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HA Final Exam Flashcards

1
Q

What is the diagnosis process?

A

ADPIE

Assessment, diagnosis, Plan, Implementation and evaluation

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2
Q

What is an actual diagnosis?

A

What is actually happening. (coughing green sputum…)

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3
Q

What is a Risk diagnosis?

A

What the patient is at risk of developing. (bleeding related to anticoagulants)

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4
Q

What is a wellness diagnosis?

A

Focuses on strengths and reflects an individuals transition to a higher level of wellness.

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5
Q

For CPR you do CAB, but for a person who is awake, what do you do?

A

ABC

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6
Q

What is a First Level Priority?

A

Emergent, life threatening. (coding, stop breathing…)

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7
Q

What is a Second Level Priority?

A

Acute. (Severe pain)

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8
Q

What is a Third Level Priority?

A

Important but not urgent. (Teaching someone who is being discharges).

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9
Q

What are the 4 types of data collection?

A

1) Complete (total health) history: Full physical exam. Yields the first diagnosis.
2) Focused or problem-centered database. Short term problem. Smaller in scope and more targeted.
3) Follow-up database. How are they after procedure
4) Emergency database. Rapid collection of data. Short, direct questions for short answers.

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10
Q

What are some things to do in an interview?

A
  • Be face to face
  • Avoid barriers such as a desk.
  • 4-5 feet away
  • Respect personal space and establish a rapport.
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11
Q

Open ended questions. What are they good for?

A

Building rapport. Facilitates beginning, topic change, and introduce a new topic.

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12
Q

What are closed ended questions good for?

A

Gets the facts. Good for forcing a choice.

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13
Q

What are the Patient centered narratives?

A

SERF

  • Facilitation: Nod head, eye contact, acknowledge them, keeps them going.
  • Silence: Shutty
  • Reflection: Echo of the patients words. clarification
  • Empathy: Lets them know you are identifying and recognizing their feelings.
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14
Q

What are the Provider or nurse centered narratives?

A

ICES

  • Interpretation: Based on inferences. (“when I mentioned suicide, you paused…?”)
  • Confrontation: Confront in a nice way. (“you say you have no pain but you are wincing…”)
  • Explanation: “you cant eat because…”
  • Summary: “So your pain started yesterday and worsens when walking?”
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15
Q

Ten traps to avoid when interviewing…

A
  • False assurance: Telling cancer patient it will be ok
  • Unwanted advice: “If I were you…”
  • Avoidance language: Saying they “passed on” rather than saying “they died.”
  • Distancing: “You lost the baby.” instead of, “you lost YOUR baby.”
  • Professional Jargon
  • Leading or biased questions
  • Interrupting
  • “Why” questions: They imply blame. “Why didn’t you get yourself checked?”
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16
Q

How do you close and interview?

A
  • End with an open ended question.
  • Ease into closure
  • Thank them for their cooperation
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17
Q

What do you need to know for a complete health history?

A

OLDCARTS

  • Onset
  • Location
  • Duration
  • Character
  • Associated symptoms
  • Relieving factors
  • Timing
  • Severity.
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18
Q

What does a functional assessment measure?

A

A persons self-care ability. Can they perform en daily ADL’s.

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19
Q

When considering Kids, what does HEEADSSS mean?

A

Home environment, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety

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20
Q

When palpating, what is Light and Deep touching looking for?

A

Light: pain
Deep: masses, organs…

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21
Q

When palpating, what are these used for…

  • Fingertips?
  • Grasping action of finger and thumb?
  • Dorsa of the hand?
  • Base of fingers?
A
  • Fine tactile discrimination, texture, swelling, pulsation, lumps
  • Detect position, shape, consistency of an organ or mass
  • Temperature
  • Best for vibration
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22
Q

What is percussion used for?

A

Used to assess the location, size, and density of an organ. It can also detect an abnormal mass or elicit a deep tendon reflex.

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23
Q

What are the percussion sounds?

A

-Amplitude: A loud of soft sound.
-Pitch: The number of vibrations per second.
-Quality: A subjective difference due to a sounds distinctive overtones.
Duration: Length of time the note lingers.

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24
Q

What are the percussion characteristics?

A
  • Resonant (medium): clear, hollow sound over the lungs.
  • Hyperresonant (booming, louder): Sound over a childs lung, but abnormal in an adult. (Increased air as in emphysema)
  • Tympany (drum-like, loud): Over air-filled viscus like the stomach or intestine. Hollow sound.
  • Dull (muffled thud, soft): Dense organs such as liver or spleen.
  • Flat (Dead stop of sound, very soft): No air present. Over a bone, dense muscle, or TUMOR.
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25
Q

What is the Bell and diaphragm used for?

A

Bell: Low pitched sounds. Push soft.
Diaphragm: High pitched sounds. Push firmly.

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26
Q

When weighing patients, what is important?

A

Consistency. If you weigh them with their clothes on, do it that way every time.

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27
Q

What are the ranges for BMI?

A

19-25 Normal
25-30 Overweight
30-40 Obese
40+ Morbidly obese

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28
Q

Where are the different places that you can take temperature?

A
  • Oral: Under tongue. Do it 15 minutes after they have eaten or have been chewing gum. If you can only do one, DO ORAL.
  • Axillary
  • Tympanic
  • Temporal artery: Gun across forehead
  • Rectal: Most accurate. Use in those who are comatose, in shock, or confused.
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29
Q

What temperature is a fever?

