Phys Assessment Flashcards
What does subjective mean?
What someone tells you (history)
What does objective mean?
measurment/reading (phys exam)
What are the 2 components of clinical reasoning?
Diagnostic & Critical Thinking
What is the diagnostics composed of
cues, info, signs, symptoms, lab data
what is the difference between a sign and symptom
sign= you can see it, symptoms= experiences
What are the 6 nursing processes
ADOPIE= Assess, diagnostic, outcome, planning, implementation, evaluation
Medicine Treats…
disease
Nursing…
how patient reacts
Diagnosis
Valid influences, compare “clusters”, identify related factors
Outcome
realistic, something that can be measured, TIME FRAME, unique to PT
Planning
establish priorities, refer back to outcomes, plan of care, interventions
Implementation
readiness, review interventions, collaborate team members, counseling, refer continuing care
Evaluation
meet or did not meet final outcome
What are the first priorties that are essential?
ABCs= Airway, breathing, circulation (brain)
What are some components of Critical Thinking
identify assumptions, validate, normal/abnormal, relevance, inconsistencies, patterns, missing info, actual & potential risk, setting priorities, patient centered, evaluate
4 Types of Data
1) Complete Health Data 2) Episodic/Problem Centered/Focus data 3) Follow-up data 4) Emergency data base (ABCs)
Expanding Concepts of Health…x5
1) Biomedical Model 2) Holistic Health (whole body, culture) 3) Health promotion/prevention 4) culture 5) genetics
High level assessmen
holism, life cycle, culture must not detract from importance, hands on expertise
Interview means
factors that may affect communication
3 Phases of Interview
1) Process of Communication 2) Internal 3) External Factors
Process of Communication means.
sending/receiving internal/external facotrs
Internal Factors composed of…
empathy, ability to LISTEN
External Factors composed of
privacy, refuse interruptions, phys envt, dress, note taking, recording, electronic health record
Techniques of Communication
open vs closed ended questions (case by case), nonverbal skills, eye contact, voice, touch, dress
What do adolescents prefer being around?
peer groups
What are you viewing in infants?
nonverbals
At what ages are parents involved in the interviewing?
Infant-school age
What should you watch for in communication with older people
slang words
What are some special need situations
acute illness, under the influence, anxious, crying, sexually aggressive, hearing impaired
What type of questions should you ask for special need situations
closed questions
What is the first thing you should do in cross cultural situations
identify your own biases
What does cross cultural communication entail?
etiquette, space & distance, cultural considerations on gender, sexual orientation
What are ways we overcome communication barriers
interpreters, vocal cues, action cues, object cues, space/touch
Are mental status assessments objective or subjective
always subjective
What does etiology mean
cause
What are 2 types of measuring mental disorders
organic & psychiatric
What is an example of an organic mental disorder
alzheimers, dementia, bc they are known causes
Alert & Oriented x 4 (behavior orientation)
1) person 2) place 3) time 4)situation (what brought you here)
What is recent memory?
short term
What is remote memory
long term
What does perception mean?
awareness of 5 senses
What are 4 components of mental health assessment
1) appearance 2) behavior 3) cognition 4) thought processes
What does aphasia mean
language impairment
QPR stands for
question, persuade, refer
Broca refers to
physical incapability to speak
Wernicke
not being able to speak correctly
presbycusis means
age related hearing loss
Define health
balance of person with one’s physical, mental, and environment
Illness
loss of balance with physical, mental and environment
What is ethnicity
a group having similar traits: common language, common heritage and cultural similarities
Race
relates more towards the appearance of a person. Biologically with inherited genetic traits.
Nationality
place where the person was born
Heritage
ancestors of a person
Culture
more of a microcosm; one trait or characteristic
What is a database?
Sub & Objective data gathered from a patient plus the results of any diagnostic studies completed
What is a nursing “diagnosis”
actual/potential health problems or of wellness strengths
Frequencies of visits…
varies depending on person’s illness and wellness needs
define cultural diversity
transcultural phenomenon. At least 2 people having diff cultural orientations
what does evidence based mean?
combining clinical expertise with the use of nursing research, while considered values of the PT
What is clustered data
patterns and relationships among the data
A good rule of an interviewer is to..
spend more time listening than talking
When a patient denies something but acts in the opposite
bring verbal and nonverbal behavior to PT attention
When should touch be used
if interviewer knows pt well
at what age should interviewer question child him/herself
age 7
What interviewing techniques should be avoided for an adolescent
silence and reflection
What is the proper distance for personal space
1.5-4 ft
Religion is defined as
belief in a divine or superhuman spirit to be obeyed or worshiped
Why is there a need for cultural care
demographic change
The imbalance of hot and cold is considered “illness” among…
Hispanic-American heritage
What is an amulet
the evil eye
What does empacho mean?
a culture-bound syndrome that ha no equivalent from a biomedical perspective
What does “review of systems” mean?
the evaluation of the past and present health state of each body system
What does PQRSTU Stand for
1) Provocative 2)Quality/Quantity 3)Region/Radiation 4) Severity 5) Timing 6)Understanding
What 2 section of child’s health history become important to current health status
developmental and nutritional history
What is one way to detect dementia
mini-cog
A Major characteristic of dementia is
impairment of short & long term memory
Dysarthria
difficult or unclear articulation of speech that is otherwise linguistically normal.
