Health Assessment Midterm

  1. If a female is having abdominal pain, what is an important question to ask the patient about?
  2. Solid organs _____ their shape.
    What are some examples?
    • liver, spleen, pancreas, adrenal glands, kidneys, ovaries and uterus
  3. Hollow organs shape depends on ______.
    What are some examples of hollow organs?
    • Depends on their content.
    • stomach, gallbladder, small intestines, colon and bladder
  4. If a patient was recently on IV antibiotics what are you concerned about?
    Cdiff infection
  5. Name 3 types of meds that cause constipation.
    • Nsaids
    • Narcotics
    • Antibiotics
  6. What is the correct sequence for examination of the abdomen?
    • 1. Inspection
    • 2. Auscultation
    • 3. Percussion
    • 4. Palpation
  7. If a patient is greater than 60 years old, what lab should you run routinely?
    Hepatitis Panel
  8. Upon assessment, you notice your patient has an enlarged spleen, what diagnosis are you concerned about?
  9. Upon assessment, you realize your patient has an enlarged liver, what diagnosis are you concerned about?
    What tests would you perform to confirm your diagnosis?
    • Cirrhosis
    • LFTs, Hep Panel
  10. What is an associated symptom noticed on examination of a patient with a neoplasm of the esophagus or stomach?
    severe bad breath
  11. If a patient has peptic ulcers, what would you expect their breath to be like?
    acid like -- BAD breath
  12. If a patient has hepatic failure, what would you expect their breath to be like?
    sickly, sweet odor
  13. If your patient has esophageal diverticulum, what would you expect their breath to be like?
    odor of something decaying
  14. If your patient has a severe bowel obstruction, what would you expect their breath to be like?
    odor of feces
  15. If your patient has cirrhosis with portal shunting, what would you expect their breath to be like?
    odor of rotten eggs and garlic
  16. What are bruits?
    vascular sounds resembling heart sounds
  17. What do venous hums indicate?
    Are these common?
    What do they sound like?
    • -indicate increased collateral circulation between the portal and venous system
    • -rare
    • -sound like continuous humming
  18. Are friction rubs common?
    What do they sound like?
    • Rare
    • rubbing sandpaper
  19. If you notice pulsating in the abdomen what do you suspect?
    Can this be a normal finding?
    • AAA
    • yes if the patient is very thin/frail
  20. If you believe your patient has an AAA what would you order?
  21. If an AAA is >5cm what should you do?
    consult vascular surgeon
  22. What is a symptom noted in the abdomen with CHF?
    possible edema in abdomen
  23. Ascites in the abdomen can be related to what disease?
    hepatic failure
  24. What is rebound tenderness?
    What abdomen complication is it associated with?
    • -provider will palpate deeply in the abdomen and then will suddenly release pressure, if pain is worse when the provider releases pressure + rebound tenderness
    • -significant with peritoneal irritation and appendicitis
  25. What is a positive Murphy's sign?
    What abdominal complication does it correlate with?
    • -Palpate below the right costal margin.  As the patient to take a deep breath.  If the patient stops breathing mid-inspiration because of pain, the sign is positive.
    • -Acute Cholecystitis (may also be present with hepatitis)
  26. What is a positive McBurney's sign?
    What abdominal complication is it associated with?
    • -McBurneys sign is tenderness and rigidity from the umbilicus to the right anterosuperior iliac spine. (rebound tenderness)
    • -Appendicitis
  27. What is the obturator test?
    What acute complication is it associated with?
    • -With this test, the patient is placed in the supine position and their right leg is flexed at the hip and knee.  A hand is placed just above the patient's knee with another hand at the patient's ankle.  The leg will be rotated internally and externally.  If that patient experiences pain in the abdomen the test is positive.
    • -Ruptured appendix or pelvic infection
  28. If that patient were to stand on his/her toes and then drops down to their feet real fast and severe pain is felt, what condition are you suspicious of?
  29. When is morning sickness with pregnancy most common?
    First trimester
  30. A neonate should pass meconium within ___.
    If they pass meconium in utero what are you concerned about?
