Term
| What things are considered vital signs? |
|
Definition
Temperature
Pulse
Respiration
Blood pressure
Oxygen saturation
Pain Level
|
|
|
Term
| When should you assess vital signs? |
|
Definition
1. Any time there is a change in the patient’s condition
2. Upon admission to any healthcare agency
3. Based on agency institutional policy and procedures
4. Before and after surgical or invasive diagnostic procedures
5. Before and after activity that may increase risk
Before administering medications that affect cardiovascular or respiratory functioning
|
|
|
Term
| What regulates temperature? |
|
Definition
| Thermoregulatory center in the hypothalamus |
|
|
Term
The thermoregulatory center receives messages from ______________ in the body.
|
|
Definition
|
|
Term
| The thermoregulatory center initiates responses to __________, __________, or __________. |
|
Definition
produce body heat
conserve body heat
increase heat loss
|
|
|
Term
| What are the factors affecting vital signs? |
|
Definition
•Exercise
•Respiratory and CV disease
•Alterations in fluid, electrolyte, and acid balances
•Medications
•Trauma
•Infection
•Pain
•Anxiety
•Nicotine (vasoconstrictor) |
|
|
Term
Primary source of heat production is __________.
|
|
Definition
|
|
Term
|
Definition
|
|
Term
| What hormones are released to increase BMR? |
|
Definition
| Epinephrine & Norepinephrine |
|
|
Term
| What is the primary source of heat loss? |
|
Definition
|
|
Term
| What are the sources of heat loss? |
|
Definition
•Skin
•Evaporation of sweat
•Warming and humidifying inspired air
•Eliminating urine and feces |
|
|
Term
| What is a normal pulse for a newborn? |
|
Definition
|
|
Term
| What is normal respirations for a newborn? |
|
Definition
|
|
Term
| What is a normal BP for a newborn? |
|
Definition
|
|
Term
| What is a normal pulse for a 1-3 year old? |
|
Definition
|
|
Term
| What is normal respirations for a 1-3 year old? |
|
Definition
|
|
Term
| What is a normal BP for a 1-3 year old? |
|
Definition
|
|
Term
| What is a normal pulse for a 6-8 year old? |
|
Definition
|
|
Term
| What is a normal pulse for a 10 year old? |
|
Definition
|
|
Term
| What is a normal pulse for a teen? |
|
Definition
|
|
Term
| What is a normal pulse for an adult? |
|
Definition
|
|
Term
| What is a normal pulse for a >70 year old? |
|
Definition
|
|
Term
| What is normal respirations for a 6-8 year old? |
|
Definition
|
|
Term
| What is normal respirations for a 10 year old? |
|
Definition
|
|
Term
| What is normal respirations for a teen? |
|
Definition
|
|
Term
| What is normal respirations for an adult? |
|
Definition
|
|
Term
| What is normal respirations for a >70 year old? |
|
Definition
|
|
Term
| What is a normal BP for a 6-8 year old? |
|
Definition
|
|
Term
| What is a normal BP for a 10 year old? |
|
Definition
|
|
Term
| What is a normal BP for a teen? |
|
Definition
|
|
Term
| What is a normal BP for an adult? |
|
Definition
|
|
Term
| What is a normal BP for a >70 year old? |
|
Definition
|
|
Term
The body gives off waves of heat from uncovered surfaces (lost through skin).
|
|
Definition
|
|
Term
An oscillating fan blows currents of cool air across the surface of a warm body.
