HA Study Guide for Exam 1

Acculturation-the learning of the ideas, values, conventions and behavior that

characterizes a social group.
Assimilation-the act, process, or instance of assimilating to adopt the ways of another
culture, become part of a different society.
Biculturalism-of relation to or including two distinct cultures.
Complete database-collected in primary care setting, health history, full physical exam
(baseline) opportunity to build relationship.
Culture-the sum of attitudes, customs and beliefs that distinguish one group of people
from another.
Diagnostic reasoning-process of analyzing health data and drawing conclusions to
identify diagnosis.
Emergency database-urgent, rapid collection of crucial information compiled with life
saving measures.
Episodic database- collected when person has an episode of symptoms.
Ethnicity-refers to a social group that may possess shared traits such as a common
geographic origin, religion, language, values, etc.
First level-emergent, life-threatening and immediate, airway, breathing.
Second level-next in urgency, LOC change, mental status, acute pain, elimination
problems.
Third level-can be addressed after urgent problems, long-term problems.
Heritage consistency-the depth to which you and a given patient identify with a
certain heritage.
Nursing process-assessment, diagnosis, outcome identification, planning,
implementation and evaluation
Objective assessment-observe by inspecting, percussing, palpating and auscultation
during physical exam.
Religion-refers to an organized system of beliefs concerning the cause, nature and
purpose of the universe.
Spirituality-is born out of each persons unique life experience and his/her personal
effort to find purpose and meaning in life.
Subjective assessment-what person says about themselves?
Chief complaint-the reason the patient is seeking medical help. What is bothering the
patient?
Functional assessment-measures a persons self-care ability in the areas of general
physical health in absence of illness. (ADLs)
Mental status exam-is a persons emotional and cognitive function.
Crepitus-describes the grating, crackling and popping sounds and sensations
experienced under the skin and joints or crackling due to presence of air in subcutaneous
tissue.
Nutritional assessment-is balance between nutrient intake and nutrient requirements.
Effected by physiological, psychosocial, developmental, cultural and economic factors.
Vital signs: Normal Ranges
Temperature: 96.8 to 100.4
Respirations: Adult: 10 to 20
<1: 30 to 40
1-2: 25 to 40
2-5: 25 to 32
8-10: 20 to 26
12-14: 18 to 22
16: 12 to 20
Heart rate: 50 to 95
Blood pressure:
Normal 120/80
Prehypertension 120-139/80-89
Stage 1 Hypertension 140-159/90-99
Stage 2 Hypertension 160/100
O2 100%
Unexplained weight loss might be a sign of illness.
Refer to lab sheet

BMI:
Underweight <18.5
Normal 18.5 to 24.9
Overweight 25 to 29.9
Obesity (1) 30 to 34.9
Obesity (2) 35 to 39.9
Extreme 40
Differentiate between the complete, episodic, and emergency database
The difference between the databases is the different settings they are collected in.
Emergency is in time of emergent situations. Episodic is when the patient has an
episode and complete is in your primary care setting, when there is no immediate
danger.
Different traditional causes of illness:
Biomedical or scientific theory-assumes that all events in life have a cause and effect.
Function mechanically.
Naturalistic or holistic-American Indians, Asians and others who believe that human life is
an aspect of nature. Believe forces of nature must be kept in natural balance and
harmony.
Yin/Yang theory-health exists with balance.
Magicoreligious-believe super natural forces dominate. Ex. Voodoo, witchcraft.
Faith healing-is based on religious beliefs and is prevalent in Christian groups. Ex.
Christian Scientists
Culture-bound syndromes- especially in the US
Is a combination of psychiatric and somatic symptoms that are considered to be a
recognizable disease only with a specific society or culture? Ex. Anorexia nervosa.
Techniques of communication:
The working phase: is the data-gathering phase. Include ability to form questions
appropriately and your responses to answers given by the client.
Open-ended questions-ask for narrative information states the topic to be discussed but
only in general terms. Use to begin interview, introduce new section and whenever
patient introduces new topic.
Closed or direct questions: ask for specific information. yes, no answers.
Verbal responses-assisting the narrative, encourage free expression while keeping the
person focused. Help teller amplify the story.
10 traps of interviewing:
1. Providing false assurance or reassurance-dont tell people its going to be okay.
2. Giving unwanted advice-no advice based on hunch.
3. Using authority-doctor knows best
4. Using avoidance language-dont use euphemisms.
5. Distancing-impersonal speech to put space between a threat and self.
6. Using professional jargon-sounds exclusionary and paternalistic.
7. Using leading or biased questions, you dont smoke, do you?
8. Talking too much-listen more than you talk.
 9. Interrupting-dont cut people off.
10. Using why questions-implies blame and condemnation.

