B2 | Health Assessment

heart 5 landmarks

- Aortic valve: 2nd intercostal space / r . of Sternal border - Pulmonic value: 2nd intercostal space / L . of sternal border - Erb's point ( 2nd pulmonic ): 3rd intercostal space / L. Sternal border - Tricuspid valve: 4th or 5th intercostal space L. Sternal border -Mitral valve ( apical , apex PMI , bicuspid ): 5th intercostal space / L . midclovicular line

Open - ended questions

- elicit a pt's unique story - more than a yes or , prompts pts to describe a situation in more than just one of two words , allowing pts to actively describe their health status ( show pts you want to hear their thoughts & feelings ) - gives the pt the ability to decide how much information to disclose

pulse oximetry:

( SpO₂ ) > 95 %

Palpate (nails)

- expect to find a firm nail base + check for any abnormalities → > ( erythema / swelling ) - upon palpation , gently grasp pt's finger + observe the color of the nail bed - white pt's : nails / nail bed appears pink w / white nail tips - dark - skinned pt's : nail beds are dorkly pigmented w/ a blue / reddish hue , brown / black pigmentation is normal w / longitudinal streaks

Inspect/palpate (ears)

- external ear structures - middle ear inspected w / otoscope (examination ONLY done by advancced health professional), pull pinna up & back

lymphatic system

- filter substances that travel through the lymphatic fluid + contain lymphocytes ( WBC ) , help the infection / disease - primary purpose : filter fluid for waste before It's returned to the blood

Recommendation

- giving advice on the next tx (treatment) plan or what you feel is best for the client - "Can we start the client on NPO status and begin a bowel regimen for tx?"

Inspection (head)

- head is normally held upright + midline to the trunk -note pt's facial features - > look at eyelids , eyebrows nasolabial folds , mouth for shape & symmetry ( normal for slight symmetry to exist ) skull is generally round w / prominences in the frontal area anteriorly & posteriorly Occipital area )

disparities are linked to:

- inadequate access to language services - inadequate resources - poor-patient provider communication - lack of culturally competent care - fragmented delivery of care

Auscultation (lungs)

- lobes : right ( 3 ) lobes • right upper , right middle , right lower left ( 2 ) lobes • left upper , left lower - rate of inspiration / expiration

Inspect (abdomen)

- note posture + look for evidence of abdominal splinting - check for abnormal movement / shadows , Stand on pt's right side + inspect above abdomen - assess abdominal contour ( direct examination light over the abdomen )

Observation :

- observe a pt's verbal & nonverbal behaviors , such as the use of eye contact , body language & positioning , or tone of voice - establish trust w / the pt so they feel comfortable asking you questions about the healthcare environment planned treatments , & diagnostic testing in order to partner w / you in making decisions & planning goals of care

Cultural Knowledge

- process in which healthcare professionals seek & obtain a sound educational base about culturally diverse groups - focus on the integration of (3) specific issues: health-related beliefs & cultural values, care practices, & disease incidence & prevalence

Cultural Awareness

- process of conducting a self-examination of one's own biases toward other cultures and the in - depth exploration of one's cultural & professional background - being aware & documenting racism & other " isms " in healthcare -know self-bias

Back channeling

- reinforce your interest in what a pt has to say by using good eye contact & listening - includes active listening promos such as " all right " , " go on " , or " uh - huh " - shows that you heard what a pt says , are interested in hearing the full story , and are encouraging the pt to give more details

Leading questions

- risk b / c they can limit the information a pt will provide to what a pt thinks you want to know

Vesicular sounds :

- soft breezy , & low - pitched -inspiratory phase is 3 times longer than expiratory phase ( 3 : 1 inspiration > expiration ) -location : best heard over periphery of lung ( except over scapula -origin : created by air moving through smaller airways

Inspect (lungs)

- symmetry - Chest rise + fall breathing ( unlabored / effortless )

Expected characteristics (neck)

- symmetry of neck muscles - neck normally moves w / out discomfort - normally lymph nodes aren't easily palpable , however , small , mobile , non tender nodes are common

Close - ended questions

- to seek specific information about a problem - limits answers to one or two words such as " yes " or " no " or a number or frequency of a symptom - does not allow for thorough assessment

edema

- use 2 thumbs / index fingers to palpate the pretibial area & pedal area ( or any area suspected of edema )

Palpation (lungs)

- vibrations ( tell pt to say 99 , 2in apart for finger placement on back ) - intercostal spaces - Angle of louis ( sternal angle )

active Rom

- what can be achieved when opposing muscles contract & relax , resulting in joint movement - make the effort without outside help

Background (SBAR)

- what is going on with the client? time frame? can be the who, what where, when, why & how - "The client has been vomiting after each meal for the last three days."

