First assesment Exam chapters 2-5/8-13 in no particular order (10/11 still not done)

Preperation: The infant

1-2 hours after feeding, maintain warm environment(neonatal will need radiant heater) Have infant in diaper, make sure hands and tools are warm, use a soft voice and smile at the infant a lot, maintain eye contact when established, maintain smooth motions, offer toys as distraction, let infant touch non-dangerous tools.

24 hour diet recall

24 hour diet recall has four sources of errors. First, the individual or family member may not be able to recall the type or amount of food eaten. Second, intake within the last 24 hours may be atypical of usual intake. Third, the individual or family member may alter the truth for a variety of reasons. Fourth, snack items and the gravies, sauces, and condiments may be under reported. It is important to also prompt the individual to report liquid intake as some individuals will omit drinks and simply report food consumed.

Preperation: The Adolecent

Adolescent will need feedback that their body is developing normally, dont treat like a child, however dont overestimate and treat like an adult

Pulse Rate

Be aware that many medications and drugs affect heart rate, such as caffine. In resting adult, normal heart rate rangeis 60 to 100 beats per minute (bpm). Rate normally varies with age. More rapid in infancy and childhood and moderate during adult and older years Rate also varies with gender; after puberty, females have slightly faster rate than males. In adult, a heart rate less than 60 bpm is bradycardia. This occurs normally in well-trained athletes whose heart muscle develops along with skeletal muscles. Stronger, more efficient heart muscle pushes out a larger stroke volume with each beat, thus requiring fewer beats per minute to maintain a stable cardiac output. A more rapid heart rate, over 100 bpm, is tachycardia. Occurs normally with anxiety or with increased exercise to match body's demand for increased metabolism

Dealing with culture

Becoming a culturally competent practitioner: cultural competency includes the attitudes, Knowledge, and Skills necessary for providing quality care to diverse populations. Culturally sensitive: implies that caregivers possessed some basic knowledge of in constructive attitudes toward the diverse cultural population found in the setting in which they're 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 situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences. Completing a cultural assessment: lack of cultural knowledge has long been identified as a challenge to providing high-quality Healthcare. categorical cultural knowledge related to language, food preferences, religion, and Healthcare beliefs is limiting. Cultural sensibility: is the deliberate proactive Behavior by Healthcare Providers to examine cultural situations through thoughtful reasoning, responsiveness, and discrete interactions. Cultural assessment: keep in mind that all domains may not be appropriate given your setting. However, each of the domains is an important component of understanding culture. Heritage, Health practices, communication, family roles and social orientation, nutrition, pregnancy birth childbearing, spirituality religion, death, and health providers are all aspects about a patient that should be considered Spiritual assessment: an easy-to-use spiritual assessment tool is FICA. Faith, importance would be do you consider yourself spiritual or religious? Influence, what importance does your faith or belief have in your life? Community are you part of a spiritual or religious community? Address and or action how should I address these issues in your Healthcare?

Past Health

Childhood illnesses: measles, mumps, rubella, chicken pox, 4 to 6, and strep throat. Ask about serious illnesses that may have effect for the person in later years. Accidents or injuries: auto accidents, fractures, penetrating wounds, head injuries, and burns. Serious or chronic illnesses: asthma, depression, diabetes, hypertension, heart disease, HIV, sickle cell anemia, cancer, seizure disorders. Hospitalizations: cause, name of Hospital, how the condition was treated, how long a person was hospitalized, in the name of the position. Operations: type of surgery, date, name of the surgeon, name of the hospital, and how the person recovered. Obstetric history: number of pregnancies, a number of deliveries in which the fetus reach full term, number of preterm pregnancies, a number of incomplete pregnancies, and number of children living. Immunisations: routinely assessed vaccination history nerds the recommended vaccines. Last examination date: physical, dental, vision, hearing, chest x-ray, mammogram, Pap test, stool culture, serum blood cholesterol. Allergies: note both the allergen and the reaction. For drug allergies, list only those that are true allergic reactions, not unpleasant side effects. Current medications: medication reconciliation is comparing a list of current medications with a previous list, which is done a

Preperation: The toddler

Children age 1-2 understand symbols, may require blanket or stuffed animal, Introduce yourself to both caregiver and child, however ignore the child for the first bit so they may size you up. Dont ask for permission from this age group, they will often say no to anything and continuing will lose trust, instead give them kind but firm orders. Praise the child when they are cooperative.

Sequence: The Toddler

Collect some data during history. While focusing on caregiver, note toddler's gross and fine motor skills. Start with nonthreatening areas, saving distressing procedures till the end.

Vital Signs: Temperature

Core temp should be 99F or 37.2C, Body maintains steady temperature through feedback mechanismregulated in hypothalamus of brain. oral temp should be 35.8C to 37.3C (96.4F to 99.1F), Rectal temp should be 0.4-0.5C above an oral measurement. Diurnal cycle of 1° F to 1.5° F, with trough occurring in early morning hours and peak occurring in late afternoon to early evening Menstruation cycle in women:progesterone secretion, occurring with ovulation at midcycle, causes a 0.5° F to 1.0° F rise in temperature that continues until menses Exercise:moderate to hard exercise increases body temperature Age:wider normal variations occur in infant and young child due to less effective heat control mechanisms; in older adults, temperature usually lower than in other age groups, with a mean of 36.2° C (97.2° F)

Skin abnormalities 3 (the dry ones this time)

Crust: the thickened, dried-out exudate left when vesicles/postulates burst or dry up. Color can be red-brown, honey, or yellow. Examples are impetigo, weeping, eczematous dermatitis, scab after abrasion. Scale: compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of excess dead keratin cells. Examples after scarlet fever or drug reaction, seborrheic dermatitis, eczema, ichthyosis. Fissure: linear crack with abrupt edges, extends into dermis, dry or moist. Examples are cheilosis-at corners of mouth caused by excess moisture; athletes foot. Erosion: scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without scar because erosion does not extend into dermis. Ulcer: deeper depression extending into dermis, irregular shape, may bleed, leaves scar when heals, examples are status ulcer, pressure injury, chancre.

Hypopoituitary Dwarfism

Defiiency in growth hormone in childhood stunts growth

Demographic of USA

Demographic profile of the United States: the estimates of the USA population illustrate the increasing diversity in a population and highlight the importance of cultural competence in healthcare. Immigration: immigrants are people who are not USA citizens at birth.

Mental status

DEFINING MENTAL STATUS - Mental status is a person's emotional and cognitive function. Mental health is a state of well-being in which every individual realizes his or her own potential, can cope with normal stresses of Life, can work productively and fruitfully, and is able to make a contribution to her or his community. mental status cannot be scrutinized directly like the characteristics of skin or heart sounds. It's functioning is in 4 through assessment of individuals Behavior. Mental disorder: is apparent when a person's response is much greater than expected reaction to a traumatic life of it. Major depression is characterized by feelings that are unrelenting or include delusional or suicidal thinking, Feelings of low self-esteem or worthlessness, or loss of ability to function. Organic disorders: brain disease of known specific origin, delirium, dementia, alcohol and drug intoxication, and withdraw. Psychiatric mental disorders: in which an organic etiology has not yet been established. Consciousness: being aware of One's Own existence, feelings, and thoughts of the environment. This is the most Elementary of mental status functions. Language: using the boys to communicate one's thoughts and feelings. This is a basic to love humans, and it's lost has a heavy social impact on the individual. Mood and affect: both of these elements deal with a prevailing feelings. Effect is a temporary expression of feelings or state of mind, and mood is more durable, a prolonged display of feelings that cold color the whole emotional life. Orientation: the awareness of the objective World in relation to the self, including person, place, and time. Attention: the power of concentration, and the ability to focus on one specific thing without being distracted by many environmental stimuli. Memory: the ability to lay down and store experiences and perceptions for later recall. Remote memory brings up years worth of experiences. Abstract reasoning: pondering a deeper meaning beyond the concrete and literal. Thought process: the way a person thinks The Logical train of thought. Thought content: what the person thinks, specific ideas, beliefs, the use of words. Perceptions: and awareness of objects through the five senses. Emotional and cognitive functioning mature progressively from simple reflex behavior in a complex logical and abstract thought. Age-related changes in sensory perception can affect mental status. For example, vision loss may result in apathy, social isolation, and depression. Hearing changes are common in older adults. Age-related hearing loss involves high frequency sound. Continents are high frequency sounds: therefore, older people who have difficulty hearing them have problems with normal conversation. This problem produces frustration, suspicion, and social isolation and may make the person look confused.

The Aging adult

During later years the tasks are to develop the meaning of life in one's own existence and to adjust to changes and physical strength and health.

Sequence: The Preschooler

Examine thorax, abdomen, extremities and genitalia first, check head, eye, ear, nose, and throat last.

Force of Pulse

Force of pulse is strength of heart's stroke volume. Weak, thready pulse reflects a decreased stroke volume (e.g., as occurs with hemorrhagic shock). Full, bounding pulse denotes increased stroke volume, as with anxiety, exercise, and some abnormal conditions. Pulse force recorded using three-point scale•3+ Full, bounding•2+ Normal•1+ Weak, thready•0 Absent

Skin abnormalities

General shock, cardiac arrest, peripheral arterial insufficiency, raynaud disease, and hyperthyroidism causes change in skin temperature. Hyperthyroidism and hypothyroidism cause change in skin texture. Diaphoresis that occurs with thyrotoxicosis, heart attack, anxiety, and pain causes change in skin moisture. This is through the process called diaphoresis. Dehydration will also cause change in skin moisture. Mobility is decreased with edema. Poor turgor is evident in severe dehydration or extreme weight loss. When skin is pinched it tents.

Othostatic Procedure

Have person rest supine for 2 or 3 minutes, take baseline readings of pulse and BP, and then repeat with person sitting and then standing. For person who is too weak or dizzy to stand, assess BP supine and then sitting with legs dangling.Record BP by using even numbers.Also record person's position, arm used, and cuff size, if different from standard adult cuff.Record pulse rate and rhythm, noting whether pulse is regular.

