Podcast
Questions and Answers
What is the first action to take when assessing an elderly patient with a cardiac history?
What is the first action to take when assessing an elderly patient with a cardiac history?
Which symptom suggests a patient may be in respiratory distress?
Which symptom suggests a patient may be in respiratory distress?
Which chest condition is characterized by an expanded chest shape?
Which chest condition is characterized by an expanded chest shape?
Which of the following is a correct technique for performing a testicular exam?
Which of the following is a correct technique for performing a testicular exam?
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What is the significance of listening for crackles or rales in a patient?
What is the significance of listening for crackles or rales in a patient?
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What does a decrease in pulse compared to heartbeats indicate?
What does a decrease in pulse compared to heartbeats indicate?
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Which characteristic is NOT typical of elderly patients’ arteries?
Which characteristic is NOT typical of elderly patients’ arteries?
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What should you do if a patient complains of pain during assessment?
What should you do if a patient complains of pain during assessment?
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What is a common technique to check for whispered pectoriloquy?
What is a common technique to check for whispered pectoriloquy?
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What should be done if a patient feels faint during assessment?
What should be done if a patient feels faint during assessment?
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What does a positive Romberg test indicate?
What does a positive Romberg test indicate?
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Which of the following describes the gag reflex?
Which of the following describes the gag reflex?
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What is indicated by a lifted leg producing sciatic pain?
What is indicated by a lifted leg producing sciatic pain?
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What does a decrease in height among the elderly often suggest?
What does a decrease in height among the elderly often suggest?
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Which test is performed to assess the strength of the upper extremities?
Which test is performed to assess the strength of the upper extremities?
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Severe nystagmus is characterized by what?
Severe nystagmus is characterized by what?
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In the context of patient assessment, what does the term 'crepitation' refer to?
In the context of patient assessment, what does the term 'crepitation' refer to?
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Which cranial nerves are primarily involved in the gag reflex?
Which cranial nerves are primarily involved in the gag reflex?
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What is one potential outcome of mistakenly trying to pull a joint medially?
What is one potential outcome of mistakenly trying to pull a joint medially?
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What might be indicated by a patient with color blindness?
What might be indicated by a patient with color blindness?
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Study Notes
N220 Health Assessment Final Review - Fall 2024
- The review covers health promotion, diagnostic reasoning, transcultural expression of illness, communication techniques, interview techniques, review of systems, cultural health assessment, health history, subjective vs. objective, setting priorities for nurses, ISBAR, health habits, cardiac health history, normal lung sounds, Parkinson's syndrome, palpations, COPD, and the lymph system.
Health Promotion
- Topics covered include sunscreen use, diet, exercise, smoking history, alcohol use, drug use, sex history, vaccine history, and annual physical examinations
- This section focuses on preventative care for various health concerns or habits
- Health promotion teaching is differentiated by sex: Males include prostate cancer, CRC, HPV, PSA, CRC screening, FIT (Fecal Immunochemical Test), HPV vaccine, and testicular exams; and Females discuss Breast self-examination techniques, early detection, and potential changes in breast tissue.
Diagnostic Reasoning
- The hypothetico-deductive model is applied to analyze health data to identify a diagnosis.
- Components include attending to clues, clustering related clues, formulating diagnosis hypotheses, gathering supporting data to evaluate hypotheses, and looking for relationships between collected data for better understanding of the data given.
Transcultural Expression of Illness
- Pain expression varies significantly across cultural contexts.
- Expectations, manifestations, and management of pain, are all deeply rooted in cultural background.
- This includes cultural learning, cultural understanding of the situation, and pain expression varies based on individual experiences.
- Healthcare professionals need to consider these cultural expressions and preferences.
Communication Techniques
- Communication techniques are divided into introduction, working phase, and closing phase.
- Interview questions are categorized into open-ended and closed-ended types.
- "Open-ended" questions facilitate detailed responses while "closed-ended" questions solicit short, direct responses.
