CNM Purple Big Book: General Health Assessment and Health Promotion 2013 Flashcards Preview

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Flashcards in CNM Purple Big Book: General Health Assessment and Health Promotion 2013 Deck (216):
1

ROS endocrine focus

Menses, breasts, pregnancy, thyroid, menopause

1

ROS genitourinary

In uterine exposure to DES if born before 1971
Uterine or ovarian problems
History or symptoms of STI or pelvic infection
History or sx of vaginal infections
History of abnormal Paps - date, abnormality, tx
Hx or sx of UTI
Sx of urinary incontinence

2

Concluding question

Is there anything else I need to know about your health in order to provide you with the best health care?

3

Prevalence

Existing level of disease

4

Incidence

Rate of new disease

5

Tympani

Loud, high-pitched, drum-like sound, eg, gastric bubble, gas-filled bowel

6

Resonance

Loud, low-pitched, hollow sound, eg. Healthy lungs

8

Dull

Soft to mod, mod-pitched, thud-like sound, eg liver, heart

9

light palpation is used to identify...

~1 cm deep
muscular resistance
areas of tenderness and
large masses or areas of distention

10

deep palpation

~4cm deep
used to delineate organs and
to identify less obvious masses

11

underweight

BMI <18.5

12

normal weight

BMI 18.5-24.9

13

Overweight

BMI 25-29.9

14

Obesity

BMI 30-39.9

15

Extreme obesity

BMI 40 or greater

16

waist circumference provides msmt of abd fat as independent prediction of risk for

DM II, dyslipidemia, HTN, and CVD in individual with BMI 25-39.9

17

in adult femaile, incr relative risk is indicated at a waist circumferece greater than

35 in

18

Primary lesions

occur as an initial, spontaneous rxn to an internal or external stimulus
(macule, papule, pustule, vesicle, wheal)

19

Secondary lesion

result from later evolution or trauma to a primary lesion
(ulcer, fissure, crust, scar)

20

Thyroid nl PE

palpable with no masses or tenderness, rists symmetrically with swallowing

21

Lymph node HEENT locations

preauricular, postauricular, occipital, tonsilar, submandibular, submental, superficail cervical, posterior and deep cervical chains, supraclavicular

22

Lymph node PE wnl

<1 cm, nontneder, mobile, soft, discrete

23

snellen chart used for what kind of vision

central

24

rosenbaum card used for what vision

near vision

25

impaired near vision

presbyopia

26

impaired far vision

myopia

27

Tragus tenderness may indicate

otitis externa

28

mastoid process tenderness may indicate

otitis media

29

Tympanic membrane PE wnl

intact, pearly gray, translucent, with cone of light at 5:00 and 7:00, umbo and handle of malleus visible; no bulging or retraction

30

decreased tactile fremitus

emphysema, asthma, pleural effusion

31

increased tactile fremitus with...

lobar pneumonia, pulmonary edema

32

crackles

intermittent, nonmusical, brief sound

33

rhonchi

low-pitched, snoring qulaity

34

wheezes

high-pitched, shrill quality

35

pleural friction rub

grating or creaking sounds

36

transmitted voice sounds/vocal resonance (bronchophoney, egophoney, whispered pectoriloquy) indicate

fluid or a solid mass in lungs

37

physiologic split S2 heard during

inspiration

38

s1 heard best at

apex

39

S2 heard best at

base

40

fixed split S2

heard in inspiration and expiration; may be heard with atrial septal defect or right ventricular failure

41

increased S3

early diastole, low-pitched;
may be normal in children, young adults, and in late pregnancy; not nml in older adults

42

increased S4

late diastole, low-pitched;
may be normal in well-trained athletes and older adults;
heard with aortic stenosis and hypertensive dz

43

murmurs

systolic murmur may be physiologic (pregnancy) or pathologic (diseased valves);
diastolic murmur usually indictes valvular dz

44

murmur of mitral valve stenosis

early/late diastole, low-pitched, grade I-IV; heard loudest at apex without radiation; no respiratory phase variation

