Study Guide For Health Assessment Exam 1 Kd

Front 1

What are the purposes of a health history ?

Back 1

to collect subjective & objective data

Front 2

What are the purposes of a review of system?

Back 2

To evaluate the past and present health state of each body system

To double-check in case significant data were omitted in “present illness section”

To evaluate health promotion practices

Front 3

Seven Components of Health History

Back 3

1. Biographical Data
2. Reason for Seeking Care
3. Present Health or History of Present Illness
4. Past Health
5. Family History
6. Review of Systems
7. Functional Assessment

Front 4

Biographical Data

Back 4

Name
Address and phone number (opt)
Age and birth date
Birthplace (opt)
Sex
Marital status
Race & Ethnic origin (opt)
Occupation—usual and present
Source of history

Front 5

Reason for Seeking Care

Back 5

symptom and sign

Front 6

Present Health or History of Present Illness

Back 6

Short statement or Chronological record for ill patient

Front 7

Past Health

Back 7

Childhood illnesses
Accidents or injuries
Serious or chronic illnesses
Hospitalizations
Operations
Obstetric history
Immunizations
Last examination date
Allergies
Current medications

Front 8

Family History

Back 8

Age and health –or- cause of death of blood relatives

Health of close family members (spouse, children)

Family history of various conditions e.g. heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, obesity, mental illness, etc.

Front 9

Functional Assessment

Back 9

Measures a person’s SELF-CARE ability in health and in absence of illness and Includes:
ADLs,
Independent living,
nutrition,
social relationships and resources;
coping;
home environment

Front 10

Functional Assessment Areas

Back 10

Self-esteem, self-concept
Activity/exercise
Sleep/rest
Nutrition/elimination
Interpersonal relationships/resources
Coping and stress management
Personal habits
Alcohol
Street drugs
Environment/hazards
Occupational health

Front 11

PQRSTU

Back 11

P: Provocative or Palliative. What brings it on? What were you doing when you first noticed it? What makes it better? Worse?
Q: Quality or Quantity. How does it look, feel, sound? How intense/severe is it?
R: Region or Radiation. Where is it? Does it spread anywhere?
S: Severity Scale. How bad is it (on a scale of 1 to 10)? Is it getting better, worse, staying the same?
T: Timing. Onset—Exactly when did it first occur? Duration—How long did it last? Frequency—How often does it occur?
U: Understand Patient's Perception of the problem. What do you think it means?

Front 12

eight critical characteristics

Back 12

Location
Character or quality (descriptive terms)
Quantity or severity
Timing
Setting
Aggravating or relieving factors
Associated factors
Patient’s perception

Front 13

What is the purpose of inspection

Back 13

Systematic, deliberate critical observations

Concentrated “watching”

Front 14

What is the purpose of palpation

Back 14

use of touch to determine texture, size, consistency, & location of body parts.

Front 15

What is the purpose of percussion

Back 15

tapping the person's skin with short, sharp strokes to assess underlying structures

Front 16

What is the purpose of auscultation

Back 16

listening to sounds produced by the body

Front 17

proper technique of INSPECTION

Back 17

begins the moment you first meet the person

always comes first

Front 18

proper technique of PALPATION

Back 18

Types- light and deep

Light- detect surface characteristics; accustom patient to being touched (~1/2 inch deep)

Deep- best use for abdominal contents (1-2 inches)

How
Fingertips- Use for fine tactile discrimination
Finger-Thumb Opposition- Use for position,shape, consistency of an organ/ mass.
Dorsa of hands/fingers - Use for temperature
Metacarpophalangeal joints or ulnar side of hand- Use for vibrations

Front 19

proper technique of PERCUSSION

Back 19

Non-dominant hand-middle finger placed firmly on area to be percussed; fingers separated

Striker hand: makes a striking force; sharp downward wrist motion;

Tip of middle finger strikes joint of middle finger on non-dominant hand

Front 20

proper technique of AUSCULTATION

Back 20

listen in certain anatomical areas for presence or absence of sound & for quality of sound heard. Areas assessed: heart, blood vessels, lungs, abdomen

Front 21

Hypothermia

Back 21

core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 °C (95.0 °F)

Front 22

Hyperthermia

Back 22

fever

Front 23

PULSE DEFICIT

Back 23

Apical Rate minus Radial Rate
Obtain by two people simultaneously taking apical rate and radial rate Indicates a weak contraction of the ventricles; occurs with atrial fibrillation, premature beats and heart failure

Front 24

PULSE PRESSURE

Back 24

Systolic Pressure minus Diastolic Pressure

reflects Stroke volume: amount of blood the heart pumps with each beat ( ~70 ml per beat in adult)

Front 25

Apnea

Back 25

suspension of external breathing

Front 26

Bradypnea

Back 26

abnormally slow breathing rate.

