NURS 340 Health Assessment Final Exam

bereavement

state of loss, sorrow, and/or grief due to the death of a loved one, decline in personal or a loved one's health, or the end of an important relationship

symptom

subjective evidence of a disease, such as pain or a headache

consciousness

being aware of one's own existence, feelings, and thoughts and being aware of the environment Birth -rudimentary; cerebral cortex not yet developed 18-24 months -gradually develops along with language; learns that he or she is separated from other objects in environment and has words to express this

heavy alcohol use

binge drinking on 5 or more days in the past month (SAMHSA). Or for men, 15 or more drinks per week; for women, 8 or more drinks per week (CDC)

circumlocution

talking in circles

circumstantiality

talks with excessive and unnecessary detail, delays reaching point; sentences have a meaningful connection but are irrelevant (this occurs normally in some people). ex. "when was my surgery? well I was 28, I was living with my aunt, she's the one with psoriasis, she had it bad that year because of the heat, the heat was worse than it was the summer of '92..."

affect

temporary expression of feelings or state of mind

Step 2: Hypothesis [Diagnostic Reasoning Process]

tentative explanation for a cue or a set of cues that can be used as a basis for further investigation

health or illness

the balance or imbalance of the person, both within one's being (physical, mental, and/or spiritual) and in the outside world (natural, communal, and/or metaphysical)

Assessment

the collection of data about an individual's health state

cultural sensibility

the deliberate proactive behavior by health care providers who examine cultural situations through thoughtful reasoning, responsiveness, and discreet interactions

dysarthria

the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system; slurred speech

boutonniere deformity

the knuckle looks as if being pushed through a buttonhole. It is a common deformity.

duration

the length of time a note lingers

Babinski test abnormal response

called Babinski sign positive -There is dorsiflexion/extension (up going) of the toes especially the big toe and fanning (spreading apart) of the other toes during and immediately after stroking the lateral plantar surface of the foot. · (Fanning of toes is a positive test)

organic disorders

caused by brain disease of known specific organic cause [e.g., delirium, dementia, alcohol and drug intoxication, and withdrawal]

interpersonal communication

communication that occurs between 2 or more individuals from different health professions -requires an environment of mutual respect and collaboration

attention

concentration, ability to focus on one specific thing -gradually increases in span through preschool years so that by school age most children are able to sit and concentrate on school work for a period of time -some are late in developing concentration

obtunded

confused

dysphonia

difficulty producing speech sounds, usually due to hoarseness

electronic health recording

direct computer entry of a patient's health record while in the patient's presence

lethargic

drowsy

culture

the nonphysical attributes of a person - the thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups 1) learned from birth through language acquision and socialization 2) shared by all members of the same cultural group 3) adapted to specific conditions related to environmental and technical factors and to the availability of natural resources 4) dynamic and ever changing

socialization

the process of being raised within a culture and acquiring the characteristics of that group

ethnocentrism

the tendency to view your own way of life as the most desirable, acceptable, or best and to act in a superior manner to another culture's way of life

environment

the total of all conditions and elements that make up the surroundings and influence the development of a person

avoidance language

the use of euphemisms to avoid reality or to hide feelings

distancing

the use of impersonal speech to put space between one's self and a threat

holistic health

the view that the mind, body, and spirit are interdependent and function as a whole within the environment

thought process

the way a person thinks, the logical train of thought -School readiness coincides with thought process; around age 7 years thinking becomes more logical and systematic and the child is able to reason and understand

biomedical model

the western european/north american tradition that views health as the absence of disease

cranial nerve V

trigeminal nerve

cranial nerve IV

trochlear nerve

alcohol use disorder

two or more of the following events in a year: tolerance (increased amounts to achieve effect; diminished effect from same amount); withdrawal; a great deal of time spent obtaining alcohol, using it, or recovering from its effect; important activities given up or reduced because of alcohol; drinking more or longer than intended; persistent desire or unsuccessful efforts to cut down or control alcohol use; use continued despite knowledge of having a psychological problem caused or exacerbated by alcohol

anisocoria

unequal pupil size

obsession

unwanted, persistent thoughts or impulses; logic will not purge them from consciousness; experienced as intrusive and senseless ex. violence (parent having repeated impulse to kill a loved child); contamination (becoming infected by shaking hands)

focused database

used for a limited or short-term problem; concerns mainly one problem, one cue complex, or one body system

follow-up database

used in all settings to monitor progress of short-term or chronic health problems

Ad hoc interpreter

using a patient's family member, friend, or child as interpreter for a patient with limited English proficiency (LEP)

language

using the voice to communicate one's thoughts and feelings

cranial nerve 10

vagus

cranial nerve 8

vestibulocochlear nerve

empathy

viewing the world from the other person's inner frame of reference while remaining yourself; recognizing and accepting the other person's feelings without criticism

function of occiptal lobe

visual reception center

objective data

what the health professional observes by inspecting, palpating, percussing, and auscultating during the physical examination

subjective data

what the person says about himself or herself during history taking

thought content

what the person thinks- specific ideas, beliefs, the use of words

tactile hallucinations

when someone experiences some perception related to touch when it is not really there

Working with interpreter

whenever possible, use interpreter or bilingual team member for communication

testing of nerve 8

whispered voice test

elder abuse

willful infliction of force that results in bodily harm, pain, and/or impairment on a person age 65 years or older. Examples include pushing, slapping, hitting, shaking, burning, and rough handling

Testing of function of cranial nerve 1

with person's eyes closed, occlude on nostril and present an aromatic substance -use familiar, obtainable, and nonnoxious smells such as coffee, toothpaste, orange, vanilla, soap, or peppermint. -alcohol wipes smell familiar and are easy to find -normal person kind find scent on both sides of nose -smell decreases with age -any assymetry with nose is important

Clanging

word choice based on sound, not meaning, includes nonsense rhymes and puns ex. "My feet are cold. Cold, bold, told. The bell tolled for me."