A

100.5 or higher

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30
Q

What does Diurnal mean?

A

The temperature rises through the day 1 - 1.5 degress.

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31
Q

What is the grading scale of a pulse?

A

0 Absent
1+ barely palpable
2+ Found it with no problem. Normal
3+ Bounding. After running.

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32
Q

What is the normal heart rate in adults?

A

60 - 100

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33
Q

What is Blood Pressure?

A

The force of the blood against the walls of the vessels.

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34
Q

What is the Diastolic Pressure?

A

Resting Pressure. Rest and filling. 2/3 of cardiac cycle

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35
Q

What is systolic pressure?

A

1/3 of the cardiac cycle.

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36
Q

Which blood pressure method is more accurate, manual or machine?

A

Manual

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37
Q

Which ethnic groups are prone to have higher BP?

A

African Americans and native Americans.

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38
Q

When is BP highest?

A

Afternoon.

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39
Q

Mean Arterial Pressure: MAP = ?

A

[(2 x diastolic) + systolic] / 3

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40
Q

cardiac output = ?

A

heart rate + stroke volume

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41
Q

What factors effect BP?

A
  • Peripheral Vascular Resistance: The opposition of blood flow through arteries.
  • Cardiac output
  • Volume of circulating blood (decreased V = decreased BP)
  • Viscosity
  • Elasticity of the vessel walls.
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42
Q

What is hypovolemia?

A

State of decreased blood volume

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43
Q

How should the sphygmomanometer fit?

A

Width 40% and length 80%

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44
Q

What are the Phases of BP and explain…

A

Phase I: Tapping
Auscultory Gap: No sound (silence for 30 - 40 mmhg during deflation)
Phase IV: Abrupt muffling
Phase V: Silence

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45
Q

What is a normal Systolic and Diastolic BP?

A

S: 90 - 139
D: 60 - 90

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46
Q

What is the orthostatic BP and when do you take it?

A

You take it when you suspect 1) volume depletion 2) HTN of 3) Person reports fainting or syncope.
-Have them rest supine for 2-3 minutes, check their baseline BP, then check it with them sitting and standing.

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47
Q

What are some common abnormalities it BP and what are they?

A
  • Arterial Obstruction: Difference of 10 - 15 mmHg in between arms.
  • Coarctation of the aorta: Arm reading higher than thigh reading.
  • Big Auscultatory gap: Common in HTN clients.
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48
Q

At what age do you start taking BP?

A

3 years

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49
Q

What are some Vital Sign variations in the following?

A
  • Young kids: BP will be lower but everything else higher
  • Preschoolers: Listen for one minute. It will be fast.
  • School age: Explain what you are doing.
  • Until age 2: Measure kids lying down. If they are curled measure from head to thigh, to knee, to heel.
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50
Q

What are the Vital Sign variations in older adults?

A
  • Temperature: May be lower. Less likely to note a fever but more at risk for hypothermia.
  • Pulse: May have an irregular rhythm. Rigid radial artery
  • Respirations: May be more shallow with a faster rate.
  • BP: Systolic BP increases, widened pulse pressure.
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51
Q

What is a Pulse oximeter?

A

Tells what the O2 saturation is. Normal is 97 - 98%.

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52
Q

What is the Doppler?

A

Ultrasound used to find someone’s pulse and BP.

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53
Q

How does a physician Document?

A 
SOAP
Subjective
Objective
Assessment
Plan
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54
Q

What is the fifth vital sign?

A

Pain. It is subjective.

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55
Q

What are the sources of pain?

A

Deep somatic
Cutaneous
Referred
Neuropathic

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56
Q

What are the types of pain?

A

Acute: Broken bone
Chronic: Persistent. Pain from old wreck…
Malignant: Tumor
Nonmalignant

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57
Q

Does age effect pain perception? Does Dementia effect pain perception?

A

No and No. But there may be a difference from males to females due to genetic differences.

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58
Q

What are 3 assessment tools for pain?

A

Numeric: Rating scale
Descriptor: None –> mild –> moderate –> severe
Faces Pain scale

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59
Q

By which age can kids point to where they hurt? When can they point to a face that describes how they feel?

A

2

4 - 5

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60
Q

What is Peritonitis?

A

A rigid board like abdomen. EMERGENCY

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61
Q

Precordium?

A

Portion of the body over the heart and great vessels.

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62
Q

Great vessels?

A 
Superior Vena cava
Inferior Vena cava
Pulmonary arteries
Pulmonary veins
Aorta
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63
Q

Where does the heart lie in relation to the chest?

A

Right sternal border, Left midclavicular line, and the 2nd and 5th intercostal spaces.

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64
Q

What are the layers of the heart?

A
  • Pericardium: Sac around the heart and the root of the great vessels
  • Epicardium: Outer layer of the heart.
  • Myocardium: Muscular tissue of heart.
  • Endocardium: Innermost layer of the tissue that lines the chambers of the heart.
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65
Q

What is diastole?

A

Ventricles relax and fill with blood.

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66
Q

When and where is S1 best heard?

A

At diastole and at the Apex.

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67
Q

What is systole?

A

Heart contraction

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68
Q

When and where is S2 heard best?

A

During systole and at the Base of the heart.

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69
Q

S3?