Front 27

Eupnea

Back 27

normal, good, unlabored ventilation

Front 28

Cheyne-stokes

Back 28

The pattern of breathing with gradual increase in depth and sometimes in rate to a maximum, followed by a decrease resulting in apnea

Front 29

Tachypnea

Back 29

rapid breathing

Front 30

Cardiac output (CO=SV x R)

Back 30

equals the volume of blood in each systole (called the stroke volume) times the number of beats per minute (rate)

Front 31

What information is obtained in physical appearance?

Back 31

Age
Gender
Level of conscious-ness
Skin color
Facial features

Front 32

What information is obtained in Body structure

Back 32

Stature
Nutrition
Symmetry
Posture
Position
Body build, contour
Obvious physical deformities

Front 33

What information is obtained in Mobility?

Back 33

Gait
Range of motion

Front 34

What information is obtained in Behavior?

Back 34

Facial expression
Mood and affect
Speech
Dress
Personal hygiene

Front 35

various routes of temperature measurement

Back 35

Oral/Electronic thermometer- swift, accurate and convenient

Electronic thermometer- swift, accurate, unbreakable, disposable probe covers

Axillary- safe and accurate for infants and young children when environment is controlled

Rectal- used only when other routes are not practical. use when cannot close mouth because of O2 or breathing tubes; eg comatose, confused, in shock

Tympanic membrane thermometer (TMT)- senses infrared emissions of the tympanic membrane; Used in unconscious or unwilling to cooperate

Front 36

What are the four qualities considered when one assesses the pulse?

Back 36

RATE-Normal rate for adult age group 60-100

Bradycardia- < 60 bpm; Tachycardia- >100 bpm

RHYTHM- normally, an even tempo regular or irregular

FORCE: 3+ full, 2+ normal; 1+ weak & thready,
0- absent

ELASTICITY- springy, straight, resilient

Front 37

What is the appropriate procedure for assessing normal respirations?

Back 37

assess while person is unaware;
count for 30 seconds unless suspect abnormality

Front 38

what is blood pressure

Back 38

the pressure exerted by circulating blood upon the walls of blood vessels

Front 39

what is Systolic pressure

Back 39

maximum pressure felt on the artery during LV contraction or systole

Front 40

diastolic pressure is

Back 40

elastic recoil or resting pressure that blood exerts between each contraction

Front 41

pulse pressure is

Back 41

the pressure of the pulse; the difference between the systolic and diastolic pressures.

Front 42

pulse deficit

Back 42

difference between the heart rate and the pulse rate in atrial fibrillation.

Front 43

patient factors that affect blood pressure:

Back 43

Take BP when person is anxious, angry, just exercised
Faculty arm position, above or below level of heart
Inaccurate cuff size ( most common error)
Cuff wrapped too loose or uneven or bladder outside

Falsely high systolic readings when
Deflating cuff too slowly
Legs not flat on floor: crossed

Falsely high diastolic readings when
Person supports their own arm
Halting during descent and re-inflating to recheck systolic

Front 44

What is normal BMI range

Back 44

18.5-24.9

Front 45

normal value for Temperature

Back 45

Normal Oral 98.6 F (37 C) with range of 94.6 (35.8) to 99.1 (37.3)

Rectal range : 99 .3 F (37.4 C) to 99.6 F (38.40 C)

Front 46

normal value for Pulse

Back 46

Normal rate for adult age group 60-100

Front 47

normal value for Blood Pressure

Back 47

Normal BP: < or = 120/ < or = 80

Front 48

normal value for Respirations

Back 48

Normal rate for age group: Adult 10-20/min

Front 49

How do you obtain Temperature

Back 49

thermometer

Front 50

How do you obtain Pulse

Back 50

use pads of first 3 fingers,
at flexor aspect of wrist laterally along radial bone;
press until you feel the strongest pulsation

Front 51

How do you obtain blood pressure

Back 51

Use Sphygmomanometer and stethoscope

Front 52

How do you obtain respiration

Back 52

assess while person is unaware;
count for 30 seconds unless suspect abnormality

Front 53

Annular

Back 53

circular

Front 54

Confluent

Back 54

(run together)

Front 55

Discrete

Back 55

Discrete (distinct)

Front 56

Grouped

Back 56

Grouped (clusters)

Front 57

gyrate

Back 57

Gyrate (twisted; coiled)

Front 58

target or iris

Back 58

Target or iris (concentric rings)

Front 59

linear

Back 59

Linear (scratch; streak)

Front 60

polycyclic

Back 60

Polycyclic (annular lesions run together)

Front 61

Zosteriform

Back 61

Zosteriform (linear, along nerve route)

Front 62

Macule

Back 62

color change; flat, < 1 cm.

