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Stack #20348


wellness optimal functioning; not just the absence of illness, perfect health or the biopsychosocial ideal
medical model goal is to cure; mechanistic; objective data based on scientific proof
nursing model goal is to care; holistic/comprehensive; scientific but also intuitive
symptoms subjective
signs objective; you observe with your own senses
pyrexia with fever
normal rectal +1 degree
normal axillary -1 degree
how should you assess a small child's temperature? axillary or tympanic
safety point for temperature? 102.2; be aware of sudden and abrupt changes in tempeerature
metabolism changes with fever? increases 13% for every 1 degree celsius of increase; ensure nourishment and hydration
pulse strengths 3+ bounding; 2+ normal, 1+ weak/thready; 0 absent
apnea absence of repirations; about 15seconds
eupnea normal rate (12-20)
tachypnea rapid (>20)
bradypnea slow (<12)
systolic maximum force exerted against arterial wall during ventricular contraction
systole Systolic; maximum force exerted against arterial walls during ventricular contraction
diastolic minimal force exerted agains arterial wall when ventricles are relaxed
pulse pressure MAP; subtract diastolic - systolic; Normal 30-50
BP regulators peripheral resistance; elasticity of vessel walls; pumping action of th heart; blood volume; blood viscosity
bp cuff too large lower BP measured than actual
bp cuff too small higher BP measured than actual
when to measure head circumference? every visit to 2years old; annually to age 6
orthostasis BP drops as person rises by at least 25/10mmHg
When should peek-a-boo be achieved? 1 year old
Culture The system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another and that are transmitted from generation to generation through learning
Cultural competence treating every patient with equal respect and dignity regardless of culture, race or ethnicity
Provider causes of health disparities conscious or unconscious biases; ineffective communication; inability to build trust; time limitations
External Environment presence of others; physical; space; comfort; note-taking
Internal Environment mutual respect; empathy/sympathy; acknowledgment of feelings; confidentiality; openness and optimism
Phases of the Interview Introduction, Working and Closing
Introduction phase salutations, explanations
Working phase communication, data gathering, body language, responses
Closing phase futher explanation and questions; summarize findings; plan next steps
When to assess LOC? Assess LOC and language first in order to determine the depth of assessment that's needed
Continuum of consciousness alert --> lethargic --> obtunded --> stupor --> comatose
Glasgow Coma Scale common level of consciousness tool r/t eye opening, verbal response and motor response
Components of Cognition ABCT
ABCT -- A Appearance: posture, body movements, hygiene and groomin
ABCT -- B Behaviors and Moods: appropriate, continuum of mood and affect
ABCT -- C Concentration (Cognitive Signs): Orientation, attn span, recen and remote memory, new learning, judgment
ABCT -- T Thought Processes: Abnormals are hallucinations, delirium, dementia
delirium drugs/illness; internal; usually something fixable
dementia impaired memory, cognition, brain-related causes; i.e. poor vascular supply to the brain; alzheimers
Mental Status Assessment We CANNOT measure it directlyl Indirect measures of cognitive and emotional status and observations of behaviors
Folstein MMSE perfect score = 30
Mental Status Screening clock drawings; Set Test for the elderly
Screening for Depression CDI, BDI, ZUNG, CES...
CAGE test Use for suspected illicit substances
CAGE -- C Have you ever felt you ought to cut down on your drinking or drug use?
CAGE -- A Do you get annoyed at criticism of your drinking or drug use?
CAGE -- G Do you ever feel guilty about your drinking or drug use?
CAGE -- E Do you ever take an early morning drink or use drugs first thing in the morning?
What drug has the most impact on a person's daily life? food
IBW ranges <70% is undernutrition; >120% is overnutrition
Good fats polyunsaturated and monounsaturated
Bad fats saturated fats and trans fats
BRAT for gastroenteritis: bananas, rice, apples and toast
Waist to hip ratio greater than 1 for men or greater than 0.8 for women indicates obesity
Rxnship between TIBC and iron inversely proportional
4 types of assessments pyramidal: emergency, follow-up, episodic, and complete
Present Illness - acronym PQRSTU
PQRSTU - P Provocative and palliative factors; what makes it worse and what makes it better
PQRSTU - Q Quality or Quantity: descrive the pain with the adjectives
PQRSTU - R Region or Radiation: where does i t start, where does it move to (radiate) where is it more severe?
PQRSTU - S Severity Scale: rate your pain
PQRSTU - T Timing: before or after meals, awakens from sleep; how often? constant?
PQRSTU - U Understand patient's perspective:r/t employment
GPA - P Para is deliveries
Review of Systems (ROS) what is reported, not what is found through physical examination; an expansion of the health history
Created by: vlarberg