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Health Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is subjective data?

A

What a patient says about himself or herself during history taking.

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2
Q

What is objective data?

A

Observed when inspecting, percussing, palpating, and auscultating patient during physical examination

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3
Q

What is database?

A

Formed from objective data, subjective data, and the patient’s record and laboratory studies.

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4
Q

Name the steps of the nursing process in order:

A
  1. Assessment
  2. Diagnosis
  3. Outcome identification
  4. Planning
  5. Implementation
  6. Evaluation
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5
Q

What takes place during the assessment phase of the nursing process?

A
  • Collect data
  • Use evidence based assessment techniques
  • Document relevant data
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6
Q

What happens during the diagnosis phase of the nursing process?

A
  • Compare clinical findings with normal and abnormal variations
  • Interpret data:
    • identify clusters of clues
    • make hypothesis
    • test hypothesis
    • derive diagnosis
  • Validate inferences based on findings
  • Document the diagnosis
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7
Q

What is a cue?

A

A piece of information, a sign or symptom, laboratory result or imaging result

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8
Q

What is a hypothesis?

A

A possible explanation for the cue or set of cues

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9
Q

What is the outcome identification part of the nursing process?

A
  • Identify expected outcomes that are for that individual person
  • Establish realistic and measurable outcomes
  • Develop a time line
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10
Q

What is the planning part of the nursing process?

A
  • Establish priorities
  • Set time lines
  • Document plan of care
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11
Q

What is the implementation step of the nursing process?

A
  • Implement in a safe and timely manner
  • Use evidence based interventions
  • Collaborate with colleagues
  • Coordinate care delivery
  • Provide health teaching
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12
Q

What is the evaluation step of the nursing process?

A
  • Progress toward outcomes
  • Conduct systematic, ongoing, criterion-based evaluation
  • Use ongoing assessment to revise diagnoses, outcomes, plan
  • Disseminate results to patient and family
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13
Q

What are the priority problems levels?

A

1 - First-level priority
2- Second-level priority
3- Third-level priority
4- Collaborative problems

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14
Q

What are first-level priorities?

A

Emergent, life threatening, and immediate

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15
Q

What are Second-level priorities?

A

Next in urgency, requiring attention so as to avoid further deterioration

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16
Q

What are third-level priorities?

A

Important but can be addressed after more urgent problems

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17
Q

Current and best clinical practice based on research standards focused on systematic reviews of randomized clinical trials (RCTs)

A

Evidence-based assessment

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18
Q

What is RCTs?

A

Randomized clinical trials

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19
Q

What is EBP?

A

Evidenced-based practice (Research into practice)

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20
Q

What should evidence-based assessment be used in conjunction with?

A

Should be used in conjunction with provider experience to lead to better health outcomes for patients

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21
Q

What are the four types of databases that can be collected from patient?

A

1 - Complete total health database
2 - Episodic / problem-centered database
3 - Follow-up database
4 - Emergency database

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22
Q

When would a complete total health database be used?

A

When a patient is a new admission to a hospital

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23
Q

What is a complete total health database?

A
  • complete health history and full physical examination

- describes current and past health state and forms baseline to measure all future changes

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24
Q

What is an episodic or problem-centered database?

A
  • Used for limited or short-term problems
  • Collect “mini” database, more focused than a complete database
  • Concerns mainly one problem
  • History and examination follow direction of presenting concern
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25
Q

What is a follow-up database?

A
  • Status of all identified problems should be evaluated at regulate and appropriate intervals
  • Note changes that have occurred
  • Evaluate whether problem is getting worse or better
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26
Q

What is an emergency data base?

A
  • Rapid collection of data, often compiled concurrently with lifesaving measures
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27
Q

What is a biomedical model?

A

Looking at only biological factors when diagnosing and treating a condition

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28
Q

What is clustering?

A

Interpreting data by identifying clusters of cues

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29
Q

What does EBP stand for?

A

Evidence based practice

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30
Q

What does NANDA stand for?

A

North American Nursing Diagnosis Association

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31
Q

How far should you sit from your patient during the interview?

A

You should social distance (sit 6 feet away)

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32
Q

What is the point of the interview?

A
  • Subjective data collection
  • Patient perception of health
  • First step in the therapeutic relationship
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33
Q

What is the goal of the interview?

A

Identify health strengths and problems as a bridge to the physical examination

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34
Q

What type of data does the interview collect?

A

Subjective data (what the person says about his or her health)

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35
Q

Why is collecting subjective data so important?

A

Because the patient knows everything about their health and the nurse knows nothing

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36
Q

What are characteristics of a successful interview?

A
  • Gather complete and accurate data, including description and chronology of any symptoms of illness
  • Establish rapport and trust so person feels free to share all relevant data
  • Patient teaching (health promotion/prevention)
  • Building a relationship of open communication and trust
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37
Q

What expectations should be set before the interview?

A
  • Time and place of interview and physical exam
  • Introduction and role
  • Purpose of interview
  • How long it will take
  • Expectation of participation
  • Presence of others (family, etc.)
  • Confidentiality and to what extent it may be limited
  • Any costs that the patient must pay
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38
Q

What are the external factors to keep in mind during communication during the interview?

A
  • Ensure privacy
  • Refuse interruptions
  • Physical environment (no music, lights up, med temp room)
  • Dress is appropriate for setting
  • Note-taking may be unavoidable
  • Tape and video recording
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39
Q

What are some things to keep in mind when introducing yourself to a patient?

A
  • Always introduce yourself, even if you have taken care of them before
  • Call them by Mr. Mrs. or Ms. and their last name
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40
Q

What are open-ended questions?

A
  • Questions that ask for narrative responses

- Questions that state the topic only in general terms

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41
Q

What type of question should be mostly used during the interview?

A

Open-ended questions

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42
Q

When should open-ended questions be used?

A
  • To begin the interview
  • To introduce a new section of questions
  • Whenever the patient introduces a new topic
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43
Q

What are closed or direct questions?

A
  • Questions that ask for specific information

- Questions that elicit a short one or two word answer, a yes or no answer, or a forced choice

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44
Q

When should direct questions be used during the interview?

A
  • After opening narrative to fill in details person may have left out
  • When you need many specific facts about past health problems or during review of systems
  • To move the interview along
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45
Q

What is a reflection?

A
  • Restating back what the client said

- Is a statement, not a question

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46
Q

When should a reflection be used with a client?

A

Can be used to encourage or keep exploring an issue without additional questions

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47
Q

How do you use a reflection with a client?

A
  • Start with “You feel…”, “You’re wondering…” , “It sounds like…”
  • May use new words, but much of the reflection should be the same as what the client said
  • Voice inflection should go down. Should not be said as a question.
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48
Q

What is a summary statement?

A
  • Summaries are longer reflections

- Collection of main themes from the section just completed

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49
Q

When should a summary statement be used?

A
  • Can be used to consolidate several pieces of information
  • When transitioning to a new topic
  • To finish a conversation
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50
Q

How do you make a summary statement to your client?

