Final Exam Review Flashcards
What are some examples of communication barriers?
Ten trap questions
list 10 traps for interviewing?
1) providing false assurance or reassurance
2) Giving unwanted advice
3) Using authority
4) Using avoidance
5) Engaging in distancing
6) Using professional jargon
7) using leading or biased questions
8) Talking too much
9) Interupting
10) Using “why” questions.
Components of health hx?
Family health hx ?
Specific to patient: Past health such as vaccines, diseases, injuries, hospitalizations, medical hx ,surgeries, illness
Health info on close relatives
Subjective vs objective data
Subjective is what the patient tells you
Objective is data observed and what you see
Open ended vs close ended ?
Which would give the most info?
Closed - yes or no answers
Open- detailed answers - most info
What order would you conduct assessment of the abdomen
Inspect
Auscultate
Palpate
Percussion
Normal lung sounds ?
Bronchial ?
Bronchovestibular?
Vestibular ?
Where would you hear each on anterior and posterior ?
Bronchial- pitch is high, ampliflitude is loud - trachea and larynx
Bronchovestibular- pitch is moderate and amplitude is moderate - major bronchi and right scapula and upper sternum
Vestibular- pitch is low and amplitude is soft. Like wind in trees, over peripheral lung fields
Found by the sternum
Mole/lesion assessment:
How to assess ?
What might cancer look like?
ABCDE
Asymmetry- both side look the same?
Border irregularities
Color variations
Diameter greater than 6mm
Elevation or evolution
Inspection findings r/t
Scoliosis
Lordosis
Kyphosis
Scoliosis- shoulders are uneven, spine is uneven when bending over -curve is greater than 10 degrees
Lordosis- arched lower back (lumbar/cervical region)
Kyphosis- arches upper back -(thoracic region)
Define functional ability
Ones ability to perform activities necessary to live in modern society and include driving, using the phone, or performing personal tasks such as bathing and toileting
Define instrumental ADLs
Tasks such as shopping , meal
Preparation, house keeping, laundry, managing finances , taking meds , transportation.
Yard work, home maintenance, cooking
Importance of cuff size when taking bp?
If too big - false low
If too small- false high
?? How big to be
What does clubbing look like? Causes??
Protruding nails (bulbous)
Low oxygen in blood can cause (hypoxia)
Heart auscultation areas?
Aorta- 2nd Rt intercostal
Pulmonary- 2nd Lt
Erbs-3rd
Tricuspid 4th
Mitral/apical-5th
APEToman
Location of apical pulse
Mitral 5th- loudest at S1 here
Abnormality would be stenosis or regurgitation
Location of pulses ?
Radial wrist
Brachial - other side of elbow
Dorsal pedis - between big toe and second
Posterior tibial - back ankle
Popilital - behind knee
Apical- Lower left
Carotid - neck
Femoral - crotch
Temporal- behind eye on head
Glasgow coma scale?
What are the components?
Based on eye opening response, verbal response, and motor responses
13-15 points=minor brain injury
9-12 points=moderate brain injury
3-8 points =severe brain injury
Jendrassik maneuver
Have patient hook fingers together and clench their teeth to allow them to relax enough to elicit a patellar reflex
Cerebellum function tests
Rapid alternating movements - palm and back of hand knee pats
Finger to finger
Finger to nose **
Heel to shin - rub opposite heel along shin bone
Romberg test- standing with eyes closed and arms out holding the position
Test for each cranial nerves?
1-smell , plug one nostril
2-test visual acuity
3,4,6-tracking the finger and ocular movements
5- test clenching of teeth , push down on chin
7- smile, frown, lift eyebrows, show teeth, facial symmetry
8 hearing whispered voice test
9 and 10 depress tounge with blade and say ah , see uvula and tounge at midline
11-shrugging shoulders
12- to tremors, no protruding tounge , Normal clear speech
Deep tendon reflexes?
5 components :
An intact sensory nerve (afferent) A functional synapse in the cord An intact motor nerve fiber (efferent) The neuromuscular junction A competent muscle
Location of organs by quadrant
RUQ
RLQ
LLQ
LUQ
Midline
RUQ- liver, right kidney, gallbladder, colon, pancreas
LUQ- stomach left kidney, spleen, colon, pancreas
RLQ- appendix, colon, small intestine, ureter,major vein and artery to right leg
LLQ- colon, small intestine, ureter , major vein and artery to left leg
Midline- aorta, pancreas, small intestine, bladder, spine
Signs of arterial/venous insufficiency in extremities ?
