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HA Exam 4 - Wk 13-16 > Putting it all together - Bates Ch. 4 > Flashcards

Putting it all together - Bates Ch. 4 Flashcards

1
Q

Common and concerning symptoms include:

A

fatigue and weakness
fever, chills, night sweats
wt changes
pain

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2
Q

___ is a sense of weariness or loss of energy that pt’s describe in various ways. Ex: “I don’t feel like getting up in the morning. I don’t have any energy.”

A

Fatigue

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3
Q

___ is a common symp of depression and anxiety.

A

Fatigue

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4
Q

___ is a demonstrable loss of muscle power.

A

Weakness

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5
Q

___ refers to an abnormal elevation in body temp. Ask if pt has been experiencing chills.

A

Fever

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6
Q

Feeling cold, goosebumps, and shivering accompany a ___ temp, while feeling hot and sweating accompany a ___ temp.

A

rising

falling

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7
Q

Feeling hot and night sweats accompany ___, but can also occur in ___ and ___.

A

menopause, TB, malignancy

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8
Q

What other sympt typically accompany fever?

A

Malaise, headache, and pain in the muscles and joints

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9
Q

What meds may affect/decrease temp and possibly mask fever?

A

ASA, acetaminophen, corticosteroids, NSAIDS

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10
Q

Wt changes result from what? (Rapid change in wt esp suggests this)

A

changes in body fluids, NOT tissue

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11
Q

Wt gain occurs when what?

A

caloric intake exceeds caloric expenditure over time, typically resulting in increased body fat.

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12
Q

Edema from extravascular fluid retention is visible in what 3 most common conditions?

A

HF, nephrotic syndrome, and liver failure

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13
Q

Underwt = ___
Normal BMI = ___
Overwt BMI = ___-___
Obese BMI = ___

A

< 18.5
18.5-24.9
25-29
>30

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14
Q

Drugs assoc w/wt gain:

A

tricyclic antidepressants; insulin and sulfonylurea; contraceptives, glucocorticoids, and progestational steroids; mirtazapine and paroxetine; gabapentin and valproate; and propranolol

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15
Q

Wt ___ is defined as loss of 5% or more of usual body wt over a 6-month period. Mechanisms include:

A

loss
decreased food intake d/t anorexia, depression, dysphagia, vomiting, abd pain, or financial difficulties; defective GI absorption or inflam; and increased metabolic requirements

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16
Q

Abuse of these things can also cause wt loss:

A

alcohol, cocaine, amphetamines, opiates, withdrawal from marijuana, heavy smoking

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17
Q

Causes of wt loss include:

A

GI dis; endocrine disorders (DM, hyperthyroidism, adrenal insuff); chronic inf (HIV/AIDS); malignancy; chronic cardiac, pulm, or renal failure; depression; diuresis; and anorexia or bulimia

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18
Q

Wt loss w/relatively high food intake suggests what 3 disorders?

A

DM, hyperthyroidism, malabsorption

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19
Q

What things increase the likelihood of malnutrition?

A

poverty, old age, social isolation, phys disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, drug abuse

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20
Q

Weakness, easy fatigability, cold intol, flaky dermatitis, and ankle swelling are all signs of ___.

A

malnutrition

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21
Q

Overwt and obesity increase risk of what things?

A

heart dis, numerous types of CA, Type 2 diab, stroke, arthritis, sleep apnea, infertility, depression

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22
Q

Reducing wt by 5-10% can improve what physiologic things?

A

b/p, lipid levels, glucose tolerance, and reduce the risk of diab and HTN

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23
Q

4 steps to promote optimal wt and nutrition:

A
  1. measure BMI and waist circumference
  2. assess dietary intake
  3. assess pt’s motivation to change
  4. provide counseling about nutrition and exercise
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24
Q

Risk factors for heart dis and obesity-related dis:

A

HTN, high LDL, low HDL, high triglyc, high BG, fam hx of premature hrt dis, phys inactivity, and cigarette smoking

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25
Q

What are common roadblocks to sustained wt loss?

A

hitting a plateau d/t feedback physiologic systems that maintain body homeostasis; poor adherence to diet d/t increasing hunger over time as wt declines and inhibition of leptin ( a protein cytokine secreted and stored in fat cells that modulates hunger)

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26
Q

Strategies that promote wt loss:

A
  1. Walk 30-60 mins 5 or more days/wk
  2. the total calorie goal, usually 800-1200 calories/day, is more important than type of diet
  3. portion-controlled meals, meal planning, food diaries, and activity records are helpful
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27
Q

If BMI is < 18.5, investigate for what?

