SPE

Question 1

hypertension

Answer 1

questions
- HA? vision? SOB? palpitations? chest pain? dizziness? edema? fatigue? activity intolerance? diet? alcohol? life stressors? cholesterol level?
assessment
- vitals [BP x6] + pain
- heart
– place pt. in 30-45o
— inspect skin color, chest wall for lifts + heaves + abnormal pulsation
— auscultate then palpate carotid [3 spots]
— assess apical pulse at PMI, cap. refill, JVD
– place pt. in supine position
— auscultate at 5 landmarks using bell + diaphragm, left lateral side
— palpate pulses
— assess temp. + cap. refill of lower extremities, pretibial edema
— perform homans sign for thrombophlebitis
- lungs
– inspect thorax for shape, symmetry
– assess resp.’s for quality + rate, visible sign of resp. distress [use of accessory muscles, cyanosis, clubbing, labored breathing], skin on anterior + posterior thorax
- palpate tactile fremitus
- auscultate anterior + posterior fields
teach
- decrease stress, alcohol, salt, fat. cholesterol; increase exercise, fiber, veggies, water; no smoking; DASH diet

Question 2

diabetes

Answer 2

questions
- blurred vision? poly’s? weight gain/loss? prolonged healing? numbness or tingling in feet? diet? med. management? usual FBS? changes in resp.’s?
assessment
- vitals
- lungs
- heart + peripheral vascular
- neurological
– assess the cranial nerves
— snellen chart, peripheral vision [CN2]; extraocular vision [CN 3, 4, 6]; facial movement + symmetry [CN 7]; whisper test for hearing, Romberg test [CN 8]; verbalize gag reflex [CN 9, 10]; spinal accessory muscle strength [CN 11]; rapid alternating movement, opposition, finger to finger, heal to shin; gait, muscle strength, rapid alternating movements, opposition, finger to nose, knee to shin [cerebellar fx.]; deep tendon reflexes [triceps, brachioradialis, patellar, Achilles, plantar]
teaching
- diet, exercise, med. management, BS checks, med ID bracelet, travel, prolonged healing, dec’d sensation, effects of stress/illness; daily foot checks; hypergly: signs of infection, poly’s, blurry vision, syncope; hypogly: dizzy, fatigue, HA, nausea, sweat, tingling, confusion

Question 3

congestive heart failure

Answer 3

questions
- SOB? fatigue? cough (dry, hacking)? # of pillows, nocturia? weight gain? swelling in legs or abd. (blue)? chest pain? palpitations? dizziness? cool/dusky skin? salt use?
assessment
- vitals
- lungs
- heart [JVD]
teaching
- diet [decrease salt, fat/chol., fluids]; no caffeine/smoke; exercise; daily weight; rest periods; elevate feet

Question 4

COPD

Answer 4

questions
- SOB? activity intolerance? chest pain? # of pillows? cough? vaccines? heartburn?
assessment:
- vitals
- heart
- lungs [99]
teaching
- no smoking; deep breathing exercises; weight management; avoid crowds; increase fluids [3 L daily]; O2 therapy; report changes; upright position; space activities

Question 5

asthma

Answer 5

questions
- SOB? cough [productive, sputum color/amount]? chest tightness? med. management? pets? carpet? smoking in house? allergies? rashes? activity intolerance? frequent resp./sinus infection? heartburn? stress? frequency of attacks? insomnia?
assessment
- vitals
- heart
- lungs
teaching
- in-home smoking; reduction of allergens triggers; med. management; better management of upcoming attacks; emergency inhaler

Question 6

headache/migranes

Answer 6

questions
- COLDSPA? NV? aura? neurological deficits? speech changes? fevers? head trauma? seizures? blackout? weakness? changes in balance/coordination? light/sound sensitive? time of day? relieving factors?
assessment
- vitals
- heart
- lungs
- neuro.
- pain
-- Precipitating factors
-- Quality [burning, aching, stabbing, dull]
-- Radiation
-- Severity [1-10]
-- Time [duration]
teaching
- stress reduction; HA log w/ activities + food; triggers

Question 7

peripheral vascular disease

Answer 7

questions
- pain w/ activity? leg cramps? skin changes? changes in skin color? temp. or sensation abnormalities? would healing alterations? leg sores?
assessment
- vitals
- lungs
- heart [peripheral vascular (allen’s test)]
teaching
no smoking; elevate/cross legs; no restrictive clothing; compression stockings; shoes when ambulating

Question 8

abdominal pain

Answer 8

questions
- COLDSPA? appetite changes? weight gain/loss; NVD; food intolerance? difficulty swallowing; blood in stool/vomit? change in BM/urination? jaundice?
assessment
- vitals
- heart
- lungs
- abdominal
– inspect mouth [tongue, teeth, gums, tonsils, uvula]; abd. [contour, symmetry, skin, visible pulsations, umbilicus mid-line]
– auscultate using diaphragm [bowel sounds x 4], using bell [aorta + femoral arteries]
– percuss x 4
– palpate lightly x 4; deeply palpate bladder above symphysis pubis, CVA for tenderness
- pain
teaching
- s/s of complications; alcohol use; sx. diary; use of OTC med.’s [NSAIDS]