Situation (SBAR)

- who you are, who the client is, why they were admitted, the ability to look up the client, beginning info to allow your provider or other members of the care team - "Good afternoon Dr. Rich, this is Nurse Natalie on trauma 1. I have Charles Brown in room 302 who was admitted for a possible bowel obstruction."

Assessment

- your findings, what you see, hear, feel, smell - "After listening to the bowel sounds for 5 minutes in each quadrant, there are no bowel sounds found LLQ, RLQ, RUQ, LUQ are absent."

Muscle strrength scale (0-5) What is expected?

-5 is expected

[ Nursing Health History

-Defined as a formal method used to collect data about a pt ( required content , and length of a nursing health history will vary by health cares setting 1. Physical & developmental : perception of health status , past health problems & therapies , present health therapies , risk factors activity & coordination , review of systems , developmental stage , effect of health status on developmental stage , occupation , etc. 2. Intellectual : intellectual performance , problem solving , educational level , communication patterns , attention span , etc. - Spiritual : beliefs & meaning , religious experiences , rituals and practice , fellowship and courage 3. Emotional : behavioral and emotional status , support system , self concept , body image , mood , sexuality , and coping mechanisms 4. Social : financial status , recreation activities , primary language , cultural heritage and influences community resources , etc.

pt safety

-basic needs , food safety , fall safety in home , fall prevention

Inspect (nails)

-nail bed for color , length , symmetry , cleanliness configuration -nails are normally transparent , smooth , well - rounded + convex , w / a nail bed angle about 160 degrees . ( > 180 degrees = clubbing )

JVD

-to inspect , JVD ; have pt lie flat in supine position & elevate neck or laterally move the neck at an angle of 30-45 degrees

Cultural congruent care

-transcultural care emphasizes the need to provide care based on a n individual's cultural beliefs, practices, and values; therefore effective communication is a critical skill in culturally competent care & helps you engage a pt & family in respectful, patient-centered dialogue -(requires you to address your own implicit bias; be respectful of & responsive to individual pt preferences, needs, values: & ensure that pt values guide all clinical care)

Inspection | Eyes ( neurological assessment )

PERRLA : pupils Equal , Round , Reactive to Light + Accomodation Snellen Chart ( normal 20/20 ) • tests distant vision • numerator is 20 , or distance the pt stands from the chart • denominator is the distance from which the normal eye is able to read the chart ( the larger the denominator , the poorer the pt's visual acuity 6 oculor movements ( 6 point gaze test )

Cultural Competency

Professional health care must be culturally sensitive, appropriate and competent to meet the multifaceted health care needs of each person family and community

BP :

Systole : 120mm Hg ( lowest 90 mmHg ) Diastole : 80mmHg ( lowest 60 mmHg ) Pulse pressure : 30-50

pulse locations

Temporal, Carotid, Apical, Brachial, Radial, Ulnar, Dorsalis Pedis, Femoral, Popliteal, Posterior Tibial

Cultural desire

The motivation of a healthcare professional to want to and not have to engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful and seeking cultural encounters

Social determinants of health (greatly affect health disparities):

conditions in which people are born, grow, live, work, and age that affect health functioning & quality of life outcomes

Thyroid Location

glands lies in anterior louer neck , in front of & both sides of trachea, normally cannot be visualized, ask pt to hyperextend + drink water

Emic

insider perspective

Comfort

later a Provide necessary comfort measures before beginning an interview ( when pts have symptoms , keep questions short & focused b . Maintain privacy c . Select a location for the interview that is quiet & free of interruptions ( set aside 10-15 minute period when no other activities are planned & do not answer mobile phone / pager unless it's an emergency ) d . Avoid making the pt tired . Do not need to compete the interview in one session

