Phys Asses #2 Flashcards
(519 cards)
1
Q
High incidence of occurrence across patient care settings
A
Alcohol Use and Abuse
2
Q
Many patients will have significant history of ___ that has impact on their health status.
A
drinking
3
Q
____ and ____ data reflect adverse consequences of excessive alcohol use.
A
Morbidity and mortality
4
Q
A high number of medications are classified as ___.
A
alcohol interactive.
5
Q
Alcohol dependence increases the risk for __, ___, and ___.
A
ED visits, ICU admissions, and sepsis.
6
Q
Become more problematic = Binge drinking associated with __
A
increasing health risks
7
Q
Most abused and used psychoactive drug
A
Alcohol
8
Q
Pts use alcohol at an earlier an
A
earlier age
9
Q
Impact of health and well-being
A
Alcohol
10
Q
___ of meds will interact with alcohol
A
45%
11
Q
50% of individuals over the age of __
A
12
12
Q
Dosed dependent- the amount consumed
A
Alcohol
13
Q
Moderate drinking associated with
A
hypotension, cardiomyopathy, can lead to increase in left ventricular mass, dilation of ventricles, and thinning of cardiac walls
14
Q
Drinking 2.1 standard drinks in a day leads to
A
32% increase in developing breast cancer
15
Q
__ of Americans over the age of 18 are current alcohol drinkers
A
56%
16
Q
Defining Illicit Drug Use: Seven categories of illicit drug use
A
Marijuana/hashish, cocaine (including crack), heroin, hallucinogens, methamphetamines, inhalants, or prescription-type drugs used nonmedically.
17
Q
___ show highest prevalence.
A
12 years and older
18
Q
Illicit drug use has serious consequences for
A
health, relationships, and future jobs, school, and career.
19
Q
___ percent over the age of 12 have reported using illicit drug
A
> 10.1
20
Q
Negative impacts of numerous factors-
A
cancer (Comorbidities)
21
Q
Most misused drug, 80% of drug users use-
A
Marijuana
22
Q
LOC changes, Increase or decrease responsiveness to medications
A
Illicit Drug Use
23
Q
Increased rate of deaths from drug overdose as opposed to
A
motor vehicle accidents
24
Q
Increase in Rx for pain medication
A
Contributing factors to Rx abuse and Opioid crisis:
25
Increase Marketing strategies to promote medications
Contributing factors to Rx abuse and Opioid crisis:
26
Misrepresentation of “addictive” nature
Contributing factors to Rx abuse and Opioid crisis:
27
Combination addictions—drinking and taking alcohol-interactive medications.
Contributing factors to Rx abuse and Opioid crisis:
28
Monitor for signs of misuse or abuse
Prescription Drug Abuse and Opioid-Related Deaths
29
Very common in pts
Prescription Drug Abuse and Opioid-Related Deaths
30
More than __ individuals have drug abuse
1 out of 12
31
Alcohol releases dopamine which causes
euphoria
32
As pts use or misuse drugs the feeling of euphoria decreases.
The receptors are desensitized
33
Can help identifying drug use and abuse and help provide support to over
come addictions.
34
Gold standard of diagnosis is well defined in
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)
35
Alcohol problems underdiagnosed both in primary care settings and in hospitals
Substance Abuse
36
___ often unrecognized until patients develop serious complications (liver failure, kidney issues, heart issues)
Excessive alcohol use
37
Women who drink 8 or more alcoholic bev per week or 4 or more alcoholic bev on occasion are considered at
risk drinkers
38
Takes more to achieve same desired effect-
tolerance
39
Decreased effect with same amount of alcohol-
alcohol tolerance
40
Pg 88- alcohol use disorder assessment. Ask pt several questions regarding alcohol use.
Depending if yes or no to questions will determine severity
41
If they answer yes or no to 2-3 of the questions its considered mild
4-5 moderate, >6- severe
42
Effect of alcohol on developing brain
development and maturity
43
Associated risk between alcohol use and other high-risk behaviors leading to
sexual high-risk.
academic problems in school.
injuries from trauma.
continuation of alcohol abuse/disease in later life
44
Brain is not fully developed for
Developmental Competence: Adolescents
45
12-17 yr olds diagnosed with AUD-
3.4% are also going to have an illicit drug disorder, 2.5% will have alcohol disorder
46
Developmental Competence: Pregnancy
Dangers to mother as well as to fetus
47
Developmental Competence: Pregnancy
Development of Fetal Alcohol Syndrome spectrum
48
Potential adverse consequences of alcohol use to fetus are well known.
Development of Fetal Alcohol Syndrome spectrum
49
Physical deformities as well as learning and behavioral problems
Development of Fetal Alcohol Syndrome spectrum
50
____ of alcohol has been determined safe for pregnant women.
No amount
51
Any women contemplating pregnancy or who is pregnant should be screened for alcohol use.
Abstinence should be recommended.
52
An increasing number of older adults are
drinking.
53
1. Decreased metabolic function (liver, amount of water available, and renal function). Increases bioavailability of alcohol. Increased effect for extended period of time. Can lead to injury
Characteristics that increase risks associated with alcohol use:
54
2. Muscle mass decline. Leads to increased concentration of alcohol in pts body.
Characteristics that increase risks associated with alcohol use:
55
3. Polypharmacy can interact with alcohol.
Characteristics that increase risks associated with alcohol use:
56
4. Increase risk for cognitive decline.
Characteristics that increase risks associated with alcohol use:
57
5. Increase risk for falls, incidence of depression and GI issues
Characteristics that increase risks associated with alcohol use:
58
Three domains: alcohol consumption, drinking behavior or dependence, and adverse consequences (Maximum score: 40)
Quantitative format uses numbers to identify a response.
59
Useful in primary care with adolescents and older adults
Quantitative format uses numbers to identify a response.
60
Relatively free of gender and cultural bias
Quantitative format uses numbers to identify a response.
61
AUDIT-C: shorter form for acute and critical care units (maximum score: 12)
Quantitative format uses numbers to identify a response.