|
|
Definition
|
|
Term
| Body fluid in the form of perspiration and insensible loss is vaporized from the skin. |
|
Definition
|
|
Term
| The body transfers heat to an ice pack,causing the ice to melt. |
|
Definition
|
|
Term
| What temperature ranges indicate hypothermia? |
|
Definition
| 95°F (35°C) - 93.2°F (34°C) |
|
|
Term
| What temperature ranges indicate average (normal range)? |
|
Definition
| 97°F (36°C) - 98.6°F (37°C) |
|
|
Term
| What temperature ranges indicate febrile (pyrexia)? |
|
Definition
| 100.4°F (38°C) - 104.0°F (40°C) |
|
|
Term
| What temperature ranges indicate hyperthermia (hyperpyrexia)? |
|
Definition
| 105.8°F (41°C) - 111.2°F (44°C) |
|
|
Term
| According to circadian rhythms, body temperature is lowest in the _________, and highest at ________. |
|
Definition
|
|
Term
| What factors affect body temperature? |
|
Definition
•Circadian rhythms
•Age and gender
•Environmental temperatures |
|
|
Term
| What is the pulse regulated by? |
|
Definition
| The automatic nervous system through the cardiac sinoatrial node (CN 10 Vagus) |
|
|
Term
| Parasympathetic stimulation __________ heart rate. |
|
Definition
|
|
Term
| Sympathetic stimulation __________ heart rate. |
|
Definition
|
|
Term
| Number of contractions over a peripheral artery over one minute. |
|
Definition
|
|
Term
| Cardiac output = _________ |
|
Definition
|
|
Term
| What is the average stroke volume in an adult? |
|
Definition
|
|
Term
| Bradycardia is a pulse rate _______ beats/min in an adult. |
|
Definition
|
|
Term
| Tachycardia is a pulse rate ______ bpm. |
|
Definition
|
|
Term
| Asystole is a pulse rate of ______ bpm. |
|
Definition
|
|
Term
| What must always be documented with pulses? |
|
Definition
Rate
Rhythm
Quality (amplitude) |
|
|
Term
| How is rate quality defined? |
|
Definition
•0 - Absent pulse - No pulsation is felt despite extreme pressure.
•1+ - Thready pulse - Pulsation is not easily felt, and slight pressure causes it to disappear.
•2+ - Weak pulse - Stronger than a thready pulse; light pressure causes it to disappear.
•3+ - Normal pulse - Pulsation is easily felt,takes moderate pressure to cause it to disappear.
•4+ - Bounding pulse - The pulsation is strong and does not disappear with moderate pressure |
|
|
Term
| Atrial fibrillation would result in a pulse rhythm of _______________. |
|
Definition
|
|
Term
| What is the most accurate pulse? |
|
Definition
|
|
Term
| What pulses do you auscultate and what pulses do you palpate? |
|
Definition
Carotid – a/p
Apical - a
Brachial - p
Radial - p
Femoral – a/p
Popliteal - p
Posterior tibial - p
Pedal – p
Aortic – a/p
|
|
|
Term
| What occurs during renal stenosis? |
|
Definition
| narrowing of renal arteries; bruit will be present on auscultation |
|
|
Term
| Movement of air in and out of lungs. |
|
Definition
|
|
Term
| What occurs during inhalation? |
|
Definition
| Negative pressure in the thoracic cavity created by the downward contraction of diaphragm passively draws air into lungs. |
|
|
Term
| Internal respiration take place in _________, while external respiration take place in __________. |
|
Definition
the cellular level
pulmonary ventilation (just lungs) |
|
|
Term
| What is the strongest stimulus to breathe? |
|
Definition
| CO2 build-up in the bloodstream |
|
|
Term
| What is the average volume of the lungs in an adult? |
|
Definition
|
|
Term
| What should always be documented regarding respirations? |
|
Definition
|
|
Term
| Dyspnea is ________ and SOB is _________. |
|
Definition
|
|
Term
| Expiration is ________ than inspiration. |
|
Definition
|
|
Term
| ________ is an abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or voice box (larynx). It is usually heard when taking in a breath. |
|
Definition
|
|
Term
| A whistling sound made by the flow of high-velocity air through narrowed airways and is heard during both inspiration and expiration. |
