Patient assessment Flashcards
1
Q
Natural factors which increase body temperature
A
Late afternoon is highest point but ovulation, exercise and first 5 months of pregnancy increase temperature as well!
2
Q
Les’ preferred normal temperature range for patients?
A
36.5-37.5 degrees C
3
Q
What point of day has lowest body temperature?
A
The morning
4
Q
What temperature method is recommended for peds?
A
Axillary
5
Q
Common temperature taking methods
A
Tympanic, axillary and oral
6
Q
Normal HR
Tachy HR
Brady HR
A
60-100 normal
Over 100 is tachy
Under 60 is bradycardia
7
Q
Define
Bigeminy and trigeminy
And what your first step would be upon discovering one
A
Trigeminy beats in groups of 3
Bigeminy is beats in groups of 2
Needs an ECG
8
Q
Name the categories of pulse grade
A
4+ pulse strong and impossible to occlude 3+ pulse difficult to occlude 2+ brisk or normal pulse 1+ thready or weak pulse 0 no pulse
9
Q
3 key factors when reporting pulse
A
Rate rhythm and grade
10
Q
define: Tachypnea bradypnea hyperpnea hypopnea
A
tachypnea- RR above normal
Bradypnea RR below normal
hyperpnea- minute volume increased
hypopnea- minute volume decreased
11
Q
2 factors to report for breathing?
A
RR and rhythym/pattern
12
Q
define the values for the following:
normal BP
hypertension
hypotension
A
normal= 120/80 hypertension= 140/90 or over hypotension= less than 90/60
13
Q
optimal bladder arm coverage %
in adults
in peds
A
adutls is 80%
peds is 100%
14
Q
which korotokoff phases are used to asses BP?
A
phase 1- systolic pressure
phase 5 diastolic
15
Q
what can succesfull patient centered care proportedly improve?
A
patient safety
communication
compliance with treatment plan
16
Q
what are the 4 stages of patient client interaction?
A
1- chart review. clarify in your mind and with charts what your role is today.
2- introdctory stage. establish rapport with the patient
use their name formally until they tell you not too
3-initial assesment. identify patients baseline condition and need for treatment as physician has ordered
4-follow up stage. communicate with the patient for a moment. “do you have any questions for me” on way out always look back and do one final glance over patient and room.
17
Q
3 categories of space
A
intimate 0-2 ft
personal 2-4
social 4-12
18
Q
tips to express genuine concern
A
face patient square on
use eye contact
be an active lsitener
consider appropriate touch
19
Q
what does the acronym PQRST stand for
and when should we use it?
A
Provocative "what caused it" Qualtiy or quantity "burning, sha R region/radiation S severity "out of 10 T timing "since when does it hurt" it is for pain
20
Q
what acronym is used for a primary survey?
A
SAMPLE
21
Q
what does sample stand for?
A
Symptoms allergies medication Past history last meal events prior
22
Q
what are to factors which can be used in predictive medicine?
A
family history
or
occupational/ environemental histoy
23
Q
3 key things to review on patient file before meeting them
A
admission note-describes pertinent facts ot their admission
physicians orders- lists treatments and hterapies
progress reports- descrie the patients response to treatment
24
Q
define DNR
A
do no resusitate
aka do not attempt to revive patient
common in elderly
25
define and distinguish between symtpoms and signs
signs are objective "measureable imperical data"
| symptoms are subjective what the patient says
26
what is a cough and what causes it?
a protective reflex triggered by stimulation of cough receptors.
27
primary symptoms of cardiopulmonary disorders
```
cough
sputum production
hemoptysis
SOB
chest pain
```
28
```
your patient grimaces when they are being interiveiwed post op. She is suffering some confusion about her responses. What could be impeding her communication skills?
self-concept
listening habits
pain and anxiety
hearing impairment
```
pain and anxiety
29
active listening is most essential of what stage of the clinical encounter?
the initial assesment stage
30
what are the 4 stages of the clinical encounter
introductory stage
initial assesment stage
treatment and monitoring
follow up
31
patient is having difficulty learning to use their enhaler. after many attempts they stil cannot use it independently and properly. what should your next step be?
request permission from doctor to find more acceptable delivery system
cease attempts and give up
push the patient to try harder and practice more
chart trx as not given and return later
request permission from patients doctor to find more acceptable delivery route
32
what space is appropriate to develop patient rapport
social
33
why should you always log off your computer when leaving the computer?
