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NURS202 Summary > 202 summary slides > Flashcards

202 summary slides Flashcards

1
Q

axillary temp

A

under armpit
0.5C < oral**

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2
Q

rectal temp

A

anus
0.5 > oral**

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3
Q

tympanic temp

A

forehead

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4
Q

oral temp

A

preferred, under the tongue

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5
Q

pulse assessment considerations

A

rate
rhythm
elasticity
force

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6
Q

temp normal

A

35.8-37.3

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7
Q

bp normal

A

120/80 mmHg

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8
Q

heart rate normal

A

60-100 bpm

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9
Q

resp rate

A

12-20 rpm

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10
Q

systolic pressure

A

top #
pressure against artery during contraction

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11
Q

diastolic pressure

A

bottom #
pressure at rest when heart recoils btwn contractions
Relaxation of heart

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12
Q

considerations for resp rate

A

rate, rhythm, depth

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13
Q

atrioventricular

A

tricuspid (RA=>RV) and mitral (LA=LV)

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14
Q

semilunar

A

pulmonic (RV=>aorta=>lungs) and aortic (LV=>systemic circulation)

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15
Q

route of blood flow

A

Inferior/superior vena cava => RA => tricuspid => RV => pulmonic => pulmonary artery => lungs => pulmonary vein => LA => mitral valve => LV => aortic valve => aorta => body

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16
Q

s3

A

soft, dull, low-pitched sound heard after S2 (Al-Ber-Ta)
norm in children and young adults, not normal in older adults

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17
Q

s1

A

AV valve closure (LUB-dub); represents start of systole

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18
Q

s2

A

SL valve closure (lub-DUB); represent end of systole

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19
Q

split s2

A

aortic valve closes b4 pulmonic (lub-T-DUB) on expiration

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20
Q

s4

A

very soft, low-pitched sound heart b4 s1 (NEW-Bruns-Wick)
usually abnormal

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21
Q

summation gallop

A

hearing s4-s1-s2-s3

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22
Q

murmurs

A

blowing, swooshing sounds arising from turbulent blood flow

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23
Q

arteries

A

high pressure vessels that deliver oxygenated blood

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24
Q

veins

A

low pressure, one-way vessels with valves that bring deoxygenated blood back to heart; closer to surface of skin

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25
Q

clubbing

A

nail bed > 160 degrees, rep poor blood perfusion which causes compensatory increases in blood flow which causes tissue hypertrophy

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26
Q

edema

A

swelling of skin across bony prominences as fluid in vessels shifts outside vessel walls; graded 1+ => 4+

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27
Q

peripheral arterial disease

A

narrowing of arteries that carry blood from heart to legs, leads to skin discolouration in extremities, coldness, cramping, and leg numbness/weakness

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28
Q

peripheral vascular disease

A

narrowing of the vessels that carry blood back to heart, causes numbness, weakness, and pain at rest

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29
Q

deep vein thrombosis

A

blood clot in extremities when blood is hypercoagulable state with limited blood flow

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30
Q

right lung

A

3 lobes
shorter and wider to make space for liver

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31
Q

left lung

A

2 lobes
narrower and longer to make space for the heart

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32
Q

for ped’s w resp

A
  • assess rr for one full min bc of abnormal breathing rates
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33
Q

preg and resp assessment

A

enlarging uterus elevates diaphragm => SOB, activity intolerance, fatigue, etc

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34
Q

geriatric resp considerations

A
  • less elastic recoil
  • decreased residual volume
  • may have round, barrel-shaped throacic cage
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35
Q

normal anterior

A

posterior/transverse diameter should be 1:2 ratio

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36
Q

indrawing

A

lower chest muscles move inward while taking deep breaths while rest of chest moves out

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37
Q

retractions

A

intercostal muscles are sucked inward which indicates reduced thoracic pressure

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38
Q

pallor

A

pale discoloration of skin => reduced perfusion

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39
Q

cyanosis

A

blue discoloration of skin/mucous membranes => deoxygenated blood

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40
Q

costal margins should be _____ on assessment

A

90 degrees

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41
Q

tactile fremitus

A

feeling vibrations w the palms of your hands when patient repeats a specific phase; no vibration indicates obstruction

