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AHA Exam 4 - aha exam 4
aha exam 4
Course
Advanced Health Assessment (NURS612)
133 Documents
Students shared 133 documents in this course
University
Maryville University
Academic year: 2023/2024
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NURS 612 Exam 4 Key Points to Review
**Please note that this is an optional tool to use in preparation for Exam 4. It may
or may not contain all the content on Exam 4. **
For all modules, review the end of each chapter for a list and description of the
differential diagnoses for each system.
Key Points to Review: Mental
Health
Student Notes
What questions do you ask a patient
with a chief complaint of a mood
disorder such as anxiety or
depression?
How do you feel?
How are your spirits?
Do you have thoughts that life is not worth
living?
Do you want to harm yourself?
Do you have plans to take your own life?
Do you want to die?
Has there been a change in your sleep
habits?
Are you fearful of anything?
What are the subjective data you
collect when you assess a patient's
mental health in a primary care
setting?
Disorientation & Confusion
Depression
Anxiety
Perceptual Disorder
Hallucinations
Auditory, Visual, Haptic, olfactory
See things or hear voices
Mind plays tricks on you
TV/Radio speaks to you
Thought Content
Fantasies, Dreams
People want to harm me
I have special powers
Someone trying to influence me
Can’t get thoughts out of my head.
What are the objective data you
collect when you assess a patient's
mental health in a primary care
setting?
Mania: pressured speech
Depression: slow, short answers
Cognitive Disorder: uneven or slurred
Grooming
Posture
Facial Expressions
Appearance as compared to stated age
Level of Activity
Retardation, Agitation
Tics, Tremors, Grimacing, Unusual
mannerisms
Emotional appearance
Anxious, Tense, Sad, Unhappy,
Bewildered, Tearful
Voice
Faint, Loud, Hoarse
Eye Contact
Normal, Hypervigilant, Avoidant
Attitude
Irritable, Aggressive, Seductive,
Guarded, Defensive, Indifferent,
Apathetic, Cooperative, Sarcastic
Affect
Labile, Blunt, Appropriate to content,
Inappropriate, Flat
Speech
Speed, Pressured, Stammer/Stutter,
Pitch, Articulation, Incoherent
Thought Processes and Judgement
What is the difference between a
patient's behavior with a diagnosis of
dementia and behavior with a
diagnosis of delirium?
Dementia
Chronic, progressive failing memory,
cognitive impairment, behavioral
abnormalities, personality changes
Delirium
Acute onset of changes in cognition, arousal,
consciousness, mood, behavior
Emergency
How can you assess/test a patient's
memory? If the patient has poor
recent memory, what are the possible
differential diagnoses?
DDx: Dementia, Acute Infection, Temporal
Lobe Trauma, Anxiety, Depression
Immediate Recall: ask patient to listen and
then repeat a sentence or series of numbers
Recent Memory: give patient a short time to
view 4 or 5 objects; ask about them 10
minutes later to list the objects
Remote Memory: ask about verifiable past
events or information such as sibling’s name,
high school, subjects of common knowledge.
How can you assess a patient's
orientation? If the patient is
disoriented, what are the possible
differential diagnoses?
Person, Place, Time, Events
DDx: dementia, brain pathology (tumor,
trauma, stroke), cognitive/developmental
impairment, psychosis
What is the Mini Mental Status Exam
(MMSE)? Why do you conduct this
exam? What do the results determine
as a possible differential diagnosis?
DDx: dementia (Alzheimer, vascular,
Parkinson), delirium (likely not as this is an
emergency and not time to perform MMSE)
Standardized tool to assess cognitive
function changes over time
Help determine mental states and
memory decline in the older adult
Measures orientation, registration,
attention & calculation, recall, ability
to follow commands, language
texture, symmetry, thickness; testes should
move freely with palpation (smooth/rubbery)
N: deeper pigmentation than normal
skin, coarse appearance, asymmetry
(L hangs lower d/t longer spermatic
cord)
AbN: lumps (sebaceous cysts),
edema, hard mass
How do you assess for inguinal
hernias?