45

normal lymph nodes

<1cm, non-tender, mobile, soft and discrete

46

uterine size, nullip and parous

nulliparous: 5.5-8 cm long
parous 2-3 cm larger

47

ovarian size during reproductive years

3cm x 2 cm x 1 cm

48

CBC nl findings adult female

4.2-5.4 million/mm3

49

low CBC values

hemorrhage, hemolysys, dietary deficiencies, hemoglobinaopathies, bone marrow failure, chronic illness, medications

50

high CBC values

dehydration, diseases causing chronic hypoxia such as congenital heart dz, polycythemia vera, medications

51

H/H

rapid indirect measure of RBC count

52

nl H/H non-pregnant female

37-47%

53

nl H/H pregnant female

=/> 33% first and third trimesters
=/>32% second trimester

54

Hgb

measurement of total hgb (which carries oxygen) in the blood

55

nl hgb non-pregnant

12-16 g/dL

56

nl hgb pregnant

=/> 11 g/dL first and third trimester
=/> 10.5 g/dL second trimester

57

Low H/H due to

anemia, hemoglobinopathies, cirrhosis, hemorrhage, dietary deficiency, bone marrow failure, renal dz, chronic illness, some cancers

58

High H/H due to

erythrocytosis, polycythemia vera, severe dehydration, severe COPD,
Heavy smokers or those living at higher elevations may also have higher hgb.

59

Red blood cell indices

provide info re size, weight and Hgb [ ] of RBCs, useful in classifying anemias

60

Mean corpuscular volume (MCV)

average volume or size of a single RBC

61

nl MCV

80-95 mm, normocytic

62

Microcytic/abnormally small MCV

seen in iron deficiency anemia and thalassemia

63

Macrocytic/abnormally large MCV

seen with megaloblastic anemias such as vitabin B12 deficiency and folic acid deficiency

64

Mean corpuscular hemoglobin (MCH)

average amount or weight of Hgb within RBC

65

nl MCH

27-31 pg/cell

66

causes for abnormal MCH

same as MCV

67

Mean corpuscular hemoglobin concentration MCHC

average [ ] or % of Hgb within a single RBC

68

nl MCHC

32-36 g/dL, normochromic

69

decreased [ ] or hypochromic

seen with iron deficiency anemia and thalassemia

70

WBC with differential

provides information useful in evaluating individual with infection, neoplasm, allergy or immunosuppression

71

nl WBC (adult)

5000-10,000/mm3

72

increased WBC

seen with infection, trauma, inflammation, some malignancies, dehydration

73

decreased WBC

seen with some drug toxicities, bone marrow failure, overwhelming infections, immunosuppression

74

WBC may be elevated but a normal finding in

late pregnancy and labor

75

neutrophils

increased with acute bacterial infections and trauma.
Increased immature forms (band or stab cells) referred to as a "shift to the left",
seen iwth ongoing acute bacterial infection

76

basophils and eosinophils

increased with allergic rxn and parasitic infections.
NOT increased with bacterial or viral infection

77

lymphocytes and monocytes

increased with CHRONIC bacterial and
ACUTE viral infxns

78

Peripheral blood smear

microscopic examination of smear of peripheral blood to examine RBCs, platelets, and leukocytes

79

platelet count

used to evaluate abnl bleeding or blood clotting

80

Nl platelet (adult)

150,000-400,000

81

low platelets (thrombocytopenia)

hypersplenism, hemorrhage, leukemia, cancer chemotherapy, infection

82

high platelet count (thrombocytosis)

some malignant disorders, polycythemia vera, rheumatoid arthritis

83

Urinalysis

dipstick and/or microscopic evaluation of urine.
includes eval of appearnace, color, odor, pH, protein, specific gravity, leukocyte esterase, nitrites, ketones, crystals, casts, glucose, WBCs, RBCs