A

**Ventricles are resistant to filling.
“Kentucky”
Heard at the end of S2. Best heard with the bell. May be normal in children, young adults and in the 3rd trimester of pregnancy. It is abnormal in older adults and it indicates heart failure.

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70
Q

S4?

A

**When ventricles are resistant to filling.
“Tennessee”
S4 is best heard with the bell. It is heard just before S1, at the end of diastole.

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71
Q

If all 4 heart sounds are present, what is indicated?

A

Severe heart failure

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72
Q

What is a murmer? How is it heard best?

A

Turbulant blood flow. Best heard with the diaphragm.

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73
Q

What are used for electrical conduction in the heart?

A

-SA node, AV node, Perkinje fibers, R/L bundle braches and the ventricles.

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74
Q

How many beats does the SA node produce per minute?
If the SA doesn’t work, what kicks in?
If the AV Doesn’t work what kicks in?

A

SA 60-100.
AV 40-80
Ventricles 20-40

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75
Q

What is the Cardiac output?

A

The amount of blood the heart pumps out in 1 minute.

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76
Q

What is Preload?

A

Venous return that builds during diastole

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77
Q

What is stroke volume?

A

Amount of blood that is ejected with each beat.

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78
Q

What is Afterload?

A

The load against which the heart contracts to eject blood.

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79
Q

Which artery reveals the activity on the Left side of the heart?

A

Carotid

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80
Q

Which artery do you listen to for bruits?

A

Carotid

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81
Q

What does the Jugular do?

A

Empties Deoxygenated blood into the vena cava. It reveals the activity of the right side of the heart.

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82
Q

What is the foramen ovale?

A

A hole valve that connects the right atrium to the left atrium thus bypassing the right ventricle and the pulmonary arteries. It closes about 1 hour after birth.

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83
Q

What is the Ductus Arteriosus?

A

Blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fluid filled non-functioning lungs.

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84
Q

How would you expect the blood volume to differ on a pregnant female? Cardiac output? Pulse rate? When is the lowest BP in pregnancy? What about peripheral vessels in a pregnant female?

A
  • it increases by 30 - 40%.
  • increases
  • increased by 10 - 15 beats/minute.
  • in the 2nd trimester
  • Pregnant females have peripheral vasodilation which decreases atrterial BP.
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85
Q

How does BP differ in aging adults?

A

Vessel walls calcify which causes stiffening of the vessel walls. This causes high Systolic BP. It also causes the left ventricle wall to thicken. This causes arrhythmias and prolonged pulse rate.

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86
Q

What is Dyspnea?

A

Shortness of breath

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87
Q

If a person is sleeping with a bunch of pillows, what does this indicate?

A

Orthopnea, which is a shortness of breath while lying flat.

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88
Q

What is Left heart failure?

A

Blood backs out into the pulmonary vascular system.

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89
Q

What is Right heart failure?

A

Jugular vein distention. Blood backs up into the vena cava. They get a fluid filled abdomen, large liver, extreme peripheral edema.

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90
Q

What is Hemoptysis?

A

Coughing up blood

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91
Q

What is Pink frothy sputum indicative of?

A

Pulmonary edema.

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92
Q

What is nocturia?

A

Frequent peeing at night.

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93
Q

What is the Hepatojugular Reflex and when would you perform it?

A
  • It is when you position the Pt supine, have them hold their breath as you push on the right upper quadrant of the abdomen. Watch the jugular pulsation. If heart failure is present then the jugular veins will elevate for as long as you push/
  • You do this if venous pressure is elevated or you suspect heart failure.
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94
Q

Where is the apical pulse?

A

On the 5th intercostal space and the left midclavicular line.

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95
Q

Where is Erbs Point?

A

3rd intercostal space, left sternal border.

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96
Q

What causes S1 and where is it loudest?

A

Closure of the AV valves. It signals the beginning of systole. It is loudest at Apex.

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97
Q

What causes S2 and where is it loudest?

A

Closure of the semilunar valves. Loudest at the base.

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98
Q

What is Splitting of S2?

A

A split S2 occurs toward the end of inspiration and it is heard only in the pulmonic valve area.

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99
Q

How do you grade a murmer?

A

I - Barely audible
II - Faint but audible
III - Moderately loud and easy to hear
IV - Loud, associated with a thrill
V - Very loud, audible with a stethoscope lifted off chest
VI - Loudest, entire stethoscope lifted off chest wall

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100
Q

What is a pericardial friction rub? How do you auscultate?

Where is it best heard?

A
  • It is caused from inflammation of the pericardium. It is a high pitched scratchy sound similar to sand paper rubbing.
  • Use diaphragm with person sitting up and leaning forward with breath held in expiration.
  • Best heard at the Apex and left lower sternal border
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101
Q

What are the symptoms of a heart attack in a woman?

A

(Running in marathon and indigestion)

-Pain, breathlessness, cold sweat, anxiety, nausea, sleep disturbances, unusual fatigue/weak, indigestion.

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102
Q

What are the clinical manifestations of Left sided heart failure?

A

-Dyspnea, cough, crackles, low O2 saturation, S3 heart sounds, paroxysmal nocturnal dyspnea, tachycardia, pulmonary congestion. (People, Don’t, Care, That, Cats, Like, Purring, Sometimes)

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103
Q

What are the clinical manifestations of Right sided heart failure?

A

(THEJAWW)

-Tachycardia, Hepatomegaly, Edema, JVD, Ascites, Weakness, Weight gain.