Functions of the skin:

Largest organ in body: 20 ft. surface are in average adult.
Guards from environmental stresses (trauma, pathogens, dirt) and adapts it to other
environmental influences. (Heat, cold)
-Protection-minimize injury
-Prevents penetration-barrier that stops invasions and loss of water
-Perception-vast sensory surface
-Temperature regulation-heat dissipation
-Identification-how we recognize one another
-Communication-emotions are expressed
-Wound repair-cell replacement
-Absorption and excretion-limits
-production of vitamin D-converts UV light
Normal findings for:
Skin: even and consistent with genetic background. It varies from pinkish tan to dark
tan. Dark-skinned people normally have areas of lighter pigmentation on the palms, nail
beds and lips.
-pigment darker in sun exposed areas
-should be warm and equal bilaterally.
-hand and feet might be slightly cooler.
Moisture-should not be excessive.
Texture-normal skin feels smooth and firm.
Thickness-callus areas on palms and soles
Mobility-ease to rise
Turgor-ease to return to normal place.
Bruising-shouldnt bruise easily.

Lesions:
1. Color
2. Elevation: flat, raised
 3. Pattern or shape (annular, grouped)
4. Size in cm
5. Location and distance on body
6. Any exudate
Hair: fine or thick, straight, curly, shiny. Coat body and be even all over.
Nails: shape contour, slightly curved or flat, smooth and rounded, clean.
The profile sign: 160
Surface is smooth and regular, not brittle or splitting.
Abnormal findings for skin:
Widespread color change: any change over the whole body.
Pallor-white (not enough hemoglobin)
Erythema-intense redness of the skin from excess blood.
Cyanosis-bluish, mottled color from decreased perfusion. Deoxygenated blood
Jaundice-a yellowish skin color, rising amounts of bilirubin.
Skin Lesions:
Annular or circular-ex. Ringworm, begins in center and spreads to peripheral.
Confluent-lesions that run together. Ex. Hives (uticaria)
Discrete-distinct individual lesions and remain separate. Ex. Skin tag, acne
Gyrate-twisted or coiled
Grouped-clustered together into one area. Ex. Contact dermatitis
Linear-line/straight patter/ scratch/ streak, stripe ex. Poison ivy (wash off oil immediately)
Target-concentric rings of color.
Zosteriform (dermatome)-linear and run along nerves ex. Herpes virus, shingles
Polycystic-annular or circular lesions grow together. Ex. Psoriasis
Macule-small <cm, color change in skin, flat, definitive border, circumscribed.
Patch-large >cm ex. Mongolian spot, birth mark, define same as macule.
Papule-small <cm- elevated, solid lesion, circumscribed definitive borders ex. Wart, mole
Plaque-large >cm, same as papule.
Nodule-solid, elevated, hard or soft, deeper into dermis, larger than cm.
Tumor-larger than several cm ex. Lymphoma, hemangioma
Wheal-superficial, raised, transient reddened lesions can be irregular. Ex. Mosquito bite
Urticaria-hives, very itchy.
Vesicle-elevated cavity containing free fluid up to 1 cm. ex. Blister, herpes lesion.
Bulla-same definition as vesicle but >cm ex. Burn
Pustule-purulent or turbine fluid. Ex. Acne
Cyst-encapsulated fluid filled cavity in dermis or subcutaneous layer.
Crust-thickened dried out exudate, left when vesicle or pustule rupture.
Scales-compact area of dead skin ex. Herpes simplex lesion
Fissure-linear crack in skin, into dermal layer well defined edges. Ex. Athletes foot
