Clinical Flashcards

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1
Q

ABC

A

Airway, breathing, circulation

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2
Q

AD

A

Right ear (auris dexter)

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3
Q

AK

A

Above the knee

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4
Q

Ama

A

Autonomic nervous system

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5
Q

A&P

A

Anterior, posterior

Auscultation, percussion

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6
Q

AS

A

Left ear (auris sinister)

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7
Q

AU

A

Both ears (aures unitas)

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8
Q

A&W

A

Alive and well

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9
Q

BK

A

Below knee

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10
Q

BM

A

Bowel movement

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11
Q

BP, B/P

A

Blood pressure

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12
Q

BRAT

A

Bananas, rice, applesauce, toast diet

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13
Q

C

A

Celsius

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14
Q

CA

A

Cancer

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15
Q

CC, cc

A

Chief complaint

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16
Q

CNS

A

Central nervous system

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17
Q

C/O

A

Complains of

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18
Q

CXR

A

Chest xray

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19
Q

D&C

A

Dilation and curettage

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20
Q

DNR

A

Do not resuscitate

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21
Q

Dx

A

Diagnosis

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22
Q

EMS

A

Emergency medical service

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23
Q

ENT

A

Ears, nose, throat

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24
Q

Eq

A

Equivalent

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25
Q

ER

A

Emergency room

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26
Q

F

A

Fahrenheit

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27
Q

FH

A

Family history

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28
Q

F/u

A

Follow up

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29
Q

FUO

A

Fever of underdetermined origin

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30
Q

FYI

A

For your information

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31
Q

GI

A

Gastrointestinal

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32
Q

HBP

A

High blood pressure

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33
Q

HEENT

A

Head, ear, eye, nose, throat

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34
Q

H&P

A

History and physical

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35
Q

HR

A

Heart rate

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36
Q

HRT

A

Hormone replacement therapy

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37
Q

Hx

A

History

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38
Q

ICU

A

Intensive care unit

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39
Q

I&D

A

Incision and drainage

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40
Q

L&A

A

Light and accommodation

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41
Q

LBP

A

Lowe blood pressure

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42
Q

LMP

A

Last menstrual period

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43
Q

L&W

A

Living and well

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44
Q

MA

A

Mental age

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45
Q

N/O

A

No complaints

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46
Q

OD

A

Right eye (oculus dexter)

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47
Q

OS

A

Left eye (oculus sinister)

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48
Q

OU

A

Each eye (oculus uterque)

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49
Q

PE, ex

A

Physical examination

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50
Q

PERRLA

A

Pupils equal/round/reactive to light and accommodation

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51
Q

PH

A

Past history

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52
Q

PNS

A

Peripheral nervous system

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53
Q

WNL

A

Within normal limits

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54
Q

VS

A

Vital signs

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55
Q

UTI

A

Urinary tract infection

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56
Q

Tx

A

Treatment

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57
Q

TPR

A

Temperature, pulse, respiration

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58
Q

TIA

A

Transient ischemic attack

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59
Q

Sx

A

Symptoms

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60
Q

SOB

A

Shortness of breath

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61
Q

SID

A

Sudden infant death

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62
Q

SH

A

Social history

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63
Q

ROS

A

Review of system

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64
Q

ROM

A

Range of motion

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65
Q

REM

A

Rapid eye movement

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66
Q

Px

A

Prognosis

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67
Q

PT

A

Physical therapy

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68
Q

Asepsis

A
  • State of being free from pathogen
  • technique is use of measure that prevent contact with disease causing contaminants
  • elimination of infection is general goal of asepsis
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69
Q

Medical asepsis

A
  • maintain cleanliness, prevent spread of all pathogenic microorganisms, by good hygiene practice.
  • dermal patch application, oral/rectal tympanic temp measurement, venipuncture (thoroughly clean skin puncture site, hand washing, gloves), cerumen removal, proctoscopy, blood pressure measurement, eye irrigation or instillation
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70
Q

Medical aseptic Hand washing

A
  • keep hands lower than forearm

- with water running, dry hands with clear/dry paper towel, turn off faucet using clean/dry papertowel

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71
Q

Surgical asepsis hand washing

A
  • use sterile scrub brush
  • wash hand / forearms
  • hold hand higher than elbow
  • use sterile towel instead of paper towel
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72
Q