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42
Q

hyperresonance

A

booming, low-pitched sound indicating too much air in lungs

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43
Q

dull

A

flat sound (almost like knocking on wood) indicating abnormal lung densities

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44
Q

Normal Breath Sounds on Auscultation

A
  • Bronchial: high-pitched, loud sounds heard over the neck (trachea, larynx)
  • vesicular: low-pitched, quiet sounds heard over peripheral lung fields
  • bronchovesicular: moderately pitched, moderately loud noises that are a mix of bronchial and vesicular sounds
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45
Q

Abnormal/adventitious Sounds on Auscultation

A
  • Crackles (rales): sounds like bubbling/rattling; represents fluid in the lungs (e.g. pneumonia)
  • Wheezes: high-pitched whistling noise rep reduction in airway diameter (e.g. asthma)
  • Stridor: high-pitched crowing noise representing upper airway obstruction
  • Pleural friction rub: rasping sound caused by friction of the visceral and parietal pleura against each other
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46
Q

3 layers of skin

A
  • Epidermis: thin, tough upper layer
  • Dermis: contains connective tissue
  • Subcutaneous: contains adipose (fat) tissue for energy and protection against injury
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47
Q

most significant functions of skin

A
  • Protection
  • Sensory perception
  • Communication
  • Wound repair
  • Production of Vitamin D
  • Absorption and excretion
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48
Q

Developmental terms for skin/hair: Newborns

A
  • Lanugo: soft, fine layer of hair
  • Vernix caseosa: white, cheese-like biofilm that covers the skin
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49
Q

Developmental terms for skin/hair: Puberty

A
  • Sebaceous glands: microscopic glands in hair follicles that secrete sebum (protective oil layer to prevent skin dryness)
  • Secondary sex characteristics: physical traits that appear during puberty due to hormonal changes
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50
Q

Developmental terms for skin/hair: Preg

A

Striae: indentations that occur when layers of the skin experience prolonged periods of stretch
(Stretch marks)

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51
Q

Developmental terms for skin/hair: Geriatrics

A
  • Senile lentigines: hyperpigmented macules that are irregularly shaped, often in sun-exposed areas
  • Seborrheic keratoses: benign, hyperpigmented growths that are waxy/shiny and slightly raised
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52
Q

pallor

A

pale; often related to inadequate perfusion/chronic diseases

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53
Q

erythema

A

redness; often related to infections

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54
Q

cyanosis

A

blue discolouration; often related to inadequate perfusion

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55
Q

jaundice

A

yellow discolouration; often related to buildup of bilirubin

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56
Q

diaphoresis

A

sweating

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57
Q

exudate

A

substance secreted by body

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58
Q

annular lesion

A

circular, ring-like

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59
Q

confluent lesion

A

circular cascade, connected together

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60
Q

discrete lesion

A

separate lesions with defined borders

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60
Q

discrete lesion

A

separate lesions with defined borders

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61
Q

grouped lesion

A

groups of discrete lesions

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62
Q

gyrate lesion

A

raised borders

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63
Q

target lesion

A

“bullseye” lesion with definable zones of discolouration

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64
Q

linear lesion

A

straight line pattern

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65
Q

polycyclic lesion

A

incomplete rings/circles; > 1 cyclic component

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66
Q

zosteriform lesion

A

unilateral, curved lesion common in herpes zoster virus infections

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67
Q

macule

A

flat lesion < 1 cm

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68
Q

papule

A

raised lesion < 1 cm
Elevated, solid, palpable lesion

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69
Q

nodule

A

raised lesion btwn 1-2cm
Slightly elevated lesions on or in the skin

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70
Q

wheal

A

formed, raised lesion
Suddenly formed elevation of skin surface

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71
Q

vesicle

A

fluid-filled lesion < 1 cm

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72
Q

cyst

A

fluid-filled nodule lined by epithelial cells consisting of fluid, tissue, and fats

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73
Q

pustule

A

collection of free pus, indicates infection
Acne

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74
Q

scale

A

visible peeling/flaking of outer skin layers

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75
Q

fissure

A

linear breaks in skin
(Foot cracks)

