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Board Certification 2 (Purple book) > Advanced Health Assessment > Flashcards

Advanced Health Assessment Flashcards

1
Q

In general, if you find that the clients symptoms are not psychiatrically based, you should

A

refer them out

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2
Q

Which part of the physical assessment should an NP be especially good at

A

the neuro exam

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3
Q

Components of the neuro exam

A

Reflexes

Cranial Nerves

Coordination and fine motor

Sensory

Motor

Neurological soft signs

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4
Q

Components of the neuro exam: Reflexes

A

Normal reflexes: Check biceps, triceps, brachioradialis, patellar, Achilles, plantar

Grade reflexes and note symmetry

Primitive reflexes (head lag, flexion, rooting, grasping, Moro, glabellar, Babinski)

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5
Q

Babinski

A

A positive Babinski is fanning the of the toes. It’s normal up to 2 years old

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6
Q

Neuro exam: CN1

A

Close your eyes an occlude each nostril one at a time and test your smell

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7
Q

Neuro exam: CN2

A

Snellen chart

Opthalmoscope

Peripheral vision test

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8
Q

Neuro exam: CN3

A

Check the 5 eye movements

Check PERLA

Corneal light reflex (shining a light at the bridge of the nose to see if the light is symmetrical in both eyes)

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9
Q

Neuro exam: CN4

A

Check eye movements

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10
Q

Neuro exam: CN5

A

Trigeminal

Clench your teeth, feel to see if one side of the face is weaker

Look for lip tremor or random mouth movements

Test their sense of touch in their face and mouth

Corneal reflex!

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11
Q

Neuro exam: CN6

A

eye movements

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12
Q

Neuro exam: CN7

A

Look at the face for drooping/paralysis

Wrinkle forehead, close eyes, frown, smile, puff cheeks

Sense of taste

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13
Q

Neuro exam: CN8

A

Hearing, webber, rinne

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14
Q

Neuro exam: CN9

A

Glossopharyngeal

Same test as CN10 vagus nerve

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15
Q

Neuro exam: CN 10

A

Open and say “ah” (check the uvula)

Gag reflex

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16
Q

Neuro exam: CN11

A

Accessory spinal

Try to raise your shoulders while I hold them done

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17
Q

Neuro exam: CN12

A

Hypoglossal

Stick out your tongue and look for tremors

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18
Q

Neuro exam: Coordination and fine-motor skills

A

Equilibrium- Use the Romberg test, they stand on one leg and look for swaying

Diadochokinesia- Are they able to perform rapid alternating movements

Dyssynergia- Finger-to-nose, heel-to-knee

Handwriting

Gait

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19
Q

Neuro exam: Sensory functions

A

Can they feel pain, temperature, light touch, two point discrimination, stereogenesis (what’s in your hand?), graphesthesia

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20
Q

Neuro exam: Motor functions

A

Muscle mass- is there atrophy? Hypertrophy?

Muscle tone- is there tension even when resting?

Muscle strength

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21
Q

Choreiform movements

A

Rapid, jerking tics

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22
Q

Peds BMI

A

If they’re BMI is over the 85th percentile, they are at risk for being overweight

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23
Q

Adult BMI

A

20 to 25 is normal

25 to 29 is overweight

30 to 35 is obese

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24
Q

In addition to the obvious things, high BMI is a risk for

A

OA and some types of cancer

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25
Q

If a patient has a high temperature, which 2 meds might they be taking?

