Term
| how is autonomy defined in the ethical context? |
|
Definition
| a patient may choose between alternatives; a patients need for self determination |
|
|
Term
| how is beneficence defined in the ethical context? |
|
Definition
|
|
Term
| how is nonmaleficence defined in the ethical context? |
|
Definition
|
|
Term
| how is utilitarianism defined in the ethical context? |
|
Definition
| appropriate use of resources with concern for the greater good of the larger community |
|
|
Term
| what are the 4 c's of communication in a positive patient relationship? |
|
Definition
| courtesy, comfort, connection, confirmation |
|
|
Term
| what are the purpose of open ended questions? |
|
Definition
| gives the patient discretion about the extent of the answer |
|
|
Term
| what is the purpose of a direct question? |
|
Definition
| seeks specific information |
|
|
Term
| why are leading questions the most risky? |
|
Definition
| because they may limit the information provided to what the patient thinks you want to know |
|
|
Term
| how can you lessen a patients' anxiety and decrease the potential barrier to communication? |
|
Definition
| never dissembling, avoiding an overload of information, pacing the conversation, and presenting a calm demeanor |
|
|
Term
| why is silence important in a patient relationship at times? |
|
Definition
| silence allows the patient a moment of reflection or time to summon courage; some issues can be so painful and sensitive that silence becomes necessary and should be allows; be comfortable with silence but give it reasonable bounds |
|
|
Term
| what should one do if a patient starts crying? |
|
Definition
| let the moment pass at the patient's pace; resume your questioning only when the patient is ready; show compassion |
|
|
Term
| how should a physician deal with an angry patient? |
|
Definition
| avoid being defensive, but acknowledge the problem and only when appropriate, apologize and ask how to make things better |
|
|
Term
| what is the cage questionaire and what does it stand for? |
|
Definition
the cage questionaire is one model for discussing the use of alcohol
cage is an acronym for cutting down, annoyance by criticism, guilty feeling, and eye openers |
|
|
Term
| what does the tace questionaire stand for? |
|
Definition
T: how many drinks does it take to make you feel high?
A: have people annoyed you by criticizing your drinking?
C: have you felt you ought to cut down on your drinking?
E: have you ever had an eye opener drink first thing in the morning to steady your nerves/get rid of a hangover? |
|
|
Term
| what is the crafft questionaire used for? |
|
Definition
valid means of screening adolescents for substance related problems
c-car with others drinking
r-relaxation usage
a-use alone
f-forget things you did
f-family member encouragement to cut down
t-trouble ever gotten into for drinking |
|
|
Term
| what % of reported victims of domestic violence are women? |
|
Definition
| 94% from every ethnic and socioeconomic group |
|
|
Term
| true or false: the patient is almost always the initiator of discussion when talking about domestic violence |
|
Definition
|
|
Term
| what does HITS stand for? |
|
Definition
used for domestic violence questioning
h-hurt you physically
i-insult or talk down to you
t-threaten you with physical harm
s-scream or curse at you |
|
|
Term
| what is the purpose of the cage, crafft, and tace questionaires? |
|
Definition
| to find out if a problem exists in screening |
|
|
Term
| what is the acronym "fica" stand for when screening for spirituality? |
|
Definition
f-faith, belief, meaning
i-importance and influence
c-community involvement
a-actions; how religious beliefs affect decisions |
|
|
Term
| is there evidence that prayer can aid in healing? |
|
Definition
|
|
Term
| should the age of the patient deter discussion of sexuality? |
|
Definition
|
|
Term
| true or false: the sexual orientation of a patient must be known if appropriate continuity of care is to be offered |
|
Definition
|
|
Term
| do kids have the same right to confidentiality as adults? |
|
Definition
|
|
Term
| what is a complete history? |
|
Definition
| makes you as thoroughly familiar with the patient as possible; most often this history is recorded the first time you see the patient |
|
|
Term
| what is an inventory history? |
|
Definition
| related to but does not replace the complete history; it touches on the major points without going into detail; getting a "feel" for the situation |
|
|
Term
| what is a problem/focused history? |
|
Definition
| taken when the problem is acute, possibly life threatening, requiring immediate attention so that only the need of the moment is given full attention |
|
|
Term
| what is an interim history? |
|
Definition
| designed to chronicle events that have occurred since your last meeting with the patient; its substance is determined by the nature of the problem and the need of the moment |
|
|
Term
| when a patient is in a seated position, where should a drape lie? |
|
Definition
| drape should cover the patient's lap and legs |
|
|
Term
| what is irritant contact dermatitis? |
|
Definition
| a type of latex reaction where chemical irritation does not involve the immune system; symptoms are usually dry, irritated areas on the skin, typically the hands |
|
|
Term
| what is a type IV dermatitis latex reaction? |
|
Definition
delayed hypersensitivity
allergic contact dermatitis which involves the immune system and is caused by the chemicals used in latex products; resembles reaction to poison ivy; begins in 24-48 hours after contact |
|
|
Term
| what is a type I systemic latex reaction? |
|
Definition
true allergic reaction caused by protein antibodies that form as a result of interaction between a foreign protein and the body's immune system
symptoms include asthma, tissue swelling, eye/nose itching, GI symptoms, etc. |
|
|
Term
| when the patient is in the supine position, where should a drape be placed? |
|
Definition
| drape should cover the patient from chest to knees or toes |
|
|
Term
| when the patient is in the prone position, where should a drape be placed? |
|
Definition
| drape the patient to cover the torso |
|
|
Term
| what is the dorsal recumbent position? |
|
Definition
| the patient lies supine with knees bent and feet flat on the table |
|
|
Term
| where should a drape be placed on a patient in the dorsal recumbent position? |
