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Module 1 Advanced Health Assessment
Your middle-aged patient has a BMI of 29. You would tell him that. Hyperlipidemia & weight gain are a problem The results are within normal limits ** He is at risk for CAD & DM He is at risk for BPH & DM You realize that as an Advanced Practice Nurse you must ask questions regarding sensitive topics. To be most effective you employ the basic principles that guide responses to sensitive topics. All of these are important which is the most... Be succinct Be focused Be direct ** Be nonjudgmental Susie Lee presents for a checkup to your office. You have not seen her before but she was last seen by the MD in your group for a URI 2 years ago. According to the CPT definition she is classified as... New ** Established Billable at a higher level Concurrent care Ms. Waters is being assessed for a job physical. You ask her about her exercise regimen. She responds that she uses the treadmill every day for 30 minutes. What would be your next question? Do you get a good workout?
Do you do anything else? Have you had any injuries? ** How long have you been doing this? Which of the following would a woman age 19 need screened? BP & cholesterol clinical breast exam pap and pelvic ** dental screen Shirley age 56 presents with a blood pressure of 156/94 mmhg. Your history taking should: Be directed toward sysmptoms suggesting causes of HTN. Include an evaluation of dietary intake & physical activity. evaluate all OTC drugs, herbel remedies or illicit drug use. ** all of the above Screening is considered a form of: health counseling primary prevention ** secondary prevention tertiary prevention
Past medical history includes § Childhood/adult illness § Surgeries with dates § Immunizations ▪ Pediatric, adolescent, adult § Serious injury/trauma - transfusions § Medications ▪ Prescription ▪ OTC § Allergies and response § Screening exams § Psychiatric/mental health issues Family History (FH) A review of medical events in the patient's family including diseases that may be hereditary or place the patient at risk Family History Includes ¡ FH: Family history: age & health~ looking for illnesses with a familial link § CAD, cholesterol § DM § HTN, Stroke § CA § TB § Asthma § Bleeding, anemia § Alcoholism § Weight, mental health Social History (SH) information about the patient's tobacco use, alcohol and drug use, sexual history, relationship status, and other significant social facts that may contribute to the care of the patient Tobacco - Pack-years {# of ppd x # years) Which of the following is not a step of tobacco assessment? Ask Advise Assess Assist
Arrange **Admit Genogram A family diagram that depicts each member of the family and shows connections between 2- generations. O symbol on genogram female square symbol on genogram male X on genogram deceased D on genogram year of death b on genogram year of birth
Q: Quantity or Quality: How does "it" feel, look, sound, smell? How much are you experiencing now? Does it interfere with ADLs Is it worse better or different than last time? R System analysis R: Region / Radiation: Where is "it" located? Does "it" travel any where else in your body? S System analysis S: Severity On a scale of 1 - 10 how bad is "it"? At it's worse do you have to sit down, lie down, or slow down? Is it getting better, worse, or the same? T System analysis T: Timing When did "it" begin? date/time Type of onset - How did it start? suddenly or gradually Frequency - how often does it occur? When does it occur? What time of day? Does it wake you up? Does it happen after/before food? Seasonal? Duration- how long does it last? Associated symptoms
Symptoms related to the chief complaint. Seven attributes of a symptom OLD CARTS: Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, and Timing subjective data things a person tells you about that you cannot observe through your senses; symptoms Includes "CC", HPI, PMH, SH, FH, ROS objective data information that is seen, heard, felt, or smelled by an observer; signs physical assessment, lab values, testing Nutrition Assessment a comprehensive analysis of a person's nutrition status that uses health, socioeconomic, drug, and diet histories; anthropometric measurements; physical examinations; and laboratory tests. BMI <18. underweight BMI 18.5-24.
Duke Activity Status Index Pediatric History and Examination depends on what? Developmental level HEADS assessment Adolescent assessment "H" HEADS assessment Home life "E" HEADS assessment Education "A" HEADS assessment What kind of activities do you do? what is affect, ambition, anger? "D" HEADS assessment drugs
"S" HEADS assessment sex Mini mental status examination -orientation of time & place -attention & calculation of counting backwards by 7 -registration & recalling of objects -language, including naming of objects, following commands & ability to write Geriatric screening tool for cognitive status Mini mental status examination (MMSE) Mini Mental Exam Score= Max score- no impairment Mini Mental Exam Score=24- No cognitive impairment Depressed patients WITHOUT dementia Mini Mental Exam Score=18-
Geriatric screening tool for Functional Status- Activities of Daily Living Katz activities of daily living Katz ADL Scale -designed to assess bathing, dressing, toileting, urinary/bowel continence, transferring, feeding -1 point for each ADL that can be completed independently -scores range from a maximum of 6 (totally independent) to 0 (totally dependent) Katz ADL Scale Max Score 6 Katz score of 0 totally dependent Katz score of 6 totally independent Geriatric screening tool for Functional Status- Instrumental Activities of Daily Living Lawton Instrumental Activities of Daily Living (IADL)
Lawton Instrumental Activities of Daily Living an instrument used to measure an individual's ability to perform instrumental activities of daily living; may assist in assessing one's ability to live independently Geriatric screening tool for nutritional adequacy Mini Nutritional Assessment (MNA) Fastest growing HIV population 50+ CAGE questionnaire a frequently used screening tool used to identify patients who may have alcohol abuse A screening tool to assess for alcohol abuse CAGE questionnaire "C" CAGE Have you ever felt you should Cut down on your drinking? "A" CAGE
Do any of your friends use drugs/etoh? "F" RAFFT Does a family member have a problem? "T" RAFFT Have you ever gotten in trouble b/c…? What two questions should you ask everyone about violence?
- Have you ever been hit by your partner?
- Have you ever been forced to have sex by your partner? All of the following indicate someone may be a victim of abuse EXCEPT unexplained or inconsistent story delay of treatment past history behavior of abuser is suspicious - hovering **patient wants you to call the police and the partner is there What affects the results of MMSE?
Education level Montreal Cognitive Assessment (MOCA) Screens for mild cognitive impairment (MCI) MOCA exam A brief (10 minutes) screening tool for mild cognitive impairment (MCI) Can detect people who score in the normal range of MMSE More sensitive for the early or mild impairment MCI is a risk factor for dementia Normal score of 26- Lower score requires more in-depth assessment MOCA Score=26- Normal Last interview question? Is there anything else you want to tell me? Most important question during HPI? Have you ever had this before?
