Health ass Super Idol 的笑容都没你的甜

Question 1

Past history of skin disease (subjective) 1

Answer 1

Any past skin disease or problems?

-How was this treated?

-any family history of allergies or allergic skin problems?

Question 2

Past history of skin disease (subjective) 2

Answer 2

Any known allergies to drugs, animals, or plants?

Question 3

Past history of skin disease (subjective) 3

Answer 3

Any birthmarks, tattoos?

Question 4

Past history of skin disease (subjective) 4

Answer 4

Change in pigmentation. Any change in skin color or pigmentation?

• a generalized color change (all over) or localized?

Question 5

Past history of skin disease (subjective) 5

Answer 5

Change in mole. Any change in a mole: color size, shape, sudden appearance of tenderness, bleeding, itching?

-any “sores” that do not heal?

Question 6

Past history of skin disease (subjective) 6

Answer 6

Excessive dryness or moisture. Any change in the feel of your skin: Temperature, moisture, texture?

-Seborrhea: oily

Any excess dryness? Is it seasonal or constant?

-xerosis: dry

Question 7

Past history of skin disease (subjective) 7

Answer 7

Pruritus: any skin itching? is it mild (prickling, tickling) or intense (intolerable)?

-Does it awaken you from sleep?

-Where is the itching? When did it start?

-Any other skin soreness or pain? Where?

Question 8

Past history of skin disease (subjective) 8

Answer 8

Excessive bruising. Any excess bruising? Where on the body?

-How did this happen?

-How long have you had it?

Question 9

Past history of skin disease Rash and lesion (subjective) 9

Answer 9

Rash or lesion. Any skin rash or lesions?

-Onset. When did you first notice it?

Question 10

Past history of skin disease Rash and lesion (subjective) 10

Answer 10

-Location: Where did it start?

-Where did it spread?

-Character or quality. Describe the color.

• Is it raised or flat? Any crust, odor? Does it feel tender, warm?

-Duration. How long have you had it?

Question 11

Past history of skin disease Rash and lesion (Subjective) 11

Answer 11

Setting. Anyone at home or work with a similar rash? Have you been camping, acquired a new pet, tried a new food, drug? Does the rash seem to come with stress?

• Alleviating and aggravating factors. What home remedies have you tried? Bath, lotions, heat? Do they help or make it worse?
• Associated symptoms. Any itching, fever?

Question 12

Past history of skin disease rash and lesion (subjective) 12

Answer 12

• What do you think rash/lesion means?
• Coping strategies. How has rash/lesion affected your self-care, hygiene, ability to function at work/home/socially?
• Any new or increased stress in your life?

Question 13

Past history of skin disease rash and lesion (subjective) 13

Answer 13

Medications. Which medications do you take?

• Prescription and over-the-counter?
• Recent change?
• How long on medication?

Question 14

Past history of skin disease (subjective) 14

Answer 14

Hair loss. Any recent hair loss?

• A gradual or sudden onset? Symmetric? Associated with fever, illness, increased stress?
  -alopecia (hair loss)
• Any unusual hair growth?
  -Hirsutism is shaggy or excessive hair.
• Any recent change in texture, appearance?

Question 15

Past history of skin disease (subjective) 15

Answer 15

Change in nails. Any change in nails: shape, color, brittleness? Do you tend to bite or chew nails?

Question 16

Past history of skin disease (subjective) 16

Answer 16

Environmental or occupational hazards. Any environmental or occupational hazards?

• How much sun exposure do you get from outdoor work, leisure activities, sunbathing, tanning salons?
• With your occupation such as dyes, toxic chemicals, radiation?
• How about hobbies? Do you perform any household or furniture repair work?

Question 17

Past history of skin disease (subjective) 17

Answer 17

Patient-centered care. What do you do to care for your skin, hair, nails? Which cosmetics, soaps, chemicals do you use?

• Clip cuticles on nails, use adhesive for false fingernails?

Question 18

Additional History for Infants and Children (subjective) 18

Answer 18

1. Does the child have any birthmarks?
2. Was there any change in skin color as a newborn?

• Any jaundice? Which day after birth?

3. Have you noted any rash or sores? What seems to bring it on?

• Have you introduced a new food or formula? When? Does your child eat chocolate, cow’s milk, eggs?

Question 19

Additional History for the Adolescent (subjective) 19

Answer 19

1. Have you noticed any skin problems such as pimples, blackheads?

• How long have you had them?
• How do you treat them?
• How do you feel about it?

Question 20

Additional History for the Aging Adult (subjective) 20

Answer 20

1. Which changes have you noticed in your skin in the past few years?
2. Any delay in wound healing?

• Any skin itching?

