Final Flashcards
Asking about sensitive topics
Do not cast judgment
Establishing trust and building a foundation for therapeutic alliance
Use patient-centered and clinician-centered care
Sequencing of questions – what types of questions should be first, second, etc.
Open-ended (1)
More specific (2)
Yes/No (3)
How to determine if a patient has decision-making ability to make informed decisions (Can give history but not make informed decisions)
The ability to understand health information, weigh choices and consequences, reason through options and communicate a choice
Where to document smoking history in health history interview
Social history section
How to determine priority issue when completing a health history interview
Chief complaint in patients own words should be investigated first
What is the most effective way to open an interview when a patient reports a concern?
“Can you tell me about”
What is important to remember regarding older patients with confusion and the ability for the patient to make decisions about their care?
Decision-making ability is temporal and situational; it can fluctuate based on the patient’s condition and the complexity of the decision to be made
How to provide culturally sensitive care
Ask patient/caregiver if they have questions regarding care/visit/etc/
Knowing how to use, when to use, and normal/abnormal findings for each assessment technique- Inspection
Visually examining for: Shape, skin, masses, movement
Knowing how to use, when to use, and normal/abnormal findings for each assessment technique- Auscultation
Using a stethoscope to listen for: abnormal/normal heart and lung sounds, bowel sounds, bruits, etc.
Knowing how to use, when to use, and normal/abnormal findings for each assessment technique - Percussion
Used to identify if there is fluid noted in certain areas, identify the location of organs within the body (define liver size), etc.
What body systems do we percuss? Thorax, Lungs, Abdomen
Knowing how to use, when to use, and normal/abnormal findings for each assessment technique - Light Palpation
Examining with light and deep palpation to assess for: Crepitus [in abdomen can be a sign of gas or fluid within the subcutaneous tissues], hernias, lipomas, and masses.
Knowing how to use, when to use, and normal/abnormal findings for each assessment technique - Deep Palpation
Additionally, palpation is used to identify liver borders, gallbladder and spleen
What is the only body system we perform deep palpation on?
Abdomen
What is the Obturator sign?
Internally rotate right leg at the hip with the knee at 90 degree flexion. Will produce pain if positive. Positive would be appendicitis
What is Murphy’s sign?
As the patient takes a deep breath in, gently palpate in the lowermost right anterior rib cage of the abdomen at the midclavicular line. If acutely inflamed gallbladder contacts the examining fingers then pain will be evoked with the arrest of inspiration.
The ANA Code of Ethics, Provision 3 “The nurse promotes, advocates for, and strives to protect, the health, safety, and rights of the patient”
Patient privacy: Advocate for environment with physical privacy, and auditory privacy- safeguard patients’ right to privacy
Remember to ensure:
Patient safety
Patient comfort
Patient understanding
Cultural considerations and culturally sensitive care
Findings that might indicate melanoma
What findings would be suspicious of nodular basal cell carcinoma?
What is the appropriate approach to assess lymph nodes?
Obturator sign
Appendicitis (Patient has rebound tenderness in right lower quadrant)
Murphy’s sign
Cholestasis
What is the normal liver span found with percussion?
Liver estimates the liver size along right midclavicular line by percussion, palpate and characterize the liver edge for surface, consistency, tenderness. Liver span should be between 6-12 cm
Normal age and frequency of screening for colorectal cancer?
Proper techniques for assessing the heart
You may want to elevated the head of the bed to 30 degrees during the assessment
Proper position to assess aortic regurgitation murmur
Have the patient sit, leaning forward and exhaling while listening
How do you grade murmurs?
Grade 1- Barley Audible
Grade 2- Audible but soft
Grade 3- Easily audible (moderately loud)
Grade 4 - Easily audible and associated with a thrill
Grade 5- Easily audible, associated with thrill, still heard with stethoscope lightly on the best
Grade 6- Easily audible, associated with thrill, still heard with the stethoscope off the chest
What does a fixed split S2 mean?
Right ventricular failure
Cholesterol levels
The AHA recommends at least 150 minutes of moderate-intensity cardiorespiratory activity each week in order to reduce the risk of cardiovascular disease
What to assess if the patient has trouble falling asleep supine?
Make sure to further ask the patient if they are also experiencing shortness of breath we are concerned for heart failure
Documenting lymph nodes
Appropriate terminology/descriptions, sizing, etc.
