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N507 Exam 1 > (4) General Survey, VS, Pain > Flashcards

(4) General Survey, VS, Pain Flashcards

1
Q

health history: common or concerning symptoms

A

fatigue & weakness
fever, chills, night sweats
weight change
pain

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2
Q

fatigue - abnormal dx?

A 
depression/anxiety
infections (hepatitis, mono, TB)
endocrine disorders (hypothyroid, adrenal insufficiency, DM)
heart failure
chronic dz of kidney, lungs, liver
electrolyte imbalance
moderate-severe anemia
malignancies
nutritional deficiency
medications
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3
Q

weakness - abnormal dx?

A

localized in neuroanatomical pattern: neuropathy or myopathy

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4
Q

recurrent chills - abnormal dx?

A

systemic bactermia

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5
Q

night sweats - abnormal dx?

A

TB

malignancy

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6
Q

low temp - abnormal dx?

A

immunocompromised pt w/ sepsis

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7
Q

edema - abnormal dx?

A

heart failure
nephrotic syndrome
liver failure
venous stasis

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8
Q

clinically significant weight loss?

abnormal dx?

A

loss of 5% or more of usual body weight over 6 months

GI, endocrine, infections, HIV, malignancy, chronic cardiac, pulmonary, renal failure, depression, eating disorder

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9
Q

weight loss w/ high food intake - abnormal dx?

A

DM
hyperthyroid
malabsorption
bulimia

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10
Q

drugs associated w/ weight loss

A 
anticonvulsants
antidepressants
levodopa
digoxin
metformin
thyroid meds
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11
Q

drugs associated w/ weight gain

A 
TCAs
insulin and sulfonylurea
contraceptives
glucocorticosteroids
pregestational steroids
mitrazapine
paroxetine
propanolol
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12
Q

BMI chart levels

A 
underweight <18.5
normal 18.5-24.9
overweight 25.0-29.9
obesity (I) 30.0-34.9
obesity (II) 35.0-39.9
extreme obesity >40.0
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13
Q

waist circumference w/ increased risk

A

women >35”

men > 40”

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14
Q

4 steps to promote optimal weight and nutrition

A
  1. measure BMI and assess risk factors
  2. asses dietary intake
  3. assess motivation to change
  4. provide counseling about nutrition and exercise
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15
Q

exercise needed to achieve health benefits

A 
150 minutes (2hr30min) of moderate intensity cardio activity a week
OR 75 minutes (1hr15min) of vigorous-intensity cardio a week
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16
Q

General Appearance

A 
apparent state of health
level of consciousness
signs of distress
skin color / obvious lesions
dress, grooming, personal hygiene
facial expression
odors of body and breath
posture, gait, motor activity
height and weight
BMI
waist circumference
17
Q

excess clothing - abnormal dx?

A

hypothyroid
hide rash or needle marks
hide anorexia
personal lifestyle choice

18
Q

how to count heart rate

A

palpate radial pulse

listen to apical pulse

19
Q

definitions of HTN

A 
office BP on 2 separate occasions >140/90
home BP >135/85
ambulatory automated BP
- 24hr average >130/80
- daytime average >135/85
- nighttime average >120/70
20
Q

types of HTN

A

white coat - conditioned anxiety response
masked - office BP < 140/90 but daytime BP > 135/85
nocturnal - nocturnal fall of <10% of daytime is associated w/ poor cardiovascular outcomes (can only be IDed on 24 hr ambulatory BP monitoring)

21
Q

correct BP cuff size

A

-width of inflatable bladder of cuff 40% of upper arm circumference
length of inflatable bladder 80% of upper arm circumference
- lower border of cuff 2.5 cm above AC crease

22
Q

Ausculatory gap - abnormal dx?

A

arterial stiffness
atherosclerotic disease

(if unrecognized may lead to underestimation of SBP or overestimation of DBP)

23
Q

stage II HTN

A

> 160/100

24
Q

BP arms vs legs

A

normal: SBP 5-10 higher in legs than arms

abnormal dx = coarctation of aorta, occlusive aortic disease

25
Q

types of pain

A 
nociceptive
neuropathic
central sensitization
psychogenic
idiopathic
26
Q

Nociceptive Pain

A

linked to tissue damage to the skin, musculoskeletal system, or viscera but sensory nervous system is intact

ex: arthritis, spinal stenosis

  • acute or chronic
  • mediated by afferent A-delta and C-fibers of the sensory system
  • involved afferent nociceptors can eb sensitized by inflammatory mediators and modulated by both psychological processes and neurotransmitters like endorphins, histamines, acetylcholine, serotonin, norepinephrine, dopamine
27
Q

Neuropathic Pain

A
  • direct consequence of a lesion or dz affecting somatosensory system
  • may become independent of inciting injury, become burning, lancinating, or shock like
  • may persist after healing from initial injury
  • central nervous system injury (stroke, trauma), spinal nerve issues
  • triggers induce changes in pain signal processing through neuronal plasticity leading to pain that persists beyond healing from initial injury
28
Q

Central Sensitization Pain

A
  • alteration of central nervous system processing of sensation, leasing to amplification of pain signals
  • lower pain threshold to non painful stimuli and response pain may be more severe than expected
    ex: fibromyalgia w/ psych overlap & somatization disorders that respond best to medications that modify neurotransmitters like serotonin and dopamine
29
Q

Idiopathic Pain

A

w/o identifiable etiology

30
Q

Idiopathic Pain

A

w/o identifiable etiology

31
Q

steps to manage chronic pain

A
  1. measure pain intensity and pain interference
  2. measure mood
  3. measure effect of pain on sleep
  4. measure risk of substance abuse
  5. measure opioid dose
32
Q

readiness to change model

A 
Precontemplation
Contemplation
Preparation
Action
Maintenance
33
Q

calcium food source

A

dairy
calcium fortified cereal, juice, soy milk. tofu
dark green leafy veggies
sardines

34
Q

iron food source

A

lean meat, dark turkey, liver
clams, mussels, oysters, sardines, anchovies
iron fortified cereal
enriched whole grain bread
spinach, peas, lentil. turnip greens, artichokes
prunes, raisins

35
Q

folate food source

A 
cooked dried beans and peas
oranges
liver
spinach, mustard greens
black eyed peas, lentils, okra, chick peas, peanuts
floated fortified cereals
36
Q

vitamin D food source

A

fortified milk, OJ, cereal
cod liver oil, swordfish, salmon, herring, mackerel, tuna, trout
egg yolk
mushrooms

37
Q

diet changes : HTN

A 
increase K (white/sweet potatoes, white beans, beet greens, soybeans, spinach, lentils, kidney beans, yogurt, tomato, bananas, plantains, dried fruit, OJ)
decrease NA (canned foods, pretzels, potato chips, pizza, pickles, olives, processed foods, butter fried foods, table salt)

N507 Exam 1 (10 decks)

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