Health Assessment Exam 1 Copy (1) PDF

Exam 1 - Chapters 1, 2, 3, 4, 6, 7, 8, 9, 10, 11 Chapter 1 - Evidence-Based Assessment (4 Questions) 1.​ Identify where assessment data comes from. Assessment is the collection of data about the individual’s health state. The purpose of assessment is to make a judgement or diagnosis. Subjec...

Exam 1 - Chapters 1, 2, 3, 4, 6, 7, 8, 9, 10, 11 Chapter 1 - Evidence-Based Assessment (4 Questions) 1.​ Identify where assessment data comes from. Assessment is the collection of data about the individual’s health state. The purpose of assessment is to make a judgement or diagnosis. Subjective + Objective = Database 2.​ Identify the steps in the Nursing Process. -​ Assessment -​ Diagnosis -​ Planning -​ Implement -​ Evaluation 3.​ Identify the Clinical Judgment Model. The Clinical Judgment Model was developed as a way of structuring nursing education to enhance clinical judgment skills of novice practitioners. Novice - Needs clear cut rules to guide actions due to lack of experience with patients. Competency - Sees actions in with the contents of patient goals or plans of care. Proficient - Understands a patient situation as a whole rather than a list of tasks. Expert - Intuitive grasp of a clinical situation and zeros in on the accurate solution. 4.​ Identify priority setting during an assessment. 1st Level - Those that are emergent, life threatening, and immediate, such as establishing an airway or supporting breathing. 2nd Level - Those requiring intervention to forestall further deterioration, such as mental status change, acute pain, abnormal laboratory findings, elimination problems, or risk to safety. 3rd Level - Important but can be addressed after more urgent problems, are typically long term problems such as mobility, lack of knowledge, or family coping. 5.​ Demonstrate knowledge of different types and frequencies of assessments. There are four types of patient databases.  1.​ Complete (Total Health) Database: The most comprehensive database that includes your complete health history and physical examination. It’s typically done in a primary care setting. 2.​ Focused or Problem-Centered Database: This is for a limited or short-term problem. You collect a “mini” database that’s smaller in scope and more targeted. It’s used in all settings. 3.​ Follow-Up Database: This focuses on the status of any previous identified problems, such as short-term or chronic health conditions. It’s used in all settings. 4.​ Emergency Database: An urgent and rapid collection of crucial information that’s often compiled with lifesaving measures. Diagnosis must be swift and sure. Chapter 2 - Cultural Assessment (4 Questions) 1.​ Recognize social determinants of health. SDOH are the non-medical factors that shape our health. They are the conditions in which people are born, live, work, and age that impact their overall health and well-being. 2.​ Explain how to complete a cultural data collection. Aim towards assessing individuals, families and communities regarding health beliefs and values. Your goal is to work with their beliefs and value systems to provide effective and appropriate care. Treat patients as they would want to be treated. 3.​ Discuss Culture. Culture is a complex phenomenon that includes attitudes, beliefs, self-definitions, norms, roles, and values. Culture acts as a web of communication. Culture has four basic characteristics: -​ Learned from birth through the processes of language acquisition and socialization -​ Shared by all members of the same cultural group -​ Adapted to specific conditions related to environmental and technical factors and to the availability of natural resources -​ Dynamic and ever changing 4.​ Identify the attributes of cultural competence. To be culturally competent, you must have questions to ask about unique cultures of your patients to be able to identify cultural factors that may influence the patients’ beliefs about health and wellness. 5.​ Define common terms and definitions related to culture. Race - Reflects self-identification and is typically a social construct referring to a group of people with similar physical characteristics. Ethnicity - Refers to a social group that may possess shared traits such as common geographic origin, migratory status, religion, language, values, traditions, or symbols, and food preferences. Spirituality - Connection to something larger than oneself and a belief in transcendence. Religion - Organized system of beliefs concerning the cause, nature, and purpose of the universe, as well as attendance of religious services. Chapter 3 - The Interview 1.​ Explain the difference between Subjective and Objective data. Subjective data is information that the patient tells you. Objective data is information that you observe or measure. 