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NUR 240 > 202 Exam 2 > Flashcards

202 Exam 2 Flashcards

1
Q

tension headache
(onset/duration?)

A

mild to moderate less disabling form of migraine
location: usually on both sides across frontal, temporal or occipital region
band-like tightness (nonthrobbing)
gradual onset
diffuse dull aching pain

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2
Q

migrane headache
(onset/duration?)

A

HA of genetically transmitted vascular and trigeminal nerve origin (2-3 times more common in women)
commonly one-sided, pain often behind eyes, temporal or frontal region
throbbing, pulsating
rapid onset (can last up to 72 hrs or more)

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3
Q

cluster headache
(onset/duration?)

A

intermittent , excruciating, unilateral with autonomic signs
location: on one side, often behind or around the eye
abrupt onset (45-90 mins)
can occur multiple times a day in “clusters”

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4
Q

cancerous lumps feel like

A

hard, fixed, not tender

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5
Q

parkinsons disease

A

a deficiency of the neurotransmitter dopamine, and degeneration of the substantia nigra of the basal ganglia in the brain

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6
Q

Cushing’s syndrome

A

excessive secretion of adrenocorticotropic hormone (ACTH), person develops round moon-like face

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7
Q

Bell’s palsy

A

a lower motor neuron lesion producing rapid onset of cranial nerve VII paralysis of facial muscles (unilateral)

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8
Q

brain attack or CVA

A

a upper motor neuron lesion (central). caused by a blood clot of a cerebral vessel as in atherosclerosis (ischemic stroke) or a rupture in a cerebral vessel (hemorrhagic stroke)

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9
Q

four functions of respiratory system

A

changing chest size during respiration
inspiration
expiration
control of respiration

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10
Q

Clear sputum

A

bronchitis, viral infection, cold

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11
Q

Yellow or green sputum

A

respiratory infection or bacterial infection

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12
Q

pulmonary edema sputum color

A

pink and frothy (very concerning)

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13
Q

anteroposterior-transverse diameter ratio

A

1:2

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14
Q

tactile fremitus pg 439

A
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15
Q

solid viscera organs/glands

A

liver
pancreas
spleen
adrenal glands
kidneys
ovaries
uterus

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16
Q

hollow viscera organs/glands

A

stomach
gallbladder
small intestine
colon
bladder

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17
Q

solid vs hollow viscera

A

solid: retains shape, solid in mass
hollow: shape depends on content (changes shape), organ is hollow

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18
Q

proper assessment order for abdomen

A

IAPP: inspect, auscultate, percussion, palpation

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19
Q

what is significant about kidney placement

A

the left kidney is slightly higher than the right. important for physical examination

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20
Q

dysphagia

A

difficulty swallowing

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21
Q

you may see abdominal pulsations in which people

A

newborns, children, skinny adults, HTN, a triple A, peristalsis

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22
Q

normal bowel sounds characteristics

A

high-pitched, gurgling, cascading (normally 5-30 times per min)

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23
Q

hyperactive bowel sounds

A

high-pitched, rushing, tinkling, signal increased motility
“borborygmi”
Colitis

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24
Q

hypoactive bowel sounds

A

most commonly follow abdominal surgery or with inflammation of the peritoneum, late bowel obstruction, NPO

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25
Q

two tests to confirm ascites

A

fluid wave
shifting dullness

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26
Q

arteries in the abdomen

A

aortic
renal
iliac

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27
Q

what is a bruit

A

A bruit is an audible vascular sound associated with turbulent blood flow

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28
Q

rebound tenderness (blumbergs sign)

A

hold hand at 90 degrees, palpate slowly and deeply, then lift up quickly
perform test at end of exam because it can cause pain and muscle rigidity

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29
Q

inspiratory arrest test (Murphy’s sign)

A

murphy’s sign is elicited in pts with acute cholecystitis by asking patient to take in a hold a deep breath while palpating the right subcostal (below the ribs)
if pain occurs when the inflamed gallbladder comes into contact with the examiners hand, murphy’s sign is positive
signifies acute cholecystis

