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Nursing School > Exam 2: NR414 > Flashcards

Exam 2: NR414 Flashcards

1
Q

Blood dumps into

A

right atrium

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2
Q

Cardiac Cycle.. (p.458)

A
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3
Q

Heart consists of

A
  1. Heart (muscular pump)
  2. Blood Vessels- 2 cont loops
    1. pumonary cicrulation
    2. systemic circulation
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4
Q

Mediastinum

A
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5
Q

Right and left Cardiac Borders

A
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6
Q

Apex and Base of heart

A
  • know the landmarks
  • base is up
  • apex is down
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7
Q

Apical Impulse (pic)

A
  • feeling the contraction/ closure of valves
  • feel all of them on kids
  • adults not always able to feel
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8
Q

What are the 4 chambers of the heart?

A
  1. Right Aorta
  2. Left Aorta
  3. Right Ventricle
  4. Left Ventricle- (probls occur here)
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9
Q

3 Layers of the heart wall

A
  1. Pericardium
  2. Myocardium
  3. Endocardium
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10
Q

What can cause infection in the cardiac

A
  • bad gums
  • central line
  • weak valve
  • inflammation
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11
Q

Parts of the heart

A
  • chambers
  • valves
    • av
    • Tri
    • Mitral
  • semilunar
    • pulmonic
    • aortic
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12
Q

Lub Dub sounds is..

A

valves closing

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13
Q

Diastolic phase

A
  • Filling
  • Relaxing
  • Atrial Kick
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14
Q

Systole Phases

A
  • contraction
  • ejection
  • blood pumped out
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15
Q

Which side of the heart is pressure lower?

A
  • Right side
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16
Q

What is the first heart sound?

A
  • Closure of AV valves (mitral/tri)
  • (S1)
  • louder at apex
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17
Q

What is the second heart sound?

A
  • closure of semilunar valves
  • S2
  • louder at the base
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18
Q

What can effect respiration?

A

inspiration may cause a split S2

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19
Q

S1

A
  • Right atrium is filling
  • pressure is high
  • dumping blood into right ventricle
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20
Q

S2

A
  • left ventricle sending blood out
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21
Q

Listening to the heart, what side of your stethoscope do you hear low pitched sounds?

A

Bell

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22
Q

What is a brewy?

A

turbulent blood flow

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23
Q

What does S3 sound like

A
  • kentucky
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24
Q

What does S4 sound like?

A

“Tenessee”

Gallop

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25
Q

When does S3 occur?

A
  • early in diastole
  • immediately after S2
  • at the very end
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26
Q

Pathological Reasons for Listening for S3

A
  • Anemia,
  • sign of HF
  • Volume overload
  • hyperthyroidism
  • pregnancy
  • renal failure
  • persists when sitting up
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27
Q

When does S4 occur

A
  • End of diastole
  • prestyole
  • when ventricle is resistant to filling, just before S1
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28
Q

Where is S4 best heard

A

apex, left lateral position (left sided

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29
Q

Reasons for listenting for S4

A
  • decreased compliance of ventricle
  • systolic overload
  • aortic stenosis
  • systemic hypertension
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30
Q

Lifestyle that can affect heart

A
  • Smoking
  • Inactivity
  • Sitting a lot
  • Nutrition
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31
Q

How are murmurs graded?

A

1-4

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32
Q

What does a murmur sound like?

A
  • washing machine
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33
Q

What are reasons for having a murmur

A
  • During menstrual cycle (benign)
  • During Exercise
  • Thyroid level too high
  • Anemia (low blood)-less rbcs, less oxygen
  • expected for infants
  • structural defects in valve
  • unusual openings in chambers
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34
Q

What are you assessing for in heart sounds

A
  • pitch
  • volume/intensity
  • duration
  • timing- Sys, Dia
  • noting you heard S1 & S2
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35
Q

Cardiac Output Formula =

A
  • SV X HR
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36
Q

What is a resting adult CO

A

4-6 of blood/min

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37
Q

What is preload?