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76
Q

erosion

A

partial thickness wound with loss of epidermal tissue

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77
Q

ulcer

A

deeper, concave, and full thickness loss of tissue
- Pressure injury: wound that occurs with excessive shear/friction over bony prominences; risk is assessed with Braden Scale
(Deeper than erosion lesion)

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78
Q

excoriation

A

pruritic skin patches with thin crusts and redness from repeated skin picking

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79
Q

scar

A

pigmentation left on skin indicating prior damage and subsequent healing - Atrophic scar: depressed scar r/t excessive collagen/fat damage

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80
Q

lichenification

A

thickened, leather, and hyperpigmented appearance of skin with exaggerated borders

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81
Q

keloid

A

excessive scar tissue growth

82
Q

hematoma

A

collection of pooling of blood within tissues

83
Q

whats in the RUQ

A

bowel and liver

84
Q

what in the RLQ

A

bowel and appendix

85
Q

whats in the LUQ

A

stomach, bowel, spleen, pancreas

86
Q

whats in the LLQ

A

bowel

87
Q

epigastric region

A

(+L/R hypochondriac): stomach, pancreas, aortic artery

88
Q

umbilical region

A

(+L/R lumbar): above umbilicus

89
Q

suprapubic/hypogastric

A

(+L/R iliac): bladder, pubic bone, female reproductive organs

90
Q

abdominal developmental considerations: ped’s

A
  • Umbilical cords are really important
  • Less muscle tone in the abdomen
  • Vomiting/diarrhea/dehydration can kill
91
Q

abdominal developmental considerations: preg

A
  • Morning nausea related to elevated hormone levels, impaired carbohydrate metabolism, etc. - - - Heartburn and constipation
92
Q

abdominal developmental considerations: geriatrics

A
  • Fat accumulation
  • Less salivation
  • Vomiting/diarrhea/dehydration can kill
  • Smaller liver => increased gallstones
  • Poorer kidney function => drug considerations - Constipation
93
Q

Order of Assessment for GI

A

Change of assessment order: IAPP
- Prevents agitating bowel sounds prematurely (which would occur in palpation) - we’re trying
to hear bowel sounds alone to ensure they are present at rest

94
Q

GI assessment considerations

A

Stool is extremely important
- Red/black/tarry blood suggests the presence of blood (from a GI bleed, cancer, etc.)
- Colon cancer screening for all pts > 50 every 2 years
- High-risk pts are screened at 40 or 10 years before their most recent family member’s
onset of cancer
- Grey blood can indicate jaundice or liver dysfunction
Different abdominal shapes
Light vs. deep palpation
- Light: detects tenderness
- Deep: detects organs and abnormal masses - Palpate painful regions last

95
Q

normal bowel sounds

A

bubbling, clicking sounds every 5-15 seconds in all quadrants

96
Q

absent GI sound

A

No bowel sounds present within 5 minutes of listening
- Suggests intestinal obstruction, paralytic ileus, or peritonitis

97
Q

sluggish bowel sounds

A

<= 3 BS/min
- Suggests paralytic ileus or intestinal obstruction

98
Q

hyperactive bowel sounds

A

excess gurgling (borborygmi) - Suggests increased GI activity

99
Q

female anatomy; developmental considerations and implications

A
  • Divided into external (visible) and internal genitalia
  • Developmental considerations
  • Infant/Child: an external exam usually suffices, parental consent
  • Adolescent: menarche, physiological leukorrhea, pelvic exams only when required
  • Pregnant patients: varicose veins/hemorrhoids, increased venous congestion (hyperemia),
    internal exam findings
  • Geriatrics: hormonal decline, menopause, vaginal friability, uterine/ovarian size, decreased
    lubrication
  • Health promotion
  • Cervical cancer screening: Pap smear starting at 21 and every 3 years afterwards to identify
    abnormal cell growth/aggregation, HPV vaccinations for patients of all genders
  • STI screening for sexually active patients
100
Q

male: developmental considerations and implications

A

Know your structural anatomy (as always)
Testicular self exams: screening for prostate cancer
- Think TSE: Timing (once/month), Setting (shower), Examination method (one testicle at a time; palpate thumb and finger with both hands, rolling gently; note any structural changes/lumps)
Infants:
- Inspection: Voiding, foreskin
- Palpation: Testicular descent, hydrocele, inguinal bulge
Adolescent puberty is rated through Tanner’s sexual maturity rating
- Adapt your communication based on developmental considerations
- Tanner’s sexual maturity rating scale
Adult/geriatrics:
- Sperm production declines at 40, testosterone declines at 50, changes in sexual response/expression
and penile size

