Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 229 Professional practice 4 FINAL > Physical assessment + BP measurement + Resp/cardiac/endocrine/Neuro assessment > Flashcards

Physical assessment + BP measurement + Resp/cardiac/endocrine/Neuro assessment Flashcards

1
Q

What are 4 basic techniques for physical assessment? IPPA

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does inspection consist of?

A
  • Discolouration? – Any jaundice, paleness?
  • Their age
  • Tremors?
  • Breathing speed?
  • Drooping or asymmetrical facial features?
  • Speech
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does palpation consist of?
What do you assess with it

A

the use of touch to determine physical characteristics
- feel pulsations
- feel vibrations
- locate body structures (i.e hip bones for waist circumference)
- Assess size
- Assess texture
- Assess temperature
- Assess tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is percussion?
Sounds of low density? High density? Examples

A

Body surface is struck to produce a sound

Low density (lungs) = low pitch sounds
High density (thigh) = high pitch sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to properly strike a body structure to produce a sound?

A
  • last 2 phalanges of left middle finger rest firmly on patients
  • strike the last joint of your left middle finger, impact should be crisp
  • ensure none of your other fingers is touching the patient to minimize any dampening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe each sounds of percussion: high/low pitch, type of sound, correlated body aprt
Tympany
Hyperresonance
Resonance
Dullness
Flatness

A

Tympany:
- high pitch
- loud, drum sound
- Gastric air bubble

Hyperresonance
- low pitch
- loud booming sound
- distended lungs in emphysema

Resonance
- low pitch
- hollow sound
- normal lung

Dullness
- muffled thud
- liver,
- fluid filled space

Flatness
- high pitch
- soft sound
- muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does auscultation mean? Examples

A

Listening for sounds produced by body

Ex
- gas moving in gut
- blood flow through valves (korotkoff sounds)
- air moving in/out of lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does gait imply?

A

A person’s manner of walking
- Parkinson’s? certain meds (antipsychotics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to calculate BMI
underweight
normal
overweight
Class 1 obese
Class 2 obese
Class 3 obese

A

BMI = Kg/Height^2

underweight: <18.5
normal: 18.5-24.9
overweight: 25-29.9
Class 1 obese: 30-34.9
Class 2 obese: 35.0-39.9
Class 3 obese: 40.0+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are risks associated with low BMI (4)

A
  • undernutrition
  • osteoporosis
  • infertility
  • impaired immunocompetence (impaired wound healing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are risks associated with high BMI (7)

A
  • Type 2 diabetes
  • Dyslipidemia
  • HTN
  • Coronary heart disease
  • Gallbladder disease
  • Obstructive sleep apnea
  • certain cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What BMI do you measure waist circumference?
Effect on category

Normal values for men and women

A

If BMI = 25-35
- bumps up 1 category

Men: 40 inches
Women: 35 inches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is BMI not accurate? (4)

A
  • Adults who are not finished growing
  • Adults who naturally have a very lean or very muscular build
  • certain racial and ethnic groups
  • adults over the age of 65 (range for overweight 25-29.9)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a normal temperature

A

36.4 - 37.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to convert celsius to farenheit

A

(Degrees in C) x (9/5) + 32

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mean temp of the following age groups
Pediatric
Adult
Geriatric

A

Pediatric: 37.2
Adult: 37
Geriatric: 36

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which age group is tympanic thermometer not recommended in?

A

Birth - 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which age group is rectum temp reading used?

A

Birth to 5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is recommended temperature route for older than 5 years

A

Mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause increased temperature? (4)
Fever = 38.2 degrees orally

A

Infection
Medication
Inflammation
- blood clots (DVT, PE, MI)
Cancer tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should you refer for fever? (5)

A
  • Fever lasting more than 3 days
  • Recurrent fever
  • High fever (40.5+)
  • Assoc with confusion, stiff neck, chest pain etc
  • fever in neonates and infats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is it possible to have an infection without a fever?
Which group of people is it common in?