A

force of stretch in heart from venous return

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38
Q

What is afterload?

A

Ventricular pressure needed to eject blood

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39
Q

What are the neck vessels

A
  • carotid artery
  • jugular veins
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40
Q

What is important about carotid artery pulses

A
  • pulse goes along with S1, nsync
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41
Q

What do the neck vessels say about the heart (carotid, jugular) p.473

A

how well the heart is functioning

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42
Q

What happens to the neck vessels when lying down vs sitting up

A
  • sitting you can see it
  • sitting up it goes away
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43
Q

What happens heart/neck when Aging?

A
  • BP increases
  • lifestyles
  • sodium
  • Left ventricle increases
  • Increase Arrhythmias
  • Orthostatic Hypotension (getting out of bed fast)
  • check for bruits in carotid
  • systolic heart murmurs
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44
Q

Where do you assess an adult heart

A

5th intercostal

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45
Q

Where do you assess an infant’s heart?

A

3-4 intercostal

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46
Q

What is PMI referring to?

A
  • Point of Maximal Impulse
  • Where to assess
  • Mitral Area
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47
Q

High risk factos for heart disease

A
  • high blood pressure
  • smoking
  • high cholesterol
  • diabetes
  • obesity
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48
Q

What protects the heart for women?

A

estrogen

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49
Q

How does obesity affect Cardiovascular Disease?

A
  • fat around the organs (stomach)
    *
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50
Q

What are you assess for objective data

A
  • room prep
  • position and draping
  • equipment needed
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51
Q

what type of assessment do you take for bruit?

A

auscultate

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52
Q

What type of assessment do you take for carotid arteries?

A

palpate

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53
Q

What is difficult to see in healthy people related to the heart?

A

jugular veins

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54
Q

What type of assessment do you take for the Precordium

A

inspect, palpate (PMI), percussion (not reliable)

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55
Q

All patients take meds Mneumonic

A
  • Aortic Valve
  • Pulmonic Valve
  • Tricuspid Valve
  • Mitral Valve
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56
Q

What do blood vessels do?

A

Transport Blood which transports oxygen

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57
Q

What do lymphs do?

A
  • Helps vessels control fluid,
  • gets rid of waste.
  • Immunity.
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58
Q

What are you markers for major arteries?

A

ulnar, radial, brachial

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59
Q

When feeling pedal pulses what artery?

A
  • femoral
  • politeal
  • posterior tibial
  • doral pedis (top of foot)
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60
Q

What are signs getting good blood flow?

A
  • Cap refill less that 3
  • Warmth
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61
Q

Intraluminal valves help to ensure

A

blood moves towards the heart

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62
Q

What do varicose veins look like?

A
  • blue
  • torturous
  • you can feel
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63
Q

How would the skin present itself if you had arterial insufficiencies?

A
  • thin, shiny skin, thick nails
  • less hair on legs
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64
Q

What is a DBT

A
  • Deep vain thrombosis
  • Clott
    • pain & warmth
    • on one side
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65
Q

How are pulses measured

A

0-4, 2 is normal

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66
Q

Modified Allen’s Test

A
  • should see blanching
  • compression on radial & ulnar arterties
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67
Q

What are some peripheral vascular disease

A
  • raynaud’s syndrome
  • lymphedema
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68
Q

What is blooms taxonomy?

A
  • helps to define different questions
  • Creating
  • Evaluating
  • Analyzing
  • Applying
  • Understanding
  • Remembering
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69
Q

What is the precordium?

A

anterior chest overlying the heart and great vessels

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70
Q

Describe the Tricuspid Valve

A

Right atrioventricular valve

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71
Q

What is the function of the pulmonic valve?

A

protect the orifice between the right ventricle and the pulmonary artery

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72
Q

Jarvis:

How does atrial systole occur?

A

independently of ventricular function

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73
Q

Jarvis:

The second heart sound is the result of:

A

closing of the mitral and tricuspid valves

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74
Q

Jarvis:

When palpating an apical impulse what is the normal size?

A

2 cm

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75
Q

Jarvis:

Where do you listen in the pulmonic valve area?