A

Repeat back the important parts of what the client told you. Always end with asking “What did I miss?”

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51
Q

What should the interview always end with?

A

A positive comment:

  • Affirmation
  • Acknowledgement
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52
Q

What is an affirmation?

A

Find a positive attribute about that person

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53
Q

What is an acknowledgement?

A

State your appreciation for that person

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54
Q

What are the 10 traps of interviewing?

A 
1- Providing false assurance or reassurance
2- Giving unwanted advice
3- Using authority
4- Using avoidance language
5- Engaging in distancing
6- Using professional jargon
7- Using leading or biased questions
8- Talking too much or too fast
9- Interrupting
10- Using too many “why” questions
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55
Q

What are some things to remember when considering gender during the interview?

A
  • Beware of maintaining cultural norms during interview and examination process
  • Maintaining privacy and modesty
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56
Q

What are some things to keep in mind about sexual orientation during the interview process?

A
  • Maintaining neutrality related to patient’s presentation by being mindful of communication patterns
  • Being aware of your own personal bias and baggage
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57
Q

Biographical Data to be collected from patient:

A 
1- Name
2- Address and phone number
3- Age and birth date
4- Birthplace
5- Sex
6- Marital status
7- Race
8- Ethnic origin
9- Primary language and if interpreter is needed
10- Occupation: usual and present
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58
Q

What considerations need to be taken about the source of patient’s history?

A
  • Record who furnishes information
  • Judge reliability of informant and how willing he or she is to communicate
  • Note any special circumstances, such as use of interpreter
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59
Q

What is one way to gauge whether an informant is reliable?

A
  • A reliable person always gives the same answers when questions are rephrased or are repeated later in interview
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60
Q

What should be asked after taking the patient’s demographics?

A

Reason for seeking care

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61
Q

What is Reason for Seeking Care and how should it be written?

A

Why is the patient there?

Should be enclosed in quotation marks to indicate patient’s exact words

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62
Q

What is another name for “Reason for seeking care”

A

Chief complaint

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63
Q

What information goes in Present Health or History of Present Illness section?

A
  • Location of pain
  • Character or quality
  • Quantity or severity
  • Timing
  • Setting
  • Aggravating or relieving factors
  • Associated factors (does this happen every time you…?)
  • Patient’s perception (ask pt what they feel like is happening)
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64
Q

Which section does the subjective data collected from patient go?

A

In the “present health” or “history of present illness” section

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65
Q

What is included in past medical history?

A
  • childhood illnesses
  • accidents or injuries
  • serious or chronic illnesses
  • hospitalizations
  • operations
  • obstetric history
  • immunizations
  • last examination date
  • allergies
  • current medications
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66
Q

What needs to be documented for the patient’s medications?

A
  • drug name
  • dose
  • route
  • times per day
  • last does taken
    (Can also ask what they take it for if unsure)
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67
Q

What information is needed when asking about family history?

A
  • Age and health or cause of death of relatives
  • Health of close family members (immediate family members and grandparents)
  • Family history of various conditions
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68
Q

What are some examples of conditions in the family history that would be good to know?

A
  • heart disease
  • high blood pressure
  • stroke
  • diabetes
  • cancer
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69
Q

What systems do we need to ask the patient about?

A

general overall health state, skin, hair, head, eyes, ears, nose and sinuses, mouth and throat, neck, breast, axilla, respiratory system, cardiovascular, peripheral vascular, gastrointestinal, urinary system, male genital system, female genital system, sexual health, musculoskeletal system, neurologic system, hematologic system, endocrine system

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70
Q

What are the five steps to evidence-based practice?

A 
1- Ask the clinical question
2- Acquire sources of evidence
3- Appraise and synthesize evidence
4- Apply relevant evidence in practice
5- Assess the outcomes
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71
Q

What is facilitation as an examiners verbal response while talking with a patient?

A

A response that encourages the client to say more and shows them that you are interested
Ex: “go on”, nodding yes, maintaining eye contact

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72
Q

Why would an examiner use silence when talking with a patient?

A
  • lets the client know they have time to think
  • gives you a chance to observe client
  • give client a chance to not be interrupted and not lose train of thought
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73
Q

What is empathy and why would it be used when talking with a client?

A
  • Names a feeling and allows its expression
  • Allows person to feel accepted and strengthens rapport
  • Useful when client hasn’t identified the feeling or isn’t ready to discuss it yet
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74
Q

When is clarification useful when talking with a patient?

A
  • Useful when the patient’s word choice isn’t clear

- summarizes the person’s word and simplifies the statement to ensure you are on the right track

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75
Q

What is confrontation when talking with a client?

A
  • Clarifying inconsistent information

- Focusing client’s attention on an observed behavior, action, or feeling

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76
Q

What is interpretation when talking with a client?

A
  • Links events, makes associations, and implies cause
  • Not based on direct observations but instead on inference or conclusion
  • Your interpretation may be incorrect but helps prompt further discussion
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77
Q

What is an explanation when talking with a client?

A
  • Informing the person

- Sharing factual and objective information

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78
Q

What are the different types of nonverbal behaviors we should keep in mind toward our patient during an interview?

A
  • appearance, whether you’re standing or sitting, where you are in relation to the patient, your posture, how you are leaning, if you’re distracted vs engaged, facial expression, eye contact, tone of voice, rate of speech, touch
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79
Q

What are the four different distance zones? And how far is each zone from the patient?

A

1- Intimate zone (0 to 1.5ft)
2- Personal distance (1.5 to 4ft)
3- Social distance (4 to 12ft)
4- Public distance (12+ft)

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80
Q

Remarks about the intimate zone, what is it used for?

A
  • Visual distortion occurs

- Best for assessing breath and body

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81
Q

Remarks about personal distance

A
  • Perceived as an extension of the self, similar to a bubble
  • Voice moderate
  • Body odors apparent
  • No visual distortion
  • Much of physical assessment occurs at this distance
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82
Q

Remarks about social distance

A
  • Used for impersonal business transactions
  • Perceptual information much less detailed
  • Much of interview occurs at this distance
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83
Q

Remarks about public distance

A
  • Interaction with others is impersonal
  • Speaker’s voice must be projected
  • Subtle facial expressions imperceptible
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84
Q

What age is a patient in the sensorimotor stage?

A

Birth to 2 years

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85
Q

What age is a patient in the preoperational stage?

A

2-6 years

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86
Q

What age is a patient in the concrete operations stage?

A

7-11 years

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87
Q

What age is a patient in the formal operations stage?

A

12+ years

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88
Q

Characteristics of the sensorimotor phase

A
  • Infant learns by manipulating objects

- At birth reflexive communication, then moves though 6 stages to reach actual thinking

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89
Q

Characteristics of preoperational stage

A
  • Beginning use of symbolic thinking
  • Imaginative play
  • Masters reversibility
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90
Q

Characteristics of concrete operations stage

A
  • Logical thinking

- Masters use of numbers and other concrete ideas such as classification and conservation

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91
Q

Characteristics of the formal operations stage

A
  • Abstract thinking. Futuristic; takes broader, more theoretical perspective
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92
Q

Language development during sensorimotor stage

A
  • Communication largely nonverbal
  • Vocab of more than 4 words by 12 mo.
  • Increases to over 200 and use of short sentences before 2 yrs
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93
Q

Which senses does a nurse use?