A

Yes
- children <6m
- Immunocompromised people
- Elderly people

Confusion or delirium in these populations is indicative of an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a normal heart rate in
Child 1-6
Child 6-12
Adult

A

Child 1-6:
- 75- 160 bpm

Child 6-12:
- 80-120 bpm

Adult:
- 60 - 100 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where can you measure pulse for rate & rhythm (4)

A

Radial
Carotid
Femoral
Brachial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are pulse sites to assess PAD, diabetic foot? (3)

A

Popliteal
Posterior tibial
Dorsalis Pedal Pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What HR defines bradycardia
Cause? (3)

A

< 60 bpm

Drug related
- BB, CCB, digoxin
Cardiac dysfunction, athletes/fit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What HR defines tachycardia
Cause? (4)

A

> 100 bpm

Due to stress, anxiety, dehydration
Medication
- Ventolin, Caffeine, stimulants (pseudoephedrine, phenylephrine)

Arrhythmias (afib)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What do you have to note when measuring a pulse (3)

A

Rate
Rhythm
Amplitude (absent, weak, normal, full)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Normal respiratory rate?

A

12 - 20 rpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What do you have to note when measuring resp rate (5)

A

Rate
Rhythm (regular/ irregular)
Depth (shallow, deep)
Effort (laboured, accessory muscles used)
Sound (wheezes present)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is tachypnea characterized as?
Symptoms? (4)
Conditions? (3)

A

> 20 rpm
Sx:
Exertion, fever, pain, distress

Conditions:
Heart failure, pneumonia, DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is bradypnea characterized as?
Cause? (3)

A

<12 rpm

Cause
- CNS (brainstem stroke)
- Sedation (alcohol, ilicit drugs)
- Narcotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a normal adult BP

A

120/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are factors that affect BP (7)

A
  1. Age
  2. Time of day
  3. Weight
  4. Exercise
  5. Emotion
  6. Medication
  7. Caffeine and smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

In the stethoscope, what is the diaphragm used for? what is the bell used for?

A

diaphragm
- BP, lung sounds

Bell (smaller circle)
- Low frequency (DO NOT PUT PRESSURE)
- Heart murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How much should the bladder inside the cuff encircle the patient’s arm?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the 5 phases of kortkoff sounds (6)

A

Phase 1: First sound = systolic
Phase 2: sounds soften and have a swishing quality
Auscultatory gap: sounds may disappear for a short time
Phase 3: The return of sharper sounds which may exceed intensity of phase 1 sounds
Phase 4: distinct abrupt muffling of sounds, become soft and fainting away
Phase 5: Sounds disappear = diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which of the following errors gives falsely high/low BP values (general & specific SBP, DBP): Rationale?
Anxious
Arm position above level of heart
Arm position below level of heart
Patient supports own arm
Legs are crossed
Cuff to small
Cuff to loose or uneven
Not palpating radial artery
Deflating cuff too quickly
deflating too slow/not waiting 1-2 min before repeating

A

Anxious
- false high
- SNS (wait 5 minutes)

Arm position above level of heart
- False low
- eliminates effect of hydrostatic pressure

Arm position below level of heart
- false high
- additional force of gravity added to brachial artery

Patient supports own arm
- false high DBP
- sustained muscular contraction

Legs are crossed
- False high SBP and DBP
- blood pooling from legs to thoracic area

Cuff to small
- False high DBP
- need excessive pressure to occlude brachial artery

Cuff to loose or uneven
- False high
- need excessive pressure to occlude brachial artery

Not palpating radial artery
- False low SBP
- miss initial systolic tapping

Deflating cuff too quickly
- False low SBP or high DBP
- insufficient time to hear tapping

deflating too slow/not waiting 1-2 min before repeating
- False high DBP
- Venous congestion in forearm

39
Q

What indicated hypertension in visit 1?
What indicates no HTN?
What indicates further assessment?

