lOMoAR cPSD| 47061011
Recognizing Alterations in Health
- The ability to maintain an open and thoughtful mind when caring for others is crucial, so
nurturing the ability to question what you see and beyond is part of the journey when learning
pathophysiology.
The cues on which to focus fall into these general categories.
Observed Cues
- Clinical manifestations are the signals that indicate homeostasis has been lost. The person can
report these (e.g., pain, tenderness) or seen by others (e.g., rashes, coughing). Sometimes
referred to as signs and symptoms, clinical manifestations can include fever, bleeding, swelling,
and pain, to name a few.
o What to Ask
How long has this been happening?
What makes this condition better?
What makes this condition worse?
What else can you tell me about your condition?
Environmental Cues
- Environmental cues are aspects of a person that impact their health and include their physical
environment, both indoors and outside. External environmental cues include air pollution, clean
drinking water, lead paint, the work environment, and chemical exposure. Internal
environmental cues include but are not limited to, acid-base balance, oxygenation, genetic
mutations, and fluid balance. o What to Ask
Is something in the person’s environment contributing to the altered
homeostasis?
What allergens are present in their living environment?
Does the person work with or near chemicals or toxic waste?
Historical Cues
- Historical cues are those contained within a person’s past medical history (PMH), such as
illnesses that tend to occur in families (genetics) and lifestyle choices (diet and exercise) that
impact health. o What to Ask
Has someone in the individual’s family experienced the same illness?
What does the individual eat?
Do they smoke or use other forms of tobacco?
Are recreational drugs used? What and how often?
Has the person been exposed to an infectious disease?
Time-Sensitive Cues
- Some clinical manifestations result from pathophysiologic changes that can threaten a person’s
life (e.g., heart attack or stroke) if action is not taken immediately. Recognizing these time-
, lOMoAR cPSD| 47061011
sensitive cues often results in immediate action, such as calling emergency services (911 in the
United States).
o What to Ask
Ask the person:
• When did the symptoms start?
• Is this impacting your ability to function (e.g., walk if the leg is injured;
breathe if the lips are swollen)?
Ask yourself:
• Are the underlying pathologic changes likely to resolve on their own?
• How likely is the alteration in health to cause permanent damage if not
corrected?
• How quickly will cells and tissues die if action is not taken?
• Can these clinical manifestations be addressed where the person is
now?
Knowledge, Skills, and Attitudes for Recognizing Cues (KSAs)
- Knowledge o Understanding normal anatomy and physiology (A&P), the pathophysiological
changes that occur with disease, and the body's response are crucial to recognizing cues. A
person with this knowledge can recognize cues (clinical manifestations), determine if the
information is normal or abnormal, and consider what additional information (more cues)
should be gathered.
- Skills o Most skills required to recognize cues for altered health are those of the senses: sight,
smell, hearing, and touch. An example is the ability
to notice when the skin is red, feel warmth, and hear a cry of pain. The physical
assessment skills used by nurses and other health professionals allow more specific cues
to be assessed yet are not necessary for recognizing that an alteration in health is
present.
- Attitudes o How a person approaches the search for cues greatly influences what cues are
noted. For example, a parent whose child frequently has inner ear infections may assume that
an episode of ear pain is just another infection without looking at the ear or asking the child
what may have happened before the pain began. If the parent has looked and asked, they may
discover that the ear was bleeding after the child’s older sibling stuck a pencil in the ear right
before the pain started.
o For this reason, the best practice for recognizing cues is to consider everything reported,
seen, heard, or felt to determine if other cues are present. Once all cues are present,
knowledge will guide further actions.