    • 24 hours
    • infection
  31. What is a common assessment finding of the abdomen in a neonate?
    • protuberant abdomen
    • (round belly)
  32. When a neonate has jaundice, the yellowness will fade in what direction??
    • fades from toes to head
    • -may need phototherapy to help!
  33. Why does diverticulosis occur in the elderly?
    changes in elastic tissue and colonic pressure
  34. How should a patient be laying to assess the abdomen?
    Flat... with knees bent to prevent flexion of the abdominal muscles. Make sure to drape patient appropriately.  Patient's hands will be to their sides with their head resting on a pillow.
  35. If you hear tympany when assessing a patients abdomen what do you assume is in this space?
    • space is hollow (air or gas)
    • -the abdomen is mostly hollow
  36. What would dullness on abdominal percussion be indicative of?
    • feces or fluid
    • organs (such as liver, spleen -- will only have dullness if enlarged)
  37. When a patient comes in complaining of a complication with the abdomen, which part should you assess last?
    • most painful area last
    • watch facial expressions when palpating painful area!
  38. What is located in the RUQ?
    • gallbladder
    • liver
    • some pancreas
  39. What is located in the LUQ?
    • pancreas
    • spleen
    • stomach
    • intestines
  40. What is located in the RLQ?
    • intestines
    • appendix
    • ovaries/testicles
    • part of bladder (sits in the middle of abd.)
  41. What is located in the LLQ?
    • intestines
    • part of bladder
    • ovaries/testicles
  42. How can you assess for Kidney infection/tenderness?
    place your hand on the patients back at the costovertebral angle.. make your hand into a fist and lightly strike the hand on the patients back.. will feel pain if there is a complication with the kidneys
  43. Jaundice is usually first noted where?
    • conjunctiva
    • --use natural light when assessing for jaundice... incandescent light can mask the appearance of jaundice on the skin
  44. What are spider angiomas?
    When are they seen? (3)
    • -dilated blood vessels noted above the umbilicus
    • 1. liver disease
    • 2. pregnancy
    • 3. malnutrition
  45. What is palmar erythema?
    redness of the hands, often seen with spider angiomas
  46. What is koilonychia?
    spoon shaped nails
  47. What is blue lunula?
    and what is it associated with?
    • -Blueness to the lunula of the nails (Cresant shaped area by the nail base)
    • -Wilson's disease
  48. Half and half nails (where there is an increase in the size of the luluna) is associated with ____.
  49. What is spider nevi?
    What disease is it associated with?
    • -spider like cluster of capillaries (like spider veins)
    • -liver disease
  50. What is acanthosis nigricans?
    brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas (associated with DM)
  51. What is Xanthalasma?
    sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids. While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed
  52. Aphthous also means...
    canker sores
  53. Fetorhepaticus means?
    Bad breath --- breath of the dead!
  54. What is leukoplakia?
    • White/gray patches in the mouth
    • characteristic of oral cancer
  55. What is odenophagia?
    painful swallowing
  56. What is dyspepsia?
    pain and burning (acidic)
  57. What is tenesmus?
    Painful but unproductive urge to defecate
  58. What is grey turners sign?
    • Bluish discoloration to the flanks
    • associated with pancreatitis
  59. What is cullens sign?
    Bluish discoloration the belly button... associated with pancreatitis
  60. What is hematochezia?
    passage of bright red stools
  61. What are some common findings associated with advanced liver disease?
    • 1. Hyperbilirubinemia
    • 2. Ascites
    • 3. Increased estrogen levels (breast development, testicular atrophy, spider angioma)
    • 4. Lower extremity edema
    • 5. Varices (dilated veins)
