Physical Assessment Exam 1 Flashcards
What is the importance of cultural awareness?
- Increased understanding of cultural diversity by being self-aware and knowledgeable about one’s own culture
- Awareness is an interactive and ongoing process for members of the healthcare profession
- Performing cultural self-assessment is an integral part of becoming culturally competent
It is important that we have what?
Cultural Sensitivity
Health related beliefs and practices is what?
One component of the cultural assessment
What is a basic patient right?
To have an interpreter present
What are some emerging minority group trends?
- Differences noted in age, poverty level, and household composition
- All ethnic and racial minority groups exceed the national poverty level
- Low educational attainment and lower income are correlated with likelihood of disability
- Family size and multigenerational families are more evident in minority groups
What are some Social Determinants of Health (SDOH)?
- Education
- Social and Community Context
- Health and health care
- Neighborhood and built environment
- Economic stability
What are health care disparities?
A particular type of health difference that is closely linked with social, economic, or environmental disadvantage
What are the National Standards for Culturally and Linguistically Appropriate Services in Health Care?
- Set of 15 standards
* Provide blueprint to improve quality of care for diverse populations to eliminate health disparities
Title IV Civil Rights Act 1964
- LEP
* Providing assistance with communication utilizing resources such as interpreters
In a culture there are what?
Basic characteristics that are learned from birth through a process of language accuisition and socialization
Culture is not what?
Biologically or genetically determined
Subculture
When people join a culture and then based on a subculture they have a shared interest
Assimilation is what?
- An immigrant loses their ethnic identity to take on the identity of the common culture
- Ex: person from Japan comes to U.S. and they start to wear clothes from U.S. (Adapting to surroundings); it doesn’t change their heritage
- One sided
What is spirituality?
•It is a broader term that encompasses something larger than one’s own existence with a belief of transcendence.
- Effort to find purpose and meaning
- Comes from one’s own life experiences
What is religion?
- An organized belief system that has a shared experience that can assist in meeting one’s individual spiritual needs
- Peoe can have jewelry and clothing related to beliefs
What is the biomedical or scientific theory?
•Cause and effect that can provide physical and psychological illnesses
Example: germ theory
What is the naturalistic or holistic belief?
- Belief in the forces of nature that there is a balance in the universe
- Example: yin/yang theory like eastern medicines
- Illnesses that can cause cold: ear ache, chest cramp, gastrointestinal cramping, joint pain, tuberculosis
- Ilnessea that can cause hot: sore throat, absessed teeth, rashes, or kidney disorders
- Will only consume warm after pregnancy
What kind of healers do Hispanics use?
- Curandero
- Espiritualista
- Yerbo
- Sabedor
What kind of healers do black people have?
- Hougan
- Spiritualist
- Old lady
What kind of healers do American Indians have?
- Shaman
- Medicine woman
- Medicine man
What kind of healers do Asians have?
- Herbalists
- Acupuncturist
- Bone setters
What kind of healers do Amish people have?
Braucher
In traditional treatments and folk healers healing is not complete unless what?
Body and mind are healed
What developmental competence do we need to have?
Based on someone’s culture, they may or may not accept some of the treatments that we think are necessary.
What is a cultural taboo?
Example: If a jahovas witness accepts a blood transfusion
Transcultural expression of pain is:
- Expectations, manifestations, and management of pain are all embedded in a cultural context
- Pain has been found to be a highly personal experience, depending on cultural learning, the meaning of the situation, and other factors unique to the person
- Silent suffering has been identified as the most valued response to pain by health care professions
What is Culturally sensitive?
Caregivers possess basic knowledge and understanding
What is Culturally appropriate?
Caregivers apply knowledge to improve health outcomes
What is Culturally competent?
Caregivers apply a universal concept of understanding to all contextual aspects of care
What is cultural care?
Provision of health care across cultural boundaries in consideration of context
What should we do first as nurses to help us know where our culture stops and the patients culture starts?
