EXAM 1 HA - Study Guide - Exam 1 PDF

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Study Guide - Exam 1...

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Advanced Health Assessment Exam #1 Review WEEK 1 – Intro to HA  Comprehensive Assessment: - new pts in hospital, provides personalized knowledge, strengthens relationship, helps identify and rule out physical concerns, baseline for future assessments, platform for health promotion, develops proficiency o General Assessment: Identify data (reliability), chief complaint(s), present illness, past history, family history, personal and social history, review of systems o Review of Symptoms: General, skin, HEENT, neck, breasts, respiratory, cardiovascular, gastrointestinal, peripheral vascular, urinary, genital, musculoskeletal, psychiatric, neuro, hematologic, endocrine o Techniques of exam: Inspect, Palpate, Percuss, Ascultate  Focused Assessment – For established pts, especially during routine and urgent visits, focused concerns and symptoms, restricted to specific body system  Skilled Interviewing Techniques: Active listening, empathetic responses, guided questioning, nonverbal communication, validation, reassurance, partnering, summarization, transitions, empowering the patient  Guided Questioning: Open ended questions to focused questions, using questions that elicit graded responses, asking series of questions, offering multiple choice answers, clarify what patient means, encourage to continue, echoe  Sequence of Interview: o Preparation – Review record, set goals, adjust environment o Sequence – Greet pt and establish rapport, establish agenda, invite pt story and perspective, identify and respond to emotional ques, expand and clarify, generate testing and hypothesis, share treatment plan, close interview, self-reflect. o Cultural Context – Demonstrate cultural humility  Diagnostic Tests o Sensitivity – The probability that a person with a disease has a positive test (true positive rate)

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o Specificity – The probability that a non-diseased person has a negative test (true negative rate) o Positive Predictive Value (PPV) – The probability that a person with a positive test has disease o Negative Predictive Value (NPV) – The probability that a person with a negative test does not have disease o Prevalence – Based on the characteristics of patient population and the clinical setting Addiction, Dependence, Tolerance o Addiction – adaptation in which drug exposure unduces changes that result in diminution of one or more of the drugs over time o Physical dependence – manifested by drugs class specific withdrawal syndrome that is from abrupt cessation, reduction o Addiction – primary, chronic, neurobiologic disease Intimate partner violence leading cause injury and second leading cause of death in women Ethics: o Nonmaleficence – First do no harm o Beneficence – Act in the best interest of the patient o Autonomy – Informed pts have the right to make their own clinical decisions General Survey: o Apparent state of health – general observations o Level of Consciousness – awake and alert and responsive o Signs of distress – cardiac, resp, pain, anxiety or depression o Skin color and obvious lesions o Dress, Grooming, Personal Hygiene o Facial expressions o Odors of the body and breath – fruity, alcohol (don’t assume alcohol on breath explains changes of behavior) o Posture, Gait, Motor Activity o Height and Weight o Calculating BMI lb X 700 / inches (2.2lbs=1kg ; 1in=2.54cm) Hypertension o Normal 120/80 o Pre – HTN 120/80 – 139/89 o HTN stage 1 140/90 – 159/99 o HTN stage 2 160/100 and higher

 Types of pain o Nociceptive (somatic) – tissue damage, musculoskeletal, or viscera o Neuropathic – direct consequence of a lesion or disease o Central sensitization – alteration of central nervous system processing of sensation, leading to amplification of pain signals o Psychogenic – the influence of pts report of pain o Idiopathic – without an identifiable etiology  Differential Diagnosis: o Select most likely diagnosis o Consider diagnosis that are statistically relevant based on age, sex, PMH, and lifestyle habits o Look for life-threatening diagnosis o Eliminate diagnostic possibilities o Formulate a working diagnosis o Test the hypothesis – diagnostic tests if needed o Reevaluate (confirm or rule out) based on diagnostic tests F – feelings I – ideas F – function E – expectations P – Presenting complaint O – onset L – location D – duration C – character A – aggravating and alleviating factors R – radiation T – timing I – introduction N – note goals T – transparency E – ethics R – respect beliefs P – patient focus R – retain control E – explain T – thanks

