Putting it all together - Bates Ch. 4 Flashcards
Common and concerning symptoms include:
fatigue and weakness
fever, chills, night sweats
wt changes
pain
___ 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.”
Fatigue
___ is a common symp of depression and anxiety.
Fatigue
___ is a demonstrable loss of muscle power.
Weakness
___ refers to an abnormal elevation in body temp. Ask if pt has been experiencing chills.
Fever
Feeling cold, goosebumps, and shivering accompany a ___ temp, while feeling hot and sweating accompany a ___ temp.
rising
falling
Feeling hot and night sweats accompany ___, but can also occur in ___ and ___.
menopause, TB, malignancy
What other sympt typically accompany fever?
Malaise, headache, and pain in the muscles and joints
What meds may affect/decrease temp and possibly mask fever?
ASA, acetaminophen, corticosteroids, NSAIDS
Wt changes result from what? (Rapid change in wt esp suggests this)
changes in body fluids, NOT tissue
Wt gain occurs when what?
caloric intake exceeds caloric expenditure over time, typically resulting in increased body fat.
Edema from extravascular fluid retention is visible in what 3 most common conditions?
HF, nephrotic syndrome, and liver failure
Underwt = ___
Normal BMI = ___
Overwt BMI = ___-___
Obese BMI = ___
< 18.5
18.5-24.9
25-29
>30
Drugs assoc w/wt gain:
tricyclic antidepressants; insulin and sulfonylurea; contraceptives, glucocorticoids, and progestational steroids; mirtazapine and paroxetine; gabapentin and valproate; and propranolol
Wt ___ is defined as loss of 5% or more of usual body wt over a 6-month period. Mechanisms include:
loss
decreased food intake d/t anorexia, depression, dysphagia, vomiting, abd pain, or financial difficulties; defective GI absorption or inflam; and increased metabolic requirements
Abuse of these things can also cause wt loss:
alcohol, cocaine, amphetamines, opiates, withdrawal from marijuana, heavy smoking
Causes of wt loss include:
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
Wt loss w/relatively high food intake suggests what 3 disorders?
DM, hyperthyroidism, malabsorption
What things increase the likelihood of malnutrition?
poverty, old age, social isolation, phys disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, drug abuse
Weakness, easy fatigability, cold intol, flaky dermatitis, and ankle swelling are all signs of ___.
malnutrition
Overwt and obesity increase risk of what things?
heart dis, numerous types of CA, Type 2 diab, stroke, arthritis, sleep apnea, infertility, depression
Reducing wt by 5-10% can improve what physiologic things?
b/p, lipid levels, glucose tolerance, and reduce the risk of diab and HTN
4 steps to promote optimal wt and nutrition:
- measure BMI and waist circumference
- assess dietary intake
- assess pt’s motivation to change
- provide counseling about nutrition and exercise
Risk factors for heart dis and obesity-related dis:
HTN, high LDL, low HDL, high triglyc, high BG, fam hx of premature hrt dis, phys inactivity, and cigarette smoking
What are common roadblocks to sustained wt loss?
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)
Strategies that promote wt loss:
- Walk 30-60 mins 5 or more days/wk
- the total calorie goal, usually 800-1200 calories/day, is more important than type of diet
- portion-controlled meals, meal planning, food diaries, and activity records are helpful
If BMI is < 18.5, investigate for what?
anorexia, bulimia, and other serious medical conditions
Sodium intake should be < ___ mg/day. Saturated fatty acids should be < ___% of total calories; and dietary chol should be < ___ mg/day.
1500
10%
300
What are the 10 tips to a great plate?
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.
Adolescent females and women of childbearing age should increase intake of what 3 nutrients?
iron, Vit C, and folic acid
Those who weight more will use ___ calories, and those who weigh less will use ___ calories.
more, fewer
What factors contribute to a pt’s body habitus?
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
Excess clothing may reflect the cold intol of what? Unkempt appearance may be seen in ___ and ___.
hypothyroidism
depression, dementia
Watch for the stare in ___, the immobile face in ___, and a flat or sad affect in ___.
hyperthyroidism, parkinsonism, depression
Breath odors can indicate the presence of what things?
alcohol, diabetes (fruity), pulm inf, uremia, or liver failure
How do pt’s w/Lt-sided HF sit?
What about COPD pt’s?
sit upright
lean forward w/arms braced
___ pt’s appear agitated and restless, whereas pt’s in ___ often avoid mvmnt.
Anxious, pain
Short stature = ___
Long limbs in proportion to the trunk = ___
Ht loss = ___
Turner’s synd and hypopituitary dwarfism
hypogonadism and Marfan’s synd
osteoporosis and vertebral compression fx
Generalized fat = ___
Truncal fat w/relatively thin limbs = ___
obesity
Cushing’s synd and metabolic synd
If pt’s BMI > 35, should do what?
measure waist circumference just above the hips.
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?
diabetes, HTN, cardiovasc dis
V/S include:
temp, pulse, respirs, and b/p
often O2 sat as well
This type of b/p monitoring is fully automated and allows recording over an extended period of time.
Ambulatory b/p monitoring
This device sense the natural oscillations in the arterial pressure waves and estimate the syst and diast pressure according to empirically derived algorithms.
Automated office b/p device
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.
high, normal
normal, high
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.
40%
80%
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 ___.
high, low
Steps to ensure accurate b/p measurement:
- Instruct toe pt to avoid what for 30 mins before the b/p is obtained?
- Make sure the exam room is ___ and ___.
- Ask the pt to sit quietly for ___ mins in a chair, rather than on the exam table.
- Make sure the arm selected is what?
- Palpate the ___ artery to confirm it has a viable pulse.
- Position the arm how?
- Rest the arm on a table a little above the pt’s what?
- smoking or drinking caffeinated beverages
- quiet, comfortable
- 5
- free of clothing
- brachial
- so that the brachial artery, at the AC crease, is at heart level
- waist
A loos cuff or a bladder that balloons outside the cuff leads to what?
falsely high readings
___ sounds are relatively low in pitch and generally heard better w/the bell.
Korotkoff
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 ___ ___.
systolic pressure
diastolic pressure
Pressure difference of more than 10-15 mm Hg taken in both arms occurs in what conditions?
subclavian steal synd and aortic dissection
B/P classification: Normal = \_\_\_/\_\_\_ PreHTN = \_\_\_/\_\_\_ Stg 1 HTN = \_\_\_/\_\_\_ Stg 2 HTN = \_\_\_/\_\_\_ If diab or renal dis = \_\_\_/\_\_\_
120/80 120-139/80-89 140-159/90-99 > or = 160/ > or = 100 < 130/< 80
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?
Orthostatic hypotension
A fall in syst pressure of 20mm Hg or more, esp when accompanied by symp of tachy, indicates what?
orthostatic/postural hypotension
Palpation of an irregularly irregular HR rhythm indicates what?
a-fib
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.
coarctation of the aorta
higher
Coarctation of the aorta and occlusive aortic dis are distinguished by HTN in the ___ ext, and low b/p in the ___ ext.
upper, lower
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.
radial
Normal temp = ___
Normal HR = ___-___
Normal RR = ___/min
98.6 F/ 37 C
60-100 (50-90 in Bates)
20
Prolonged expiration is common in ___.
COPD
Hyperpyrexia = > \_\_\_ F Hypothermia = < \_\_\_ F
106 deg
95 deg
What are some causes of fever?
inf, trauma, post-op, crush injuries, malignancy, bld disorders, drug reactions, immune disorders
The chief cause of hypothermia is what? What other things can predispose to hypothermia?
exposure to cold
reduced mvmnt as in paralysis, interference w/vasoconstriction from sepsis or excess alcohol, starvation, hypothyroidism, hypoglycemia, elderly
___ 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.
Pain
___ ___ 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
Chronic pain
The 3 common pain scales include:
Visual Analog Scale
Numeric Rating Scale
Wong-Baker FACES Pain Rating Scale
What is the leading cause of disability and impaired performance at work?
Chronic pain
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
Nociceptive/Somatic
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.
Neuropathic
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
Central sensitization
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
Psychogenic and idiopathic
What are the 4 A’s to monitor pt’s outcomes for pain?
Analgesia
ADL’s
Adverse effects
Aberrant drug-related behaviors
Risk factors for fatal overdose include:
age 65 and older, depression, substance abuse, and concurrent benzo tx
