Exam One - Think Tank Flashcards
Body language and pain
fretful hand movements, restless
Comprehensive review of systems
reason for visit, extent of illness
NPs handle multiple patient complaints
one at a time and all must be explored/drilled down
How do you document lack of communication from a patient?
“pt is not a reliable source”
What are you assessing when using a proverb or metaphor ?
abstract reasoning
chalazion
focal lesion appears to be inflammatory in nature on the meibomian gland
Nutritional assessment in the elderly
MNA - mini nutritional assessment
height/weight
biochemical – albumin & hemoglobin
functional
Patch test on a papule that erupted
allergic contact dermatitis
Documentation of a specific family members history :
age their family member experienced it/onset
Assessment of elderly pt after rehab
functional / ADLs
Newborn assessment sequence
1st-head/fontanelles
2nd - extremities
3rd - trunk/abdomen
Newborns assessment technique likely to yield most clues
Inspection
Valid and reliable pain scale for children
Wong-Baker Pain Scale
Description of pain in trigeminal neuralgia
burning, shock-like, sharp-shooting
Diverse patient population & health risks
40 y/o +, hypertension, AA or Hispanic - open-angle glaucoma leading cause of blindness
patients greatest at risk for suicide
Elderly males
Documenting physical assessment finding and the use of abbreviations
should be restricted, could lead to liability/malpractice
Use of a family member as a translator
Document skepticism of understanding treatment/diagnosis/meaning.
A 4-year-old with no/minimal pain - what would you expect on the Wong-Baker scale
smiling
Wong-Baker Pain Scale
for children, rated on a 1-5 scale of smiley/sad face
1-2 no-little pain
3-4 sad face pain
5 extreme pain
Diagnostic procedure to rule out fungus
scrape test from active border
fluorescein dye and cobalt light is used to confirm what diagnosis
corneal abrasion
when patient has severe pain in eye, you can suspect
foreign body
What is LEAST important to know? Elbow injury playing tennis
Have you ever had this pain before?
LMC for females
Allergies to food/drugs
Cardiovascular family history
Cardiovascular family history
Test to confirm abnormal corneal light reflex
cover/uncover test
Priority for someone with major depression
Safety, thoughts of self-harm, harm to others
PHQ-9 test
Photophobia, eye discomfort in only one eye, no visual change, you can suspect
bacterial conjunctivitis
Blepharitis is
thickened, crusted area at lash line and no other eye structures are involved
Alterations in things that do not exist, perceived thoughts, internal perceptions that patient believes to be true but is not
hallucinations
small raised bump after an injury, friable (bleeds easily), vascular papule
pyogenic granuloma
Perceptions of pain
it is what the patient says it is
greatly impacted by emotions and quality of sleep can greatly impact perceptions of pain
Pain assessment scale for dementia
use a checklist for non-verbal
HPI vs PMH
HPI narrative
PMH bullets
Characteristics leading to believe a skin lesion is a melanoma
ABCDE
asymmetry
borders irregular
color difference
diameter
evolution
what abnormals do you find on African Americans that need further testing
hyperpigmentation
Drusen bodies (opthalmic exam)
what order do you document assessment
Data is always documented by body systems, with subjective and objective data grouped accordingly
a dark-colored skin person will have ___ gums
lighter
Assessment of abdominal pain in a child
“point to where it hurts”
What do Wood’s Lamp colors mean = yellow/green.
it is fungal and it is pseudomonas aeruginosa
What is the value of using a pain scale ?
patients response to therapy interventions can be documented. encompasses re-evaluation.
How do we notate a chief complaint in a patients medical record?
whatever the patient says in quotes or italics, or parenthesis
Smoking
brother & dad died
last hospital
smoking is social hx
bro & dad is family hx
last hospital is PMH
Pt comes in complaining of chest pain. What is the BEST next question to ask.
Please describe your pain. Open-ended question.
Woman, 1 month postpartum, fatigue, loss of appetite, inability to sleep and states “ I don’t want to go on anymore”
Postpartum depression. Post partum depression differs from “baby blues” because it is longer than 2 weeks.
Distinct raised red circular, scaly border on arm of child
tinea corporis
Disease process that appears usually on knees, elbows, & face. They are silvery and scaly.
plaque psoriasis
JAHCO requires pain assessment when…
every shift, admission, & re-assessment of pain. Must document pain scale.
how will you rate a pts LOC? drowsy, but wakes up and answers appropriately, & falls back asleep
lethargy
Pain OLDCARTS
Onset
Location
Duration
Character
Aggravating
Relieving
Treatment
Severity
Focused vs Comprehensive
Comprehensive is everything
Focused is on chief complaint.
The extent of illness and reason for visit determines if it is focused or comprehensive
Providing care to a trans patient
Risk factor indicators for biological gender and for how they identify