The interview: Interviewing people with special needs

Hearing impaired people: as the population ages, you will encounter more people who are deaf or hard-of-hearing. Ask the person his or her preferred way to communicate by singing, lip reading, or writing. If the person has hearing aid, make sure that he or she is using them properly. A complete health history of someone who is deaf requires a sign language interpreter. If a person prefers lip reading, be sure to face him or her squarely and have good listening on your face. written communication is he fishing in sections such as path health history or review of systems winforms can easily be used. Acutely three people: emergency situations require combining the interview with a physical examination. A hospitalized person with a critical or severe illness is usually too weak, Too Short breath, or too much pain to talk. The person will react according to preconceived ideas about what a serious illness means: the Sandy thing you say should be direct and precise. People under the influence of street drugs or alcohol: it is common for people under the influence of alcohol or other mood-altering drugs to be admitted to the hospital. All of these drugs affect the central nervous system, increase risk for overdose, accidents, and injuries. Also, chronic alcohol or drug use creates complex medical problems that require more care. You top priority is to find out the time of the person's last drink or drug, how much he or she took, and the name of each drug that was taken. Personal questions: occasionally people will ask you questions about your personal life or opinions. You do not need to answer every question. Be where there may be an ulterior motive to the questions, such as anxiety or loneliness. Try redirecting your response back to the person's frame of reference. Sexually aggressive people: on some occasions personal questions extend to flirtatious compliments, seductive innuendos, or sexual advances. Your response must make it clear that you are a health professional who can best care for the person by maintaining a professional relationship. Crying: a beginning examiner may feel uncomfortable when the client starts to cry, but crying is a big relief to a person. Sometimes you're can look as if he or she is on the verge of tears but is trying hard to suppress them. Again, instead of moving on to something new, acknowledge the expression by saying "you look sad." Anger: occasionally you'll try to interview a person who's already angry. Do ask about the anger in here the person out. Deal with the angry feelings before you ask anything else. An angry person Cannot Be an Effective participant in a health interview. Threats of violence: over 70% of nurses report physical or verbal abuse in the workplace, and this number is likely due to Under reporting of incidents of violence. If you sense any suspicious or threatening behaviour, act immediately to diffuse the situation, or obtain additional support from others. Anxiety: finally take it for granted that nearly all sick people have some anxiety.

Lifestyle Modifications, Lifestyle Modifications

Hypotension Seen in acute myocardial infarction (AMI), shock, hemorrhage, vasodilation, and/or Addison's disease Essential or primary HTNBP Pressure Guidelines •ACC/AHA Task Force•JNC-8 Guidelines Cardiovascular risk stratification•Major risk factors impacting target organs •Smoking, dyslipidemia, diabetes mellitus, above 60 years of age, gender (men and postmenopausal women), and family history of cardiac disease Abnormal Findings Associated with Vital Signs Copyright Prevention and management Weight loss Limit alcohol use Increase aerobic exercise activity pattern Reduce sodium intake Maintain adequate sources of dietary potassium, calcium and magnesium Smoking cessation Reduce intake of saturated fats and cholesterol

Sequence: The infant

If baby is sleeping get heart lung and abdominal sounds before waking up.

Doppler Techniques

In many situations, pulse and BP measurement is enhanced by using an electronic device, Doppler ultrasonic flow meter.Technique works by a principle that sound varies in pitch in relation to distance between sound source and listener: pitch is higher when distance is small, and pitch lowers as distance increases.In this case, sound source is blood pumping through artery in rhythmic manner.Handheld transducer picks up changes in sound frequency as blood flows and ebbs, and it amplifies them.

Diffent forms of communication

Interprofessional communication: is communication that occurs between two or more individuals from different Health Professions. Ineffective interprofessional communication has been linked to delays and treatment, medication errors, misdiagnosis, patient injury, and death. Standardized communication: standardized communication formats are becoming more popular in the healthcare setting. Situation, background, assessment, recommendation. this was first developed by the United States military to standardize communication prevent misunderstandings it is called sbar.

The Procedure Doppler Techniques

Listener hears whooshing pulsatile beat. Doppler technique is used to locate peripheral pulse sites. For BP measurement, Doppler technique augments Korotkoff sounds. Through this technique, you can evaluate sounds that are hard to hear with a stethoscope, such as those in critically ill individuals with a low BP, in infants with small arms, and in obese persons in whom sounds are muffled by layers of fat. Also, proper cuff placement is difficult on obese person's cone-shaped upper arm. In this situation, you can place cuff on more even forearm and hold Doppler probe over radial artery.Copyright For either location, use the following procedure: Apply coupling gel to transducer probe. Turn Doppler flow meter on. Touch probe to skin, holding probe perpendicular to artery. A pulsatile whooshing sound indicates location of artery. May need to rotate probe, but maintain contact with skin. Do not push probe too hard or you will wipe out pulse. Inflate cuff until sounds disappear; then proceed another 20 to 30 mm Hg beyond that point. Slowly deflate cuff, noting point at which first whooshing sounds appear; this is systolic pressure.

Lesions and red dots (sue me im tired)

Macule: solely a color change, flat and circumscribed, of less than 1cm. Examples: freckles, flat, nevi, hypopigmentation, petechiae, measles, scarlet fever. Papule: something you can fel. Caused by superficial thickening in epidermis. Lichen planus, molluscum, and wart. Plaque: papules coalesce to form surface elevation wider than 1 cm. Examples are psoriasis and lichen planus. Nodule: solid, elevated, hard or soft, larger than 1 cm. May extend deeper into the dermis than papule. Examples are xanthoma, fibroma, and intradermal nevi. Tumor: larger than a few centimeters in diameter, firm or soft, deeper into dermis: may be benign or malignant, although tumor implies cancer to most people. Lipoma hemangioma. Wheal: superficial, raised, transient, and erythematous: slightly irregular shape from edema (fluid held diffusely in the tissue). Examples are mosquito bites, allergic reactions, dermographism. Vesicle: elevated cavity containing free fluid, up to 1cm blister. Clear serum flows if wall is ruptured. Examples are herpes simplex, early varicella, herpes zoster (shingles), contact dermatitis. Pustule: turbid flow (pus) in the cavity. Circumscribed and elevated. Impetigo and acne.

More Skin abnormalities

Mongolian spot: is a common variation of hyperpigmentation in african0-american, asian, american indian, and latino newborns. It is a blue black macular area at the sacrum or buttocks, but sometimes on the abdomen, thighs, shoulders, or arms. Cafe au lait spot: a large, round or oval patch of light brown pigmentation that is usually present at birth. Erythema toxicum: a common rash that appears in the first 3 to 4 days of life and consists of tiny punctate red macules and papules on the cheeks, trunk, chest, back, and buttocks. The cause is unknown, and no treatment is needed. Cutis marmorata: a transient mottling in the trunk and extremities in response to cool room temperatures. It forms a reticulated red or blue pattern over the skin. Physiologic jaundice: a yellowing of the skin, sclera, and mucous membranes that develops after the third or fourth day of life and is due to red blood cell hemolysis that occurs after birth. When the Hb of the destroyed red blood cells is metabolized by the liver and spleen, its pigment is converted to bilirubin. Milia: This is a common variation that resolves spontaneously within a few weeks. Tiny white papules on the cheeks, forehead, and across the nose and chin due to sebum that occludes the opening of the follicles.

Health risks due to dietary flaws

Obesity: is when someone is 20 percent above ideal body weight. In most cases a small caloric surplus over a long period results in extra weight. Obesity causes risk of hypertension, increased serum levels, and increased triglycerides. Marasmus: is caused by inadequate protein intake of protein and calories or prolonged starvation. Anorexia, bowel obstruction, cancer, cachexia, and chronic illness are among the clinical conditions leading to marasmus. Visceral protein levels may remain within normal ranges. Kwashiorkor: caused by diets high in calories but little or no protein (liquid diets, fad diets, and long term use of dextrose containing). In contrast to individuals with marasmus, those with kwashiorkor have decreased visceral protein levels but adequate anthropometric measures. They may appear well nourished or even obese. Marasmus/kwashiorkor mix: is caused by prolonged inadequate intake of protein and calories such as severe starvation and severe catabolic states. Nutritional assessment findings include muscle, fat, and visceral protein wasting. Individuals have usually undergo acute catabolic stress such as major surgery, trauma, or burns in combination with prolonged starvation or have aids wasting. Without nutritional support, this type of malnutrition is associated with the highest risk for morbidity and mortality.

Optimal Nutrition

Optimal nutrition status is achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands caused by growth, pregnancy, or illness. People having optimal nutritional status are more active, have fewer physical illnesses, and live longer than people who are malnourished.

Measurement of Oxygen Saturation

Pulse oximeter: a noninvasive method to assess SpO2 Sensor attached to person's finger or ear lobe has diode that emits light and detector measures relative amount of light absorbed by HbO2 and unoxygenated (reduced) Hb. Compares ratio of light emitted to light absorbed and converts this ratio to percentage of oxygen saturationCopyright Healthy person with no lung disease and no anemia normally has an SpO2 of 97% to 98%. Select appropriate pulse oximeter probe. Finger probe spring loaded and feels like clothespin attached to finger but does not hurt. At lower oxygen saturations, ear lobe probe more accurate and less affected by peripheral vasoconstriction.

Pulse

Pulse: palpable flow felt in the periphery as a result of pressure wave generation from stroke volume. Provides indicator of rate and rhythm of heartbeat as well as local data on condition of artery Palpation techniqueUsing pads of the first three fingers, palpate radial pulse at flexor aspect of wrist laterally along radius bone until strongest pulsation is felt. If rhythm is regular, count number of beats in 30 seconds and multiply by 2. The 30-second interval is most accurate and efficient when heart rates are normal or rapid and when rhythms are regular. For irregular pulse, count for full minute.