Explore your own personal history to develop cultural sensibility so you don’t impose your cultural beliefs onto the patient.
How to individual care for someone’s culture?
- Ask ooen-ended questions
- Make care specifically adapted to them
- Make adaptions by
What is the interview purpose?
- This is the best chance to gain an understanding of the patients beliefs, concerns, and perception of their individual health state
- Allows for complication of subjective data and awareness of objective data (physical appearance, posture, ability to carry on a conversation, and demeanor)
What are successful interview characteristics?
- Gather complete and accurate data about person’s health state including description and chronology of any symptoms
- Establish trust to foster acceptance and allow for data sharing
- Teach person about their individual health state
- Discuss health promotion and disease prevention
- Build rapport to continue therapeutic relationship
An interview helps what with a patient?
Helps build rapport
What is the contract terms of the interview?
- Location
- Explanation: Intro and role
- Purpose:Mutual goal
- Time frame: How long?
- Participation: Who?
- Confidentitality: can promise if hurting themselves or someone else
- Cost: How much?
What is verbal communication?
Words you speak and tone used
What is nonverbal communication?
- Body language helps to provide cues which may be correlated with true feelings.
- Recognize importance of unconscious messages
What are some internal factors of communication?
- We should try to maximize our communication skills
- Be an active listener
- Some times awkward silence is okay
What are some external factors?
Something that can interupt the interview process
•Ensure privacy
•Avoid interruptions
•Physical environment: equal seating
•Dress: appearance and comfort
•Note taking: keep to a minimum; give focused attention
What are electronic health records?
- Helps information be more fluid
- Can see trends in their labs, vital signs, etc.
- Can be a barrier with patients
What are some techniques of communication?
Open and closed ended questions
Patient leads and reactions obtained from interviewer
- Facilitation: encourage to say more
- Silence: direct attentiveness
- Reflection: echoes to help express meaning
- Empathy: names a feeling and allows its expression
- Clarification: asking for confirmation
What goes with assisting the narrative?
Confrontation: clarifying inconsistent information
Interpretation: makes association to identify cause or conclusion
Explanation: inform them by sharing factual and objective information
Summary: provides conclusion based on verified information which in turn identifies that the interview process is closing
What are the ten traps of interviewing?
- Provide false assurance or reassurance
- Giving unwanted advice
- Using authority
- Using avoidance language
- Engaging in distancing
- Using professional jargon
- Using leading or biased questions
- Talking to much
- Interrupting
- Using “why” questions
What is it when you look to see if body language and verbal communication are consistent?
Congruency
What are nonverbal modes of communication?
- Physical appearance
- Posture
- Gestures
- Facial Appearances
- Eye contact
- Voice
- Touch
When closing the interview what should we do?
- Summarize what happened with interview
- “Ask is there anything else you want to add” or “do you feel like I missed anything?”
- Give an idea about what the next steps are
What is developmental competence?
Interview the parent or caregiver of a child
Always take into consideration what of a person?
The level of maturity
With communicating with different ages you should use what?
The stages of cognitive development as a guideline to facilitate communication.
How should you incorporate an infant?
- Gentle handling with quiet calm voice
* Birth to 12 months
How should you incorporate an infant?
- Gentle handling with quiet calm voice
* Birth to 12 months
What is the stage of cognitive development for a toddler?
- 12-36 months
* Give one direction at a time and provide simple explanations
What is the stage of cognitive development for a preschooler?
- 3-6 years old
* Short directions with concrete explanation
What is the stage of cognitive development for school-age?
- 7-12 years old
* Ask questions to gathers data and be nonjudgmental
What is the stage of cognitive development for adolescents?
- Starts with puberty
* Respectful, honest attitude with focus on the individual
With the older adults
- Can have a caregiver there to answer questions
- Address with respect
- Consider appropriate pacing of interview
- Physical limitations
- May need increased response time
- May have more information to provide
- Use therapeutic touch to provide empathy
How to interview someone with special needs?
