NSG 500 EXAM 1 (From Blosser's Zoom Review) Flashcards
- Interviewing skills: how to approach patients, start the process, and obtain information.
So what is the best interview technique when trying to get information from somebody? Open-ended questions. Give patient time to answer the questions. Give them time to tell their stories. Basically an open-ended interview technique.
If the patient says something to you that is confusing, ask them more specific questions. If when using that open-ended interview technique, and the patient mentions something, that is the time to ask more specific questions. Example: “How long exactly has it been going on?” “Has it been a day, a week, a month?”
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- Cultural sensitivity: Purpose, reason it is important, how culture may impact aspects of an exam of emotional health.
The definition of cultural sensitivity: Being aware and understanding of the different beliefs of different cultures, specifically those that are different from your own. Understanding that there are cultures and beliefs and values that are different from your own.
For example if you are attempting to give a child a flu vaccine and the parent does not want it, the first you do is to try to understand where they are coming from, why they do not want vaccination. Is it a cultural issue? Is it a misbelief they might have that you can do some education on? But, you have to question with sensitivity, and by making sure you understand where they’re coming from. So just ask more questions.
This could involve things like vaccines, blood transfusions and other blood products, also nutrition and diet, etc. All of these things could play into cultural beliefs. The first thing is understanding where they’re coming from and why they’re against something.
Also with cultural stuff, understanding that different cultures display different emotions; some cultures can be very stoic. You can’t really use body language or facial expressions to gauge what they’re feeling. So you might have to actually ask questions and inquire. Some cultures are prone to outbursts and have high emotions. Understand that that could be a culture/diversity issue.
- The steps for assessment: inspection, palpation, percussion, auscultation.
- You’re going to assess all the body systems in the same order and way except for the abdomen.
- For the abdomen: inspection, auscultation, palpation, percussion.
On which part of the body can you feel vibrations most effectively? This is the ulnar side of the hands; this can be used on the back to check the lungs.
Where do you have good fine discrimination feeling? Fingertips. Use your fingertips when checking for lymph nodes.
What is the definition of resonant, and where would we use that terminology? Resonant means that you can hear it effectively and it’s going to be something that is air-filled. So when you’re listening to normal lungs they should sound resonant.
Where might you hear “dull?” Or feel dull? The liver. A solid organ. When percussing you may feel a dullness over the liver. Percussing over the lungs should be high-pitched and resonant.
- When are you inspecting?
You’re always inspecting, everywhere on the body. You’re always using your eyes and you’re always looking. Inspection is first in order but you are always inspecting regardless.
- What is the best technique for auscultation?
You want to make sure the environment is quiet and that the stethoscope is up against naked skin.
- When you are using your otoscope, when would you use a pneumatic tube?
You want to put air on the tympanic membrane, and you would do this in pediatrics. You’re putting a little bit or air in there and checking for bulging of the tympanic membrane. It’s because everything is smaller and harder to see in the ear of a child. You’re looking for pressure behind the tympanic membrane.
- What is the correct technique to perform an otoscopic exam for an adult?
How are you going to position the ear? Up and back.
- What is the correct technique to perform an otoscopic exam for a child?
How are you going to position the ear? Down and back.
- Equipment:
What is one piece of equipment that you are not going to use on a pediatric patient? (infant or toddler)
It’s the reflex hammer. You’re going to use your hand instead.
- Equipment:
What is the ophthalmoscope for?
It’s used for the eye, especially fundoscopic exam.
- Equipment:
The Wood’s lamp is used to look at the eye and different parts of the skin to find fungus, corneal abrasions.
- Indications of cognitive impairment (history or PE findings):
If you have an older adult that is showing signs of cognitive impairment (like a dementia dx), the first thing they are going to do is try to hide it, or make excuses, or downplay symptoms, or deny it. They may show some inappropriate emotions. May laugh when asked a difficult question. May divert the question to something else that is easier to answer. May get really angry and say they aren’t answering the question.
- Areas of the brain and their function.
- the parietal part deals with sensation
- the temporal deals with auditory and memory
- the frontal controls behavior and emotion, vocabulary, and speech
- cerebellar gives you sense of place, handwriting, fine motor control, drawing
- Main findings in acromegaly:
- acromegaly is a type of gigantism.
What specifically is going to be enlarged?
- hands, tongue, facial features
- What is Turner syndrome?
- A missing ‘X’ chromosome. Can only affect women. Only females can be diagnosed. So because of the missing X chromosome you will get a lack of sexual development, including under-developed ovaries. They are also very prone to heart defects.
- What is Cushing’s syndrome?
- A disease characterized by too much ACTH and cortisol.
- Overgrowth of hair, especially facial hair.
- Moon-shaped or rounded face
- buffalo hump
- hyperpigmentation in different areas
- What is precocious puberty?
- super early sexual development
- Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.
What are the symptoms of a vitamin B deficiency?
- fatigue, heart palpitations, sores in corner of your mouth, decreased energy, fatigue, SOB, some palpitations
- Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.
What are the symptoms of a vitamin E deficiency?
- affects muscle and nerve function
- Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status.
What is the most common lab finding to diagnose a protein deficit? Albumin.
- Milestone developments (latest times). (walk, talk, use sentences)
At what age (and this is up to) would you expect to see walking? 18 months.
