Exam 1 Flashcards
Parts of a successful patient interview
selecting an appropriate physical setting, using a patient centered approach, and creating a positive rapport with the patient; privates, queit, comfortable room free of distraction, sit face to face
Central element of Patient Centered Care
treating each patient as a unqiue individual, respecting the patient for who they are, and responding to needs and preferences
Gender Identity
represents a persons own internal sense of gender
Gender Expression
refers to how an individual presents his or her gender within the context of a culture and society
Cisgender
gender identity consistent with the sex assigned at birth
Transgender
gender identity that does not mathc the sex assigned at birth; male identifies as female (transfemale) or female identifies as male (transmale)
Nonbinary
person does not identify as male or female
Agender
person does not identify with any gender
Family Members as Translators
family members are discouraged as being translators bc the family may alter th emeaning of what is said or describe what they think is wrong with the patient
Three phases of the interview
introduction, discussion and summary
Introduction Phase
greet the patient; introduce self to patient; establish puropse of the visit from patient; describe the purpose and process of the interview
Discussion Phase
facilitate and maintain a patient centered approach; use various communication skills and techniques to collect data
Summary Phase
summarize the data with the patient; allow the patient to clarify the data; create a shared understanding of the problems with the patient; plan for next steps and end einterview
Key Points to Ensure a Successful INterview
make a good first impression, be prepared, be an attentive listener through the interview, avoid using medical jargon
Open Ended Questions
broadly stated questions encourage a free flwoing, open response; elicit responses that are more than one or two words
Directive Questions
or closed ended questions; require only one or two words to answer or leads patinets to focus on a set of thoughts
Facilitation
uses phrases to encourggae the patient to continue talking
Reflection
technique used to gain claification by restating a phrsase used by the patient in the form of a question
Confrontation
used when inconsistencies are noted between what the patient reports and observations or other data about the patient; tone of voice is imp when using; use a ton that communications confusion or misunderstanding rather than one that is accusatory and angry
Why Questions
try to avoid them because they can be perceived as threatning and may put patients on the defense; say “I noticed severeal prescriptions left in the bottle….did you intend to take them all”
Overly Talkative Patient
use of directive or close ended questions may help to maintain direction and flow of the conversation
Comprehensive Health History
performed for new patients in any setting, including a hospital admissino, an initial clinic visit or home visit
Problem Based Assessment
includes data that is limited in scope to a specifc problem; such as a lacerated foot; but should still include impt stuff such as allergies
Episodic Assessment
generally focuses on a specific problem or problems for which a ptient has already received treatment
Components of Health History
biographic data, resons for seeking care, history of presenting illness, present health status, past health history, family history, personal and psychosocial history, review of systems
OLD CARTS
onset, location, duration, characteristics, aggravating afactors, related symptoms, treatment, severity
When does patient inspection begin?
as soon as you meet the patient
General Appearance
includes overall state of health, age, level of consciousness, obvious signs of distress, skin and hygiene
Unintentional Weight Change
increase- may be the first sign of fluid retention (1L of fluid retained = incrased by 2.2 lbs)
Temperature
regualted by he hypothalamus; range 96.4-99.1 F; lowest temp in the morning and highest in late afternoon/early evening
Oral Temperature
smoking, ingestion of hot/cold food/liquid impacts accuracy delay reading for 10 mins in these situations
Tympanic Membrane Temp
tug ear upward on helix for adults (and downwards on the earlobe for infants and children); helps straighten the external auditory canal
Axillary Temp
though to poorly reflect core body temp bc it is not close to any major blood vessels and thermometer is placed between skin surfaces; but common for infants and children
Rectal Temp
reflect core body temperature and is considered more accurate than noninvasive approaches ; but is taken on infants and comatose
Mean usually breathe…
diaphragmatically which increased the movement of the abdomen
Women usually breathe….
