Health Assessment And Physical Examination

Front 1

What is involved in a complete health assessment

Back 1

Behavioral and physical examination

Front 2

Use a physical examination to do the following:

Back 2

1. Gather baseline data about the patient's health status

2. Supplement, confirm, or refute subjective daa obtained in the nursing history

3. Identify and confirm nursing diagnoses

4. Make clinical decisions about a patient's changing health status and management

5. Evaluate outcomes of care

Front 3

Should you ever leave a confused or combative patient alone?

Back 3

No, never.

Front 4

What are the two allergic responses to natural rubber latex (NRI)?

Back 4

1. The most immediate is an immunological reaction type 1 response for which the body develops antibodies known as immunoglobulin E that can lead to an anaphylactic response.

2. The second is the allergic contact dermatitis type 4 response which causes a delayed reaction that appears 12 to 48 hours after exposure.

Front 5

Breast Cancer

(Women at average Risk)

Back 5

Ages 40-44 ---Mammograms

Ages 45-54 ----Monthly BSE dependent on HCP

Agent 55 and older ----switch to mammogram every 2 years

Front 6

Colon/Rectal cancer

Back 6

Ages 50 and up--- Men and women have one of the following: fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually or flexible sigmoidoscopy (FSIG) every 5 years

Front 7

Ear disorders

Back 7

All Ages ----- Periodic hearing checks as needed

Over age 65 ----- Regular hearing checks

Front 8

Ovarian Cancer

Back 8

Age 18 and up or on becoming sexually active ----Annual pelvic examinations

Front 9

Prostate Cancer

Back 9

Age 50 and up ----- Men who have at least a 10 year life expectancy need to have a digital rectal examination (DRE) and prostate-specific antigen (PSA) blood test annually.

Front 10

Skin Cancer

Back 10

Ages 20 to 40 ---- See specialist every 3 years

Over 40 ----- Annual skin checkups with biopsy of suspicious lesions

Front 11

Testicular Cancer

Back 11

Age 15 and up --- Monthly testicular self-examination (TSE)

Front 12

Uterine Cancer

Back 12

Screening begins 3 years after having vaginal intercourse but no later than age 21

Front 13

Cervical Cancer

Back 13

Age 21-29 ----Pelvic examination by health care provider plus pap test with cytology every 3 years

Age 30-65 ---- Pap test with cytology every 3 years

Over 65-- No testing needed if previous regular testing was normal

Front 14

Endometrial cancer

Back 14

Same as for cervical cancer

Front 15

What are the four techniques used in a physical examination?

Back 15

1. Inspection

2. palpation

3. percussion

4. Auscultation

Front 16

Inspection

Back 16

Occurs when interacting with a patient, watching for nonverbal expressions of emotional and mental status.

Front 17

Olfaction

Back 17

Sense of smell used to detect abnormalities that cannot be recognized by other means. For example, when a patient's breath has a sweet, fruity odor, assess for signs of diabetes.

Front 18

Palpation

Back 18

Involves using the sense of touch to gather information.

Front 19

What do you palpate for?

Back 19

You palpate the skin for temperature, moisture, texture, turgor, tenderness, an thickness and the abdomen for tenderness, distention, or masses.

Front 20

Which part of the hand is it best to use to determine position, texture, size, consistency, masses, fluid, and crepitus?

Back 20

The palmar surface of the hand and finger pads is more sensitive than the fingertips.

Front 21

Which part of the hand should be used to assess temperature?

Back 21

The dorsal surface .

Front 22

Which part of the hand is best to use to detect vibration?

Back 22

Palmar surface of the hand and fingers

Front 23

How do you measure position, consistency, and turgor?

Back 23

By lightly grasping the body part with your fingertips.

Front 24

When should you palpate tender areas?

Back 24

last.

Front 25

What are the two types of palpation?

Back 25

Light (pressing inward about 1cm (1/2 inch)) and Deep (pressing inward about 4cm (2 inches))

Front 26

Percussion

Back 26

Involves tapping the skin with the fingertips to vibrate underlying tissues and organs. The vibration travels through body tissues and the character of the resulting sound reflects the density of underlying tissue.

Front 27

Auscultation

Back 27

involves listening to sounds the body makes to detect variations from normal.

