Health Assessment Exam #1 Blueprint

Health Assessment Exam #1 Blueprint Unit 1-3 (Hx and Interviewing, Physical Overview, HEENOT) Questions from study guide: • Know the difference between hypertropia, exotropia, esotropia, and hypotropia.. (Bickley et al. , 2021, pg 368) - Esotropia (inward deviation) Exotropia (Outward deviation) Hypertropia (Upward deviation) Hypotropia (Downward deviation) • Know the difference between Lacrimal gland enlargement, Dryness of the eyes, Nasolacrimal duct obstruction, and Thyroid eye disease. Lacrimal gland enlargement, also known as dacryoadenitis, can be caused by a number of conditions, including infections, inflammation, or autoimmune diseases: · Acute dacryoadenitis Most common in children and young adults, this is usually caused by a viral or bacterial infection, such as mumps, Epstein-Barr virus, staphylococcus, or gonococcus. Symptoms include tenderness, redness, and swelling of the gland, which can cause the eyelid to droop and form an S-shape. · Chronic dacryoadenitis Can be caused by non-infectious inflammatory disorders, such as thyroid eye disease, sarcoidosis, or orbital pseudotumor. · Lacrimal gland tumors These can include pleomorphic adenomas, which can cause diplopia and limited ocular motility. Lacrimal gland lymphomas are more common in patients over 60, but can also occur in children. · Sjögren Syndrome An autoimmune disorder that causes the progressive degeneration of the lacrimal glands. Symptoms of lacrimal gland swelling include: Pressure on the eye and Distorted vision. Treatment for lacrimal gland swelling depends on the cause. For example, viral conditions like mumps can be treated with rest and warm compresses. You should see an eye care specialist or healthcare provider as soon as you notice any swelling, pain, or discoloration near your ey • What is therapeutic communication and special consideration for blind patients and patients hard of hearing? Blind-/Low-Vision: Shake hands to establish contact and explain your name/role. Present anyone else in the room. Verbally orient to room. Encourage glasses if they wear them. Explain things verbally sing gestures wont be received by patient . (Bickley et al. , 2021, pg 66) Hearing impairment: Find out the pt preferred method. Might need ASL interpreter. Encourage use of hearing aids. (Bickley et al. , 2021, pg 65) • How do we establish an effective patient encounter? Step 1 Initiating the encounter ▪ Setting the stage/preparation ▪ Greeting the patient and establishing initial rapport Step 2 Gathering information ▪ Initiating information gathering ▪ Exploring patient's perspective of illness ▪ Exploring biomedical perspective of disease including relevant background and context Step 3 Performing the physical examination Step 4 Explaining and planning ▪ Provide correct amount and type of information ▪ Negotiate plan of action ▪ Shared decision making Step 5 Closing the Encounter How do you establish rapport with patients with disabilities? Make eye contact, engage in simple conversations. Avoid talking down to patient or been condescending. (Bickley et al. , 2021, pg 66) Clues to the Patient’s Perspective on Illness What information is gathered in a clinical assessment? Physical Exam o Vitals o General – Orientation, mood, memory odors, grooming, etc o Eye -Pupils size, accommodation, conjunctiva, sclera, otoscope. Acuity. o HENT- Scalp, hair, face, Ear Canal-otoscope, nose, Mouth (Symmetry, color, moisture, lesions, mucosa, teeth, palate, tongue). Weber test/Rinhe Test.  Nerve I- Olfactory- Not tested.  Nerve II- Optic -Snellen chart  Nerve III- oculomotor– Extra ocular movement- Follow fingers  Nerve IV -trochlear - Extra ocular movement - Follow fingers  Nerve VI -abducens- Extra ocular movement - Follow fingers  Nerve V -Trigeminal- Motor, sensory and corneal reflex. Clench jaw. Touch skin.  Nerve VII facial – Raise eyebrows, puff cheeks, smile.  Nerve VIII -vestibulocochlear – whispering something  Nerve IX glossopharyngeal – say “Aaaa”. Quality of voice. Hoarse? Gag reflex with tongue depressor.  Nerve X -Vagus.  Nerve XI spinal accessory – trapezius muscles (Shrug shoulders, turn neck side to side).  