84

nl U/A

no nitrities, ketones, crystals, casts or glucose.
clear, amber yellow, aromatic.
pH 4.6-8.0
protein 0-8mg/dL
specific gravity (adult) 1.005-1.030
leukocyte esterase negative
WBCs 0-4 per high power field
RBCs at 2 or less

85

Blood glucose used for

diagnosis and eval of DM

86

fasting glucose

NPO (except water) x 8hr
nl (adult) <100
impaired 100-125
diagnostic for diabetes 126 or higher

87

Two-hour postprandial glucose during OGTT

sample obtained 2 hours after a glucose load of 75g
nl = <140 mg/Dl
impaired glucose tolerance 140-199
dx of DM = 200 or more

88

ADA criteria for dx of DM

sx of DM plus random non-fasting glucose of 200 or more.
fasting glucose of 126 or more
2-hr postprandial 200 or more
repeat testing on subsequent day to confirm dx
ADA recommends using fasting glucose rather than OGTT for screening

89

HbA1C

NOT for dx of DM
Gold standard for measurement of long-term glycemic control in individuals with DM
reliable tool for evaluating need for drug therapy and monitoring effectiveness of therapy

90

Good diabetic control HbA1c

<7%

91

BUN and creatinine

used in evaluation of renal fxn

92

BUN

indirect measure of renal and liver fxn

93

nl BUN

10-20 mb/dL

94

increased BUN

hypovolemia, dehydration, reduced cardiac function, GI bleeding, starvation, sepsis, renal dz

95

decreased BUN

liver failure, malnutrition, nephrotic syndrome

96

serum creatinine

indirect meausre of renal fxn

97

nl serum creatinine

0.5-1.1 mg/dL

98

increased levels creatinine

renal disorders, dehydration

99

decreased creatinine

debilitation and decreased muscle mass

100

Lipid profile

determines risk for coronary heart dz and eval of hyperlipoproteinemia.
Includes total cholesterol, triglycerides, HDL, LDL.
Fast 12-14 hr prior to test

101

Total cholesterol nl level

<200 mg/dL
may be elevated in pregnancy

102

triglycerides nl

35-135 mg/dL
may be elevated in pregnancy

103

HDL

removes cholesterol fro mperipheral tissues and transports to liver for excretion

104

nl HDL

40 mg or greater

105

low HDL assoc with

incrased risk for heart and peripheral vascular disease

106

LDL

cholesterol carried by LDL can be deposited into peripheral tissues

107

nl LDL

<130 mg/dL

108

high LDL assoc with

increased risk for heart and peripheral vascular dz

109

Thyroid stimulating hormone (TSH)

used to dx hyperthyroidisim, primary hypothyroidism, differentiat primary from secondary hypothyroidism, and to monitor thyroid replacement or suppression therapy

110

nl TSH

0.4-4.7 mU/mL

111

increased TSH

seen with primary hypothyroidism and thyroiditis

112

decreased TSH

seen with secondary hypothyroidism, hyperthyroidism, suppressive doses of thyroid medication

113

free thyroxine (FT4)

used in dx of thyroid dz

114

nl FT4

0.58 - 1.64 ng/dL

115

increased FT4

hyperthyroidism and acute thyroiditis

116

decreased FT4

hypothyroidism

117

nl Total thyroxine (T4)

4.5-12.0

118

T4 measurement affected by

increases in thyroxine-binding globulin (TBG)

119

causes for increased TBG

pregnancy, OCP use, estrogen therapy

120

universal donor blood type

O neg because no antigens on RBCs

121

universal blood type recipient

AB positive because no antibodies to react to transfused blood

122

rubella titer indicating immunity

1:10 or greater

123

high titers of rubella

1:64 or greater, may indicate current infection

124

Rubella IgM antibody titer

used if preg woman has suspicious rash; IgM antibodies appear 1-2 days after onset of rash; disappear 5-6 wks after infection

125

how soon are HIV antibodies detectable in 95% of infected individuals?

withing 6 months of infection

126

PCR used for

to confirm indeterminate Western blot result OR negative results in persons with suspected HIV infxn

127

which test if suspect recent HIV infxn before development of immune response?

