Ch. 11 Patient Assessment Flashcards
Adventitious breath sounds
Abnormal breath sounds, such as wheezing, rhonchi, crackles, strider, and pleural friction rubs.
Alert and oriented (A X O)
A determination made when assessing mental status by looking at whether the patient is oriented in four areas: person, place, time, and event.
Anisocoria
Unequal pupils with a greater than 1-mm difference
Aphasia
The language impairment that affects the production or understanding of speech and the ability to read or write.
Apparent life-threatening event (ALTE)
An episode characterized by some combination of apnea (central or obstructive), color change (cyanosis, pallid, erythematous, or plethoric) change in muscle tone, and choking or gagging.
Ascites
Abnormal accumulation of fluid in the peritoneal cavity; typicallly signals liver failure.
Aspiration
The entry of fluids or solids into the trachea, bronchi, and lungs; the act of drawing material in or out by suction.
Auscultation
The act of using a stethoscope to listen to sounds within the body
AVPU
Method of assessing mental status by determining whether a patient is Awake and alert, responsive to Verbal stimuli or Pain, or Unresponsive.
Battle signs
Bruising over the mastoid process, which may indicate a basilar skull fracture; also known as a retroauricular ecchymosis or raccoon eyes.
Beck triad
The combination of a narrowed pulse pressure, muffled heart tones, and jugular venous distention associated with cardiac tamponade; usually caused by penetrating chest trauma.
Blood pressure (BP)
Measurement of the force exerted against the walls of the blood vessels as the product of cardiac output and peripheral vascular resistance.
Bronchial sounds
Hollow, tubular, lower-pitched sounds heard over the trachea.
Bronchophony
Test of decreased breath sounds performed by placing the diaphragm of the stethoscope over the area in question while the patient says “ninety-nine” a loud, clear sounds indicates lug consolidation
Bronchovesicular sounds
A combination of the tracheal and vesicular breath sounds; heard where airways and alveoli are found, in the upper part of the sternum and between scapulae.
Bruit
An abnormal whooshing sound of turbulent blood flow moving through a narrowed artery; usually heard in the carotid arteries.
Capnography
The use of noninvasive diagnostic tool that can quickly and efficiently provide information on a patient’s ventilatory and circulatory status with a graphic and digital depiction similar to an electrocardiograph.
Capnometry
The use of a capnometer, which is a monitoring device used to measure the amount of expired carbon dioxide. The reading is usually given as a digital reading.
Cerumen
Ear wax
Chief complaint
The reason the patient is seeking help.
Crackles
Wet rattling, bubbling, or crackling lung sounds indicative of fluid in the small airways; also known as rails
Crepitus
A crackling, grating, or grinding sound often heard when fragments of broken bones rub together.
Current health status
A composite picture of a number of factors in a patient’s life, such as dietary habits, current medications, allergies, exercise, alcohol or tobacco use, recreational drug use, sleep patterns and disorders, and immunizations.
Crushing reflex (triad)
The combination of a slowing pulse, rising blood pressure, and an erratic respiratory pattern; a grave sign for patients with head trauma or cerebrovascular accident.
Cyanosis
A blue-gray skin color that is caused by invadequate levels of oxygen in the blood.
Delirium
An acute confusion also state characterized by global impairment of thinking, perception, judgment, and memory.
Dementia
the gradual and pervasive deterioration or losss of cognitive cortical functions
Diaphoresis
Excessive sweating; it is often associated with shock.
Diastolic pressure
The result of residual pressure In the circulatory system while the left ventricle is relaxing
Differential diagnosis
Process of comparing one disease versus other diseases by comparing clinical findings that could account for a patient’s illness; also refers to the list of possible conditions considered based on the patient’s signs and symptoms.
Diplopia
Doubled vision
Ecchymosis
Localized bruising or collection of blood within or under the skin
Egophony
A test of decreased breath sounds performed by placing the diaphragm of the stethoscope over the area in question while the patient says a drawn out “eye;” an “A” sound indicates lung consolidation.
Field impression
Field conclusion on the patients problem based on the clinical presentation and the exclusion of other possible causes through considering the differential diagnoses.
Focused exam
Type of physical exam that is typically performed on responsive patients who have sustained an isolated injury.
This type of exam is based on the chief complaint and focuses on one body system or part.
Full-body exam
A systematic head-to-toe exam performed during the secondary assessment of a patient who has sustained a significant MOI, is unresponsive, or is in critical condition.
General impression
Overall initial impression that determines the priority of patient care; based on the patient’s surroundings, the mechanism of injury, signs and symptoms, and the chief complaint.
Glasgow Coma Scale (GCS)
An evaluation tool used to determine level of consciousness by evaluating and assigning point values (scores) for eye opening, verbal response, and motor response, which are then totaled; effective in helping predict patient outcomes.
Guarding
Contraction of the abdominal muscles indicating peritoneal irritation