Rasmussen Health Assessment Final Exam Concepts

Spirituality

A person's personal effort to find purpose and meaning in life

Patellar Reflex

A reflex extension of the leg resulting from a sharp tap on the patellar tendon Reflex of L2-L4

Venous Insufficiency

Caused by blood clots (deep vein thrombosis) and varicose veins.

Compression Fracture

Crack, break down between two bones (spinal fracture)

Closed Fracture

Fracture that doesn't break the skin

Submandibular

Halfway along jaw bone line (mandible)

Caregiver Burnout

Heavy & Long Duration Burden Complaints Increased Stress Increased Anxiety Social Isolation Depression Weight Loss Mental/Physical/Emotional = Exhaustion--> Negative attitude Dislike Patient Abuse Untended

Snellen Chart (how to use it)

Place the Snellen alphabet chart in a well-lit spot at eye level. Position the person on a mark exactly 20 feet from the chart. Use an opaque card to shield one eye at a time during the test; inadvertent peeking may result when shielding the eye with the person's own fingers. If the person wears glasses or contact lenses, leave them on. Remove only reading glasses because they blur distance vision. Ask the person to read through the chart to the smallest line of letters possible. Encourage trying the next smallest line also. (NOTE: Use a Snellen picture chart for people who cannot read letters.)

Apical Pulse

Pulse felt on the left side of chest slightly below the nipple. Taken with a stethoscope

PERRLA

Pupils are Equal/Round/Reactive to Light/Accommodating

Close-Ended Questions

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

Tests for Cerebellar Function

Rapid Alternating Movement Finger to Finger Test Finger to Nose Heel to Shin Gait Romberg Test Sensory Touch Areas & ID Spinothalamic Trct Light Touch Vibration

Whisper Test

Stand behind and rub fingers together or whisper Patient states what side the sound is on

Information Prior to Meeting Your Client

Time and Place Purpose Rough Estimate of How Long Meeting Will Last Age of Patient

Why is it Important Choose Correct Cuff Size

To Small = High Reading To Big = Low Reading To Narrow = High Reading

Objective

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

Subjective

What the person says about himself or herself during history taking

Egophony Exam (normal/abnormal findings)

(Greek: "the voice of a goat") Auscultate the chest while the person phonates a long "ee-ee-ee-ee" sound Normally you should hear "eeeeeeee" through your stethoscope Over area of consolidation or compression the spoken "eeee" sound changes to a bleating long "aaaaa" sound

Assessment Techniques Across the Life Span (chapter 8)

***REVIEW CHAPTER 8!!!***

Edema and How to Assess and Document

*Is fluid Accumulating in the interstitial space *Imprint your thumb firmly 3 to 4 sec *Feet/Ankles = Hair follicle prominent/mobility decreased +1 Mild Pitting- slight indentation, no perceived swelling +2 Moderate Pitting- Indent subsides slightly +3 Deep Pitting- Indent remains for short time, looks swollen +4 Very Deep Pitting- Indent lasts long time, looks very swollen Unilateral: Local or Peripheral causes Bilateral: Generalized over whole body Central Problem: Heart failure or kidney failure

Grading Peripheral Pulses

0- No Pulse 1- Faint 2- Slightly more diminished 3- Normal 4- Bounding

Pain Assessment with Older Adults

1) Breathing Independent of vocalization 0-Normal 1- Labored breathing occasional short period of hyperventilation 2- Noisy labored breathing, long period of hyperventilation, cheyne-strokes respirations 2) Vocalization 0-None 1-Occational moan/groan, low speech 2-Repeated trouble calling out loud, moaning/groaning/crying 3)Facial Expression 0-Smiling/Expressive 1-Sad, frightened, frown 2-Facial grimacing 4) Body Language 0-Relaxed 1- Tense, distressed pacing, fidgeting 2-Rigid, fists clenched, knees pulled up, striking out, pulling/pushing away 5) Consolability 0-No console 1-Distracted or reassured by voice or touch 2- Unable to console/distract/reassure