|
Definition
| place drape in a diamond position from chest to toes |
|
|
Term
| where should a drape be placed in the lithotomy position? |
|
Definition
| drape in the diamond position as with the dorsal recumbent position |
|
|
Term
| what is the lithotomy position used for? |
|
Definition
| generally used for the pelvic examination |
|
|
Term
| what is the sims position used for? |
|
Definition
| used for examination of the rectum or obtaining rectal temperature |
|
|
Term
| how should a physician drape a patient in the sims position? |
|
Definition
| drape the patient from shoulder to toes |
|
|
Term
| to determine position, texture, size, consistency, fluid, crepitus, form of a mass or structure, what part of the hand should a physician use? |
|
Definition
| palmar surface of the fingers and finger pads |
|
|
Term
| for determining vibration, what part of the hand should a physician use? |
|
Definition
| ulnar surfaces of the hand and fingers |
|
|
Term
| for determining temperature, what part of the hand should the physician use? |
|
Definition
| dorsal surface of the hand |
|
|
Term
| what is percussion and how is it ordered? |
|
Definition
striking one object against another to produce vibration and subsequent sound waves
classified according to:
tympany
hyperresonance
resonance
dullness
flatness |
|
|
Term
| true or false: in percussion, tympany is the loudest and flatness is the quietest |
|
Definition
|
|
Term
| what are some common percussion errors? |
|
Definition
failing to exert firm pressure with the finger placed on the skin surface
failing to separate the hammer finger from the other fingers
snapping downward from the elbow or shoulder rather than from the wrist
striking with the finger pad rather than the fingertip of the hammer finger |
|
|
Term
|
Definition
| listening for sounds produced by the body |
|
|
Term
| a healthy person with no anemia or lung disease has an spO2 of what? |
|
Definition
|
|
Term
| what is being recognized more and more as the fifth vital sign? |
|
Definition
|
|
Term
| does the scale need to be calibrated everytime you weigh a patient? |
|
Definition
|
|
Term
| how would someone perform pivot transfer on a patient with a mobility impairment? |
|
Definition
| standing in front of patient, the assistant takes the patients knees between his or her own knees, grasps the patient around the back and under the arms, raises the patient to a vertical position and then pivots from the wheelchair to the table |
|
|
Term
| how would someone perform cradle transfer on a patient with a mobility impairment? |
|
Definition
| while bending or squatting beside the patient, the assistant puts one arm under both of the patient's knnes and the other arm around the back and under the armpits. assistant then stands and carries the patient to the table |
|
|
Term
| how would two person transfer be performed on a patient with a mobility impairment? |
|
Definition
method 1: patient folds arm across chest; assistant standing behind the patient kneels down, putting his or her elbows under the patient's armpits and grasps the patients opposite wrists; the second assistant lifts and supports the patient under the knees
method 2: used if patient cant fold arms; the assistant standing behind the patient puts his or her hands together around the patient if possible so there is less likelihood of losing hold of the patient; the second assistant lifts and supports the patient under the knees |
|
|
Term
| what is autonomic hyperreflexia? |
|
Definition
| describes a set of symptoms common to people with spinal cord injury; it is often due to stimulation of the bowel, bladder, or skin below the spinal lesion |
|
|
Term
| what are the 3 types of stethoscopes? |
|
Definition
| acoustic, magnetic, electronic |
|
|
Term
| describe an acoustic stethoscope |
|
Definition
has a rigid diaphragm with a natural frequency of 300 Hz
transmits low pitched sounds when very light pressure is used
has a bell endpiece |
|
|
Term
| describe a magnetic stethoscope |
|
Definition
has a single endpiece that is a diaphragm
compression of the diaphragm activates the air column as magnetic attraction is established between the iron disk and the magnet |
|
|
Term
| describe the electronic stethoscope |
|
Definition
picks up vibrations transmitted to the surface of the body and converts them into electrical impulses
impulses are amplified and transmitted to a speaker, where they are reconverted to sound |
|
|
Term
| which stethoscope is most commonly used? |
|
Definition
|
|
Term
| describe a stereophonic stethoscope |
|
Definition
with a single tube, diaphragm and bell, it looks and functions like an acoustic stethoscope
has a two channel design which allows the stethoscope to differentiate between right and left auscultatory sounds |
|
|
Term
| what does a pulse oximeter measure? |
|
Definition
the percentage of hemoglobin saturated with oxygen
oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through
deoxygenated hemoglobin absorbs more red light and allows more infrared light to pass through |
|
|
Term
|
Definition
dopplers are ultrasonic stethoscopes that detect blood flow rather than amplify sounds, and they vary in frequency from 2 to 10 MHz
mechanism of action is the doppler shift principle |
|
|
Term
| what are some uses of a doppler? |
|
Definition
detect systolic blood pressures in patients with weak or difficult to hear sounds
used to auscultate fetal heart activity, locate vessels, take weak pulses, and assess vessel patency |
|
|
Term
|
Definition
determines fetal heart rate
has a band that fits against the head of the listener and makes handling of the instrument unnecessary |
|
|
Term
|
Definition
has a weighted end that, when placed on the abdomen, does not need stabilization by the clinician
can detect fetal heart rate at 17 to 19 weeks of gestation |
|
|
Term
| what is an ophthalmoscope? |
|
Definition
has a system of lenses and mirrors that enables visualization of the interior structures of the eye
the number ranging from +- 20 to +-140 corresponds to the magnification power (diopter) of the lens
positive numbers are shown in black, negative numbers in red |
|
|
Term
| what is a strabismoscope? |
|
Definition
used for detecting strabismus and can be used as part of eye testing in children
instruct the child to focus on an accommodative target, such as a wall poster that comes with the instrument.
