what the patient tells you

Ex. Pt reports pain

physical things you observe

Ex. erythema and edema

Learned

Shared

Adapted

Dynamic

• from birth through language & socialization
• by members of the same cultural group
• to conditions
• and ever changing

• Expression of pain is NOT universal
• Some prefer lay healers as opposed to medications
• Eye contact, proximity, touch, etc, are all relative to different cultures

what causes it?

What makes it better?

What makes it worse?

Does it interfere with ADL's?

How does it rate on scale 1-10

When did it begin? How often does it occur?

Is it sudden or gradual? How long does it last?

<2sec

abnormal- cardiovascular or respiratory dysfunction

Clubbing: <160degrees

abnormal-cyanotic heart disease, emphysema, bronchitis

vice-like, occipital or frontal with band-like tightness

Trigger-stress/anxiety, fatigue, exercise, food

supraorbital, frontotemporal, last 1-3 days, rest in dark room, no noise

Trigger-alcohol, menstruation, chocolate

pain around eyes, temple, forehead, cheek, unilater, lasts 1/2-2hrs, need to keep moving

Triggers-alcohol, daytime napping, will see eye-reddening

Obstruction: absense of sniff

Rhinitis: swollen, bright red nasal mucosa, upper respiratory infection

Allergy: swollen, boggy, pale and grey mucosa, transver ridge, blue shadow under eye.

Sinunitis: discharge

Thorax & Lungs

Abnormal

Chest wall: A:T=1:1 "barrel chest" & horrizontal ribs in COPD pt

Costal angle:COPD pt is >90 "barrel chest"

Chest expansion:unequal expansion-atelectasis, fractured ribs, or pneumothorax

Percussion:Hyperresonance:-low-pitched booming too much air is present-emphysema, pneumothorax

Hyporresonance: dull, abd. density-pneumonia, atelectasis, tumor

Mouth, Thyroid

Abnormal

Bleeding gums: vitamin C deficit, gingivitis

Uvula not at midline: nerve damage, occurs with poliomyelitis & diptheria

Bruit occurs with enlarged thyroid gland-hyperthyroidism

Crackles

Wheezes

Atelectic

Decreased or absent sounds

Increased breath sounds

discrete, popping sounds upon inspiration

connected, musical sounds, upon expiration

crackles disappear after cough, breath

bronchial tree obstructed or emphysema

pneumonia

Homan's sign (+)

abnormal

Bilateral Edema

Abnormal

Unilateral Edema

Abnormals

Rheumatoid Arthritis

Abnormal

Lordosis

Trust vs. Mistrust

(infants)

Autonomy vs. Shame and Doubt

(Toddler)

• Tests limits
• Goal is to achieve mastery of tasks and sense of self as separate
• Limits are necessary to prevent this
• Offer choices

Initiative vs Guilt

(Preschooler)

• Energetic learning phase
• Feel sense of accomplishment in play, work, life
• Guilt occurs if they overstep limits of their ability
• Develop conscience

Industry vs Inferiority

(School Aged)

• Peers become more and more important
• Approval of those outside of family important
• Values independence
• Don't push into things where they are likely to fail
• Group solidarity

Ego Identity vs Identity Confusion

(Adolescents)

• Defines self-worth, sexual identity
• Integrate past with future
• Explore many options

Sensorimotor Stage

(Infants)

• Reflexive-predictable, innate survival reflex
• Primary circular- responds purposefully to stimuli, initiates actions
• Secondary circular-learns from intentional behavior

Sensiomotor Stage

1-2 years

• Tertiary circular-tries different ways to attain goals
• Ritual important
• Separation anxiety peaks
• Mental representations

Preoperational Stage

Toddlers (2-3)

• Thinking is concrete & tangible, cannot reason
• Object permanence well-established
• Egocentric
• Symbolic thought

Preoperational Stage

Preschoolers (3-6)

• Intuitive thought at age 4
• Increasing sense of causality, time
• Less egocentric but have magical thinking
• Very curious about factual information about world
• Takes words literally

Concrete Operations

School Aged (7-11)

• Conservation of mass
• Like to collect things
• Prefer rules & structure
• Strong sense of what is fair
• Can use mental representations to plan or solve

Formal Operations

Adolescents (13-18)

• Abstract thinking
• Hypothetical situations
• Can start to appreciate the perspective of others
• Recognize injustices
• Reciprocity & equal respect
• Sensitive to hyprocrisy

nerve damage, meds (ototoxic), inner ear,

hearing aids cannot fix problem

blockage, damage to drum, external or middle ear

hearing aids can help!