HIV plasma RNA.
A + test should be confirmed with subsequent intibody testing to document seroconversion

128

Hepatitis B (HBV) test

HBsAg (antigen) rises shortly before onset of clinical sx, peaks during first week of sx, and returns to nl by the time jaundice subsides

129

HBsAg

indicates active HBV infection: individual is infectious. Person is carrier if antigen persists

130

HBsAb

antibody appears 4 weeks after disappearance of surface antigen.
Indicates end of acute infectious phase, and signifies immunity to subsequent infection.
Also used to denote immunity s/p hep b vaccine

131

Tuberculosis: purified protein derivative (PPD) test

usually + w/i 6 wks after infection.
does not indicate active/dormancy of infxn

132

CDC def of + PPD

high risk pop: 5mm induration or greater
moderate risk pop: 10 mm induration or greater
gen pop: 15 mm induration or greater

133

+PPD

once + rxn, usually persists for life

134

false neg PPD

incorrect admin (needs to be intradermal) or immunosuppression

135

false pos PPD

may result if individual had prior vaccination with bacillus of Calmette and Guerin (BCG) vaccine

136

PPD test CONTRAINDICATED

if hx of BCG vax or active TB since severe local rxn can occur

137

daily fat intake

20-35% of calories

138

daily saturated fats

<10% of calories

139

daily trans fats

as low as possible

140

daily cholesterol intake

<300 mg/day

141

daily sodium intake

<2300 mg/day ~1 tsp

142

one drink equivalents

12 oz beer, 5 oz wine, 1.5 oz hard liquor

143

14-18 yr old daily calium intake

1300 mg/day

144

19-50 yr old daily calium intake

1000 mg/day

145

51 yr old daily calium intake

1200 mg/day

146

vit D intake daily

adults 400-600 IU/day

147

according to National Osteoporosis Foundation: calcium/vit D intake

50 yr: 1200 mg/day, 800-1000 IU

148

sources of calcium

milk, yogurt, soybeans, tofu, canned sardines/salmon with edible bones, cheese, fortified cereals and OJ, supplements

149

sources of vit D

fortified milk, egg yolks, saltwater fish, liver, supplements, regular exposure to direct sunlight without sunscreen

150

folate requirements for women of childbearing age

0.4 mg/day (400 microgm/day)

151

folate requirement if hx of neural tube defect or sz disorders or insulin-dependent DM

may benefit from 4 mg (4000 micorgm/day)

152

sources of folic acid

dried beans, leafy green vegetables, citrus fruits and juices fortified cereals
Most multivitamins include 0.4 mg folic acid

153

iron requirements for non-pregnant women

14-18 yr: 15 mg/dL
19-50 yr: 18 mg/dL
>51 yr: 8 mg/dL

154

sources of iron

meat, fish, poultry, fortified cereals, dried fruits, dark green vegetables, supplements

155

concerns with vegetarian diets

plan to avoid deficiencies in protein calcium, iron, vit B12, vit D

156

Physical Activity Guidelines for Americans

engage in at least 150 min of moderate-intensity or 75 min vigorous intensity aerobic physical activity each week
Performed for at least 10 minutes per episode
Spread throughout the week

157

HR in moderate intensity exercise

achieves 50-69% of maximum HR
Max HR = 220 minutes minus age

158

ex aerobic physical ctivity

brisk walking, running, bicycling, jumping rope, swimming

159

amt of muscle strengthening activites/wk

2 or more days each week
of moderate or high intensity involving all major muscle groups
ex: weight lifting, exercises with elastic bands or use of body weights (push ups, tree climbing) for resistance

160

bone strengthening activity

running, brisk walking, weight training, tennis, dancing

161

BSE breast self exam

ACS: teach, but not necessary
ACOG: perform monthly

162

CBE clinical breast exam

ACS: q 3 yrs from 20-39 yr old
q year age 40+
ACOG: periodic eval, yearly or as appropriate >18 yr
q year age 40+