Interview Techniques
- Key questions to ask a patient during an interview include chief complaint, history of present illness (HPI), past medical history (PMH), family history (FHx), medications, allergies, and any external factors that might affect the interview.
- Techniques cover asking open-ended and closed-ended questions, listening to the patient's answers, and addressing hearing-impaired patients.
Review of Systems
- This section focuses on a structured evaluation of the patient's health.
- It includes a series of questions that evaluate the body (e.g., respiratory, cardiovascular) to identify any potential issues and concerns in health for the patient, which can indicate signs or symptoms of a variety of conditions
- Key to using yes/no questions that collect data pertinent to the patient's reported complaints.
Cultural Health Assessment
- Culture significantly influences health beliefs, care practices, and decision-making.
- Key considerations include preferred language, health care beliefs, predominant sick care practices, geographic origin and CDC consultations, family role in care, decision-making practices, touch practices, perception of time, pain reactions, birth/death rituals, food practices, and immunization practices.
Health Habits
- Smoking history includes pack years calculation using daily cigarette count and years smoked.
- Nutritional information includes calorie calculations based on grams of fat, protein, and carbohydrates.
Cardiac Health History
- Includes questions on ruling out heart failure (weight changes, breathing/activity level, pillows at night, ability for ADLs), cholesterol checks, and treatment plan.
- Also includes listening to heart sounds using a stethoscope.
Normal Lung Sounds
- Normal lung exams involve listening using a stethoscope for characteristics like symmetrical chest wall movement, symmetrical diaphragmatic excursion, and good air movement.
- Lung sounds include vesicular, bronchial, and tracheal sounds, all with varied intensities, durations, and pitches, all characterized according to where they are normally heard on the body.
- Special sounds such as egophony, whispered pectoriloquy, and bronchophony also can be considered during assessment.
Parkinson's Syndrome
- Characterized by resting tremor, masked facies, and the presentation of sunken eye-balls and exhausted expression. It is a symptom of dopamine and basal ganglia deficiency.
Palpations
- Palpations are assessments involving physically touching the body to feel for characteristics pertinent to patient concerns or suspected conditions.
- This includes touching the frontal, maxillary upper cheek to examine certain areas for conditions or possible abnormalities.
- Palpation needs a methodical approach, starting from specific points (e.g., clavicle) methodically examining the area for characteristics that are pertinent to the concern (e.g. pain, swelling, or masses or tenderness).
COPD and Lungs: Pathology
- COPD presents with features like barrel chest and clubbed fingers.
- Patients could show signs of respiratory distress.
- This is a respiratory pathology assessment of the patient, focusing on the lungs, their structure, and function, to determine any issues.
Lymph System
- Includes areas of the body (axilla, inguinal, cervical) where lymph nodes may be palpated to asses for possible signs or sxs.
Health Promotion Teaching—Male
- Covers topics like prostate cancer, colorectal cancer (CRC), HPV, PSA, and testicular exams, screening recommendations, and vaccinations as preventative strategies.
Health Promotion Teaching—Female
- Includes preventative strategies such as preventing STIs, unintended pregnancy, and promoting HPV vaccines.
- This also covers the importance of self-care behaviors such as self-exam techniques, early detection of abnormalities in breast tissue, and how to perform a comprehensive breast-self examination technique.
Objective Findings Breast Mass
- Key aspects considered for assessing a breast mass include its location, size, shape, consistency, tenderness, mobility, borders, and any skin retractions.
- This is a method for assessing the appearance and characteristics for a breast mass.
Neurological Testing (Cranial Nerves)
- The following cranial nerves and their functions are covered in detail: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory, Glossopharyngeal, Vagus, Accessory, and Hypoglossal.
Neurological Testing (LOC/Orientation and Other Tests)
- This covers techniques such as speech, clarity, and appropriateness
- LOC/Orientation, gag, PERRLA, pupillary size, EOM, visual fields, visual acuity, facial symmetry, sensation, and hearing are included.