62
___ will help detect less severe alcohol problems (hazardous and harmful drinking) as well as alcohol abuse and dependence disorders.
The AUDIT
63
Helpful with emergency department (ED) and trauma patients because it is sensitive to current as opposed to past alcohol problems.
The AUDIT
64
If currently intoxicated= information inaccurate.
The AUDIT
65
Refer to the AUD identification test
AUDIT Questionnaire
66
Helps mild to severe alcohol issues
AUDIT Questionnaire
67
Utilized from adolescences to older adults
AUDIT Questionnaire
68
Does ask a question and requires a number for an answer. Not open to interpretation.
AUDIT Questionnaire
69
Anything greater than 8 in a male or greater than a 4 in females or anyone over the age of 60 indicates hazardous alcohol consumption
AUDIT Questionnaire
70
When performing these assessment make sure private and non confrontational
AUDIT Questionnaire
71
Standard Clinical Diagnostic Criteria Goal:
Determine whether there is a maladaptive pattern of alcohol use causing clinically significant impairment or distress to the pt
72
has your drinking repeatedly caused or contributed to the following?”
Risk for bodily harm, relationship trouble, role failure, and/or run-ins with law
Ask, “In the past 12 months:
73
“Have you not been able to stick to drinking limits, or have you repeatedly gone over them?”- can indicate tolerance if not able to
Ask, “In the past 12 months:
74
Shown tolerance, signs of withdrawal, kept drinking despite problems, spent a lot of time drinking or anticipating drinking or recovering drinking and/or spent less time on other matters or activities that had been important or pleasurable
Ask, “In the past 12 months:
75
Screening women for alcohol problems
TWEAK questions help identify at-risk drinking in women, especially pregnant women.
76
TWEAK Questions
Tolerance, Worry, Eye-opener, Amnesia, Kut down
77
Tolerance:
how many drinks can you hold? Or how many drinks does it take to make you feel high?
78
Worry:
have close friends or relatives complained about your drinking?
79
Eye-opener:
do you sometimes take a drink in morning when you first get up?
80
Amnesia:
has a friend or family member told you about things you said but could not remember?
81
Kut down:
do you sometimes feel the need to cut down?
82
Scored with 1 point except for tolerance and worry bc each 2 points
TWEAK Questions
83
Score greater than 2 points indicates a drinking problem
TWEAK Questions
84
Greater than 3 indicates tolerance
TWEAK Questions
85
SMAST-G Questionnaire
Screening aging adults
86
Use the ____for older adults who report social or regular drinking of any amount of alcohol.
SMAST-G questionnaire
87
___ have specific emotional responses and physical reactions to alcohol.
Older adults
88
10 questions with yes/no responses that address these factors.
SMAST-G questionnaire
89
Two or more “yes” questions indicate alcohol problem
SMAST-G questionnaire
90
Consequences of substance abuse are so debilitating and destructive to patients and their families that a short statement of assistance and concern is given here.
Advise and Assist (Brief Intervention)
91
If your assessment has determined the patient to have at-risk drinking or illicit substance use, state your conclusion and recommendation clearly.
Advise and Assist (Brief Intervention)
92
Non confrontational, make sure they understand and what you recommend
Advise and Assist (Brief Intervention)
93
Drinking more that is medically safe and it is recommended that they quit drinking
Advise and Assist (Brief Intervention)
94
Can assist and willing to assist in achieving stop drinking goal
Advise and Assist (Brief Intervention)
95
Includes vital signs and oxygen saturation , N/V, tremors, Lvl of anxiety and agitation, paroxysmal sweats, auditory and tactile visual disturbances, headache and orientation status
10 measured criteria with individual scoring to arrive at a composite score
96
Individual subscales include 7 criteria with the exception of Orientation which includes 4 criteria
10 measured criteria with individual scoring to arrive at a composite score
97
Score of 0 to 7 can monitor every 4 hours.
Based on continued assessment provides trended results to determine level of monitoring that is needed.
98
All scores below 8 for 72 hours, you can discontinue.
Based on continued assessment provides trended results to determine level of monitoring that is needed.
99
Pts withdrawling from alcohol, most sensitive in order to assess objective measurements
Clinical Institute Withdrawal Assessment Scale (CIWA)
100
Used in monitoring progress of withdrawl
Clinical Institute Withdrawal Assessment Scale (CIWA)
101
Perform continued assessments
Clinical Institute Withdrawal Assessment Scale (CIWA)
102
Allows to avoid over medicating withdrawal pts
Clinical Institute Withdrawal Assessment Scale (CIWA)
103
Clinical Signs of Withdrawal- Alcohol-
Delirium tremens (DTS), anxiety, diarrhea, depression, seizures, tremors, tachycardia, headache, insomnia
104
Clinical Signs of Withdrawal- Sedatives-
similar to alcohol- anxiety, irritability
105
Clinical Signs of Withdrawal- Nicotine-
Headache, vasodilation, anger, irritability
106
Clinical Signs of Withdrawal- Cannabis-
Mild or occasional use- None. Heavy use- irritability, sleep disturbances, weight loss, loss of appetite or sweating
107
Clinical Signs of Withdrawal- Cocaine-
Anxiety, depression, fatigue, insomnia
108
Clinical Signs of Substance-Abuse Disorders:
“Substances” refers to non-medical agents taken to alter mood or behavior.
109
Clinical Signs of Withdrawal- Opiates (morphine, heroin, meperidine)-
Dilatated pupils, runny nose, excessive tears, tachycardia, sweating, hair on body to stand up. Extreme runny nose
110
Intoxication:
maladaptive behavioral changes due to effects on CNS from substance
111
Abuse:
daily or recurrent use such that impairment and decreased functioning has occurred leading to ongoing problems
112
Dependence:
physiological reliance
113
Tolerance:
requires more to get the desired effect
114
Withdrawal:
cessation of substance leads to physiological effects
115
Substance-
to alter mood or behavior
116
Intimate partner violence, child abuse and older people abuse is a
significant risk factor
117
Intimate Partner Violence: Four main categories
Physical violence, Sexual violence, Stalking, Psychological aggression
118
Physical violence:
force resulting in injury or death
119
Sexual violence:
attempted or completed acts without permission
120
Stalking:
repeated unwanted attention through various methods
121
Psychological aggression:
emotional abuse of an aggressive nature
122
Also includes teen dating violence is on the
rise
123
Can be physical, sexual, psychological, or emotional
teen dating violence
124
Youths who experience this are more likely to experience mental health issues and/or participate in unhealthy behaviors.
teen dating violence
125
Assess signs of violence in use
teen dating violence
126
Sexting or cyber abuse can be a
means of access.
