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632 Final Quiz

Substance abuse/Domestic viol./Pain/Nutritional/Child exam

How many times in the past year have you had 5 or more drinks a day one or more heavy drinking days means this person is an at risk drinker
At risk drinking for men >14 drinks/week or >4 drinks/occasion
At risk drinking for women >7 drinks/week or >3 drinks/occasion
AUDIT The alcohol use disorders identification test
The AUDIT covers 3 domains alcohol consumption, drinking behavior or dependence, and adverse consequences from alcohol
CAGE questionnaire Cutdown, Annoyed, Guilty, Eye-opener (answering yes to greater than 2 questions signal possible abuse
Screening women for alcohol problems- TWEAK Tolerance, Worry, Eye-opener, Amnesia, Kut down
Screening aging adults- SMAST-G Short Michigan Alcohol Screening Test- Geriatric Version
GGT (gamma glutamyl transferase) most commonly used biochemical marker of alcohol drinking. Chronic alcohol drinking of >4 drinks/day for 4 to 8 weeks significantly raises GGT.
Serum aspartate aminotransferase (AST) is an enzyme found in high concentrations in the heart and liver months of chronic drinking increases AST
MCV (mean corpuscular volume is an index of red blood cell size. heavy alcohol drinking for 4 to 8 weeks increases MCV
Blood alcohol concentration BAC of >0.08 = legal intoxication in most states (3 standard drinks)
Dependence physiologic dependence on substance
Tolerance requires increased amount of substance to produce same effect
Cocaine inoxication Pupillary dilation
Opiate intoxication Pupillary constriction
Opiate withdrawal similar to influenza symptoms and pupillary dilation
IPV screening- Primary care every first visit for a new chief complaint, every new patient encounter, every new intimate relationship, and all periodic exams
IPV screening- ER/Urgent care all women/all visits
IPV screening- OB/GYN each prenatal and postpartum visit, each new intimate relationship, all routine GYN visits, all family planning visits, and all visits in STI visits
IPV screening- Inpatient part of all admissions and discharge
Abrasion a wound caused by rubbing the skin or mucous membrane
avulsion the tearing away of a structure or part
bruise superficial discoloration due to hemorrhage into the tissues from the ruptured blood vessels beneath the skin surface, without the skin itself being broken; also called contusion
contusion a bruise; injury to tissues without breaking of skin; blood from broken blood vessels accumulates, producing pain, swelling tenderness
cut incision
ecchymosis a hemorrhagic spot or blotch, larger than petechial, in the skin or mucous membrane, forming a non-elevated, rounded or regular, blue or purplish patch
hematoma a localized collection of extravasated blood usually clotted in an organ, space, or tissue
hemorrhage the escape of blood from a ruptured vessel, which can be external, internal, and/or into the skin or other organ
incision a cut or wound made by a sharp instrument; the act of cutting
laceration the act of tearing or splitting; a wound produced by the tearing and or splitting of body tissue usually from blunt impact over a bony surface
lesion a broad term referring to any pathologic or traumatic discontinuity of tissue or loss of function of a part
Nociceptors designed to detect painful sensations from the periphery and transmit them to the CNS
Nociceptors are located within the: skin, connective tissue, muscle, and the thoracic, abdominal, and pelvic viscera
Nociceptors carry the pain signal to the CNS by 2 afferent fibers A& and C
A& fibers are myelinated an larger in diameter so they transmit the pain signal rapidly to the CNS
C fibers are unmyelinated and smaller and they transmit the signal more slowly. These are diffuse and aching and last longer after the injury.
transduction occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery.
transmission (second phase) the pain impulse moves from the level of the spinal cord to the brain.
perception (third phase) indicates the conscious awareness of a painful sensation.
modulation (fourth phase) the pain message is inhibited through this phase or else we would continue to experience pain.
Examples of nociceptive pain skinned knee, kidney stones, menstrual cramps, muscle strain, venipuncture, or arthritic joint pain.
Neuropathic pain implies: an abnormal processing of the pain message from an injury to the nerve fibers.
