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