2.​ Describe how to have a successful patient interview. -​ Gather complete and accurate data about the patients’ health state, including the description and chronology of any symptoms. -​ Establish trust so that the patient feels accepted and thus free to share all relevant data. -​ Teach the patient about their health state. -​ Build rapport for a continuing therapeutic relationship. -​ Discuss health promotion and disease prevention. 3.​ Discuss the use of AIDET. Acknowledge - Greet the patient. Introduce - Explain your role in providing their care. Duration - Provide the patient with time expectations. Explanation - Explain what they should expect from yourself and others. Thank You - Thank them. AIDET builds rapport. 4.​ Identify the different questions used in data gathering. In the working phase (data gathering) you will use a combination of open-ended and closed questions during the interview. Open-ended questions allow full expression, unbiased and narrative information. Closed questions ask for specific information. They elicit a one or two-word answer. 5.​ Recognize traps of interviewing. Traps are nonproductive verbal and nonverbal messages. -​ Providing false assurance or reassurance -​ Giving unwanted advice -​ Using authority -​ Using avoidance language -​ Distancing -​ Using professional jargon -​ Using leading or biased questions -​ Talking too much -​ Interrupting -​ Using “why” questions 6.​ Discuss nonverbal skills. Nonverbal modes of communication include physical appearance, posture, gestures, facial expression, eye contact, voice, and touch. Nonverbal skills provide clues to understanding feelings. 7.​ Discuss considerations when communicating with different ages and patients’ with special needs. When working with a child, you must build rapport with two people, the child and the accompanying caregiver. Infants (birth to 12 months) primary method of communicating is through nonverbal communication. Toddlers (12 to 36 months) want to know WHY; therefore it’s important that you provide a simple explanation of what you want. Make sure to provide warnings before transitions. Preschoolers (3 to 6 years) see the world from their own point of view. Make sure communication is direct, concrete, literal and set in the present. School-Age (7 to 12 years) children can tolerate and understand others viewpoints. They are objective and realistic. They want to know function aspects - how things work and why things are done. Make sure to include the child in the interview because they have the verbal ability to add important data to the history. Adolescents (beginning at puberty) value their peers and think that no adults understand them. Respect is the most important thing you can communicate to the adolescent. They need to feel validated as a person. Focus on them before the problem. Your communication must be totally honest. Older adults have the developmental task of finding the purpose of their own existence and adjusting to the inevitability of death. They’ll have a longer story to tell so be prepared. Make sure to address them by their proper surname. Chapter 4 - The Complete Health History 1.​ Explain why a complete health history is completed. A complete health history is completed for many reasons. -​ To collect subjective and objective data -​ Provides a complete picture of the patients past and present health -​ It recognizes and affirms what the person is doing right to stay healthy -​ For the well person, it’s used to assess lifestyle, exercise, healthy diet, substance use, risk reduction, and health promotion behaviors. -​ For the ill person, it includes detailed and chronological records of their health problems. 2.​ Identify different sources of data. Primary - The patient is the primary source of subjective data. Secondary - Information from the patient's chart, family members, or other healthcare team members. 3.​ Discuss gathering of present and past health status. For the present health status of a well person, the statement can be short like, “I feel healthy right now.” For the ill person, it should include a chronological record of the reason for seeking care, from the time the symptom started until now. For the ill person, you should include OLDCARTS or PQRSTU. Past health includes: childhood illnesses, accidents/injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunization, and last examinations. Present health includes: current medical conditions, medication reconciliation, and allergies. 4.