What Matters Most
Patient Information o Jeb is a 37-year-old male who has been was 18. Two years ago, Jeb lost
his footing and while moving a heavy table, which a professional mover since he
landed on his left leg. He had surgery to repair a broken leg fell on the s tairs and
damage to his knee, both on the left side. He was out of work for three months to heal and
, lOMoAR cPSD| 47061011
complete physical therapy. Because of his decreased activity, Jeb gained 47 pounds while off
work. o For several months, Jeb has noticed stiffness and pain in his left knee. At first, it
was toward the end of the day, but over the last week, Jeb has been in pain as soon as he
leaves bed and starts walking. His
coworkers have noticed that Jeb limps when he walks, can no longer lift
heavy objects, and needs to take breaks more frequently. Jeb is taking over-the-counter
pain medicine, but it does not help.
Observed cues.
Environmental cues
Historical cues
Time-sensitive cues
- that Jeb limps when he walks, can no longer lift heavy objects, and needs to take breaks more
frequently. Jeb is taking over-the-counter pain medicine, but it does not help.
What Matters Most for Jeb
- Observed Cues
o These are things that the individual and others can see, including:
o 37-year-old male (also an historical cue; someone can determine a person's general age
by observation)
o limps when he walks
- Environmental Cues o These facts provide information on environmental factors that can
impact someone’s health, including their job.
o professional mover o fell on the stairs
- Historical Cues o The person’s past medical history (PMH) contains the most historical cues. o
37-year-old (also an observed cue) o professional mover since the age of 18 o fell on the stairs.
o a heavy table landed on his left leg
o surgery to repair a broken leg and damage to his knee o out of work for 3 months o
completed physical therapy o gained 47 pounds
Stiffness and pain in his left knee o At first, it was toward the end of the
day, but over the last week, he has had pain as soon as he leaves bed and starts
walking. o no longer able to lift heavy objects o needs to take breaks more
frequently
o taking over-the-counter pain medicine, but it does not help
Time-Sensitive Cues
o These facts help determine how quickly the cues must be addressed to prevent
complications. o limps when he walks (also an observed cue) no longer able to lift
heavy objects (also a historical cue) needs to take breaks more frequently (also a
, lOMoAR cPSD| 47061011
historical cue) taking over-the-counter pain medicine, but it does not help (also a
historical cue)
What do the observed cues tell you about where in the body the alteration exists?
Once a body system (e.g., musculoskeletal, cardiovascular, and sensory), or lack of body system if the
cues are all over (e.g., fever, fatigue, and body aches), has been identified, the remaining questions focus
on the system, or systems, involved.
What pathophysiologic processes could be causing the cues?
Headaches can be caused by stress, altered sleep or eating patterns, hormones, allergies, altered
electrolytes, inflammation, infection, poor oxygenation, or perfusion.
What additional cues are present to narrow the list of possible causes?
- Environmental cues may include increased community influenza cases (infection,
oxygenation, inflammation), extreme heat (fluid and electrolyte imbalance if the person
spends time outdoors), or air pollution (oxygenation).
- Historical cues gained from talking with the person may reveal a history of migraine
headaches (altered fluid, electrolyte, or acid-base balance), an inoperable brain tumor
(inflammation, oxygenation, perfusion), or the loss of work (stress response).
- Is time currently an essential factor?
o Time-sensitive cues, while less likely to help identify the pathophysiologic
processes, are vital to understanding the severity or critical nature of the health
alteration.
o For example, knowing when chest pain started is less helpful if the person has
an arrow sticking out of their chest since it is likely to have led to inflammation,
potential infection, bleeding (perfusion), and trouble breathing (oxygenation). Of
course, this person needs medical attention right away.
o Airway, breathing, and circulation (the ABCs) are key time-sensitive cues.
If the airway is blocked, it is an emergency.
If the person is not breathing normally, it is an emergency.
If a large amount of blood is lost, it is an emergency.
Systems and Processes pulmonary reproductive sensory (eyes,
Body Systems cardiovascular ears, nose) Key Pathophysiologic
endocrine gastrointestinal Processes cellular regulation cognition
genitourinary hematological fluid, electrolyte, and acid-base
integumentary lymphatic imbalances genetics hormonal and
musculoskeletal neurological glucose regulation immunity
Recognizing Alterations in Health
- The ability to maintain an open and thoughtful mind when caring for others is crucial, so
nurturing the ability to question what you see and beyond is part of the journey when learning
pathophysiology.