Surgical asepsis

A
  • Exclusion of all microorganism
  • most or all sterile invasive procedure: include venipuncture, parenteral administration, also used when gloving, setting up and maintain sterile tray
  • venipuncture / parenteral administration, suture removal, dressing change, urinary catheter insertion, minor laceration closure, minor laceration closure, sterile solution pouring, local infection incision and drainage, culture collection
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73
Q

Guideline for surgical asepsis

A

-1 inch border around sterile field considered contaminated
-hold sterile items above waist
-always face sterile field, never reach over field
-if must leave field, place sterile towel over it
-never cough/ sneeze over sterile field
-sterile object comes in contact with unsterile item, cannot be used
-if in doubt, do not use
-if field has bee broken, start all over with set up
-for venipuncture / parenteral administration
—must use and maintain sterile equipment for invasive procedure
—any introduction of sterile item in patient must always be performed with no-touch technique
—skin should not be touched in area of insertion after skin cleaned
—sterile device must not touch no sterile service

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74
Q

Antiseptic

A
  • used to cleanse infective agent from human skin and wound
  • alcohol wipes, sponges, cotton tip
  • prepare skin by using outward circular motion from incision site 2-5 minutes
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75
Q

Sanitization

A
  • cleaning of debris, blood, pathogenic microorganism from instrument, equipment, examine room
  • use of disinfectant or detergent solution with non metal brush
  • first step before disinfecting and sterilization
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76
Q

Disinfection

A
  • reduction of number of pathogenic microorganism on objects or in materials so they pose no threat of disease
  • use of chemicals on instruments, equipment, countertops
  • chemical: glutaraldehyde (cidex), chemical germicides, household bleach (sodium hypochlorite)
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77
Q

Sterilization

A

-destroy all microorganism by dry heat, steam heat, chemical or gases

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78
Q

Gas heat sterilization

A

For late equipment, used in hosptials

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79
Q

Dry heat sterilization

A

For instruments prone to corrosion

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80
Q

Chemical sterilization

A

For heat-sensitive equipment

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81
Q

Steam heat sterilization

A
  • Autoclave, for heat and moisture stable instruments and equipment
  • most common method in medical office
  • procedure: operate with distilled water, wrap instruments, steam temp must be 250-254 F, sterilize for 20-40 minutes, begin timing when indicators show the recommended temp and pressure, maximum shelf life for sterile pack is 30 days
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82
Q

History

A

Keep history of each patient medical treatment
-must be thorough to provide foundation for all current and future care of patient by practice
-area covered in patient history:
—presenting problem: reason for visit
—sign: observed, test results, exam resulted
—symptoms: patient provide information, child given opportunity to express symptoms in own word
—past and present disease
—medical problems
—medication, include over the counter
—pregnancy and births
—allergy and other peculiarities
—past surgery and injury
—social history: alcohol, drugs, sexual orientation
—mental health: past and present
—family history: cause of death, disease

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83
Q

Vital statistic

A

Vital signs plus menus ration (height and weight)

  • useful in assessing present health of patient, patient progress, diagnosis, variation from normal ranges of individual
  • tracking for patient illness
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84
Q

Vital signs

A

Measure vital sign to determine how well patient body is functioning
-include temperature, pulse, respiration and BP

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85
Q

Temperature

A

-average: 98.6 (F) or 37 (C)

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86
Q

Pyrexia

A

Medical term for fever

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87
Q

Febrile

A

Describes a patient with fever

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88
Q

Low body temperature causes

A

-blood loss, fainting, dehydration, fasting, central nervous system injury

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89
Q

Oral temperature

A
  • under tongue in mouth
  • 98.6 (F)
  • 36.8 (C)
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90
Q

Rectal

A

Rectum

  • 100 (R) (F)
  • 37.8 (R) (C)
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91
Q

Axillary

A

In armpit area (least accurate)

  • 97.6 (A) (F)
  • 36.4 (A) (C)
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92
Q

Tympanic

A

Eardrum (quick and easy)

  • adult: pull ear up and back
  • child: pull ear down and back
  • 100 (T) (F)
  • 37.8 (T) (C)
93
Q

Pulse

A
  • indicator of heart and blood vessel function
  • indirect measure of cardiac output
  • regular rhythm, rate, easy to palpate
  • apply gentle pressure on artery against bone at side, do not use thumb to measure
  • on infants require stethoscope
  • rate equal to number of heartbeat felt in a minute
  • rhythm regular recurrent expansion and contraction of artery
  • volume is strength, force of pulse
  • adult: 60-100
  • children: 70-120
94
Q