​ Explain review of systems and functional assessments during data collections. Review of systems are to evaluate the past and present health state of each body system, to double check in case any significant data was not omitted in the present illness section, and to evaluate health promotion practices. Functional assessment measures a person’s self-care ability in the area of general physical health, such as ADLs that include: bathing, dressing, toileting, eating, and walking. Along with ADLs, they measure the patient's ability to perform instrumental ADLs (needed for independent living) such as housekeeping, shopping, cooking, laundry, phone use, managing finances, nutrition, social relationships and resources, self-concept and coping, and home environment. 5.​ Discuss considerations for data collections with different ages. HEEADSSS is a method of interviewing for adolescents that assesses the home environment, education, eating, activities, drugs, sexuality, suicide/depression, and safety. Chapter 6 - Substance Use Assessment 1.​ Discuss alcohol use and abuse. Alcohol is the most used and abused psychoactive drug in the United States. Most of the time, prescriptions and over-the-counter medications interact negatively with alcohol. Medication can change the metabolism of alcohol, and alcohol can change the activity or metabolism of the medication, with the risk of adverse drug reactions (ADRs). It’s especially significant with drugs that depress the CNS (opioid pain relievers, heroin, antihistamines, and antidepressants). Alcohol has many effects on the cardiovascular system, it’s associated with hypertension, ischemic heart disease, stroke, cardiomyopathy, heart failure, and atrial fibrillation. 2.​ Define illicit drug use (include what is the opioid epidemic). There are 7 categories of illicit drug use: -​ Marijuana -​ Cocaine -​ Heroin -​ Hallucinogens -​ Inhalants -​ Methamphetamine -​ Psychotherapeutics Any amount of illicit drug use has serious legal consequences and consequences for health, trauma, brain maturation, relationships, school, and career. The opioid epidemic is a public health crisis. Many people who misuse prescription opioids switch to heroin as prescription opioids become harder to obtain. Heroin is readily available and low cost. 3.​ Recognize developmental considerations that should be taken into account when completing a substance assessment. Addiction is influenced by genetic, environmental, and developmental factors. Adolescents are more likely to engage in risky behavior. Alcohol slows brain development and reduces maturity levels in adolescents. Marijuana is the most used illicit drug in the United States. It has detrimental effects on development in adolescents, negative effects on school performance and mental health, difficulty concentrating and maintaining attention, impaired learning and problem solving, and impaired coordination. There is no safe time for a pregnant woman to drink. Alcohol slips easily through the placenta, which results in physical, learning and behavioral problems in the fetus, known as fetal alcohol syndrome. Aging adults who drink alcohol are more at risk for falls, depression, gastrointestinal problems, toxic reactions, and fatal overdoses. Aging decreases a person's tolerance for alcohol. Older adults may be on multiple medications, which can interact adversely with alcohol. 4.​ Describe the subjective data collection related to substance use (include AUDIT & CAGE questionnaires). -​ Ask about alcohol use. Based on their response, ask further questions. Nurse: “Do you sometimes drink beer, wine, or other alcoholic beverages?” Male Patient: “Yes” Nurse: “How many times in the past year have you had 5 or more drinks a day?” (4 for women) -​ Use the AUDIT questionnaire (Alcohol Use Disorders Identification Test) The AUDIT questionnaire covers three domains: alcohol consumption (questions 1-3); drinking behavior or dependence (questions 4-6); and adverse consequences from alcohol (questions 7-10). Record the score at the end of each line and total; the maximum total is 40. A score of 0-7=low risk. A score of 8-14=hazardous or harmful. A score of 15 or more is indicative of alcohol dependence. -​ CAGE questionnaire The CAGE questionnaire stands for Cut down, Annoyed, Guilty, Eye-opener. It takes less than 1 minute to complete so it works well in busy primary care settings. By answering “yes” to 2 or more questions signals possible alcohol abuse and a need for further assessment. -​ Ask about use of illicit substances 5.​ Describe the objective data collection of substance abuse (include CIWA assessment).  -​ Breath alcohol analysis detects any amount of alcohol in the end of exhaled air following a deep inhalation until all ingested alcohol is metabolized. It can be correlated with BAC and is the basis for legal interpretation of drinking (>0.08% = legal intoxication in most states). -​ Clinical Institute Withdrawal Assessment (CIWA) is used when caring for people experiencing alcohol withdrawal. The CIWA is the most sensitive scale for objective measurement. Withdrawal symptoms include: nausea/vomiting, tremors, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation and clouding of sensorium. Chapter 7 - Family Violence & Human Trafficking 1.​ Review types of violence (include intimate partner, child abuse & neglect, elder abuse & neglect & human trafficking). Intimate partner violence can be divided into 4 main categories: 1.​ Physical violence 2.​ Sexual violence 3.​ Stalking 4.​ Physiological aggression Child abuse and neglect includes: -​ Neglect -​ Physical abuse -​ Sexual abuse -​ Emotional abuse Elder abuse and neglect is underreported. Forms of elder abuse include: -​ Physical abuse -​ Sexual abuse or abusive sexual contact -​ Psychological or emotional abuse -​ Neglect -​ Financial abuse or exploitation Human trafficking involves compelling or coercing a person to provide labor or services, or to engage in commercial sex acts. Human trafficking does not need to involve the movement of people from one place to another.  2.​ Describe the subjective data collection related to a violence assessment (include HITS screening tool). -​ Use open-ended questions -​ “Do you feel safe at home?” -​ Use the HITS screening tool. HITS is a 4-item tool that asks clients to answer the following questions from never to frequently. How often does your partner: 1.​ Physically hurt you? 2.​ Insult or talk down to you? 3.​ Threaten you with harm? 4.​ Scream or curse at you? Each question is scored from 0 (never) to 5 (frequently) and the answers are totaled. A score greater than 10 is indicative of intimate partner violence. 3.​ Describe the objective data collection related to a violence assessment. A thorough head-to-toe examination is imperative for any patient with suspected or known abuse. A visual examination of the entire body is necessary in order to document any lesions. -​ Document the size, color, pattern of any bruises, but do not try to determine timing of the injury based solely on the color of the bruise. Objectively describe the findings. Ask about medications, or abnormal blood values that might cause a person to bruise more easily. Nutritional supplements can also contribute to bruising. -​ Look for bruises in atypical places that may take the shape of an object (belt buckle or imprint of fingers) -​ Immersion injury patterns -​ Pattern burn injury -​ Thigh bruises -​ Defensive wounds 4.​ Recognize the critical role of the nurse as a mandated reporter. Mandated reporters must call protective services hotline when a child, elder, vulnerable-adult abuse, or neglect is disclosed, assessed, or suspected. You must document the call with the protective services hotline by including the reason for the call, time of call, full name of who took your call, and response of the call taker. Chapter 8 - Assessment Techniques & Safety in the Clinical Setting (8 Questions) 1.​ Explain & demonstrate the exam techniques of inspection, palpation, percussion & auscultation. Inspection is concentrated watching that’s done 1st when you meet the patient (general survey). -​ Compare left and right sides of their body -​ Inspection requires good lighting, adequate exposure, and occasional use of certain instruments. Palpation applies your sense of touch to assess for the following factors: texture, temperature, moisture, organ location and size, swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps, masses, and presence of tenderness or pain. -​ Start with light palpation to detect surface characteristics and to accustom the person to being touched. Percussion is tapping the patient's skin with short, sharp strokes to assess underlying structures. -​ Strokes yield an audible vibration -​ It signals the density of the structures within the body -​ The stationary hand avoids bony prominences (ribs or scapulae) -​ The striking hand aims for just behind the nail bed -​ Amplitude (or intensity) is described as a loud or soft sound -​ Pitch (or frequency) is described as the number of vibrations per second -​ Quality (timbre) is the subjective difference caused by the distinctive overtones of a sound -​ Dull is a soft sound → Resonance is a medium-loud sound → Hyperresonance is a loud sound -​ A structure with relatively more air (lungs) produces a louder, deeper, and louder sound because it vibrates freely, whereas a dense, more solid structure (liver) gives a softer, higher, shorter sound because it does not vibrate as easily. Auscultation is listening to sounds produced by the body, such as the heart, blood vessels, lungs, and abdomen. -​ The diaphragm (flat surface) is used for high pitched sounds, like breath, bowel, and normal heart sounds.  -​ The bell (deep, hollow, and cuplike shape) is best for low pitched sounds such as extra heart sounds or murmurs. -​ To evaluate any body sounds, you must keep the room quiet and warm, as well as your stethoscope, wet excessive chest hair to minimize crackling sounds, and place the stethoscope directly onto the skin. 2.​ Identify common equipment utilized during physical exams. Otoscope - funnels light into the ear canal and onto the tympanic membrane Ophthalmoscope - illuminates the internal eye structures Tuning fork - used for auditory screening and assessment of vibratory sensation Percussion or reflex hammer - used to test deep tendon reflexes (DTRs) Doppler - uses ultrasonic waves to detect and amplify difficult-to-hear sound (fetal heart tones) Penlight - provides focused light source for inspection 3.​ Describe standard precautions. Standard precautions are applied to all patients, regardless of suspected or confirmed infection status, and in any setting in which healthcare is delivered. -​ Hand hygiene -​ Use of gloves, gown, make, eye protection, or face shield -​ Respiratory hygiene/cough etiquette 4.​ Identify hand hygiene principles. Most important step to decrease the risk of microorganism transmission! -​ Before and after every physical patient encounter -​ After contact with blood, body fluids, secretions, and excretions -​ After contact with any equipment contaminated with body fluids -​ After removing gloves -​ Alcohol-based hand sanitizer is to be rubbed for 20-30 seconds 5.​ Recognize the different types of Personal Protective Equipment (PPE) that is used for transmission-based precautions. Transmission-based precautions are additional precautions that are used with infectious agents. There are 3 types of transmission-based precautions: -​ Contact: spread by direct contact (C. diff)  → Gown & gloves -​ Droplet: spread by close respiratory contact (influenza or pertussis) → Basic surgical mask in addition to standard precautions -​ Airborne: spread by airborne agents (tuberculosis) → Gown, respirator (N95), eye protection, and gloves 6.​ Describe what occurs during a physical exam. -​ Begin the examination by touching the patients hands, checking skin color, nail beds, and metacarpophalangeal joints. This eases the patient into being touched during the exam. -​ You may need to ask the patient to change positions during the exam as you assess different parts of the body systems. -​ Use additional drapes to maintain the patients privacy and prevent chilling. -​ Throughout the examination, occasionally offer some brief teaching about the patient's body. -​ At the end of the exam, summarize your findings, share the necessary information, and thank the person. Let them know if there are any follow-up needs or next steps, or if anything is scheduled afterwards. 7.​ Identify different developmental considerations that may need to occur during a physical exam. Infant -​ Position: Flat on a padded exam table or held by their caregiver -​ Best done 1 or 2 hours after feeds so they’re not too drowsy or hungry -​ Nude -​ You should warm your hands before examining -​ Use brightly colored toys to help with distraction -​ Listen to their heart, lungs, and abdomen first Toddler -​ They’re more difficult to exam because they fear invasive procedures and dislike being restrained. -​ Use their caregiver to help with position changes, or complete the exam on the caregivers lap.  -​ They’ll have a security object, such as a blanket or teddy bear. -​ Begin by greeting the caregiver and gather objective data during the history interview with them. -​ Have the caregiver undress the child one part at a time. -​ Make the assessment a game for the toddler and start with non threatening areas first. -​ Offer the child choices if possible. -​ Inform the child of what you’re going to do. Use the caregiver to demonstrate procedures. Preschool -​ Start with noninvasive tasks, such as the head, eyes, ears, and nose. Examine the throat last. -​ They retake on tasks independently, plan the tasks, and see them through. -​ Preschoolers are often cooperative, helpful, and easy to involve. -​ They may see illness as punishment and fear body injury from invasive procedures. -​ Preschoolers may be held or sit on the exam table. -​ Use short and simple explanations. -​ They’re willing to undress but wait until the end for the genital examination to remove underpants. -​ Offer choices when possible, or not at all. -​ Explain the steps in the examination process. -​ Let them