Mouth (expected findings)

lips : pink , moist , symmetrical & smooth ( lip color in pt w / dark skin varies from pink → > plum ) teeth: smooth , white + shiny mucosa : glistening , pink , smooth + moist buccal mucosa : glistening , pink , soft , moist + smooth gums : usually pale , Øtenderness , pink , smooth , t moist , fit tightly around each tooth tongue : normal : medium or dull red in color , moist slightly rough on the top surface , & smooth along the lateral margins • hard palate ( roof of mouth ) · located anteriorly / dome shaped · soft palate ( extend posteriorly towards the pharynx ) • normally light pink & smooth

Bronchial :

loud and high pitched hollow quality - expiration lasts longer than inspiration ( 3 : 2 ratio ) - location : heard only over the trachea -origin : created by air moving through the trachea close to the chest wall

lymph nodes (expected characteristics)

normally not palpable if visible , should be small , mobile , nontender , < 1cm

Etic

outsider perspective

pt - centered interview

1. Setting the stage 2. Gathering information about the pt's problems & setting an agenda 3. Collecting the assessment or a nursing health history 4. Terminating the interview

5 main points (neck)

tests sternocleidomastoid + trapezius the neck backward - neck muscles : ask pt to flex neck w / chin to chest , hyperextend move head laterally to each side - trachea -have pt sit / lie down ( palpation ) , palpate suprasternal notch , slipping thumb / index fingers @side - jugular veins - carotid veins - lymph nodes

Inspect/expected findings (skin)

texture of skin is normally soft , smooth , even + flexible for children + adults Temp : warm Moisture : normally smooth & dry Color : uniform in color appropriate for ethnicity

Cultural skills

the ability to conduct a cultural assessment of a pt to collect relevant cultural data about a patient's presenting problem, as well as accurately conducting a culturally based physical assessment

physiology heart

- Cardiac cycle: systole / diastole systole : ventrices contract + eject blood from L. ventricle into the aorta + from R. ventricle into the pulmonary artery diastole : ventricles relax & the atria contract to move blood into ventricles + fill the coronary arteries - SI : valve closure of the mitral tricuspid values ( " Lub " ) L > heard better at the apex ( mitral value ) L occurs after the long diastolic pouse & before the short systolic pause ( difficult to hear in relation to carotid pulsation ) L > high pitched , dull in quality - S2 : valve closure of the aortic + pulmonic Valves ( " Dub " ) heard better at the base ( aortic arealvalue L > follows the short systolic pouse & precedes the long diastolic pause

Ears (expected findings)

- Cerumen : yellow , waxy substance in the car canal ( external ear )

Palpate (abdomen)

- Check for distention , masses , & tenderness

Inspect (hair)

- Color , distribution , quantity , thickness , texture + lubrication of body hair ( be aware of normal distribution in a man + woman ) -assess for couses of changes in thickness , texture , & lubrication of scalp hair & changes in hair growth I ( diet affects - assess for wigs , hairpieces , hair - care products + ask pt if there has been any loss , growth , or recent changes • alopecia : hair loss or thinning of hair - > related to genetic , endocrine disorders ( diabetes thyroiditis , menopause )

Objective data (evidence-based assessment)

- Findings resulting from observation of pt behavior & clinical signs as well as direct measurement, including what you see, hear, and touch - When you collect objective data, apply critical thinking intellectual standards (e.g., clear, precise, and consistent) so that you can correctly interpret your findings - Ex: inspect the condition of a wound, observing a patient walk down the floor, measuring blood pressure (BP), and describing specifically an observed behavior (patient seizure)

Orientation / Setting an agenda

- Introduce yourself - Explain why you are collecting data & provide pt confidentiality - Important to set an agenda for the interview & explain how you will gather information about a pt's chief concerns or problem ( e.g. , asking questions and performing a physical examination ) - Focus on pt's goals , preferences , and concerns ( not your personal agenda ) - Phase where you establish a therapeutic relationship with a pt

Health History

- Lifestyle patterns & habits - Focus on your pt 1. Avoid having the laptop separate you from the pt ( do not type while talking to pt ) 2. White down data right away ASAP 3. Client can see their own data ( Turn your laptop away when you are showing data of other pts while assessing the database )

Working phase ( collecting assessment data )

- Open - ended questions to allows pts to describe their concerns or problems clearly - Ask them to describe what they know about their health problems or to describe their health care expectations

mental health status ( health history )

- Orientation + LOC ( level of consciousness ) - hygiene , choice of dress , etc.

