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What is the purpose of the Health History?
To collect Subjective (the history) and Objective data (physical exam and lab studies) on the client.
What is the first purpose of the review of systems?
To evaluate the past and present health state of each body system.
What questions are asked for:

Onset: Exactly when did it first occur?  Duration: How long did it last?  Frequency: How often does it occur?
What is the second purpose of the review of systems?
To double-check in case any significant data were omitted in the present illness section.
What is some of the common knowledge for the stethoscope?
1. Any extra noise in a room can produce "roaring".  Keep room quiet.

2. Warm stethoscope endpiece up before touching skin.

3. Friction of a hairy area may cause crackles or rales, to minimize wet hair before auscultating.
What questions are asked for:

Provocative or Palliative
What brings it on? What were you doing when you first noticed it? What makes it better? Worse?
What questions are asked for:

Severity Scale
How bad is it on a scale of 0 - 10 with 10 being the worst?  Is it getting better, worse, staying the same?
What questions are asked for:

Quality or Quantity
How does it look, feel, sound?  How intense/severe is it?
What is the third purpose of the review of systems?
To evaluate health promotion practices.
What is a functional assessment?
It is a person's self-care ability in the areas of general physical health or absence of illness.
What are the characteristics of a resonant sound?
A: Medium-loud

P: low

Q: Clear, Hollow

D: Moderate

Sample: Over normal lung tissue
What are some of the different categories of the functional assessment?
Self-Esteem/Self Concept, Activity/Exercise, Sleep/Rest, Nutrition/Elimination, Interpersonal Relationships/Resources, Spiritual Resources, Coping and Stress Management, Personal Habits, Alcohol, Street Drugs.
What are the skills required for the physical assessment?
Inspection, Palpation, Percussion, and Ausculation
What does "Inspection" mean
Concentrated Watching
This always come first in the physical assessment..
What does "Palpation" mean?
Palpation applies your sense of touch to asses the following factors: texture, temp, moisture, organ location & size, as well as any swelling, crepitation, presence of lumps or masses, & presence of tenderness or pain
Why do we collect the Health History?
To use as a screening tool for health symptoms and health promotion.
What does "Percussion" mean?
Percussion is tapping a person''s skin with short, sharp strokes to assess underlying structures
What are the two methods of percussion?
Direct (immediate) and Indirect (mediate)
Define Amplitude (or intensity).
A loud or soft sound.  The louder the sound, the greater the amplitude.  Loudness depends on the force of the blow and the structure''s ability to vibrate.
What questions are asked for:

Region or Radiation
Where is it?  Does it spread anywhere?
Define Quality (or timbre).
A subjective difference due to a sound''s distinctive overtones.  A pure tone is a sound of one frequency.  Variations within a sound wave produce overtones.  Overtones allow you to distinguish a C on a piano from a C on a violin.
Define Duration.
The length of time the note lingers.
What are the 8 critical characteristics of a symptom?
Location, character or quality, quantity or severity, timing, setting, aggravating or relieving factor, associated factors, patients perception
What questions are asked for:

Understanding Patient''s Perception of the Problem
What do you think it means?
What are the characteristics of a hyperresonant sound?
A: Louder

P: Lower

Q: Booming

D: Longer

Sample: Normal over Childs lung. Abnormal in Adult, over lungs with increased amount of air as in emphysema
What are the characteristics of a dull sound?
A: Soft
P: High
Q: Muffled thud
D: Short
Sample: Relatively dense organs as liver or spleen
What are the characteristic of a Flat sound?
A: Very Soft
P: High
Q: A deep stop of sound, absolute dullness
D: Very short
Sample: When no air is present.  Over thigh muscle, bone, or over tumor.
What does sound result from?
The vibration of some structure
Define Auscultation.
It is listening to sounds produced by the body such as the heart and blood vessels and the lungs and abdomen.
How does a stethoscope work?
It blocks out the extrenuating noises.  It does NOT amplify sound.
In which situation do you use the diaphragm of a stethoscope?
Used most often because its flat edge is best for high-pitched sounds - breath, bowel, and normal heart sounds.
How does elasticity of vessel walls influence blood pressure?
When walls are stiff/rigid, pressure increases.
What are the BMI ranges?
< 18.5 Underweight
18.5 - 24.9 Normal Weight
25 - 29.9 Overweight
30 - 39.9 Obese
> 40 Extreme Obesity
What are the characteristics of a tympany sound?
A: Loud

P: High

Q: Musical and Drumlike

D: Sustained Longest

Sample: Over air filled viscus, i.e. stomach, liver
What are the four areas of the general survey?
Physical Appearance, Body Structure, Mobility, Behavior.
What are the items in the General Survey that are addressed during the Physical Appearance portion?
Age, Sex, Level of Consciousness, Skin Color, Facial Features
What does PQRSTU stand for?
P: Provocative or Palliative

Q: Quality or Quantity

R: Region or Radiation

S: Severity Scale

T: Timing

U: Understand Patients Perception
What are the items in the General Survey that are addressed during the Mobility portion?
Gait, Range of Motion (ROM)
What are the items in the General Survey that are addressed during the Behavior portion?
Facial Expression, Mood and Affect, Speech, Dress, Personal Hygiene
What are the seven components of Health History?
Biographical data, Reason for seeking care, Present health or history of present illness, past health, family history, review of systems, functional assessment
This is the Subjective sensation a person feels for the disorder.  It is what the person tells you.
This is the objective abnormality determined by the examiner.  It is detectable on physical exam or in lab reports.
What are the items in the General Survey that are addressed during the Body Structure portion?
Stature, Nutrition, Symmetry, Posture, Position, Body Build/Contour, Obvious physical deformities
How do you assess the respiration of a client?
Assess while the person is unaware.  Count for 30 seconds unless suspect abnormality.
When doing the Functional Assessment on an older adult what additional questions would you ask?
1. Questions about how ADL''s are affected by the aging process

2. Past health back 5 years

3. Health promotion and functional assessment are important.
What are the Waist Circumference ranges?
>35 in females and >40 in males equals increased risk for cardiovascular disease and diabetes
What does a "full, bounding" pulse denote?
Increased stroke volume
What is the normal temperature in the older adult?
Usually lower than in other age groups, with a mean of 97.2F (36.2C)
What are some influences on temperature?
1. Diurnal Cycle of 1-1.5 degrees - low in a.m., peaks in early evening.
2. Menstrual cycle increases at ovulation
3. Exercise - moderate to hard increases
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