HIPAA
34
what are some important cultural beliefs to explore with patient during the assesment stage.
concepts of health and disease
responses to authority
gender and family roles
reliigous values
35
what is an ill advised way to decrease patient anxiety?
prescription of analgesic
36
what are 4 key elements of a good patient action plan?
a specific measurable goal
barriers to goal measurement
actions to achieve the goal
a follow uo mechanism
37
what piece of equipment is essential to protect yourself from airborne hazards?
properly fitting N95
38
what are your first steps after a patient poorly responds to the trx you have given after patient is stablilzed
speak with nurse, chart response and chart whoseover you notified
39
in setting up a postural drainage treatment what info could be important for you to obtain?
patients med sched
pt ideal body weight
pt meal schedule
med sched
| meal sched
40
all of the following are acceptable for an RT to suggest to a pt with COPD except what?
help pt develop good action plans
training pt in self care techniques
recomending diet or nutrition changes
providing information about disease process
diet and nutrition change recomendations shouldnt be given
41
T or F
| proper diagnosis and trx are determined to a great extent by the accuracy and detal of the patients history
T
42
in what section of the patient history can a detailed description of the patients current symptoms be found?
history of present illness
43
information obtained form the patient an which cannot be percieved by the observer is known as?
subjective data
44
where in patient info could you find potential history of exposrure to asbestos?
occupational history
45
subjective manifestations of the disease are commonly known as?
symptoms
46
define pertinent negaitve
a sign or symptom assocaited woith the disease or suspected disease process which the patient denies having.
47
DNR means?
do no resusitate
48
```
family history can be helpful in diagnosing which of the following?
acute bronchitis
cystic fibrosis
pnuemothorax
pulmonary edema
```
CF
49
which of the following could lead to a weak cough?
a. Reduced lung recoil
b. Bronchospasm
c. Weak inspiratory muscles
all of the above
50
```
A cough described as being persistent for more than 3 weeks would be called which of the following?
acute
paroxysmal
chronic
nocturnal
```
chronic
51
Which of the following problems associated with hemoptysis?
a. Tuberculosis
b. Lung carcinoma
c. Pneumonia
all of the above
52
A patient’s complaint of breathlessness or air hunger would be defined as which of the following?
a. Hemoptysis
b. Wheezing
c. Dyspnea
d. Cyanosis
dyspnea
53
What term is used to describe shortness of breath in the upright position?
a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
platypnea
54
What term is used to describe shortness of breath in the upright position?
a. Orthopnea
b. Platypnea
c. Eupnea
d. Apnea
increase in lung compliance
55
What term is used to describe difficult breathing in the reclining position?
a. Apnea
b. Platypnea
c. Orthopnea
d. Eupnea
orthopnea
56
\
radiates to the neck
57
Which of the following may cause syncope?
a. Severe cough
b. Pulmonary embolism
c. Hypovolemia
d. All of the above
all of the above
58
define syncope
temporary loss of consciousness due to low BP
59
Which of the following is (are) true regarding dependent edema cause by lung disease?
a. It is caused by pulmonary vasodilation
b. Accompanying hepatomegaly may be present
c. It is caused by acute systemic hypertension
d. All of the above
accompanying hepatomegaly may be present
60
Chronic pulmonary hypertension may lead to which of the following clinical findings?
a. Pedal edema
b. Inspiratory crackles
c. Hepatomegaly
d. A and C
hepatomegaly and pedal edema
61
define hepatomegaly
swollen liver
62
Which of the following is associated with night sweats?
a. Tuberculosis
b. Congestive heart failure
c. Asthma
d. Interstitial pulmonary fibrosis
TB
63
Which of the following symptoms is least likely to be associated with GERD?
a. Pedal edema
b. Hoarseness
c. Coughing
d. Wheezing
pedal edema
64
In what decade of life is snoring and obstructive sleep apnea (OSA) most likely to be present in adult males?
a. 20 to 29 years
b. 30 to 39 years
c. 40 to 49 years
d. 50 to 59 years
50-59
65
all of the following are included in the measurement of vital signs, except which one?