turn on the strabismoscope and place it over the patients eye
you are able to see in but the patient is not able to see out |
|
|
Term
| what is a snellen alphabet visual acuity chart? |
|
Definition
screening examination of far vision for literate, verbal and english speaking adults and school age children
measurement other than 20/20 indicates either a refractive error or an optic disorder |
|
|
Term
| which visual acuity tests should be used for children ages 3 to 5? |
|
Definition
| the tumbling E and the HOTV test |
|
|
Term
| what is the tumbling E visual acuity test? |
|
Definition
a nonalphabet version of the snellen chart
has a capital letter e facing in different directions |
|
|
Term
| what is a HOTV visual acuity chart? |
|
Definition
consists of a wall chart composed only of h's, o's, t's and v's
child has board and has to match letter pointed to by physician with letter on the board |
|
|
Term
| what is an LH symbols visual acuity chart? |
|
Definition
| consists of four optotypes (circle, square, apple, house) that blur equally; the child has to find a matching block or point to the shape that matches the target presented |
|
|
Term
| what is the broken wheel cards test? |
|
Definition
consists of 6 pairs of cards with the following acuities: 20/100, 20/80, 20/60, 20/40, 20/30, and 20/20
in each pair, one card has solid wheels while the other has broken wheels
the child identifies the card that has the broken wheels on the pictured car |
|
|
Term
| which charts are used to assess near vision? |
|
Definition
| rosenbaum or jaeger charts |
|
|
Term
| what is a rosenbaum chart? |
|
Definition
| contains a series of numbers, e's, x's, and o's in graduated sizes |
|
|
Term
|
Definition
a screening test for use with individuals at risk of macular degeneration
monitors about 10 degrees of central vision and is used when retinal drusen bodies are seen during an ophthalmologic examination or when there is a strong family history of macular degeneration
patient notes the occurence of line distortion or actual scotoma on a graph paper |
|
|
Term
|
Definition
provides illumination for examining the external auditory canal and the tympanic membrane
can also be used for the nasal examination if nasal speculum not available
a handbulb attached to the other end of the tubing, when squeezed, produces puffs of air that cause the tympanic membrane to move |
|
|
Term
|
Definition
assesses the functions of the ossicular chain, eustachian tube, and tympanic membrane, as well as the interrelation of these parts
the probe introduces a pressure of 200 daPa to the middle ear canal
the positive pressure forces the tympanic membrane inward and the approximate ear canal volume is recorded |
|
|
Term
| what is the nasal speculum used to visualize? |
|
Definition
| used with a penlight to visualize the lower and middle turbinates of the nose |
|
|
Term
| what are tuning forks used for? |
|
Definition
used in screening tests for auditory function and for vibratory sensation as part of the neurologic examination
as they are activated, vibrations are created that produce a particular frequency of sound wave, expressed as cycles per second of hertz
for auditory evaluation use a fork with a frequency of 500 to 1000 hz
forks of lower frequency can cause you to overestimate bone conduction and can be felt as vibration as well as heard
for vibratory sensation use a fork of lower frequency; best for vibration is 100 to 400 hz
activate the tuning fork by tapping it against the heel of your hand then apply the base of the fork to a bony prominence |
|
|
Term
| what is a percussion hammer (reflex) used for? |
|
Definition
used to test deep tendon reflexes
hold the hammer loosely between the thumb and the index finger so that the hammer moves in a swift arc and in a controlled direction |
|
|
Term
| what is a neurologic hammer used for? |
|
Definition
used for testing deep tendon reflexes
has a brush and sharp needle
dont use sharp needle
some models come with a rotating wheel |
|
|
Term
| what is a tape measure used for measuring? |
|
Definition
determining circumference, length and diameter
make sure that tape measure is not caught or wrinkled beneath patient and that it is not applied too tightly to depress the skin |
|
|
Term
| what is a transilluminator? |
|
Definition
consists of a strong light source with a narrow beam; the beam is directed to a particular body cavity and is used to differentiate between various media present in that cavity
air, fluid and tissue differentially transmit light
this allows you to detect the presence of fluid in sinuses, the presence of blood or masses in the scrotum, and abnormalities in the cranium of infants |
|
|
Term
| describe a vaginal speculum |
|
Definition
composed of two blades and a handle
3 basic types used to view the vaginal canal and the cervix
the pederson speculum has blades that are as long as those of the graves speculum but are both narrower and flatter for women with small vaginal openings |
|
|
Term
|
Definition
used to determine the degree of joint flexion and extension
consists of two straight arms that intersect and that can be angled and rotated around a protractor marked with degrees |
|
|
Term
|
Definition
contains a light source with a wavelength of 360 nm
this is a black light that causes certain substances to fluoresce
used primarily to determine the presence of fungi or skin lesions |
|
|
Term
|
Definition
| skin surface microscope that uses epiluminescence microscopy with or without the application of oil on a skin lesion to illuminate and magnify a lesion to allow for a more detailed inspection of the surface of pigmented skin lesions |
|
|
Term
| what are calipers for skinfold thickness used to measure? |
|
Definition
| designed to measure the thickness of subcutaneous tissue at certain points of the body |
|
|
Term
|
Definition
device designed to test for loss of protective sensation, particularly on the plantar surface of the foot
