Important concepts for MT1 Flashcards
What are the four basic techniques used in physical assessment? Which is ALWAYS completed first?
Inspection - completed first
Palpation
Percussion
Auscultation
What are the different lobes of the cerebral cortex? What are two important areas to assess for aphasia?
Parietal, occipital, temporal and frontal lobes.
assess Broca’s and Wernicke’s areas
What are the different components of the PNS?
12 Cranial nerves
31 spinal nerves
ANS (includes reflexes)
What are the different components of the neurological assessment?
Vitals GCS - LOC Cranial Nerves Cerebellar function Proximal limb weakness Sensation reflexes
What are the different scores to look out for on the GCS?
Should be 15 if no issues
13+ - mild impairment
9-12 - moderate
8 or lower indicates coma (cannot protect airway)
What is the GCS score range?
3-15
Describe a decerebrate posture.
Decerebrate - damage to upper brain stem - extension
Describe a decorticate posture.
Decorticate - damage to one or more spinothalamic or dorsal column tracts - flexion
What is receptive aphasia?
What is expressive aphasia?
Receptive: isnt processing what is being asked but has no issues producing language
Expressive - understands what is being told to the person, but cannot get the words out
What are the mnemonics for the cranial nerves?
On old Olympus towering top a Fin and German viewed some hops
(II -optical, III -
oculomotor, VII - Facial, IX - Glossopharyngeal, X -Vagus)
Some say marry money but my brother says big brains matter more
(II - sensory, III - motor, VII - both, IX - both, X - both)
What is used to test CN II?
Snellen Chart
What is done to asses CN III?
PERRLA (pupils equal, round, reactive to light, accomodation) Direct light reflex Consensual light reflex Accomodation 6 cardinal fields of gaze
What are the 6 cardinal signs of gaze for?
Exaggerated H - for our case, testing CN III
What is done to assess CN 7?
Make the patient make faces (puff out cheeks, raise eyebrows, bare teeth, smile, etc.0
What is done to assess CN 9 and 10?
Why?
Make patient say ahh
See if the patient can swallow
This is to see if they can eat on their own - if the nerves are impaired - at huge risk for aspiration
For Cerebellar function, what assessments are done to evaluate balance and proprioception?
Evaluate gait
Tandem walking
Romberg’s test
Pronator drift
For cerebellar functioning, what is doe to evaluate coordination and skilled movements?
rapid alternating movements
finger to finger test
finger to nose test
heel to shin test
What is the babinski reflex?
Take something sharp and drag it along the outside of the foot and over the balls of the feet.
Positive = fanning of feet
negative = contraction of feet
Decreased or loss of motor nerve power due to problem with motor nerve or muscle fibers.
paralysis
Rapid, continuous twitching of resting muscle that can be seen or palpated (fine or coarse)
fasciculations
involuntary, compulsive, repetitive twitching of a muscle group (e.g. wink, grimace, head movement, shoulder shrug)
tic
rapid, sudden jerk at regular intervals (e.g. hiccups)
myoclonus
involuntary contraction of opposing muscle groups, results in rhythmic, back and forth movement of one or more joints
tremor
involuntary muscle twitching
chorea
slow, writhing (twisting), continuous, and involuntary movement of the extremities
athetosis
person stumbles and cannot keep in appropriate space
ataxia
What does S1 (sound) relate to?
beginning of systole - closing of mitral/tricuspid valve
What does S2 (sound) relate to?
Beginning of diastole - closing of aortic and pulmonary semilunar values
Where is the PMI?
Apical pulse - between 4th and 5th ICS at the midclavicular line
(left nipple for guys, about wire of bra for girls)
What is the expected heart rate range for adults?
Older adults?
Kids?
60-100
Higher for older adults and kids
What is important to document when assessing pulse?
Strength
rhythm
Rate
symmetry and location
Bradycardia
slow HR
Tachycardia
fast HR
pulse deficit
diff in pulse between assessment sites
asystole
no pulse
dysrhytmia
irregular rhythm
Cuff size should be what size?
20% of diameter of upper arm
What are the blood pressure sounds called? Which one’s are important?
Korotkoff sounds
1 - systolic BP
5 - diastolic BP
What are the expected values for BP in adults?