Shape, size, delimitation, mobility, consistency, tenderness
When documenting be specific as possible such as “lymph nodes were 2x2cm”
Urgent action findings with head/neuro findings
Accurate technique to percuss thorax (if right-handed)
Use the third finger of the right hand, strike the third finger of the left hand
What is a normal soft, low-pitched sound found when auscultating the lungs?
Vesicular
What would a resting tremor look like versus a postural tremor?
How do you assess for rotator cuff injury and what findings do you expect to find?
Cannot abduct the shoulder
What does a goniometer assess?
Measures joint range of motion
What is Parkinsonian gait?
How should you assess the tibiofemoral joint?
What findings are expected in a patient with rheumatoid arthritis?
What tests might you do to assess for carpal tunnel?
What test is done to assess for a posterior meniscus tear?
What is ballottement? What are you assessing for?
Older adult mild forgetfulness findings may indicate what?
Cranial Nerves and tests to assess each
How to use an ophthalmoscope?
Including disc and cup, retina, and retinal vessels, help to darken the room when completing the exam
What size speculum should you use with an otoscope when assessing children’s ears?
Use the largest possible speculum
Positioning of the patient during the breast assessment
Inspect the breast in four views: arms at the side, arms overhead, arms pressed against hips, and leaning forward to assess skin appearance, size, symmetry, contour, nipple characteristics
Best would be sitting with arms at both sides
Findings that indicate chronic Venous Insufficiency?
Brown pigmentation
What are normal lab values for cholesterol levels
less than 200 Total cholesterol, HDL 45, Triglycerides 150, LDL less than 100-130
What are some aspects of a low-cholesterol diet?
White meats, limiting other meats, whole grains are good, good fats vs bad fats, no butter, fish is good, nuts and grains, eggs in moderation
What is smegma?
Cheesy, white material under the foreskin of the penis
Reproductive Exam Considerations
Ask permission,
if male examiner female chaperone,
only really need pelvic exam over 21 unless indicated
Goal is to expose/visualize just one area at a time
Appropriate timing of assessing infant milestones during comprehensive assessment
It is best to assess infant milestones at the end of the interview right before you start the assessment
Normal developmental finding in 3-year old
A 3-year-old should be able to pedal a tricycle and jump in place. They should know colors, speak in sentences, and ask “why?” A 3-year-old should be able to sing songs, recognize themselves in a mirror, and know their gender.
Scoliosis testing with plumb line – how do you do this? What age group is screened?
Assessing for scoliosis using a Plumb Line. Have patient stand straight, then place the top of the plumb line at C7, and the plumb line will fall to the left of right of the spline if the patient has scoliosis
Should be assessed as part of health promotion and starting at the preadolescent to adolescent age group
Adolescent causes of hypertension
Most common cause of hypertension in adolescents is essential hypertension
What might you see in a child that could indicate the child has muscular dystrophy?
A child pushing off the floor with arms to stand while leaving legs extended is concerning for muscular dystrophy
Expected facial features found in a child with Down Syndrome
Expected facial findings in a child with downs syndrome included flattened appearance to the face (including the nasal bridge), outside corners of eyes that point upward (oblique palpebral fissures and prominent epicanthal folds), small ears, short neck, and tongue that tends to stick out of the mouth
What are common visual disorders of childhood?
What do you expect to see in a child with acute otitis media?
Ear pain may be a result of acute otitis media. Signs of acute otitis media include a red, bulging tympanic membrane with dull or absent light reflex and diminished movement on otoscopy.
What type of otoscope when a child has ear pain?
pneumatic otoscope
Assess cranial nerve IX in school-aged/adolescents
by having them shrug their shoulders
Health promotion needs during growth spurts
Need of sleep
Mini-Cog test for Older adult – how to score and what findings mean
Expected skin findings in older adults versus abnormal findings
What is the 10-Minute Geriatric Screener and expected findings?
Risk factors for osteoporosis
What is the “timed get up and go” test for older adults? How do you perform the test and what do the findings mean?
What is the difference between delirium and dementia?
What test can be used to assess for hearing loss (due to aging) in the older adult?
What health promotion activities are recommended for older adults (65+)?
Documenting assessment data with appropriate terminology/phrases/descriptions
What’s included in a general survey?
What describes a negative predictor value?
What are the strongest health promotion recommendations based on?
What are the recommendations for aerobic activity to reduce the risk of cardiovascular disease?
Know how to calculate a BMI and what is normal versus abnormal findings