patients who cannot feel the application of the monofilament at the point that it bends have lost their protective sense and are at increased risk for injury |
|
|
Term
| the palpable and sometimes visible arterial pulses are the result of? |
|
Definition
|
|
Term
| what is the arterial blood pressure? |
|
Definition
| the force exerted by the blood against the wall of an artery as the ventricles of the heart contract and relax |
|
|
Term
| which arteries have the most definitive pulse for evaluation of cardiac function? |
|
Definition
| the carotid arteries since they are the most accessible of the arteries closest to the heart |
|
|
Term
| what is the dicrotic notch? |
|
Definition
| the secondary upstroke in the descending part of a pulse tracing corresponding to the transient increase in aortic pressure upon closure of the aortic valve. |
|
|
Term
| the jugular veins empty directly into? |
|
Definition
|
|
Term
| the level at which the jugular venous pulse is visible gives an indication of what? |
|
Definition
|
|
Term
| the jugular veins reflect the activity of which side of the heart? |
|
Definition
|
|
Term
| the larger internal jugular veins lie where? |
|
Definition
| run deep to the sternocleidomastoids, near the carotid arteries, and are less accessible to inspection |
|
|
Term
| what does the a wave stand for in venous pulsations? |
|
Definition
first and most prominent component
is the result of a brief backflow of blood to the vena cava during right atrial contraction |
|
|
Term
| what does the c wave stand for in venous pulsations? |
|
Definition
| a transmitted impulse from the vigorous backward push produced by closure of the tricuspid valve during ventricular systole |
|
|
Term
| what does the v wave stand for in venous pulsations? |
|
Definition
caused by the increasing volume and concomitant increasing pressure in the right atrium
it occurs after the c wave, late in ventricular systole |
|
|
Term
| what does the x slope stand for in venous pulsations? |
|
Definition
| caused by passive atrial filling |
|
|
Term
| what does the y slope stand for in venous pulsations? |
|
Definition
| reflects the open tricuspid valve and the rapid filling of the ventricle |
|
|
Term
| describe pulmonary vascular resistance and systemic vascular resistance in infants and children? |
|
Definition
PVR drops and SVR increases
blood flows more freely to the lungs and less freely systemically
the ductus arteriosus closes, usually within the first 12 to 14 hours of life |
|
|
Term
| what happens to the systemic vascular resistance during pregnancy? |
|
Definition
SVR decreases and peripheral vasodilation occurs, often resulting in palmar erythema and spider telangiectasias
the systolic blood pressure decreases slightly
there is a greater decrease in the diastolic pressure; lowest levels occur in the second trimester |
|
|
Term
| calcification and other changes in the walls of the arteries in the elderly cause what? |
|
Definition
cause dilation and tortuosity of the aorta, aortic branches, and the carotid arteries
the superficial vessels of the forehead, neck and extremities also become tortuous and more prominent |
|
|
Term
| what are some key components of a healthy diet? |
|
Definition
| olive oil in abundance, wine in moderation |
|
|
Term
| true or false: women are four times more likely to develop varicose veins than men |
|
Definition
|
|
Term
| out of all the arterial pulses, which arteries are the most easily accessible and closest to the cardiac source? |
|
Definition
the carotids
most useful in evaluating heart activity |
|
|
Term
| what does the allen test test for? |
|
Definition
| patency of the ulnar artery |
|
|
Term
| describe an alternating pulse |
|
Definition
characterized by alternation of a pulsation of small amplitude with the pulsation of large amplitude while the rhythm is regular
possible cause: left ventricular failure |
|
|
Term
| describe a pulsus bisferiens pulse |
|
Definition
best detected by palpation of the carotid artery
characterized by 2 main peaks
the first is termed the percussion wave and the second the tidal wave
although the mechanism is not clear, the first peak is believed to be the pulse pressure and the second the reverberation from the periphery
possible cause: aortic stenosis combined with aortic insufficiency |
|
|
Term
| describe a bigeminal pulse |
|
Definition
result from a normal pulsation followed by premature contraction
amplitude of the pulsation of the premature contraction is less than that of the normal pulsation
possible cause: disorder of rhythm |
|
|
Term
| describe a large bounding pulse |
|
Definition
readily palpable
does not fade out and is not easily obliterated by the examining fingers
pulse is recorded as a 3+
possible causes: exercise, anxiety, fever, hyperthyroidism, aortic rigidity |
|
|
Term
| describe a paradoxic pulse |
|
Definition
| characterized by an exaggerated decrease in the amplitude of pulsation during inspiration and increased amplitude during expiration |
|
|
Term
| what is a water-hammer pulse (corrigan pulse)? |
|
Definition
collapsing
has a greater amplitude than expected, a rapid rise to a narrow summit and a sudden descent |
|
|
Term
| if a pulse is graded +4 what does that indicate? |
|
Definition
|
|
Term
| if a pulse is graded +3 what does that indicate? |
|
Definition
|
|
Term
| if a pulse is graded +2 what does that indicate? |
|
Definition
|
|
Term
| if a pulse is graded +1 what does that indicate? |
|
Definition
| diminished, barely palpable |
|
|
Term
| what should the resting pulse rate be in a normal individual? |
|
Definition
|
|
Term
| what is tachycardia in an adult? |
|
Definition
| when the resting pulse rate exceeds 100 bpm |
|
|
Term
| what is bradycardia in an adult? |
|
Definition
| when the resting pulse rate is less than 60 |
|
|
Term
| what is sinus arrhythmia? |
|
Definition
| a cyclic variation of the heart rate characterized by an increasing rate on inspiration and decreasing rate on expiration |
|
|
