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ECOS I Exam 1 > General Assessment & Intro To Instruments > Flashcards

General Assessment & Intro To Instruments Flashcards

1
Q

Universal precautions for pt care

A

Standards set by CDC
Protect the pt and provider from the spread of infectious diseases
Wash hands before and after wearing gloves

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2
Q

When should gloves be worn?

A

If there is obvious blood, body fluid and pt presenting with diarrhea

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3
Q

What are the CDC standards for pt care?

A

Perform hand hygiene
Use PPE if possible exposure to infectious material
Follow respiratory hygiene/cough etiquette principles
Ensure appropriate pt placement/isolation
Properly handle, clean and disinfect pt care equipment and instruments
Follow safe injection practices (face shield for LP)
Proper handling of needles and sharps

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4
Q

What are the 4 types of hand hygiene based on CDC guidelines?

A

Hand washing, antiseptic hand wash, alcohol based hand rub, and surgical hand hygiene/antisepsis

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5
Q

Hand rubbing with an alcohol based hand rub

A

The gold standard technique to perform hand hygiene on all occasions except for those described for hand washing with soap and water
Recommended for health care works for the routine, day to day decontamination of hands

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6
Q

Hand washing with soap and water

A

Occupies a central place in hand hygiene and should be employed when hands are visibly dirty or soiled with blood/other body fluids; after using the toilet; and when exposure to potential spore forming pathogens (C. Diff) is strongly suspected or proven including outbreaks of diarrhea

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7
Q

What are the 4 main vital signs?

A

BP, pulse, respiratory rate and temperature

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8
Q

The bell of the stethoscope is used for

A

Low pitched sounds (bruits)

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9
Q

The diaphragm of the stethoscope is used for

A

High pitched sounds (breath sound and heart tones)

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10
Q

What are the three types of sphygmomanometers?

A

Mercury, aneroid and digital

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11
Q

What is the gold standard for reading BP?

A

By auscultation

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12
Q

Cuff selection for BP measurement

A

The length of the cuff’s bladder should be at least equal to 80% of the circumference of the upper arm and the width of the bladder should be at least equal to 40% of the length of the upper arm

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13
Q

Korotkoff sound

A

The first knocking sound heard when taking BP measurements and it indicates the pt’s systolic pressure
When the sound disappears it marks the diastolic pressure

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14
Q

Which other factors should be noted when taking BP?

A

Pressure difference in both arms, pt position, which arm was used and the cuff size

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15
Q

What environment is ideal for taking BP?

A

Pt should avoid smoking, caffeine and exercise >30 min prior to measuring BP
Exam room quiet and warm
Pt should sit quiet for 5 min with feet on the floor (not on exam table)
Arm should be free of clothing, dialysis fistulas, cut down scares and lymphedema

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16
Q

What are the three common errors in BP monitoring?

A

Falsely high BP, falsely low BP and auscultatory gap

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17
Q

Falsely high BP

A

Brachial artery below the heart
Cuff too small (narrow)
Cuff too large (wide) on a large arm

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18
Q

Falsely low BP

A

Brachial artery above heart

Cuff too large (wide) on a small arm

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19
Q

Auscultatory gap

A

Period of diminished or absent Korotkoff sounds during the manual measurement of BP
Improper interpretation of this gap may lead to BP monitoring errors: namely an underestimation of systolic BP and/or an overestimation of diastolic BP

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20
Q

Checking the pulse rate

A

Use your index finger not thumb
Report whether pulse is regular or irregular
Pulse rate is by convention reported per minute
Count for 30 seconds and multiply by 2
Can also count for 15 sec and multiply by 4

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21
Q

What are the different locations in which you can check the pt’s pulse?

A

Radial artery, dorsalis pedis artery, carotid artery, brachial artery, abdominal aorta, femoral artery and popliteal artery

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22
Q

Scale for grading pulses

A

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

23
Q

Two methods for measuring respiratory rate

A

Look for chest rise and count
Listen while examine heart or lungs with stethoscope
-count for 30 seconds and multiply by 2
-most adults breathe at about 15-20 breaths per min
-dont call attention to the fact that you are counting

24
Q

Where can you take a pt’s temperature?

A

Orally (measures body temp)
Rectally (higher than when taken by mouth)
Axillary (lower than when taken by mouth)
Ear (core temp/internal organs)
Skin (quick)

25
Q

When is the general assessment of the pt made?

A

Once you have first looked at the pt and as you are doing your interview and PE

26
Q

The general assessment of the pt consists of noting their

A

Apartment state of health (general judgment)
Level of consciousness (alert, awake and responsive)
Signs of distress (cardiac or respiratory, pain, anxiety or depression)
Skin color and obvious lesions (skin color, scars, plaques or nevi)

27
Q

When observing the general appearance of the pt, which factors should also be noted?

