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Open-Ended Questions
- Ask for narrative information
- Use in beginning of the interview
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Close- Ended Questions
(Direct)
- Ask for specific iformation
- Use after persons openning narrative to fill in any details he or she left out
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Restating
(reflection)
Repeating part of what the person has just said
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Empathetic response
- Recognizing the feeling
- accept it and allow the person to express it without embarrasement
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Clarification
- Used when the persons word choice is ambiguous or confusing
- Used to summarize the persons words
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Subjective Information
What the person says about himself during history taking
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Objective Information
- What you say as a health professional
- Observed by:
- Inspecting
- Palpation
- Percussing
- Auscultating
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Eccrine Gland
Coiled tubules that open directly onto the skin surface and produce a dillute saline solution called sweat
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Aprocrine Gland
- Produce thick, milky secretions and
- Open into the hair follice
- Mainly in the axillae, anogenital area, nipple, navel
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Gynecomastia
Enlargement of the breast tissue, making it clinically distinguishable from other tissue in the chest wall
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Bronchophony
Ask person the repeat "99" while you listen with a stethoscope
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Egophony
Auscultate the chest while the person pronates a long ee-ee-eee
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Percussion Notes
- Hyperesonnant
- Resonant
- Tympany
- Dull
- Flat
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Resonant lung sound
- Medium Loud
- Low-pitched
- Hollow, clear
- Moderate length
- Normal lung sound
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Hyperresonant percussion notes
- Loud
- Booming
- Low-pitched
- Long
- On child's lungs
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Tympany percussion notes
- Loud
- High-pitched
- Musical, drumlike
- Longest
- Over air filled viscus like stomach or intestines
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Dull Percussion notes
- Soft
- High pitched
- Muffled thud
- very short duration
- On dense organs like liver or spleen
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Flat percussion notes
- Very soft
- high-pitched
- a dead stop of sound
- very short duration
- when no air present like over bone, thigh or tumor
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Harlequin
Lower half of body turns red and upper half blanches with a distinct demarcation line down the midline
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Erythema Toxicum
Flea bite rash on newborn, red macules and papules on the cheeks, trunk, chest, back and buttocks
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Acrocyanosis
Bluish color around the lips, hands and fingernails, feet and toenails
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Cafe Au Lait
(Milk with cream)
- Large round or oval patches of light-brown pigmentation
- Present at birth
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Cutis Marmorata
Transient mottling in the trunk and extremeties in response to cooler room temperatures
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Carotenemia
Comes from injesting large amounts of food containing carotene , a vitamin A precursor
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Physiologic Jaundice
Yellowing of the skin, scleras, and mucous membranes develops after the 3rd and 4th day of life
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Nonverbal Cues
(Positive)
- Close proximity to patient
- Facial animation
- Smiling
- Eye Contact
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Nonverbal Cues
(Negative)
- Standing
- Lip biting
- Avoiding eye contact
- Inappropriate touch
- Frowning
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Thyroid Function and Hormones Secreted
- Endocrine gland synthesis and secretes:
- (T3) Thyroxine
- (T4) Triiodothyronine
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Lymph Node Function
Separate vessel system which retrieves excess fluid from the tissue spaces and return it to the bloodstream
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Lymph Node location
- Cervical
- Axillary
- Epitrochlear
- Inguinal
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Corneal Light Reflex
(Hershberg Test)
Assess the parallel alignment of the eye axes by shining a light toward the persons eyes
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EOM
- Superior Rectus
- Interior Rectus
- Medial Rectus
- Inferior Oblique
- Lateral Rectus
- Superior Oblique
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Normal Vs. Allergies (Nasal)
- Normalred color and smooth surface
- Allergies
- Mucousa looks swollen, boggy, pale and grey
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How to treat Nose Bleed
(Epitaxis)
- Person sits up with head tilted forward
- Pinch nose between thumb and forfinger
- 5-15 minutes
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Complications of Stroke
- Paralysyis of lower facial muscles
- upper half of face is not effected
- person can wrinkle forehead and close eyes
- positive Babinski and Hoffmans reflex
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Dehydration
S/S
- Mucous membranes look dry
- Lips look parched
- Skin is fissured, resembling dry cracked lake
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Where do breast tumors most commonly appear
- Axillary tail of Spence
- (Upper outer quadrant)
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Colostrum
Thick yellow fluid is the precursor for milk containing the same amount of protein and lactose but practically no fat
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Proper Auscultation Format
- Posterior from the apices at C7 to T10
- Laterally down to the 7th or 8th rib
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Benefits of Colostrum
Its is rich with antibodies that protect the newborn against infection so breastfeeding is important
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Tactile Fermitus:
How is it created
Sounds generated from the larynx through lungs and then chest wall where you feel tham as vibrations
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Physiological changes:
New born vs. Elderly
- Skin
- Fontanel
- Inner ear structure
- gynecomastia
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Malignant Tumor Characteristics
- 30 - 80 increases after 50
- Irregular, star-shaped
- Firm to stony hard
- Poorly defined
- Single
- Fixed mobility
- Skin retraction
- grows constantly
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Benign Tumor Characteristics
- 30 - 55 yrs old decrease after menopause
- Round, lobular
- Firm, rubbery
- Well demarcated
- Mobile
- Tender
- Usually multiple
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What area do Cervical lymph nodes drain
Drain the head and neck
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What area does axillary node drain
Drain breast and upper arm
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What area does the epitrochlear node drain
- Drains the hand and lower arm
- In the antecubital fossa
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Where does the Inguinal node drain
- Lower extremities
- External genetalia
- Anterior abdominal wall
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Define Lanugo
fine downy hair of the new born
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Define Vernix Caseosa
Thick cheesy substance made up of sebum and shed epithelial hair
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Define Presbycusis
Gradual sensorineural loss caused by nerve degeneration in the inner ear or audtory nerve
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Tension Headache Characteristics
- Occipital, frontal
- Bandlike tightness
- Vise-like
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Migraine Headache Characteristics
- Supraorbital,retroorbital, front-temporal
- Throbbing or temporal arteritis
- Occur 2x a month
- Last 1-3 days
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Cluster Headache Characteristics
- Pain around eye, temple, cheek, forehead
- Unilateral or bilateral
- 1-2 a day
- Last 1/2 to 2 hrs
- 1-2 mos
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Webers Test
(Hearing)
- Place a vibrating tuning fork in the midline of the persons skull and ask whether the tone is the same in each ear
- NormalEqual on both sides
- AbnormalSound lateralizes to one ear with a conductive or sensorineural loss
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Rinne Test
(Hearing) -+
- Place tunning for on the mastoid process and ask him or her to signal when the sound goes away
- Quickly invert the fork so vibrating end is near ear canal
- NormalAC > BCAbnormalhearing loss if AC<BC
- conductive loss if sound is heard longer by bone conduction
- Example purulent Otitis Media
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How to avoid breast feeding Complications
Frequent nursing helps drain the ducts and sinuses, stimulate milk production, nipples may crack but if kept dry and exposed to air it will heal rapidly
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