WEEK 2 – Growth and Development  4 Principles of Child Development o Proceeds along a predictable pathway governed by the maturing brain o Range of normal development is wide (mature at different rates) o Various physical, social and environmental factors as well as diseases effect development and health o Level affects how you conduct the clinical history and physical exam  Pediatric Health Promotion o Age appropriate development and achievement of child  Physical (maturation, growth, puberty)  Motor (gross, fine)  Cognitive (developmental milestones, language, school performance)  Emotional (self-regulation, mood, temperament, self-efficacy, self-esteem, indeoendence)  Social (competence, responsibility, integration with family, community, peers) o Health Supervision Visits  Periodic assessments of clinic and oral health  More frequent if special needs o Integration of physical exam findings o Immunizations o Screening procedures o Anticipatory Guidance  Healthy habits  Nutrition and healthy eating  Safety and preventionof injury  Physical activity  Sexual development and sexuality  Self-responsibility, efficacy, and healthy self-esteem  Family relationships  Positive parenting strategies  Emotional and mental health  Oral health  Recognition of illness  Sleep

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 Screen time  Prevention of risky behaviors (tobacco, alcohol)  School and vocation  Peer relationships  Community interactions o Partnership among health care provider, child/adolescent, and family APGAR o HR (0-absent) (1-100) o Resp rate, effort (0-absent) (1-skoow irregular) (2-good strong) o Muscle tone (0-flaccid) (1-flexion of arms and legs) (2-Active) o Reflex irritability (0-none) (1-grimmace) (2-vigorous cry) o Color (0-blue pale) (1-pink body blue extremities) (2-all pink) Physical Development o By 1 year birth weight triples and height by 50%, standing and putting objects into mouth o 3 months lift head and clasp hands o 6 months roll over, reach for objects turn to voices and some sit up with support o Birth to 1mo – focuses, follows, responds to sounds, regards face o 1mo to 2mo – Head control, coos, smiles o 2mo to 3mo – rolls over, grasps rattle, works for toy, babbles o 4mo to 5mo – squeals, laughs o 5mo to 6mo – sits o 7mo to 8mo – dada, mama, feeds self, indicates wants o 9mo to 10mo – pulls to stand, crawls, waves and peak a boo o 11mo to 12mo – walks, 2-3 words, uses spoon When can’t distract infant with object, face or sound – consider visual or hearing deficit Preterm infants o At risk for short term complications (resp and cardio) o Long term complications (neurodevelopment) Postterm infants o Risk for perinatal mortality or morbidity (asphyxia, meconium aspiration) LGA – (mothers with DM) o Metabolic and congenital abnormalities o Hypoglycemia (jitters, irritable, cyanosis) Preterm AGA

o RDS o Apnea o PDA with left to right shunt o Infection  Preterm SGA o Asphyxia o Hypoglycemia o Hypoglycemia  Infant Skin o Polycythemia – ruddy complexion (reddish purple color) o Cutis Marmorata – prominent in premmies and congenital hypothyroidism and downs o Acrocyanosis – blue skin – if does not disappear in 8 hours or with warming – cyanotic congenital heart disease (central cyanosis on tongue and oral mucosa – bad) o Café-au-lait spots – pigmented light brown isolated lesions have no significance o Neurofibromatosis - multiple lesions with sharp borders (more than 5 café spots and axillary freckling) o Candida Diaper Dermatitis – bright red rash including the folds with small satellite lesions along edges o Contact dermatitis – irritant rash secondary to diarrhea or irritation and noticed along contact area o Impetigo – infection due to bacteria and can appear bullous or crusty and yellowed with some pus o Jaundice – physiologic occurs during days 2-5 progresses from head to toe o Millaria Rubra – Scattered vesicles on an erythematous base, usually on the face and trunk (obstruction of sweat glands goes away within weeks) o Erythema Toxicum – Appears on 2-3 of days of life. Erythematous macules with central pinpoint vesicles scatters diffusely over entire body (like flea bites) disappear within 1 week (yellow or white pustules) o Erythema infectiosum (5th disease) – HPV B19 school age. Incubation 4-14 days AVOID preggos. Fever, slap face, rash on face, upper and lower extremeties, proximal to distal – rash subsides to irritated or trauma skin (pain and fever meds)

