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Health Assessment > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Cerebral cortex

A
  • center for highest functions
  • thoughts, memory, reasoning, sensation, voluntary movement
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2
Q

Basal ganglia

A
  • large bands of gray matter
  • initiates/coordinates movement
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3
Q

Thalamus

A

main relay station for all senses

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4
Q

Hypothalamus

A

major respiratory center with basic vital functions

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5
Q

Cerebellum

A
  • coiled structure under occipital lobe
  • voluntary movements, equilibrium, mm tone
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6
Q

Brainstem

A
  • central core of brain made of nn fibers
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7
Q

Spinal cord

A
  • nervous tissue
  • tracts that connect to brain and spinal nn
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8
Q

ANS communicates with

A

internal organs and glands

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9
Q

PNS

A

all nerve fibers outside CNS

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10
Q

Somatic nervous system

A
  • communicates with sense organs and voluntary mm
  • sensory and motor
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11
Q

Cranial nerve 1

A

olfactory - smell

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12
Q

Cranial nerve 2

A

optic - near and distant visual acuity, visual fields

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13
Q

Cranial nerve 3

A

Oculomotor
- EOM movements (6 cardinal positions)
- palpebral fissures
- PERRLA

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14
Q

Cranial nerve 4

A

trochlear
- EOM, palpebral fissure, PERRLA

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15
Q

Cranial nerve 5

A

trigeminal
- clench teeth, light touch on cheeks, forehead, chin

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16
Q

Cranial nerve 6

A

Abducens
- EOM movements, palpebral fissures, PERRLA

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17
Q

Cranial nerve 7

A

Facial: smiling, puffed cheeks, taste

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18
Q

Cranial nerve 8

A

vestibulocochlear: hearing

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19
Q

Cranial nerve 9

A

Glossopharyngeal
- uvula movement when patient says “ahh”
- gag reflex

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20
Q

Cranial nerve 10

A

vagus
-uvula movement when patient says “ahh”
- gag reflex

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21
Q

Cranial nerve 11

A

spinal accessory - shoulder shrug

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22
Q

Cranial nerve 12

A

hypoglossal - tongue symmetry

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23
Q

Nerve mnemonic

A

our old oak table top adds fun and gaudy vibes some holidays

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24
Q

Cranial nn function mnemonic

A

some say marry money but my brother says bad bitches marry money

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25
Q

AAOx4

A

alert to person, place, time, situation

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26
Q

Cranial nn III, IV, VI assessment

A
  • eye movements
  • pupillary light reflex
  • PERRLA
  • 6 cardinal positions
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27
Q

Increased intracranial pressure causes

A

sudden, unilaterally, dilated, and nonreactive pupils

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28
Q

Ptosis can occur with

A

myasthenia gravis or dysfunction of cranial n 3

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29
Q

Strabismus

A

deviated gaze or limited movement

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30
Q

Nystagmus

A

can occur with disease of visibular system, cerebellum, or brainstem

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31
Q

Cranial n. VII assessment

A

Note mobility and facial symmetry
- smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks

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32
Q

Abnormal facial n findings

A

loss of movement or asymmetry
- can occur with stroke or bells palsy

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33
Q

Cranial n. VIII assessment

A

test hearing by ability to hear normal conversation

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34
Q

Cranial nn IX, X assessment

A
  • depress tongue with blade and say “ahhh”
  • uvula and soft palate should rise midline
  • tonsils should move inward
  • absence of symmetry could mean stroke and risk of aspiration
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35
Q

Cranial n XII assessment

A
  • have patient stick out tongue
  • no tremors, midline
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36
Q

Cranial n XI assessment

A
  • examine sternomastoid and trapezius mm for equal size and strength
  • ask patient to rotate head against resistance applied to chin
  • ask patients to shrug shoulders against resistance
  • mm weakness could occur from stroke or peripheral n damage
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37
Q

Assessing gait

A

should be smooth and effortless

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38
Q

Romberg test

A
  • pt. stands with feet together arms at side
  • have them close eyes and balance
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39
Q

Positive romberg test can occur with

A

multiple sclerosis, intoxication, loss of proprioception, poor vestibular function

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40
Q

Assessing pain/sensation

A

tested using dull and sharp side randomly on extremities x4
- patient should distinguish sharp or dull

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41
Q

Assessing sensation

A

patient identifies random object placed in hands

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42
Q

Astereognosis

A

inability to identify object correctly - can occur in stroke

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43
Q

Deep tendon reflex testing

A
  • short snappy blow of hammer onto tendon
  • usually patellar/quadriceps
  • right and left should have equal response
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44
Q

