Patient Assessment and Prevention Strategies

Components of Patient Assessment

• Objective data is observed, such as physical assessment findings.
• Subjective data is the patient's point of view, such as chief complaints and symptoms that can't be directly observed.

Three Levels of Prevention

• Primary prevention focuses on health promotion and decreasing the risk of disease exposure. Examples include immunizations, child car seats, nutrition, and exercise.
• Secondary prevention focuses on early disease detection and treatment to stop progression. An example would be a focused assessment to identify potential issues in a system.
• Tertiary prevention focuses on managing long-term health conditions to prevent complications.

Recommended Tests

• Physical exams involve a comprehensive assessment of the body.
• Dental exams help monitor oral health and identify potential issues.
• Blood pressure screenings are crucial to detect and manage hypertension.
• Serum cholesterol tests assess cardiovascular risks.
• Blood glucose screenings help monitor blood sugar levels and identify diabetes risk.
• Vision exams evaluate eye health and vision clarity.

Types of Assessment

• Basic assessment focuses on overall health and well-being.
• System-based assessment concentrates on a specific body system.
• Focused assessment addresses a specific complaint or area of concern.
• Comprehensive assessment involves a detailed evaluation of the entire body and health history.

Preventative Interventions

• Breast cancer screening includes mammograms recommended every 2 years for women aged 50-74, with optional personal preference between 40-49. Clinical breast exams and self-exams are not evidence-based.
• Prostate cancer screening might involve a digital rectal exam (DRE).

Changes Associated with Aging

• Around age 35, bone formation and destruction become unequal, increasing reabsorption/destruction and decreasing formation.
• Decreased bone mass and increased risk of injury are common.
• Osteopenia develops, characterized by decreased bone density.
• Increased bone prominence is visible.
• Kyphotic posture can emerge.
• Synovial joint cartilage loses elasticity and compressibility.
• Muscle tissue atrophies.
• Decreased range of motion (ROM) becomes evident.
• Movement slows down.

Dehydration

• Early signs include dark yellow urine.
• Extreme dehydration shows amber to brown urine.
• Mucous membranes become dull and dry, losing their shiny, moist appearance.
• Hardened stool and constipation can occur.

Urinary Retention

• A distended abdomen and abdominal pain are indicative.
• Reduced or complete lack of urination (micturition) is present.

Receiving IV Fluids

• Excessive fluids or boluses can cause clear urine.

Eyes, Ears, Nose, Mouth, and Throat

• Corneal light reflex: Examining for a reflected dot of light in the same position on each eye is expected.
• Peripheral vision: Assessing using a hand or object from behind, covering and uncovering each eye. The expected finding is equal strength in both eyes.

Assessment Techniques

• Inspection involves observing a patient's appearance, posture, and body movement.
• Palpation uses touch to assess temperature, texture, size, and consistency of different areas.
• Percussion involves tapping on body surfaces to assess underlying structures, such as the lungs.
• Auscultation involves listening to body sounds using a stethoscope.

Peripheral Pulses

• Assess carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial pulses.
• Evaluate rate (beats per minute), rhythm (irregular or regular), and strength (absent, diminished, brisk, increased, full volume).
• Strength is graded on a scale of 0-4.

Standing Assessment

• Assess venous system with the patient standing.
• Examine for visible, dilated veins and varicose veins.

Carotid Arteries

• Palpate one carotid artery at a time.
• Assess for bruits (whooshing sounds) using the bell side of the stethoscope while the patient holds their breath.

Edema

• Inspect for swelling, assess for pitting edema, and grade the severity.
• Grade 1 = 2mm, disappears immediately
• Grade 2 = 4mm, disappears within 10-15 seconds
• Grade 3 = 6mm, lingers for 1 minute
• Grade 4 = 8mm or more, remains for 2-5 minutes

Lower Lymphatics

• Palpate lymph nodes in a routine order: epitrochlear, axillary, and inguinal.

Allen's Test

• Evaluates the patency of the radial and ulnar arteries.
• Modified Allen's test involves using a Doppler device to assess blood flow.

Homan's Sign

• Evaluates for deep vein thrombosis by extending and dorsiflexing the patient's foot.

Arteriovenous Fistula

• Inspect for signs of an AV fistula.

Deep Vein Thrombosis

• Varicose veins cause pain, swelling, fatigue, and cramping.
• Note any visible, dilated, or tortuous veins, as these may be signs of DVT.