|
Definition
|
|
Term
| ____________ lung sounds are heard in the peripheries of the lungs. |
|
Definition
|
|
Term
| What happens to the diaphragm in people with chronic lung disease. |
|
Definition
|
|
Term
| What are the blood pressure ranges for the different stages of hypertension. |
|
Definition
•Normal - <120/80
•Prehypertension - 120-139/80-89
•Hypertension(Stage I) - 140-159/90-99
•Hypertension(Stage II) - >160/100 |
|
|
Term
| A form of hypertension with no known cause. |
|
Definition
|
|
Term
| A form of hypertension caused by a known pathology. |
|
Definition
|
|
Term
| What is hypertension caused by? |
|
Definition
•Increased peripheral vasc. resistance
•Reduced elasticity of arterial wall (arteriosclerosis, Ca++)
•Vasoconstriction r/t chemical factors (i.e. ACE effect), atherosclerosis |
|
|
Term
| What s the most accurate means to assess a person's respiratory status? |
|
Definition
|
|
Term
| What are respirations controlled by? |
|
Definition
| Respiratory centers in the medulla and pons |
|
|
Term
| The force of blood against walls of arteries. |
|
Definition
|
|
Term
| What is occurring when the left and right ventricles contract? |
|
Definition
|
|
Term
| What is occurring when the heart is at rest and there is passive filling of both atria? |
|
Definition
|
|
Term
| Blood pressure = _________ X __________ |
|
Definition
|
|
Term
| Amount of blood forced out of heart with each ventricular contraction. |
|
Definition
| Stroke volume (about 70 mL) |
|
|
Term
| Cardiac Output = __________ X _________ |
|
Definition
|
|
Term
| The ___________ is good indicator of the constant pressure on the arterial walls. |
|
Definition
|
|
Term
| What are the commonly used arteries for assessing blood pressure? |
|
Definition
|
|
Term
| In what phase would you hear the first systolic value? |
|
Definition
|
|
Term
| In what phase would you hear the diastolic value? |
|
Definition
|
|
Term
| What is the minimum systolic pressure needed to perfuse the kidneys? |
|
Definition
|
|
Term
| How is a palpated BP documented? |
|
Definition
|
|
Term
| What are the factors affecting blood pressure? |
|
Definition
•Age, gender, race
•Circadian rhythm
•Food intake
•Exercise
•Weight
•Emotional state
•Body position
•Drugs/medication |
|
|
Term
| If a cuff too small for BP assessment is used, the BP will be erroneously ________. |
|
Definition
|
|
Term
| If a cuff too large for BP assessment is used, the BP will be erroneously ________. |
|
Definition
|
|
Term
| What position should your patient be in when assessing BP? |
|
Definition
| Sitting w/ arm even with heart |
|
|
Term
| When should a manual cuff be used? |
|
Definition
•Anytime there is a Dx of HTN or hypotension
•Anytime there is a change in BP
•Anytime a drug is given that affects BP
•Pre or post operative |
|
|
Term
| What causes orthostatic hypotension? |
|
Definition
•Loss of vessel elasticity
•Fluid loss
•Autonomic nervous system reflexes defective
|
|
|
Term
| What procedure should be completed to determine if a patient has orthostatic hypotension? |
|
Definition
|
|
Term
| What BP is considered hypotensive? |
|
Definition
|
|
Term
| What are the S/S of orthostatic hypotension? |
|
Definition
•Decreased cerebral perfusion
•Dizziness
•Weakness
•Blurred vision
•Syncope (fainting)
•Drop in BP
•Increased HR |
|
|
Term
| What is an acceptable BP, according to JNC VII report, for 40-70 year olds with at least one comorbidity. |
|
Definition
|
|
Term
| A condition that causes HTN when there is a fat plaque buildup in arterial vessels which causes a narrowing of the lumen of the vessel. |
|
Definition
|
|
Term
| A condition that causes HTN when there is deposition of Ca++ in intima-media of the blood vessel causing loss of elasticity. |
|
Definition
|
|
Term
The ankle-brachial index (ABI) result is used to predict the severity of ______________________.