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30
Q

3 types of hernias

A

umbilical hernia
epigastric hernia
incisional hernia

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31
Q

umbilical hernia

A

the protrusion of the momentum or intestine through a weakness or incomplete closure in the umbilical ring

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32
Q

epigastric hernia

A

protrusion of abdominal structures presents as a small fatty nodule at epigastrium in midline, through the Linea alba

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33
Q

incisional hernia

A

a bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up or standing

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34
Q

percussion of healthy lungs produces

A

resonance

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35
Q

which lung sound dominates

A

vesicular

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36
Q

decreased fremitus

A

asthma, collapsed lung, obstructed bronchus, pneumothorax, and emphysema
pleural effusion- fluid build up in the pleural cavity surrounding the lungs so it absorbs the vibrations from the visceral lung tissue (blocks the sound)

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37
Q

increased fremitus

A

increased density of lung tissue = increase vibrations example- pneumonia

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38
Q

enlarged thyroid gland is called a

A

Goiter

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39
Q

lymph node locations (10)

A
  1. preauricular
  2. posterior auricular
  3. occipital
  4. jugulodigastric
  5. superficial cervical
  6. posterior cervical
  7. supraclavicular
  8. deep cervical chain
  9. submandibular
  10. submental
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40
Q

lymph nodes characteristics and assessment

A

characteristics: <1cm, freely moveable, enlarged/inflamed = could indicate acute infection or illness
assessment: bimanual palpation, circular motion

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41
Q

anterior landmarks on thoracic cage

A

suprasternal notch
sternum
manubriosternal angle
costal angle

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42
Q

posterior landmarks on thoracic cage

A

vertebra prominens
spinous processes
inferior border of scapula
twelfth rib

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43
Q

number of lobes on each lung

A

2 lobes on the left
3 lobes on the right

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44
Q

listen to lower lobes (posteriorly or anteriorly?)

A

posteriorly

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45
Q

During a health history interview with patient what question should you ask? (thorax and lungs)

A

do you have to sleep with a lot of pillows at night? (orthopnea)

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46
Q

bronchial (trachea) breath sound characteristics

A

pitch: high
amplitude: loud
duration: inspiration < expiration
quality: harsh, hollow, tubular
location: trachea, larynx

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47
Q

Bronchiovesicular breath sound characteristics

A

pitch: moderate
amplitude: moderate
duration: inspiration = expiration
quality: mixed
location: over major bronchi where fewer alveoli are located

48
Q

Vesicular breath sound characteristics

A

pitch: low
amplitude: soft
duration: inspiration > expiration
quality: rustling
location: over peripheral lung fields where air flows through smaller bronchioles and alveoli

49
Q

adventitious lung sounds: Crackles

A

discontinuous popping sounds heard over inspiration
mechanisms: inhaled air collides with previously deflated airways, airways suddenly pop open
example- (late)- pneumonia, heart failure, interstitial fibrosis. (early)- chronic bronchitis, asthma, emphysema

50
Q

adventitious lung sounds: wheezes

A

continuous musical sounds heard mainly over expiration
mechanisms: air compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors
example- acute asthma, or chronic emphysema, COPD

51
Q

percussion sound that predominates over abdomen

A

tympany

52
Q

measurement of pulmonary function status

A

forced expiratory time
pulse oximeter
6-minute walk

53
Q

Barrel chest

A

AP-T 1:1
chronic emphysema and asthma as a result of hyperinflation of lungs

54
Q

scoliosis

A

a lateral s-shaped curvature ofd the thoracic and lumbar spine usually involved in vertebrae rotation
most common in adolescent aged girls

55
Q

kyphosis

A

exaggerated posterior curvature of the thoracic spine that cause significant back pain and limited mobility (humpback)

