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-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 a professional mover
since he was 18. Two years ago, Jeb lost his footing and fell on
the stairs while moving a heavy table, which landed on his left
leg. He had surgery to repair a broken leg and damage to his
knee, both on the left side. He was out of work for three months
to heal and 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
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.
- 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-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 a professional mover
since he was 18. Two years ago, Jeb lost his footing and fell on
the stairs while moving a heavy table, which landed on his left
leg. He had surgery to repair a broken leg and damage to his
knee, both on the left side. He was out of work for three months
to heal and 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
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.