163

Mammograms

ACS: q year age 40+
ACOG: q 1-2 yrs age 40-49, then yearly

164

MRI

ACS: 20% (high) LR = mammo+MRI yearly start age 30
ACOG: <15% LR = not recommended
ACOG: combination of yrly mammogram and MRI in women with BRCA gene mutation beg age 25 or younger based on earliest age of onset in family

165

breast cancer risk assessment tools

BRCAPRO,
Claus model
Tyrer-Cuzick model

166

Paps

ACS: begin approx 3 yr after beg vag intercourse or by 21 yr old
up to 29 yr: yearly if smear, q 2 yr if liquid-based
30 yr+: if 3 consecutive nl Pap, may do q 3 yr unless hx of in utero DES exposure, HIV infectio or immunosuppression
ACOG: begin at age 21
21-29 yo: q 2 yr
30+ yo: neg Pap, neg HPV = no more than q 3 yr

167

Chlamydia screening

CDC: yearly for all sexually active females 25 yo or younger

168

Blood Pressure

at least every 2 years for adults

169

Cholesterol screening

NCEP:
Fasting lipid profile: q 5 yrs beginning age 20
(total cholesterol, LDL, HDL, triglycerides)

170

Total cholesterol levels

240 mg/dL = high

171

LDL levels

<130 = desirable
130-159 mg/dL = borderline high
160-189 mg/dL = high
190 mg/dL = very high

172

HDL levels

60 mg/dL = High = protective against CHD (desirable)

173

Triglyceride levels

200 mg/dL = High

174

CHD risk factors for women

> 55 yr old
family hx of premature CHD (male relative <40 mg/dL
DM

175

Fecal occult blood test recommendations

ACS & ACOG: yearly beginning at age 50

176

Sigmoidoscopy recommendations

ACS & ACOG: q 5 yrs beginning age 50
-OR-
colonoscopy q 10 yrs
-OR-
double contrast barium enema q 5 yrs
More frequent testing and starting at younger age if risk factors including IBS and personal or fam hx of colonic polyps or colon cancer

177

Plasma glucose recommendations

American Diabetic Association
Fasting plasma glucose q 3 yr starting 45 yo
More frequent if risk factors including:
BP >140/90
DM in first-degree relative
African American
Asian
Hispanic
Native American
obesity at >120% or greater of desirable weight
OR BMI =/>27
hx of gestational DM or baby weighing >9 lb at birth
HDL 250 mg/dL

178

Thyroid function screening

USPTF: routine screening for thyroid function is NOT warranted in asymptomatic individuals
ACOG: TSH periodically for women with an autoimmune condition or strong family hx of thyroid dz

179

Tuberculosis screening

CDC, ACOG: perform on all individuals at high risk

180

vision screening

by ophthalmologist
q 3-5 yrs for AA 20-39 yo
q 2-4 yr 40-64 AND q 1-2 yr >65 regardless of race
Yearly for DM regardless of age

181

dental screening

routine detnal care and preventive services including oral cancer screening at least once every year

182

Bone Mineral Density screening

screen all women >65 for osteoporosis/osteopenia with BMD test
Screen POSTmenoparusal women <65 yo WITH risk factors

183

high risk groups for whom HBV is recommended

individuals with multiple sex partners, are household contacts or sex partners of those with HBV infection; injection drug users; healthcare workers or otherwise at occupational risk; inmates of long-term correctional institutions
3-doses: now, 1 mo, 6 mo

184

At what age is influenza vac recommended?

Yearly after age 50.

185

What groups of younger individuals is yearly flu vax recommended?

Those with pulmonary, CV, or other chronic medical disorders and those who may transmit flu to them. Also to any woman who will be in 2nd/3rd trimester during flu season.

186

Who can use LAIV?

Healthy nonpregnant individuals under 50 years old.

187

Pneumococcus vax recommendations.

All immunocompetent individuals x1
<64 if living conditions are high risk for pneumonia.