A
  • Sight
  • Smell
  • Touch
  • Hearing
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94
Q

Skills performed during assessment, in order:

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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95
Q

What is inspection?

A

Close, careful scrutiny, first of the whole person and then of each body system

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96
Q

When does inspection start?

A

Begins when you first meet the patient

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97
Q

What should the assessment of each body system start with?

A

Inspection

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98
Q

What is the first step of assessment?

A

Inspection

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99
Q

What does inspection require?

A
  • Good lighting
  • Adequate exposure
  • Occasional use of instruments
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100
Q

What is the second step of assessment?

A

Palpation

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101
Q

What are we feeling when we palpate?

A
  • Texture
  • Temperature
  • Moisture
  • Organ location and size
  • Swelling, vibration, or pulsation
  • Rigidity or spasticity
  • Crepitation
  • Presence of lumps or masses
  • Presence of tenderness or pain
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102
Q

What are the types of palpation techniques?

A
  • Fingertips
  • Fingers and thumb
  • Dorsa of hands and fingers
  • Base of fingers or ulnar surface of hands
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103
Q

What do we use our fingertips to palpate?

A

Best for fine tactile discrimination of skin texture, swelling, pulsation, determining presence of lumps

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104
Q

What are the fingers and thumb used for during palpation?

A

Detection of position, shape, and consistency of organ or mass

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105
Q

What are the dorsa of hands and fingers used for during palpation?

A

Best for determinng temperature because skin here is thinner than on palms

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106
Q

What are the base of fingers or ulnar surface of hand used for during palpation?

A

Best for vibration

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107
Q

Explain the sequence of events used during palpation?

A
  • Light palpation first
  • Deeper palpation when needed (use intermittent pressure)
  • Bimanual palpation
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108
Q

When should deeper palpation not be used?

A

In there is a situation in which deep palpation could cause internal injury or pain

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109
Q

What is bimanual palpation?

A

Requires use of both hands to envelop or capture certain body parts or organs for more precise delimitation

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110
Q

What is the third step of the assessment process?

A

Percussion

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111
Q

What is percussion?

A

Tapping person’s skin with short, sharp strokes to assess underlying structures

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112
Q

What is percussion used for?

A
  • Mapping location and size of organs
  • Signaling density of a structure by a characteristic sound
  • Detecting a superficial abnormal mass
  • Eliciting pain if underlying structure is inflamed
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113
Q

What are the characteristics of sound we listen for during percussion?

A
  • Amplitude
  • Pitch
  • Quality
  • Duration
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114
Q

What is amplitude?

A

Is the sound loud or quiet?

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115
Q

What are we listening to pitch for?

A

To determine if it’s high pitch or low pitch

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116
Q

What are we listening to when determining the quality of the sound while doing percussion?

A

A subjective difference caused by the distinctive overtones of a sound (clear or hollow, booming, muffled thud, a dead stop, etc.)

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117
Q

What are we listening to when determining the duration of a sound during percussion?

A

The length of time the note lingers

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118
Q

What is the fourth step in assessment?

A

Auscultation

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119
Q

What is auscultation?

A

Listening with a stethoscope

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120
Q

How does a stethoscope work?

A

It does not magnify sound, but it blocks out extraneous sounds

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121
Q

What is the diaphragm of a stethoscope used for?

A

Listening to high pitched sounds

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122
Q

What is an example of sounds the diaphragm used to listen to?

A

Lung sounds, some heart sounds, bowel sounds

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123
Q

What type of pressure should be used when using the diaphragm of a stethoscope?

A

Firm pressure

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124
Q

What type of pressure should be used when using the bell part of the stethoscope?

A

Light pressure

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125
Q

What type of sounds is the bell of a stethoscope used to listen to?

A

Lower pitched sounds

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126
Q

What are some examples of sounds the bell of the stethoscope would be used to listen to?

A 
Some heart sounds
Vascular sounds (blood flow sounds)
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127
Q

Describe correct placement of the diaphragm?

A

Applied tightly and firmly to the skin

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128
Q

Describe the correct placement of the bell?

A

Applied lightly to the skin

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129
Q

The single most important step to decrease infection

A

Wash your hands

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130
Q

When should you wash your hands (or use hand sanitizer)?

A
  • Before and after physical contact with each patient
  • After contact with blood, body fluids, secretions, and excretions
  • After removing gloves
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131
Q

When should you wear gloves?

A
  • When potential exists for contact with any body fluids
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132
Q

If there is potential for blood or body fluid spattering, what should you do?

A

Wear a gown, mask, protective eyewear, and gloves

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133
Q

List the different types of percussion notes that can be heard

A
  • resonant
  • hyperresonant
  • tympany
  • dull
  • flat
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134
Q

What are characteristics of a resonant percussion note?

A
  • Medium-loud amplitude
  • Low pitch
  • Clear, hollow quality
  • Moderate duration
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135
Q

Example of where a resonant percussion note can be heard?

A

Over normal lung tissue

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136
Q

What are the characteristics of a hyperresonant percussion note?

A
  • Louder amplitude
  • Lower pitch
  • Booming quality
  • Longer duration
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137
Q

What is an example of where a hyperresonant percussion note can be heard?

A
  • Normal over child’s lung

- Abnormal in the adult, over lungs with increased amount of air as in emphysema

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138
Q

What are the characteristics of a tympany percussion note?

A
  • Loud amplitude
  • High pitch
  • Musical and drumlike quality
  • Longest duration
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139
Q

What is an example of where a tympany percussion note can be found?

A

Over air-filled viscus (e.g. the stomach, the intestine)

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140
Q

What are the characteristics of a dull percussion note?

A
  • Soft amplitude
  • High pitch
  • Muffled thud quality
  • Short duration
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141
Q

What is an example of where a dull percussion note can be found?

A

Relatively dense organ as liver or spleen

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142
Q

What are the characteristics of a flat percussion note?

A
  • Very soft amplitude
  • High pitch
  • A dead stop of a sound, absolute dullness quality
  • Very short duration
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143
Q

What is an example of where a flat percussion note can be heard?

A

When no air is present, over thigh muscles or bone, or over a tumor

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144
Q

What does the term Standard Precautions mean?

A

It is the principle that all fluids, etc. could contain transmissible infectious agents.

So, precautions apply to all patients:

  • hand hygiene
  • use of PPEs
  • respiratory hygiene/cough ettiquite
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145
Q

What is a nosocomial infection?

A

A health care-associated infection

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146
Q

What are considered vital signs?

A
  • Temperature
  • Pulse
  • Respirations
  • Blood pressure
  • Blood oxygen
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147
Q

How does the body maintain a steady temperature?