- Milestone developments (latest times). (walk, talk, use sentences)
At what age (and this is up to) would you expect to hear talking (1-2 words): 12 months
- Milestone developments (latest times). (walk, talk, use sentences)
At what age (and this is up to) would you expect to hear talking (full sentences): 36 months
- Differences between subjective and objective data.
self-explanatory.
If can’t see, hear, or feel then it’s subjective.
- Skin lesions
Macule - flat and small, like a freckle. An area of pigmentation that you cannot palpate
- Skin lesions
wheal - Redness, white and inflamed, raised, feels soft or kind of boggy to the touch. An example would be hives or an insect bite.
Urticaria would be multiple areas of these hives.
- Skin lesions
papule - The area will be raised, and you’ll be able to palpate it. It’s going to be circumscribed, so it’ll be something like a skin tag. Could be a scab, or pimple that’s not ready to pop.
An example would be molluscum.
- Skin lesions
pustule - Has pus in it. So an abscess, pimple, etc.
- Skin lesions
vesicle - raised area with fluid. That fluid is going to be serous.
An example would be a herpetic lesion.
- Skin lesions
impetigo - common staph or strep infection on the face. Usually kids will get it. They’ll get a bunch of red sores and require antibiotics to treat it.
- Skin lesions
When are you going to be concerned about a mass or lesion?
- irregular borders
- different colors
- change in size
- painfulness
- if it becomes immobile
- if it bleeds easily
- Skin lesions
Herpes - Herpetic lesions will give you the vesicular rash.
- What are normal changes in the skin of an older adult?
- loss of skin turgor
- thinning
- wrinkles
- skin tags
- severia keratosis (areas of severe pigmentation and dark brown spots; non-cancerous, benign)
- cherry angiomas (conglomeration of blood vessels right beneath the skin)
- Skin lesions
Basal cell carcinoma - going to be an open area with red patches.
- Skin lesions
Solar keratosis - s pre-malignancy or malignancy. Has scaly areas that are raised. These require a biopsy because they are pre-cancerous.
- Skin lesions
malignant melanoma - a mole that’s increased in size, changes color, has gotten darker, has gotten irregular.
- What to expect when palpating lymph nodes
How do you differentiate infection from malignancy?
- if hard, non-tender, doesn’t move, fixed: likely malignant
- Tender and mobile: infection or inflammation
- What to expect when palpating lymph nodes
You should not be able to palpate normal lymph nodes, and if you do they should feel elastic.
- Normal changes in the adult regarding their lymph
- fibrotic lymph nodes
- they’ll feel fatty
Fibrotic and fatty are the key words you’ll need to focus on.
- Areas you’ll be able to do a lymph node exam
- popliteal (fossa behind the knee)
- inguinal area
- the iliac
- mesoteric and splenic in abdominal exam (maybe)
- epitrochlear
- brachial
- supraclavicular
- cervical
- occipital
- pre-orricular
- What is one way to differentiate between a lymph and a cyst?
- illuminate it
- it may have surrounding redness as well
- may be fluctuant, feeling boggy
- What is the best way to palpate the thyroid?
- from standing behind them.
- have them swallow, and you should feel the thyroid elevate
- Hypothyroidism
What are some findings?
- weight gain
- hair loss
- everything slows down
- cold
- bradycardia
- constipated
- dry skin
- decreased metabolism
- Hyperthyroidism
What are some findings?
- weight loss
- bulging eyes (exopthalmus)
- tachycardia
- hot skin
- fast metabolism
- skinny and hungry
- History of findings suggestive of different types of headaches: migraine, tension, cluster
Migraine - typically associated with nausea and vomiting. Can be unilateral or bilateral. Described as a throbbing or pulsing sensation.
Tension headache - going to go across the frontal area. It’s going to be a squeezing or banding sensation.
Cluster headache - what you’re going to feel behind ONE eye. An area of intensity behind the eye, and it’s going to feel like a lot of pressure.
- How is pain assessed? What is the gold standard?
Gold standard: “pain is what the patient says it is.” (Not true, not always)
At what age can you reliably use a pain scale on a pediatric without observation?
- 3 years of age
- Overall changes in the older adult to differentiate normal from abnormal?
- fibrotic thyroid and skin changes are going to be normal findings
- Nutrition: What is a normal BMI? Overweight BMI? Obese BMI? Physical signs of nutrient deficiency?
- Normal BMI is 18-24
- Overweight BMI is 25-29
- Obese BMI is greater than 30
- What is physiologic jaundice of the newborn?
When is it normal and what does it indicate if abnormal?
- Normal is 2-3 days after birth. That would be considered physiologic.
- If it’s later than that, that would be a bad finding, and it’s usually going to indicate hemolysis.
- If you trans-illuminate the skull of an infant, what are you looking for?
- hydrocephalus
- What are normal/abnormal skin changes in pregnancy?
- linea negra: that fine line of hair that goes from the umbilicus down to the pubic-ranus(?)
- might have some itching
- they could develop some varicose veins and some spider veins
- you could see stretch marks or striae
Where do the lymph nodes stop in the arm?
The trochlear area. elbow.
How far down in the legs would you expect to feel for lymph nodes?
- the popliteal area behind the knee.
