Exam 2 Flashcards
What are the identifiers for a nutritional assessment?
Obesity
Dietary deficits(malnutrition, under nutrition)
Guidance for health promotion and disease prevention
What is optimal nutritional status?
Balance of nutrient intake to meet daily metabolic demands
What can change someone’s metabolic demands?
High levels of exercise
Elevated body temperature
Diseases
What can affect nutritional status?
Development
Cultural behaviors
Economic status
What do people with optimal nutritional status have?
Improved immune systems
More energy for activities
Body heals quicker
Types of malnutrition
Undernutrition
Overnutrition
Undernutrition
Inadequate nutrient intake or nutritional reserves been depleted
What can cause under nutrition?
Certain diseases
Disorders
Lifestyle behaviors
Risk factors of undernutrition
Lower socioeconomic status
Long work hours
Poor food choices
Chronic dieting
Chronic diseases
Dental problems
Illness or trauma
Limited access to sufficient foods
Eating disorders
Overnutrition
Intake of nutrients exceeds the metabolic needs of the body to maintain normal growth, development, and metabolism
Risk factors for overnutrition
Obesity
Cardiovascular disease
Type two diabetes
Hypertension
Cancer
Gallbladder disease
Sleep apnea
Immune system diseases
Things that affect hydration
-Exposure to high environmental temperatures
-Lower access to adequate fluids
-High intake of alcohol or diuretic fluids (coffee, soft drinks)
-People with impaired thirst mechanisms
-People taking diuretic medication’s
-Diabetic clients with severe hyperglycemia
-People with high fevers
Optimal hydration
Maintains functions, like urination, bowel, elimination, sweating, temperature, regulation, toxin, illumination, metabolism, enzyme, production, nutrient, absorption, immune system, efficiency, calorie burning efficiency, and health of skin, hair and nails
Daily water recommendation
Eight , 8oz glasses
Dehydration/underhydration
-Dehydration can go unnoticed in normal people under adverse conditions
-Development of a sense of thirst typically after dangerous deficit of fluid
Overhydration
-Typically not a problem in a healthy person
-People at risk for overhydration are those with kidney, liver, and cardiac diseases
Components of a nutritional assessment
Health history interview
Physical examination
Physical growth and development
Nutritional status
Laboratory tests
What type of data is collected first in a health assessment?
Subjective data
Types of objective data
Patient diet
Weight loss or gain
Current weight
Patient/family history
Lifestyle and health practices
What do you use when evaluating symptoms?
COLDSPA
What is COLDSPA?
-C: character
-O: onset
-L: location
-D: duration
-S: severity
-P: pattern
-A: associated factors
What is used for warning signs of poor nutrition?
DETERMINE
What is DETERMINE?
-D: disease
-E: eating poorly
-T: tooth loss or mouth pain
-E: economic hardship
-R: reduced social contact
-M: multiple medicines
-I: involuntary weight loss or gain
-N: needs assistance
-E: elderly (80yrs or older)
What are signs of foodborne illness?
Nausea
Vomiting
Diarrhea
Abdominal cramps
Most common pathogens of foodborne illnesses
Norovirus
Salmonella
Clostridium perfringens
Campylobacter
What is a food allergy?
A immune response to irritation, or the inability to break down enzymes
What are the most common allergies?
Peanuts, tree, nuts, milk, eggs, wheat, soy, fish, shellfish, sesame
How long do symptoms take for allergic reactions?
Minutes to hours after ingestion
What type of equipment is needed for an exam?
Scale
metric measuring tape
Marking pencil
Calipers
What is a anthropometric measurement?
Height and weight
Vital signs
BMI
Mid arm and waist circumference
Skinfold thickness
Mid arm muscle circumference
Different body types
Ectomorph
Endomorph
Mesomorph
Ectomorph
Small frame
Flat chest
Thin
Lean muscle
Hard to gain weight
Mesomorph
Athletic
Hardbody
Strong
Defined muscles
Gaines muscle easily
Endomorph
Soft and round body
Gaines muscle, and fat easily
Stocky
Hard to lose fat
Muscles not defined
Visceral fat
Inside and around organs
Subcutaneous fat
Directly underneath the skin
Abnormal nutrition
Marasmus
Kwashiorkor
Marasmus
Protein and calorie malnutrition
Kwashiorkor
Pro Tien malnutrition
Findings of elderly’s nutritional safety
Muscle tone and mass decrease
Loss of subcutaneous fat
Fat is redistributed
Tinting (fluid loss, mount, nutrition, loss of collagen)
Fat moves from face and neck and goes to arms, abdomen and hips
How to communicate interview and assessment findings
Validate information collected
Ask additional questions
Compare, objective and subjective data
Document both normal and abnormal findings
Age ranges for TBI risk factors
Newborn-4yrs
15-19yrs
Adults over 65 yrs
TBI risk factors
Transportation accidents
Violence
Falling
Caregivers
TBI risk factors for infants and toddlers
-Environmental
-Lack of parental knowledge of shaken baby syndrome
-Caregivers risk of shaken baby syndrome
TBI risk factors for children and teens
-Lack of protective equipment in sports and bicycle use
-Lack of safety practices while driving
TBI risk factors for adults and older adults
-Knowledge and use of safety practices for driving
-Impairment of physical or mental stability
-Maltreatment or domestic violence
TBI prevention teachings
-Use of child safety seats( car seat, booster)
-Wearing a seatbelt any time any motor vehicle
-Wearing a helmet or protective equipment
-Making living areas safe for elders (tripping hazards, mats and rugs, bar, rails, handrails, proper lighting)
-Never drive under the influence
What is HIT
Headache impact test
Questions to ask for HIT
-When you have headaches, how often is the pain severe?
