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Holistic Lecture > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

cardiac landmarks for assessment and how to assess

A

APE To Man, A2 (aortic), P2 (pulmonary). Erb’s point, T1 (tricuspid), M1 (mitral); assess clock wise starting with aortic (right upper quadrant)

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2
Q

direction of blood flow through the heart

A

IVC and SVC- RA- tricuspid- RV pulmonic valve- pulmonic artery-lungs -pulmonary veins- LA-bicuspid- LV -aortic valve-body and coronary arteries

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3
Q

diastole

A

ventricles relax and fill with blood

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4
Q

systole

A

heart contracts

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5
Q

two distinct components to each heart sound exist because

A

cardia depolarization occurs slightly later on the right side of the heart than on the left side

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6
Q

discribe conduction of the heart from SA node

A

conduction: cardiac impulse originates in the sinoatrial node and spreads through the atria and to the atrioventricular node, where it is delayed. Impulses travel to the bundle of His, the right and left bundle branches and then to the ventricles.

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7
Q

what are signs of aging that occur to the cardio vascular system

A

systolic increases, left ventricular wall thickens, decreased ability of the heart to augment cardiac output with exercise, increased presence of supraventricular and ventricular arrhythmias with aging

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8
Q

how to assess for JVD

A

inspect for JVD when head of exam table 45 degrees, positive indicates increased CVP and right side heart failure

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9
Q

how to assess carotid artery

A

auscultate for bruit, positive indicates narrowing of carotid artery

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10
Q

what is a bruit

A

blowing, swishing sound that indicates blood flow turbulance in a vessel

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11
Q

how should you assess pulse deficit?

A

detect irregular rhythm assess apical beat simultaneously with radial pulse, if difference in the two is detected subtract radial rate from apical rate. this is recorded as the pulse deficit

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12
Q

what type conditions does pulse deficit cause

A

present with weak contration of ventricles occuring with atrial filbrillation, premature beats, or heart failure

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13
Q

How should we assess point of maximal impulses PMI?

A

palpate where apical impulse can be best palpated, heave or lift of chest wall occurs with ventricular hypertrophy; right ventricular heave at sternal border, left ventricular heave at apex

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14
Q

4 guide lines for S1 vs. S2 sound

A
  1. S1 is normally first except for in trachyarrhythmias
  2. S1 is louder than S2 at the apex; S2 louder than S1 at base
  3. S1 coinsides with the carotid artery pulse
  4. S1 coinsides with the R wave in on ECG monitor
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15
Q

what is S3

A

third heart sound, ventricular gallop (ken-tuck-y), heard best at apexwith client lying on left side, normal in children and young adults, sign of heart failure in other adults

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16
Q

what is S4

A

fourth heart sound artial gallop (ten-nes-see), heard over tricuspid or mitral areas, occurs before S1, heard in older adults with hypertension aortic stenosis or history of myocardial infarction, listen with bell at apex with pt in left lateral position

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17
Q

grading scale of murmurs

A

i-barely audiable ii-audible but quiet and soft iii-moderately loud with no thrust or thrill iv- loud with thrill v- very loud with thrust or thrill vi- loud enough to hear before stethoscope come in contact with skin

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18
Q

Aortic prosthetic valve sounds

A

hear a ticking or clicking sound with artificial (mechanical) valve

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19
Q

assessing pericardial friction rub

A

have pt sit up, lean foward and exhale, listen with diaphragm over 3rd ICS on left side of chest, sounds like scratchy rubbing sound

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20
Q

what is thrill?

A

palpable vibration suggests valve dysfunction, feels like purring cat

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21
Q

what is a heave or lift?

A

during palpation can feel lifting of chest wall; if along left sternal borde, may be right ventricular hypertrophy and if over left ventricular area may be ventricular aneurysm

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22
Q

characteristics to look for of a murmur

A

timing, loudness, pitch, pattern, quality, location, radiation, posture

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23
Q

regurgitation murmur

A

back flow of blood bc of incompetent valve that can’t close properly so blood leaks back into previous chamber

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24
Q

stenosis

A

murmur caused by narrowing of valve opening bc calcification, fibrosis, or thickening of leaflets lead to a decreased blood flow through the valve

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25
Q

blood vessels with age

A

grow more rigid and lead to rise in systolic BP

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26
Q

Modified Allen Test

A

used to determine if there is adequate collateral circulation before cumulating the atery or performing aterial blood gases

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27
Q

major artery supplying the arm and leg

A

brachial artery and femoral artery; ulnar artery one most often not palpable

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28
Q

bruit over femoral artery

A

partial occlusion of the artery

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29
Q

3 stomach lobes

A

fundus, body and pylorus

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30
Q

Stomach functions:

A

Breakdown of food particles
Very little absorption takes place in the stomach.
Secretes hydrochloric acid and digestive enzymes to breakdown fats and proteins.

