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Advanced Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Health History Goals

A
  • Gather info: provide subjective database
  • Identify actual and potential health problems
  • Identify teaching and referral needs
  • Negotiate management
  • Support emotional and spiritual needs
  • Contract for: positive behavioral change, disease prevention
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2
Q

Traditional Health History

A
  • Start with general survey
  • Review chart/records
  • Understand where things go in chart
  • CC: chief complaint in patient’s own words
  • HPC/HPI: history of present concern/illness
  • PMH: past medical history
  • FH: family history
  • SH: social/lifestyle history
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3
Q

Importance of Genogram

A
  • Useful if patient is concerned about genetic risk or interaction of genetic/environmental factors
  • Helps patient/provider determine risk for developing a condition, understanding the reason for developing a condition, understanding if they will pass on the risk to children
  • Contains 3 generations - gender, age, dates of death
  • Only contains medical history
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4
Q

CN I

A

Olfactory
* test with familiar aromatic odors, one nare at a time with eyes closed

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5
Q

CN II

A

Optic
* Test distant and near vision

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6
Q

CN III

A

Oculomotor
* Allows EOM to move inward, lateral, upward
* Responsible for upper eyelid symmetry

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7
Q

CN IV

A

Trochlear
* Allows EOM to move eye inward and downward towards nose

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8
Q

CN VI

A

Abducens
* Allows EOM to move eye laterally to ear
* Inspect pupils’ size for equality and their direct and consensual response to light and accommodation (PERRLA)

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9
Q

CN V

A

Trigeminal
* Palpate jaw muscles for tone and strength when patient clenches teeth

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10
Q

CN VII

A

Facial
* Inspect symmetry of facial features with various expressions
* Smile, frown, puffed cheeks, wrinkles forehead

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11
Q

CN VIII

A

Acoustic
* Whisper neat patient’s ear and have them repeat
* If deafness suspected: use Rinne’s Test and Weber’s Test
* Test vestubular action: Romberg Test

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12
Q

CN IX and X

A

Glossopharyngeal and Vagus
* Test gag reflex and ability to swallow
* Inspect palate and uvula for symmetry and gag reflex
* If both are fully functioning - intact gag reflex

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13
Q

CN XI

A

Accessory Spinal Nerve
* Have patient shrug shoulders or turn head side to side for function

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14
Q

CN XII

A

Hypoglossal
* Have patient stick out tongue and assess for midline

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15
Q

External Ear Exam

A

Inspection
* Note level of the ears
* Inspect auricles and moce them around gently to assess tenderness
* Inspect auditory canal (cerumen, discharge, redness, tenderness)

Palpation
* Palpate mastoid process for tenderness or deformity
* Palpate tragus since tenderness can be sign of infection

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16
Q

Internal Ear Exam

A
  • Hold otoscope so ulnar aspect of hand makes contact with patient
  • Have patient tilt head slightly toward opposite shoulder
  • Pull ear back and up fro adult, back and down for child
  • Insert Otoscope under direct vision to point just beyonf protective hairs angled toward nose
  • Use shortest and largest speculum that will fit comfortable
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17
Q

Ptosis

A

Drooping of upper eyelid

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18
Q

Exophthalmos

A

Bulging of eyes (indicative of Grave’s Disease)

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19
Q

Xanthelasma

A

Regular, slightly raised/yellow lesions
Suggests lipid disorder

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20
Q

Anisocoria

A

Unequal pupils

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21
Q

Presbiopia

A

Near focus ability more difficult
Hard to see small print clearly
Increases with age and need reader glasses

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22
Q

Strabismus

A

Cross-eyed

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23
Q

Mitosis

A

Pupils <2mm from opiates

24
Q

Mydriasis

A

> 6mm from cocaine or THC

25
Q

Snellen Chart

A

Record smallest print successfully read at 100%
* 20/40: what normal eye can read at 40ft, tested eye can read at 20ft
* 20/200 = legal blindness

