Midterm Exam Flashcards
1
Q
Comprehensive Health Assessment
A
everything including health history, head-to-toe assessment, a baseline for the patient
used for a patient entering a new facility
2
Q
Problem-Based or Focused Health Assessment
A
based on problem or specific area of patient
used in ER or express clinic
3
Q
Episodic Assessment
A
check on specific episode, check up after focused normally
4
Q
Shift Assessment
A
thorough assessment at start of shift to detect changes
done every 12 hours
5
Q
Screening Assessment
A
mammogram, pap smear, an assessment to detect early issues
6
Q
Subjective vs. Objective Data
A
subjective: coming from patient (pain)
objective: info collected by you (via exam)
7
Q
Primary vs. Secondary Data
A
primary: comes from patient directly
secondary: comes from another person (family member) or chart
8
Q
Types of Prevention (Primary, Secondary, Tertiary)
A
primary: preventing disease from developing through promoting healthy lifestyle (diet, exercise, sleep)
secondary: screening efforts to promote early detection of disease (mammogram, pap smear, blood test)
tertiary: minimizing disability from acute or chronic illness or injury and allowing for most productive life within limitations (take meds, exercise, diet)
9
Q
Standard Precautions
A
apply in all health care settings
hand hygiene
utilize PPE as necessary
proper management of patient care equipment
10
Q
Techniques used for assessment
A
inspection, palpation, percussion, auscultation
11
Q
Areas of hands to use for palpation (heat, vibration, texture, masses)
A
palmar surface of fingers and finger pads are more sensitive than fingertips (texture, size)
ulnar surface of hand to fifth finger is most sensitive to vibration
dorsal surface is better for assessing temperature
12
Q
Temperature
A
regulated by hypothalamus
expected range from 96.4 - 99.5 F
13
Q
Oral vs. Axilla vs. Rectal
A
Oral is considered accurate
Axilla is one degree lower than oral
Rectal is one degree higher than oral
14
Q
Heart Rate/Pulse
A
heart rate: number of times in a minute a pulsation is felt
rhythm: regularity of pulsations or time between each beat
amplitude: strength of pulse and perfusion of blood to various parts of body (0, 1+, 2+, 3+)
15
Q
Respiratory Rate
A
rate: breaths per minute
rhythm: regular or irregular pattern
depth: shallow, moderate, or deep
16
Q
Oxygen Saturation
A
lower than 90% is considered abnormal and require further evaluation
17
Q
Normal Blood Pressure
A
less than 120 and less than 80
18
Q
Elevated Blood Pressure
A
120-129 and less than 80
19
Q
High Blood Pressure (Hypertension Stage 1)
A
130-139 or 80-89
20
Q
High Blood Pressure (Hypertension Stage 2)
A
140 or higher or 90 or higher
21
Q
Hypertensive Crisis
A
higher than 180 and/or higher than 120
22
Q
PQRST Symptom Analysis
A
P - provoking factors
Q - quality
R - region/radiating
S - severity
T - time/treatment
23
Q
Questions to ask for P in PQRST Symptom Analysis
A
What factors precipitated the pain?
What were you doing at onset of pain?
24
Q
Questions to ask for Q in PQRST Symptom Analysis
A
Describe pain (ache, sharp, burning)
25
Questions to ask for R in PQRST Symptom Analysis
Where is pain?
Does it radiate?
26
Questions to ask for S in PQRST Symptom Analysis
Rate pain on scale (0-10, FACES, etc)
27
Questions to ask for T in PQRST Symptom Analysis
How long have you had pain?
Is it constant/intermittent?
What have you done to treat pain?
28
Acute Pain vs. Chronic Pain
acute: recent onset and results from tissue damage, is usually self-limiting, and ends when tissue heals
chronic: may be intermittent or continuous pain lasting more than 6 months
29
Nociceptive Pain vs. Neuropathic Pain
nociceptive: somatic structures (bones, joints, muscles) or visceral organs (chest, abdomen, or pelvic areas)
neuropathic: abnormal processing of sensory input by the central or peripheral nervous system (caused by damaged nerves)
30
Referred Pain vs. Phantom Pain
referred: pain felt in location away from injury
phantom: pain felt in an amputated extremity
31
CAGE Questionaire
used to test for alcohol abuse
Have you every felt the need to CUT DOWN on your drinking?