-How often do headaches limit your ability to do usual daily activities?
-When you have a headache, how often do you wish you could lie down?
-In the past 4 weeks, how often have you felt too tired to do work or daily activities because if your headaches?
-In the past 4 weeks, how often have you felt fed up or irritated because your headaches?
-In the past 4 weeks, how often did headaches limit your ability to concentrate on work or daily activities?
Sinus headache
Deep, constant, throbbing, pain, or pressure, like pain in one specific area of face or head; tender to the touch
Occurs with, or after a cold, acute sinusitis, acute febrile illness
Cluster headache
Stabbing pain may be accompanied by tearing eyelid, drooping, redness, or runny nose
Has sudden onset may be precipitated by ingesting alcohol
Tension headache
Dull, tight defuse
No prodromal stage may occur with stress, anxiety, or depression
Migraine, headache
Accompanied by nausea, vomiting, and sensitivity, to noise or light
May have prodromal stage such as visual disturbances, vertigo, numbness, or tingling in the fingers or toes
May be precipitated by emotional disturbances, anxiety, or ingestion of substances, to which client is sensitive
Tumor related headache
Aching, steady, neurologic and mental symptoms, as well as nausea and vomiting
No prodromal stage may be aggravated by coughing, sneezing or sudden movements of the head
How to prepare a client for head and neck examination
-Ask them to remove wigs, hat, hair, clips, jewelry, scarves
-Upright position
-Explain the importance of being still
-Explain what you were doing
-Be cautious of any cultural considerations
Tools needed for head and neck exam
Small cup of water
Stethoscope
Penlight
Gloves
Techniques for head, examination
-Inspect for size shape, and configurations
-Palpate for consistency
-Inspect face for symmetry, movement expression
Where to palpate temporal artery
Between top of ear and eye
Where to palpate temporomandibular joint
Please finger over front of each ear and have client open and close mouth
Techniques to inspect neck
Observe neck that is slightly extended for symmetry, lumps, and masses
Inspect swallowing movement of neck
Ask client to swallow a sip of water and observe the movement of the thyroid cartilage
Inspect cervical vertebrae
Ask the client to flex the neck chin to chest
Inspect ROM
Turn head right to left, touch ear to shoulder, chin to chest, Chin to ceiling
Palpate trachea
Place finger on sternal notch, feel each one and palpate tracheal rings
Palpate lymph nodes
Preauricular
Postauricular
Occipital
Submandibular
Submental
Tonsillar
FAST- signs of stroke
Face drooping
Arm weakness
Speech difficulties
Time to call
Signs and symptoms of hypothyroidism
Increased sensitivity to cold
Constipation
Depression
Fatigue
Pale dry skin
Heavy periods
Thin hair or nails
Weakness
Unintentional weight gain
Abnormal findings of head and neck
Hyperthyroidism
Hypothyroidism
Headaches
Stroke
TBI
Acromegaly
Cushing syndrome
Scleroderma
Bell palsy
Hyperthyroidism(thyrotoxicosis)
Bulging eyes
Hypothyroidism(myxedema)
Dull, puffy face
Edema around the eyes
Dry, course, and sparse hair
Headaches
Stroke
FAST
TBI
Traumatic brain injury
Acromegaly
Enlargement of the facial features(eyes, nose), hands and feet
Cushing syndrome
Moon shaped face
Reddened cheeks
Increased facial hair
Scleroderma
Tightened hard face with thinning facial skin
Bell palsy
Begins suddenly and reaches a peek within 48 hours
Twitching
Weakness
Paralysis
Drooping eyelids or corner of the mouth
Drooling
Dry eye
Dry mouth
Decreased taste
Facial distortion
What do older client to have arthritis or osteoporosis experience?
Neck pain, and a decreased range of motion
Why are facial wrinkles more prominent in older clients?