fear

worried about known external danger ex. fear of flying on airplanes

echking patellar reflexes

· Checks the quadriceps reflex, L2 to L4 (knee jerk) · Let lower leg dangle freely to flex knee and stretch tendons; strike tendon directly just below patella

communicating with a patient that has cognitive and speech impairments

· It is best to use simple questions that have "yes" or "no" answers

positive babinski test in adults

· There is dorsiflexion/extension (up going) of the toes especially the big toe and fanning (spreading apart) of the other toes during and immediately after stroking the lateral plantar surface of the foot. · Is always pathological in adults

Consciousness

Birth -rudimentary; cerebral cortex not yet developed 18-24 months -gradually develops along with language; learns that he or she is separated from other objects in environment and has words to express this

Step 3: Gather Data Relative to Hypothesis [Diagnostic Reasoning Process]

Develop list of significant signs/symptoms for all patient health needs. A less formal structure than your final list of diagnoses will be and is in no particular order -Cluster assessment data that appears to be associated -Identify patterns -Validate Data -Identify Gaps -Repeat procedures for validation if necessary

parkinsonism

Having tremor, muscle rigidity, stooped posture, and a shuffling gait.

reflection

examiner response that echoes the patient's words; repeats part of what the patient has just said

facilitation

examiner's response that encourages the patient to say more, to continue with the story

clarification

examiner's response used when the patient's word choice is ambiguous or confusing

interpretation

examiner's statement that is not based on direct observation, but is based on examiner's inference or conclusion; links events, makes associations, or implies cause

explanation

examiner's statements that inform the patient; examiner shares factual and objective information

euphoria

excessive well-being ex. "Im high" "I feel like flying" "I feel on top of the world"

testing of cranial nerve III. IV, VI

eyes are observed for symmetry of movement, globe position, asymmetry or droop of the eyelids (ptosis), and twitches or flutters of globes or lids Extraocular movements controlled by these nerves are tested by asking the patient to follow a moving target (eg, examiner's finger, penlight) to all 4 quadrants (including across the midline) and toward the tip of the nose this test can detect nystagmus and palsies of ocular muscles

confabulation

fabricates events to fill in memory gaps ex. gives detailed description of his long walk around the hospital although you know Mr. J remained in his room all afternoon

cranial nerve VII

facial nerve

child neglect

failure to provide for a child's basic needs (physical, educational, medical, and emotional)

summary

final review of what examiner understands patient has said; condenses facts and presents a survey of how the examiner perceives the health problem or need

cranial nerve 9

glossopharyngeal

pedigree or genogram

graph family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least two to three generations such as parents, grandparents and siblings -aunts, uncles, nieces, nephews, and cousins

bradycardia

heart rate fewer than 50 or 60 beats per minute in the adult (depending on agency)

tachycardia

heart rate greater than 95 beats per minute in the adult

executive function

high-level cognitive skills, including organizational and regulatory ability

alcohol abuse

one or more of the following events in a year: recurrent use resulting in failure to fulfill major role obligations; recurrent use in hazardous situations; recurrent alcohol-related legal problems (e.g., DUI); continued use despite social or interpersonal problems caused or exacerbated by alcohol

Childhood mental disorder

one that is diagnosed and begins in childhood, e.g. -ADHD -behavioral or conduct problems -anxiety -depression -autism spectrum disorders -substance abuse disorders (12-17 years mainly)

ambivalence

opposing emotions towards idea, person ex. person feels love and hate toward another at the same time

cranial nerve II

optic nerve

religion

or organized system of beliefs concerning the cause, nature, and purpose of the universe, as well as attendance of regular services -religion and spirituality have been shown to improve physical health -failure to assess spiritual needs has been shown to increase health care costs, especially end of life, and unmet spiritual needs can lead to poor outcomes

psychiatric disorders

organic etiology has not yet been established, e.g. anxiety disorder or schizophrenia.

Perseveration

persistent repeating of verbal or motor response, even with varied stimuli ex. "Im going to lock the door, lock the door. I walk every day, and I lock the door. I usually take the dog, and I lock the door."

blocking

person stops in middle of thought process ex. forgot what I was saying

mental disorder

person's response is much greater than expected reaction to a traumatic life event -clinically significant behavioral, emotional, or cognitive syndrome that is associated with significant distress (a painful symptom) or disability (impaired functioning) involving social, occupational, or key activities

intimate partner violence (IPV)

physical and/or sexual violence (use of physical force) or threat of such violence; also psychological or emotional abuse and/or coercive tactics when there has been prior physical and/or sexual violence between spouses or non-marital partners (dating, boyfriend-girlfriend) or former spouses or non-marital partners

elder neglect (physical)

physical harm (actual or potential) to a person age 65 years or older because of failure to provide for the person's well-being. Examples include inadequate feeding and hydration, unsanitary living conditions, and poor personal hygiene

Provisions of Title VI of the Civil Rights Act of 1964

When people with limited english proficiency (LEP) seek health care in settings such as hospitals, nursing homes, clinics, and daycare centers, and mental health centers, services cannot be denied to them

child physical abuse

physical injury resulting from punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. Even if the parent or caregiver did not intend to harm the child, such acts are considered abuse when done purposefully

cranial nerve 11

spinal accesory

binge drinking

on one occasion: 5 or more standard alcohol drinks for men; 4 or more standard alcohol drinks for women

Agraphia

(inability to communicate through writing) often occurs in patients with aphasia

pitch

(or frequency) the number of vibrations (or cycles) per second of a note

amplitude

(or intensity) how loud or soft a sound is

quality

(or timbre) a subjective difference in a sound as a result of the sound's distinctive overtones

Subculture

Groups within a larger culture that have differences in education, occupation, age, and gender, or ethnicity

Adult Cognition

-Response time is slow than in youth; slow response affects new learning if a new presentation is rapidly paced, the older person does not have time to respond to it Recent Memory - requires some processing (e.g. medication instructions, 24-hr diet recall, names of new acquaintances), is somewhat decreased with aging Remote Memory - not affected Vision loss - can result in apathy, social isolation, or depression Hearing changes common in older adults; produces frustration, suspicion, and social isolation any may make a person look confused More potential for loss: -can cause disorientation, disability, or depression 1) loved ones 2) job status and prestige 3) income 4) energetic nature 5) resilient body Increase in living with chronic diseases may increase fear of loss of independence or of death

Recent Memory

-The ability to recall events of the past few days

Impact of Racial and Cultural Diversity of individuals on the U.S. Health Care System; Need for cultural and racial competence?

