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135 Cards in this Set
- Front
- Back
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Acculturation
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Process by which an individual accomodates to the traits and behaviors of another culture. Degree can vary. The past is rarely rejected.
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Culture
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A complex, integrated system reflecting the whole of human behavior and experience: a group's adoption of shared values, the attempt to make sense of their world.
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Custom
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Habitual activity of a group or subgroup: patterned responses to given occasions, generally passed on from one generation to the next
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Enculturation
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Process by which an individual assumes the traits and behaviors of a given culture, adapting to it, adopting its values, and taking on that particular cultural identity.
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Ethnocentrism
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Belief in the superiority of one's own group and culture
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Ethos (AKA Ethnic Group)
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Group of the same race or nationality, with a common culture and distinctive traits.
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Minority
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Group that is different from the majority of a population, in regards to religion, race, or ethnic origin. When the difference is deep-seated in historical relationships or is obvious, the minority group may be treated injustly, sometimes obviously, sometimes subtly.
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Norm
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Prescribed standard of allowable behavior within a group or subgroup. To the extent that individuals adopt the positive values of their group or groups, and to the extent that they measure up to the norms, they are judged favorably or unfavorably by the pther members of the group.
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Race
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Physical, not a cultural, differentiator based on a common heredity, using as identifier characteristics such as skin color, head shape, stature.
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Rite
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Prescribed, formal, customary observances (i.e. ceremonial religious act or graduation)
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Ritual
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Stereotypic behavior regulating religious, social, and professional behaviors (i.e. please and thank you) in a variety of situations.
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Stereotype
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Simplified, generally inflexible conception of the members of a group or subgroup
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Subculture
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Group or subgroup having values and behavioral patterns or other distinctive traits that differentiate it from other groups or subgroups within a larger culture. Individuals may share the traits of more than one group or subgroup and may, with adaptation, shed some traits and adopt others.
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Values
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Ideals, customs, institutions, and behaviors within a group or subgroup for which the members of the group have a respectful regard. Values may be positive or negative and desirable or undesirable
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What are the three modes of communication we use that all vary by culture?
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speech, body language, and space
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Describe what the "ETHNIC" Pneumonic used to understand the patient's perspective on their health and healthcare stands for.
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E - Explanation
T - Treatment H - Healers N - Negotiate I - Intervention C - Collaboration |
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What are the six areas the Department of Health and Human Services has identified in which racial and ethnic minorities experience serious disparities in health access and outcomes?
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1. Cancer Screening/Management
2. Cardiovascular Disease 3. Diabetes 4. HIV Infections/AIDS 5. Immunizations 6. Infant Mortality |
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What four health disparities disproportionately impact racial and ethnic minorities?
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1. Mental Health
2. Hepatitis 3. Syphillis 4. Tuberculosis (TB) |
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What does "Culture" include?
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Language
Beliefs Etiquette Law Morals Entertainment Education Sets of dynamically evolving shared traits |
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The following impacts of culture influence the way patients seek medical care and the way clinicians provide care
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Age, Gender, Race, Ethnic Group, Cultural Attitudes, Regional Differences, Socioeconomic Status
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What determines how patients interpret, explain, respond to, and deal with disease?
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Culture
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What is the key reward for baby boomers in the work place?
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"Money, title, recognition, and the corner office"
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What are the primary access barriers to health care?
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Lack of Insurance
Under Insurance Inability to pay for care or treatments |
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What are the secondary access barriers to health care?
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Those barriers encountered between home and the provider's office
Availability of Care Transportation Waiting times (i.e. systems of care) |
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What are the tertiary access barriers to health care?
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When language and culture hinder and limit the provider-patient communication
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Why is West Virginia considered isolated culturally and economically?
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Because of its terrain
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How do Appalachians perceive themselves?
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Strong
Hard-working Hardy Survivors Patriotic Smart Make due with what they have Take care of their own Strong family ties Artistic Foresters Religious Moral Traditional Loyal to the land and the state Not Extravagant Altruistic |
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What impacts our view of health?
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Work and Work Environment
Religious and Moral Values Personal Beliefs and Values (such as self esteem and self worth) |
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How does the Appalchian culture view Health?
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Absence of Illness
Ability to do whatever they want Having Needs Met (hunger, shelter, freedom, belonging, family, community) |
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List some factors that influence Health Access
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Cost
Transportation Financial Cultural Education Maturity (work for a delayed reward) Previous Medical Treatment - personal and professional Medically Underserved Areas |
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What should a physical exam that takes into consideration a person's Appalachian culture include?