a. Pulse
b. Respiratory Rate
c. Urinary output
d. Blood pressure
urinary output
66
Which of the following changes is consistent with a fever?
a. Decreased respiratory rate
b. Increased pulse rate
c. Decreased oxygen consumption
d. Decreased blood pressure
increased pulse rate
67
Which of the following methods of temperature measurement is recommended for neonates?
a. Oral
b. Axillary
c. Rectal
d. Ear
axillary
68
What is the normal value of the resting pulse rate in the adult?
a. 30-60 beats/min
b. 60-100 beats/min
c. 80-120 beats/min
d. 100-150 beats/min
60-100 bpm
69
What is the normal range for respiratory rate for adults?
a. 6-10 breaths/min
b. 8-12 breaths/min
c. 12-20 breaths/min
d. 15-25 breaths/min
12-20 breaths
70
Which of the following causes tachycardia in the adult?
a. Hypothermia
b. Hypoxemia
c. Hypertension
d. Polycythemia
hypoxemia
71
Which of the following arterial sites is the most common for evaluating the pulse in the adult patient?
a. Pedal
b. Temporal
c. Radial
d. Femoral
radial
72
Which of the following causes tachypnea in the adult?
a. Hypothermia
b. Narcotic overdose
c. Metabolic acidosis
d. Hyperoxia
metabolic acidosis
73
Which of the following causes an erroneously low blood pressure measurement?
a. Inflation pressure held in the cuff between measurements
b. Use of blood pressure cuff that is too narrow
c. Not enough pressure used in the cuff during measurement
d. Tachycardia
not enough pressure used in the cuff during measurement
74
Hypotension may often be associated with all of the following, except which ones?
a. Reduced perfusion
b. Less oxygen delivery to the tissues
c. Excessive salt intake
d. Dehydration
excessive salt intake
75
The peak pressure in the arteries is known as which of the following?
a. Pulse pressure
b. Diastolic pressure
c. Systolic pressure
d. Pulse pressure
systolic pressure
76
56. A decrease in the intensity of the palpated pulse during inhalation is a definition of which of the following?
a. Abdominal paradox
b. Pulse pressure
c. Pulsus paradoxus
d. Pulsus alternans
pulsus paradoxus
77
What is the normal range for pulse pressure?
a. 10-20 mmHg
b. 20-25 mmHg
c. 30-50 mmHg
d. 35-40 mmHg
35-40mmhg
78
If a patient experiences syncope when moving from the supine to the upright position, what is the likely cause?
a. Left ventricular failure
b. Postural hypotension
c. Excessive vasoconstriction
d. Pulsus paradoxes
postural hypotension
79
Which of the following is not a typical component to physical examination?
a. Inspection
b. Palpation
c. Auscultation
d. Interviewing
interviewing
80
Pursed-lip breathing is most often seen in patients with which of the following diseases?
a. Pulmonary fibrosis
b. COPD
c. Pneumonia
d. Congestive heart failure
COPD
81
Which of the following is an unlikely cause of diaphoresis?
a. Myocardial infarction
b. Fever
c. Pulmonary fibrosis
d. Exercise
Pulmonary fibrosis
82
In which of the following conditions is lymphadenopathy of the neck seen?
a. Infection of the upper airway
b. Asthma
c. Cystic fibrosis
d. Atelectasis
upper airway infection
83
define lymphadenopathy
disease fo the lymph nodes
84
Which of the following may cause an increased jugular vein distension?
i. Chronic hypoxemia
ii. Right-sided heart failure secondary to left-sided heart failure
iii. Right-sided heart failure alone
a. i and ii
b. ii and iii
c. i, ii and iii
c
85
What spinous process is most prominent with the patient sitting and with the head bent forward?
a. T1
b. C1
c. C7
d. S3
C7
86
At which of the following topographic locations is the bifurcation of the trachea located on the anterior chest?
a. Over the upper part of the manubrium
b. Beneath the sternal angle
c. The fourth rib at the sternum
d. Under the xiphoid process
beneath the sternal angle
87
The minor (horizontal) fissure begins at which of the following locations on the anterior chest?
a. Second rib at the sternal border
b. Fourth rib at the sternal border
c. Sixth rib at the sternal border
d. Seventh rib at the sternal border
fourth rib at the sternal border
88
An “inward depression of the sternum” describes which of the following thoracic configurations?