A

the 2nd Left Interspace

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76
Q

Jarvis:

What is the difference between S2 & S3?

A

S3 is lower pitched and is heard at the apex

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77
Q

Jarvis:

When auscultating the heart your first step is to:

A

identify S1 & S2

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78
Q

Jarvis:

Where is a split S2 heard most clearly?

A

pulmonic

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79
Q

Jarvis:

Why is the stethoscope placed lighting against the skin?

A

it does not act as a diaphragm

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80
Q

Jarvis:

What is the function of the venous system?

A

Hold more blood when blood volume increases

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81
Q

Jarvis:

What organs aid the lymphatic system?

A

spleen, tonsils, thymus

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82
Q

Jarvis:

What causes varicose veins in pregnant women?

A

pressure of the growing uterus on the veins

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83
Q

Jarvis:

A 4+ edema of the right leg is documents. The best description of theis type of edema is:

A

very deep pitting, indentation lasts a long time

84
Q

Jarvis:

A known risk for venous ulcer development is:

85
Q

Jarvis:

What does Brawny mean?

A

non pitting edema

86
Q

What are we listening for in the heart? x 5

A
  1. Rhythmn/Rate
  2. S1 & S2 together
  3. S1 & S2 separate
  4. S3 & S4
  5. Murmurs
87
Q

When do we switch from diaphram to bell?

A

S3 & S4, murmurs

88
Q

Where is the aortic valve?

A

2nd intercostal rt sternum

89
Q

Where is the pulmonic valve

A

2nd intercostal left sternum

90
Q

Where is the tricuspid valve?

A

5th ICL left sternum

91
Q

Where is the mitral valve

A

5th intercostal midclavical

92
Q

S1 is the closure of which valves?

A

av valves (mitral/tri) @apex

93
Q

s2 is the closure of which valves?

A

semilunar, pulmonary/aortic (at base)

94
Q

Where do you hear split S2

A

pulmonic valve stays open a little bit during inspiration

95
Q

Where is the systolic contraction

A

in between lub and dub

96
Q

Where is the diastolic?

A

before or after lub dub

97
Q

Posterior Throacic Cavity/Locating Lungs

A
  • vertebra prominens (c7)
  • spinous processes (knobs)
  • inferior border of scapula (7th/8th rib)
  • 12th rib
98
Q

Where are the highest point in the lungs

A

apex, above clavical

99
Q

Where is the lateral lung

A

Apex of acula, 7th or 8th rib

100
Q

Are the lobes of the lungs symmetrical

101
Q

What is different about the lung because of the heart?

A

left lung lobe is more narrow

102
Q

Anterior Reference Lines for the lungs

103
Q

Which side as 3 lobes

A

right side

104
Q

Where is the base of the lungs?

A

lower border, rest on diaphram (6th intercostal)

105
Q

Which lung lobe is shorter?

A

the right side, because of the liver

106
Q

Why do you have to listen to posterior, anterior, lateral?

A

your missing significant lung space

107
Q

What is the pleura

A

a membrane

108
Q

What does visceral pleura

A

sack for the lungs

109
Q

Parietal pleura is where

A

lines the inside of the chest wall and diaphragm

110
Q

What is the pleural cavity

A

inside of envelope, filed with only mL of lubricating fluid. Negative pressure

111
Q

Why is the negative pressure?

A

lungs are being pulled open, otherwise lungs would collapse

112
Q

Costodiaphragmatic recess

A

pleurae extend 3cm below level of lungs. If area fills with fluid will cause problems. Shortness of breath.

113
Q

Pleural friction rub?

114
Q

Trachea dn Bronchial Tree

A
  • dead space, not available for gas exchange
  • gas xchange occurs in bronchial
115
Q

4 major function of respiratory syst

A
  1. supply o2 for energy
  2. see slides
116
Q

What is controlling respiration

117
Q

What controls the respiration

A

ponds and medula of brain stem

118
Q

Hypercapnea

A

too much CO2

119
Q

hypoxia

A

low oxygen

120
Q

hypoxemia

A

low oxygen in the blood

121
Q

What is the major muscle of inspiration

122
Q

Is expiration passive or active

123
Q

What happens to adults lung capacity

124
Q

What increases for adults

A

kyphosis, infection, dysnia, thorax becomes rounded

125
Q

What infectious disease has declines

126
Q

What is the BCG vaccine?

