202 summary slides Flashcards
1
Q
axillary temp
A
under armpit
0.5C < oral**
2
Q
rectal temp
A
anus
0.5 > oral**
3
Q
tympanic temp
A
forehead
4
Q
oral temp
A
preferred, under the tongue
5
Q
pulse assessment considerations
A
rate
rhythm
elasticity
force
6
Q
temp normal
A
35.8-37.3
7
Q
bp normal
A
120/80 mmHg
8
Q
heart rate normal
A
60-100 bpm
9
Q
resp rate
A
12-20 rpm
10
Q
systolic pressure
A
top #
pressure against artery during contraction
11
Q
diastolic pressure
A
bottom #
pressure at rest when heart recoils btwn contractions
Relaxation of heart
12
Q
considerations for resp rate
A
rate, rhythm, depth
13
Q
atrioventricular
A
tricuspid (RA=>RV) and mitral (LA=LV)
14
Q
semilunar
A
pulmonic (RV=>aorta=>lungs) and aortic (LV=>systemic circulation)
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
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
17
Q
s1
A
AV valve closure (LUB-dub); represents start of systole
18
Q
s2
A
SL valve closure (lub-DUB); represent end of systole
19
Q
split s2
A
aortic valve closes b4 pulmonic (lub-T-DUB) on expiration
20
Q
s4
A
very soft, low-pitched sound heart b4 s1 (NEW-Bruns-Wick)
usually abnormal
21
Q
summation gallop
A
hearing s4-s1-s2-s3
22
Q
murmurs
A
blowing, swooshing sounds arising from turbulent blood flow
23
Q
arteries
A
high pressure vessels that deliver oxygenated blood
24
Q
veins
A
low pressure, one-way vessels with valves that bring deoxygenated blood back to heart; closer to surface of skin
25
clubbing
nail bed > 160 degrees, rep poor blood perfusion which causes compensatory increases in blood flow which causes tissue hypertrophy
26
edema
swelling of skin across bony prominences as fluid in vessels shifts outside vessel walls; graded 1+ => 4+
27
peripheral arterial disease
narrowing of arteries that carry blood from heart to legs, leads to skin discolouration in extremities, coldness, cramping, and leg numbness/weakness
28
peripheral vascular disease
narrowing of the vessels that carry blood back to heart, causes numbness, weakness, and pain at rest
29
deep vein thrombosis
blood clot in extremities when blood is hypercoagulable state with limited blood flow
30
right lung
3 lobes
shorter and wider to make space for liver
31
left lung
2 lobes
narrower and longer to make space for the heart
32
for ped's w resp
- assess rr for one full min bc of abnormal breathing rates
33
preg and resp assessment
enlarging uterus elevates diaphragm => SOB, activity intolerance, fatigue, etc
34
geriatric resp considerations
- less elastic recoil
- decreased residual volume
- may have round, barrel-shaped throacic cage
35
normal anterior
posterior/transverse diameter should be 1:2 ratio
36
indrawing
lower chest muscles move inward while taking deep breaths while rest of chest moves out
37
retractions
intercostal muscles are sucked inward which indicates reduced thoracic pressure
38
pallor
pale discoloration of skin => reduced perfusion
39
cyanosis
blue discoloration of skin/mucous membranes => deoxygenated blood
40
costal margins should be _____ on assessment
90 degrees
41
tactile fremitus
feeling vibrations w the palms of your hands when patient repeats a specific phase; no vibration indicates obstruction
42
hyperresonance
booming, low-pitched sound indicating too much air in lungs
43
dull
flat sound (almost like knocking on wood) indicating abnormal lung densities
44
Normal Breath Sounds on Auscultation
- 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
45
Abnormal/adventitious Sounds on Auscultation
- 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
46
3 layers of skin
- Epidermis: thin, tough upper layer
- Dermis: contains connective tissue
- Subcutaneous: contains adipose (fat) tissue for energy and protection against injury
47
most significant functions of skin
- Protection
- Sensory perception
- Communication
- Wound repair
- Production of Vitamin D
- Absorption and excretion
48
Developmental terms for skin/hair: Newborns
- Lanugo: soft, fine layer of hair
- Vernix caseosa: white, cheese-like biofilm that covers the skin
49
Developmental terms for skin/hair: Puberty
- 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
50
Developmental terms for skin/hair: Preg
Striae: indentations that occur when layers of the skin experience prolonged periods of stretch
(Stretch marks)
51
Developmental terms for skin/hair: Geriatrics
- 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
52
pallor