Have you ever felt ANNOYED by criticism of your drinking?
Have you ever felt GUILTY about your drinking?
Have you ever felt the need to drink a morning EYE-OPENER?
32
AUDIT Tool
Alcohol
Use
Disorders
Identification
Test
33
Mini-Mental State Exam
measures cognitive impairment or DEMENTIA
memory
ability to form sentences
simple math problems
repeat simple sentences
reading
writing
copying (drawing)
judgment (give scenario to see what they would do)
34
Holmes Social Readjustment Rating Scale
STRESS assessment
an assessment tool that lists events that could happen in a patient's life that could affect that patient's mental health in terms of stress
35
Role of Neurotransmitters
essential role in human emotions and behavior; help transmit messages
36
Neurotransmitters that affect mental health
norepinephrine
serotonin
dopamine
histamine
acetylcholine
Gamma-aminobutyric acid (GABA)
37
Depression Signs and Symptoms
feelings of helplessness and hopelessness and recurrent suicidal thoughts
mood and affect are altered, with extreme sadness or anxiety and agitation
somatic complaints: altered appetite, sleep problems, constipation, headache, and fatigue
38
Bipolar Disorder Signs and Symptoms
episodes of mania, depression, or mixed moods
manic phase: excessive emotional displays, excitement, or hyperactivity accompanied by elation or delusions of grandeur
depressive phase: apathy and feeling of profound sadness, loneliness, guilt, and lowered self-esteem
39
Delusions
beliefs so strong you can't convince them otherwise
40
Schizophrenia Signs and Symptoms
severe disturbance of thought and associative looseness
impaired reality testing (hallucinations, delusions)
limited socialization
Clinical Findings: flat, blunted or bizarre emotions, disorganized thinking, jumbled or illogical speech, impaired reasoning, autistic thinking: delusions and hallucinations, severe ambivalence
41
Hallucinations
experiences of apparent perception of something that doesn't exist
can affect any of the 5 senses
42
Anxiety Signs and Symptoms
uneasiness or discomfort from mild anxiety to panic
4 Levels: mild, moderate, severe, panic
43
Delirium Signs and Symptoms
ACUTE AND TREATABLE
disturbance of consciousness and rapidly developing change in cognition
altered level of consciousness, impaired memory, fluctuating attention span, may have hallucinations or delusions, "sundowning" may increase, speech may be rapid, inappropriate or rambling
44
Dementia Signs and Symptoms
CHRONIC AND NONREVERSIBLE
memory impairment, slow onset, consciousness intact but memory, judgment, and calculation impaired, flat affect, may have delusions, speech is slow and incoherent
45
Stress Signs and Symptoms
irritable, angry, impatient, or wound up
overwhelmed
anxious, nervous or afraid
46
Primary Lesions
EXPECTED variations of the skin
moles, freckles, patches, and comedones (acne)
47
Secondary Lesions
some are considered expected
scar
48
Vascular Lesions (& examples)
many are considered common
petechiae, purpura, ecchymosis, angioma
49
Petechiae vs. Purpura
petechiae: tiny, flat, reddish-purple, nonblanchable spots in skin LESS THAN 0.5 cm
purpura: flat, reddish-purple, nonblanchable discoloration in skin GREATER THAN 0.5 cm
50
Ecchymosis
BRUISE
reddish-purple, nonblanchable spot of variable size
51
Angioma
benign tumor consisting of a mass of small blood vessels; can vary in size from very small to large
52
Stage 1 Pressure Ulcer
intact skin w/ nonblanchable redness, usually over a bony prominence; area may be painful, firm, soft, warmer, or cooler compared to adjacent tissue
53
Stage 2 Pressure Ulcer
partial-thickness loss of dermis; presents as a shiny or dry shallow open ulcer w/ pink wound bed w/out slough or bruising; may also present as an intact or open/ruptured serum-filled blister
54
Stage 3 Pressure Ulcer
full-thickness skin loss involving damage to or necrosis of subcutaneous tissue; subcutaneous fat may be visible, but bone, tendon, or muscles are not exposed; slough may be present; wound may include undermining and tunneling
55
Stage 4 Pressure Ulcer
full-thickness tissue loss w/ exposed bone, tendon, or muscle; slough or eschar may be present w/in wound bed; undermining or tunneling often present
56
Unstageable Pressure Ulcer
full-thickness tissue loss in which the actual depth of the ulcer is completely obscured by slough and/or eschar in the wound bed
57
Vesicle vs. Pustule vs. Bulla
vesicle: elevated, circumscribed, superficial, not into dermis; filled w/ serous fluid; LESS THAN 1 cm in diameter
pustule: elevated, superficial lesion; similar to vesicle but filled w/ purulent fluid
