 - 32

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45
Q

Respirations normal for 8 - 10 yrs

A

20 - 26

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46
Q

Respirations normal for 12 - 14 ys old

A

18 - 22

47
Q

Respirations normal for 16 yrs old

A

12 - 20

48
Q

Normal respirations for Adult

A

10 - 20

49
Q

What are you assessing when taking respirations

A

Rate, rhythm, force

50
Q

Blood Pressure normal value

A

Below 120/80

Systolic over Diastolic

51
Q

What is systole?

A

Ventricular contraction

52
Q

What is Diastole?

A

Ventricular relaxation

53
Q

What is MAP?

A

Mean Arterial Pressure: pressure forcing blood into the tissue averages over the cardiac cycle

54
Q

What can vary your BP?

A

Weight, age, Sex, Race, Exercise, Emotions, Stress

55
Q

What 5 factors determine your BP?

A

Cardiac Output, Peripheral Vascular Resistance, Volume of Circulating Blood, Viscosity, Elasticity of Vessel Walls

56
Q

Why would you check thigh BP in an adult or adolescent if their brachial artery is high?

A

Because if you check thigh pressure and its lower than the arm (which is not normal) then it means coarctation of the aorta

57
Q

What happens if you use a BP cuff that is too small?

A

BP will be higher than usual

58
Q

What happens if you use a BP cuff that is too big?

A

BP will be lower than usual

59
Q

What is the normal BP range?

A

Lower than 120/80

60
Q

What is considered stage 1 hypertension?

A

140-159/90-99

61
Q

What is considered stage 2 hypertension?

A

> 160/ >100

62
Q

When would you take a tympanic temperature?

A

You would use with a toddler that squirms

63
Q

When would you take an axillary temp?

A

With an infant

64
Q

When would you take an oral temp?

A

When the child is old enough to keep his or her mouth closed with thermometer under their tongue

65
Q

When would you take a rectal temp?

A

When no other routes are feasible, last resort

66
Q

When should you palpate a radial pulse?

A

When the child is older than 2

67
Q

Where should you take a pulse for infants and toddlers?

A

Auscultate and Palpate Apical pulse

68
Q

How long should you count respirations for an infant and how should you count?

A

You should count for a full minute. Keep in mind that infants breather more diaphragmatically than thoracic so you can watch their abdomen for movement

69
Q

Is BP the same, higher or lower in infants and children compared to adults?

A

Lower

70
Q

Why would you use an electric BP device that uses oscillometry or a doppler on children younger than 3?

A

Because it is hard to hear the Korotkoff sounds since it is very light and cant be heard with a stethescope

71
Q

Vital signs that change in the aging adult

A

Rhythm of their pulse may be slightly irregular, decreased in vital capacity and decreased inspiratory reserve volume, Aorta and major arteries stiffen, (systolic BP slightly higher), lower temp (greater risk for hypothermia)

72
Q

Electric vital signs monitor should not be used in people with a low systolic BP of _______ or lower

A

90

73
Q

What is considered hypotension?

A

<95/60 mm Hg in a normotensive adult, or below the normal BP for a hypertensive individual

74
Q

Reasons for hypotension

A

Acute M.I, shock, hemorrhage, vasodilation, Addison’s disease

75
Q

Is pain a vital sign?

A

Yes

76
Q

4 phases of nociception

A

Transduction, Transmission, Perception, Modulation

77
Q

What is neuropathic pain?

A

(Pain from direct damage to the nerve) The type of pain that does not adhere to typical phases inherent in nociceptive pain. Constant dull pain (Neuropathic back pain, Herpes Zoser, Diabetes or HIV, Central post stroke pain)

78
Q

What is Nociceptive pain

A

(Nociceptors is tissue send messages to CNS) Activity of nociceptors in cutaneous and deep musculoskeletal tissue in response to tissue damaging stimuli inflammation (postoperative pain, bone metastases, arthritis, sports injury, mechanical back pain, liver metastases, pancreatic cancer)

79
Q

What does OLDCARTS stand for?