Any change in feet, toenails? Any bunions? Is it possible to wear shoes?

Have you had any falls this year? How many? (bruises, trauma)

Any history of diabetes, peripheral vascular disease?
-Risk for skin lesions in feet or ankles.

Question 21

ABCDEF (mole)

Answer 21

Asymmetry (not regularly round or oval, two halves of lesion do not look the same)

Border irregularity (notching, scalloping, ragged edges, poorly defined margins)

Color variation (areas of brown, tan, black, blue, red, white, or combination)

Diameter greater than 6 mm (i.e., the size of a pencil eraser), although early melanomas may be diagnosed at a smaller size.

Elevation or Evolution

Funny looking (refers to the “ugly duckling” sign, in which the suspicious lesion stands out as looking different compared with its neighboring nevi)11 (see Table 13.10, Malignant Skin Lesions, p. 238).

Additional symptoms: rapidly changing lesion; a new pigmented lesion; development of itching, burning, or bleeding in a mole. All of these signs should raise suspicion of malignant melanoma and warrant referral.

Question 22

Abnormal color changes

Answer 22

These are: pallor (white), erythema (red), cyanosis (blue), and jaundice (yellow).

Question 23

LESIONS

Answer 23

If any lesions are present, note the:

1. Color.
2. Elevation: flat, raised, or pedunculated.
3. Pattern or shape: the grouping or distinctness of each lesion (e.g., annular, grouped, confluent, linear). The pattern may be characteristic of a certain disease.
4. Size, in centimeters: use a ruler to measure. Avoid household descriptions such as “quarter size” or “pea size.”
5. Location and distribution on body: is it generalized or localized to area of a specific irritant; around jewelry, watchband, eyes?
6. Any exudate. Note its color and any odor.

Question 24

NAILS

Answer 24

View the index finger at its profile and note the angle of the nail base; it should be about 160 degrees (Fig. 13.13). The nail base is firm to palpation. Curved nails are a variation of normal with a convex profile. They may look like clubbed nails, but notice that the angle between nail base and nail is normal (i.e., 160 degrees or less).

The surface is smooth and regular, not brittle or splitting.

Nail thickness is uniform.

The nail firmly adheres to the nail bed, and the nail base is firm to palpation.

Question 25

Stage 1 Pressure injuries/ulcers (Non-Blanchable Erythema)

Answer 25

Intact skin is red but unbroken. Localized redness in lightly pigmented skin does not blanch (turn light with fingertip pressure). Dark skin appears darker but does not blanch. May have changes in sensation, temperature, or firmness.

Question 26

Stage 2 pressure injuries/ulcers (Partial-Thickness Skin Loss)

Answer 26

Loss of epidermis and exposed dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed. No visible fat or deeper tissue.

Question 27

Stage 3 pressure injuries/ulcers (Full-Thickness Skin Loss)

Answer 27

PI extends into subcutaneous tissue and resembles a crater. See subcutaneous fat, granulation tissue, and rolled edges, but not muscle, bone, or tendon.

Question 28

Stage 4 pressure injuries/ulcers (Full-Thickness Skin/Tissue Loss)

Answer 28

PI involves all skin layers and extends into supporting tissue. Exposes muscle, tendon, or bone, and may show slough (stringy matter attached to wound bed) or eschar (black or brown necrotic tissue), rolled edges, and tunneling.

Question 29

Ear subjective 1

Answer 29

Earache. Any earache or other pain in ears?

• Location—Feel close to the surface or deep in the head?
• Does it hurt when you push on the ear?
• Character—Dull, aching or sharp, stabbing? Constant or come and go? Is it affected by changing position of head?

(RATIONALE) Otalgia occurs directly from ear disease or is referred pain from a problem in teeth or oropharynx.

Question 30

Ear subjective 2

Answer 30

Any accompanying cold symptoms or sore throat? Any problems with sinuses or teeth?

(RATIONALE) Virus/bacteria from upper respiratory infection (URI) may migrate up the eustachian tube to inflame the middle ear.

Question 31

Ear subjective 3

Answer 31

Infections. Any ear infections? As an adult or in childhood?

• How frequent were they? How were they treated?

(RATIONALE) A history of chronic ear problems alerts you to possible hearing loss.

Question 32

Ear subjective 4

Answer 32

Discharge. Any discharge from your ears?

(RATIONALE) Otorrhea suggests infected canal or perforated eardrum such as:
External otitis—Purulent, sanguineous, or watery discharge.

Acute OM with perforation—Purulent discharge.

Cholesteatoma—Dirty yellow-gray discharge, foul odor.