bulla: vesicle GREATER THAN 1 cm in diameter (BLISTER)
58
Macule vs. Papule vs. Patch
macule: flat, circumscribed area that is a change in the color of the skin; LESS THAN 1 cm in diameter
papule: elevated, firm, circumscribed area LESS THAN 1 cm in diameter
patch: flat, nonpalpable, irregular-shaped macule MORE THAN 1 cm in diameter
59
Braden Scale
an assessment tool for predicting the risk of pressure ulcers
60
Signs of Melanoma (ABCs)
A - asymmetry (not round or oval)
B - border (poorly defined or irregular border)
C - color (uneven, variegated)
D - diameter (usually greater than 6 mm)
E - evolving (skin lesion that looks different from others or is changing in size, shape, or color)
F - feeling (itching, tingling, or stinging)
61
Assessing Skin Turgor
picking up and slightly pinching skin on forearm or under the clavicle; skin should be elastic and return to place immediately when released
62
Plaque
a circumscribed, elevated, plateaulike, solid lesion GREATER THAN 1 cm in size
63
Wheal
elevated lesion caused by localized edema (HIVES)
64
Nodule
slightly elevated lesions on or in skin; LARGER THAN papules
65
Tumor
abnormal growths of tissue that can be malignant (cancerous) or benign (harmless)
66
Cyst
abnormal, fluid-filled sacs that can develop in tissues in any part of the body
67
Clubbed Nails
abnormal, rounded shape of nail bed
caused by respiratory disease and cardiovascular disease
68
Migraine - Where? Duration? Quality of Pain? Who? Other info?
Where? - unilateral
Duration? - several hours to several days
Quality of Pain? - throbbing
Who? - all but women > men
Other info? - nausea and vomiting, dizzy, aura, photosensitivity
69
Cluster Headache - Where? Duration? Quality of Pain? Who?
Where? - unilateral (eye, temple, etc)
Duration? - 30-60 min; multiple times per day
Quality of Pain? - stabbing/burning
Who? - adolescent to YA; men > women
70
Tension Headache - Where? Duration? Quality of Pain? Who? Other info?
Where? - back or front of head
Duration? - several days
Quality of Pain? - vice-like pressure
Who? - 20-40 year olds (either sex)
Other info? - muscle tension
71
Sinus Headache - Where? Duration? Quality of Pain? Who? Other info?
Where? - frontal/maxillary
Duration? - until drainage
Quality of Pain? - pressure
Who? - everyone
Other info? - eye sensitivity
72
Post-Traumatic Headache (concussion) - Where? Duration? Quality of Pain? Who? Other info?
Where? - entire head
Duration? - several days
Quality of Pain? - dull to painful ache
Who? - athletes/MVA
Other info? - nausea and vomiting, blurred vision, photophobia, dizzy, decrease concentration, giddiness
73
Palpebral Fissure
opening between eyelids
74
Conjunctivae
two, thin, transparent mucous membranes lie between eyelids and eyes
75
Sclera
tough, fibrous outer layer; white of eye
76
Cilia
nasal hairs
77
Turbinates
concha; line lateral walls of nasal cavity, providing large surface area of nasal mucosa for heat and water exchange
78
Salivary Glands
parotid, sublingual, submandibular; release saliva through small ducts in response to presence of food
79
Oropharynx
back of mouth
includes uvula and tonsils
80
Larynx
voice box
81
Lymph Nodes
tiny oval clumps of lymphatic tissue, usually grouped along blood vessels
82
Dizziness vs. Vertigo
Dizziness: faintness, light-headedness
Vertigo: sensation of movement, usually rotational like whirling/spinning
83
Tinnitis
ringing in the ear
84
Presbyopia
loss of elasticity of the lens of the eye due to aging
85
Ptosis
lid of either eye covering part of the pupil
86
Corneal Arcus
white, opaque ring encircling the limbus
87
Miosis
pupil is constricted (< 6 mm)
88
Mydriasis
pupil is dialated (> 6 mm)
89
Nystagmus
involuntary movement of eyeball in horizontal, vertical, or rotary direction
jerking movement (alcohol use)
90
Strabismus
eye that moves to focus after being uncovered
LAZY EYE
91
Presbycusis
hearing loss associated with aging
92
Assessment Techniques of the Head/Face
Jaw movement
Palpate Sinuses
Palpate temporal arteries
transillumination of sinuses
93
Assessment of the Eyes
PERRLA
Accommodation
Consensual pupils
Six Cardinal fields of Gaze
Corneal Light Reflex
Red Reflex
94
Visual Acuity Test
Distance/ Near / Peripheral Vision
Snellen Chart
95
Aniscoria
unequal pupils
96
PERRLA
Pupils are
Equal and
Round and
Reactive to
Light and
Accommodation
97
Consensual Pupils
both eyes/pupils work/move the same way
98
Accommodation
look at something far away then close to nose to see if pupils change with the distance of the object
99
Six Cardinal Fields of Gaze
do eyes move smoothly and together?
