Maryville Advanced Health Assessment Key Points Exam #4 WITH QUESTIONS AND ELABORATED ADVANCED ANSWERS

Maryville Advanced Health Assessment Key Points Exam #4 WITH QUESTIONS AND ELABORATED ADVANCED ANSWERS HPI questions for a patient with a chief complaint of an abdominal pain - ANSWER -onset and duration: sudden or gradual, persistent -character: dull, sharp, stab, cramp -location: at time of onset, change over time, radiates to another area, superficial or deep -associated symptoms: n/v, diarrhea, constipation, flatus, belching, jaundice, change in girth, weight changes. -relationship to: menstrual cycle, change in menses, intercourse, urination, defecation, inspiration, change in body position, change in food or alcohol intake, stress, time of day, trauma. -recent stool characteristics: color, consistency, odor, and frequency. -urinary characteristics: frequency, color, volume consistent with intake, force of stream, ease of starting stream, ability to empty bladder. -Medications: high doses of aspirin, steroids, NSAIDS HPI questions for a patient with a chief complaint of indigestion - ANSWER -character: feeling of fullness, heartburn, discomfort, excessive belching, flatulence, loss of appetite, severe pain. -location: localized or general, radiating to the arms or shoulders. -relationship to: amount, timing of food intake, menses -onset of symptoms: time of day or night, sudden or gradual. -symptoms relieved by: antacids, change in diet, rest, or activity. -medications: antacids (calcium carbonate, H2 blockers, PPIs) HPI questions for patient with a chief complaint of nausea - ANSWER -associated with: vomiting, particular stimuli such as time of day, activities, odors, food intake, menses. -medications: antiemetics HPI questions for a patient with a chief complaint of vomiting - ANSWER -character: nature (color, bright red blood, coffee grounds, bilious, undigested food particles), quantity, duration, frequency, ability to keep liquids or food in stomach. -associated symptoms: constipation, diarrhea, fever, chills, headache, nausea, weight loss, abdominal pain or cramping, heartburn. HPI questions for a patient with the chief complaint of diarrhea - ANSWER -character: watery, copious, explosive, color, presence of blood, mucus, undigested food, oil, or fat, odor, number of times per day, duration, change in pattern. -associated symptoms: fever, chills, thirst, weight loss, abdominal pain or cramping, fecal incontinence. -relationship to: amount, type and timing of food intake, stressful life events or daily stressors. -travel history and or ill contacts -Medications: laxatives or stool softeners, antidiarrheals HPI questions for the patient with the chief complaint of constipation - ANSWER -character: presence of bright red blood, black or tarry, diarrhea alternating with constipation, accompanied by pain or discomfort -pattern: last BM, pain with defecation, change in consistency or the size of the stool. -diet: recent change in diet, intake of fiber, change in fluid intake -medications: laxatives, stool softeners, diuretics, iron HPI questions for the patient with jaundice - ANSWER -onset and duration -color of stools or urine -associated with abdominal pain, chills, fever -exposure to hepatitis, use of recreational drugs, high----risk sexual activity -medications: high doses of acetaminophen, antipsychotics, antiepileptics, antibiotics HPI questions for the patient with fecal incontinence - ANSWER -character: stool characteristics, timing in relation to meals, number of episodes per day, occurring with or without warning sensations -associated with: use of laxatives, presence of underlying disease HPI questions for the patient with dysuria - ANSWER -character: location (suprapubic, distal urethra), pain or burning, frequency or volume changes -associated fever or other systemic signs of illness: bacterial infection, tuberculosis, fungal or viral infection, parasitic infection -increased frequency of sexual intercourse or high risk sexual activity. -changes in the amount of fluid intake HPI questions for patients with urinary frequency - ANSWER -change in pattern or volume -associated with other characteristics: urgency hematuria, incontinence, nocturia, increased thirst, weight loss -change in urinary stream: dribbling HPI questions for patient with urinary incontinence - ANSWER -character: amount and frequency, constant or intermittent, dribbling vs frank incontinence -associated with urgency, previous surgery, coughing, sneezing , walking up the stairs, nocturia, menopause -medications: diuretics HPI questions for patient with hematuria - ANSWER -character: color (bright red, rusty brown, cola-colored) present at the beginning, end, or throughout voiding. -associated symptoms: flank or costovertebral pain, passage of wormlike clots, pain on voiding -alternate possibilities: ingestion of foods containing red vegetable dyes, ingestion of laxatives containing phenolphthalein -medications: aspirin, NSAIDS, anticoagulants, diuretics, antibiotics Changes in the abdomen with pregnant patients - ANSWER -striae from stretched skin -abdominal muscles have less tone -2nd trimester lower esophageal sphincter pressure decreases=GERD -gastric emptying does not change but gastro transit time is prolonged leading to constipation. -gallbladder can distend, decreased emptying time and change in tone. This can lead to the development of gallstones. -bladder sensitivity increased=frequency and urgency -colon is displaced leading to increased constipation and flatus. Changes in the abdomen with older patients - ANSWER -motility of the intestine is slower -reduced circulation to the intestine -digestive enzymes and protective mucus decreases in the intestinal tract -liver size decreases after fifty years of age. -the liver looses the ability to metabolize certain drugs What is the proper order of the abdominal exam? - ANSWER Inspection, auscultation, percuss, and palpate Order is different from other systems so examiner does not alter the frequency of bowel sounds. How would you inspect the abdomen? - ANSWER -patient should be seated. -assess symmetry while patient is breathing and holding breath. -patients bladder should be emptied. Four Quadrants of the abdomen - ANSWER see picture Nine quadrants of abdomen - ANSWER see picture How should NP be situated during abdominal exam? - ANSWER first seated at patients side, then standing behind patient. Unexpected findings of abdominal inspection - ANSWER -umbilicus displaced, inflamed, swollen, or bulging. -any distention, bulges or masses -jaundice, cyanosis, redness -glistening, taunt appearance -bruises or discoloration -bluish periumbilical discoloration -striae -asymmetry A glistening taut appearance can indicate - ANSWER ascites Cullen's sign - ANSWER ecchymosis in umbilical area, seen with pancreatitis