Temporal pulse

A

Over temporal bone on side of face

95
Q

Carotid pulse

A

Front of neck, next to trachea

96
Q

Apical

A

Lower left corner of heart, require stethoscope, used for infants

97
Q

Brachial pulse

A

Within bend of elbow

98
Q

Radial pulse

A

On thumb side of inner wrist

99
Q

Femoral pulse

A

Groin

100
Q

Popliteal pulse

A

Posterior of knee

-used to check for circulation

101
Q

Dorsalis pedis pulse

A

Top of foot, medically

-used to check for circulation

102
Q

Arrhythmia

A

Irregular heartbeat

103
Q

Bradycardia

A

Slow, regular beat: less than 60 bpm

104
Q

Bruit

A

Sound made by blockage in carotid artery

105
Q

Extrasystole

A

An extra beat, heart contraction, which interrupts normal regular rhythm of heart

106
Q

Pulse oximetry

A
  • Measure percentage of oxygenated hemoglobin
  • 95% or higher is normal
  • used to access pulmonary function of patient with pneumonia, bronchitis, emphysema, asthma
107
Q

Pulse pressure

A

Difference between systolic and diastolic reading

  • give tone of arterial wall
  • higher than 50 or lower than 30mm Hg is abnormal
108
Q

Tachycardia

A

Rapid, regular beat, greater than 90 bpm

109
Q

Respiration

A

Act of breathing

  • works with heart and circulation to remove waste product, provide nourishment to body cells
  • adult: 12-20 breath per minute
  • children 18-30 breath per minute
  • ratio of respiration to pulse rate is 1 breath to 4 pulse beats, evenly space, moderate depth, quiet
110
Q

Dyspnea

A

Difficult or painful breathing

111
Q

Eupnea

A

Normal breathing

112
Q

Exhalation

A

Lung deflate, diaphragm rise to assist lung

113
Q

Hyperpnea

A

Rapid, deep breathing

114
Q

Inspiration

A

Inhalation, lungs fill, diaphragm move down to allow expansion

115
Q

Tachypnea

A

Rapid breathing

116
Q

Blood pressure

A

Arterial pressure measurement

  • assessing health of patient heart and blood vessels
  • measure force of blood against artery wall
  • measured in millimeter of mercury (mm Hg)
  • common site: brachial artery-inside elbow of arm
  • left arm gives slightly higher reading
  • do not press thumb on stethoscope bell, thumb has a pulse
  • rises with age due to elasticity in blood vessels
  • first sound systolic
  • second sound diastolic
117
Q

Systolic

A

Pressure produced on artery vessel as left ventricle contracts, sends blood into artery.
Normal is less than 120 mm Hg

118
Q

Diastolic

A

Relaxation phase of heart left ventricle refills with blood

Normal is less than 80 mm Hg

119
Q

Korotkoff’s sound

A

Sounds between 1st and last sound

120
Q

Sphygmomanometer

A

Device used to measure BP
-dial: register pressure
-cuff: regulate flow of blood through blood vessel
-pressure bulb: used to pump air into cuff
—inflate cuff 20 mm Hg above point which radial pulse disappears
-control valve: controls release of air from cuff

121
Q

Vision test

A

May be done as part of routine physical exam

  • Snellen chart is used most often
  • chart made up of rows of letters
  • from top to bottom
  • letters in each row decrease in size
  • patient stands 20 ft from chart, each eye tested separate, both eyes together
  • measurement of 20/30 means smallest line an eye, less visual acuity, see at 20 ft is seen by normal eye at 30 ft
  • measurement 20/40-1 means smallest line an eye, with less visual acuity, sees at 20 ft is seen by normal eye at 40 ft minus 1
122
Q

Color blindness test

A
  • reader need to identify various character of set of 24 color test plates from pseudoIsochromatic plate Ishihara color vision test book
  • green and red blindness most common type of abnormal color perception
  • color blindness occurs more in male than female
123
Q

Auscultation

A

Listen to body sounds with stethoscope

124
Q

Inspection

A

Visual exam of patient

125
Q

Manipulation

A

Body part moved to assess range of motion

126
Q

Palpation

A

Touch skin surface, using some pressure to feel underlying organs to assess texture, temp, movement and shape