o Seborrhea – salmon red, scaly eruption often involves the sace, neck, axilla, diaper area, and behind ears o Atopic dermatitis – Erythema, scaling, dry skin and intense itching o Pustular Melanosis – Common in black infants @ birth. Small vesiculopustules over a brown macular base for several months o Milia – Pinhead size smooth white raised areas without surrounding erythema on nose, chin, and forehead. Usually appears within first few weeks of life and gone over several weeks o Benign Birthmarks (eyelid patch) – fades within first year o Salmon Patch (stork bite or angel kiss) – Splotchy pink mark fades with age o Slate blue patches – Common in dark skin. Important to note them to avoid mistake for bruises o Cephalohematoma – swelling from birth trauma o Verruca vulgaris – dry rough warts on hands o Verruca plana – small flat warts o Plantar warts – tender warts on feet o Mollusum contagiosum – dome shaped fleshy lesions o Roseola – eosey rash on chest and back (measles, typhoid, syphilis) o Tinea capitis – scaling crusting hair loss, painful plaque (kerion) and occipital lymph node o Tinea Corporis – Annular lesions has central clearing and papules along the border o Pityriases rosea – oval lesions on trunk in older children Christmas tree pattern o Urticatia (hives) – pruritic allergic sensitivity reactions change shape quickly o Scabies – intensly itchy papules and vesicles sometimes burrows most often on extremeties  Fontanelles (soft concavities) and Sutures (ridges) o Anterior Fontanelle @ birth (4-6 cm) closes between 2-26 months o Posterior @ birth (1-2 cm) closes by 2 months  Abnormalities o Craniosynostosis – premature closing of the cranial sutures o Congenital hyperthyroidism – coarse facial features o Upslanting palpebral fissures – Downs o Downslanting palpebral fissures – Noonan o Short palpebral fissures – Fetal alcohol

o Positive Chvostek sign – facial contractions caused by repeated contractions of facial muscles (hypocalcemic tetany, tetanus, hyperventilation) o Congenital Ptosis – damage to cranial nerve 3 from birth trauma, cannot open an eye even when awake o Nystagmus - wondering or shaking eyes o Macroglossia – several systemic conditions. If associated with hypoglycemia abd ompholacele = Beckwith-Wiedemann Syndrome o Abnormal Cries  Shrill or high pitch – increased ICP and narcotic addictions  Hoarse – hypocalcemic tetany or congenital hypothyroidism  Cont. inspiratory and expiratory stridor – Upper airway pbstruction  Absence in cry – Severe illness, vocal cord paraysis or profound brain damage  School-Age Assessment o 1yr – walks, runs, 2-3 single words, peak a boo, separation anxiety o 2yr – throws ball overhead, 2-3 word phrases, draws circle, imitates activities, prefers tasks by self o 3 yr – pedals tricycle, jumps in place, uses utencils, knows colors, sentences, asks why, sings songs, knows self in mirror, knows gender o 4yr – Cuts with scissors, hops, balances on 1 foot, 100% of speech understandable, talks in paragraphs, imaginative, sings, imaginary play, takes turns, puts on clothes o 5yr – Copies, skips, balances with 1 foot, walks on tip toes, says ABCs copies figures, defines words, dresses self, buttons, zips, plays games, knows whole name and telephone number Stages of Development (Erikson & Piaget)  Birth to 2 yrs (infancy) – Trust vs Mistrust & Sensorimotor  1.5 – 3 yrs (toddler) – Autonomy vs shame and doubt & Preconceptual  3 – 6 yrs (preschool) – Initiative vs guilt & Preoperational  6 – 12 yrs (school-age) – Industry vs inferiority & concrete operational thought (12yr formal operational thought)