pale; often related to inadequate perfusion/chronic diseases
53
erythema
redness; often related to infections
54
cyanosis
blue discolouration; often related to inadequate perfusion
55
jaundice
yellow discolouration; often related to buildup of bilirubin
56
diaphoresis
sweating
57
exudate
substance secreted by body
58
annular lesion
circular, ring-like
59
confluent lesion
circular cascade, connected together
60
discrete lesion
separate lesions with defined borders
60
discrete lesion
separate lesions with defined borders
61
grouped lesion
groups of discrete lesions
62
gyrate lesion
raised borders
63
target lesion
“bullseye” lesion with definable zones of discolouration
64
linear lesion
straight line pattern
65
polycyclic lesion
incomplete rings/circles; > 1 cyclic component
66
zosteriform lesion
unilateral, curved lesion common in herpes zoster virus infections
67
macule
flat lesion < 1 cm
68
papule
raised lesion < 1 cm
Elevated, solid, palpable lesion
69
nodule
raised lesion btwn 1-2cm
Slightly elevated lesions on or in the skin
70
wheal
formed, raised lesion
Suddenly formed elevation of skin surface
71
vesicle
fluid-filled lesion < 1 cm
72
cyst
fluid-filled nodule lined by epithelial cells consisting of fluid, tissue, and fats
73
pustule
collection of free pus, indicates infection
Acne
74
scale
visible peeling/flaking of outer skin layers
75
fissure
linear breaks in skin
(Foot cracks)
76
erosion
partial thickness wound with loss of epidermal tissue
77
ulcer
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)
78
excoriation
pruritic skin patches with thin crusts and redness from repeated skin picking
79
scar
pigmentation left on skin indicating prior damage and subsequent healing - Atrophic scar: depressed scar r/t excessive collagen/fat damage
80
lichenification
thickened, leather, and hyperpigmented appearance of skin with exaggerated borders
81
keloid
excessive scar tissue growth
82
hematoma
collection of pooling of blood within tissues
83
whats in the RUQ
bowel and liver
84
what in the RLQ
bowel and appendix
85
whats in the LUQ
stomach, bowel, spleen, pancreas
86
whats in the LLQ
bowel
87
epigastric region
(+L/R hypochondriac): stomach, pancreas, aortic artery
88
umbilical region
(+L/R lumbar): above umbilicus
89
suprapubic/hypogastric
(+L/R iliac): bladder, pubic bone, female reproductive organs
90
abdominal developmental considerations: ped's
- Umbilical cords are really important
- Less muscle tone in the abdomen
- Vomiting/diarrhea/dehydration can kill
91
abdominal developmental considerations: preg
- Morning nausea related to elevated hormone levels, impaired carbohydrate metabolism, etc. - - - Heartburn and constipation
92
abdominal developmental considerations: geriatrics
- Fat accumulation
- Less salivation
- Vomiting/diarrhea/dehydration can kill
- Smaller liver => increased gallstones
- Poorer kidney function => drug considerations - Constipation
93
Order of Assessment for GI
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
GI assessment considerations
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
normal bowel sounds
bubbling, clicking sounds every 5-15 seconds in all quadrants
96
absent GI sound
No bowel sounds present within 5 minutes of listening
- Suggests intestinal obstruction, paralytic ileus, or peritonitis
97
sluggish bowel sounds
<= 3 BS/min
- Suggests paralytic ileus or intestinal obstruction
98
hyperactive bowel sounds
excess gurgling (borborygmi) - Suggests increased GI activity
99
female anatomy; developmental considerations and implications
- 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
male: developmental considerations and implications
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
urine assessment/considerations
- 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
what are lymph nodes responsible for
- Lymph nodes are responsible for engulfing pathogens to prevent harmful substances from entering circulation
- Lymphatic system helps detect and eliminate foreign substances
103
Things to consider with pediatrics: for head/eyes/ears/nose/throat
- 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
Things to consider with geriatrics: for head/eyes/ears/nose/throat
- 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
accomodation
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
pupillary light reflex
pupils should equally constrict when light is shined into eyes
107
snellen eye chart
