Exam 1 Flashcards
1
Q
Orthopenic
A
Propped with pillows
2
Q
Eupeniec
A
Normal/ quiet breathing
Resting respiratory rate
3
Q
Tachypneic
A
Fast breathing
4
Q
Bradypneic
A
Slow/ labored breathing
5
Q
Ethnicity
A
Belonging to social group with common national or cultural tradition
6
Q
Acculturation
A
Assimilate a diff culture usually dominant one
7
Q
Dysphagia
A
Difficulty swallowing
8
Q
Orthostatic hypotension
A
Decrease in systolic pressure of 20mm/Hg
OR
Decrease in diastolic of 10mm/Hg
Within 3 min standing from sitting or supine
9
Q
Alcohol naive
A
Preferring alcohol
10
Q
Subjective
A
SYMPTOM
What patient says
11
Q
Objective
A
SIGN
What is observed
PHYSICAL APPEARANCE, BODY STRUCTURE, MOBILITY, BEHAVIOR
Self actualization Esteem Love/belonging Safety Physiological
12
Q
BP common errors
A
Sitting without back support
Crossed legs
Full bladder
Tobacco use
Elbow unsupported, too high or too low
Talking
Cuff not sized
13
Q
BP cuff size
A
80% arm circumference
40% width
14
Q
Radial artery
A
Right side of inner arm
15
Q
Ulnar artery
A
Left side of inner arm
16
Q
Brachial artery
A
Inner elbow
17
Q
Delirium
A
Confusion over time
18
Q
Dimentia
A
Confusion built over time
19
Q
Mental assessment
A
Nurses 1st test for consciousness
A-B-C-T
Appearance
Behavior
Cognition
Thought process
20
Q
Accessing orientation
A
Person, place, time
“Why did you come to the clinic today?”
Attention span
Recent memory: 24-hour diet
Remote memory: past health, bday
21
Q
Aphasia
A
Loss of ability to speak and write coherently
Inability to give info
22
Q
MMSC
A
Mini-mental state exam
Cognitive functions to go home
Safe marker
11 questions
23
Q
Nutrition screening
A
24 hour recall
Food frequency- type and frequency
Food Diary- can be difficult if writing ability
Direct observation- feeding techniques
24
Q
Stethoscope bell
A
Soft low-pitched sounds
25
Examination of ear canal
Largest that will fit
26
Orientation
Awareness of objective world in relation to the self
27
Nonciceptive pain
Functioning and intact nerve fibers in periphery and CNS are stimulated
Outside events in nervous system (actual or potential tissue damage)
1. Transduction -stimulus takes place
2. Transmission- spinal cord to brain
3. Perception- conscious awareness of pain
4. Modulation- descending pathways release 3rd set neurotransmitters to produce analgesic effect
28
Neuropathic pain
Caused by lesion or disease of somatosensory nervous system
Abnormal processing of pain message from injury to nerve fibers
Ex. Diabetes, shingles, HIV/AIDS, etc
29
Visceral pain
Originates in larger internal organs
Dull, deep, squeezing, cramping
Direct injury to organ or stretching of organ due to tumor, ischemia, distention, severe contraction
Pain travels to ANS (vomiting, nausea,pallor, diaphoresis)
Ex. Ureteral colic, acute appendicitis,ulcer pain, cholecytitis
30
Somatic pain
Musculoskeletal tissues or body surfaces
ANS: Nausea, sweat, tachycardia, hypertension
31
Deep somatic pain
Blood vessels, joints, tendons, muscles, and bone
Pressure, trauma, ischemia
Aching or throbbing
32
Cutaneous pain
Skin surface and subcutaneous tissues
Superficial, sharp, burning
Cutaneous "cut" knife- sharp
33
Referred pain
Particular site but originates in another location
Both sites innervated by same spinal nerve
Diff for brain to differentiate
34
Acute pain
Short term
Self limiting
After injury, pain gone after healed
Ex. Surgery, trauma, kidney stones
35
Incident pain
Acute pain
Happens with certain movements
Ex. Lower back pain when standing
36
Chronic (persistent) pain
6 months or longer
Malignant or nonmalignant
37
Malignant pain
Cancer related
Tumor cells
Induced by tissue necrosis or stretching of organ by growing tumor
38
Nonmalignant pain
Musculoskeletal conditions
Ex. Arthritis, low back pain, fibromyalgia
39
Breakthrough pain
Spike in pain level
Moderate to severe
End-of-dose medication failure