Subcutaneous fat decreases in age
Lower face may shrink in the mouth may be drawn inward
What happens to the strength of pulsation in the temporal artery is an older clients?
It may decrease
Why would cervical curvature increasing in older clients?
Because of kyphosis of the spine
Dowager’s hump
Fat accumulation around the cervical vertebrae(especially in women)
What do older clients thyroid feel like?
More nodular or irregular, because of fibrotic changes that occur with aging
Thyroid could also be felt lower due to structural changes because of age
Cataracts
Often preventable
Leading cause of blindness
Develop slowly, and are often found in people over 65 years of age
Clouding of the eye lids causing a person to see as though looking through a frosty or foggy window with vision, even more affected at night
Symptoms of cataracts
Feeding or yellowing of colors
Sensitivity to light or glare
Seeing halos around lights
Double vision in one eye
Frequent prescription changes
Risk factors for Cataracts
Increasing age
Diabetes
Excessive exposure to sunlight
Smoking
Obesity
HPT
Previous eye injury or surgery
Prolonged use of corticoidsteroid medication
Excessive amounts of alcohol
Preventing Cataracts
-Have regular eye examinations(yearly, or twice a year at 65 years of age)
-Where is sunglasses that block ultraviolet be raise
-Protect eyes, if exposed to radiation sources
-Avoid or stop smoking
-Avoid access alcohol intake
-Maintain healthy weight
-eat a well-rounded diet
-Supplements to prevent cataracts
-Seek medical attention for prolonged eye inflammation
Who has the poorest visual acuity in the United States?
Japanese and Chinese Americans
Who has the second poorest corrected visual acuity in the United States
African-Americans and Hispanics
Who has the best corrected visual acuity in the United States
Native Americans and whites
Presbyopia
Common in clients over 45
Gradual loss of eyes ability to focus on nearby objects
Entropion/Ectropion
Eyelid turns in and causes eyelashes to rub against the cornea
Pinguecula
Yellowish nodules on bulbar conjunctiva
Arcus senilis
Half circle of gray, white or yellow deposits in the outer edge of the cornea
Made of fat and cholesterol deposits
Chart used to test sight
Amsler chart
How to prep client for eye exam
Explain the need to be close to the patients face with a ophthalmoscope to view retina
Equipment used for eye exam
Snellen chart/ E chart
Penlight
Opaque cards
Ophthalmoscope
Gloves
Abnormal findings of external eye
Conjunctivitis
Exophthalmos
Conjunctivitis
Inflammation of the conjunctiva
Symptoms of conjunctivitis
Redness in one of those eyes
Itchiness in one or both eyes
A gritty feeling
Discharging one or both eyes
Formation of crust
Tearing
Abnormal findings of the extraocular muscles
Psuedostrabismus
Esotropia
Exotropia
Phoria
Paralytic strabismus
Pseudostrabismus
Normal in young children
The pupils will appear at the inner canthus
Esotropia
Eye turns inward
Extropia
Eye turns outward
Ptosis
Drooping eye
Ectropion
Outwardly turned lower lid
Physical assessment of the eye (trauma)
Foreign body
Perforated globe
Blood in eye
Swollen lid
White cornea
Irregular shaped pupil
Risk factors for hearing loss
Ototoxic meds
Childcare
Bottlefeeding, while lying down
Fall and winter seasons
Poor air quality
Family history
Cleft palate
Down syndrome
Ethnicity
Enlarged adenoids
Smoking
Premature birth
Education to avoid hearing loss
-Avoid loud sound exposure
-Avoid activities that involve loud sounds, or risks to had an ear injury
-Avoid listening to loud music for long periods of time
-We are ear protectors, and take breaks from loud noises
-Have your hearing checked periodically
-Avoid tools the remove wax
Subjective data for ears and hearing
Changes in hearing
Personal health history
Family history
Lifestyle and health practices
Other symptoms
Equipment needed for an ear exam
Watch
Tuning fork
Weber test
Rinne test
Otoscope
Weber test
Placed the base of the tuning fork on the bridge of the forehead, nose, or teeth
Rinne Test
Place the piece of the tuning fork on the mastoid bone behind the ear. Have the patient indicate one sound is no longer heard.
Inspecting the auricle, tragus, and lobule
Inspect size, shape, and position
Palpation of auricle and mastoid process
Firm, non tender
No bumps or lesions
Whisper test
Stand 2 feet behind patient on one side, and whisper a word, and see if they can tell you what you whispered
Romberg test
Tests the clients equilibrium
Ask the client to stand with her feet together, arms at side and eyes open and then with eyes closed
Can maintain position for 20 seconds without swaying or minimal swaying
Otoscope
Flashlight that is used to visualize the eardrum and external ear canal
How to use otoscope
Using thumb and fingers grasp a clients auricle firmly pull out of and back
Abnormal findings of the external ear
Malignant lesion
Otitis externa
Cerumen buildup (earwax)
Polyp
Exostosis
Microtia
Tophi
Polyp
Growth inside ear canal due to chronic ear infections or skin cyst
Exostosis
Known as surfers ear
Abnormal bone growth within the ear canal due to chronic irritation , hereditary, and unknown reasons
Microtia
Congenital abnormality, where the external ear does not fully develop
Tophi
Hard, external or natural associated with deposits of uric acid crystals in advanced gout
Abnormal findings of the tympanic membrane
Acute otitis media
Blue/dark red tympanic membrane
Perforated tympanic membrane
Serious otitis media
Scarred tympanic membrane
Retracted tympanic membrane
Chronic suppurative otitis media with cholesteatoma
Acute otitis media
Red, bulging membrane, decreased, or absent light reflects
Blue or dark red tympanic membrane
Indicates blood behind the eardrum due to trauma
Perforated tympanic membrane
Perforation results from rupture caused by increased pressure
Serous otitis media
Yellowish bulging membrane with bubbles behind it
Scarred, tympanic membrane
White spots in streaks indicate scarring from infection
Retracted tympanic membrane
Prominent landmarks are caused by negative air pressure due to obstructed tube or chronic otitis media
What to document after ear assessment
Biographic data
Reason for seeking care
History or present health concerns
Personal health history
Family history
Lifestyle and health practices
Physical examination findings
Risk factors for oral cancer
Tobacco use
Alcohol consumption
Prolong skin exposure
HPV virus
Men more than women
Fair skin
Age over 45
Poor oral hygiene
Poor diet
Weakened immune system
Marijuana use
Chewing betel nut(south, and south east Asia)
Reducing risks of oral cancer
Avoid smoking cigarettes or using tobacco
Avoid excessive alcohol use
Avoid chewing betel nuts
Avoid infection with HPV (oral sex)
Avoid excessive sun exposure
Eat a well-rounded diet
Practice oral hygiene
Avoid smoking marijuana
Client in preparation for examination of the mouth, throat, nose, and sinuses
Sitting position with their head at eye level
Explain procedure
Remove dentures, retainers, or rubber bands on braces
Equipment needed for mouth, throat and nose assessment
Non-latex gloves
Gauze pad
Penlight
Tongue depressor
Nasal speculum
Examination of mouth
Lips
Teeth
Buccal mucosa
Inspect and palpate tongue
Check strength of tongue
Inspection of nose
Inspect and healthy external nose
Check patency of airflow through nostrils
Inspect internal nose
Inspection of sinuses
Palpate sinuses
Percuss sinuses
Abnormal findings of mouth and throat
Herpes Simplex type one(cold sores)
Cheilosis of lips
Carcinoma of the lip
Leukoplakia
Hairy leukoplakia
Candida albicans infection
Black hairy tongue
Carcinoma of the tongue
Canker sore
Gingivitis
Receding gums
Kaposi sarcoma lesions
Acute tonsillitis
Strep
Abnormal findings of sinuses
Nasal polyp
Perforated septum
Deviated septum
Age related changes of the mouth, throat, nose, and sinuses
Ability to smell and taste decreases
Gums recede
Difficulty with oral hygiene
Oral mucosa is often dryer and more fragile
Preparation of client for abdominal assessment
Have client empty their bladder
Remove clothes and put on a gown
Lie down and supine position
Arms folded across chest or resting by sides
Equipment for abdominal assessment
Centimeter ruler
Small pillow
Marking pen
Stethoscope
Order of abdomen examination
Inspection
Auscultation
Percussion
Palpation
Abnormal abdominal findings
Abdominal edema, or swelling
Abdominal masses
Unusual pulsations
Pain associated with appendicitis
Discoloration
Nonhealing wounds
Inflammation
Normal abdominal findings
Proper skin color
Stretch marks
Scars
Lesion free
Rash free
Flat or round it abdomen
4 signs for assessing appendicitis
Psoas
Obturator
Hypersensitivity
Blumberg
Psoas sign
Pain in RLQ when leg is hyperextended
Irritation of the iliopsoas due to appendicitis
Obturator sign
Pain in the RLQ when hip and knee are flexed, and leg is rotated, internally and externally
Irritation of the up to return muscle, due to appendicitis or a perforated appendix
Blumberg sign
Abdominal pain or tenderness experience when examiner test for a rebound tenderness
Peritoneal irritation
Hypersensitivity
Performed with a sharp object such as a broken cotton tip, applicator or tongue blade
Stroke the abdomen with said object, client should feel no pain and no exaggerated sensation
Is pain is indicated it may indicate appendicitis
Murphy sign
Pressure is applied under the liver border at the right costal margin, and client inhales deeply
Indicates inflammation of the gallbladder