Components of The Complete Health History and Data for Each

1. Biographic: data, name, address, and phone number; age and birth date; birthplace; gender; marital partner status; race; ethnic origin; and occupation, primary language 2. Reason for seeking care: a brief, spontaneous statement in the person's own words that describes the reason for the visit 3. Present health or history of present illness: (Healthy Person)-short statement about the general state of health, (Ill Person)-chronologic record of the reason for seeking care, from the time the symptom first started until now. Isolate each reason for care identified by the person 4. Past history: Past health events are important because they may have residual effects on the current health state. The previous experience with illness may also give clues about how the person responds to illness and the significance of illness for him or her. 5. Medication reconciliation: a comparison of a list of current medications with a previous list 6. Family history: Accurate family history highlights diseases and conditions for which a particular patient may be at increased risk. A person who learns that he or she may be vulnerable for a certain condition may seek early screening and periodic surveillance 7. Review of systems: (1) to evaluate the past and present health state of each body system, (2) to double-check in case any significant data were omitted in the Present Illness section, and (3) to evaluate health promotion practices 8. Functional assessment or activities of daily living (ADLs): measures a person's self-care ability in the areas of general physical health or absence of illness; ADLs such as bathing, dressing, toileting, eating, walking; instrumental ADLs (IADLs) or those needed for independent living such as housekeeping, shopping, cooking, doing laundry, using the telephone, managing finances; nutrition; social relationships and resources; self-concept and coping; and home environment Source of History: 1. Record who furnishes the information—usually the person himself or herself, although the source may be an interpreter or caseworker. Less reliable is a relative or friend. 2. Judge how reliable the informant seems and how willing he or she is to communicate. What is reliable? A reliable person always gives the same answers, even when questions are rephrased or repeated later in the interview. 3. Note if the person appears well or ill; a sick patient may communicate poorly.

Peripheral Pulses, Location, Assessed, Graded/Documented

3+, Increased, full, bounding 2+, Normal 1+, Weak 0, Absent Radial pulses Ulnar pulses Brachial pulses Femoral Popliteal Dorsalis Pedis Posterior Tibial

Apical Pulse, How to Assess and Location

5th Intercoastal down and to the left 4th Intercostal down and to the left-CHILDREN Listen for a FULL Minute

Capillary Refill

>2 sec = Sluggish <2 sec = Normal

Functional Assessment, Why is it Completed, What is Included, How is it Preformed

ADLs/IADLs/Mobility Cognition Continence Senses Mobility Psychosocial Issues Katzs Activities of Daily Living Lawton Instrument Activities of Daily Living Scale Observation Cognition Mind Mood Speech Mobility Caregiver Assessment Create Interventions to Promote Independence & Health

Falls in Older Adults

About 30% of Geriatric Population per Year Fall Increased Risk Mobility Strength Decreased Balance and Speed Reflex Confusion Dizziness Poor Eye Sight Past Fall History (increases risk) Causes: Fractures & Head Trauma

Achilles

Achilles Reflex ("Ankle Jerk") (L5 to S2). Position the person with the knee flexed and the hip externally rotated. Hold the foot in dorsiflexion and strike the Achilles tendon directly. Feel the normal response as the foot plantar flexes against your hand.

Secondary Prevention

Aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent re-injury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems

Tertiary Prevention

Aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy

Order of Inspection, Percussion, Palpation, & Auscultation (each body system)

All Body Systems * Inspect *Percussion *Palpation *Auscultation Abdominal *Inspect *Auscultation *Percussion *Palpation

Costovertebral Angle

Angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney.

Shapes of Skin Lesions

Annular (Circular)- Center of body to periphery Confluent- Run together Discrete- Distinct, individual lesions that remain separate Gyrate- Twisted, coiled spiral, snake-like Linear- Scratch, streak, line, stripe Target (iris)- Resembles iris of eye, concentric rings of color in lesions Zosteriform- Linear arrangement along a unilateral nerve route Poly Cyclic- Annular lesions that grow together

Atrial Insufficiency

Any condition that slows or stops the flow of blood through your arteries. Arteries are blood vessels that carry blood from the heart to other places in your body.

