Quiz 2 Flashcards
(155 cards)
1
Q
What is TEMPERATURE an indicator of?
A
infection & metabolism
2
Q
What is PULSE an indicator of?
A
cardiovascular health
3
Q
What is RESPIRATION an indicator of?
A
respiratory system & metabolic function
4
Q
What is BLOOD PRESSURE an indicator of?
A
peripheral measurement of cardiovascular function
5
Q
What is PAIN an indicator of?
A
uncomfortable sensation and emotional experience associated with tissue damage
6
Q
Temperature is regulated by what?
A
Hypothalamus
7
Q
What is a fever response called?
A
pyrexia
8
Q
What is the average respiration rate for a resting adult?
A
12-20/min
9
Q
What are the 2 respiration rhythms?
A
regular & irregular
10
Q
What are the different respiration depths?
A
shallow, moderate, deep
11
Q
Systolic BP is a result of what?
A
Cardiac output
Blood volume
Compliance of the arteries
12
Q
BP is highest in?
A
systole
13
Q
BP is the lowest in?
A
diastole
14
Q
What is pulse pressure?
A
the difference b/w systolic and diastolic pressures
15
Q
What should the pulse pressure be?
A
40mm Hg
16
Q
What is normal body temperature?
A
98.6
17
Q
What is the “normal” body temperature range?
A
97.2 (36.2) - 99.9 (37.7)
18
Q
Temperature above 99.9 means what?
A
fever
hyperthermia
pyrexia
19
Q
A fever in a child will show what temperatures for these areas?
Rectal?
Oral?
Axillary?
A
Rectal - 100.4 (38)
Oral - 99.5 (37.5)
Axillary - 99 (37.2)
20
Q
At what temperature does an adult show signs of a fever?
A
above 99-99.5 (37.2-37.5) depending on time of day
21
Q
What is the normal pulse rate?
A
60-100 bpm
22
Q
Pulse rate faster than 100bpm?
A
tachycardia
23
Q
Pulse rate slower than 60 bpm?
A
bradycardia
24
Q
What is described as normal pulse contour?
A
smooth & rounded
25
Pulse amplitude is described on a scale of 0-4, what do each number represent?
```
0 - Absent, not palpable
1 - Diminished, barely palpable
2 - Expected
3 - Full, increased
4 - Bounding, aneurysmal
```
26
How does too big of cuff size influence BP?
decreases
27
How does too small of cuff size influence BP?
increases
28
What is the recommended bladder width? (BP)
1/3-1/2 of arm circumference
29
What is the recommended cuff length (BP)?
80% of arm circumference
30
Where should the cuff be applied?
2-3cm above the antecubital crease
31
After determining the palpable systolic pressure, how much do you inflate the cuff?
20-30mm Hg above the found palpable systolic BP
32
At what speed do you deflate the BP cuff?
2-3 mm Hg per second
33
Turbulent blood flow through the narrowed lumen causes what type of sounds?
Korotkoff
34
What is the normal range for adult systolic BP?
100-120 mm Hg
35
What is the normal range for adult diatonic BP?
60-80mm Hg
36
This occurs when the Korotkoff sounds are soft or absent temporarily when the cuff pressure is lowered.
Auscultatory Gaps
37
What are the 4 vital signs?
1. Temperature
2. Pulse
3. Respiration
4. Blood Pressure
38
What can be considered the 5th vital sign?
Pain
39
What are the 5 methods of measuring temperature?
1. Oral
2. Rectal
3. Axillary
4. Tympanic
5. Forehead
40
How does the body generate heat?
shivering, a rapid contraction and relaxation of the skeletal muscles
vasodilation, which increases heat loss through the skin
evaporation of perspiration
41
What is arterial pulse and pressure?
the palpable and sometimes visible arterial pulses that are a result of ventricular systole
42
How long does the arterial pulse wave take to be felt in the dorsal pedis artery?
0.2 seconds
43
How long does it take for a red blood cell to travel to the dorsal pedis artery?
2 seconds
44
What variables contributes to the characteristics of the pulse? (5)
1. Volume of blood ejected (stroke volume)
2. Distensibility of the aorta and large arteries
3. Obstruction of blood flow (e.g. narrowing of the aortic valve [stenosis] or aorta [coarctation], vasculitis -blood vessels inflammation with narrowing-or PAD
4. Peripheral arteriol resistance
5. Viscosity of the blood
45
What is the dominant muscle during respiration that contracts and moves downward during inspiration to increase intrathoracic pressure?