|
|
Definition
| peripheral arterial disease (PAD) |
|
|
Term
| What differences in BP and pulse during a tilt test would indicate orthostatic hypotension? |
|
Definition
| >20 Systolic >10 Diastolic (or total of >30mmHg difference) or >40 Pulse difference |
|
|
Term
| A normal resting ankle-brachial index is ______________. |
|
Definition
|
|
Term
| The pulse pressure in the ankle is ________ the pulse pressure in the brachial. |
|
Definition
|
|
Term
| Ankle-brachial index (ABI) = |
|
Definition
| Ankle Systolic Pressure / Brachial Systolic Pressure |
|
|
Term
| When assessing ankle-brachial index (ABI), which BP readings should be used? |
|
Definition
| The highest BP out of 3 values of each site. |
|
|
Term
| If the ankle-brachial index (ABI) is 0.41 to 0.9, this indicates _________. |
|
Definition
|
|
Term
| If the ankle-brachial index (ABI) is 0.4or less, this indicates _________. |
|
Definition
|
|
Term
| What are the characteristics of PAD? |
|
Definition
•No hair growth on anterior lower leg
•Skin becomes thin & shiny
•Freckles on anterior LE
•Decreased blood flow
•Skin is cooler |
|
|
Term
| What are the characteristics of PVD? |
|
Definition
•Engorgement
•Edema in lateral lower extremities
•Warm to touch
•Arterial pulse is not affected
•Color changes on medial LE
•Ulcers on legs that wont heal (venous stasis ulcers)
|
|
|
Term
| What is the purpose of the health assessment? |
|
Definition
•To provide a clear description of current health status.
•To organize collected data into patterns.
•To formulate a conclusion (outcome) i.e. NSG DX/MED. DX
|
|
|
Term
| The conclusion/DX of the health assessment is only as accurate as _______. |
|
Definition
|
|
Term
| Data quality from a health assessment is dependent on the __________. |
|
Definition
|
|
Term
| Which is more important, NSG Hx or the physical assessment? |
|
Definition
|
|
Term
| What is the longest piece of the history? |
|
Definition
|
|
Term
| What are the seven variables/characteristics of a patient's CC? |
|
Definition
•Location
•Timing
•Duration
•Intensity
•Quality/Quantity
•Aggravating/Alleviating Factors
•Associated Symptoms
|
|
|
Term
| What is included in the PMH? |
|
Definition
•Illnesses
•Diagnoses
•Hospitalizations
•Immunizations
•Travel
•Childhood illnesses
•Allergies (foods, drugs, environmental, insects)
•Medications
•Surgical Hx
•Family Hx |
|
|
Term
|
Definition
|
|
Term
| What is included in the social Hx? |
|
Definition
Tobacco use (packs/day X years)
ETOH
Recreational drugs
Lving situation
Type of work
Hobbies
Exercise
Capability of completing ADLs |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Burning, itching, or tingling with no apparent cause. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the four characteristics of sound? |
|
Definition
•Pitch
•Loudness
•Quality
•Duration |
|
|
Term
|
Definition
| Can put fingers around the edge |
|
|
Term
| What can be assessed during percussion? |
|
Definition
|
|
Term
| Inspection starts with the ___________. |
|
Definition
|
|
Term
| The palm of the hand is used to assess what? |
|
Definition
|
|
Term
| The fingertips are used to assess what? |
|
Definition
raised/flat lesions
pulses
temperature |
|
|
Term
| What are the characteristics of masses determined by palpation? |
|
Definition
Shape
Size
Consistency
Surface
Mobility
Tenderness
Pulsatile |
|
|
Term
| What are the characteristics of skin and structures determined by palpation? |
|
Definition
Temperature
Turgor
Moisture
Vibrations
Shape
Texture |
|
|
Term
| Where would flat sounds occur during percussion? |
|
Definition
| thigh area or bone (soft) |
|
|
Term
| Where would dull sounds occur during percussion? |
|
Definition
|
|
Term
| Where would resonance sounds occur during percussion? |
|
Definition
|
|
Term
| Where would hyperresonance sounds occur during percussion? |
|
Definition
| emphysematous lung (very loud) |
|
|
Term
| Where would tympany sounds occur during percussion? |
|
Definition
| abdomen or puffed-out cheek (loud) |
|
|
Term
|
Definition
|
|
Term
| Venous ulcers are usually located where? |
|
Definition
| Medial aspect of the legs just above the ankle. |
|
|
Term
| Arterial ulcers are usually located where? |
|
Definition
| The heels, tips of toes, between the toes where the toes rub against one another or anywhere the bones may protrude and rub against bed sheets, socks or shoes. |
|
|
Term
| What are the pattern descriptors of lesions/rashes? |
|
Definition
Round
Discrete (separate or distinct)
Grouped
Confluent (flowing or coming together)
Linear
Annular/Circular |
|
|
Term
|
Definition
| Where 2 skin areas touch or rub together |
|
|
Term
|
Definition
| Skin innervated by a single nerve |
|
|
Term
| What characteristic should you document with an irregular lesion? |
|
Definition
Asymmetry
Border Irregularity
Color variation
Diameter
Elevation
|
|
|
Term
|
Definition
| blood in the lowest part of iris |
|
|
Term
|
Definition
| Bifurcation of bronchi main stem at the angle of louis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Mean and children use the _________ to breathe while women use the _________ to breathe. |
|
Definition
Diaphragm
Thoracic or Costal |
|
|
Term
| What characteristics are documented regarding the pulmonary exam? |
|
Definition
|
|
Term
| An escape of air from the lungs through the visceral plura then through the parietal plura under the skin. |
|
Definition
| Crepitus (SubQ Emphysema) |
|
|
Term
| Children have an AP:lat ______ ratio. |
|
Definition
|
|
Term
| Adults have an AP:lat ______ ratio. |
|
Definition
|
|
Term
| Where are bronchial sounds heard? |
|
Definition
| From the angle of louis and above |
|
|
Term