Subjective data (evidence=based assessment)

- Pt's verbal descriptions of their health problems gathered during interviews (informal/formal) - Includes pt's feelings, perceptions, and self-reported symptoms - Often reflects physiological, social, or psychological changes

Hair (expected findings)

- Scalp is normally smooth + inelastic w / even coloration even distribution of hair 2 types of hair : a . soft , fine , vellus hair ( covers the body ) b . Coarse , long , thick terminal hair ( visible on scalp , axillae , pubic areas in facial beard on men )

Termination of the interview

- Summarize your discussion with a patient and check for accuracy of the information - Let your patient know when the interview is coming to an end

Inspect (throat)

- anterior / posterior pillars , soft palate , uvula tonsils - have pt tip head back slightly + open mouth as you place tongue depressor in mouth - normally pharyngeal tissues are pink / smooth , well hydrates - Small Irregular spots of lymphatic tissue + small blood vessels are normal

-Probing

- as the pts tell their stories , encourage a full description without trying to control a story's direction - probe with more open - ended questions - each time a pt offers more details , probe again until the pt has nothing else to say & has told the full description - if a pt becomes fatigued or uncomfortable , know that it is time to postpone the interview until later

Bronchovesicular:

- blowing sounds that are medium pitched & of medium intensity -inspiratory phase - expiratory phase ( 1 : 1 ) -location : best heard posteriorly between scapulae & anteriorly over bronchioles lateral to sternum at 1st & 2nd intercostal space -origin : created by air moving through the trachea close to the chest

Auscultate (abdomen)

- bowel sounds in all 4 quadrants ( start RLQ ) - auscultate 5-20 sec . each quadrant - when Øbowel sounds are heard after 1 min . , listen at each quadrant for 5 min . for total of 20 min . for ALL quadrants - best time to auscultate is in between meals

passive Rom

- can be defined as what is achieved when an outside force , such as a therapist , causes movement of a joint usually maximum range of motion - pt is not the one engaging the muscles you would normally use to start the movement & do the work

[ general survey ]

- defined as an appraisal of the pt's presentation , and behavior provides information about characteristics of an illness , the pt's ability to function independently , body image , emotional state , recent changes in weight , and developmental status - assess appearance and behavior while prepare the pt for the physical examination General survey includes : 1. Gender and race 2. Age 3. Signs of distress 4. Body type 5. Posture & gait 6. Hygiene & body odor 7. Affect & mood 8. Speech 9. Signs of pt abuse 10. Substance

gait

- describes a particular manner or style of walking expected : balanced , symmetrical , & steady ) Assess : 1. observe the pt entering the room , & note speed , stride & balance 2. ask the pt to walk across the room , turn , & come back 3. ask the pt to walk heel - to - toe in a straight line ( this may be difficult for older pts even in the absence of disease , so stay at the pt's side while they are walking

factors that affect VS

1. Body temperature : age , exercise , hormone level , circadian rhythm , stress environment , temperature alterations 2. Pulse : exercise , temperature , medications , postural changes , emotions , acute pain , hemorrhage , pulmonary conditions 3. Respiration : exercise , acute pain , anxiety , smoking , body position , medications , neurological injury , hemoglobin function 4. Pulse oximetry : interference w / light transmission & interference w / arterial pulsations 5. BP : age , stress , ethnicity & genetics , gender daily variation , medications , active & weight , smoking 6. Activity of occupation ( occupational stress 7. Vital Signs : time of day , stress ( emotional & physical ) , temperature alterations , weather conditions , exercise / activity , medication , postural changes ( supine , sitting , standing ) , acute pain , smoking , disease / injury status , noise food / liquid components

Male genitalia ( * All men 15 years and older should start performing gential self - examination )