127
Q

Percussion

A

Listen to body sound by tapping to assess resonance of appropriate organ and body cavities

128
Q

Romberg balance test

A

Assess muscle abnormalities

-pt stands with feet together, eyes closed

129
Q

Newborn, infant, toddler exam

A

-length, weight are taken, plotted on growth chart
-immunization are done according to schedule
-Denver II developmental screening test:
—test screens gross, fine motor skills, personal skill, development
—administered periodically between 1 and 6 years of age

130
Q

Newborns

A

Assess for apgar score 1 and 5 minutes after birth

  • measure 5 signs: appearance (color), pulse, grimace (reflex to stimuli), activity (muscle tone), respiration
  • each sign scored with 0, 1, 2 and totaled
  • BP: 60-90/30-62
  • axillary temp: 98.2 F
  • receive 1st hep B immunization
131
Q

Infant/toddler

A

-infant up to 1 year old
-toddler 1-3 years old
-head circumference measure is made, just above eyebrow/top of ear
—performed until 36 months old
-infant pulse (apical): 100-160 with stethoscope for 1 minute, document with number and AP

132
Q

Supine position

A

For breast, ab, arm, leg, head, neck, EKG

-laying on back, arms to side

133
Q

Sitting position

A
  • examine head, chest, heart, back, arm, lungs, knee/ankle reflex
  • sitting upright on table, legs over side of table
134
Q

Sim’s position

A

Fexsigmoidoscopy, anal

-laying on left side, right knee bent, left leg straight, left arm behind back, right arm in front

135
Q

Dorsal recumbent

A
  • Examine head, neck, chest, heart

- laying on back, arms to side, knee bent, feet flat on table

136
Q

Protologic position

A

Examine anus / rectum

-laying on front side, bent at waist, knee bent

137
Q

Lithotomy position

A
  • examine female genitalia, endometrial biopsy

- laying on back, feet in stirrup

138
Q

Trendelenburg’s position

A
  • some surgical position, low BP, shock

- lying on back, head below rest of body

139
Q

Fowler’s position

A
  • examine head, neck, chest: for shortness of breath and low back pain
  • sitting up at 90 degree angle with back resting on table
140
Q

Prone

A

Examine back, feet, musculoskeletal

-lying on stomach, arms by head

141
Q

Knee-chest position

A

Examine anal, perianal, proctologic

-lying with front toward table, knee bent, arms by head

142
Q

Ishihara color number plate

A

Test for color blindness

143
Q

Nasal speculum

A

Check for structure of nose in adults

144
Q

Ophthalmoscope

A

Check health of eye

-red reflex indicate good health

145
Q

Otoscope

A

Examine inner structure of ear

146
Q

Pen light

A

Check pupil response to light, nasal passage, tongue, mouth

147
Q

Percussion hammer

A

Check reflexes

148
Q

Pin wheel

A

Check touch sensation

149
Q

Pupil toon meter

A

Test for glaucoma

150
Q

Snellen chart

A

Used most often to test vision

151
Q

Sphygmpmampmeter

A

Check BP

152
Q

Stethoscope

A

Used for auscultation

153
Q

Tape measure

A

Compare measurement of limbs, circumference of infant head

154
Q

Thermometer

A

Check temperature

155
Q

Tongue depressor/laryngeal mirror

A

Check mouth and throat

156
Q

Tuning fork

A

Used to assess hearing, size C most common

157
Q

Vaginal speculum

A

Check structure of vagina

158
Q

Cutting

A

Scissors, scalpel

159
Q

Grasping/clamping

A

Hemostat, forceps, clamp, needle holder

160
Q

Probing/dilating

A

Speculum, scope, probe, retractor, dilator

161
Q

Vaporizing tissue

A

Laser

162
Q

Sewing tissue

A

Suture

163
Q

Basal metabolic rate

A

Represent energy used while fasting or resting to maintain vital functions

164
Q

Metabolism

A

All chemical reaction occur within cells of living organism to allow for growth, reproduction, energy production, waste excretion-anabolism
Catabolism