| Where are bronchovesicular sounds heard? |
|
Definition
| On the MCL across from the angle of louis |
|
|
Term
| Where are vesicular sounds heard? |
|
Definition
| Out in the peripheries of the lungs; lateral and lower on the anterior and posterior thorax |
|
|
Term
| What are adventitious sounds? |
|
Definition
| Abnormal sounds, such as wheezes, stridor, crackles, and rhonchi |
|
|
Term
| Circumscribed, Flat, Nonpalpable Change in Skin Color ≤1 cm |
|
Definition
| Macule (Ex. Petechiae, freckle) |
|
|
Term
| Circumscribed, Flat, Nonpalpable Change in Skin Color >1 cm. |
|
Definition
|
|
Term
| Palpable, Elevated Solid Mass ≤0.5 cm. |
|
Definition
|
|
Term
| Palpable, Elevated Solid Mass >0.5 cm. |
|
Definition
|
|
Term
| Palpable, Elevated Solid Mass 0.5–2 cm; firmer than a papule. |
|
Definition
| Nodule (Ex. Nevus [wart]) |
|
|
Term
| Palpable, Elevated Solid Mass >2 cm. |
|
Definition
|
|
Term
| Irregular, superficial area of localized skin edema. |
|
Definition
| Wheal (Ex. Hives, mosquito bite) |
|
|
Term
| Circumscribed, Superficial Skin Elevations Formed by Free Fluid in a Cavity Within the Skin Layers Filled with serous fluid, ≤0.5 cm. |
|
Definition
| Vesicle (Ex. Herpes simplex) |
|
|
Term
| Circumscribed, Superficial Skin Elevations Formed by Free Fluid in a Cavity Within the Skin Layers Filled with serous fluid, >0.5 cm. |
|
Definition
| Bulla (Ex. 2nd-degree burn) |
|
|
Term
| Circumscribed, Superficial Skin Elevations Formed by Free Fluid in a Cavity Within the Skin Layers filled with pus. |
|
Definition
| Pustule (Ex. Acne, impetigo) |
|
|
Term
| When listening to bronchial breath sounds, inspiration is ___________ than expiration. |
|
Definition
|
|
Term
| When listening to bronchovesicular breath sounds, inspiration is ___________ expiration. |
|
Definition
|
|
Term
| When listening to vesicular breath sounds, inspiration is ___________ than expiration. |
|
Definition
|
|
Term
| When does wheezing occur? |
|
Definition
| During inspiration and expiration |
|
|
Term
|
Definition
|
|
Term
| When does friction rub occur? |
|
Definition
| Inspiration and expiration |
|
|
Term
| Where is friction rub heard best? |
|
Definition
| Lower lateral anterior surface |
|
|
Term
| Where is the aortic pulse located? |
|
Definition
|
|
Term
| Where is the pulmonic pulse located? |
|
Definition
|
|
Term
| Where is the tricuspid pulse located? |
|
Definition
|
|
Term
| Where is the mitral pulse located? |
|
Definition
|
|
Term
| Where is the abdominal aorta pulse located? |
|
Definition
| Below the xiphoid process |
|
|
Term
| Is a split S2 sound in kids normal? |
|
Definition
|
|
Term
| What valves are closed during S1? |
|
Definition
|
|
Term
| What valves are closed during S2? |
|
Definition
|
|
Term
| How far should the jugular vein distend? |
|
Definition
|
|
Term
| Which closes first, mitral or tricuspid? |
|
Definition
|
|
Term
| Which closes first, aortic or pulmonic? |
|
Definition
|
|
Term
| S1 is heard loudest over the ______ of the heart. |
|
Definition
|
|
Term
| S2 is heard loudest over the ______ of the heart. |
|
Definition
|
|
Term
| Diastole occurs after _____. |
|
Definition
|
|
Term
| Bruit are heard only over __________. |
|
Definition
|
|
Term
| Murmurs are heard over the __________. |
|
Definition
|
|
Term
| Mumurs occur between ___________. |
|
Definition
|
|
Term
|
Definition
| the occurrence of two beats of the pulse in rapid succession |
|
|
Term
|
Definition
| Accumulation of fluid in abdomen |
|
|
Term
| Ascites usually occurs in the _________ of the abdomen. |
|
Definition
|
|
Term
|
Definition
| Separation between left and right rectus abdominus |
|
|
Term
| How long do you have to listen in each quadrant of the abdomen for BS to determine absent BS? |
|
Definition
| 2-3 minutes (or 5 minutes) |
|
|
Term
| What are the common causes of decreased BS? |
|
Definition
Inflammation
Ileus (gut stops)
Pertonitis (inflam. of peritoneum)
Post-surgery
Pneumonia |
|
|
Term
| What are the common causes of increased BS? |
|
Definition
|
|
Term
| What is located in the RUQ of the abd.? |
|
Definition
•Pylorous
•Duodenum
•Liver
•Right kidney and adrenal gland
•Hepatic flexure of colon
•Head of pancreas |
|
|
Term
| What is located in the LUQ of the abd.? |
|
Definition
•Stomach
•Spleen
•Left kidney and adrenal gland
•Splenic flexure of colon
•Body of pancreas |
|
|
Term
| What is located in the RLQ of the abd.? |
|
Definition
•Cecum
•Appendix
•Right ovary and fallopian tube (female)
•Right ureter and lower kidney pole •Right spermatic cord (male)
|
|
|
Term
| What is located in the LLQ of the abd.? |
|
Definition
•Sigmoid colon
•Left ovary and fallopian tube (female)
•Left ureter and lower kidney pole
•Left spermatic cord (male)
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Term
| What is inspected in muscles? |
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Definition
Size
Shape
Symmetry
Color
Contour
Bulk
Tone |
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Term
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Definition
| A small hemorrhagic spot in the skin or a mucous membrane, larger than a petechia, forming a nonelevated, rounded, or irregular blue or purplish patch. |
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Term
| What items during assessment are rated and what are the normal ratings? |
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Definition
Pulse (0 to 4) 3
Reflexes (0 to +4) +2
Tonsils (0 to +4) +2
Edema (0 to +4) 0
Muscle str. (0 to 5) 5 |
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Term
| What variations are present for the elderly? |
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Definition