play with equipment to reduce their fears. -​ Don’t rush the child. -​ Give feedback and reassurance during the examination. School Age -​ Usually cooperative because they desire approval from caregivers and teachers. -​ They should sit or lay on the table. -​ An older school age child may not want their caregiver present. -​ They should use a gown but keep their underpants on. -​ Break the ice with small talk about their interests. -​ Show them how to use equipment. -​ Comment on how their body works since they’re interested in learning more. -​ Progress the school age child with a head-to-toe assessment. Adolescent -​ At this age, adolescents need to feel satisfied and comfortable with themselves. They value their peers' values and want to be accepted. -​ They should be sitting on the table but with their street clothes on. -​ Do the examination without the presence of their caregiver. -​ Give feedback to ensure their body is healthy and working the way it should. -​ Communicate with care. Focus on teaching adolescents how to promote their health and well-being. -​ Perform the head-to-toe assessment. Examine genitalia last and quickly. Aging Adult -​ Aging adults have tasks that are directed in developing the meaning of life and one’s own existence, and to adjust to changes in physical strength and health. -​ They should be examined on the table. Older, more frail, adults may need to be supine. -​ Arrange the sequence to allow as few position changes as possible. -​ Match the pace of the aging adult, slowly and carefully. -​ Use physical touch because other senses may be diminished (they can’t see or hear as well). -​ Be aware that aging years contain more life stress. -​ Use the head-to-toe approach. Sick Patient -​ Adapt your assessment to the person’s comfort level, such as positioning if they’re in distress. -​ You may initially collect a mini database on areas appropriate to the body before completing a full assessment. Chapter 9 - General Survey & Measurement (16 Questions from Chapter 9-11) 1.​ Identify & describe a general survey & the different components that make it up. The general study is the study of the whole person, the general health state and any obvious health characteristics. Starts with the very first encounter of the patient. As you proceed with the health history, the measurements, and vital signs, make sure to consider the components of the general survey. It includes subjective parameters that apply to the whole person, such as:  -​ Physical appearance: age, sex, level of consciousness, skin color, facial features, and overall appearance. -​ Body structure: stature, nutrition, symmetry, posture, position, body build, contour, and obvious physical deformities. -​ Mobility: gait and range of motion -​ Behavior: facial expression, mood and affect, speech, speech pattern, dress, and personal hygiene 2.​ Demonstrate how & when to obtain patient measurement. Nursing observations, health history, vitals signs, and then patient measurements are obtained. After measurements, data collection and plan formulation (nursing process) are done. 1.​ Weight -​ Remove shoes and heavy outer clothing -​ Try and measure weight around the same time of day and wearing the same type of clothing -​ Record weight in both kilograms and pounds -​ Unexplained weight loss can be a sign of short term/chronic illness. -​ Unexplained weight gain can indicate fluid retention -​ It’s often used to calculate medication dosages -​ Use the same scale every time. 2.​ Height -​ Use the wall-mounted device or the measuring pole on the balance scale to record their height. -​ They should be shoeless, standing straight with gentle traction under the jaw, looking straight ahead with their feet, shoulders, and buttocks touching the wall or measuring poll. -​ Record their height in feet, inches, and centimeters. 3.​ Body Mass Index (BMI) -​ BMI is a practical marker of healthy weight for height and an indicator of obesity or malnutrition. It’s used to guide patient progress towards a healthy weight and identify those that are at risk for developing health problems. -​ BMI shows the relationship between height and weight, but doesn’t take into consideration muscle mass. -​ It can be less effective in children and older adults.  -​ Using BMI in conjunction with other measures, such as waist circumference can better determine one’s risk in developing chronic diseases. -​ Be sure to compare their weight from previous visits. 4.​ Waist Circumference -​ Excessive abdominal fat is an important independent risk factor for disease, such as heart disease and type 2 diabetes. -​ To measure: Have the patient stand and find the hip bone (very top of the iliac crest). Use the measuring tape around the waist, parallel to the floor, level with the iliac crest. It should be snug. Record measurement at the end of normal expiration. 