Bronchophony Exam (normal/abnormal findings)

Ask the person to repeat "ninety-nine" while you listen with the stethoscope over the chest wall; listen especially if you suspect pathology Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said Pathology that increases lung density enhances transmission of voice sounds; you auscultate a clear "ninety-nine" The words are more distinct than normal and sound close to your ear

Whisper Pectoriloqy Exam (normal/abnormal findings)

Ask the person to whisper a phrase such as "one-two-three" as you auscultate The normal response is faint, muffled, and almost inaudible With only small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint; it sounds as if the person is whispering right into your stethoscope, "one-two-three"

Open-Ended Questions

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

Romberg Test, Expected vs Abnormal Results (safety)

Assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance NORMAL: Stand eyes closed for 20 sec Stand close in case of fall Should be able to stay balanced and still ABNORMAL: Falling Taking a step

ADPIE

Assessment Diagnosis Planning Implementation Evaluation

ABCDE's of Skin Lesion (skin cancer)

Asymmetrical Board Irregular Color Different Colors Diameter >3mm Elevation/Evolution

Tonsillitis

Bright red throat White or yellow exudate on tonsils & pharynx Swollen uvula Enlarged, tender anterior cervical & tonsil nodes Severe sore throat Painful swallowing Temp. >101 F Antibiotics Lasts 3 to 5 days

Physiological Indications of Pain

Cardiac: -Tachycardia -Increased BP -Increased Myocardial O2 Demand -Increased Cardiac Output Pulmonary: -Hypoventiliation -Hypoxia -Decreased Cough -Atelectasis (partial/complete collapse of the lung) Gastrointestinal -Nausea -Vomiting -Ileus (obstruction of intestine) Renal -Oliguria (small amount of urine) -Urinary retention Musculoskeletal -Spasm -Joint stiffness Endocrine -Increased adrenergic activity CNS: -Fear -Anxiety -Fatigue Immune: -Impaired cellular immunity -Impaired wound healing Chronic Pain -Depression -Isolation -Limited mobility -Confusion -Family distress -Diminished quality of life

Cardiovascular Assessment

Carotid artery and the jugular veins 1. Auscultate rhythm at apex: Regular, irregular? (Do NOT listen over gown.) 2. Check apical pulse against radial pulse, noting perfusion of all beats. 3. Assess heart sounds in all auscultatory areas: First with diaphragm, repeat with bell. 4. Check capillary refill for prompt return. 5. Check pretibial edema. 6. Palpate posterior tibial pulse, right and left. 7. Palpate dorsalis pedis pulse, right and left. NOTE: Be prepared to assess pulses in the lower extremities by Doppler imaging if you cannot find them by palpation. 8. Verify that the proper IV solution is hanging and flowing at the proper rate according to the physician's orders and your own assessment of the patient's needs.

Right Lower Quadrant (RLQ) Organs

Cecum Appendix Right Ovary & Tube Right Ureter Right Spermatic Cord

Pain Scale for Different Age Groups

Children- use face pain scale Adults- use numeric pain scale

Types of Headaches and Their Symptoms

Cluster Headache Migraine Headache Tension Headache

Primary Prevention

Concerned with preventing the onset of disease; it aims to reduce the incidence of disease. It involves interventions that are applied before there is any evidence of disease or injury. Examples include protection against the effects of a disease agent, as with vaccination

Changes and Common Findings seen in the Geriatric Population

Constipation NOT Pain Mobility Strength/Flexibility/Speed Chronic Disease Prevalence Rates Disabilities Polypharmacy Potential

Assessing Radial Pulse, What do You do if it is Irregular

Count for a full minute. As you begin the counting interval, start your count with "zero" for the first pulse felt. The second pulse felt is "one," and so on. Assess the pulse, including (1) rate, (2) rhythm, and (3) force

How to Assess for Possible Kidney Stones

Crystals of Calcium Oxalate or Uric Acid Pass to Ureter = Urgent Care because of obstructed urine flow Severe Abdominal Pain Nausea Vomiting Hematuria Blood Test--> Increased Calcium or Uric Acid Levels Urine Test Imaging

Glasgow Coma Scale

Determine level of Consciousness *Eye Opening 1 to 4 *Motor Response 1 to 6 *Verbal Response 1 to 5

Pressure Ulcers

Develop over bony prominence, when circulation is impaired. (heel, ischium, sacrum, elbow, scapula, vertebra) Stage One: Intact skin appears red but unbroken, no blanching Stage Two: Partial thickness skin erosion with loss of epidermis or dermis (superficial ulcer looks shallow and blistered/red/pink) Stage Three: Full thickness pressure ulcer, extending into the subcutaneous tissue (crater), see fat but no muscles, bone, or tendon Stage Four: Full thickness ulcer involves all skin layers and extends into supporting tissue (muscles, bone, or tendon)