Minimize or ignore significant symptoms
Present w/ atypical S/S of disease
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Term
| What are the common surgeries of the elderly? |
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Definition
Cataracts
Skin lesions removed
Joint replacement
Cholecystectomy, appendectomy, T & A |
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Term
| What should you always review with the elderly patient? |
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Definition
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Term
| What ROS (integumentary) questions would ask an elderly patient? |
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Definition
•New or rough lesions that don't heal
•Lesions that bleed easily
•Bruising easily
•Nail care - podiatrist |
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Term
| What tastes do the elderly lose first? |
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Definition
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Term
| What should be noted about mucous after a productive cough? |
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Definition
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Term
| What should we ask the elderly during ROS (Respiratory)? |
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Definition
Cough
Appetite
Trouble breathing any time of the day |
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Term
| Paroxysmal nocturnal dyspnea |
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Definition
| attacks of severe shortness of breath and coughing that generally occur at night, usually awakening the person from sleep, and may be quite frightening. |
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Term
| A shade coming down in a field of vision is a sign of what? |
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Definition
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Term
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Definition
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Term
| When the world is spinning, _________ is occurring. When I'm spinning ____________ is occurring. |
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Definition
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Term
| What increases risk for UTIs in elderly males? |
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Definition
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Term
| What should always be your first concern with elderly DM patients? |
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Definition
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Term
| What neurological problems are common in the elderly? |
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Definition
Decreased ability to feel temp. & objects
Seizures
Tremors or shaking
Difficulty walking or moving about
Loss of balance |
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Term
| What variables should you always look for in elderly patients with changes in mental status? |
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Definition
1. Dehydration (Drugs get toxic)
2. Infection
3. Medicines |
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Term
| What should you check first if an elderly patient states that they feel bugs crawling all over their skin? |
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Definition
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Term
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Definition
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Term
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Definition
| fragile capillaries (ruptures) |
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Term
| In the elderly, lymph nodes are ________. |
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Definition
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Term
| The thyroid in elderly patients is ________________. |
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Definition
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Term
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Definition
| farsighted (can't see close objects) |
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Term
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Definition
| nearsighted (can't see far objects) |
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Term
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Definition
| an opaque ring, gray to white in color, that surrounds the periphery of the cornea. |
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Term
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Definition
| Tiny yellowish plaques that are slightly raised on the skin surface of the upper or lower eyelids. |
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Term
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Definition
| A non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the sclera. |
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Term
| Do elderly patients tend have presbyopia or myopia? |
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Definition
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Term
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Definition
| Age-related hearing loss with gradually progressive inability to hear, especially high frequency sounds. |
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Term
| The elderly typically have a __________ pulse pressure. |
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Definition
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Term