The cues on which to focus fall into these general categories.
Observed Cues
- Clinical manifestations are the signals that indicate homeostasis has been lost. The person can
report these (e.g., pain, tenderness) or seen by others (e.g., rashes, coughing). Sometimes
referred to as signs and symptoms, clinical manifestations can include fever, bleeding, swelling,
and pain, to name a few.
o What to Ask
How long has this been happening?
What makes this condition better?
What makes this condition worse?
What else can you tell me about your condition?
Environmental Cues
- Environmental cues are aspects of a person that impact their health and include their physical
environment, both indoors and outside. External environmental cues include air pollution, clean
drinking water, lead paint, the work environment, and chemical exposure. Internal
environmental cues include but are not limited to, acid-base balance, oxygenation, genetic
mutations, and fluid balance. o What to Ask
Is something in the person’s environment contributing to the altered
homeostasis?
What allergens are present in their living environment?
Does the person work with or near chemicals or toxic waste?
Historical Cues
- Historical cues are those contained within a person’s past medical history (PMH), such as
illnesses that tend to occur in families (genetics) and lifestyle choices (diet and exercise) that
impact health. o What to Ask
Has someone in the individual’s family experienced the same illness?
What does the individual eat?
Do they smoke or use other forms of tobacco?
Are recreational drugs used? What and how often?
Has the person been exposed to an infectious disease?
Time-Sensitive Cues
- Some clinical manifestations result from pathophysiologic changes that can threaten a person’s
life (e.g., heart attack or stroke) if action is not taken immediately. Recognizing these time-
, lOMoAR cPSD| 47061011
sensitive cues often results in immediate action, such as calling emergency services (911 in the
United States).
o What to Ask
Ask the person:
• When did the symptoms start?
• Is this impacting your ability to function (e.g., walk if the leg is injured;
breathe if the lips are swollen)?
Ask yourself:
• Are the underlying pathologic changes likely to resolve on their own?
• How likely is the alteration in health to cause permanent damage if not
corrected?
• How quickly will cells and tissues die if action is not taken?
• Can these clinical manifestations be addressed where the person is
now?
Knowledge, Skills, and Attitudes for Recognizing Cues (KSAs)
- Knowledge o Understanding normal anatomy and physiology (A&P), the pathophysiological
changes that occur with disease, and the body's response are crucial to recognizing cues. A
person with this knowledge can recognize cues (clinical manifestations), determine if the
information is normal or abnormal, and consider what additional information (more cues)
should be gathered.
- Skills o Most skills required to recognize cues for altered health are those of the senses: sight,
smell, hearing, and touch. An example is the ability
to notice when the skin is red, feel warmth, and hear a cry of pain. The physical
assessment skills used by nurses and other health professionals allow more specific cues
to be assessed yet are not necessary for recognizing that an alteration in health is
present.
- Attitudes o How a person approaches the search for cues greatly influences what cues are
noted. For example, a parent whose child frequently has inner ear infections may assume that
an episode of ear pain is just another infection without looking at the ear or asking the child
what may have happened before the pain began. If the parent has looked and asked, they may
discover that the ear was bleeding after the child’s older sibling stuck a pencil in the ear right
before the pain started.
o For this reason, the best practice for recognizing cues is to consider everything reported,
seen, heard, or felt to determine if other cues are present. Once all cues are present,
knowledge will guide further actions.