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31
Q

innocent murmur

A

indicates having no other valvular or other pathologic causes; healthy children

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32
Q

functional murmur

A

due to increased blood flow in the heart; anemia fever pregnancy hyperthyroidism

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33
Q

S1

A

closure of the av valves, loudest at apex, can be split which is rare but normal

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34
Q

S2

A

closure of semilunar valves, loudest at base, can split at end of inspiration only heard in pulmonic valve areas

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35
Q

preload

A

venous return that builds during diastole

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36
Q

Afterload

A

the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure

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37
Q

manual compression test of the leg

A

put one hand on lower part of vein and put other hand at the top and compress from the top. competent valves will prevent a wave transmission and lower fingers will feel no change

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38
Q

if femoral pulse is absent you would expect

A

all pulses below to be absent.

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39
Q

all pulses to assess

A

temporal, coronary, radial, ulnar(may not be palpable), brachial, femoral, popliteal, posterior tibial, dorsalis pedis

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40
Q

pitting scale for edema

A

1+: mild pitting, slight indent, no swelling 2+: moderate pitting indent subsides rapidly 3+: deep pitting, indent remains short time, leg looks swollen 4+: very deep pitting indent lasts long time, leg very swollen

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41
Q

how to obtain ankle brachial index

A

use arm BP cuff above ankle and assess ABP using Doppler of DP or PT and divide that by the systolic BP of the brachial arm; ABI=ankle sys BP/ brachial sys BP

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42
Q

ABI; what range indicates the presence of peripheral vascular disease and mild claudication

A

0.9- 0.7

normal is 1.06

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43
Q

frontal lobe

A

personality, emotions intellectual

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44
Q

parietal lobe

A

sensation

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45
Q

occipital lobe

A

visual

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46
Q

broca’s area

A

motor speech; frontal

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47
Q

basal ganglia

A

motor system; extrapyramidal

48
Q

thalamus

A

relay station between the spinal cord and brain stem

49
Q

hypothalamus

A

control center of vital functions, temp, heart rate, sleep, pituitary, ANS and emotions

50
Q

cerebellum

A

coordination of voluntary movements, equilibrium, and muscle tone

51
Q

brain stem

A

midbrain, pons, medulla (vital autonomic center, controls respiration heart GI nuclei for CNs 8-12 and crossing of motor fibers

52
Q

spinal cord

A

transmits messages to and from brain to spinal nerves and it mediate reflexes

53
Q

right side of brain controls

A

left side of body

54
Q

sensory pathways transmit messages to

A

the thalamus

55
Q

spinothalamic tract

A

sensations of pain temp crude or light touch

56
Q

posterior column

A

sensations od position vibration and finely localized touch

57
Q

corticospinal or pyramidal tract

A

motor cortex to brainstem and decussate (crossover) to opposite side of the brain; voluntary movements and writing

58
Q

extrapyramidal tracts

A

maintain muscle tone control body movements such as walking

59
Q

cerebellar system

A

gets information about position of muscles and provides equilibrium

60
Q

upper motor neurons

A

located in CNS; diseases with upper neurons are stroke cerebral palsy and multiple sclerosis

61
Q

lower motor neurons

A

located mainly in the peripheral NS; diseases include spinal cord lesions poliomyelitis and amyotrophic lateral sclerosis

62
Q

neurological screening

A

person that seems healthy for neurological problems

63
Q

the complete neurological exam

A

complete if any problems such as headache, neurological deficit, change level of consciousness, muscle weakness or incoordination, or seizures

64
Q

neuro-recheck is used on

A

anyone one with an identified problem to rack the situation to see if it worsens or gets better; report neurological changes promptly

65
Q

brudzinski’s and Kernig’s test

A

check for mono

66
Q

cushings triad

A

opposite signs of shock, hypertension bradycardia and decrease RR

67
Q

Mental status ABCT

A

Appearance, behavior, cognitive ability, thought process

68
Q

Alert

A

fully aware of external and internal stimuli

69
Q

lethargic

A

drifts off to sleep when not stimulated

70
Q

obtunded

A

sleeping most of the time, difficult to arouse

71
Q

stupor

A

responds only to persistent or vigorous shake or pain

72
Q

coma

A

no response to pain, ranges from “light coma” with some reflex action to ‘deep coma’ with no motor activity