DTR ranking

A

0 = no response
1+ = diminished
2+ = average, expected
3+ = brisker than average
4+ = very brisk, hyperactive (disease)

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45
Q

Plantar reflex testing

A
  • position thigh in slight external rotation
  • draw slow stork up lateral side of sole of foot and inward across the ball of foot
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46
Q

Plantar reflex testing: expected

A

plantar flexion of toes and inversion of foot

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47
Q

Plantar reflex testing: abnormal

A

babinski signs - dorsiflexion and fanning of toes
- occurs with brain injury, stroke, brain tumor, MS, spinal cord injury

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48
Q

Joints

A
  • union between 2 bones
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49
Q

Fibrous joints

A
  • united by fibrous tissue or cartilage
  • immoveable
  • skull sutures
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50
Q

Cartilaginous joints

A
  • separated by fibrocartilaginous discs
  • slightly moveable
  • vertebrae
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51
Q

Synovial joints

A
  • freely moveable
  • joint cavity lined with synovial membrane
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52
Q

Cartilage

A
  • avascular, tough, firm, flexible
  • absorbs shock and allows for movement
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53
Q

Ligaments

A
  • connect bone to bone
  • stabilize bones and limits movemente
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54
Q

Bursae

A
  • fluid filled sacs that cushion bones and ligaments
  • located in areas of potential friction
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55
Q

Tendons

A

connect mm to bone, strong fibrous cord

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56
Q

MM makes up how much body weight

A

40-50%

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57
Q

Swelling in musculoskeletal indicates

A

joint irritation, excess joint fluid, inflammation, bony enlargement

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58
Q

Subluxation

A

two bones in joint stay in contact but misaligned

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59
Q

Contracture

A

shortening of mm leading to limited ROM

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60
Q

Ankylosis

A

stiffness or fixation in joint

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61
Q

Warmth + tenderness of musculoskeletal means

A

inflammation

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62
Q

5+ mm grade

A

full ROM against gravity, full resistance, normal

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63
Q

4+ mm grade

A

full ROm against gravity, some resistance, good

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64
Q

3+ mm grade

A

full ROM with gravity, fair

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65
Q

2+ mm grade

A

full ROM with gravity eliminated, passive motion, poor

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66
Q

1+ mm grade

A

slight contraction, trace

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67
Q

0 mm grade

A

no contraction, zero

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68
Q

Crepitation

A

audible/palpable crunching or grating accompanying movement

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69
Q

ROM assessment

A
  • start with active motion
  • passive motion if limitations are assessed
  • should be equal bilaterally
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70
Q

TMJ ROM

A
  • place fingers in front of ears and have person open and close mouth then clench jaw
  • should feel smooth movement
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71
Q

TMJ dysfunction

A

crepitus and pain during movement or chewing
- tenderness with palpation

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72
Q

Cervical spine ROM - flexion

A

touch chin to chest

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73
Q

Cervical spine ROM - extension

A

lift chin to ceiling

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74
Q

Cervical spine ROM - lateral bending

A

touch ears to shoulders

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75
Q

Cervical spine ROM - rotation

A

turn chin towards shoulder

76
Q

Shoulders ROM - internal rotation

A

rotate arms internally behind back

77
Q

Shoulders ROM - external rotation

A

touch both hands behind head

78
Q

Shoulders ROM - abduction

A

with arms at sides, raise both arms, touch palms together above head

79
Q

Shoulders ROM - adduction

A

move arms back down in front of body

80
Q

Elbow ROM - flexion/extension

A

bend and straighten elbow

81
Q

Elbow ROM - pronation/supination

A

hold hand on table, front and back sides to table

82
Q

Hands and wrist ROM - extension

A

bend hand up at wrist

83
Q

Hands and wrist ROM - flexion

A

bend hand down at wrist

84
Q

Hands and wrist ROM - ulnar deviation

A

with palms flat, turn them outward and in

85
Q

Hands and wrist ROM - abduction

A

spread fingers apart

86
Q

Hands and wrist ROM - adduction

A

tight fist

87
Q

Hands and wrist ROM - phalen test

A

hold both hands back to back
- if patinet has carpal tunnel it willll cause numbness and burning

88
Q

Hips ROM - flexion (90 degrees)

