NBCSN Health Appraisal Questions and Answers 2023

NBCSN Health Appraisal Questions and Answers 2023 Goal of appraisal What's normal, what's progressing, what's referrable Nurse process To organize assessment and care Restate, clarify, summarize Incidence vs. Prevalence Incidence= only new cases during a specific time in a specific population. Prevalence = old and new cases (proportion of population affected at a given time / population affected over a lifetime) amblyopia must be found before age 6 for correction screening letters should be sent to parents to let them know it'll happen; follow-up neccessary to determine compliance and outcomes healthy history begins when kid enters the office; mostly subjective; meal, family's health, sleep, interventions tried, fever 101* axillary and plastic strip thermometers underestimate body temp monitor temp every 20 minutes per intervention apical pulse pulse taken with a stethoscope and near the apex of the heart at PMI; kids <7 at 4th intercostal space; >7 at 5th intercostal space. Regular HR can stop at 30 seconds, irregular go full minute. Normal HR preschoolers/K-1: 75-115, 8-15: 70-110, girls >15 60-100 and boys >15 is 55-95 Normal RR Count for 30 seconds; irregular count a full minute. Ages 3-7 is 20-25; ages 8-12 is 14-22; ages 12 and up is 12-20. BP Use R arm for consistency; cuff should be 40% of arm between elbow and shoulder, 80-100% width (too small = high readings); inflate cuff to 30mm Hg above where pulse last heard; deflate 2-3 mm Hg/second; Korotkoff sound beginning is systolic BP. Normal BP= 3 years 90/40, 7 years 97/57, 11 years 104/61, 15 years 113/64. Recheck after 5 minutes. Pain measurements FACES (pictures of faces for >3 years old), numeric, and FLACC (face, legs, activity, crying, consolability) stadiometer measures height; don't use the one attached to scales; 4 points of contact to wall- heels, butt, shoulder, head; measure to 1/8 inch. Short stature affects 5% of kids; maybe want growth hormone if below the 10th percentile. Weight Measure to the nearest 1/4 pound. BMI Use a tool, not the equation kg/m squared. Normal 18.5-24.9;Overweight is 25-29.9; obese >30 Pediatric BMI Ages 5-13: overweight: 17-22.6; At risk is 19-27.8. For all youth, BMI percentile >95 is obese, 85-95 is overweight, and under 5 percentile is overweight Too much vitamin A or fatty acid deficiency Skin dryness Generalized edema protein deficiency or Na excress Hyperpigmentation of skin deficient of niacin, B12, folic acid ammonia odor may be UTI Hyperressonance (percussion) Sounds booming-- normal in lungs of very young kids. ciliary body of eye manages shape and position of the lens pupil abnormals miosis = <2 mm; mydriasis = >6 mm; aniscoria is 2 different sizes retina rods and cones receive stimuli they send to brain- should have red reflex when observing; pay attention to white area in the pupil on a photo-- may mean retinoblastoma macula central vision and color perception; made up entirely of cones vision matures at 6 years old, so major vision issues need corrected before that. Vision acuity 20/50 for kindergarten, 20/40 for grades 1-6 Hirschberg test evaluate symmetry of light off the patients corneas Hearing mature at birth; normal conversation 50-70 dB; Threshold screening done in schools; 20 dB in most states; OAE used for hard to test kids; Hearing loss Usually sensorineural (nerve VIII); 45 mild loss, 45-65 moderate, 65-90 severe cherry red lips carbon monoxide poisoning (acidosis) fissures at corners of mouth riboflavin or niacin deficient Teeth by numbers 20 in kids; 36 in adults Dental caries the most common disease of childhood anatomy of the heart base is at the TOP; aortic to R of 2nd intercostal space by sternum, pulmonic at the L; tricuspid at 5th intercostal space; mitral at 5th medial to midclavicular line (usually PMI is here) S1 and S2 makes lub-dub, with grade 1 as softest and grade 5 is loudest; murmur sometimes while lying down by sternal border between S1 and S2 muslces 1/4 total weight at birth, 1/6 at adolescence bow-leg and knock-knee (genu varum & genu valgum) knees > 5 cm before age 7 and >7.5 cm after age 7 lordosis and kyphosis swayback and hunchback Scoliosis >10 degrees spine curve; onset usually at onset of puberty; occurs 2-4% of population with mostly girls 4:1, right midthoracic most common; Adams forward bend test to measure Cobb angle; over 40* needs surgery; Backpack weight Should not be more than 20% of weight; cranial nerves I-XII On occasion our trusty truck acts funny. Very good vehicle any how I: Olfactory (S) II: Optic (S) III: Occulomotor (M) IV: Trochlear (M) V: Trigeminal (B) VI: Abducens (M) VII: Facial (B) VIII: Vestibulocochlear (S) IX: Glossopharyngeal (B) X: Vagus (B) XI: Accessory (M) XII: Hypoglossal (M) afferent vs efferent peripheral nervous system messages afferent (sensory) (carries TO the brain) and efferent (motor) carries FROM the brain sympathetic vs parasympathetic nervous system sympathetic (fight or flight) and parasympathetic (rest and digest) The Cerebrum lobes and functions: frontal- emotions/speech/voluntary muscle action parietal- touch, propioception, temperature, pain occipital- interpretation of visual temporal- interpretation of sound; Wernicke speech for spoken/written language; taste, smell, balance, personality limbic system short-term memory and aggression, fear, affection spinal roots C5- shoulder/humerous C6- biceps/wrist C7- finger C8/T1 - finger flex L2/L3/L4 - quads L5-ankle/toe dorsiflex S1 - plantar flexion cerebellum Balance and coordination; Romberg test Glasgow Coma Scale E 4 V 5 M 6 TOTAL Score: 3-16 Eyes 4- spontaneous 3- to voice 2- to pain 1- unresponsive Voice 5-appropriate 2-incomprehensible Motor 6- obeys commands 4-withdraws from pain 3- abnormal flexion 2- abnormal extension Brudzinski's sign pain when neck is flexed Kernig's sign Sign of meningitis; positive when the leg is fully bent at the hip and knee, and subsequent extension of the knee leads to pain