- Vulnerable population that could be: acutely ill, drug/alcohol abuse, sexually aggressive, emotionally distraught crying, anger and/or threatening violence and anxious
- Use appropriate resources during situation
- Be alert to “personal questions” queries as they may indicate ulterior motives: provide appropriate response based on personal ethics
What is the largest national emerging minority?
Hispanics
We need to maintain what with people?
Privacy and modesty
We need to be aware of what with sexual orientation of people?
Own personal bias or baggage
Someone can be what without having what?
Literate; health literacy
What are some techniques to improve health literacy?
- Teach back so they can show you they know what they’re doing
- Oral teaching: instructions; no medical jargon
- Written material: Should be an 8th grade reading level; 12 point don’t; CAPS w/ bullet points
What includes communicating with other professionals?
- Two or more individuals
- Creates an environment of mutual respect and enhances collaboration
- No assumptions should be going on and could lead to patient errors
- Maintain open lines of communication
What is a standardized communication?
SBAR
Situation:provide a brief description of pertinent variables, demographics, clinical diagnosis, and location
Background: provide pertinent history as it directly relates to patient’s current health status.
Assessment: state pertinent findings obtained with interpretation data
Recommendation or request: state what you need or want for the patient in terms of medical treatment and/or assistance
•Its important to get information that the next person needs to know
What is the purpose of a health history?
- Collect subjective and objective data from physical exam and labs.
- Shows past and present health status
- Used as a screening tool
- Printed or electronic format available for review and updates
- Sequence may vary
- Focus may differ in terms of clinical practice setting and/or nature of complaint
What are the 8 health history sequence?
- Biographical data
- Dource of history
- Reason for seeking care
- Present health or history of present illness
- Past health
- Family history
- Review of systems
- Functional assessment and ADLs
The health history focus may be different in terms of what?
- Individual patient concerns
- Developmeny considerations
- Presence of health problems
- No detection of health problems
- Concerns r/t aging
- Identification of vulnerable population
- Identified barriers to communication
What is biographic data?
Name Address Phone number Age Birth date Birthplace Gender (identification) Relationship status Race Ethnic Origin Occupational: usual and present Primary language
What is source of history?
Who is giving the information?
Is it reliable?
What is the reason for seeking care?
- It’s a brief spontaneous statement in persons own words describing reason for the visit.
- Use quotations for what they say
- Focus on patients prioritized reasons for care
How do you. Get a present health or history of present illness?
•Collect all provided data and identify the right critical characteristics •Location •Character (quality) •Quantity (severity) •Timing •Setting •Aggravating or relieving factors •Associated factors •Patients perception •
What do we want to know about a past medical history?
- How did it impact them in their day to day lives?
- Is it still impacting them today?
- Something in their past could cause them to speak care today
What do we want to know about in the past medical history?
- Childhood illnesses
- Accidents or injuries
- Serious chronic illnesses
- Hospitalizations
- Operations
- Obesteric history
- Immunizations
- Last examination date
- Allergies: note allergen and reaction
- Current medications
What is part of a family history?
- Highlight disease or conditions that may be at risk for genetically
- Provide age and health or cause of death of relatives
- Ability based on results to seek early screening, make possible lifestyle adjustments, an/or undergo periodic surveillance
- Pedigree or genogram used as standardized tool to organize data
Cross cultural care implications
- Is there anything related to their religion or spirituality that could be changed in their health care to be more culturally competent.
- Nutrition: taboo foods or food combinations
Review of systems
- Looks at body system to see how well it’s functioning and start from head to toe (cephalocaudal)
- Think about age and make it age appropriate
- Any previous surgeries?
- Look at ADLs too
When documenting you should always be very what?
- Objective with head to toe and don’t use negative writing or phrasing.
- Limit to patients statement or subjective date
It’s important to talk to patient’s about what?
Health promotion practices
Ex:Yearly exams
Teaching males about monthly testicular self examination
Teaching females about breast examinations
What includes a functional assessment?