A

raise leg with knee extended

89
Q

Hips ROMS: flexion 120 degrees

A

bend knee and raise leg while other leg remains straight

90
Q

Hips ROM - internal and external rotation

A

flex knee and swing foot outward and inward

91
Q

Hips ROM - abduction and adduction

A

swing leg laterally, then medially

92
Q

Ankle/Foot ROM - plantar flexion

A

point toes to floor

93
Q

Ankle/Foot ROM - dorsiflexion

A

point toes to nose

94
Q

Ankle/Foot ROM - eversion

A

turn soles of feet out

95
Q

Ankle/Foot ROM - inversion

A

turn soles of feet in

96
Q

Spine ROM: flexion

A

bend foward and touch toes

97
Q

Spine ROM: extension

A

bend backwards

98
Q

Spine ROM: lateral bending

A

bend sideways

99
Q

Spine ROM: rotation

A

twist shoulders

100
Q

Mental status is

A

emotional and cognitive function

101
Q

First sign of impending health crisis

A

change in mental status/LOC

102
Q

Mental health

A

state of well-being where they realize their potential, can cope with stress, work productively, and contribute to community

103
Q

Mental disorder

A

clinically significant syndrome associated with distress or disability

104
Q

Organic disorder

A

caused by brain disease of known specific organ cause

105
Q

Examples of organic disorders

A

delirium, dementia, intoxication, withdrawal

106
Q

Psychiatric mental disorder

A

an organic etiology has not yet been established

107
Q

Consciousness

A

awareness of one’s own existence, feelings, thoughts

108
Q

Language

A

using voice to communicate

109
Q

Mood

A

durable, prolonged display of feelings that color the whole emotional life

110
Q

Affect

A

temporary expression of feelings or state of mind

111
Q

Orientation

A

awareness of objective world in relation to self

112
Q

Attention

A

power of concentration, ability to focus on one thing

113
Q

Memory

A

ability to store experiences and perception for later recall

114
Q

Abstract reasoning

A

deeper meaning beyond the literal

115
Q

Perceptions

A

awareness of object through the 5 senses

116
Q

Flat affect

A

lack of emotional response

117
Q

Inappropriate affect

A

emotional reaction inappropriate for the situation

118
Q

Depersonalization

A

loss of identity

119
Q

Elation

A

joy and optimism, overconfidence, increased motor activity, not necessarily pathologic

120
Q

Euphoria

A
  • excessive well being
  • can be inappropriate
  • implies a pathologic mood
121
Q

Ambivalence

A

opposing emotions toward something

122
Q

Liability

A

rapid shift of emotions

123
Q

Mental status is inferred by assessing…

A

appearance, behaviors, cognition, thoughts (ABCT)

124
Q

Factors that could affect mental health interpretations

A
  • illness
  • current medications
  • education and behavioral level
125
Q

Components of assessing appearance

A

posture, body movements, dress, grooming and hygiene, pupils

126
Q

Body movements that signal anxiety

A

restless, fidgety

127
Q

Body movements that signal depression and dementia

A

apathy, psychomotor slowing

128
Q

Body movements that signal schizophrenia

A

abnormal posturing, bizarre gestures

129
Q

Body movements suggesting pain

A

facial grimacing

130
Q

Body movements suggesting neurological disorders

A

involuntary tics

131
Q

Meticulous dress may indicate

A

OCD

132
Q

Inappropriate dress/poor hygiene may indicate

A

alzheimer’s

133
Q

Unilateral neglect of grooming may suggest

A

stroke

134
Q

Unexpected LOC

A

loses track of conversation, falls asleep, lethargic, confused

135
Q

Unexpected speech findings

A

dysphonia, uncommunicative, dysarthria, inability to find words

136
Q

Components of assessing behavior

A

LOC, facial expression, speech, mood and affect

137
Q

Components of assessing cognition

A

orientation, attention span, recent memory, remote memory, new learning

138
Q

Disorientation may indicate

A

delirium or dementia

139
Q

Recent memory deficit causes

A

delirium, dementia, alcoholism

140
Q

To test recent memory, ask the patient

A

what they ate in the last 24 horus

141
Q

To asses remote memory, ask the person about

A

past birthdays, anniversaries, historical events

142
Q

Remove memory loss occurs in

A

alzheimer’s and dementia

143
Q

Test new learning by

A

recalling 4 words

144
Q

Components of assessing thoughts

A

thought process, thought content, perceptions

145
Q

Screening for depression

A
  • patient health questionnaire (PHQ-2)
  • 2 questions
  • move to full PHQ-9 if patient answers several days
146
Q

LOC: alert

A
  • awake, readily aroused, orientated
  • aware of external + internal stimuli
  • respond appropriately
  • meaningful itneraction
147
Q

