Health Assessment - Lecture 9

Front 1

Explain the following methods of nutritional assessment: 24hr recall(4 errors), food frequency questionnaire(2 errors)

Back 1

-most popular (easiest), everything eaten within last 24 hours?relies on memory, atypical intake, alter truth, snack/condiments
-how many x/day/wk/month person eats foods -doesn't quantify intake amt, relies on memory(how much)

Front 2

Explain the following methods of nutritional assessment: food diary(4), direct observation (1 errors)

Back 2

-individual writes everything consumed down for a period of time(3 wk days, 1 wkend day), noncompliance, innacurate recording, atypical intake, conscious alteration
-look at what they eat and how much, requires inpatient

Front 3

If a person had recent surgery, trauma, burns or infection, how do their nutritional needs change? How do chronic illnesses influence nutrition? N&V&D&C effect?

Back 3

-caloric/nutrient needs up to 2-3x greater -twice as likely to have nutritional deficits (diabetes, pancreatitis, malabsorption) -nutrient intake/absorption

Front 4

Why is it important to ask about medications? supplements?

Back 4

-possible interaction with digestion, absorption, and metabolism -can reach toxicity levels (vitamins/minerals)

Front 5

For nutritional assessment inspection for the following, explain normal and abnormal: Hair, Skin, Eyes, Tongue, Nails, MS,

Back 5

-shiny, firm; dull, dry -smooth, no dryness; dry, flaking(cracks, lesion)
-clear, shiny cj: pink moist; pale/red cj, dry -red, smooth; beefy red/pale -smooth, pink; brittle, spoon -erect posture; rickets, osteo

Front 6

How do you calculate BMI? Normal range? Waist to hip ratio for men/women?

Back 6

Wt(lb) / Ht ^2 x 703 -18.5 to 24.9 -(Waist circumference/hip circumference)<1.0 for men, <.8 for women

Front 7

What are normal Hct/Hgb values for women(purpose)? men? low Hct/Hgb indication of? Normal cholesterol range(purpose)? Explain moderate risk and high risk of CAD? TG ranges(define)? Borderline CAD? High risk?

Back 7

-(cell volume for iron status) 36-46 -37-47 -anemia -(for fat metabolism) 120mg/dl to 200mg/dl -200-239, 240+ -(scr for hyperlipidemia, cad)-0-19yo= 10to 100mg/dl, 20-65= 40-200mg/dl -250-500, 500+

Front 8

Explain total lymphocyte count? Range? Lymphocyte depletion(mild), moderate? severe? When might affect TLC?(5)

Back 8

-test of immune functioning (WBC) -1800 to 3000 -1500 to 1800 -900 to 1500, <900 -surgery, trauma, infection, cancer, chronic disease

Front 9

Explain serum albumin test? range?Moderate visceral depletion? severe? When would this occur?(3)

Back 9

-measurement of visceral protein status -3.5 to 5.5 g/dl -2.8-3.5, <2.8 -protein/calorie malnutition, altered hydration status(increases), liver dysfunction

Front 10

What organs are in the: RiUQ? LUQ? RLQ? LLQ? Midline abdomen?

Back 10

-liver(most), gallbladder, duodenum, pancrease(head), right kidney, various colon -stomach, spleen, liver(left part), pancrease(body), left kidney, various colon -Cecum, appendix, right ovary tube, right ureter, right sperm cord -left ovary and tube, left ureter, left sperm cord, various colon -abd aorta, uterus, bladder

Front 11

anorexia can occur with what conditions?(3) Dysphagia may be an indication of? What is pyrosis? Eructation?

Back 11

-gastrointestinal disease, pregnancy, psychological disorders -throat/esophageal disorders -heartburn from reflux of gastric acid -belching

Front 12

Explain the three different types of abdominal pain: visceral, parietal, referred

Back 12

-from internal organ(dull, poor localize) -inflammation of overlying peritoneum(sharp, precise local, movement hurts) -disorder in another site

Front 13

Give the corresponding indication for the following stool colors: Black, grey, red

Back 13

-occult blood(melena) from GI bleeding or iron medications -hepatitis -GI bleeding or localized bleeding around anus

Front 14

A patient comes in because of excess use of tylenol, what disease might you suspect? What are other contributors?