Culture and genetics as it pertains to health history

Review of systems: the purpose of the section our first, to evaluate the past and present health of each body system. Second, to double-check in case any significant data were omitted in the present illness section. Third, to evaluate health promotion practices. Remember that the history should be limited to Patient statements or subjective data, factors that the person says were or were not present. General overall health State: present weight, fatigue, weakness or malaise, fever, chills, sweats or night sweats. Skin, hair, and nails: history of skin disease, pigmentation or color change, change in mole, excessive dryness or moisture, brightest, excessive bruising, rash or Lesion. nurse can engage in health promotion for sun exposure. Head: any and usually frequent are severe headache, and he head injury, dizziness, or vertigo. Eyes: difficulty with vision, eye pain, double vision, redness or swelling, watering or discharge, glaucoma or cataracts. Nurse May provide health promotion by encouraging patient to wear glasses. Ears: earaches, infections, discharge, and its characteristics, tonight is her where to go. Nurse May promote health promotion we're hearing aid use. Nose and sinuses: discharge and its characteristics, NE I'm usually frequent are severe cold, sinus pain, nasal obstruction, nosebleeds common allergies are hayfever, or change in sense of smell. Mouth and throat: mouth pain, frequent sore throat, bleeding gums, toothache, lesions in mouth or tongue, dysphagia, hoarseness or voice changing, tonsillectomy, alter taste. Nurse May promote dentures. Neck: pain, limitation of motion, lumps or swelling, and larger tendered notes, goiter. Breast: pain, lump, nipple discharge, rash, history of breast disease, any surgery on breast. nurse May encourage self examination of breasts. Axilla: tenderness, lump or swelling, rash. Respiratory system: history of lung disease such as asthma, emphysema, bronchitis, pneumonia, TB. Chest pain with breathing, wheezing or noisy breathing, shortness of breath, how much activity produces shortness of breath, cough, sputum, toxin air pollution exposure. Nurse can encourage chest x-ray. Cardiovascular: chest pain, pressure, tightness or fullness, palpitation, sinuses, dips Nia on exertion, Ortho apnea, paroxysmal nocturnal dyspnea, nocturia, edema, history of heart murmur, hypertension, coronary heart disease, anemia. Peripheral vascular: coldness, numbness and tingling, swelling of legs, discoloration in hands or feet, varicose veins are complications, intermittent claudication, thrombophlebitis. Gastrointestinal: appetite, food intolerance, dysphagia, heartburn, indigestion, pain, other abdominal pain, pyrosis, nausea and vomiting, history of abdominal disease, rectal conditions. Urinary system: frequency, urgency, nocturia, hasn't been serious training, history of urinary disease, pain in flank, groin. Male genital system: penis or testicular pain, sores or lesions, penile discharge, lumps, hernia. Female genital system: menstrual history, cycle and duration, NE amenorrhea or menorrhagia, premenstrual pain or dysmenorrhea, vaginal itching, discharge in his characteristics, age of menopause, menopausal signs or symptoms, postmenopausal bleeding. Sexual Health: begin with I asked all patients about their sexual health. Are you presently in a relationship involving intercourse? Ask about condoms, is there disparia, changes in direction or ejaculation, are contraceptive used, are you happy as your contraceptives, are you at risk for chlamydia, gonorrhea, herpes, venural warts. Musculoskeletal system: history of arthritis. Pain, stiffness, swelling, deformity, limitation of motion, north of the joint motion. Any pain, stiffness, back pain. Neurologic system: history of seizure disorder, stroke, fainting, blackouts. Sensory function, numbness, tingling. Cognitive function, memory disorder, recenter distant. Mental status, nervousness, mood change, depression, our history of mental health dysfunction or hallucinations. Suicide. Hematologic System: Bleeding tendency of skin or mucous membranes, excessive bruising, lymph node swelling, exposure to toxic agents or radiation, blood transfusion reactions. Endocrine system: history of diabetes or diabetic symptoms. History of thyroid disease, intolerance to heat and cold, change in skin pigmentation or Texture, excessive sweating, relationship between appetite and weight, abnormal hair distribution, nervousness, Tremors, and need for hormone therapy.

The procedure: Oral temp

Shake a mercury-free glass thermometer down to 35.5° C (96° F) and place it at base of tongue in either of posterior sublingual pockets; not in front of tongue. Instruct person to keep his or her lips closed. Leave in place 3 to 4 minutes if person is afebrile, and up to 8 minutes if febrile; take other vital signs during this time.Wait 15 minutes if person has just taken hot or iced liquids and 2 minutes if he or she has just smoked.

Postion: School-age

Should be sitting or lying on exam table, 5-8 usually have modesty but typically allow caregivers and siblings in room, 9-12 typically will be in room alone.

Postion: the Adolescent

Sitting on exam table, keep cloathing on as much as possible, examine adolescent alone

Belief

Spirituality: is a broader term focused on a connection to something larger than oneself and a belief in transcendence. Religion: refers to an organized system of beliefs concerning the cause, nature, and purpose of the universe, as well as the attendance of regular services. Religion is a shared experience of spirituality or the values, beliefs, and practices into which people either are born or that they may adopt to me their personal spiritual needs through communal actions, such as religious affiliation.

Nociceptors Fibers

Substantia gelatinosa:Specific area of cord in which fibers synapse with interneurons A cross section shows that gray matter of the spinal cord is divided into a series of consecutively numbered laminae (layers of nerve cells).Considered to be lamina II, which receives sensory input from various areas of bodyPain signalsthen cross over to other side of spinal cord and ascend to brain by anterolateral spinothalamic tract.

Othrostatic Vital Signs

Take serial measurements of pulse and blood pressure in the following situations: You suspect volume depletion. Person is known to have hypertension or taking antihypertensive medications. Person reports fainting or syncope. Position changed from supine to standing, normally slight decrease (less than 10 mm Hg) in systolic pressure may occur.

Preperation: School-age

Talk about family, school, sports, etc to break ice. Let child undress themselfs, demonstrate equipment, Comment on body on how it works, allow them to listen to heartbeat (its rewarding :))

Older Debt: Vital Signs

Temperature: changes in body's temperature regulatory mechanism leave aging person less likely to have fever but at greater risk for hypothermia Temperature is less reliable index of older person's true health state; sweat gland activity is also diminished. Pulse:normal range of heart rate is 60 to 100 bpm, but rhythm may be slightly irregular Radial artery may feel stiff, rigid, and tortuous in older person, although does not necessarily imply vascular disease in heart or brain. Increasingly rigid arterial wall needs faster upstroke of blood, so pulse is actually easier to palpate. The Aging Adult: Vital Signs. Respirations: aging causes decrease in vital capacity and decreased inspiratory reserve volume You may note shallower inspiratory phase and an increased respiratory rate.Blood pressure: aorta and major arteries tend to harden with age As heart pumps against a stiffer aorta, systolic pressure increases, leading to widened pulse pressure. In many older people, both systolic and diastolic pressures increase, making it difficult to distinguish normal aging values from abnormal hypertension.

The Interview: The Process of Communication

The vehicle that carries you and your client through the interview is communication. Sending: likely you are most aware of verbal communication which is the words you speak, vocalizations, the tone of voice. Nonverbal communication is as important as verbal communication. This is your body language, posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your chair. Receiving: your words and gestures must be interpreted by the receiver. To maximize your communication skills, first you need to be aware of internal and external factors and their influence. Your message can be Sabotage by the listeners bias or any preconceived notions. It takes mutual understanding by the sender and receiver to have successful communication. Internal factors: internal factors are those specific to you, the examiner. As you cultivate communication skills, you need to focus on the four inner factors of liking others, and empathy, the ability to listen, and self-awareness. Liking others: one essential factor for a successful entry into a helping profession is a genuine liking of other people. This means a generally optimistic view of people. And Assumption of strengths in a tolerance for weaknesses. An atmosphere of warmth and caring is necessary, and the client must believe that he or she is accepted unconditionally. Empathy: empathy means viewing the world from the other person's inner frame of reference while remaining you. Empathy is the ability to recognize how someone perceives his or her world. The ability to listen: listening is not a passive role in the communication process. It is an active and demanding role. Self-awareness: to effectively communicate with others, you must know yourself. External factors: the setting may be in a hospital room, and examination room or in an office, or the person's home. In any location, optimal conditions are important to have a smooth interview. Ensure privacy: aim for Geographic privacy. A private room in the hospital, clinic, office, or home. Refuse interruptions: most people resent interruptions except in case of an emergency. Physical environment: make sure the rooms temperature is comfortable. Provide sufficient lighting. Secure quiet environment. Remove distracting objects or equipment. Place a distance between you and the client 4 to 5 ft. Arrange equal status seating. Both you and the client should be comfortably seated, at eye level. Standing communicates your haste and assumed superiority. Dress: the client should remain in street clothes during the interview except in an emergency. Your parents and clothing should be appropriate to the setting and should meet conventional Professional Standards. Note taking: It Breaks I contact too often. Shifts your attention away from the person. Impedes observation of the client's nonverbal Behavior. Is threatening to the client during discussion of sensitive issues. Healthcare Providers must capture biomedical, psychological, and emotional information in order to develop therapeutic relationships with a client.

kids pressure and stuff: really shouldent be tested on this so... whatever.

Tympanic measurement (TMT and TAT) Useful with toddlers who squirm at restraint needed for rectal route, and useful with preschoolers not yet able to cooperate for oral temperature Rapid that it is usually over before child realizes it Infants and Children: Temperature: Axillary and Oral Axillary route safer and more accessible than rectal route; however, its accuracy and reliability have been questioned When axillary route used, place tip well into axilla, and hold child's arm close to body. Use oral route when child old enough to keep mouth closed; usually at age 5 or 6, although some 4-year-old children can cooperate. When available, use an electronic thermometer because it is unbreakable and it registers quickly. Infants and Children: Temperature: Rectal Use rectal route with infants or with other age groups when other routes are not feasible, such as with the child who is unable to cooperate, agitated, unconscious, critically ill, or prone to seizures. Infant may be supine or side lying, with examiner's hand flexing knees up onto the abdomen.Separate buttocks with one hand, and insert lubricated electronic rectal probe no farther than 2.5 cm (1 in); insertion any deeper risks rectal perforation. Normally rectal temperatures measure higher in infants and young children than in adults, with an average of 37.8° C (100° F) at 18 months. Also, temperature normally may be elevated in late afternoon, after vigorous playing or after eating. Infants and Children: Pulse, Heart Rate, and Respirations Pulse Palpate or auscultate an apical rate with infants and toddlers. In children older than 2, use radial site. Count pulse for a full minute to take into account normal irregularities, such as sinus dysrhythmia.Heart rate normally fluctuates more with infants and children than adults from exercise, emotion, and illness. Respirations Watch infant's abdomen for movement, because infant's respirations are normally more diaphragmatic than thoracic. Sleeping respiratory rate is the most accurate in infants. Count for a full minute due to pattern variation. Infants and Children: Blood Pressure (1 of 3)In children aged 3 and older, and in younger children at risk, measure a routine BP at least annually.For accurate measurement in children, make some adjustment in choice of equipment and technique.Most common error is to use incorrect size cuff.Cuff width must cover two thirds of upper arm, and cuff bladder must completely encircle it. Use a pediatric-sized endpiece on stethoscope to locate sounds. Infants and Children: Blood Pressure (2 of 3)If possible, allow crying infant to become quiet for 5 to 10 minutes before measuring the BP; crying may elevate the systolic pressure by 30 to 50 mm Hg.Use disappearance of sound (phase V Korotkoff) for diastolic reading in children.In children, height more strongly correlated with BP than ageNew charts avoid misclassification as normotensive or hypertensive of children who are at extremes of normal growth. Infants and Children: Blood Pressure (3 of 3)For children of same age, BP classified as 90th and 95th percentiles lower for very short children, whereas tall children given higher normal range Children younger than 3 years have such small arm vessels that it is difficult to hear Korotkoff sounds with a stethoscope.Instead, use an electronic BP device that uses oscillometry, such as Dinamap, and gives digital readout for systolic, diastolic, and MAP and pulse.Or use a Doppler ultrasound device to amplify sounds

Temporal Artery

Uses infrared emissions from temporal artery. Sliding probe across forehead Takes multiple readings and produces average result Reading takes approximately 6 seconds.

Preperation: The Preschooler

Verbal communicatin with child at this age is important, explain things in simple terms. Typically willing to undress, leave underwear on until needed to observe genital region. Do not allow choice when there is none. Allow child to play with equipment. Allow them to help (ie. holding stethoscope). Offer small games to keep child engaged, use a slow deliberate approach, compliment child on cooperation

Infants and Children: Developmental Competence

Vital signs BP is not normally checked in children less than 3 years of age. Whenever possible, avoid rectal route and take a tympanic, inguinal, or axillary temperature. Infant: reverse order of vital signs to respirations, pulse and temperature Preschooler: consider normal fear of body mutilation may increase with any invasive procedure School-age: Promote cooperation by explanation and participation in handling equipment Adolescent: Same consideration as with adults

General survey: The Aging adult

Weight: the older adult appears sharper and Contour, with more prominent bony landmarks than younger adult. Body weight decreases during the 80s and 90s. This factor is more evident in males, perhaps because of Greater muscle shrinkage. The distribution of fat also changes during the late 80s and 90s. Even with good nutrition, subcutaneous fat is lost from the face and periphery. Additional fat is deposited in the abdomen and hips. This change in fat distribution and loss in muscle mass can affect the BMI. An aging person becomes shorter, the BMI reflecting the shorter height May overestimate the body fat content. Height: by their 80s and 90s many people are shorter than they were in their 70s because of thinning of the vertebral discs, shortening of the individual vertebrae, postural changes of kyphosis, and slight flexion in the knees and hips. Because long bones do not shorten with age, the overall body proportion looks different. A shorter trunk with relatively long extremities. Kyphosis is the humpback appearance common in the very old and in those with osteoporosis.

Thigh Pressure

When BP measured at arm is excessively high, compare it with thigh pressure to check for coarctation of aorta(congenital form of narrowing). Particularly in adolescents and young adults Normally thigh pressure higher than that in arm. If possible, turn person to prone position on abdomen. Wrap large cuff around lower third of thigh, centered over popliteal artery on back of the knee. Auscultate popliteal artery for reading. Normally systolic value is 10 to 40 mm Hg higher in thigh than in arm, and diastolic pressure is same.

Preperation: older adult

adjust the examination Pace to meet the possible slow pace of the Aging person. Use physical touch as this is especially important with the Aging person because their senses such as vision and hearing may be diminished. do not mistake diminished Vision or hearing for confusion. Be aware that aging years contain more life stress. Loss is inevitable, including changes and physical appearance.

Postion: The Preschooler

age 3 often will still be on caregivers lap, 4-5 typically like being on the examination table.

anorexia nervosa

an eating disorder in which an fanatic concern with weight gain leads people to starve themselves

acromegaly

enlargement of the extremities caused by excessive secretion of growth hormone after puberty

Transcultural expression of pain

pain is universally recognized phenomenon, and it is important aspect of assessment. With in different cultures there are various ways of perceiving pain and pain tolerance

Sequence: School-age

same as adult, head to toe

Developmental competence

Developmental competence: older immigrants who have made major lifestyle adjustments in their moved from their Homeland the United States or from a rural to an urban area may not be aware of Health Care Alternatives, preventive programs, health care benefits, and screening programs for which they are eligible. These people also may be in various stages of culture shock.

Postion: The Infant

Caregiver should be present, infant should be laid flat on a padded examination table, may be held by caregiver for support. At 6 months infant should be proformed in caregivers lap, at 9-12 months the infant is aware of surrounding and due to the infant's lack of object permeance, the caregiver must be in full view.

Endogenus Obesity

Caused by ecessive production of ACTH causeing Cushing syndrome, weight gain and edema, not caused by excessive calorie intake

A Safer Environment

A safer environment: in addition to monitoring the cleanliness of your equipment, take all steps to avoid any possible transmission of infection between persons or between person and Examiner. Some of these micro-organisms like MRSA are multidrug-resistant. the single most important step to decrease the risk of microorganism transmission is to wash your hands properly and thoroughly. First, before and after every physical patient encounter. Second, after contact with blood, body fluids, see creations, and excretions. Third, after contact with any equipment contaminated with body fluids. Fourth, after removing gloves. Use the mechanical action of soap and water hand-washing when hands are visibly soiled and when the person is infected with Spore forming organisms.

The General Survey: Physical Appearance

Age: the person appears his or her stated age. Appears older than stated age, as with chronic illness or chronic alcoholism. Delayed or precocious puberty. Sex: sexual development is appropriate for sex and age. If the individual is transgender, note the stage transformation. Level of consciousness: the person is alert and oriented to person, place, time, and situation. Attend to and respond appropriately to your questions. Confused, drowsy, lethargic. Skin color: colortone is even, pigmentation bearing with genetic background, skin is intact with no obvious lesions. Make note of tattoos and piercings and stages of healing. Pallor, cyanosis, jaundice, erythmia, and lesions. Facial features: facial seizures are symmetric with movement. Immobile, Mask-like, asymmetric, drooping. overall appearance: no signs of acute distress or present. Cardiac Arrest batiri signs, diaphoresis, clutching the chest, shortness of breath, wheezing. Pain, indicated by facial Grimace, holding body part.

Blood Pressure factors

Average BP in young adult is 120/80 mm Hg; varies normally with many factors: Age:gradual rise through childhood and into adult years Gender:after puberty, females show a lower BP than males; after menopause, females higher than males Race: Differences exist relative to combination of genetics and environment. Diurnal rhythm:Daily peak and trough levels r/t timing cycles Average BP in young adult is 120/80 mm Hg; varies normally with many factors:Weight:Obesity increases blood pressure as compared to normal weight recorded measurements of same age.Exercise:Will cause a transitory increase in blood pressure Emotions:Will increase in response to sympathetic nervous system response Stress:Will increase in response to increased stress and tension

Health History Of The Adult

Biographic data: biographic data include name, address, and phone number: age and birthdate: birthplace: gender: relationship status:: ethnic origin colon and occupation. Source of History: first, record who furnishes the information usually the person himself or herself, although the source may be an interpreter or caseworker. Less reliable is relative or friend. Second, judge how reliable the informant seems and how willing he or she used to communicate. A reliable person always gives the same answer, even when questions are rephrased or repeated later in the interview. Third, no one appears well or ill, a sick patient may communicate poorly. Reason for seeking care: this is a brief, spontaneous statement in a person's own words that describes the reason for the visit. A symptom is a subjective Sensation that the person feels from a disorder. A sign is an object of abnormality that you as examiner could you text on physical examination or through diagnostic testing. Occasionally a person may have many reasons for seeking care. Some people try to self diagnose based on similar signs and symptoms and their relatives are friends. The reason for seeking care is not a diagnostic statement. Avoid translating it into the terms of a medical diagnosis. For example an individual may be seeking treatment for shortness of breath but not emphysema.

The Interview: Communication with different ages

Birth to 12 months: infants use Coos, gurgles, facial expressions, and cries to identify their needs. It is important to establish rapport with an infant. As infants get older, they may begin to exhibit stranger anxiety and will be more Cooperative when the caregiver is kept in view or allowed to hold them during the examination. The toddler, 12 to 36 months: at this stage children are beginning to develop communication skills children use telegraphic speech, which is usually a combination of a noun and a verb and includes only words that have concrete meaning. Toddlers struggle for control and autonomy: therefore provide simple choices when possible. Toddlers want to know why; therefore it is important that you provide a simple explanation of what you want. The preschooler 3 to 6 years: is a 3 to 6 year old is egocentric he or she sees the world mostly from his or her own point of view. A three-year-old uses more complex sentences with more parts of speech. Between 3 and 4 years of age the child uses three to four word telegraphic sentences containing only essential words. Preschoolers have active imaginations, so education and explanations can be provided through play. Preschoolers can have animistic thinking about unfamiliar objects. They imagine that unfamiliar or inanimate objects can come alive and have human characteristics. Preschoolers communicate indirect, concrete, literal, and set in the present. The school-age child, 7 to 12 years: the school-age child can read. School-age children can decenter and consider all sides of a situation to form a conclusion. Children of this age group have the verbal ability to add important data to the history. For the well-child seeking a check-up, those questions about school, friends, or activities directly to the child. The Adolescent: adolescence begins with puberty. Adolescents want to be adults, but they do not have the cognitive ability yet to achieve their goal. They are between two stages. Sometimes they are capable of mature actions, and other times they fall back on childhood response patterns, especially in times of stress. Adolescents value their peers. Successful communication is possible and rewarding. The guidelines are simple: the first consideration is your attitude, the second consideration is your communication must be totally honest, stay in character: avoid using language that is absurd for your age or professional roll, Focus first on the Adolescent and not on the problem, do not assume that adolescents know anything about a health interview or physical examination, keep your questions short and simple, the communication responses described for the adult need to be reconsidered when talking with adolescents, later in the interview after you have developed a rapport with the Adolescent you can address topics that are emotionally charged including smoking alcohol drug use sexual behavior suicidal thoughts and depression, adolescents will assume that health professionals have similar values and standards of behavior as most of the other authority figures in their life and they may be reluctant to share this information, if confidential material is uncovered during the interview consider what can remain confidential and what you believe must share for the well-being of the Adolescent, take every opportunity for positive reinforcement, 4 lifestyle choices that a risky this is a premium opportunity for discussion in early intervention. The older adult: the Aging adult has the developmental task of finding the purpose of his or her own existence and adjusting to the inevitability of death. Always address the person by his or her proper surname, and avoid using the first name. Older adults have a longer story to tell: therefore plan accordingly. The interview will likely take longer, and you don't want to appear rushed. It is important to adjust the pace of the interview to the Aging person. Consider physical limitations when planning the interview. Touch is a nonverbal skill that is very important to older people.

Blood Pressure

Blood pressure (BP) is force of blood pushing against side of its container, vessel wall.Strength of push changes with event in cardiac cycle.Systolic pressure:maximum pressure felt on artery during left ventricular contraction, or systoleDiastolic pressure:elastic recoil, or resting, pressure that blood exerts constantly between each contraction Pulse pressure: difference between systolic and diastolic •Reflects stroke volumeMean arterial pressure (MAP):pressure forcing blood into tissues, averaged over cardiac cycle

Measuring Blood Pressure

Blood pressure measured with stethoscope and aneroid sphygmomanometer Aneroid gauge subject to drift and must be recalibrated at least once each year and must rest at zero. Cuff is inflatable bladder inside a cloth cover. Width of rubber bladder should equal 40% of circumference of person's arm; length of bladder should equal 80% of this circumference.

The General Survey: Body Structure

Body Structure Stature: the height of Sears within normal range for age, genetic Heritage. Excessively short or tall abnormalities in body height and proportion. Nutrition: the weight appears within normal range for height in body build, body fat distribution is even. Cachetic, emaciated. Simple obesity, with even fat distribution. Centripetal ie truncal obesity. That concentrated in neck, face, trunk, with in extremities, as in Cushing syndrome. Symmetry: body parts look equal bilaterally and are in relative proportion to each other. Unilateral atrophy or hypertrophy. Asymmetric location of body part. Posture: the person stands comfortably erect as appropriate for age. Note the normal plumb line through anterior ear, shoulder, hip, patella, ankle. Exceptions are the standing toddler who has a normally from protuberant also known as lordosis in the aging person, who may be stupid with kyphosis. Position: the person sits comfortably with arms relaxed at sides and said turn to examiner. Tripod, leaning forward with arms braced on chair arms, occurs with chronic pulmonary disease. Sit straight up and resists lying down is heart failure. Curled up in fetal position is acute abdominal pain. Elongated arm span is mar fans. Bodybuild, Contour: first, arm span equals height. Second, body length from Crown to pubis roughly equals length from pubis to sole.

The Interview: Culture and Genetics

Cultural considerations on gender: violating cultural norms related to appropriate male female relationships May jeopardize a professional relationship. It is imperative to ensure that the patient is carefully Drake that all times, curtains are closed, and, when possible, doors are closed. Do not enter a room without knocking first in announcing yourself. Cultural considerations on sexual orientation: lesbian, gay, bisexual, and transgender individuals are aware of heterosexist biases in the communication of these biases during the interview and physical examination. Heterosexism refers to the belief that heterosexuality is the Only Natural Choice and assumes that everyone is or should be heterosexual. Heterosexism is a form of homophobia and leads to discrimination. Working with an interpreter: clients with language barriers experienced many negative Health outcomes, especially if an interpreter is not used. Interviewing a non-english-speaking person requires a bilingual interpreter for full communication. Try not to use family members as interpreters. Whenever possible, work with a bilingual team member or a trained medical interpreter. All entrepreneurs are trained to remain neutral, they can influence both the content of information exchanged in the nature of the interaction. Although you will be in charge of the focus and flow of the interview, view yourself in The Interpreter as a team. Health literacy: refers to the ability to understand instructions, navigate the healthcare system, and communicate concerns with the healthcare provider. Health literacy and Compasses a variety of factors beyond basic reading, including the ability to use quantitative information and to understand and remember verbal instructions. Tools for screening health literacy: you can ask standardized questions. Oral teaching: as a clinician there are steps you can take to ensure that your clients understand the information you are providing. be sure to use language that the patients can understand. When discussing medical information with clients, keep it simple, you short sentences and words containing no more than two syllables, limit the number of messages you are giving the client, be sure to tell the person what they will gain by following your instructions, present only needed information, focus on the client, use the active voice, and avoid jargon. Written materials: when preparing or using written materials, make sure to assess the appropriateness of the materials. Written material should be at the 5th grade reading level or below. Pictures are often used in writing materials, but you must be careful to select appropriate graphics. Teach back: although ensuring appropriate verbal and written communication is important, one of the easiest things you can do when teaching a client is to use the teach back approach. Teach back simply means asking the client if they have questions. This verbal discussion allows you to assess the understanding and may open the door for the client to ask questions. F. Communication with other professionals: throughout your career, you will work with professionals from a variety of healthcare disciplines. It is imperative that you learn to communicate effectively with other professionals. The use of therapeutic communication will not only help in your interactions with patients, but will also guide your interactions with other professionals.

The General Survey: Behavior

Facial expression: the person maintains eye contact, expressions are appropriate to the situation. Flat, depressed, angry, sad, anxious. However, note that anxiety is common in ill people. Also some people smile when they are anxious. Mood and affect: the person is comfortable and Cooperative with the examiner and interacts pleasantly. Hostile, distrustful, suspicious, crying. Speech: articulation, the ability to form words, is clear and understandable. Speech pattern: dstream of talkin is fluent with an even Pace. The person conveys ideas clearly. Word choice is appropriate for culture and education. Communicates in prevailing language easily by himself or herself or with an interpreter. Dress: clothing is appropriate to The Climate, looks clean and fits the body, and is appropriate to the person's culture and age group. Culturally determined dress should not be labeled as inappropriate by Western standards or adult expectations. Clothing too large and held up by belt suggest weight loss, as does the addition of new holes in belt. Clothing too tight May indicate obesity. Long sleeves May conceal needle marks of drug users. Personal hygiene: the person appears clean and groomed appropriately for his or her age, occupation, and socioeconomic group. Many cultures do not include use of deodorant or women shaving legs. Hair is groomed, brushed. Makeup is appropriate for age in culture.

Functional assessment including activities of daily living

Functional assessment measures a person's self-care ability in the areas of General physical health. These include bathing, dressing, toileting, eating, walking. Self-esteem, Self-Concept: Education, value belief system, financial status. Activity and exercise: daily profile reflecting usual daily activities, feeding, bathing, hygiene, dressing, toileting, walking, standing, climbing stairs. sleep and rest: sleep patterns, daytime naps, and he sleep aids. Nutrition and elimination: record the diet by recall of all food and beverage has taken over the past 24 hours. Indicate any food allergy or intolerance. Record daily intake of caffeine. Interpersonal relationships and resources: social roles. Spiritual resources: many people believe in a relationship between spirituality and health, and they may wish to have spiritual matters addressed in the traditional Healthcare setting. Use the faith, influence, community, and address questions to incorporate the person spiritual values into the health history. Coping and Stress Management: types of stress in life, especially in the past year. Any changes in lifestyle or any current stress, methods trying to relieve stress and whether these have been helpful. Personal habits: tobacco, alcohol, street drugs. Alcohol: Health Care Professionals often fail to question about alcohol and less problems are obvious. However, alcohol interacts adversely with all medications, it is a factor in many social problems such as assaults, rapes, high-risk sexual behavior, and child abuse. You may wish to use a screening questionnaire to identify excessive or uncontrolled drinking such as the cut down, annoyed, guilty, and eye opener test. Illicit or street drugs: asked specifically about prescription painkillers. Norco, cocaine, amphetamines, heroin, and marijuana. Indicate frequency of use and how use has affected worker family. Environment and Hazards: housing and neighborhood. Access to Transportation, heating utilities, safety of area, involvement in community. No environmental health, use of seatbelts, geographical occupational exposures. Intimate partner violence: how are things at home do you feel safe. Occupational Health: after a person to describe his or her job. Ever work with any health hazards such as Asbestos, and he lands, chemicals, repetitive Motion. Perception of Health: ask the person questions such as how do you define health. What do you expect to be nurses.

The General Survey: Mobility

Gait: feet approximately shoulder-width apart: foot placement is accurate: walk is smooth and even, and person can maintain balance without assistance. Associated movements such as symmetric arm swing are present. Range of motion: note full Mobility for each joint and that movement is deliberate, accurate, smooth, and coordinated. No involuntary movement. Limited joint range of motion. Paralysis is absent movement. Jerky, uncoordinated movement. Tics, Tremors, seizures.

Culture and Healing

Healing and culture: health is defined as the balance of the person, both within one's being and in the outside world. Before determining whether cultural practices are helpful, harmful, or neutral you must first understand the logic of the traditional belief systems coming from a person's culture and then grass the nature and meaning of the health practice from the person's cultural perspective. Beliefs about causes of illness: disease causation may be viewed in three major ways: from a biomedical or scientific perspective a naturalistic or holistic perspective, or a magicoreligious perspective. Biomedical: the biomedical or scientific theory of illness causation assumes that all events in life have a cause and effect. Naturalistic: the second way in which people explain the cause of illness is from the naturalistic or holistic perspective, found most frequently among American Indians, Asians, and others who believe that human life is only one aspect of Nature and a part of the general order of the cosmos. Some Asians believe in the yin-yang theory in which health exists when all aspects of the person aren't perfect balance. Many Hispanic, Arab, and Asian groups embraced the hot/cold theory of health and illness. Magicoreligious: The basic premise is that the world is an arena in which supernatural forces dominate. Examples of magical cause of illness include believes in Voodoo or witchcraft, whereas Faith healing is based on religious beliefs.

Traditional treatments and folk healers

Hispanics May rely on types of herbalists. blacks me mention having received assistance from voodoo's or priestesses. Asians me mention that they have visited herbalist, acupuncturist, or bonesetter's. Amish have brauche which are folk healers who use herbs and tonics in the home or Community context. Brausche, is a folk Healing Art, refers to the sympathy caring, which is sometimes called Pow Wow in English. Many cultures believe that the Cure is in complete unless healing of Body, Mind, and Spirit is carried out. In the United States an estimated 38% of adults use some form of complementary therapy to treat an illness, including acupuncture, ayurvedic, biofeedback, Chiropractic or osteopathic manipulation.

Needed nutrients (and the state of food in America)

In utero babies specifically need iron, folate, and zinc to develop well. Infants from birth to 4 months ought to be receiving all their nutrients from breast milk. In adolescence humans grow rapidly while experiencing significant changes in their endocrine system. Calcium and iron needs increase as they increase growth of bones and muscles. In adulthood the need for calories slows down. ( "Adults generally need to focus on avoiding self-destructive coping mechanisms. Unfortunately adults in mainstream U.S.A. are part of an obesogenic environment. Monocropping overlords are peddling soy, wheat, and corn sprayed with BT toxin producing defoliants. The entire country's food culture is dictated by the top 1% who have destroyed local farming practices in the past 70 years. Realistically people should have their own gardens, and procure food from farmers markets. But this country isn't progressive for this to be normal on a large scale." A direct quote from Chelsy that I am leaving in because she was 100% correct.) Aging adults are at risk of deficiency from medication and poorly functioning GI from years of abuse in the standard american ecosystem. They should consider taking supplements.

The Interview: Techniques of Communication

Introducing the interview: you make me nervous at the beginning of the interview. Keep in mind that the client is probably nervous as well. After a brief introduction, ask open-ended questions, and then let the person proceed. You do not need much friendly small talk to build rapport. The working phase: the working phase is the data-gathering phase. You will likely use a combination of open-ended and closed questions during the interview. Open ended questions: the open-ended question asks for narrative information. It states the topic to be discussed but only in general terms. The open-ended question is unbiased. Closed or direct questions: closed or direct questions asked for specific information. Direct questions help you elicit specific information and are useful to fill in any details that were initially left out after the person's opening narrative. Direct questions are also useful when you need specific facts such as past medical history or during the review of systems. Ask only one direct question at a time. Choose language the client understands. Verbal responses: you have asked the first open-ended question, and the client begins to answer. Your role is to encourage free expression while keeping the person focused. There are nine types of verbal responses. The first five responses are facilitation, silence, reflection, empathy, and clarification. The 10 traps of interviewing: the 10 traps of interviewing are providing false assurance, giving unwanted advice, using Authority, using avoidance language, distancing, using professional jargon, using leading or biased questions, talking too much, interrupting, using why questions. Non verbal skills: non verbal modes of communication include physical appearance, posture, gestures, facial expression, eye contact, voice, and touch. Closing the interview: this is a good time to give you a summary of what you have learned during an interview. The summary is a final statement of what you and the client agree that he'll stay to be. It should include positive Health aspects, and the health problems that have been identified, any plans for action, and an explanation of the subsequent physical examination. As you depart from clients, thank them for the time spent in their cooperation.

The aging adult

It is important to conduct even a brief examination of all older people admitted to the hospital. Confusion is common in aging people and is easily misdiagnosed. Delirium is president in 8 to 17% of elderly people who present to the emergency department. 40% of nursing home residents have delirium when presented to the ED. Delirium is an acute confusional change or loss of consciousness and perceptual disturbance, it may accompany acute illness. It is usually results when the underlying causes treated. Dementia: is a gradual, Progressive process, causing decreased cognitive function even though the person is fully conscious and awake: it is not reversible. Alzheimer disease accounts for about two-thirds of cases of dementia in older adults. In older adults check sensory status before assessing any aspect of mental status. Vision and hearing changes caused by aging May alter alertness and leave the person looking confused. Follow the same abct guidelines as described for the younger adult with the following additional considerations: Behavior: Level of Consciousness: in a hospital or Extended Care setting, the Glasgow Coma Scale is a quantitative tool that is useful in testing consciousness. The system of voids ambiguity when numerous examiners care for the same person. Cognitive functions: orientation: many aging person's experience social isolation, loss of structure without a job, a changing residence, or shirt term memory loss. These factors affect orientation, and this person may not provide the precise date or complete name of the agency. New learning: and people of normal cognitive function, and age-related decline occurs in performance in the four unrelated words test. People in their 70s average two through four words recalled over 5 minutes. They will improve their performance at 10 and 30 minutes after being reminded by verbal cues. Supplemental mental status examination: the mini Cog: the mini Cog is a reliable, quick, and easily available instrument to screen for cognitive impairment in otherwise healthy older adults. The mini Cog is not influenced by educational level or health literacy of the patient and can be used in a variety of settings, including the hospital. The mini Cog test the person's executive function, including the ability to plan, manage time, organized activities, and manage working memory.

Yet more skin abnormalities

Lentigines: are a common type of hyperpigmentation commonly found in seniors. Seborrheic keratosis: looks dark, greasy, and stuck on. They develop mostly on the trunk, but also on the face and hands. Actinic keratosis: these lesions are red-tan scaly plaques that increase over the years to become raised and roughened. Acrochordons: or skin tags are overgrowths of normal skin that form a stalk and are polyp-like. They occur frequently on eyelids, cheeks and neck, and axillae trunk. Sebaceous hyperplasia: consists of raised yellow papules with a central depression. They are more common in men, occurring over the forehead, nose, or cheeks. They look pebbly. Petechiae: are tiny punctate hemorrhages. They are round, and discrete, dark red, purple, or brown. Bruise: is a mechanical injury that results in hemorrhage into tissues. Hematoma: is a collection of blood outside of blood vessels. Hematoma is a bruise. Measles: red-purple maculopapular blotchy rash, and appears on 3rd or 4thg day of illness rash appears first behind ears and spreads over face and then over neck, trunk, arms, and legs. German measles: pink, papular rash that first appears on face, then spreads. Chickenpox: small, tight vesicles first appear on the trunk and spread to face, arms, and legs.

Blood Pressure Factors 2

Level of BP determined by five factors Cardiac output:increase in CO leads to increase in BP whereas decrease in CO leads to decrease in BP Peripheral vascular resistance:increased resistance (vasoconstriction) leads to increase in BP whereas decrease in resistance(vasodilation) leads to decrease in BP Volume of circulating blood: fluid retention leads to increased BP whereas hemorrhages leads to decreased BPViscosity: increase associated with increase in BP Elasticity of vessel walls:increasing rigidity associated with increase in BP

Present health or history of present illness

Location: be specific, ask the person to point to the location. Character Quality: this calls for specific descriptive terms such as burping, sharp, dull, aching, 9, throbbing, shooting, Vice like when describing pain. Quantity or severity: attempt to quantify the sign or symptom, such as profuse menstrual flow. Timing: when did The Simpsons first appear? Give the specific date and time or state specifically how long ago the symptoms started prior to arrival. Setting: where was the person or what was the person doing when the symptoms started? What brings it on? Aggravating or relieving factors: what makes the pain worse? Is it aggravated by weather, activity, food, medication, standing, fatigue, time of day, or season? Associated factors: is this primary symptom associated with any others? Review the body systems related to this symptom now rather than waiting for the review of systems section later. Patient's perception: find out the meaning of the symptom by asking how to fix daily activities. You may find it helpful to organize this question sequence in the mnemonic pqrstu.

achondroplastic dwarfism

Long bones stop growing in childhood Normal torso, short limbs Failure of cartilage growth in metaphysis Spontaneous mutation produces mutant dominant allele

Respirations

Normally person's breathing is relaxed, regular, automatic, and silent.Because most people are unaware of their breathing, do not mention that you will be counting respirations, because sudden awareness may alter normal pattern.Instead, maintain your position of counting radial pulse and unobtrusively count respirations.Count for 30 seconds or a full minute if you suspect an abnormality.Avoid 15-second interval; the result can vary by a factor of + or −4, which is significant with small number. Also, a fairly constant ratio of pulse rate to respiratory rate exists, which is about 4:1.Normally both pulse and respiratory rates rise as a response to exercise or anxiety.Re

Pallor, Erythema, Cyanosis, Jaundice

Pallor is when the red-pink tones from the oxygenated hemoglobin in the blood are lost. The skin takes on the color of connective tissue which is mostly white. Pallor occurs in times of acute high stress or anxiety because vessels vasoconstrict from sympathetic nervous system stimulation. In dark skinned people look for the lack of luster in red tones. Erythema is intense redness of the skin from excess blood (hyperemia) in the dilated superficial capillaries. This sign is expected with fever, local inflammation, or emotional reactions such as blushing in vascular flush areas. Erythema causes increased skin temperature as the vascularization is increased. In dark skinned people it is hard to see the inflammation, so you must feel for warmth or taught surface. Cyanosis is a blushing or mottled color from decreased perfusion because the tissues have high levels of deoxygenated blood. This is best seen in the lips, nose, cheeks, ears, and oral mucous membranes. In dark skinned people cyanosis is hard to see. Look for other clinical signs such as changes in LOC and respiratory distress. Jaundice is a yellowish skin color indicating rising amounts of bilirubin in the blood. Jaundice in an adult does not occur normally. It is first noted in the junction of the soft palate in the mouth and in the sclera. Jaundice occurs with hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.

Cultural differences in diet

People across different cultures have different eating habits. Many Hindu's are lacto vegetarian, and do not eat meat. Even within the white people in America there are different diets. Some people are vegan, some whole food plant based, some survive on fast food. Asian's eat fresher food generally than many people groups in America. Hispanic people eat certain things like beans, rice, lard, tortillas, etc. This will change the nutritional needs of people based on the culture they are from.

Arm Pressure

Person may be sitting or lying, with bare arm supported at heart level. Palpate brachial artery; with cuff deflated, center it about 2.5 cm (1 in) above brachial artery and wrap it evenly. Now palpate brachial or radial artery. Inflate cuff until artery pulsation obliterated and then 20 to 30 mm Hg beyond.•This will avoid missing an auscultatory gap, when Korotkoff sounds disappear during auscultation. Deflate cuff quickly and completely; wait 15 to 30 seconds before reinflating so blood trapped in veins can dissipate. Place bell of stethoscope over site of brachial artery, making a light but airtight seal. Diaphragm endpiece usually adequate, but bell designed to pick up low-pitched sounds of blood pressure reading Rapidly inflate cuff to maximal inflation level you determined. Then deflate the cuff slowly and evenly, about 2 mm Hg per heartbeat. Note points at which you hear first appearance of sound, muffling of sound, and final disappearance of sound.

General Survey: Infants and children

Physical appearance: Same basic elements as with the adult, children just learning to walk have a wide gait and toddlers have a proturding abdomen (lordosis). Behavure: note responce to stimuli, and level of alertness Parental Bonding: note childs interactions with caregivers. Signs of child abuse are that the child avoides eye contact and exibits no seperation anxiety Weight: For infants place on a platform scale, weigh to the nearest 10g, for toddlers weigh to the nearest 100g, by age 2 use upright scale, leave underpants on Length: Until age 2 measure the infants body length in supine by using a horizontal measuring board, extend the naturally flexed legs and stretch the spine in order to measure correctly. Past 2, measure by using a ruler on a scale or wall, posture should be straight and should be measured to the nearest 1mm. Explore more if height falls within 95th or 5th percentile with no explanation, vast difference in weight and height(ie. 95percentile weight, 5th percentile height) sudden stop in growth, and no growth spurts. Use judgement and genetic background info to determine if this is abnormal. Head Circumfrence: a newborns head measures 32-38cm, after 2 years of age chest circumfrence is larger than head

Pulse Rythm

Rhythm of pulse normally has a regular, even tempo. Sinus dysrhythmia:one irregularity commonly found in children and young adults Heart rate varies with respiratory cycle, speeding up at peak of inspiration and slowing to normal with expiration. Inspiration momentarily causes a decreased stroke volume from left side of heart. To compensate, heart rate increases. If any other irregularities are felt, auscultate heart sounds for a more complete assessment.

Skin

The three layers of the skin are the dermis, epidermis and subcutaneous layer of adipose tissue. The epidermis is thin but tough. It consists of the basal cell layer and the horney cell layer. The basal cell layer is responsible for forming new cells, and the horney cell layer is from when the cells migrate up and flatten into the top layer. The dermis is the inner supportive layer consisting mostly of connective tissue, or collagen. This is the tough fibrous layer that enables the skin to resist tearing. Finally, there is the subcutaneous layer. This entire layer is adipose tissue. Adipose tissue stores fat for energy, and helps create a loose cushion that allows skin increased mobility over structures. The skin has many functions. Five interesting functions are protection, perception, communication, production of vitamin D, and identification.

Components of the mental status examination

This one is long, I am aware, it was all under one section A full mental status examination is a systematic check of emotional and cognitive function. However, the steps describes you really need to be taken in their entirety. Usually you can assess mental status through the context of the health history interview. Appearance, Behavior, Cognition, and Thought process. APPEARANCE Posture: Posture is erect, and position is relaxed. Body movements: body movements are voluntary, deliberate, coordinated, smooth, and even. Restless, fidgety movements of hyperkinetic appearance occurs with anxiety. Apathy and psychomotor slowing occur with depression and dementia. Abnormal posturing and bizarre gestures occur with schizophrenia. Facial grimaces may occur with pain. Involuntary tics can occur with neurologic disorders. Dress: dresses appropriate for setting, season, age, gender, and social group. Inappropriate dress can occur with organic brain syndrome. Eccentric dress combination in bizarre make up a crew esquizofrenia romantic syndrome. Unilateral neglect occurs following some Strokes. An appropriate dress, poor hygiene, and lack of concern with appearance occur with depression and severe Alzheimer's disease. Grooming and hygiene: the person is clean and well-groomed. A disheveled appearance in a previously well-groomed person is significant. Pupils: no pupil size and reaction to light. Dilated or constricted pupils may be a sign of recent drug use. Recent antisocoria can be the result of a brain tumor. BEHAVIOR Level of Consciousness: the person is awake, alert, and aware to stimuli from the environment and within the self and responds appropriately and reasonably soon to stimuli. Facial expression: the look is appropriate to the situation and changes appropriately with the topic. There's comfortable eye contact unless precluded by cultural norm. Flat, mask like expression occurs with Parkinson's and depression. Speech: judge the quality of speech by noting that the person makes laryngeal sounds effortlessly and shares conversation appropriately. Dysphonia is abnormal volume, pitch. Monopolizes interview or a silent, secretive, or uncommunicative. Mood and affect: judge this by Body Language and facial expression and by asking directly how do you feel today? Or how do you usually feel? The mood should be appropriate to the person's place and condition and change appropriately with topics the person is willing to cooperate with you. COGNITIVE FUNCTION Orientation: you can discern orientation through the course of the interview by asking about the person's address, phone number, and health history. Assess using time, place, and person. Disorientation occurs with delirium and dementia. Orientation is usually lost in this order: first of time, then to place, and rarely to person. Attention span: check the person's ability to concentrate by noting whether he or she completes a thought without wandering. no any distractibility or difficulty attending to you. Note that attention span commonly is imperative people who are anxious, fatigue, or drug intoxicated. Digression from initial thought. Irrelevant replies to questions. Easily distracted stimulus bound. Confusion, negativism. Recent memory: assess recent memory in the context of the interview by the 24 Hour Diet recall or by asking the time the person arrived at the agency. Recent memory deficit occurs with delirium, dementia, and amnestic syndrome, or Korsakoff syndrome and chronic alcoholism. Remote memory: in the context of the interview, ask the person verifiable past events. Remote memory is lost when the cortical storage area for that memory is damaged from Alzheimer Dementia or any disease that damages the cerebral cortex. New learning: the four unrelated word test. This test the person's ability to lay down new memories. Say to the person I'm going to say 4 words. I want you to remember them. In a few minutes I will ask you to recall them. After 5 minutes, ask for the recall of the forwards. To test the duration of the memory, ask for recall 10 minutes and at 30 minutes. People with Alzheimer's dementia score a 0 or 1 Word recall. Impaired new learning ability also occurs with anxiety. Additional testing for persons with Aphasia: word comprehension: Point articles in the room, parts of the body, or articles from pockets and ask the person to name them. Reading: ask the person to read available print. Aphasia is the loss of the ability to speak or write coherently or to understand speech or writing as a result of stroke or brain damage. Writing: ask the person to make up and write a sentence describing the weather or their job. Nope coherence, spelling comment and parts of speech. Reading and writing are important in the planning, Health teaching, and Rehabilitation. Agraphia often occurs in patients with aphasia. THOUGHT PROCESSES AND PERCEPTIONS Thought process: ask yourself does this person make sense? The way a person thinks should be logical, goal-directed, coherent, and relevant. Illogical, unrealistic thought process. Digression from initial thought. Ideas room together. Evidence of blocking. Thought content: what the person says should be consistent and logical. Obsessions, compulsions. Perceptions: the person should be consistently aware of reality. The perceptions should be congruent with yours at the following questions: how do people treat you? Do other people talk about you? Do you feel as if you're ever being watched? Have you heard your name when alone? Illusions, hallucinations. Auditory and visual hallucinations occur with psychiatric and organic brain disease in psychedelic drugs. Tactile hallucinations occur with alcohol withdrawal. Screen for anxiety disorders: anxiety and depression are the two most common mental health problem seen in people seeking General Medical Care. Before most common anxiety disorders are Gad, panic disorder, social anxiety disorder, post-traumatic stress disorder. Scores on the generalized anxiety disorder 2 range from 0 to 6. 0 suggests that no anxiety disorder is present, whereas a score greater than 3 is suggestive of generalized anxiety disorder. Screen for depression: many formal screening tools are available. However, a shorter screening method is the patient Health questionnaire, which entails asking two questions about depressed mood and anhedonia that will detect a majority of depressed patients. Finding positive answers to these questions then requires further diagnostic tools to assess specific depressive disorders. Phq-9 score of 5 to 9 or minimal symptoms. Then 10 to 14 is minor depression. 15 to 19 is major depression. Greater than 20 is major depression and severe. Screen for Suicidal Thoughts: suicide is preventable, but it is the 10th leading cause of death in the United States and the second leading cause among those ages 15 through 34 years. Females are more likely to have Suicidal Thoughts, but males are four times more likely to commit suicide. Important clues in warning signs of suicide: prior suicide attempts, depression, hopelessness, firearms in the home, family history of suicide, incarceration, Family Violence, sexual abuse, self-mutilation, anorexia, verbal suicide messages, saying goodbye. Judgement: a person exercises judgment when he or she can compare and evaluate the Alternatives in a situation in recent appropriate course of action. To assess judgment in the context of the interview, know what the person says about Job plans, so Shore family obligations, and plans for the future. Impaired judgement is unrealistic or impulsive decisions in wish-fulfillment. These occur with developmental disability, emotional dysfunction, schizophrenia, and organic brain disease. Supplemental mental status examination: the mini-mental state examination is a test of the cognitive functions of the mental status examination. The mmse is quick and easy, and quizzes standard set of only 11 questions, and requires only 5 through 10 minutes to administer. The mmse is used with caution in people with low education, who may have problems copying intersecting pentagons, spelling World backwards, or performing serial sevens. The mmse also lack sensitivity for mild cognitive impairment. Montreal cognitive assessment: the MoCA examines more cognitive domains in the mmse, is more sensitive to mild cognitive impairment, and can be obtained free of charge. Scores that occur with dementia and delirium are classified as follows 18 through 23 is mild cognitive impairment. 0 through 17 is severe cognitive impairment. Any score less than 26 is indicative of mild cognitive impairment.

Pressure Ulcer

Stage 1 is non-blanchable: intact skin is red but unbroken. Localized redness in lightly pigmented skin does not blanch. Dark skin does not planch. Stage 2 is partial thickness skin loss: loss of epidermis and exposed dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed. Stage 3: full thickness skin loss: PI extends into subcutaneous tissue and resembles a crater. Subcutaneous fat, granulation, tissue, and rolled edges, but not muscle, bone, or tendon. Stage 4: full thickness skin/tissue loss: PI involves all skin layers and extends into supporting tissue. Exposes muscle, tendon, or bone, and may show slough or echar.

The Procedure: Rectal Temp

Take rectal temperature only when other routes are not practical due to clinical presentation. Wear gloves and insert lubricated rectal probe cover on an electronic thermometer only 2 to 3 cm (1 in) into adult rectum, directed toward umbilicus. For a glass thermometer, leave in place for 2½ minutes. Disadvantages to rectal route are patient discomfort and time-consuming and disruptive nature of activity.

Postion:older adult

The older adult Should be sitting on examination table, a frail older adult may need to be supine. Arrange the sequence to allow as few position changes as possible. Allow rest periods when needed.

Postion: The Toddler

Toddler should be sitting on caregiver's lap, Enlist aid of caregiver for more invasive procedures (ie. rectal temp)

Typanic membrane Procedure

Tympanic membrane thermometer (TMT) senses infrared emissions of tympanic membrane (eardrum). Tympanic membrane shares same vascular supply that perfuses hypothalamus (internal carotid artery).Probe tip has shape of otoscope. Gently place covered probe tip in person's ear canal; temperature can be read in 2 to 3 seconds.The Procedure: Temperature Tympanic Membrane The Procedure: Temperature Tympanic Membrane (2 of 2) Tympanic membrane thermometer (TMT)Minimal chance of cross-contamination with tympanic thermometer because ear canal is lined with skin and not mucous membrane. Used with unconscious patients or with those who are unable or unwilling to cooperate with traditional techniques

The General Survey: Measurement

Weight: use a standardized balance or electronic scale. Instruct the person to remove his or her shoes and heavy outer clothing before standing on the scale. When a sequence of repeated weight is necessary, aim for approximately the same time of day and the same type of clothing worn each time. Record the weight both in kilograms and in pounds. An unexplained weight loss may be a sign of short-term illness, fever, infection, disease of the mouth or throat, or chronic illness. height: use a wall mounted device or the measuring pool on the balance scale. The person should be shoeless, standing straight with gentle traction under the job, and looking straight ahead. Feet, shoulders, and buttocks should be in contact with the wall or measuring pole. Body mass index: body mass index is a practical marker of optimal healthy weight for height and an indicator of obesity or malnutrition. Researchers recommend using BMI in conjunction with other measures such as waist circumference. Using BMI alone, might Miss classify healthy people as unhealthy. a healthy BMI is a level of 19 or greater to less than 25. Show the person how his or her own weight matches up to the National guidelines for optimal BMI. The cause of weight gain is usually excess caloric intake. Occasionally it is endocrine disorders, drug therapy, or depression. In the United States more than two-thirds of adults and one-third of children are overweight or obese. Overweight and obesity affect more Hispanics and non-hispanic blacks than non-hispanic whites, whereas Asian Americans have a much lower prevalence than any other ethnic group. waist circumference: excess abdominal fat is an important independent risk factor for disease. If most of the weight is carried around the waist instead of around the hips, the person is at higher risk for heart disease and type 2 diabetes. A waist circumference greater than 35 in in women and greater than 40 in in men increases the risk for type 2 diabetes, hypertension, and cardiovascular disease in people with a BMI between 25 and 35.

The Interview: Interviewing a Parent or Caregiver

When your client is a child, you must build rapport with two people, the trial in the accompanying caregiver. Most of your communication is with the caregiver of a younger child, but make sure that you do not ignore the child completely. Nonverbal communication is even more important to Children than it is to adults. Stages of cognitive development: a child's thought process, perception Of the world, and emotional responses to situations are very different from those of an adult. Regression is a common response during times of acute stress: there for a child May regress in his or her ability to communicate at this time.

The production of sound

all sound results from vibrations of some structure. Amplitude or intensity is how loud or soft a sound. Pitch or frequency is the number of vibrations per second. Quality or Timbre is the subjective difference caused by the distinctive overtones of a sound. Duration is the length of time the note lingers. A basic principle is that a structure with relatively more are like the lungs produce a Louder, deeper, and longer sound because of vibrates freely. A denser more solid structure like the liver is a softer, higher, shorter sound because it does not vibrate as easily.

Palpation

an examination technique in which the examiner's hands are used to feel the texture, size, consistency, location of certain body parts, swelling,virbration, pulsation etc. Warm hands first, use fingertips for fine tactile discrimination, use a grasping action to check for organs or lumps, use dorsa (back of hands) to for temp as it is thinner than palms, base of fingertips (metacarpophyarngeal joints) or ulnar surface for vibration. Start light then press harder, bimanual palpation uses both hands to envelop certain body parts.

The General approach

consider your emotional state and that of the person being examined. A person may be anxious about being examined by a stranger and about the unknown outcome of the examination. Usually the beginning examiner feels anything but self-assured.

Culture related Concepts:

culture is a complex phenomenon that includes attitudes, beliefs, self definitions, norms, rules, and values. It is also a web of communication, and much of culture is transmitted non-verbally through socialization or enculturation. Socialisation or enculturation is the process of being raised within a culture and acquiring the Norms, values, and behaviors of that group. Culture has four basic characteristics that are learned, shared, adapted, and dynamic.

Equipment

during the examination you do not want to be searching for equipment or need to leave the room to find an item. Have all your equipment easily accessible and laid out in an organized fashion. designate a clean versus a used area for handling your equipment. You can use to Separate Tables or used to separate areas of the same table. Distinguish to clean area buy one or two disposable paper towels. On this house place all the new or newly alcohol swab equipment that you will use for this person. Otoscope: funnels light into the ear canal and on to the tympanic membrane. Ophthalmoscope: illuminates the internal eye structures.

Giantism

excessive secretion of human growth hormone during childhood

Inspection

general observation of the patient as a whole, progressing to specific body areas, always comes first, compare left and right sides of body for symmetry, requires good lighting.

Marfan Syndrome

genetic connective tissue disorder that can cause a ruptured aorta, cause afflicted to be abnormally tall and skinny, with weak heart

Sequence: The Adolecent

head to toe, examine genitalia last and be VERY quick about it

The Stationary Hand

hyperextend the middle finger in places distal joint and tip firmly against the person skin. Avoid placement over the ribs, scapulae, and other bony prominences. Check your Technique to ensure that only the distal joint and tip of your middle finger or touching a person.

Family history

in the age of genomics and accurate family history highlights disease and conditions for which a particular patient may be at increased risk. A pedigree, or genogram is a graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives and at least three generations such as parents, grandparents, and siblings. Other relatives who are included in the genogram are honest, uncle's, nieces, nephew's, and cousins.

Acculturation

is the process of adopting the culture and behavior of the majority culture. The losses and change that occur when adjusting to or integrating a new system of belief, routines, and social rules are known as acculturative stress, which has important implications for health and illness.

Auscultation

listening to sounds produced by the body, such as the heart and blood vessels in the lungs and abdomen. Most body sounds ever so often must be channeled through a stethoscope for you to evaluate them. You will use the diaphragm most often because it's flat Edge is best for high pitched sounds like breath, Bell, a normal heart sounds. The belt and peace has a deep, Halo, cut like shape. It is best for soft, low pitch sounds such as extra heart sounds were murmurs. Any extra noise can produce a roaring in your stethoscope, therefore the room must be quiet. Keep the examination room warm, and warm your stethoscope. The fictional emps from a man's hairy chest causes a crackling sound that mimics and abnormal breath called crackles. To minimize this problem, with the hair before auscultating the area. Never listen through again. Finally avoid your own artifacts such as breathing on the tube or the sump from bumping the tubing.

Ethnicity

refers to a social group that may possess shared traits, such as common Geographic origin, migratory status, religion, language, values, Traditions are symbols, and food preferences.

Percussion

tapping the person's skin with short, sharp Strokes to assess underlying structures. Mapping out the location in size of an organ by exploring where the percussion note changes between the borders of an organ and its neighbors. Signaling the density of a structure by characteristic note as demonstrated in air, fluid or solid. Detecting an abnormal Mass if it is fairly superficial the percussion vibrations penetrate about 5 cm deep. A deeper Mass would give no change in percussion. You listening a deep tendon reflex using the percussion hammer.

Clinical Setting

the examination room should be warm and comfortable, quiet, private, and well it. One possible stop any distracting noises. Lighting with natural daylight is best, although it is not generally available. A gooseneck lamp helps provide high-intensity lighting. This provides tangential lighting which highlights pulsations in body Contour is better than perpendicular lighting.

Determinants of health and health disparities

the social determinants of Health include economic stability, education, social and Community context, neighborhood and built environment, and health care. For the past two decades the goals of healthy people have been to eliminate Health disparities. Although overall quality of healthcare is improving in the United States, access to care and health disparities are not showing any improvement.

Sequence: Older adult

use the head to toe approach, as in the younger adult. Adapter assessment to the person's Comfort level. Initially a may be necessary just to examine the body area is appropriate to the problem, collecting a mini database. You may return to finish a complete assessment after the initial distress is resolved.

The Striking Hand

use the middle finger of your dominant hand has the Striking finger. place just behind the nail bed or at the distal interphalangeal joint. What's the Striking finger so that its tip, not the finger pad, makes contact. It hits directly at the right angles to the stationary finger. Percuss two times in each location using even, staccato blows. What's the Striking finger off quickly, as resting finger Dampens vibrations.

Hands-On

which preparation it is possible to interact with your own patient in a confident manner. Begin my bench during the person's height, weight, blood pressure, temperature pulse, and respirations. As you proceed through the examination, occasionally offers some brief teaching about the person's body.