  62. What is icterus?
    • yellow discoloration of the sclera
    • associated with liver disease
  63. What is bilirubinuria?
    golden-brown discoloration of the urine
  64. What symptoms would be present with cholecystitis?
    severe epigastic pain, RUQ pain, referred to shoulder, + Murphy's sign
  65. What symptoms would be present with diverticulitis?
    epigastic pain, radiates to L side especially after eating
  66. What symptoms would be present with intestinal obstruction?
    severe pain, spasmlike
  67. What symptoms would be present with pancreatitis?
    acute, excruciating pain, LUQ, referred flank and L shoulder pain, guarding, N/V
  68. What symptoms would be present with a perforated ulcer?
    • abrupt RLQ pain
    • "burning"
  69. What symptoms would be present with the rupture of an organ?
    nonlocalized pain
  70. What symptoms would be present with bilary stones?
    • intense RUQ pain
    • "cramping"
  71. Level of consciousness
    How aware the person is of his environment
  72. Attention
    The ability to focus or concentrate
  73. Alert
    Patient is awake and aware
  74. Lethargic
    Must speak in a loud forceful manner to illicit a response
  75. Obtunded
    Must shake patient to get a response
  76. Stupurous
    Pt unarousable except with painful stimuli
  77. coma
    completely unarousable
  78. memory
    Process of recording and retrieving info
  79. Short term memory vs Long term memory
    Mins to days vs Months to years
  80. Orientation
    Aware of person, place and time (requires memory and attention)
  81. Perceptions
    Awareness of the objective in the environment to the 5 senses and their interrelationships
  82. thought processes
    The logic, coherence and relevance of a patient’s thoughts as they lead to thoughts and goals; how people think
  83. insight
    Awareness that thought, symptoms or behaviors are normal or abnormal; distinguishes that a daydream or hallucination are not real
  84. Judgement
    Process of comparing and evaluation different possible courses of action
  85. affect
    The observable mood of a person expressed through facial expression, body movements and voice
  86. mood
    The sustained emotion of the patient
  87. euthmic
    Normal mood
  88. Dysthymic
    depressed mood
  89. manic
    elated mood
  90. Fluency
    Involves the rate, flow and melody of speech
  91. Circumlocutions
    Words of phrases are substituted for the word a person cannot remember “the thing you block out your writing with” ---eraser
  92. Paraphasias
    Words are malformed, wrong or invented (“I write with a den”, I write with a branch”)
  93. Delrailment
    Speech in which a person shifts topics with no apparent relation between the topics
  94. flight of ideas
    Accelerated change of topics in a very fast but generally coherent(organized)manner
  95. Neologisms
    Invented or distorted words
  96. incoherence
    Distorting words
  97. confabulation
    Remember things differently than others did, may make things up
  98. Perserveration
    can't let things go. constantly bringing them up
  99. Echolalia
    repetition of words
  100. Schizophrenia
    disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior. – “split mind”
  101. OCD
    characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). With obsessive-compulsive disorder, you may realize that your obsessions aren't reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.
  102. malingering
    To pretend you’re ill to get out of work – exaggerating symptoms to gain something
  103. Conversion disorder
    Physical symptoms occur without specific cause such as blindness or paralysis – all in the patient’s head
  104. Somatization disorder
    Physical complaints but there is no physical reason for your complaints, believe something is wrong even tho it’s not
  105. CAGE Questionnaire r/t to Alcohol&Illicit Drugs
    Have you ever felt the need to CUT down on drinking? Have you ever felt ANNOYED by criticism of your drinking? Have you ever felt GUILTY about drinking? Have you ever taken a drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover?
  106. Bipolar DIGFAST
    Distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness
  107. Depression SIGECAPS
    Sleep, interest, guilt, energy, concentration, appetite, psychomotor activity, suicide
  108. Clanging
    Speaking with rhyming words even tho it doesn’t make any sense
  109. delusions
    Fake, fixed beliefs that are not shared by other members of the person’s culture
  110. compulsions
    Strong irresistible impulse to perform an act
  111. Obsessions
    The domination of ones thoughts by an idea, image or desire
  112. Anxiety
    Excess anxiety and worry about a number of topics of most days for 6 months
  113. Delusion of Reference
    Person believes an outside event or object has an unusual personal reference to them (comet passing the earth means they should buy a car)
  114. Somatic delusion
  115. Believing one has a disease or defect that he does not
  116. Illusions
    Misinterpretations of the real stimuli (postman leaves mail, patient believes he is trying to poison him)
Card Set
Health Assessment Midterm
Midterm Fall 2013