Putting it all Together Flashcards
Investigate cognitive abilities
State of consciousness, response to analogies, abstract reasoning, arithmetic calculation, memory, attention span
Pre-screening exam
If positive, then administer
PHQ-9
First two questions of the PHQ-9
During the past two weeks, have you often been bothered by feeling down, depressed, or hopeless?
During the past two weeks, have you often been bothered by having little interest or pleasure in doing things?
Generalized anxiety disorder (GAD) - Charcterized by and other features
Characterized by excessive and persistent worrying that is hard to control, causes significant distress or impairment, and occurs on more days than not for at least six months.
Other features include psychological symptoms of anxiety, such as apprehensiveness and irritability, and physical (or somatic) symptoms of anxiety, such as increased fatigue and muscular tension
Screening tool for anxeity
GAD-7
Most common psychiatric disorder in the general population
Depression
In the absence of screening, it is estimated that only 50 percent of patients with
major depression are identified
Depression May present with
mood, cognitive, neurovegetative, or somatic symptoms.
Depression mood manifiestations include
sadness, emotional distress, emotional numbness, or sometimes anxiety or irritability.
Depression Neurovegetative symptoms
include loss of energy, changes in sleep, appetite, or weight
At the Start
Identify self as student nurse practitioner.
Integrate the history and PE to meet the needs of the patient.
Put the patient at ease by explaining your actions.
Respect patient privacy.
Revisit problem areas.
Trust your instincts.
Patient factors affecting accuracy
Sensory deprivation
Emotional constraints, apparent and unapparent
Language barriers
Cultural barriers
Every observation has a certain sensitivity
Assurance that if something is to be found, it will be found
Every observation has a certain specificity
Assurance that if it is found, it is a true finding and not a misinterpretation or false-positive finding
Uncertainty
The potential for error increases uncertainty and our discomfort.
We cannot always express our findings in numbers.
We cannot avoid probabilities.
There is false comfort in the apparent certainty of many numbers.
Concluding the Examination
Allow patient time to dress.
Discuss findings and plan of care with patient.
Answer questions.
Include family, if patient requests.
If examination takes place in a hospital bed, return everything to normal position and ensure patient’s comfort.
Newborn
Apgar score; gestational age; congenital anomalies; degree of awareness or apathy; posture; skin color; facies
Inspect for congenital anomalies.
Palpate fontanels; extremities; abdomen; rest of baby
Infant
Vary sequence as appropriate for age and wakefulness; observe before touching; evaluate feeding and crying
Examination sequence: general inspection; chest, lungs, heart; abdomen; head and neck; upper and lower extremities; genitals and rectum; neurologic; back; behavior
Examination of Children
Observe parent-child connection; slowly initiate contact during history; remain flexible.
General inspection; observe child playing.
Child on parent’s lap
Upper and lower extremities; head and neck; chest, heart, lungs
Child supine, still on lap, diaper loosened
Abdomen; inguinal lymph nodes; external genitalia
Child standing
Spinal alignment; posture; gait
Child returns to parent’s lap
Eyes/vision; ears/hearing; nose; mouth; pharynx
Examination of Pregnant Patients and Older Adults
Pregnant patients Abdomen; pelvis Older adults May require alternative positions May take longer to examine Functional assessment Medications General and focused assessment Psychosocial assessment
Closing Discussion
Be aware of your biases.
Determine difference between urgent and nonurgent data and patient needs.
Share summary information with the patient.
