Narrative Flashcards
Neuro (9) :
- General appearance
- Lvl consciousness
- Orientation
- Pupils
- Body movement
- Sensory-vision/hear
7.Sensation - Speech
- Glascow coma scale
Neuro: General appearance
-Clean/orderly
>Shuffled, disorganized
Neuro: Level consciousness
-Awake, alert
>Drowsy
Neuro: Orientation
-x4 (place, time, person, event)
> Confused as to___ place…
Neuro: Pupil
-PERRLA 3mm
>Unequal
Neuro: speech
-Clear, fluent
>incoherent, slurred
Neuro: Movement
-All extremities move equally (MAE)
-Tremor, jerking
Neuro: Sensory
- adequate vision/hearing
> Blind, hard of hearing, glasses, hearing aid
Neuro: Sensation
-Sensation intact
> Decreased sensation
Neuro: GCS
Motor response (6)
Verbal response (5)
Eye opening (4)
Cardiovascular (7)
- General Appearance
- Apical rate
- Heart sounds
- Cap refil
- Circulation: color, warmth
- Edema
- Peripheral pulses
Cardio: General App
-Dry, pink, calm
>Diaphoretic, pale, anxious
Cardio: Apical pulse
- 6 -100 BPM
> Less/more Irregular
Cardio: Heart sound
-S1, S2
>Murmur, extra sound
Cardio: Edema
- No edema
> pitting/ non-pitting +1, +2, +3 +4
Cardio: Cap refil
- 1-3 seconds
> more than 3 sec
Cardio: peripheral Circulation
- Pink, warm, nontender
>cyanosis, cool
Cardio: Peripheral pulse
- Regular, symmetrical +1 thread, +2 weak +3 strong +4 bounding
> asymmetrical
Respiratory (5)
- Lung sounds
- Rate
- Chest shape
- Cough/sputum
- Effort
Resp: Lung sounds
-Clear in all lobes
> diminished, absent
(clear upper lobes diminished in bases)