1. With patient standing, ask him to
bear down like having a bowel
movement. While patent is straining,
inspect are of the inguinal canal and
region of the fossa ovalis.
2. Have patient relax.
3. Insert examining finger into the lower
part of the scrotum and carry upward
along the vas deferens into the
inguinal canal. Feel the oval external
ring. Ask patient to cough. If hernia
is present, you will feel a sudden
presence of a bulge against your
finger.
How do you assess a palpable mass
in the scrotum? Using
transillumination, what do the findings
indicate as possible differential
diagnoses?
DDx:
Hydrocele
Hernia
Incarcerated Hernia (surgical emergency),
Testicular CA
Determine whether it is fluid, gas, or solid
material
Attempt to reduce the size of the mass by
pushing it back through the external inguinal
canal
If you can transilluminate the mass & no
change in size with attempted reduction,
most likely contains fluid.
A mass that does not transilluminate but
does change size, it is likely a hernia
A mass that neither changes in size nor
transilluminates may be an incarcerated
hernia or testicular cancer
How do you elicit the cremasteric
reflex? What is a normal and an
abnormal finding?
DDx: Testicular Torsion, Epididymitis, Orchitis
Stroke inner thigh upward with blunt object
and watch for rise of scrotum/testes.
N: ipsilateral scrotum/testes should
rise
AbN: scrotum and testes will not rise
and requires further investigation
Key Points to Review: Breasts Student Notes
What questions do you ask a patient
with a chief complaint of a breast
Breast Pain, Lumps, Nipple Discharge
Any lump/swelling in breasts/axillae
problem?
Risk Factors for Breast Cancer
History of family hx of breast cancer
Age of menarche (<11 or >14)
Menopause >
Nullip or 1st child after 30
Advanced age
Lifestyle: high fat diet, alcohol use, tobacco
use, sedentary lifestyle
Hormone Replacement Therapy >4 years
Long-term use of oral contraceptives
Redness, Warmth, Dimpling of
breasts
Change in size/firmness of breasts
Pain in breasts
Discharge from nipples
Age of menarche
Menopause?
Hx: prior disease, surgery, biopsy,
implants, trauma
Children? What age did you have 1st
Medications/Hormones
Family Hx
Lifestyle (diet, alcohol, caffeine)
Mammogram
Breast self exams
Describe how you inspect the breasts.
What do the normal and abnormal
findings indicate as possible
differential diagnoses?
DDx:
Breast: Cyst, Fibroadenoma, Malignant
Tumor, Fat Necrosis, Mastitis, Gynecomastia
(males), Premature Thealarche (<8yo female)
Nipples/Areolae: Intraductal Papilloma,
Papillomatosis, Duct Ectasia, Galactorrhea,
Paget Disease
Have patient seated with arms loosely at
sides
Size/Symmetry/Contour
Color/Texture
Nipples and Areolas
Retraction/Dimpling
N: should be smooth, contour
uninterrupted, symmetric venous
patterns, increased pigmentation to
areolae (symmetrical)
AbN: retractions may indicated
carcinoma, edema (peau d’orange)
due to blocked lymph drainage,
unilateral blood flow (↑blood flow to
malignancy)
Describe how you palpate the breasts,
including the lymph nodes. What do
the normal and abnormal findings
indicate as possible differential
diagnoses?
DDx of Palpable Mass:
Cyst, Mastitis, Fibroadenoma, Fat Necrosis,
Malignant Tumor
Texture—Tenderness—Masses
Supine with pillow or towel under shoulder
and hand at head
Light, medium, and deep pressure
methodically and consistent pattern
1) Vertical strips
2) Concentric Circles
3) Wedge Sections
Lymph Nodes:
N: no lumps; lymph nodes should not be
palpable
AbN: palpable mass, fixed mass, pain, nipple
discharge
4) Spray with cytologic fixative and label
5) The insert the brush device into the
vagina and into the cervical os
6) Rotate one-half turn; remove and
roll/twist brush over slide, spray and
label
How do you assess for bacterial
vaginosis using a potassium
hydroxide test?