A

Onset, Location, Duration, Character, Aggravation factors, Relieving factors, Timing and Severity (OBJECTIVE)

80
Q

What is PQRST for pain assessment

A

Provocation/Palliation, Quality/Quantity, Region/Radiation, Severity scale, Timing

81
Q

Visceral vs Somatic Pain

A

Visceral: Originates from larger organs
Somatic: originates from musculoskeletal tissue or body tissue

82
Q

Cutaneous vs Referred pain

A

Cutaneous: is derived from the skin surface and subcutaneous tissue “sharp pain”
Referred: Pain that is felt in a particular site but originates from another location

83
Q

Acute pain behaviors

A

Guarding, Grimacing, Vocalizations like moaning, Agitation, Restlessness, Stillness, Diaphoresis, Change in vital signs

84
Q

Chronic Pain behaviors

A

Lasts longer than 6 months

Bracing, Rubbing, Diminished activity, Signing, Change in appetite

85
Q

Pain assessment toold

A

Numeric rating, Verbal descriptor scales, Visual analog scale

86
Q

Wong Baker Scale

A

Faces pain rating scale for infants and children

87
Q

Oucher scale

A

1 - 10 scale using real faces of infants

88
Q

NIPS

A

Neonatal infant pain scale

89
Q

CRIES

A

Postoperative pain for preterm and term neonates

90
Q

FLACC

A

infants and young children under 3

91
Q

PIPS

A

premature infant pain profile

92
Q

PAINAD

A

Pain Assessment In Advanced Dementia
Focuses on breathing, vocalization, facial expressions, body language, consolability
(Agitation, Pacing, Repetitive yelling indicates pain

93
Q

Objective vs Subjective

A

Objective: what you observe
Subjective: What patient tells you

94
Q

CRPS

A

Complex Regional Pain Syndrome
(Chronic progressive nerve condition, characterized by burning pain, swelling, stiffness and discoloration of the affected extremity. Occurs weekks to months after a nerve injury [causes neuropathic “short circuit”])

95
Q

Results of overnutrition

A

Type 2 diabetes, heart disease, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, osteoarthritis

96
Q

BMI for overweight

A

25 or greater

97
Q

BMI for Obese

A

BMI of 30 and up

98
Q

Types of nutritional assessments

A

Nutrition screening (first step), Comprehensive nutritional assessment (dietary info, clinical info, physical exam, lab tests) , 24 hr recall, Food diary ( can be inaccurate and atypical, could be altered deliberately)

99
Q

Should children drink skim or low fat milk under the age of 2?

A

No because they need fat

100
Q

Normal weight gains for pregnant women

A

25 - 35 lbs for normal weight women
28 - 40 lbs for underweight women
11 - 20 lbs for overweight women

101
Q

Most commonly anthropometric measures

A

Heigh and weigh, tricep skin fold test, elbow breadth, arm and head circumference

102
Q

3 derived weight measure

A

Body weight as a percentage of ideal body weight, Percent usual body weight, BMI

103
Q

Android obesity

A

Person with greater proportion of fat in upper body, especially abdomen

104
Q

Gynecoid obesity

A

Person with most fat in the hips and thighs

105
Q

Waist circumference

A

Measured in inches at larges circumference below ribcage and above umbilicus

106
Q

Hip circumference

A

Measured in inches at largest circumference of buttocks (can indicate greater health risk alone)

107
Q

Skinfold thickness, location mainly done

A

Triceps

108
Q

What does low hemoglobin and Hematocrit mean?

A

Low iron

109
Q

Serum Albumin

A

Protein, patient with renal problems have low protein

110
Q

Adolescent nutrition

A

Shoudl increase caloric and protein intake to meet demands of bone growth and increasing muscle mass

111
Q

Difference between boys and girls during growth

A

Boys are taller around 10 -17

Girls have more body fat and double their weight between 8 - 14

112
Q

Metabolic syndrome and the 5 biomarkers

A 
Syndrome  carries increased cardiac risk and is diagnosed when a person has 3 of the following 5 biomarkers
-Elevated BP
-Increased fasting plasma glucose
-Elevated triglycerides
-Increased waist circumference
Low high-density LipoproteinS (HDL)
113
Q

Sarcopenic obesity

A

Sarcopenia (loss of muscle mass) combines with an increase in body fat

Health Assessment Exam 1 (6 decks)

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