Test Your Advanced Health Assessment Skills

Advanced Health Assessment: Patient Interview and Health History

• The clinical encounter has 5 phases: initializing, preparation, rapport, gathering information, physical exam, explaining and planning, and closing.

• The purpose of the health history is to gather sensitive and nuanced information, establish a diagnosis, educate the patient, and promote health and disease prevention.

• The components of the health history include identifying data, reliability, chief complaint, subjective data (CC, HPI, PMH, FH, PSH, ROS), objective data (physical exam, labs and imaging, patient education), and SOAP note.

• Useful tools for CC and HPI include OLDCART, PQRST, and the eight descriptors of a symptom.

• Anesthesia H&P includes assessing the patient's status of health and illnesses, airway and spinal issues, and determining if the procedure/surgery is elective, urgent or emergent.

• Common pitfalls during health history taking include not listening to the patient's answer, using jargon, not speaking directly to the patient, and not listening to family and friends.

• Perioperative lab testing and imaging are related to the surgery type and patient's condition, including BMP/CMP, coag panel, CBC, 12 leads EKG, CXR, and CT/MRI.

• HEENT and Focused Airway Assessments include evaluating pain, headaches, tinnitus, vertigo, difficulty breathing/blockage, rhinorrhea, sore throat, hoarseness, and swollen glands.

• Physical exam techniques include inspection, palpation, percussion, and auscultation.

• The order of operations for physical exam techniques is inspection, palpation, percussion, and auscultation.

• Cranial nerves should be assessed, including CN VII (Facial) for raising eyebrows, smiling/frowning, showing teeth, and puffing cheeks.

• The head should be assessed for face color, pigmentation, texture, thickness, and hair distribution.An Overview of Airway Assessment

• The airway assessment includes examination of the mouth, nose, throat, ears, trachea, and thyroid gland.

• The auditory acuity can be tested using the Weber and Rinne tests.

• The nose and paranasal sinuses should be inspected for symmetry, deformity, and obstruction.

• The tongue, floor of the mouth, and pharynx should be checked for lesions, color, and texture.

• The neck should be inspected for symmetry, masses, scars, and visible lymph nodes.

• The full anesthesia airway assessment includes examination of tongue size, nostril patency, mallampati score, dentition, facial hair, thyromental distance, atlanto-occipital joint extension, and cervical spine movement.

• The inter-incisor gap should be measured in fingerbreadths, with a minimal acceptable value of > 4cm to facilitate easy insertion of a laryngoscope blade.

• The thyromental distance should be measured to determine how readily the laryngeal axis will fall in line with the pharyngeal axis.

• The Delikans sign can be used to assess atlanto-occipital joint extension.

• Difficult mask ventilation can be caused by factors such as obesity, age > 55, lack of teeth, and history of snoring.

• The airway template includes Mallampati score, thyromental distance, inter-incisor distance, mandibular protrusion/TMJ mobility, teeth, neck ROM, neck circumference, and neck masses.

• A thorough airway assessment is crucial for successful airway management during anesthesia.

Advanced Health Assessment: Patient Interview and Health History

• The clinical encounter has 5 phases: initializing, preparation, rapport, gathering information, physical exam, explaining and planning, and closing.

• The purpose of the health history is to gather sensitive and nuanced information, establish a diagnosis, educate the patient, and promote health and disease prevention.

• The components of the health history include identifying data, reliability, chief complaint, subjective data (CC, HPI, PMH, FH, PSH, ROS), objective data (physical exam, labs and imaging, patient education), and SOAP note.

• Useful tools for CC and HPI include OLDCART, PQRST, and the eight descriptors of a symptom.

• Anesthesia H&P includes assessing the patient's status of health and illnesses, airway and spinal issues, and determining if the procedure/surgery is elective, urgent or emergent.

• Common pitfalls during health history taking include not listening to the patient's answer, using jargon, not speaking directly to the patient, and not listening to family and friends.

• Perioperative lab testing and imaging are related to the surgery type and patient's condition, including BMP/CMP, coag panel, CBC, 12 leads EKG, CXR, and CT/MRI.

• HEENT and Focused Airway Assessments include evaluating pain, headaches, tinnitus, vertigo, difficulty breathing/blockage, rhinorrhea, sore throat, hoarseness, and swollen glands.

• Physical exam techniques include inspection, palpation, percussion, and auscultation.

• The order of operations for physical exam techniques is inspection, palpation, percussion, and auscultation.

• Cranial nerves should be assessed, including CN VII (Facial) for raising eyebrows, smiling/frowning, showing teeth, and puffing cheeks.

• The head should be assessed for face color, pigmentation, texture, thickness, and hair distribution.An Overview of Airway Assessment

• The airway assessment includes examination of the mouth, nose, throat, ears, trachea, and thyroid gland.

• The auditory acuity can be tested using the Weber and Rinne tests.

• The nose and paranasal sinuses should be inspected for symmetry, deformity, and obstruction.

• The tongue, floor of the mouth, and pharynx should be checked for lesions, color, and texture.

• The neck should be inspected for symmetry, masses, scars, and visible lymph nodes.

• The full anesthesia airway assessment includes examination of tongue size, nostril patency, mallampati score, dentition, facial hair, thyromental distance, atlanto-occipital joint extension, and cervical spine movement.

• The inter-incisor gap should be measured in fingerbreadths, with a minimal acceptable value of > 4cm to facilitate easy insertion of a laryngoscope blade.

• The thyromental distance should be measured to determine how readily the laryngeal axis will fall in line with the pharyngeal axis.

• The Delikans sign can be used to assess atlanto-occipital joint extension.

• Difficult mask ventilation can be caused by factors such as obesity, age > 55, lack of teeth, and history of snoring.

• The airway template includes Mallampati score, thyromental distance, inter-incisor distance, mandibular protrusion/TMJ mobility, teeth, neck ROM, neck circumference, and neck masses.

• A thorough airway assessment is crucial for successful airway management during anesthesia.