A

What indicated hypertension in visit 1?
- 180/110+

What indicates no HTN?
What indicates further assessment?
- AutomatedOBP 135/85+
- OfficeBPM: 140/90+

40
Q

What out of office assessment is preferred? Ambulatory or home BP measurement

A

Ambulatory BP measurement

41
Q

Do clinicians overestimate/underestimate BP measurement?

A

Overestimate
- by at least 10/5 mmHg
- maybe by 20/10 mmHg

42
Q

Which is more accurate BP device, mercury or oscillometric

A

Mercury

43
Q

Which BP measurement is the preferred method for in office BP determination according to CHEP

A

Automated blood pressure measurement
- easier to use
- when properly done has a similar reading as a 24h ambulatory BP reading

44
Q

How many minute intervals between each BP measurement

A

1-2 minutes

45
Q

What BP device used in the SPRINT study? How many tests average of?

A

Omron HEM-907
- average of 3 readings after 5 minutes of rest

46
Q

What is the width of the cuff size of arm circumference?
Length of bladder of arm circumference

A

Width: 40% arm circumference

Length: bladder inside the cuff encircle 80% of the patient’s arm

47
Q

Where should the lower edge of cuff be after centre of bladder over brachial artery?

A

Lower edge of cuff 2-3 cm from elbow crease

48
Q

How do you estimate systolic BP before measuring BP

A
  1. Determine HR and estimate the SBP
    ○ Palpate the radial pulse, for 15s (multiplied by 4, if regular HR)
  2. Inflate cuff until pulse is gone. Note the SBP.
  3. Deflate the cuff and wait 60s to allow the venous congestion to dissipate.
    - This helps you hear the sounds better when you auscultate in the next step.
49
Q

How much you inflate the cuff? How much do you deflate the cuff

A

Inflate
- 30 mmHg higher than the systolic

Deflate
- rate of 2mmHg / HR

50
Q

How many times do you repeat BP readings?
Which arm?

A

3 times in the same arm
- discard the first
- average the next 2

Always measure BP in arm that gives the HIGHER reading
- which means measure in both arms at least once

51
Q

What to document when taking down BP (5)

A

Avg BP to the nearest 2 mmHg
Which arm
Position of the patient (seated)
HR (note if regular or not)
Note if patient was anxious, upset, in pain

52
Q

What are home blood pressure measurement valuable for (2)

A
  1. Identifies white-coat hypertension
  2. Identifies masked hypertension or masked uncontrolled hypertension (if on meds)
53
Q

How often does the ambulatory BP measure BP?

A

Every 15-30 minutes while awake
every 30-60 minutes while sleeping

54
Q

11 essential elements to proper BP measurement

A
  1. Patient resting 5 minutes prior
  2. Legs uncrossed
  3. Feet on floor
  4. Arm and back supported
  5. Correct cuff size
  6. Cuff placed over bare arm
  7. no talking
  8. No phone
  9. BP taken in both arms
  10. Correctly identifying which arm is higher
  11. Correctly identifying which arm to use
55
Q

How often should you measure BP in the self-measure series

A

2 readings are taken each morning and each evening for 4-7d (ideally 7d)

Recommend them to discard the first reading but keep the next 2, though some guidelines recommend them to discard the entire first day of readings

56
Q

How is Orthostatic hypotension diagnosed?
Considered for?

A

Sitting to standing (wait 1 minute in between)
- drop in 20 mmHg in systolic OR
- drop in 10 mmHg in diastolic

Consider for
- Older frail individuals
- those with orthostatic symptoms
- unexplained falls
- patients with DM

57
Q

What are the 4 common respiratory symptoms

A

Cough, SOB, sputum, wheezing

58
Q

What conditions can cough be associated with? (7)
Characteristics?

A
  1. URTI
  2. Asthma
    - dry hacking or wheezing
  3. COPD
    - productive
    - a lot in the AM
  4. Pneumonia
    - productive (sometimes not)
  5. Drugs (ACE)
    - dry, non productive
  6. GERD
  7. Heart Failure
    - Night-time, sometimes sputum
59
Q

What colour is an infectious cause of sputum?
What colour is pulmonary edema secondary to HF?