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104
Q

What is a lipid profile used for?

A

Looks for abnormalities in lipids. Can approximate risk for certain genetic diseases including cardiovascular disease.

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105
Q

What is a creatine Kinase?

A

If elevated it can mean Heart attack.

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106
Q

Troponin I

A

Indicators of Heart damage. Helps to differentiate between Angina and MI.

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107
Q

What is C-reactive protein used for?

A

Used to evaluate risk of coronary artery disease which can lead to heart attack.

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108
Q

What is B type natriuretic peptide (BND) associated with?

A

Heart failure if its more than 100.

109
Q

What is an ECG used for?

A

Looks at the electrical conduction if the heart.

110
Q

What is Ischemia?

A

Deficient blood flow due to blockage in a blood vessel.

111
Q

What does the Lymphatic system do?

A

Retrieves excess fluid and dumps it back into the blood.

112
Q

What does the Right lymphatic duct drain and where does it empty?

A
  • It drains the right side of the head, neck, right arm, right side of thorax, right lung, and pleura, right side of heart, and upper section of the liver.
  • It empties into the Right subclavian vein.
113
Q

What does the Thoracic duct drain and where does in empty?

A
  • Drains everything the right lymphatic duct doesn’t.

- It empties into the subclavian vein.

114
Q

What are lymph nodes?

A

Small oval clumps of lymphatic tissue located at intervals along vessels. The T-lymphocytes live in the lymph nodes.

115
Q

What to the lymph nodes do?

A

Filter fluid before it returns back into the blood.

116
Q

What are the superficial nodes and what do they drain?

A

Cervical: Drains head and neck
Axillary: Drains breast and upper arm
Epitrochlear: is by the elbow
Inguinal:Is by femoral artery and drain lower extremities.

117
Q

How do lymph nodes differ in children?

A

larger

118
Q

What is arterial insufficiency and what are the symptoms?

A

Slowing of the blood in the arteries. Clammy, cold, hair changes, loss of hair, shiny thick skin. Can happen in ATHEROSCLEROSIS.

119
Q

What is venous insufficiency and what are the symptoms?

A

Result of damage to the vein walls and the valves of the veins. They aren’t working as well. Will see blood pooling, swelling, blue color, reddy, warm, darkened pigment around the ankle area.

120
Q

If swelling is on one side, what does it mean?

A

Thrombosis. One sided painful swelling. EMERGENCY.

121
Q

Before you stick an artery, what do you do?

A

A modified Allens test.
-You depress the radial and ulnar at the same time while the patient pumps their fist. Have them open their hand and you release the ulnar side. Color will return to hand within 2 seconds if normal.

122
Q

Pitting edema grading…

A

1+ Slight indentation
2+ Indentation subsides rapidly
3+ Indentation remains for a short time
4+ Indentation lasts for several minutes

123
Q

If there is swelling in both legs, what should you expect?

A

heart failure.

124
Q

If you have swelling in one leg what should you expect?

A

Blood clot

125
Q

If they have non-pitting edema, what should you expect?

A

arterial disease or arterial occlusion. (both or one sided)

126
Q

What is the arterial deficit assessment? (Elevation Pallor)

A

Position patient in supine position. Raise legs bilaterally off the table about 30 cm. have the patient move feet to drain venous blood. observe skin color. Next have patient sit with legs dangling off bed. Observe for return of color to skin. Skin color should return within 10 seconds.

127
Q

What is the Ankle-Brachial Index (ABI)

A

It is used to determine the extent of peripheral artery disease (PAD). You take the ankle and brackial systolic pressure. The expected value for ABI is 1 - 1.2. An ABI of 0,9 or less indicates PAD.

128
Q

When it somes to babies what is the last thing to change when they are in distress? Because of this, what do you have to rely on?

A
  • Blood pressure

- **Rely on capillary refill!

129
Q

Ischemic ulcer:

A

lack of blood flow. This is an arterial problem. If no blood flow it wont bleed and tissue dies. Happens on toes, lateral ankles and heels.

130
Q

Venous Ulcer:

A

The blood pools and cuts off circulation. Plenty of blood so they will bleed a reddy color. You see it on ankles and with pitting edema.

131
Q

What are 2 types of peripheral vascular disease in the arms?

A
  • Raynauds: The arterioles constrict especially in response to cold and it cuts off the circulation. Its usually in fingers. It is usually found in fingers. WIlll turn red blue and deep red. The skin is smooth, shiny and can get ulcers. It comes and goes.
  • Lymphadema: 60 - 90% are females between 15 and 40. Almost always occurs from damage or removal of lymph nodes in people who had them removed due to cancer. It can be very painful. Hard to treat and no cure. This is non-pitting edema.
132
Q

Pulse variations:

A
  • Weak “thread” pulse: Weak pulse, decreased cardiac output. (low CO and PAD)
  • Full bounding pulse: Fear, anxiety
  • Pulse bigeminus: The force of the pulse is going to be variable but the rhythm is regular. Premature ventricular or atrial contraction.
133
Q

What are the nurses interventions with edema?

A

Assess edema every 4 hours. Assess peripheral pulse every 4 hours. Evaluate pain. Meticulous foot care daily. Maintain extremity warmth. Provide eduation.

134
Q

What are varicose veins?

A

Valves aren’t working so blood is pooling.

135
Q

What is Deep Vein Thrombophlebitis?