Gout Risk Factors

Diet: Meat/Seafood/Sweetened beverages/fruit sugar beverages Obesity Medications Family History Male > Female Surgery or Trama

Therapeutic Communication

Facilitation • Encourages client to say more • Shows person you are interested Silence • Communicates that client has time to think • Silence can be uncomfortable for novice examiner, but interruption can make client lose his or her train of thought • Provides you with chance to observe client and note nonverbal cues Reflection • Echoes client's words by repeating part of what person has just said • Can help express feelings behind words • Mirroring client's words can help person elaborate on problem Empathy • Names a feeling and allows its expression • Allows person to feel accepted and strengthens rapport • Useful in instances when client hasn't identified the feeling or isn't ready to discuss it Clarification • Useful when person's word choice is ambiguous or confusing • Summarize person's words, simplify the statement, and ensure that you are on the right track Confrontation • Clarifying inconsistent information • Focusing client's attention on an observed behavior, action, or feeling Interpretation • Links events, makes associations, and implies cause • Not based on direct observations but instead on inference or conclusion • Your interpretation may be incorrect but helps prompt further discussion Explanation • Informing person • Sharing factual and objective information Summary • Condenses facts and validates what was discussed during the interview • Signals that termination of interview is imminent • Both client and examiner should be active participants

Barriers to Communication

Factors that distort, disrupt, or even halt successful communication

Gross Hearing

Frequency test with headphones

Preauricular

Front of ear

Anterior Cervical

Front of neck

Tension Headache

Headache of musculoskeletal origin; may be a mild-to-moderate, less disabling form of migraine Usually both sides, across frontal, temporal, and/or occipital region of head: forehead, sides, and back of head Band-like tightness, Vise-like Non-throbbing, Non-pulsatile Gradual onset, lasts 30 minutes to days Diffuse, dull aching pain Mild-to-moderate pain Situational, in response to overwork, posture Stress, anxiety, depression, poor posture Not worsened by physical activity Fatigue, anxiety, stress Sensation of a band tightening around head, of being gripped like a vice Sometimes photophobia or phonophobia Rest, massaging muscles in area, NSAID medication

Bronchial Breath Sound, Where is it Heard

High Loud Inspiration < expiration Harsh, hollow tubular Trachea and larynx

Range of Motion (ROM) of Shoulders

Inspect and compare both shoulders posteriorly and anteriorly. Check the size and contour of the joint and compare shoulders for equality of bony landmarks. Normally no redness, muscular atrophy, deformity, or swelling is present. Check the anterior aspect of the joint capsule and the subacromial bursa for abnormal swelling Test ROM by asking the person to perform four motions. Cup one hand over the shoulder during ROM to note any crepitation; normally none is present Test the strength of the shoulder muscles by asking the person to shrug the shoulders, flex forward and up, and abduct against your resistance. The shoulder shrug also tests the integrity of cranial nerve XI, the spinal accessory.

Range of Motion (ROM) of the Cervical Spine

Inspect the alignment of head and neck. The spine should be straight, and the head erect. Palpate the spinous processes and the sternomastoid, trapezius, and paravertebral muscles. They should feel firm, with no muscle spasm or tenderness • Touch chin to chest. Flexion of 45 degrees • Lift the chin toward the ceiling. Hyperextension of 55 degrees. • Touch each ear toward the corresponding shoulder. Do not lift the shoulder. Lateral bending of 40 degrees • Turn the chin toward each shoulder. Rotation of 70 degrees

Range of Motion (ROM) of Wrist and Hand

Inspect the hands and wrists on the dorsal and palmar sides, noting position, contour, and shape. The normal functional position of the hand shows the wrist in slight extension. This way the fingers can flex efficiently, and the thumb can oppose them for grip and manipulation. The fingers lie straight in the same axis as the forearm. Normally no swelling or redness, deformity, or nodules are present. Palpate each joint in the wrist and hands. Facing the person, support the hand with your fingers under it and palpate the wrist firmly with both of your thumbs on its dorsum (Fig. 22-23). Make sure that the person's wrist is relaxed and in straight alignment. Move your palpating thumbs side to side to identify the normal depressed areas that overlie the joint space. Use gentle but firm pressure. Normally the joint surfaces feel smooth, with no swelling, bogginess, nodules, or tenderness • Bend hand up at wrist. Hyperextension of 70 degrees • Bend hand down at wrist. Palmar flexion of 90 degrees • Bend fingers up and down at metacarpophalangeal joints. Flexion of 90 degrees. Hyperextension of 30 degrees • With palms flat on table, turn them outward and in. Ulnar deviation of 50 to 60 degrees and radial deviation of 20 degrees • Spread fingers apart; make a fist. Abduction of 20 degrees; fist tight. The responses should be equal bilaterally • Touch thumb to each finger and to base of little finger. The person is able to perform, and the responses are equal bilaterally