Front 28

How do we describe the sounds we hear?

Back 28

1. Frequency - the higher the frequency the higher the pitch

2. Loudness - refers to the amplitude of the sound wave

3. Quality - blowing or gurgling

4. Duration - length of time that sound vibration lasts.

Front 29

When a patient first enters an examination room what do you observe for first?

Back 29

His or her walk and general appearance.

Front 30

what is CAGE

Back 30

If you suspect alcohol abuse CAGE questionnaire provides a useful set of questions to guide assessment.

Cut down

Annoyed

Guilty

Eye-Opener

Front 31

What does a weight game of 5 pounds (2.3kg) in 1 day indicate?

Back 31

Fluid retention problems

Front 32

When is a weight loss considered significant?

Back 32

More than 5% of body weight in a month of 10% in 6 months

Front 33

Integumentary system

Back 33

refers to the skin, hair, scalp, and nails. To assess the integument, you first gather a health history to guid your examination and use the techniques of inspection and palpation.

Front 34

With patients with poor circulation or diabetes it is important that you inspect this often overlooked area.....

Back 34

The feet!

Front 35

Why do white and black adolescents and adults ordinarily have body odor?

Back 35

Because they have a greater number of functioning apocrine glands.

Front 36

Which groups often do not have body odor because they have less functioning apocrine glands?

Back 36

Asians and Native Americans/American Indians

Front 37

Pigmentation

Back 37

Skin color.

In older adults pigmentation increases unevenly

Front 38

Where is pallor most evident?

Back 38

In the face, buccal (mouth) mucosa, conductive, and nail beds.

Front 39

Where should you observe for cyanosis (bluish discoloration)?

Back 39

in the lips, nail beds, palpebral conjuctivae, and palms.

Front 40

Jaundice

Back 40

yellow-orange discoloration.

Front 41

What is the best site to assess for Jaundice

Back 41

The patient's sclera

Front 42

erythema

Back 42

red discoloration that can indicate circulatory changes

Front 43

Indurated

Back 43

hardened

Front 44

Turgor

Back 44

refers to the elasticity of the skin

Front 45

Can you reliably assess for turgor on the back of the hand?

Back 45

No, because the skin on the back of the hand is normally loose and thing.

Front 46

Petechiae

Back 46

non blanching, pinpoint-size, red or purple spots on the skin caused by small hemorrhages in the skin layers.

Front 47

What are two common causes of Edema

Back 47

Direct trauma and impairment of venous return

Front 48

What does edematous skin appear like?

Back 48

stretched and shiny

Front 49

If your fingers leave an indentation in the edematous area what is it called?

Back 49

Pitting edema

Front 50

The degree of Edema is dependent on the depth of pitting. What is a level 1, 2, 3, and 4?

Back 50

1 is 2mm

2 is 4mm

3 is 6mm

4 is 8mm

Hint: level x 2 = depth

Front 51

Lesion

Back 51

refers broadly to any unusual finding of the skin surface

Front 52

Primary lesions

Back 52

Macules and nodules. Come from some stimulus to the skin

Front 53

Secondary Lesions

Back 53

Example, Ulcers. Occur as alterations in primary lesions.

Front 54

Macule

Back 54

Flat, non palpable change in skin color; smaller than 1 cm (e.g., freckle, petechiae)

Front 55

Papule

Back 55

Palpable, circumscribed, solid elevation in skin, smaller than 1 cm. (eg. elevated nevus)

Front 56

Nodule

Back 56

Elevated solid mass, deeper and firmer than papule; 1-2 cm (e.g. wart)

Front 57

Tumor

Back 57

Solid mass that extends deep through subcutaneous tissue; larger than 1-2 cm (e.g. epithelioma)

Front 58

Wheal

Back 58

Irregular shaped, elevated area or superficial localized edema; varies in size (e.g., hive, mosquito bite)

Front 59

Vesicle

Back 59

Circumscribed elevation of skin filled with serous fluid; smaller than 1 cm (e.g. herpes simplex, chickenpox)

Front 60

Pustule

Back 60

Circumscribed elevation of skin similar to vesicle but filled with pus; varies in size (e.g. acne, staphylococcal infection)