Back 14

-peptic ulcer disease -alchy, smoking, helicobacter infx

Front 15

What are some things you should consider before assessing GI patient?

Back 15

-warm room(cold=muscle tightness), empty bladder, supine, inquire for pain

Front 16

What is most important about assessment techniques for GI?

Back 16

-change in sequence: Inspect, auscultate, percuss, palpate

Front 17

Compare normal and abnormal findings for Inspection: Contour, Symmetry, Umbilicus, Skin, Turgor, Demeanor

Back 17

-flat to rounded; protuberant, scaphoid -symmetric bilateral; bulges masses, pulsation, hernia -midline/inverted; everted w/acites/mass -smooth/even, red/jaundice/glisten(ascites) -none; poor=dehydration/GI disease -relaxed w/benign expresssion; restless, turning for comfort/stillness/knees up

Front 18

How often do bowel sounds occur? Borborygmus is what? Define hyperactive sounds? hypoactive/absent?

Back 18

-5-30x/min -stomach growing -loud, high pitched, rushing, tinkling sounds = increased motility
-follow abd surgery or inflammation of peritoneum

Front 19

Vascular sounds of abdomen: normal vs abnormal? Name the 4 major arteries to listen for bruits? bruits may indicate?

Back 19

-no sounds - systolic bruit-pulsatile blowing sound -Aorta, left renal, iliac, femoral -aneurysm

Front 20

Most appropriate nutritional assessment method for: 64 year old woman w/mild dementia, 25 year old inpatient

Back 20

-food diary -direct observation

Front 21

When percussing on abdomen, what sounds are you looking for? Adipose tissue, fluid, or mass may would sound?

Back 21

-mostly tympany(hollow) -dull

Front 22

In percussing for liver span, what is the adult range? Correlates with? Percussion sounds? Purpose of percussing liver? Where is spleen located? size?

Back 22

-6-12cm. -height -dull -hepatomegaly presence or changes in liver size -left anterior axillary line -<7cm (hard to locate)

Front 23

What is the purpose of the CVA test? What if pain is present? Purpose of the fluid wave? What does ascites occur with? (7)

Back 23

-assess the kidney -sharp pain w/inflamed kidney -ascite fluid in peritoneal cavity -heart failure, htn, cirrhosis, hepatitis, pancreatitis, cancer

Front 24

Purpose of shifting dullness percussion? What would you hear to confirm fluid?

Back 24

-perform after positive fluid wave test(presence of ascites) -dullness as you percuss the side abdomen

Front 25

What is the purpose of light palpation? depth? what are abnormal findings?(4) deep palpation?

Back 25

-check skin surface and superficial musculature - 1cm -muscle guard, rigid, large mass, tender -enlargements of organs, consistency 5-8cm

Front 26

If patient is cold, tense or ticklish, what might be a problem? How to solve this?

Back 26

-voluntary guarding -use their hand on top of yours.

Front 27

For the spleen, how large must it be to be palpable? When might the spleen enlarge?Normal size of aortic width? Abnormalities of aorta?

Back 27

-3x -mononucleosis, trauma -2.5 to 4cm -widened with aneurysm, pulsations with aortic aneurysm

Front 28

Explain the following procedures: Inspiratory arrest(w/ abnormal reaction), Rebound tenderness(blumberg)(w/abnormal reaction)

Back 28

-hold fingers under liver border, pt takes deep breath; sharp pain, stops inspiration midway(cholecystitis, gallbladder inflam)
-choose non tender area, push hand at 90 degree angle slow & deep, lift hand quickly; pain on release of pressure(peritoneal inflam)

Front 29

Explain the Obturator test (abnormal result)

Back 29

-lift right leg flexing at hip and 90 degrees at knee, rotate internally and externally -pain(perforated appendix)