Range of Motion (ROM) of Elbow

Inspect the size and contour of the elbow in both flexed and extended positions. Look for any deformity, redness, or swelling. Check the olecranon bursa and the normally present hollows on either side of the olecranon process for abnormal swelling Palpate with the elbow flexed about 70 degrees and as relaxed as possible. Use your left hand to support the person's left forearm and palpate the extensor surface of the elbow—the olecranon process and the medial and lateral epicondyles of the humerus—with your right thumb and fingers • Bend and straighten the elbow. Flexion of 150 to 160 degrees; extension at 0. Some healthy people lack 5 to 10 degrees of full extension, and others have 5 to 10 degrees of hyperextension • Movement of 90 degrees in pronation and supination. Hold the hand midway; then touch front and back sides of hand to table

Range of Motion (ROM) of Ankle and Foot

Inspect while the person is in a sitting, non-weight-bearing position and when standing and walking. Compare both feet, noting position of feet and toes, contour of joints, and skin characteristics. The foot should align with the long axis of the lower leg; an imaginary line would fall from midpatella to between the first and second toes. • Point toes toward the floor. Plantar flexion of 45 degrees. • Point toes toward the nose. Dorsiflexion of 20 degrees • Turn soles of feet out, then in. (Stabilize ankle with one hand and hold heel with the other to test the subtalar joint.) Eversion of 20 degrees. Inversion of 30 degrees • Flex and straighten toes

Abdominal Assessment

Inspect, Auscultate, Percussion, Palpte *Tenderness *Lesions *Bowel Sounds *Palpate some (not all) organs *Shape (round, flat, scaphoid (sunken), protuberant) *Bowel Movement quality and history

Right Upper Quadrant (RUQ) Organs

Liver Gallbladder Duodenum Head of Pancreas Right Kidney & Adrenal Splenic Flexure of Colon Part of Transverse & Descending Colon

Viewing Tympanic Membrane in the Adult and Child

Look for pearly grey tympanic membrane Adults: Up and Back Child: Down and Back

Vesicular, Where is it Heard

Low Soft Inspiration > expiration Rustling, like the sound of the wind in the trees Over peripheral lung fields where air flows through smaller bronchioles and alveoli

Colon Cancer Modifiable vs Non-Modifiable Risk Factors

MODIFIABLE: Diet (obesity) Physical Activity Obesity Smoking Alcohol Use Low Fiber Intake NON-MODIFIABLE: Age Personal History Family History Race

Posterior Auricular

Mastoid- Superficial to the mastoid process

Bronchovesicular, Where is it Heard

Moderate Moderate Inspiration = expiration Mixed Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in 1st and 2nd intercostal spaces

Risk Factors for Breast Cancer (modifiable and non-modifiable)

Modifiable: Alcohol Consumption Physical Activity Diet Non-Modifiable Genetics White Women increase >45 years old African American increase <45 years old Hormone Therapy Income because of increased mammogram screening

Comminuted Fracture

Not clean, small pieces, broke in two or more places

What is Included in a Comprehensive Diet History

Nutritional Assessment *Diet History *Clinical Information *Physical Exam *Anthropocentric Measures *Lab Tests *Physical Activity *Questionnaire *24 Hour Recall *Food Diary