-U.S. is becoming a minority-majority nation; minorities with make up around 56% of the population by 2060 -Diversity requires cultural competence -U.S. health care providers travel abroad for work in a variety of health care settings in the international community -Medical and nursing teams volunteer to provide free care in developing countries -Health Care Providers participate in international exchanges -Short term assessments of visiting foreign travelers -international university faculty -students from study abroad programs -family members of foreign diplomats -immigrants -refugees

Communication with Providers

-recognize contribution other providers provider to team -keep lines of communication open -foster team work environment

5 Steps to Evidence Based Practice

1) Ask the clinical question 2) Acquire Sources of evidence 3) Appraise and synthesize evidence 4) Apply relevant evidence in practice 5) Assess the outcomes

Cultural Assessment

1) Cultural Self Assessment a) Where is your family from b) Do you or your family have cultural traditions? c) what led you to a career in healthcare d) list your personal values, attitudes, and beliefs 2) Cultural Assessment Domanins a) Heritage. Country of ancestory; years in the U.S. b) Health Practices. Use of traditional healer; complementary/alternative therapies; preventative medicine; any practices that are unacceptable (e.g. blood transfusion) c) Communication. Primary language; preferred name and method of communication; use of touch as a communication strategy d) Family roles and social orientation. Who makes health care decisions within the family; family priorities; role of extended family; relationship status e) Nutrition: Any forbidden foods; fasting rituals; foods avoided or consumed during illness and in the peripartum period f) Pregnancy, birth, child-rearing. Number of children in the family; beliefs surrounding pregnancy; beliefs surrounding childbirth and child-rearing; special rituals after delivery g) Spirituality/religion. Religious affiliation; religious beliefs; holidays; spirituality assessment h) Death. Rituals in preparation for death; meaning of death; grieving i) Health providers. What is the role of the nurse or doctor; preference for same sex provider; any healers besides physicians and nurses

Interview Process

1) Introducing Interview 2) Questioning a) open ended questions - leaves person free to answer in any way b) closed or direct questions - help elicit specific information and useful for filling in required info c) verbal responses I Reactions (client leads) -facilitation -silence -reflection -empathy -clarification II Expression of own thoughts and feelings to client (provider leads) -confrontation -interpretation -explanation -summary

Complementary Therapy used by different cultures

1) acupuncture 2) ayurveda 3) biofeedback 4) chiropractic or osteopathic manipulation 5) deep breathing exercise 6) guided imagery 7) diet based therapies 8) homeopathy 9) hypnosis 10) meditation 11) tai chi 12) yoga 13) traditional folk healing 14) over-the-counter medications

Nonverbal skills

1) physical appearance -indicates competence vs disorganization 2) Posture -indicates confidence 3) Gestures -indicates agreement vs anxiety or other moods 4) facial expression -reflects emotions and conditions 5) eye contact -indicates confidence and interest 6) voice -indicates meaning 7) touch -has different means based on culture

10 traps of interviewing

1) providing false assurance or reassurance -can trivialize patient and cut off communication 2) Giving unwanted advice -client will feel you are being inappropriate and can reduce rapport between client and provider 3) Using authority -reduces clients ability to communicate, client/provider relationship is a two way relationship 4) Using avoidance language -avoid this and be direct 5) Distancing language -being direct helps client cope with their health 6) Avoid Using professional jargon -ensures client has full understanding of their health 7) Using leading or biased questions -can lead to assumptions or false statements 8) talking too much -listen more than you talk to client 9) interrupting -indicates you are impatient with client 10) using "why" questions -indicates judgement of client

Clinical Decision Making Depends on:

1) the best evidence from a critical review of research literature 2) patient's own preferences 3) clinician's own experience and expertise 4) physical examinations and assessments

evidence-based practice

a systemic approach emphasizing the best research evidence, the clinician's experience, patient preferences and values, physical examination, and assessment

standard alcohol drink

14 grams of pure alcohol as found in one 12-ounce beer (5% alcohol); one 8-ounce malt liquor (7% alcohol); one 5-ounce glass of wine (12% alcohol); or 1.5 ounces of spirits (gin, vodka, whiskey, rum) (40% alcohol)

procedure for performing plantar flexion

a. (Push on the gas pedal) against your resistance

Korsakoff syndrome

An amnesia resulting from chronic alcoholism and nutritional deficit

Step 5: Arriving at Final Diagnosis [Diagnostic Reasoning Process]

As title states

orientation

Awareness of the objective world in relation to the self

anxiety

apprehensive from the anticipation of a danger whose source is unknown ex. I feel nervous and high strung. I worry all the time. I cant seem to make up my mind

disease causation

Can be viewed in three major ways: 1) from a biomedical or scientific perspective -all life events have a cause and effect germ theory: microorganisms such as bacteria and viruses cause illness 2) a natural or holistic perspective -found most commonly among American Indians, Asians and others who believe that human life is only one aspect of nature and a part of the natural order of the cosmos -forces of nature must be kept in balance in order to maintain order in health and life (ying/yang theory) a) yin: represents female and negative energy such as emptiness, darkness, and cold b) yang: male and positive, emitting warmth and fullness -health consists of positive state of total well-being, including physical, psychological, spiritual, and social aspects of the person (hot/cold theory) 3) magicoreligious perspective -world is an arena where supernatural forces dominate -fate of world depends on these forces Ex. voodoo, witchcraft, faith healing