Nerve XII – Hypoglossal - Stick out tongue. Symmetry? o Neck- palpate lymph nodes, masses, neck pulsations, trachea midline? Swallow. Check thyroid. Back, Posterior Thorax and Lungs. Observed muscles of back. Percuss chest and lungs. o Respiratory. Rate, rhythm depth, Auscultate lungs, under the axilla. Upper extremities. ROM. Strength Squeeze two fingers. BUE resistance. Point-topoint movement. Coordination. Examine female breast tissue. Arms raised, axillary nodes. Nodules? Palpate percuss the thorax. Listen to breath sounds. o o o o o o Cardiovascular. Thorax observation of Jugular vein, carotid pulse, listen bruit. Apex with bell. Heart listen x 6 spots. Gastrointestinal. Listen to Bowel sounds. Palpate light then harder. Percuss the liver. Don’t forget the femoral and popliteal pulses. Inguinal lymph nodes. BLE for discoloration, skin issues, edema. Pedal pulses. Varicose veins? ROM/Strength of BUE/BLE. Reflexes knee, Babinski feet. Musculoskeletal – Gait. Knee bends. Integumentary- moist, ulcers, pallor, discolorations, molds. Neurologic/Psychiatric- Mental, status, cranial nerves, motor system, reflexes. BUE, BLE reflexes. Genitourinary. General genitalia. Females: Pap smear and bimanual palpation uterus, anorectal fistula. Explain the Mnemonic FIFE ▪The patient's Feelings, including fears or concerns about the problem ▪The patient's Ideas about the nature and the cause of the problem ▪The effect of the problem on the patient's life and Function ▪The patient's Expectations of the disease, of the clinician, or of the health care, often based on prior personal or family experiences. (Bickley et al. , 2021, pg 13) Understanding Racism and Bias and Social Determinants of Health Racism and Bias Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a person on the basis of their perceived group or identity. Social Determinants of Health The conditions in which people are born, grow, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces include economic policies and systems, development agendas, social norms, social policies, and political systems. How to improve patient health and reduce inequities. Pending answer • How to address health disparities. At pt level: Ask patient about social challenges, guide to resources to access benefits/support services (MCD, health clinics, etc) At practice level: offer culturally safe care, use patient care navigators, “ensure that care is accesible to those most in need” At community level: Partening with local organizations/public health agencies. (Bickley et al. , 2021, pg 19) Causes of fatigue Fatigue is a common symptom of depression and anxiety. Fatigue es normal response to hard work, sustained stress, grief. Investigate further if fatigue is unrelated to those situations (Bickley et al. , 2021, pg 212) Assessment of fatigue Fatigue is a common symptom of depression and anxiety, but consider infectious, endocrine, adrenal, heart failure, COPD/CKD, anemia, electrolyte imbalance, malignancy, nutritional deficits and medications side effects. (Bickley et al. , 2021, pg 212) Know the difference between hypothyroidism and hyperthyroidism. • Alzheimer's disease characteristics, diagnostic tests, and treatment plans. Consists of evidence of a causative genetic mutation from family history or genetic testing, or the presence of cognitive decline in TWO or MORE cognitive domains, with ALL THREE of the following features: clear evidence of decline in memory and learning and at least one other cognitive domain, steady progressive decline in cognition without extended plateaus, and no evidence of mixed etiology from other neurodegenerative, cerebrovascular, mental, or systemic disease. Alertness and attention are preserved Other Dementias are unlikely Memory difficulties take the form of repeating questions, losing objects, or confusion when performing tasks such as shopping. LATE STAGES: impaired judgement and disorientation progressing to aphasia, apraxia, left-right confusion, and dependence of instrumental activities of daily living, Psychosis and agitation can also occur NO CURE – treatments can include: - Cholinesterase inhibitors These drugs increase levels of acetylcholine, a brain chemical that helps nerve cells communicate. They are