What Matters Most
Patient Information o Jeb is a 37-year-old male who has been was 18. Two years ago, Jeb lost
his footing and while moving a heavy table, which a professional mover since he
landed on his left leg. He had surgery to repair a broken leg fell on the s tairs and
damage to his knee, both on the left side. He was out of work for three months to heal and
, lOMoAR cPSD| 47061011
complete physical therapy. Because of his decreased activity, Jeb gained 47 pounds while off
work. o For several months, Jeb has noticed stiffness and pain in his left knee. At first, it
was toward the end of the day, but over the last week, Jeb has been in pain as soon as he
leaves bed and starts walking. His
coworkers have noticed that Jeb limps when he walks, can no longer lift
heavy objects, and needs to take breaks more frequently. Jeb is taking over-the-counter
pain medicine, but it does not help.
Observed cues.
Environmental cues
Historical cues
Time-sensitive cues
- that Jeb limps when he walks, can no longer lift heavy objects, and needs to take breaks more
frequently. Jeb is taking over-the-counter pain medicine, but it does not help.
What Matters Most for Jeb
- Observed Cues
o These are things that the individual and others can see, including:
o 37-year-old male (also an historical cue; someone can determine a person's general age
by observation)
o limps when he walks
- Environmental Cues o These facts provide information on environmental factors that can
impact someone’s health, including their job.
o professional mover o fell on the stairs
- Historical Cues o The person’s past medical history (PMH) contains the most historical cues. o
37-year-old (also an observed cue) o professional mover since the age of 18 o fell on the stairs.
o a heavy table landed on his left leg
o surgery to repair a broken leg and damage to his knee o out of work for 3 months o
completed physical therapy o gained 47 pounds
Stiffness and pain in his left knee o At first, it was toward the end of the
day, but over the last week, he has had pain as soon as he leaves bed and starts
walking. o no longer able to lift heavy objects o needs to take breaks more
frequently
o taking over-the-counter pain medicine, but it does not help
Time-Sensitive Cues
o These facts help determine how quickly the cues must be addressed to prevent
complications. o limps when he walks (also an observed cue) no longer able to lift
heavy objects (also a historical cue) needs to take breaks more frequently (also a
, lOMoAR cPSD| 47061011
historical cue) taking over-the-counter pain medicine, but it does not help (also a
historical cue)
What do the observed cues tell you about where in the body the alteration exists?
Once a body system (e.g., musculoskeletal, cardiovascular, and sensory), or lack of body system if the
cues are all over (e.g., fever, fatigue, and body aches), has been identified, the remaining questions focus
on the system, or systems, involved.
What pathophysiologic processes could be causing the cues?
Headaches can be caused by stress, altered sleep or eating patterns, hormones, allergies, altered
electrolytes, inflammation, infection, poor oxygenation, or perfusion.
What additional cues are present to narrow the list of possible causes?
- Environmental cues may include increased community influenza cases (infection,
oxygenation, inflammation), extreme heat (fluid and electrolyte imbalance if the person
spends time outdoors), or air pollution (oxygenation).
- Historical cues gained from talking with the person may reveal a history of migraine
headaches (altered fluid, electrolyte, or acid-base balance), an inoperable brain tumor
(inflammation, oxygenation, perfusion), or the loss of work (stress response).
- Is time currently an essential factor?
o Time-sensitive cues, while less likely to help identify the pathophysiologic
processes, are vital to understanding the severity or critical nature of the health
alteration.
o For example, knowing when chest pain started is less helpful if the person has
an arrow sticking out of their chest since it is likely to have led to inflammation,
potential infection, bleeding (perfusion), and trouble breathing (oxygenation). Of
course, this person needs medical attention right away.
o Airway, breathing, and circulation (the ABCs) are key time-sensitive cues.
If the airway is blocked, it is an emergency.
If the person is not breathing normally, it is an emergency.
If a large amount of blood is lost, it is an emergency.
Systems and Processes pulmonary reproductive sensory (eyes,
Body Systems cardiovascular ears, nose) Key Pathophysiologic
endocrine gastrointestinal Processes cellular regulation cognition
genitourinary hematological fluid, electrolyte, and acid-base
integumentary lymphatic imbalances genetics hormonal and
musculoskeletal neurological glucose regulation immunity