101
Q

urine assessment/considerations

A
  • Urine amount, colour, and odour can be a predictor of many illnesses
  • Normal urine output: 30 mL/hour; 1500 mL/day
  • Urge to urinate begins when stretch receptors are activated: 200-250 mL in bladder
  • Some patients are catheterized because of inability to void related to obstructions,
    decreased mobility, or loss of sphincter control

Want to assess for signs of infection: redness, dysuria, hematuria, fever, leakage around catheter site - Risk factors:
- Prolonged catheterization - Sex: females more at-risk - Diabetes
- Malnutrition
- Age: older adults more at-risk
- Impaired immunity (e.g. infection, autoimmune disorder, etc.)

102
Q

what are lymph nodes responsible for

A
  • Lymph nodes are responsible for engulfing pathogens to prevent harmful substances from entering circulation
  • Lymphatic system helps detect and eliminate foreign substances
103
Q

Things to consider with pediatrics: for head/eyes/ears/nose/throat

A
  • Fontanelles: Soft depressions in between bony plates that have not yet fused
  • Caput succedaneum: Collection of fluid above the periosteum that crosses scalp lines
  • Cephalhematoma: Collection of blood under the periosteum that stays within one scapular region
  • Skull circumference: macro- vs. micro- vs. normocephalic
  • Assessment of pinna for child < 3 - pull pinna straight down
104
Q

Things to consider with geriatrics: for head/eyes/ears/nose/throat

A
  • Presbyopia: difficulty of lens in focusing light on retina causing nearsightedness
  • Glaucoma: medical emergency when optic nerve becomes damaged, often from increased pressure - - Cataracts: clouding of the lens causing blurred vision
  • Retinopathy: damage of retinal blood vessels causing blurred vision
105
Q

accomodation

A

Accommodation is tested by having patient focus on finger/pen, then moving it towards the nose; would expect pupils to constrict and cornea to converge

106
Q

pupillary light reflex

A

pupils should equally constrict when light is shined into eyes

107
Q

snellen eye chart

A

Snellen eye chart - visual acuity
- Top number represents pt’s distance from chart during examination (fixed at 20 ft)
- Bottom number represents distance at which someone with healthy, “normal” vision could
read the line that the pt ended on

108
Q

healthy tympanic membrane characteristics

A

Healthy tympanic membrane characteristics: shiny, translucent, pearl-grey,
membranes intact

109
Q

what is the tonsillar grading scale from and too

A

1+ to 4+

110
Q

Assessing mental health

A

important to do for ALL patients, not just ones admitted with psychiatric illnesses
Appearance
Behaviour: pressured speech: rapid speech with few pauses
Cognition
- Labile mood: rapid fluctuation and large range of emotions
- Judgment: ability to recognize that you have an illness
- Insight: how you would react in a situation to protect yourself
Thoughts
- Suicidal: thoughts of deliberately harming yourself
- Homicidal: thoughts of deliberately harming others
- Obsessions: repeated/unwanted thoughts/urges
- Hallucinations: abnormal sensory perception (e.g. seeing ghosts)
- Delusions: firm, fixed belief that is realistically false (e.g. I am the Prime Minister) - Perseveration: fixation on a specific topic (e.g. fixated on the birds in the sky)
- Flight of ideas: erratic speech that jumps between unrelated thoughts
- Blocking: sudden interruption in thought process represented by abrupt pause in speech
- Tangentiality: disorganized, irrelevant responses to posed questions; pt never ends up answering the
question

111
Q

montreal cognitive assessment (MoCA)

A

30-pt questionnaire for detecting dementia/delirium/mild cognitive impairments

112
Q

neuro for ped’s

A

Pediatrics: assessment based on developmental milestones
- Nipissing District Developmental Screen: determines if a child is meeting developmental
milestones (e.g. walking, standing, holding objects) based on age