Tactile Discrimination
- These tests assess the client's ability to sense point location, identify familiar objects by touch, identify numbers/letters traced on the skin, and identify areas touched.
Range of Motion (ROM)
- Procedures for ROM assessment include: Supine and weight-bearing positions as applicable, determining normal ROM for each joint, avoiding forcing the joint beyond its current ROM, and performing care as well as caution and support.
Posture and Anthropometrics
- Height decrease as a characteristic of older adults is mentioned, as is the relation to bone density
Grading MSK Strength
- Five grades are used to evaluate muscular strength based on the ability to move a joint across a full range of motion with varied levels of resistance, and their descriptions.
Self-Care Abilities
- Assesses independent functioning, devices/equipment needed for assisted tasks, levels of supervision required, and the need for full care.
Functional Assessment of ADLs
- This section focuses on assessing a patient's ability to perform activities of daily living (ADLs) to determine any limitations or assistance needs.
- It assesses a patient's ability to perform typical daily tasks.
Hearing Impairment
- Focuses on assessing hearing impairment through a series of questions, including onset, character, situations in which the patient notices the loss, whether people seem to shout, and if sounds seem hollow.
- This also evaluates the patient's history by asking if the patient's hearing loss is a result of recently traveling by plane, and the presence of family history of the same.
Carpal Tunnel Testing
- Includes techniques like Phalen's test and Tinel's sign to assess for carpal tunnel syndrome.
Knee Assessment: Fluid
- Techniques to assess for fluid in the knee, such as ballottement of the patella (used for large amounts of fluid) and bulge sign (used for small amounts of fluid), are described.
Balance and Coordination
- The balance and coordination assessments cover gait (pattern), tandem walking, tandem balance, Romberg test, finger-to-nose test, rapid alternating movement, and heel-to-shin test.
Assess Motor & Cerebellar Function
- Neurological assessment related to coordination, symmetry of body parts, muscle strength/tone, and involuntary movements, such as tremors or nystagmus. It determines if involuntary actions or abnormalities in motor function exist.
Health History
- Sections cover common medical history information pertinent to patient care, such as issues with body parts (joints, muscles, or bones, and related medical history)
Self-Care Abilities
- This part covers a variety of tasks related to self-care assessment, such as the ability to perform tasks such as rising from a lying position to a sitting position, standing from a chair, climbing/descending stairs, and picking an item off the floor, along with tying shoes/writing checks.
Shoulder Assessment (Shoulder III)
- Includes assessments of the acromioclavicular, scapular, and glenohumeral joint, palpation of the axilla, including ROM assessment and testing muscle strength during the motions, testing for potential crepitations or abnormal sounds.
Straight Leg Raising (Lasègue's) Test
- Describes how to perform this test to determine if a patient has spinal issues or nerve root compression. Describes the symptoms to look out for if the test is positive.
Nursing Interventions–Abnormalities
- This considers various musculoskeletal conditions/problems and their interventions including applying ice/heat packs, elevating legs, and immobilizing joints.
Stroke and GCS
- Stroke assessment protocols include evaluating the ability to respond (through looking at response to stimulation), following commands, performing localized movements when stimulated, performing non-purposeful movements under stimulation, flexing/extending extremities to pain stimuli, extending all extremities due to pain stimuli, and making no response to noxious stimuli.
Symmetry
- Important aspect of symmetry, noting the symmetry between limbs or sides of the body during assessments (Strength and Romberg tests) , are important aspect that must be considered during the patient assessment process.
Additional Assessments
- These sections provide guidance for testing speech, swallowing/gag reflex (9), additional relevant tests and findings with clear descriptions for proper assessment (including hearing assessment, etc)
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Description
This quiz covers essential assessment techniques and symptoms related to elderly patients, focusing on cardiac and respiratory health. It aims to enhance your understanding of specific conditions and assessment methods applicable in nursing care for older adults.
