Day 3 - Patient Assessments

Question 1

What are cranial nerves 3, 5, 7, 9, 10, 11, 12, and what do they control?

Answer 1

CN III Oculomotor
*
CN V Trigeminal
*
CN VII Facial
*
CN IX (9) Glossopharyngeal
*
CN X Vagus
*
CN XI (11) Spinal Accessory
*

Question 2

What are the components of GCS?

Answer 2

Eye opening: E1-4
Verbal response: V1-5 (T)
Motor response: M1-6

Question 3

Decorticate vs. decerebate

Answer 3

Decorticate
* abnormal flexion
* elbows/wrists bent

Decerebrate
* abnormal extension
* elbows straight/wrists bent
* worse on GCS

Question 4

What are the 3 subtypes of delirium?

Answer 4

Hypoactive - decreased LOC
Hyperactive - agitiation
Mixed - fluctuates

Question 5

What does Central pain vs. peripheral pain assess?

Answer 5

Central pain assesses arousal and higher levels of brain function.
Peripheral pain is used to assess eye opening, may ilicit spinal reflex: not good for motor response

Question 6

What are 3 pain assessment tools?

Answer 6

Visual scale - they identify a face that they relate to
Numeric rating scale - they rate their pain 1-10
Behaviour Pain Scale CPOT - they are unable to explain, we assess based on behaviour

Question 7

What are 2 pain and sedation assessment tools?

Answer 7

Sedation Agitation Score (SAS)
* 1 (unarousable) - 7 dangerously agitated

Richmond agitation sedation scale (RASS)
* -5 (unarousable) - +4 danger to staff, violent

Question 8

What are the two delirium assessment tools?

Answer 8

Intensive care delirium screening checklist (ICDSC)
* 1-8 total points
* 4+ is positive

Confusion assessment method for ICU (CAM-ICU)
* 4 features
* positive when both 1-2 are + plus 3 OR 4

Question 9

What are the anterior respiratory landmarks? Where?

Answer 9

Suprasternal notch - superior sternum
Angle of Louis - below sternum
Medistinal line - midline chest
Midclavicular line - midclavicle down
Midaxillary line - armpit down
2nd rib
Lung boundaries

Question 10

What are the normal breath sounds?

Answer 10

Bronchial
Bronchovesicular
Vesicular

Question 11

What are the cardiac landmarks?

Answer 11

A PEt Monkey
Aortic
Pulmonic
Erbs point
Tricuspid
Mitral

Question 12

Normal vs. abnormal heart sounds

explain how they are made

Answer 12

Normal: S1 (closure of mitral and tricuspid valves) & S2 (closure of aortic and pulmonic valves)

Abnormal
S3 (can be norm. for young patients)
* heard after S2
* rapid early filling in diastole with rush of blood hitting noncompliant ventricle
* SLOSH-ing-in

S4
* heard before S1 & S2
* atrial kick pushes blood into noncompliant ventricle
* a-STIFFF-wall

Murmurs, pericardial friction rub, bruits

Question 13

Differentiate murmurs, pericardial friction rub, bruits

Answer 13

Murmurs
* turbulent blood flow caused by valves, defects, dilated chambers

Pericardial friction rub
* grating sound
* inflammation of the pericardium
* heard most at Erbs point
* caused by MI, cardiac surgery

Bruits
* swishing sound
* narrowing/partial obstruction of an artery = turbulent flow

Question 14

What are the abdominal quadrants?

Answer 14

Separated by a cross over the umbilicus
RLQ, RUQ, LUQ, LLQ

Question 15

What organs are in each quadrant?

Answer 15

RUQ
* duodenum
* liver
* gallbladder
* transverse colon
* small intestine
* right kidney

RLQ
* appendix
* ascending colon
* small intestines
* rt ureter
* reproductive organs
* fallopian tube, ovary, spermatic cord

LLQ
* descending colon
* sigmoid colon
* small intestine
* left ureter
* reproductive organs

LUQ
* stomach
* pancreas
* spleen
* transverse colon
* left kidney

Question 16

What are the types of feeding tubes?

What are their indications?

Answer 16

NG - temporary, awake patients
OG - temporary, intubated patients
Kaofeed tube - small bore, weighted tip
NJ - for patients not absorbing
PEG - permanent / long term requirements
PEJ - long term requirements with poor absorptions in the stomach