A

Carbamazepine and clozapine (which cause agranualocytosis, which causes fever)

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26
Q

Which 2 meds causes SJS

A

lamotrigine and carbamazepine

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27
Q

Evaluate moles with ABCDE

A 
Asymmetry 
Borders irregular 
Color variation
Diameter greater than 6mm
Elevation
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28
Q

If they have cataracts, which med might they be on

A

Quetiapine

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29
Q

How should the tympanic membrane appear

A

Pearly, translucent, no bulging or retractions

30
Q

Palpating the thyroid

A

You usually cannot feel it unless the person is thin

31
Q

What are the 2 classes of drugs where we see ECG changes (in general)

A

antipsychotics and TCAs

32
Q

What medication and what disorder often cause peripheral edema

A

Lithium, anorexia

33
Q

Palpating the liver

A

Often not palpable, except for in thin clients

34
Q

Normal value of thyroxine T4

A

0.8 to 2.8

35
Q

Diseases that have increased thyroid levels

A

Grave’s

Hashimoto’s

Thyrotoxicosis due to T4

Acute thyroiditis

36
Q

Diseases that have decreased thyroid levels

A

Cushing’s

Thyrotoxicosis due to T3

Renal failure

Cirrhosis

37
Q

Things that can increase thyroid levels

A

Heparin, aspirin, propranolol

38
Q

Things that can decrease thyroid levels

A

Furosemide (lasix), methadone

39
Q

Normal value of thyroid stimulating hormone

A

2 to 10

40
Q

Things that can decrease TSH

A

T3, aspirin, steroids, heparin

41
Q

Things that can increase TSH

A

Lithium

42
Q

Hypothyroid symptoms

A 
Everything is slower
Confusion
Headaches 
Syncope
Fluid retention
Muscle aches and stiffness
Sensory disturbance (hearing)
Ataxia 
Loss of amplitude in ECG
43
Q

Hyperthyroid symptoms

A

Labile
Abdominal pain
Dysrhythmias

44
Q

Calcium levels

A

Normal value 8.8 to 10.5

Low calcium = tetany/muscle excitability, alkalosis, hypoparathyroid, renal failure, pancreatitis, confusion, paresthesias of the mouth and digits, convulsions, prolonged QT interval, stomach cramps, hyperactive bowel sounds

High calcium = hyperthyroidism, hyperparathyroidism, coma, metastatic cancer, acidosis, Addison’s disease, fatigue, weakness, anorexia, nausea, constipation, behavioral change, renal impairment, Shortened QT interval, depressed T waves, bradycardia, heart block

45
Q

Calcium functions

A 
Enzyme cofactor for blood clotting
Hormone secretion
Cell receptors 
Plasma membrane stability and permeability 
Nerve impulses and muscle contraction
46
Q

How is calcium mediated

A

It’s mediated by 3 things: parathyroid, vitamin D, and calcitonin

47
Q

Things that increase or decrease calcium levels

A

High calcium is caused by growth in children, drinking too much milk, lithium, thiazide diuretics, antacids, and vitamin D

Low calcium is caused by anticonvulsants, aspirin, calcitonin, steroids, heparin, laxatives, diuretics, albuterol, and birth control

48
Q

Sodium levels

A

135 to 145

49
Q

Sodium functions

A

acid-base balance

membrane transport

retaining/excreting water

50
Q

Too much sodium can be caused by

A

hypervolemia, dehydration, diabetes insipidous, gastroenteritis, too much salt, adrenocorticosteroids, methyldopa, hydralazine, cough medication

51
Q

Too little sodium can be caused by

A

addison’s disease, renal disorder, vomiting/diarrhea, lithium, vasopressin, diuretics

52
Q

Having not enough sodium can cause

A

lethargy, headache, confusion, anxiety, seizures, come, hypotension, tachycardia, decreased urine, weight gain, edema, JVD

53
Q

Having too much sodium can cause

A

convulsions, pulmonary edema, thirst, fever, dry membranes, tachycardia, restlessness

54
Q

Magnesium level

A

1.3 to 2.1

55
Q

Magnesium functions

A

Cofactor in intracellular enzyme reactions

It’s regulated by the kidney

56
Q

Things that increase magnesium

A 
Addison's
Adrenalectomy
Renal failure
Diabetic ketoacidosis
Dehydration
Hypothyroidism
Hyperthyroidism
Antacids, salicylates, lithium
57
Q

