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When does the general survey begin?
1st moments of patient encounter
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What vital signs should be documented during the general survey?
- BP
- HR
- RR
- Temp
- Normal ranges for all
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What is often associated as the 5th vital sign?
Pain
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What are the common or concerning symptoms of the health hx for the gen survey?
- Wt change
- Fatigue/weakness
- Fever, chills, night sweats
- Pain
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What are some good questions to start with when concerning changes in weight?
- How often do you check your wt?
- How is it compared to a yr ago?
- Why do you think it has changed?
- What would you like to weigh
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Does rapid changes in wt over a few days indicated change in tissue or body fluids?
Body fluids
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What can be associated with rapid weight loss?
- Anorexia
- Dysphagia
- Vomiting
- Not enough food supply
- GI absorption issues
- Increased metabolism
- Loss of nutrients-urine, feces, or skin
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What does wt loss with a relatively high food intake suggest?
- DM
- Hyperthyroidism
- Malabsorption
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What is fatigue?
Nonspecific symptom w/many causes & refers to weariness or energy loss
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What type of questioning do you want to ask when dealing w/concerns of fatigue?
Open-ended & have patient describe what they are exp
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What is weakness?
Denotes a loss of muscle power
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Fatigue is a common symptom of depression & anxiety states but it is important to also consider what?
- Infections
- Endocrine disorders
- Heart failure
- Pulmonary disease
- Kidneys or liver
- Electrolyte imbalance
- Anemia
- Meds
- Nutritional deficits & malignancies
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If weakness is localized in a neuroanatomical pattern in may suggest what?
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When is a good time to ask about fever?
Acute or chronic illness
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What is the normal pattern of body temp throughout the day & how does a fever exaggerate this?
- Body temp is normally higher in the day & falls at night
- Fever changes this pattern & typically night sweats occur
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What are some general symptoms that often accompany a fever?
- Malaise
- Headache
- Muscle & joint pain
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During menopause what are some common feelings?
Heat & sweating
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Night sweats are also seen in patients that have what?
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What is the most important thing to focus on when dealing with concerns of a fever?
- Timing of illness
- Associated symptoms
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What is one of the most common symptoms prompting office care?
Pain
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What are the important topics for health promotion & counseling during the gen survey?
- Optimal wt, nutrition, diet
- Exercise
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Overweight is characterized by a BMI of what?
25.0 to 29.9
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Obesity is characterized by a BMI of what?
30.0 to 34.9
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Obesity II is charactrized by a BMI of what?
35.0 to 39.9
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Extreme obesity is characterized by a BMI of what?
Greater than or equal to 40
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The normal range for BMI is what?
18.5 to 24.9
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Underweight is characterized by a BMI of what?
Less than 18.5
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If a patient reduces their wt by 5% to 10% they can improve what?
- BP
- Lipids
- Glucose tolerance
- Reduce risk for DM & hypertension
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What are some tips for promoting optimal wt & nutrition?
- BMI & waist circumference measurments
- Risk factors for HD & obesity related diseases
- Dietary intake
- Patient's motivation to change
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What are the 9 key messages when promoting patient health?
- Variety of foods among basic food groups-staying w/in energy needs
- Control portion size to manage bw
- 30 min of daily exs
- Increase intake of fruits & veggies, whole grains, nonfat or lowfat dairy
- Choose fats wisely-sat,trans,cholesterol low
- Carbs-sugars, starches, fiber
- Little salt
- Alcohol in moderation
- Keep food safe to eat
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What is important for the adolescent & childbearing female to increase their daily intake of what?
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It is important for older adults to identify w/foods that are rich in what?
VB12 & Ca+
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What is important to discuss w/patients in regards to blood pressure & diet?
Reg & freq exs, decreased Na intake & increased K intake along with healthy wt reduces risk for hypertension & lowers BP
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What is the daily recommended intake of sodium per day?
2400mg or 1tsp
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The general appearance of the general survey begins as soon as the clinician enters the room & making note of what?
- Apparent state of health
- Level of consciousness
- Signs of distress
- Skin color
- Dress, grooming, personal hygiene
- Facial expressions
- Odors of body & breath
- Posture, gait, motor activity
- Height
- Weight
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How do you select the proper blood pressure cuff size?
- Width-40% of upper arm circumference
- Length-80% UAC
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What happens if the cuff is too small (narrow) when recording BP?
BP will read high
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What happens if the cuff is too large (wide) when recording BP?
- BP will read low small arm
- BP will read high lrg arm
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When recording an accurate BP how long should the patient refrain from drinking caffeinated beverages or smoking?