1. First note the sexual maturity of the patient by observing the size and shape the panis and testes , the size , color , and texture of the scrotal skin ; and the character and distribution of pubic hair 2. Inspect skin covering the genitalia : normally it is clear , without lesions 3. Dorsal vein is apparent on inspection 4. Urethral meatus : usually the opening is glistening and pink without discharge , palpate the shaft to detect localized hardness or tenderness ( pts who have lain in bed for a prolonged time sometimes develop dependent edema in the penis shaft ) 5. Testicles → > Normal findings : Smooth , rubbery , nontender , and sensitive ( left testicle is lower than the right ) 6. Scrotum : Scrotal skin is usually loose , and the surface is coarse , more deeply pigmented than body skin . ( tightening of the skin or loss of wrinkling reveals edema ) ( size normally changes with temperature b / c dartos muscle contracts in cold and relaxes in warm )

movement of muscles

1. Flexion : movement decreasing angle between 2 adjoining bones ; bending of limb ( elbow , fingers , knee ) 2. Extension : movement increasing angle between 2 adjoining bones ( elbow , knee , fingers ) 3. Hyperextension : movement of body part beyond its normal resting extended position ( head ) 4. Pronation : movement of body part so that front or ventral surface faces downward ( hand , forearm ) 5. Supination movement of body part so tat front or ventral surface faces upward ( hand , forearm ) 6. Abduction : movement of extremity away from midline of body ( leg , arm , fingers ) 7. Adduction : movement of extremity toward midline of body ( leg , arm , fingers 8. Internal rotation : rotation of joint inward ( knee , hip ) 9. External rotation : rotation of joint outward ( knee , hip ) 10. Eversion : turning of body part away from midline ( foot ) 11. Inversion : turning of body part toward midline ( foot ) 12. Dorsiflexion : flexion of toes & foot upward ( foot ) 13. Plantar flexion : bending of toes & foot downward foot )

How to identify patients who are at risk of malnutrition

1. General appearance : easily fatigued , no energy , falls asleep easily ; looks tired , apathetic , cachectic 2. Weight : overweight , obese , or underweight ( special concern for underweight ) ; unplanned weight loss over period of time 3. Posture : poor posture , sagging shoulders , sunken chest , humped back 4. Muscles : flaccid , weak , poor tone , tender ; " wasted " appearance ; impaired mobility 5. Mental status : inattentive , irritable , confused 6. Neurological function : burning & tingling of hands & feet ( paresthesia ) , loss of position & vibratory sense , decrease or loss of ankle & knee reflexes 7. Gastrointestinal function : anorexia , indigestion , constipation or diarrhea , symptoms of malabsorption , liver or spleen enlargement , abdominal distention 8. Cardiovascular function : tachycardia , abnormal rhythm , elevated BP 9. Hair : stringy , dull , brittle , dry , thin , and sparse , depigmented 10. Skin ( general ) : rough , dry , scaly , pale , pigmented , irritated , bruises , petechiae 11. Face & neck swollen , skin dark over cheeks & under eyes 12. Lips : dry , scaly , swollen ; redness & swelling at the corners of the mouth ( cheilosis ) ; angular lesions at corners of mouth , fissures , or scars ( stomatitis ) 13. Mouth , oral mucous membranes : swollen , deep red oral mucous membranes ; oral lesions 14. Gums : spongy , bleed easily , inflamed , receding 15. Tongue : swelling , scarlet & raw , magenta color , beefy ( glossitis ) 16. Teeth : missing teeth , broken teeth 17. Eyes : eye membranes pale ( pale conjunctivae ) , redness of membrane ( conjunctival injection dryness or infection 18. Nails : spoon - shaped ( koilnychia ) , brittle , ridged 19. Legs & feet : edema , tender calf , tingling , weakness , lesions 20. Skeleton : bowlers , knock-knees , chest deformity at diaphragm , beaded ribs , prominent scapulas