Assessing Skin of a Dark Skinned Individual

PALLOR Anemia/Shock-Brown skin appears yellow-brown, dull; black skin appears ashen gray, dull; skin loses its healthy glow—Check areas with least pigmentation such as conjunctivae, mucous membranes Local arterial insufficiency- Ashen gray, dull; cool to palpation Albinism (Total absence of pigment melanin throughout the integument)- Tan, cream, white CYANOSIS Increased amount of unoxygenated hemoglobin Central (Chronic heart and lung disease cause arterial desaturation)- Dark but dull, lifeless; only severe cyanosis is apparent in skin (Check conjunctivae, oral mucosa, nail beds) ERYTHEMA Hyperemia (Increased blood flow through engorged arterioles such as in inflammation, fever, alcohol intake, blushing)- Purplish tinge but difficult to see; palpate for increased warmth with inflammation, taut skin, and hardening of deep tissues Polycythemia (Increased red blood cells, capillary stasis)- Well concealed by pigment; check for redness in lips Carbon monoxide poisoning- Cherry-red color in nail beds, lips, and oral mucosa Venous stasis (Decreased blood flow from area, engorged venules)- Easily masked; use palpation for warmth or edema JAUNDICE Increased serum bilirubin, more than 2 to 3 mg/100 mL from liver inflammation or hemolytic disease such as after severe burns, some infections- Check sclera for yellow near limbus; do not mistake normal yellowish fatty deposits in the periphery under the eyelids for jaundice; jaundice best noted in junction of hard and soft palate and also palms Carotenemia—Increased serum carotene from ingestion of large amounts of carotene (rich foods)- Yellow/orange tinge in palms and soles Uremia (Renal failure causes retained urochrome pigments in the blood)- Easily masked; rely on laboratory and clinical findings BROWN-TAN Addison disease (Cortisol deficiency stimulates increased melanin production)-Easily masked; rely on laboratory and clinical findings

Left Lower Quadrant (LLQ) Organs

Part of Descending Colon Sigmoid Colon Left Ovary & Tube Left Ureter Left Spermatic Cord

Greenstick Fracture

Partial break in soft bone (children)

Preparing to Meet Your Client

Past History Data Supplies Purpose for the appointment

Components of the General Survey

Physical Appearance Body Structure Mobility Behavior Measurements Vital Signs

Plantar Reflex

Plantar Reflex (L4 to S2). Position the thigh in slight external rotation. With the reflex hammer draw a light stroke up the lateral side of the sole of the foot and inward across the ball of the foot, like an upside-down J. The normal response is plantar flexion of the toes and inversion and flexion of the forefoot

Posterior Cervical

Posterior triangle along the edge of the trapezius muscle (back of neck)

Respiratory Assessment

Sit and lean slightly forward Deep Breaths Listen side to side 6 spots each side 2 axillary spots each side

Osteoporosis Risk Factors

Steroid Use Female Family History

Left Upper Quadrant (LUQ) Organs

Stomach Spleen Left Lobe of Liver Body of Pancreas Left Kidney and Adrenal Splenic Flexor of Colon Part of Transverse & Descending Colon

Caregiver Strain

Stress from Care--> Demands Exceed Resources Difficulties Assuming & Functioning in that Role--> the Emotional/Physical Health Fatigue

Common Errors When Taking Blood Pressure

Taking blood pressure reading when person is anxious or angry or has just been active- Falsely high- Sympathetic nervous system stimulation Above level of heart- Falsely low- Eliminates effect of hydrostatic pressure Below level of heart- Falsely high- Additional force of gravity added to brachial artery pressure Person supports own arm- Falsely high diastolic- Sustained isometric muscular contraction Faulty leg position (e.g., person's legs are crossed)- Falsely high systolic and diastolic- Translocation of blood volume from dependent legs to thoracic area Cuff too narrow for extremity- Falsely high-Needs excessive pressure to occlude brachial artery Cuff wrap is too loose or uneven, or bladder balloons out of wrap- Falsely high- Needs excessive pressure to occlude brachial artery Inflating cuff not high enough- Falsely low systolic- Misses initial systolic tapping or may tune in during auscultatory gap (tapping sounds disappear for 10 to 40 mm Hg and then return; common with hypertension) Inflating cuff too high- Pain Pushing stethoscope too hard on brachial artery- Falsely low diastolic- Excessive pressure distorts artery, and sounds continue Too quickly- Falsely low systolic or falsely high diastolic- Insufficient time to hear tapping Too slowly- Falsely high diastolic- Venous congestion in forearm makes sounds less audible Halting during descent and reinflating cuff to recheck systolic- Falsely high diastolic- Venous congestion in forearm Failure to wait 1-2 min before repeating entire reading- Falsely high diastolic- Venous congestion in forearm Examiner's "subconscious bias"; a preconceived idea of what BP reading should be because of person's age, race, gender, weight, history, or condition- Error anywhere- Never assume that because a person appears healthy, his or her BP will be within normal limits Examiner's haste Faulty technique Examiner's digit preference; "hears" more results that end in zero than would occur by chance alone (e.g., 130/80) Diminished hearing acuity Defective or inaccurately calibrated equipment- Error anywhere