•ADLs ex: I’d someone breaks their leg
•Objectively measure functional status
•Relevant data r/t lifestyle and type of living environment
Look at screening tools
What to look for in the functional assessment with ADLs?
- Self-esteem, self-concept
- Activity and exercise
- Sleep and rest
- Nutrition and elimination
- Interpersonal relationships and resources
- Spiritual resources
- Coping and stress management
- Personal habits
- Illicit or street drugs
- Environment and work hazards
- Intimate partner violence
- Occupational health
Development Competence for Child
•What is the specific age and developmental stage of a child (how was pregnancy, labor and delivery, perinatal period)
•Nutritional data for growth and development (Making milestones as they age)
•
What to get for a past health history for a child?
- Do they have any child illnesses? Mumps, Chickenpox, Rubella
- Be specific when documenting
- Know if they had any
* accidents or injuries
* chronic or acute illnesses
* prenatal, perinatal, and postnatal status
* Taking and Medications or vitamins
* Immunizations or Allergies
* Operations or Hospitalizations
* Developmental History (did they meet developmental milestones?)
* Nutritional History
* Family history
Review of systems in a child should include what?
What was the child doing to make them think they were having this problem?
Example: ear ache: crying, pulling at ear, doesn’t want to lay on that side
Make the child feel comfortable because they might be scared (use their teddy bear): TODDLERS
Method of interviewing an adolescent focuses on assessment of what?
HEEADSSS •Home environment •Education and employment •Eating •Activities (peer related) •Drugs •Sexuality •Suicide and depression •Safety from injury and violence
Defining mental status
Mental status is a person’s emotional and cognitive functioning
When looking at someone’s mental status we are looking at their what?
- Consciousness
- Language
- Mood
- Affect
- Orientation and attention
- Memory and abstract reasoning
- Thought process, thorough content and perception
Organic disorders are what?
Due to brain disease of know specific organic cause •Delirium •Dementia •Alcohol and drug intoxication •Withdrawl
When is it more challenging to gather information with a mental assessment?
Children and adolescents
What are the four main headings of a mental status assessment?
ABCT Appearance Behavior Cognition Thought process
For patients that need a more thorough mental status exam it could be because what?
- An abnormal in the ABCT’s
- Abnormal coping skills
- Dysfunction
- Trauma
- Tumor
- Neurological accidents
- Stroke: can still assess this if there is impairment w/language but we have to be more creative (name things around the room or body parts)
What are factors that could affect our findings?
- Alcoholism
- A disease they have
- Medication they’re on that could cause side effects
- Educational level with answering questions
- Stress responses
It would make it hard for us to get the information to interpret it
Examination sequence of steps
- Data Collection
- Assess accurately and assure validity
- Basic function (consciousness and language)
- Sequence of steps forms a hierarchy in which the most basic functions are assessed first
Examination sequence of steps
- Data Collection
- Assess accurately and assure validity
- Basic function (consciousness and language)
- Sequence of steps forms a hierarchy in which the most basic functions are assessed first
Doing a general survey includes what?
•Appearance °Behavior •Cognitive functions •Thought processes •How do they answer questions? •Language
Their appearance includes what?
Posture: what does it look like?
Body movements:
Dress: what are they wearing?
Grooming and hygiene: some cultures may not shave including women
With behavior there is what?
LOC: Person is awake and alert, not able to arouse them
Facial expression: is appropriate with conversation and their facial expressions matches their body language
Speech
Mood and affect: body language and facial expressions match
What goes along with cognitive function in a mental assessment?
Orientation: know name, week, year, where they are
Attention span: can they carry on a conversation without losing concentration, falling asleep, or changing the subject
What is the 10th leading cause of death in the U.S.?
- Suicide
* Makes usually follow through with it.
What are questions to test judgement?
What are your goals? Are you having hallucinations? Have you ever heard someone talk to you and no one else in the room?
Ask when they have an abnormal ABCT
What are some cognitive assessments?
Mini mental state exam
Montreal cognitive assessment