127
__ women and ___ men have been abused by intimate partner
33%
25%
128
Defined at state and federal levels—The Child Abuse Prevention and Treatment Act
Child Abuse and Neglect
129
Recently amended to include sex and human trafficking
Child Abuse and Neglect
130
Enhance protection for infants with Fetal Alcohol Spectrum Disorder
Child Abuse and Neglect
131
Neglect:
failure to provide for children’s basic needs
132
Physical abuse:
nonaccidental injury that leads to harm of a child
133
Sexual abuse:
fondling, sexual acts, exploitation, and trafficking
134
Emotional abuse:
pattern of behavior that harms a child’s sense of self-worth or development
135
Be cautious when providing care to children if they experienced
child abuse
136
Nurses are considered mandatory reporters, report any suspected abuse and neglect to
law enforcement
137
When suspecting, be sure to document using exact words.
If child is able to give a description use the child's words, verbatim
138
Involves both intentional and failure to act by a caregiver or trusted person. Can include abuse and neglect.
Older Adult Abuse and Neglect
139
Underreported with 60% performed by a family member
Older Adult Abuse and Neglect
140
Forms of older adult abuse
Physical abuse, Sexual abuse or abusive sexual contact, Psychological or emotional abuse, Neglect, Financial abuse or exploitation
141
Physical abuse:
intentionally assaulted, injured, threatened, or restrained
142
Sexual abuse or abusive sexual contact:
any sexual contact against one’s will
143
Psychological or emotional abuse:
includes verbal and nonverbal behaviors intended to humiliate, isolate, or affirm control
144
Neglect:
failure of caregiver to meet basic older adult needs
145
Financial abuse or exploitation:
unauthorized use and/or improper use of older adult’s funds/resources
146
Increased needs, changes in LOC
Older Adult Abuse and Neglect
147
If suspect abuse still report
Older Adult Abuse and Neglect
148
Immediate effects as well as residual effects of acts of violence leading to complications and more __
Chronic health problems
149
Gender r/t gynecologic and obstetrical conditions with impact on fetus
Preterm, low birth weight, and perinatal death
150
Violence= more likely to suffer from mental health problems
Depression, suicide, PTSD, and substance abuse
151
Children who are abused are more likely to experience ongoing poor health as they age.
Impact on brain development, behavioral learning delays, and higher risk for chronic disease
152
Rape victims More likely to use __
Marijuana
153
__ of rape victims to use cocaine than no rape victims
6x
154
child maltreatment can lead to a decreased quality of life.
can last into adulthood
155
Barriers to Treatment of Intimate Partner Violence
Societal stressors, Legal status, Lack of access to culturally appropriate care
156
Poverty level leading to increased difficulties in daily struggles and conflict in relationships
Societal stressors
157
Past experience with discrimination based on lack of understanding of cultural diversity
Societal stressors
158
Poor past experiences with understanding cultural diversities- they feel segregated.
Societal stressors
159
Immigration status may prevent individual from seeking care based on fear of deportation.
Legal status
160
Violence Against Women Act (AWA) provides legal support.
Legal status
161
Traditional roles foster dependency.
Lack of access to culturally appropriate care
162
Need for bilingual cultural interpreters in clinical practice settings
Lack of access to culturally appropriate care
163
Important to have interpreters
Lack of access to culturally appropriate care
164
When addressing care be mindful about cultural differences
Lack of access to culturally appropriate care
165
Ethnic and racial minorities are at greater risk for no
Treatment for Intimate Partner Violence
166
____ women and men are at greater risk for IPV
Multiracial American Indians, Alaskan natives and non Hispanic black
167
When documenting abuse, use specific words regarding the
victim
168
Documentation: IPV, Child Abuse, or Older Adult Abuse
Provide detail, Transcribe verbatim, Physical exam, Provide digital photographic documentation in the medical record, May have to separate
169
Provide detail
Non-biased progress notes, injury maps(identifying injuries, skin assessment), and photographic evidence (Further investigation)- make sure to obtain consent.
170
Transcribe verbatim
Information received from individual
171
Physical exam
Thorough documentation using forensic technology terms
172
Provide digital photographic documentation in the medical record
Obtain consent
173
May have to separate
The patient from the parent, spouse, and/or caregiver—follow protocol
174
All women of childbearing age (14 to 46) should be screened.
US Preventative Task Force Guidelines (USPTF)
175
Insufficient evidence to support screening of older adult or vulnerable adults
US Preventative Task Force Guidelines (USPTF)
176
No current recommendations for children
US Preventative Task Force Guidelines (USPTF)
177
Early detection is the key in terms of prevention of
long-term complications.
178
Health care providers are
mandatory reporters.
179
All women of child bearing age from
14-46 should be screened
180
Should be taken place with or without symptoms occurring
Routine Screening for Intimate Partner Violence (IPV)
181
How to Assess for Intimate Partner Violence
Gathering of subjective data
182
Use of open-ended questions to start the conversation-
to get as much info from the individual as possible
183
Interview the individual separately from the
perpetrator.
184
Listen for cues which may indicate a pattern or responses that don’t match the
“physical” injury that is present.
185
Be aware of state laws and requirement to
report.
186
Be aware of the IPV tool used in your clinical setting.
Intimate Partner Violence Screening tools
187
May be as simple as a single question—“Do you feel safe at home?”
