PCM 2 Flashcards
Adult BP
90/60
to 120/80
Adult RR
12-18 breaths per min
Adult pulse
60-100 bpm
Adult temp (range and average)
97.8-99.1F
avg 98.6F
how long should you count an infant’s RR?
a full 60 seconds
what vitals are expected to increase during fever?
HR
BP
RR
does a normal BP in children mean they are stable?
NO! BP is the last to change in a clinically decompensating child. do not assume they arre stable just because their BP is normal
what is an extremely ominous sign in a child?
bradycardia
usually the result of hypoxia…act quickly as the child is extremely critical
what is HEADSSS?
Home
Education/Employment
What is general trend for newborn compared to adult
RR
HR
BP
higher RR and HR
lower BP
What is CRAFFT questionnaire
evaluates adolescent risk factors and current habits; 2 or more yes suggests high risk serious substance use problem
- ever ridden in a Car driven by someone high or using drugs/alcohol
- ever use drugs or alcohol to Relax and feel better about yourself
- ever use drugs or alcohol when you are Alone
- ever Forget things you did while using drugs or alcohol
- do your Family/friends ever tell you that you should cut down your drinking or drug use?
- ever gotten into Trouble while using drugs or alchol
for what treatments can minors give consent for?
Infectious Disease
Birth control (except sterilization)
Substance abuse
Mental illness
what is the 5 A’s model
for facilitating a change
Ask about use Advise to quit Assess willingness to quit Assist attempt to quit Arrange follow up contact
what is the CAGE questionnaire
screening for substance abuse
1 yes is a positive test
ever ... felt need to Cut down drinking felt Annoyed by criticism of drinking had Guilty feelings about drinking take a morning Eye opener, a drink first thing in the morning to steady your nerves
what are two common perceptions patients have about ETOH abuse
beer is not alcohol
most pts do not perceive they need treatment for substance abuse
what are the ABCDEs of delivering bad news
Advance prep Build therapeutic relationship Communicate well Deal with patient and family reactions Encourage and validate emotions
what as RADAR for IPV
Routinely inquire about violence Ask direct questions Document findings Assess safety Review options and referrals
what group experiences highest rate of IPV
women age 16-24
*underreporting in LGBTQ, males, elders
clues of physical violence that you may see on interview and exam?
- abrasion
- avulsion
- bruise, hematoma, petechiae
- puncture/stab
- laceration, cut, or incision
providers are bound not to contact law enforcement against will of IPV victim EXCEPT in what 2 cases
- wounds inflicted by knives or firearms
- younger than 18
- older than 60
describe and name three tests are for rotator cuff injury?
Neer impingement sign - press on scapula with one hand, raise patient’s arm straight up with the other (compresses greater tuberosity against acromion)
Hawkins impingement - flex shoulder and elbow to 90 degrees, then with one hand on forearm and one on elbow, rotate arm internally
Drop arm sign - fully abduct arms to shoulder level, then lower it slowly
what test for AC joint
crossover test
describe empty can test and what it tests
supraspinatus rotator cuff tear
elevate arms to shoulder level in front of patient, internally rotate arms with thumbs down as if emptying a can.
ask pt to resist downward pressure
name and describe two tests for carpal tunnel
Tinel’s - Tap over median nerve in carpal tunnel (t for tap)
Phalen’s - press backs of hands together to form right angles for 60 seconds (compresses median nerve, positive if numbness and tingling)
what are advance directives?
name and describe two types of advance directives
advance directives are formal documents that direct healthcare decisions
if patients lose capacity to speak for themselves
- living will - pt directs types of treatments the want/don’t want if capacity to make decision is lost. only kick in when pt can’t communicate and when circumstances in document occur
- power of attorney - person who pt designates to make decisions on pt’s behalf if they become unable to do so
what are 3 causes of holosystolic murmurs?
tricuspid regurg
mitral regurg
VSD
mnemonic for systolic murmurs
MR PASS is the MVP
Mitral Regurg (and tricusp) Mitral Valve Prolapse Physiologic Aortic Stenosis (and pulmonic) Systolic
mnemonic for diastolic murmurs
MS ARD
Mitral Stenosis (and tricusp) Aortic Regurg (and pulmonic) Diastolic
what is the basis of S3?
when can it be normal?
in acute HF, high LA pressure causes blood to slam into LV in early diastole.
can be normal in “suckers” - athletes, young people, pregnant people -vigorous LV relaxation quickly sucks blood into LV
what is the basis of S4?
what is it
atrial kick slamming into a stiffened LV near the end of diastole
moderately loud, no thrill
grade 3
loud with palpable thrill
grade 4
very loud with thrill, heard with stethoscope partly off chest
grade 5
very loud with thrill, may be heard with stethoscope completely off chest
grace 6
optic disc bulging and blurred margins
papilledema- increased ICP
very loud with thrill, may be heard with stethoscope completely off chest
grade 6
