Final Health Assessment Madison

what patient says about himself or herself during history taking
PAIN IS SUBJECTIVE

observed when inspecting, percussing, palpating, and auscultating patient during physical examination

emergent, life threatening, and immediate
3mo old throwing up blood

next in urgency, requiring attention so as to avoid further deterioration
not going to die immediately
gash on head or uti

important but can be addressed after more urgent problems
fever, sweating, vomit

approach to treatment involves multiple disciplines
need more specialties

rapid collection of data, often compiled concurrently with lifesaving measures
get all information right now

other symptoms that go with your primary symptom

aware to person and environment
awake, alert, and oriented to person, place, and time (x3)

time

1) diurnal cycle = 1-1.5 Fº with trough in early morning hours and peak occurring late afternoon
2) menstruation = ovulating causes .5-1.0 Fº rise
3) exercise = increases body temp
4) age = infant and young child less effective heat control, older people lower temp 97.2

gathering complete and accurate data
establish rapport and trust so person feels free to share all relevant data
patient teaching
relationship of open communication and trust
6 feet (social distance) eye level

a standard blood pressure cuff

question that promotes detail

ask specific information

know where

correct spelling

180 degrees from nail bed or a straight line

deeper depression extending into dermis, irregular shape
may bleed, leaves scar when heals

linear crack with abrupt edges
extends into dermis, dry or moist

self-inflicted abrasion, superficial, sometimes crusted
scratches from intense itching

scooped-out but shallow depression, superficial
epidermis lost, moist but no bleeding
heals without scar because erosion does not extend into dermis

compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells

arterial = pale, cyanotic, mottled
venous = may be reddish-blue

arterial = cool to cold
venous = warm

arterial = thin, shiny skin, dependent rubor, elevation pallor of foot
venous = firm, brawny, brownish pigmentation in area between medial and lateral malleolus, skin thickened and tough, cyanosis when dependent

arterial = thickened and ridged
venous = not thickened

arterial = loss of hair over toes and dorsum of foot
venous = present

arterial = none or minimal
venous = moderate to severe, pitting, ankle, foot, lower leg

arterial = decreased or absent
venous = present but may be difficult to palpate through edema

arterial = intermittent claudication (relieved by rest)
venous = aching, cramping, feeling of fullness, relieved by elevation

arterial = between toes or tips of toes, heels, lateral malleolus, well-defined edges, deep, circular ulcer base-black or gangrene, non bleeding
venous = medial malleolus and lower leg, uneven edges, superficial, ulcer base-granulation tissue-beefy red to yellow, bleeding, may or may not be painful

health history

96.4-99.1 ºF

60-100 bpm

10-20 bpm

97 to 98%

count for 30 seconds or full minute if you suspect and abnormality

palpate to where the BP goes away
then use stethoscope to pump it up 30 mmHg past where the palpation went away and listen for BP
Systolic = top number first sound heard
Diastolic = bottom number last sound heard

Less than 120 AND less than 80

120-129 AND less than 80

130-139 OR 80-89

140 or higher OR 90 or higher

higher than 180 AND/OR higher than 120

rapid respiratory rate
considered any rate above 25 bpm

decreased respiratory rate
ranges from 8-12 bpm

a more rapid heart rate >100

adult resting heart rate is <60

less than 18.5

1 per day

2 per day

warm, damp washcloth

lip reading
frowning or straining
posturing (turning head)
does not answer appropriately (says huh?)
irritable or startled
speech garbled
inappropriately loud voice
tone flat
tv volume increasing

no it protects the ear
eardrum should be concave

central vision
vision acuity
20 feet away
one eye at a time then bith

fixate something far away then look close at penlight

0 don't see at all
1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching uvula
4+ touching each other

should be flat, slightly pulled at the center (concave)
pearl-gray color

will hear very end of inspiration
sounds like hair rubbing together

sounds like crunchy leaves
suction with fluid it will come back
just after beginning of inspiration and a little into expiration

two pieces of leather rubbing together
grating
caused by inflammation
end of inspiration beginning of expiration

high-pitched whistling sound
very end of inspiration and all of expiration

inflammation in upper airway
sounds like a seal
all of inspiration

low-pitched
blowing bubbles in milk
expiration

regular pattern
waxing and waning

like Cheyne-Stokes but irregular

shallow and spaced out breathing
overdose, lot of pain, or anesthesia

Inspiration > Expiration

Inspiration = Expiration

Expiration > Inspiration

move finger or big toe up and down
ask patient which way it is moved
do few trials before you ask patient to close eyes

Pupils Equal Round and Reactive to Light and Accommodation

closing of Mitral and Tricuspid valves
heard the best at Apex of Heart
marks the start of systole

closing of semilunar valves
signals end of systole (heard best at base of heart)

avoid excessive pressure on the carotid sinus
palpate medial to the sternal muscle
ONE carotid artery at a time
Normal Strength 2+

sounds like liquid moving instead of a pulsation sound

PALPABLE vibration
turbulent blood flow that usually accompanies loud murmurs
sounds like a cat purring

Z pattern

doppler

contraction towards the stroke

between xiphoid process and umbilicus
shouldn't be able to see obese patient

sensory
not tested routinely
assess patency (occlude nostril, sniff
normal: can identify odor on each side of nostril

sensory
visual acuity
visual fields by confrontation
ophthalmoscopic exam

pupil check
EOM (cardinal positions of gaze)

motor = clench teeth
sensory = light touch sensation

motor = wrinkle forehead, close eyes, smile, pucker lips, puff out cheeks
sensory = not tested routinely, sense of taste

sensory
whispered voice test

motor = note pharyngeal movement (say "ahh") and gag reflex
sensory = taste (not done)

rotate head forcibly against resistance applied to side of chin
shrug shoulders against resistance

inspect tongue
normal = no wasting or tremors
ask person to say "light, tight, dynamite"
normal = clear and distinct

push against resistance

flex muscles by bending
stretch out muscle

movement away from the midline
movement toward the midline

turning hands palm down
turing hands up (holding soup)

circular movement of a limb
goes around in a circle

into the middle of the body
leaving body
foot

twisting wrist
nodding head no

forward and backward movement of the chin

shrugging shoulders up and down

wrist side to side

liver
gallbladder

appendix
cecum

stomach
spleen