Spiritual Assessment

Faith (F) - Do you consider yourself spiritual or religious? Do you have spiritual beliefs, values, or practices that help you cope with stress? Influence (I) - What importance does your faith or belief have in your life? Have your beliefs influenced you in how you handle stress? Do you have specific beliefs that influence your health care decision? If so, are you willing to share those with your health care team? Community (C) - Are you part of a spiritual or religious community? If so, how does this group support you? Is there a group of people you really love or who are important to you? Address/Action (A) - How should I address these issues in your healthcare? *Refer to RCOPE assessment tool attached as picture. Assess how a person copes with a loss or serious illness from a religious standpoint.

delusions

Firm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contrary ex. Grandiose - person believes that he or she is God; famous, historical, or sports figure; or other well-known person Persecution - "Theyre out to get me!"

swan-neck deformity

Flexion contracture resembles curve of a swan's neck, as in metacarpophalangeal joint. Then hyperextension of the PIP joint, and flexion of the DIP joint. It occurs with chronic RA, often accompanied by ulnar drift of the fingers.

Routine universal screening for intimate partner violence

asking all adult patients time they are in the health care system, no matter what their problem or concern, whether they have experienced IPV

testing of cranial nerve 2

For the 2nd (optic) cranial nerve, visual acuity is tested using a Snellen chart for distance vision or a handheld chart for near vision; each eye is assessed individually, with the other eye covered. Visual fields are tested by directed confrontation in all 4 visual quadrants

Cultural consideration for interviews

Gender -try not to violate culturally appropriate views on male-female relationships -maintain patient modest as to not offend this cultural view Sexual Orientation -do not marginalize homosexual relationship through questioning -know state laws -use appropriate health teaching materials -don't make assumptions -make sure forms are neutral -ask patient's their preferred pro-noun -show caring demeanor regardless -avoiding asking intrusive questions -dont assume orientation -be nonjudgemental

open-ended question

asks for longer narrative information; unbiased; leaves the person free to answer in any way

Barriers to Evidence Based Practice

Individual -nurses lack research skills in evaluating qualify of research studies -nurses are isolated from other colleagues knowledgeable in research -nurses lack confidence to implement change Organizational -Often takes up to 17 years for research findings to be put into practice -nurses lack time to go to the library to read research -health care institutions have inadequate library research holdings -organizational support for EBP is lacking when nurses wish to implement changes in patient care

Communicating with different ages and behavior types

Infant to 12 months -nonverbal communication is mainly used with this age group -when needs are met they are usually calm -when angry, tired, scared, hungry, or uncomfortable they will cry or be difficult to console 12-36 months (Toddler) -can include 1-2 word vocabulary (telegraphic speech) -older toddlers usually want to know why -give simple directions, one at a time 3-6 years (preschooler) -sees world mostly from own's point of view -3 year old still uses telegraphic sentences -5-6 year old has well developed grammar -use direct language, avoid confusing phrases, provide concrete explanations 7-12 (school aged child) -can tolerate others viewpoints -can read -has reasoning skiills -ask child about things first, then caregiver The adolescent -sometimes capable of mature actions, other times not -don't treat adolescents as children -treat them with respect -totally honest communication with them -always stay in character -focus on adolescent, not the problem (reduces anxiety) -keep questions short and simple -after rapport is built, then ask about emotionally charged questions -take every opportunity to use positive reinforcement Older Adult -always address by surname, avoid first names -adjust interview to pace of aging person -consider physical limitations during interview -touch is important nonverbal skill to older people Hearing impaired -requires sign language interpreter -if person prefers lip reading, be sure to face him or her squarely and have good lighting on your face -written communication is efficient in sections such as past health history or review of systems when forms can easily be used Acutely Ill People -focus interview on pertinent information only a) history of present illness b) medications c) allergies d) last meal e) basic health state -focus on making personal comfortable first before starting interview People under influence of drugs/alcohol -ask simple and direct questions -imperative to find out last use of drugs or alcohol and what types -once hospitalized, they should be assessed for extent of problem Sexually Aggressive People -some see illness as a challenge to their self-esteem and sexual adequacy; this can make them act out in many different ways -maintain professional relationship, reinforce that you care about wellbeing of individual -maintain your boundaries -communicate you won't tolerate sexual advances Crying -when you make a person cry, don't assume you have hurt the person, you may have broached a topic that is important -crying is a relief, don't move on to new topic until the client feels ready themselves Anger -dont take anger personally -deal with feelings of anger before moving on to anything else Threats of Violence -identify red flags of violence or abuse -act immediately to defuse violent/aggressive situations -dont raise your voice or act aggressively in return -act interested in what person is saying -most important thing is your own personal safety

Social Determinants of Health (SDOH)

Influencers on a person's health 1) economic stability 2) education 3) social and community context 4) neighborhood and built environment 5) health and healthcare *Evidenced-based research indicates poverty has the biggest impact on individual health

Factors to providing a good interview

Internal 1) empathy 2) liking others 3) the ability to listen 4) self-awareness External 1) Ensure Privacy 2) Refuse interruptions 3) Good physical/comfortable environment without distractions, 4-5 ft of space for interview, comfortable seating meeting each other at eye level 4) Dress (client in street clothes/provider in appropriate clothes) 5) Note taking can be distracting, keep to minimum 6) Electronic health care record used for recording patient data -not always good at capturing biomedical, psychological, emotional information

Closing Interview

Maintain positivity and provide summary of everything to the patient

Interviewing parent or caregiver

Most communication is with parent or caregive -recommend parent accompany child, interviewing friends can result in missed information

nerve acronym

On old Olympus's towering top a Finn and German viewed some hops Olfactory I Optic II Oculomotor III Trochlear IV Trigeminal V Abducens VI Facial VII Auditory or Vestibulocochlear VIII Glossopharyngeal IX Vagus X Spinal Accessory XI Hypoglossal XII