113
Q

neuro for geriatrics

A

changes in strength and gait, weakened deep tendon reflexes

114
Q

cerebral cortex + components (7)

A

Cerebral cortex
- Frontal lobe: personality, behaviour, emotions, intellect
- Parietal lobe: sensory input
- Occipital lobe: vision
- Temporal lobe: hearing, smell, taste
- Basal ganglia: small bands of grey matter that control motor function
- Thalamus: relays sensory messages between brain and spinal cord
- Hypothalamus: homeostatic functions - HR, BP, hormones

115
Q

brain stem

A

connects thalamus and hypothalamus to control basic bodily functions needed for survival (e.g. breathing, sleep-wake cycle)

116
Q

cerebellum

A

voluntary motor movement and coordination

117
Q

clonus

A

uncontrolled, prominent muscle spasms (DTR 4+/5+)
Involves involuntary and rhythmic muscle contractions

118
Q

tremors

A

involuntary shaking/trembling

119
Q

paralysis

A

loss of voluntary/involuntary motor function due to neurological disturbance

120
Q

paresis

A

weakness of voluntary movements

121
Q

paresthesia

A

abnormal numbness/tingling

122
Q

dysarthria

A

difficulty forming language

123
Q

syncope

A

sudden loss of strength with temporary loss of consciousness due to sudden
interruption in cerebral perfusion

124
Q

vertigo

A

sensation of rotational spinning

125
Q

reflexes and infants

A

presence of some reflexes that aren’t present in adulthood - Unable to assess cranial nerves directly

126
Q

preschool/school-age reflexes

A

fine/gross motor skills, balance and walking, developmental milestones

127
Q

older adult reflexes

A

decreased strength, tremors, etc.

128
Q

what does the Glasgow Coma Scale assess

A

Best motor response
Best verbal response
Best eye contact
- Maximum (fully alert and oriented; full respiratory control) = 15
- Compromised airway protection = 7-8
- Minimum (deep coma/death) = 3

Lower score means worse injury

129
Q

assessment: increased intracranial pressure

A
  • Brain tissue is enclosed by bony prominences that cannot expand/shrink; small increases in brain size (e.g. swelling) can be fatal
  • From blockages in CSF drainage, infection, bleeding, and cerebral edema
  • Cerebral perfusion impacted
  • S/S: Changes in behaviour, altered LOC, headache, lethargy, weakness, numbness, eye movement problems, diplopia, seizures, vomiting
130
Q

what format is used for an MSK assessment

A
  • Subjective: aim is to understand patient’s concerns and goals and determine red, yellow, and
    blue flags
  • Objective: includes scan exam, neurological assessment of myotomes, dermatomes, and
    reflexes, regional exam of the spine OR peripheral joints, and special tests
  • Analysis: includes brief patient profile, diagnosis, cause, and stage
  • Plan: includes problem list with treatment goals
131
Q

what does a subjective assessment do

A

Subjective assessment gathers data for a patient profile
- Patient identifiers (age, sex), social, medical, and surgical history, history of presenting illness
or concern, medications used, aggravating or relieving factors related to presenting concern, and general health

132
Q

red, yellow, blue flags for MSK

A

Red Flags: findings which indicate serious medical pathology
- NIFTI is a helpful acronym to recall what findings fall under serious medical pathology
- Neurological deficits, Infection, Fracture, Tumor, Inflammation
Yellow Flags: findings which indicate psychosocial issues including depression and anxiety
Blue Flags: findings that may indicate that litigation (legal action such as a lawsuit) is involved

133
Q

when to scan for neuro assessment

A

To Scan or Not to Scan?
- A scan exam should be completed when neurological s/s are present or it is unclear what the
cause of presenting symptoms are (want to r/o neurological cause)
- If indicated, a scan exam should be completed during the objective part of the assessment