A

Clot in a deep vein causes inflammation of the deep vein. You will see cyanosis and swelling. It requires immediate medical attention. The biggest risk is that it will come lose and go to the lungs, brain, heart and occlude a vessel.

136
Q

What is a split S2?

A

Its normal. The aortic valve closes 0.06 seconds before the pulmonic valve. It happens right at the end of inspiration. Best place to hear it is at the pulmonic valve area.

137
Q

non synovial joints

A

Cannot move/no ROM. Skull, sutures, vertebrae.

138
Q

Synovial joints

A

Freely moving and separated from each other. (ankle). The cavity is filled with a lubricant to permit sliding.

139
Q

Cartilage

A

Bone cushion and covers surface of opposing bones in a synovial joint.

140
Q

ligaments

A

strengthen joints and run directly from one bone to another that strengthens joints/prevent undesirable movement.

141
Q

bursa

A

enclosed sac filled with synovial fluid and decreases friction.

142
Q

muscle

A

causes movement with contraction. attached to bone via ligament.

143
Q

tendon

A

Fibrous cord that connects muscle to bone.

144
Q

What movements can the spine make?

A

Flexion, Extension, Abduction, Rotation

145
Q

Which Spinous processes are prominent at the base of the neck?

A

C7 and T1

146
Q

What posture change is common in pregnant women?

A

Lordosis

147
Q

What musculoskeletal differences are in the aging adult?

A
  • Osteoporosis
  • Shorter due to shorteing of the spine
  • Kyphosis: hump back
  • Loss of subcut fat leaves bony prominances
148
Q

What is…

  • Dislocation?
  • Subluxation?
  • Contracture?
  • Ankylosis?
  • Effusion?
A
  • Out of joint.
  • Partial dislocation
  • Shortening of muscle which limits ROM
  • Stiffness or fixation of a joint.
  • Excess fluid at joint.
149
Q

ROM Grading:

A

5: full ROM against resistance. 100%. NORMAL
4: full ROM against gravity, some resistance. 75%
3: full ROM with gravity. 50%
2: full ROM without gravity. (passive ROM) 25%
1: No contraction.

150
Q

What is the Phalens test?

A

Hands back to back, flex wrist 90 degrees for about 60 seconds. If there is numbness or burning it can be a sign of carpel tunnel.

151
Q

What is the Tinel test?

A

Direct percussion of the medial nerve. If there is burning or numbness it can mean carpel tunnel.

152
Q

What is the Ballottement Test?

A

Pushing the patella into the femur, if no fluid is present then the patella will be snug on the femur. Normally you cant move it that much. Indicates too much fluid.

153
Q

What is the straight leg raise?

A

Reproduces back and leg pain and indicates a potential herniated disc.

  • When the leg is flexed at the hip to the point of pain, its a herniated disc.
  • If the unaffected leg hurts when raised also, its more of a sign of a herniated disc.
154
Q

3 tests that check for hip dislocation in infants?

A
  • Allis test: Place infant supine, flex their knees, knees should be equal.
  • Ortolanis maneuver: Should be done at every visit until age 1. Flex knees up, adduct unitl thumbs touch, then abduct until you hear a “clunk.” This is the sound of the femur popping into place.
  • Examine gluteal folds: Should be equal # of folds.
155
Q

What is Genu Varum?

What is Genu Valgum?

A
  • varum: Bow legged (R - apart)

- valgum: Knock knees (G - together)

156
Q

What is the waddling gait in pregnancy?

A
  • Relaxation of the pelvic girdle.
  • Protuberant abdomen
  • Relaxed muscles because of hormones.
157
Q

Osteoarthritis:

A
  • Worse at night.
  • Unilateral and noninflammatory
  • Heberdons nodes - top knuckle
  • Bouchards nodes - Middle knuckle.
158
Q

Rheumatoid arthritis:

A
  • Worse in the morning.
  • Systemic, bilateral
  • Swan neck
  • Boutonniere deformity
  • Ulnar deviation
159
Q

What is Tophi gout?

A

-Chronic-pain hard nodules.
Warm red inflamed and painful big toe.
**Always check for increased uric acid levels in men over 40 and overweight.

160
Q

What is the vertebralprominens?

A

C7.

161
Q

Where will you find most of the upper and middle lobes of the lungs?

A

Anterior chest

162
Q

Where would you find almost all of the lower lobe?

A

posterior chest

163
Q

What is Acinus?

A

Contain the bronchial ducts, alveoli and alveoli sacs

164
Q

What are the 4 main functions of the respiratory system?

A

1) Oxygen supply
2) Removal of CO2
3) Maintain acid/base balance of arterial blood
4) Maintenance of heat exchange.

165
Q

What happens in older adults that makes it harder for them to breath?

A

Calcification of costal cartilage and muscle strength of the thorax declines.

166
Q

What is tactile Fremitus?
What does increased vibrations mean?
What does decreased vibrations mean?

A
  • A palpable vibration.
  • Increased = fluid in lungs
  • decreased = obstruction, solid tissue, asthma.
167
Q

What does hyperresonance mean?

A

Too much air is present. Emphysema

168
Q

What does a dull sound mean when percussing?

A

Fluid buildup. Pneumonia.

169
Q

Is percussion useful with an infant?

A

NO

170
Q

What are the normal breath sounds?