Question 33

Ear subjective 5

Answer 33

Hearing loss. Do you have any trouble hearing?

• Onset—Did the loss come on slowly or all at once? Trouble understanding speech?

(RATIONALE) Presbycusis is gradual onset over years, bilateral, mostly high-frequency loss, worse in noisy environments, whereas a trauma hearing loss is often sudden.

Question 34

Ear subjective 6

Answer 34

• Do people seem to shout at you?

(RATIONALE) Recruitment—A hearing loss with low-intensity speech, but sound actually becomes painful when speaker repeats in a loud voice.

Question 35

Ear subjective 7

Answer 35

• Do ordinary sounds seem hollow, as if you are hearing in a barrel or under water?
• Recently traveled by airplane?
• Any family history of hearing loss?

(RATIONALE) This happens when cerumen expands and becomes impacted, as after swimming or showering.

Question 36

Ear subjective 8

Answer 36

• Effort to treat—Any hearing aid or other device? Anything to help hearing?
• Coping strategies—How does the loss affect your daily life? Any job problems? Feel embarrassed? Frustrated? How do your family, friends react?

(RATIONALE) Hearing loss can cause social isolation, decreased quality of life, functional decline, cognitive decline, depression.

Question 37

Ear subjective 9

Answer 37

Environmental noise. Do you consider the noise level where you are working now to be high?

• Noise protection—Any steps to protect your ears such as headphones or ear plugs?

(RATIONALE) Old trauma to hearing initially goes unnoticed but results in further decibel loss in later years.

Question 38

Ear subjective 10

Answer 38

Tinnitus. Ever felt ringing, roaring, or buzzing in your ears? When did this occur? How long have you had it?

(RATIONALE) Tinnitus is the perception of sound without an external source; it occurs with sensorineural hearing loss, cerumen impaction, middle ear infection, and other ear disorders.

Question 39

Ear subjective 11

Answer 39

Vertigo. Ever felt vertigo; that is, the room spinning around or yourself spinning?

(RATIONALE) Occurs with dysfunction of labyrinth. Increases risk for falls and doing daily activities.5 Feeling of spinning of person (subjective vertigo) or of objects around person (objective vertigo).

Question 40

Ear subjective 12

Answer 40

Patient-centered care. How do you clean your ears?

(RATIONALE) Potential trauma from invasive instruments. Cotton-tipped applicators can impact cerumen, causing hearing loss.

Question 41

Whisper test

Answer 41

Stand arm’s length (2 feet) behind the person. Test one ear at a time while masking hearing in the other ear to prevent sound transmission around the head. This is done by placing one finger on the tragus and pushing it in and out of the auditory meatus. Move your head to 1 to 2 feet from the person’s ear. Exhale fully and whisper slowly a set of 3 random numbers and letters, such as “5, B, 6.” Normally the person repeats each number/letter correctly after you say it. If the response is not correct, repeat the whispered test using a different combination of 3 numbers and letters. A passing score is correct repetition of 4 of a possible 6 numbers/letters. Assess the other ear using yet another set of whispered items “4, K, 2.”

Question 42

Eye subjective 1

Answer 42

Vision difficulty. Any difficulty seeing or any blurring? Any blind spots? Come on suddenly or progress slowly? In one eye or both?

• Do spots move in front of your eyes? One or many? In one or both eyes?

(RATIONALE) Floaters are common with myopia or after middle age as a result of condensed vitreous fibers. Usually not significant, but acute onset of floaters (“shade” or “cobwebs”) occurs with retinal detachment.

Question 43

Eye subjective 2

Answer 43

• Any halos/rainbows around objects? Or rings around lights?

(RATIONALE) Halos around lights occur with acute narrow-angle glaucoma.

Question 44

Eye subjective 3

Answer 44

• Any blind spot? Does it move as you shift your gaze? Any loss of peripheral vision?

(RATIONALE) Scotoma, a blind spot inside an area of normal or decreased vision, occurs with glaucoma and optic nerve disorders.

• Any night blindness?

(RATIONALE) Night blindness occurs with optic atrophy, glaucoma, vitamin A deficiency.

Question 45

Eye subjective 4

Answer 45

Pain. Any eye pain? Please describe.

*Come on suddenly?

(RATIONALE) Sudden onset of eye symptoms (pain, floaters, blind spot, loss of peripheral vision) requires emergency referral.

Question 46

Eye subjective 5

Answer 46

• Quality—Burning or itching? Or sharp, stabbing pain? Pain with bright light?
• A foreign body sensation? Or deep aching? Or headache in brow area?