What is echolalia
meaningless repetition of another person’s spoken words as a symptom of psychiatric disorder.
The part of the hand used for assessment of vibration are
ulnar surface of the hand
Performing indirect percussion, the stationary finger is struck where..?
at the middle joint
How would you describe the pitch of a sound wave obtained by a percussion
number of vibrations per second
The bell of the stethoscope is used for..
soft, low pitched sounds
Which aperture is used for a patient with undilated pupils
small
If an infant is asleep, where can you start with the examination
heart, lung, and abdomen
When does examination of a child change to head to toe
school age
When inspecting ear canal, which speculum is used for the otoscope
the largest that will fit
During gen survey what are the 4 areas of interest
1)Appearance 2)Body structure 3)Mobility 4)Behavior
What is gait
a person’s manner of walking
Measuring gait, the base is usually…
as wide as the shoulder width
What changes in head circumference measurements in relation to the chest will occur from infancy to early childhood
head will be 2 cm larger than the chest circumference. Between 6 months & 2 years they will be the same.
From 80 - 90 what happens to height and weight
both decrease
To accurately assess patients pulse what is the range?
start with zero to 30
A normal pulse for a patient is..
2+
How do you accurately assess a patient’s respiration?
count for 20 seconds
What is pulse pressure
the difference between systolic and diastolic pressure
What is coarctation?
narrowing of the aorta
If PT has coarctation the thigh pressure would be..
lower than in the arm
What is the mean arterial pressure
diastolic pressure plus one third pulse pressure
Why is sizing of a bp cuff important
too narrow will give false reading that is HIGH
Diastolic
when the heart refills with blood
systolic
when heart is contracting
what is nociception
pain receptors
neuropathic pain
burning painful sensation that moves around toes and bottoms of feet.
Diaphoretic means
inducing perspirations
visceral pain
sweating, pale, pain in abdomen
What is a pre-term baby more sensitive too
painful stimuli
What is the wong baker scale
visual facial expressions to define pain scale (ex broken arm)
analgesics
pain reliever
Complex Regional Pain I
chronic pain that usually affects an arm or a leg.
This is a pain problem expected with impaired older adult
peripheral vascular disease
What is a common physiologic change that occurs with pain
tachycardia
Assessing Pain Mnemonic
P- OLDCARTS
P-OLDCARTS
previous hx, onset, location, duration, character, aggravating, radiation, timing, severity
What are the 4 steps in a regular physical exam
1) inspection 2)Palpation 3)Percussion 4)Auscultation
What are the steps when examing the abdomen
1) Inspection 2)Auscultation 3) Palpation 4) Percussion
Gen Survey Application
1)Appearance 2)Body Structure (lordosis/kyphosis) 3)Gait (how they walk) 4)Behavior 5)Weight
- horny layer- shedding
- basal layer on the bottom
junctional nevus
Compound Nevus
- Annular Lesion
- circular (ringworm)
- Confluent Lesion
- ex hives//uriticaria
- Discrete lesion
- Skin tags//acne
Gyrate Lesion
grouped lesions
linear lesion
Target Lesion
- zosteriform
- linear around unilateral nerve
- ex: herpes
- Polycyclic
- i.e. psoriasis
- anular lesions grow together
- Macule
- Patch larger than 1 cm
- flat not raised
-
Papule
- Plaque larger than 1 cm
- can feel, slightly elevated
- mole wart
- Nodule
- tumor larger than 3 cm
-
Wheal
- Urticaria-hives
- raised irregular shape due to edema
- mosquito bites, allergies
-
Vesicle
- Bulla- larger than 1cm
- a blister, herpes chicken pox, shingles
- Cyst
- encapsulated fluid filled cavity
- subcutaneous layer.
- Pustule
- pus filled cavity
- Crust
- dried out when blisters burst
- Scale
- compact flakes of skin
- Fissure
- ex cracks at corner of mouth
- Erosion
- shallow depression
- moist but no bleeding
- Ulcer
- irregular shape, may bleed
- leaves scar
- Scar
- replaced with connective tissue (collagen)
- Atrophic Scar
- thinning of the epidermis
- decreased visibility of normal skin markings
- shiny
- Lichenification
- when someone scratches an area excessively
- Keloid
- hypertrophic scar
- elevetated skin by excess scar tisue
- Pressure Ulcer Stage I
- red but ubroken
- will not blanch
- Stage 2 Ulcer
- loss of epidermis
- like open blister
- Stage 3 ulcer
- extending into subcutaneous tissue
- resembling a crater
- Stage IV Ulcer
- breaks through all skin layers
- visible bone or tendons
What causes milia?
sebum occludes skin follicles
Epidermis layer
- basal layer,
- thin,
- stratum corneum
Dermis Layer
- collagen
- elastic tissue
Subcutaneous layer
- adipose tissue
This is when lower half of the body turns red, upper half blanches..
Harlequin
This term is used when you notice mottling on trunk and extremities
Cutis Marmorata
large round or oval patch of light brown usually present at birth
cafe au lait