A
  • Through a feedback mechanism which is regulated in the hypothalamus of the brain
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148
Q

How can the body’s temperature become unbalanced?

A

Due to outside temperatures or infection

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149
Q

Routes of measuring a patient’s temperature

A
  • Oral sublingual
  • Rectal
  • Axillary
  • Tympanic membrane
  • Temporal artery
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150
Q

What is a normal oral temperature of a resting person?

A

37 degrees celcius

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151
Q

What is a normal oral temperature range?

A

35.8 - 37.3 degrees Celcius

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152
Q

What is the most used route to take a patient’s temperature, and why?

A

Oral sublingual site

Because it’s accurate and convenient

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153
Q

What is a reason someone’s oral temperature my not be accurate?

A

If they just drank something cold

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154
Q

What is the most accurate route of tempature measurement?

A

Rectal

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155
Q

When would a patient’s temperature be taken rectally?

A

If they are:

  • comatose
  • confused
  • in shock
  • cannot open or close mouth
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156
Q

What bodily temperature indicates hyperthermia?

A

Greater than 38 degrees Celsius

Greater than 100.4 degrees F

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157
Q

What temperature indicates hypothermia?

A

Less than 36 degrees Celsius

Less than 96.8 degrees F

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158
Q

A patient has a temperature of 39 degrees Celsius. They have? Spelling?

A

Hyperthermia

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159
Q

A patient has a temperature of 35 degrees Celsius. They have? Spelling?

A

Hypothermia

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160
Q

What is normal temperature influenced by?

A
  • Diurnal cycle
  • Menstruation cycle in women
  • Exercise
  • Age
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161
Q

What is the diurnal cycle?

A

Temperature raises 1 - 1.5 degrees F in the late afternoon / evening

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162
Q

What happens to someone’s temperature during their menstruation cycle?

A
  • Progesterone secretion during ovulation at midcycle

- Causes a 0.5 - 1 degree F rise in temperature that continues until menses

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163
Q

How can exercise affect body temperature?

A

Moderate to hard exercise increases body temperature

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164
Q

How does age affect body temperature?

A
  • Wider normal variations occur in infant and young children (they have less effective heat control mechanisms)
  • In older adults, temperature is usually lower with a mean of 36.2 degrees C
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165
Q

What is the mean body temperature of older adults?

A
  1. 2 degrees C

97. 2 degrees F

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166
Q

What is pulse a measurement of?

A

Stroke volume

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167
Q

What is stroke volume?

A

Amount of blood every heart beat pumps into aorta

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168
Q

How does stroke volume cause pulse?

A

Force flares arterial walls and generates pressure wave, felt in periphery as pulse

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169
Q

What information is gained from palpating a peripherial pulse?

A
  • Gives rate and rhythm of heartbeat

- Gives local data on condition of artery

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170
Q

Pulse point usually palpated while measuring vital signs

A

Radial pulse

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171
Q

How would you palpate the radial pulse?

A
  • Use pads of first three fingers
  • Radial pulse is at flexor aspect of wrist, laterally along radius bone
  • Push until strongest pulsation is felt
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172
Q

What is documented after taking someone’s pulse?

A
  • Rate
  • Rhythm
  • Force
173
Q

If rhythm of pulse is regular, how should you count?

A

Count number of beats in 30 seconds and multiply by 2

Start counting after 1st beat is heard

174
Q

If rhythm of pulse is irregular, how should you count?

A

Count number of beats in one full minute

175
Q

Why is the 30 second interval used when measuring pulse?

A

It is the most accurate and efficient method when heart rates are normal or rapid and when rhythms are regular

176
Q

When assessing pulse, what should you pay attention to?

A
  • Rate
  • Rhythm
  • Force
  • Elasticity
177
Q

Which patients may not have a pulse with good elasticity?

A

Patients with heart disease, smokers

178
Q

Normal heart rate range in a resting adult

A

60 to 100 bpm

179
Q

What bpm indicates a patient has tachycardia?

A

Greater than 100 bpm

180
Q

What bpm indicates a patient has bradycardia?

A

Less than 50 bpm

181
Q

If a patient has a bpm of 45 bpm, what do they have?

A

Bradycardia

182
Q

If a patient has a bpm of 115, what do they have?

A

Tachycardia

183
Q

What is the rhythm of a normal pulse?

A

Normally has an even tempo

184
Q

What are some examples of patients who would not have a pulse with an even tempo?

A

If they have sinus arrhythmia

Or atrial fibrillation

185
Q

How is pulse force recorded?

A

Using a three-point scale

186
Q

Explain the three-point scale when documenting pulse

A

3+ : Full, bounding
2+ : Normal
1+ : Weak, thready
0 : Absent

187
Q

When would someone have a 3+ pulse force?

A

When they have increased stroke volume

  • Exercise
  • Anxiety
188
Q

When would someone have a 1+ pulse force?

A

When they have decreased stroke volume

  • hemorragic shock
  • old and dehydrated
189
Q

What does a 2+ pulse force indicate?

A

Normal (most healthy people)

190
Q

How should respirations be?

A

Breathing should be relaxed, regular, and silent

191
Q

How should you measure respirations?

A
  • Do not mention that you will be counting them

- Count for 30 seconds (or a full minute if you suspect an abnormality)

192
Q

What is a normal rate of respirations?

A

10-20 breaths per minute

193
Q

Why should we write out breaths per minute instead of abbreviating to bpm

A

Can get confused with beats per minute

194
Q

In general, what is blood pressure measuring?

A

The force of blood pushing against the side of vessel wall

195
Q

What is systolic pressure?

A

Maximum pressure felt on artery during left ventricular contraction, or systole

196
Q

What is diastolic pressure?

A

Elastic recoil, or resting, pressure that blood exerts constantly between each contraction

197
Q

If you were explaining the difference between systolic and diastolic pressure to your patient, how would you explain it?

A

Systolic is when the heart is squeezing the blood, and diastolic is when the heart relaxes

198
Q

What is the average blood pressure in young adults?

A

120/80 mm Hg

199
Q

What biological factors cause blood pressure to vary?

A
  • Age
  • Gender
  • Race
200
Q

How does age affect blood pressure?

A

A gradual rise occurs from childhood to adult

201
Q

How does gender affect blood pressure?

A

BP is lower in females than in males

202
Q

How does race affect blood pressure?

A

BP is usually higher in African Americans

203
Q

Factors the level of blood pressure are determined by:

A 
1- Cardiac output
2- Peripheral vascular resistance
3- Volume of circulating blood
4- Viscosity
5- Elasticity of vessel walls
204
Q

How does cardiac output affect blood pressure?

A

More blood pumped = increased pressure

205
Q

How does peripheral vascular resistance affect blood pressure?

A

When vessels become smaller or constricted, pressure needed to push becomes greater (think big straw vs. skinny straw)

206
Q

How does the volume of circulating blood affect blood pressure?

A

This refers to how tightly blood is packed into arteries

So, increasing contents in vessels (ex: blood transfusion) increases pressure

207
Q

What is viscosity?