Term
| where are sites to auscultate for a bruit? |
|
Definition
| temporal, carotid, subclavian, abdominal aorta, renal, iliac, and femoral arteries |
|
|
Term
| where is a venus hum heard? |
|
Definition
at the medial end of clavicle and anterior border of the sternocleidomastoid muscle
has no clinical significance
in adults may occur with anemia, pregnancy, thyrotoxicosis or intracranial arteriovenous malformation |
|
|
Term
| when can carotid artery bruits be heard? |
|
Definition
with vigorous left ventricular ejection
sounds are usually low pitched and relatively hard to hear
occurs with stenotic disease in cervical arteries |
|
|
Term
|
Definition
| pain that results from muscle ischemia |
|
|
Term
| what is the first symptom of peripheral arterial disease? |
|
Definition
| pain that results from muscle ischemia (claudication) |
|
|
Term
| what is the capillary refill time? |
|
Definition
time it takes the capillary bed to fill after it is occluded by pressure
gives some indication of the health of the system
refill should occur almost instantly, in less than 2 seconds |
|
|
Term
| if there is pain in the calf muscles, what is a probably obstructed artery? |
|
Definition
| superficial femoral artery |
|
|
Term
| if there is pain in the thigh, what is the probaly obstructed artery? |
|
Definition
| common femoral artery or external iliac artery |
|
|
Term
| if there is pain in the buttock, what is a probable obstructed artery? |
|
Definition
common iliac artery and distal aorta
erectile dysfunction may accompany the stenosis |
|
|
Term
| blood pressures taken when the patient is supine tend to be higher or lower? |
|
Definition
|
|
Term
| does blood pressure increase with age? |
|
Definition
|
|
Term
| what is the optimal blood pressure? |
|
Definition
<120 systolic
<80 diastolic |
|
|
Term
| what is the classification for prehypertension in adults? |
|
Definition
120-139 systolic
80-89 diastolic |
|
|
Term
| what is the classification for stage 1 hypertension in adults? |
|
Definition
140-159 systolic
90-99 diastolic |
|
|
Term
| what is the classification for stage 2 hypertension in adults? |
|
Definition
>160 systolic
>100 diastolic |
|
|
Term
| when recording blood pressure in both of the patient's arms which reading should be accepted as the closest to the patient's blood pressure? |
|
Definition
|
|
Term
| what is the pulse pressure? |
|
Definition
| the difference between the systolic and the diastolic pressures |
|
|
Term
| what should be the normal range for the pulse pressure? |
|
Definition
| should range from 30-40 mm Hg, to as much as 50 mm Hg |
|
|
Term
| which pressure, systolic or diastolic, is more readily responsive to a wide range of physical, emotional and pharmacologic stimuli? |
|
Definition
|
|
Term
| true or false: hypertension is usually defined on the basis of several measurements taken over time |
|
Definition
|
|
Term
| do persons with hypertension generally show easily identifiable symptoms? |
|
Definition
|
|
Term
| what is a paradoxical pulse? |
|
Definition
the difference in systolic pressure between expiration and inspiration
should be 5 mm Hg
if it is greater than 10 mm Hg, the paradoxical pulse is exaggerated |
|
|
Term
| what are some conditions that may undermine the accuracy of blood pressure even with impeccable technique? |
|
Definition
cardiac dysrhythmias
aortic regurgitation
venous congestion
valve replacement |
|
|
Term
| describe how one would measure the jugular venous pressure |
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Definition
requires two rulers at least 15 cm long
a ed or examining table with an adjustable angle of back support is used
use a light to supply tangential illumination across the neck to accentuate the appearance of the jugular venous pulsations
patient in supine position; position results in engorgement of the jugular veins
the jugular pulse can only be visualized; it cannot be palpated
the vertical distance above the level of the heart is noted as the mean JVP in centimeters of water; a value less than 9 cm H20 is the expected value |
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Term
| does the effect of respiration, venous compression or abdominal pressure have an effect on the carotid pulse waves? |
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Definition
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Term
| what effect does venous compression have on the jugular pulse waves? |
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Definition
| easily eliminates pulse wave |
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Term
| what effect does respiration have on the jugular pulse waves? |
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Definition
| level of pulse wave decreased on inspiration and increased on expiration |
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Term
| what effect does abdominal pressure have on jugular pulse waves? |
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Definition
may cause some increased prominence even in well persons
with right sided heart failure, jugular vein may be more visible |
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Term
| how would one assess the hepatojugular reflex? |
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Definition
use your hand to apply firm and sustained pressure to the abdomen in the midepigastric region and instruct the patient to breathe regularly
observe the neck for an elevation in JVP followed by an abrupt fall in JVP as the hand pressure is released |
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Term
| how would one evaluate the hand veins? |
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Definition
palpate the hand veins, which should be engorged, to make sure they are compressible; slowly raise the hand until the hand veins collapse
use a ruler to note the vertical distance between the midaxillary line at the nipple level and the level of collapse of the hand veins.