A

TB vaccine

127
Q

What percent of the us pop has asthma

128
Q

What hemoptysis?

A

coughing up blood

129
Q

What do you ask for SOB

A

what brings it on, how long does it last

130
Q

What health hx are you looking for (subj data)?

A
  1. smoking history
  2. environmental exposure
  3. self care behaviors
  4. chest pain with breathing
  5. SOB
  6. Cough
  7. past history of resp infections
131
Q

What vaccination do you want to ask about for self care behavior?

A
  • flu shot
  • pneumonia
  • ppd
132
Q

What do you ask older adults for health hx lungs?

A
  • fatigue
  • exercise
  • chest pain when breathing
133
Q

What is your objective data for lungs?

A
  1. position- start at back
  2. draping
  3. timing during a complete exam
  4. posterior and then anterior
  5. cleaning stethoscope end piece
134
Q

What equipment do you need for lung exam?

A
  1. stehoscope
  2. sruler
  3. marking pen
  4. alcohol swabs
135
Q

What is a normal ratio for antero to posterior (transvers)

A

1:2 or 5:7(side to side)

136
Q

What is barrel chest

A
  • COPD
  • 1:1
  • chest comes out farther
137
Q

What position do you put person

A

orthopneic position, tripod

138
Q

What is tactle fremitus

A
  • palpable vibration
  • ulnar edge of hand
  • chest wall thickness
  • 99, blue moon, generate strong vibe
  • should be symmetrical
  • position of bronchi to chest wall
139
Q

When is percussion used?

A
  • low pitched, clear, hollow sound
  • for lung fields
  • want to hear resonance
140
Q

What does dull sounds mean?

A

something blocking, increased density of tissue

141
Q

Auscultation of the lungs?

A
  • should be hearing clear sounds
  • apices in supravlacilular around down to 6th rib
142
Q

Brochovesicular breath sounds

A

moderate pitch. Inspiration = expiration. All over bronchi. Midline

143
Q

What are crackles?rales

A
  • caused by fluid
144
Q

Vesicular

A

Inspiration greater than expiration. on lung tissue

145
Q

What does adventitious ounds mean?

146
Q

What is wheezing

A

narrowing of the airways

147
Q

Atelectatic crackles

A
  • a portion of the lung is collapsed and airless
  • end-inspiratory crackles
  • hear posterior
148
Q

Voice Sounds

A
  • bonchophony
  • egophony
  • whispered
149
Q

WOB

A
  • work of breathing
  • quality of reps
  • Rib interpaces- retractions?
  • accessory neck muscles
150
Q

Forced expiratory time or volume

A

normal is about 4 seconds

151
Q

what is the 6 min distance walk

A

means they can complete adls if can go 300 meters.

152
Q

Know breathing patterns 18-4, 18-5, 18-6

153
Q

What is the difference between biots and cheyne stokes?

A

biots is irregular

154
Q

What are discontinuous sounds?

A

crackles

atelectic crackles

pleural friction rub

155
Q

What are continuous sounds

A

wheeze, stridor

156
Q

What are fine crackles vs course crackles?

157
Q

plearual friction rub

A
  • leather rubbing together
  • pleuritis
158
Q

What are high pitches wheezing?

A

asthma, sibilant

159
Q

What are low pitched wheezing

A

sonorous, copd

160
Q

What is a life threatening sound

A

stridor, crowing

161
Q

What are some nursing diagnoses for lungs?