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Usual Precautions
Kind Mannerisms Limit Exposure (but evaluate well) Explain Gloves Try no tto use "slang" words that may be misinterpreted |
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What should the summing up process in a patient-physician encounter include that takes into consideration a patient's Appalachian culture?
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Meet patients on their own terms
Resist stereotyping Understand yourself and your attitudes Constrain your prejudices and tendencies to be judgmental These steps will lead towards strides in cultural competence |
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To ensure you are culturally competent, what should you do?
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Know the population and the health risks associated with the race, culture, and area
Ask the patient about themselves Ask the patient about their illness and what they think causes the illness Design and use health questionnaires that incorporate cultural information gathering |
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TRUE OR FALSE: Within a culture many groups and subgroups exist
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TRUE
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List the essential elements of healthcare communication
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1. Build the Relationship (B)
2. Open the Discussion (O) 3. Gather Information (G) 4. Understand the Patient's Perspective (U) 5. Share Information (S) 6. Reach and Agreement on Problems and Plans (A) 7. Provide Closure (P) Pneumonic = BOGUS-AP "That iPhone game I bought, Angry Birds, is a BOGUS - AP!" |
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List some facets of the Sharing Information element of healthcare communication
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1. Its more about relationship building
2. Avoid medical jargon 3. Elicit beliefs, concerns, questions, expectations about the illness and treatment |
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What is a great way to Share Information with a patient and build the relationship?
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Ask-Tell-Ask
-Alternate between telling small amounts of information -Check for understanding -Ask how the information will affect them |
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Describe the Ask-Tell-Ask method of Sharing information with a patient
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Ask to assess patient needs
- Informational needs - Attitudes and motivation - Level of literacy Tell Information -Brief, based on their interests/needs -Personalize information -Simple language -Words that do not unnecessarily alarm -Supplemental materials Ask -Understanding -Concerns and/or Questions -Elicit and respond to feelings -Elicit barriers |
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List some facets of the Reaching Agreement element of healthcare communication
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1. Present options where they exist
2. Elicit the patient's thoughts about options, offer opinion or advice (KEY for reaching agreement) 3. Acknowledge agreements/disagreements 4. Validate the patient's right to make choices 5. Integrate patient's feelings and preferences 6. Avoid overwhelming the patient or pushing for a quick decision |
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List some facets of the Providing Closure element of healthcare communication
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1. Do content closure as well as
2. Personal Closure (helps build relationship) |
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Describe the process of arriving at a diagnosis
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1. Recognize patterns
2. Sampling the universe - excessive testing 3. Algorithms 4. Hypothesis generation and testing |
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What are some of the aspects of source oriented types of medical records?
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1. Information filed as it comes in
2. No table of contents 3. Difficult to find information |
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List the elements of a Problem Oriented medical record
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1. Data Base
2. Problem List 3. Progress Note 4. Initial Plan |
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What is included in the Data Base of a problem oriented medical record?
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- Past and present history
- Review of systems - Physical exam - physiologic data and lab - Consults |
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Describe what a problem list is
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A comprehensive list of the patient's past and present health, divided into acute and chronic
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Describe the facets of a Progress Note (SOAP)
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This is the note you write on each visit. It contains subjective, objective, assessment, and plan (SOAP)
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What is included in the Subjective portion of the progress note (SOAP)?
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- History and symptoms of present and past problems
- What the patient tells you (i.e. Subjective) |
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What is included in the Objective portion of the progress note (SOAP)?
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- Physical exam
- Physiological data - X-rays - Lab results |
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What is included in the assessment portion of the progress note (SOAP)?
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Diagnosis or present state of problem
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What is included in the plan portion of the progress note (SOAP)?
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- Therapy (meds and procedures)
- Investigations - Education |
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What is included in the initial plan of the problem oriented type of medical record?
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- Diagnostic Tests
- Therapeutic Treatments - Patient Education |
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When is it mandated by the Federal Government that Electronic Medical records have to be used in all healthcare settings?
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2015
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What are the advantages of Electronic Medical Records?
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Efficiency, Quality Assurance, Easily Shared Patient Info
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Can any part of the electronic medical record ever be deleted or blackened out?
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No. You must put a line through the error, initial and date it.
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What part of the medical record, subjective or objective, do OLDCARTS, MIIMASH, and SHORES fall into?
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Subjective
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What does OLDCARTS stand for?
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Onset
Location Duration Character A/A (Associated and Aggravating Factors) Relieving factors Temporal (setting) Severity |
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What does MIIMASH stand for?
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Medications
Immunizations Injuries Medical Illnesses Allergies Surgeries Hospitalizations |
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What does SHORES stand for?
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Safety of relationships
Habits (EtOH, Tobacco, drugs) Occupation Religion Environment Sexual relationship(s) |
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What comprises the Objective portions of the diagnosis?