Intimate Partner Violence Screening tools
188
USPTF prefers standardized tools
HITS and STaT
189
range from never to frequently.
HITS—4 item questionnaire
190
Can be used with teens.
HITS—4 item questionnaire
191
Asks how often partner physically hurt you. Insult or talk down to you. Threaten with harm. Scream or curse.
HITS—4 item questionnaire
192
Scored from 0-5. score greater than 10 indicates intimidate partner violence.
HITS—4 item questionnaire
193
Have you ever been in a relationship where partner has pushed or slapped you. Threatened you, thrown broken or punched things.
STaT—3 item questionnaire
194
Answering yes to any indicates positive screening for IPV.
STaT—3 item questionnaire
195
All adolescents should be screened for IPV.
STaT—3 item questionnaire
196
Ask about abuse in open needed question
STaT—3 item questionnaire
197
The nurse is assessing a patient who admits to being physically abused by her spouse. The patient says, “I wish I would have agreed with my husband, because then I wouldn’t have been hit.” What is the nurse’s best response?
“It is not your fault that your husband lost control. Changing your actions will not prevent him from abusing you again.” – provide reassurance
198
Older adult as a vulnerable population as they lose
independence
199
Recommended routine screening by multiple agencies but no specific tool specified
Assessment of Older Adult Abuse and Neglect
200
Assessment of abuse or neglect in cognitively challenged persons is complicated.
Assessment of Older Adult Abuse and Neglect
201
Validated in primary care
Older adult abuse suspicion index
202
For use with cognitively intact patients
Older adult abuse suspicion index
203
Includes 6 questions with 5 questions asked of the patient and the last question answered by the physician
Older adult abuse suspicion index
204
Can be complicated to assess in elderly population (abuse/neglect)
Older adult abuse suspicion index
205
Greater risk for financial abuse, theft, forcible transfer of property, corrosion to steal assets
Older adult abuse suspicion index
206
Dementia and Alzheimer’s cannot do this assessment
Older adult abuse suspicion index
207
Provide anticipatory guidance (support)
Health care providers
208
Ideal individual to be able to monitor, observe, and assess for potential problems
Health care providers
209
Developmental screening tools to identify delays
Use appropriate resources to educate caregiver/parent
210
Parent/caregiver teaching and education in order to seek resources for addictions, behavioral issues, etc
Use appropriate resources to educate caregiver/parent
211
If child is verbal, history should be obtained away from caregivers through open-ended questions or spontaneous statements. So they could understand. Need two witnesses with
child and caregiver.
211
Medical history is important part of examination.
Assessment of Child Abuse and Neglect
212
Preschool age with bruises on bony provinces =
Play
213
Bruising on ___ are rare and should arise concern to HC provider
Buttocks, hands, feet, and abdomen
214
Child who is immobile who has significant bruising or underlying illness, warrants
comprehensive assessment
214
Significant fractures or fracture in different stages in healing may need to have a
bone scan on radiologic bone assessment to see past injuries
215
Multiple injuring with multiple stages of healing=
suspicions for abuse
216
When documenting history and physical findings of child abuse and neglect
use words child has used to describe how his or her injury occurred.
217
Remember the possibility that the abuser may be accompanying the child.
If child is nonverbal, use reports of caregivers.
218
Know your institutional protocol for obtaining history in cases of suspected child maltreatment
Some protocols may delay a full interview until it can be done by a forensically trained interviewer.
219
Be aware of normal range of findings based on
developmental age.
219
Abuse may be hidden under clothing.
Visual examination of the entire body is required.
220
Atypical bruising pattern or bruise in the shape of an object (flyswatter, hand, whip)
Visual examination of the entire body is required.
221
Significant injury observed in non-mobile individual
Visual examination of the entire body is required.
221
Use appropriate terminology r/t bruising.
Maintain consistency for accurate interpretation to maintain consistency.
222
Include baseline laboratory testing
CBC with platelet count, basic blood chemistries, serum LFTs, coagulation panel and UA
223
Laceration-
produced by tearing/slitting. Blunt impact over a boney surface
224
Pattern injury-
Distinct shape- whip, hand, extension cord
225
TYPES OF INJURIES
Laceration, Contusion, Hematoma, Abrasion, Patterned
226
Laceration
a deep cut or tear in skin or flesh.
227
Contusion
Bruise, injury to soft tissue. No breakage in skin
228
Hematoma
Blunt force trauma, localized collection of blood, clotted in organ, tissue,
228
Abrasion
Rug burn
229
Patterned
Injury from an object
230
Front of body is more susceptible to bruising due to
falling forwards
231
This 19-item yes/no instrument is used extensively by nurses in the health care system.
Danger assessment (DA)
232
It starts with a calendar so women can more accurately see how frequent and severe violence has become over the past year.
Danger assessment (DA)
233
This is also an excellent assessment of frequency and severity of violence for health care providers.
Danger assessment (DA)
234
The more yes answers, the more serious the danger of the woman’s situation.
Danger assessment (DA)
235
Over 55% of all female homicides are related to IPV
Danger assessment (DA)
236
Over 11% of those victims have experienced violence of the month preceding the homicide
Danger assessment (DA)
237
If we fail to assess pt for risk of violence, it is a missed opportunity in order to intervene and decrease risk of danger
Danger assessment (DA)
238
The higher the number of yes answers is going to measure the amount of danger in the women's situation, same tool law enforcement uses.
Danger assessment (DA)
239
Not going to be used in all patients.
Danger assessment (DA)
240
Important from first seeing them for the first time
General Survey and Measurement
241
Begins as soon at the pt walks into the room
General Survey and Measurement
242
Monitor for different areas which includes physical appearance, body structure, mobility, and behavior
General Survey and Measurement
242
The general survey is a study of the
whole person
242
Covers general health state and any obvious physical characteristics
general survey
243
Provides an overall impression
general survey
243
Includes areas of physical appearance, body structure, mobility, and behavior
general survey
244
Includes objective parameters that apply to the whole body
general survey
245
Overall impression, H to T
general survey
245
Observe body stature, nutritional status
general survey
246
Once learned = Second nature
general survey
247
Objective Data: Physical Appearance
Age, Sex, LOC, Skin color, Overall appearance
247
Age:
What age they appear to be and what age they are
248
Sex:
Sexual development level and age make sure its appropriate.