100
How to test for Eye Alignment?
Corneal Light Reflex
if abnormal? cover-uncover test
101
Red Reflex
red glow over pupil when light illuminates retina
102
Conjunctivitis
pink eye
103
Cataract
cloudy lens
104
Assessment of Hearing
Proper technique for use of otoscope
whisper test
finger-rub test
Weber (above head)/ Rinne (behind/front of ear) test with tuning fork
105
Otitis Media
infection of MIDDLE EAR
S&S:
ear pain
tympanic membrane appears inflamed, red, and may be bulging or immobile
pain does NOT change w/ manipulation of ear
106
Bacterial Infection Nasal Drainage
thick or purulent green-yellow discharge
107
Epistaxis Nasal Drainage
NOSE BLEED
bloody
108
Allergic Rhinitis Nasal Drainage
watery
109
Foreign Body Nasal Drainage
foul-smelling, unilateral discharge
110
Appendicitis
appendix becomes inflamed and filled w/ pus
111
Cholecystitis
inflammation of gallbladder
112
Cholelithiasis
GALL STONES
113
Diverticulitis
inflammation of diverticula (in muscular wall of colon)
114
Epigastric
lying upon or over stomach
contains duodenum, portion of liver, pancreas, and portion of stomach
115
GERD (gastroesophageal reflux disease)
reflux of gastric acid into lower esophagus (CHRONIC)
116
Hiatal Hernia
protrusion of stomach through esophageal hiatus of diaphragm into mediastinal cavity
117
Nephrolithiasis
KIDNEY STONES
118
Pancreatitis
acute or chronic inflammation of pancreas
119
Peptic Ulcer
ulcer in lower end of esophagus, in stomach, or in duodenum
120
Peritoneum
abdominal lining, serous membrane forming a protective cover
121
Rebound Tenderness
sign of inflammation in peritoneum in which pain is elicited by sudden withdrawal of hand pressing on abdomen
122
Hematemesis
vomiting blood
123
Proper Order for Assessing Abdomen
inspect, auscultate, palpate, percuss
124
What is the position for an abdominal assessment?
supine
125
Auscultation Sounds - Frequency? Why do we do it? Absent? Expected Findings?
Frequency? - auscultate 15 sec per quadrant and count amount of sounds
Why do we do it? - to assess for intestinal motility
Absent? - must listen for 4-5 minutes, no intestinal motility
Expected Findings? - between 5-30 sounds (normoactive)
126
Borborygmi
intense, episodic
very hyperactive (pt may have blockage)
127
Pulsations - normal/abnormal findings (abdomen)
normally vascular sounds are not heard
abnormally you would hear bruits
128
Use of stethoscope for bowel sounds vs vascular sounds
bowel sounds: diaphragm
vascular sounds: bell
129
What sounds do you expect to percuss and where?
Resonance: over normal lung tissue
Tympany: over abdomen
Flat: solid tissue like bones/muscles
Dull: over dense areas (heart/liver)
130
7 Fs for Abdominal Distension (bloating)
1. flatus (gas)
2. fluid (ascites)
3. fetus (pregnant)
4. fat (obesity)
5. fibroid tumor (uterus)
6. fatal growth (cancerous)
7. feces