WEEK 3 - Dermatology

 Melanoma – Least common skin cancer but most lethal (70% of skin cancer deaths) due to high rate of metastasis o A – Asymmetry o B – border irregularity o C – color variations o D – diameter >6mm (pencil eraser) o E – elevated o F – firm to palpation o G – growing progressively over several weeks o Document number, size, shape color, texture, primary lesion, location, configuration  Secondary lesion – evolve from primary lesions (scratching, trauma, infections, or healing process)  Primary lesion (physical changes of skin caused by direct disease process) o Flat (cannot palpate with eyes closed)  Macule – flat lesion 1cm o Raised (can palpate with eyes closed)  Papule – raised lesion, no fluid 1cm  Vesicle – raised lesion with fluid 1cm o Other primary lesions  Erosions – depressed areas part or all epidermis has been lost  Ulcers – necrosis of epidermis, dermis, and sometimes subQ  Maceration – Wet skin turns white and easily infected with bacteria and fungi  Nodules – marble-like lesion larger than 0.5cm deeper and firmer than papule extends to dermis and subQ  Ecchymoses  Excoriated – traumatized or abraded skin from scratching or rubbing  Fissure – linear cleavage of skin extends to dermis  Petechiae (plural petechiae) – small (1-2mm) red or purple spot caused by minor bleed (geriatric) (senile purpura)  Palpable Purpura  Pustule – circumscribed elevated lesion with pus (folliculitis)  Wheal – area of localized dermal edema that comes and goes 12 days (hives)

 Cherry angioma – bright cherry red pinhead 1/4in diameter smooth or raised  Spider angioma – swollen blood vessels beneath skin surface, central red spot with extensions  Telangetasia – vascular lesion formed by dilation of group of small blood vessels  Tinea – superficial skin infection by fungi. Spreads from person to person (ring worm, jock itch)  Alopecia – hair loss  Older Adults o Hypothermia more common o Basal cell carcinoma  Translucent nodule that spreads and leaves a depressed center with firm elevated border o Squamous Cell Carcinoma  Firm reddish lesion often emerging in a sun exposed area o Actinic Purpura – Pacthy red-purple spots (bruis)  Systemic disease and skin findings o Addisons – hyperpigmentation of oral mucosa, creases of palms and soles o Acquired Immune Deficiency Syndrome – HPV, herpes, varicella, cytomegally, TB, candidiasis – folliculitis, psoriasis, severe seborrheic dermatitis o Chagas Disease – Unilateral conjunctivitis and lid edema o Chronic renal disease – pallor, xerosis, uremic frost, pruritis, half and half nails, calciphlaxis o CREST – clacinosis, raynauds, matted face and palms o Chrons – Erythema nodosum, pyoderma, fistulas and ulcers o Cushings – Striae, atrophy, purpura, ecchymosis, acne, moon face, buffalo hump o Dermatomyositis – macules, patches or papules, ragged cuticles o Diabetes – Pruritis, dermopathy, acanthosis nigricans, candidiasis, ulcers o Disseminates intravascular coagulation – purpura, petechiae, hemorrhagic bullae, induration, necrosis o Dyslipidemias – Xanthomas, xanthelasma o Gonococcemia – Purple to grey macules, papules or hemorrhagic pustules