249
Level of consciousness:
Alert, oriented?
250
Skin color:
Pallor, Jaundice, Erythematic, Cyanosis, Pink,
251
Overall appearance:
Gait, symmetric movement and appropriate. General statement of pt overall appearance related to comfortable.
252
Objective Data: Body Structure
Stature, Nutrition, Symmetry, Posture, Position
253
Stature:
Nutrition is appropriate. Over weight, underweight, emaciated, cachectic.
254
Nutrition:
Body fat distribution. Appropriate? A lot in abdomen?
255
Symmetry:
Moving extremities together, same manner, and increased or decreased muscle mass on one side.
256
Posture:
Appropriate and appropriate their age, appear comfortable.
257
Position:
Kyphosis? Slumped appearance-depression s/sx, lordosis.
258
Tripod breathing-
COPD
259
HF=
Paroxysmal dyspnea
260
Objective Data: Mobility
Gait: normally base is as wide as shoulder width
261
Foot placement:
accurate; walk smooth, even, and well-balanced; and associated movements, such as symmetric arm swing, are present
262
Range of motion:
note full mobility for each joint, and that movement is deliberate, accurate, smooth, and coordinated.
263
No involuntary movement-
tics, muscle spasms- document.
264
Able to maintain balance without assistance- normal pt walking. If they do pay attention
Mobility
265
If wide base- dizziness, altered LOC
Mobility
265
If paralysis- unable to move extremity could be sensory, musculoskeletal or cva
Mobility
266
Objective Data: Behavior
Facial expression, Mood and affect, Speech, Dress, Person Hygiene
267
Facial expression
Note expressions both while face is at rest and while person is talking
268
Mood and affect
immediate expression of emotion; mood refers to the more sustained emotional makeup of the patient's personality.
269
Speech:
articulation (ability to form words) clear and understandable
270
Stream of talking is fluent, with an even pace
Speech
271
Conveys ideas clearly
Speech
271
Word choice appropriate to culture and education
Speech
272
Person communicates in prevailing language easily by himself or herself or with interpreter.
Speech
273
Maintain eye contact if appropriate
Make sure pt is comfortable
Behavior
274
Dress:
Make sure the clothing fits too large- lost weight, too small- edema or more fat. More holes in belt- weight gain/edema
275
Amish women wear clothing from
nineteenth century.
276
Indian women may wear
saris.
277
Culturally determined dress should not be labeled as bizarre by
Western standards or by adult expectations
278
Personal hygiene:
Can be a sign of depression and environment they live in.
able to care for themselves and live a healthy life.
If familiar with a patient and has hygiene issues and usually does not- experiencing depression, malaise, or current illness.
279
Always remain unbias to people that are
not normal
280
Instruct person to remove his or her shoes and heavy outer clothing before standing on scale.
Objective Data: Measurements Weight
281
When sequence of repeated weights is necessary, aim for approximately same time of day and same type of clothing worn each time.
Objective Data: Measurements Weight
282
Show person how his or her weight matches up to recommended range for height.
Objective Data: Measurements Weight
282
Record weight in kilograms and pounds.
Objective Data: Measurements Weight
283
Same clothes, scale, time
Objective Data: Measurements Weight
284
Balnce or electronic standing scale for people that can stand
Objective Data: Measurements Weight
285
Always compare current and previous weight to make sure it is accurate
Objective Data: Measurements Weight
286
Unexplained weight loss-
short term illness
287
Unexplained weight gain-
edema or fluid retention
288
Height and Body mass index
Objective Data: Measurements
289
Align extended headpiece with top of the head.
Height
289
Use wall-mounted device or measuring pole on scale.
Height
290
___ is practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition.
Body mass index
291
Can overestimate body fat in people who are very muscular.
Body mass index
292
Can underestimate body fat in older adults who are lean
Body mass index
292
__ normal BMI
19-25
293
When measuring height.-
Shoeless, standing straight, looking straight ahead, and feet and shoulders up against the hard surface.
294
Assesses body fat distribution as indicator of health risk.
Objective Data: Waist Circumference
295
Excess abdominal fat is an independent risk factor for disease, over and above that of body mass index (BMI).
Objective Data: Waist Circumference
296
Waist circumference measured in inches at smallest circumference below rib cage and above iliac crest
Objective Data: Waist Circumference
297
Hip circumference measured in inches at largest circumference of buttocks
Objective Data: Waist Circumference
298
How and where they carry their weight.
Objective Data: Waist Circumference
299
Increase risk for disease- large waist circumference
Objective Data: Waist Circumference
300
Measure in inches at the end of expiration
Objective Data: Waist Circumference
300
Diseases: Heart disease and type 2 diabetes
Objective Data: Waist Circumference
301
Waist Circumference: A measurement ____ is increasing risk of type 2 diabetes, heart disease, dyslipidemia, and hypertension.
>35 in women and >40 in men
301
Increased in pts with BMI 25-35.
Objective Data: Waist Circumference
302
Interpret based on age and developmental ability
General survey r/t infants and children
302
Behavior and parental bonding
General survey r/t infants and children
303
Measurement—weight and length (height)- best indicator in physical growth in infants and children.
General survey r/t infants and children
303
Best view of child’s general health. Compare to growth charts and watching trends
General survey r/t infants and children
304
Physical growth based on CDC growth charts
Head circumference and chest circumference
305
Up until age of 2 obtain weight measurement laying down (supine position)
using horizontal measuring board
306
If caregiver/parent appears to be grossed out, irritated, disgusted by the child-
raise red flags
306
Assess parental and child bond-
appears appropriate
307
Head measurement is also important
General survey r/t infants and children
308
At birth and then Conducted at each well child check until age 2 years.
Head meaurements
309
Then annually up to 6 years of age
Head measurements
310
Compare with expected size for age.
