Nur 416 - Patient assessment Exam 2 summary

Patient Assessment Exam 2
Head, Neck, Respiratory
 Recognize and classify sinusitis, allergic rhinitis, and pharyngitis using patient-specific
information
o Sinusitis
 Classification
 Acute- <4 weeks
 Subacute – symptoms 4-12 weeks
 Chronic- symptoms >12 weeks
 Recurrent- 4+ episodes per year with intermittent symptom
resolution
 Complicated bacterial sinusitis- infection extending beyond the
paranasal sinus mucosa into adjacent structures
 Pathogens: strep pneumo, h. flu, rhinovirus, adenovirus, influenza-
mostly viral
 Symptoms
 Nasal congestions
 Pressure – nasal
 Coryza- common cold
 Rhinorrhea
 Hypoemia or anosmia (reduced ability to smell/taste)
 Fever
 Halitosis
 HA
 Pharyngitis
 Physical exam
 Erythema or edema
 Tenderness in cheeks
 Diffuse mucosal edema
 Narrowing of meatus
 Diagnostic criteria (at least 2 major, or 1 major and >2 minor)
 Major symptoms
o Purulent nasal discharge
o Nasal congestion
o Facial congestion/ pressure
o Hyposmia/anosmia
o Fever
 Minor symptoms
o HA
o Ear pressure
o Halitosis

, o Dental pain
o Cough
o Fever
o Fatigue
o Rhinitis (allergic)
 Classification
 Intermittent: <4 days/week OR <4 weeks
 Persistent: >4 days/week AND for >4 weeks
 Mild: no disruption or impairment of activities/sleep
 Moderate-severe: disruption of sleep, daily activities, more
 Symptoms, signs
 Sneezing, pruritis, rhinorrhea, nasal congestion, postnasal drip,
cough
 Infraorbital or periorbital edema
 Transverse nasal crease (allergic salute)
 Adenoidal breathing
 Pale, bluish nasal turbinates
 Conjunctival redness and edema
o Pharyngitis
 Pathogens:
 Coronavirus, adenovirus, herpes simplex, influenza, Epstein-barr
 GAS, C.diphtheriae, n. gonorrhoeae, mycoplasma pneumoniae
 Symptoms
 Sore throat
 Dysphagia
 Fever
 Swollen cervical lymph nodes
 Dysphonia
 Signs – physical exam
 Hyperemia of the pharynx
 Tonsillar hypertrophy
 Tonsillar exudate
 Swollen, tender anterior cervical lymph nodes
 Assess the likelihood of group A streptococcal pharyngitis using the Centor criteria
o Clinical decision tool to assess the likelihood of pharyngitis due to group a
streptococcus (GAS)
 Tonsillar exudates
 Tender anterior cervical adenopathy
 Fever by history
 Absence of cough
o >/= 3 of above – likely GAS (take a strep test)
o Complications of GAS

,  Sinusitis
 Retropharyngeal or peritonsillar abscess formation
 Rheumatic fever
 Glomerulonephritis
 Scarlet fever
 Distinguish between normal and abnormal lymph nodes and recognize possible causes of
lymphadenopathy
o Normal lymph nodes—discrete, soft, nontender and moveable
o Abnormal (lymphadenopathy): swollen or enlarged
 Acute infection- bilaterally enlarged, warm, tender, firm, but moveable
 Cancer- unilaterally hard, nontender, and fixed
 HIV- bilaterally enlarged, nontender, and moveable
 Identify and classify asthma and COPD using patient-specific information
o Asthma
 Cough, dyspnea, wheeze
 In response to environmental triggers
 Level of control
 Daytime symptoms >2/ week
 Nighttime awakenings
 SABA use >2/week
 Activity limitations due to asthma
 (3-4 = uncontrolled, 1-2 = partly controlled)
o COPD
 Emphysema + chronic bronchitis
 Dyspnea, chronic cough (worse AM), sputum production, recurrent
wheeze
 GOLD classification
 All must have FEV1/FVC <0.7
 Gold 1: FEV1> 80% (highest function)
 Gold 2: FEV1 50-80%
 Gold 3: FEV1 30-50%
 Gold 4: FEV1 < 30%
 Recognize the clinical presentation of respiratory distress and pneumonia
o Respiratory distress
 Acute distress
 Nasal flaring
 Pursed lip breathing
 Wheezing
 Cyanosis
 Accessory muscle use
o Pneumonia
 Physical exam signs
 Hypoxemia (low O2 sat)