165
Q

Anabolism

A

Use energy to construct components of cells

-proteins and nuclei acids

166
Q

Catabolism

A

Break down organic matter and receive energy by cellular respiration

167
Q

Calorie

A

Unit of heat energy

-amount of oxygen used

168
Q

Nutrients

A

Consist of carbohydrate, protein, fats

-essential to supply energy from chemical in food that body cannot synthesize

169
Q

Carbohydrate

A

For energy, classified by complexity

  • simple sugar: white bread, rice, potatoes, pasta
  • complex plant food: most vegetables and fruit produce
170
Q

Protein

A
  • build and repair body tissue

- composed of amino acids

171
Q

Fats

A
  • for energy and heat
  • saturated: animal fat
  • unsaturated: liquid at room temp
  • monounsaturated: olives, avocados
  • polyunsaturated: nuts, seeds
172
Q

Grain

A

Highest daily amount

-at least 3 oz of whole grain

173
Q

Vegetable

A

Variety: more dark green and orange

174
Q

Fruits

A

Variety: fresh, frozen, canned, dried, less juice

175
Q

Dairy

A

Low fat or no fat

176
Q

Meat and beans

A

Low-fat, lean meat, poultry, fish, nuts, beans

177
Q

Oils

A

Lowest daily amount

  • fish, nuts, vegetables
  • less solid fat (butter, shortening)
  • no trans fats
178
Q

Vitamin A

A

Fat soluble, beta carotene

Prevent night blindness

179
Q

Vitamin E

A

Fat soluble

Anticoagulant

180
Q

Vitamin D

A

Fat soluble, for calcium absorption

Lower risk of rickets and osteomalacia

181
Q

Vitamin K

A

Fat soluble, for blood clot, lower risk of hemorrhage

182
Q

Vitamin C

A

Water soluble, lower risk of scurvy, heal wounds, protect against infection

183
Q

Vitamin B

A

Water soluble, support metabolism, promote hemoglobin formation

184
Q

Calcium

A

Bone building, cardiac function, muscle contraction, blood coagulation

185
Q

Chloride

A

Body pH and fluid balance

186
Q

Phosphorus

A

Metabolism of protein, calcium, glucose

187
Q

Sodium

A

Body pH balance, muscle contraction control, level regulated by kidney

188
Q

Potassium

A

Protein synthesis, pH balance, heartbeat regulation

189
Q

Magnesium

A

Bone building, metabolism, enzyme activity

190
Q

Zinc

A

Growth, healing, sense of taste glucose tolerance

191
Q

Iron

A

Hemoglobin component needed for oxygen transport through body

192
Q

Thermotherapy

A

Application of dry, moist heat for pain relief, lower occurrence of muscle spasm, localized swelling, encourage tissue repair, encourage infected area drainage

193
Q

Diathermy

A

Type of termotherapy

  • produce heat in body tissue by high-frequency current
  • use for arthritis, tendonitis
194
Q

Ultraviolet

A

Type of thermotherapy

-controlled lamp exposure therapy

195
Q

Ultrasound

A

Type of thermotherapy

  • use water-soluble gel and high frequency sound waves
  • most common use of diathermy
196
Q

Cryotherapy

A
  • application of dry or moist cold
  • use for: vasoconstriction, involuntary muscle contraction, decrease blood supply to area, numbing effect on nerve ending, controlling bleed or swelling, pain
197
Q

Massage

A

Used to lower pain and muscle tension

198
Q

Electric muscle stimulation

A
  • transcutaneous electric nerve stimulation (TENS) unit use for orthopedics:
  • arthritis, back injury, sports injury
  • not for patient with cardiac disease or pacemakers due to electrical stimulation
199
Q

Traction

A
  • part of body pulled or stretch

- to align bone or relieve vertebral bone compression, reduce/relieve spasm/shortenings

200
Q

Walker

A

Mobility device

-top of walker should be just below waist, same height as top of hip bone, elbow bent 30 degrees while using

201
Q

Crutches

A

Should reach 1-1.5 inch below armpit

  • handgrips at top of hip line
  • patient stands on good leg, moves crutches ahead of good foot
202
Q

Medical emergencies

A
  • check scene for safety
  • check for life threatening condition: no sign of life, unconscious, convulsions, respiratory distress, severe bleeding, deep wound, chest or other severe pain
  • call 911
  • check second time: mental orientation, vital sign, skin color/moister, abnormal skin color, palpitate for pain, bone fracture, bleeding

-care for injured or ill person, if alone take action:
—call 911 first-if unconscious or sudden collapse of infant or child.
—care for up to 2 minutes: any drowning person, unwitnessed adolescent, child or infant collapse and unconscious