3.​ Explain how to calculate Body Mass Index (BMI). Imperial System: BMI= 703 x Weight (in pounds) / Height (in inches) Metric System: BMI= Weight (in kilograms) / Height (in meters) 40 kg/m = Extreme obesity 4.​ Identify development considerations that may need to occur during a general survey. Infants & Children -​ General survey: physical appearance, body structure, and mobility -​ Behavior: note the response to stimuli and level of alertness -​ Caregiver bond: note the child’s interaction with the caregiver Measurement -​ Weight: Weight an infant on a platform-type scale while protecting them from falling. -​ Length: Until they’re 2, measure infants body length by using a horizontal measuring board by gently stretching the spine and legs. -​ Height: Use the ruler mounted on the scale or wall while they stand straight and have their buttocks, shoulders, and heels touching the ruler Head Circumference  -​ Measure head circumference for newborns through 6 years of age. -​ Use the plastic measuring tape rather than a paper tape measure. Wrap the plastic measuring tape around the head aligned with the eyebrows at the prominent frontal bone and the occipital bone at the widest span. -​ Newborn’s head measures about 32 to 38 cm (34 cm average) and is about 2 cm larger than the chest circumference. Chest Circumference -​ The chest grows at a faster rate than the cranium. After 2 years, the chest circumference is greater than the head circumference. -​ Measured with tape around the chest at the nipple line. -​ It’s valuable in comparison with the head circumference but not necessarily by itself. Social determinants of health play a role in a child's growth and development. Physical growth is considered the best index of a child’s general health. Height and weight are recorded at every visit. The most important evidence for growth potential appears to be economic, nutritional, and environmental. The aging adult’s general survey is observed through physical appearance, posture, and gait. Weight -​ Body weight decreased during the 80s and 90s, along with muscle mass. -​ Fat distribution changes from the face and redirects to the abdomen and hips. -​ Aging adults have more lean tissue than younger adults. Height -​ By their 80s and 90s, many aging adults are shorter due to the thinning of vertebral discs, postural changes of kyphosis (hunching of the back), and slight flexion in the knees and hips. 5.​ Define abnormal findings related to body height & proportion. -​ Hypopituitary Dwarfism: Deficiency in growth hormone in childhood that results in retardation. -​ Gigantism: Excessive secretion of growth hormone by the anterior pituitary that results in overgrowth in the entire body. -​ Achondroplastic Dwarfism: A genetic disorder in converting cartilage to bone that results in normal trunk size, short arms and legs, and short stature.  -​ Acromegaly (Hyperpituitarism): Excessive secretion of growth hormone in adulthood after normal completion of body growth causes overgrowth of bone in face, head, hands, and feet but no change in height. Internal organs also enlarge. -​ Bulimia Nervosa: Mental health disorder characterized by episodes of binge eating and then purging. -​ Anorexia Nervosa: Mental health disorder characterized by severe and life-threatening weight loss in an otherwise healthy person. -​ Endogenous Obesity (Cushing Syndrome): Excessive fat accumulation in the trunk of the body due to the excessive secretion of cortisol. -​ Marfan Syndrome: An inherited connective tissue disorder that’s characterized by tall, thin stature, long and thin fingers, hyperextensible joints, and arm span greater than height. Chapter 10 - Vital Signs 1.​ Identify the significance of vital signs. Vital signs are an objective measurement of the body’s basic function. Vital signs include: Temperature, Blood Pressure, Pulse, Respiratory Rate, and Oxygen Saturation There are many factors that play into normal ranges, such as age, BMI, and gender. Vital signs help you monitor your patient’s health and indicate deterioration (especially in the acute care setting). 2.​ Explain different assessment techniques & different equipment used to obtain vital signs. Temperature can be taken many different ways: 1.​ Oral -​ Most convenient and commonly used -​ Electronic thermometers are swift and accurate (usually 20-30 seconds) 2.​ Rectal -​ Most accurate since the result is as close to a core temperature as possible -​ More invasive route and needs to be done in the left lateral decubitus position (laying on their left side) 3.