56
Q

pectus excavatum

A

sunken sternum and adjacent cartilages (also called funnel breast). depression at 2nd ICS

57
Q

pectus carinatum

A

a forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions long costpchondral junctions (pigeon breast)

58
Q

cheyne-stokes respiration

A

a cycle in which respirations gradually wax and wane in a regular pattern, increasing rate and depth then decreasing.
most common in heart failure, in some cases renal failure, meningitis, drug overdose, increase intracranial pressure

59
Q

biot respirations

A

similar to cheyne stokes however pattern is irregular. series of normal respirations (3-4 breaths) followed by period of apnea

60
Q

chronic obstructive breathing

A

normal inspiration and prolonged expiration to overcome airway resistance

61
Q

rhonchal fremitus

A

vibrations felt when inhaled air passes through thick secretions in the larger bronchi (may decrease by coughing)

62
Q

pleural friction fremitus (palpable friction rub)

A

produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid
the opposing surface makes a coarse grating sound when rubbed together during breathing

63
Q

discontinuous lung sounds

A

crackles- fine
crackles - coarse
atelectatic crackles
pleural friction rub

64
Q

continuous lung sounds

A

wheeze- sibilant
wheeze- sonorous rhonchi
stridor (r/t anaphylaxis)

65
Q

Stridor lung sound

A

originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissue, or lodged foreign body

croup and acute epiglottis, ANAPHYLAXIS

66
Q

percussion (of the lungs) is helpful in identifying ___

A

surface alterations of lung tissue

67
Q

layers of the heart (outer to inner)

A

pericardium
myocardium
endocardium

68
Q

precordium

A

the area on the anterior chest directly overlying the heart and great vessels

69
Q

S1 sound occurs with __

A

closure of the Atrioventricular (AV) valves (tricuspid and mitral)
beginning of systole

70
Q

S2 sound occurs with __

A

closure of the semilunar valves (pulmonic and aortic) and signals the end of systole

71
Q

effect of respiration on amount of blood in heart

A

moRe to the Right heart
Less to the Left

72
Q

extra heart sounds

A

S3 - occurs immediately after S2 (may hear in pts with CHF, Acute MI, coronary artery disease, late pregnancy)
S4- occurs immediately before S1 (athletes, elderly pt, chronic hypertension, aortic stenosis, cardio myopathy)

73
Q

S1 is louder at ___ and coincides with ____ pulse

A

the apex, carotid artery pulse

74
Q

S2 is louder at

A

the base

75
Q

jugular veins give information about the __ side of the heart

A

right
(JVD shows more in right jugular vein)

76
Q

jugular vein distention can indicate

A

Right side heart failure
Right heart pressure
venous congestion

77
Q

cultural consideration- prevalence of heart disease and stroke is higher among ___

A

black adults

78
Q

cyanosis is r/t ____

A

decrease cardiac output

79
Q

edema

A

starts in lower extremities and works its way up

80
Q

nocturia

A

frequent urination during the night

81
Q

how to palpate carotid arteries

A

one at a time
grade 1+ 2+ or 3+

82
Q

how to check carotid artery for bruit

A

ask pt to take a breath in, then out and hold breath and then listen

83
Q

apical pulse location (palpate)

A

midclavicular line 5th ICS

84
Q

how to calculate pulse deficit

A

difference between apical pulse rate and radial pulse rate

apical minus radial

85
Q

most common irregular heart rhythm

A

atrial fibrillation

86
Q

how to listen for extra heart sounds (S3 and S4)

A

roll pt to their left side and listen with the bell at the apex for presence of diastolic filling sounds (S3 and S4)

87
Q

point of max impulse = apical pulse location

A
88
Q

auscultatory areas on heart

A

aortic area (2nd ICS, right sternal border)
pulmonic area (2nd ICS, left sternal border)
Erb’s point (3rd ICS, left sternal border)
tricuspid area (5th ICS, left sternal border)
mitral area (5th ICS, left midclavicular line)

89
Q

sound of a murmur

A

swishing

90
Q

pericardial friction rub

A

inflammation of the pericardium
sound is high pitched and scratchy
examples: cardio myopathy, pericarditis

91
Q

abnormal pulsations on the precordium

A

a thrill is heard at the base of the heart in the 2nd and 3rd ICS on the right (indicates severe aortic stenosis, and systemic hypertension) and on the left (indicates pulmonic stenosis and pulmonic hypertension)

92
Q

a lift (heave) occurs with ____

A

right ventricular hypertrophies

seen in pts with pulmonic valve disease, pulmonic hypertension, and chronic lung disease

93
Q

peripheral vascular system lymph nodes

A

cervical
axillary
epitrochlear
inguinal

94
Q

intermittent claudication

A

r/t arterial disease, numbness, tingling or cramps*

95
Q

use doppler for pulse

A

amplitude
only gets your systolic

96
Q

lack of hair on one foot vs the other indicates

A

less blood flow and less nutrients

97
Q

water-hammer (corrigan’s) pulse

A

3+ , collapses suddenly

98
Q

peripheral vascular disease in arms

A

raynauds syndrome
lymphedema- accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment

99
Q

peripheral vascular disease in legs

A

arteriosclerosis-ischemic ulcer
venous (stasis) ulcer
superficial varicose veins
DVT

100
Q

deep vein thrombosis

A

requires immediate attention, high risk for PE

101
Q

ascites

A

free fluid in the peritoneal cavity

102
Q

blood flow through the heart

A

Superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonic valve
pulmonary artery –> lungs to exchange CO2 for Oxygen
pulmonary veins
left atrium
mitral valve (bicuspid)
left ventricle
aortic valve
aorta—> oxygenated blood to the rest of the body

103
Q

tests for suspected appendicitis

A

lliopsoas muscle test
obturator muscle test

104
Q

Chronic arterial symptoms

A

Deep muscle pain usually in calf
Intermittent claudication- feels like a cramp
Aggravating factors: walking, claudication distance (distance it takes to produce pain), elevation
Relieving factors: rest, dangling

105
Q

Acute arterial symptoms

A

Distal to occlusion, may involve entire leg
Throbbing
Sudden onset
Six Ps: pain, pallor, pulselessness, Paresthesia, poikilothermia, paralysis

106
Q

Chronic venous symptoms

A

Calf, lower leg
Aching, tenderness, feeling of fullness
Aggravating factors: Prolonged sitting or standing
Relieving factors: elevation, lying, walking
Associated symptoms: edema, varicosities
At risk: jobs with long time sitting or standing, obesity, prolonged bed rest, varicosities, trauma

107
Q

Acute venous symptoms

A

Calf
Moderate to intense, sharp, deep, tender
Pain increases with palpating
Helped by pain medication
Symptoms: red, swollen, warm

108
Q

Modified allen test

A

Used to evaluate the adequacy of collateral circulation before cannulating the radial artery
Occlude both radial and ulnar pulse and then release the ulnar

109
Q

Cervical lymph nodes drain

A

The head and neck

110
Q

Ancillary lymph nodes drain

A

The breast and upper arm

111
Q

Epitrochlear lymph nodes drain

A

The AC fossa and the hand and lower arm

112
Q

Inguinal nodes drain

A

Most of the lymph of the lower extremity, external genitalia and anterior abdominal wall

113
Q

Artery that supplies the hand

A

Ulnar

114
Q

+ Blumbergs test indicates

A

Appendicitis

115
Q

Murphys test indicates

A

Inflamed gallbladder

116
Q

Hemoptysis

A

Coughing up blood

117
Q

Manual compression test

A

Varicose veins
palpate the dilated vein with the fingertips of one hand. With the other hand, firmly compress the vein at a point at least 8″(20.3 cm) higher. Feel for an impulse transmitted to your lower hand

NUR 240 (18 decks)

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