A
  • Bronchial: Loud/high pitched. Inspiration < expiration.
  • Bronchiovesicular: Moderate pitch. Inspiration = exp.
  • Vesicular: Low/ soft. Inspiration > expiration.
171
Q

What assessments do you do if you suspect lung disease?

A

-Bronchophony: 99…99…99
-Egophony: EE…EE…EE
Whispered pectoriloquy: Whisper a phrase.

172
Q

What is Forced Expiratory Time (FET)?

A
  • They time it takes for them in exhale a deep breath. Should be 4 seconds or less.
  • If its more than 4 seconds there could be a pulmonary obstruction.
173
Q

What is the 6 minute distance walk?

A

Patient walks 300 meters in 6 minutes. Moniter them for shortness of breath and measure any air flow obstruction.

174
Q

What is…

  • Pectus excavatum?
  • Pectus Carinatum?
A
  • Sunken sternum

- Forward protrusion of the sternum

175
Q

What are Fine crackles?

A

Rales. Brief, discontinuous. popping lung sounds that are high pitched. Sounds like wood burning. Occurs during inspiration and is NOT cleared by coughing.

176
Q

What are coarse crackles?

A

Discontinuous. Loud, low pitched bubbling or gurgling sound. Sounds like Velcro. Occurs during early inspiration.

177
Q

What is a pleural friction rub?

A

Discontinous. Coarse low pitch. Happens during inspiration and expiration. Sounds like leather rubbing.

178
Q

What are high-pitched wheeze - sibilant wheeze?

A

Continuous. Muscle squeeking on expiration.

179
Q

Low pitched wheeze - sonorous wheeze?

A

Continuous. Expiration. Cleared with coughing. Snoring or moaning.

180
Q

Stridor?

A

Continuous. Noisy breathing occurring secondary to obstructed air flow through a narrowed airway. EMERGENCY. Can hear without a stethoscope. Happens on Inspiration.

181
Q

What is Eupnea?

A

Normal rate and rhythm.

182
Q

Tachypnea?

A

Rapid, shallow. >24/minute

183
Q

Bradypnea?

A

Slow, regular. <10/minute

184
Q

Apnea?

A

Absent rate

185
Q

Hyperventilation?

A

Deep increased rate

186
Q

Hypoventilation?

A

Irregular shallow pattern

187
Q

Cheyne-Stokes?

A

Wax and Wanes that gradually become deep and fast then slows down.

188
Q

Biot’s?

A

Irregular was and wane that is deep and fast abrupt and irregular phases.

189
Q

Kussmauls?

A

Faster deeper respiration without pauses.

190
Q

Contents of the RUQ? LGPKATC

A
  • Liver
  • Gallbladder
  • Pancreas head
  • Kidney
  • Adrenal gland
  • Transverse colon
  • Colon - hepatic
191
Q

Contents of the RLQ? US of AC

A
  • ureter
  • spermatic cord
  • ovary
  • fallopian tube
  • appendix
  • cecum
192
Q

Contents of the LUQ? SSPLACCK

A
  • Stomach
  • Spleen
  • Pancreas body
  • Liver
  • Adrenal gland
  • colon, tranverse
  • colon, descending.
  • Kidney
193
Q

Contents of the LLQ? CS

A
  • Colon

- small intestine

194
Q

Contents of the midline?

A
  • Uterus
  • Bladder
  • Aorta
195
Q

What are the regions of the abdomen?

A
  • Epigastric: Under the costal margins
  • Umbilical: around the belly button
  • Hypogastric: above the pubic bone
196
Q

How is the bladder and liver different in newborns?

A

Bladder is higher up and Liver is bigger.

197
Q

How are bowel sounds different in pregnant women?

A

Decreased bowel sounds are normal

198
Q

How is the liver different in older adults?

A

bigger

199
Q

What is Visceral pain?

A

Dull generalized pain from internal organs not localized to one area.

200
Q

What is parietal pain?

A

Sharp precisely located pain aggravated by movement due to inflammation of peritoneum.

201
Q

What is referred pain?

A

Pain that is occurring in a different area then the problem.

202
Q

What are the F’s of abdominal distention?

A 
Fat
Fluid
Feces
Fetus
Flatus (gas)
Fibroid (tumor in uterus)
Full bladder
False pregnancy
Fatal tumor
203
Q

Where do you listen for bruits?

A

Aorta, Renal arteries, Iliac arteries, Femoral arteries.

204
Q

When percussing the abdomen…

  • When would hyperresonace be present?
  • When would you percuss dullness?
A
  • Gas in the abdomen

- Distended bladder. Adipose tissue. (fat, fluid, masses)

205
Q

Fluid wave test?

A

Midline hand. Hit one side and see if wave travels to the other. Use this to see if there is gas or fluid. Tests for Ascites.

206
Q

Testing for shifting dullness?

A

Tests for Ascites. Percuss with them supine, mark where it turns from tympany to dullness. Then turn them onto their side, percuss and mark where it turns from tympany to dullness. Mark it.

207
Q

What are 2 ways to palpate the Liver?

A
  • Bimanual: Right hand on right side of patient and push towards patients ribs upward and inward at the 11th - 12th rib.
  • Hooking: Stand to right, hook fingers around ribs and pull inward and upward. If liver isn’t enlarged you wont feel anything.
208
Q

Is the spleen normally palpable?

A

NO

209
Q

Why should you never palpate an enlarged spleen?

A

It could rupture.