26
Q

Cataracts

A

Progressive clouding of the eye due to age

27
Q

Glaucoma

A

Damage to ocular nerve, can be due to increased ocular pressure
Can cause vision loss, peripheral vision loss, and blindness

28
Q

Macular Regeneration

A

Causes loss in center of field of vision
* Dry: center of retina deteriorates
* Wet: leaky blood vessels grow under retina

29
Q

Retinal Detachment

A

Retina separates in back of eye
Lose vision, painless
Can be corrected with surgery

30
Q

Tympanic Membrane Findings

A

Normally shiny, translucent, pearly gray
* Left ear: cone of light at 7
* Right Ear: cone of light at 5
* Fluid in ear can alter where cone of light goes - indicated infection

31
Q

Normal Lymph Nodes

A

Movable, discrete, soft, non-tender

32
Q

Abnormal Lymph Nodes

A

Large, tender
* Acute infection: enlarges, bilateral, tender, firm, freely movable
* Malignancy: hard, >3cm, unlateral, matted/fixed to structues

33
Q

Assessing Lymph Nodes

A
  • Gentle circular motion using finger pads
  • Start with preauricular nodes
  • Gentle pressure, use both hands to assess symmetrically except for submental gland under chin
  • Deep cervical chain - have patient turn head towards examined side
34
Q

Cardiac Physiology

A

4 chambers separated by valves to prevent backflow
* 2 AV: Tri and Mi
* 2 SL: P and A
* open and close passively

35
Q

Landmarks for Auscultation

A
  • Aortic: 2 ICS RSB / S2>S1
  • Pulmonic: 2 ICS LSB / S2>S1
  • Erb’s: 3 ICS LSB / S1 = S2
  • Tricuspid: 4 ICS LSB / S1>S2
  • Mitral (Apical): 5 ICS MCL / S1>S2
36
Q

Inspection of CVS

A
  • Look for scars, prior cardiac surgery, chest deficiencies (barrel/pigeon)
  • Look for pulsations, lift/heave
  • Apical Impulse: pulsation created at 5th ICS and left MCL as a result of L ventricle moving outward during systole
  • Displacement of apical pulse to left = enlarged heart
  • Lift/heave: pulsation that is not apical, considered abnormal, forceful thrusting as result of increased heart workload (ventricular hypertrophy)
37
Q

Palpation of CVS

A
  • Palpate carotid - note strength and compare with apical pulse
  • Position patient supine with head of bed/table slightly elevated
  • Use palm of hand, go from apex to LSB to base
  • Thrill: palpable vibration; signifies turbulent blood flow - can help identify murmur location
38
Q

Auscultaion of CVS

A
  • Carotids with bell, listen for bruit - can be sign of atherosclerosis or TIA/ischemic stroke
  • Asks patient to hold breath momentarily
  • 3 positions: sitting up, lying on side (listen with bell), lying on back, head is raised 30-45 degrees
  • Zig-zag pattern starting at base then going downwards
  • S1: loudest at apex, S2: loudest as base
39
Q

Cardiac Murmur Causes

A

Main sign of valvular heart disease
Causes
* High rate of blood flow through either normal or abnormal valve
* Valve opening problem - stenosis: valve tissues (leaflets) are stiffer/hardened which narrows the valve opening
* Closing - Insufficiency/Regurgitation: leaflets do not
close completely, blood flows backward, heart may enlarge to compensate and lose elasticity/efficiency, pooling can cause stroke or PE

40
Q

Grading Murmurs I-VI

A

I: barely audible with stethoscope in quiet room
II: quiet but clearly audible with stethoscope
III: moderately loud like S1/2
IV: loud, associated with thrill
V: very loud, easily palpable
VI: extremely loud, audible with stethoscope not in contact with chest, thrill palpable and visable

41
Q

Heart Murmur Descriptions

A
  • disruption of blood flow through heart: blowing/swishing sound
  • innocent murmur: healthy children and adolecents
  • timimg: where in cardiac cycle
  • loudness: intensity
  • pitch: low, medium, high
  • pattern: crescendo, decrescendo across cardiac cycle
  • quality: blowing, musical, harsh, rumbling
  • location: heard best
  • radiation
42
Q