What are the BP of children in relation?
<120/80
Children usually have a lower BP
For adults, what ranges constitute: hypotension normotension pre-hypertension hypertension
Hypotension: S <90; D <60
Normotension: S <120; D <80
Prehypertension: S: 120-139; D: 80-90
Hypertension: S > 140 or D >90
What time of the day is the most common for heart attacks? Why?
Morning - higher amount of stress hormones
BP through the day?
Lower in the morning, rises through the day
How do the following affect BP: diabetes ethnicity gender stress pregnancy
diabetes - higher
ethincity - blacks have a higher BP, asians and indigenous too
gender - males higher after puberty, females higher after menopause
stress = up
pregnancy = down
What is orthostatic hypotension?
Decrease in blood pressure when standing from a lying or seated position
What temperature measurements are considered core?
Surface?
Core - tympanic and rectal
Surface - oral, skin, axilla
What is the expected normal range for oral temperature? Axillary? Tympanic? Temporal? Rectal?
Oral - 36.5-37.5 Axillary - 35.9-37.2 Tympanic - 36-37.5 temporal -36.5-37.5 Rectal - 37-37.5
Expected temperature range for oral temp?
36.5-37.5
Expected temperature range for axillary?
35.9-37.2
Expected temperature for tympanic?
36-37.5
Expected temperature for temporal?
36.5-37.5
remember TempORAL is the same as oral
Expected temperature for rectal?
37-37.5
What temperature indicates fever?
38 - anywhere
How does age impact temperature?
Geriatrics less able to mount fever.
Kids have more unstable temperatures.
Describe how the circadian rhythm affects temperature.
temperature goes down at night, increases during the day (think about metabolism).
What does febrile mean?
patient has a fever
Afebrile
no fever
what is a pyrogen?
substance that induces fever
What are rigors?
chills - a step up from shivering
Why isnt advil or Tylenol given before vacccinations anymore?
because it might affect the immune response
How is ventilation measured/observed?
count rate of breathing, depth and rhythm (As well as effort), symmetry
How is diffusion and perfusion measured?
SpO2
When inspecting a patient who has respiratory difficulties, what kind of abnormalities could be observed?
use of extra muscles
cyanotic
poor cap refill
Why would one asses respirations for more than 30 seconds?
if anything is irregular or for young children
What is apnea?
Period of no breathing
What is stridor?
Emergency situation related to narrowing of the airways
What is tracheal tug?
Often seen in kids - the use of neck muscles to breathe
What is the expected adult respiratory rate?
12-20 bpm
children and elderly people often breathe faster
What is tachypnea? Bradypnea?
Dyspnea?
Tachypnea - fast breathing
bradypnea - slow breathing rate
dyspnea - laboured breathing
What is ASEPTIC?
A - appearance and behaviour S - speech E - emotion and affect P - perception T - thought process I - insight C - cognition
What do we assess in a general survey?
1 - General observations (appearance, psychomotor behaviour, attitude toward interviewer) 2 - Mood 3 - Affect 4 - Speech characteristics 5 - Perception 6 - Thought - content, process/form 7 - Sensorium - LOC, orientation, memory, attention and concentration, comprehension and abstract reasoning 8 - Insight 9 - Judgement
What are the 3 components of the general observations of the general survey?
Appearance - groomed? Hygiene, appropriate?
Psychomotor behaviour - posture, gait, coordination, facial expression, maneurisms
Attitude towards interviewer - accomodating, cooperative, open, apathetic, bored, guarded, supsicious, hostile
What is the difference between mood and affect?
Mood is what the patient tells us - subjective
mood is month - more long-term
Affect is what we describe the patient as - objective
How can emotion be described in the general survey?
Euthymic - normal
euphoric - elated
Dysphoric - depressed, restless
What are the different ways in which affect is described in the general survey?
Range - full or constricted
Intensity - heightened, blunted, flat
Appropriate -
stability - stable or labile
How are speech characteristics charted or observed in the general survey?
Quantity - talkative vs. subdued
Rate of speech production - slow, fast, pressured
Quality - monotone, staccato, loud
What are two perceptual disturbances?