210
Q

How to palpate the kidney…

A

Duck-bill. Place hands together and ask the patient to enhale. Press hands together. Most often non-palpable or may feel lower pole of right kidney. It the patient has urolithiasis (kidney stones) it will be painful.

211
Q

When should you never palpate the aorta?

A

When you suspect an aortic aneuryism. You can rupture it.

212
Q

When can the bladder be palpated? Can it always be palpated?

A

When its distended with urine. NO.

213
Q

Blumbergs test?

A

APPENDISCITIS. Rebound tenderness. Used to check for appendicitis. Press on the LRQ and let go. It will be painful.

214
Q

Murphy’s sign?

A

GALLBLADDER. Hold fingers under the liver border, have them take a deep breath, stop inspiration, if gasp is heard its positive for gallbladder stones (cholecystitis)

215
Q

Iliopsoas muscle test?

A

APPENDISCITIS.

216
Q

Obturator muscle test?

A

APPENDISCITIS. Test knee and hip flexed, drop knee, rotate ankle, if it is positive pain will be felt.

217
Q

Cullen Sign?

A

Ecchymosis (bruise) around umbilicus.

-Blood in the peritoneum, pancreatitis, ectopic pregnancy, internal bleeding.

218
Q

Grey turner sign?

A

Ecchymosis of flanks. Blood in the peritoneum and pancreatitis.

219
Q

Rovsing Sign?

A

APPENDISCITIS. RLQ pain intensified with LLQ palpation. Referred pain. Peritoneal irritation.

220
Q

What is the amylase and lipase test used for?

A

To detect pancreatitis

221
Q

What is the ERCP used for?

A

Identifies gallstones in the liver.

222
Q

Barium anema?

A

Enema of barium sulfate to outline the stomach so we can take pictures.

223
Q

Where is the tail of Spence located?

A

In the axilea

224
Q

What are the 5 stages of development in females?

A
  • Tanner 1: Preadolescent. Nipple raised above level of breast.
  • Tanner 2: Budding stage. Bud shaped elevation of the areola, areola increased in diameter.
  • Tanner 3: Breast and areola enlarges. No contour separation.
  • Tanner 4: Increasing fat deposits. Areola elevated above that of breast.
  • Tanner 5: Adult. Areola part of general breast contour and is strongly pigmented. Nipple projects.
225
Q

What is Gynecomastia?

A

Temporary enlargement of the male breast during adolescence. Usually unilateral. May reappear in the aging male due to testosterone deficiency.

226
Q

What is a supernumerary nipple?

A

Extra nipple.

227
Q

What does a recent nipple retraction signify?

A

disease.

228
Q

What are the maneuvers to screen for retraction?

A
  • Seated with arms over head. (accentuates dimpling and reveals variation in contour).
  • Seated with hands pressed against hips (Reveals deviations in contour/symmetry).
  • Seated and leaning forward from waist (Assesses symmetry and contour of large breasts).
229
Q

Which areas do you palpate breasts?

A
  • Down the chest wall in a line from the axilla.
  • Along the anterior border of the axilla.
  • Along the posterior border of the axilla.
  • Along the inner aspect of the upper arm.
230
Q

What is the method used for a breast examination?

A
  • check all 4 quadrants.
  • systematic approach. Start and end at the same spot.
  • Use finger pads, gentle but firm palpation.
  • Light palpation then deeper palpation.
231
Q

What are the techniques used when doing palpation for a breast exam?

A
  • Vertical strip technique
  • Concentric circles
  • Wedge method. (wheel spokes, tail of spence)
232
Q

Where do most malignancies occur when it comes to breast cancer?

A

In the upper outer quadrant of the breast.

233
Q

How do you palpate for discharge in a breast?

A

Compress nipple between thumb and forefinger. Take note of color and determine origin.

234
Q

Are lymph nodes palpable?

A

NO

235
Q

What are the 5 D’s of the nipple?

A
  • Deviation
  • Dermatologic changes
  • Depression/inversion
  • Discoloration
  • Discharge
236
Q

If you feel a lump during a breast exam, what do you note?

A 
Location (clock face)
Size
Shape
Consistency
Mobility
Distinctness (1 or more) 
Nipple
Skin over lump
Tenderness
Lymphadenopathy
237
Q

How often and when should females do a breast self examination?

A
  • Once per month

- 1 week after period

238
Q

When should post-menopausal women do a breast self-examination?

A

Every month on the same day of the month.

239
Q

How will the older adults breast differ?

A

-Breasts may appear flattened and elongated.
-Nipples smaller and flatter
-Finer, granular feel
May have fluid filled breast cysts.

240
Q

What is Mastitis?

A

Infection of breast tissue. You will see swelling, tenderness, heat, erythema, chills, fever, tachycardia (staph aureas)

241
Q

What can cause Gynecomastia in men?

A
  • Hormone imbalance
  • Liver failure
  • antihypertensive meds
  • steroids/estrogens
242
Q

Fibroadenoma?

A
  • 15-30 years of age and up to 55.
  • Round. lobular
  • Firm, rubbery
  • Clear margins.
  • Very mobile, slippery
  • not tender
  • No skin retraction
  • Grows quickly.
  • Benign.
243
Q

Benign Breast disease?

A
  • 30-55 years of age.
  • Round lobular
  • Firm, soft, rubbery.
  • clear margins
  • Usually multiple
  • Tender
  • No retraction
  • May increase or decrease rapidly in size.
  • Benign.
244
Q

Cancer?