confirm this level by lowering the hand slowly until the veins distend again and raise it back until they once again collapse. this distance should be identical to the mean JVP |
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Term
| when should one suspect a deep vein thrombosis? |
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Definition
| if swelling, pain and tenderness occur over a vein |
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Term
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Definition
flex the patients knee slightly with one hand and with the other dorsiflex the foot
the complaint of calf pain with this procedure is a positive sign and may indicate venous thrombosis
absence of homan sign does not preclude venous thrombosis |
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Term
| what indicates pitting edema? |
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Definition
| a depression that does not rapidly refill and resume its original contour |
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Term
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Definition
dilated and swollen, with a diminished rate of blood flow and an increased intravenous pressure
result from incompetence of the vessel wall or venous valves, or an obstruction in a more proximal vein |
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Term
| if edema is unilateral, what should one suspect? |
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Definition
| the occlusion of a major vein |
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Term
| are the brachial, radial and femoral pulses of the newborn easily palpable? |
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Definition
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Term
| what does the usual newborn blood pressure range between? |
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Definition
60-96 mm hg systolic
30-62 mm hg diastolic
a sustained increase in blood pressure is almost always significant |
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Term
| what causes a venus hum in children? |
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Definition
| caused by turbulence of blood flow in the internal jugular veins |
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Term
| true or false: a very ill baby with a good blood pressure can quickly become hemodynamically unstable |
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Definition
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Term
| true or false: blood pressures that would typically be considered usual in nonpregnant women may indicate impending problems in a pregnant one |
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Definition
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Term
| how is hypertension defined in older adults? |
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Definition
defined as a pressure greater than 140/90
the systolic blood pressure may increase with age |
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Term
| hypertension in children under the age of 10 is caused by what? |
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Definition
| kidney disease, renal arterial disease, coarctation of the aorta, or pheochromocytoma |
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Term
| how should one use the charts developed for percentiles of hypertension in children? |
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Definition
find the child's age on the left side of the table and follow the age row horizontally across the table to the intersection of the line for the child's height percentile.
find the blood pressure closest to the childs
then determine whether the childs systolic and diastolic blood pressures are below, at, or above the 90th or 95th percentile values |
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Term
| what is temporal arteritis? |
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Definition
an inflammatory disease of the branches of the aortic arch including the temporal arteries
also called giant cell arteritis
flulike symptoms, ocular symptoms, headache in the temporal region, tongue pain and jaw claudication from ischemia |
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Term
| what is an arterial aneurysm? |
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Definition
localized dilation, generally defined as 1.5 times the diamete of the normal artery, caused by a weakness in the arterial wall
is a result of atherosclerosis
4 times more common in men than in women
tha patient may describe a severe ripping pain |
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Term
| what is an arteriovenous fistula? |
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Definition
a pathologic communication between an artery and a vein
may be congenital or acquired
if the fistula is too large, there may be significant arterial to venous shunting of blood
patients may present with lower extremity edema, varicose veins or claudication due to ischemia |
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Term
| what is peripheral arterial disease? |
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Definition
stenosis of the blood supply to the extremities by atherosclerotic plaques
most common cause is peripheral atherosclerosis
limb appears healthy but pulses are weak or absent
edema seldom accompanies this disorder, but ulceration is common in severe disease, and the muscle may atrophy |
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Term
| what is the raynaud phenomenon? |
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Definition
exaggerated spasm of the digital arterioles usually in response to cold exposure
primary raynaud occurs most commonly in young, healthy individuals; most commonly women with no evidence of an underlying cause
secondary raynaud is associated with an underlying connective tissue disease such as scleroderma or systemic lupus erythematosus
involved areas will feel cold and achy, which improves on rewarming |
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Term
| what is arterial embolic disease? |
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Definition
atrial fibrillation can lead to clot formation within the atrium; if the clot is unstable, emboli may be dispersed throughout the arterial system
symptoms include pain and paresthesias
emboli can also be caused by atherosclerotic plaques, infectious material and atrial myxomas |
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Term
| what is venous thrombosis? |
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Definition
can occur suddenly or gradually and with varying severity of symptoms; it can be the result of trauma or prolonged immobilization
tenderness along the iliac vessels or the femoral canal, in the popliteal space or over the deep calf veins
pulmonary embolism may occur without warning
may be asymptomatic |
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Term
| what is hypertension responsible for? |
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Definition
stroke, renal failure, and congestive heart failure
blood pressure consistenly at 140/90 or higher
pathogenesis poorly understood
you should always assess for any end-organ damage that may be present (papilledema and evidence of heart failure) |
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Term
| what is tricuspid regurgitation? |
