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what is Subjective data gathered during the health assessment?
What client tells you
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What is objective data gathered during health assessment?
Information gathered during physical exam
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What are the purposes of a health history?
understand client, promote health and wellness, council about disease prevention, negotiate plan of care
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What are 4 types of health history
Initial, interval/follow up, focused/problem oriented, emergency
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What is involved in a history of present illness?
Onset, Precipitating factors and progression, Quality and quantity, Relieving and aggravating factors, Sequelae, Timing, Understanding
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What are constitutional symptoms?
Unexplained fever, night sweats, weight loss or gain, change in appetite, fatigue
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What are the ages for: childhood, adolescence, adulthood
- Childhood - to 12
- Adolescence - 12-18
- Adulthood - 18+
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What is a question that must be asked with every health assessment?
Any drug allergies
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How do you find a tobacco use pack history?
packs/day x years smoking
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When taking a family history how far back do you go?
If possible 3 generations - find out conditions, cause of death, current health
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What are the techniques of physical assessment?
Observation/inspection, palpation, percussion, ascultation
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What are the plexor and pleximeter?
- Plexor - middle finger that strikes during percussion
- Pleximeter - stationary finger that is struck
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What pitches are the diaphragm and bell of the stethoscope used for?
- Diaphragm - high pitched - breath and bowel, heart sounds
- Bell - Bruits and cardiac murmurs
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What are the layers of the skin?
- Epidermis - superficial, avascular, melanocytes
- Dermis - vascular CT with sebacious glands and some hair follicles
- Subcutanious tissue - fatty cells, sweat glands
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What is an apocrine gland?
a gland that opens into a hair follicle, produces an odorless secretion in response to emotional stimuli, causes body odor due to bacterial decomposition
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What are three types of skin cancer?
basal cell, squamous cell, malignant
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What are ABCDE of skin cancer
Asymmetry, border, color, diameter, evolution
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What is carotine?
golden yellow skin pigment, exists in subcutanious fat and keratinized areas. Carotenemia is excessive carotene causing yellowness that does NOT involve conjunctivae or other mucous membranes
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What is jaundice?
increased bilirubin levels causing yellowness in skin, conjunctivae, etc. Suggests liver disease or excessive hemolysis of RBC. Check under NATURAL light.
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What is rubor?
increase in blood flow causing reddening.
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What is pallor?
decrease in blood flow making patient pale.
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What is cyanosis?
increased concentration of deoxyhemoglobin due to hypoxia causing blueness of skin.
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What do you check for peripheral and central cyanosis?
- Perepheral - nails, skin on extremeties
- Central - BUCCAL MUCOSA, lips, tongue
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What is diapheresis?
Excessive sweating
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Where and how do you check for turgor?
check for tenting in sternoclavicular junction
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What are striae?
stretch marks - silver or pink. Purple indicates possible Cushings
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What is Vitiligo?
pigmentary disorder with loss of melanocytes. Chalk white, nonscaling, macular patches
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What is a primary skin lesion?
A lesion that was not there before
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What is a macule?
a flat, nonpalpable, circumscribed lesion under 1 cm eg. freckle, measle
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What is a patch?
a flat, nonpalpable, circumscribed lesion over 1 cm e.g. vitiligo, stage 1 pressure ulcer
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What is a papule?
an elevated, circumscribed, palpable, solid lesion under .5cm eg nevus, wart
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What is a plaque?
elevated, circumscribed, palpable, solid over .5cm lesion. eg psoriasis
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What is a nodule?
elevated, circumscribed, palpable, solid, .5cm - 2cm lesion, deeper and firmer than papule e.g. lipoma, cyst
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What is a tumor?
elevated, circumscribed, palpable, solid over 2cm lesion e.g. carcinoma
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What is a wheal?
a transient, irregular edematous variable sized lesion e.g insect bite/hive
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What is a vesicle?
elevated, circumscribed, palpable, serious fluid filled lesion under 0.5cm e.g. herpes simplex, herpes zoster, chickenpox
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What is a bulla?
elevated, circumscribed, palpable, serious fluid filled lesion over 0.5cm e.g. impetigo, large burn
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What is a pustule?
vesicle or bulla that becomes pus filled e.g acne, impetigo, furuncles, carbuncles, folliculitus
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What is a cyst?
encapsulated, fluid filled or semi-solid lesion in subcutanious tissue or dermis
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What is a secondary skin lesion?
A lesion that results from a primary lesion
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What are above and below skin surface secondary lesions?