Arterial- arteriosclerosis is stiffening or hardening of artery walls,
Atherosclerosis is narrowing of the artery because of plaque build up.
Symptoms -pain-worse with activity Intermittent claudication Rest pain- increased occlusion Worse with legs in elevated position Varcrose vein- worse in dependent position
Signs- coldness Pallor (pale) Hair loss Skin tight, shiny , hard Decreased/absent pedal pulse Sores-round, minimal drainage , no odor
Bowel sounds?
?? What do normal sound like??
Assess LRQ first, click wise
4 quadrants for 5 min each
What does PERRLA stand for?
What does accommodation mean?
Pupils, equal, round, reactive to light, accommodation
Accommodation means pupils get bigger with distance and constrict when close up
Staging of pressure ulcers ?
Stage 1- red but unbroken
Stage 2- partial thickness skin erosion with loss of epidermis or dermis. Superficial
Stage 3-full thickness into the subcutaneous tissue. May see fat but no bone or tendon
Stage 4- full thickness and involves all skin layers including bone muscle and tendon. Maybe have eschar and slough
Unstageable- Black Eschar
Pectus escavatum vs Pectus carinatum
Pectus escavatum-sunken in
Pectus carnatum- protruding
Concentrated observation of the client
Inspection
Purposeful touch on the client
Percussion
Tapping with short, sharp strokes to assess underlying structures
Percussion
Listening
Auscultation
Purposeful touch on the client
Palpation
Edema scale
1-4 +
How long each resolve ?
0 + none
1+mild pitting 2mm and disappears rapidly
2+ moderate 4mm, 10-15 second pitting
3+ moderately severe, 6mm and lasts more than 1 min
4+ severe pitting edema, 8mm and lasts more than 2 minutes
Headache table page 271
?
Exacerbated by alcohol, stress, Day time napping , wind, heat.
Ipsilateral autonomic signs: Nasal congestion or runny nose , watery or reddened eye, eyelid, drooping, miosis
Feelings of agitation
Infant reflexes
Babinski
Moro
Grasp
Tonic neck
Root
Step
Suck
Neurological recheck exam?
Pupil response - size 2-6mm
Level of consciousness
Motor function
Vital signs
Lymph nodes names?
What’s normal?
What’s abnormal?
Submental -below jaw
Submandibular
Tonsillar
Preauricular
Postauricular
Anterior cervical
Posterior cervical
Occipital
Supraclavicular
Normal is non tender and non palpable
Components of general survey?
A study of the whole person, covering the general health state and any obvious physical characteristics.
Into to physical exam
Whole person not just one body system
What does the finger to nose test evaluate
Coordination
Touch toes - what does this evaluate
Scoliosis
ROM
Jaundice in a dark skin- where to assess
Palms
Scleras
Characteristics of psoriasis
Scaly , erthyematous patch with silvery scales on top
Usually on elbows, knees , low back, genital area
Doris flexion
Drawing the foot up
Active vrs passive ROM
Active is when patient can do it their self
Passive - staff helps
The ability to perceive and recognize the form of an object when unable to see or hear info about it by using texture, size , temp, etc
Stereognosis
The ability to recognize writing on the skin purely by the sense of touch
Graphesthesia
Increased loudness of whispering noted during auscultation with stethoscope on a patients torso
Whispered pectoriloguy
Increased voice sounds heard when listening to lungs , open caused by lung consolidation and fibrosis
Egophony
Abnormal transition of sounds from the lungs or bronchi
Bronchoscopy
Bababinski reflex , when does it disappear?
Stoke finger at bottom of foot , birth- 24 months
Good , normal , unlabored breathing
12-20
Eupneic
Slow breathing
Fast
Bradypneic
Less than 10 /min
Tachypneic greater than 24
SOB / dyspnea when lying flat
Prop up HOB
Orthopnea
Linear arrangement along with unilateral nerve route (one side of body)
Zosteriform
Blowing / swooshing sound heard through bell side of stethoscope when arerty is partially occluded
Bruit