A

anorexia, bulimia, and other serious medical conditions

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28
Q

Sodium intake should be < ___ mg/day. Saturated fatty acids should be < ___% of total calories; and dietary chol should be < ___ mg/day.

A

1500
10%
300

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29
Q

What are the 10 tips to a great plate?

A

balance calories,
eat less,
avoid oversized portions,
eat nutrient-dense foods more often,
make half the plate fruits and veggies, switch to fat-free or low-fat milk,
make half of grain intake whole grains,
eat food high in solid fats/salt/sugar less often,
use the Nutrition Facts label to choose lower sodium versions of foods like soup, bread, and frozen meals,
and drink H2O or unsweetened beverages instead of sweetened soda, energy drinks, or sports drinks.

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30
Q

Adolescent females and women of childbearing age should increase intake of what 3 nutrients?

A

iron, Vit C, and folic acid

31
Q

Those who weight more will use ___ calories, and those who weigh less will use ___ calories.

A

more, fewer

32
Q

What factors contribute to a pt’s body habitus?

A

socioeconomic status, nutrition, genetic makeup, degree of fitness, mood state, early illnesses, facial coloration, dentition and condition of the tongue and gingiva, color of the nail beds, and muscle bulk

33
Q

Excess clothing may reflect the cold intol of what? Unkempt appearance may be seen in ___ and ___.

A

hypothyroidism

depression, dementia

34
Q

Watch for the stare in ___, the immobile face in ___, and a flat or sad affect in ___.

A

hyperthyroidism, parkinsonism, depression

35
Q

Breath odors can indicate the presence of what things?

A

alcohol, diabetes (fruity), pulm inf, uremia, or liver failure

36
Q

How do pt’s w/Lt-sided HF sit?

What about COPD pt’s?

A

sit upright

lean forward w/arms braced

37
Q

___ pt’s appear agitated and restless, whereas pt’s in ___ often avoid mvmnt.

A

Anxious, pain

38
Q

Short stature = ___
Long limbs in proportion to the trunk = ___
Ht loss = ___

A

Turner’s synd and hypopituitary dwarfism
hypogonadism and Marfan’s synd
osteoporosis and vertebral compression fx

39
Q

Generalized fat = ___

Truncal fat w/relatively thin limbs = ___

A

obesity

Cushing’s synd and metabolic synd

40
Q

If pt’s BMI > 35, should do what?

A

measure waist circumference just above the hips.

41
Q

Risk for what 3 things increases significantly if the waist circumference is 35 inches or more in women and 40 inches or more in men?

A

diabetes, HTN, cardiovasc dis

42
Q

V/S include:

A

temp, pulse, respirs, and b/p

often O2 sat as well

43
Q

This type of b/p monitoring is fully automated and allows recording over an extended period of time.

A

Ambulatory b/p monitoring

44
Q

This device sense the natural oscillations in the arterial pressure waves and estimate the syst and diast pressure according to empirically derived algorithms.

A

Automated office b/p device

45
Q

W/white coat HTN, the b/p is ___ but ambulatory pressures are ___, so cardiovasc risk is low.
W/masked HTN, the b/p is ___ but the ambulatory b/p is ___, indicating high risk of cardiovasc dis.

A

high, normal

normal, high

46
Q

Width of the inflatable bladder of the b/p cuff should be around ___% of upper arm circumference.
Length of the inflatable bladder should be about ___% of upper arm circumference.

A

40%

80%

47
Q

If the b/p cuff is too small/narrow, the b/p will read ___. If it is too large/wide, the b/p will read ___.

A

high, low

48
Q

Steps to ensure accurate b/p measurement:

  1. Instruct toe pt to avoid what for 30 mins before the b/p is obtained?
  2. Make sure the exam room is ___ and ___.
  3. Ask the pt to sit quietly for ___ mins in a chair, rather than on the exam table.
  4. Make sure the arm selected is what?
  5. Palpate the ___ artery to confirm it has a viable pulse.
  6. Position the arm how?
  7. Rest the arm on a table a little above the pt’s what?
A
  1. smoking or drinking caffeinated beverages
  2. quiet, comfortable
  3. 5
  4. free of clothing
  5. brachial
  6. so that the brachial artery, at the AC crease, is at heart level
  7. waist
49
Q

A loos cuff or a bladder that balloons outside the cuff leads to what?