- above - scales, lichenification, crust, atrophy
- below - erosion, fissure, ulcer, scar, keloid, excoriation
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What are vascular abnormalities?
Petechae, hematoma, purpura
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What is the scale for edema?
- trace +1 - 2mm
- Mild +2 - 4mm, 10-15 seconds response
- Moderate +3 - 6mm, 1-2 minutes response
- Severe +4 - 8mm, 2-5 minutes response
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What is onychomycosis?
Fungal infection of nail, thickening, browning, crumbling, patching
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What is clubbing of the nails?
caused by hypoxia, normal nail angle 160, early - 180, late - over 180. Do Schamroth technique to test
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What is normal capillary refill for finger and toenails?
- fingernails - under 3 sec
- toenails - under 5 seconds
- checks for perepheral oxygenation
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What is acute pain?
It is short lived, has sympathetic system involvement (increased pulse and blood pressure)
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What is chronic pain?
Long standing pain with adaptation of sympathetic nervous system
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What are the three categories of chronic pain?
- Chronic malignant
- Chronic nonmalignant
- Persistant or recurring
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What are harmful effects of unrelieved pain?
- Endocrine - prolonged stress response
- Cardiovascular - increased HR, O2 demand, BP, hypercoagulation
- Respiratory - disfunction
- GI - decreased motility
- Musculoskeletal - muscle spasm or immobility
- Cognitive - confusion
- Immune - depressed immune response, enhanced tumor growth
- Infection - decreased subcutaneous O2
- Emotional
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Where do you assess strength and regularity of aortic pulsations?
Suprasternal notch
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Where does the trachea bifurcate?
at the angle of Louis
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What rib is at the tip of the scapula?
7th
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What is the posterior equivilent of the Angle of Louis?
T4
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How is the right main bronchus different to the left?
wider, shorter, more vertical, more succeptable to aspiration
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Where are the apices of the lungs located?
2-4 cm above 1st rib into base of neck
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Where is the base of the lung located?
T10 posterior, 8th rib axillary, 4th rib anteriorly
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Which lung lobe has 3 compartments?
Right anterior
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Where are the most common symptoms of respiratory disfunction?
Dyspnea, cough, sputum production, chest pain
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What are objective signs of dyspnea?
increased respiratory rate, nasal flairing, dusky mucosa, use of accessory muscles to breathe
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How does respiration change with aging?
chest wall becomes more ridged, respiratory muscles weaken, shallower breathing, decrease in elastic recoil, alveoli less elastic, decreased cough reflex
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What is the most important assessment?
Inspection
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What is the tripod position?
using arms to support weight and lift chest to increase breathing capacity
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What is a barrel chest?
Occurs with COPD, chest appears in continuous inspiration, kyphosis, costal angle greater than 90 degrees
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What is stridor??
an inspiratory wheeze that is heard in trachea
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What are Cheyne-Stokes?
cyclic pattern of apnea and varied breathing in final stages of life.
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What is Kussmaul's respiration?
Hyperpnea and hyperventalation - happens with DKA
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What is crepitus?
a cracking sensation felt when palpating
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What is tactile fremitus?
vibrations of air in bronchial tubes heard when patient says "99"
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When would tactile fremadus be reduced?
COPD
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When would tactile frematus be increased?
pneumonia, tumor
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What is normal resonance when percussing thorax?
loud intensity, low pitch, long duration, hollow sounding
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What would be indicated by hyperresonance when percussing thorax?
COPD, pneumothorax
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What would be indicated by dullness when percussing thorax?
pneumonia, tumor
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what are normal tracheal breath sounds?
loud, high pitched, harsh, hollow. Inspiration = expiration
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What are normal bronchiovesicular breath sounds?
Intermediate intensity and pitch
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What are normal vesicular breath sounds?
soft, low pitched, breezy, swishy. Inspiration longer than expiration
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What are 3 characteristics of crackles?
occur on inspiration, discontinuous, air through fluid
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What are three characteristics of wheezes?
occur on expiration, continuous, air through bronchoconstriction with inflammation
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What are fine crackles?
high pitched, discontinuous popping sounds at the end of inspiration
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What are medium crackles?
lower more moist sounds heard mid inspiration
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What are coarse crackles?
louder, lower pitched bubbly sounds through inspiration
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What are sibilant wheezes?
prolonged high pitched, musical sound heard primarily on expiration
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What are sonorous wheezes?
low pitched snoring or moaning sound heard primarily in expiration but can be throughout
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