​ Tympanic -​ Noninvasive and nontraumatic, that's extremely quick. -​ For adults: grab the ear and pull up and back  -​ For children under age 3: pull ear down and back 4.​ Temporal Artery -​ Used by sliding the probe across the forehead and behind the ear -​ Not as reliable and accurate as other methods Pulse: Every beat the heart pumps an amount of blood (stroke volume) into the aorta. The force flares the arterial walls and generates a pressure wave, which is felt in the periphery as the pulse. -​ Using the pads of your first 3 fingers, palpate the radial pulse at the flexor aspect of the wrist laterally along the radius bone. -​ If the rhythm is regular, count the number of beats for 30 seconds then multiply by 2. If it’s irregular, count the number of beats for a full minute. -​ Assess the pulse for rate, rhythm and force and document. If anything irregular is felt, heart sounds should be auscultated. -​ Normal rates vary with age being rapid in infancy and childhood, and more moderate during adult and older years. It varies with gender, after puberty females have a slightly faster rate than males. Respiration Rate -​ Normal breathing should be relaxed, regular, automatic, and silent -​ To be most accurate, count the respiration rate for 60 seconds -​ Report the rate of the breaths per minute, as well as the characteristics of the breathing Blood Pressure is the force of the blood pushing against the vessel wall. -​ The strength of the push changes with the event in the cardiac cycle. -​ Systolic pressure is the max pressure felt on the artery during left ventricular contraction or systole. -​ Diastolic pressure is the elastic recoil or resting pressure that blood exerts constantly between each contraction -​ Pulse pressure is the difference between the systolic and diastolic pressures and reflects stroke volume. -​ Mean Arterial Pressure (MAP) is the pressure forcing blood into the tissues averaged over the cardiac cycle. MAP > 60mmHg is needed to maintain adequate tissue and organ perfusion.  -​ Average blood pressure varies due to age, sex, race, social determinants, diurnal rhythm, weight, exercise, emotions, and stress. -​ Noninvasive blood pressure is an electric device attached to the cuff to take your blood pressure. It doesn’t determine the quality of the pulse like a manual blood pressure does. It indicated BP, MAP, and pulse rate. -​ Manual blood pressure is taken with a sphygmomanometer and stethoscope. Manual blood pressure can determine the quality of the pulse with palpating. -​ To get the most accurate blood pressure ensure: 5 minutes of rest before measuring, sit the patient in a chair with back support, have legs uncrossed and arms supported at the level of the heart, and use the proper blood pressure cuff size to get an accurate reading (wrong size cuffs can misdiagnose patients). -​ Normal = < 120 mmHg / < 80 mmHg -​ To ensure consistency, document the extremity used, position placed on the body, and cuff size. Oxygen saturation is a highly accurate noninvasive measurement of estimated arterial blood oxygen saturation (SPO2). -​ Can be applied to fingers, forehead, nose, toes on adults. For infants, it can be applied on the palm of their hands, thumbs, or foot. -​ Normal SPO2 readings are between 97% and 99% A doppler is used to measure the blood flow through your blood vessels. -​ It picks up changes in sound frequency as the blood flows and ebbs while amplifying them. -​ It’s used to locate peripheral pulse sites 3.​ Define terms for abnormal vital sign readings. Bradycardia - Heart Rate is less than 60 beats per minute Tachycardia - Heart Rate is above 100 beats per minute Tachypnea - Rapid respiratory rate above 25 breaths per minute Bradypnea - Decreased respiratory rate below 12 breaths per minute Hypertension - High blood pressure is when systolic is more than 140 mmHg, or diastolic is more than 90 mmHg, or both Hypotension - Low blood pressure with values that are 20 mmHg or diastolic pressure > 10 mmHg after changing to a standing position. 4.​ Identify orthostatic vital signs & how to assess them. Take serial measurements of their pulse and blood pressure when: 1.​ You suspect volume depletion 2.​ When the person is known to have hypertension or is taking antihypertensive medications 3.​ When the person reports syncope or near syncope (dizziness) When suspected, have the patient rest supine for 3-5 minutes then take their pulse and BP. Then, have them sit up and assess their pulse and BP. Next, have the patient stand up and assess their pulse and BP. Finally, after they’ve been standing for 3 minutes, assess their pulse and BP. When they go from supine to standing, normally a slight decrease (