Head measurements
311
Series of measurements which gives accurate information of the pattern. 32-38 cm is normal measurement.
Head measurements
312
2 cm larger than the circumference of the chest.
Head measurements
313
Compare to head circumference
Chest measurements
313
Chest grows faster than the head
Chest measurements
314
Around the nipple line of the child
Chest measurements
315
Only important to compare to the head to monitor growth and appropriate.
Chest measurements
316
Right at their eyebrow line-measure head at
34 head measurement and chest 32= normal finding for newborn
317
Normal consequence of aging changes r/t posture and gait-
weakens, muscle atrophy, postural changes- kyphosis, fluctuation of knees and hips to compensate for that change.
318
Ambulate with a wider base to compensate for decrease balance.
General survey r/t aging adults
319
Measurement—weight and height
General survey r/t aging adults
319
Trunk appears shorter and extremities are very long-
kyphosis and losing muscle mass
319
Sharper features and bony landmarks may be more prominent.
Older adults enter 80 or 90s may appear shorter-
shortening and thinning of vertebrae
320
Dwarfism
Hypopituitary dwarfism and Achondroplastic dwarfism-
320
Lacking growth hormone, occurs in childhood.
Halts the growth.
Height and weight may fall into the 3rd percentile for their age. S/sx Delayed puberty, Hypothyroidism, And adrenal insufficiency.
Hypopituitary dwarfism
321
Halts the growth.
Hypopituitary dwarfism
322
Height and weight may fall into the 3rd percentile for their age.
Hypopituitary dwarfism
323
S/sx Delayed puberty, Hypothyroidism, And adrenal insufficiency.
Hypopituitary dwarfism
323
genetic disorder convert cartilage into bone.
Achondroplastic dwarfism
324
Result in normal trunk size and very short arms and leg.
Achondroplastic dwarfism
325
Short stature.
Achondroplastic dwarfism
326
Relatively large head, frontal bossing.
Deal with lumbar lordosis and abdominal protrusion.
327
Deal with lumbar lordosis and abdominal protrusion.
Deal with lumbar lordosis and abdominal protrusion.
328
Too much growth hormone in adulthood.
Gigantism versus acromegaly (hyperpituitarism)
329
Already completed normal growth.
Gigantism versus acromegaly (hyperpituitarism)
330
Bones in head, face, hands and feet are most effected
Gigantism versus acromegaly (hyperpituitarism)
331
Excessive secretion of growth hormones in adulthood after normal completion of bone growth
acromegaly
332
Bones in face, head, hands and feet (no changes in height)
acromegaly
333
Internal organs can also enlarge-
acromegaly
334
Metabolic disorders may be present- Diabetes mellitus, Hyperpituitarism, greater risk for diabetes
acromegaly
335
Skull is rigid box that protects brain.
Structure and function: Head
335
Made up of Cranial Bones
Structure and function: Head
336
Sutures- where the bones of the skull meet, immovable joints
336
Two pairs of salivary glands accessible to examination on the face:
Parotid glands
Submandibular glands
337
Parotid glands
are in cheeks over mandible, anterior to and below ear; the largest of salivary glands, they are not normally palpable. When extending head, If palpable indicates diagnosis of HIV or mumps.
338
Submandibular glands
beneath mandible at angle of jaw
339
Responsible for sensation of the face and motor function (biting + chewing)
Trigeminal nerve
340
Trigeminal nerve
Or Cranial nerve V (5)
341
Most complex cranial nerve
Trigeminal nerve
342
Inability to note sharp/dull sensations indicates damage to nerve
Trigeminal nerve
343
Assessing both sides of the face to compare
Trigeminal nerve
343
Neck delimited by
Base of skull and inferior border of mandible above, and by manubrium sterni, clavicle, first rib, and first thoracic vertebra below
343
Think of neck as conduit of many structures.
Neck
344
Connects respiratory, cardiovascular, lymphatics, neurovascular, digestive system-
neck function
345
Major neck muscles
Sternomastoid and trapezius are innervated by cranial nerve XI.
346
Sternomastoid enables
Head rotation and flexion and divides each side of neck into two triangles: anterior and posterior triangles
346
Two trapezius muscles move
shoulders and extend and turn head.
347
If shoulder and neck pain= damage to
cranial nerve 11
348
Assessing pt by- shrug shoulders against resistance
cranial nerve 11
349
Thyroid: Endocrine gland
Straddles trachea in middle of the neck
The gland has two lobes
350
Should not have significant pain and should shrug shoulders with resistance
cranial nerve 11
351
Synthesizes and secretes
Thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
Thyroid: Endocrine gland
352
If thyroid is enlarged-
listen for a bruit using the bell of the stethoscope. Bruit- Increased blood flow or hyperplasia.
353
Highly vascular.
If hyperthyroidism do not press on thyroid bc it can release more hormones
Thyroid: Endocrine gland
354
Men thyroid -
in small palpable v within upper edge of thyroid cartilage- Adams apple
355
Hugs the second and third tracheal reeves
Thyroid gland
356
Major part of immune system
Lymphatic System
357
Rich supply of lymph nodes- head and neck contains 60-70 lymph nodes
Lymphatic Systematic System
358
Be aware of lymphatic drainage takes place.
Lymphatic Systematic System
359
If enlarged lymph node, assess above it.
Lymphatic Systematic System
360
Lymphatic Purpose-
detect and eliminate foreign substances from the body
361
Leads to Lymphatic drainage.
Lymphatic Systematic System
362
Proximal to enlarged lymph nodes-
swollen lymph nodes
363
Normal, should be movable discrete and can have varying levels of firmness but should be soft
lymph nodes
364
Should not be tender
lymph nodes
365
Firm lymph nodes-
cancer
366
If swollen check source up stream
lymph nodes
367
Separate from the cardiovascular system but work together
Lymphatic Systematic System
368
Only area able to access examination of lymph nodes, are the
head, neck, arms, inguinal area, axilla area
369
Located like beads on a string
Lymphatic Systematic System
370
Bones of neonatal skull are separated by sutures and fontanels, spaces where the sutures intersect.