o Hemochromatosis – skin bronzing and hyperpigmentation o Hypothyroidism – Dry, rough, pale skin, coarse brittle hair, alopecia cool skin brittle nails o Hyperthyroidism – Warm, moist, soft, velvety skin, thin fine hair, alopecia o Acute idiopathic thrombocytopenic purpura (ITP) – accelerated removal of platelets (after measles, mumps, mono) o Infective endocarditis – janeway lesions, olser nodes, splinter hemorrhages, petechiae o Kawasaki – Mucosal and palms and soles erythema, strawberry tongue o Liver disease – Jaundice, spider angiomas, pruritis, purpura o Leukemia/lymphoma – pallor, nodules, petechiae, ecchymoses, pruritis, vasculitis, bullous doiseases o Leukocytoclastic vasculitis – Palpable purpura, purpuric wheals, hemorrhagic bullae o Rocky mountain spotted fever – pink and reddish papules progress to purpuric papules, starts on wrists and ankles then palms and soles then trunk and face Immunizations: - Passive immunity – short-term from introduction of antibodies from another person or animal (Hep B)(mom to baby) - Active immunity – Long-term developed in own body by natural and by vaccinations - Innactive vaccines – tetanus and DTap - Herd immunity – live vaccines Chickenpox/Vericella  Incubation period: 14-16 days  Reservoir: human viral  Transmission: respiratory, contact  Temporal pattern: winter, early spring  Communicability: very contagious  Complications: bacterial infections of skin and soft tissue (A strep), pneumonia, encephalitis  Diagnosis: by rash, blood and cultures  Treatment: antibiotics, antivirals, antihistamine  Prevention: 2 dose vaccine  Vaccine: 90% effective, IM, sore, red, swelling at site, fever, mild rash, temp pain and joint stiffness

 Vaccine schedule/catch-up schedule: 12-15mo & 4-6yrs What: Diphtheria  Incubation period: 2-5 days  Reservoir: human (bacteria -thick coating in back of throat)  Transmission: respiratory  Temporal pattern: winter  Communicability: very  Complications: blocks airway with thick coating, abnormal heart rhythm, heart failure, affect nerves and cause paralysis. 1 in 10 die (under 5 1 in 5)  Diagnosis: clinical presentation, culture, blood agar plate  Treatment: antibiotics, antitoxins  Prevention: vaccine and booster doses  Vaccine: IM, redness, swelling, fever (rare – 105 fever, crying 3+ hours, seizures)  Vaccine schedule/catch-up schedule: 2, 4, 6, 15-18, and 4-6 yrs (5 doses) What: Flu/Influenza  Incubation period: 24 hours after end of fever  Reservoir: human virus  Transmission: respiratory  Temporal pattern: fall, winter  Communicability: very  Complications:  Diagnosis: rapid flu swab in nose  Treatment: antivirals  Prevention: Vaccine every year  Vaccine: IM or nasal, Sore, red, swell, headache, fever, nausea, muscle aches  Vaccine schedule/catch-up schedule: every fall after 6 mo (2 dose series between ages 6mo and 8yrs or first time vaccination)

What: Hep A  Incubation period: 28 days  Reservoir: human virus  Transmission: Contact - stool  Temporal pattern:  Communicability: Children do not show symptoms but can pass it  Complications: Liver disease, fever, no eating, tired, stomach pain, vomit, dark urine, yellow skin and eyes

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Diagnosis: blood Treatment: none Prevention: vaccine and 2nd dose 6mo later Vaccine: IM, sore, headache, tired, fever, no eating Vaccine schedule/catch-up schedule: 12-23 mo & 6mo after first

What: Hep B  Incubation period: 75 days  Reservoir: human blood and body fluids  Transmission: contact blood and fluids  Temporal pattern:  Communicability: at birth, open cuts, sharing toothbrush, chewed food, can live on object for 7 days  Complications: liver disease, and cancer  Diagnosis: blood  Treatment: no cure, antivirals to keep liver from damage  Prevention: vaccine 3 dose  Vaccine: IM, fever, sore  Vaccine schedule/catch-up schedule: Shortly after birth, 1-2mo, and 6-18mo (3 doses)

What: Hib  Incubation period: unknown – disease develops within 7 days of exposure  Reservoir: human bacteria  Transmission: respiratory  Temporal pattern: sep-dec and mar-may  Communicability: very  Complications: meningitis, throat swelling, joint and skin infection, pneumonia, bone infection, death  Diagnosis: blood or spinal fluid  Treatment: antibiotics  Prevention: 4 dose vaccine  Vacci...