NR509 Final Exam Study Guide: Advanced Physical
Assessment: Chamberlain College of Nursing
(Feb 2022)
NR509
Mental Status Examination - Appearance and behavior
Speech and language
- (depression = slow, mania = fast)
Mood
Thoughts and perceptions
Cognitive functions (including memory, orientation, attention, Information and
vocabulary, calculations, abstract thinking, and constructional ability)
Screening for Depression, early signs - Low self-esteem
Loss of pleasure in daily activities (anhedonia)
Sleep disorders
Difficulty concentrating or making decisions
Pts Vulnerable to depression - Young
Female
Single
Divorced or separated
Seriously or Chronically ill
Bereaved
Psychiatric disorders
Substance abuse
Personal or family hx of depression
Suicide Risks - Age 45-54 & elderly > 85yrs
Men higher rates
Men use firearms
but women 3x more likely to attempt
women use poison
Non-hispanic whites
American Indian/Alaska Native women 15-24 yrs
DSM-5 - widely used system for classifying psychological disorders.
Generalized Anxiety Disorder (GAD) - a disorder characterized by chronic excessive
worry accompanied by three or more of the following symptoms: restlessness, fatigue,
concentration problems, irritability, muscle tension, and sleep disturbance
Questions to ask for GAD - Over the past 2 weeks...
Have you been feeling nervous, anxious or on edge?
Have you been able to stop or control worrying ?
,Over the past 4 weeks...
Have you had an anxiety attack-suddenly feeling fear or panic?
Schizophrenia - a group of severe disorders characterized by disorganized and
delusional thinking, disturbed perceptions, and inappropriate emotions and actions
Schizoid - detachment from social relationships with a restricted emotional range
Suicide Prevention - A community-based approach that includes family, friends, and
many different professional and social service providers that are committed to reducing
suicide by creating a safety net that provides protection.
Depressions is twice as common - in women than men
screening for depression - Patient health questionnaire
can ask the first two questions
-over the past 2 weeks have you felt down, depressed or hopeless??"
-"over the past two weeks have you felt little interest in doing things" (anhedonia)
-if the person answers several days proceed with the other questions
-if question 10 is answered somewhat difficult it indicates functional impairment
5-9 minimal symptoms
10-14: minor depression
15-19: major depression
Self Breast Exam - For high risk patients
Monitor for any change in size, contour
5 to 7 days after your period.
Laying down
Use finger pads of the three middle fingers
3 levels of pressure in each spot
Firmer closer to chest + ribs
Examine breast up and down "strip" pattern
Repeat left breast w/right hand
Adult Breast - May be soft, granular, nodular or lumpy
Often bilateral
Palpable Masses of the Breast - 15-25 yrs
-Fibroadenoma (smooth, rubbery, round, mobile, nontender)
25-50yrs
-Cysts (soft-fir, round, mobile)
-Fibrocystic Changes (nodular, ropelike)
-Cancer (irregular, firm, may be mobile or fixed to surrounding tissue)
Pregnancy
, Lactating adenomas
Cysts
Mastitis
Cancer
Factors that increase Relative Risk of Breast Cancer - - Age (65+ vs. < 65yrs, although
risk increases across all ages until age age 80)
- Biopsy0confirmed atypical hyperplasia
- Certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2)
- Ductal Carcinoma in situ
- Lobular Carcinoma in Situ
- Personal hx of early-onset (<40yrs) Breast cancer
- 2 or more 1st degree relatives w/breast cancer diagnosed at an early age.
2.1-4.0
- High endogenous estrogen or testosterone levels (postmenopausal)
- High-dose radiation to chest
- Mammographically extremely dense (>50%) breasts compared to less dense (11-25
%)
- 1 first degree relative w/breast cancer
1.1-2.0
-Alcohol consumption
-Ashkenazi Jewish Heritage
- Diethylstilbestrol exposure
- Early menarche (<12 years)
- Height (>5 ft 3inch)
- High Socioeconomic status
- Late age at first full-term pregnancy (>30yrs)
-Late Menopause (>55yrs)
- Non-atypical ductal hyperplasia of fibroadenoma
- Never breastfed a child
- No full term pregnancies
- Obesity (postmenopausal)/adult weight gain
- Personal hx of breast cancer (40+yrs)
- Personal hx of endometrium, ovary, or colon cancer.
- Recent + long term use of menopausal hormone therapy containing estrogen and
progestin
- Recent oral contraceptive use
Gail Model Risk Assessment Tool - Breast Cancer Risk Assessment
For individuals...