These membrane-covered “soft spots” allow growth of brain during first year; gradually ossify. For childbirth and growth
371
Posterior Closure of fontanels-
1-2 months will close and be triangular shaped
372
Anterior Closure of fontanels-
diamond shaped, will close 9 months- 2 years of age
373
Well developed at birth and grows to adult size when the child is
6 years old
374
facial hair also appears on boys : first on upper lip, then on cheeks and lower lip, and last on the chin.
In adolescence
375
noticeable enlargement of the thyroid cartilage occurs, and with it, the voice deepens.
In adolescence
376
Facial bones and orbits appear more prominent.- lose fat, muscle, decreased elasticity, decreased moisture(water). If lost teeth the facial features change even more
Older Adults
377
During fetal period the head growth will be
fast
378
When assessing lymph nodes may be palpable in children up until they reach puberty,
can be a normal finding even if no s/sx of illness.
379
Grows rapidly at 10-11. Puberty it starts to atrophy,
lymph nodes.
380
Leading cause of acute pain and lost productivity
Headache
381
Classified by etiology and often misdiagnosed,
Headache
382
Headache classified by location and etiology.
tension, migraine, cluster headache.
383
Headache Health History
Determine surgeries, hx of headaches, recent infection, radiation, smoking.
384
Complain of acute onset of headache, neck stiffness/pain, and fever-
suspect meningeal infection
385
Severe headache with no Hx of headache-
Hemorrhage, CVA
385
Note facial expression and appropriateness to behavior or reported mood.
Inspection of the Face
386
Goal in headache's-
prevent neurological dysfunction, address asap.
386
Facial structures
Always should be symmetric.
387
Note any involuntary movements (tics) in facial muscles; normally none occur. Gather more info and document.
Inspection of the Face
388
Asymmetry- stroke, bells palsy- damage to cranial nerve 7.
Inspection of the Face
389
Head and neck symmetry
Inspection and Palpation-Neck
390
Range of motion- not pain/discomfort
Inspection and Palpation-Neck
391
Observe for enlargement of glands and/or pulsations.
Inspection and Palpation-Neck
392
Thyroid gland-enlargement
Difficult to palpate; check for enlargement, consistency, symmetry, and presence of nodules
Position patient for best approach (posterior)
393
Palpate nodes noting location, size, shape, delimitation, mobility, consistency, and tenderness.
Inspection and Palpation-Neck
393
Gentle palpation in neck and lymph nodes
Inspection and Palpation-Neck
394
Trachea- midline
Inspection and Palpation-Neck
395
Palpate both sides to compare
Inspection and Palpation-Neck
396
Using a gentle (esp. pain and discomfort) circular motion of finger pads, palpate lymph nodes.
Examining Lymph Nodes
397
Do not vary sequence or you may miss some small nodes.
Examining Lymph Nodes
398
Up to 1 cm in size
Examining Lymph Nodes
398
If palpable, note location, size, shape, and if discrete or matted together.
Examining Lymph Nodes
399
Measure infant’s head at each visit up to age
2 years and yearly up to age 6 years.
400
Note infant’s head posture and head control; infant can turn head side to side by
2 weeks.
401
Two common variations in newborn cause shape of skull to look markedly asymmetric due to birth trauma:
Caput succedaneum
Cephalohematoma
402
Caput succedaneum:
Swelling across suture lines in newborns. Self limiting- swelling will go down.
403
Cephalohematoma:
Trauma occurring hours after birth and gradually increase in size. Bleeding. Periosteum holds the blood.
404
Molding- for child birth and growth
Skull
405
Positional molding (positional plagiocephaly)
flat spot from laying down. common
406
Fontanels
Observe anterior and posterior fontanel. Depressed or sunken in= dehydrated or malnourished.
407
Head and neck control
Observe for appearance of tonic neck reflex which disappears between 3 and 4 months of age.
408
By age of ___ infants should maintain head control.
4 months
409
Should hold head up when erect and steady themselves if pulled up.
Physical Examination: Infants and Children
410
While crying lying down or vomiting may notice bulge in fontanels- increased intercranial pressure.-
Physical Examination: Infants and Children
410
Physical Examination: Pregnant Female- During second trimester- chloasma may show on face.
A blotchy, hyperpigmented area over cheeks and forehead that fades after delivery
411
Physical Examination: Aging Adult: Temporal arteries
may look twisted and prominent.- esp. losing muscle tone to face or body fat
412
Thyroid gland may be palpable normally during pregnancy.
bc highly vascular and has increased blood flow. Increase in hyperplasia
413
In some aging adults, a mild rhythmic tremor of head may be normal.
Benign finding
414
Older adult: Neck may show an increased concave curve
to compensate for kyphosis.
415
Maintain patient safety by indicating patient perform ROM and position changes slowly
minimize potential for dizziness.
416
Decreased elasticity loss of sub fat and decreased moisture
Older adult
417
Changing positions slowly- avoid falls and dizziness.
Older adult
418
Types of headaches:
Tension, Migraine, Cluster
419
Tension Headache definition
HA of musculoskeletal origin; may be a mild-to-moderate, less disabling form of migraine
420
Tension Headache location
Usually both sides, across frontal, temporal, and/or occipital region of head: forehead, sides, and back of head
421
Tension Headache character
Band-like tightness, viselike, nonthrobbing, nonpulsatile
422
Tension Headache duration
Gradual onset, lasts 30 mins to days
423
Tension Headache quantity/severity
Diffuse, dull aching pain
Mild to moderate pain
424
Tension Headache timing
Situational, in response to overwork, posture
425
Tension Headache aggravating symptoms or triggers
Stress, anxiety, depression, poor posture.
Not worsened by physical activity
425
Tension Headache associated symptoms
Fatigue, anxiety, stress.
Sensation of band tightening around head, of being gripped like a vise.