134
Q

objective assessment neuro

A
  • Scan Exam
  • Describes an exam completed on the lower OR upper part of the body to r/o neurological
    cause
  • Includes either a cervical OR lumbar assessment, peripheral joint scan, and neurological
    assessment of dermatomes, myotomes, reflexes, and irritation
  • Observation
  • Posture, alignment, symmetry, skin quality (temp, colour, texture, tone)
  • Active Range of Motion (AROM)
  • Any pain present w/ movement and its quality (OPQRST), ROM available and symmetry of this
    movement
135
Q

scan exam movement neuro: spinal joints

A
  • Includes cervical and lumbar (neck and lower back)
  • Assess flexion and extension, rotation, repeated movements, and sustained movement;
    repeat for peripheral joints
136
Q

scan exam movement neuro: peripheral joints

A
  • Upper: TMJ, shoulders, elbow, wrist, and hand
  • Lower: hip, knee, and foot
  • As always, have an understanding of the basic anatomy involved including spinal segments
137
Q

scan exam neuro: myotomes

A

Myotomes: refers to a group of muscles innervated by a specific nerve root

138
Q

scan exam neuro: dermatomes

A

Dermatomes: refers to an area of the skin innervated by a specific nerve root

139
Q

scan exam neuro: reflexes

A

Reflexes: involuntary and (ideally) nearly instant movement in response to a stimulus; includes deep tendon reflexes and upper motor neuron reflexes (Babinski, clonus, and Hoffman)

140
Q

special neuro tests for scan exam

A

Special tests: Spurling’s test, cervical distraction test, and straight leg raise/prone knee bend

141
Q

what nerve/root for bicep

A

musculocutaneous
C5, (C6)

142
Q

what nerve/root for radial

A

radial
C6, (C5)

143
Q

what nerve/root for triceps

A

radial
C7

144
Q

what nerve/root for patellar

A

femoral
L3-L4

145
Q

what nerve/root for achilles

A

tibial
S1-S2

146
Q

grading of muscle strength

A

0- no muscle contraction; paralysis
1- muscle contraction is seen or identified w palpation, but it is insufficient to produce joint motion even w elimination of gravity
2- muscle can move the joint it crosses thru a full ROM only if the part is properly positioned so that the force of gravity is eliminated
3- muscle can move the joint it crosses thru a full ROM against gravity but without resistance
4- muscle can move joint it crosses thru a full ROM against gravity but w/o any resistance
5- muscle can move the joint it crosses thru a full ROM, against gravity, and against full resistance applied by the examiner

147
Q

regional exam:

A

Spinal or Peripheral?
- Determine if the source of symptoms is coming from the spine; if yes, complete regional
spinal exam, and if no, complete regional exam of peripheral joints
- Assess ROM and strength, perform special tests to test for specific conditions, and palpate
- Strength can be assessed using a grading scale (included in previous slide)

148
Q

analysis of neuro exam

A
  • Includes a brief statement that includes the patient’s age, sex, purpose of visit, onset of presenting
    issue, diagnosis or impression, cause, and stage
  • E.g. 24 year-old female, RHD, 3-weeks post op ORIF left ankle, developed right scapular pain
    and numbness and tingling in her right forearm after 2 weeks of crutch walking. Diagnosed with Long Thoracic Nerve Palsy caused by neural ischemia in the acute stage and acutely progressing
149
Q

Plan

A
  • A problem list is identified r/t one of four factors:
  • Increased pain
  • Decreased ROM
  • Decreased strength
  • Decreased functioning
  • Treatment goals are identified
  • Long term and short term
150
Q

Nociception

A

physiological process which communicates tissue damage to the central nervous system

151
Q

Transduction

A

noxious (unpleasant) stimuli cause cell damage signalling release of sensitizing chemicals including prostaglandins, bradykinin, serotonin, substance P, and histamine which generate action potential

152
Q

Transmission

A

action potential continues from the site if injury→spinal cord→ brain stem→ thalamus → cortex

153
Q

perception

A

conscious experience of pain

154
Q

modulation

A

neurons originating in the brainstem descend to the spinal cord and descend to spinal cord and release substances which inhibits nociceptive impulses

155
Q

Sensory-Discriminative

A

recognition of a sensation as painful; sensory pain elements include PAIN (pattern, area, intensity, nature)

156
Q

Motivational-affective

A

emotional response to pain experience

157
Q

behavioural reaction to pain

A

observable actions used to express/control pain (facial expression,
posturing, adjusting social and physical activity)

158
Q

cognitive-evaluative reactions to pain

A

beliefs, attitudes, and meaning attributed to pain

159
Q

sociocultural

A

includes demographics, support systems, social roles, past pain experiences, and cultural aspects

