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