188

Rubella vax recommendation

All nonpregnant women of childbearing age who lack documented evidence of immunity or evidence of vax after 12 months old

189

C/I to rubella vax

Pregnancy (and don't get preg for four weeks)
Immunocompromised unless HIV
Hypersensitivity to neomycin

190

When in preg may Td be given?

2nd/3rd trimesters

191

Varicella vax given how?

two doses 4-8 wks apart

192

C/I to varicella vax

pregnancy (and don't become pregnant for 4 wks after vax)
hx of anaphylactic rxn to neomycin
immunocompromised indivuduals

193

zoster vax recommendation

all individuals 60 yr or older regardless of prev hx of herpes zoster (shingles) or chickenpox

194

Hep A vax recommendation

if living or traveling in country with high Hep A levels, IV drug users, occupational exposure risks, food handlers, individuals with chornic liver dz or clotting factor disorders
2 doses 6 mo apart

195

HPV vax

age 11 or 12
now, in 2 months, and 6 mo after first
can be given anytime 13-26

196

meningococcal vax

one dose: all kids 11-18yrs
college freshmen in dorms
those with anatomic or fxnal splenia
if traveling to regions where meningococcal dz is hyperendemic or epidemic

197

Major side effects to nicotine replacements

Patch: local skin reaction
Gum/lozenge/inhaler: mouth and throat irritation
Spray: nasal irritation
all: HA, dizziness, nausea

198

C/I to nicotine replacement

serious cardiac arrhythmias
severe angina
recent myocardial infarction
concurrent smoking
Pregnancy category D

199

Buproprion major side effects:

insomnia
dry mouth
nausea
skin rash

200

C/I for bupropion

seizure disorder
eating disorder
use of MAOI
concomitant use of other forms of bupropion
Pregnancy cat B
not recommended during bf

201

Varenicline tablets

reduces nicotine withdrawal sx; blocks effect of nicotine if individual resumes smoking; nicotinic acetylcholine receptor partial agonist

202

Major s/e of varenicline

n/v
changes in dreaming
constipation
gas
neuropsychiatric sx

203

C/I to varenicline tablets

precautions with psychiatric disorders and renal impairment
Pregnancy cat C
not recommended during bf

204

Client education for varenicline

initiate med 1 week before smoking cessation
concomitant use of nicotine replacement may increase s/e
discontinue med and report any agitation, depression, and suicidal ideation

205

female sexual dysfunction

Must cause personal distress to be considered a sexual dysfunction
May be persistent or recurrent, lifeong or acquired, generalized or situational
Etiology may include relationship factors, medical conditions, medication side effects, psychological factors, sexual abuse hx

206

vaginismus

involuntary contraction of musculature of the outer third of the vagina that interferes with vaginal penetration

207

Differential dx, other medical conditions that may account for s/s of aging

Hypothyroidism
Glaucoma, cataracts
Chronic cardiac and pulmonary disorders
Depression
Alzheimer's disease

208

anthropometry

measurement of the human individual

209

arcus senilis

opaque ring at margins of cornea with decreased tear production

210

in ageing, what changes are there to the thorax?

rib cage less mobile
increased A-P diameter

211

in aging individuals, what abdominal changes are there?

decreased muscle tone
may have less pain with abdominal pathology

212

in aging individuals, what neurologic changes happen?

slower reaction time
may have decreased response to pain stimuli

213

What happens to lab values in the aging person?

There is no significant change in the absence of disease process

214

What happens to glucose levels as a person ages?

decreased glucose tolerance common in older people - fasting glucose levels increase after age 50

215

what is the cutoff for mammography screening?

ACS and ACOG currently do not have cut off age

216

Labs for women after age 65

Yearly: dipstick u/a
mammography
fecal occult blood test
Q 1-3 yrs: Paps
Q 3-5 yrs: cholesterol
TSH
Q 5 yrs: sigmoidoscopy -OR-
Q10 yrs: colonoscopy