| A lot of older people will __________ during the night. |
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Definition
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Term
| The elderly have a ___________ pulmonary excursion rate. |
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Definition
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Term
| A few crackles in the bases of the elderly are ___________. |
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Definition
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Term
| What are the common variations for the elderly in GI? |
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Definition
Decreased BS
Decreased abd. muscle
Organs more easily palpated
Hernias |
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Term
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Definition
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Term
| What variations are present in the elderly regarding musculoskeletal. |
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Definition
•Wider base of support, decline in step length/stride length
•Decreased sensory input (harder to feel what they are touching), slower motor responses
•OA - Heberden nodules (hard or bony swellings that can develop in the distal interphalangeal joints)
•Calluses, bunions, thick malshaped toenails, fungal effects
•Joint stiffness and decreased ROM |
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Term
| People with OA feel _______ after moving around whereas people RA feel _______ after moving around. |
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Definition
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Term
| What group commits suicide most frequently in the elderly? |
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Definition
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Term
| What should be assessed concerning birth history? |
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Definition
•weeks gestation
•type of delivery
•length of labor
•state of newborn |
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Term
| What should be assessed concerning postnatal history? |
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Definition
•Bleeding
•Rashes
•Reflexes
•Colic
•Feeding
•Fever |
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Term
| What measurements should always be taken on a child under 2 years old? |
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Definition
Head/chest circumference
Height/weight |
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Term
| What do you note when plotting on a growth chart for a child? |
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Definition
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Term
| How many centimeters should children grow every year? |
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Definition
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Term
| How many pounds should children gain every year? |
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Definition
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Term
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Definition
| Ringworm (fungal infection) |
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Term
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Definition
| A contagious skin infection caused by Staph or Strep. |
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Term
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Definition
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Term
| Coughing at night in small children can be an early indication of _____________. |
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Definition
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Term
| What should be assessed in the respiratory hx of children? |
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Definition
Asthma
Atopic dermatitis
Allergies |
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Term
| What questions should you ask when assessing cardiovascular in children? |
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Definition
•Congenital anomalies (defects)
•Skipping heart
•Squatting/resting during play or blue lips
•Dyspnea or SOB |
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Term
| What are the S/S of appendicitis? |
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Definition
Pain mid abd. settling to RLQ
No appetite
Fever
Pain in abd. when flexing knee
Malaise |
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Term
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Definition
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Term
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Definition
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Term
| What re the characteristics of rhinorrhea? |
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Definition
| Nasal mucosa boggy, blueish/gray, edematous (allergy) |
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Term
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Definition
| ring inside nose from buildup of mucous |
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Term
| If a child comes in with a very high fever, what should you check for first? |
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Definition
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Term
| During a pediatric exam, you should expect to hear mostly ____________ lung sounds. |
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Definition
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Term
| A diminished femoral pulse in a child may indicate _____________. |