A

The thickness of blood

208
Q

How does elasticity of vessel walls affect blood pressure?

A

Stiff walls = increased pressure

209
Q

How does the viscosity of blood affect blood pressure?

A

When blood is thicker, pressure increases

210
Q

Example of increased cardiac output:

What happens to blood pressure?

A

Heavy exercise

BP goes up

211
Q

Example of decreased cardiac output:

What happens to blood pressure?

A 
Pump failure (weak pumping action after myocardial infarction, or in shock)
BP goes down
212
Q

Example of a decrease in circulating blood:

A

Hemorrhage

213
Q

Example of an increase in volume of circulating blood:

A
  • Increased sodium and water retention

- Intravenous fluid overload

214
Q

What causes an increase in the viscosity of blood?

A

Increased hematocrit in polythemia

215
Q

What can cause increased rigidity in arterial walls?

What would happen to blood pressure?

A

Hardening as in arteriosclerosis

Heart is pumping against greater resistance, so BP would go up

216
Q

In which situations should you take serial measurements of pulse and blood pressure?

A
  • You suspect volume depletion
  • Person is known to have hypertension or taking antihypertensive medications
  • Person reports fainting or syncope
217
Q

How should you detect orthostatic or postural vital signs?

A

1- Have person rest supine for at least 3 mins, then take baseline BP and pulse readings
2- Have person sit up and assess BP and pulse
3- Have person stand up and assess BP and pulse
4- After person has been standing for 3 minutes, assess BP and pulse

218
Q

It is normal for blood pressure to drop by how much when a person stands up?

A

1 mm Hg

219
Q

If a patient reports fainting upon standing, what are you going to try to detect?

A

Orthostatic hypotension

220
Q

What is orthostatic hypotension?

A

When a patient has a drop in BP greater than 20mm Hg systolic
OR a drop in BP greater than 10mm Hg diastolic when they change position from lying to standing

221
Q

When can orthostatic changes typically occur in patients?

A
  • prolonged bed rest
  • older age
  • hypervolemia
  • with some medications
222
Q

Symptom of high blood pressure that is often overlooked

A

Headache

223
Q

Measurements of NORMAL blood pressure

A

Systolic LESS THAN 120
AND
Diastolic LESS THAN 80

224
Q

Measurements of ELEVATED blood pressure

A

Systolic between 120-129
AND
Diastolic LESS THAN 80

225
Q

Measurements of STAGE 1 HYPERTENSION

A

Systolic between 130-139
OR
Diastolic between 80-89

226
Q

Measurements of STAGE 2 HYPERTENSION

A

Systolic 140 or higher
OR
Diastolic 90 or higher

227
Q

Measurements for a HYPERTENSIVE CRISIS

A

Systolic higher than 180
AND/OR
Diastolic higher than 120

228
Q

If a patient has a BP of 120/80 mm Hg, what is their blood pressure category?

A

Stage 1 hypertension

229
Q

If patient has a BP of 120/78 mm Hg, what is their blood pressure diagnosis?

A

Elevated

230
Q

If a patient has a BP of 118/76 mm Hg, what is their blood pressure category?

A

Normal

231
Q

If a patient has a BP of 210/89 mm Hg, what is their blood pressure category?

A

Hypertensive crisis

232
Q

If a patient has a BP of 131/78 mm Hg, what is their blood pressure category?

A

Stage 1 hypertension

233
Q

If a patient has a BP of 160/89 mm Hg, what is their blood pressure category?

A

Stage 2 Hypertension

234
Q

If a patient has a BP of 135/91 mm HG, what is their blood pressure category?

A

Stage 2 Hypertension

235
Q

How is oxygen saturation measured?

A

Which a pulse oximeter

236
Q

What is a pulse oximeter?

A

A noninvasive method to assess arterial oxygen saturation

237
Q

What unit is blood oxygen measured in?

A

SpO2

238
Q

SpO2 of a healthy person with no lung disease and no anemia?

A

97% to 98%

239
Q

What level of blood oxygen is worrisome?

A

Less than 97% SpO2

240
Q

What is primary hypertension?

A

There is no known cause responsible for it

This makes up 95% of cases

241
Q

What is an auscultatory gap?

A
  • Period when Korotkoff sounds disappear during auscultation
  • Maximum inflation pressure helps avoid this
  • Does occur in about 5% of people, most often in hypertension caused by a noncompliant arterial system
242
Q

What are Korotkoff sounds?

A
  • Sounds heard during BP reading

- Consist of phases I, IV, & V

243
Q

Name of a blood pressure cuff

A

Sphygmomanometer

244
Q

What does TPR BP stand for?

A

Temperature, pulse, respiration, blood pressure

245
Q

What does SpO2 stand for?

A

Oxygen saturation

246
Q

Abbreviation for oxygen saturation

A

SpO2

247
Q

If a patient has nail polish and the pulse oximeter can’t read through it, what should you do?

A

Put it on the side of their finger, side of hand, or ear

248
Q

What is the 2-step blood pressure method used for?

A
  • To prevent injury to patient from inflating cuff too far

- To give a smaller window on sphigmomanometer to listen to

249
Q

Steps of the 2-step blood pressure method:

A
  • Put cuff on
  • Palpate brachial pulse
  • Inflate cuff
  • Look at # of mmHg when you can no longer feel pulse
  • Deflate cuff, wait for a few minutes
  • Put stethoscope on brachial pulse
  • Inflate to 20-30mm Hg above # you just found
  • Deflate cuff
  • 1st sound is systolic, no more sound is diastolic
250
Q

What are the phases of Korotkoff sounds?

A 
Phase I
Ausulatory gap (abnormal)
Phase II
Phase III
Phase IV
Phase V
251
Q

What does plase I of Korotkoff sounds sound like?

A

Tapping: Soft, clear tapping, increasing in intensity

252
Q

Why can you hear sound during phase I of Korotkoff sounds?

A

The cuff pressure decreases and blood spurts at high velocity into brachial artery. The turbulent blood flow is audible

253
Q

What does phase II of Korotkoff sounds sound like?

A

Swooshing: softer murmer follows tapping

254
Q

Why does phase II Korotkoff sounds sound like swooshing?

A

You can hear the turbulent blood flow through still partially occluded artery

255
Q

What does phase III of Korotkoff sounds sound like?

A

Knocking: crisp, high-pitched sounds

256
Q

Why does phase III of the Korotkoff sounds sound like tapping?

A

There has been a longer duration of blood flow through the artery. Artery closes just briefly during diastole

257
Q

What does phase IV of Korotkoff sounds sound like?

A

Abrupt muffling: Sound mutes to low-pitched, cushioned murmer; blowing quality

258
Q

Why does phase IV of the Kortokoff sounds sound like abrupt muffling?

A
  • Artery no longer closes in any part of the cardiac cycle

- Change in quality, not intensity

259
Q

What does phase V of the Kortokoff sounds sound like?