(RATIONALE) Quality is valuable in diagnosis. Photophobia is the inability to tolerate light

Question 47

Eye subjective 6

Answer 47

Strabismus, diplopia. Any history of crossed eyes? Now or in the past? Does this occur with eye fatigue?

(RATIONALE) Strabismus is a deviation in the parallel axes of the two eyes.

• Ever see double? Constant, or does it come and go? Does your double vision go away if you cover one eye or the other?

(RATIONALE) Diplopia is the perception of two images of a single object. Diplopia in one eye is caused by dry eyes, uncorrected refractive error, cataract.

Question 48

Eye subjective 7

Answer 48

. Redness, swelling. Any redness or swelling in the eyes?

• Any infections? Now or in the past? When do these occur? In a particular time of year? Anyone else in home with same condition?

(RATIONALE) Redness occurs with conjunctivitis and other “red-eye” conditions

Question 49

Eye subjective 8

Answer 49

Watering, discharge. Any watering or excessive tearing?

(RATIONALE) Lacrimation (tearing) and epiphora (excessive tearing) are caused by irritants or obstruction in drainage of tears.

Question 50

Eye subjective 9

Answer 50

History of ocular problems. Any history of injury or surgery to eye? Or any history of allergies?

(RATIONALE) Allergens (e.g., makeup, contact lens solution) cause irritation of conjunctiva or cornea.

Question 51

Eye subjective 10

Answer 51

Glaucoma. Ever been tested for glaucoma? Results?

• Any family history of glaucoma?

(RATIONALE) Glaucoma is characterized by increased intraocular pressure.

Question 52

Eye subjective 11

Answer 52

. Use of glasses or contact lenses. Do you wear glasses or contact lenses? How do they work for you?

Question 53

Eye subjective 12

Answer 53

Patient-centered care. Last vision test? Ever tested for color vision?

(RATIONALE) Self-care behaviors for eyes and vision.

Question 54

Eye subjective 13

Answer 54

Which medications are you taking? Systemic or topical? Do you take any medication specifically for the eyes?

(RATIONALE) Medication side effects (e.g., prednisone may cause cataracts or increased intraocular pressure).

Question 55

Eye subjective 14

Answer 55

• How about smoking—Do you smoke?
• If you have experienced a vision loss, how do you cope? Do you have books with large print, books on audio tape or CD, braille?

(RATIONALE) Cigarette smoking is associated with AMD, cataract, diabetic retinopathy, and eye inflammation.

Question 56

Additional history for infants and children

Answer 56

• Any vaginal infections in the mother at time of delivery?
  (RATIONALE) Increased eye infection or disease for the newborn

2. Considering age of child, which developmental milestones of vision have you (parent) noted?
3. Does the child have routine vision testing at school?
4. Are you (parent) aware of safety measures to protect child’s eyes from trauma? Do you inspect toys?

• Have you taught the child safe care of sharp objects and how to carry and use them?

Question 57

Additional History for the Aging Adult

Answer 57

1. Have you noticed any visual difficulty with climbing stairs or driving? Any problem with night vision?
   (RATIONALE) Loss of depth perception, contrast sensitivity, peripheral or central vision may occur.
2. When was the last time you were tested for glaucoma?
   (RATIONALE) At age 60 or 65 years people need annual examination to screen for vision changes and age-related eye diseases.

• Any aching pain around eyes? Any loss of peripheral vision?
• If you have glaucoma, how do you manage your eyedrops?
  (RATIONALE) Compliance may be a problem if symptoms are absent. Assess ability to administer eyedrops.

Is there a history of cataracts? Any loss or progressive blurring of vision?

Do your eyes ever feel dry? Burning? What do you do for this?
(RATIONALE) Decreased tear production may occur.

Any decrease in usual activities such as reading or sewing? Driving?
(RATIONALE) AMD is a loss of central vision that impairs daily pleasures and activities.

Question 58

Snellen chart

Answer 58

-Visual acuity test (lines of letters)

Question 59

Presbyopia

Answer 59

the decrease in power of accommodation with aging, is suggested when the person moves the card farther away. (near vision)

Question 60

PERRLA

Answer 60

Pupils Equal, Round, React to Light, and Accommodation.

Question 61

Pain impulse Process

Answer 61

There are four major processes: transduction, transmission, modulation, and perception. Transduction refers to the processes by which tissue-damaging stimuli activate nerve endings. Transmission refers to the relay functions by which the message is carried from the site of tissue injury to the brain regions underlying perception. Modulation is a recently discovered neural process that acts specifically to reduce activity in the transmission system. Perception is the subjective awareness produced by sensory signals; it involves the integration of many sensory messages into a coherent and meaningful whole.