Front 63

Papule

Back 63

color change ;elevated; < 1 cm.

Front 64

Nodule –

Back 64

solid, elevated; into dermis; > 1 cm

Front 65

Tumor –

Back 65

a nodule that is > few cms

Front 66

Wheal –

Back 66

superficial, red, raised, edema within

Front 67

Urticaria -

Back 67

wheals that coalesce (hives)

Front 68

Cyst –

Back 68

encapsulated fluid-filled; elevated

Front 69

Vesicle-

Back 69

elevated w/ free-flowing fluid, < 1 cm; eg.”blister”

Front 70

Pustule –

Back 70

turbid (pus) fluid; elevated, circumscribed; eg. “acne”

Front 71

Epidermis made of

Back 71

Major ingredient: tough, fibrous protein (keratin)

Front 72

Dermis

Back 72

Major ingredient : Fibrous Connective tissue (collagen)
Also, resilient elastic tissue (stretch)
Contains: nerves, sensory receptors, blood vessels, and lymphatics

Front 73

Subcutaneous Layer

Back 73

Major ingredient :Adipose tissue
Stores fat cells for energy, provides
insulation for temperature control,
aids in protection (soft cushioning)

Front 74

What happens to each of the 3 layers of skin as we age?

Back 74

1. Dry wrinkled skin from
 turgor and  sebaceous gland activity)
2. Fragile epidermis at risk for tears or injury from epidermis thickness
3. More susceptible to dry skin and  sensation of pain/touch/temperature from
 perfusion of the dermis
4. Subcutaneous skin layer thins so
 risk of hypothermia and  risk of pressure ulcers
5. Number of active epidermis melanocytes  so  susceptability to sun exposure
6.Hyperplasia of melanocytes in sun exposed areas so
hyperpigmentation (liver spots= lentigines and hypopigmentation (age spots) …especially on hands

Front 75

What is the preferred precise way to determine lesion size?

Back 75

cm

Front 76

5. What are four types of abnormal color changes to the skin

Back 76

Pallor

Front 77

Jaundice

Back 77

Yellow color=> rising amounts of bilirubin in blood

Front 78

Cyanosis

Back 78

Bluish mottled color=> decreased perfusion with oxygenated blood

Front 79

Erythema

Back 79

Intense redness from excess blood (hyperemia) in dilated superficial capillaries;

Front 80

Pallor

Back 80

loss of the red-pink tones from oxygenated hemoglobin; epidermis takes on color of collagen layer (dermis)

Front 81

Where on the body would you pallor color changes???...in light skinned? In dark skinned

Back 81

light skin-> pale, white
brown-skin-> yellow-brown
black skin-> ashen gray
Generalized pallor seen in: mucous membranes, lips, nail beds,
Pallor of anemia seen in: palpebral conjunctiva and nail beds

Front 82

Where on the body would you Erythema color changes???...in light skinned? In dark skinned

Back 82

Light skin- red, bright pink
Dark skin- purplish tinge; best to palpate for warmth

Front 83

Where on the body would you cyanosis color changes???...in light skinned? In dark skinned

Back 83

Light skin- dusky blue
Dark skin- dark but dull; best to check conjunctiva, oral mucosa, nail bed

Front 84

Where on the body would you Jaundice

Back 84

Yellow color=> rising amounts of bilirubin in blood
Light skin=>sclera, hard palate, mucous membrane, then over skin
Dark skin=> junction of hard & soft palate in mouth; palms

Front 85

What is skin turgor and how is it assessed and for what reason?

Back 85

Turgor (skin return to place promptly)
Normal: No ”tenting” (stands by itself)
Reflects elasticity of skin.
Poor turgor may =
severe dehydration
or weight loss

Front 86

What does the ABCDE rule stand for and what does it assess?

Back 86

Teach skin self-examination

Front 87

basal cell carcinoma

Back 87

most common type skin cancer. It appears as a raised soft lump or a red patch on sun-exposed areas of the body.
Found most often on the head or neck, and somewhat less often on the arms and legs.
A slow-growing cancer that only rarely spreads to other areas of the body. But if left untreated, it can extend deep below the skin and cause local damage and scarring.