203
Q

ABC of cardiopulmonary resuscitation

A

CPR

  • A: check airways
  • B: look, listen, feel for breathing
  • C: check carotid artery for circulation (pulse)
204
Q

Medical office emergency equipment

A
  • cardiac code cart
  • oxygen with mask delivery
  • cold packs
  • wound care kit
  • personal protective equipment
  • childbirth or delivery kit
205
Q

First degree burns

A

Red, no blister

Tx: immerse in cool water, apply sterile, cool, wet compress

206
Q

Second degree burn

A

Red, blistering

-tx: immerse in cool water 1-2 hours, cover with dry sterile dressing

207
Q

Third degree burn

A
  • full skin thickness, may involve muscle
  • tx: cover with thick, dry sterile dressing/dressing soaked in sterile saline solution if available
  • do not pull off adhere clothing because of infection and dehydration
208
Q

Chemical burn

A
  • if powered agent: try to brush off

- if not, rinse copiously, cover with sterile dressing

209
Q

Myocardial infarction

A

S/s: chest pain, left arm pain, jaw pain, sweating, indigestion, rapid respiration, nausea, vomiting
-care: active EMS, get code cart/oxygen, check ABC if needed, check vital sign, keep patient calm

210
Q

Convulsion

A
  • S/s: jerking, spasmodic body movement, loss of consciousness
  • care: activate EMS, protect head, maintain airway
211
Q

Stroke

A

Cerebrovascular accident

  • S/S: slurred speech, confusion, paralysis to 1 side of body, unequal pupils
  • care: activate EMS, maintain airway, check vital sign, keep patient calm
212
Q

Bleeding from limb, head or neck

A

Elevate injured part above heart if possible

213
Q

Severe bleeding

A
  • apply direct pressure with sterile compress
  • add more compress as needed, do not replace used compress, it disturb clotting process
  • life or death situation: last resort is tourniquet application, not time of application
214
Q

Syncope

A
  • s/s: unconsciousness result from drop in BP or low level of oxygen
  • care: place in supine position with head lower than heart
  • maintain open airway
  • apply cool compress to forehead
  • loosen tight clothing
215
Q

Shock

A
  • s/s: cool, pale, moist skin, low BP, weak / rapid pulse, agitation, restlessness, dyspnea, weakness
  • care: active EMS, maintain airway, place in Trendelenburg’s position (if no head injury), check vitals, keep patient warm
216
Q

Anaphylactic

A

Severe allergic reaction

-low blood pressure, edema, tachycardia, dyspnea

217
Q

Cardio genie

A

Impaired cardiac function

218
Q

Hypovolemic

A

Hemorrhagic, low blood volume

219
Q

Insulin

A

Severe hypoglycemia

220
Q

Neurogenic

A

Trauma to nervous system

-fainting (blood vessel dilate, loss of tone, low BP, heart rate)

221
Q

Septic

A

Infection spread by blood to all body systems

222
Q

Traumatic

A

Loss of interstitial fluid

-large burn areas

223
Q

Ashtma

A

Narrowing airway causing breathing difficulty or wheezing sound
-care: check ABC, patient upright, if possible, assist with inhaler, monitor oxygen with pulse oximeter, keep patient calm

224
Q

Hyperventilation

A

Leading to lower carbon dioxide level results in dizziness or unconsciousness
-care: place paper bag over patient nose and mouth, have patient breath slow and calm

225
Q

Choking

A

Coughing audibly
-encourage patient to continue coughing
clutching throat, unable to produce sound
-perform himlich’s maneuver: bear hug from behind, 1 hand cover balled fist below ribs/above navel, pull in upward thrusts to dislodge foreign object

226
Q

Fractures

A

Care: immobilize with splint, elevate (if possible), apply ice packs, use sling for fractured clavicle or arms

227
Q

Inhaled, ingested, injected poisoning: chemical or natural

A
Activate EMS
Call poison control for instructions
Use personal protective equipment
Check ABC
Check vitals
228
Q

Insulin shock

A

Moist, pale, rapid heart rate, confusion

-care: give food containing sugar will rapidly absorbed (orange juice/glucose gel)

229
Q

Diabetic coma

A
  • s/s: dry, flushed skin, fruity breath, extreme thirst, confusion, rapid respiration
  • care: activate EMS, provider must administer insulin