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Definition
| Coarctation of aorta (COA) |
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Term
| Where is the apical impulse on a child <7 YO located? |
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Definition
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Term
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Definition
| Split closure of the valves in the heart. |
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Term
| Skin turgor is tested on the __________ of children. |
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Definition
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Term
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Definition
| Narrowing of foreskin that blocks urination. |
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Term
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Definition
| A rare congenital (present from birth) defect located at the opening of the urethra. In this condition, the urethra does not develop into a full tube and the urine exits the body from an abnormal location. (hypospadias or hyperspadias) |
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Term
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Definition
| A pilonidal cyst is a cyst that develops along the tailbone (coccyx) near the cleft of the buttocks, approximately 5 cm from the anus. |
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Term
| The process of development is ___________. |
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Definition
| Continuous, systematic, & predictable |
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Term
| The rate of development is __________. |
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Definition
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Term
| What are the characteristics of the first trimester? |
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Definition
2-8 weeks
embryo stage
critical organ development occurs
caution against teratogenic substances
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Term
| What are the characteristics of the second trimester? |
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Definition
4 mos. – 6 mos.
fetal movement
hair, eyelashes
20th wk. fully formed |
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Term
| What are the characteristics of the third trimester? |
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Definition
7mos – 9mos
gaining weight
decreased activity due small space
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Term
| What are the main concerns for the infant-daycare aged child? |
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Definition
infections
toys
mouthing
immunizations
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Term
| What are the main concerns for the toddler-preschool aged child? |
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Definition
immunizations
safety at home/car
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Term
| What are the main concerns for the school/adolescent aged child? |
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Definition
safety
sports
risk taking
tobacco
etoh
drugs
sex
infections |
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Term
| When does teething, primary teeth, and secondary teeth occur? |
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Definition
8-10 months – teething
20 teeth by 30 months old
6-8 years old - first permanent
18-20 years old – all permanent
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Term
| What factors affect personal hygiene? |
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Definition
Culture
Socioeconomic class
Spiritual practices
Developmental level
Health state
Personal preferences
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Term
| What factors should you consider when examining skin? |
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Definition
Cleanliness
Color
Temperature
Turgor
Moisture
Sensation
Vascularity
Evidence of lesions
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Term
| What are the types of self-car deficits? |
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Definition
Feeding
Bathing and hygiene
Dressing and grooming
Toileting
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Term
| How often would you administer artificial tear solution or normal saline if a patient's blink reflex is absent? |
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Definition
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Term
| The focus of safety assessments are on what? |
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Definition
The individual
The environment
Specific risk factors
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Term
| What are the Joint Commission's safety goals? |
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Definition
•Improve patient identification.
•Improve communication among caregivers.
•Improve safety of high-alert medications.
•Eliminate wrong site, wrong patient, wrong procedure, and wrong surgery.
•Improve safety using infusion pumps.
•Improve effectiveness of clinical alarm systems.
•Reduce risk of healthcare acquired infections.
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Term
| What is the RACE acronym? |
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Definition
•Rescue anyone in immediate danger.
•Activate the fire code and notify appropriate person.
•Confine the fire by closing doors and windows.
•Evacuate patients and other people to a safe area.
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