Front 88

malignant melanoma lesions

Back 88

3 percent of all skin cancers, but 75 percent of all skin cancer deaths.
Malignant melanoma develops on sun-exposed areas of the skin, as well as inside the eye, in the mouth, and on the palms of the hands and soles of the feet — and it usually starts in a skin mole.
Malignant melanoma often occurs at a younger age than other skin cancers;
It is the most common type of cancer in people aged 20 to 29. [CDC 2007]

Front 89

What are normal finding when assessing nails, nail beds of fingers or toes, and circulation? How is it done?

Back 89

Shape and contour
Profile sign= ankle of nail base (normal is 1600 or less)

Consistency
smooth, regular; not brittle or splitting

Color -
even; pink nail bed underneath
capillary refill: normal= less than 3 seconds
inspect toenails; separate toes and note smooth skin in between

Front 90

Describe the rash that occurs with shingles. What is part of the treatment for this as described in the PPT?

Back 90

caused by the reactivation of the chickenpox virus, varicella zoster, which can lie dormant for years in the nerve tissue of a person who has had chickenpox.
Once the virus reawakens, it spreads up the nerve fibers to the skin and produces the telltale rash of shingles.
Shingles appear as a blistering rash that runs along one half of the body (usually, thorax area) in a belt-like fashion.

Front 91

What examinations are performed on the neck, head and how do you do them?

Back 91

1. Inspect and palpate the skull
General size and contour
Note any deformities, lumps, tenderness
Palpate temporal artery, temporomandibular joint

2. Inspect the face
Facial expression
Symmetry of movement (cranial nerve VII)
Any involuntary movements, edema, lesions

3. Inspect and palpate the neck
Active ROM
Enlargement of salivary glands, lymph nodes, thyroid gland
Position of the trachea

4. Auscultate the thyroid
For bruit (if enlarged)

Front 92

What happens to vision as one ages?

Back 92

Visual fields narrow and depth perception is distorted (especially climbing/descending stairs)
Pupils are smaller, reducing night vision
Lens yellow and become opaque, resulting in distortion of green, blue and violet tones; and increased sensitivity to glare
Production of tears decrease so eyes feel dry or burn

Front 93

What are the 3 most prevalent problems that plague older patients?

Back 93

Cataract, Glaucoma, Macular degeneration

Front 94

What are the three visual reflexes and how do your perform them?

Back 94

1. Pupillary light reflex
normal constriction of pupils when bright light shines on retina; no conscious control of it.
A. Direct light reflex- when bright light exposed to one eye
B. Consensual light reflex-simultaneous constriction of other pupil

2. Fixation a reflex directing eye towards an object attracting that person’s attention; Impaired by drugs, alcohol, fatigue

3. Accommodation convergence of the axes of the eyeballs with constriction of the pupils: adapts eyes for near vision

Front 95

cornea

Back 95

covers iris and pupil

Front 96

sclera

Back 96

fibrous protective white covering

Front 97

conjunctiva

Back 97

thin mucous membrane; transparent protective covering of eyeball and mucous membrane

Front 98

how you would assess for:

accommodation

Back 98

Have person focus on distant object; should see pupils dilate. Then, have person shift gaze to near object –your finger held ~3 inches from nose;

Front 99

how you would assess for:
PERRLA

Back 99

How (3 steps):
nspect both for round and equal

Pupillary light reflex
HOW: Advance light in from each side forward from ear

Accommodation
HOW: Have person focus on distant object; should see pupils dilate. Then, have person shift gaze to near object –your finger held ~3 inches from nose;

Front 100

how you would assess for:
confrontation

Back 100

Cover patient’s eye & opposite eye of examiner
2 ft away using pencil or finger
Slowly advance it in from periphery-
Ask person to say “now” when sees it

Front 101

confrontation

Back 101

Gross measure of peripheral vision - CN II
Compare patient’s peripheral vision to examiner (assuming it’s normal

Front 102

PERRLA

Back 102

P, Pupils; E, Equal; R, Round; R, React to light; A, Accommodate

Front 103

Corneal light reflex (Hirschberg test)

Back 103

Assesses parallel alignment of eye axes by shining light towards person’s eye.

Front 104

vertigo

Back 104

room spinning; true twirling motion

Front 105

18. What happens to hearing as one ages?

Back 105

Cilia lining the ear canal becomes course and thick so sounds waves traveling toward eardrum are impeded

Causes cerumen to accumulate and
appocrine gland atrophy makes cerumen drier

A life history of frequent infections results in eardrum scarring

Front 106

cn I

Back 106

nose
olfatory

Front 107

cn 2

Back 107

eyes peripheral vision