Teaching Health Information to Clients

Oral -conduct health literacy screener -when discussing health information, keep conversation "simple-stupid" Written Materials -should be 5th grade reading level or below -font should be easily readable -avoid medical jargon Teach Back -Client repeats information, provider corrects cliient after repeat -helps to easily determine client understanding

Step 1: Cue Recognition [Diagnostic Reasoning Process]

Piece of information, a sign or symptom, or a piece of laboratory or imaging data

Negative Religious Coping

Reflect spiritual struggle with one's self or with God -Illness may be related to God's punishment, to an act of the devil, or totally within the hands of God

amnestic syndrome

Severe loss of memory for both long and short term information

Standardized Communication Formats (SBAR)

Situation (S) - state your name, unit, patient's name, room number, problem, when it happened, severity Background (B) - admitted diagnosis, when admitted, appropriate immediate assessment data Assessment (A) - findings, what found, what is wrong Recommendation or request (R) - state what you need to continue treating patient or for yourself

phobia

Strong, persistent, irrational fear of an object or situation; feels driven to avoid it ex. cats, dogs, heights, enclosed spaces

Interview

Successful Interviews Allow: 1) gather complete and accurate data about the person's health state, including the description and chronology of any symptoms 2) Establish trust so that the person feels accepted and thus free to share all relevant data 3) teach the person about his or her health state 4) build rapport for a continuing therapeutic relationship 5) discuss health promotion and disease prevention

exam findings associated with a positive romberg sign/test

Sways, falls, widens base of feet to avoid falling. Positive Romberg sign is loss of balance that occurs when closing the eyes. You eliminate the advantage of orientation with the eyes, which had compensated for sensory loss. A positive Romberg sign occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication), loss of proprioception, and loss of vestibular function. ------------------------ · Ask pt to stand with feet together and arms at side · Once in stable position, ask him or her to close the eyes and hold position · Wait 20 secs Normally a pt can maintain posture and balance even with visual orienting information blocked, although slight swaying may occur (stand close to catch the person incase he or she falls)

Step 4: Evaluate New Hypothesis with newly collected data; Final Diagnosis [Diagnostic Reasoning Process]

Take newly collected data to confirm or deny previous hypothesis

telegraphic speech

speech used by age 3 or 4 years in which three- or four-word sentences contain only the essential words

functions of cerebellum

The cerebellum is a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium (i.e., the postural balance of the body), and muscle tone. • It does not initiate movement but coordinates and smooths it (e.g., the complex and quick coordination of many different muscles needed in playing the piano, swimming, or juggling). • It is like the "automatic pilot" on an airplane in that it adjusts and corrects the voluntary movements but operates entirely below the conscious level. - If a patient is having difficulty maintaining their balance & are unsteady - there may be a problem in the cerebellum. · **concerned with motor function and muscle tone of voluntary movements**

functions of cerebral cortex

The cerebral cortex is the center for a human's highest functions, governing thought, memory, reasoning, sensation, and voluntary movement. -We test the cerebral cortex to determine if the patient is oriented to their surroundings.

Linguistic Competence

To prevent serious health outcomes for limited english proficience (LEP) people, it is imperitive that health care professionals communicate effectively and utilize resources such as interpreter resources

compulsion

Unwanted repetitive, purposeful act; driven to do it; behavior thought to neutralize or prevent discomfort or some dreaded event ex. handwashing, counting, checking, and rechecking, touching

echolalia

automatic and immediate repetition of what others say ex. Nurse: "I want you to take your pill." Patient: (mocking) "Take your pill. Take your pill."

mandatory reporter

a specified group of people (e.g. health care providers) is required by law to report abuse (of a specified nature against specified people) to a governmental agency (e.g., protective services, the police)

auscultatory gap

a brief period when Korotkoff sounds disappear during auscultation of blood pressure; common with hypertension

spirituality

a broad term focused on a connection to something larger than oneself, and a belief in transcendence

medication reconcilation

a comparison of a list of current medications with a previous list, which is done every hospitalization and every clinic visit.

complete database

a complete health history and full physical examination

Values

a desirable or undesirable state of affairs and a universal feature of all cultures

wellness

a dynamic process and view of health; a move toward optimal functioning

Title VI of the Civil Rights Act of 1964

a federal law that mandates that when people with limited English proficiency (LEP) seek health care in health care settings such as hospitals, nursing homes, clinics, daycare centers, and mental health centers, services cannot be denied to them

dementia

a gradual progressive process, causing decreased cognitive function even though the person is fully conscious and awake; not reversible

nursing process

a method of collecting and analyzing clinical information with the following components: (1) assessment (2) diagnosis (3) outcome identification (4) planning (5) implementation (6) evaluation

neologism

a new word, expression, or usage; the creation or use of new words or senses

Health Disparity

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage -Measured by comparing the % of difference from one group to the best group rate for a disease -adversely affects groups of people who have systemically experienced greater obstacles to health based on their: 1) racial or ethnic group 2) religion 3) socioeconomic status 4) gender 5) age 6) mental health 7) cognitive 8) sensory 9)physical disability 10) sexual orientation 11) gender identity 12) geographic location 13) other characteristics linked to discrimination or exclusion Facts -African American children are twice as likely to die from asthma as non-Hispanic whites -Overall, infant mortality rate for AA infants is 10.93 per 1,000 live births as compared to 5.90 per 1,000 lives overall -may be related to lack of health insurance -few differences in health between ethnicities/races has anything to do with biological differences and mainly is related to SDOH

leading question

a question that implies that one answer would be better than another

cultural and linguistic competence

a set of congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations

ethnicity

a social group within the social system that claims to possess variable traits such as a common geographic origin, migratory status, and religion