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-Vitals
-Physical Exam -Physiologic Data -X-Rays -Lab Results |
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What part of the SOAP note does the differential diagnosis belong in?
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Assessment
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What constitutes the Plan portion of the SOAP note?
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-Therapy (meds and procedures)
- Investigations - Referrals - Patient Education |
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What are the cardinal principles of the exam?
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- Inspection
- Palpation - Percussion - Auscultation |
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When does the Inspection portion of the exam begin?
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When you walk into the room
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What is the most productive portion of the exam?
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Inspection
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What is the Inspection portion of the exam dependent on?
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The knowledge of the physician
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When you palpate a patient during an exam, what should you be looking for?
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Evaluate for tenderness, texture, temperature, tone, and masses
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What is Percussion and what are you looking for when you use it as an exam technique?
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Percussion is when the surface of the body is struck to emit sounds that very in intensity according to the density of underlying tissue.
Look for tympanic, resonant, and flat sounds |
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What comprises the Auscultation portion of the exam?
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Heart Sounds, Vocal Sounds, Vessel Sounds, Lung/Breath Sounds, Abdominal Sounds
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You accidentally stick your self with a needle while attempting to give a patient her HPV vaccine. What should you do?
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Report the exposure and injury immediately!
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What does excess Growth Hormone (GH) in children cause?
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Gigantism
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What does excess Growth Hormone (GH) in adults cause?
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Acromegaly (bone thickening leading to "coarse" features because bone plates are closed = no long bone growth)
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How do you calculate BMI?
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[Weight (lb) / Ht^2 (in)] x 703
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What does chronic illness usually lead to?
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weight loss or wasting
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What do diabetes, hyperlipidemia, and cardiovascular disease risk all have in common?
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An obesity related component
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If a patient's weight loss is unexpected or unexplained, what should you consider?
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chronic disease or cancer
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What is considered undernourished in terms of the BMI?
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Below 18.5%
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What is considered Appropriate in terms of BMI?
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18.5-24.9%
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What is considered Overweight in terms of BMI?
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25-29.9%
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What is considered Obese in terms of BMI?
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30-39.9%
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What is considered Extremely Obese in terms of BMI?
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Greater than 40%
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When you weigh someone, what do you need to ensure in terms of their clothing?
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That they are not wearing shoes or heavy clothing
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How are infants weighed? How long should they be measured this way?
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On an infant scale, lying down on their back. They should be measured this way until they are 2 years old. TRACK growth rates on a growth chart.
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TRUE OR FALSE: weight fluxuates throughout the day
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TRUE. You may need to measure multiple times per day to track changes
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How long should a child's head surcumference be measured?
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Until they are 2 years old. TRACK on growth chart
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What is a high rate of growth in the head associated with?
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Increased intracranial pressure or hydrocephalus
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What two anatomical structures on the head should the tape measure go around when measuring a child's head?
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occipital prominence and supraorbital prominence
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What is considered a Preterm birth in terms of gestational age?
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Before 37 weeks
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What is considered a Term birth in terms of gestational age?
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37-41 weeks
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What is considered a Post term birth in terms of gestational age?
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After 41 weeks
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What is the Sexual Maturity Rating based on?
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The Tanner Criteria which looks at secondary sex characteristics
Breast development, pubic hair, penis/scrotum |
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What do the Tanner Scale number designations stand for in terms of sexual maturity?
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1 = Prepubertal
4 = Well developed but not quite adult 5 = Normal adult characteristics |
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Who typically starts and finishes puberty first? Males or females?
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females
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At what ages do males and females typically finish puberty?
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Female = 14.5 + or - 2 years
Males = 17.5 + or - 2 years This is why girls are always so much more mature than boys :) |
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When is puberty officially finished?
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When the epiphysis of long bones are ossified
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What are the characteristics of female puberty onset?
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Breast Buds (often the first sign)
Growth spurt 1 year before menarche (period) Girls growth spurt occurs earlier than boys |
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What are the characteristics of male puberty onset?
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Enlargement of scrotum/testis above 2cm is usually the first sign
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What is precocious puberty?
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Early onset of puberty:
Girls: before 6-7 years Boys: before 9 years |
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What are the possible causes of precocious puberty?
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may be related to endocrine disorders or exogenous hormone exposure
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TRUE OR FALSE: Pain is subjective to both the patient and the physician?
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True
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TRUE OR FALSE: JCAHO requires that all patients be assessed for pain
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True
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What are the determining factors for pain?
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Age, emotion, cultural background, sleep deprivation, and previous pain experience
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What are the (general) differences between visceral and somatic pain?