A
  • 30-80 years of age.
  • Irregular, star shaped
  • Firm, stony, hard
  • Poorly defined.
  • Single
  • Fixed
  • Usually not tender but can be.
  • Skin retraction
  • Grows constantly
  • Serious. Malignant
245
Q

What is Ductal carcinoma? (Pagets disease)

A

Red, scaling, crust patch formation on nipple, areola and surrounding tissue. Its unilateral

246
Q

Who should self examine for testicular cancer?

A

Every male 13+. Usually occurs from 15-40. 4 times more likely in White males.

247
Q

When should men begin prostate screenings?

A

Age 50. Increased risks in African-americans.

248
Q

What is testicular torsion?

A

Pain is acute
Fever is rare
50% patients experience nausea and vomiting
Elevation of affected testicle does not lessen pain
Surgical intervention is considered an emergency

249
Q

What is Epididymitis?

A 
Pain is gradual
Fever occurs in 50%
Nausea & vomiting rare
Elevation of affected testicle usually lessens pain
50% of patients exhibit voiding symptoms
Antibiotic therapy is indicated
250
Q

What is Human Papilloma Virus?

A
  • Very common sexually transmitted virus.
  • Can cause cervical changes predisposing to cervical cancer.
  • Vaccine recommended before women become sexually active.
  • The vaccine doesn’t prevent all types, but most of the major ones.
251
Q

Colorectal Screening test?

A 
Includes:
    - Fecal occult blood test (FOBT)
    - Flexible sigmoidoscopy
    - Colonoscopy
    - Double contrast barium enema    
When to perform:
    - by age 50 without increased risk factors
    - age 20 to 25 with family history HNPCC
252
Q

What is Vitiligo?

A

Acquired condition. It is patch areas on the skin due to pigment loss. More likely in dark skinned people.

253
Q

If a lesion is present, what do you note?

A 
Color
Elevation
Pattern
Size
Location
Exudate
254
Q

What is the difference between a primary and secondary lesion?

A

Primary-lesion of previously unaltered skin

Secondary-When a lesion changes due to scratching or infection.

255
Q

Skin lesions…What is each one?

1) macule
2) papule
3) patch
4) plaque
5) nodule
6) wheal
7) urticaria
8) vesicle
9) bulla
10) cyst
11) pustule

A

1) Color change. Flat. less than 1 cm. (freckle)
2) Can feel. solid, elevated. less than 1 cm. (mole)
3) Macules larger than 1 cm. (vitiligo)
4) Papules coalesce to form surface elevation wider than 1 cm. Platuea and disk shaped lesion. (psoriasis)
5) Solid, elevated, hard or soft, larger than 1 cm.
6) Superficial, raised, transient, irregular shape due to edema. (mosquito bite)
7) Wheals coalesce to form extensive reaction, intensely prutitic (itchy).
8) Elevated cavity containing fluid up to 1 cm. (blister)
9) Larger than 1 cm. Friction blister.
10) Encapsulated fluid filled cavity.
11) pus-filled, circumscribed and elevated. (Acne)

256
Q

What are 4 types of purpuric lesions?

A

1) Petechiae: Less than 2 mm, round, discrete, dark red (infection, clotting). Don’t blanch.
2) Purpura: Extensive patches of petechiae, don’t blanch.
3) Hematoma: Bruise you can feel.
4) Ecchymosis: Trauma induced, bleeding and liver disorders. Various color changes depending on stage of healing.

257
Q

Know the Secondary skin lesions:

1) Crust
2) Scale
3) Fissure
4) Erosion
5) Ulcer
6) Excoriation
7) Scar
8) Lichenification
9) Keloid

A

1) scab
2) compact flakes of skin. after psoriasis or eczema
3) Linear crack with abrupt edges. At corners of mouth.
4) Scooped out shallow depression.
5) Deep depression extending into dermis.
6) Self inflicted abrasion. Insect bites.
7)
8) Prolonged scratching thickens skin. Looks like moss or lichen
9) An elevated scar.

258
Q

What are the ABCDE’s of lesions?

A

A-assymetry
B-border irregularity
C-color variation
D-diameter

259
Q

Normal skin developmental considerations in infants…

A
  • Mongolian spots
  • Café au lait
  • Milia
260
Q

Normal developmental considerations in pregnant females…

A
  • striae
  • chloasma
  • linea nigra
261
Q

Normal developmental considerations in older adults…

A
  • Senile lentigines
  • Seborrheic keratosis
  • Acrochordons
262
Q

Stage I Ulcers:

A

Intact skin appears red but unbroken. Localized redness. Light skin will blanch darker skin wont.

263
Q

Stage II Ulcers:

A

Partial thickness skin erosion with loss of epidermis or also the dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red pink wound bed.

264
Q

Stage III Ulcers:

A

Full thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. May see subcut fat but not muscle bone or tendon.

265
Q

Stage IV Ulcers:

A

Full thickness pressure ulcer involves all skin layers and extends into supporting tissue. Exposes muscle tendon or bone and may show slough or eschar.

266
Q

What is onchyomycosis?

A

Fungal infection of the nails.

267
Q

What are Raccoons eyes?

A

It is bruising around the eyes that signals basal skull fracture, or craniotomy that ruptured meninges.

268
Q

For communication, what does SBAR stand for?

A

Situation
Background
Assessment
Recommendation

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