Term
| 3 types of physical assessments |
|
Definition
1. complete assesment
2. daily assessment
3. focused assesment of body part |
|
|
Term
| who completes a "complete assessment" |
|
Definition
|
|
Term
| when ___________ the client, always explain the reason, when/where, what will happen, assist as needed, ask to empty bladder, collect sample if needed, continuously reassure, be specific about taking clothing off for gown |
|
Definition
|
|
Term
| when ___________ the patient, take into account the patients age, physical condition, energy level, ROM limitations |
|
Definition
|
|
Term
| most accessible positions |
|
Definition
|
|
Term
| _______ assessment includes: head to toe assessment, healthh history, level of activity/functioning |
|
Definition
|
|
Term
| __________ assessment usually not done by an lpn |
|
Definition
|
|
Term
| _____ may be delegated tasks such as these: inventory of personal property, allergies, medication list, dietary habits, past medical history, fall risk assessment, info related to impairments and disability |
|
Definition
|
|
Term
| conducted at the beginning and end of each shift; can be performed by rn; includes head to to systematic/efficient; energy level, fewest position changes, modified for different ages, general or specific |
|
Definition
|
|
Term
| when you enter the room, _______ begins |
|
Definition
|
|
Term
| important in ___________ assessment: LOC, alert, lethargic, sedated, or unconscious |
|
Definition
|
|
Term
|
Definition
|
|
Term
| person, place, time, incident = |
|
Definition
|
|
Term
| how to check _______ response: speech is clear, appropriate, slurred, incoherent, dysphagia, or aphasia (no speech) |
|
Definition
|
|
Term
| how to check _________ response: squeeze both fingers; equal bilaterally, grips, flexion/extension |
|
Definition
|
|
Term
| how to assess _________: description; sharp, dull, burning, non-existant, scale 0-10 |
|
Definition
|
|
Term
| pupils are normally ___-___ mL in diameter |
|
Definition
|
|
Term
|
Definition
| Pupils are Equal, Round, React to Light and Accommodate |
|
|
Term
| when you hold a piece of paper up and you can see something written behind it but paper loses focus, and then look at paper and written thing loses focus |
|
Definition
|
|
Term
| light makes the pupil ______ |
|
Definition
|
|
Term
| darkness makes the pupil ________ |
|
Definition
|
|
Term
| temperature, pulse, respirations, bloodpressure, and pulse oximetery (and pain) are all __________ ________ |
|
Definition
|
|
Term
| always record _______ and ________ at the same time each day and use the same, appropriate equipment. |
|
Definition
|
|
Term
| why might tattoos/piercings swell |
|
Definition
| hepatitis, infection, allergy |
|
|
Term
| pinching the skin to check for hydration |
|
Definition
|
|
Term
|
Definition
| 60-100 beats/min (resting) |
|
|
Term
| what is a bilateral pulse |
|
Definition
| means that the pulse rate should be the same throughout the whole body |
|
|
Term
| pulse is usually taken ______ or _________ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| instrument used to listen to internal sounds in the body |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
0- absent
1- thready
2- weak
3- normal
4- bounding |
|
|
Term
| strong visible pulse that is difficult to stop with pressure |
|
Definition
|
|
Term
|
Definition
|
|
Term
| edema is a sign that the ________ may be beginning to fail |
|
Definition
|
|
Term
| how to display capillary refill |
|
Definition
| pushing the nail beds...white/pink |
|
|
Term
| way to test for capillary refill; frowned upon; may cause deep vein thrombosis |
|
Definition
|
|
Term
| difference between thrombosis and embolus blood clots |
|
Definition
thrombus is stationary
embolus moves |
|
|
Term
| fast breathing; more than 24 breaths per minute |
|
Definition
|
|
Term
| slow breathing; less than 10 breaths per min |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| measures oxygen saturation at the capillary level |
|
Definition
|
|
Term
| pulse oximetry normal level |
|
Definition
|
|
Term
| life threatening pulse oximetry |
|
Definition
|
|
Term
| always ___________ before you ____________ the abdomen |
|
Definition
|
|
Term
| when muscles in the abdomen cease to hold the intestines back and the abdomen is distende |
|
Definition
|
|
Term
| what quadrant for appendicitis |
|
Definition
|
|
Term
| ___________ in old people can be a sign of constipation |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| newborns with increased pigmentation in sacral area |
|
Definition
|
|
Term
| newborns with tiny whiteheads on the face and nose |
|
Definition
|
|
Term
|
Definition
|
|
Term
| where to assess infant respirations |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| medical term for "hearing loss" |
|
Definition
|
|
Term
| _________ fontanel closes at 8 weeks |
|
Definition
|
|
Term
| ____________ fontanel closes at 18 weeks |
|
Definition
|
|
Term
| voluntary head control by ____ months |
|
Definition
|
|
Term
| top of ears line with (BOTTOM/TOP) of eyes |
|
Definition
|
|
Term
| __________ of feet up to age 2 1/2 years old |
|
Definition
|
|
Term
| may be expressed after 1st trimester; milk |
|
Definition
|
|