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
healthy tympanic membrane characteristics
Healthy tympanic membrane characteristics: shiny, translucent, pearl-grey,
membranes intact
109
what is the tonsillar grading scale from and too
1+ to 4+
110
Assessing mental health
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
montreal cognitive assessment (MoCA)
30-pt questionnaire for detecting dementia/delirium/mild cognitive impairments
112
neuro for ped's
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
neuro for geriatrics
changes in strength and gait, weakened deep tendon reflexes
114
cerebral cortex + components (7)
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
brain stem
connects thalamus and hypothalamus to control basic bodily functions needed for survival (e.g. breathing, sleep-wake cycle)
116
cerebellum
voluntary motor movement and coordination
117
clonus
uncontrolled, prominent muscle spasms (DTR 4+/5+)
Involves involuntary and rhythmic muscle contractions
118
tremors
involuntary shaking/trembling
119
paralysis
loss of voluntary/involuntary motor function due to neurological disturbance
120
paresis
weakness of voluntary movements
121
paresthesia
abnormal numbness/tingling
122
dysarthria
difficulty forming language
123
syncope
sudden loss of strength with temporary loss of consciousness due to sudden
interruption in cerebral perfusion
124
vertigo
sensation of rotational spinning
125
reflexes and infants
presence of some reflexes that aren’t present in adulthood - Unable to assess cranial nerves directly
126
preschool/school-age reflexes
fine/gross motor skills, balance and walking, developmental milestones
127
older adult reflexes
decreased strength, tremors, etc.
128
what does the Glasgow Coma Scale assess
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
assessment: increased intracranial pressure
- 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
what format is used for an MSK assessment
- 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
what does a subjective assessment do
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
red, yellow, blue flags for MSK
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
when to scan for neuro assessment
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
objective assessment neuro
- 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
scan exam movement neuro: spinal joints
- Includes cervical and lumbar (neck and lower back)
- Assess flexion and extension, rotation, repeated movements, and sustained movement;
repeat for peripheral joints
136
scan exam movement neuro: peripheral joints
- 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
scan exam neuro: myotomes
Myotomes: refers to a group of muscles innervated by a specific nerve root
138
scan exam neuro: dermatomes
Dermatomes: refers to an area of the skin innervated by a specific nerve root
139
scan exam neuro: reflexes
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
special neuro tests for scan exam
Special tests: Spurling’s test, cervical distraction test, and straight leg raise/prone knee bend
141
what nerve/root for bicep
musculocutaneous
C5, (C6)
142
what nerve/root for radial
radial
C6, (C5)
143
what nerve/root for triceps
radial
C7
144
what nerve/root for patellar
femoral
L3-L4
145
what nerve/root for achilles
tibial
S1-S2
146
grading of muscle strength
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
regional exam:
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
analysis of neuro exam
- 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
Plan
- 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
Nociception
physiological process which communicates tissue damage to the central nervous system
151
Transduction
noxious (unpleasant) stimuli cause cell damage signalling release of sensitizing chemicals including prostaglandins, bradykinin, serotonin, substance P, and histamine which generate action potential
152
Transmission
action potential continues from the site if injury→spinal cord→ brain stem→ thalamus → cortex
153
perception
conscious experience of pain
154
modulation
neurons originating in the brainstem descend to the spinal cord and descend to spinal cord and release substances which inhibits nociceptive impulses
155
Sensory-Discriminative
recognition of a sensation as painful; sensory pain elements include PAIN (pattern, area, intensity, nature)
156
Motivational-affective