Hypospadias

a. A congenital disorder of the urethra i. Urethral meatus opens on the ventral (under) side of the glans or shaft --------------------------------------------- · A congenital disorder of the urethra (1 in 300 baby boys) · Urethral meatus opens on the ventral (under) side of the glans or shaft · About 90% of openings are on or near the head of the penis with a groove extending from the meatus to the expected location at the tip. · Shiny tissue extends from the meatus to the tip and the foreskin is not fully developed, leaving the ventral side of the glans uncovered. · Circumcision can proceed · Surgical correction of hypospadias can be at age 3 months or older

abnormal findings during inspection of breast exam

a. A sudden increase in the size of one breast signifies inflammation or new growth b. Redness, bulging, or dimpling c. Skin lesions, rashes, focal vascular pattern d. edema

physical exam findings associated with deficit of cranial nerve VII

a. Absent or asymmetric facial movement b. Loss of taste

Phalen test procedure

a. Ask the person to hold both hands back-to-back while flexing the wrist 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand.

teaching testicular self exam

a. Encourage self-care by teaching every male from 13 to 14 years old through adulthood how to examine his own testicles i. Cup one testicle at a time using both hands ii. Examine by rolling the testicle between thumb and fingers iii. Familiarize yourself with the spermatic cord and epididymis iv. Feel for lumps, change in size or irregularities ------------ · Every male from 13 to 14 years old through adulthood · T-timing is once a month · S-examine in the shower, warm water relaxes scrotal sac · E-examine, check for, and report changes immediately · Young males, coming in for school sports clearance o 1. Cup one testicle at a time using both hands (warm in shower) o 2. Examine by rolling the testicle between thumb and fingers using slight pressure o 3. Familiarize yourself with the spermatic cord and epididymis tube list structure that connects on the back side of each testicle o 4. Feel for lumps, changes in size or irregularities (normal for one testis to be slightly larger than the other)

kyphosis

a. Enhanced thoracic curve typically seen in aging people common, with a backward head tilt to compensate

common exam findings along with symptoms of patients with rheumatoid arthritis

a. Fatigue b. Weakness c. Anorexia d. Weight loss e. Low-grade fever f. Lymphadenopathy · Inflammation of synovial tissues, hyperplasia, and swelling lead to fibrosis, cartilage and bone destruction, which limit motion and show as deformity · Chronic inflammatory pain

ligaments

a. Fibrous bands from one bone to another that strengthen the joint and prevent unwanted movement

patient teaching for prevention of STIs

a. Get tested b. Use protection c. Wash before and after intercourse.

physiologic causes of stress incontinence

a. Involuntary urine loss with physical strain, sneezing, or coughing

osteoporosis

a. Loss of bone density from decreased mineralization -higher - denser bone -lower - consistent predictor of hip and vertebral fractures

signs and symptoms of HSV-2 (herpes) related to STI

a. Male genital lesions · Scrotal pain · (I couldn't find anything on this one) · Ask about use with a condom during sex

menorrhagia

a. Menstrual bleeding that lasts more than 7 days

test nerve 12

a. Movement of tongue

test nerve 11

a. Movement of trapezius and sternomastoid muscles, spinal accessory

measurement and normal findings of leg length discrepancy

a. Normally these measurements are equal or within 1 cm. symmetric · Measure between fixed points from anterior iliac spine to medial malleolus, crossing medial side of knee

abnormal findings of prostate palpation that be suggestive of cancer

a. Palpable hardness of the prostate gland I suggestive of prostate cancer b. Any stone-hard, irregular, fixed nodule is indicative of prostate cancer.

General recommended guidelines for pap smear screening

a. Pap smear every 3 years or as recommended per published guidelines

crepitation

a. Patient complaints of dry, crackling or grating sounds -An audible and palpable crunching or grating that accompanies movement.

passive range of motion

a. Performing ROM on patient to prevent contractures

lordosis

a. Pronounced lumbar curve seen in obese people/pregnancy

testing of cranial nerve V

a. Sensory function: with a person's eyes closed, test light touch sensation by touching a cotton wisp to designated areas on a person's face: forehead, cheeks, and chin i. If a patient is unable to differentiate between light touch sensation with a cotton ball on their face; this would indicate damage to the Trigeminal Nerve: Cranial Nerve V.

positions/movements for normal range of motion of the ankle

a. Sitting and standing and walking i. Compare feet, contour of joints, summitry ii. Normally flat feet iii. Toes point straight forward and lie flat · Inversion—Moving the sole of the foot inward at the ankle · Eversion—Moving the sole of the foot outward at the ankle · Hinge joint: limited to flexion (dorsiflexion) and extension (plantar flexion) in one plane

Glasgow coma scale - most appropriate setting for use

a. Some hospitalized people have head trauma, or a neurologic deficit caused by a systemic disease ALL ICU PATIENTS · 3 areas: o Eye opening o Verbal response o Motor response · Total score reflects functional level of the brain

common symptoms of osteoarthritis

a. Stiffness b. Swelling with hard, bony protuberances c. Pain with motion of affected joints · noninflammatory, localized, progressive disorder involving deterioration of articular cartilages (cushion b/w bones) and subchondral bone, synovial inflammation, and formation of new bone (osteophytes) at joint surfaces · Joint stiffness, swelling with hard, bony protuberances, pain with motion of affected joints, and limitation of motion

expected normal findings of palpating testes

a. The testes should move freely, sliding through the fingers and the thumb. b. Each testicle should feel smooth, oval, rubbery, and firm. c. The testes should be equal in size. d. The epididymis should feel soft, nontender, and smooth e. Spermatic cord should feel smooth and nontender ------------ · Asymmetry is an expected finding with the left lower side lower than the right · The hemiscortum should be palpable with the thumb and two fingers o Content should move freely, sliding through your thumb and fingers up from the epididymis o Spermatic cord should feel smooth and nontender

procedure to check for presence of babinski reflex

a. To illicit stroke your finger up the lateral edge and across the ball of the foot. i. The big toe bends up and back to the top of the foot and the other toes fan out.

