NUR-634 Advanced Physical Assessment Midterm Study Guide with complete solutions.

Subjective Data -symptoms from the client's point of view and include: feelings, perceptions, and concerns -what the patient tells you Objective Data -what the health professional observes by inspecting, palpating, percussing, and auscultating during the physical examination -observed signs Assessment -the clinical reasoning process that interprets the patient's history and physical examination, singles out identified problems, and movement from each problems to its action plan Plan -incorporates patient education, changes in medications, needed tests, referrals to other clinicians, and return visits for counseling and support -requires good interpersonal skills and sensitivity to the patients goals, economic means, competing responsibilities, and family struggles/dynamics Percussion -a diagnostic procedure designed to determine the density of a body part by the sound produced by tapping the surface with the fingers -use of the striking or plexor finger (usually the 3rd) to deliver a rapid tap or blow against the distal pleximeter finger (usually the distal 3rd finger of the left hand laid against the surface) to evoke a sound wave -the 5 sounds are resonant, flat, dull, hyper resonant, and tympanic -Resonant sounds are low pitched, hollow sounds heard over normal lung tissue. -Flat are normally heard over solid areas such as bones. thigh -Dull or thudlike sounds are normally heard over dense areas such as the heart or liver. Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors. -Hyperresonant sounds that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults. Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air, such as may occur in patients with COPD, or patients having an acute asthmatic attack. An area of hyperresonance on one side of the chest may indicate a pneumothorax. -Tympanic sounds are hollow, high, drumlike sounds. Tympany is normally heard over the stomach, but is not a normal chest sound. Tympanic sounds heard over the chest indicate excessive air in the chest, such as may occur with pneumothorax. Attributes of a Symptom -seven attributes -OPQRST & Associated manifestations (anything else accompanying it) -onset, provocative/palliative, quality, region/radiation, severity, timing Talkative Challenging Patient Intervention -give 5-10 minutes uninterrupted -focus on and ask questions to what seems most important to patient -summarize concerns and focus on #1 concern today -avoid impatience Angry Challenging Patient Intervention -acknowledge any involvement you may have in their anger and make amends -avoid reinforcing criticism of other clinicians -validate their feelings without agreeing with their reasons -ensure a safe environment, alert staff/security -stay calm and avoid being confrontational -keep a relaxed and nonthreatening posture Silent Challenging Patient Intervention -be attentive and respectful and encourage patient to continue when they are ready -watch for nonverbal cues such as difficulty controlling emotions -watch for signs of depression -ask why they are quiet Confusing Challenging Patient Intervention -guide questions, ask for clarification, and summarize -watch for underlying issue if there is interference with communication -when there are multiple symptoms focus on context of the symptoms emphasizing the patients perspective -consider delirium or intoxication -conduct a mental status examination focusing on LOC. orientation, memory, and capacity to understand -ask for permission to speak with family members to obtain their perspectives Hearing Impaired Challenging Patient Intervention -determine patients preferred method of communication -do they belong to the deaf/hearing culture -when did the hearing loss occur relative to the development of speech and language -kinds of schools patient attended -use an interpreter -hand written questions (timely) -do they use hearing devices -unilateral hearing loss sit on good side -remove background noise -face lip readers -speak normal volume and rate -ask for teach back and give written instructions to take home ABCDE-EFG -method used to screen moles for melanomas -if 2 present risk of melanoma increases and biopsy should be considered -Assymetry, Border irregularity, Color Variations, Diameter 6mm, Evolving -EFG added to help detect aggressive nodular melanomas (Elevated, Firm to palpation, growing progressively)