Download NR 509 / NR509 Advanced Physical Assessment Midterm Exam Week 1 to 4 Review and more Exams Nursing in PDF only on Docsity!
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NR 509 / NR509 Advanced Physical Assessment
Midterm Exam Week 1 to 4 Review
- The interview process Answer Initiating the session Gathering information Physical examination Explanation and planning Closing the session These steps are proving structure and building the relationship
- interviewing techniques Answer Nonverbal communication Empathy
2 / Active listening Validation reassurance partnering summarize Guided questioning Empowerment
- Setting the stage for examination Answer Explaining point for point what the exam- ination will entail, preparing, privacy, awareness of the setting in which the exam is taking place, do not assume it is ok to have others in the room, being aware of disabilities.
- Establishing Rapport Answer Earning trust, following through, showing empathy and compassion, being knowledgeable of the information provided
- Gender Pronouns Answer
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- Fundamentals of skilled interviewing Answer Active listening, empathetic responses, guided questioning, nonverbal communication, validation, reassurance, partnering, summarization, transitions, empowering the patient
- verbal communication Answer expressing ideas to others by using spoken words
- nonverbal communication Answer communication using body movements, gestures, and facial expressions rather than speech
- Challenging Patient Situations and behaviors Answer Silent Talkative With confusing narrative With altered state or cognition With emotional
5 / lability Angry or aggressive Flirtatious Discriminatory With hearing loss With low or impaired vision With limited intelligence Burdened by personal problems Nonadherent With low literacy With low health literacy With limited language proficiency With terminal illness or dying
- 5 R's off cultural humility Answer Reflection— what did I learn? Respect—did I treat everyone involved w respect? Regard—did unconscious bias drive this encounter? Relevance—how was cultural humility relevant?
7 / past medical history, family history, personal and psy- chosocial history, and a review of all body systems Psych Obstetrics Surgery c-section goes here Hospital stays
- Components of Health History Answer
- Demographic information
- Source of history
- Chief concern
- History of present illness ——OLDCARTS
- Past health history and current health status
- Family history
- Social history
- Health promotion behaviors
- ROS ——all subjective
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- Determining the Scope of patient assessment Answer The patient's symptoms, age, and health history help determine the scope of the focused examination, as does your knowledge of disease patterns.
- seven attributes of a symptom Answer
- Location
- Quality
- Quantity or severity
- Timing (including onset, duration, and frequency)
- The setting in which it occurs
- factors that have aggravated or relieved the symptom
- associated manifestations
- subjective data Answer what the person says about himself or herself during history taking
- objective data Answer information that is seen, heard, felt, or smelled by an observer; signs
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- Percussion
- Auscultation
- Head to toe assessment Answer an assessment that organizes the collection of com- prehensive physical data by proceeding through the entire body from head to toe General survey Vital signs -skin
- head, EENT -neck -back -posterior thorax and lungs -breasts and axillae (ask to lay down) -anterior chest and lungs -cardiac ——elevate the HOB for JVD assessment ——- slight left side for mitral stenosis Then sit and lean forward, aortic regurg
11 / —abdomen. (Supine) —-Lower extremity's (supine) nervous/skeletal Then stand up ——-sit down for mental/cranial/motor/reflexes If needed genital and rectal exams
- The clinical reasoning process Answer Knowledge, Context, Experience Patients story Data acquisition Accurate problem presentation Generation of hypothesis Search for and selection of illness Diagnosis
- The problem list Answer
13 / Pertinent positives-support Dx Pertinent negatives —r/o Dx
- The summary statement Answer Chief complaint is placed in context of pt's overall heath status Includes pertinent parts of H&P and labs Succinct and short Demonstrates clinical reasoning skills Make case for diagnosis Distillation of ur understanding of the case
- Assessment (medical diagnoses) Answer Supports what Dx you are going to use and helps w plan development
- Planning (treatment and interventions) Answer What you plan to do to treat the diagnosis Teaching, meds, exercise, diet, next follow up, recording of home monitoring I.e. BP, pulse, weight, blood sugars, keeping journals for events that occur,
14 / what you ate, when you take pain meds.
- Using elements of the physical examination as diagnostic tests Answer Elicited through the classic techniques of inspection, palpating, percussion, and ausculta- tion.
- Evaluating diagnostic tests Answer Validity of the findings Reproducibility off the results SnNOUT ——-a sensitive test with negative result RULES OUT disease SpPIN ——-a specific test with a positive result RULES IN disease.
- Clinically appraising the evidence Answer
16 / Mood Behavior Personal hygiene Odors Posture Motor Activity Breathing
- vital signs Answer BP PULSE RESPIRATORY RATE AND TEMPERATURE useful in detecting or monitoring medical problems AND SETS THE TEMPO OF THE EVALUATION
- Classifying normal and abnormal blood pressure Answer Correct cuff size Comfortably seated Appropriate cuff position <120mmhg and <80 mmhg is normal 120-129/<80 elevated
17 / 130-139/80-89 stage I HTN
140/90 stage 2 HTN
- acute pain Answer episode of pain that lasts from seconds to less than 6 months Surgery trauma illness Protective function
- chronic pain Answer episode of pain that lasts for 6 months or longer; may be intermit- tent or continuous Cancer Recurring in intervals of months to years Lasting 1 month beyond the course of acute illness
- anorexia nervosa Answer An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat
- bulimia nervosa Answer an eating disorder characterized by episodes of overeating, usually of high-
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- Assessing acute and chronic pain Answer Patient pain history Assessing severity Health disparities in pain
- mental status examination Answer appearance, orientation, speech , affact/mood, impulsive/potential for harm, judgement/insight, thought processesses, intellectual functioning
- Speech patterns of individuals Answer Dysarthria defective articulation Aphasia language disorder Dysphonia impaired volume, pitch, quality ——-Testing for aphasia—- Comprehension Repetition Naming Reading comprehension Writing
20 / Broca aphasia—-expressive Wernicke aphasia—— receptive
- Hallucinations Answer false sensory experiences, such as seeing something in the absence of an external visual stimulus Auditory visual olfactory gustatory tactile somatic May not recognize the experience Can occur in dementia delirium ptsd schizophrenia and substance use
- assessing abstract thinking Answer ask to interpret a proverb Similarities Concrete responses to abstract thinking assessment are common in intellectual disability delirium or dementia and may reflect limited education. Schizophrenias may answer concrete or with personal and bizarre interpretations
- screening for depression Answer PHQ-9 Geriatric depression scale