Treatment: shortening interval between doses or increasing level of dose
40
Phantom pain
Coming from body part that is no longer there
Post amputation phenomenon
41
Pain assessment
To find accurate pharmacologic and nonpharmacologic strategies to interrupt pain
42
Evidence based practice (EBP)
Patients preference is valued
1. Best evidence to date RESEARCH
2. Clinicians experience
3. Patients preferences PRINCIPLES
43
Primary prevention
Aims to prevent disease or injury before it occurs
Preventing exposures to hazards, altering unhealthy or unsafe behaviors and increasing resistance to disease or injury
44
Secondary prevention
Aims to reduce impact of disease or injury that has already occurred
Detecting and treating disease or injury as soon as possible to halt or slow process
Ex. Regulatory exams, screening tests, rehabilitation programs
45
Tertiary prevention
Soften impact of ongoing illness or injury with long lasting effects
Helping with managing long term health problems and injuries
Ex. Rehabilitation, support groups
46
Religion
Organized system of beliefs
Cause, nature, and purpose of the universe
Creators and rulers of universe
47
Spirituality
Individuals unique life experiences
personal efforts to find purpose to meaning of life
48
Pulse oximetry
Monitors oxygen saturation in blood
95-100%
49
3 unrelated words
Recall at 5 min, 10 min, 30 min
50
Cultural assessment
Patients have right to cultural beliefs, values, and practices
51
If unable to find radial pulse
Search for apical pulse
52
Pulse characteristics
Rhythm
53
Intermittent pulse
Dropping of beats
Irregular
Too weak to open semilunar valves
54
Heritage assessment tool
Necessary for building cultural competence
55
General survey
Study of whole person
General health state
Physical characteristics , first impressions
Ex. How person walks in
56
Pain
5th vital sign
Not associated with old age
57
Acute pain: Nonverbal
Guarding
Moaning
58
Chronic pain: nonverbal
"Learn to love without pain"
Increased risk of under-detection
Increasing sleep
59
SOAP charting
Subjective
Objective
Assessment
Plan
60
Wong-Baker scale of pain
Facial expressions
Ages 4-5
61
Cultural competence
Access own beliefs before patients
Environment change =cultural change DYNAMIC
62
Illness belief across culture
Loss of balance
63
Disparity?
Reduces this risk?
Poverty
Receiving diff care
ER: takes in all ppl
64
Successful interview characteristics
Father complete and accurate data
Establish report and trust
Teach about healthy state
65
Interview contract
What's expected
- purpose
- time
- presence of others?
Interview goal
66
Internal factors of communication
Empathy
Liking others
Ability to listen
67
External factors of communication
Environment
Ensuring privacy
Refuse interruptions
Dress
Note taking- lacks eye contact
Tape and video recording
68
Working phase of interview
Data gathering
69
Culturally congruent care
Provide care across culture
Now federal mandate
Caring is an enabling process!
70
Health literacy
Able to read and write but not associated with health
71
History present illness (HPI)
Location
Quality
Quantity
Timing
Setting
72
Pain: PQRSTU
Palliating/precipitating factors
-what makes pain better/worse?
Quality/quantity
-describe pain?
Region/radiation
-does pain move around or stay in same place?
Severity
-Scale 0-10
Timing
-Is pain constant or intermittent?
Understanding patients perception
-What do you think it means?
73
Adolescents: HEEADSS
Home
Education/employment
Eating
Activities
Drugs and alcohol
Sexuality
Suicide
74
Abdominal examination sequence
Inspection
Palpation
Percussion
Ausculation
75
Inspection
Using eyes
Always doing
Always comes 1st
76
Palpation
Texture, temp, moisture, pain, organ size
Fingertips
Fingertips and thumb
Dorsa(outside of hand) and fingers -determining temp
77
Auscultation
Doesn't magnify sounds
Goal: recognize normal sounds
78
Don
Put on
79
When to take vital signs?