Front 61

Ulcer

Back 61

Deep loss of skin surface that extends to dermis and frequently bleeds and scars; varies in size (e.g., venous stasis ulcer)

Front 62

Atrophy

Back 62

Thinning of skin with loss of normal skin furrow, with skin appearing shiny and translucent; varies in size (e.g., arterial insufficiency)

Front 63

Basal Cell Carcinoma

Back 63

most common in sun-exposed areas and frequently occurs with a history of sun-damaged skin; it almost never spreads to other parts of the body

Front 64

Squamous cell carcinoma

Back 64

more serious than basal cell and develops on the outer layers of sun-exposed skin; these cells may travel to lymph nodes and throughout the body.

Front 65

Malignant melanoma

Back 65

a skin cancer that develops from melanocytes, begins as a mole or other area that has changed in appearance and is usually located on normal skin (NOTE: melanoma also can originate in noncutaneous primary sites including mucosal epithelium (GI tract, retinas, and leptomeninges). In African-Americans (more than in other races) it can also appear under fingernails or on the palms of the hands and soles of the feet.

Front 66

How do you assess the skin for carcinoma

Back 66

ABCD:

Asymmetry- Look for an uneven shape

Border irregularity - look for edges that are

blurred, notched or ragged.

Color- look for pigmentation that in not uniform;

variegated area of blue, black, and brown and

areas of pink, white, gray, blue, or red are ab

normal.

Diameter- Look for areas greater than 6mm

(about the size of a typical pencil eraser)

Front 67

Hirsutism

Back 67

a condition of unwanted, male-pattern hair growth in women. A woman will have hair growth on the upper lip, chin, and cheeks, with villus hair becoming coarser over the body.

Front 68

Alopecia

Back 68

Hair loss or thinning of the hair is usually related to genetic tendencies or endocrine disorders such as diabetes, thyroiditis, and even menopause.

Front 69

The three types of lice

Back 69

Pediculus humanus capitis (head lice)

Pediculus humans corporis (body lice)

Pediculus pubis (crab lice)

Front 70

What is the semilunar whitish area at the base of the nail bad called?

Back 70

The lunula

Front 71

Why do we check the shape and condition of the nails?

Back 71

They can give clues to pathophysiological problems

Front 72

what is the normal nail bed angle

Back 72

160 degrees

Front 73

Clubbing

Back 73

change in angle between nail and nail base (eventually larger than 180 degrees); nail bed softening with nail flattening; often enlargement of fingertips

Front 74

Cause of clubbing?

Back 74

Chronic lack of oxygen; heart or pulmonary disease

Front 75

Beau's lines

Back 75

Transverse depressions in nails indicating temporary disturbance of nail growth (nail grows out over several months)

Cause: Systemic illness such as severe infection; nail injury

Front 76

Koilonychia (spoon nail):

Back 76

Concave curves

Causes: Systemic illness such as severe infection., nail injury

Front 77

Splinter Hemmorrhages

Back 77

Red or brown linear speaks in nail bed

Causes: Minor trauma, subacute bacterial endocarditis, trichinosis

Front 78

Paronychia

Back 78

Inflammation of skin at base of nail

Cause: Local infection, Trauma

Front 79

What is included in the assessment of the head and neck?

Back 79

head, eyes, ears, nose, mouth, pharynx, and neck (lymph nodes, arteries, thyroid gland, and trachea)

Front 80

Holding your head tilted to one side acts as a behavioral indicator of what potential issues?

Back 80

hearing or visual loss, or a physical indicator of muscle weakness in the neck.

Front 81

Hyperopia

Back 81

Farsightedness, a refractive error in which rays of light enter the eye and focus behind the retina.

Front 82

Myopia

Back 82

Nearsightedness, a refractive error in which rays of light enter the eye and focus before the retina.

Front 83

Presbyopia

Back 83

impaired near vision in middle-age and older adults caused by loss of elasticity of the lens and associated with the aging process.

Front 84

Retinopathy

Back 84

noninflammatory eye disorder resulting from changes in retinal blood vessels. It is a leading cause of blindness.