supination

a. Turning the forearm so the palm is up

Important regions of the breast exam that are especially important when palpating for breast lumps

a. Upper outer quadrant of the breast tail of spense, the nipple and areola

symptoms exhibited for a patient with injury to the broca's area of the frontal lobe

a. When injured in the dominant hemisphere, expressive aphasia results; the person cannot talk. i. The person can understand language and knows what he or she wants to say but can produce only a garbled sound.

stereognosis

a. With his or her eyes close, place a familiar object (paper clip, key, coin, cotton ball) in the person's hand and ask him or her to identify it. b. Normally a person will explore it with the fingers and correctly name it. ---------------- · Test the persons ability to recognize objects by feeling their forms, sizes, and weights · With his or her eyes closed, place a familiar object (pen, coin) in the persons hand and ask him or her to identify it · Normally person will explore it with the finger and correctly name it · Test a different object in each hand; testing the left hand assesses right parietal lobe functioning · Astereognosis- inability to identify objects correctly (occurs with sensory cortex lesions, stroke) · *finely localized touch (can known object without looking)**

procedure for graphesthesia test

a. With the person's eyes closed, use a blunt instrument to brace a single digit number or a letter on the palm. Ask the person to tell you what it is. · ability to "read" a number by having it traced on the skin · with persons eyes closed, use a blunt instrument to trace a single digit number or a letter on the palm · ask the person to tell you what it is · good measure of sensory loss if the person cannot make the hand movements needed for stereognosis, occur with arthritis · abnormal: inability to distinguish number occurs with lesions of the sensory cortex

mammogram screening guidelines for women's health

a. all women over the age 40 years should have an annual mammogram. · Optional annual screening for those at average risk at ages 40 to 44 years and definite annual mammography beginning at age 45 years

parethesia

a. is an abnormal sensation: burning, tingling, or prickly sensations. b. Typically, sensations are in hands or feet, but can be located anywhere on the body.

cranial nerve VI

abducens nerve

memory

ability to lay down and store experiences and perceptions for later recall

visuospatial

ability to process visual information and perceive relationships between objects in space

health literacy

ability to understand instructions, navigate health care system, communicate concerns with the health care provider -understanding of quantitative information -understanding verbal instructions

flight of ideas

abrupt change, rapid skipping from topic to topic, practically continuous flow of accelerated speech; topics usually have recognizable associations or are plays on words ex. "Take this pill? The pill is blue. I feel blue. (sings) She wore blue velvet."

inappropriate effect

affect clearly discordant with content of person's speech ex. laughs while discussing admission for liver biopsy

testing of 9 and 10 nerves

ahh or yawns; uvula and soft palate should rise midline; depress with tongue blade

stroke volume

amount of blood pumped out of the heart with each heartbeat

delirium

an acute confusional change or loss of consciousness and perceptual disturbance that may accompany acute illness; usually resolves when the underlying cause is treated

otoscope

an instrument that illuminates the ear canal, enabling the examiner to look at the ear canal and tympanic membrane

ophthalmoscope

an instrument that illuminates the internal eye structures, enabling the examiner to look through the pupil at the fundus (background) of the eye

irritability

annoyed, easily provoked ex. person internalizes a feeling of tension, and a seemingly mild stimulus "sets him (or her) off"

prevention

any action directed toward promoting health and preventing the occurrence of disease

child emotional abuse

any pattern of behavior that harms a child's emotional development or sense of self-worth. It includes frequent belittling, rejection, threats, and withholding love and support

nerve 12

hypoglossal

documentation of findings of normal patellar reflexes

i. Knee extends, quadriceps muscle contract

Patient teaching for breast exam

i. Lie down, press the 3 middle fingers in a circular motion and uses 3 levels of pressure. Follow an up and down pattern ii. Sit up. Examine underarm with arm slightly raised iii. Note surface changes with hands pushed on hips, shoulders hunched. 1. Self-breast exams should be performed once a month ----------------------------------------------------------- · The self-breast exam should be performed once a month · The simpler the plan, the more likely the person is to comply. · Describe correct technique and rationale and expected findings to note as woman inspects her own breasts. · Teach woman to do this in front of a mirror while she is disrobed to waist. · At home, she can start palpation in shower, where soap and water assist palpation. · Then palpation should be performed while lying supine. · Encourage woman to palpate her own breasts while you monitor her technique. · Use of model for return demonstration as well as pamphlets may be helpful. · **Keep it simple**

documentation of findings of abnormal patellar reflexes

i. No response or exaggerated response

function of frontal lobe

i. Personality, behavior, emotions, and intellectual function

phalen's test

i. Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome

function of temporal lobe

i. Primary auditory reception center, with functions of hearing, taste, and smell.

function of parietal lobe

i. Primary center for sensation

common symptoms related to menapause

i. Uterus shrinks in size because of decreased myometrium. ii. Uterus droops as sacral ligaments relax, and pelvic musculature weakens. 1. Sometimes it may protrude, or prolapse, into vagina iii. Ovaries atrophy to 1 to 2 cm and are not palpable after menopause. iv. Cervix shrinks, looks paler, thick, glistening epithelium v. Vagina becomes shorter, narrower, and less elastic because of increased connective tissue. vi. Atrophy of tissues with increased alkalinity vii. Externally, mons pubis looks smaller because fat pad atrophies. viii. Labia and clitoris gradually decrease in size. Pubic hair becomes thin and sparse

Animism

imagining that inanimate objects (e.g., a blood pressure cuff) come alive and have human characteristics

Aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding). -loss of the ability to speak or write coherently or to understand speech or writing as a result of a stroke or brain damage

Culturally sensitive

implies that caregivers possess some basic knowledge of and constructive attitudes toward the diverse cultural populations found in the setting in which they are practicing

culturally appropriate

implies that the caregivers apply the underlying background knowledge that must be possessed to provide a given person with the best possible health care

culturally competent

implies that the caregivers understand and attend to the total context of the individual's situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences

child sexual abuse

includes fondling a child's genitals, incest, penetration, rape, sodomy, indecent exposure, and commercial exploitation through prostitution or the production of pornographic materials

word salad

incoherent mixture of words, phrases, and sentences; illogical, disconnected, includes neologisms ex. "Beauty, red-based five, pigeon, the street corner, sort of."

