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Patient Eval Test 1 > Ch. 4 General Survey, Vital Signs, Pain > Flashcards

Ch. 4 General Survey, Vital Signs, Pain Flashcards

1
Q

Fatigue is a common symptom of what?

A
  • Depression and anxiety
  • Infections (such as hepatitis, infectious mononucleosis, & tuberculosis)
  • Endocrine disorders (hypothyroidism, adrenal insufficiency, diabete mellitus, panhypopituitarism)
  • Heart failure
  • Chronic disease of the lungs, kidneys, or liver
  • Electrolyte imbalance
  • Moderate to severe anemia
  • Malignancies
  • Nutritional deficits
  • Medications
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2
Q

Weakness, especially if localized in a neuroanatomical pattern, suggests what?

A

Possible neuropathy or myopathy

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3
Q

What do recurrent shaking chills suggest?

A

More extreme swings in temperature and systemic bacteremia

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4
Q

What does feeling hot and sweating accompany?

A

Menopause

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5
Q

What do night sweats occur with?

A

Tuberculosis and malignancy

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6
Q

What do rapid changes in weight over a few days suggest?

A

changes in body fluids, not tissues

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7
Q

In what conditions is edema from extravascular fluid retention visible?

A

heart failure, nephrotic syndrome, and liver failure

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8
Q

What drugs are associated with weight gain?

A
  • tricyclic antidepressants
  • insulin & sulfonylurea
  • contraceptives, glucocorticoids, & progestational steroids
  • mirtazapine & paroxetine
  • gabapentin & valproate
  • propranolol
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9
Q

Causes of weight loss include what?

A
  • gastrointestinal diseases
  • endocrine disorders (diabetes mellitus, hyperthyroidism, adrenal insufficiency)
  • chronic infections, HIV/AIDS
  • malignancy
  • chronic cardiac, pulmonary, or renal failure
  • depression
  • anorexia nervosa or bulimia
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10
Q

Weight loss with relatively high food intake suggests what?

A
  • diabetes mellitus, hyperthyroidism, or malabsorption

- consider also binge eating (bulimia) with clandestine vomiting

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11
Q

What factors increase the likelihood of malnutrition?

A

poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, and drug abuse

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12
Q

What drugs are associated with weight loss?

A

anticonvulsants, anti-depressants, levodopa, digoxin, metformin, and thyroid medication

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13
Q

Metabolic syndrome risk factors increase the risk of what?

A

CVD and diabetes

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14
Q

According to the American Heart Association and the Institute of Medicine, what is the max sodium you should intake per day?

A

1,500 mg/day

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15
Q

What details should you observe when judging a patient’s apparent state of health?

A

Is the patient acutely or chronically ill, frail, or fit and robust?

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16
Q

Signs of cardiac or respiratory distress.

A

clutching of the chest, pallor, diaphoresis, labored breathing, wheezing, coughing

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17
Q

Signs of pain.

A

wincing, sweating, protectiveness of a painful area, facial grimacing, or an unusual posture favoring one limb or body area

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18
Q

Signs of anxiety or depression.

A

anxious facial expressions, fidgety movements, cold and moist palms, inexpressive or flat affect, poor eye contact, or psychomotor slowing

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19
Q

When assessing a patient’s skin, what should you take note of?

A

pallor, cyanosis, jaundice, rashes, bruises should be pursues

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20
Q

What might excess clothing on a patient reflect?

A

cold intolerance of hypothyroidism, hide skin rash or needle marks, mask anorexia, or signal personal lifestyle preferences

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21
Q

Patient’s wearing slippers or shoes with cut-out holes may indicate what?

A

gout, bunions, edema, or other painful foot conditions

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22
Q

What can run-down shoes contribute to?

A

foot and back pain, calluses, falls, and infection

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23
Q

Copper bracelets can be worn for what?

A

arthritis

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24
Q

Significance of “grown-out” hair and nail polish?

A

can help you estimate the length of an illness

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25
Q

What do fingernails chewed to the quick reflect?

A

stress

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26
Q

What can unkempt appearance be seen in?

A

depression and dementia, but this appearance must be compared with the patient’s probable norm

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27
Q

What does a blank stare suggest?

A

hyperthyroidism

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28
Q

What does an immobile face suggest?

A

parkinsonism

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29
Q

what does a flat or sad affect suggest?

A

depression

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30
Q

what does decreased eye contact suggest?

A

may be cultural or may suggest anxiety, fear, or sadness

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31
Q

Breath odors can indicate what?

A

the presence of alcohol, acetone (diabetes), pulmonary infections, uremia, or liver failure

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32
Q

What are other serious and potentially correctable problems from alcoholism?

A

hypoglycemia, subdural hematoma, or postictal state

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33
Q

When is there a preference for sitting upright?

A

in left-sided heart failure

34
Q

when is there a preference for leaning forward with arms braced?

A

in chronic obstructive pulmonary disease

35
Q

how do anxious patients appear?

A

agitated and restless

36
Q

how to patients in pain act?

A

they often avoid movements

37
Q

what motor activity should you look for in a patient?

A

tremors, other involuntary movements, or paralysis

38
Q

an impaired gait increases the risk of what?

A

falls

39
Q

what conditions can cause very short stature?

A

Turner’s syndrome, childhood renal failure, and achondroplastic and hypopituitary dwarfism

40
Q

what conditions cause long limbs in proportion to the trunk?

A

hypogonadism and Marfan’s syndrome

41
Q

what conditions cause height loss?

A

osteoporosis and vertebral compression fractures

42
Q

what causes generalized fat?

A

simple obesity

43
Q

what causes truncal fat with relatively thin limbs?

A

Cushing’s syndrome and metabolic syndrome

44
Q

what are causes of weight loss?

A

malignancy, diabetes mellitus, hyperthyroidism, chronic infection, depression, diuresis, and successful dieting

45
Q

what improves blood pressure control?

A

self-monitoring of blood pressure by well-instructed patients using approved devices (done twice a day at the upper arm with automatic readouts)

46
Q

what happens if the blood pressure cuff is too small (narrow)?

A

the blood pressure will read high

47
Q

what happens if the blood pressure cuff is too large (wide)?

A

the blood pressure will read low on a small arm and high on a large arm

48
Q

what happens if the brachial artery is 7 to 8 cm below heart level?

A

the blood pressure will read approximately 6 cm higher

49
Q

what happens if the brachial artery is 6 to 7 cm higher than the heart level?

A

the blood pressure will read 5 cm lower

50
Q

what does a loose cuff or a bladder that balloons outside the cuff lead to?

A

falsely high readings

51
Q

what can an unrecognized auscultatory gap lead to?

A

serious underestimation of systolic pressure or overestimation of diastolic pressure

52
Q

what should you do if you find an auscultatory gap?

A

record your findings completely

53
Q

what is an auscultatory gap associated with?

A

arterial stiffness and atherosclerotic disease

54
Q

when do the muffling point and disappearing point never disappear?

A

in aortic regurgitation

55
Q

when should you record both the muffling point AND the disappearing point when taking blood pressure?

A

if the difference is 10 mmHg or greater (in some people they are farther apart)

56
Q

When venous congestion makes the heart sounds less audible, what can this produce?

A

artificially low systolic and high diastolic pressures

57
Q

when do pressure differences of more than 10-15 mmHg occur?

A

in subclavian steal syndrome and aortic dissection

58
Q

what are the target “end organs” of hypertension?

A

the eyes, heart, brain, and kidneys

59
Q

What do hypertensive retinopathy, left ventricular hypertrophy, and neurologic deficits suggest?

A

stroke

60
Q

what does renal assessment require?

A

urinalysis and blood tests of renal function

61
Q

what does treatment of isolated systolic hypertension in patients 60 years or older reduce?

A

total mortality and both mortality and complications from cardiovascular disease

62
Q

Is a blood pressure of 110/70 mmHg normal?

A

usually is normal, but could also indicate significant hypotension if past pressures have been high

63
Q

what does a fall in systolic pressure of 20 mmHg ore more, especially when accompanied by symptoms and tachycardia, indicate?

A

orthostatic (postural) hypotension

64
Q

what can cause a fall in systolic pressure of 20 mmHg or more?

A

drugs, moderate or severe blood loss, prolonged bed rest, and diseases of the autonomic nervous system

65
Q

in what rare cases are patients pulseless?

A

due to occlusive disease in the arteries of the limbs from Takayasu arteritis, giant cell arteritis, or atherosclerosis

66
Q

what is white coat hypertension?

A

constitutes roughly 15-20% of Stage 1 hypertensives, the office blood pressure is high but ambulatory pressures are normal, so cardiovascular risk is low

67
Q

What does using a small cuff overestimate?

A

systolic blood pressure in obese patients

68
Q

palpation of an irregularly irregular rhythm indicates what?

A

atrial fibrillation

69
Q

what is needed to identify all irregular patterns?

A

an ECG is needed to identify the type of rhythm

70
Q

what does coarctation of the aorta result from?

A

narrowing of the thoracic aorta, usually proximal but sometimes distal to the left subclavian artery

71
Q

how are coarctation of the aorta and occlusive aortic disease distinguished?

A

by hypertension in the upper extremities and low blood pressure in the legs, and by diminished or delayed femoral pulses

72
Q

what is prolonged expiration common in?

A

COPD

73
Q

what does fever or pyrexia refer to?

A

elevated body temperature

74
Q

what does hyperpyrexia refer to?

A

extreme elevation in temperature, above 41.1 celsius (106 fahrenheit)

75
Q

what does hypothermia refer to?

A

an abnormally low temperature, below 35 celsius (95 fahrenheit) rectally

76
Q

what are causes of fever?

A

infection, trauma such as surgery or crush injuries, malignancy, blood disorders such as acute hemolytic anemia, drug reactions, and immune disorders such as collagen vascular disease

77
Q

what is the chief cause of hypothermia?

A

exposure to cold

78
Q

who is especially susceptible to hypothermia and less likely to develop a fever?

A

older adults

79
Q

what are other predisposing causes oh hypothermia, aside from exposure to cold?

A

reduced movement as in paralysis, interference with vasoconstriction from sepsis or excess alcohol, starvation, hypothyroidism, and hypoglycemia

80
Q

what do rapid respiratory rates tend to increase?

A

the discrepancy between oral and rectal temperatures (in these situations, rectal temperatures are more reliable)

81
Q

what kind of disorder may chronic pain be?

A

a spectrum disorder related to mental health and somatic conditions

82
Q

What are the four A’s to monitor patient outcomes of pain management?

A

Analgesia, Activities of daily living, Adverse effects, Aberrant drug-related behaviors

Patient Eval Test 1 (1 decks)

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