160
Q

Nociceptive pain

A

damage to somatic or visceral tissue (e.g. incision, broken
bone, arthritis)’ typically responsive to analgesic medications
- Somatic: aching or throbbing, localized, and arising from bone, joint, muscle, skin or
connective tissue
- Visceral: tumour involvement or obstruction and arising from internal organs

161
Q

neuropathic pain

A

damage to peripheral nerve or central nervous system
- Burning, shooting, stabbing, or electrical
- Sudden, intense, and short-lived or lingering
- Difficult to treat but opioids, anticonvulsant and antidepressant medications can be used

162
Q

acute pain

A
  • short history of onset and does not last longer than days or weeks
  • variable
  • if pain is severe pain behaviours (e.g. moaning, rubbing, and splinting) may be prominent features
  • features of sympathetic hyperactivity when pain is severe (e.g. tachycardia, hypertension, sweating, mydriasis)
163
Q

chronic pain

A
  • long history with often poorly-defined onset; duration unknown
  • variable
  • depression and irritability is prominent feature
  • specific behaviour may or may not be present. if pain is severe and for long duration specific behaviours (e.g. assuming a comfortable position) may occur
  • usually have one or more vegetative signs such as lassitude, weight loss, insomnia, loss of libido. sometimes these signs may be difficult to distinguish from other disease-related effects
164
Q

OPQRST

A

Onset: when it began
Provoking and palliating factors: what makes it worse/better
Quality: qualities of pain
Region and radiation: location and localized or radiates to diff areas
Severity: 0-10
Time: new, old, when it hurts most, etc

165
Q

tolerance

A

need for increased dose to maintain same degree of pain control; not synonymous with addiction

166
Q

physical dependence

A

expected response to ongoing exposure to pharmacological agents manifested by withdrawal syndrome when blood levels drop abruptly

167
Q

addiction

A

a complex disease characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving

168
Q

Ped’s communication considerations

A
  • be at eye level to child
  • make sure to keep kid with parent when possible for comfort
169
Q

age class for neonate

A

birth to one month

170
Q

age class for infant

A

1-12 months

171
Q

toddler age class

A

1-3yrs

172
Q

preschool age class

A

3-6yrs

173
Q

school-age age class

A

6-12yrs

174
Q

adolescent age class

A

12-18yrs

175
Q

newborn reflexes: rooting reflex

A

stim: baby’s mouth touches the skin or nipple
response: baby’s head turns toward the stim
0-4 months

176
Q

newborn reflexes: sucking reflex

A

stim: roof of baby’s mouth against finger or nipple
response: baby starts sucking finger or nipple
0-7 months

177
Q

newborn reflexes: moro reflex

A

stim: baby is startled
response: baby moves their head back, extends their limbs and usually cries
0-2 months

178
Q

newborn reflexes: fencing reflex

A

stim: baby’s head is turned left or right
response: corresponding arm extends, the other arm bends
0-7 months

179
Q

newborn reflexes: grasp reflex

A

stim: baby’s palm is stroked
response: baby closes their fingers in a grasp
0-5 months

180
Q

newborn reflexes: strep reflex

A

stim: baby held upright on solid surface
response: baby appears to be taking steps
0-2 months

181
Q

sensorimotor

A

0-2 yrs
coordination of senses w motor responses, sensory curiosity about the world. language used for demands and cataloguing. object permanence is developed

182
Q

preoperational

A

2-7yrs
symbolic thinking, use of proper syntax and grammar to express concepts. imagination and intuition are strong, but complex abstract thoughts are still diff. conservation is developed.

