Neurological Assessment Quiz

N220 Health Assessment Final Review

• Fall 2024 review for N220 Health Assessment

Health Promotion

• Questions to ask the patient:
  • Sunscreen use
  • Diet habits
  • Exercise routine
  • Smoking history (pack years)
  • Alcohol use (ETOH)
  • Drug use
  • Sexual history
  • Vaccination records
  • Annual physical exam history

Diagnostic Reasoning

• Analyzing health data and drawing conclusions to identify diagnoses
• Components of the hypothetico-deductive model:
  • Attending to available cues
  • Clustering related cues
  • Formulating diagnostic hypotheses
  • Gathering data relevant to hypotheses
  • Evaluating hypotheses with new data
  • Critical thinking skills to identify relationships in the data

Transcultural Expression of Illness

• Pain expression is culturally influenced
• Expectations, manifestations, and management of pain vary across cultures.
• Often, pain is perceived as a highly personal experience.
• Meaning and significance of the situation influence pain expression.
• Silent suffering may be a culturally valued response.

Communication Techniques

• Introduction phase: Setting the stage
• Working phase: Types of interview questions
• Open-ended: "narrative" style
• Closed: "short, one or two words"
• Closing the interview: Summary

Interview Techniques

• Open-ended questions:
  • Chief Complaint: "Why I am here"
  • History of Present Illness (HPI): Timeline and details of the complaint
  • OLD CARTS
  • Past Medical History (PMH)
  • Family History (FHx)
  • Medications
  • Allergies
• Creating a quiet interview environment:
• Important for hearing-impaired individuals
• Control external factors
• Closed-ended questions:
  • "Did you take your medications today?"

Review of Systems

• YES/NO Questions: Use system-specific questions
• One question above and below the chief complaint
• Cover all systems
• Complete Health History

Cultural Health Assessment

• Preferred language
• Health care beliefs
• Predominant sick care practices
• Geographic origin and CDC consultation during outbreaks
• Family role in care, Decision-making practices, Touch practices, Perception of time, Pain reactions, Birth/death rites, Food practices. Immunization Practices

Health History: Putting It All Together

• Clustering cues: Group related information
• A large amount of information is collected.

Other

• Life-threatening situations: Immediate action needed to avoid further deterioration. The patient's family should be involved to support their coping abilities.
• Listening for bruits in a 70-year-old with cardiac history. This involves using a stethoscope to listen for abnormal sounds (bruits).
• Assessing the apex and pulse rate. The heart rate is checked by listening to the heartbeat at the apex (the point of maximum impulse) and checking for the pulse. The number of heart beats in a minute are recorded
• Normal lung sounds:
• Vesicular: Soft, relatively low pitch, and heard over most of the lungs
• Bronchial: Loud, relatively high pitch, and heard between the scapula and anteriorly
• Tracheal: Very loud, relatively high pitch, heard over the trachea in the neck.
• Tremor and facial expressions, sunken eyes, and masking of emotions are indicators of illness.
• Palpation: Technique for examining the body using hands
• Palpation (head and face): Thumb placed under the eyebrow, frontal and maxillary areas are palpated.
• Barrel chest and clubbing of fingers. These physical characteristics observed could indicate lung diseases.
• COPD: Chronic obstructive pulmonary disease, the patient could be experiencing Respiratory distress.
• Health Promotion Teaching (Male):
  • Prostate, colorectal, and HPV cancer screening
  • PSA (Prostate-Specific Antigen) screening: An effective early screening test for prostate cancer
  • Colorectal cancer (CRC) screening: Recommended starting at age 50
  • Fecal Immunochemical Test (FIT): Screening test for CRC that should start at age 40.
  • HPV vaccination for men under 26
  • Testicular exams: How and when to conduct them
• Breast self-exam: Perform this a few days after a menstrual cycle to ensure early detection of changes, size, shape, symmetry, skin texture, and nodules.
• Joint crepitation: A popping, clicking, or cracking sound in a joint.
• Anthropometrics: Assessing height and bone density—a decrease in bone density often occurs in the elderly, causing a decrease in height
• Self-Care Ability: Assessing the patient's ability to complete basic self-care tasks.
• Activities of Daily Living (ADLs): Analyzing the patient's ability to perform daily tasks (bathing, toileting, eating, dressing, mobility, communicating)
• Methods of communication: Finding the most effective way to communicate with patients
• Large amount of fluid: Could have fluid around joints or internal organ
• Water on the knee: Accumulation of fluid within the knee joint
• "Walking pattern" and balance tests assess neurological functions
• Motor, cerebellar functions: Coordination check, muscle and tone check, assessing involuntary movements, including tremors and other unusual movements
• Self-care abilities: Assess patient's ability to perform actions: rising, walking, climbing, descending, getting objects on the floor, and writing checks.
• Shoulder examination: Palpate joints, assess range of motion (ROM), check for crepitation
• Sciatic pain from lifting: Indicates possible herniated disc.
• Patient presenting with pain while sitting: Pain continuing when sitting is a significant indicator.
• Gag reflex: Check for swallowing difficulties and/or gag reflex, which assesses the 9th cranial nerve.
• Assessing level of consciousness: Testing the level of a patient's consciousness using the Glasgow Coma Scale
• Hypothyroidism: Slow metabolism and thyroid problems can cause symptoms.
• Symmetry look at the symmetry of movement when testing muscle strength, and check symmetry of body.
• Alternating arm swing A neurological function check involves gently shaking the patient's shoulder to assess level of consciousness.