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Visceral - often more diffuse and dull
Somatic - generally sharper and well localized |
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Which assesses pain well?
1. SHORES 2. MIIMASH 3. OLDCARTS |
OLDCARTS
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What is important to note when assessing pain?
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Its character; throbbing, stabbing, sharp, dull, achy, cramping, qnawing, burning
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Because a patient's pain is relative to many factors, what is a good way to assess the pain that can help with this?
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Using the pain scale (1-10)
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How can the pain scale be adapted to children?
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By using a pictorial scale with faces
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Before starting to examine a patient with pain, what should you do?
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Ask the patient to point to the painful area so you don't unnecessarily aggravate it
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What should you look for that relates to pain even if the patient denies that the pain is serious?
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Physical signs that the pain is serious:
Vital Sign changes Facial mask of pain, guarding, sweating, etc. |
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What are the Functions of the skin?
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1. Fluid loss (prevents)
2. Excretion (of wastes) 3. Sensory perception 4. Temperature regulation 5. Insulation 6. Vitamin D precursors (produces) 7. Express emotions 8. Regulation of BP 9. Protection (from environment) Pneumonic = FESTIVE-RP |
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TRUE or FALSE: The epidermis is vascular.
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False
Epidermis is avascular |
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List the Layers of the epidermis
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S. corneum - dead keratinized cells; protects against harmful substances and fluid loss
S. germinativum (S. basale) - Melanocytes are located here, giving skin its coloration |
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What makes up the Dermis Layer below the epidermis?
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Dermis - Vascular CT. Contains sensory nerves and autonomic motor fibers
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What makes up the Subcutaneous tissue layer below the dermis?
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Hypodermis - fatty CT layer. Generates heat and provides insulation, which prevents hypothermia
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What do the Eccrine glands do and where can they be found in the body?
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Eccrine: Sweat Glands (reg. body temp.) Everywhere except lip margins, eardrums, nail beds, inner surface of prepuce, and glans penis
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What do the Sebaceous glands do and where can they be found in the body?
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Produce oily sebum which keeps hair and skin from drying out.
Secretions are stimulated by testosterone Sebaceous - Sebum |
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What do the Apocrine glands do and where can they be found in the body?
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Secrete sticky white substance in response to emotion
Secretions are odorless but bacterial decomposition of these causes characteristic body odor Located in the axilla, nipples, areola, anogenital area, eyelids, and external ears. Apocrine = "A-areas" |
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Define Lanugo
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Find silky hair over shoulders and back of newborns. Sheds 10-14 days after birth
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Define Vellus hair
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short, fine, soft, nonpigmented
V=fine |
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Define Terminal hair
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coarse, longer, thicker, pigmented
T=terminal, as in the at the end of the abdomen, you can find the terminal hair of the genital area. |
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What is the nail plate?
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finger nail
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What is the paronychium?
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soft tissue surrounding the nail border.
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What is the lunula?
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round white are on a nail. It marks the end of the nail matrix, the site of nail growth
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What is the eponychium?
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the cuticle
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Define vernix caseosa
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A mixture of sebum and cornified epi that covers the infant at birth
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Why are infants more prone to hypothermia?
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they have poorly developed subcutaneous fat.
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What gland does not function in new borns?
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eccrine
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Define cutis marmorata
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mottled appearance to the skin as a result of changes in ambient temp.
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Define milia
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A small white papule that commonly occurs on the face of a newborn
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What are some of the key things that happen during adolescence?
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Apocrine glands enlarge and become active
Increased sebaceous gland activity (acne!) Terminal hair appears (axilla, pubic area, and face of males) |
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What changes in the skin would you expect to see in a pregnant woman?
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Increased blood flow to the skin
Vascular lesions such as hemangiomas and vascular spiders inc. in size Increased eccrine and sebaceous gland activity Skin thickens, and increased subcutaneous fat Increased pigmentation of the face, nipples, areola, axilla, and vulva |
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What changes in the skin would you expect to see in an elderly patient?
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eccrine and sebaceous gland activity decreased
Epi thins and is less elastic Decreased number of melanocytes Transition from terminal to vellus hair on scalp |
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What are some of the common symptoms of skin disease
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rashes, new lesions, changes in lesions, itching, changes in color or texture of skin, changes in nails
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What is clubbing of the nail and what is it associated with?
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Clubbing is when the angle between the nail plate and the proximal nail fold increases. Associated with respiratory or cardiovascular disease.
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Define Lindsay's nails
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proximal nail = white
Distal nail = pink Associated with renal disease |
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Define Terry's nails
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White except for a narrow zone at the distal tip. Associated with cirrhosis and hypoalbuminemia
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