a. Kyphosis
b. Pectus excavatum
c. Flail chest
d. Barrel chest
pectus excavatum
89
What type of lung problem is associated with severe kyphoscoliosis?
a. COPD
b. Restrictive lung disease
c. Pneumothorax
d. Pulmonary fibrosis
restrictive lung disease
90
Which of the following best describes an apneustic breathing pattern?
a. Prolonged exhalation
b. Prolonged inhalation
c. Deep and fast
d. Absence of breathing
prolonged inhalation
91
What is indicated by the presence of retractions?
a. Heart failure
b. An increase in the work of breathing
c. Pneumothorax
d. Restrictive lung disease
increase WOB
92
Which of the following I:E ratios is consistent with a severe asthma attack?
a. 3:1
b. 2:1
c. 1:1
d. 1:3
1:3
93
Which of the following breathing patterns is associated with narrowing of the intrathoracic airways?
a. Prolonged inspiratory time
b. Prolonged expiratory time
c. Rapid and shallow
d. Rapid and deep
prolonged expiratory time
94
Which of the following indicate diaphragmatic fatigue?
i. Paradoxical pulse
ii. Abdominal paradox
iii. Respiratory alternans
iv. Biot breathing pattern
a. i and ii
b. ii and iii
c. iii and iv
2 and 3
95
Which of the following causes an increased tactile fremitus?
a. Atelectasis with a patent bronchiole
b. Pleural effusion
c. Emphysema
d. Obesity
atelectasis with a patent bronchiole
96
Which of the following causes a bilateral decrease in chest expansion?
a. Lung tumor
b. Pneumothorax
c. COPD
d. Pleural effusion
COPD
97
Which of the following causes an increase resonance to percussion of the chest?
a. Lobar consolidation
b. Pneumothorax
c. Pleural effusion
d. Atelectasis
pneumothorax
98
What clinical condition would cause the range of diaphragm movement to be reduced bilaterally?
a. Severe emphysema
b. Left lower lobe atelectasis
c. Congestive heart failure
d. Pneumonia
severe emphysema
99
Normal tracheal breath sounds are produced by which of the following mechanisms?
a. Turbulent airflow through large airways
b. Filtered sounds through lung tissue
c. Passage of air through secretions
d. Passage of air through narrowed airways
turbulent airflow through large airways
100
Which of the following terms is used to describe discontinuous adventitious lung sounds?
a. Wheeze
b. Crackles
c. Rhonchi
d. Stridor
crackles
101
The finding of late inspiratory crackles on auscultation of a patient might indicate which of the following?
i. Atelectasis
ii. Pulmonary fibrosis
iii. Bronchospasm
iv. Pneumonia
a. i only
b. i and iii
c. i, ii and iii
d. i, ii and iv
atelectasis, PF and pneumonia
102
What clinical condition is most closely associated with polyphonic wheezing?
a. Pneumonia
b. Pneumothorax
c. Asthma
d. Pulmonary fibrosis
asthma
103
Which of the following lung sounds is commonly heard in patients with upper airway obstruction?
a. Polyphonic wheeze
b. Fine inspiratory crackles
c. Coarse inspiratory and expiratory crackles
d. Inspiratory stridor
inspiratory stridor
104
Which of the following is the normal topographic location of the PMI?
a. Third intercostal space at the anterior axillary line
b. Fourth intercostal space at the anterior axillary line
c. Fifth intercostal space at the midclavicular line
d. Sixth intercostal space at the midsternal line
fifth intercostal space
105
what is PMI
point of maximal impulse; the location where the cardiac pulse can be palpated externally.