Diaphragm
46
What do external intercostal muscles do during respiration?
increase anteroposterior chest diameter during inspiration
47
What do internal intercostal muscles do during respiration?
decrease the lateral diameter during expiration
48
What happens to a woman's BP beginning at about 8 weeks gestation?
commonly decreases
49
When is BP at it's lowest point in pregnancy?
mid pregnancy
50
This gradually rises to prepregnant levels by term
Diastolic BP
51
This is referred to as the transmission of pain injuries from the site of injury or tissue damage to the dorsal horn of the spinal cord and brain.
Nociception
52
What is Nociception?
the transmission of pain impulses from the site of injury or tissue damage to the dorsal horn of the spinal cord and brain
53
What are the 2 specialized nerve fibers that nociception is mediated by?
1. Myelinated A-delta fibers (LARGE): carry sharp, well-localized pain, which is quickly transmitted
2. Unmyelinated C-polymodal fibers (small): carry dull, burning, diffuse, and chronic pain, which is slowly transmitted
54
What do Myelinated A-delta fibers (LARGE) carry?
sharp, well-localized pain, which is quickly transmitted
55
What do Unmyelinated C-polymodal fibers (small) carry?
dull, burning, diffuse, and chronic pain, which is slowly transmitted
56
After the sensory information reaches the dorsal horn of the spinal cord, there is a ____-____ control of nociceptive transmission within the spinal tracts.
two-way
57
Biochemical mediators produced in response to tissue damage help move the pain impulse form the nociceptors (pain receptors) to: (4)
1. dorsal horn of the spinal cord
2. Ascending spinal tracts
3. Thalamus
4. Cerebral Cortex
58
What are the biochemical mediators? (7)
1. Bradykinin
2. Prostaglandin
3. Leukotrienes
4. Serotonin
5. Histamine
6. Catecholamines
7. Substance P
59
What stimuli present from the brain or periphery can modify pain impulses once they have reached the spinal cord? (4)
1. Endorphins
2. Serotonin
3. Norepinephrine
4. Non-pain impulses (light touch sensation such as massage)
60
Emotions, cultural background, sleep deprivation, pervious pain experience, and age are among those factors that have an impact on the perception and interpretation of _______?
pain
61
What are the 4 reasons older adults may not report pain?
1. they believe it to be a normal part of aging
2. they do not want to be a nuisance
3. they believe reporting pain will lead to expensive testing or hospitalization
4. they are hesitant to take pain medications
62
Words used for pain, what they told their parents, what caused the hurt in the past, and pain behaviors are especially important to note when seeing what patient population?
children
63
What is the temporary increase in the body's temperature in response to disease or illness?
Fever
64
At what locations can the pulse best be palpated? (7)
1. Carotid
2. Brachial
3. Radial
4. Femoral
5. Popliteal
6. Dorsal Pedis
7. Posterior Tibial
65
What are the pulse characteristics you should be looking for? (7)
1. Rate
2. Rhythm
3. Contour (waveform)
4. Amplitude (force)
5. Symmetry
6. Obstruction
7. Variations
66
If you find that the patients pulse is irregular, how long should you palpate it for?
60 seconds
67
Rates as close to ______bpm may occur in neonates?
200
68
The rapid decrease in neonates pulse rate is relatively rapid, and the rate may be closer to _____bpm at a few hours of age.
120
69
A newborn's pulse rate is more variable than that of older infants with activities such as feeding, sleeping, and waking. True or False?
True
70
During pregnancy, HR gradually increases until is it how much higher at term?
10-30%
71
HR may be slower in older adults, what is the wide range?
40-100bpm
72
Stiffness of blood vessels and increased vascular resistance in older adults causes the BP to INCREASE or DECREASE?
increase
73
T/F? Children are more variable than those of adults and react with wider swings related to exercise, fever, or stress.
T
74
Term for faster than normal respiratory rate?
Tachypnea
75
Term for slower than normal respiratory rate?
Bradypnea
76
What is the expected respiratory rate for neonates?
40-60
| * rates of 80 may be noted
77
T/F Babies delivered by cesarean section may have a slower respiratory rate than babies delivered vaginally.
F * babies delivered via C-section have a faster respiratory rate than those delivered vaginally
78
When is the greatest variation of respiratory rate without significant gender difference?
first 2 years of life
79
T/F BP taken supine position tend to be lower than those taken in sitting position.
T
80
How many phases are there during the Korotkoff sounds?
5 Phases
81
What are the 5 phases of Korotkoff sounds?
1. sharp "thud"
2. blowing or swishing sound
3. softer thud than phase 1, still crisp
4. softer blowing sound that disappears
5. silence
82
How many consecutive beats indicate the systolic pressure reading?
2
83
Point at which the initial crisp sound becomes muffled, this is recorded as?
first diastolic sound
84
BP standards for children are provided by what 3 percentiles?
1. gender
2. age
3. height
85
What is the expected newborn BP range for both systolic and diastolic?
60-96 mm Hg -Systolic
| 30-62 mm Hg - Diastolic
86
T/F A sustained increase in BP is almost always significant.
T
87
During what trimester of pregnancy is their a gradual increase in BP?
second -third trimester
88
Preeclampsia is determined by what BP reading?
BP reading greater or equal to 160 mm Hg systolic or 110 mm Hg diastolic
89
What 3 things are seen during preeclampsia?
1. Hypertension
2. swelling
3. protein in urine
90
Gestational Hypertension is shown by what BP reading?
greater than 140 mm Hg systolic or 90 mm Hg diastolic
91
T/F Gestational Hypertension risk in lower in women with multiple gestations.
F
92
How long does the Visual Analog Scale (VAS) for pain need to be?
10cm or 100mm
93
When assessing pain behaviors what should you look for?
Guarded, protective behavior, hands over painful area, distorted posture, irritability
Facial mask of pain: distorted expression
Vocalizations: groaning, crying, or talkative patient becomes quiet
Body movements such as head rocking, pacing, inability to keep hands still
94
These things can be recorded when assessing pain behaviors (5)
1. changes in vital signs
2. pallor and diaphoresis
3. pupil dialation
4. dry mouth
5. decreased attention span, greater confusion
95
What does the CRIES scale assess?
Pain assessment for surgical pain in newborns
96
What does the CRIES scale stand for?
```
Crying
Requires Oxygen
Increased Vital Signs
Expression
Sleeplessness
```
97
What scale can be used for assessing pain in children that has faces on it?
Wong/Baker Faces Rating Scale & Oucher Scale
98
When is FLACC used?
pain assessment in nonverbal children
99
What does FLACC stand for?
```
Face
Legs
Activity
Cry
Consolability
```
100
This scale is used most commonly to assess acute pain associated with surgery in children between 2 months and 7 years
FLACC
101
This type of fever varies during the day and DOES return to normal.
Intermittent
102
This type of fever varies during the day but DOES NOT return to normal.
Remittent
103
This type of fever either remittent or intermittent with difference between peak and baseline of more than 1.4 degrees C.
Hectic
104
This type of fever can be seen with abscess or pyogenic infection such as pyelonephritis and ascending cholangitis, but may also be seen with TB, hypernephromas, lymphomas, and drug reactions
Hectic
105
This type of fever occurs, resolves, & recurs again days to weeks.
Relapsing
| * rare in the US, can be seen with Hodgkin's disease (Pel-Ebstein fever), Malaria, Borrelia infection from ticks
106
This type of fever is associated with bile duct obstruction and biliary colic.
Charcot intermittent fever
107
This fever has little change during the day, can be seen with typhoid fever, bacterial endocarditis, TB, fungal diseases, bacterial pneumonia, neoplasm, connective tissue disease, and drug induced fever.
Sustained
108
T/F The height of temperature elevation has little diagnosis significance.
T
109
Hypothermia
temp below 98.6
| *chronic renal failure, antipyretic drugs acetaminophen and NSAIDs
110
For every degree of increases temp, the pulse increases by?
around 10 bpm
111
This pulse contour occurs with left ventricular failure.
Alternating OR Pulsus alternans
| * more significant if pulse is slow
112
This pulse contour occurs with aortic stenosis combined with aortic insufficiency.
Pluses Bisferians
| * best detected by palpating the carotid artery.
113
This pulse contour is characterized by two main peaks.
Pulses Bisferians
* first peak is percussion wave & second peak is tidal wave (1st is thought to be the pulse pressure and 2nd reverberation from the periphery)
114
This pulse contour occurs with disordered rhythm.
Bigeminal pulse
* result from a normal pulsation followed by a premature contraction. Amplitude and pulsation of the premature contraction is less than that of normal pulsation)
115
This pulse contour occurs with exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis.
Large, bounding pulse (also called hyperkinetic or strong)
* readily palpable, doesn't "fade out" and is not easily obliterated by the examining fingers.
* recorded as 3+
116
This pulse contour occurs do to premature cardiac contraction, tracheobronchial obstruction, bronchial asthma, emphysema, pericardial effusion, constrictive pericarditis.
Paradoxic pulse (pulses paradoxus)
117
Pulse contour characterized by an exaggerated decrease (>10 mm Hg) in the amplitude of pulsation during inspiration and increased amplitude during expiration.
Paradoxic pulse
118
Pulse contour occurs with patent ductus arteriosus and aortic regurgitation.
Water-hammer pulse
| * also known as collapsing pulse
119
This pulse contour has a greater amplitude than expected, a rapid rise to a narrow summit, and a sudden descent.
Water-hammer pulse
120
T/F Essential hypertension is pathologic origin is poorly understood.
T
121
Secondary hypertension potential causes include: (6)
1. renal disease
2. renal artery stenosis
3. aldosteronism
4. thyroid disorders
5. coarctation of the aorta
6. pheochromocytoma
122
Hypothyroidism, CNS disorder and narcotics can show this type of abnormal respiration
Bradypnea
123
COPD and pursed lips breathing can show this types of abnormal respiration.
Hyperpnea
124
Metabolic acidosis and compensation for pH by hyperventilation can show this type of abnormal respiration.
Kussmaul breathing
125
Respiration described as faster than 20 breaths per min and deep breathing.
Hyperventilation
126
Respiration described as frequently interspersed deeper breath.
Sighing
127
Respiration described as increasing difficulty in getting breath out.
Air trapping
128
Respiration described as varying periods of increasing depth interspersed with apnea.
Cheyne-Strokes
129
Respiration described as rapid, deep, and labored.
Kussmaul
130
Respiration described as irregularity interspersed periods of apnea in a disorganized sequence of breaths.
Biot
131
Respiration described as significant diagnosis with irregular and varying depths or respiration.
Ataxic
132
A form of chronic pain caused by a primary lesion or dysfunction of the CNS that persists beyond expected after healing.
Neuropathic pain
133
What are the potential causes for neuropathic pain?
postherptic neuralgia, diabetic peripheral neuropathy, trigeminal neuralgia, or radiculopathy
134
Damaged peripheral nerves fire repeatedly
Neuropathic pain
135
A syndrome in which regional pain extends beyond a specific peripheral nerve injury in an extremity with motor, sensory, an autonomic changes.
Complex Regional Pain Syndrome
136
This syndrome has no relationship between the original trauma severity and the severity and cause of the symptoms.
Complex Regional Pain Syndrome
137
Splinting from pain (rib fx, pleurisy) is a cause of what respiration pattern?
Tachypnea
138
Neurologic, electrolyte disturbance, infection, pain are causes of what respiration pattern?
Bradypnea
139
Anxiety, exercise, and CNS or metabolic disease can cause what respiratory pattern?
Hyperventilation
140
Deep and most often rapid breaths caused by metabolic acidosis.
Kussmaul
141
Shallow respirations caused by pain.
Hypopnea
142
Apnea periods (may be sleep apnea) due to cerebral CNS damage or a drug reaction.
Cheyne-stokes
143
Respiration pattern caused by emotional stress.
sigh
144
The respirations pattern is seen in someone who has an obstruction and is barrel chested.
Air trapping
145
Respiration that is irregular with apnea periods caused by increased intracranial pressure, drugs, or brain damage at the medulla.
Biot respiration
146
Respiration that is significantly disorganized, caused by increased intracranial pressure, drugs, or brain damage at the medulla.
ataxic respiration
147
Symptoms of?
Essential- asymptomatic
Malignant - headache, blurred vision, dyspnea, encephalopathy
Hypertension DDX
148
what are the long term consequences for hypertension?
heart failure and papilledema
149
DDX for hypertension?
rental disease, renal artery stenosis, aldosteronism, thyroid disorders, coarctation of the aorta, pheochromocytoma
150
DDX for Neuropathic pain?
Postherapetic neuralgia, diabetic peripheral neuropathy, trigeminal neuralgia, radiculopathy
151
Symptoms of?
burning, intense tightness, shooting, stabbing, shock-like sensation, may be worse at night, hyperalgesia, allodynia, sleep disturbance
Neuropathic pain
152
What are the objective findings of Neuropathic pain?
pain (e.g. stocking and glove), pain with non-painful stimuli, Neuro symptoms: decreased light touch, pin prik, vibration, proprioception, numbness, weakness, deep tendon reflexes.
153
Cause is unknown, sympathetic nervous system disfunction.
Complex regional pain syndrome
154
Symptoms of?
| Burning, shooting, aching pain, cold sensitive, pain with pressure, allodynia, numbness possible.
Complex regional pain syndrome
155
What are the objective findings of Complex regional pain syndrome?
edema, red and hot, cyanotic, increased sweating, temperature difference between affected and unaffected.