73
Q

delirium

A

disturbance of consciousness or cognition that is acute in onset

74
Q

flat affect

A

lack of emotional response

75
Q

elation

A

extreme joy and optimism

76
Q

euphoria

A

cheerfulness and optimism that is inappropriate to the situation

77
Q

ambivalence

A

experiencing opposing emotions about a topic

78
Q

lability

A

rapidly shifting emotions

79
Q

Glasgow coma scale

A

highly predicts mortality; 1) eye opening 2) verbal 3)motor movement

80
Q

decorticate rigidity

A

arms/ hands on chest

81
Q

decerebrate rigidity

A

arms to sides with hands pointed outward

82
Q

normal score for mini mental status exam

A

24-30

83
Q

explain how to assess the cranial nerves

A

1-smell 2-eye chart, fields, scope 3-pupils and eyes follow object 4-normal eye movement 5-muscles of mastication light touch 6-move each eye laterally 7-face symmetry 8-hearing with tuning fork, whisper 9-gag and cough 10-gag and swallow 11- turn head shrug shoulders 12-stick tongue out

84
Q

kinesthesia

A

big toe and finger up and down; abnormal is reported as loss of position test

85
Q

tactile discrimination

A

fine touch, problems occur with lesions in sensory cortex or posterior column; client closes eyes for this test

86
Q

graphesthesia

A

draw a number on hand with clients eyes closed

87
Q

extinction

A

touch both sides of body and ask how many areas feel touched; no report of touch on opposite side of stroke

88
Q

scoring reflexes

A

4+ hyperactive 3+ brisk 2+ normal 1+present but diminished 0 absent

89
Q

four unrelated word test

A

ask after 5, 10 and 30 minutes; Alzheimer’s anxiety and depression can cause a score of 0 or 1

90
Q

mini mental assessment includes

A

orientation, registration, recall, calculation, language, and graphomotor function; used to screen for cognitive loss and quality of cognitive function

91
Q

set test- FACT

A

for mental status, asked to name 10 items in four categories or sets: fruits animals colors towns; max score is 40, less than 15 indicates possible dementia

92
Q

Dysdiadochokinesia

A

slow clumsy response to RAM

93
Q

stereognosis

A

recognize familiar object by feel

94
Q

only test temperature discrimination when

A

pain sensation is absent

95
Q

hypertension increases the risk for stroke and ______ have great risk for hypertension and for alzheimer’s

A

African Americans

96
Q

Cullen’s sign

A

bluish umbilicus indicates intra-abd hemorrhage

97
Q

turner’s sign

A

bruise on flank indicates retroperitoneal hemorrhage

98
Q

dilated tortuous visible abdominal veins

A

indicates inferior vena cava obstruction

99
Q

rebound tenderness

A

used when client has RLQ pain and may have appendicitis

100
Q

Inspiratory arrest or Murphy’s sign

A

when palpating the liver, there is pain and when the client is asked to take a deep breath they stop breathing when there is gallbladder (cholecysitis)

101
Q

iliopsoas muscle test

A

when thought to have appendicitis, client supine lift rt leg straight up flexed at the hip and push on thigh as client tries to keep leg up; if positive pain is felt in the RLQ

102
Q

drug and alcohol abuse are more common in

A

native and African americans

103
Q

obesity is more frequent in

A

Hispanics and African americans

104
Q

_____ are at greater risk for gastric cancer

A

Japanese

105
Q

lactose intolerance is greater in

A

non-white and jewish americans

106
Q

muscle strength grading

A

5- full ROM against gravity/ full resistance 4- Full ROM against gravity/ some resistance 3- full ROM against gravity 2- full ROM with gravity eliminated 1- slight contraction 0- no contraction

107
Q

phalen’s test

A

carpel tunnel test; wrist bent 90 degrees causing numbness or burning

108
Q

tinel’s test

A

hit nerve

109
Q

kyphosis

A

hump on back

110
Q

what is ascites

A

fluid wave across abdomen, need two people to preform test

111
Q

explain borbory gmi

A

hyperactive bowel sounds bc of hyper-peristalsis when a person can feel own stomach growling

112
Q

ballottment test

A

to test for large amounts of fluid around the patella

113
Q

bulge sign

A

small amount of fluid in knee joint, can displace fluid

114
Q

McMurray’s test

A

rotate knee hearing click positive for meniscus tear

115
Q

_____ measures angles of joint flexion

A

goniometer

Holistic Lecture (4 decks)

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