-Private room


-Controlled lighting and temperature


-Minimize distractions and interruptions.

Facilitate: be friendly, introduce self, call client by formal name, explain what is to follow and give a time frame, maintain confidentiality, active listening, have equipment ready.

Hinder: note taking, having bias and preconceptions, breaching confidentiality, distance, an inappropriate time, lengthy.

Identify/Define effective interviewing techniques.

a.Open-ended questions - allow pt to express feelings, details, and opinions.
b.Closed-ended questions - allows ‘yes’ or ‘no’ questions.
c.Encourage talking
d.Silence - give pt time to gather thoughts.
e.Therapeutic interviewing - avoid asking WHY

List/Explain the components of a complete health history.

Biographic data (age, sex, race.), chief complaint, history of present illness, medical hx (current medications, review of systems), and family health hx, psychosocial hx, and activities of daily living.

Identify increased genetic traits & health risks, and disorders prevalent in selected ethnic, racial, & population groups.

Jewish, Greek, & Scandinavian- ANEMIA
Japanese- GI CANCER
Mexican- DIABETES
African American & Native American- HTN

Identify potential areas of cultural conflict between customs & values of clients and their families and those of HCP.

Eye contact is viewed as rude and aggressive in Native Americans, Asians, & people from Arabic speaking countries.  Some cultures don’t like to be “touched” or comforted, maintain space.

Describe how different spiritual beliefs may influence the clients view of health, illness, & death.

If the pt feels spiritually threatened they may exhibit anxiety, withdrawal, hopelessness, and crying behaviors.  Every culture is different with the way that they handle different situations.  As a nurse you should always provide empathy (silence, hand holding, call pastoral service).  If you don’t the pt may feel untrustworthy towards you and not express all the information that you need to help him.

Identify s/s that indicate client is experiencing spiritual distress.

-Anxiety
-Withdrawal
-Hopelessness
-Crying behavior

Explain how to perform inspection palpation, percussion, & auscultation, & identify which areas of the body are assessed with each technique.

Inspection: #1. Use of vision & smell to observe color, size, location, movement, symmetry, odors, & sounds.
Palpation: #2. Use of touching, need short fingernails and warm hands. 2 types : Light(for surface abnormalities) or Deep(for internal organs and masses).  Always palpate tender areas LAST.
Percussion: #3. Striking one object against another to cause vibration and produce sound.  Produces Flatness, Dullness, Resonance, Hyperresonance, Tympany. 2 types: DIRECT(assessment of sinuses) and INDIRECT(everywhere else).
Auscultation: #4. Listening.

Describe initial assessment observation.

Collecting information about the client’s physical presence, psychological presence, s/s & VS.  VS should be taken first.  Look at body stature, motor activity, body and breath odors, dress, personal hygiene, mood and manner, speech.

Identify common skin lesions.

a.Macule- <1cm and flat

b.Papule- <1cm and raised

Describe the methods used to assess integumentary changes in both light and dark skin clients.

INSPECTION & PALPATION!

Cyanosis: examine the conjuctuvae, palms, soles, and tongue.

Erythema: palpate for warmth.

Jaundice: examine the sclera.

Pallor: examine for an ashen color.

Petechiae: examine areas such as the abd.

Rashes: Palpate the area for texture changes.

State the warning signs of carcinoma in pigmented lesions.

A Asymmetry of shape

B Border irregularity

C Color variation within one lesion

D Diameter greater than 5 mm

A (asymmetrical)

B (borders)

C (color)

D (diameter)

E (evolution or progression of the lesion)

Identify pathophysiological changes in hair & nails.

Hair loss and graying occurs due to a decrease in melanocyte function.
Nail growth slows and nails become brittle and thin.  Nails also lose luster and become yellow.  Clubbing is also sometimes seen due to lack of O2.

List common eye abnormalities.

1.Arteriole narrowing
2.Decreased visual acuity.
3.Diplopia
4.Eye D/C
5.Eye pain
6.Periorbital edema
7.Ptosis
8.Strabismus
9.Vision loss
10.Visual floaters & halos.

Describe the pathophysiology of common abnormalities in the eye physical assessment.

1.Arteriole narrowing
2.Decreased visual acuity- refractive errors, abnormal shape of the eyeball.
3. Diplopia- extraoccular muscles are misaligned.
4.Eye D/C- inflammatory or infectious disorders.
5.Eye pain
6.Periorbital edema- swelling around the eyes from allergies, inflammation, or crying.
7.Ptosis- muscle weakness or damage to oculomotor nerve.
8.Strabismus- extraocular weakness or paralysis.
9.Vision loss
10.Visual floaters & halos.- caused by small cells floating in v.humor.

Demonstrate an eye physical assessment.

1.Inspect external eye & lids for position, lumps, lesions, D/C.  Check the pupils and corneal reflex.
2. Test visual acuity with the snellen chart.
3.Assess muscle function with the corneal light reflex and cardinal positions of gaze.
4.Palpate nasolacrimal sac.
5.Examine with opthalmoscope.

1.Hearing loss- could be caused by an obstruction, fluid in the middle ear, hardening of the bones used to conduct sound waves, or loss of hair cells.

2.Ear D/C- caused by allergies, infections, trauma.

3.Tinnitus- medication side effects, loud noises.

4.Ear pain- a result from infection, obstruction, or trauma.

1.Pain- trauma.

2.Drainage/epistaxis- dry irritated mucous membranes, trauma, infection, drugs, diviated septum.

3.Blockage or congestion- nasal or sinus disorders, trauma, allergies, exposure to irritants, sinusitis.

1.Halitosis (bad breath)

2.Oral lesions

3.Swelling

4.Dysphagia (difficulty swallowing)- increases risk of choking and aspiration.

INSPECTION, & PALPATION.

Ears:

1.inspect & palpate the external structures, the top of the ear should line up with the eyes.

2.otoscope examination

3.test hearing acuity using Weber's (measures equality of bone conduction) and Rinne's test (compares air conduction with bone conduction).

PALPATION, INSPECTION, AUSULTATION.

Nose:

1.Assess for symmetry, D/C, swelling, lesions.

2.Evaluate sense of smell.

3.Check sinuses through palpation.

Throat:

1.Assess structures, say "Ah", check gag reflex.

2.Palpate nodes, thyroid, trachea.

3.Listen to carotid arteries.

Demonstrate physical assessment techniques for the evaluation of the breasts & regional lymphatics.

Inspection: breasts should be smooth & undimpled.  Have pt raise arms or bend forward to assess symmetry.

Palpation: supine, place arms behind head, compress tissue gently with finger pads circular, wedged, or vertical. Palpate axillary nodes.

Describe common variations & abnormal changes of the breasts.

It's common for breasts to be 2 different sizes; pregnancy and menstrual cycle can also cause variation.

Abnormalities:

1.Dimpling

2.Nipple inversion

3.Nipple D/C

4.Pain

5.Visible veins

Identify risk factors for breast cancer.

• Age > 50 
• Personal history of breast cancer
• Mother, grandmother, or sister with breast cancer
• Menarche at an early age
• Menopause at advanced age
• Obesity- BMI > 30
• Alcohol intake > 3 servings per day
• American or European descent
• Urban dweller
• Nulliparous
• First birth after age 30
• Higher education and socioeconomic status
• Atypical hyperplasia
• Significant mammographic breast density
• BRCA 1 or BRCA 2 gene mutation