Q1) define interview and explain the principles of interviewing
The interview is a process of communication or interaction in which the subject or interviewee gives the needed information verbally in a face to face situation.
Principles Of Interviewing:
- Interviewing is a special kind of conversation
- Has a definite purpose
- More structured
- Strong element of control
- Two parties only: interviewer and respondent
- Different amounts of speaking (30/70)
- A significant aspect of daily business
Q2) describe the component of health history that should be produced during the assessment of skin, head and neck
- Any previous skin disease or problem (infection, rashes, lesions, itching).
- How was it treated?
- Skin allergic problem
- precipitating factors (stress, weather, drugs)
- Any birth marks or tattoos.
- Change in skin color, pigmentation and lesions
- Any recent hair loss
- Amount of sun exposure
Examination of Skin:
- lLocation/ distribution
Q3) classify the structure landmarks of the nose mouth and pharynx
- The nose is the first segment of the respiratory system.
- It is the sensory organ of smell
- External nose (It shaped like a triangle with one side attached to the face on its leading edge.
- The superior part is the bridge and the free corner is the tip.
- The oval openings at the base of the triangle are the nares just inside, each nares widen into the vestibule.
- The upper third of the external nose is made of bone, the rest is cartilage. The parts of the nose are:
- Nasal cavity
- Mouth is the first segments of the digestive system and the airway of the respiratory system.
- The oral cavity is the short passage boarded by the lips, palate, checks, and tongue.
- It continues the teeth, gums, tongue and salivary glands.
- The arching roof of the mouth is the palate, it is divided into two parts.
- The interior, hard palate; Posterior to this is the soft palate.
- The uvula is the free projection hanging down from the middle of the soft palate.
- The cheeks are the side walls of the oral cavity.
- Floor of the mouth is tongue and horse shoe shaped mandible bone.
- Submandibular gland
- Sublingual fold, duct and gland
Q4) describe the specific assessment to be made during the physical examination of abdomen
a. Shape and contour
i. Look across abdomen left to right
ii. Can use pen light to look for visible bulging or masses
iii. Look for distention
b. Umbilicus – discoloration, inflammation, or hernia
c. Skin texture and color
d. Lesions or scars
i. Note details – length, color, drainage, etc.
e. Visible pulsations
f. Respiratory movements (belly breather)
a. Start in RLQ → RUQ → LUQ → LLQ
i. This follows the large intestine
b. Use diaphragm of stethoscope to listen for 1 full minute per quadrant
i. Active – Should hear 5-30 clicks per minute
iv. Absent – must listen for 5 minutes per quadrant to confirm this
c. Use bell of stethoscope to listen for bruits
i. Aorta – over the epigastrium
ii. Iliac and femoral arteries – Inguinal are
iii. Renal arteries – A few cm above and to the side of the umbilicus
1. Press firmly
iv. The presence of a bruit could indicate narrowing of the arteries – if this is a new finding, report to provider
a. Percuss x 4 quadrants, starting in RLQ as with auscultation
b. Expect to hear tympany
c. Dullness could indicate a mass, fluid-filled bladder, blood in the belly, or significant adipose tissue
i. Exception – dullness over the liver is expected
d. CVA tenderness
i. Place nondominant hand flat over the costovertebral angle (flank).
ii. Strike your hand with the ulnar surface of your dominant hand
iii. Should be nontender
iv. Repeat bilaterally
a. Light palpation – small circles in all 4 quadrants
i. Can do 4 small areas in each quadrant to be thorough
b. Deep palpation – deeper circles in all areas
c. Palpating for masses – make note of size, location, consistency, tenderness, and mobility
d. Make note of any guarding or tenderness
e. Assess for rebound tenderness
i. Press down slowly and deeply
ii. Release quickly
iii. Ask patient which hurt most (down or up)
iv. Rebound tenderness over RLQ could indicate appendicitis
f. If distended, perform Fluid-Wave test to look for ascites:
i. Place patient’s hand over umbilicus
ii. Place your hand on right flank, then tap or push on the left flank with your other hand
iii. If you feel the tap/push on the opposite hand, that’s a Positive Fluid-Wave test
1. Indicates Ascites
iv. You may also see the patient’s hand ‘wave’ with the fluid
Q5) define breast examination and discuss the steps of self-breast examination
A physical exam of the breast performed by a health care provider to check for lumps or other changes. Also called CBE.
steps of self-breast examination
Step 1: stand up before the mirror and Start by looking for differences between your breasts
- Good breast self-exams should be concerned with both the look and feel of breasts. The look element should be performed while either standing or sitting in front of a mirror, with your clothes removed. Examine both breasts and look for:
- Visible lumps
- Any unusual differences between the two breasts
iii. Dimpling or indentations in the breast tissue
- Redness, scaliness, or other changes to the skin or nipples that appear abnormal
- Changes to your nipples, for example a nipple that is newly inverted or pulling in
Step 2: Put your hands on your hips, pull your elbows forward
- Look for the same changes in the breasts from Step 1 — such as redness, lumps and indentations — this time with your hands resting on your hips
while squeezing your elbows forward since this might bring out lumps that might not appear otherwise. Keep your hands on your hips and slowly swivel from side to side to catch possible abnormalities from more angles.
- Next, lift your arms above your head to see if there’s any puckering or dimpling of the skin when you elevate them. “When you raise your arms, the mass, if there is one, stays there and the skin pulls in,” says Kruper.
Step 3: Use 3 fingers when examining your breasts
- The feel part of the breast self-exam should be done while lying down, with a pillow propping up your head and your arm resting behind it. With the opposite hand, take the first three fingers — index, middle and ring fingers — and use them to press down around the breast and surrounding area using circular motions. Using three fingers, rather than just one, keeps you from mistaking normal breast tissue for lumps. Increase the pressure you use with each pass around the breasts to ensure you are not just feeling superficial tissue.
Step 4: Examine the areas surrounding the breast
- After examining your breasts, it is important to perform a check of the areas around them. Continue to use circular motions and increasing pressure as you move from the collarbone to the sternum and down below the breast. From the lower part of the breast, travel up to the area under your arm to look for any swelling in the lymph nodes. “What you’re looking for is something that stands out — something that feels like a pea, or a marble or a walnut,” says Kruper. “Something that definitely feels different than the surrounding breast tissue.”
Step 5: Perform the test at the same time each month
A, Be sure to do the breast self-examination the same time every month. If you are still menstruating, Kruper recommends you do the exam about seven to 10 days after your menstrual cycle, since at that time there will likely be fewer cycle-related changes in the breast tissue. Women who are postmenopausal can do the exam at any time of the month, as long it is around the same time each month.
B, Keep in mind that there is some debate about whether women should perform routine breast self-exams to find potentially cancerous lumps.
According to current research, some of the issues depend on the possibility of false positives and the possibility that the screenings might not really increase a woman’s probability of survival.
Q6) classify the equipment needed to perform a physical examination
The equipment needed to perform a physical examination
- Within reach and ready
- Arranged as per need
- Required equipment
- Extra supplies/equipment
- Clean or sterile equipment
- Warm metallic piece
The following are the more common but essential medical tools that are used during physical health exam.
- Medical Weighing Scale
- TUNING FORK
- NASAL SPECULUM
- PERCUSSION HAMMER
- VAGINAL SPECULUM
Q7) define health assessment and identify types of health assessment
A health assessment is a plan of treatment that outlines a person’s unique requirements and how those needs will be met. A is provided by the hospital system or a skilled nursing facility. Health assessment is the evaluation of one’s health status through a physical exam and a health history. It is done to detect diseases in people who appear to be healthy.
There are four types of Health Assessment
1) Comprehensive Initial Assessment:
- The initial assessment, also known as triage assessment.
- Performed shortly after admittance to hospital
- Performed by the nurse to collect data on all aspects of patient’s health
- It helps to determine the nature of the problem and prepares the way for the ensuing assessment stages.
- The initial assessment is used more than the other assessments used by nurses.
- Components may include obtaining a patient’s medical history or putting him/her through a physical exam, or preparing a psychosocial assessment for a mental health patient.
- Other components may include obtaining a patient’s vital signs and taking subjective statements from the patient, as well as double-checking the subjective symptoms with the objective signs of the condition.
2) Focused Assessment:
- The focused assessment is the stage in which the problem is exposed and treated.
- Due to the importance of vital signs and their ever-changing nature, they are continuously monitored during all parts of the assessment.
- May be performed during initial assessment or as routine ongoing data collection
- Performed to gather data about a specific problem already identified, or to identify new or overlooked problems
- Performed by the nurse to collect data about the specific problem
- Depending on the problem, initial treatment for pain and long-term treatment for the root cause of the trouble is administered and monitored.
- Part of the goal of the focused assessment is to diagnose and treat the patient in order to stabilize her condition.
- Focused assessments may also include X Rays or other types of tests.
3) Time-Lapsed Assessment:
- Once treatment has been implemented, a time-lapsed assessment must be conducted to ensure that the patient is recovering from his problem and his condition has stabilized.
- Depending on the nature of the problem, the time-lapsed assessment may span the length of one or two hours or a couple of months.
- Performed to compare a patient’s current status to baseline data obtained earlier
- Performed to reassess health status and make necessary revisions in plan of care
- Performed by the nurse to collect data about current health status of patient
- During the time-lapsed assessment, the current status of the patient is compared to the previous baseline during and prior to treatment.
- Similar to the focused assessment, the time lapsed assessment may also include lab work, X-rays or other diagnostic medical testing.
4) Emergency Assessments:
- During emergency procedures, a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient.
- Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation.
- If the nurse is not in a health care setting, emergency assessments must also include an assessment for scene safety so that no other individuals, including the nurse himself/herself are hurt during the rescue and emergency response process.
- Performed by the nurse to gather data about the life-threatening problem