NR 509 Bates / Midterm 2024

NR 509 Bates / Midterm 2024 Preauricular nodes in front of the ear Posterior auricular node Occipital node superficial to the mastoid process (behind the ear) at the base of the skull posteriorly Tonsillar node at the angle of the mandible Submandibular node midway between the angle and the tip of the mandible. These nodes are usually smaller and smoother than the lobulated subman-dibular gland against which they lie Submental nodes in the midline a few centi-meters behind the tip of the mandible Superficial cervical nodes Posterior cervical nodes superficial to the sternocleidomastoid. along the anterior edge of the trapezius. Deep cervical chain lymph nodes deep to the ster-nocleidomastoid and often inaccessible to examination. Hook your thumb and fingers around either side of the sterno-cleidomastoid muscle to f ind them. Supraclavicular nodes shotty deep in the angle formed by the clavicle and the sterno-cleidomastoid. Small, mobile, discrete, nontender nodes, are frequently found in normal people physical assessment techniques Inspection - visual examination; Palpation - tactile examination; Percussion - tactile and auditory examination; Auscultation - auditory examination head and neck Begin the physical assessment by inspecting general appearance of head/neck facial expression, contours, asymmetry comprehensive assessment Seeing patient for first time; Includes all the elements of the health history and the complete physical examination; fundamental and personalized knowledge about the patient that strengthens the clinician-patient relationship; provides a complete basis for assessing these concerns and answering patient questions focused assessment chief complaint such as cough, abdominal pain, sore throat, etc. or a follow up for a chronic illness; Your history and physical will be much more focused on the chief complaint as you begin diagnosis and management basic maximize patient's comfort, avoid unnecessary changes in position, enhance clinical efficiency, move head to toe, examine the patient from their right side active listening closely attending to what the patient is communicating, connecting to the patient's emotional state, and using verbal and nonverbal skills to encourage the patient to expand on his or her feelings and concerns Empathic responses the capacity to identify with the patient and feel the patient's pain as your own, then respond in a supportive manner Guided questioning show your sustained interest in the patient's feelings and deepest disclosures and allows the interviewer to facilitate full communication, in the patient's own words, without interruption. Nonverbal communication eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs—crossed, neutral, or open validation Partnering relationship helps to affirm the legitimacy of the patient's emotional experience. When building rapport with patients, express your commitment to an ongoing Summarization Giving a capsule summary of the patient's story during the course of the interview to communicate that you have been listening carefully. Transitions Inform your patient when you are changing directions during the interview empowering the patient encourage patients to ask questions, express their concerns, and probe your recommendations in order to encourage them to adopt your advice, make lifestyle changes, or take medications as prescribed. subjective apparent only to the person affected' perceptions, feelings, thoughts, expectations. Cannot be observed and can be discovered only by asking questions objective detectable by an observer or can be tested against an acceptable standard; tangible, observable facts; includes observation of the clients behavior, medical records, lab and diagnostic tests, data collected by physical exam chief complaint Make every attempt to quote the patient's own words 7 attributes of a symptom Location, quality, quantity or severity, timing - including onset duration and frequency, setting in which it occurs, alleviating/aggravating factors, associated manifestations Past medical history Medications (prescription, OTC and herbs), allergies to drugs foods seasonal environment (document reaction to each), childhood; illness/hospitalizations, adult illnesses (diabetes, HTN, HIV, hispitalizations, gender of sexual partners, sexual practices), surgical history (dates, indications, types), OBGYN (menstrual hx, methods of contraception, sexual function) , psychiatric (illness and time frame, diagnosis, hospitalizations, treatments), health maintenance (immunizations, wellness exams, pap smears, colonoscopy, etc), family history, personal and social history (intersts, stress, spiritual beliefs, lifestyle habits) review of symptoms (1) to obtain additional information about the patient's chief complaint and history of present illness; and (2) to elicit symptoms of potential problems in uninvolved systems; ask yes or no questions and then follow up when there is a response that indicates an abnormality with open-ended questions; head-to-toe approach - remember that the ROS is subjective data ONLY Problem list defined as a list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient; includes all the medical, social, and psychologic problems the patient has or may have; List the most active and serious problems first and record their date of onset. Helps to individualize the patient's care. On follow-up visits, provides a quick summary of the patient's clinical history and a reminder to review the status of problems the patient may not mention differential diagnosis all the medical diseases that may possibly explain the patient's chief complaint or principal problem; A chief complaint must be identified first. Includes all medical diseases that may possibly explain problem/ CC head Areas are associated with the bone that they are in front of salivary glands parotid glands near mandible glands that lie superficial and behind mandible - visible and palpable when enlarged submandibular gland glands beneath the tongue parotid and submandibular superficial temporal artery common issues with the head openings of these are visible in oral cavity artery that is in front of the ear and runs upward - readily palpable Headache; Change in vision - Hyperopia, Presbyopia, Myopia, Scotomas, Diplopia; Hearing loss, earache, tinnitus; Vertigo Hyperopia presbyopia myopia Scotoma farsightedness; This makes close-up objects appear blurry gradual loss of your eyes' ability to focus on nearby objects nearsightedness A spot in your vision that can be dark, very light, blurred, or flickering · Trouble se