Maryville University Advanced Health Assessment Exam 3 Questions and Answers

Risk factors for suicidal ideations - -Social isolation (living alone, divorced, widowed) -Mental health disorder (depression) -Terminal health condition -Family hx -Personal losses or challenges (unemployment, legal problems) -Plan for suicide or previous attempt -Alcohol or substance abuse -Access to firearms or other self harm Depression - Sudden or insidious, longer than 2 weeks, no impaired consciousness, impaired concentration/memory/thought processes, insomnia or too much sleep, fatigue, anxiety, slowed speech, homeless, loss of interest of pleasure, associated with grief or stressful life event Abdominal pain HPI questions - -Onset: when, sudden vs gradual -Location: of onset, change? radiates, superficial or deep -Duration: persistent, recurrent, intermittent -Character: dull, sharp, burning, gnawing, stabbing, cramping, aching, colicky, also stool/urine characteristics -Aggravating factors: medications? -Relieving factors: medications, home remedies -Temporal factors: related to menses, intercourse, urination, defecation, inspiration, change in body position, food/alcohol, stress, time of day, trauma? -Associated symptoms: vomiting, diarrhea, constipation, flatus, belching, jaundice, abdominal girth, weight loss or gain Abdominal: inspection: Contour - -Normal: flat, rounded, or scaphoid, umbilicus centrally located, symmetric -Abnormal: distention, bulges, umbilicus inflammation/bulging, masses, hernias, diastasis recti Abdominal: Inspection: Movement - -Normal: Smooth, even movement with respiration -Abnormal: limited motion on respiration (peritonitis), peristalsis (obstruction), marked pulsations (aortic aneurysm) Abdominal: Palpation - -Normal: smooth, soft, without resistance or tenderness, spleen, kidneys, and healthy gallbladder are not palpable, liver palpable at costal margin (firm, smooth, even, nontender) -Abnormal: Palpable tender gallbladder = cholecystits, common bile duct obstruction = nontender enlarged gallbladder, any masses, guarding, pain, bulges, nodules, granulation Palpation of the kidney - Right kidney is more often felt than the left. One hand on flank, one hand on costal margin. As patient inhales deeply, lift the flank and palpate deeply Conditions for chronic abdominal pain - IBS, lactose intolerance, diverticular disease, constipation, uterine fibroids, hernia, GERD, peptic ulcer, gastritis Aarons sign - palpation of McBurneys causes heart or stomach pain = appendicitis Ballance sign - dullness to percussion of flank that disappears w/ change of position= peritoneal irritation