S1 Heart Sound

A
  • Closure of AV valves - signals beginning of systole
  • Mitral component of first sound (M1) slightly precedes tricuspid (T1)
  • Usually hear these two components fused as one sound
  • Can hear S1 all over precordium, but loudest at apex
43
Q

S2 Heart Sound

A
  • Closure of semilunar valves - signals end of systole
  • Aortic component of second sound (A2) slightly precedes pulmonic (P2)
  • Although heard all over precordium, S2 loudest at base
44
Q

ECG Reading

A
  • Poor placement can result in misinterpretation
  • Help diagnose heart arrhythmias and alert ST elevation
  • Consider: warm/dry skin, extremity electrodes should point posteriorly
  • Patient supine with HOB slightly raised
  • Stay still, no shivering
45
Q

Mental Status and LOC

A
  • Change in MS or LOC = first clue to deteriorating condition
  • First signs of neurological deterioration are subtle - can be best detected by family members & conversation w/ patient
  • Consciousness is the degree of wakefulness or ability to arouse the patient. Not the same as orientation, a patient may be conscious but not oriented.
46
Q

Motor Assessment Significance

A
  • Note any voluntary/involuntary movement: tics/tremors
  • Movements should be smooth and coordinated
  • Coordination, fine motor skills, balance can only be performed when patient is awake & alert & can respond to verbal stimuli
47
Q

Sensory Assessment Significance

A
  • Majority of neuropathy issues begin distally (start assessing at the feet then move to the hands)
  • Use safety pin to test superficial pain
48
Q

Posturing

A

Associated with head trauma
* Decorticate Rigidity: rigid flexion, preserves brainstem function, arms like a C
* Decerebrate Rigidity: arms are pronated outwards, indicates brainstem damage, arms like an E

49
Q

Deep Tendon Reflexes

A
  • Testing for muscle contraction in response to direct/indirect percussion of a tendon
  • Clonus: foot is dorsiflexed & taps multiple times (sign of neurological condition)
50
Q

Cerebellar Assessment Significance

A
  • Test coordination, fine motor skills, and balance
  • Assess patient’s gait - should have smooth, rhythmic cadence with equal amount of time in swing/stance phase, opposite arm movements
51
Q

Cerebellar Assessment

A

Balance
* Tandem: heel-toe walking
* Romberg test: feet together, eyes closed, look for swinging - lesion present, patient able to compensate by opening eyes

Coordination
* Rapid alternating movements
* Finger to nose to finger test - inability could indicate cere dysfunction
* Heel down shin - loss of coordination is abnormal

Gait Disturbances
* Could indicate spastic hemiparesis, cerebellar ataxia, parkinsonian gait

52
Q

Glasgow Coma Scale

A
  • Used to quantify LOC/Neurological impairment (usually for patients with trauma and other hypoxic effects)
  • Based on: Eye opening, Motor Response, Verbal response
  • Patient receives score for best response in each of these areas (score added together)
  • Score range 3-15 = higher the better
  • <8 indicates coma, lower scores indicate greater degree of damage
  • Infants and children are slightly different
53
Q

Nystagmus

A

Abnormal, involuntary, rapid eye movements

54
Q

Strabismus

A

Involuntary drifting of one eye out of alignment with the other eye - lazy eye

55
Q

Senile Letingines

A

Hyperpigmented macules of skin that occur in irregular shapes, appearing most commonly in the sun-exposed areas of the skin such as on the face and back of the hands

56
Q

Bruit

A

The sound of blood flowing through a narrowed portion of an artery. The sound means that the blood flow may be partially blocked; artery blockage is most often due to atherosclerosis
Typically heard over the aorta, renal arteries, iliac arteries, and femoral arteries

57
Q

Which respiratory sound indicates an upper airway obstruction?

A

Stridor: abnormal, high-pitched, musical breathing sound

Advanced Assessment (4 decks)

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