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Definition
the backflow of blood into the right atrium during systole
commonly due to conditions that lead to dilation of the right ventricle
symptoms include ascites or peripheral edema
v wave is much more prominent and occurs earlier often merging with the c wave |
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Term
| what is atrial fibrillation? |
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Definition
may result in decreased cardiac output and atrial thrombus formation with subsequent embolization
the a wave is absent and the pulse is irregularly irregular |
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Term
| what is cardiac tamponade? |
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Definition
accumulation of fluid within the pericardial space leading to compression and dysfunction of the heart chambers
the JVP fails to fall with inspiration as it usually does and may actually increase (Kussmaul sign); pulsus paradoxus |
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Term
| what is constrictive pericarditis? |
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Definition
chronic inflammation and subsequent scarring of the pericardium
pericardial thickening and inelasticity
diminished cardiac filling and output
there is a prominent y-descent |
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Term
| what is coarctation of the aorta? |
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Definition
a stenosis seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum
due to congenital defect of the underlying vascular wall
asymptomatic unless severe hypertension or vascular insufficiency develops
acquired due to inflammatory aortic disease or severe atherosclerosis |
|
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Term
| what is kawasaki disease? |
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Definition
acute vasculitic illness of uncertain cause affecting young males more often than females
the critical concern is cardiac involvement in which aneurysms of a coronary artery may develop
can result in both vascular stenosis and aneurysm formation
symptoms include weight loss, fatigue, myalgias, as well as arthritis
findings include conjunctival injection, strawberry tongue, and edema |
|
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Term
| what is preeclampsia-eclampsia? |
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Definition
defines a syndrome specific to pregnancy; it is determined by hypertension that occurs after the 20th week of pregnancy and the presence of proteinuria
eclampsia is preeclampsia with seizures when no other cause for the seizures can be found
result from a combination of vascular and immunologic abnormalities within the uretoplacental circulation
may be diagnosed with proteinuria
elevation of blood pressure |
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Term
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Definition
results from chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension
may result from incompetent valves, obstruction of blood flow, or loss of the pumping effect of the leg muscles
frequently is asymptomatic
patients describe a leg heaviness and discomfort progressing to edema and ulceration |
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Term
| what are some factors that may limit the patient's ability to observe well and to report accurately? |
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Definition
sensory deprivation
emotional constraints: apparent and unapparent
language barriers
cultural barriers
unresponsive or comatose patient |
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Term
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Definition
taken at 1 and 5 minutes of age, provides insight to the baby's in utero, intrapartum and immediate postnatal experience
a low score is evidence of difficulty
the apgar score does not address problems that are suggested by increased irritability, tachypnea, or tachycardia |
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Term
| what does a soap note stand for? |
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Definition
subjective data-patient tells you
objective data-direct observations from what you see
assessment
plan |
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Term
| describe heart rate and its normal ranges |
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Definition
VARIES WITH AGE **Born at 150, end at 0
Normal heart rate range adults: 50-60 up to 90-100
Palpable rate, not just the rhythm monitor
Pulse is palpable because of distension of the artery wall, transmission is faster into smaller vessels, 15 times the speed of the blood
Pulse pressure: difference between systolic and diastolic pressures: wider, easier to feel
Elevated blood pressure: easy to feel pulse,
Hypotensive: difficult to palpate pulse, 70 - 60?
Average heart rate at birth 120-160
Average resting heart rate drops from birth until adulthood, but then can go up again as we age because many of us develop disease or don’t exercise, but if we stayed in shape, slow decrease in rate over time
Exercise Heart rate, maximal 220-age 20. maximal at 140 age 80
Women, average resting heart rate is faster : smaller heart: your heart is the size of your fist |
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Term
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Definition
| severe constricting pain (pectoris) area, usually occurs with exertion, however, unstable or MI can occur at rest |
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Term
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Definition
| loss of consciousness and body tone |
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Term
| what happens during shock? |
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Definition
| cells of the body receive inadequate amounts of oxygen, usually secondary to perfusion problem |
|
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Term
| describe the causes and characteristics of bradycardia |
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Definition
Definition: Heart rate below 50 (60)
Differential Diagnosis:
Physiological: Trained athletes can have resting heart rate in the 30’s, secondary to high vagal tone, ideal oxygen delivery and utilization
Medications can also cause, B blockers, digitalis, Ca channel blockers, drug overdoses
Cardiac conduction system disease: may be confined to the electrical cells or not: LEV’s disease: age VS, heart rate: ASHD cardiomyopathy, rheumatic fever. The lower the origin of the rhythm in the cardiac conduction system, the slower the heart rate: sinus node usually the fastest
Inferior wall MI (BOTTOM OF HEART) : decreased flow to SA & AV nodes, increased vagal tone: bradycardia
Hyperkalemia, hypothyroidism can cause as well |
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Term
| what happens during tachycardias? |
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Definition
As heart rate increases, the amount of time spent in systole (pump squeeze) and diastole (relaxes) decreases. Diastole takes longer, time to fill the ventricles. Diastole shortens more than systole with tachycardias.
For all of us there will be a FAST enough heart rate where there is inadequate filling time for the heart which will lead to a drop in cardiac output. The heart will cease being an effective pump.