Front 85

Strabismus

Back 85

a congenital condition in which both eyes do not focus on an object simultaneously; these eyes appear crossed. Impairment of the extraocular muscles or their nerve supply causes strabismus.

Front 86

Cataracts

Back 86

an increased opacity of the lens, which blocks light rays from entering the eye. Cataracts sometimes develops slowly and progressively after age 35 or suddenly after trauma. They are one of the most common eye disorders. Most older adults (65 years old and older) have some evidence of visual impairment from cataracts.

Front 87

Glaucoma

Back 87

intraocular structural damage resulting from elevated intraocular pressure. Obstruction of the outflow of aqueous humor causes this. Without treatment the disorder leads to blindness.

Front 88

Macular Degeneration

Back 88

associated with aging and results in damaging sharp and central vision. There are two types of macular degeneration: wet and dry. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula, ultimately leading to blood and fluid leakage. Dry AMD occurs when the macula thins over time as part of the aging process, gradually blurring central vision. Macular degeneration is one of the leading causes of blindness and low vision in the United States. There is no cure.

Front 89

Nystagmus

Back 89

an involuntary, rhythmical oscillation of the eyes, occurs as a result of local injury to eye muscles and supporting structures or a disorder of the cranial nerves innervating the muscles.

Front 90

What do we inspect the eyelids for?

Back 90

position, color; condition of the surface; condition and direction of the eyelashes; and the patient's ability to open, close and blink.

Front 91

ptosis

Back 91

An abnormal drooping f the lid over the pupil

Front 92

ectropion

Back 92

An older adult frequently has lid margins that turn out

Front 93

entropion

Back 93

An older adult frequently has lid margins that turn in.

Front 94

What can cause lid edema?

Back 94

caused by allergies or heart of kidney failure

Front 95

What does blinking do?

Back 95

Lubricates the cornea

Front 96

Lacrimal gland

Back 96

located in the upper outer wall of the anterior par of the orbit, is responsible for tear production. It is sometimes the site of tumors or infections and should be inspected for edema and redness.

Front 97

Conjunctivitis

Back 97

An infection in the conjunctivae that presents with redness.

Front 98

arcus sinilis

Back 98

a thin white ring along the margin of the iris that is common with aging but is abnormal in anyone under age 40.

Front 99

What does cloudy pupils indicate?

Back 99

Cataracts

Front 100

What can cause dilated pupils?

Back 100

glaucoma, trauma, neurological disorders, eye medications, (e.g. atropine) or withdrawal form opioids.

Front 101

What can cause constricted or pinpoint pupils?

Back 101

Inflammation of the iris, use of drugs (e.g. pilocarpine, morphine, or cocaine), pinpoint pupils are a common sign of opioid intoxication.

Front 102

PERRLA

Back 102

If assessment of pupils is normal in all tests you record this abbreviation with stands for pupils equal, round, reactive to light, and accommodation).

Front 103

What are the three parts of the ear?

Back 103

External, middle, and inner ear

Front 104

External ear structures?

Back 104

auricle, outer ear canal, and tympanic membrane (eardrum)

Front 105

Eustachian tube

Back 105

connects the middle ear to the nasopharynx. Pressure between the atmosphere and the middle ear is stabilized through this tube.

Front 106

The inner ear structures

Back 106

cochlea, vestibule, and semicircular canals

Front 107

What are the causes of disorders of the ear

Back 107

mechanical dysfunction (blockage by cerumen or foreign body), trauma (foreign bodies or noise exposure), neurological disorders (auditory nerve damage), acute illness (viral infection), and toxic effects of medications.

Front 108

When palpating the external ear if the pain increases the pain what is likely?

Back 108

an external ear infection is likely

Front 109

If palpating the auricle and tragus does not influence the pain?

Back 109

the patient can have a middle ear infection

Front 110

What does tenderness in the mastoid area indicate?

Back 110

mastoiditis.

Front 111

cerumen

Back 111

yellow waxy substance in the ear.

Front 112

What are the three types of hearing loss?

Back 112

conduction, sensorineural , and mixed.

Front 113

Ototoxicity

Back 113

injury to the auditory nerve

Front 114

high maintenance doses of antibiotics can cause?

Back 114

ototoxicity

Front 115

Normal nasal mucosa is

Back 115

pink