A

Silence

260
Q

Why is there silence during phase V of the Kortokoff sounds?

A

There is a decreased velocity of blood flow

261
Q

Which Kortokoff phase determines systolic blood pressure?

A

Phase I

262
Q

Which Korotkoff sound determines diastolic pressure?

A

Phase V

263
Q

If pt’s BP is taken while angry or upset:

A

Falsely high

264
Q

If pt’s BP is taken while arm is above level of heart:

A

Falsely low

265
Q

If pt’s BP is taken with arm below level of heart:

A

Falsely high

266
Q

If pt supports their own arm during BP reading:

A

Falsely high diastolic

267
Q

If pt’s legs are crossed during BP reading:

A

Falsely high systolic and diastolic

268
Q

If the BP cuff is too narrow during reading:

A

Falsely high BP

269
Q

If cuff is wrapped too loosely or undevenly during BP reading:

A

Falsely high BP

270
Q

If the cuff is inflated too low during BP reading:

A

Falsely low systolic

271
Q

If the cuff is inflated too high during BP reading:

A

Pain for the pt

272
Q

If you push stethoscope too hard on bracial artery during BP reading:

A

Falsely low diastolic

273
Q

If you deflate the BP cuff too quickly:

A

Falsely low systolic or falsely high diastolic

274
Q

If you deflate the BP cuff too slowly:

A

Falsely high diastolic

275
Q

Halting during descent and reinflating cuff to recheck systolic:

A

Falsely high diastolic

276
Q

Failure to wait 1-2 minutes before repeating entire BP reading:

A

Falsely high diastolic

277
Q

List hypertension risk factors:

A
  • Smoking
  • Dyslipidemia
  • Diabetes mellitus
  • Age >60 years
  • Gender (men & postmenopausal women)
  • Family history of cardiovascular disease
278
Q

Lifestyle modifications to control blood pressure:

A
  • lose weight
  • limit alcohol
  • increase aerobic physical activity
  • reduce sodium
  • maintain adequate potassium intake
  • maintain adequate calcium and magnesium intake
  • stop smoking
  • reduce saturated fat and cholesterol
279
Q

When is general survey done?

A

During first step, (Assessment) while introducing yourself to patient

280
Q

What are we assessing during general survey?

A
  • Physical appearance
  • Body structure
  • Mobility
  • Behavior
281
Q

When do we assess mental status?

A

At the same time as general survey (during Assessment while introducing yourself)

282
Q

What are we assessing during mental status assessment?

A
  • Appearance
  • Behavior
  • Cognition
  • Thought process
283
Q

In more detail, what factors are we noting during general survey?

A
  • Age: appears stated age
  • Sex: appears stated sex
  • Skin color: ethnicity, pink, even skin tone, tattoos, body piercings, etc.
  • Facial features: symmetrical? Abnormalities?
  • Stature/posture: extremely tall or short? Erect?
  • Mobility: gait, range of motion, able to ambulate independently
284
Q

What is mental status?

A

A person’s emotional and cognitive functioning

285
Q

What are optimal functioning aims for mental status?

A
  • Life satisfaction
  • Work satisfaction
  • Caring relationships
  • Self satisfaction

A balance between good and bad days

  • Social function
  • Occupational function
286
Q

How is mental status assessed?

A

It is inferred through assessment of behaviors.

It is not 100% objective

287
Q

Which behaviors are we assessing during mental status assessment?

A
  • Consciousness
  • Language
  • Mood and affect
  • Orientation
  • Attention
  • Memory
  • Abstract reasoning
  • Thought process
  • Thought content
  • Perceptions
288
Q

What is a patient’s mood, in relation to mental status?

A

A more prolonged display of feelings

289
Q

What is affect in relation to a patient’s mental status?

A

Temporary expression of feelings

290
Q

What does orientation mean in relation to mental status?

A

Does the person know person, place, time:

  • Who they are
  • Where they are
  • What time it is
291
Q

What does perceptions mean in relation to mental status?

A

Patient’s awareness through all of their senses

292
Q

List the levels of consciousness:

A
  • Alert
  • Lethargic (somnolent)
  • Obtunded
  • Stupor or semi-coma
  • Coma
293
Q

What does it mean if a patient is alert?

A

Awake
Oriented
Meaningful interactions

294
Q

What does it mean if a patient is lethargic (somnolent)?

A

Not fully alert
Drifts to sleep
Aroused when name called

295
Q

What does it mean if a patient is obtunded?

A

Sleepy

Difficult to arouse (need to shout or sternal rub)

296
Q

What does it mean if a patient is stupor (or semi-coma)?

A

Unconscious

Responds only to vigorous sternal rub

297
Q

What does it mean if a patient is in a coma?

A

Completely unconscious

No response to pain or stimuli

298
Q

Examples of a patient being in coma:

A
  • Right after surgery and still sedated

- Sometimes a trauma patient

299
Q

What is a mental status examination (MSE)?

A

A systemic check of emotional and cognitave functioning

300
Q

When do we perform the MSE?

A

Assessed while asking health history interview questions

301
Q

What are the four main headings of the mental status examination?

A

Appearance
Behavior
Cognition
Thought process

(ABCT)

302
Q

When is it necessary to perform a full mental status exam?

A

When integrating the MSE in HH, you notice or learn:

  • Behavior changes
  • Memory changes
  • Brain lesions (trauma, tumor, stroke)
  • Aphasia (secondary to brain damage)
  • Symptoms of phychiatric mental illness
  • Family concerns about patient
303
Q

When observing a patient’s appearance during a MHE, what are we looking at?

A

Dress

Grooming and hygiene

304
Q

What do we pay attention to about how a patient is dressed during a MHE?

A

Appropriate for:

  • Setting
  • Season
  • Age
  • Gender
  • Social group
305
Q

What do we pay attention to about a patient’s grooming and hygiene during a MHE?

A

Clean and well groomed?

Disheveled appearance in previously well-groomed person is significant

306
Q

Factors we observe when assessing a patient’s behavior during a MHE?

A

Level of consciousness
Facial expression
Speech
Mood and affect

307
Q

What are we noting about a person’s level of consciousness during a MHE?

A

Person is awake, alert, aware

Responds appropriately

308
Q

What are we noting when assessing a patient’s facial expression during a MHE?

A

Appropriate to situation

Changes appropriately with topic

309
Q

What are we noting about a patient’s speech during a MHE?

A

Shares conversation appropriately
Pace is moderate
Articulation is clear and understandable
Word choice is effortless

310
Q

What are some ways a patient’s speech may not be moderate?

A 
If they’re anxious and speaking fast
Pressured speech (won’t let you get a word in)
311
Q

What are some examples of what would make a person’s speech not be articulate?

A

Dentures

Stroke

312
Q

What does it mean for a patient’s word choice to be effortless? What would be the opposite of effortless?

A

Appropriate to educational level
Completes sentences

Pauses to think

313
Q

How do we judge a patient’s mood and affect?

A

Body language
Facial expression
Asking “how do you feel today?”