106
Which of the following locations is best for auscultating the mitral valve?
a. Third intercostal space at the anterior axillary line
b. Fourth intercostal space at the anterior axillary line
c. Fifth intercostal space at the midclavicular line
d. Sixth intercostal space at the midsternal line
fifth intercostal
107
What produces the sounds associated with the first heart sound?
a. Closure of the atrioventricular (AV) valves
b. Closure of the semilunar valves
c. Left ventricular muscle movement
d. Blood flow through normal valves
closure of AV valve
108
What clinical condition is most commonly associated with a gallop heart rhythm?
a. Pneumonia
b. Pericarditis
c. Congestive heart failure
d. Aortic stenosis
CHF
109
Which of the following may cause an increased P2 component of the second heart sound?
i. Pulmonary hypertension
ii. Pulmonary embolism
iii. Cor pulmonale
iv. Systemic hypertension
a. i and iii
b. ii and iii
c. i, ii and iii
d. i, ii, iii and iv
pulmonary hypertension
pulmonary embolism
cor pulmonale
110
Which of the following is/are associated with right heart failure?
i. Jugular venous distention
ii. Hepatomegaly
iii. Pedal edema
iv. Systemic hypertension
a. i only
b. i and ii
c. i and iii
d. i, ii and iii
jugular venous distension
hepatomegaly
pedal edema
111
what are the 3 phases of a cough?
inspiratory, compression and expiratory
112
is it advised to give anti-tussives to a patient with a productive cough? why or whynot?
it is ill advised, as they are assisting the body in expelling the infection, and thus to stop that impedes this process.
113
define and distinguish between acute and chronic and paroxysmal
acute- sudden onset, short course
chronic- over 3 weeks persistent
paroxysmal- periodic, prolonged episodes, which come and go
114
clear coloured sputum indicates what?
normal function
115
black coloured sputum indicates what?
smoke or coal dust inhalation
116
brownish coloured sputum indicates what?
cigarette smoker
117
frothy white or pink coloured sputum indicates what?
pulmonary edema
118
sand or small stone coloured sputum indicates what?
aspiration of foreign material-broncholithiasis-calcified ro ossified material in the bronchial lumen
119
purulent coloured sputum indicates what?
infection
120
purulent apple-green thick coloured sputum indicates what?
haemophilus influenzae infection
121
pink, thin, and blood streaked sputum indicates what?
streptococci or staphyloccoc infetion
122
red currant jelly purulent sputum indicates what?
klebsellia infection
123
rusty sputum indicates what?
pneumococci
124
yellow or green copious sputum indicates what?
pseudomonas species pneumonia
125
fetid or foul smelling sputum indicates what?
lung abscess, anaerobic infections or bronciectasis or aspiration
126
mucoid (white-gray and thick) sputum indicates what?
emphysema, pulmonary tuberculosis, early chronic bronchitis, neoplasms, asthma
127
grayish sputum indicates what?
legionnaires disease
128
silicone like casts in sputum indicates what?
bronchial asthma
129
blood streaked or bloody sputum (hemoptysis) indicates what?
bronchogenic carcinoma, TB, chronic bronchitis, coagulpathy, pulmonary contusion or abscess.
130
distinguish between hemoptysis and hematemesis
hemoptysis is blood in sputum, hematemesis is vomitted blood
131
SOB is the cardinal symptom ofd what disease?
cardiac disease
132
dyspnea scoring scale
modified borg scale
0- nothing
10 is maximal maximal effort
133
american thoracic society shortness of breath scale
0 no SOB
1 slight- troubled when wlaking uphill or vigourous walking on the flat
2 moderate- walks slower than people of same age due to breathlessness
3 severe- stops for breath after wlaking about 100 yards
4 very severe- too breathless to leave house, looses breath when dressing or undressing
134
define psychogenic dyspnea
SOB due to panic disorder or mental health, not related to physical exertion
135
define cardiac and circulatory dyspnea
inadequate supply of O2 to tissues primarily caused by exercising
136
define hyperventilation
rate and depth of breathing whihc exceeds the bodies curretn metabloc demand. results in hypocapnoia and decreased cerebral blood flow.
137
edema in the ankles and lower legs is most often casued by
RHF or LHF
138
define cor pulmmonale
right ventricular hypertrophy caused by increased diseased state or resistance in the pulmonary circulation
139
a patient has 1cm deep edema which takes 90 seconds to refill, they would be classified as what level on the pitting edema scale?