Positive Religious Coping

indicates that the person is strongly connected to a divine presence, is spiritually connected with others, and has a benevolent outlook on life

Elderspeak

infantilizing and demeaning language used by a health professional when speaking to an older adult

psychological abuse

infliction of emotional and/or mental anguish by humiliation, coercion and threats and/or lack of social stimulation. Examples include yelling, threats of harm, threats of withholding basic medical and/or personal care, and leaving the person along for long periods

sphygmomanometer

instrument to measure arterial blood pressure

elation

joy or optimism, overconfidence, increased motor activity; not necessarily pathologic ex. "Im feeling very happy" -can be a pathologic sign of mania

flat effect

lack of emotional response ex. topic varies, expression do not

folk healer

lay healer in the person's culture apart from the biomedical or scientific health care system

rage

loss of control ex. person has expressed violent behavior toward self or others

depersonalization

loss of identity ex. "I dont feel real." "I feel like im not really here"

jargon

medical vocabulary used with a patient in an exclusionary and paternalistic way

interview

meeting between the examiner and patient with the goal of gathering a complete health history

nonverbal communication

message conveyed through body language - posture, gestures, facial expression, eye contact, touch, and even where one places the chairs

verbal communication

messages sent through spoken words, vocalizations, or tone of voice

illusion

misperception of an actual existing stimulus, by any sense ex. Folds of bedsheets appear to be animated

hypochondriasis

morbid worrying about his or her own health, feels sick with no actual basis for that assumption ex. preoccupied with the fear of having cancer; any symptom or physical sign means cancer

abduction

moving a limb away from the midline of the body

adduction

moving a limb toward the midline of the body

sign

objective evidence of disease such as a fever

cranial nerve III

oculomotor nerve

cranial nerve 1

olfactory nerve

abstract reasoning

pondering a deeper meaning beyond the concrete and literal -usually develops between 12-15 years of age, few adolescents rarely achieve this

geographic privacy

private room or space with only the examiner and patient present

Acculturation/Assimilation

process of social and psychological exchanges with encounters between persons of different cultures, resulting in changes in either group Acculturative Stress loss and change that occurs when adjusting to or integrating a new system of beliefs, routines or social roles Culture Shock state of disorientation or inability to respond to the behavior of a different cultural group because of its sudden strangeness, unfamiliarity, and incompatibility with the newcomer's perceptions and expectations Dimensions of Acculturative Stress 1) Instrumental/Environmental -Financial -language barriers -lack of access to health care -unemployment -lack of education 2) Social/Interpersonal -loss of social networks -loss of social status -family conflict -family separation -intergenerational conflict -changing gender roles 3) Societal -discrimination/stigma -level of acculturation -political/historical forces -legal status

cultural care

professional health care that is culturally sensitive, appropriate, and competent

mood

prolonged display of a person's feelings

closed questions

questions that ask for specific information and elicit a short, one- or two- word answer, a "yes" or "no," or a forced choice

Emergency Database

rapid collection of the database, often compiled concurrently with lifesaving measures

lability

rapid shift of emotions ex. person feels euphoric, tearful, angry feelings in rapid succession

depression

sad, gloomy, dejected ex. i dont enjoy anything anymore

Hallucination

sensory perception that occurs in the absence of an external stimulus -may strike any sense: visual, auditory, tactile, olfactory, gustatory ex. visual: seeing an image (ghost) of a person who is not there; auditory: hearing voices or music

loosening associations

shifting from one topic to an unrelated topic; person seems unaware that topics are unconnected ex. "My boss is angry with me, and it wasn't even my fault. (pause) I saw that movie too, Lassie. I felt really bad about it. But she kept trying to land the airplane and she never knew what was going on."

critical thinking

simultaneously problem solving while self-improving one's own thinking ability

testing of nerve VII

smile, frown, close eyes tightly, show teeth, lift eyebrows, puff cheeks

Subjective data gathering for breast exam 1

Ø Pain, lump, and discharge Ø Rash, swelling, trauma Ø History of breast disease Ø Surgery or radiation Ø Medications Ø Patient-centered care Ø Perform breast self-examination/last mammogram · If a patient reports complaints of breast pain, do not dismiss their symptoms. We need to ask the patient more information about their pain. · Trauma o Any trauma or injury to the breasts? o Presentation: Did it result in any swelling, lump, or break in skin? · History of breast disease o Any history of breast disease yourself? o Diagnosis: What type? How was this diagnosed? o Medical management: When did this occur? How is it being treated? o Family history: Any breast cancer in your family? Who? Sister, mother, maternal grandmother, maternal aunts, daughter? o At what age did this relative have breast cancer? · Preadolescent girl o Appearance: Have you noticed your breasts changing? o Onset: How long has this been happening? o Description: What have you noticed? o Feelings: What do you think about all this? · Pregnant woman o Appearance: Have you noticed any enlargement or fullness in the breasts? o Presentation: Is there any tenderness or tingling? o Medical history: Do you have inverted nipples? o Anticipatory planning: Are you planning to breastfeed your baby? · Menopausal woman o Have you noticed any change in breast contour, size, or firmness?

positioning patient for rectal exam

• Male: left lateral decubitus, standing, or lithotomy o Standing male to rest elbow on exam table and point toes together; this relaxes the regional muscles, making it easier to spread the buttocks • Females: lithotomy for examining genitalia or left lateral decubitus for exam of rectum alone.

common symptoms of benign prostatic hypertrophy

• The prostate gland starts to enlarge during middle adult year • Prostatic growth creates bladder outlet obstruction because it constricts the urethra • Impedes urine output