> 50yrs, no family hx or 1 affected 1st degree relative
Have annual screening mammograms
Incorporates....
race
1st degree relatives w/breast cancer
Assessment: Chamberlain College of Nursing
(Feb 2022)
NR509
Mental Status Examination - Appearance and behavior
Speech and language
- (depression = slow, mania = fast)
Mood
Thoughts and perceptions
Cognitive functions (including memory, orientation, attention, Information and
vocabulary, calculations, abstract thinking, and constructional ability)
Screening for Depression, early signs - Low self-esteem
Loss of pleasure in daily activities (anhedonia)
Sleep disorders
Difficulty concentrating or making decisions
Pts Vulnerable to depression - Young
Female
Single
Divorced or separated
Seriously or Chronically ill
Bereaved
Psychiatric disorders
Substance abuse
Personal or family hx of depression
Suicide Risks - Age 45-54 & elderly > 85yrs
Men higher rates
Men use firearms
but women 3x more likely to attempt
women use poison
Non-hispanic whites
American Indian/Alaska Native women 15-24 yrs
DSM-5 - widely used system for classifying psychological disorders.
Generalized Anxiety Disorder (GAD) - a disorder characterized by chronic excessive
worry accompanied by three or more of the following symptoms: restlessness, fatigue,
concentration problems, irritability, muscle tension, and sleep disturbance
Questions to ask for GAD - Over the past 2 weeks...
Have you been feeling nervous, anxious or on edge?
Have you been able to stop or control worrying ?
,Over the past 4 weeks...
Have you had an anxiety attack-suddenly feeling fear or panic?
Schizophrenia - a group of severe disorders characterized by disorganized and
delusional thinking, disturbed perceptions, and inappropriate emotions and actions
Schizoid - detachment from social relationships with a restricted emotional range
Suicide Prevention - A community-based approach that includes family, friends, and
many different professional and social service providers that are committed to reducing
suicide by creating a safety net that provides protection.
Depressions is twice as common - in women than men
screening for depression - Patient health questionnaire
can ask the first two questions
-over the past 2 weeks have you felt down, depressed or hopeless??"
-"over the past two weeks have you felt little interest in doing things" (anhedonia)
-if the person answers several days proceed with the other questions
-if question 10 is answered somewhat difficult it indicates functional impairment
5-9 minimal symptoms
10-14: minor depression
15-19: major depression
Self Breast Exam - For high risk patients
Monitor for any change in size, contour
5 to 7 days after your period.
Laying down
Use finger pads of the three middle fingers
3 levels of pressure in each spot
Firmer closer to chest + ribs
Examine breast up and down "strip" pattern
Repeat left breast w/right hand
Adult Breast - May be soft, granular, nodular or lumpy
Often bilateral
Palpable Masses of the Breast - 15-25 yrs
-Fibroadenoma (smooth, rubbery, round, mobile, nontender)
25-50yrs
-Cysts (soft-fir, round, mobile)
-Fibrocystic Changes (nodular, ropelike)
-Cancer (irregular, firm, may be mobile or fixed to surrounding tissue)
Pregnancy
, Lactating adenomas
Cysts
Mastitis
Cancer
Factors that increase Relative Risk of Breast Cancer - - Age (65+ vs. < 65yrs, although
risk increases across all ages until age age 80)
- Biopsy0confirmed atypical hyperplasia
- Certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2)
- Ductal Carcinoma in situ
- Lobular Carcinoma in Situ
- Personal hx of early-onset (<40yrs) Breast cancer
- 2 or more 1st degree relatives w/breast cancer diagnosed at an early age.
2.1-4.0
- High endogenous estrogen or testosterone levels (postmenopausal)
- High-dose radiation to chest
- Mammographically extremely dense (>50%) breasts compared to less dense (11-25
%)
- 1 first degree relative w/breast cancer
1.1-2.0
-Alcohol consumption
-Ashkenazi Jewish Heritage
- Diethylstilbestrol exposure
- Early menarche (<12 years)
- Height (>5 ft 3inch)
- High Socioeconomic status
- Late age at first full-term pregnancy (>30yrs)
-Late Menopause (>55yrs)
- Non-atypical ductal hyperplasia of fibroadenoma
- Never breastfed a child
- No full term pregnancies
- Obesity (postmenopausal)/adult weight gain
- Personal hx of breast cancer (40+yrs)
- Personal hx of endometrium, ovary, or colon cancer.
- Recent + long term use of menopausal hormone therapy containing estrogen and
progestin
- Recent oral contraceptive use
Gail Model Risk Assessment Tool - Breast Cancer Risk Assessment
For individuals...
> 50yrs, no family hx or 1 affected 1st degree relative
Have annual screening mammograms
Incorporates....
race
1st degree relatives w/breast cancer