how to test muscle strength

1. Neck ( sternocleidomastoid ) : place hand firmly against pt's ! " upper jaw & ask pt to turn head laterally against resistance 2. Shoulder ( trapezius ) : place hand over midline of pt's shoulder exerting firm pressure & have pt raise shoulders against . resistance 3. Biceps : pull down on forearm as pt attempts to flex arm 4. Triceps : as you flex pt's arm , apply pressure against forearm & ask pt to straighten arm 5. Quadriceps : when pt is sitting , apply downward pressure to thigh & ask pt to raise leg up from table 6. Gastrocnemius : pt sits while examiner holds shin of flexed leg & ask pt to straighten leg against resistance

factors that don't affect VS

1. Occupation 2. Isolation precaution

Female Genitalia Assessment

1. Review menstrual history , including age at menarche ( first occurrence of menstruation ) , frequency and duration of menstrual cycle , character of flow ( e.g. , amount , presence of clots ) , presence of dysmenorrhea ( painful menstruation ) , pelvic pain , dates of last two menstrual periods , and premenstrual symptoms ( Info helps to reveal the level of reproductive health , including normalcy of menstrual cycle ) - Expected findings: 1. Inspect quantity and distribution of hair growth ( For adults , it grows in a triangle over the female perineum and along the medial surfaces of the thighs , the underlying skin is free of inflammation , irritation , or lesions ) 2. Labia majora: Skin of perineum is smooth , clean , and slightly darker than other skin - The mucous membranes appear dark pink and moist - Labia majora can be gaping or closed , appear dry or moist , and are usually symmetrical . Normally without inflammation , edema , lesions , or lacerations ( After childbirth : labia majora separates , causing the labia minora to become more prominent ) ( When a women reaches menopause , the labia majora become thinned ; they become atrophied in older age ) - Labia minora is normally thinner than the labia majora , and one side is sometimes larger - Tissue inside the labia minora is soft , without tenderness - Size of clitoris varies , but normally does not exceed 2cm ( 1 inch ) in length and 0.5 cm ( 44 inch ) in width - Urethral orifice : Normally intact without inflammation , anterior to the vaginal orifice and is pink - Vaginal orifice : Opening is thin , vertical slit , and the tissue is moist .

orthostatic of vital signs

1. Three minutes in between positions for Orthostatic Hypotension ( postural hypotension ) -ex : 3 min . supine - > take BP- > change position ( sitting ) , take BP & wait 3 min . - > change ( standing ) , take BP 2. Occurs when a normotensive person develops symptoms ( e.g. , light - headedness or dizziness ) 3. BP change / difference for each position -drop in systolic by at least 20 mm Hg & drop in diastolic by at least 10 mm Hg within 2-5 min of quiet standing or 5 min of supine rest

breast self examination BSE

1. best time for BSE if the 4th through 7th day of menstrual cycle or right after the menstrual cycle ends when the breast is no longer swollen or tender from hormone elevations 2. if the women doesn't menstruate ( due to pregnancy or menopause ) , advise her to check her breasts on the same day each month

How to properly ask questions about diet ( food and fluid intake )

1. diet history focus on pt's food preferences , allergies 2. gather info about the pt's illness & activity level to determine energy needs & compared food intake 3. nursing assessment of nutrition : health status , age , cultural background , religious food pattern socioeconomic status ; psychological factors ; use of alcohol or illegal drugs ; and complete medication history 4. ask appropriate questions

Respiration :

12-20 breaths / min ( deep + regular )

Normal pulse

2+ , equal bilateral

axillary :

36.5 ° C ( 97.7 ° F )

avg . oral / tympanic

37 ° C ( 98.6 ° F )

avg . rectal :

37.5 ° C ( 99.5 ° F )

pulse :

60-100 beats / min ( strong/regular )

Skin (unexpected findings)