314
Q

When assessing a patient’s orientation, what main questions should we ask them? And examples of how to ask them

A

Time
- Day of week, date, year, season

Place
- where they live, address, phone number, present location, name of city and state

Person
- name, age, type of work they do

315
Q

How do you document orientation if patient is completely orientated?

A

Awake, alert, and oriented to person, place, and time.

316
Q

How do you document orientation if a patient only knows who they are?

A

Awake, alret, oriented to person, not time or place

317
Q

How do you document if a patient doesn’t know date/month/year/season?

A

Awake, alert, oriented to person and place, not to time

318
Q

What does a patient’s attention span referr to when doing MHE?

A

Completes a thought without wandering

319
Q

How can you assess a patient’s recent memory?

A

Assess 24 hour diet recall or by asking time person arrived at agency

320
Q

How can you assess a patient’s remote memory?

A

Verify historical events, birthdays or anniversary dates

321
Q

What is a patient’s judgement when doing a MHE?

A

Ability to compare and evaluate alternatives and reach an appropriate course of action

322
Q

How can we assess whether a patient has good judgement during a MHE?

A
  • Test on daily or long-term goals
  • Note what person says about job plans, social or family obligations, and plans for the future.
  • Ask for rationale for their health care (compliance/decision making)
323
Q

What would make us determine that a patient has good judgement during a MHE?

A

All thoughts and plans are logical and realistic

324
Q

List of factors that can cause impared judgement:

A
  • long history of drug use
  • developmental disability
  • emotional dysfunction
  • schizophrenia
  • organic brain disease (Altzhimer’s/dimensia)
325
Q

How can you test a patient’s new learning abilities in a MHE?

A

The four unrelated words test

326
Q

What is the four unrelated words test?

A

A highly sensitive and valid memory test

327
Q

How do you perform the four unrelated words test on a patient?

A
  • Pick four words with different sounds
  • Ask person to remember four words
  • Ask patient to repeat (be certain of understanding)
  • Ask for recall in 5, 10, & 30 minutes

Normal response is accurate recall

328
Q

Loss of ability to speak (spelling)

A

Aphasia

329
Q

What is aphasia?

A

Loss of ability to speak, write coherently, or understand speech

330
Q

If you suspect a patient has aphasia, how can you test their word comprehension?

A

Point to articles and have patient name them

331
Q

If you suspect a patient has aphasia, how can you test their reading?

A

Ask person to read available print (can they read?)

332
Q

If you suspect a patient has aphasia, how can you test their writing ability?

A

Ask person to write a sentence; note coherence and spelling

333
Q

What is a mandatory regulatory requirement when assessing patients?

A

Screening for suicidal thoughts

334
Q

How do you go about asking a patient about suicidal thoughts?

A

Begin with more general questions - probe if needed

335
Q

Examples of questions you’d ask a patient to determine if they have suicidal thoughts?

A
  • Have you ever felt so blue you thought of hurting yourself or do you feel like hurting yourself now?
    If yes, - Do you have a plan to hurt yourself?
    If yes, - How would other people react if you were dead?
336
Q

What is PHQ-9?

A

A patient health questionare to assess for depression

337
Q

What is GAD-7?

A

Patient health questionare to assess for generalized anxiety disorder

338
Q

When do you ask patient all 9 questions of the PHQ-9?

A

If answer is yes to first 2 questions

339
Q

Most abused phychoactive drug

A

Alcohol

340
Q

What does it mean if a medication is additive to alcohol?

A

Makes patient very drowsy when mixed with alcohol

341
Q

What does it mean if a patient’s medication interacts with alcohol?

A

Doesn’t blend - makes them very sick

342
Q

Comorbidities of alcohol:

A
  • up to 1 drink/day = increased breast cancer risk
  • chronic alcohol use = liver disease
  • heavy/binge drinking = increased risk of cardiac issues
  • hypertension
343
Q

Fastest growing drug problem in US

A

Prescription drug use

344
Q

How many adolescents use illicit drugs?

A

1 out of 10

345
Q

How many Americans over 12 use illicit drugs?

A

9.5%

346
Q

3 most frequently abused prescription opoid pain relievers:

A
  • oxycodone
  • hydrocodone
  • methadone
347
Q

What should you ask if you find out a patient is taking opoid pain relievers?

A

How much they take

How long they have been taking them

348
Q

What is CAGE?

A

A questionare to determine alcohol dependence

349
Q

Why is accurate diagnosis of alcoholism needed?

A

For:

  • advice
  • intervention
  • appropriate treatment
  • and follow up
350
Q

Which trimester during pregnancy, do women drink the most? When do they drink the least?

A 
Most = 1st trimester
Least = 3rd trimester
351
Q

Which age range does alcohol use decrease?

A

Age 65 or older

352
Q

Why does alcohol use decrease with age?

A

Effects of alcohol become increased with smaller amounts because body’s ability to filter out alcohol decreases

353
Q

Characteristics of older adults that increase risk with alcohol use:

A
  • Liver metabolism and kidney function decrease = alcohol in blood for longer
  • Less tissue mass = increased alcohol concentration in blood
  • Medications = interact with alcohol
  • Increases risks of falls, depression, and GI problems
354
Q

If patient is currently intoxicated or going through substance withdrawl, how should you collect subject data?

A

Collect what you can, maybe ask a family member

And record the rest later

355
Q

How should you ask a patient about alcohol use?

A

“Do you sometimes drink beer, wine, or other alcoholic beverages?”
If yes - “How many times in the past year have you had:
- Five or more drinks a day (for men)
- Four or more drinks a day (for women)?”

356
Q

How many drinks is it ok for women to drink?

How many drinks is it ok for men to drink?

A

Women: 1 drink or less per day
Men: 2 drinks or less per day

357
Q

What is nutritional status?

A

The degree of balance between nutrient intake and nutrient requirements

358
Q

Factors that affect nutritional status:

A
  • Physiologic
  • Psychological
  • Developmental
  • Cultural
  • Economic
359
Q

What are the purposes of nutritional assessment?

A
  • Identify individuals who are malnorished (or at risk)
  • Provide data for providing nutrition plan of care
  • Establish baseline data for evaluating effacacy of nutritional care
360
Q

Underweight BMI measurement:

A

<18.5

361
Q

Overweight BMI measurement:

A

25-29.9

362
Q

Obese BMI measurement:

A

> 30

363
Q

Nutrition screening is a quick and easy way to identify the following:

A
  • nutritional risk
  • weight loss
  • inadequate food intake
  • recent illness
364
Q

Parameters of nutrition screening:

A
  • weight and weight history
  • diet information
  • anthropometric measures
365
Q

Methods for collecting current dietrary intake information:

A
  • 24 hour recall
  • food frequency questionnaire
  • food diary
366
Q

Easiest and most popular nutrition screening method

A

24 hour recall

367
Q

What does a 24 hour nutrition recall entail?

