Summary NR509 ADVANCED PHYSICAL ASSESSMENT MIDTERM STUDY GUIDE 2023 FOR A GUARANTEED PASS WITH A+ GRADE

lOMoARcPSD|29700879 NR509 ADVANCED PHYSICAL ASSESSMENT MIDTERM STUDY GUIDE 2023 FOR A GUARANTEED PASS WITH A+ GRADE Midterm Study Guide General Study Tips and Recommendations: • Topics and content on guides are intended to focus student attention when reading/studying. • Multiple test items are derived from the same topic areas to encourage deeper comprehension. • Students must have a broad understanding of content and not simply memorize passages in textbooks or articles. • Information in red letters in the chapters as well as tables and appendices at the end of the chapters may include test items. • All exam questions are written at a high level of comprehension. You are expected to analyze, synthesis, and evaluate patient scenarios in order to answer the questions. • Read all of the answers BEFORE reading the stem of the question. This will help you focus on the key content and not get distracted by extraneous information. • Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body system chapters in the textbook. Chapter 1 Approach to the Clinical Encounter • The Interviewing Process o The interviewing process that generates the patient’s story is fluid and draws on numerous relational skills to respond effectively to patient cues, feelings, and concerns. The adaptability of the interviewer has been compared to the impro - visation of jazz musicians who listen attentively to notes and themes and play to each other’s cues. This “in-the-moment” flexibility lets the interviewer adapt to the patient’s leads as the story unfolds.13 The interview should be “open -ended,” drawing on a range of techniques to cue patients to tell their stories — active listening, guided questioning, nonverbal affirmation, empathic responses, vali- dation, reassurance, and partnering. These techniques are especially valuable when eliciting the patient’s chief concerns and the History of the Present Illness. • Approach and Structure of the Clinical Encounter o • Disparities in Health Care o Communicating effectively with patients from every background has always been an important professional skill. Nonetheless, the disparities in risks of disease, morbidity, and mortality are marked and broadly documented across different population groups, reflecting inequities in health care access, income level, type of insurance, educational level, language proficiency, and provider decision making.46,47 To moderate these disparities, clinicians are increasingly urged to engage in self -reflection, critical thinking, and cultural humility as they experience diversity in their clinical practices.48–50 lOMoARcPSD|29700879 • Prioritization • Documenting the Clinical Encounter Chapter 2 Interviewing, Communication, and Interpersonal Skills • Fundamentals of Skilled Interviewing —other study guide • Verbal and Nonverbal Communication o Nonverbal Communication. Both clinicians and patients continuously display nonverbal communication that provides important clues to our underlying feelings. Being sensitive to nonverbal cues allows you to “read the patient” more effectively and send messages of your own. Pay close attention to eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs—crossed, neutral, or open. Be aware that some forms of nonverbal communication are universal, but many are culturally bound. • Challenging Patient Situations and Behaviors Chapter 3 Health History • Different Health Histories As you learned in Chapter 1, the scope and detail of the history depends on the patient’s needs and concerns, your goals for the encounter, and the clinical setting (inpatient or outpatient, the amount of time available, primary care or subspecialty). ▪ For new patients, in most settings, you will do a comprehensive health history. ▪ For patients seeking care for specific concerns, for example, cough or painful urination, a more limited interview tailored to that specific problem may be indicated; this is sometimes known as a focused or problem -oriented history. ▪ For patients seeking care for ongoing or chronic problems, focusing on the patient’s self -management, response to treatment, functional capacity, and quality of life is most appropriate.15 ▪ Patients frequently schedule health maintenance visits with the more fo- cused goals of keeping up screening examinations or discussing concerns about smoking, weight loss, or sexual behavior. ▪ A specialist may need a more comprehensive history to evaluate a problem with numerous possible causes. By knowing the content and relevance of the different components of the com- prehensive health history, you are able to select the elements most lOMoARcPSD|29700879 • ● Identifying data and source of the history; reliability • ● Chief complaint(s) • ● Present illness • ● Past history • ● Family history • ● Personal and social history • ● Review of systems pertinent to the visit and shared goals for the patient’s health. This chapter sets guideposts for interviewing and the health history, outlined below. • Comprehensive Adult Health History • Determining the Scope of the Patient Assessment o At the outset of each patient encounter, you will face the common questions, “How much should I do?” and “Should my assessment be comprehensive or focused?” For patients you are seeing for the first time in the office or hospital, you will usually choose to conduct a comprehensive assessment, which includes all the elements of the health history and the complete physical examination. In many situations, a more flexible focused or problem -oriented assessment is appro - priate, particularly for patients you know well returning for routine care, or those with specific “urgent care” concerns like sore throat or knee pain. You will adjust the scope of your history and physical examination to the situatio n at hand, keeping several factors in mind: the magnitude and severity of the patient’s prob - lems; the need for thoroughness; the clinical setting —inpatient or outpatient, primary or subspecialty care; and the time available. Skill in all the components of a comprehensive assessment allows you to select the elements that are most pertinent to the patient’s concerns, yet meet clinical standards for best practice and diagnostic accuracy. • Subjective Versus Objective Data o As you acquire the techniques of history taking and physical examination, remember the important differences between subjective information and objective information, summarized in the table below. Symptoms are subjective concerns, or what the patient tells you. Signs are considered one type of objective informa - tion, or what you observe. Knowing these differences helps you group together the different types of patient information. These distinctions are equally impor - tant for organizing written and oral presentations about patients into a logical and understandable format.