Blood pressure and perfusion of body tissues drops, symptoms occur
Atrial contraction improves filling of the main pump by 20-30%. Loss of that function decreases cardiac output, especially in older people
One common rhythm abnormality, Atrial fibrillation, accomplishes both: fast and no atrial contraction |
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Term
| what are some questions one would ask a patient if there is a recorded abnormal heart rate? |
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Definition
Symptomatic? Or not
Fever
Palpitations
Short of breath
Chest pain
Syncope
History of thyroid problems
History of hypertension
History of heart attack or other heart problems, murmurs
History of any lung disease |
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Term
| what does blood pressure depend on? |
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Definition
| BP depends on the stroke volume of the heart, compliance of the aorta and peripheral artery resistance |
|
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Term
| describe the 5 korotkoff components? |
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Definition
1: The first 2 snapping sounds as arterial BP> slightly greater than BP cuff elevation
2: Murmur of flow occurring between systolic and diastolic arterial pressure
3: Loud crisp tapping
4: Thumping (muted) about 10mm above true diastole* Pediatric
5. Disappearance of all sound, BP cuff pressure below arterial diastole |
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Term
| what are some causes for transient hypertension? |
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Definition
| white coat syndrome (anxiety), cold room, smoking, caffeine, exercise |
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Term
| history of a hypertensive patient should include questions on? |
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Definition
Vision
Heart pain
Stroke and carotid artery problems
Kidneys: both cause and effect of hypertension |
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Term
| describe respiratory rate and its normal range |
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Definition
Normal range 12-20 (adults)
Charts for newborns and children
If abnormal, why? Primary: LUNG CAUSE or Secondary to another problem ie heart, metabolic
Lungs function not only for gas exchange but also as a compensatory mechanism for adjustment of metabolic problems in the body (along with Kidneys)
Tumor, CNS bleed or ischemic stroke affect medullary and cerebral breathing centers and therefore secondarily the respiratory rate |
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Term
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Definition
| many primary and secondary causes but it is the normal response to hypoxia (decreased below normal levels of oxygen in inspired gas, the arterial blood and tissues) |
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Term
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Definition
| deoxygenation of 5 grams of hemoglobin in every 100ml. of blood |
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| what is the normal body temperature and what temperature constitutes a fever? |
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Definition
First clinical thermometer Sir Thomas Clifford Allbut 1866, Normal 98.6o F, +-0.9oF (37o C)
Every degree elevation increases basal metabolic rate (and heart rate) by 10%
Obtain temperature, where? Site variation
Temperature varies throughout the day, highest usually in the evening or at night, Why?
Fever (pyrexia Gr feverish): Temperature> 37.5o C (99.5oF), signifies inflammation and tissue destruction, not always infection |
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Term
| what does the suffix itis stand for? |
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Definition
|
|
Term
| what does the suffix rhea stand for? |
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Definition
|
|
Term
| what is hyperthermia and what are its consequences? |
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Definition
Temperature above 104o begins to cause damage. Above 104o enzymes are denatured, mitochondrial function is disturbed and oxygen dependent metabolic pathways are disrupted.
Temperatures can exceed 105.5o F+ and cause severe brain damage and or death. With cell damage at high temperatures, rhabdomyolysis (acute destruction of skeletal muscle), cytotoxic cerebral edema (brain swelling), hypotension, failure of lungs, heart, kidney and liver and GI hemorrhage can occur
Heat stroke, total loss of thermal regulation, temperatures can reach 112o F Total loss of thermal regulation results in CNS depression, hypohidrosis with severe physiological and biochemical abnormalities: DEATH |
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Term
| what is hypothermia and what are its consequences? |
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Definition
Hypothermia causes generalized enzymatic slowing, vasoconstriction and cessation of O2 dependent metabolism
Respiratory, cardiac suppression with increased dysrhythmia, renal failure: Acute Tubular Necrosis
Death with total loss of hypothalamic regulation 84o F or below
The pluses of being hypothermic:
Damage mediated cell suicide
Cold water drowning, CPR till warm, actually used in heart bypass pump surgery to protect the heart: the heart is put into asystole, & now being used to prevent cell damage in cardiac arrest in Emergency Rooms
Hypothermia: temperature below 35o C
Rx: increase core temperature, continue CPR until temperature is normal |
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Term
| what questions should be asked for a patient with hyperthermia? |
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Definition
Temperature measured, if so, range and or how high, pattern of the fever
Associated night sweats
Shaking chills (higher temperature, more of a risk of loss of thermal control
Lethargic or stuporous |
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Term
| what questions should be asked for a patient with hypothermia? |
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Definition
Exposure
Drowning
Drugs
Brain signs, stroke, Parkinsonism confusion, lethergy
History of hypothyroidism: lethargic, slow motor skills, slow thinking, hoarseness |
|
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Term
|
Definition
19-25
60 % of US population >25
weight in relation to height |
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Term
| what are some questions to ask for a history on an obese individual? |
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Definition
Hunger, thirst, increased urination, weakness, weightloss (3 P’s, 2 W’s)
Sudden change, fluid retention: heart or kidney disease (malnutrition, liver disease)
Diet habits, types of food and times
Exercise or lack thereof |
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Term
| define oxygen saturation and the maximal lung alveolar pO2 |
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Definition
The quantity of oxygen bound hemoglobin in normal systemic arterial blood: normal 97%. (1.4 ml. of oxygen/100 ml blood containing usually 15 grams of hemoglobin)
Post perfusion by capillaries, venous saturation drops to 75% saturation.
Differs from pO2: the partial pressure of single component of a mixture of gasses in a liquid. It is usually expressed in mm Hg or Torr
Maximal lung alveolar pO2 is 104 mm Hg, too high only when given medically, inspired O2, frequency, depth on ventilator |
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Term
| how long is a stethoscope? |
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Definition
length of tubing is 30.5 to 40 cm (12 to 18 inches) to minimize distortion
tubing is thick stiff and heavy for better conduction |
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