Things that decrease magnesium

A 
Hyperaldosteronism
Hypokalemia
Diabetic ketoacidosis
Malnutrition
Alcoholism
Pancreatitis
Gi loss
Malabsorption
pregnancy induced HTN
thiazide diuretics, calcium, insulin, neomycin, aldosterone, ethanol
58
Q

Effects of hypomagnesemia

A 
depression
confusion
irritability
increased reflexes but with muscle weakness
ataxia
nystagmus 
tetany
convulsions
59
Q

Effects of hypermagnesemia

A 
N/V
muscle weakness and depressed contractions
hypotension
bradycardia
respiratory depression
depressed nerve functioning
60
Q

Chloride level

A

98 to 106

the level changes according to how much sodium there is

61
Q

Increased chloride is caused by

A 
acidosis
hyperkalemia
Hypernatremia 
dehydration
renal failure 
Cushing's 
Hyperventilation 
Anemia
Potassium chloride, acetazolamide, methyldopa, diazoxide, and guanethidine
62
Q

Decreased chloride is caused by

A 
aalkalosis
hypokalemia
hyponatremia 
GI loss
Diuresis
Overhydration
Addison's 
Burns
Elevated triglycerides 
Ethacrynic acid
Furosemide
thiazide diuretics 
bicarbonate
63
Q

Potassium level

A

3.5 to 5

64
Q

Potassium functions

A 
Regulates the intracellular environment
Glycogen deposits in the liver and muscles
Maintains resting membrane potential
Conducts impulses
Cardia rhythms 
muscle contractions
65
Q

Too much K is caused by

A 
acidosis
insulin deficiency 
Addison's 
Acute renal failure Hypoaldosteronism
Infection 
Dehydration
amphotericin
tetraacycline
heparin
epinephrine 
K sparring diuretics
isoniazid

vigorously pumping the hand
hemolysis
High platelet count

66
Q

Too little Potassium is caused by

A 
Alkalosis 
too much insulin
GI loss
laxative abuse
burns
trauma
surgery
cushing's 
hyperaldosteronism
thyrotoxicosis 
anorexia
Not eating enough meat and veggies
furosemide, ethacrynic acid, thiazide, insulin, aspirin, prednisone, cortisone, gentamycin, lithium, laxatives

Sample left at room temp

67
Q

Hyperkalemia causes

A 
muscle weakness
paralysis
tingling of lips and fingers 
restlessness
intestinal cramping
diarrhea 
Narrow/tall T waves
Shorten T wave
Depressed ST segment, prolonged PR interval, wide QRS complex leading to heart attack
68
Q

Hypokalemia causes

A 
impaired carb metabolism 
impaired renal function
polyuria 
polydipsia
weakness and no muscle tone 
dysrhythmias 
paralysis and respiratory arrest
69
Q

ALT

A

Normal level = 5 to 35

Liver cancer, hepatitis, mono = Over 300

Many things can cause, like severe burns, pancreatitis = 100 to 300

Uremia and hemodialysis can falsely elevate the level

These meds can truly elevate ALT:

Acetaminophen, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, OC, phenothiazines, propranolol, tetracylcine, verapamil

70
Q

AST

A

Normal value = 5 to 40

2 to 3 times elevated = DTs, pericarditis, pulmonary infraction

3 to 5 times elevated = Biliary obstruction, arrhythmias, liver tumor, chronic hepatits

5 times elevated = Acute liver damage, acute pancreatitis, MI, shock, mono

AST can be elevated by: exercise, HTN drugs, cholinergics, anticoagulants, digitalis, erythromycin, isoniazid, methyldopa, OC, opiates, salicylates

71
Q

GGT values

A

Normal = 10 to 38

We check the values to see if someone abuses alcohol.

It can be elevated with alcohol, liver problems, heart problems, pancreas problems, DM, seizures

High levels of GGT can be caused by alcohol, barbituates, and phenytoin

Low levels can be caused by late pregnancy, OC, and clofibrate

Board Certification 2 (Purple book) (22 decks)

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