Hallucinations - feeling stimuli when they are absent
Illusions - misrepresenting actual stimuli
What are the two components of thought that are assessed in the general survey?
content - what the person is thinking about
process/form - manner in which thoughts are formed and expressed
What are the superficial aspects of cognition that are assessed in the general survey?
LOC - arousal or wakefulness
Orientation - ability to grasp the significance of environmental information - time, place, person
What are the in-depth assessments of cognition in the general survey?
memory
attention and concentration
comprehension and abstract reasoning
How is STM evaluated in the general survey?
3 unrelated words
how is attention and concentration evaluted in the general survey?
serial 7s
How is abstract reasoning evaluated in the general survey?
similarity between objects - train and bike
Understanding the reality of a set of circumstances.
Awareness of own thoughts and feelings and an ability to compare them with the thoughts and feelings of others.
Insight
ability to reach a logical decision about a situation and to choose course of action
judgement
When you evaluate someone’s problem solving abilities and capacity to learn from the past, you are evaluating what?
judgement
What are critiques of the general survey?
highly subjective, affected by SES and demographic factors, changes with experience of nurse
Free nerve endings/receptors capable of responding to painful stimuli.
nociceptors
nociceptors are located where?
What are they activated by?
throughout the body tissues
activated by thermal, mechanical and chemical stimuli
Describe the transmission of pain.
pain stimulus in periphery –> impulse –> SC –> brain stem –> thalamus –> central structures of brain –> pain is processed
What is nociceptive pain?
Normal processing of stimulus.
What is neuropathic pain?
abnormal processing of sensory input
What are examples of nociceptive pain? neuropathic?
Nociceptive - cutaneous, somatic, visceral, referred, parietal, phantom limb pain
Neuropathic - diabetic neuropathy, phatom limb pain
Why is phantom limb pain considered both nociceptive and neuropathic?
because there was a trauma assocaited to the pain, but is the result of abnormal processing of stimuli.
Pain can be classified by duration or frequency. Elaborate (i.e. what are the different subcategories)
duration
= chronic or acute
frequency
- continuous or intermittent
What are some physiological responses that go along with the pain response?
increase in HR increase Respiratory rate diaphoresis vomitting pallor muscle tension
If a person is unconscious, what do we assume in regards to pain?
present and needs to be treated
What conditions of pain would be considered an emergency?
unexpected intense pain, particularly if sudden or associated with increased pulse, decrease pressure or fever
What does OLDCARTS stand for?
onset, location, duration, charactierstics, aggravating, relieving, timing, severity, self-preception
What does OPQRTSU stand for?
Onset provoking quality radiate timing severity understanding
Regarding bronchi, what is important anatomically and its relation to healthcare/
right bronchi is shorter and wider than the left one - greater risk for aspiration
Where would a tracheotomy be performed?
What breathing abnormality occurs there?
Suprasternal notch
tracheal tug
Why is C7 important?
Around where the lung apices are
What is important about the costal angle?
Location of base of lung for posterior aspect
What are some respiratory risk factors?
Smoking
environmetnal factors (occupational, travel, home)
determinants of health
How is smoking reported in the history?
Pack years - number of packs smoked per day * number of years smoking
How should the client be positioned for a respiratory assessment?
sit up, slightly hunched forward with rolled shoulders
(if they have to lie down, will assess laterally
What is the normal anterior-posterior to lateral size ratio for the chest:?
1:2
What is the anterior-posterior to lateral size ration for the chest in barrel chest patients?
1:1
What is palpation in a respiratory assessment used for?
Find chest tenderness
Extra assessments (if no x-ray) - tactile fremitus, chest excursion (pneumo)
Abnormal findings - crepitus (rice krispies)
Where would you hear bronchial sounds? Bronchovesicular?
Vesicular?
B - near the neck region
BV - sternal border
V - peripheral lung fields
What is the general inspiration to expiration ratio for vesicular sounds?
3:1
What are abnormal breath sounds called?
Adventitious sounds - when airways narrow or there is fluid or mucus or inflammation of airways
Lack of oxygen perfusion
hypoxemia
eupnea
unlaboured breathing
expectorate
coughing
hemoptysis
coughing up blood