Deep somatic pain comes from sources such as the blood vessels, joints, tendons, muscles, and bone.
Cutaneous pain comes from skin surface and subcutaneous tissues
Rating scales can be introduced at what age 4 to 5 years of age
PAIN AID scale Pain assessment in advanced dementia scale- score of 4 or more indicates need for pain management.
Reflexive sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration of the affected extremity.
Mini Nutritional assessment (MNA) score of 8-11 at risk for malnutrition
MNA tool score 0-7 needs a more comprehensive assessment
Bleeding gums Vitamin C deficiency
Glossitis (beefy red tongue) Vitamin B deficiency
Waist circumference at risk for men >40 in.
Waist circumference at risk for women >35 in.
Mid arm circumference norm for 20 y.o. woman 23-34.5cm
Mid arm circumference norm for 20 y.o. man 27.2-37.2cm
Arm span is nearly equivalent to height measure from sternal notch to the longest finger on the dominant hand, then multiply by 2
Elbow breadth, a measure of skeletal breadth is the most accurate method to determine frame size.
Hemoglobin/Hct- infant 14.5-22.5/44-72
Hemoglobin/Hct -2 months 9-14/28-42
Hemoglobin/Hct Children 6-12 11.5-15.5/35-45
Hemoglobin/Hct adult males 14-18/37-49
Hemoglobin/Hct adult females 12-16/36-46
Total cholesterol 120-200
Triglycerides age 0-19 10-100
Triglycerides age 20-65 <150
Serum albumin is a common measurement of visceral protein status
Serum albumin half-life 17-20 days
Normal serum albumin 3.5-5.5g/dL
Serum transferrin half life 8-10 days
True /False- Serum transferrin may be a more sensitive indicator of visceral protein status than albumin. True
C-reactive protein (CRP ) a plasma protein marker of inflammatory status produced by the liver, is used to monitor metabolic stress.
CRP normal values < 0.1 mg/dL
Marasmus (protein calorie malnutrition) is due to inadequate intake of protein and calories or prolonged starvation.
Kwashiorkor (protein malnutrition) is due to diets high in calories but contain little or no protein, example; low protein liquid diets, fad diets, and long term use of dextrose containing IV fluids. Appear well-nourished or obese.
Pellagra pigmented keratotic scaling lesions resulting from a deficiency of niacin
Magenta tongue a sign of riboflavin deficiency
Pale tongue Iron deficiency
Follicular hyperkeratosis dry bumpy skin associated with vitamin A and/or linoleic acid (essential fatty acid) deficiency.
Rickets sign of vitamin D and calcium deficiency
Bitot's Spots Foamy plaques of the cornea that are a sign of vitamin A deficiency
Erikson an individual's psychosocial development throughout the life stages, which he delineated
Piaget a child's cognitive development and the way in which the child learns about the world as his or her abilities to reason correspond to cognitive growth
Kohlberg expanded on Piaget focused on the moral development in children
More than six 5mm Café-au-lait spots and axillary freckling are associated with: neurofibromatosis
Facial port wine stains are seen in: Sturge Weber syndrome (often mental retardation present)
Low frontal hairline and thick, markedly arched eyebrows joined at the midline are clinical findings in: Brachmann-de-Lange syndrome (which causes cognitive, speech, behavior, and growth abnormalities)
Upward slanting palpebral fissures and midface hypoplasia are seen in: Down Syndrome
A smooth philtrum, flattened nose bridge, upturned nose, and thin upper lip are signs of: FAS-fetal alcohol syndrome
Cataracts and microphthalmia are seen in: congenital rubella
Low-set ears are seen in Noonan syndrome
Primitive reflexes should not persist past 4 months- if present cerebral palsy is suspected
Developmental surveillance occurs within the context of the health maintenance visit.
Developmental screening entails the use of standardized screening checklist to whether the child achieving expected developmental milestones.
Developmental evaluation in-depth assessment that is performed when a child is suspected of having a developmental delay or disorder.
The AAP recommends screening for autism spectrum disorders at: the 18 and 24 month well child visit.
Interval history recent illness, update any changes in family situation, living conditions
Created by: 1096147201