3+ moderate for 0.6-1.3 cm and 1-2 minute refill
140
the pitting edema scale
1-trace slight with rapid refill
2-mild 0-0.6 cm with 10-15 second refill
3-moderate 0.6-1.3 cm with 1-2 minute refill
4- severe 1.3cm+ with 2min + refill
141
common causes of fever (pulmonary diseases)
empyema (pus in lungs), TB, pnuemonia, legionaires
142
most common cause of snoring and sleep apnea is?
obesity
143
peak ages for male and females for OSA
50-59 male and 60-64 female
144
```
signs and symptoms of CHF
eyes
skin
brething
lung sounds
sputum colour
BP change
etc
```
dilated pupils- sympathetic response
pale skin
dyspnea SOB from pulmonary congstion
orhtopnea
crackels and wheezes
frothy pink andor white sputum
decreased blood pressure ;leads toincrease pulse
vomiting as peristalsis slows and stomach backs up
dependant edema
fall O2 sats
jugular vein distension from venous congestion
S3 gallop
decreased urine output
enlarged spleen and liver from veinous buildup impedes diaphragmatic excursion.
145
importance of vital signs
establish a baseline, observe trends and determine general patient status
146
what are the 4 classic VS?
temp, pulse, RR and BP
147
what are the other vital signs considered 5th vital
pain and pulse ox
148
what are some clinical patient signs of hypoxemia
```
impaired coordination
cool extremities
diaphoresis
decreased mental function
increased WOB and use of accesory muscles
tahcycardia
arrhytmia
initial increase in BP
```
149
how does having a fever impact O2 and CO2 in the body?
O2 consumption increases 10% per degree celsius fever increase
CO2 production increases aswell
150
aside from exposure to cold, when else can we find hypothermia?
head injury patients to reduce ICP?
151
how does hypothermia affect O2 and CO2 in the body?
decreases O2 consumption and decreases CO2 production
152
define pulsus paradoxus
drop in systolic pressur eby 10 mmhg during inspiration
153
define pulsus alterans
beat to beat change in the stregnth of cardiac contraction, caused by chagning preload.
154
define apnea
lack of spontaneous breaths
155
define eupnea
normal rate of breathing
156
define bradypnea
less than normal rate of breathing
157
define tachypnea
rapid rate of breating
158
define hypopnea
decreased depth of breathing
159
define hypernea
increased depth of breathing with or without an increased rate
160
describe cheyne stokes breathing pattern
crescendo and decrescendo followed by apnea periods
161
decribe biots breathing
quick shallow breaths folllowed by apnic periods
162
describe kussmauls breathinf
deep and laboured breathing pattern
163
describe apnuestc breating
inspirations followed by inadequate expiraitons, causd by severed or damaged pons?
164
normal BP range
stage 1 hypertension
stage 2 hypertension
stage 3 hypertension
120-139/80-89
140-159/90-99
160-179/100-109
180+/ 110+
165
define isolated systolic hypertension
systolic over 140mmhg and diastolic less than 90 mmhg
166
define the term ausculatory gap in terms of BP
a range in the korotakoff sounds where no audible noise is heard although noise is heard above and below the range
167
why must one remove glasses of patient wile assesing pupil response?
light could be amplified by lenses and/or lense could distort pupil size.
168
why must you take a pulse as you increase cuff pressure wile taking BP?
to minimize hyperinflation
169
how do normal temperature ranges vary from oral, redctal and axillary? (according to Welch Allyn) in degrees celsius
axillary- 34.7-37.3
oral 35.5-37.5
rectal- 36.6-38.0
thermoscan- 35.8-38.0
170
distinguish between the 4 different scores for eyes in the glasgow coma scale
4 spontaneously open
3 open in response to speech
2 open in reposnse to pain
1 do not open at all
171
distinguish between the 5 different scores for verbal responses in the glasgow coma scale
```
5 oriented
4 confused
3 inappropriate words/makes no sense
2 incomprehensible sounds
1 no sounds
```
172
distinguish between the 6 scores for motor response in the glasgw coma scale
```
6 obeys verbal command
5 localizes pain
4 withdraws from apin
3 flexion to pain
2 extension to pain
1 none
```
173
someone is considered to be ina coma with a GCS score of what or less?
7
174
where is the tracheal bifurcation located in the front?
sternal angle/angle of louis
175
what are reasons for jugular venous distension?
CHF-right sded
176
where on chest are vesicular breaths found normally?
on the lungs surface?
177
cause and sound of friction rubs
caused by pleuritis and sound squeaky
178
what anatomy is responsible for each of the heart sounds?
lub- AV valve closing
| dub- pulmonic and aortic valves closing