Cyanosis : blush discoloration in lips , nail beds , palms & palpebral conjuctiva pallor : pale appearance in lips , nall beds & mucous membrane jaundice : yellow - orange discoloration ( best site : sclera ) erythema : red discoloration ( indicates circulatory changes )

female / male breast

Female assessment ( start w / least . invasive ) 1. menstrual cycle 2. build trust , know hormones change w / menstrual system 3. when assessing the female genitalia , lithotomy position Breast assessment ( women & men both do this ) | Inspection & palpation ( feel for nodes ) Procedure : 1. use finger pads of 3 middle fingers to feel for lumps Patterns : dime - size circular motion , up & down pattern ( most effective based on studies ) , inward & outward pattern 2. split the breast into 4 different quadrants ( axillary tail of spence ) -upper & lower inner quadrant - -upper & lower outer quadrant 3. usually feels dense , firm , and elastic ( breast tissue ) Inspect : 1. inspect breast for size & symmetry ( normally extend from 3rd to the 6th ribs w / nipple at level of 4th intercostal ) also common for one breast to be smaller 2. contour and shape of breast 3. inspect the color 4. inspect nipple & areolar for size , color , shape , discharge , & direction in which the nipples point -normal areolas are round or oval & nearly equal bilaterally , color ranges from pink to brown - nipples point in symmetrical directions , are everted , & have no drainage - note : normal to feel a firm ridge in the lower curve of each breast Male breasts : use the same technique to palpate for masses used in examination of the female breast ** know patterns , maintain a consistent pattern

-Breast Cancer ( women at risk )

a . Ages 40-44 1. should have the choice to start annual breast cancer screening with mammograms if they wish to do so . The risks of screening as well as the potential benefits should be considered 2. monthly breast self - examination ( BSE ) dependent on health care provider recommendation ( not recommended by ACS ) b . Age 45-54 1. Monthly BSE dependent on health care provider recommendations ( not recommended by ACS ) 2. Should get mammogram every year c . Age 55 and older 1. Should switch to mammograms every 2 years or have the choice to continue yearly screening - Women w / a personal history of breast cancer , a family history of breast cancer , a genetic mutation known to increase the risk of breast cancer ( such as BRCA ) , and women who have had radiation therapy to the chest before the age of 30 are at a higher risk for breast cancer , not average risk . These women require earlier and more extensive screening

- Colon rectal cancer

a . Ages 45 and older , rectal exam done annually 1. Men and women need to have one of the following sensitive tests that look for signs of cancer : fecal occult blood test ( FOBT ) or flexible sigmoidoscopy ( FSIG ) or colonoscopy . Earlier screening is necessary if risk factors exist .

Confirmation

a . At the end of an interview , ask the pt to summarize the discussion so that there are no uncertainties . Be open to further clarification or discussion . End by asking if the pt has anything else they want to discuss

Courtesy

a . Greet pts by the name by which they prefer to be addressed b . Introduce yourself & explain your role the first time you meet c . Ensure pt that information shared will remain confidential among the health care team d . Sit down next to the pt & do not make an effort to exit the room too soon e . Ask the pt's permission to conduct an interview in a visitor's presence f . Try to reduce computer time entering ; remember key words & record later

Connection

a . Make a good first impression ( do not state at a computer screen while filling in required data fields or talking on a mobile phone ) b Begin with open ended questions , allow pts to fully describe their symptoms , be observant , respect silence , be flexible & open minded . Let the pt's needs , concerns , or questions guide your follow - up question

Health disparities

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage (differences in health care outcomes & dimensions of health care, include access, quality, and equity, among population groups

Social determinants examples:

age, race, ethnicity, socioeconomic status, access to nutritious food, transportation services, religion, sexual orientation, level of education, literacy level, disability (physical & cognitive), and geographic location (e.g., access to health care)

temp . range :

avg . 36-38 ° C / 96.8-100.4 ° F

Palpation (head)

palpote skull for nodules / masses gently rotate fingertips down the midline of the Scalp + along the sides of the head for abnormalities palpate temporomandibular joint ( TMJ ) space bilaterally La place fingertips anterior to tragus of each ear > fingertips should slip into joint space as the pt's mouth opens to gently polpate the joint spaces normally movements should be smooth , although not unusual to hear / feel a clicking / snapping in the TMJ

Cultural encounters

process that encourages healthcare professionals to directly engage in face to face cultural interactions and other types of encounters with patients from culturally diverse backgrounds

Disparities:

race/ethnicity, gender, location, disability, or social determinants

pt positions

sitting, supine, dorsal recumbent, left lateral recumbent for heart, lithotomy, prone, knee-chest

Palpate (skin)

skin turgor ( test for hydration ) lumps / bumps / masses