A

Nutritional status (normal, slim, cachectic, obese, etc)
State of hydration if obvious
Posture (stooped, erect, flaccid)
Gait (normal, shuffling, antalgic, asymmetrical, unsteady)
Dress (causal, meticulous, disheveled, nude)
Hygiene
Cooperation (personable, conversational, aloof, distracted)
Height/weight (stated with vitals)
Odor
Primary survey (seconds)
Secondary survey (minutes)

28
Q

What are some signs of distress that can be noted when observing general appearance?

A

Affect/mood: pleasant, depressed, flat affect
Verbal tones: anger, frustration, obnoxious, impatient
Posture: restless, gait, shifting
PE findings: sweating, flushed

29
Q

When completing the overall assessment of the skin you should

A

Scan the skin for variations in skin tone looking for features such as pigment variations, erythema, flushing, jaundice, pallor (pale) or cyanosis

30
Q

Macule

A

Flat lesion <1 cm

31
Q

Patch

A

Flat lesion >1cm

32
Q

Papule

A

Raised lesion, <1cm, not fluid filled

33
Q

Plaque

A

Raised lesion, >1cm, not fluid filled

34
Q

Vesicle

A

Raised lesion, <1cm and fluid filled

35
Q

Bulla

A

Raised lesion, >1cm and fluid filled

36
Q

Primary lesions

A

Flat or raised
Examples: macule, patch, papule, plaque, vesicle, bulla, erosion, ulcers, nodules, ecchymoses, petechiae and palpable purpura

37
Q

When observing the pt’s scalp and hair you should

A

Evaluate scalp for scars, deformities, bumps, etc
Evaluate hair for any abnormal changes in texture and pattern loss (alopecia)
Assess for presence of excess hair distribution (hrisutism) or virilization (male secondary sx characteristics in female)

38
Q

Ophthalmoscope

A

Used to visualize inner aspect of eye including retina, vascular supply, optic nerve, etc
Ask pt to look over shoulder, look through aperture, approach pt, hand on pt forehead, R eye to examine R eye, start 15 degrees from center laterally and move toward the pt to identify red reflex

39
Q

Large/medium/small light source - ophthalmoscope setting

A

Small light is used when the pupil is very constricted (ex. In a well lit room)
Large light is best if using mydriatic eye drops to dilate
Medium sized light is used in a dark non dilated pupil

40
Q

Half light ophthalmoscope setting

A

If the pupil is partially obstructed by a lens with cataracts, the half circle can be used to pass light through only the clear portion of the pupil to avoid light reflecting back

41
Q

Red free ophthalmoscope setting

A

Used to visualize the vessels and hemorrhages in better detail by improving contrast
Will make the retina look black and white

42
Q

Slit beam ophthalmoscope setting

A

Used to examine contour abnormalities of the cornea, lens and retina

43
Q

Blue light ophthalmoscope setting

A

Can be used to observe corneal abrasions and ulcers after fluorscein staining

44
Q

Grid ophthalmoscope setting

A

Used to make rough approximations of relative distance between retinal lesions

45
Q

When checking the ear of a child >12 months or an adult you should hold the otoscope in one hand and use your free hand to

A

Pull the other ear gently up and back which straightens the ear canal and improves visualization

46
Q

When observing the ear canal in a child less than 12 months old you should gently pull the outer ear

A

Down and back

47
Q

Using a tuning fork for hearing evaluation

A

Air conduction - lasts longer than bone conduction; hold the fork in front of external auditory meatus
Bone conduction - hold handle on bones area behind the ear

48
Q

Evaluating vibratory sense with a tuning fork

A

Place handle on patella and compare L and R for duration

49
Q

The tuning fork can be used to perform two

A

Neurological tests: gross hearing for CN and vibration sense

50
Q

Upper extremity deep tendon reflexes

A

Biceps (hammer strikes thumb), triceps (hammer strikes ligament) and brachioradialis (hammer strikes ligament)

51
Q

Lower extremity deep tendon reflexes (LE DTRs)

A

Patellar and Achilles reflex

52
Q

Scale for grading reflexes

A

4 - very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension)
3 - brisker than average; possible but not necessarily indicative of disease
2 - average; normal
1 - somewhat diminished; low normal
0 - reflex absent

53
Q

Osteopathic Structural Exam (OSE) integrates information about the

A

Musculoskeletal system even when dealing with non musculoskeletal complaints

54
Q

Documenting OSE includes

A

Tissue texture changes, asymmetry, range of motion and tenderness

ECOS I Exam 1 (26 decks)

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