Erosion-area that is scooped out but shallow. Epidermis is lost but no bleeding. Ex. Rug
burn
Ulcer-erosion that is deeper and extends into or past dermis, irregular in shape, bleed
and leave scar tissue behind. Stage ulcers 1-4 Braden scale.
Decubitus ulcer-skin breakdown, bony prominence, sacral area, heels, occipital of head.
Ex. Bed sore, elbows table 12-6 Jarvis
Excoriation-superficial, caused from scratching or itching anything that causes intense
pruritus.
Scar-scar tissue, healed skin
Keloid-abnormal healing of skin. Appears more in African American and darker skinned
people.
Straie gravidum-stretch marks
Lichenification-prolonged and intense scratching over time.
Port wine lesion-large, flat, patch, typically on face or scalp (red, blue, purple) made
worse by exercise, heat, pressure.
Hemangiomas-benign proliferation of blood vessels in dermal layer, raised, blanched
when apply pressure.
Petechiae-prolonged pushing, trauma, breakage of blood vessels around eyes and face.
Purpura-confluent, extensive, patch of petechiae, blood thought of broken down vessels.
Cancer:
Basal-starts as papule and has pearly translucent top, broken vessels, pearly borders
Squamous-fast growing, carcinoma, red, scaly, patch, with sharp margins. 10mm=cm
Hair loss-
Tinea capitis-ringworm on scalp
Alopecia areata-unknown cause
Traction-from corn rows, tight pony tails
Trichotillomania-self-induced hair loss from twisting or pulling on hair
Hirsutism-excessive body hair in females.
Direction movements of musculoskeletal system:
1. Flexion-bending a limb at a joint
2. Extension-bending a limb at a joint
3. Abduction-away from midline
4. Adduction-toward midline
5. Pronation-palm down
6. Supination-palm up
7. Circumduction-moving in circle
8. Inversion-sole of foot inward
9. Eversion-sole of foot outward
10. Rotation-moving head around center axis
11. Protraction-forward and parallel to ground
12. Retraction-backward and parallel to ground
13. Elevation-raising a body part
14. Depression-lowering a body part
Muscle testing and grade system
Grade
5 full ROM against gravity/full resistance/normal
4 Full ROM against gravity/ some resistance/good
3 full rom against gravity/fair
2 full rom with gravity eliminated/poor
1 slight contraction/trace
0/no contraction/0
Common skeletal changes:
Pregnancy: increase levels of relaxin, estrogen cause increase mobility in joints.
Lordosis, compensate enlarging fetus.
Aging: bone remodeling, osteoporosis, decreased height.
Skills used for physical exam:
Inspection-concentrated watching
Palpation-sense of touch to assess these factors: texture, temperature, moisture, organ
location and size.
Percussion-is tapping the persons skin with short, sharp strokes to assess underlying
structures.
Auscultation-listening to sounds produced by the body. Such as heart, blood vessels and
lungs.
Pain assessment:
Overall pain assessment-chronic pain and acute pain ex. Initial pain assessment, the
Brief Pain inventory, McGill Pain Questionnaire

Reflect pain intensity (0 to 10)

Simple descriptive pain (no pain, worst possible)
Faces pain scale (for children)
Review guidelines for defining normal, prehypertension, and Hypertension
(Stages1 & 2)
Know when to use the bell/ diaphragm during auscultation
Bell is designed to pick up low-pitched sounds such as the sounds of a BP reading. If bot
experienced can use diaphragm.