Question 9

angina

Answer 9

questions
- activity intolerance? relived w/ rest? predictable? associated w/ NV? SOB? palpitations? radiating pain? pallor/cyanosis; length of time of pain?
assess
- vitals
- lungs
- heart
- pain
teaching
- diet; exercise; reduce stress, salt/ fat/ chol.; no smoking s/s of MI; report inc'd angina; rest after activity

Question 10

myocardial infarction

Answer 10

questions
- activity intolerance? chest pain? associated w/ NV? SOB? palpitations? radiating pain? change in skin color? flu-like sx.'s? previous MI?
assessment
- vitals
- lungs
- heart
teaching
- med. management; diet, exercise; stress reduction; nitro storage

Question 11

chronic renal failure

Answer 11

questions
- urination difficulty? amount? color? skin changes? hydration? weight changes? med./ dialysis management?
assessment
- vitals
- lungs
- heart
- abd. [CVA] 
teaching
- fluid restrictions; daily weights; diet [Na, K, phos., protein]; dialysis [3x day for 3-8 hr]; site care

Question 12

peptic/ gastric ulcer disease

Answer 12

questions
- food intolerance? positioning for sleep? changes in stool [blood]? OTC med.'s [NSAIDS, antacids]?
assessment
- vitals
- lungs
- heart
- abd.
teaching
- OTC med.'s [NSAIDS]; weight loss; diet [no caffeine/ carb. drink, foods irritable to stomach]

Question 13

chronic pancreatitis

Answer 13

questions
- food intolerance? changes in BM? NV? pain [LUQ or midepigastric]? skin changes on abd.?
assessments
- vitals
- lungs
- heart
- abd. [LUQ or midepigastric pain; skin changes; abd. changes]
- pain
teaching
- small freq. meals; diet [bland foods; no rich foods, caffeine/ alcohol; supplemental fat-soluble vit.’s]

Question 14

meningitis

Answer 14

questions
- fatigue? neck pain/ stiffness? HA? blurred vision? difficulty concentrating? seizures? vomiting? rashes [petechiae]? fever?
assessment
- vitals
- lungs
- heart
- neuro.
- lymph nodes
-- assess lymph nodes
-- palpate thyroid gland [posterior method]
-- tilt head side to side + swallow
- pain
- kernig [leg]; brudzinski [head]
teaching
- family report changes or decrease in LOC; s/s inc'd ICP; vaccinations; high protein; diet [high kcal; small, frequent meals]; report fever

Question 15

pneumonia

Answer 15

questions
- SOB? chest pain? immunosuppressive drugs? recent aspiration? weakness? NV? fatigue? HA? sore throat? exposure to chemicals/ toxins/ allergens? last PPD?
assessment
- vitals [for fever, chills, night sweats]
- heart
- lungs
- lymph nodes
teaching
- pulm. toileting?; vaccines; increase fluids, calories; antibiotic compliance; no smoking

Question 16

deep vein thrombosis

Answer 16

questions
- pain in calf? edema in one lower leg? warm/ red skin? signs of resp. distress? recent pregnancy? activity level? SOB/ cough?
assessment
- vitals
- lungs
- heart [allens]
teaching
- s/s of pulm. embolism; prevention of future clots [exercise]; med. for anticoagulation; meticulous skin care; no smoking; weight loss

Question 17

cerebral vascular accident

Answer 17

questions
- changes in strength, sensation, movement? difficulty swallowing? emotional, memory, and judgmental problems? special difficulties? incontinence? changes in speech? HA?
assessment
- vitals
- lungs
- heart 
- neuro.
teaching
- med. prevention; support prep., reduce alcohol; no smoking; ROM; contractures

Question 18

tuberculosis

Answer 18

questions
- proximity to cases? frequency of testing? immunosuppression? med. compliance? CXR? difficulty breathing [productive cough, amount, color]? fatigue? activity intolerance? joint, urinary, lymph issues? anorexia/ weight loss? fever [afternoon]? night sweats? last PPD? 
assessment
- vitals
- heart
- lungs
- lymph nodes
teaching
- importance of frequent testing; med. compliance

Question 19

transient ischemic attacks

Answer 19

questions
- changes in strength, sensation, movement? difficulty swallowing? emotional changes? memory or judgment problems? special difficulties? incontinence? changes w/ speech? HA? 
assessment
- vitals
- lungs
- heart
- neuro.
teaching
- med. prevention? support prep.; decrease alcohol; stop smoking; ROM; contractures

Question 20

HIV

Answer 20

questions
- unprotected sex? sharing needles? preg.? night sweats? swollen lymph? weight loss? fatigue? NVD? other STI infections or hepatitis? change in bowel habits?
assessment
- vitals
- lungs
- heart
- neuro. [gait]
teaching
- strict med. regiment; keep lesions clean + dry; frequent mouth care [yeast]; transmission; clean blood spills w/ 1:10 bleach water; opportunistic infections

Question 21

ethical perspective

Answer 21

everything we talk about is confidential…
do you have a plan to cope? how can I help?
how does this make you feel?
- tell me more about that?
what concerns do you have?
do you have a support system at home?
do you have any questions?
what do you think is stopping you from telling…?
pastoral care/ support groups