LOC: lethargic

A
  • not fully alert
  • drifts to sleep when not stimulated
  • can be aroused to named when called in normal voice
  • looks drowsy
  • responds appropriately to questions but thinking is slow/fuzzy
  • inattentive, loses train of thought, decreased spontaneous movements
148
Q

LOC: obtunded

A
  • transitional state between lethargy and stupor
  • sleeps most of time
  • difficult to arouse - needs loud shout or vigorous shake
  • confused when aroused
  • monosyllable conversation
  • speech may be mumbled/incoherent
  • requires constant stimulation for marginal cooperation
149
Q

LOC: stupor/semi-coma

A
  • completely unconscious
  • no response to pain or stimuli
  • light coma has some reflex activity
  • deep coma has no motor response
150
Q

LOC: delirium

A
  • clouding of consciousness, inattentive, incoherent conversation
  • impaired recent memory
  • agitated, visual hallucinations, disorientated, confusion worse at night
151
Q

Glascow coma scale

A
  • accurate, reliable, quantitative tool for testing consciousness
  • looks at functional state of brain as a whole
  • measures eye opening, verbal response, motor response
152
Q

Glascow score < 7

A

coma

153
Q

Glascow score of 15

A

fully alert normal person

154
Q

Galscow coma scale: eye opening response

A

spontaneous = 4
to speech = 3
to pain = 2
no response = 1

155
Q

Glascow coma scale: motor response

A

obeys verbal command = 6
localizes pain = 5
flexion - withdrawal = 4
flexion - abnormal = 3
extension - abnormal = 2
no response = 1

156
Q

Glascow coma scale: verbal response

A

oriented x 3 - appropriate = 5
conversation confused = 4
speech inappropriate = 3
speech incomprehensible = 2
no response = 1

157
Q

Delirium is an

A

acute confusional state, potentially preventable in hospitalized persons

158
Q

Delirium characteristics

A

disorientation, illusions, hallucinations, defective memory, agitation, inattention

159
Q

Dementia definition

A

chronic progressive loss of cognitive and intellectual function

160
Q

Dementia characteristics

A
  • perception and consciousness are intact
  • disorientation, impaired judgment, memory loss
161
Q

Depression definition

A

long-term depressed mood > 2 weeksD

162
Q

Depression characteristics

A

lack of pleasure, sleep and appetite disturbance, hopelessness, guilt, sadness, despair, suicidal ideation

163
Q

Delirium onset

A

sudden, hrs to days

164
Q

Dementia onset

A

over months

165
Q

Depression onset

A

may be gradual with exacerbation during crisis

166
Q

Delirium cause/contributing factors

A

hypoglycemia, fever, dehydration, hypotension, infection, adverse drug reactions, head injury, change in environment, pain, stress, substance abuse

167
Q

Dementia cause/contributing factors

A

alzheimer’s, vascular disease, immunodeficiency, virus, neurologic disease, alcoholism, head trauma

168
Q

Depression cause/contributing factor

A

loneliness, crises, declining health, medical conditions

169
Q

Delirium cognition

A

impaired memory, judgment, calculations, attention span, fluctuates during the day

170
Q

Dementia cognition

A

impaired memory, judgment, calculations, attention span, abstract thinking, agnosia

171
Q

Depression cognition

A

difficulty concentrating, forgetfulness, inattention

172
Q

Delirium LOC

A

altered

173
Q

Dementia LOC

A

not altered

174
Q

Depression LOC

A

not altered

175
Q

Delirium activity levels

A
  • increased or reduced
  • sundowning
  • reversed sleep/wake cycle
176
Q

Dementia activity level

A
  • not altered
  • sundowning
177
Q

Depression activity level

A
  • usually decreased
  • lethargy, fatigue, no motivation
  • poor sleep, wake up early
178
Q

Delirium emotional state

A
  • rapid swings, fearful, anxious, suspicious, aggressive
  • hallucinations, delusions
179
Q

Dementia emotional state

A

flat, agitation

180
Q

Depression emotional state

A

extreme sadness, apathy, irritability, anxiety, paranoid, ideation irritability

181
Q

Delirium speech and language

A

rapid, inappropriate, incoherent, rambling

182
Q

Dementia speech and language

A

incoherent, slow, inappropriate, rambling, repetitions

183
Q

Depression speech and langauge

A

slow, flat, low

184
Q

Delirium prognosis

A

reversible with proper and timely treatment

185
Q

Dementia prognosis

A

not reversible, progressive

186
Q

Depression prognosis

A

reversible with proper and timely treatment

187
Q

The greatest influence on health status is

A

poverty

Health Assessment (4 decks)

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