A
  • questionnaire or pt is interviewed and asked to recall everything eaten in past 24 hours
368
Q

Possible errors during a 24 hour nutrition recall

A
  • Pt unable to remember everything
  • Pt may alter truth
  • Snack items/sauces/condiments often underreported
369
Q

What is a food frequency questionnaire?

A

Documents times per day, week or month individual eats particular foods

370
Q

Drawbacks of a food frequency questionnaire?

A

Does not quantify amount of intake

Relies on pt’s memory for how often a food was eaten

371
Q

What is the most accurate method of screening a patient’s nutrition?

A

Food diary

372
Q

What does a food diary entail?

A

Documents everything consumed for a certain period of time

373
Q

What is the recommended period of time recommended to document for a food diary?

A

Three days

2 week days, 1 weekend day

374
Q

Potential problems with a food diary?

A
  • noncompliance
  • inaccurate recording
  • atypical intake on recording days
  • conscious alteration of diet during recording period
375
Q

Height and weight, triceps skinfold thickness, and circumferences are examples of what type of measurements?

A

Anthropometric measures

376
Q

Most commonly used anthropometric measures:

A
  • height and weight
  • triceps skinfold thickness
  • circumferences
377
Q

What are derive weight measurements used for?

A

3 derived weight measures are used to depict changes in body weight

378
Q

What are the three derived weight measures?

A
  • body weight as a percentage of ideal body weight
  • percent of usual body weight
  • body mass index
379
Q

What measurement is a marker of optimal weight for height and an indicator of obesity?

A

BMI

380
Q

How do you collect a patient’s serial weight?

A

Weigh pt at the same time every day (most accurate in AM, after patient sleeps)

381
Q

Measurement that assesses body fat distribution as an indicator of health risk

A

Waist-to-hip ratio

382
Q

Define android obesity

A

Apple shape

Persons with greater proportion of fat in upper body, especially abdomen

383
Q

Define gynecoid obesity

A

Pear shape

Persons with most of fat in hips and thighs

384
Q

Waist circumference measurements that indicate an increased risk of CV and metabolic disease:

A

Women: > 35 inches
Men: > 40 inches

385
Q

How should you measure a patient’s waist circumference?

A

Measure smallest part of waist, right above hip bones

386
Q

Factors that determine if pt has metabolic syndrome:

A
  • elevated BP
  • impaired fasting glucose
  • increased triglycerides
  • decreased healthy cholesterol
  • increased waist circumference
387
Q

Number that determines a patient has impaired fasting glucose

A

Blood sugar >100 when fasting

388
Q

When should you measure a patient’s fasting glucose?

A

At LEAST 2 hours after eating

Is most accurate when they first wake up, before eating

389
Q

How do you determine if a patient has metabolic syndrome?

A

If pt has 3 out of 5 factors

390
Q

Measurements provide an estimate of body fat stores or extent of obesity or undernutrition

A

Skinfold thickness

391
Q

Most commonly selected area for skinfold thickness measurement

A

Triceps skinfold (TSF)

392
Q

When comparing measurements of skinfold thickness, which factors should you take into consideration?

A

Age
Sex
Body frame

393
Q

Define pain

A

A highly complex and subjective experience that origionates from the CNS, the PNS, or both

394
Q

Detect painful sensations from periphery and transmit them to the CNS

A

Nociceptors

395
Q

Where are nociceptors located?

A 
Skin
Joints
Connective tissue
Muscle
Thoracic, abdominal, and pelvic viscera
396
Q

How are nociceptors stimulated?

A

Mechanical or thermal trauma

Or by chemical mediators from site of tissue damage

397
Q

4 phases of nociception:

A

1- Transduction
2- Transmission
3- Perception of pain
4- Modulation

398
Q

Explain the transduction phase of nociception

A
  • injured tissue releases chemicals that propagate pain message
  • action potential moves along an afferent fiber to the spinal cord
399
Q

Explain the transmission phase of nociception

A

The pain impulse moves from the spinal cord to the brain

400
Q

Explain the perception of pain phase of nociception

A

Signifies the conscious awareness of a painful sensation

401
Q

Explain the modulation phase of nociception

A

Neurons from brainstem release neurotransmitters that block the pain impulse

402
Q

What ensures that the process of nociception can happen?

A

Must have intact and functioning nerve fibers in the periphery

403
Q

Indicates type of pain that does not adhere to typical phases

A

Neuropathic pain

404
Q

What does neuropathic pain imply?

A

An abnormal processing of pain message

405
Q

Examples of neuropathic pain

A
  • pt with diabetes hurts to walk, but doesnt have sores on feet
  • amputee has a phantom limb
406
Q

Most difficult type of pain to assess and treat

A

Neuropathic pain

407
Q

Why is neuropathic pain so difficult to assess and treat?

A
  • pain is often perceived long after site of injury heals

- pain can not be identified by diagnostic testing

408
Q

List pain sources based on origin

A
  • Visceral pain
  • Referred pain
  • Deep somatic pain
  • Cutaneous pain
409
Q

Pain that originates from larger interior organs

A

Visceral pain

410
Q

What can visceral pain stem from?

A

Direct injury to organ or from stretching of organ from tumor, ischemia, distention, or severe contraction

411
Q

Along with pain, what does visceral pain present with?

A

Autonomic responses such as vomiting, nausea, pallor, and diaphoresis

412
Q

Pain that is felt at a particular site but originates from another location

A

Referred pain

413
Q

Where may referred pain originate from?

A

Visceral or somatic structures

414
Q

Sources of deep somatic pain

A 
Blood vessels
Joints
Tendons
Muscles
Bone
415
Q

What can an injury with deep somatic pain result from?

A

Pressure
Trauma
Ischemia

416
Q

Pain derived from skin surface and subcutaneous tissues

A

Cutaneous pain

417
Q

Characteristics of cutaneous pain

A

Injury is superficial with a sharp, burning sensation

418
Q

Something to keep in mind about cutaneous pain

A

A clinician’s lack of awareness and understanding of neuropathic pain may contribute to this mislabeling

419
Q

Categories of pain

A

Acute pain

Chronic pain

420
Q

What is acute pain?

A

Short term and self-limiting pain that provides a protective purpose (warns of injury)

421
Q

Examples of acute pain

A

Surgery
Trauma
Kidney stones
Child birth

422
Q

Time frame for acute pain

A

Less than 6 months

423
Q

What is chronic pain?

A

Diagnosed when pain continues for 6 months or longer

424
Q

Time frame for chronic pain

A

At least 6 months and greater

425
Q

Examples of chronic pain

A

Arthritis
Cancer
Broken bones can lead to chronic pain

426
Q

Pain is always…?

A

Subjective

427
Q

Most reliable indicator of pain?

A

Patient’s subjective report

428
Q

How to perform a brief pain inventory:

A
  • ask patient to rate pain (0-10) scale

- pediatric patient - use faces scale

429
Q

Initial pain assessment questions

A

P, Q, R, S, T, 3As:

Pain location
Quality
Radiating
Severity
Timing
Aleviating
Aggrivating
Associated

Health Assessment (17 decks)

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