emotional response to pain experience
157
behavioural reaction to pain
observable actions used to express/control pain (facial expression,
posturing, adjusting social and physical activity)
158
cognitive-evaluative reactions to pain
beliefs, attitudes, and meaning attributed to pain
159
sociocultural
includes demographics, support systems, social roles, past pain experiences, and cultural aspects
160
Nociceptive pain
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
neuropathic pain
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
acute pain
- 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
chronic pain
- 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
OPQRST
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
tolerance
need for increased dose to maintain same degree of pain control; not synonymous with addiction
166
physical dependence
expected response to ongoing exposure to pharmacological agents manifested by withdrawal syndrome when blood levels drop abruptly
167
addiction
a complex disease characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving
168
Ped's communication considerations
- be at eye level to child
- make sure to keep kid with parent when possible for comfort
169
age class for neonate
birth to one month
170
age class for infant
1-12 months
171
toddler age class
1-3yrs
172
preschool age class
3-6yrs
173
school-age age class
6-12yrs
174
adolescent age class
12-18yrs
175
newborn reflexes: rooting reflex
stim: baby's mouth touches the skin or nipple
response: baby's head turns toward the stim
0-4 months
176
newborn reflexes: sucking reflex
stim: roof of baby's mouth against finger or nipple
response: baby starts sucking finger or nipple
0-7 months
177
newborn reflexes: moro reflex
stim: baby is startled
response: baby moves their head back, extends their limbs and usually cries
0-2 months
178
newborn reflexes: fencing reflex
stim: baby's head is turned left or right
response: corresponding arm extends, the other arm bends
0-7 months
179
newborn reflexes: grasp reflex
stim: baby's palm is stroked
response: baby closes their fingers in a grasp
0-5 months
180
newborn reflexes: strep reflex
stim: baby held upright on solid surface
response: baby appears to be taking steps
0-2 months
181
sensorimotor
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
preoperational
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
concrete operational
7-11 yrs
concepts attached to concrete situations. time, space, and quantity are understood and can be applied, but not as independent concepts
184
formal operational
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
pediatric cardiovascular considerations
- 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
preg patient: provide prenatal edu
- healthy diet, exercise
- no tobacco or alc or drugs
- recommended folic acid supplementation 3 months prior to conception
- assess dental care
187
conception and menstruation physiology
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
the body produces what 4 hormones to maintain preg
- hCG (human chorionic gonadotropin)
- hPL (human placental lactogen)
- progesterone
- estrogen
189
3 categories of signs of preg
- 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
Naegele's Rule
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
GTPAL for preg
- 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
Antenatal Considerations: Fundal height
- 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
Antenatal Considerations: fetal heart rate (FHR)
- 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
Antenatal Considerations: Fetal Movement Count
- 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
Preg trimesters
- 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
Preg trimesters
- 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
presbyopia
diff of lens in focusing light on retina causing nearsightedness
198
glaucoma
med emergency when optic nerve becomes damaged, often from increased pressure -- cataracts: clouding of lens causing blurred vision
199
retinopathy
damage of retinal blood vessels causing blurred vision
200
lanugo
soft, fine layer of hair
201
vernix caseosa
white, cheese-like biofilm that covers the skin
202
senile lentigines
hyperpigmented macules that are irregularly shaped, often in sun-exposed areas
203
seborrheic keratoses
benign, hyperpigmented growths that are waxy/shiny and slightly raised