A

falsely high readings

50
Q

___ sounds are relatively low in pitch and generally heard better w/the bell.

A

Korotkoff

51
Q

When taking a manual b/p, the level at which you hear the sounds of at least 2 consecutive beats is known as the ___ ___. Continue to lower the pressure slowly until the sounds become muffled and then disappear, which is known as the ___ ___.

A

systolic pressure

diastolic pressure

52
Q

Pressure difference of more than 10-15 mm Hg taken in both arms occurs in what conditions?

A

subclavian steal synd and aortic dissection

53
Q 
B/P classification:
Normal = \_\_\_/\_\_\_
PreHTN = \_\_\_/\_\_\_
Stg 1 HTN = \_\_\_/\_\_\_
Stg 2 HTN = \_\_\_/\_\_\_
If diab or renal dis = \_\_\_/\_\_\_
A 
120/80
120-139/80-89
140-159/90-99
> or = 160/ > or = 100
< 130/< 80
54
Q

You are assessing what when you measure b/p and HR in 2 positions - supine after the pt is resting from 3-10 mins, then w/in 3 mins after the pt stands up?

A

Orthostatic hypotension

55
Q

A fall in syst pressure of 20mm Hg or more, esp when accompanied by symp of tachy, indicates what?

A

orthostatic/postural hypotension

56
Q

Palpation of an irregularly irregular HR rhythm indicates what?

A

a-fib

57
Q

You can detect what condition by comparing b/p in the arms and legs?
In normal pt’s, the syst b/p should be 5-10 mm ___ in the arms.

A

coarctation of the aorta

higher

58
Q

Coarctation of the aorta and occlusive aortic dis are distinguished by HTN in the ___ ext, and low b/p in the ___ ext.

A

upper, lower

59
Q

The ___ pulse is commonly used to assess HR. Measure x 30 secs and multiply by 2. If the rate is unusually fast or slow, count for 60 secs.

A

radial

60
Q

Normal temp = ___
Normal HR = ___-___
Normal RR = ___/min

A

98.6 F/ 37 C
60-100 (50-90 in Bates)
20

61
Q

Prolonged expiration is common in ___.

A

COPD

62
Q 
Hyperpyrexia = > \_\_\_ F
Hypothermia = < \_\_\_ F
A

106 deg

95 deg

63
Q

What are some causes of fever?

A

inf, trauma, post-op, crush injuries, malignancy, bld disorders, drug reactions, immune disorders

64
Q

The chief cause of hypothermia is what? What other things can predispose to hypothermia?

A

exposure to cold
reduced mvmnt as in paralysis, interference w/vasoconstriction from sepsis or excess alcohol, starvation, hypothyroidism, hypoglycemia, elderly

65
Q

___ is an unpleasant sensory and emotional experience associated w/tissue dmg. It involves sensory, emotional, and cognitive processing but may lack a specific phys etiology.

A

Pain

66
Q

___ ___ is pain not assoc w/CA or other medical conditions that persists for more than 3-6 months; pain lasting more than 1 month beyond the course of an acute illness/injury; pain recurring at intervals of months or yrs

A

Chronic pain

67
Q

The 3 common pain scales include:

A

Visual Analog Scale
Numeric Rating Scale
Wong-Baker FACES Pain Rating Scale

68
Q

What is the leading cause of disability and impaired performance at work?

A

Chronic pain

69
Q

This type of pain is linked to tissue dmg to the skin, musc syst, or viscera but the sensory nervous syst is intact.
Ex: arthritis or spinal stenosis

A

Nociceptive/Somatic

70
Q

This type of pain is a direct consequence of a lesion or dis affecting the smoatosensory sys. Mechanisms postulated to evoke this type of pain include CNS brain or spinal cord injury from stroke or trauma; periph nervous syt disorders causing entrapment or pressure on spinal nerves and referred pain snd w/increased or prolonged pain responses to inciting stimuli.

A

Neuropathic

71
Q

W/this type of pain, there is alteration of CNS processing of sensation, leading to amplification of pain signals. There is lower pain threshold to nonpainful stimuli and the response to pain may be more severe than expected.
Ex: fibromyalgia

A

Central sensitization

72
Q

This type of pain involves the many factors that influence the pt’s report of pain - psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support systems.
This is a pain w/out an identifiable etiology

A

Psychogenic and idiopathic

73
Q

What are the 4 A’s to monitor pt’s outcomes for pain?

A

Analgesia
ADL’s
Adverse effects
Aberrant drug-related behaviors

74
Q

Risk factors for fatal overdose include:

A

age 65 and older, depression, substance abuse, and concurrent benzo tx

HA Exam 4 - Wk 13-16 (5 decks)

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