thoracic; which is seen with movement of the chest
Blood Pressure
force of blood against the arterial walls and reflect the relationship between cardiac output and perpheral resistance
Systolic Blood Pressure
maximum pressure exerted on arteries when the ventricles contract or eject blood from the heart
Diastolic Blood Pressure
represents the minimum amount of pressure exerted on the vessels; this occurs when the ventricles relax and fill with blood
Pulse Pressure
the difference between the systolic and diastolic pressure; normally ranges from 30-40 mmhg
Orthostatic Hypotension
a 20-30 mmhg drop in BP when the patient moves from a lying or sitting position to standing indicates orthostatic hypotension
Age (BP)
from childhood to adulthood there is a gradual rise in BP
Gender- BP
after puberty, females usually have a lower blood pressure than males; however, after menopuase, a womans BP may be higher
Pregnancy -BP
during pregnancy, diastolic BP may gradually drop slightly during the first two trimesters of pregnancy, but then it typically returns to the prepregnant levels by term
Race- BP
the incidence of hypertension is twice as high in african americans as in whites
Emotions- BP
feeling anxious, angry, or stressed may increase blood pressure
Pain- BP
eperiencing acute pain may increase BP
Personal Habits- BP
ingesting caffeine or smoking a cigaretter within 30 mins before measurement may incrase BP
Errors resulting in False High BP
allowing patient to cross legs; positioning of arm below the heart; using a too narrow cuff; reflating cuff too slowly; reinflating cuff before completely deflating it;failing to wait before a repeat measurement
Errors resulting in False Low BP
arm above heart; using a too wide cuff; not inflating cuff enough; deflating cuff too fast; pressing diaphragm too firmly
Pain Threshold
the point at which a stimulus is perceived as pain (which is typically very similar for everyone)
Pain Tolerance
the duration or intensity of pain that a person endures or tolerates before responding outwardly; highly dependent/variable through culture s
Problem Based Coping strategies for Pain
involve changing activity patterns or intentional self care activites; walking, stretching, vitamins, etc
Emotional Based Coping Strategies for Pain
include religious coping and social support
Risk Factors for Skin Cancer
personal history of skin cancer, family history of skin cancer, older age, exposure to UV, lifetime sun exposure, sever, blistering sunburns especially at an early age, fair skin, blond/red hair, blue or green eyes, moles
Pruritus
itching
Xerosis
dry skin
Seborrhea
oily skin
Hyperthyroidism and Nails
may cause the nail to separate from the nail bed and make the nail appear “dirty”
ABCDE
asymmetry, border, color, diameter, evolving
Hypopigmentation
albinism; a complete absence of pigmentation
Hyperpigmentation
increased melanin deposit; may be indication of an endocrine disorder
Cool Skin
generalized cool or cold skin is an abnormal finding and may be associtated with shock or hypothermia; if specifically in extremeties it may be an indicator of poor peripheral perfusion
Diaphoresis
excessive sweating
Clubbing
the angle of the nail base exceeds 180 degrees; commonly associated with chronic respiratory or cardiovasucalr diasease
Cyanosis
light skin- grayish blue tone especially in nail beds, earlobes, lips, mucous membranes, palms and soles of the feet; dark skin- ashen gray color most easily seen in the conjunctiva of the eye, oral mucous membranes, and nail beds
Erythema
light skin- reddish tone with evidence of increased skin temp secondary to inflammation; dark skin- deeper brown or purple skin tone with evidence of increased skin temp secondary to inflammation
Pallor
dark skin- skin tone appears lighter than normal; may appear ashen, yellowish brown
Atopic Dermatitis
dermatitis is used to describe a variety of superficial inflammatory conditions of the skin that can be acute or chronic; atopic dermatitis is a chronic superficial inflammation of the skin with an unknown cause; however it is commonly associtated with hay fever and asthma and is thought to be familial
Contact Dermatitis
inflammatory reaction of the skin that develops in response to irritants or allergens such as metals, plants, chemicals or detergent ; develops in an area exposed to the causative irritant or allergen and appears as localized erythema that may also include edema, wheals, scales or vesicles that may weep ooze and become crust; pruritus
Seborrheic Dermatitis
chronic inflammation of the skin, has no known cause and affects individuals throughout their lives, often with periods of remission and exacerbation;
Stasis Dermatitis
see in older adults, inflammation of the skin usually affecting the lower legs; area or areas of erythema and prurutis followed by scaling, petechiae, and brown pigmentation
Psoriasis
chronic; inflammatiory process causes lesions of psoriasis and can range from mild to severe
Herpes Varicella
chicken pox; high comminicable viral infection; initially lesions are macuales but they progress to papules and tehn vesicles and then crusts
Herpes Zoster
shingles; dorman herpes varicells virus; commonly on trunk and face
Basal Cell Carcinoma
most common form of skin cancer; locally invasice and rarely metastasizes
Squamous Cell Carcinoma
second most frequent form of skin cancer; typically on head or neck
Hirsutism
condition associated with an increase in growth of facial, body or pubic hair in women
Sinus Headaches
may cause tenderness over frontal or maxillary sinuses
Tensions headaches
tend to be located in the front or back of the head; described as viselike
Cluster Headaches
produce pain over the eye, temple, forehead and cheek; burning or stabbing feeling over one eye
Presyncope
feeling of faintness and impending loss of consciousness; sometimes called a near faint; often cardiovascular symptom
Disequilibrium
feeling of falling; often a vestibular function disorder
Vertigo
sensation of movement, usually rotational motion such as whirling or spinning; subjective vertigo is the sensation that ones body is rotating in space; objective vertigo is the sensation that objects are spinning around the body; cardinal symptom of vestibular dysfunction
Nose Discharge
thick or purulent green-yellow, malodorous discharge usually results from a bacterial infection; foul smelling discharge (especially unilateral) assocaited with foreign body or chronic sinusisits
Normocephalic
term designating that the skull is symmetric and appropriately proportioned for the size of the body
Ptosis
the lid of either eye covering part of the pupil
Conjunctivitis
may be indicated by red conjunctiva, particulary with purulent drainage
Yellow Sclera
may indicatae jaundice caused by liver disease or obstruction of the common bile duct
Pupil diameter
less than 2mm or greater than 6mm is an abnormal finding
Perrla
pupils are equal and round and react to light and accommodation
Perforation
hole in the tympanic membrane
Yellow/Amber Tympanic Membrane
serous fluid in the middle ear, which may indicate otitis media with effusion
Redness Tympanic Membrane
infection in the middle ear such as acute purulent otitis media
Chalky White Tympanic Membrane
infection in the middle ear such as otitis media
Blue or Deep Red of Tympanic Membrane
blood behind the tympanic membrane, which may have occured secondary to injury
Red Streaks on Tympanic Membrane
injected/increased vascularizatino may be caused by allergy
Dullness of Tympanic Membrane
fibrosis or scarring of the TM secondary to repeated infections
White Flecks/Plaques on TM
healed inflammation of the TM
Weber Test
if sound lateralizes to one side the test should be considered abnormal; lateralization of sound to the affected ear suggests conductive hearing loss; lateralization to the unaffected ear suggests sensorineural hearing loss
Rinne Test
consider abnormal if sound is heard longer by bone conduction than air conduction
Migraine Headache
second most common; throbbing unilaterla districuion of the headache pain; may accompany dpression, restlessness irratibilty, photophobia nausea or vomiting; may last up to 72 hrs
Hydrocephalus
abnormal accumulation of cerebrospinal fluid
Hordeolum
stye; acute infection originating in the sebaceous gland of the eyelid; painful red and edematous
Conjunctivitis
inflammation of palpebral or bulbar conjunctiva; eye appears red; bacterial conjunctivitis produces purulent exudate causing a stickiness in the morning; viral conjunctivites produces a watery exudate; allergic conjunctivitis produces a stringy mucoid dischard and itchiness of the eyes
Cataract
opacity of the crytalline lens; cloudy or blurred vision; glare from lights, diplopia, changes in glasses prescription; red reflex absent
Glaucoma
increase in intraocular pressure; open angle, closed angle, congenital, and caused by drugs/meds
Acute Otitis Media
infection fo the middle ear; ear pain, TM inflamed and red may be bulging; later stages may lead to discoloration, purulent drainage and sudden relief of pain suggest TM perforation
Conductive Hearing Loss
results from a blockage of teh external canal or problems with TM or problems wit h middle ear; chief complain is decreased ability to hear and report of muffled tones
sensorineural hearing loss
caused by structural changes, disorders of the inner ear or problems with the auditory nerve; over 90% of hearing loss
Epistaxis
nose bleed
Hyperthyroidism
excessive production of thyroid hormone; can be caused by graves disease (most common cause); increased metabolis, goiter
Hypothyroidism
derceased thyroid hormone production; can be caused by autoimmune thyroiditis, decreased secretion of thyroid releaseing hormone, congential defects, treatment of hyperthyroidism, iodine deficiency; decreased metabolism and slow motion
Cigarette use is…
documented in pack years; number of years that a person has smoked multiplied by the number of packs of cigarettes smoked each day