Religion

The belief in a divine or superhuman power or powers to be obeyed and worshiped as the creator(s) and ruler(s) of the universe and a system of beliefs, practices, and ethical values

What is Occurring During Systole (parts involved)

The maximum pressure felt on the artery during left ventricular contraction

What is Occurring During Diastole (parts involved)

The part of the cardiac cycle when the heart refills with blood following systole (contraction). Ventricular diastole is the period during which the ventricles are filling and relaxing, while atrial diastole is the period during which the atria are relaxing.

Range of Motion (ROM) of Knee

The person should remain supine with legs extended, although some examiners prefer the knees to be flexed and dangling for inspection. The skin normally looks smooth, with even coloring and no lesions. • Bend each knee. Flexion of 130 to 150 degrees • Extend each knee. A straight line of 0 degrees in some people; a hyperextension of 15 degrees in others • Check knee ROM during ambulation • (optional) If able, squat and try a duck walk. Duck walk shows intact ligaments and no effusion or arthritis

Location of Heart Valves

The two atrioventricular (AV) valves separate the atria and the ventricles. The right AV valve is the tricuspid, and the left AV valve is the bicuspid or mitral valve (so named because it resembles a bishop's mitered cap).

Triceps Reflex

Triceps Reflex (C7 to C8). Tell the person to let the arm "just go dead" as you suspend it by holding the upper arm. Strike the triceps tendon directly just above the elbow. The normal response is extension of the forearm. Alternatively hold the person's wrist across the chest to flex the arm at the elbow and tap the tendon

Testicular Cancer Risk Factors

Undescended Testicles Tall No Physical Exercise Increased Calcium Intake African American Family History Agent Orange

Cultural Assessment

Used to identify beliefs, values, and health practices that may help or hinder nursing interventions Must first understand your own culture Understanding barriers such as language, religious practices, comfort-ability of male/female care What is health to them

Range of Motion (ROM) of Hip

Wait to inspect the hip joint together with the spine a bit later in the examination as the person stands. At that time note symmetric levels of iliac crests, gluteal folds, and equally sized buttocks. A smooth, even gait reflects equal leg lengths and functional hip motion. • Raise each leg with knee extended. Hip flexion of 90 degrees • Bend each knee up to the chest while keeping the other leg straight. Hip flexion of 120 degrees. The opposite thigh should remain on the table • Flex knee and hip to 90 degrees. Stabilize by holding the thigh with one hand and the ankle with the other hand. Swing the foot outward. Swing the foot inward. (Foot and thigh move in opposite directions.) Internal rotation of 40 degrees. External rotation of 45 degrees • Swing leg laterally, then medially, with knee straight. Stabilize pelvis by pushing down on the opposite anterior superior iliac spine. Abduction of 40 to 45 degrees. Adduction of 20 to 30 degrees • When standing (later in examination), swing straight leg back behind body. Stabilize pelvis to eliminate exaggerated lumbar lordosis. The most efficient way is to ask person to bend over the table and support the trunk on the table. Or the person can lie prone on the table. Hyperextension of 15 degrees when stabilized.

Range of Motion (ROM) of the Temporomandibular

With the person seated, inspect the area just anterior to the ear. Place the tips of your first two fingers in front of each ear and ask the person to open and close the mouth. Drop your fingers into the depressed area over the joint and note smooth motion of the mandible. An audible and palpable snap or click occurs in many healthy people as the mouth opens • Open mouth maximally. Vertical motion. You can measure the space between the upper and lower incisors. Normal is 3 to 6 cm or three fingers inserted sideways • Partially open mouth, protrude lower jaw, and move it side to side. Lateral motion. Normal extent is 1 to 2 cm • Stick out lower jaw. Protrude without deviation Palpate the contracted temporalis and masseter muscles as the person clenches the teeth. Compare right and left sides for size, firmness, and strength. Ask the person to move the jaw forward and laterally against your resistance and open mouth against resistance. This also tests the integrity of cranial nerve V