1. Obtain specimen of vaginal discharge
using a swab. Smear sample on a
glass slide and add a drop of NS.
Place a coverslip on the slide, view
under the microscope. Presence of
bacteria-filled epithelial cells (clue
cells) indicates BV.
2. On a separate slide, place vaginal
discharge and apply a drop of
aqueous 10% KOH. The presence of
a fishy odor (“whiff test”) suggests
BV.
The KOH dissolves epithelial cells and debris,
facilitating visualization of the mycelia of a
fungus.
Describe how you perform a bimanual
exam. What do the normal and
abnormal findings indicate as possible
differential diagnoses?
DDx:
Vaginal cyst, vaginal carcinoma
Cervical carcinoma
Pelvic inflammatory disease
Ruptured tubal pregnancy
Pregnancy, Uterine Fibroids
••Insert tips of gloved index & middle fingers
into vaginal opening and press downward
while the muscles relax. Gradually insert
fingers to full length into the vagina.
••Palpate vaginal wall as you insert your
fingers (should be smooth, homogeneous,
nontender)
••Locate cervix with palmar surface of
fingers, run fingers around circumference &
feel for fornices, size, length, and shape
(should be firm like tip of the nose in non-
preg; midline and moveable 1-2cm without
pain)
••Place palmar surface of other hand on
abdominal midline midway between
umbilicus and symphysis pubis; place
intravaginal fingers in the anterior fornix;
slide abdominal hand toward the pubis,
pressing downward and forward with the flat
surface of your fingers & push inward and
upward with fingertips of the intraVG hand
(should feel fundus between both hands at
level of the pubis); palpate size, shape,
contour (should be pear-shaped), mobility
••Palpate ovaries with fingers of abdominal
hand on RLQ pressing intraVG fingers deeply
inward & upward toward the abdominal hand
while sweeping the flat surface of abd hand
deeply inward and obliquely downward
toward symphysis pubis.
AbN: Vagina: cysts, nodules, masses,
growths; Cervix: nodules, hardness,
roughness, pain (PID, ruptured tubal
pregnancy)
Uterus: pregnancy, fibroid, tumor
Was this document helpful?
AHA Exam 4 - aha exam 4
Course: Advanced Health Assessment (NURS612)
133 Documents
Students shared 133 documents in this course
University: Maryville University
Was this document helpful?
NURS 612 Exam 4 Key Points to Review
**Please note that this is an optional tool to use in preparation for Exam 4. It may
or may not contain all the content on Exam 4. **
For all modules, review the end of each chapter for a list and description of the
differential diagnoses for each system.
Key Points to Review: Mental
Health
Student Notes
What questions do you ask a patient
with a chief complaint of a mood
disorder such as anxiety or
depression?
How do you feel?
How are your spirits?
Do you have thoughts that life is not worth
living?
Do you want to harm yourself?
Do you have plans to take your own life?
Do you want to die?
Has there been a change in your sleep
habits?
Are you fearful of anything?
What are the subjective data you
collect when you assess a patient's
mental health in a primary care
setting?
Disorientation & Confusion
Depression
Anxiety
Perceptual Disorder
Hallucinations
Auditory, Visual, Haptic, olfactory
See things or hear voices
Mind plays tricks on you
TV/Radio speaks to you
Thought Content
Fantasies, Dreams
People want to harm me
I have special powers
Someone trying to influence me
Can’t get thoughts out of my head.
What are the objective data you
collect when you assess a patient's
mental health in a primary care
setting?
Mania: pressured speech
Depression: slow, short answers
Cognitive Disorder: uneven or slurred
Grooming
Posture
Facial Expressions
Appearance as compared to stated age
Level of Activity
Retardation, Agitation
Tics, Tremors, Grimacing, Unusual
mannerisms
Emotional appearance
Anxious, Tense, Sad, Unhappy,
Bewildered, Tearful
Voice
Faint, Loud, Hoarse
Eye Contact
Normal, Hypervigilant, Avoidant
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