162
Q

What is the nose function

A
  • warms, moistens, filters inhaled air, smells
163
Q

Where does the nasal cavity extend

A
  • roof of mouth,
  • septum,
  • turbinates.
    contain boney projections
164
Q

Paranasal sinuses

A
  • frontol- above eyes
  • maxiallary, cheek bone
  • ethmoid, eyes
  • sphenoid
165
Q

What is the mouth

A
  • airway for the respiratory sys
  • hard palate- whitish
  • soft palate- pinker
166
Q

Parotid lies within

A

cheeks, in front of ear

167
Q

submandibular

A

beneath maniblee

168
Q

What are 3 salivary glands

A

parotid

submandibula

sublingual

169
Q

How many teeth do you have

170
Q

Developmental care for aging adult

A

reduce smell, gum loss, nose more prominent

171
Q

What is rhinorrhea

A

fancy word for nasal discharge

172
Q

What do you ask about for nose sub data

A

colds, sins pain, trauma, epistazis, allergies, altered smell, discharge

173
Q

What self care behavior for moth and throat

A

brushing teeth, dental visits, floss

174
Q

What age do you start going to the dentist?

175
Q

Where do you test patency of nostrils

A

CN 1- sense of smell

176
Q

Where is the most common place to see mouth cancer?

A

underneath tongue

177
Q

Tonisl grading

A
  • 1+ you can see them
  • 4+ almost blocking off airway
178
Q

What do tonsils look like

A

deep divet/crips (pockets)

179
Q

When should you do the oral exam for children

A

at the end

180
Q

What are abnormalities of the nose

A
  • epistaxis- bloody nose
  • acute rhinitis- membranes dk red, drainage- purulent
  • allergic rhinitis- white gray- serous drainage
181
Q

Where do blood noses start?

A
  • inside your nostrils (anterior)
  • back of your nose (posterior).
182
Q

How do you assess for abnormal findings of nose?

A

nasal flaring

183
Q

Small Intestine is for

184
Q

large intestine

A
  • waste
  • absorbs water/electrolytes
  • elimination
185
Q

defecation

A

process of elimnation of waste

186
Q

Feces

A

semi solid mass of fiber, undigested food

187
Q

Where does fecal material reach

188
Q

What do stretch receptors initiate

A

contraction of sigmoid colon/rectal muscles

189
Q

What is valsalva maneuver

A

involuntary bearing down

190
Q

what does the external sphincter do

191
Q

What factors affect bowel elimination

A
  • diet/fiber
  • activity
  • hydration
  • meds
  • developmental stage
  • dont get control of sphincter until 2 yrs
192
Q

What are the words used and how often is it normal?

A
  • poop, stool, bm, feces, defecate
193
Q

When do we get concerned about bowel movement

A

if they have not gone in 3 days

194
Q

What parts of bowel routine is importance?

A
  • daily time clock
  • hot drinks
  • stool softeners
  • privacy
  • position and ab pressure
  • bearing down
195
Q

What should you asses when assistance with elimination

A

privacy, how does patient feel

196
Q

What encourages defecation

A
  • water,
  • fiber
  • exercise
197
Q

What does poop that floats mean?

198
Q

Common alterations in defecation

A
  • diarrhea,
  • constipation,
  • fecal impaction,
  • bowel diversion
199
Q

How do we monitor for fluid impalances

A
  • turgor,
  • mucos membranes
  • in/out
200
Q

What is a diarrhea diet

A
  • clear liquid
  • BRAT
  • avoid cafeine, spicy foods
201
Q

Anti diarrheal meds

A

lomotil, imodium

202
Q

Should meds be given for diarrhea caused by food poisonoing?

203
Q

Managing fecal impaction

A
  • prevention
  • determine presence
  • enemas
  • man/dig stimulation
  • establish bowel program
204
Q

What is an enema

A
  • fluid breaks up fecal mass,
  • intiiates defecation reflex
  • position patient left lateral position
  • promotes defecation
  • phys order
  • chux undereath
205
Q

How much solution for enema of adult

A

350-500 mL

206
Q

Common Diagnostic tests

A
  • stool for ocult blood- “guaiac test”
  • direct visualization
  • radiographic view- flat plate of ab

Nursing School (33 decks)

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