Upon admission
Any changes in health status
80
Body temp factors
Age
Circadian rhythms
Exercise
Hormones
Stress
Environment
81
Pulse rate
60-100bpm
Apical: most accurate
82
Cyanosis
Lack of oxygen
Blue/grey
Seen before pallor
83
Obstetric history
Gravidity: # pregnancies (Grav 3)
Term: full term or pre term (Term 2) (pre term 1)
Incomplete pregnancies: miscarriages or abortions (Ab 0)
Living: Number of children living (living 3)
84
Medication reconciliation
Comparison of list of current medications to previous list
Purpose: reduce errors and promote patient safety
Name, dose, schedule
85
Nociceptors
Detect painful sensations from periphery and transmit them to CNS
Located in skin, joints, CT, muscle, and thoracic, abdominal, pelvic viscera
Direct: Mechanical or thermal trauma
Secondarily: chemical mediators released from site of tissue damage
86
Pain assessment tool
Based on purpose, time invoked in administration, patients ability to comprehend and complete tool
87
Overall pain assessment tool
Most useful
Detect chronic pain conditions or acute problems
Ex. Initial pain assessment, brief pain inventory, McGill Pain Questionnaire
88
Initial pain assessment
8 questions
Location
Duration
Quality
Intensity
Aggravating / relieving factors
89
Brief pain inventory
Rate pain within 24 hours
Mood, walking ability, sleep
90
McGill Pain Questionnaire
Patient to rank list of descriptors of intensity and give overall intensity rating
91
CRIES
pain perception for infant
Crying: high pitched (1) inconsolable (2)
Requires O2: Saturation below 95%
Increased vital signs
Expression: Grimace present
Sleeplessness: pain ⬆️unable to sleep
92
FLACC Scale
Objective assessment of pain
Young children
```
Face: smile, frown, or clenched jaw
Legs: relaxed, tense, or kicking
Activity: lying or restless
Cry
Consolability: content or dicomfort
```
93
PAINAD Scale
Dementia patients pain scale
Breathing independent of vocalization: normal or noisy
Negative vocalization: groaning
Facial expression
Body language: relaxed or clenched
Consolability: console or distracted
94
Allodynia
Experience of pain after normally non painful tactile
Ex. From clothing
95
Oral temperature
Posterior lingual pocket lateral to midline
96
Tympanic temperature adult
Pull pinna back and upward
97
Rectal temperature
1.5 in (3.5 cm)
Position against blood vessels
98
Reflection
Echoing patients words
99
Clarification
Use when persons words are ambiguous or confusing
Asking for agreement
Person can confirm or deny your understanding
100
Confrontation
Frame of reference shifts from patients perspective to yours
Focus attention on patients feeling or statement
Honest feedback
101
Interpretation
Based on inference or conclusion
Patient can correct
102
Developmental competence
Interviewing the caregiver
Communicating with diff age differences (infants, school age, adolescents)
103
Overcoming communication barriers
Working with and without interpreters
Nonverbal cross cultural communication
Touch- comprehensive assessment and cross-culture
104
Diagnostic reading
Analyzing data
Drawing conclusions
Diagnosis identification
Verifying all data
105
Critical thinking
Assessing
Diagnosing
Planning
Implementing
Evaluating
106
Collecting data
Complete
Focused problem
Follow up
Emergency database
107
First and landmark standard
Organizations ensure patients receive effective, understandable, and respectful care
Cultural health beliefs and practices and preferred language
108
Cultural and linguistic competence
Congruent behaviors
Attitudes
Policies
Enables work in cross-cultural situations
109
VI Civil rights act
Service las cannot be denied to ppl of limited English proficiency
110
Culture characteristics
Learned
Shared
Adapted
Dynamic
111
Assimilation
Developing a new cultural identity and becoming like members of dominant culture
112
Biculturalism
Dual pattern of identification and often divided by loyalty
113
Naturalistic of holistic theory
Yin and yang
| Hot and cold
114
Pain pathway
Site of injury
Spinal cord
Brain stem
Cerebrum
115
Psychogenic pain
Pain related to mental disorder
116
Pain assessment
Where is pain?
When did it start?
What does it feel like?
How much pain do you have right now?
117
Brief pain inventory
24 hours
0-10 Scale
Mood, sleep, walk changes
118
Puncher Scale
6 pictures
Diff expressions of pain
0-5 Scale
119
CAGE Test
Have you ever thought to CUT down on drinking?
Have you ever been ANNOYED of criticism?
Have you ever felt GUILTY?
Do you drink in morning, EYE opener?