At least 30 min
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How should the examining room be for the patient when getting ready to get a BP checked?
Quiet & comfortably warm
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How long should the patient be seated b4 recording BP & where should their arm level be at?
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Should the arm selected have clothing around it or be free of clothing?
Free of clothing
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How should the arm be positioned for the most accurate BP?
Heart level-4th interspace
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What will happen if the brachial artery is 7 to 8 cm below heart level during a BP recording?
BP will read about 6 cm higher
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What will happen if the brachial artery is 6 to 7 cm higher than heart level during a BP recording?
BP will read 5 cm lower
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What can most likely occur if the cuff is loose or bladder balloons outside the cuff?
False high reading
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How should the cuff be placed on the arm for a BP?
Centered over Brachial a w/lower border about 2.5 cm above antecubital crease.
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How do you determine how high to raise the cuff pressure?
1st-estimate systolic pr by palpation of radial a & inflate cuff until radial pulse disappears & note pressure then add 30 mm HG to this number.
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Why is it important to estimate how high to inflate the cuff for a BP?
- Prevents unnecessarily high cuff pr
- Avoids ausculatory gap
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What is the ausculatory gap?
Silent interval that may be present btwn sys & dia pr
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How long should you wait after estimating how high to inflate the cuff?
15 to 30s
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What can possibly happen with an unrecognized auscultatory gap?
Lead to serious underestimation of sys pr or overestimation of dia pr
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Korotkoff sounds are relatively high or low pitch sounds & heard better w/bell or diaphragm?
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An auscultatory gap is associated with what?
- Arterial stiffness
- Atherosclerotic disease
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What is the normal range for BP?
- Sys-less than 120
- Dia-less than 80
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Pre-hypertension is classified as what?
- Sys-120 to 139
- Dia-80 to 89
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Hypertension stage 1 is classified as what?
- Sys- 140 to 159
- Dia- 90-99
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Hypertension stage 2 is classified as what?
- Sys greater than 160
- Dia greater than 100
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Hypertension also effects on end organs which include?
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What is the normal HR?
50-90 bpm
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How do you identify an irregular heart rhythm?
- Beats appear in basic rhythm
- Irregularity vary consistently w/respiration
- Totally irregular
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What is the normal respiratory rate for an adult?
20 breaths pm
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What do you want to observe when recording respiratory rate & rhythm?
- Rate
- Rhythm
- Depth
- Effort of breathing
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How do you measure respiratory rate & rhythm?
Count number respirations in 1 min
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What is the typical avg temp?
37 C
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Are rectal temperatures higher or lower than oral temps & what is the difference?
Higher-.4 to .5 C
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Are axillary temp higher or lower than oral temps & what is the difference?
Lower-1 C but take about 5-10min to register
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If a patient has a weak or inaudible korotkoff sound what can you have them do to try to increase the intensity of the sounds?
- Raise arm b4 & while you inflate cuff then lower arm to determine BP
- Inflate cuff & have them make fist several times
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What is white coat hypertension?
BP higher in office than at home/relaxed setting
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How do you term if the pain is considered chronic pain?
- Greater than 3-6mo's
- Greater than 1mo for acute illness/inj
- Pain recurring at intervals of mo's/yrs
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When dealing with the pain patient how should you go about the patients history?
- Location
- Severity
- Associated features
- Attempted tx, meds, related illnesses & impact on ADL's
- Health disparities
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When is it appropriate to use the face pain scale in the clinical setting?
- Children
- Language barriers
- Cognitive impairment
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What are the different types of pain?
- Nociceptive or somatic
- Neuropathic
- Psychogenic
- Idiopathic
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What is the pain that is related to tissue damage?
Nociceptive/somatic
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What is the pain that is related to direct injury to the peripheral or CNS?
Neuropathic
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What is the pain that is associated with many factors that influence the patients report of pain to include: psychiatric, personality, coping style, cultural norms, & social support systems?
Physchogenic
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What is the pain that is associated without an identifiable etiology?
Idiopathic
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What are the four A's to monitor patient outcomes?
- Analgesia
- ADLs
- Adverse effects
- Aberrant drug-related behaviors
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What is the state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug's effects over time?
Tolerance
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What is the state of adapatation that is manifested by a drug-class specific w/drawl syndrome?
Physical dependence
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What is the primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development & manifestations?
Addiction
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The normal resp rate range is btwn?
- 14-20-adults
- Up to 44 infants
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Slow breathing is termed?
Bradypnea
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Rapid shallow breathing is termed?
Tachypnea
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Rapid deep breathing is termed?
Hyperpnea or hyperventilation
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