often the first medicines tried and can help with memory and behavioral symptoms. Examples include donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon). - Memantine (Namenda) This drug works by blocking the effects of glutamate, a chemical in the brain. It can help slow the progression of symptoms in moderate to severe Alzheimer's disease. - Immunotherapy drugs These drugs target the protein beta-amyloid to help reduce amyloid plaques, a hallmark of Alzheimer's. Examples include lecanemab and donanemab. - Antidepressants, antipsychotics, and anti-anxiety drugs These drugs may help with behavioral and psychological symptoms like depression, anxiety, and agitation. However, they should only be used after other strategies have been tried. - Person-centered care This involves tailoring a person's care to their interests, abilities, history, and personality. It can be effective in managing some symptom • Suicide. Who has the highest incidence? 2nd leading cause of death among 15 to 24 yo. Man are 4x more likely than women to die of suicide. Man more likely use firearm, women to use poison. 90% of all suicides are non-Hispanic whites. (Bickley et al. , 2021, pg 263-264) What screening test will be performed for dementia? The Montreal Cognitive Assessment (MoCa) (Bickley et al. , 2021, pg 277) What are common illicit drugs? ¼ USA Americans reported binge drinking. SUD – Marijuana, cocaine, psychotherapeutic drugs. ( Bickley et al. , 2021, pg 267) What are common drugs that are overdosed? Opioids, Fentanyl (Bickley et al. , 2021, pg 267) • What foods reduce cardiovascular risks? Enlist Common causes of breath odor (Halitosis) Poor oral hygiene, tobacco smoking, plaque retention on teeth, dentures and periodontal disease (Bickley et al. , 2021, pg 267). Diagnostic tests performed for bacterial throat infection? Rapid Antigen testing for streptococcal and fusobacterium. (Bickley et al. , 2021, pg 422). Risk factors for carcinoma of the lip. · · · · Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others Fair skin Excessive sun exposure to your lips A weakened immune system What causes angioedema? Localized subq or submucosal swelling cause by leakage of the intravascular fluid into the interstitial tissue.. Triggered by mast cells. Associates S/S urticaria and pruritus. Usually resolves within 24-48 hrs. Can be LIFE THREATNING if it involves larynx, tongue, upper airway and develops into anaphylaxis (Bickley et al. , 2021, pg 430) Primary syphilis characteristics, diagnostic tests, and treatment plan. Characteristics: Small red papule becomes a chancre – painless erosion up to 2cm in diameter, base is smooth, red and glistening, boarders are raised and indurated. Chancre heals within 2-3 weeks Causative organism: Treponera pallidiium which is a spirochete. Incubation period is 9-90 days after exposure. May develop inguinal lymphadenophathy within 7 days – lymph nodes are rubbery, non-tender, mobile 20-30% of patients develop secondary syphilis while chancre are still present -this suggests HIV infection  Blood tests A doctor will order a blood test to check for syphilis. If the test is positive, a second test will be performed to confirm the diagnosis.  Medical exam A doctor will review your exam and ask questions to determine the stage of infection.  Antibiotics The preferred treatment for syphilis is penicillin, which is given as a single shot in the early stages. If you're allergic to penicillin, your doctor may suggest an alternative antibiotic or a process to help your body get used to penicillin Exudative tonsillitis characteristics, diagnostic tests, and treatment plan. Streptococcal pharyngitis typically produces white/yellow exudates on the tonsils or posterior pharynx, with red beefy uvula, palatal petechia(Bickley et al. , 2021, pg 430) Test: Rapid antigen strep test. To detect group A streptococcus. Tx Strept throat. (Dynamed) Foods high in potassium Here are some examples – there are a ton more · · · · · · · · Avocados, bananas, melons, oranges, prunes and raisins Artichokes, winter squash, plantains, spinach, potatoes and tomatoes Bran products and granola Beans (baked, black, pinto, etc.) Brown or wild rice Certain fishes Chicken Beef