A

What colour is an infectious cause of sputum?
- purulent and yellow-green or rust

What colour is pulmonary edema secondary to HF?
- frothy and pink

60
Q

Which conditions does dyspnea (SOB) occur in? (5)
Characteristics?

A
  1. Asthma
    - SOB with wheezes in acute attacks
  2. COPD
    - Mild to severe SOB with exertion
  3. Pneumonia
  4. CHF
    - SOB while laying flat due to fluid overlaod (orthopnea)
  5. Angina
    - SOB during angina
61
Q

Define barrel chest. What condition is it most common in?

A

COPD due to years of overinflation

Barrel chest means “front-to-back” is = “side-side” length

62
Q

Define kussmal breathing
Condition?

A

Rapid, deep, sighing breaths (a form of hyperventilation)
- metabolic acidosis DKA

63
Q

Define cheyne-stokes respiration
Condition?

A
  • Breathing and periods of not breathing
  • Common in infants but also in end-of-life or post-stroke/brain stem damage

Longer apneas when closer to death

64
Q

What condition does use of accessory muscle indicate?
Refer/not refer

A

COPD
- refer

65
Q

How to tell if someone has normal breaths by palpation
If not, what condition?

A

When you place your hands on someone’s back as they take deep breaths,
your hands should spread apart and come back evenly

Condition
- pneumonia
- atelectasis (collapsed lung)
- splinting

66
Q

What sound does the following percussion noises make in lungs?
normal
Hyperresonance
Dullness

A

normal
- Resonant
- long, loud, low pitched

Hyperresonance
- very loud, low pitched
- emphysema (alveoli damage in lungs, SOB)

Dullness
- consolidation (air is replaced with fluid)
- pneumonia, aspiration, cancer

67
Q

What are the following adventitious sounds caused by?
What condition?
Crackles (2)
Wheezes (1)
Rhonchi (2)
Stridor (1)

A

Crackles
- Air through fluid
- CHF, infection

Wheezes
- airway narrowing
- Asthma

Rhonchi
- secretions
- bronchitis or pneumonia

Stridor
- loud, high-pitched crowing sound
- airway obstruction, needs immediate attention

68
Q

What does the Peak flow meter measure?
What is it useful for?
How to record value?

A

Measures peak expiratory flow (PEF)
- maximum forced expiratory flow obtained during FVC

Useful to see
- effectiveness of bronchodilator
- in patients with poor control of asthma

Document
- take 3 readings and record the highest one

69
Q

What do the 3 zones mean in respiratory in terms of
PEF
Symptoms
Meds

A

Green zone
- Good control
- PEF: >80%
- Symptoms: No wheezing or SOB
- Meds: as usual

Yellow zone:
- Mod exacerbation
- PEF: 50-80%
- Symptoms: persistent wheezing OR SOB
- Meds: take B2 agonist

Red zone
- Severe exacerbation
- PEF: <50%
- Symptoms: SEVERE wheezing AND SOB
- Meds: Take B2 agonist

70
Q

What are common cardiac symptoms

A

N/V
Anxiety
SOB
Pain
Weakness
Pallor/cyanosis
Diaphoresis

Change in LOC
Syncope
Hypotension
Hypertension
Palpitations
Decreased urinary output

71
Q

How to differentiate chest pain in Cardiac, GI, MSK in terms of:
History
Type of pain
Precipitating factors
Relieved by

A

Cardiac:
- History: Risk factors for CHD
- Type of pain: Heavy pressure, crushing
- Precipitating factors: Exertion or stress
- Relieved by: rest or NTG

GI
- History: Gastritis or indigestion
- Type of pain: burning
- Precipitating factors: food
- Relieved by: antacids

MSK
- History: trauma
- Type of pain: Sore, achy, or sharp pain
- Precipitating factors: physical movement
- Relieved by: Rest, heat, pain meds

72
Q

What conditions/drugs cause edema
Solution for drugs?