183
Q

concrete operational

A

7-11 yrs
concepts attached to concrete situations. time, space, and quantity are understood and can be applied, but not as independent concepts

184
Q

formal operational

A

11 yrs old and older
theoretical, hypothetical, and counterfactual thinking. abstract logic and reasoning. strategy and planning become possible. concepts learned in one context can be applied to another

185
Q

pediatric cardiovascular considerations

A
  • location of apex for palpation and auscultation varies depending on age
  • in newborns, radial pulse will not be palpable so more central pulses should be used
186
Q

preg patient: provide prenatal edu

A
  • healthy diet, exercise
  • no tobacco or alc or drugs
  • recommended folic acid supplementation 3 months prior to conception
  • assess dental care
187
Q

conception and menstruation physiology

A

1st to 7th day: least fertile
8-9: possible to conceive
10-14: ovulation the fertile window
15-16: possible to conceive
17-28: unlikely to concieve

188
Q

the body produces what 4 hormones to maintain preg

A
  • hCG (human chorionic gonadotropin)
  • hPL (human placental lactogen)
  • progesterone
  • estrogen
189
Q

3 categories of signs of preg

A
  • Presumptive: symptoms experienced by the pregnant individual including amenorrhea, nausea, fatigue, and breast tenderness
  • Probable: signs detected by examiner including enlarged uterus
  • Positive: objective evidence of fetus including auscultation of fetal heart tones, ultrasound
190
Q

Naegele’s Rule

A

can be used to determine estimated DOB
- Take the first date of the patient’s last menstrual period, count forward 9 months, and add 7 days
- Alternatively, count back 3 months from the first day of the last menstrual cycle, then add 1 year and
7 days

191
Q

GTPAL for preg

A
  • Gravida: total number of pregnancies prior plus present pregnancies regardless of
    gestational age, type, time, or method of termination/outcome; multiples count as one
    pregnancy
  • Term: total number of previous pregnancies with birth occurring at greater than or equal to
    37 completed weeks
  • Preterm: total number of previous pregnancies with birth occurring between 20+0 and 36+7
    completed weeks
  • Abortus: total number of spontaneous or therapeutic abortions occurring prior to 20+0
    weeks; spontaneous abortions include miscarriage, ectopic pregnancy, missed abortion, and
    molar pregnancy
  • Living children: total number of children the patient has given birth to that are currently
    living
192
Q

Antenatal Considerations: Fundal height

A
  • Distance from symphysis pubis to the top of uterus
  • Should be equal to the gestational age in weeks after week 18 (e.g. 25 cm = 25 weeks) - Ensure empty bladder prior to assessment
193
Q

Antenatal Considerations: fetal heart rate (FHR)

A
  • FHR can be determined through auscultation of fetal heart tones on the abdomen
  • Ensure to count for one full minute
  • Normal values range from 110-160 bpm
194
Q

Antenatal Considerations: Fetal Movement Count

A
  • Subjective assessment of pregnant individual
  • Fetal movement may be felt as early as week 14 and should be present by week 24
  • Ask pregnant individual to count the baby’s movement in 2 hours, and there should be a
    minimum of 6 movements in 2 hours
195
Q

Preg trimesters

A
  • First trimester - Weeks 1-12
    Second trimester
  • Weeks 13-27
  • Maternal changes include: quickening, palpable fetal movement, breast enlargement and colostrum, linea nigra, striae gravidarum,and increased BP
    Third trimester
  • Weeks 28-birth
  • Maternal changes include: blood volume and components, uterine enlargement, edema of the LE, posture and lordosis, varicosities, hemorrhoids, and lightening (dropping)
196
Q

Preg trimesters

A
  • First trimester - Weeks 1-12
    Second trimester
  • Weeks 13-27
  • Maternal changes include: quickening, palpable fetal movement, breast enlargement and colostrum, linea nigra, striae gravidarum,and increased BP
    Third trimester
  • Weeks 28-birth
  • Maternal changes include: blood volume and components, uterine enlargement, edema of the LE, posture and lordosis, varicosities, hemorrhoids, and lightening (dropping)
197
Q

presbyopia

A

diff of lens in focusing light on retina causing nearsightedness

198
Q

glaucoma

A

med emergency when optic nerve becomes damaged, often from increased pressure – cataracts: clouding of lens causing blurred vision

199
Q

retinopathy

A

damage of retinal blood vessels causing blurred vision

200
Q

lanugo

A

soft, fine layer of hair

201
Q

vernix caseosa

A

white, cheese-like biofilm that covers the skin

202
Q

senile lentigines

A

hyperpigmented macules that are irregularly shaped, often in sun-exposed areas

203
Q

seborrheic keratoses

A

benign, hyperpigmented growths that are waxy/shiny and slightly raised

NURS202 Summary (12 decks)

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