Sometimes photophobia or phonophobia
426
Tension Headache relieving factors, effort to treat
Rest, massaging muscles in area, NSAID meds
427
Migraine Headache definition
HA of genetically transmitted vascular and trigeminal nerve origin. HA plus prodrome, aura, other symptoms: 2-3 times as common in women as in men
428
Migraine Headache location
Commonly one sided but may occur on both sides. Pain is often behind the eyes, the temples, or forehead
429
Migraine Headache duration
Rapid onset, peaks 1-2 hrs, lasts 4-72 hrs, sometimes longer
429
Migraine Headache character
Throbbing, pulsating
429
Migraine Headache quantity/severity
Moderate to severe pain
430
Migraine Headache aggravating symptoms or triggers
Hormonal fluctuations (premenstrual)
Foods (alcohol, caffeine, MSG, nitrates, chocolate, cheese)
Hunger, letdown after stress, sleep deprivation, sensory stimuli (flashing lights or perfumes), changes in weather, and physical activity
431
Migraine Headache timing
=2 per month, lasts 1-3 days
=1 in 10 patients have weekly headaches
432
Migraine Headache associated symptoms
Aura (visual changes as blind spots or flashes of light, tingling in an arm or leg vertigo)
Prodrome (change in mood, behavior, hunger, cravings, yawning)
N/V photophobia, phonophobia, abdominal pain
Person looks sick
Family hx of migraine
432
Migraine Headache relieving factors, effort to treat
Lie down, darken room, use eyeshade, sleep, NSAID early, avoid opioid
433
Cluster Headache definition
Rare HA that is intermittent, excruciating, unilateral, with autonomic signs
434
Cluster Headache location
Always one sided. Often behind or around the eye, temple, forehead, cheek
435
Cluster Headache character
Continuous, burning, piercing, excruciating
436
Cluster Headache duration
Abrupt, onset, peaks in minutes, lasts 45-90 mins
437
Cluster Headache quantity/severity
can occur multiple times a day
438
Cluster Headache timing
1-2/day, each lasting 1/2 to 2 hrs for 1 to 2 months; then remission for months or years
439
Cluster Headache aggravating symptoms or triggers
Exacerbated by alcohol, stress, daytime napping, wind or heat exposure
440
Cluster Headache associated symptoms
Ipsilateral autonomic signs: nasal congestion, runny nose, watery or reddened eye, eyelid drooping, miosis
Feelings of agitation
441
Cluster Headache relieving factors, effort to treat
Need to move, pace floor
442
Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head.
Hydrocephalus
443
Dilated scalp veins.
Hydrocephalus
444
Face looks small in relation to their head. Setting sun eyes-sign.
Hydrocephalus
445
Most common chromosomal abnormality with characteristic facial abnormalities.
Down syndrome
446
Facial features: flat nasal bridge, small broad nose, up slanting to the eyes, inner epicanthal folds, thicker tongue that may protrude and broad neck and webbing small hand with palmar crease
Down syndrome
447
Plagiocephaly
Positional or deformational due to sleeping position. Laying on one side, flattened head
448
Abnormal Findings: Pediatrics
Craniosynostosis, Atopic (allergic) facies, Fetal alcohol spectrum disorders (FASD), Allergic salute and crease
449
Craniosynostosis
Premature closing of one or more cranial sutures that leads to head malformation. Does not allow growth
450
A variety of presentations seen in children who have chronic allergies
Atopic (allergic) facies
451
Include exhausted face, allergic shiners, morgan lines, central facial pallor, and allergic gapping, which can lead to can lead to malocclusion of the teeth and malformed jaw bc its still forming.
Atopic (allergic) facies
452
- blue shadows below the eyes from sluggish venous return,
allergic shiners
453
double or single crease on the lower eyelids
morgan lines
454
open mouth breathing
allergic gapping,
455
Narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia
Fetal alcohol spectrum disorders (FASD)
456
Allergic salute and crease
Appearance of transverse line on the nose in response to chronically repeated use of hand to push the nose up and back
457
Not possible to palpate adult
thyroid gland
458
If painless or rapidly growing nodule it can be cancerous esp. present in a
young person
459
Hard and fixed, not mobile-
cancerous nodules
460
Physical presentation neck and face
Thyroid Disorders: Graves Disease
461
Goiter
Thyroid Disorders: Graves Disease
462
Eyelid retraction
Thyroid Disorders: Graves Disease
463
Exophthalmos- protruding of the eyes
Thyroid Disorders: Graves Disease
464
Carotid gland inflammation-
hiv and mumps
465
Intolerance to heat
fine-straight hair
bulging eyes
facial flushing
enlarged thyroid
tachycardia,
systolic BP increase,
breast enlargement,
Hyperthyroidism
466
weight loss,
muscle wasting,
flinger clubbing,
tremors,
increased diarrhea,
menstrual changes (amenorrhea)
localized edema
Hyperthyroidism
467
Physical presentation neck and face
Hypothyroidism
468
Puffy edematous face
Hypothyroidism
469
Periorbital edema
Hypothyroidism
470
Coarse facial features
Hypothyroidism
471
Coarse hair and eyebrows
Hypothyroidism
472
Decrease in thyroid hormone
Hypothyroidism
473
Decreasd metabolic rate
Hypothyroidism
473
Cause; hashimoto thyroiditis
Hypothyroidism
473
Severe non pitting edema
Hypothyroidism
474
S/sx: fatigues, cold intolerance, puffy, swollen face, hands, feet.
Hypothyroidism
475
Coarse facial features and slow refexes. Cold-thyroid furnace
Hypothyroidism
476
Intolerance to cold
receding hairline
facial & eyelid edema
dull-blank expression
extreme fatigue
thick tongue-slow speech
Hypothyroidism
477
anorexia
brittle nails & hair
menstrual disturbances
hair loss
apathy
lethargy
dry skin (coarse & scaly)
muscle aches & weakness
constipation
Hypothyroidism
478
Late manifestations of Hypothyroidism
Subnormal temp
Bradycardia
Weight gain
Decreased LOC
Thickened skin
Cardiac Complications