A

Conditions
- HF
- thrombophlebitis (inflammation of wall vein)

Meds
- Amlodipine
- ACE

Switch to ARB

73
Q

Describe the following edema
Mild pitting
Moderate pitting
Deep pitting
Very deep pitting

A

Mild pitting
- slight indentation

Moderate pitting
- indentation subsides quickly

Deep pitting
- indentation remains for a short time

Very deep pitting
- indentation remains a long time, sig swelling

74
Q

Heart sounds
S1 and S2
Valves?
Onset?
Shorter/longer

A

S1
- AV valves closing (tri & bicuspid valve)
- Onset of systole
- Longer duration

S2
- Pulmonary and aortic valves close
- End of systole
- Shorter than S1

75
Q

T/F S3 is not normal children and adolescents

A

False

76
Q

S3
Cause?
Onset?
Conditions?

A

Cause?
- LV failure and volume overload
- blood leaves atria and crashes into full ventricle

Onset?
- Early in diastole

Conditions?
- HF
- MI
- Pulmonary edema

77
Q

S4
Cause?
Onset?
Conditions?

A

S4
Cause?
- LV hypertrophy
- Blood from Left atrium trying to enter a stiff, non-compliant left ventricle during atrial contraction

Onset?
- end of diastole

Conditions?
- Atrial gallop

78
Q

What does diabetic polyneuropathy present with?

A

Intensely painful feet
Pain, paresthesias (pins and needles),
Sensory loss

78
Q

What are the 2 pulses on the foot

A

Dorsalis pedis
Posterior tibialis

79
Q

Why do we care about foot ulceration?

A

Acute ulcers
Chronic plantar ulcer

Foot deformities
- Muscle atrophy

80
Q

What is the tuning fork test and monofilament test

A

Hit fork on distal part of great toe

Ask the patient to tell you when they can’t feel a vibration,
Count until you can’t feel it, if more than 8 = peripheral neuropathy

Monofilament
- poke around bottom of foot and 1 on top of foot

81
Q

What are the 5 components of a neurological exam

A
  1. Mental status
  2. Cranial nerve
  3. Motor
  4. Reflexes
  5. Sensory
82
Q

What to look for in mental status>

A

Appearance
Mood
Affect
Speech
Though process
Active recall

83
Q

What do you make sure a person is oriented to?

A

Person (name)
Place (where are you)
Time (date, month, day of the week)

84
Q

What medical conditions and medications can decrease orientation?

A

Medical
- UTIs in elderly
- Hepatic encephalopathy

Medications
- Anticholinergics
- Benzodiazepines

85
Q

How to assess level of consciousness? Whats the name of scale? What are the 3 areas

A

Glasgow Coma Scale

3 areas
1. Eye opening
2. Best verbal response
3. Best motor response

86
Q

What are cranial exam abnormalities caused by? (5)

A

Compression
Stroke
Inflammation
Head trauma
Medications

87
Q

What to assess for in motor function (5)

A
  1. Strength
  2. Gait
  3. Balance
  4. Coordination
  5. Abnormal movements
88
Q

What is the cogwheel rigidity when assessing for strength

A

Wrist is unable to flex and extend normally (very jerky)
- Associated with Parkinson’s

89
Q

What is gait?
What is ataxia?

A

Abnormal body position and arm movements while walking

Ataxia
- inability to coordinate muscle movements

90
Q

What test do you use to test for balance

A

Romberg test
- stand feet together
- close etes for 20-30 seconds

91
Q

What are possible cause of not having a good balance?

A

Vestibular dysfunction
Cerebellar dysfunction
Intoxication

92
Q

What are you assessing for when you ask a patient to have rapid alternating movements
i.e touch thumb to each finger of same hand
OR pat thigh while alternating fron and back of hand

A

coordination

93
Q

What Abnormal movements are you looking for? (2)

A

Tremors
Dyskinesia - involuntary uncontrollable movements (caused by antipsychotics)

Pharm 229 Professional practice 4 FINAL (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions