Health Assessment / Patho Final (yeet)
3 Major Functions of the Lymphatic system
1. collects excess fluid and plasma proteins from the spaces between body cells and returns it to the venous system, BP pushes out more fluids into the capillary beds than the veins can reabsorb, without lymphatic drainage, fluid would build up and produce edema 2. transports digested fats/lipids from the small intestine to the cardiovascular system 3. immune function, lymphatic capillaries join to form larger vessels that pass through filters called lymph nodes, cells within the lymph nodes engulf cellular debris and bacteria and produce antibodies, microbes are exposed to B and T cells lymphocytes within the nodes which produces an antigen-specific immune response
Visual Pathways
-physical anatomical connections b/w the eyes & brain and the flow of visual info along these connections (crossing over)
Confrontation Test
Gross measure of peripheral vision; compares person's peripheral vision with yours Position yourself at eye level about 2 feet away, direct person to cover one eye with opagque card and to look at your with other eye, cover your own eye opposite to person's covered on, you are testing the uncovered eye hold pencil or fingers as the target and start midline between you and the person, slowly advance it in from periphery in several directions, ask person to say "now" as target is first seen, this should be just as you see the object also
Normal temperature is influenced by...
Diurnal cycle (1-1.5º change occurring in early morning hours and peak occurring in late afternoon to early evening), Menstruation cycle in women (progesterone secretion, occurring with ovulation at midcycle, causes a 0.5 to 1.0º rise in temp that continues unti menses, Exercise, Age (wider normal variation in infants/children due to less effective heat control mechanisms, in older adults temp is usually lower with an average of 97.2)
Lifestyle Habits and Health Practices
Does fatigue, chest pain, or SOB limit your ADLs? Has chest discomfort had any affect on sexual activity? How many pillows do you sleep on at night? Do you feel rested in the morning?
Factors that Affect Mental Health
Economic and social factors, unhealthy life choices, exposure to violence, personality, spiritual/cultural factors, impairment in structure or function of the neuro system, psychosocial development
Older Adult Eye Assessment
Lacrimal apparatus may decrease tear production, yellowish elevated nodules on sclera (pingueculae) are due to thickening of bulbar conjunctiva due to prolonged exposure to the sun, wind, dust), xanthelasma (soft, raised yellow plaques occurring on lids at inner canthus, common in 50s, more frequent in women, occur with both high and normal cholesterol levels)
Which type of stroke is a "silent stroke"?
Lacunar Infarcts (only 20% of all strokes)
Strep throat may lead to __________________, which may lead to _______________________.
Rheumatic Fever (autoimmunne disease), rheumatic heart disease
Upper Airway Inflammation
Rhinitis, Sinusitis, Pharyngitis, Tonsilitis, Epiglottis, Laryngitis Local manifestations: redness Systemic manifestations: fever Viral infections more common than bacterial infections, bacterial infections are more symptomatic, higher fevers, more gunk, longer lasting
Raynaud's disease
a peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or stress white/pallor = ateriospasm, diminished bloodflow Cyanosis = slight relaxation of spasm allowing a trickle of blood to the area Rubor = from hyperemia as spasms resolve and blood flow retunrs
Peau d'orange
a pitted or dimpled appearance of the skin, especially as characteristic of some cases of breast cancer
Cover test
a test that detects a small degree of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. ask the person to stare straight ahead at your nose, place a card in front of one eye and note the uncovered eye. A normal response is a steady fixed gaze.. if the uncovered eye jumps to reestablish fixation, eye muscle weakness exists
Pulmonary embolism
a thrombus develops in a vein, breaks off (emboli), lands in pulmonary vasculature, as the vasculature gets smaller, the emboli gets stuck seriousness depends on the size of the embolus and the location in the lungs, can be survivable or deadly Tx: clot busting drugs -- fibrinolytics -- pt needs to be treated quickly and be assessed for safety of taking this drug, clot removal (depending on where it is), if the clot is small - ppl can recover w a lil bit of dead tissue no biggie bc vasculature remodeling will take place
mesothelioma
a type of tumor specifically associated with asbestos, is often present within the pleural membrane, but can also metastasize (cancers related to asbestos can develop decades after exposure)
Immunizations (Vaccines)
a vaccine is a weakened virus, it cannot cause disease, it has the gene for the disease removed, a vaccine is administered to the body and the body "thinks" its an antigen, the body then builds specific Igs against it, sometimes more than one dose is needed (Hep B needs 3 doses)
intraluminal valves
a valve within the veins that opens toward the heart and closes to prevent back flow of blood
Pulse
a wave of blood created by contraction of the left ventricle of the heart
whispered pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue However, over areas of tissue abnormality, the whispered sounds will be clear and distinct.
Roosevelt Dawson
a young man with Guillain-Barre Syndrome who commited assisted suicide with Dr. Kervokian
Diseased livers may not be able to make ___________ or ________________________.
albumin or clotting factors
In the body, the major solutes are...
albumin, sodium, potassium, phosphate, magnesium, calcium, bicarbonate, and glucose.
If its not viral hepatitis is might be...
alcoholic hepatitis
Hypomagnesemia is frequently seen in...
alcoholics
The CDC recommends the pneumococcal vaccine for...
all children younger than 2 and adults older than 65
When measuring pulse...
always count for a full minute if irregular
Autoimmune Hepatitis
any age or sex, but 70-80% is female, unknown etiology, treatment is steroids and immunosuppressants, requires close follow up for many years, try and wean steroids (could cause flare ups), can lead to cirrhosis if not treated
Wear a gown, mask, and protective eyewear when potential exists for...
any blood or body fluid splattering
Aging Adults - Mouth, Nose, Throat Qs
any dryness in mouth? are you taking any meds? have you lost any teeth? can you chew all types of food? are you able to care for your teeth or dentures? any changes in sense of taste or smell?
Ear - Environmental Subjective Data
any loud noises at home or on the job? now or in the past? heavy machinery, loud peristent music, gunshots while hunting? do you take any steps to protect your ears (headphones, ear plugs)?
Nose Assessment Qs
any nasal discharge? watery, purulent, mucoid, bloody? how often do you get colds? any sinus pain? do you have chronic postnasal drip?any trauma to the nose? how often do you get nosebleeds? color of the blood? from one nostril or both? how do you treat them? Any allergies/hay fever? what are you allergic to? how do you treat your allergies? any change in sense of smell?
Mental Status Examination: Objective Data
appearance, behavior, cognition, and thought processes, posture, body movements, dress, grooming and hygiene, level of consciousness, facial expression, speech
Patients with right-sided diverticular disease can have RLQ tenderness similar to...
appendicitis
Right Lower Quadrant
appendix, ascending colon, cecum, right kidney, right ovary and tube, right ureter, right spermatic cord
MS Subjective Assessment
ask pt to point to the pain, document the mechanism of injury/trauma, clarify whether pain is localized, diffused, acute, or chronic, what is pt's functional status?
If a scrotal mass is palpated...
ask the pt to lie down, if it disappears, refer pt for further eval, if it does not disappear, ausculate for bowel sounds and push it upward into the abdomen - not able to be pushed in: incarcerated hernia
Assessing Client's Abdomen
ask them to empty their bladder, put on a gown, lie supine with arms folded across chest or resting at sides, drape client, breath slowly through the mouth
RN Care of AVF
assess for thrills and bruits!!! presence is good, occlusion is bad!! No IVs, BPs, to that arm to prevent thrombosis which can result in distal ischemia / shunting of blood
Preparing Oneself for Physical Exam
assess your own feelings, anxiety can be conveyed to the already anxious client, achieve confidence in performing physical assessment by practicing techniques on friends, classmates, relatives, ALWAYS protect yourself!!!
Glossopharyngeal (IX) and Vagus (X)
assessed together, controls swallowing, sensation in soft palate and tonsils, taste perception on posterior third of tongue and salivation, test by watching for symmetrical elevation when client says "ahh", touch posterior pharyngeal wall with a tongue depressor to elicit the gag reflex, ask pt to swallow
Glandular tissue
contains milk glands or 15-20 lobes that radiate in spoke fashion from the nipple, each lobe contains several lobules in which secreting alveoli are embedded in grape like clusters, mammary ducts from alveoli converge into a milk duct that leaves each lobe and brings milk to the nipple
Wheezes
continuous high-pitched whistling sounds produced during breathing, suggests partial airway obstruction due to secretions, tissue inflammation and swelling or a foreign body
Special Considerations when Interviewing
developmental stage, variation in communication (esp in older adults), cultural variation (related to male/female relationship or sexual orientation), emotional variation, and working with interpreters
Modifiable RF for CHD
diabetes, hypertension, smoking, obesity, physical inactivity
RDW (RBC distribution width)
difference between biggest and smallest RBC
Pulse Pressure
difference between systolic and diastolic pressure, "normal" finding is 40-50, less than 30 or greater than 50 indicates cardiovascular disease
Orthopnea is:
difficulty breathing when lying down
Older Client - Abdominal Assessment
dilated superficial capillaries without a pattern may be seen, this is normal due to less subQ tissue
Ebola is transmitted by
direct contact with contaminated fluids (blood, vomit, pee, poop, sweat, semen, spit, other fluids) or contact with objected contaminated with the virus (needles, medical equipment), infected fruit bats or apes/monkeys, possibly semen from a man who has recovered from Ebola
Collection of Objective Data
direct observation by examiner, physical characteristics, body functions, appearance, behavior, measurements, results of lab tests
Bacterial vaginosis
discharge is thin and gray/white, fishy smell, coats vaginal wall and cervix, vaginal wall and labia appear normal
Subjective Nose Data
discharge, frequent colds, upper respiratory infections, sinus pain, trauma, epistaxis (nosebleeds), allergies, altered smell
Seile purpura
discoloration due to increased capillary fragility
Grey Turner's sign
discoloration over the flanks suggesting intra-abdominal bleeding, usually between the last rib and top of the hip
Less common symptoms of MI
discomfort in the shoulder area, dizziness, changes in headache, vision problems
Bovine Spongiform Encephalopathy
disease of cattle ("mad cow disease") that can be transmitted to humans, causing Creutzfeldt-Jakob disease infectious agent is unknown, most accepted theory is that the agent is a prion
Flat, hollow, or less rounded shoulders are seen with?
dislocation
Dysplasia
disordered cells, cells that have lost normal architectural arrangement, a PRECANCEROUS condition, a chronic stressor in the cell environment can cause dysplasia, must be watched carefully because very often will develop into neoplasia
Myelodysplastic Syndrome (MDS)
disorders of the stem cells in the bone marrow, all or part of the bone marrow hematopoiesis is disorderly and ineffective -- differentiation of all or one category of precursor stem cells into committed cell lines is impaired, the patient suffers deficient numbers of all blood cells or one type of blood cells (WBC, RBC, platelets) -- those who have been treated by chemo/radiation are susceptible to this
Kidney Transplants: C/I
disseminated malignancies, untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, non-adherence substance abuse
Palpate the fingers from the ___________ end to the ___________ end, noting any tenderness, swelling, bony prominences, nodules, or crepitus.
distal, proximal
First question to ask when assessing the prostate:
do you have any problems starting your stream?
Guidelines for Documentation
document legibly in non-erasable ink, use correct grammar, use ONLY abbreviations that are acceptable to and approved by the institution, write entries objectively without premature judgements or diagnoses, record patient's understanding and perception of the problem, support objective data with specific observations obtained during the physical exam, avoid using the word normal for normal findings!!!
Earache COLDSPA
does it feel close to the surface or deep in the head? does it hurt to press on the ear? is it dull, achy, or sharp? is it constant or does it come and go? is it affected by changing head positions? Any accompanying cold symptoms or sore throat? Any problems with sinuses or teeth? Any recent ear trauma? what do you do to relieve the pain?
Prostate Cancer: Pt Education
don't overeat, avoid high-fat foods, eat a diet rich in fruits and veggies, fiber, and omega-3s, soy products and other legumes may have a positive effect, drink green tea daily, drink no more than 2 alcoholic drinks per day, get moderate exercise daily, sleep in a dark room
The heart is a pump that...
drives circulation
ptosis
drooping upper lid
Transmission of Flu
droplet infection and aerosols generated by coughs and sneeze, fomites (utensils, clothing) and hand to hand contact can also spread the virus
Parkinson's Disease Treatment
drug therapy to replace dopamine) (levodopa) palliative
Collection of Subjective Data
elicited and verified only by the patient, biographical info (name, age, religion, occupation), history of present health concern, past health history, family history, health and lifestyle practices (nutrition, activity, relationships, cultural beliefs, family structure)
Auscultation
eliminate distracting noise, expose the body part being auscultated, avoid listening through clothes
Low residue diet
eliminates or limits foods that are high in bulk and fiber, this slows down the gut, gives bowels a rest, tx for crohn's dz
Renal Replacement Therapy
encompasses life-supporting treatment for renal failure including: hemodialysis (HD), peritoneal dialysis (PD), Continuous Renal Replacement Therapy (CRRT, aka slow HD for ICU/unstable pts), renal transplants
Acromegaly
excessive secretion of growth hormone from the anterior pituitary gland , onset 20-40, progresses over years 90% of the time its from a stimulating pit tumor acro = extremities, soft tissue, hands, feet, ears, nose enlargement, shoes stop fitting, rings stop fitting, cardiomegaly, visual changes visual changes often the first complaint, tunnel vision most common (biemporal hemianopsia) tumor needs to be removed, there is risk of damaging pituitary
Diarrhea
frequent passage of loose, watery stools, not a disease a SYMPTOM caused by: decreased fluid re-absorption (Celiac, IBD - Crohn's and ulcerative colitis, mucosal damage) increased fluid secretion (bacterial infection, drugs, sorbitol, Zollinger-Ellison) motility problems (IBS, diabetic enteropathy, dumping syndrome)
Aging and the hair matrix
functioning melanocytes decrease, leading to gray fine hair
Other causes of pancreatitis
gallstones are second most common cause (sphincter of oddy), others are way less common: trauma, virus, duodenal ulcer, cysts, abscesses, cystic fibrosis, drugs, post-op complication, ERCP, cause can also be unknown: idiopathic
When inspecting and palpating skin, notice the color...
general pigmentation, freckles, moles, birthmarks, any widespread color changes - pallor, erythema, cyanosis, or jaundice
Herpes Simplex Virus HSV-2
genital herpes, can be acute and latent (inactive)
Urethral discharge
gently squeeze the glans, yellow could be gonorrhea, any discharge should be cultured
3 types of Breast tissue
glandular (milk production/functional layer), fibrous (supports glandular tissue), adipose (fatty tissue - determines size and shape of breast)
Peritonitis
localized or generalized inflammation of peritoneum, caused by blood borne organisms, pancreatitis, trauma, peritoneal dialysis aka vague pain that worsens when something perforates
Pupils expand when
looking far away, there is little light
Hemorrhagic CVA Tx
mannitol or 3% saline (to reduce edema), surgical decompression (removal of blood to reduce swelling, minimize damage), clipping/coiling if caused by ruptured aneurysm
CKD: Drug Therapy
many drugs are excreted by the kidneys, adjust drug dosages to degree of renal function, consider the effects of dialysis, AVOID NSAIDs (may worsen renal status)
chloasma
mask of pregnancy, discoloration changes on face
breast pain
mastalgia
Oxygen
maximizes O2 to the heart for MI pts
Nipple Discharge
may be physiologic, benign, or problematic, can be elicited from women who are non-pregnant and non-lactating, volume may increase with stimulation, may be milk, opalescent, serous, bloody, or purulent, may be related to medications, If Spontaneous, Persistent, Bloody, From A Single Duct --> Pathology
Patients with hearing loss
may be watching your face and lips rather than your eyes, frowning or straining forward to hear, posturing of head to catch sounds with better ear, misunderstands questions, frequently asks you to repeat, irritable or shows startle reflex when you raise your voice, person's speech sounds garbled, vowel sounds distorted, inappropriately loud voice, flat, monotonous tone of voice speak in a lower voice, talk slowly to patients
Females and MI
may have non-textbook presentation
Older Adults Ear Assessment
may have pendulous earlobes with linear wrinkling d/t loss of elasticity of pinna, coarse, wiry hairs may be present at opening of canal, eardrum normally whiter in color, more opaque, duller and thicker than in younger adults, may have trouble hearing higher tones
Aortic Valve Regurgitation
may result from disease of aortic valve leaflets, aortic roots, or both caused by bacterial endocarditis, trauma, aortic dissection (a life threatening emergency)
Measurement of BP
measure on dominant arm first, no caffeine or nicotine 30 prior, have patient rest quietly for 5 minutes and empty bladder, legs should not be crossed
HIV RNA level (Diagnostic workup)
measurement of viral load; how many viral particles are present in the blood EARLIEST test to detect HIV infection
Elicitation of pain is not a positive sign in every patient with...
meningitis
Women's Health Hx includes...
menstrual cycle, age at time of first menstrual period, menopause, vaginal discharge, pain or itching in genitalia or groin, fertility problems, lumps, swelling, or masses in genitalia or groin, urinating difficulty, changes in urine color, odor, difficulty controlling urine, sexual performance, sexual activity pattern, symptoms during cycle, PMS
Clinical Manifestations of N&V
metabolic alkalosis (increase ph) from loss of gastric HCl Metabolic acidosis (decreased ph) from loss of bicarb if contents from small intestines are vomited severe loss of fluids and electrolytes (can result in circulatory failure and collapse)
Trochlear (IV)
motor, controls downward and inward eye movement, test with 6 cardinal positions of gaze
Abducens (VI)
motor, controls lateral eye movement, test with 6 cardinal positions of gaze
Oculomotor (III)
motor, controls pupillary contriction, eyelid elevation, and movement, test with 6 cardinal positions of gaze
Accessory (XI)
motor, controls strength of neck and shoulder muscles, ask pt to turn head against resistance, shrug against resistance
Test muscle strength by having pt...
move each extremity through each full ROM against resistance, document the strength, and stop the motion if the patient expresses discomfort or pain
Irritants that can cause cough
mucus, blood, dust, extremely hot or cold air, chemical fumes or vapors, inflammation of the airways, or presence of tumors
polycyclic lesion
multiple cysts
Decreased muscle strength against resistance is seen in...
muscle and joint disease
low production of GH
muscle atrophy
Assessing Muscles
muscle bulk (atrophy/hypertrophy) muscle tone (muscular resistance to passive stretching) muscle strength (0-5 scale)
Calcium is a major electrolyte used in...
muscle contraction (including the heart!!) and is kept within tight boundaries
Scrotum-Cremasteric Reflex
muscle contracts when cold, relaxes when warm, helps to regulate the temperature needs for sperm production
Acute Respiratory Distress Syndrome (ARDS)
not a condition by itself, caused by some other preceding injury or condition, sudden, progressive form of acute respiratory failure, alveolar capillary membrane becomes damaged and more permeable to intravascular fluid (alveoli fill with fluid)
Disseminated Intravascular Coagulation (DIC)
not a disease, abnormal clotting cascade that causes bleeding, causes pallor, oozing blood, GI problems, hematuria, changes in mental status, oliguria, ischemic tissue necrosis, organ failure frequently occurs with acute DIC
Mammography
not a perfect test, not reliable for pre-cancerous lesions, identifies small early cancers, 20% of 200,000 breast cancers are DCIS (in the ducts), may miss axilla and tail of Spence abnormalities, cancer may appear between mammograms failure to detect some cancers until stage 1 or later, even "early" cancers may metastasize into bloodstream or lymphatics, pre-menopausal breasts are more difficult to detect lesions, as high as 25% false negatives reported
Appendicitis pain
not distinct in early stages, usually umbilical at first, then migrates down to RLQ, mcburney's point, this intense pain is usually what brings people to the ER, accompanied by nausea and vomiting when pain suddenly gets better -- the appendix probably burst and that is BAD, rupture can cause sepsis, bacteremia, lots of complications
Vertigo
not the same as dizziness!!!! sensation that the room is spinning around them, there is an exaggerated sense of motion with any self-initiated movement, episodes last minutes to hours and often associated with severe nausea and vomiting
Face assessment
note facial expression and appropriateness to behavior or reported mood, facial structures always should be symmetric, note symmetry of eyebrows, palpebral fissures, sides of mouth, not any abnormal structures (coarse facial features, changes in skin color, abnormal swelling), note any involuntary movements
Cholelithiasiscystitis
obstructive jaundice that occurs when gallbladder is obstructed, dark amber urine (billirubin in urine), clay colored stools (lack of bili in gut), pruritus (bile salts in the skin), intolerance for fatty foods demonstrated by nausea, fullness, anorexia, bleeding tendencies, steatorrhea if stone is down further, preventing lipase from getting out of the pancreas
The lower face may look smaller in...
older adults who have lost their teeth
Decreased deep tendon reflexes is normal in...
older adults, normal with aging
McMurrary Test (Meniscal Lesion)
perform if pt complains of a "giving in" or locking knee, flex knee and hip, place thumb and index finger on either side of knee and then rotate the leg laterally/medially pain or clicking is indicative of a torn meniscus
Temporary Ostomies
performed to allow the intestine to repair itself after inflammatory disease, some types of intestinal surgery, or injury gunshot wounds, trauma
Leukemia: Diagnostics
peripheral blood eval and bone marrow eval are needed to diagnose and classify, to identify cell subtype and stage - there are morphological, histochemical, immunological, and cytogenic methods
DM Complications
peripheral neuropathy blunts pain sensation, the pain of inflammatory conditions and MI may not be perceived, silent MI is common in those with diabetes (changes to ST segment on EKG can indicate recent MI) loss of sensation in the hands and esp feet can lead to soft tissue infections that worsen, bone diseases foot exams are important!!!
Post-Ictal Care
place patient on side and turn head so that any emesis or oral secretions will drain out of the mouth and will not be inhaled
If a patient has high potassium...
place them on a EKG constant cardiac monitoring, put them on meds that cause urination/elimination to excrete it, get it back into the cell
GBS Tx
plasma exchange and immunoglobulin administration, NOT treated with immunosuppressants
Examples of Asthma rescue meds
rapid acting, adrenergic beta-2 agonists are administered via an inhaler, epinephrine (e.g., status asthmaticus)
Treatment of Hypokalemia
rapid administration of K+ can cause cardiac arrest, IV potassium must ALWAYS be diluted, and never given as an IV bolus, it is excoriating to the skin and blood vessels in large doses, administer 20 mEq in 1 liter of IV fluid
Neuro Coordination Tests
rapid alternative movements of hands, fingers to nose, touching the nurse's finger then his or her own nose, heel to shin test (pt supine)
Clostridium botulinum
rare but potentially fatal, a spore-producing, toxin secreting bacteria found in soil, can be ingested, inhaled, or invade the body through breaches in the skin, causes -- descending paralysis, affecting the cranial nerves initially, weakness progresses rapidly from the head down into the neck, arms, trunk, and legs, paralysis is reversible
Crohn's Dz
recurrent inflammation that bounces around, bloody diarrhea is less common, less risk for colon cancer, pernicious or "sneaky" anemia - loss of the production of the intrinsic factor in the stomach, tx with supplement (this anemia is not common in ulcerative colitis) fistulas are cardinal feature!!!!!!!!
Epilepsy
recurrent, unprovoked seizures, alters level of consciousness, motor, sensory, autonomic, and behavior manifestations, results when a region of cortical neurons favor a sudden-onset of hyperexcitability
Erythema
reddened skin (with blanching)
Cirrhosis complications
reduced albumin synthesis leads to changes in oncotic pressure and causes peripheral edema and ascites, treated with a combo of diuretics
T spine injury
reduced balance between parasympathetic and sympathetic nerves
Increased intracranial pressure can lead to
reduced bloodflow and oxygenation --> anoxic encephalopathy the brain being pushed downward into the foramen magnum, reducing level of consciousness, and death (forewarned by Cushing's Triad)
Morphine
reduces the pain, anxiety, and stress response of MI pt
When evaluating, a nurse should...
refer to established outcomes, evaluate the pt's condition and compare actual outcome with expected outcomes, summarize results of evaluation, identify reasons for failure to achieve expected outcomes, take corrective action to modify plan of care, and document evaluation in plan of care
Double/Triple/Quadruple Bypass
refers to how many sites in the heart that need to be bypassed
Tonicity
refers to the amount of solutes in solution compared with the amount in the bloodstream, used to describe the various intravenous solutions used in the clinical setting
Nutritional Status
refers to the degree of balance between nutrient intake and nutrient requirements - affected by many factors, including physiological, psychosocial, developmental, cultural, and economic factors
Blood Pressure
refers to the pressure exerted on the walls of the arteries by the blood, highest during systole (ventricular contraction) and lowest during diastole (relaxation of ventricles), mmHG, systolic/diastolic
Blood pH
reflects the measure of acidity or alkalinity of the blood, normal blood pH = 7.35 - 7.45, all cells in the body need to have a pH in this range for optimal function
infrascapular region
region below the scapula
Best treatment for intracranial pressure
removing part of the skull to allow the skull to expan
Major Causes of Heart Failure
repeated ischemic episodes or infarctions, chronic hypertension, Chronic obstructive pulmonary disease (right ventricle failure), dysrhythmias, valvular disorders, pulmonary embolism (right ventricle failure)
Chest Pain: Relieving Factors
rest, change of position, shallow breathing, change in temp of environment, heating pad, ice pack, leaving stressful environment, medications (analgesics, GI meds, nitroglycerine) there may be no relieving factors
Physiological consequences of Aortic Valve regurgitation
retrograde blood flow from ascending aorta to left ventricle, elevated left ventricle pressure, left ventricle dilation and hypertrophy (results in volume overload)
Preparing for the health assessment includes...
reviewing the pt record, reviewing the patient's status with other health care team members, educating yourself about the pt's diagnosis and tests performed, reflecting on your own feelings to avoid biases or judgement
Predisposing Factors for Infective Endocarditis
rheumatic heart disease, congenital heart disease, mitral valve prolapse, cardiac surgery, invasive monitor or tests, skin, bone, or pulmonary infections, poor oral hygiene, dental procedures, IV drug use
Lower Chambers of the Heart
right and left ventricles (thicker walls)
Nuring Dx r/t male genitalia
risk of injury r/t poor lifting technique, risk for infection r/t unprotected sex, sexual dysfunction r/t erectile dysfunction secondary to psychological or physiological factors, pain r/t infection or genital reproductive surgery, readiness for enhanced self-health management of reproductive system
Painful and limited abduction accompanied by muscle weakness and atrophy are seen with...
rotator cuff tear
Tricuspid Stenosis
seen in IV drug users, right side of the heart is typically affected, right atrial output is obstructed, results in right atrial enlargement and elevated systemic venous pressure -JVD, peripheral edema, hepatomegaly, ascites
Post-ictal
seizure completed, may feel weak, tired or confused for (5-30 min)
Vestbulocochlear Nerve (VIII)
sensory, controls hearing and balance, test with Romberg test, whisper test, Weber and Rinne
Olfactory nerve (I)
sensory, controls sense of smell, tested with occlusion of one nostril and identified of nonirritating and familiar odors
Optic Nerve (II)
sensory, controls visual acuity, fundi, optic discs, assess visual acuity with Snellen Chart, peripheral vision with confrontation test, check color vision
The _____________ separates the right and left sides of the heart
septum
When an MI is suspected, clinicians usually order...
serial cardiac CPK and troponin every 8-12 hours for 1-2 days to follow the progression of the MI
Urosepsis
serious systemic infection from microorganisms in the urinary tract that invade the bloodstream and release bacterial endotoxins, pts are severely ill, fever, chills, confusion, disorientation, hypotension
Red Flags for Nipple Discharge
serosanguinous, bloody, associated with a mass, unilateral, positive cytology, positive mammogram, age over 50, spontaneous
Focal seizures
simple (retains consciousness) or complex (loss or impaired consciousness)
Both anterior and posterior thorax can be examined with the pt...
sitting, if pt unable to sit up roll the pt to one side and then other examine dependent lung on each side
Calcitonin
a hormone secreted by the thyroid that has the effect of lowering blood calcium
Framingham Heart Study
a large epidemiologic study begun in the 1940s designed to assess the relationship between lifestyle factors and risk for heart disease
Parietal Pain
a localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity, as in appendicitis or peritonitis, steady and severe
Hospital-associated pneumonia (HAP)...
a lung infection that is contracted after 48 hours of hospital admission, MRSA is a common pathogen
Spinal Cord
a major part of the central nervous system which conducts sensory and motor nerve impulses to and from the brain, 45 cm long from the medulla down to the 2nd Lumbar vertebrae
Multiple Myeloma
a malignant tumor of plasma cells arising from a single clone, multiple myeloma accounts for more than 40% of primary malignant tumors of bone
Skin Turgor
a measure of skin's elasticity, the ability to return to place promptly when released, decreases as a result of aging due to thinning of the dermis and reduced elastin production, patient's hydration status also effects turgo
glycemic index
a method of classifying foods according to their potential for raising blood glucose the more processed the food, the higher the glycemic index
Hypothalamus
a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion
Nausea and Vomiting
a neurological phenomenon, your brain tells you that you're sick to your stomach, both can occur independently of each other, N doesn't always precede V,
Chalazion
a nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland, farther back on the eyelid than a stye
Cyanosis
a non-specific sign, can be peripheral or central, difficult to assess in darkly pigmented person - need to rely on clinical signs of decreased oxygenation of the brain
Cor Pulmonale
special kind of RVF, something in the lungs causes RVF - serious cardiac disease associated with chronic lung disorders, such as emphysema
Cystitis Tx
specific antibiotics through culture and sensitivity Nitrofurantoin or TMP-SMZ (Bactam) are common, increase hydration
Lysosomes
spherical, membrane bound organelles, contain digestive enzymes, digest particles or worn out cell parts brought in by endocytosis, in cell death -- autolysis occurrs - the enzymes rupture from the lysosome and digest the whole cell, WBC have many lysosomes
telangelectasias
spider or star angioma, venous lake, localized dilations of small veins of the skin
Meds that Increase Potassium
spironolactone, ACE inhibitors
Infective endocarditis vascular manifestations
splinter hemorrhages in nail beds, Roth spots (retinal hemorrhages from IE induced embolic vasculitis), Osler's nodes on fingers or toes (painful, septic emboli and micro abscesses), and Janeway's Lesions on palms or soles (painless, septic emboli and micr abscesses
As we age, our bones get more...
spongy
Assessing the Anus and Rectum
spread the clients buttocks and inspect the anal and perianal area for lumps, ulcers, lesions, STDs, cancer, hemorrhoids, rashes, or excoriations
West Nile Virus
spread to humans by the bite of an infected mosquito, common in summer-fall, no vaccines or medications to treat WNV in people, fortunately most people with WNV do not have symptoms, you can reduce your risk of WNV by using insect repellent and wearing long-sleeve shirts and long pants
Acute Pancreatitis: CM
sudden onset of epigastric pain that may radiate, "severe, deep, piercing, continuous, steady", aggravated by eating, causes nausea and vomiting, but pain is not relieved by vomiting aka "autodigestion" of the pancreas, lipase is secreted by the pancreas and is breaking down body fat, amylase is breaking down starches, enzymes end up in the bloodstream in severe cases
Chest Pain: Onset
sudden, gradual, sporadic-intermittent (comes and goes), continuous, nocturnal
cough
sudden, noisy expulsion of air from the lungs, response to irritation of receptors in the larynx, trachea, or large bronchi
MS patients...
suffers both sensory losses and motor impairment, ataxia, tremor, and dysarthria are common initial symptoms
Dimpling of breast when arms raised
suggests malignancy
Posterior auricular (mastoid) lymph node
superficial to the mastoid process
Cholecystitis: CM
symptoms can range from severe to none at all, severity depends on whether the stones are stationary or mobile or if an obstruction if present, severe pain can persist for 1 hour, once subsides there is residual RUQ tenderness, attacks last 3-6 hours after a heavy meal (usually high fat) bile isn't getting out of the gallbladder and into the gut - stool will be a weird color
After a bite from a mosquito with Zika...
symptoms occur after 2-14 days incubation, illness lasts about a week, upon resolute - long term immunity to Zika results
Interstitial Cystitis (IC)
syndrome characterized by urgency, frequency, feeling of bladder fullness, pain, also called Painful Bladder Syndrome (PBS), dx based on symptoms, no known etiology, patho is unclear
Jobs of the Liver
synthesize albumin, filter blood, synthesize blood blood clotting factors, ammonia detox
STDs
syphilitic chancre, genital warts, herpes blisters, HIV
Percussion
tapping body parts to produce sound waves -- eliciting pain, determining location, size, shape, determining density, detecting abnormal masses, eliciting reflexes
Tinea (ringworm): dermatophyte
target looking Transmission: contact Treatment: topical vs. systemic anti-fungals or antivirals
Viral conjunctivitis
tearing in the eye
Percussion of the Chest
technique used to determine whether the underlying tissues are air-filled, fluid-filled or solid
aging adult and mouth
teeth look worn down or abraded, teeth loosen with bone resorption and may move with palpation, yellowing d/t worn enamel, may look longer as gum margins recede, tongue looks smoother due to papillary atrophy, buccal mucosa is thinned and may look shiny
Intussusception
telescoping of a segment of the intestine (folding in on itself)
Physiologic Murmurs
temporary increase in blood flow, anemia, pregnancy, fever, and hyperthyroidism
Ulcerative Colitis
tends to stay in the same relative location, recurrent inflammation at distal portion of the colon that can slowly ascend upward (not common), bloody diarrhea is common, increased risk of colon cancer may occur at any age, but peaks between 15-25, both sexes equally affected
Deep Tendon Reflexes
tested with a reflex hammer that is used to strike a tendon Biceps, Triceps, Brachioradialis, Patella, Achilles Test in sitting position, limbs relaxes, tendon is tapped quickly with hammer which causes contraction of the muscle
Testing Hearing Acuity
testing begins with interview: how well does the person hear conversational speech? Ask the person directly if there is a hearing difficulty If they say yes - refer for audiometric testing If no perform, voice test (whisper test) Document any presence of hearing loss, refer any abnormal findings for more accurate measures with pure tone audiometry
manual compression test
testing for valves that are incompetent, have the patient stand still place one hand on the lower part of the varicose vein and another hand and 20 cm higher..if you feel a wave that means there are incompetent valves, used when varicosities are present to assess for incompetent valves
Genomics
testing people for mutations in genes
ELISA and Western Blot
tests for HIV antibodies, formation of antibodies takes between 2weeks to 6months
Why does hypertension occur during Cushing's triad?
the body is trying to increase blood flow to the brain by any means necessary, even if HTN is harmful
molecular mimicry
the body mistakes its own tissues for foreign antigens with similar amino acid sequences
second degree prolapse
the body of the uterus is still within the vagina, but the cervix protrudes from the vaginal orifice (opening)
Thalamus
the brain's sensory switchboard, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla
Mono Symptoms
the cervical lymphnodes are tender and symmetrically enlarged, pharyngitis, fatigue, headache, fever, chills, abdominal pain, N&V pharyngitis is often the most prominent sign with tonsillar enlargement and exudate, some people develop periorbital edema and a papular rash on the trunk and arms
First degree prolapse
the cervix is still within the vagina
Uremia
the complex of symptoms arising from renal failure
Conjunctivitis
the conjunctiva of the eye commonly becomes infected or inflamed, S&S: the conjunctiva becomes red, swollen, and the eye feels itchy, purulent or watery discharge, highly contagious, persons can spread the bacteria or virus through touching the eye and then contacting another person's hands, contaminated objects or bedding can transmit it as well Dx: swabs for bacterial or viral culture are sometimes necessary Tx: patients are treated with antibiotics, antivirals, or antihistamines
+2 pulse
"normal", obliterates with moderate pulse
Calcium and Albumin
-about half of the calcium in the body is bound to albumin -hypoalbuminemia can cause the appearance of low calcium levels called pseudohypocalcemia
Hodgkin's Lymphoma
-characterized by proliferation of abnormal giant, multinucleated cells: Reed-Sternberg cells in the lymph nodes -↑↑ proliferation of lymphocytes -unknown cause -develops in a single location: spreads along adjacent lymphatic systems; eventually infiltrate other organs [lungs, spleen, liver]
Acute Renal Failure
ARF, pre, intra, and post-renal
tanner stage 5
Adult breast
Immunoglobulins
Antibodies such as IgA, IgE, IgG, IgM, and IgD; secreted by plasma cells (mature B cells) in response to the presence of an antigen., sort of like a flag for WBCs
Assessment Qs for Eye Pain
Any eye pain? COLDSPA? Pain with bright light? A foreign body sensation or deep ache? Headache in brow area?
Chest Pain: Setting
Awake, at rest, sleep interrupted, breathing, walking, sexual activity, exercise, sports activity, domestic chores
Pre-icteric Phase: Hep A, B, C
1-21 days in length, MOST CONTAGIOUS PERIOD, mild, flu like symptoms (fever)
________________ deaths a year can be attributed to medical errors
100,000
The left lung has ____ lobes and is narrower due to the ________
2, heart
Pulmonic area
2nd ICS, left sternal border
Bright red blood emesis
Hematemesis
Blood test in person who just got Hep B (pre-immune response)
Hep B surface antigen: + Hep B surface antibodies: - Hep B core antibodies: -
Blood test in person who got Hep B a year ago and made a full recovery
Hep B surface antigen: - Hep B surface antibodies: + Hep B core antibodies: +
Stroke Diagnostic Work Up
Imaging!! CT is fastest but MRI is more accurate
Scleroderma: Treatment
Immunosuppressants
Small testis
In adults, testicular length is usually ≤3.5 cm. Small, firm testes in Klinefelter's syndrome, usually ≤2 cm. Small, soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use of estrogens, and hypopituitarism; may also follow orchitis.
Vertigo vs. Dizziness
In dizziness, the patient reports incoordination and a feeling that he or she is going to "black out" or fall. Nausea and vomiting do not necessarily accompany dizziness as they do the vertigo
Atrial fibrillation
Increased amount of electrical generation, the SA node isn't firing, but some other bundle in the atria is firing non-stop, atria are just being shocked and not contracting, blood has the POTENTIAL to stand still and that can cause atrial clots
MS Objective Exam
Inspection Palpation (joints, muscles, bones) Testing ROM Assessing strength
Hep C
LEAST SYMPTOMATIC, worst recovery!!! same CM as Hep A in 25-30% of pts, most people take antivirals - makes hep C less deadly and more of a chronic illness blood to blood transmission!!! blood tests for HCV antibodies (cheapest option, tests for hep c exposure not infection, HCV_PCR (looks for Hep C genetic material), finally genotyping to dictate treatment
Left Upper Quadrant
Left adrenal gland, left kidney, left ureter, pancreas, spleen, stomach, transverse descending colon
Which artery is commonly used as a graft in left side CABG?
Left internal mammary artery (LIMA)
Legionnaire's Disease (aka bad pneumonia)
Legionella causes a unique kind of pneumonia, which is spread via water systems such as AC, mists sprayed on produce in grocery stores, and hot tubs commonly affects small clusters of individuals living together in hotels, dorms, or cruise ships Most healthy people do not become infected with Legionella bacteria after exposure Key to prevention is maintenance of water systems in which Legionella grow, including drinking water systems, hot tubs, decorative fountains, and cooling towers
________________ (proteins) deposited in the brainstem, spinal cord, and regions of the cortex cause neurodegernation and cell death.
Lewy bodies
Skull Fractures in order of severity
Linear, Comminuted, Depressed Fracture, and Compound Fracture
Milk lines
Lines along the body from the axillary area to the inguinal area along which accessory breasts or nipples
Occipital lymph nodes
Located at the base of the skull
Treatments for MI and Unstable Angina
MONA Morphine Oxygen Nitroglycerine Aspirin
Ferrous Sulfate
MORE iron!!! but more GI side effects
Skin Pigments
Melanin, Carotene, Oxyhemoglobin, Deoxyhemoglobin
C. Diff treatments
Metronidazole (Flagyl), Vancomycin (Vancocin) - needs to be oral vanco
ABI of 0.7 - 0.41
Moderate PAD
Addisonian Crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP SHOCK,
Acute Pancreatitis: Tx
NPO, possible NG tube to remove gastric acid, pain management w IV drugs, management of metabolic complications w IV drugs first step is to stop irritating pancreas keep checking the amylase/lipase levels until they are descending, pt's pain is reducing
HSV1 treatment
No cure - antivirals shorten healing time and protect cells
S2 sound (dub)
Normal closure of aortic/pulmonary valves (end of systole), heard best with diaphragm, spilt S2 may be normal finding in adults if heart only during inspiration, louder than S1 at base
Expansion of Chest
Normally 2:1 ratio of transverse to AP diameter, i.e., the chest is shaped like a rectangle, AP diameter may increase with aging, observe use of accessory muscles and position of pt
Arachnid bites diseases
Scabies, Lyme disease, bed bugs, lice, and eczema
Tanner stage 3
The breast and areola enlarge; the nipple is flush with the breast surface
Afterload
The force or resistance against which the heart pumps.
Subjective Data - Respiratory System
COLDSPA, health history - provide clues about underlying respiratory problems and associated nursing diagnoses and risk for development of respiratory problems, avoid judgmental approaches to poor health practices, family history (smoking in home when growing up, lung dz), environmental conditions, dietary intake
Patient's blood sugar looks okay at 3 am =
Dawn phenomenon
In children, pull the pinna
back and down (kids are little so you look DOWN at them)
Senile tremors
benign and include head nodding and tongue protrusion
Respiratory Rate and Effort
best assessed when pt doesn't know you are measuring, continue to leave fingers on radial artery and observe breathing, count for 15 x 4 (unless irregular)
vernix caseosa
cheesy substance covering the skin of the fetus
Opening snap
early diastolic sound with opening of a stenotic stiff mitral valve.
Bladder Palpation
empty bladder is not palpable or tender, inspect for distention, dull percussion, a distended bladder is smooth, found and full or firm
clubbing of nails
finding in the nails that indicates chronic hypoxia
Blepharitis
inflammation of eyelids
DM1: Tx
insulin!!!!
pruritus
itching
As we age, skin...
loses elasticity, skin folds and sags
Occipital lobe
sight
A. fib won't kill you, but...
the blood clots might
Hydroxyurea (Hydrea)
chemotherapeutic agent, decreases the formation of sickled cells, many side effects, toxic, more research is needed on proper identification of who should get this drug
NHL Treatment
chemotherapy with or without radiation, more aggressive lymphomas are more responsive to treatment, biological therapy, complete remissions are uncommon, radiation alone may be enough for localized stage 1 or stage 2, asymptomatic clients with advanced disease followed with "watchful waiting" to assess the disease progress
Stable angina
chest pain that occurs when a person is active or under severe stress
The Kidney Transplant surgery is relatively easy because...
d/t the anatomical location
Assessment of fluid status can be measured by...
daily weight and 24 hour intake and output
Children affected by Zika may have normal development and intelligence, but also may manifest...
developmental delays, coordination and balance difficulty, short stature, facila distortions, hyperactivity, seizures, low intelligence
diaphragmatic excursion
distance that the diaphragm moves with inhalation, not often used in clinical setting - mission work setting more likely
Chest tubes
drain air and fluids and re-establish negative pressure, allowing re-expansion of lung, collection chamber is below chest level for gravity, one way mechanism keeps air/drainage from getting back into chest
Crust
dried yellow-brown exudate, found in lesions during the healing stage (ex: chicken pox)
Pt's who've had pupil's dilated for eye exam shouldn't...
drive for 1-2 hours and should wear sunglasses
Sinus =
electricity started at the sinoatrial node
HIV + Opportunistic Condition =
AIDS
The pancreas is both...
endocrine and exocrine
ERCP
endoscopic retrograde cholangiopancreatography
Hyperglycemia can lead to
endothelial cell injury
Endothelial Cell Injury
endothelial cells line the artery walls, injury in them causes inflammation and initiates the process of atherosclerosis
Varicocele
enlarged veins of the spermatic cord, feels like bag of worms, may cause infertility
Epidural Hematoma
epi = above, a hematoma located on top of the dura
Tenderness or pain palpated in the epicondyles of the elbow may signify...
epicondylitis (tennis elbow)
Palpation of External Female Genitalia
Batholin's glands (not visible) - between the vaginal orfice and the labia minora, urethra
lymph nodes
Bean-shaped filters that cluster along the lymphatic vessels of the body. They function as a cleanser of lymph as wells as a site of T and B cell activation
Disruption of normal enteric flora by taking antibiotics + being in a hospital = increased risk of getting
C. diff
Diencephalon
Contains thalamus and hypothalamus
EKG/ECG
Electrocardiogram-measures heart electrical activity
FFFGGG
Fistulas, First because they're Finest, Grafts Good but Gunky
Blood test in person who has never had Hep B
Hep B surface antigen: - Hep B surface antibodies: - Hep B core antibodies: -
Secondary Priorities (Secondary Survey)
Mental status changes, acute pain, abnormal labs, risks for infection, safety, or security
Assessment collects data from multiple sources such as...
clinical records, the interview, health history, physical exam, functional assessment, cultural/spiritual assessment, consultation, and review of literature
Primary (essential) hypertension
No identifiable cause, develops over years
Spleen Palpation
Normal = not palpable. Any enlargement is clinically significant. place right hand below left costal margin with finger toward client's head, ask client to inhale Assess for tenderness, shape, consistency, size
Mnemonic for Names of Cranial Nerves
Oh, Oh, Oh, To Touch and Feel Very Green Vegetables, AH!
Cataracts
clouding of the lens
9 Ps of Clinical Breast Exam
Proper History Position Perimeter Pattern Palpation Pressure Patient Education Plan of Action Prudent documentation
There is a _____________ relationship between calcium and phosphate.
Reciprocal, when there is an increase in calcium in the blood, there is a decrease in phosphate -- and vice versa.
Blood tests (esp. for troponin) can...
confirm myocardial infarction
Focused or Problem-Oriented Assessment
consists of a thorough assessment on a particular patient problem and does not cover areas not related to the problem
Ongoing or partial assessment
consists of data collection that occurs after the comprehensive database is established
Strabismus
crossed eyes
Chest Pain: Duration/Frequency
Seconds, minutes, hours, days, weeks
Brudzinski's sign
Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
Patient Positioning
Sitting, supine, sim's, standing, prone, knee-chest, dorsal recumbent, lithotomy
maligant melanoma
Small but deadly percent of all skin cancers ~4%, all melanomas start in our MELANOCYTES (not moles), John McCain had this, most rapidly increasing cancer, can spread rapidly, causes 75% of deaths from skin cancers melanocyte, over years, sustains DNA damage potentiating malignant growth CP: dark, border irregularity RF: fair skin, sun exposure, age Diagnostic: Biopsy Tx: surgery alone often curative, chemo/radiation/immunotherapy for advanced stages
Mnemonic for types of cranial nerves
Some Say Marry Money But My Brother Says Big Brains Matter More
Acute Bronchitis: Symptoms
Sore throat Nasal discharge Muscle aches Persistent cough Fever Cough becomes prominent as the disease progresses and can last from 10 to 20 days during the course of acute bronchitis Sputum may be clear, yellow, green, or even blood-tinged *Sputum color is NOT indicative of bacterial vs. viral infection
Loss of Potassium can cause
TTT, tall, tented, T waves on EKG
What is the costal angle?
The angle formed by the blending together of the costal margins at the xiphoid process. It is usually no more than 90 degrees, will be increased when the ribcage is chronically overinflated, as in emphysema
Palpate Aortic Valve
The second right intercostal space near the sternal border is the best place
CRISPR and HD
a bacterial gene editing mechanism co-oped for treatment, gene editing made easier, makes for easier and dissemination of gene editing trials, can delete bad DNA and insert correct DNA, mice have been cured of HIV with CRISPR
P wave
atrial depolarization in response to the SA node triggering
left ventricular failure
blood backs up into the lungs causing pulmonary edema > shortness of breath or sense of suffocation
Lots of cancers can cause...
cauda equina syndrome
Egophonoy
While listening to the chest with a stethoscope, ask the patient to say the vowel "e". Over normal lung tissues, the same "e" (as in "beet") will be heard. If the lung tissue is consolidated, the "e" sound will change to a nasal "a" (as in "say")
Increased likelihood of skin cancer in ______________ than in Black and Hispanic communities
White
Mental status
a person's emotional and cognitive functioning
immunosuppressant
a substance that prevents or reduces the body's normal immune response
Concussion
a sudden transient mechanical head injury with disruption of neural activity and a change in level of consciousness, stretching of nerve fibers with no structural alteraltion
Long term brain swelling is treated with...
a tube that inserted into the brain that drains fluid into the peritoneal cavity
Non-pitting Edema
caused by plasma proteins leaking out of the capillaries into the tissue drawing water with it, commonly seen with burns, localized allergic reactions like stings, and trauma
Trichomonas vaginalis
causes itching, frequent urination, discharge is yellow-green, frothy, and foul smelling, labia may appear red, swollen, tender with red spots
peritoneal cavity
abdominal cavity
Blood clots in the left atria can travel...
anywhere in the body and cause blood clots
Peritoneal Dialysis (PD)
everyday use, abdominal blood vessels act as the "semi-permeable" membrane, dialysate is infused into peritoneal cavity, fluid and lytes "shift" from intravascular space to the peritoneal cavity
Nephrolithiasis complications
hydroureter, hydronephrosis
What are the two leading causes of CKD?
hypertension and diabetes
The female reproductive system falls under...
internal genitalia
Nursing Diagnosis requires...
interpretation of data by identifying clusters of cues to make inferences, then comparing clusters of cues with definitions and characteristics, then verifying inferences and indentifying related factors, then documenting the diagnosis
nystagmus
involuntary, jerking movements of the eyes
Conductive hearing loss
involves a mechanical dysfunction of the external or middle ear, impacted cerumen, foreign bodies, a perforated TM, pus or serum in middle ear, otosclerosis
inspection
involves the senses (vision, smell, hearing)
Autonomic Dysreflexia
involves uncontrolled activation of autonomic neurons, very very very high BP produced by sympathetic tone
Palpation of Breast
is a test performed by a trained health care provider to check the texture, size, and consistency of the breast palpate nodes while pt is sitting first palpate into the axilla and then move downward note texture, elasticity, tenderness, temp, masses, nipples, if mastectomy or lumpectomy - palpate the site
In Leukemia, a stem cell transplant...
is always part of the treatment
MRI Breast
is done for cancer detection or screening in conjunction with mammography & sonography. NOT for screening average risk woman, recommneded for women with 20% or greater lifetime risk of breast cancer including women with BRCA 1 or 2, 1st degree relative with BRCA 1 or 2, history of radiation therapy to the best between 10-30yo
In Lymphoma, a stem cell transplant...
is only for those who's chemo and radiation failed
Gangrene
ischemia, infarction, and necrosis of tissue exposed to bacteria that thrive on the decaying tissue
Infarction
ischemic death (necrosis)
If a patient knows of an intracranial aneurysm...
it can be removed before it causes a hemorrhagic stroke
Limitation of ROM is the most sensitive sign of...
joint disease
Tx for Interstitial Cystitis
kegel exercises, anticholinergic drugs, botox injections, surgical procedures
KUB
kidney, ureter, bladder x-ray
Febrile and photosensitive seizures are common in...
kids
Palpation
to examine by touch - texture, temperature, moisture, mobility, consistency, strength, size/shape, tenderness
gyrate lesion shape
twisted, coiled spiral, snakelike
Volvulus
twisting of the intestine on itself, not very common
PUD: Surgical Therapy
tx when ulcer won't heal, pt continues with habits that cause/worsen ulcers, (Teddy Billroth) Billroth I (50-70% of stomach removed) and Billroth II (50% of stomach removed, stomach sutured to jejunum) there are special maneuvers to preserve vagus nerve activity
Islet cell autoantibodies may be assessed in which type of diabetes?
type one
Gallstones and Gallbladder Inflammation: Diagnostics:
ultrasounds, ERCP, percutaneous transhepatic cholangiography Labs: WBC, LFT: bilirubin, urinary bilirubin level, ALT, ASL, amylase/lipase is pancreatic involvement
3 phases of ARDS
1. Injury/exudative phase (1-7 days or 24-48 hours after lung injury or host insult) 2. Reparative/proliferative phase 3. Fibrotic phase
Glomerulophritis is also called...
"Goodpasture syndrome" after the first person to describe it in medical literature
Anaerobic metabolism / Glycolysis produces...
2 ATP + Lactic Acid
The right lung has ____ lobes but is shorter due to _____
3, liver
The usual location of the apical pulse
5th intercostal space
Cholelithiasis RF
8-10% of adults have it! female, sedentary lifestyle, familial tendency, obesity, stasis of bile, immobility, pregnancy, inflammatory or obstructive lesions
Basal Cell Carcinoma
80-90% ish of all skin cancers, cell from the basal layer of epidermis, over years sustains DNA damage potentiating malignant growth, arise in sun-exposed areas, tends to grow slowly and rarely metastasize CP: pearly/shiny, border irregularity RF: Fair skin, sun exposure, age Diagnostic: Biopsy Tx: Surgery alone is often curative, chemo/radiation/immunotherapy for advanced staged
Older adults may not be considered hypothermic below...
96, older adults may not have an elevated temp with an infection, range around 95 - 97.5
Sinus Bradycardia
<60 bpm, might require a pacemaker in bad cases
Sinus Tachycardia
>100 bpm, ventricle filling time is compromised, they can't fill appropriately, cardiac output is decreased
Liver Palpation
- may or may not be palpable - hepatomegaly: grossly enlarged liver - HOW: patient holds breath, tuck fingers up and under ribs on RUQ - should not be more than 1-3 cm below the costal margin - mild tenderness normal
Dawn phenomenon
A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus due to "sugar recruiting" effects Some pts suffer more from this than others Treatment includes administering an evening dose of intermediate acting insulin at 10 pm.
Dominant breast mass
3d breast mass that persists throughout menstrual cycle
Erb's point
3rd ICS left sternal border
Slope of the Ribs
45 degree angle, normal slope is downward, intercostal spaces are symmetric
Stress Test for MI
A diagnostic test used specifically for angina is a thallium stress test, used to show myocardial perfusion during exercise, measured on EKG (some basic tests do not use imaging, just EKG and treadmill) The pt. exercises to a max level on a treadmill or stationary bike while on a radioactive substance called thallium is injected into the bloodstream The thallium highlights the coronary artery blood flow and deficits of blood flow to the heart while it is stressed by exercise
Hypothyroidism:
A disorder caused by a thyroid gland that is slower and less productive than normal, Hashimoto's, slows everything down due to infective destruction, iodine deficiency, hyperthy treatment, complication of pituitary surgery
Malignant Cancer
Cells are bizarre-looking and spread to other sites, highly invasive into tissue, and not well-delineated
NHL can be ___________ or ______________.
Aggressive or indolent (slowly progressive)
Stage 5 CKD
Dialyzable
coup-contrecoup injury
Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds.
Diabetes: Diagnostics
Fasting blood glucose: 126 mg/dl or higher Random plasma glucose: 200 mg/dl or higher
Common MI Symptoms in Women
Fatigue, weakness, aching, indigestion, sleep difficulties, anxiety or fear, difficulty breathing
Cysts
Fluid, infection, or other matter under the skin
DKA tx
Fluids (counteracts dehydration and hyperosmolarity), insulin (administered until blood sugar is fewer than 250 mg/dl), K+ not uncommon to take blood sugar every hour and adjust insulin drip to compensate
systolic murmur
Lub murmur dub, heard during systolic, ventricles stenosis, if the tricuspid/ mitral regurg
Hepatitis A
MOST SYMPTOMATIC AND MOST RECOVERABLE virus transmitted through fecal oral route, frequently occurs in small outbreaks (restaurants, produce), found in feces 2+ weeks before onset of symptoms and up to 1 week after onset of jaundice, present in blood only briefly
It's important to educate diabetic patients about...
NUTRITION!!! good fats vs bad fats, glycemic index etc...referral to dietician can help
ABCDE skin assessment
A: asymmetry B: border C: color D: diameter E: elevation and enlargement
Atherogenesis
Endothelial injury, inflammatory mediators, macrophages, platelets to site, high circulating LDL in bloodstream
Escherichia coli O157:H7
Toxin-producing strain of E. coli, causes severe gastroenteritis and can cause hemolytic uremia syndrome (RBC and platelets are killed, dead cells can clog the nephrons, causing kidney dysfunction and renal insufficiency, in the worst case: acute tubular necrosis, one of the enterohermorrhaig E. coli (gross bleeding into the gut and out through the stool)
Acute Bronchitis: Most common pathogenic etiologies
Viruses: Influenza virus, respiratory syncytial virus, coronavirus Bacteria: mycoplasma (walking pneumonia), chlamydia pneumoniae, streptococcus pneumoniae, moraxella cararrhalis, haemophilus influenzae, bordetella pertussis (whooping cough)
IVP (intravenous pyelogram)
Visualizes the urinary system with the use of a radiopaque dye (iodine) that is injected IV (assesses renal function, looks for kidney stones), lots of dye with a few x-rays
When we treat a patient with leukemia, lymphoma, MM, or MDS with chemo, we must monitor for...
Tumor Lysis Syndrome (TLS) - chemo/radiation lyses millions of cells and releases ICF into the blood stream, can cause kidney stone formation and acute kidney injury, most at risk after cycle 1 of chemo
Lungs
Two cone-shaped, elastic structures, apices are slightly above the clavicle, base is at the level of the diaphragm, paired but not symmetric, fissures run obliquely and divide the lungs into lobes
Best way to prevent C. diff in patients
WASH YOUR HANDS
Grade 1 heart murmur
Very faint, heard only after listener has "tuned in"; may not be heard in all positions
Grade 5 heart murmur
Very loud, with thrill. May be heard when the stethoscope is partly off the chest
When you perform a full mental status examination?
When any abnormality in affect or behavior is discovered (and in certain situations)
Acetylecholinesterase inhibitors
a drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine.
Homeostasis
a dynamic steady state at which the body maintains itself at a relatively constant composition
C-peptide
a protein byproduct of insulin manufacturing, useful in type 2 diabetes as a reflection of how much insulin their pancreas is making, you can't just measure the insulin in the blood because a lot of the time they're getting insulin as shots
Assessing the Prostate
a provider may perform an prostate assessment on a client, palpating the prostate gland prior to drawing a prostate specific antigen (PSA) will raise the PSA level
Zollinger-Ellison syndrome
a rare condition in which one or more tumors form in your pancreas or the upper parts of your small intestine (aka duodenum), hypersecretory condition, meds to reduce stomach acid and heal ulcers is usual treatment
Because IgM is the immunoglobulin that responds first in infection, elevated levels indicate..
a recent or current infection
Pupil Fixation
a reflex direction of eye toward an object attracting a person's attention
linear lesion
a scratch, streak, line, or stripe
cerebral laceration
actual tearing of the brain tissue, brain layers are affected
glomerulonephritis
acute glomerulonephritis (AGN), inflammation/damage of the glomeruli of the kidney is caused by immunological mechanisms, autoimmune or post-streptococcal disease
Sharp pain of a joint is indicative of...
acute tendinitis
ATN
acute tubular necrosis
Diarrhea: CM
acute: usually from infection, self-limiting local: explosive, watery diarrhea, tenesmus (constant feeling need to empty, abdominal crampy pain systemic: fever, N/V, malaise, headache
Accomodation
adaptation of eye for near vision, pupillary constriction + convergence
Ventricular hypertrophy
adaptive and maladaptive, when someone has high BP, the ventricle has to work harder to work against the high pressure to send blood out to the body, in the short term, ventricular hypertrophy is an adaptive response, but in the long term it is maladaptive (as the heart gets bigger and bigger it becomes less efficient)
Anemia: Cardiopulmonary Manifestations
additional attempts by the heart and lungs to provide adequate O2 to the tissues, cardiac output is maintained by increasing the heart rate and stroke volume (caused by heart failure, cardiomegaly, peripheral edema)
Low production of ACTH
adrenal insufficiency
Prostate Cancer Risk Factors
african american, older than 60, having a father or brother with prostate cancer, exposure to Agent Orange, excessive alcohol consumption, working on a farm, in a tire plant, with paint, with cadmium, diets high in fat, esp animal fat
Kidney stones can be prevented...
after identifying what the current stones are made of and altering the patient's diet
Menstrual Hx
age started menses, 1st day of period, last day of period
Hypertension RF
age, african american ethnicity, family hx, obesity, diabetes, sedentary lifestyle, tobacco use, excess sodium in diet, excess alcohol, stress
Rovsing's Sign
Pain in RLQ with palpation of LLQ indicative of appendicitis
Murphy's sign
Pain with palpation of gall bladder (seen with cholecystitis)
Anemia: Integumentary Manifestations
Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations
DKA clinical presentation
Polyuria Polydipsia Polyphagia Weakness Abdominal pain Kussmaul's respirations; compensatory Nausea Vomiting Dehydration; dry mucous membranes, tachycardia, hypotension Ketonuria Ketone body odor
common opportunistic infection in Aids
Pneumocystis carinii pneumonia, cryptococcal meningitis, cytomegalovirus retinitis, tuberculosis, kaposi sarcoma, influenza (pneumonia and kaposi sarcoma only found in immunocompromised pts)
Causes of BP Variation
age, race, gender, exercise, stress and emotional state, circadian rhythm, medications, weight, caffeine or nicotine, position of the body and arm, pain and body temp
Physical Appearance Includes
age, sex, level of consciousness, skin color, facial features, overall appearance, no signs of acute distress present
Factors Affecting Muscle Strength
age, sex, muscular training
Leading cause of blindness among persons over age 40 in caucasians
age-related macular degenernation, cararacts
Facial bones and orbits appear more prominent in...
aging adults
Tension Pneumothorax
air enters pleural space with each inspiration and becomes trapped leading to pressure (tension) build up, may occur in open or closed pneumothorax Compression of mediastinal contents (heart, trachea, great vessels) --> decreased venous return and cardiac output Mediastinal shift toward unaffected side - severe dyspnea, marked cyanosis, deviated trachea to unaffected side, thready pulse, hypotension
Dyspnea
air hunger resulting in labored or difficult breathing, sometimes accompanied by pain, commonly called shortness of breath, it is inappropriate to the level of exertion
Somogyi vs Dawn phenomenon
Som=rebound hyperglycemia. Too much insulin. Decrease evening insulin Dawn-too little insulin. Increase evening insulin
Pneumothorax
air in the pleural cavity caused by a puncture of the lung or chest wall, open or closed, symptoms vary depending on size and amount of air in pleural space
Normal Lung Sounds - Bronchial
air moving into large airways, high-pitched hollow sound, 2:3 inspiration to expiration ratio
Normal Lung Sounds - Bronchovesicular
air moving through small airways, medium pitch
Dialysis solution
aka Dialysate, composition is similar to that of plasma with electrolytes and glucose (concentration varies), warmed to body temperature before installation, inflow ~ 15 min, dwell time ~ 4-6 hours, drain ~ 15 min
With a rash, check...
all areas of the body as you cannot rely on the history that rash is only in one location
The ______________ is the best guide for locating the 2nd intercostal space
Sternal angle / angle of Louis
striae gravidarum
Stretch marks, which can develop over the abdomen, breast, and thighs
Skin Presentations: Pregnancy
Striae Linea nigra Chloasma Vascular spiders
Hypothyroidism: Diagnostics
T3 (major driver of metab) and T4 (safety net in the event that T3 levels are very low, can be converted into T3) are low, TSH level is high (later stages), initially T4 will be converted to T3 enough to not ramp up TSH (early stages)
CBC with differential
look at numbers of types of WBCs -- monocytes, lymphocytes, granulocytes, neutrophils, eosinophils, basophils
It is important that the EKG of MI and atypical angina can...
look the same
Meds for Asthma fall into two general categories...
maintenance meds for daily use (long acting bronchodilators) and rescue meds for acute episodes (anti-inflammatory corticosteroids)
Respiratory Therapy
mechanical ventilation with PEEP (Peak End Expiratory Pressure) to recruit (open) collapsed alveoli antipyretics for fever, sedatives for anxiety, analgesics for pain
Spinal Cord Injuries are classified by...
mechanism of injury completeness or degree of injury primary (the trauma that hurt the spinal cord) vs. secondary (inflammatory response to injury)
PKD: Tx
medical management of lost kidney function, eventually a kidney transplate
Tx for aneurysm
medical, lifestyle first - then grafts (can be complicated, put off until absolutely has to be done)
Histology
microscopic study of tissues and cells
Acne rosacea
middle age, sebaceous papules/pustules, cause unknown, treated with antibiotics, Chronic (Rhinophyma - nose rosacea)
Diastasis recti
midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles
submental lymph nodes
midline, behind the tip of the mandible
What is a Holistic Model of Health?
mind, body, and spirit are interdependent and function as a whole, multifaceted basis of disease, individual and human environments are open systems, expands assessment factors to lifestyle behaviors, cultures, values, families, social roles, self-care behaviors, job-related stress, developmental tasks, failure, and frustrations of life, along with health promotion and disease prevention
Diastolic murmurs
mitral stenosis aortic regurgitation
Drugs that cause pupil constriction
narcotic pain meds, opioids such as codeine, fentanyl, hydrocodone, oxycodone, morphine, methadone, heroin
Skin Presentations: Aging
senile lentigines, keratoses, xerosis, skin tags, thin parchment, decreased hair growth, decreased nail growth and brittle nails
Examples of Subjective Data
sensations, symptoms, feelings, perceptions, desires, preferences, beliefs, ideals, values, and personal info
Candida fungus
normal flora
Orthostatic Hypotension
occurs during dehydration, a systolic blood pressure decrease of at least 20 mmHg or a diastolic blood pressure decrease of at least 10 mmHg within 3 minutes when going from a lying to standing position
Hemorrhagic stroke
occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed, common when brain can't keep up with hypertension, anti-coags causing little bleeds to become serious, ateriovenous malformations
Cell injury
occurs when cells are exposed to a severe stress that not longer allows them to maintain homeostasis, which results in structural and functional changes
Pitting edema
occurs when pressure is applied to a small area and an indentation persists for some time after the release of the pressure, depending on the severity, an individual can have +1, +2, or +3 pitting edema
overactive bladder (OAB)
occurs when the detrusor muscle in the wall of the bladder is too active (aka urge incontinence)
General hypopituitarism
one or two hormones are low, depends where injury to pituitary gland is
Diabetes mellitus means
one who pees sweetly
Epidermis
outer highly differentiated layer, basal cell layer forms new skin cells, outer horny cell layer of dead keratinized cells, inner cellular layer where both melanin and keratin are formed, most superficial layer of skin, thin, avascular, depends on the underlying dermis for nutrition
80-85% of nosebleeds occur
over the roof of the mouth
Free radicals ______________ cell structures
oxidize (can also be called oxidants), they disrupt the integrity of the cell membrane and damage organelles and DNA, causing cell dysfunction
Cellular Hypoxia
oxygen deprivation, most common cause of cell injury
A decrease in _______________ in the blood also increases respirations but is less effective.
oxygen, hypoxemia
metabolic alkalosis
pH > 7.45 HCO3 > 26, caused by excess bicarb ingestion or vomiting of excess gastric acid, if too much base or not enough acid in the blood, the kidney attempts to retain as much H+ as possible
Alkalosis
pH > 7.45, The buildup of excess base (lack of acids) in the body fluids.
Acidosis
pH below 7.35
Thrill
palpable vibration on the chest wall
Evaluating Edema
palpate along the shin, if there is edema assess if it is pitting or nonpitting, edema may obscure veins, tendons, and bony prominences, always use back of hands when checking temp
Palpation of Abdomen
palpate the umbilicus and surrounding area for swelling, bulges, or masses, abdomen should be soft and pt should not be in pain
Best location to assess a ventricular thrill from aortic stenosis?
palpated on the 2nd and 3rd intercostal space
Bimanual exam of female internal genitalia
palpation of the cervix, uterus, ovaries
Urticaria (wheals)
papules + macules, "maculopapular rash", commonly found in allergic reactions
Muscle loss is common in
paralyzed, immobile pts
first degree relatives
parents, siblings, children
Orientation
person (own name, age), time (day of week, date, year, season), place (present location, where the person lives, address, phone number, name of the city and state)
Condition of teeth is an index of...
person's general health
RF for peripheral Vascular disease
personal and family history of HTN, diabetes, Smoking, hyperlipidemia, coronary artery disease, obesity
Purpuric lesions
petechiae, purpura; lesions resulting from hemorrhages into the skin
C3-C5
phrenic plexus
Bacterial conjunctivitis is called...
pink eye, chunky, purulent discharge, eyes get stuck together
Why would nitroglycerine be contraindicated with aortic valve stenosis?
potent vasodilator, reduces amount of blood going back to the heart when heart is already in need of O2, can cause death
Bursae
pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures
How does Hep B differ from Hep A?
pre-iteric phase can last years in hep b!!! pts can remain infectious for years, 30% of newly infected can be asymptomatic
At risk groups for IDA
pre-menopausal women, pregnant women, persons from low socioeconomic backgrounds, older adults, individuals experiencing blood loss
The thyroid gland enlarges slightly during...
pregnancy as a result of hyperplasia of tissue and increased vascularity
Abdominal Distension
pregnancy, fat, feces, fibroids and other masses, flatus, ascitic fluid
Women's Past and Family Hx
previous gynecologic problems and any results of treatment, date of last pelvic exam by a provider, date of last pap smear and results, fever diagnosed with STD, pregnancies, reproductive or genital cancer
Arterial Blood Gases (ABGs)
primarily the concentrations of oxygen and carbon dioxide in the bloodstream, CO2 is involved in calculation of blood pH and HCO3 concentration measured in the radial artery (painful)
hemodialysis (HD)
procedure for removing impurities from the blood because of an inability of the kidneys to do so, treatment is 3x with 5 hours/tx (MWF, TTHS)
Golgi body
processes proteins synthesized by the ribosomes, prepares proteins for secretion
In a patient with a spinal cord injury, an intact vagus nerve will still...
produce its neurologic effects
Testes
produce sperm and testosterone
Pulmonic Stenosis
rare, almost always congenital, results in backward flow of blood to right ventricle, causes right ventricle hypertension and hypertrophy, clinical manifests as fatigue
Prinzmental Angina
rare, coronary vasospasm, temporary closure of blood vessels in the heart, can last long enough to cause death
Gallbladder Cancer
rare, poor prognosis because of proximity to liver, treatment if caught early: surgically removed, symptoms similar to cholecystitis
Creutzfeldt-Jakob disease (CJD)
rare, progressive, incurable, neurologic disease caused by infectious prions progressive death of the brain's nerve cells, brain tissiue has a spongiform appearance
Free Radials
reactive molecules present in the environment and generated by the body during inefficient mitochondrial metabolism, have a free electron on an oxygen that is attracted to cell membranes and damages them
MS affects a variety of cognitive domains:
recent memory, abstract reasoning, attention, and visual=spatial perception
T-Lymphocyctes need to be able to...
recognize SELF, every human cell has surface antigens called major histocompatibility cells (MHCs) also called human leukocyte antigens (HLAs), T cells know not to attack cells with the same MHC or HLAs, T cells reject foreign things like transplants that have different HLAs
When assessing respirations, take note of...
respiration rate, rhythm, depth, ease of respiration
Respiratory Health Hx
respiratory problems? Thoracic surgeries or trauma? medications for breathing probs? had chest x-ray, if yes, then what for? travel outside of the country? Smoke or exposure to smoke? Surgical history?
Posterior pituitary dx
produces TSH, ACTH, FSH, LH, GH, Prolactin, endorphins, SIADH, Diabetes insipidus both originate here
IgE and IgD
allergice response
Sickle Cell Disease: Nursing Management
alleviate symptoms of disease complications, minimize end target-organ damage, no specific treatment
Nursing Process: Evaluation
progress toward outcomes, conduct system evaluation, use ongoing assessment to revise diagnoses, outcomes, and plan, disseminate results to patient and family, continues on in a cycle
ALS
progressive atrophy of motor neurons, sensory neurons and cognitive ability remain intact, no risk factors and no treatment, highly varied clinical course!!!
macular degeneration
progressive damage to the macula of the retina
Stage 2-4 CKD
progressive kidney damage, normal GRF (kidney can function normally until 90% of nephrons are gone)
Chronic Kidney Disease (CKD)
progressive, irreversible loss of kidney function
Abdominal wall muscle
protect internal organs and allow normal compression of internal organs during functional activities like sneezing, coughing, defecation, urination, childbirth
Nails
protect the distal ends of fingers and toes, nail plate, lunula, cuticle
Genetic attributes of dark-skinned individuals afford ______________ against skin cancer due to melanin
protection
Abnormalities of the chest are described in two dimensions...
along the vertical axis and around the circumference of the chest, this creates a "grid"
Assess pt for orthostatic hypotension if...
pt takes a BP medication, has a history of dizziness or fainting, prolonged bedrest
Most ulcers don't perforate because...
pts are being treated before they get that far
Osmotic pressure is a force that ______ water into the bloodstream.
pulls
Aspiration
pulmonary aspiration occurs when material from the oropharynx enters the lower respiratory tract, mainly in pts who have trouble clearing their lungs like those with diminished gag or cough reflex and pts with decreased level of consciousness (gunk getting into the lungs)
Inflate the BP cuff until...
pulse disappears, about 10-30 mmHg above estimated systolic pressure
Purpura
purple lesions, no blanching (bruises)
Hydrostatic pressure (pressure from the capillaries) wants to...
push fluid out
Straight leg test
raise each leg to the point of pain, then dorsiflex foot - document degree of elevation when pain occurs and describe pain
wheal
raised red skin lesion due to interstitial fluid
Pustule
raised spot on the skin containing pus
Subcutaneous tissue
also called adipose or fatty tissue, lies below dermis, stores fat for energy, provides insulation for temperature control, aids in protection by providing a cushioning effect, a loose layer so it increases the skin's mobility over underlying structures
Oncotic pressure
also called colloidal oncotic pressure, refers to the force exerted specifically by albumin in the bloodstream.
angina pectoris
also called myocardial ischemia, chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle
Corneal Light Reflex
also known as the Hirschberg test, assesses parallel alignment; have pt look straight ahead, shine light from 12" and look for reflection on corneas in exactly the same position in both eyes; asymmetry indicates deviation in alignment from eye muscle weakness or paralysis
Pain caused/relieved by eating is not...
always 100% true for every pt, important question to ask during subjective assessment
Stroke Volume
amount of blood forced out of the left ventricle with each contraction
Cardiac Output
amount of blood pumped by the heart per minute
Cardiac Output (CO)
amount of blood pumped by the ventricles in 1 minute
Stroke Volume
amount of blood pumped with each contraction
Candida becomes pathogenic when...
an overgrowth of the Candida fungus occurs, commonly causing superficial diseases
ABI
ankle brachial index -- tool for objectively documenting the presence of lower-extremity peripheral arterial disease
confluent lesions
annular lesions that run together
Coal Worker Pneumoconiosis
anthracosis (black lung)
Nonverbal communication
appearance, demeanor, facial expressions, attitude, silence, listening, posture
Mitral Valve Regurgitation - Clinical Manifestations
asymptomatic for years until development of some degree of left ventricular failure, initial symptoms: weakness, fatigue, dyspnea that gradually progresses to orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema
Acute Pancreatitis: Patient Education
at discharge, educate the pt on what caused pancreatitis, how to prevent it, possible removal of gallstone, how to prevent chronic pancreatitis (a RF for pancreatic cancer)
Calcium
calcium and phosphorus are the major mineral contents of bone, Vitamin D facilitates the absorption of calcium from the gastrointestinal tract into the bloodstream (often together in supplements)
Loss of _________________ is most common cause of blindness, person is unable to read fine print, sew, or do fine work. may cause great distress
central vision
Physical Examination of the Legs
check for size, symmetry, skin color, hair distribution, femoral pulse and inguinal lymph nodes in the groin, assess for peripheral edema, inspect for varicosities and thrombophlebitis
Pain in upper right quadrant with radiation to the right and into the scapula/shoulder area is often associated with...
cholecystitis
3 main functions of the heart
deliver oxygen and nutrients to the body cells, remove waste products, maintain perfusion of the organs and tissues
An enlarged lymph node, particularly when you cannot find the source of the problem...
deserves prompt attention
Primary Prevention of ARF
detection and treatment of strep throat!!!
Goiters
enlargement of the thyroid gland, due to hyper or hypothyroidism -- compensatory response of hyperplasia, indicative of a sick thyroid that is trying to rectify what is going on
Highest Priorities: ABCs
Airway problems, Breathing problems, cardiac/circulatory problems (sometimes V for vital signs is added)
Off pump CABG (OPCAB)
An "off-pump CABG" is a CABG performed without the use of a heart-lung machine, less invasive and less memory loss compared to use of heart-lung machine
12 lead ECG
An ECG that uses 12 leads attached to the patient's skin; these include the limb leads and chest leads, measures electricity of heart from 12 different angles
breath sounds
An indication of air movement in the lungs, usually assessed with a stethoscope, identified by their intensity, pitch, and ?????
Sick hearts can be risk for...
eptopic foci
Cirrhosis leads to portal hypertension which can lead to...
esophageal varices (hemorrhoids of the esophagus)
How do the kidneys regulate blood pH?
excrete hydrogen ions and conserve bicarbonate ions
Emotional function
feelings, mood, behaviors, stability
Hypertonic IV
greater tonicity than blood, 3% NaCl
nephrotic syndrome (nephrosis)
group of conditions in which excessive amounts of protein are lost through the urine and causes low oncotic pressure (causes swelling)
submandibular lymph nodes
halfway between the angle and the tip of the mandible
Drug users will often have ____________ in their septum
holes (deviated septum)
Suprasternal notch
hollow U-shaped depression just above the sternum (manubrium), in between the clavicles
Suprasternal notch
hollow U-shaped depression just above the sternum, in between the clavicles
Proteosomes
hollow, cylindrical organelle that disposes of surplus proteins
Thalassemia major
homozygosity, life threatening, physical and mental growth often retarded, symptoms develop in childhood, splenomegaly, hepatomegaly, jaundice, blood transfusions with IV deferoxamine (can cause iron deposits that must be treated
Multiple Myeloma - CRAB
hyperCalcemia Renal damage Anemia Bone damage
Ischemic penumbra
hypoperfused area surrounding the ischemic "core", rapid reperfusion is necessary to prevent further neurological damage
AVF/AVG less serious complications
hypotension (lightheadedness, N/V, seizures) due to rapid fluid removal, muscle cramps (sometimes treated with IV bolus)
Acute blood loss leads to...
hypotension and tachycardia
Orchitis
inflammation of the testes, red, painful, heaviness, enlarged, febrile, associated with mumps
Objective Data
information that can be directly observed during interaction with the patient, information elicited through physical assessment techniques
Hypoglycemic tx
ingestion of fast acting glucose tabs or gels, juices, soft drinks, candy (acute episodes) ~~15 grams IV injection of 50 ml of 50% dextrose
TB is spread via
inhaled droplets, inhaled bacilli pass down the bronchial system to implant themselves on bronchioles or alveoli
Jugular Venous Pulse
inspect - pulse on right side of neck *Begin at 30 degree angle and adjust as necessary *Turn head slightly to the left *Direct strong light to increase visualization *Should not see distention @ 30 degrees
Tx for OSA
lifestyle chances (weight loss, reduce ETOH), CPAP machine -- cont. positive airway pressure used nightly
Tx for GERD
lifestyle changes come first!!! quit smoking, avoid foods that aggravate, weight management, caffeine/alcohol avoidance drug therapy if lifestyle changes are ineffective
Hiatal Hernia: Collaborative Care
lifestyle mods (diet, sleep at 30 def angle, small meals), antacids (h2 antags, PPIs), weight reduction if overweight surgical therapy if the other interventions fail (Nessen Fundoplication)
AV Valves
located at the entrance to ventricles (tricuspid and mitral valves)
Semilunar Valves
located at the exit of the ventricles (pulmonic and aortic)
Deep veins
located within the tissues and away from the body surface, run alonside deep arteries, conduct 90% of the venous return from the legs
Ectopic foci
location where abnormal myocardial depolarization originates
Characteristics of Breast mass
location, size, shape, consistency, moveable or fixed, distinctness, nipple, skin or lump, tender or nontender
Multiple bruses at different stages of healing and excessive bruises above knees or elbows...
should raise concern about physical abuse
Sitting pressure points
shoulder blade, buttocks, ball of foot, heel
The neck of the older adult may...
show concave curve when the head and jaw are extended forward to compensate for kyphosis of spine
Atrophy
shrinkage in muscle cells, due to disuse or diminished workload, lack of nerve stimulation (paralysis), loss of hormonal stimulation, inadequate nutrition, decreased blood flow (ischemia), aging?
Hard fixed lymph nodes
sign of malignancy
Parkinson's Disease
slow, progressive loss of dopamine-producing cells in the substantia nigra (within the basal ganglia aka deep brain), changes patient's movements such as posture, standing, walking, or writing.
Vesicle
small blister
Patient's blood sugar is high at 3 AM =
somogyi effect
How do gallstones cause acute pancreatitis?
stone obstructs the duct or ampulla of vater, causes enzymes to leak,
Kidney Stone Treatment
stones can be removed through percutaneous nephrolithotomy, broken up with lasers or sound waves (ESWL - "shock" waves, easier to pass through the urine), or removed through surgery
Bell's palsy
temporary paralysis of the seventh cranial nerve that causes paralysis only on the affected side of the face, benign, can be caused by stress
sympathetic nervous system
the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations (fight or flight)
parasympathetic nervous system
the division of the autonomic nervous system that calms the body, conserving its energy (rest and digest)
O2 needs to be used cautiously in pts with COPD so that...
the drive to breath isn't dulled
Who is most at risk for urosepsis?
the elderly, catheterized, immunocompromised
The number of mitochondria present in a cell is dependent on...
the energy requirements of the cell, heart > skeletal muscle > bone
Natriuresis is...
the excretion of a large amount of both sodium and water by the kidneys in response to excess extracellular fluid volume
Interstitial fluid (ISF)
the extracellular fluid that fills in the spaces between most of the cells of the body
Retina
the light-sensitive inner surface of the eye, containing the receptor rods and cones plus layers of neurons that begin the processing of visual information
Sodium
the main determinate of osmolarity, a positive ion (cation), found mostly in extracellular fluid, assists in the maintenance of fluid balance and osmotic pressure (norm 135-145 mEq/ml)
When inspecting and palpating skin, don't forget to check...
the moisture, texture, thickness, edema, turgor, vascularity/bruising, lesions
The greater the glucose in dialysis...
the more fluid gets removed from the patient
Osmolarity
the number of solute particles per liter of solution
Dehydration stimulates
the osmoreceptors in blood vessels which stimulate the thirst center in the hypothalamus, the peripheral baroreceptors in blood vessels to stimulate the vasoconstriction of blood vessels by the sympathetic nervous system, the kidney to secrete renin to being the RAAS system to raise blood volume and pressure, and the osmoreceptors to stimulate the posterior pituitary gland to reabsorb water at the kidney
parietal peritoneum
the outer layer of the peritoneum that lines the interior of the abdominal wall
Injuries in this region can result in loss of breathing ability because the diaphragm innervation is impaired
the phrenic plexus
cardiac resynchronization
the planned use of the shock pads
Control of Respiratory System
the pons and medulla in the brainstem
ARF: Tx
the primary goal of treating an acute rheumatic fever attack is to eradicate streptococcal organisms and bacterial antigens from the pharyngeal region, penicillin is the drug of choice for those who are not at risk of allergic rxn, a single parenteral infection of benzathine benzylpenicillin can ensure compliance, oral cephalosporin are recommended as an alternativein pts who are allergic to penicillin, however be cautious of the 20% cross-reactivity of the cephalosporin with penicillin
Total albumin in the bloodstream is indicative of...
the protein nutritional status of the body
Why do you instruct a pt to breathe through their mouth when auscultating lungs?
the pt is able to move more air when breathing through the mouth
Cardiac apex
the rounded point at the bottom of the heart
Colostomy
the surgical creation of an artificial excretory opening between the colon and the body surface varied liquid/packed stools
Bimanual palpation
the use of both hands to envelop or capture certain body parts or organs, such as the kidneys. -- place one on each side and use one hand to apply pressure and the other to feel the structure
Pleural membrane
thin, double layered membrane that encloses the lungs within the rib cage
Symptoms of Dehydration
thirst, dry, mucous membranes, poor skin turgor, hypotension, low urine output, dark colored uring, in newborns - depressed fontanelle
Barrett's Esophagus
this in-between phase between metaplasia and dysplasia,
ST Segment
time during which ventricles are contracting and emptying, should be flat
Phases of the Nursing Process
Assessment, Diagnosis, Planning, Implementation, and Evaluation
Skin Cancer - ABCDE
Asymmetry, Border, Color, Diameter (larger than pencil eraser), Evolution
Cervical Cancer Risk Reduction
Avoid exposure to HPV!!! (practice sexual monogamy, limit number of lifetime sexual partners), follow ACS guidelines for annual pap testing and any follow up treatment, learn and practice good genital hygiene, don't smoke, eat a diet rich in fruits and veggies (esp Vitamins A,C, and folate), use barrier-type contraceptives cautiously as they don't protect well against HPV, learn self-examination, get the HPV vaccine
Crohn's Dz: Etiology and patho
unknown origin, affects the entire GI tract (mouth to anus) but most often seen in terminal ilium and colon, occurs at any age but most often between 15-30, slightly higher incidence in women
Initially, the flu virus enters the....
upper respiratory tract and then invades the lower respiratory tract mucous glands, alveolar cells, and macrophages
hypospadis, epispadias
urethral meatus is located underneath / on top of the glans, present at birth and corrected with surgery
ARF: Diagnostics
urinalysis (UA), labs , creatinine clearance (24 hour urine specimen, gives more accurate picture than labs alone), renal ultrasound, CT scan, renal scan
Post-Renal Failure
urine can't get out of the kidneys, mechanical obstruction of urinary outflow and reflux into renal pelvis (BPH, prostate cancer, calculi in ureters), less than 5% of all ARF, almost always treatable if identified before kidneys are damaged
If your HF patient gets worse...
use a catheter to measure Central venous pressure (CVP) and pulmonary vascular resistance (PVR) - Readings reflect right side of the heart Pulmonary capillary "wedge" pressure (PCWP) - wedged the catheter into pulmonary artery and then took a pressure reading on the other side of the balloon, reflects what is going on on the left side of the heart Pulmonary artery pressure
Reducing Risk for HIV/AIDS
use precautions to decrease transfer of body fluids, sexual abstinence, use of condoms, double glove when handling sharp objects, single glove when handling body secretions or objects that touch bodily secretions, follow guidelines for safe handling of contaminated items, avoid high risk behaviors
When inspecting and palpating the skin, notice the temperature...
use the back of the hands, skin should be warm and temperature the same on both sides, warmth suggests normal circulatory status, hands and feet may be slightly cooler in cool environment
Bell
used for low pitched sounds
Left Lateral Position
used to accentuate or bring out a left-sided S4 or mitral murmurs and S3 an early sign of heart failure
Diaphragm
used to listen to high pitched sounds
intra-aortic balloon pump
used to strengthen the heart, device that acts as a temporary, secondary pump to supplement ineffectual contraction of the heart's left ventricle, blood inflates and oxygen rich blood is pushed into coronary arteries, balloon deflates and afterload is decreased
Older Women Client Findings: Genitalia
vaginal infection d/t atrophy of the vaginal mucosa, gray/thinning pubic hair, dryness, painful intercourse, urinary incontinence, bowel incontinence
Inspection of Internal Female Genitalia
vaginal opening, vaginal musculature, cervix, vagina, discharge is normally clear or white and without unpleasant odor
Nitroglycerine
vasodilator, very potent SE: hypotension, caution with sildenafil (Viagra) with 24-48 hours
Superficial Veins
veins located near the body surface, longest and small saphenous veins, responsible for most of the venous return of the arms
Adults have two different types of hair
vellus and terminal
Diastolic HF
ventricle has difficultly relaxin, is less elastic and cannot expand fully, the stiff ventricle cannot fill with blood adequately, therefore it pumps out insufficient blood volume, stroke volume and cardiac output are dimished
QRS Complex
ventricular depolarization and atrial repolarization, triggers main pumping contractions
T Wave
ventricular repolarization
Spinous process of C7
vertebra prominens (posterior aspect of the first rib)
Upper GI Bleeding
very bad!!!! people die from this!!!!! very high rebleeding rates!!!! go listen to bleeding love by leona lewis
Kussmaul respirations
very deep, labored breathing
constipation
very frequent cause of abdominal pain, decrease in frequency of bowel movements from what is normal, hard, difficult to pass stools, decrease in volume, retention of stool in rectum
Emergency assessment
very rapid assessment performed in life threatening situations (ABCs)
Huntington's disease
very rare, affects the whole brain but the deep brain is most vulnerable
Risk Factors for Heart Failure
very similar to RF for heart dz, risk increases with age, HF is the most common reason for hospitalization in people 65 years and older, AA at higher risk than Caucasians, family hx and genetics, diabetes, ischemic heart disease, obesity, hypertension, smoking, sedentary lifestyle
Needle marks or tracks from intravenous injection of street drugs may be...
visible on antecubital fossae, forearms, or any available vein (between the toes)
Legally blind
vision that cannot be corrected to better than 20/200 in the best eye or who has 20º (diameter) or fewer of visual field remaining
Endoscopy
visual examination within, can diagnose hiatal hernia, higher risk of perforation
External Female Genitalia
vulva: mons pubis to anal opening aka structures that can be readily identified through inspection
Hand Hygiene
wash hands and wear gloves!!!, wash hands before AND after physical contact with each patient, after inadvertent contact with bodily fluids or any equipment with body fluids, wash hands after removing gloves,
Client Abdominal Education
wash hands frequently, eat foods that have been prepared properly and cooked completely, use all recommended cautions when taking pain relievers, avoid drinking alcohol while on pain meds, avoid excessive alcohol intake, avoid or stop smoking/chewing tobacco
+1 pulse
weak, thready (easy to obliterate with light pressure)
Systolic HF
weakened ventricle has difficulty ejecting blood out of the chamber, inadequate ventricular emptying, stroke volume and cardiac output is diminished, blood accumulates in the weak ventricle, elevating pressure within the chamber and causing a backflow of blood into the atrium above it
Aneurysm
weakening of the artery wall, hypertension can weaken and rupture the artery wall, turbulent blood flow through the aneurysm, makes wall susceptible to rupture, common sites of aneurysm - aorta and cerebral arteries
Factors contributing to hiatal hernia
weakening of the muscles in the diaphragm, increase intra-abdominal pressure, obesity, pregnancy, ascites, tumors, intense physical exertion, increasing age, trauma, poor nutrition, prolonged recumbent position
Diverticula
weakness caused pouches, named for their location in the esophagus
Diverticular disease is associated with two main factors:
weakness of the bowel wall, increased intraluminal pressure
Post-Icteric Phase: Hep A, B, C
weeks to months, malaise and fatigue, 99% make a full recovery with long term immunity in Hep A
When your patient has a stroke, the first question you should ask is...
what kind of stroke is it?
Metaplasia
when one type of cell is replaced by another type of cell, (Ex: esophagus cells, which are flat epithelial cells, change to become more like columnar stomach cells)
Hiatial hernia
when part of the stomach protrudes through the diaphram into the thoracic cavity, "hiatus" = opening
Type II hypersensitivity
when someone rejects a blood transfusion
Tests for Meningeal Irritation
you're trying to irritate the inflamed meninges, Brudzinki's and Kernig's sign
Appendicitis is more common in...
young adults
Squamous cell carcinoma
~16% of all skin cancers, cell from the squamous layer of epidermis, over years sustain DNA damage potentiating malignant growth, they can metastasize CP: ulcerated, crusted RF: fair skin, sun exposure, age Diagnositic Work: Biopsy Tx: surgery alone often curative, chemo/radiation/immunotherapy for advanced stages
Paget's Disease of Nipple
uncommon form of breast cancer, starts as scaly eczema like lesion that may weep, crust, or erode. Suspect this with any persisting dermatitis of the nipple and areola. pain, tingling, burning sensation, nipple discharge
Oral malignancies are most likely to develop:
under the tongue
Clinical Breast Exam
underutilized due to assumption that other HCP will do it, lack of confidence, over-reliance on mammogram, embaressment
cryptochidism
undescended testes
Unequal height of hips suggests...
unequal leg lengths
Classic Triad of Symptoms of Parkinson's Disease
Bradykinesia, rigidity, tremor at rest (pill-rolling)
Tanner Stage 2
Breast bud stage: A small mound of breast and nipple develops; the areola widens.
Common Breast Complaints
Breast pain (mastalgia), breast mass, nipple discharge, breast size changes
Plueral Friction Rub
Breath sound described as a creaking or grating noise. Result from plueral inflammation. Is audible on both inspiration and expiration over the area of inflammation.
Examples of Medical Kidney Stone Therapy
Ca channel blockers (nifedipine), alpha blockers (tamsulosin), and muscle relaxers can increase stone passage
"Lower" Spinal Cord Injury Problems
Conus medullaris syndrome (sacral cord +/- lumbar nerve root involvement) Cauda equina syndrome (inury to lymbosacral nerve roots, usually due to lumbar disk herniation) look the same clinically, bladder and bowel areflexia, variable motor and sensory loss in the lower limbs
Hypertension: Target Organs
Heart - left ventricular hypertrophy Brain - hemorrhagic stroke Extremeties . - peripheral arterial dz Retina - retinopathy Kidney - damage of glomeruli
Corticosteroid-related complications
-Aseptic necrosis of hips, knees, and other joints - treated with calcium and vitamin D weight bearing exercises
Direct Lung Injury
-Aspiration -Near drowning -Pneumonia -Fat emboli causes ARDS
TB Vaccine
-BCG Vaccine- Bacille Calmette-Guerin (live, avirulent M. bovis) used in other countries, only about 60% effective in preventing pulmonary TB
Regurgitation
-incomplete closure of valve leaflets -results in backward flow of blood
mechanical valve replacement
-long lastingm more durable -will require anticoagulation long term for the life of the valve at fairly high levels which can put pt at bleeding risk
Chest Pain: Severitiy
0-10 pain scale
The Hib vaccine can prevent...
Haemophilus influenzae meningitis
Ebola Early Symptoms
2-21 days after exposure, fever, headache, fatigue, diarrhea, vomiting, weakness, stomach pain, lack of appetite, unexplained bleeding, joint and muscle aches
Ebola morality
40%
Eye Assessment Qs for Aging Adult
Have you noticed any visual difficulty with climbing stairs or driving? Any problems with night vision? Last time you were tested for glaucoma? Any aching pain around the eyes? Any loss of peripheral vision? How do you manage your drops? Is there hx of cataracts, blurring of vision? Any decrease in usual activities such as reading or sewing?
Gynecomastia
Abnormal development of breast tissue in males, benign enlargement of male breast that occurs when estrogen concentration exceeds testosterone levels, bilateral and firm
Subjective Data Health Hx: Children
Birthmarks? Changes in skin color of newborn? Rashes or sores? Diaper rash? Burns or bruises? Nail biting, hair twisting? Protection from sun exposure?
Etiology
CAUSE of cellular alteration or disease
HIV: Intermediate Chronic Infection
CD4 cells drop to 200-5000 cells/mL, viral load increases, HIV advances to more active state, Signs and symptoms characteristic of previous phases worsen
Tendons
Connect muscle to bone
Pancreatic Cancer: Diagnostics
ERCP is the "gold standard" b/c you can visualize pancreas ducts and tissues for tumor markers, CT scans imaging done first, then tumor markers and ERCP
Common Regions of the Abdomin
Epigastric, Umbilical, Suprapubic or Hypogastric
scrotum
External sac that contains the testes, protective, regulates temperature
Another term for antiretroviral therapy...
HAART, highly active antiretroviral therapy
Patients that need blood transfusions
Have pale conjunctiva
HIV
Human Immunodeficiency Virus, HIV leads to AIDS if left untreated
11 - 12 year olds should be vaccinated for this with a booster at 16.
Neisseria meningitidis
Osler's nodes vs Janeway's Lesions
Osler's: painful, fingers and toes Janeway's: painless, palms or soles
Chronic Pancreatitis Tx
PO amylase/lipase, bile salts, pt must control alcoholism and blood glucose sx: steatorrhea (fat in stool), once pt starts pancreatic enzyme replacement, this goes away
jugular venous pressure
Reflects right atrial pressure and right ventricular end-diastolic pressure
ABI of 0.4 0 0.3
Severe PAD
Common "Bugs: that cause meningitis
Streptococcus pneumoniae (pneumococcus) Neisseria meningitidis (meningococcus) haemophilus influenza
Oxyhemoglobin
a bright red substance formed by the combination of hemoglobin with oxygen, predominates in arteries and capillaries, Increase in blood flow thru skin = reddening of the skin; decrease in blood flow = pallor
Base
a negatively charge particle looking to associated with an H+
Apnea
absence of breathing
Melanin
brownish pigment, amount is genetically determined and is increased by exposure to sunlight
When to initiate antiretroviral (ART) tx for HIV+ pt
client readiness is most important concern, to avoid burnout and non-adherence, treatment is recommended when immune suppression is great - some guidelines suggest that treatment can be delayed until CD4 count drops below 500
Prions
infectious protein particles that do not have a genome
4 characteristics to evaluate of PMI
location, diameter, amplitude, duration
Left Sided Infective Endocarditis
more common with infections and underlying heart disease
Renal ultrasound
primarily used to detect masses
Hyperventilation
rapid deep breathing, labored
Upper Chambers of the Heart
right and left atrium (thinner walls)
Enophthalmos
sunken eyes
IgM
the first recognizer of bad guys (virus/bacteria)
Stenosis
valve orifice is restricted, door can't open all the way, impedes FORWARD -- creates a pressure gradient across open valve, degree of stenosis reflected in pressure gradient differences
Non-Hodgkin's Lymphoma
varies from slowly developing to rapidly progressive disease (type of NHLs - 90% B Cells or 10% T cells)
Basophils
"Helper" WBC (carry histamine)
Cholelithiasis (gallstones)
"bile" "stones" "process" super common, occurs in gallbladder or the cystic duct or bile duct, few symptoms until the stones get big, exact cause is unknown, stones develop when balance that keeps cholesterol, bile salts, and calcium in solution is altered so that precipitation of these substances occur
Adrenal Cortex Disorders
"hats" on top of the kidneys, fight or flight organs Cushing's Syndrome Addison's Disease
Light palpation of abdomen
-4 quad. & epigastric for overall impression -Skin and superficial musculature -One hand, press against abd. -similar to lymph node palpation
Causes of Cell Injury
-Hypoxic cell injury -Free radical injury (oxidative stress) -Physical agents of injury -Chemical injury -Infectious agent injury -Injurious immunological reactions -Genetic defects -Nutritional imbalances
Palpating Carotid Arteries
-Palpate each carotid artery -Avoid excess pressure -Only 1 side at a time (cuts off blood flow to brain) - Auscultate using the bell, ask the pt to hold their breath for a moment while listening -Note amplitude, elasticity, thrills, bruits
Scoring Deep Tendon Reflexes
0 No response 1 Sluggish or diminished 2 Active or expected response 3 More brisk than expected, slightly hyperactive 4 Brisk, hyperactive, with intermittent or transient clonus
The Stages of Health Assessment
1. Collection of subjective data (aka health history) 2. Collection of objective data (aka physical assessment) 3. Validation of data 4. Documentation of data (these tend to overlap)
Asymptomatic Bacteriuria (ASB)
2 consecutive urine cultures growing colony counts of 100,000 bacteria in a patient lacking symptoms of a UTI, most likely in women, increases with age (about 20% of women in 80s have ASB), treatment is pointless
Icteric Phase: Hep A, B, C
2-4 weeks, jaundice and pruritus due to hyperbillirubinemia
Aerobic metabolism / Krebs Cycle produces...
34 ATP
Rate of AV node
40-60 bpm
Metabolic Syndrome
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes. insulin resistance, hypertension, dyslipidemia, hyperinsulinism, centralized obesity, glucose intolerance, predisposition to DM2, Low HDL,
Epididymis
A long, coiled duct on the outside of the testis in which sperm mature.
Jaundice
A yellowing of the skin and eyes, common in liver disease
ARF: CF
Acute Rheumatic Fever, chest pain, excessive fatigue, arrhythmias, dyspnea, fever, and chills
Valsalva maneuver
Any forced expiratory effort against a closed airway such as when an individual holds his or her breath and tightens his or her muscles in a concerted, strenuous effort to move a heavy object or change positions in bed. c/i in some cardiac, neuro, post-op pts
Lymphnodes
Are small, bean-shaped organs that remove pathogens and dead cells from lymph, from very small and non-palpable to 1-2 cm, located at intervals along the lymphatic vessels, localized tissue inflammation causes the nodes to become enlarged and tender
Perception of Health
Ask questions like - how do you define health? how do you view your situation now? what are your concerns and health goals? what do you expect from us as nurses/doctors?
____________________ skills are the foundation of nursing practice.
Assessment skills
natriuretics in the body
Atrial natriuretic peptide (ANP) Brain natriuretic peptide (BNP) C-type natriuretic peptide (CNP)
Three Types of Skin Cancer
Basal cell carcinoma, Squamous cell carcinoma, and malignant melonoma
osteoclasts
Bone-destroying cells
Direct Inguinal Hernia
Bowel herniates from behind and through the external inguinal ring. It rarely travels down into the scrotum. This type of hernia is less common than an indirect hernia. It occurs mostly in adult men older than age 40.
Types of Non-Hodgkin's Lymphoma
Burkitt's lymphoma, Diffuse large B cell lymphoma, Follicular lymphoma (and many more), no hallmark feature -- but all NHLs involve lymphocytes arrested in various stages of development
Coronary Artery Bypass Graft
CABG, a piece of vein from the leg or chest is implanted on the heart to replace a blocked coronary artery and to improve the flow of blood to the heart, location of the CABG is decided based on which artery is most blocked
Crohn's and ulcerative colitis
CM vary for both, may have long periods of remission with episodes of inflammation, both diseases can be debilitating
COLDSPA
Character, Onset, Location, Duration, Severity, Pattern, Associated factors
Cholelithiasis often leads to...
Cholecystitis: "bile", "sac", "inflammation"
PUD: Treatments
Clarithromycin triple (PPI, clarithromycin, amoxicillin) - reduces gastric acid, modifying the environment the H. pylori likes to live in Bismuth quadruple (PPI, bismuth subcitrate, tetracycline, metronidazole) - BID, 14 days,
Vegetations
Collections of clotted material (fibrin, leukocytes, and microbes aka funk) that accumulate on endocardium and valves of the heart in conditions such as endocarditis and rheumatic heart disease, embolizations of portions of vegetation into circulation
Colon polyps are big risk factors in both males and females for....
Colorectal cancer
CBC
Complete Blood Count - # of cells, 3 main types (red, white, platelets), bonus: Hemacrit! % of blood that is RBC
Ligaments
Connect bone to bone
Integumentary System
Consists of skin, hair, nails, and sweat glands
Patients with CKD should avoid...
NSAIDs
Documenting data is required by...
Nurse Practice Act, accreditation or reimbursement agencies, institutional agency policy and procedure
6 cardinal fields of gaze
Stand in front of pt and have them follow obj with eyes only. H pattern or wagon wheel. Normal: smooth, symmetrical, coordinated and parallel movement Abnormal: Jerky, asymmetrical
Compartment Syndrome
Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.
Penile Cancer
This is a RARE cancer in men. Mostly in uncircumcised & not very hygienic male. Bacteria harbors in prepuse & are irritants causing carcigenic cancer. Presents with no pain, fatigue & nodular growths. Surgery is usual tx
Causes of Myocardial Ischemia
Thrombus, Atherosclerotic plaque that has embolized (most common), Prinzmetal's angina
Pre-Load
Volume of blood at the end of diastole that has to be pushed out
Heave
a forceful thrust
Neurogenic bladder
a urinary problem caused by loss of inneravtion
Pregnancy Hx
age of first pregnancy, Gravida: Para (Gravida: 6 Para: )
The number one cause of pancreatitis is...
alcohol
Eosinophils
allergic response
precordium
area of the chest wall overlying the heart and great vessels
Central Cyanosis
around the core, lips, and tongue, arterial oxygen levels are reduced or low
myasthenia gravis
autoimmune neuromuscular disorder characterized by weakness of voluntary muscles
In adults, pull the pinna
back and up
Osteoblasts
bone BUILDING cells
Irregularly irregular pulse
chaotic no real pattern difficult to measure accurately
annular lesions
circular
CPK
creatine phosphokinase (cardiac enzyme)
Lower tip usually lies at the 7th or 8th rib
inferior border of the scapula
Viscera Pleura
inner layer, covers lungs
Normal nodes feel
movable, discrete, soft, and nontender
Leading cause of blindness among persons over age 40 in Hispanics
open angle glaucoma
Verbal Communication
open-ended questions, closed-ended questions, rephrasing, well-placed phrases, inferring, providing information
os of the cervix
opening of the cervix, small and round in women who have had no children and slit like in women who have given birth
Thrush
oral candidiasis in the newborn
Familial human prion diseases are...
passed within families
Pericarditis: Complications
pericardial effusion (accumulation of fluid in the pericardial space) and cardiac tamponade (the effusion has gotten so bad the heart can't fill with blood)
Reactivation of HSV occurs during...
periods of stress, illness, or immunosuppression
cloudy dialysate indicates
peritonitis
Abdominal Hx Lifestyle Qs
smoking, alcohol use, diet, occupation, medications, fluid intake, exercise, stress
Best position to inspect for varicosities
standing
dominant breast mass
stands out from lumpiness, well defined, requires eval by breast expert, usually unilateral
Body Structure
stature and nutrition (height/weight within normal range), symmetry, posture, obvious physical deformities (missing limbs, burns, scars)
acute coronary syndrome (ACS)
sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction
Hypoglycemia complications
sweating, hunger, dizziness, nervousness, tremulousness, irritability, headache, heart palpitations, confusion, disorientation, inability to concentration, seizures, loss of consciousness
kidney causes what kind of breath odor?
sweet smelling
Snellen eye chart
that eye chart with the letters ya know
Ribs 8-10 connect to
the cartilage of the pair superior to them (this forms the costal angle)
Why is age a big cancer RF?
the older we get, the more genetic mutations we acru
Unopposed acetylcholine is apparent in...
the tremor and abnormal spasmodic muscle movements associated with Parkinson's
Gut
throat to colon
Saphenous vein
used as a graft in the right side of the heart
Chronic aortic regurgitation results from
•Rheumatic heart disease •Congenital bicuspid aortic valve •Syphilis •Chronic rheumatic heart conditions
Blood test for person who was vaccinated for Hep B
Hep B surface antigen: - Hep B surface antibodies: + Hep B core antibodies: -
ARF: Diagnostics
History and physical exam, anti-streptolysin titre (blood test for group A strep antibodies), throat culture, ESR, C-reactive protein, WBC, chest x-ray, echocardiogram
B cell Immunity
Humoral immunity, adaptive immunity, immune system memory, an antigen interacts with a B lymphocyte, and B cell laters turns into a plasma cell and remembers antigens and flags them to be attacked
Bulge test
I: detect small amount of fluid in joint Pt: supine Tech: smooth hand across medial knee, watch for refilling in lateral side + ripple on medial knee = minor joint effusion
pre renal failure treatment
IV fluids, restore blood flow
Complications of MI
Papillary muscle rupture causes mitral valve dysfunction (left side of heart) Thromboembolism from stagnant blood Pericarditis (called Dressler's syndrome) inflammation irritates sack that the heart sits in
SAIDH
Patho: too much ADH (don't pee enough) Why: Cancer (small cell lung cancer esp), pit adenoma (a tumor with its own hormone production) CM: fluid volume overload!!, hyponatremia, oliguia diagnostics: serum/urine osmolarity, urine specific gravity 0 counting the specific solutes in one cubed ml of urine, water deprivation test tx: fluid restriction, salt!!! medical ADH suppression
Inspection of the Breast
Patient should be seated with arms over the head or flexed behind the neck; adds tension to the suspensory ligaments, accentuates dimpling, and may reveal variation in contour and symmetry Seated with hands pressed against hips with shoulders rolled forward; to contract the pectoral muscles to reveal deviations in contour symmetry Seated and leaning forward from the waist; tension in the suspensory ligaments to assess the contour and symmetry of large breast . bilateral comparison of size, symmetry, contour, skin color and texture, venous patterns and lesions lift the breast and inspect the lower and lateral aspects for color changes and texture of skin skin should be smooth and the contour uninterrupted venous patterns should be symmetric
A specific form of OSA, ___________________________, is caused by a short, thick neck circumference
Pickwickian syndrome
Nasal stuffiness and epistaxis may occur during ___________ as a result of increased vascularity in the upper respiratory tract, gums may be hyperemic and softened and may bleed with normal toothbrushing.
Pregnancy, this is not abnormal
If a pt has had a hip replacement, do not test...
ROM b/c of the risk of dislocating hip prosthesis
Hodgkin's Lymphoma: Treatment
Radiation therapy (95% of stage I or stage II clients are cured with 4-6 weeks of radiation therapy), combination chemotherapy for resistant disease or high risk of relapse
Herpes Zoster (shingles)
Reactivation of latent varicella zoster virus (VZV), which resides in the sensory spinal neurons after an initial chickenpox infection Affects >60 yrs and immunosuppressed (AIDS) *Grouped vesicles on an erythematous base* painful, follows spinal nerve, unilateral
Optic disc
Region at the back of the eye where the optic nerve meets the retina. It is the blind spot of the eye because it contains only nerve fibers, no rods or cones, and is thus insensitive to light. color varies from creamy yellow-orange to pink, round or oval shape, distinct margins, and a smaller circular area inside the disc where blood vessels exit and enter
Aortic Valve Stenosis
Results in obstruction of blood flow from left ventricle to aorta during systole, effect is left ventricular hypertrophy and increased myocardial oxygen consumption because in increased myocardial mass, leads to reduced CO and pulomonary hypertension
Esophageal Diverticula
Sacs resulting from the herniation of esophageal mucosa and sub mucosa into the surrounding tissue. May develop anywhere along the length of the esophagus. Zenker's Diverticula is most common
Pheochromocytoma
a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine increased BP, often found when BP is found to be very high and does not response to hypotensive meds, headache common sx, taking out the tumor resolves this, imaging necessary
Hypocalcemia
a blood calcium level lower than 8.7 mg/dL in adults, symptoms - paresthesias around the mouth, hands, feet, muscle spasms in the fact, laryngeal spasm, arrhythmias -- Chvostek's and Trousseau's tests
Heart Failure
a chronic condition in which the heart is unable to pump out all of the blood that it receives
Barrel Chest
a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.
peripheral vascular disease (PVD)
a condition in which the legs, feet, arms, or hands do not have enough blood circulation
chronic venous insufficiency
a condition in which venous circulation is inadequate due to partial vein blockage or leakage of venous valves
Diabetes Tx
a constant balancing act of long acting and rapid acting insulin injections of rapid acting (ex: lispro) before a meal to keep blood sugar from spiking, long acting insulins once a day to keep baseline blood sugar from getting too high
Crepitus
a crackling or grating sound usually of bones, indicates roughing of the articular surface of the joints, do not confuse with distinct "crack" of tendons/ligaments
Linea nigra
a dark line appearing on the abdomen and extending from the pubis toward the umbilicus
Anemia
a deficiency in the number of red blood cells, quantity of hemoglobin, volume of packed RBCs (hematocrit), or a combination of all three
Kernig's sign
a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down
The most significant risk fact for diverticular formation is...
a diet low in fiber!!!!!!
Cataracts
a disease that causes visual impairment because of excessive growth of epithelial layers of the lens of the eye, the lens becomes thickened with less transparency and less flexibility, protein fibers degenerate, begin to clump together, and clouding of small areas of the lens occurs. As a cataract develops, the clouding becomes denser and involves a greater part of the lens, it commonly affects older adults because lens thickening is a physiological change associated with advancing age, treatment involves surgical removal of the cataract and replacement with an artificial lens called an intra-ocular lens
Diabetes mellitus
a disorder of CARB metabolism, characterized by high levels of blood glucose due to body's inability to produce or utilize insulin
Plasma membrane
a double layer of lipid molecules with carbs and proteins interspersed, selectively semipermeable, restricts intracellular losses, governs intracellular entry, separates ICF from ECF
Orthostatic hypotension
a drop in systolic BP of more than 20 mmHg upon standing from sitting or sitting from lying
Psoriasis
a genetic, chronic thickening of the epidermis that presents as overlying silver-white scales covering red, circumscribed, thickened plaques, a disease of unknown cause Frequently seen on the extensor surfaces of the elbows, knees, and scalp Tx: Topical agents, coal tar products, other agents that soften and hydrate skin, steroids are used with varying results, exposure to sunlight and saltwater baths are helpful, drugs such as methotrexate (chemo), steroids, cyclosporine, and the steroids are used systemically
C. Difficile
a gram positive, anaerobic, forming bacillus that is responsible for the development of antibiotic associated diarrhea and colitis watery diarrhea, lower abdominal pain and cramping, low grade fever, nausea and anorexia, leukocytosis
Cardiomyopathy
a group of diseases that directly affects the structural or functional ability of the myocardium, the heart is weak and no longer effective, these pts need transplants, can be primary or secondary (NICK CARTER)
Leukemia
a group of malignant disorders affecting the blood and blood forming tissues of the bone marrow, lymph system, and spleen, often thought of as a childhood disease but the number of adults affected is 10x that of children
The Heart
a hollow, muscular 4 chambered organ, size is slightly larger than the fist, located in the middle of the thoracic cavity in a space called the mediastinum, approximately 2/3 of the heart lies to the middle left, an inverted con
Visceral pain
a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera, occurs when hollow organs become distended
Instability, inability to stand, and/or a deformed hip area indicates...
a possible hip fracture
cardiac transplant
a procedure in which a patient's diseased heart is surgically replaced using a heart from a recently deceased organ donor, there are not that many hearts to transplant - cocaine can cause end-stage heart failure
Status epilepticus
a prolonged seizure lasting longer than 5 minutes, treated with IV benzos (-zepams) aka sedatives, anti-epileptics not helpful right away
Wearing gloves is not...
a protective substitute to washing hands
Skin provides...
a protective, waterproof barrier, regulates body temp, synthesizes vitamin D, allows sensory perception (pain/touch), provides non-verbal communication (facial fts, signs of abuse, medication side effects), provides identity, allows for wound repair and excretion of metabolic waste through sweat
Stereogenesis
a sense that allows a person to recognize the size, shape, and texture of an object
Anaphylaxis
a severe response to an allergen in which the symptoms develop quickly, and without help, the patient can die within a few minutes. -- ex: bee sting allergy, hives (urticaria), bronchospasm, angioedema (severe facial swelling), severe hypotension, sometimes syncope, may progress to anaphylactic shock
Esophageal Stricture
a significant narrowing of the esophagus that may significantly interfere with swallowing, usually caused by scar tissue or collagen build up from trauma to the esophagus tx: balloon dilatation or botulism injection
Papule
a small nodule (pustule = papules with fluid inside) (small)
Darwin's tubercle
a small painless nodule at the helix. congenital variation and is not significant
Hematoma
a solid swelling of clotted blood within the tissues.
Dehydration
a state of diminished water volume in the body, it is a deficit of intracellular fluid which causes body cells to shrink, it also decreases the amount of water in the ECF, may exhibit oliguria
neurogenic shock
a state of shock (HYPOTENSION) caused by nerve paralysis that sometimes develops from spinal cord injuries, bradycardia, warm, dry extremities, peripheral vasodilation, venous pooling, decreased CO, associated with injury at or above T6
Acid
a substance that dissolves to release a hydrogen ion. (H+) and an anion (-)
Raynaud's Phenomenon
a symptom associated with some autoimmune disorders, cold stimulates tricolor change in fingertips - blue, white, red, pins and needles feeling in fingers
Mental Status Examination
a systematic check of emotional and cognitive functioning, usually assessed in the context of the health history interview (this is sufficient for the most people), assess mental health strengths and coping skills and to screen for any dysfunction
Abdominal Vascular Structures
abdominal aorta, right and left iliac arteries and veins, you should not hear anything when listening over the kidneys (use the bell)
Constipation: CM
abdominal distention, abdominal pain, anorexia/nausea, headache, tenesmus, stool with blood, rectal pressure, fecolith
Peritonitis: CM
abdominal pain, rebound tenderness, muscular rigidity/guarding, fever, tachycardia, tachypnea, N/V
Abdominal Hx Qs
abdominal surgery, trauma, injury, illness? Any medications or abdominal pain? lab work or GI studies? When was your last BM? what is normal for you? family hx: stomach, colon, liver cancer? abdominal pain, appendicitis, colitis, bleeding hemorrhoids, nutritional habits of family?
Acute pancreatitis: imaging
abdominal ultrasound, CT scan (can rule out pseudocysts or abscesses, MRCP (MRI of pancreas), ERCP
Constipation: Diagnostics
abdominal x-rays, barium enemas, lower GI scopes
superficial reflexes
abdominal, cremasteric (only in males), plantar
Pyelonephritis S&S
abdominal/CVA tenderness, flank pain, N&V, fever, chills, dysuria, urinary frequency, microscopic hematuria, pyuria (WBC in urine), nitrites in urine
Ad or mal
adaptive or maladaptive, a regular scare and a keloid (an excessive response to an incision)
low production of FSH/LH
amenorrhea
RF for HIV/AIDS
anal intercourse, intravenous drug use, in heterosexuals: having multiple sexual partners, bisexual partners, partners that use IV drugs, exchange of blood or body fluids through blood transfusions, needle sticks, breastfeeding by HIV infected mother, body piercing with non-sterilized instruments, mother to infant transmission during pregnancy or delivery (esp vaginal delivery)
CKD can also result in
anemia (due to low RBC in blood) can be treated with erythropoiesis-stimulating drugs (epoetin, darbepoetin)
Epilepsy Tx
anti-epileptic agents (modify ion channels or NTs in the brain), the big three: PHENYTOIN, VALPROIC ACID, TEGRETOL many times tx involves one of these older drugs + one newer drug
Aspirin
anti-platelet, stops the body's response of responding to the inflammation caused by a MI
RF for Candida dissemination
antibiotic use, diabetes, HIV, steroids, oral contraceptives
Glaucoma
aqueous humor can't escape, increased intra-ocular pressure, sympathetic/anti-cholinergic stimulation increases intra-ocular pressure with potential pressure with potential pressure-related damage to optic nerve, cause is unknown, but possibly age related w genetic susceptibility Tx: open the "angle" with reduction in sympathetic stimulation or increase in cholinergic stimulation, marijuana ?
Peripheral Pulse
are palpable wherever a peripheral artery (e.g. radial or carotid) passes over a solid structure such as bone or cartilage, temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis
AVM
arteriovenous malformation; congenital tangle of arteries and veins in the cerebrum
Angle of Louis (sternal angle)
articulation of the manubrium and body of the sternum, continuous with the 2nd rib
Dialyzer
artificial kidney; contains a semipermeable membrane (long plastic cartridge with 1000s of parallel hollow tubes or fibers) through which particles of a certain size can pass (ultrafiltration/diffusion)
In unprepared communities, Cholera can cause death rates of...
as high as 50%
Right Upper Quadrant
ascending and transverse quadrant, duodenum, gallbladder, hepatic flexure of the colon, liver, pancreatic head, pylorus, right adrenal gland, right kidney, right ureter
Dialysis System/Site Care
aseptic technique!!! (tubing, solution, site care), exit site infection can migrate internally, leading to peritonitis, reposition the patient if outflow isn't 80% of inflow
Open Ended Questions
ask for narrative response, state topic only in general terms, use them to begin the interview, introduce a new section of questions, and whenever pt introduces a new topic
Closed/Direct Questions
ask for specific info, elicit short one or two word answers, yes or no, a forced choice, use them after opening narrative to fill in details, when you need specific facts, to move the interview along
Examination of the musculoskeletal system is closely aligned to...
assessment of the neurologic system
Vitiligo
associated with autoimmune diseases, but cause is unknown. No treatment, protect from UV exposure, occurs in all races
Erectile Dysfunction is an early sign of...
atherosclerosis/other cardiac disease -- pts will avoid telling use of sildenafil to a nurse/doctor
Sickle Cell Disease: Client Teaching
avoid high altitudes, maintain fluid intake, treat infections, pain control, folic acid daily supplements, blood transfusions in crisis, Hydroxyurea (antisickling agent) - Erthryopoietin shots for those clients unresponsive to hydroxyurea, bone marrow transplant can cute some clients
Internal cardiac defibrillator
battery-powered device placed under the skin that keeps track of your heart rate. Thin wires connect the ICD to your heart. If an abnormal heart rhythm is detected the device will deliver an electric shock to restore a normal heartbeat
Iron supplements can cause...
black stool
Lower Urinary Tract Infection (Cystitis)
bladder wall inflammation, most commonly caused by E. coli (originates in bowel), women are at higher risk due to anatomical proximity of rectum to urethra clinical manifestations: -dysuria, frequency, urgency, pressure, suprapubic pain, hematuria, pyuria (cloudy urine), incontinence
Abdominal organs located midline
bladder, uterus, prostate gland
subconjunctival hemorrhage
bleeding between the conjunctiva and the sclera, caused by a broken blood vessel in the eye
If ulcers go to far without treatment...
bleeding, holes in the gut, microbiome spreads to other parts of the body
Right Ventricular Failure
blood backs up in the vena cava causing systemic or generalized edema, backward effects are most apparent upon physical examination Hydrostatic P increases in right ventricle --> right atrium --> inferior vena cava and superior vena cava --> jugular venous distension, ascites, hepatic venous congestion (hepatomegaly), splenic venous congestion (splenomegaly), ankle or sacral edema
Infective Endocarditis - Diagnostic Studies
blood cultures, echocardiography (detects valvular vegetation's abscesses - an ultrasound), TEE (transesophageal echocardiography - ultrasound of left side of heart)
Cerebral Hemorrhage
blood flows into the brain, causing compression and displacement, this leads to tissue ischemia, as a blood clot forms, the body gradually reabsorbs the blood
Seizure Diagnostics
blood tests to RULE OUT other seizure causes or rule in epilepsy, CBC, serum chemistry, liver enzymes, brain imaging studies MRI or CT (hard b/c seizures don't happen on demand, but can tell you if there is something structural causing the seizure), EEG (v important)
Chronic Bronchitis
blue bloater, mucus and edema inhibit ventilation, patient cannot get air IN, cyanosis, cough, chronic hypoxia, clubbing of fingers, RVF --> JVD, ascites, ankle edema
DM2
body makes insulin but doesn't get it inside the cell where it needs to go (esp adiopocytes) pancreas is fine, body becomes resistant to insulin so glucose stops being brought into the cell, occurs in older adults, body compensates by increasing the heart rate, long term DM2 leads to beta cell exhaustion 90-95% of all DM cases are DM2 RF: lifestyle!!!!, age, obesity Sx: polydipsia, polyuria, polyphagia WCS: hyperosmolar hyperglycemic state (HHS)
communited fracture
bone is splintered or crushed into several pieces
Multiple Myeloma (MM) clinical presentation
bone pain/fracture, kidney damage, byproduct of plasma cells causing damage to nephron, M protein - immunoglobulin made by abnormal plasma cells
Deep Bimanual Palpation
both hands
Facial nerve (VII)
both motor and sensory, controls movement of face and taste sensation, test by having patient smile, frown, show teeth, puff cheeks, raise eyebrows, close eyes tightly against resistance, sense of taste is not normally tested
trigeminal nerve (V)
both motor and sensory, controls sensation in the cornea, nasal and oral mucosa, and facial skin, test by having the client clench their teeth, and assess the muscles of mastication, test corneal reflex by touching client's cornea with a cotton ball, check sensory function by assessing client can feel light touch and identify sharp and dull on the forehead, cheek, and chin with eyes closed
SIADH and diabetes insipidus
both relate to anti-durietic hormone!!! (stops you from peeing)
+3 pulse
bounding (does not obliterate with moderate pressure)
Diverticulitis: Tx
bowel rest, antibiotics, surgery optional based on extent of diverticular
Things that may cause "neuronal irritability"
brain neoplasms, cerebrovascular dz (most common), degenerative brain disorders such as alzheimer's, environmental stimuli like lights, loud noises, and certain music and odors, genetic predisposition, head trauma, infections, withdrawal from alcohol or sedative-hypnotic drugs, hyper or hyponatremia, and less often hypocalcemia/hypomagnesemia
compound fracture
break in the bone where the bone comes through the skin; open fracture
Brain stem
breathing, heart rate, temperature, connects the cerebrum with the spinal cord, controls alertness, arousal, breathing, blood pressure, digestion, heart rate, other autonomic functions
Excoriation
broken skin surface (usually a linear scratch)
Asthma
bronchial hyperreactivity, inflammatory response to allergens, pollutants, upper respiratory infection
Cullen Sign
bruising around umbilicus (pancreatitis or ectopic pregnancy)
Vascular abdominal sounds
bruits (HTN, normal if confined to systole) & rubs, listen with bell
When client's perform Valsalv'a maneuver by straining or bearing down...
bulges many indicate a rectal prolapse, fissures may indicate trauma, anal intercourse, or constipation, thickening of the epithelium may be due to anal intercourse
Lyme disease
bull's eye rash post deer tick bite, fever, chills, abdominal pain up to 2 weeks after a bite
Blood urea nitrogen "BUN"
byproduct of cellular recycling, important test for general hydration status/renal health
Creatinine
byproduct of muscle metabolism, important test for renal health
Smoking and birth control both increase a women's risk for...
cardiovascular problems
Carotid Artery Pulse
central artery close to heart, located groove between the trachea and the sternocleidomastoid muscle, smooth, rapid upstroke and gradual downstroke
CM of Ammonia toxicity
confusion, drowsiness, apaty, hyperactive reflexes, late findings: asterixis (flapping tremor), treated with low protein diet and lactulose
Pilonidal cyst
congenital disorder, small dimple, cyst, or sinus, contains hair, located midline in the sacrococcygeal area, palpable sinus tract that can be surgically repaired, more common in men than women
Cardioprotective Lifestyle
dietary cholesterol lower than 300 mg per day, fats should be less than 30% of total dietary calories, strictly limit saturated fats, monosaturated fats like olive oil and polyunsaturated fats such as vegetable oil preferable, 40 min 3x/wk of PA, no smoking, limited alcohol, fish oils (omega 3 fatty acids), high fiber diet
discrete lesions
distinct, individual lesions that remain separate
Diverticulosis becomes
diverticulitis
When a patient comes in complaining of fevers and chills or malaise of unknown origin...
do a blood culture, chest x-ray, urinanalysis and culture (classic work up)
go study the cardiac anatomy bc it will help with this huge ass lecture
do it rn
diplopia
double vision
Pericarditis Clinical Manifestations
dyspnea, chest pain, pericardial friction rub
Cerumen impaction
earwax buildup
Active Acquired Adaptive Immunity
either the patient contracts a disease and develops Igs and then recovers, or the patient is given a vaccine, both endow long-term immunity
Prone Position pressure points
elbow, ear, cheek, nose, breasts/genitalia, iliac crest, patella, toes
Direct BP Measurement
electronic measurement, invasive, primarily used in acute care settings (trauma/ICU)
Cushing's Ulcers
elevated intracranial pressure stimulates vagus nerve --> Ach release --> gastric parietal cell overstimulation --> HCl excess
Keloid
elevated scar tissue
Why is polyuria a symptom of diabetes>
excess glucose in the blood shifts the osmotic pressure in favor of taking water from the extravascular to the intravascular and eventually reaches the kidneys -- thirst and hunger are secondary to the body's dehydration/lack of glucose
Communication to Avoid
excessive or insufficient eye contact, distraction and distance, standing, biased or leading questions, rushing through the interview, reading the questions
Most important environmental risk factor for skin cancer is...
exposure to ultraviolet (UV) radiation both from the sun and tanning sources
spermatic cord
extends upward from the epididymis and is attached to each testicle, contains blood and lymphatic vessels, nerves, and vas deferens
Behavior
facial expression (person maintains eye contact, expressions are appropriate to the situation), mood and affect (person is comfortable and cooperative), speech (articulation is clear and understandable), dress, personal hygiene
Types of Abdomens
falt, rounded/convex, scaphoid, protuberant (viewed from the client's side)
Colorectal Cancer: Increased Risk
family hx, symptoms, positive FOBT, needs a colonoscopy
Rheumatoid Arthritis: RF
female
HIV: Acute Infection
flu like symptoms (fever, sore throat, headache, malaise, muscle and joint pain, rash), occurs about 1-3 weeks after infection, coincides with high level of HIV in blood
Constipation: Tx
fluids, fiber, exercise
Onychomycosis
fungal or yeast infection of the nails (Onycho - pertaining to the nails), secondary to paronychial infection, results in darkened, discolored and thickened nails, treated with antifungals
GERD
gastroesophageal reflux disease, most common gastric complaint, due to reduced pressure of lower esophageal sphincter (LES)
HIV: Early Chronic Infection
generally asymptomatic, fatigue, headache, low grade fever and night sweats often occur, most are not aware of infected status, CD4 counts are > 500, viral counts are low
poly cystic kidney disease (PKD)
genetic disease that affects kidneys/other organs, diagnosed in 30s-40s, renal function is impaired due to cysts
RF for varicose veins
genetic predisposition, obesity, pregnancy
Leukemia: Bone Marrow and Stem Cell Transplants
goal is to totally eliminate leukemic cells from the body using combinations of chemotherapy with or without total body irradiation, eradicates client's hematopoietic stem cells, replaced with those of an HLA-match - sibling, volunteer, identical twin, client's own stem cells removed prior
IDA Collaborative Care
goal is to treat the underlying disease, increased intake of iron, nutritional therapy, oral or occasional parenteral iron supplements, transfusion of packed RBCs
+2 pitting edema
goes down 4 cm comes back in less than 20 seconds
+3 pitting edema
goes down 6 cm comes back in less than 60 seconds
Ulcer peforation
goes from vague, cramping pain to sudden, intense pain (guarding, involuntary tension, can't even do deep palpation, probably due to gastric acid reaching other organs, need to worry about bacteria getting into other parts of the body
Carotene
golden/yellow pigment, exists in subQ fat and in heavily keratinized areas such as the palms and soles
Abescess of Bartholin's gland is a common sign of...
gonorrhea
Aging Adult Head and Neck Assessment
gradual loss of subq fat starts during later middle adult years, making nose appear more prominent in some people, nasal hairs grow coarse and stiffer, sense of smell may diminish because of a decrease in number of olfactory nerve fibers, loss of taste buds, decrease in salivary secretion
Megaloblastic Anemias
group of disorders caused by DNA synthesis, majority result from deficiency in Cobalamin (B12) and folic acid, characterized by presence of large RBCs
Holding otoscope
hammer or pen grip
happy pituitary gland =
happy other glands
Fatty liver palapation
hard nodules on liver
Mouth and Throat Assessment Qs
have you noticed any sores or lesions? how long have you had it? single or multiple? does it seem associated with stress, seasons changing, or food? how have you treated the sore? how frequent do you get sore throats? is it associated with cough, fever, fatigue, decrease appetite, headache? Is it worse when arising? what is the humidity level in the room where you sleep? smoke or dust inhaled at work? How do you treat sore throats? Bleeding gums? Toothaches? Any hoarseness, voice changes? Any difficulty swallowing? altered taste? do you smoke? what do you smoke? how many packs per day, for how many years?
Many describe the symptoms of HD as...
having ALS, Parkinson's, and Alzheimer's all at the same time
Spongiform
having the appearance or quality of a sponge
Hypertension - Clinical Presentation
headache or vision problems ?, many don't have symptoms -- "silent killer"
Subjective Neuro Assessment
headaches, dizziness, tremors, weakness, coordination, numbness or tingling, difficulty speak or swallowing, hx of seizures, hx of head injury or surgery
Musculoskeletal complains and disorders are the leading cause of...
health care visits!!! sprains, breaks, carpal tunnel, osteoporosis, tendinitis, arthritis, gout, fibromyalgia
Dim or absent breath sounds
heard over area of effusion
Interviewing People with Special Needs
hearing impaired, acutely ill, under the influence of street drugs or alcohol, those who must be asked personal questions, sexually aggressive, crying, angry and threatening violence, anxious
Ear canals with impacted cerumen give the erroneous impression of...
hearing loss
sensorineural hearing loss
hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; , may be caused by presbycusis (gradual nerve degeneration_
temporal lobe
hearing, learning, and feelings
Hiatal Hernia Complications
hemorrhage from erosion, ulcerations of the herniated portion of the stomach, strangulation of the hernia, regurgitation with tracheal aspiration
PUD: complications
hemorrhage, perforation
Constipation: Complications
hemorrhoids (most common, from frequent straining), diverticulosis, colonic perforation
friction rubs in abdomen could be caused by
hepatic or splenic
AVF/AVG serious complications
hepatitis (from the machines), sepsis
left ventricular hypertrophy
increase in thickness of myocardial wall that occurs when the heart pumps against chronic outflow obstruction
IBS
intermittent and recurrent abdominal pain associated with periods of diarrhea and constipation also may have distention, flatulence, bloating, urge to defecate, mucus common, about 15-20% of population associated with stress, psych factors "type As", food intolerances women affected more than men
GBS
known to occur after C. jejuni, cytomegalovirus (CMV), EBV, and mycoplasma pneumonia, also occured after immunizations (1976 swine flu vax), an autoimmune disorder that does not act like other autoimmune disorders
Elderly people often have....
kyphosis (forward curvature of thoracic spine)
Antibody Titer
lab tests used to confirm adequate immune protection against a particular antigen by measuring IgM and IgG immunoglobulins
Peritonitis: Diagnostics
labs: CBC, blood cultures xray, ultrasound, CT scan
Ischemia
lack of blood supply
Metabolic Acidosis can occur because of...
lactic acidosis, ketoacidosis of diabetes, renal failure causing acid waste buildup, or diarrhea or vomiting with loss of bicarb (pancreatic HCO3- is lost with prolonged, severe vomiting or diarrhea) - Clinical Manifestations: Kussmaul's breathing (deep rapid respirations, disorientation, coma, dysrhythmias, hypotension - The body will compensate by the lungs trying to blow off CO2, however the lungs can only increase the ventilatory create so much - Medical intervention: IV bicarb
Parietal lobe
language and touch (garbled speech is an example of a parietal lobe issue)
Bulla
large blister
Cerebrum
largest part of the brain, center for thought and intelligence, right hemisphere controls movement and activities on the left side and vice versa
Scoliosis
lateral curvature of the spine
BSE
lay down with hand behind the head and palpate the breast using circular motion "spokes of the wheel" or up and down "lawn mower" motion
If a patient's kidney function doesn't improve...
leads to chronic kidney disease, eventual dialysis
Changes in sodium electrolyte...
leads to potential for seizures / neuronal irritability
Aortic valve is on the _____ side of the heart, so the problems that you see originate in the _____ side of the heart
left, left
Inability to shrug shoulders against resistance is seen with...
lesion of the cranial nerve XI (spinal nerve)
Right Sided Infective Endocarditis
lesions caused by IV drug abuse
Oliguria
low urine output (<20-30 ml/hr)
Auscultation of Abdomen
low-pitched, bowel sounds should be present in all quadrants, 5 - 30 sounds in one minute is normal, listen with the diaphragm, must wait 5 minutes in one quadrant before you can say bowel sounds are absent
lithotomy position
lying on back with legs raised and feet in stirrups
Pre-renal failure
most cases of renal failure, blood can't get to the kidneys, any patho that decreases blood flow or kidney perfusion/filtration: hypovolemia, decreased CO2, vasodilation, pre-renal vascular obstructions (infective endocarditis veggies)
Sporadic PVCs
most common arrhythmia occurring with MI
Vascular obstructions
most common in people with diabetes
Urinary incontinence (UI)
most common is stress incontinence in women, loss of muscle support in pelvic floor, menopause, multiple childbirths, aging musculature, immobility, hysterectomy, and other surgery can lead to this
Sliding hiatal hernia
most common, stomach slides into thoracic cavity when supine and goes back when upright, GE junction goes up into thoracic cavity
Hepatitis Etiologies
most common: viral infections, alcohol abuse, prescription drugs, acetaminophen, statins can also damage liver and cause hepatitis less common: autoimmune liver disease, fat infiltration of liver
Murmurs
most commonly a result of valve disease
Potassium (K+)
most important electrolyte!!!, diuretic therapy is the most common cause of hypokalemia (nausea and vomitting, cardiac dysrhythmias, muscle dystony), much easier to throw out of its range
Scleroderma: Clinical Presentation
most often skin looks stretched tight, no wrinkles, (Dolly Parton) may also affect GI, kidneys, muscles, and lungs
Expiration
mostly a passive process, diaphragm relaxes and moves upward assumes a dome shape, inspiratory muscles relax and ribs move down, positive pressure inside the lungs increases and air flows out of the lungs
Hypertrophy
muscle growth, ex: the heart hypertrophies in response to hypertension, weightlifters develop hypertrophied muscles b/c of increased workload and use
Dilated and fixed pupils
mydriasis, brain dead
Prolonged ischemia leads to...
myocardial infarction
WCS: hypothyroidism
myxedema coma - infection, injury/trauma overwhelms already slow thyroid, severe bradycardia, not pushing blood forward and perfusing tissues - leads to shock, need thyroid hormone
Empirical Abx
necessary, but overused, initially started, broad spectrum abx to treat the bug until the specific bug is identified, sometimes doctors don't take a C&S because they assume your infection/bug
Hyperkalemic Patients
need an EKG! changes in K level can hurt the heart, stabilize the myocardium with calcium gluconate, enhance the removal of K, shift potassium into the cells (a short term fix), long term treatment is to limit K through diet or medication
Ear Assessment
need an otoscope with bright light, fresh batteries give off a white light, pneumatic bulb attachment, tuning forks ha, ears should be equal, level on head, note any color, lumps, or swelling
closed pneumothorax
no associated external wound, lung air enters because of disruption of visceral pleura, common in smokers, those on mechanical ventilation, and those with lung disease (spontaneous)
Hep Tx
no effective treatment, most pts recover in 4-6 weeks, prevention is key!!!!! virus just runs its course Hep A vaccine provides immunity in about 30 days, titers must remain strong for continued immunity immune globulin provides 6-8 weeks of immunity, used for travelers, can be given after known exposure to lessen severity of illness mostly symptomatic tx, if virus doesn't run its course: antivirals
Thalassemia treatment
no specific drug or diet is effective
The synovial membrane is normally...
not palpable, if thickened - it will feel "doughy" or "boggy"
Rheumatic Fever
not very common where rapid strep tests are available and strep is treated quickly, an inflammatory disease that may affect heart, brain, joints, and skin
Palpation of Joints
note any edema, heat, tenderness, pain, nodules, crepitus, compare bilateral joint findings
If any nodes are palpable...
note location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness
The _____________ __________________ is the first step in the nursing process and cannot be delegated to unlicensed personnel.
nursing assessment
Abdominal Inspection
observe coloration of the skin (Grey-Turner, Jaundice), note the vascularity (dilated veins), note any striae, scars, lesions, or rashes, inspect the umbilicus, abdominal contour, abdominal movements when breathing, assess abdominal symmetry, any aortic pulsations, peristaltic waves
Gait
observe the pt's gait as the pt walks around the room, look for evenly distributed weight!!! pt should be able to stand on heels and toes, toes should point straight ahead, posture should be erect, movements coordinated and rhythmic, arms swinging in apposition, stride length appropriate assess for falls risk!!!!!!!!!
Bowel Obstructions
obstruction of the intestine; causes pain, vomiting, abdominal distention, lack of stool, hyperactive bowel sounds adhesions, strangulated hernias, intussusception, vascular, cancer, volvulus
Duodenal Ulcers
occur at any age and in anyone, account for 80% of all PUD, H. pylori is found in 90-95% of patients PAIN RELIEVED BY EATING, burning and cramp-like
Bone conduction
occurs as the eardrum vibrates and moves the auditory ossicles
Infection in a transplanted kidney is more common because...
of the shorter ureter
causes of constipation
often from lack of dietary fiber, inadequate fluid intake, side effects of other meds (esp opioids), lack of physical activity
Ulnar Pulse
often not palpable in health person, it is deeper and not easy to detect, palpate if arterial insufficiency
Sebum
oily substance secreted by sebaceous glands, holds water in the skin
Loss of outer one third of eyebrow hair is common in...
older adults
Pain or decrease in hip rotation may signal
osteoarthritis or femoral neck stress fracture
open pneumothorax
outside air enters because of disruption of chest wall and parietal pleura (punctures)
Inspecting the tonsils
oval, rough surfaced, pink, peppered with indentations or crypts, should be no exudate on tonsils 1+ visible 2+ halfway between tonsillar pillars and uvula 3+ touching uvula 4+ touching each other you may see 1 and 2 tonsils in healthy people, esp kids
Sickle Cell Disease Symptoms
pain and swelling, pallor of mucous membranes, fatigue
Referred pain
pain felt in a part of the body other than its actual source
intermittent claudication (IC)
pain in the leg muscles that occurs during exercise and is relieved by rest
Only the patient can give you data regarding...
pain, stiffness, and levels of movement and how ADLs are affected
Parotid glands
pair of salivary glands in the cheeks in front of the ears, largest of salivary glands, normally NOT palpable
Breasts
paired elevations containing mammary glands, lie over musclces of anterior chest wall (anterior to pectoralis major and serratus anterior muscles), extend vertically from 2/3 rib to 6/7th rib, horizontally from sternum to mid-axillary line
Assessing the Knee
patient supine and then sitting with legs dangling, inspect for size, shape, symmetry, swelling, deformities, alignment, palpate for tenderness, warmth, consistency, and nodules (beginning 10 cm above the patella)
Bed bugs
peak time for feeding is 12 am - 5 am, bites may take several days to show, hide in crevices when disturbed/not active, red wheals in linear or zig-zag pattern treatment: pesticides and cleanliness
Pyelonephritis
pelvis/kidney/infection, infection of kidney caused by obstructive uropathy, ascending infection from the bladder, bladder catheterization, most common bacteria: E.coli (GI tract bacteria)
HPV may increase the risk of...
penile cancer, condom use and HPV vaccine can help prevent infection from HPV
Therapeutic Cloning
pluripotent stem cells offer the possibility of a renewable source of replacement cells and tissues to treat a myriad of diseases, conditions, and disabilities - Parkinson's, spinal cord injuries, burns, heart disease, diabetes, and arthritis
Causes of breath odor
poor oral hygiene, consumption of odoriferous foods, alcohol, smoking, or dental infection
Mouth, Nose, Throat Assessment
position pt sitting up straight with his or her head at eye level, inspect and palpate the nose, should be symmetric, midline, in proportion, with no pain, test the patancy of nostrils view each nasal cavity with person's head erect and then with the head tilted back (nasal mucosa should be red and moist) note the presence of deviated septum, any perforation or bleeding, any polyps check tongue for color, surface characteristics, moisture, inspect for any white patches or lesions
Testing Pt for Passive Movement
position test, move a finger or toe up or down and ask the pt which way it has been moved
If concussion symptoms last longer than 2 weeks, consider...
post-concussion syndrome
regularly irregular pulse
regular pattern overall with skipped beats
Kidney Transplant: Cadaveric donors
relatively healthy prior to irreversible brain injury (brain death), can preserve the kidney for 72 hours (less than 24 hours is preferred), may need dialysis until ATN in new kidney is resolved
AV node (atrioventricular node)
relays electrical impulses from atria into ventricles
female breast function
reproductive organ, produce and store milk for newborns, male breast has no milk capacity
target or iris lesion
resembles iris of eye, concentric rings of color in lesions
Each rib articulates with...
respective thoracic vertebrae
Acne vulgaris
sebaceous gland information, common between 12-25 years old, hormonal causes, treated with topicals, oral antibiotics, (Ex: Accutane - contraception necessary)
Functional Assessment: ADLs
self esteem, activity and exercise, sleep, nutrition and elimination, interpersonal relationships, spiritual resources, coping and stress management, personal habits, illicit or street drugs, environmental hazards, intimate partner violence
Use the dorsal surface of the hand to...
sense temperature
Use the palm of the hand to...
sense vibrations, thrills, fremitus (vibrations made by voice)
Low MAP indicates...
sepsis, hemorrhaging, stroke, some sort of trauma
Post-Billroth Diet
small, dry feedings, low in carbs, moderate amounts of protein and fat, 30 minutes of rest after each meal
petechiae
small, pinpoint hemorrhages
Both sodium and potassium ions required the cell's....
sodium/potassium pump to maintain sodium outside the cell and potassium inside the cell
Conditions caused by S. pyogenes
streptococcal pharyngitis, scarlet fever, rheumatic fever, glomerulonephritis, necrotizing fasciitis (flesh eating disease), and toxic shock syndome
Large bleed in the brain
stroke
Women recover better from __________ than men.
strokes
In elderly pts, the pt's dominant side may be...
stronger than the non-dominant side
Prostate
surrounds the urethra at the base of the bladder; produces a milky fluid, promotes sperm motility, neutralizes female acidic vaginal secretions
Ebola Tx:
symptomatic
urine dipstick
test that measures glucose, ketones, and other substances in the urine, uses a test strip
Male Internal Genitalia
tests, spermatic cord, epididymis, vas deferens
High MAP indicates...
that the heart is working much harder than it should, this is causing stress on the heart. Possible causes: advanced heart disease, blood clots, MI, and CVA
The portal of entry of S. pyogenes determines
the area of infection (strep throat vs. toxic shock syndrome)
Pulse rate is regulated by
the autonomic nervous system via the sinoatrial node of the heart
When inspecting and palpating the nails, note...
the shape and contour, consistency, color, and capillary refill (should be less than 1-2 seconds)
venous stasis RF
the temporary cessation or slowing of the venous blood flow, prolonged sitting, standing, or bedrest, hyper-coagulable states and vein wall trauma, varicose veins (lumen widened so valve cups cannot close, creates increased venous pressure which further dilates vein
During PVCs...
the ventricle beats independently without waiting for the sequential conduction initiated by the SA or AV nodes, don't follow an atrial contraction and do not allow for refractory period
STIs
trichomonas vaginitis, bacterial vaginosis (thought to be sexually transmitted)
Symptoms of Prostate Cancer
trouble urinating, decreased force in the stream of urine, blood in urine, blood in semen, swelling in the legs, discomfort in the pelvic area, bone pain
Vas deferens
tube that carries sperm from the epididymis to the urethra
In clinical settings, LVF and RVF...
usually affect the patient at the same time
Documentation: Vital Signs
usually documented so trends can be easily noted, Temp: degrees in F and site measured, Pulse: rate, rhythm, site measured BP: measurement, site measured, position of patient, O2 sat, pain level: what scale used
voice sounds
usually not done in routine exam. Test for presence of bronchophony, egophony, & whispered pectoriloquy
Eczema
vesicles, oozing, and crusting with excoriation, often have family history of asthma or hay fever, elevated IgE levels as it is associated with allergies or type I reaction Tx: allergen control, good skin care, avoidance of stress, foods, drink, and temperature changes that exacerbate the eczema or its symptoms. Topical or occasional systemic corticosteroids may be used, immunomodulators are showing positive results without side effects
Antioxidants such as _______,_______, ______, and ________ may help defend against oxygen free radicals.
vitamins A, E, C and beta-carotene
coffee ground emesis
vomit digested old blood
Femoral hernia mostly occurs in...
women.
Lymphatic flow is propelled by:
contracting skeletal muscles, pressure changes secondary to respiration, and contraction of the vessel walls (flow of lymph is slow compared to the flow of blood)
Chest pain often signals
coronary heart disease
LFV: Backward Effect
creates a buildup of hydrostatic pressure in the left atrium, pulmonary veins, and pulmonary capillaries s&s: dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnea, crackles in lungs
Dialysis patients can't filter out...
creatinine
Ileostomy
creation of an artificial opening into the ileum liquid stool
Strabimus
cross-eyed, no treatment results in brain "turning-off" bad eye, treatment includes patching of good eye
Debris on skin surface
crusts and scales
choleycystitis
RUQ pain or tenderness, gallbladder inflammation
Conjunctiva is pale pink, sclera white, but in persons of color they may be
"muddy" or have some pigmented macules
Neoplasia
"new growth", cancer cells, lack normal cell function - they do not work, keep dividing uncontrollably, grow and grow, lack adhesiveness to other cells (malignant cancer cells break away and travel), invasive and destructive to surrounding cells, abnormal structure and architecture, secrete inappropriate enzymes, hormones, clotting substances, tumor angiogenesis factor
paraesophageal haital hernia
"rolling", fundus and greater curvature of stomach roll up through the diaphragm, GE junction stays put
Amyotrophic Lateral Sclerosis means...
"without/lack of muscle growth in lateral nerves/injury and scarification due to inflammation"
Spinal Shock
(not real shock bc no hypotension) temporary neurological syndrome often related to secondary effects on spinal cord injury, experienced by about half of people with acute spinal cord injury, characterized by (below level of injury): decreased reflexes, lack of sensation, flaccid paralysis, may mask true post-injury neurological function (aka the pt's neurological status may improve once spinal shock resolves)
Four potential outcomes of TB infection
1. Nothing (killed by the immune system, most common) 2. Multiply and cause primary TB 3. Becomes dormant and remains an asymptomatic carrier 4. Proliferate after a latency period (reactivation disease)
Foramen magnum
A large opening at the base of the skull through which the brain connects to the spinal cord.
Histocompatibility
A state of mutual tolerance between tissues that allows them to be grafted effectively (HLA antigens must match), serum from the recipient is mixed with donor serum to test for pre-formed abx to potential donor organ, positive cross-match = absolute c/i
shunting of blood
A term that implies that blood passing through the pulmonary circuit did not become saturated with oxygen and, therefore, returns to the left side of the heart with lower than optimal levels of oxygen
Common Aneurysms
Abdominal aortic aneurysm Thoracic aortic aneurysm Dissecting aortic aneurysm - aortic linings split and you bleed between the layers Cerebral aneurysm ("Berry" aneurysm) - often "silent", sometimes not diagnosed until they rupture or are found during lookups for something else
Optimal Nutritional Status
Achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness, people with optimal nutritional status are more active, have fewer physical illnesses, and live longer
Skin Presentations: Adolescents
Acne, open and closed comedones
TB Drug Therapy
Active Disease: four primary drugs are used, sometimes all four, sometimes just three Rifampin (orange urine, hepatotoxicity) Isoniazid (peripheral neuritis, hepatotoxicity) Pyrazinamide (fever, rash) Ethambutol (malaise, GI, skin rash) Streptomycin may be used in combination with other anti-TB drugs (ototoxicity) tx lasts for 6-9, compliance can be a huge issue a pt is no longer infectious after 3 negative sputum samples
GBS onset
Acute onset of motor paralysis (ascending) with days to 2-3 weeks in onset, sensory and motor nerve involvement, progressive and usually symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes, paresthesias and numbness are usually the first symptoms
Long-term treatment for those at risk for MI or have had an MI
Angioplasty and atherectomy Angioplasty and stent placement Coronary artery bypass graft
ABCT
Appearance, Behavior, Cognition, Thought Process
Indirect BP Measurement
Ausculated or palpated (upper arm - brachial artery/thigh - popliteal artery)
Peritoneal dialysis systems
Automated peritoneal dialysis (APD) - exchanges are performed via machine "cycler", usually at night Continuous ambulatory peritoneal dialysis (CAPD) -manually performed by individual, at least 4 exchanges a day, dwell time about 4 hours, strict aseptic technique!!
A smooth tongue in a younger patient can indicate
B12 deficiency
Cerebellum
Balance and coordination, relatively small portion of the brain but contains half of the brain's neurons, damage might lead to a lack of balance, slower movements, and tremors
Mobility and Gait
Base is as wide as shoulder width, ROM is coordinated, no involuntary movement
Hyperkalemia
Blood K+ level greater than 5.1 mEq/dL, symptoms - numbness or tingling of the extremities, muscle cramping, diarrhea, apathy, mental confusion
Diagnostics for MI
Blood tests for serum cholesterol, LDL, HDL, triglycerides, electrolytes, glucose High sensitivity C-reactive protein (inflammatory measure) Serum homocysteine (peptide correlated with heart dz) Cardiac enzymes, CPK, troponin Chest x-ray Cardiac angiogram and cardiac catheterization (cath may also "treat" problem, using balloon, stent, or both)
The normal stimulus to breathe is an increase in ______________ in the blood.
CO2 (hypercapnia)
Chest Pain Assessment
COLDSPA - stabbing, aching, throbboring? Onset? Location? Duration? Severity? Patter> Aggrevating/Alleviating factors?
Why is adequate BP essential for fluid balance between capillaries and tissues?
Capillaries help maintain the vital equilibrium between vascular and interstitial spaces, hydrostatic force generated by BP is the primary mechanism by which interstitial fluid diffuses out of capillaries and enters the tissue space Interstitial fluid releases oxygen, water, and nutrients and picks up waste products, fluid re-enters the capillaries by osmotic pressure and is transported by the veins
Causes of chest pain
Cardiac disorders, heart burn, esophageal/gastric disorders/GERD, Stress, Trauma, Pulmonary disorders, Arterial aneurysms, inflammation, neurological disorders (herpes zoster)
Fatal Consequences of DKA
Cerebral edema is a severe complication that can develop in DKA. The patient may present to the emergency department (ED) in this severe state or may develop this during treatment of DKA. Early signs are headache, confusion, and lethargy. Papilledema, which is swelling of the optic disc; hypertension; and hyperpyrexia may also occur.
Ribs 1-6 attach anteriorly to the sternum via ____________.
Costocartilage
"signs" of pancreatitis
Cullen's and Grey Turner's signs
Intra-Renal failure
Damage has occurred inside the kidney, anything that directly damages renal tissue, vascular obstruction, nephrotoxins (dye, aminoglycosides), blocked tubules (clogged w gunk, myoglobin, RBCs), renal disease
deoxyhemoglobin
Darker and somewhat bluer pigment, increased concentration in cutaneous blood vessels gives the skin a bluish cast = cyanosis
Doppler ultrasonic probe
Decets a weak peripheral pulse, used to measure low blood pressure or blood pressure in lower extremity Doppler probe magnifies pulsatile sounds from heart and blood vessels
When injured, cells can...
Develop adaptive, compensatory changes in an attempt to maintain homeostasis OR Develop maladaptive changes, which are derangements of structure or function
Conduction - Ear Disorders
Disorders of sound transmission from the outer or middle ear to the receptors in the middle ear Common causes: impacted cerumen, otisis media, otosclerosis (hardening of ossicles)
Initial broad question to ask concerning cardiac assessment
Do you have any pain or discomfort in your chest?
Subjective Data: Ear
Earaches/pain, infections, discharge, hearing loss, environmental noises, vertigo, self-care behavior, use of Q tips any ear infections? how frequent? Any discharge? is it pus or blood? Any odor to the discharge? any relationship between the discharge and ear pain?
X-rays of what two conditions look the same but the underlying patho is different?
Esophageal stricture vs Esophageal achalasia
Upper GI Bleeding - Etiology
Esophagus: GERD or HH, Esophagitis, varices (hemorrhoids of the esophagus), Cancer Gastric: PUD, NSAID or steroid use, trauma (Cushing's v Curling), Cancer
ARF: Tx
FLUIDS!!!!!!! and treatment of whatever cause the ARF or insufficiency, gentle hydration (whatever that means)
Temperature
For normal cell function, the core body temp should be 96-99.9 (measured orally), can be measured tympanically, temporally, orally, axillary, or rectally Rectal is usually a degree higher than oral and temporally s usually a degree less than oral Axillary is the least accurate and rectal is the most accurate
Vital Signs
Give an immediate picture of the patient's current state of health and well being, temperature, pulse, respirations, O2 saturation, blood pressure, and pain (usually start off asking about pain first)
Mental State Assessment Tools
Glasgow Coma Scale, SLUMS Examination Tool, CAGE questionnaire (alcohol dependence), Depressive symptomatology, Mini Mental State Exam
Streptococcus
Group A beta hemolytic streptococcus (GABHS), also called streptococcus pyogenes
Upper GI Emergency Assessment and Management
HA: BP, Pulse, Capillary Refill, Neck Vein Distention Labs: CBC, BUN, type and cross-match for possible blood transfusions (A, B, AB, O, Rh status), prothrombin time/INR IV lines: preferably two large bore, should be established as soon as possible for fluid and blood replacement, whole blood, RBCs, and fresh frozen plasma (clotting factors) may be used for replacement of lost volume in massive hemorrhage In-dwelling urinary catheter, central venous pressure, CVP, PA, "wedgie" pressures
Basic Pathology of HIV
HIV infects CD4 cells (a specialized T-cell), results in all CD4 daughter cells being infected and producing new viruses
HIV/AIDS summary
HIV infects CD4 cells and monitoring the disease involves checking both CD4 counts and HIV viral load, because of the virus' natural life, an infected person is often able to maintain normal CD4 counts for years after infection, viral infection often causes flu-like symptoms acutely, nursing interventions such as nutrition and exercise are encouraged as methods to improve immune function
Risk for cervical cancer increases in clients who smoke and have...
HPV
primary hypertension
High blood pressure, the cause of which is unknown; also known as essential hypertension
Stridor
High-pitched, monophonic, inspiratory, crowing sound, louder in neck than over chest wall
Fifth disease (erythema infectiosum)
Human parvovirus B19, spread primarily via droplet infection prodromal phase may include headache, low grade fever, pharyngitis, and malaise classic skin rash follows with 3-7 days, "slapped-cheek" facial rash, may look like a sunburn
TB and Lung Tissue Reaction
Immune system is activated, fusion of infiltrating macrophages, granuloma surrounded by lymphocytes
Rheumatoid Arthritis: Treatments
Immunosuppressants!! steriods, methotrexate, DMARDs (disease-modifying anti-rheumatic drugs), monoclonal antibodies
Types of Physical Assessment
Initial comprehensive assessment, ongoing or partial assessment, focused or problem-oriented assessment, emergency assessment
Venous Ulcers
Injury and poor venous return, resulting from underlying conditions, such as incompetent valves or obstruction skin is warm, thickened, color is mottled (cyanotic), brown pigmented areas, pain is aching, tiredness, decreases with activity and walking, elevating feet relieves pain ulcers are moderately painful, pink base, pigmented skin on the edges with irregular margins located on medial aspect of ankle, pulses are usually present, edema is frequent at the end of the day, gangrene does NOT occur
Skin erosion
Loss of superficial epidermis, moist, nonbleeding surface (yeast infection, something acidic on the skin)
Types of lukemia
Lymphocytic (cancer's cell of origin was an early lymphocyte) and Myelogenous (cancer's cell of origin was an early red blood cell)
What naturally occurring hormone can also combat the growth of cancer cells, resulting in a decreased risk of prostate or breast cancer?
Melatonin
ABI of 0.9 to 0.71
Mild PAD
Transient Ischemic Attack (TIA)
Minor stroke; a disruption of cerebral circulation with neurological deficits that are reversible and last for fewer than 24 hours, a TIA does NOT leave permanent neurological injury like a stroke, clot is most common cause and eventually dissolved or moves, lasts less than 5 minutes, can be precursors to a more major event down the road
Neutrophils
Most abundant white blood cell. Phagocytic and tend to self-destruct as they destroy foreign invaders, limiting their life span to a few days.
Thyroid, single nodule
Most solitary nodules are benign; Suspect any painless, rapidly growing nodule, especially the appearance of a single nodule in a young person Cancerous nodules tend to be hard and are fixed to surrounding structures
Hypoglossal Nerve (XII)
Motor, controls tongue movement involved in swallowing and speech, test by asking the pt to stick their tongue out
What is Dialysis?
Movement of fluid/molecules across a semipermeable membrane (dialyzer) from one compartment (blood) to another (dialysate), used to correct fluid/electrolyte imbalance and remove waste, the rate of fluid removal depends on the pressure/osmotic gradient
EKG is not a confirmatory test for...
Myocardial infarction
obstructive lung disease
Narrowed airways result in resistance to airflow during breathing. Examples are asthma, bronchiectasis, COPD, and cystic fibrosis. Total lung capacity and FVC is normal. FEC1 is reduced
Macrophages
Neutrophil back up
Lesions caused by trauma or abuse
Pattern injury Hematoma Contusion (bruise)
Alternative Stress Test
Persantine (dipyridamole) --> chemical stress test, medication that makes them uncomfortable and mimics effect of exercise when pt. cannot exercise, measured on EKG
Obturator sign
RLQ pain on internal rotation of right thigh indicative of appendicitis
Psoas sign
RLQ pain with extension of right thigh indicative of appendicitis
Translation
RNA to protein; happens at ribosome in the cytoplasm
RAAS system
Renin is produced by the kidneys in response to impaired blood flow & tissue perfusion, and converts angiotensinogen in the blood to angiotensin I; ACE converts angiotensin I to angiotensin II in the lungs. Angiotensin II then vasoconstricts and stimulates the release of aldosterone. Aldosterone then promotes Na and water retention as well as K excretion.
Methods of Validation
Repeat assessment. Clarify data with client. Verify with another health care professional. Compare objective findings with subjective findings.
Temporal Arteritis
Risk of ipsilateral blindness due to occlusion of ophthalmic artery; pt sees floaters, blindness in one eye
4 key health promotion roles for the nurse as it relates to the heart
Screening pts for disease and risk factors, teaching pts relationship of RF to the disease, educating pts on lifestyle changes to reduce RFs, encouraging pts to adhere to healthy lifestyles and medical regiments to reduce disease morbidity
Scrotal Transillumination
Scrotal lesions that transilluminate include hydrocele, spermatocele and varicocele blood or tumors will NOT transilluminate
Crusts (scabs)
Secondary lesions formed from blood serum or other dried exudate
Adolescents Skin and Hair
Secretions rom apocrine sweat glands increase, subQ fat deposits increase, secondary sex characteristics / hair growth
Basic patho of IBS
Serotonin levels ? Mild celiac ? bowel hypersensitivity ?
Health Hx Present Concern - Peripheral Vascular Dz
Skin - color, temp, or texture changes Pain or cramping in arms or legs? Cold, numbness, or pallor in legs, hair loss Is pain relieved with rest?
Skin Physical Exam
Skin assessment is integrated throughout complete physical exam, scrutinize the outer skin surface first before underlying skin surface, separate areas (areas with skinfolds) such as breasts, obese abdomen, and groin - these areas are dark, warm, and moist and provide perfect conditions for irritation or infection, always inspect feet, toenails, and between toes
Hodgkin's Lymphoma Stages
Stage One: One group of lymph nodes, same side of diaphragm Stage Two: Two or more groups on the same side of the diaphragm Stage Three: On both sides of the diaphragm occasionally with involvement of another organ (Spleen is III) Stage Four: Liver, lung, bone marrow involvement
AFib stroke
Very common type. Irregular heartbeat that causes blood to clot and travel via embolus to the brain.
Hyperthyroidism: Diagnostics
TSH decreased --Pituitary senses elevated levels and is inhibiting release of TSH Free T4 elevated Radioactive Iodine Uptake --Look where iodine concentrates in thyroid --Diffusely increased in Graves (entire gland will light up) --Increased in "hot" nodules (iodine will concentrate in the nodules) Thyroid Stimulating Antibodies: + in Graves Disease
Most breast cancers occur in the upper quadrant and....
Tail of Spence
Healthy Range for Vital Signs
Temperature: 96 - 99.9 Respirations: 12-20 breaths/min Blood Pressure: ~130/85 Pulse: 60-100 bpm
Rheumatoid Arthritis: Clinical presentation
Tends to begin in the small joints of the hands, wrist and feet, then progress to knees, shoulders, hips, elbows, ankles, spine, and TMJ. Symptoms are usually bilateral and symmetric.
Fundoscopic Exam
The use of an ophthalmoscope to look through the pupil and examine the interior surface of the posterior eye, darken the room and use the large round light setting, begin at 10 inches away and move toward the person until foreheads almost touch you should see a red reflex!!!!!!!
Pneumovax
To prevent pneumonia in the elderly, infants, and children with risk factors, pneumococcal vaccine is recommended.
Indirect Lung Injury
Type of lung injury that may be caused by: -Sepsis (most common) -Shock states -Cardiopulmonary bypass -DIC -Drug overdose
Herpes Simplex Virus HSV-1
Typically causes cold sores, can be acute (abrupt onset of vesicular lesions within the epidermis, fluid filled vesicles containing active viral particle) and latent
Common Causes of Endothelial Injury
Uncontrolled diabetes (glycosylation injury), hypertension (pressure injury), hypercholesterolemia (WBC using LDL for plaque formation), smoking (nicotine vasoconstriction)
Renal CT / MRI
Used in evaluation of flank pain, hematuria, infection, trauma and to characterize and stage carcinoma Performed with and/or without contrast
ascites
abnormal accumulation of fluid in the abdomen
Graphesthesia
ability to "read" a number by having it traced on the skin
orthopnea
ability to breathe only in an upright position
Pleural Effusion
abnormal accumulation of fluid in the pleural space that compresses lung tissue and inhibits lung inflation, edematous fluid accumulates within the pleural space, caused by heart failure, severe pulmonary infection, or neoplasm The fluid may be exudate, transudate, purulent, lymph, or sanguineous
Sibilant wheeze
abnormal breath sound that is high pitched and musical in nature and is heard on inhalation and exhalation (mostly expiration)
Sonorous Wheeze
abnormal breath sound that is low pitched and snoring in nature and is louder on expiration, may clear with coughing, moaning sound
Cheyne-stokes
abnormal breathing pattern characterized by periods of dyspnea followed by periods of apnea; frequently noted in the dying patient
bradypnea
abnormally slow breathing
Causes for pulse deficit...
atrial fibrillation (AF) is a common arrhythmia that can result in a rapid, irregular heart rate, this causes an apex-radial pulse deficit because each ventricular contraction may not be strong enough to transmit an arterial pulse wave through the peripheral artery
An ______ often precedes a seizure as the perception of a strange light, an unpleasant smell, or confusing thoughts or experiences.
aura
Apical Pulse
auscultated over the apex of the heart as the heart beats, also referred to as the point of maximal impulse (PMI) - 5th intercostal space, left mid-clavicular line
Autologous vs allogenic stem cell transplant
autologous - difficult to be successful, but don't have the rejection potential allogenic - donor stem cells - risk of GVHG - graph vs. host disease
Too much sympathetic nervous system activity
autonomic dysreflexia
Sickle Cell Disease
autosomal recessive, presence of an abnormal form of hemoglobin-B in the RBC, HbS causes the RBC to stiffen and elongate (sickle shape in response to decreased O2 levels), genetic disorder, incurable disease and often fatal, treated with pain meds and IVs, basically causes blockages/deprives blood flow typical client is asymptomatic except during sickling episodes (sickle cell crisis)
Mean Arterial Pressure (MAP)
average pressure in a pt's arteries during one cardiac cycle -- a better indicator of perfusion to vital organs than systolic bp, MAP = SBP + 2(DBP)/3, "Normal" 65-110
Hamstrings
back of thigh, flex the knee
S. Pneumoniae can cause...
bacteremia, otitis media, and strep meningitis
Sty
bacterial infection that develops near the root of an eyelash and appears on the outside of the eye, S. aureus is the most common pathogenic etiology Sx: pain, swelling, redness of the conjunctiva and eyelid Tx: antibiotics, warm compresses with diluted boric acid
What diseases are vaccinated against?
bad ones, potential to be fatal
Bruits over the kidneys
bad!!
Adhesions
bands of scar tissue joining two surfaces that are normally separated, common after giving birth
Basal Skull Fracture Assessment
battle's sign (bruising behind ears), Raccoon Eyes (bruising and swelling around eyes) Halo sign in discharge from nose/ears with blood and cerebrospinal fluid)
Past Medical History
be specific and get the deets (mostly what is relevant), childhood illnesses, accidents or injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last exam data, allergies, current meds, mental health history
Pre-ictal
before a seizure
Fibrocystic Breasts
benign condition of the breast consisting of fibrous and cystic changes that render the tissue more dense; patient feels painful lumps that fluctuate with menstrual periods, cyclic or noncyclic pain, bilateral nodularity and discomfort, associated with engorgment, diffuse and may radiate to arm and shoulder may be caused by imbalance in progesterone and estrogen, may be increase in prolactin, think of the breast tissue like a sponge
Kidney Transplant: Living Donor
better survival, immediate organ availability means minimal kidney cold time and immediate kidney function, usually blood relative, but can be a non-related match
Diseased livers may not be able to removed __________ from the blood
billirubin
Complete Health History
biographical data, reasons for seeking healthcare, COLDSPA, past health history, review of systems, lifestyle and health practices
PUD: Diagnostics
biopsy of stomach, serum E. coli antibiotics, endoscopy, serum checked for H. pylori antibodies (just confirms you've been exposed to H. pylori), breath test might suggest H. pylori infection, but doesn't confirm
Generalized Seizures
both cerebral hemispheres
Transsphenoidal surgery
brain surgery through the nose
Telangiectasia
capillary dilation (spider veins)
Strokes can be caused by...
carotid stenosis
COPD
chronic obstructive pulmonary disease, common in smokers, usually a combo of chronic bronchitis and emphysema
PUD: Perforation
commonly seen in large duodenal ulcers that have not healed and are located on posterior mucosal wall, occurs when ulcer penetrates serosal surface, spillage of gastric or duodenal contents into peritoneal caivty size of perforation directly proportional to length of time client has had ulcer!!!!! sudden and dramatic onset!!! tx with STAT antibiotics!!!!!!!
Types of Bone
compact (hard, dense - shaft and outer layer) and spongy (make up ends and centers)
Mechanisms that keep blood flowing though the low pressure venous system
contraction of skeletal muscles (i.e, muscle pump - consists primarily of calf muscles), pressure gradients creasted by respiration (inspiration decreases thoracic pressure and increased abdominal pressure), intraluminal , one way valves toward the heart
Small bleed in the brain
contusion
Family Cardiac Hx
coronary artery disease? hypertension? sudden death at a younger age? stroke? diabetes? hyperlipidemia? Obesity?
Ischemic strokes
damage that occurs when the flow of blood to the brain is blocked by the narrowing or blockage of a carotid artery, blood stasis within the atria (esp the left atria) has the potential to cause emboli that make their way to the brain
Diabetes long term complications
damage to the heart, blood vessels, kidneys, eyes, and nervous system. Infections are more common in patients with diabetes, and amputations may be necessary. often due to endothelial complications, body wide damage = body wide complications all of these are preventable!!!!!!!!
Acute Rejection
days to 6 months post-op, fever, malaise, oliguria, graft tenderness, increase in BP and CREATININE is common, treated with steroids and alter immunosuppressives
As we age, sweat and sebaceous glands...
decrease in number and function, skin is dryer
Presbyopia
decreased lens elasticity leads to inability to focus close up (far-sightedness)
hypoventilation
decreased rate or depth of air movement into the lungs
How do patient's become anemic?
decreased red blood cell production - decreased nutrients (iron, B12, folic acid) blood loss - chronic hemorrhage (colon cancer) - acute trauma increased RBC destriction - hemolysis (sickle cell disease, meds, incompatible blood, trauma)
Bradypnea
decreased respiration rate
Hearing Loss COLDSPA
did the loss come slowly or all at once? has all hearing decreases or just hearing of certain sounds? in what situations do you notice loss - conversations, using the telephone, listening to the TV, at a party? do people seem to shout at you? do you have family hx of hearing loss? Do you have any hearing aids? How does loss affect your daily life?
Common sites of frostbite
ears and toes
Quadriceps
front of the thing, extend the leg and knee
Systolic murmurs may be due to..
functional flow
Sternum Parts:
manubrium, body, xiphoid process
Atrial flutter and Atrial fibrillation
neither of these are deadly for the most part, still about to maintain cardiac output, common post-CABG
Not all ___________ are cancer
neoplasia
Too much parasympathetic nervous system activity
neurogenic shock
Stroke Manifestations
neurological deficits, slurred speech, expressive aphasia, receptive aphasia, loss of gag reflex, facial droop, hemiparesis, hemiparesia, vision loss in one or both eyes, loss of sensation, some patients have disorientation, confusion, and sleepiness, which can become stupor or coma
Unstable angina
new or changing chest pain caused by ischemia - feels like an elephant sitting on chest
Subjective Data Health Hx Qs: Adults
past history of skin dz, allergies, hivers, psoriasis, or eczema? Changes in pigmentation, size, shape, tenderness or skin? Excessive dryness or moisture? Excessive bruising? Hair loss? Changes in nail shape, color, or brittleness? Self-Care behaviors?
Blood vessels are...
pathways to and from the organs and tissues to the heart
Emphysema
pink puffer, alveoli integrity destroyed, become like overdistended balloons, retention of air (CO2), pt cannot get air OUT, prolonged exhalation, barrel-shaped chest caused by excessive air in lungs, diaphragm is pushed down because of excessive air in lungs, chronic hypercapnia (tested using arterial blood gases)
Best stroke treatment is...
prevention
Mitochondria
rod shaped, synthesizes ATP, site of aerobic metabolism/oxidative phosphorylation, requires proteins, fats, carbs to produce energy, this is where the Krebs Cycle occurs
Turbulent blood flow occurs
when there are irregularities in the vessel wall, at high flow rates, and when there are sudden changes in vessel diameter. Turbulent flow also occurs in large arteries at branch points, in diseased and narrowed (stenotic or partially obstructed) arteries and across stenotic heart valves.
How does Edema occur?
when there is an excess of fluid in the extravascular compartment, it can occur because of elevated hydrostatic pressure created by excess water in the bloodstream or diminished osmotic force created by a low amount of solutes in the bloodstream
Acute Bronchitis: treatment
• Broad-spectrum antibiotic for 7-10 days • mucuolytic agents • Expectorants • bronchodilators • Increase in fluids • cough suppressants may be needed at night to allow the individual to sleep
aortic valve stenosis clinical manifestations
- angina pectoris (bc of increased need for O2) - syncope - heart failure poor prognosis when experiencing symptoms and valve obstruction is not relieved
Leukemia: Clinical Manifestations
- related to problems caused by leukemic cells infiltrating client's organs (including bone marrow) - splenomegaly, hepatomegaly, lymphadenopathy, bone pain, meningeal irritation, oral lesions (chloromas), marrow suppression sx
2 main lymph ducts
- right lymphatic duct: drains upper right quadrant of body - thoracic duct: drains rest of body - both then drain into subclavian veins
Mitral Valve Regurgitation
-Majority of cases attributed to: ~MI (bc most MIs on left side of heart) ~Chronic rheumatic heart disease ~Isolated rupture of chordae tendineae ~Mitral valve prolapse ~Ischemic papillary muscle dysfunction ~Infectious endocarditis in the short term, the body pumps more blood a lot faster to try and make up for this
Consequences of Endothelial Cell Injury
-Nitric oxide is diminished (vasodilation ability of artery diminishes) -Endothelin is secreted (vasoconstriction of artery occurs) -Thrombogenic substances secreted (blood within the artery clots more easily) -Inflammation occurs with injury, white blood cells (WBCs) incorporate lipids , foam cells , fatty streak, new atherosclerotic plaque
Critical Thinking Principles
-Proceed through sequential steps from novice to expert >incorporation of experience provides foundation for development of clinical practice -Utilize a multidimensional thinking approach to interpret data >use an organized, systematic assessment format -Validate and confirm findings based on nonjudgmental interpretation of data >check and corroborate accuracy and reliability of data -Cluster data information to support evidence as well as rule out inconsistent clinical findings in terms of differential diagnosis >distinguish relevant signs and symptoms
Pulse force 3 point scale
3+ (full, bounding), 2+ (normal), 1+ weak, thready, 0 absent (bilateral equality)
deep vein thrombosis (DVT)
A blood clot in a deep vein, most often an extremity, may be asymptomatic, unilateral extremity edema, calf tenderness, increased calf circumference, increased warmth of extremity, erythema along a vein, heavy feeling in extremity, dull aching pain when walking
Hgb A1C (glycosylated hemoglobin)
A blood test that measures the amount of glucose in the hemoglobin of red blood cells averaged over the 90-day life span of the cell, a percentage red blood cells that have a higher glycation are more "soaked" in sugar or have a prolonged hyperglycemia
Restrictive Lung Disease
A condition in which lung expansion is limited by inflammatory diseases that affect the elasticity of the chest wall pleural or lung tissue itself Total lung capacity and FVC is reduced, FEV1 is normal or reduced
Testicular Exam
A self exam that men should perform once per month once they have reached puberty to detect any lumps, swelling, pain, or discomfort in the scrotom or abdomen best performed in shower, exam by rolling testicle between the thumb and fingers, use slight pressure, feel for lumps, changes in size or irregularities
Breast Self Exam
An inspection by a woman of her breasts to detect breast cancer, recommended that all women 20 and old be informed about BSE, when menstruating - perform 4-7 days after end of menses if menstruating and on a consistent day each month if menstruating
open pneumothorax
An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound;
Nursing Process: Implementation
implement in safe and timely manner, collaborate with colleagues, use community resources, coordinate care delivery, document implementation and modifications
Sinus Bradycardia and Tachycardia are both common...
in those with heart disease
Foods Rich in K+
Bananas, orange juice, meat
High glucose and Endothelial Cell injury
in uncontrolled diabetes, glucose attaches to endothial cells and disrupts their integrity
Low production of Prolactin
inadequate lactation
Cancer surgery and seeding
inadvertent spreading of cancer cells during surgery
Hypertension - Diagnostic Workup
includes tests to look for secondary vs. primary hypertension
DM: Tx
diet should be about 50% carbs, 30% fats, and 20% protein carbs should be low glycemic index (dried beans, legumes, most veggies/fruit, whole grain breads/cereals) low fat/salt diet to prevent CVD daily exercise v important!!! can help type 2 re-sensitize to insulin
Nursing Management: IDA
diet teaching, supplemental iron, discuss diagnostic studies, emphasize compliance, iron therapy for 2-3 months after hemoglobin levels to return to normal
Why do we determine the validity of the pt's responses before completing an assessment?
if a patient is impaired the data may not be accurate
Veins
Carry deoxygenated blood back to the heart, the body has more veins than arteries, superficial veins lie closer to the surface, the walls are thinner and larger in diameter, veins have valves that control direction of blood flow
Anemia of Chronic Disease
Caused by end-stage renal disease, chronic liver disease, chronic inflammation, malignant tumors, chronic endocrine diseases Leading to underproduction of RBCs and mild shortening of RBC survival
Salmonella
Caused by poultry, food contamination, leads to flu-like symptoms + diarrhea, treated with antibiotics and hydration
Major Lymph Nodes of the Axillary
Central Axillary (mid-axillary over the ribs and serratus anterior, receives lymph from other 3 groups) - Pectoral Anterior, Subscapular Posterior, Lateral (along the inside upper arm)
Temporary Vascular Access Site
Central Venous Catheters (CVC), when immediate access is needed, usually via internal jugular, double lumen catheter, one for removal and one for return, used when waiting for other access sites to heal
Colorectal Cancer
if caught early through regular screening, there is a 90% chance of cure, most prevalent over the age of 50 (93% of cases)
Three Layers of the Heart
Epicardium (outer layer), Myocardium (thickest layer made of contractile cardiac muscle cells), Endocardium (thin inner layer of the heart)
Layers of the Skin
Epidermis, Dermis, Subcutaneous tissue
Collaborative Care for PTX
if small and the pt is stable: observation, should resolve spontaneously, may aspirate with a large bore needle If larger: insertion of chest tube
Arterial Ulcers
Injury and underlying ischemia, resulting from underlying conditions, such as atherosclerosis or thrombosis skin is cool, hairless, dry, shiny, pallor when elevated and rubor when dangling Pain is sharp, stabbing, increases with activity and walking, lowering feet relieves pain ulcers are deep, painful, pale with distinct margins located on lateral malleolus, toes, and dorsum of foot, pulses are absent or diminished, edema is infrequent, gangrene may occur
Dermis
Inner supportive layer, connective tissue/collagen, elastic with excellent blood supply, holds the sebaceous, sweat glands, and hair follicles
Physical Examination Techniques - Abdomen
Inspection, Auscultation, Percussion, Palpation
Order of Assessment for Other Body Systems
Inspection, Palpation, Percussion, Auscultation
Physical Examination Techniques
Inspection, Palpation, Percussion, Auscultation **use this order for all systems EXCEPT abdomen
Skin
Intact and functioning skin is essential for life and health, the largest organ system (covers 20sq. ft. of area)
Hyperglycemia is more/less deadly than hypoglycemia
LESS
Hep B
LESS SYMPTOMATIC< LESS PEOPLE KNOW THEY HAVE IT CM are the same as Hep A in 70%, most recover by 30% will develop chronic hep transmitted through bodily fluids!!!, can also be transferred moth to baby, infants should be vaccinated within 12 hours of birth, Hep B is detectable in almost every bodily fluid
Diverticulitis symptoms
LLQ pain (dull, steady, midabdominal pain), constipation, generally no bleed, may perforate alterations in bowel habits, increased flatulence, anorexia, low grade fever, traces of occult blood in stool
IDA: Diagnostic Studies
Labs (CBC, Reitculocytes (RBC teens), serium iron, TIBC, ferritin (iron studies), Bilirubin, Stool Guaiac test/Hemoccult, Endoscopy or Colonoscopy
Ten Traps of Interviewing
Providing false assurance or reassurance, giving unwanted advice, using authority, using avoidance language, engaging in distancing, using professional jargon, using leading or biased questions, talking too much, interrupting, using "why" questions
Diagnosis of COPD
Pulmonary function tests (PFTs) also called spirometry, FEV1 is significantly diminished in COPD bc the pts exhalation phase is slow and prolonged
S4 heart sound
Stiff/hypertrophic ventricle, also known as the "atrial gallop," occurs just before S1 when the atria contract to force (late in diastole) blood into the LV. If the LV is noncompliant, and atrial contraction forces blood through the atrioventricular valves, a S4 is produced by the blood striking the LV. Can be a sign of diastolic HF
Perforators
Veins that joint / connect the deep and superficial veins
Validation of Data
Verify that subjective and objective data are reliable and accurate, use for findings that are highly abnormal or inconsistent with other findings
Appendicitis: Tx
immediate surgical removal if inflammation is localized, NPO, IV fluids, antibiotics low fowler's (sitting forward, knees up) - reduces strain on abdomen
Scleroderma: basic pathology
immune complexes deposit in the skin and connective tissue
Lymphocytes
immune system "memory" and "self" monitoring
Strep pneumoniae is a common pathogen in....
community-acquired pneumonia (CAP)
Decompensated HF
compensatory mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results
Compensated HF
compensatory mechanisms succeed in maintaining an adequate CO that is needed for tissue perfusion.
cardiovascular system
complex system consisting of heart and a closed system of blood vessels
Curling's Ulcer
complication from severe burns!!! reduced plasma volume --> gastric ischemia --> sloughing of mucosa --> injured mucosa
Parasympathetic stimulation...
decreases heart rate
How does dehydration cause kidney stones?
decreases in urine production leads to increased concentration of calculus forming substances
3 types of Veins
deep, superficial, perforator
Hypoparathyroidism
deficient production of parathyroid hormone, usually secondary to thyroid tx low PTH --> hypocalcemia CM: muscle spasticity Tx: Vit D + Cal supps
Increased BUN indicates
dehydration!!!!! excessive protein intake and impaired renal function
How are kidney stones formed?
dehydration, urinary stasis, immobility, high protein diet, kidney diseases or infection can cause clumping of minerals in the kidneys, most common in renal pelvic or calyxes of kidneys
PR Interval
delay of AV node to allow filling of ventricles
Use palpation of _____________ or the PMI to determine if a murmur is systolic or diastolic
carotid pulse
Phalen's Test
carpal tunnel syndrome pain, numbness, tingling = positive test and is indicate of carpal tunnel syndrome
Leading cause of blindness among persons over age 40 in African Americans
cataracts and open-angle glaucoma
LVF: Forward Effects
cause decreased perfusion of the brain, kidneys, and other organs
The same organisms can set up shop in different parts of the body and...
cause different diseases
IBS: etiology/patho
cause is unknown, possibly heredity, autoimmune, infectious agent, environmental impact
Self-Care Assessment Qs
how often do you use a toothbrush, floss? last dental exam? do you wear dentures? any problems with talking?
Shigella: Gastroenteritis
humans are the only reservoir, transmitted person to person by fecal-oral route (unknowingly), outbreaks are usually in communities where sanitary standards and level of hygiene are low, common in day cares, nurseries, custodial institutions
Kyphosis
hunchback, increased forward curvature of the thoracic spine (seen in older adults)
Edema/Fluid Swelling is usually caused by...
hydrostatic or oncotic problems
pleuritis (also called pleurisy)
inflammation of the pleura, this condition is common in infections that extend to the pleura
Prostatisis
inflammation of the prostate gland, caused by bacterial infection, S&S: difficulty urinating, painful urination, pain in groin, genitals, or pelvic area, flu-like symptoms, febrile
vulvovaginitis
inflammation of the vulva and vagina, can be caused by dissemination of Candida
Common assessment signs in GI bleeding
thready pulse, cap refill is slow, won't see as much neck vein distention when lying patient back
Asthma Attack Symptoms
wheezing, coughing, dyspnea, chest tightness, use of accessory muscles Long term consequences: bronchial remodeling due to scarring, leads to restriction of airflow FEV should improve after inhaling a bronchodilator
When assessing skin turgor, "tenting" will occur...
when turgor is decreased
Lactiferous sinus
where milk accumulates during nursing
Lunula
white, opaque, semilunar area at the proximal end of the nail, lies over the nail matrix where new keratinized cells are formed
Prostate cancer is less common in people...
who do not eat meat
Syndrome =
whole bunch of different things going on
NHL clinical manifestations
widely disseminated disease usually present at the time of diagnosis, painless lymph node enlargement (primary feature), high grade lymphomas, peripheral blood is usually normal
Not all individuals exposed to Ebola...
will develop the disease
Hemorrhoid Tx
witch hazel (numbing), sclerotherapy, banding, laser coagulation
Renal angiogram
x-ray movie, visualization of renal vessels, used with suspected vascular issues, catheter is inserted into artery and advanced into renal vessels, little dye with continuous x-rays, encourage fluids afterwards to flush out dye, assess pulses distal to insertion site
Candida albicans
yeast, common in the mouth or skinfolds (breasts), very red in the middle with satellite red spots Transmission: contact Treatment: topical vs. systemic anti-fungals or antivirals
Standard Precautions
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting - hand hygiene, PPE - gloves, gown, mouth/nose/eye protection, cough etiquette
COPD vs. Asthma
Asthma have problem breathing in,(but wheeze when exhaling), COPD has problem exhaling. Asthma is more reversible and onset is early in life. COPD is not fully reversible and onset is in midlife.
Leading bacterial causes of gastroenteritis worldwide
cause severe diarrheal illness Salmonella, Shigella: gastroenteritis, escherichia coli 0157:H7, campylobacter
Metabolic acidosis/alkalosis
caused by anything other than the lungs
Causes of pitting edema
caused by either systemic disease (heart failure, obesity, pregnancy, nephrotic syndrome, malnutrition, HIV) or local conditions affecting the involved extremities (deep vein thrombus, post-op, trauma, compartment syndrome, infection, lymphedema)
Tuberculosis
caused by mycobacterium tuberculosis, involves the lungs (most common), larynx, kidneys, bones, adrenal glands, lymph nodes, meninges ~25% of global population is infected with latent TB (noninfectious) Prevalence drecreased in 1940s1950s, resurgence from 1985-1992 (epidemic of TB with HIV infections, multi-drug resistant strains of M. tuberculosis
Edema
caused by the presence of excess fluid in interstitial spaces, can be localized or systemic, skin appears puffy and feels tight
Campylobacter
causes diarrhea due to eating raw or undercooked poultry, contaminated water, contact with animals, drinking raw milk, most people can recover without specific treatment
abdominal reflex
causes lateral movement of umbilicus as abdominal muscles on one side contract
Low albumin in the bloodstream...
causes low oncotic pressure, this condition results in edema
Corynebacterium diphtheriae
causes severe pharyngitis, dyspnea, heart failure, and death
Clostridium tetani
causes tetanus aka muscle spasms or "lock jaw", larygospasm, requires mechanical ventilation
Bordetella pertussis
causes whooping cough
In circumstance of overwhelming insult...
cell injury or cell death can occurr
Skin breakdown as we age is due to...
cell replacement is slower and wound healing is delayed
Biopsy
cell sample from an organ or mass of tissue to allow for histological examination
Microtubules
cell structures that cause cellular movements, used in mitosis, drug-related apoptotic response
T Cell Immunity
cell-mediated immunity, innate immunity, T cells look for foreign cells/antigens and attack them
Benign Cancer
cells resemble normal cells and do not spread, tissue is well delineated and easily removed
ARDS - Alveolar damage
cells that produce surfactant are damaged, decreased surfactant alveoli lose ability to stay expanded, alveoli continue to flood -- hypoxemia and tissue hypoxia, shunting (blood that goes past the alveoli but doesn't get any O2_
Health Hx: Subjective Male Genitalia
change in size of scrotum (could indicate cancer, scrotum enlarges with age), sexual dysfunction (erectile dysfunction increases with age, fertility problems), changes in bowel patterns, last testicular exam, stool test, colonoscopy, STDs, family hx of cancer, lifestyle and health practices, sexual partners
Concussion symptoms
confusion and retrograde amnesia, brief loss of consciousness, headache, dizziness, N/V, mood and cognitive disturbances, sensitivity to light and noise, sleep disturbance
Objective Data - Skin Preparation
consciously attend to skin characteristics, the danger is one of omission
Mental status is inferred through the assessment of...
consciousness, language, mood and affect, orientation, attention, memory, abstract reasoning, thought processes, thought content, perceptions
Diverticulosis is a complication of...
constipation
Ednothelial injury incites the ________________ reaction
inflammation, brings WBC to the site of the damage, WBC + clotting factors provide the elements for vascular dysfunction
Cushing's triad
three classic signs—bradycardia, hypertension, and bradypnea—seen with pressure on the medulla as a result of brain stem herniation
Hoarseness can be a sign of
throat, head, neck cancers
Subjective Data Health Hx Qs: Adolescents
Skin problems like pimples, blackheads?
TB Diagnostic Studies
Skin testing (immune response demonstrated by hypersensitivity to purified protein derivative (> 10 cm = TB response) - since this test is only looking for the body's immune response to TB, it does not tell you if the person has active or latent TB, even after taking medication to treat TB, the reaction to the skin test will remain positive in most people, therefore, anyone who has a positive skin test should not have skin testing again
Type III hypersensitivity reaction
antigen-antibody complexes are deposited in tissues and result in the activation of complement and subsequent tissue inflammation and destruction example: Lupus
Our bodies build antibodies against...
antigens!!!!!!!!!
HSV-2 treatment
antivirals
Rheumatoid Arthritis: Basic Pathology
development of antibodies that form immune complexes that, through "molecular mimicry" deposit onto and cause destruction of the synovial membrane in joints
Lordosis
exaggerated lumbar curve, seen in pregnancy or obesity
Up to 80% of GRF may be lost with...
few changes to body function, kidney can survive without dialysis until almost 90% of nephrons are gone
Barium swallow
radiographic examination of the esophagus, stomach, and small intestine after oral administration of barium sulfate, less risk of perforation, can diagnose hiatal hernia
S. pyognes
secretes large numbers of toxins that facilitate the spread of infection through tissues, these products include: streptomycin S and O stretokinase, DNAases, proteases, and exotoxins
Kortokoff Sounds
sounds that are heard while taking a person's blood pressure
Neck Assessment
symmetry, ROM, lymph nodes, trachea (should be midline, can indicate lung problems), thyroid gland use a gentle circular motion of fingerpads to palpate lymph nodes
Hypomagnesemia
fewer than 1.5 mEq/L, Mg++ stored in the bone, caused by prolonged diarrhea, laxative abuse, increased renal excretion of magnesium, sepsis, burns, and serious wounds requiring debridement, common in ETOH abuse (ethanol abuse)
Pain - the 5th Vital sign
highly complex and subjective experience that originates from the CNS, PNS, or both
CKD: Diagnostics
history and physical exam, labs, renal ultrasound, CT scan, renal biopsy
Factors that Increase Risk of Testicular Cancer
history of cryptorchidism, family hx of testicular cancer, cancer of other testicle, caucasian male
Health Hx: Male Genitalia
history of present health concer, pain lesions, discharge, lumps, swelling or masses (could indicate hernia, infection, STD, cancer), urination difficulties
MS Subjective Data
history of present health concern (what brought you in today?), review of systems, past health hx, fam hx, lifestyle and health practices (nutrition/exercise)
RF for Melanom
history of previous melanoma, age over 50, mole changing, male gender, one to four atypical moles, ultraviolet radiation exposure, light eyes or skin color, severe/blistering (2nd º) sunburns as a child
Acute Kidney Injury (AKI)
increase in creatinine or decrease in urine output, potentially reversible, commonly follows severe, prolonged hypotension, dehydration, hypovolemia, or exposure to nephrotoxic agents, develops over hours/days
Hyperplasia
increase in the number of cells, increases tissue mass, (ex: pregnancy increases demand of milk, which causes hyperplasia of breast milk glands and tissue mass)
Atrial flutter
increased amount of electrical generation, more p waves than usual, "sawtooth" look to the EKG (fire, fire, fire QRS)
Infaraction/Ischemia-related edema in the brain can lead to...
increased intracranial pressure
Appendicitis
inflammation of the appendix, assess for rebound tenderness: palpating deeply and releasing pressure rapidly
mastisis
inflammation of the breast, redness, tenderness to painful, firm or hard, usually in a single quadrant of the breast, may have drainage, symptoms of flu-like infection
Colorectal Cancer Risk Factors
- Age 60 years or older • African American or Eastern European descent • A diet high in red or processed meats • Cancer elsewhere in the body • Colon polyps • Inflammatory bowel disease (either Crohn's or ulcerative colitis) - Family history of colon cancer • Personal history of breast cancer • Certain genetic syndromes: familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch's syndrome • Suspected risks also relate to diet, smoking, and alcohol: - Diets high in fat and low in fiber - Smoking cigarettes and drinking alcohol
Causes of DVT
- LACK OF AMBULATION - hyper coagulability - abnormal blood flow - endothelial injury
Initial Survey of Respiration and the Thorax
-Rate, rhythm, depth, and effort of breathing - use of accessory muscles -Facial expression -Level of consciousness -Assess patient's color -Listen to patient's breathing -Inspect the neck -Observe shape of chest -ALWAYS compare side-to-side
cystitis diagnostic testing
1) Best initial test: Urinalysis 2) Most accurate diagnostic test: Urine culture and sensitivity positive leukocyte esterase, increased WBC, positive for nitrites (indication of bacteria)
SLE - Diagnostic Workup
1. Lab work for "auto" antibodies (antinuclear antibodies) 2. General inflammatory blood tests 3. CBC (consider lupus' possible bone marrow effects) 4. Other tests to rule out
Rheumatoid Arthritis: Diagnostic Workup
1. Rheumatoid factor (+ve in ~70-80%) 2. Anti-citrullinated protein (+ve in 50% or more) 3. General inflammatory bloodwork (CRP, ESR)
Pancreatic Cancer RF
40+, high fat, meat-oriented diet, processed meats/smoking = highest risk, diabetes
RF for Cardiovascular Dz
45 yo in males and 55 yo in females, males more at risk than women until menopause, then risk is the same, AA higher risk than caucasians, family hx, high-fat, high-sodium, low folic acid diet, sedentary lifestyle, high total cholesterol, high LDL, high triglycerides, low HDL, smoking excessive alcohol use, BMI above 30, hypertension, stress
Cervical Cancer
90% of neoplasms originate in the transformational zone - this is where cells are obtained during a pap smear
Sodium (Na+)
<135 mEq/ml = hypoatremia - diarrhea, vomitting, burns, SIADH >145 = hyperatremia - dehydration, diabetes inspidus for both, be wary of neuro changes up to and including seizures hard to throw out of its range
Where are broncho vesicular sounds best heart anteriorly? posteriorly?
???
When should the examiner auscultate voice sounds?
??? idk it doesn't say
What type of percussion sound will you have over hollow organs? Over solid organs? Over lung tissue?
????
How are breathe sounds identified?
listening for one full breathing cycle in each location, compare side to side, be alert to pt discomfort related to breathing, note the intensity of breath sounds, listen for adventitious breath sounds
Endothelial Injury
ACCELERATED ATHEROSCLEROSIS, most severely impacts brain and heart, but occurs everywhere, narrows the diameters of vessels
hepatocellular carcinoma (HCC)
liver cancer, rare complication of cirrhosis, does NOT require biopsy for diagnosis, can be made radiographically, treated with excision, radiation, chemo or non-chemo bead embolization, Sorafenib (Nexavar)
Solid viscera
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus (maintain shape and consistency)
Ventricular tachycardia (V-tach)
A condition in which the heartbeat is quite rapid; if rapid enough, ventricular tachycardia will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs, reduced cardiac output and ventricular filling time At least 3 PVCs in a row (many more is common)
Whisper test
A hearing test in which the examiner stands 28-24 inches from one of the patient's ears, has the person block sound in one ear and whispers a random set of 3 numbers and letters (or three non-related words) into the other ear, asking the person to repeat what was heard. tests for loss of high frequency sounds
parathyroid hormone
A hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body, skeleton is the largest repository of calcium in the bone, when there isn't enough calcium calcium is sucked out of the bones
A patient with kidney stones may have...
more than one type of stones concurrently (30-40% Ca oxalate, 8-10% Ca phosphate, 5-8% uric acid, 10-15% struvite (Mg Ammonium Phosphate or infectious stones)
UC: Tx
ANTI-INFLAMMATORIES, 15-20% require surgery
Crohn's Dz: Tx
ANTI-INFLAMMATORIES, nutritional therapy!!! high protein, high calories, low residue, may be NPO in acute setting not cured by surgery, but majority need surgery at least once in the course of the disease
Rates of open-angle glaucoma are 3-6x higher and 6x more likely to cause blindness in
African Americans
The Aging Adult
Although pain should not be considered a "normal" part of aging, it is prevalent. - When older adult reports a history of conditions such as osteoarthritis, peripheral vascular disease, cancer, osteoporosis, angina, or chronic constipation - be alert and anticipate a pain problem - Older adults often deny having pain for fear of dependency, further testing, or invasive procedures, cost, and fear of taking painkillers - During interview, you must establish an empathic and caring rapport to gain trust - Look for behavioral cues - changes in dressing, walking, toileting § Slowness and rigidity may develop, fatigue may occur § Look for sudden onset of confusion, which may indicated poorly controlled pain
Health Assessment Subjective Qs
Any hx of crossed eyes now or in the past? Does this occur with eye fatigue? Ever see double, constant or does it come and go? In one eye or both? Any redness, swelling? Infections? When they occur? Any watering or excessive tearing? Any discharge? is it hard to open your eyes in the morning? Any hx of injury or surgery to the eye? allergies? Do you wear glasses or contacts? Last time prescription was checked?
Meniere's Disease
An increase in the endolymph that fills the membranous labyrinth, resulting in distention of this portion of the inner ear. Head trauma is one of the major causes of this disorder, however frequently there is no known etiology
Subjective Health Hx Qs: Aging Adults
Any delay in wound healing? Any changes in feet, toenails, bunions, wearing shoes? Falling - bruises or trauma? Hx of diabetes or peripheral vascular disease
Assessment Qs for Vision Difficulty
Any difficulty seeing or any blurring? Blind spots? Did it come on suddenly or slowly? One eye or both? Visual changes? headaches? Seeing halos? Is the change constant or does it come and go? Do spots move in front of your eyes, one or many? Any loss of peripheral vision? Any night blindness?
Stage 1 CKD
normal GFR, but known kidney damage present (not that bad)
Normoglycemia
normal blood sugar level
S1 sound (lub)
normal closure of mitral and tricuspid valves, beginning of systole, heard best with the diaphragm, may be spilt in children, young adults, and pregnant women, usually louder than S2 at the apex
Indirect Inguinal Hernia
Bowel herniates through internal inguinal ring and remains in the inguinal canal or travels down into the scrotum (scrotal hernia). This is the most common type of hernia. It may occur in adults but is more frequent in children.
Femoral Hernia
Bowel herniates through the femoral ring and canal. It never travels into the scrotum, and the inguinal canal is empty. This is the least common type of hernia. It occurs mostly in women.
Headache - Subjective Qs
COLDSPA, do they wake you up at night? do they last hours or days? what brings it on: activity, exercise, work, emotional upset? Note any signs of depression, any other symptoms? N/V, fever, weakness, moodiness, stomach problems? What are your coping strategies? was it brought on by an injury? history of illness? Any neck pain? Do you smoke/drink? Any hx of head or neck surgery? Do they occur in relation to your menstrual periods?
Diseases correlated with increased risk of duodenal ulcers
COPD, cirrhosis of liver, chronic pancreatitis, hyperparathyroidism, chronic renal failure
Diverticulitis: Diagnostics
CT scan, Lower GI series (barium x-ray), colonoscopty
An immunocompromised host can develop widespread dissemination of _______________ within the body, which can then progress to overwhelming sepsis.
Candida
Non-Cancer Skin Disorders
Candida albicans, HPV, Tinea (ringworm)
What testing can someone get if their PPD is known to be positive, e.g., a person who had a BCG vaccine?
Chest x-ray (not possible to make diagnosis solely on findings tho) Bacteriologic studies - stained sputum smears examined for acid-fast bacilli, usually first bacteriological evidence, 3 consecutive sputum samples are collected on different days and sent for culture to confirm
Pupillary Light Reflex
normal constriction of pupils when bright light shines on retina, person has no conscious control over it when one eye is exposed to bright light, both pupils should constrict
The pancreas, spleen, stomach, gallbladder, and small intestine are...
normally NOT palpable
Observe the uvula
normally looks like fleshy pendant, hanging in midline, ask person to say ahh and note the soft palate and uvula rise in midline, this tests cranial nerve X (the vagus nerve)
Tympanic membrane
normally shiny and translucent with a pearl-gray color, cone-shaped light reflex (a reflection of otoscope light), sections of the malleus are visible through the translucent drum
Sensorineural - Ear Disorders
Disorders of the inner ear, auditory nerve, auditory pathways within the brain Common Causes: Loss of hair cells within the inner ear Meniere's disease (autoimmune?)Multiple sclerosis, Noise trauma, Acoustic neuroma, Damage to cranial nerve VIII (e.g. aminoglycoside abx use), Damage of the auditory cortex of the brain within the temporal lobe. This type of sensorineural hearing loss is referred to as central hearing impairment.
Transcription
DNA to RNA; happens in nucleus
arteriovenous graft (AVG)
Dialysis vascular access created by connecting an artery to a vein using a self-sealing synthetic tube, those with poor vasculature (common in those with HTN or DM), ready to use in 3-6 weeks, higher risk for infection and thrombosis
Causes of Cardiomyopathy
Dilated cardiomyopathy (most common, 80%) - ventricles enlarge Hypertrophic cardiomyopathy (10%) - most often a genetic problem, walls of the ventricles thicken and become stiff, sudden death in a healthy football player Restrictive cardiomyopathy (10%) - heart can't relax, deposition of amyloid plaque, same thing that happens during Alzheimer's
TB: Clinical Manifestations
Early stages may be free of symptoms (latent infection), many incidences are found incidentally with a routine x-ray, cough becomes frequent, produces a mucoid or mucopurulent sputum, dyspnea is unusual, hemoptysis is unusual unless advanced case, chest pain may be present (pleuritic - sharp pain with inhale or exhale) Systemic Symptoms: fatigue, amlaise, anorexia, weight loss, fevers, chills, "flu-like", night sweats
Accessory Muscles of Respiration
During times of forced or labored breathing (exercise or in certain diseases), additional muscles join in to assist with breathing. Sternocleidomastroid and scalene muscles
Upper GI Bleeding Tx
Endoscopic therapy (heat cauterizes bleed vs balloon to apply pressure), drug therapy (in active bleed setting) - epinephrine, alcohol sclerotherapy, surgical therapy (if other tx fails)
IDA: Clinical Manifestations
FATIGUE, pallor (most common sign), Glossitis - inflammatory depapilation, reduced saliva --> norm flora infection, Chelitis (lip inflammation)
Cervical Cancer Risk Factors
HPV (!!!!), females in late teens to mid 30s, multiple sexual partners, esp unprotected sex and beginning at a young age or with an uncircumcised male, failure to have regular pap tests, cigarette smoking, diet low in fruits and veggies, low SES associated with low level of preventive care african american or hispanic heritage, multiple pregnancies, family history, overweight, history of chlamydia infection, history of HIV infection, daughter of a mother who took DES in early pregnancy to prevent miscarriage, use of oral contraceptives for 5 or more years
Treatment of Hyperkalemia
IV 50% dextrose, 10 units of regular insulin, +/- 75 mEq of sodium bicarbonate, Furosemide (Lasix), calcium chloride or calcium gluconate (Kalcinate), sodium polystyrene sulfonate (Kayexalate) excretion via feces, if patient is in renal failure -- dailysis
Peritonitis: Tx
IV fluids, antibiotics, antiemetics, VS monitoring, post-op care
"Shifting" K into the cells
IV insulin with glucose, simulates Sodium-Potassium pump
Pyelonephritis: Diagnostics
IVP, CT scan, ultrasound, urinalysis, culture and sensitivity
Myasthenia Gravis: treatment
Immunosuppressants, but also acetylcholinesterase inhibitors (Drug: pyridostigmine)
Iron Deficiency Anemia - Etiology
Inadequate dietary intake - 5% to 10% of ingested iron is absorbed. Malabsorption - Iron absorption occurs in the duodenum. Diseases or surgery that alter, destroy, or remove the absorption surface of this area of the intestine cause anemia. Blood loss Chronic blood loss most commonly through GI and GU systems Hemolysis Pregnancy contributes to this condition.
Respirations
Involves ventilation, diffusion, and perfusion -- rate and depth of breathing changes due to tissue demands, respiratory muscles inhibited or stimulated by respiratory centers in the medulla and pons
Outer Eye Assessment
Is the sclera shiny and white? Are the eyebrows even and full? Is the conjunctiva free of swelling, lumps, and drainage?
Difference between Ischemia and Infarction
Ischemia = reversible lack of oxygen Infarction = causes cell death
How do lungs increase CO2 in blood?
It increases through hypoventilation or slowed breathing.
MCV, MCH, MCHC
MCV = mean corpuscular volume. MCH = mean corpuscular hemoglobin. Average weight of hemoglobin in an RBC. MCHC = measure of the average concentration or percentage of HGB within a RBC.
Imbalance of neurotransmitters _____________ and ________________ cause the symptoms of Parkinson's Disease
acetylcholine (stimulates movement), dopamine (inhibits movement)
S&S of Colorectal Cancer
pain, changes in bowel habits, anemia melena (black tarry stool, found in cancers of ascending colon cancer) hematochezia (bright red blood in stool, found in cancers of descending colon)
Emergency Seizure Care
PROTECT THE PATIENT FROM INJURY - move objects that could cause injury, do NOT physically restrain patient or put something in the patient's mouth
CVI characteristics
pain, swelling, leg cramps, skin changes, varicose veins, leg ulcers
Paraphimosis
painful constriction of glans by retracted foreskin
Torsion of spermatic cord
painful, enlarged, reddened, palpable, thickened, swollen cord, testis may be higher
Tanner Stage 4
projection of areola and nipple to form a secondary mound above the level of breast
Nursing Diagnosis - Respiratory System
Risk for Ineffective Airway Clearance related to thick mucus secretions Risk for Impaired Gas Exchange r/t chronic lung disease damage from smoking Risk for Activity Intolerance r/t imbalance between oxygen supply and demand Risk for Respiratory Infection Risk for Imbalanced Nutrition r/t fatigue and dyspnea
Common "Bugs" that cause Pneumonia
S. pneumoniae (ofter preceded by viral infection) Haemophilus influenza Mycoplasma pneumoniae (walking pneumonia) Klebsiella pneumoniae Legionella (spread via mist/ventilation systems)
Causes of heart murmurs
S.P.A.M.S. *S*tenosis of a valve *P*artial obstruction *A*ortic regurgitation *M*itral regurgitation *S*eptal defect velocity of blood increases "flow murmurs" -exercise, thryotoxicosis Viscosity of blood decreases (anemia) structural defects in valves (stenosis)
STEMI
ST elevation MI, real-time ongoing death of heart tissue due to ischemia, more clinically serious MI, the heart's ability to conduct electricity is altered
dead space in respiratory system
Trachae and major Bronchi, ~150 ml in adult, provide passageway for inspired and expired air -- no gas exchange, bronchi divide into bronchioles, these end at the alveolar ducts -- air channeled into alveolar sacs and alveoli
Abdominal bulges
Umbilical hernia Epigastric hernia Diastasis recti Incisional hernia
Gallstones and Gallbladder Inflammation: Complications
abscess, pancreatitis, cholangitis (inflammation of biliary ducts), biliary cirrhosis, fistulas, gallbladder rupture, carcinoma, peritonitis
Generalized seizures
absence (petit mal), clonic, tonic, tonic-clonic (grand mal), atonic, myoclonic
0 pulse
absent
RF used to assess the 10 year CHD risk score
age, gender, height, weight, waist circumference, smoking, history of cardiovascular disease or diabetes, systolic and diastolic blood pressure, total cholesterol, LDL, HDL, triglycerides, family history of early heart disease
Ascites
abnormal accumulation of fluid in the abdomen, test for shifting dullness and perform the fluid wave test
esophageal achalasia
abnormal condition in which the lower esophageal sphincter fails to relax properly, loss of autonomic neurons, prevents peristalsis, DIABETICS most at risk, stretchiness of tissue is still there Tx: balloon dilation or botulism injection
Acromegaly
abnormal enlargement of the extremities
Kussmaul respirations
abnormal pattern of deep and labored breathing
varicosities
abnormally enlarged, twisted veins
hyperthyroidism
abnormally high secretion of thyroid hormones, 75% is Grave's Dz, autoimmune "stimulatory" effect, preceded by infections, low iodine CM: everywhere!! tachycardia, fast gut, high temp, nervousness, excitability, everything is speeding up, hard to keep weight on, effects on heart most concern (asking the heart to beat fast all the time is tiring, makes it ineffective) exopthalmos may be first "sign"
It is important to ask teenagers...
about their self care behaviors!!! They're lazy and won't do a good job How do they care for glasses/contacts? Last vision test? Ever tested for color? What meds are you taking? Systemic or topical? Any specifically for eyes?
The intercostal space between two ribs is numbered by the rib...
above it
Flu Symptoms
abrupt onset of fever, chills, headache, myalgias (muscle pain), arthralgias (sore joints), cough, and sore throat
AIDS
acquired (from HIV) immune deficiency syndrome (collection of opportunistic infections and cancer)
Validating assessment data
act of double checking, verifying data to confirm its accurate and factual, followed by documenting data
Cuticle
acts as a gasket to cover and protect the nail matrix
Guillain-Barre Syndrome (GBS)
acute inflammatory disorder that causes rapidly progressing paralysis (which is usually temporary - several days to four weeks), a post-infectious disease (autoimmune) with most patients have a prior upper respiratory infection or gastroenteritis
Epstein Barr Virus (EBV)
aka Mono, not everyone who gets EBV will have symptoms of mono
Hyperlipidemia
aka hypercholesterolemia, cholesterol is obtained from diet and liver synthesis, LDL is what contributes to atherosclerosis, HDLs maintain low levels of tissue and plasma cholesterol, so high levels of HDL keep cholesterol levels in check, HDL also enhances excretion of cholesterol
Factors Affecting Pulse Rate
age (as age increases, pulse decreases), sex (after puberty, male's pulse rate is slightly higher than females), exercise and fever (increase pulse rate), medications, dehydration (often increase pulse), stress, position changes (sitting or standing usually causes pooling of blood which increases hr)
Colonoscopies start at...
age 50, younger if h of colon cancer
Family History
age and health or cause of death of relative, health of close family members, family history of various conditions such as heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, sickle-cell anemia, arthritis, allergies, obesity, alcoholism, mental illness, seizure disorder, kidney disease, and TB (family tree/genogram)
RF for Colorectal Cancer
age over 50, family hx, IBD, familial polyposis, hx of endometrial, ovarian, or breast cancer
Presbycusis
age related degenernative changed that diminished hearing
kidney stones (renal calculi)
aka nephrolithiasis (kidney/stone/formation), very painful
Cholera
an acute intestinal infection caused by ingestion of contaminated food or water that causes severe diarrhea, dehydration, and if not treated quickly: death
renal colic
an acute pain in the kidney area that is caused by blockage during the passing of a kidney stone (felt in the back/groin)
Multiple Sclerosis (MS)
an autoimmune demyelinating disorder that results in inflammation and damage to the myelin sheath of a nerve, progressive and eventually results in CNS damage and neurological disability, characterized be remissions and exacerbations
Huntington's Disease (HD)
an autosomal dominant genetic disorder on chromosome 4 that produces a mutated form of the protein called huntingtin, the mutated protein collects within the cytoplasm of brain cells, it is linked to slow clinical neurodegeneration in parts of the brain, germ line disorder, no cure, pre-natal genetic testing is available for this
Thalassemia: Etiology
an autosomal recessive genetic disorder of inadequate production of normal hemoglobin, heme molecule is okay but the globulin protein is abnormal, hemolysis also occurs, Alpha and Beta
The fluid that accumulates in third spaces is commonly called...
an effusion
If the coronary artery diameter is blocked by 50-70%....
an inadequate amount of blood flows past the blockage and ischemia results
Stye
an inflamed swelling on the edge of an eyelid, caused by bacterial infection of the gland at the base of an eyelash.
Acute Bronchitis
an inflammation of the bronchi and bronchioles caused by either bacterial or viral infection, can also be triggered by inhalation of toxic gases or chemicals, very common in smokers
Aspiration pneumonia is caused by...
anaerobic bacteria from the stomach, up to the pharynx, and into the lungs (from regurgitation)
Clostridium perfringens
anaerobic bacteria; emits a gas identifiable as a foul odor associated with gangrene.
Hyperthyroidism: Tx
anti-thyroid meds (propylthiouracil, methimazole), partial thryoidectomy meds are more of a short term treatment, version of radioactive iodine that is destructive can also be a treatment, removing just enough thyroid to where production of hormones is within normal range, treatment can go too far and cause hypothyroidism
Infective Endocarditis Tx
antibiotics for about 6 weeks
Pericarditis: Tx
antibiotics, corticosteroids, positioning head at 45 degree angle (leaning backward/forward reduces pressure of pericardial sac on surrounding muscles/organs), pericardiocentesis (for pericardial effusion - horrible procedure that sticks a needle into the pericardial sac to draw out the fluid)
Pyelonephritis: Tx
antibiotics, high fluids, removal of urological obstruction if present
Myasthenia Gravis: Basic pathology
antibodies develop against acetylcholine receptors in muscles, slowly the Ach receptors degenerate, results in weakening muscle movement
Testicular Cancer
cancer of the testicle, usually occurring in men 15 to 35 years of age, high mortality rate esp if not detected early, male clients should be aware of the need for a monthly testicular self-exam and its importance in the early diagnosis and tx of testicular cancer
Blood clots in the right atria...
can travel to the pulmonary vasculature and can cause death
Hypotension
blood pressure that is below normal, normal in some adults such as trained athletes
Hypertension
blood pressure that is persistently above normal, must be from at least 2-3 different measurement times
Diverticulosis
bowel wall has multiple weakened areas that form small pouchings called diverticula, can collect intestinal contents and form an obstruction, most found in sigmoid and descending colon, becomes diverticulitis when pouches become inflammed
depressed fracture
broken bone portion is pressed inward, typical of skull fracture
Kidney Transplantation: Recipient Selection
candidacy determined by medical/psychosocial factors, high risk patients: CVD, DM can be successful, if living donor, can receive the transplant before needing dialysis
tumor markers
cancer antigen 19-9, carcinoembryonic - can be used as a measure for how much cancer is in the body, should go down as cancer is removed, tested with serial blood tests every 6 weeks, can't be used to screen because they are not specific to any cancer and aren't always present, could also be present with inflammatory gut diseases
Hypercalcemia
calcium level greater than 10 mg/dL, common causes are hyperparathyroidism, cancer, causes muscle flaccidity, proximal muscle weakness of the lower extremities, decreased neuromuscular activity of the bowel - causing constipation, renal calculi, ventricular arrhythmias
MS Exam
can be a long exam, make sure temperature is adequate, use proper draping to uncover only parts of the body you are currently examining, use clear, simple directions, provide demonstrations
Premature Ventricular Contraction (PVCs)
can be a manifestation of a sick heart, but common in everyone, do not always require treatment, you can live with PVCs, if the heart gets sicker, then require treatment
Esophageal infection
can be caused by dissemination of Candida
A normal cell exposed to carcinogen changes...
can eventually become neoplasia
3 common manifestations of HD
chorea (brief, irregular, dancelike movements), athetosis (twisting and writhing movements), Ballismus (thrashing motions), coginitive impairment and emotional lability (exaggerated changes in mood)
Rheumatic Heart Disease
chronic condition characterized by scarring and deformity of heart valves resulting from rheumatic fever, any or all layers of the heart may be affected (pancarditis) not caused by strep, an autoimmune disease probably caused by molecular mimicry, strep isn't causing inflammation, the body's response is causing inflammation
symptoms of interstitial cystitis
chronic pelvic pain, perineal pain, dysuria, need to urinate 50x day, nocturia, pain relieved by emptying bladder
Diabetic Ketoacidosis (DKA)
complication of type one diabetes, body cells go into starvation mode because there is no glucose in the cell breakdown of fatty acids/amino acids = ketoACIDosis (metabolic acidosis) pts have "fruity" breath (kidneys and lungs help regular pH, lungs are compensating and trying to rid the body of CO2 - leading to the smell of ketones in breath)
Neuro Assessment
comprehensive health hx is vital, investigate changes in ADLs, patient's lifestyle, level of functioing, pt's may be fearful of memory loss, loss of control, be sensitive to fears and concerns, utilize COLDSPA
Hep B and C Complications
cirrhosis - leads to problems with all of the liver's jobs: not enough albumin (sx: edema-anasarca), can't filter all the blood - blood congestion in liver - portal HTN: not uncommon for pts with portal HTN to have overall hypotension, leads to a lot of problems like esophageal varices (hemorrhoids of the esophagus) - tx with propranolol to reduce portal HTN and GI bleeds, balloons that are inflated to stop bleeds (ER), sclerotherapy - hypertonic saline, induced scarring reaction, rubber bands around distended veins, necrotizing the tissue, pts with cirrhosis don't clear ammonia like they should be (tx with laxatives - lactulose, yellow, thick fluid w sweet taste, pts poop out the ammonia, pts can sort of dose themselves - whatever induces a certain number of loose BMs/day)
Nail plate
clear, has fine longitudinal ridges that become prominent in aging, pink color from underlying highly vascular nail bed
Alveolar sacs
clusters of alveoli, this cluster formation increases the surface area available for gas exchange
HPV
clusters of small vesicles Transmission: contact Treatment: topical vs. systemic anti-fungals or antivirals
Terminal Hair
coarser, thicker, more conspicuous, and usually pigmented hair. (scalp, eyebrows, pubic hair)
Drugs that cause pupil dilation
cocaine, crack, meth, stimulants
Carilage
collagen matrix overlying body surfaces
Initial Comprehensive Assessment
collection of subjective data about the pt's perception of health of all body systems, past medical history, family history, lifestyle and health practices
Health Assessment in Nursing
collects data systematically, involves the patient, family, and environment in the data collection, uses evidence based techniques and instruments, synthesizes data in order to identify patterns and variances, and documents relevant data in a retrievable format.
Nursing Process: Assessment
collects data, documents relevant data
Nursing Assessment...
collects subjective and objective data to determine a patient's overall level of functioning in order to make a professional clinical judgement
When looking at skin lesions, note...
color, elevation, pattern/shape, size, location, any exudate
When inspecting and palpating hair, note the...
color, texture (may be affected by hair care products), distribution (gender patterns), and lesions
Leukemia: Chemotherapy
combination chemotherapy, purpose is to decrease drug resistance, decrease drug toxicity to the client by using multiple drugs with varying toxicities, and interrupt cell growth at multiple points in the cell cycle (1 week of chemo followed by 2 weeks of CBC checks to wait for toxicity to go down/cycle of neutrophil, platelets, and red blood cells)
Preparing for Physical Exam
comfortable, warm room temp, private/quiet and free of interruptions, adequate lighting, firm examination table at a height that prevents stooping, table/tray to hold equipment needed for the exam
Clostridium perfringens
common cause of gas gangrene (80-90% of cases), found in soil and isolated from normal human flora, skin, and the vagina, a highly lethal organism that causes myonecrosis - a rapidly spreading necrotizing infection of the skeletal muscle and surrounding tissue
benign prostatic hyperplasia (BPH)
common in men over the age of 50, prostate is enlarged, smooth, firm, and slightly elastic
Atrial Fibrillation (A-Fib)
common type of heart arrhythmia that is irregular and often rapid, S1 varies in intensity
Diphtheria-Pertussis-Tetanus (DPT)
common vaccine, inhibits infections of cornyebacterium diphtheriae, bordetella pertussis, and clostridium tetani
Nursing Process: Diagnosis
compares clinical findings with normal/abnormal variations, interprets data, validates diagnosis, documents diagnosis
Mini Mental State Exam
concentrates only on cognitive functioning, not on mood or thought process, standard set of 11 questions - requires only 5-10 min, good screening tool to detect dementia/delirium, a score of 24 - 30 indicates no cognitive impairment
Hormonal agents that cause pitting edema
corticosteroids, estrogen (including oral contraceptives), testosterone, progesterone
Nursing Role in Zika Virus
counsel pts regarding travel, in pts with Zika education regarding: avoiding mosquito bites, avoiding body fluid transmission with another individual, no vaccine is available
periosteum
covering of the bone, contains osteoblasts and blood vessels that promote nutrition and formation of new bone tissue
False High BP
cuff too narrow, release valve too slowly, re-inflating the cuff during auscultation, bladder not completely deflated when applied
Diarrhea: Diagnostics
culture and sensitivity of stool, ova and parasites (O&P), or there could be obvious cause tx depends on source complications w patient's potassium!!!!!!!!!!!!! v important!!!!!!!
Difference between Cystitis and Pyelonephritis
cystitis involves the bladder/urethra, pyelonephritis involves the kidney and usually causes fever and chills
ROM
demonstrate how to move each joint and ask the pt to reproduce each movement, test each joint's ROM, remember to compare bilaterally
systemic lupus erythematosus (SLE) - clinical presentation
dependent on organ/tissue affected, but rash and renal dysfunction are common
Kidney Stones: S&S
depends on the location, duration, infection, size, and edema of the stone, sharp abdominal/flank pain, hematuria, renal colic, n&v, fever, chills, UTI, oliguria, anuria
Throat inspection
depress the tongue with a tongue blade, scan the posterior wall for color, exudate, or lesions, touching the posterior wall with tongue blade elicits gag reflex (cranial nerves 9 and 10) test cranial nerve 11 by asking person to stick out tongue, should protrude midline, note any tremor, loss of movements, or deviation to side, note any breath odor
Hemolytic Anemia
destruction or hemolysis of RBCs at a rate that exceeds production - intrinsic hemolytic anemia (abnormal hemoglobin, enzyme deficiencies, RBC membrane abnormalities) - Jaundice (destroyed RBC cause increased bilirubin - enlarged spleen and liver (hyperactive with macrophage phagocytosis of defective RBCs) accumulation of hemoglobin molecules can obstruct renal tubules (tubular necrosis)
Check both arms/legs at the same time to facilitate...
detection of temperature differences, use the back of the fingers and hands bc they are more sensitive to temperature
When implementing, a nurse should...
determine patient readiness and involve the patient in the healthcare process, review planning interventions with other health care team members, utilize principles of delegation, counsel the patient and significant others, refer for continuing care, and document the care that was provided
Allen test
determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery, usually done prior to the drawing of arterial blood gases or cannulating the radial artery
1 in 5 people infected with WNV...
develop a fever and other symptoms
1 in 150 of those infected with WNV....
develop a serious, sometimes fatal illness, inflammation of the brain (encephalitis)
systemic lupus erythematosus (SLE) - basic pathology
development of "auto-antibodies" that form immune complexes, deposited almost anywhere, but most commonly affecting skin and kidney
Ocular movements can be impaired by
drugs, alcohol, fatigue, and inattention
Abdominal Percussion
dull - solid organs tympanic - air absent - pathological begin int he RLQ and move upward and clockwise,
PUD: Post-Billroth Complications
dumping syndrome (super fast peristalsis), post-prandial hypoglycemia, bile reflux gastritis interventions: diet, rest, reassurance
Third Space Fluid Accumulation
during illness, fluids can become sequestered in body cavities such as the pericardial sac, peritoneal cavity, and pleural space
Ictal
during seizure
Examples of Problems caused by Cell Injury
dysfunction of Na/K Pump, loss of plasma membrane integrity, defects in protein synthesis ability, intracellular accumulations, genetic damage
Atrial Dysrhythmias
dysrhythmia in which ectopic site(s) replace the SA node as the pacemaker, shocking patient with pads is the treatment for V tach and V fib, this allows the SA to kick back in and restore electrical activity, pt might consider a pacemaker bc some pacemakers have defibrillators in them
Otisis Media
ear infection, most times a diagnosis follows an upper respiratory tract infection, infants and toddlers are at high risk, S&S: earache, fever, hearing loss, infants and toddlers may display ear tugging, poor feeding, night waking, and irritability Tx: analgesics, antipyretics, localized antibiotics, when accumulation of fluid is excessive a tympanotomy or tympanostomy
Lateral pressure points
ear, acromion process, elbow, greater trochanter, medial and lateral condyle + mallelous, heels
Somogyi Effect
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes, no hormones involved
Nutrional Assessment: Subjective Data
eating patterns, usual weight, changes in appetite, recent surgery, trauma, burns, infection, chronic illnesses, vomiting, diarrhea, constipation, food allergies, medications or supplements, self-care behaviors, alcohol or illegal drug use, exercise
Chest Pain: Aggravating Factors
eating, physical exertion, exercise, position change, motion of arms, neck, jaw, respiratory - deep breathing or coughing, elimination, emotional upset or stress, sexual intimacy, weather
Endothelium as an Organ
endothelium cells have function aside from providing structural integrity to the artery walls, they secrete nitric oxide (vasodilator), secrete endothelin (vasoconstrictor), and secrete thrombogenic substances
Scrotum Assessment
enlarges with age, heaviness or dragging could indicate tumor, spread out the folds of skin and lift scrotal sac, spermatic cord usually longer on left side, left testis hangs lower
Children's Skin and Hair
epidermis thickens, darkens, and becomes lubricated, hair growth is accelerated
Organs located in the mediastinum (central area in the thoracic cavity)
esophagus, trachea, heart, the aorta, lymphnodes, and important nerves
Preparing the Patient for Physical Assessment
establish nurse-patient relationship during the interview, explain the procedure the physical assessment will follow, respect the patient's desires and requests
When planning, nurses should...
establish priorities based on meeting patient care goals, develop outcomes and set timeframes for meeting proposed outcomes, identify relevant interventions and utilize interdisciplinary health care team members, and document the plan of care
Nursing Process: Planning
establish priorities, develop outcomes, set timeline, identify interventions and document plan of care
What is the purpose of interviewing?
establish rapport, gather info about the patient's developmental, psychological, physiological, sociocultural, and spiritual status to identify deviations that can be treated with nursing
eAD
estimated average glucose, tells you the same thing as Hgb A1c glycated hemoglobin, uses mg/dl instead of a %
Certain skin presentations associated with different _____________.
ethnic groups, keloids in darker skin patients
CBS
every 3 years age 20-39 and annually starting at 40
-PRIL
every ACE inhibitor ends in-pril (stops the RAAS process- the reabsorption of water)
Vertigo
every felt vertigo, that the room is spinning around? ever felt dizzy, like you are not quite steady? giddy, lightheaded?
Hypothyroidism: CM
everything slooooows down + myxedema (mucopolysaccaride deposits in interstitial space with associated edema - esp in face), slow heart rate, low BP, can't keep weight off
Respiratory acidosis
failure of the respiratory system to remove or exhale Co2 from the body fluids as fast as it is produced by cells, caused by interference with breathing aka COPD, respiratory muscle weakness, suffocation consequently, COPD pts are hypercapnic and susceptible to acidosis the body responds by reabsorbing bicarbonate and excreting H+ in the kidneys, but this takes hours to days so medical intervention may be needed (intubation, mechanical ventilation - sedated as to not fight the ventilator)
Free radicals + LDLs + Endothelial Injury =
fatty streaks on artery walls, builds to become atherosclerotic plaque which with time calcifies, hardens, and fissures off in pieces
Barriers to BSE
fear or anxiety of finding lump, forgetfulness, lack of confidence, over-reliance on mammography and clinical breast exams, value conflicts
Colorectal Cancer: Diagnostics
fecal occult blood tests, CBC, liver function tests (liver is most common site of metastasis), carcinoembryonic antigen (CEA), clotting studies
Scleroderma: RF
female
Breast Cancer Risks
female, 50+, early menarche (<12) or late menopause (>55), family hx esp if 1st degree relative, BRCA 1 and 2 genes (up to 80% risk), dense breast tissue, never pregnant or over 30 years old with 1 pregnancy, HRT combined therapy, Obesity, ETOH more than twice a day, lack of exercise
Gallstones - FFFF
female, fat, forty, fertile = higher risk for gallstones
systemic lupus erythematosus (SLE) - risk factors
female, non-caucasian
Infective endocarditis Non-specific Clinical Manifestations
fever (90% of pts), chills, weakness, malaise, fatigue, anorexia, possible symptoms of heart failgure
FUO
fever of unknown origin
How does EBV infect B cells?
finds a B cell and lives it inside it basically forever, escaping immune detection, there get be a reemergence later on in SOME people, not curable - once you have it, you have for life. transmissible in the saliva
Lanugo
fine, soft hair, especially that which covers the body and limbs of a human newborn.
Breaks in Continuity of Skin
fissure, erosion, ulcers, excoriation, scar, atrophic scars, lichenification, keloids
scales
flakes or dry patches made up of excess dead epidermal cells
Macule
flat area, altered pigmentation
ulcerative colitis (UC): diagnostics
flex- sig vs colonoscopy, barium enema if direct imaging is not available, CBC, electrolytes, stool studies for blood - these can rule out other conditions
Trachea
flexible structure composed of C-shaped rings of hyaline cartilage, lies anterior to the esophagus, approx. 10-12 cm long in an adult, the right mainstem bronchus is shorter, wider, and more vertical than the left -- consequences???
pill-rolling tremor
flexing and extending the fingers while moving the thumb back and forth, as if rolling something in the fingers
Ribs 11 and 12 are
floating ribs, they do not connect anteriorly
Pitting Edema
fluid in interstitial spaces is displaced when pressure is applied to the area with a finger, this leaves a depression or "pit", usually checked along the shin (0 = no pitting, 4 = severe pitting (8mm))
Pulmonary edema
fluid in the lungs, the most common cause of pulmonary edema is LVF, increased pulmonary hydrostatic pressure, pink frothy sputum, coarse, load crackles, sounds like bubbling water ARDS - rare
Medical Assessment...
focuses primarily on the patient's physiologic development status to arrive at a diagnosis
Crackles
formerly called rales, high pitched, Fine - popping sound not cleared by cough, Coarse - low pitched, bubbling sounds like opening velcro
General Survey
forms an overall impression of the client, can determine apparent state of health, is the nurse's impression of the patient's overall appearance/behavior (physical development and body build, gender and sexual development, apparent age compared to reported age, skin condition and color, dress, behaviors, body movement, hygiene, facial expressions, speech, vital signs)
candida albicans
found in the gastrointenstinal and vaginal tracts
How do people get HIV?
fragile virus transmitted only through contact/exchange of body fluids (blood, semen, vaginal secretions, breast milk)
Kidney Stone Tx
goal is to eradicate the stone, determine the composition (strain the urine), prevent nephron destruction, control infection, relieve obstruction, pain relief, increase fluids!!!! (some small stones will pass through the urine w/ analgesics), dietary recommendations
Tinnitus
has the patient ever felt ringing, crackling, or buzzing in ears? when? does it seem louder at night? are you taking any meds?
To palpate the femoral pulse and inguinal nodes...
have pt bend the knee slightly then externally rotate the leg so that the knee is lying on the bed (frog leg position)
TMJ joint ROM
have pt clench teeth, protrude and retract jaw, move jaw laterally feeling fro contraction of the temporal and masseter muscles
Hypopituitarism: Tx
hormone replacement, hypophysectomy (taking out benign tumor)
Endoplasmic Reticulum
houses ribosomes and used for translation
Diastolic murmurs indicate...
heart disease
Systole
heart is contracting to pump blood
Diastole
heart is relaxed and ventricles are filling with blood
Past Cardiac Hx Qs
heart problems? heart disease? heart murmurs? Congenital heart disease/defect? Rheumatic fever? hypertension? diabetes? ECG, lipid profile, other cardiac diagnostic tests?
Sinus Arrhythmia
heart rate speeds up and slows down, S1 and S2 usually normal
normal sinus rhythm
heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute, P-P and R-R interval are regular, QRS follows every P wave
Supine pressure points
heels, sacrum, elbows, scapulae, back of head
Nutritional Assessment Tools
height and weight, BMI, 24-food recall, nutritional history tool, speedy checklist for nutritional heath
Platelets
help blood clot
Ballottement Test
helps detect large amounts of fluid, may indicate meniscal tears
Hep B Blood Tests
hep b virus has two protective layers of proteins (unique) - outer layer is made of surface antigens (elicit an antibody response, usually proteins = antigens), inner layer - core antigens, Hep B surface antigen = active virus, Hep B surface antibody and Hep B core antibodies - exposure to hep b, Hep B vaccine was the injection of the surface antigen
Any hepatic condition may lead to...
hepatocyte death and release of liver enzymes into blood (AST, ALT, ALP)
Hemochromatosis
hereditary disorder with an excessive buildup of iron deposits in organs, no evidence of disease until middle age, men have more issues than women, can be acquired in alcoholics
Strangulated hernia
hernia that is constricted, cut off from circulation, and likely to become gangrenous "nonreduceable"
If pt has low back pain that radiates down the back, perform the straight leg test to check for...
herniated disc
Thalassemia minor
heterozygosity, asymptomatic frequently, moderate anemia - splenomegaly, mild jaundice, body adapts to decreased hemoglobin
How does chronic hypertension lead to heart failure?
high aortic pressure against the left ventricle leads to left ventricular hypertrophy, the coronary artery blood flow becomes insufficient to supply the enlarged left ventricle -- ischemia of left ventricle leads to MI and the MI leads to heart failure
secondary hypertension
high blood pressure caused by the effects of another disease (kidney dz, Cushing's dz)
Hypertension and Endothelial Cell Injury
high shearing forces against the wall of the artery, damages endothelium
Pericardial Friction Rub
high-pitched, scratchy extra cardiac sound heard when the pericardial sac is inflamed, heard best at 3rd ICS to the left of the sternum, use diaphragm and have pt sit up, lean forward, exhale, and hold his/her breathe
DKA complications
hyperglycemia --> polydipsia dilutional hyponatremia false hyperkalemia (due to H+ and K+ switching placing in cells) 800,900, 1100 blood sugar levels not uncommon
Diabetes: Acute Complications
hyperglycemia, hypoglycemia, KDA in DM1, HHS in DM2
Hyperparathyroidism
hypersecretion of the parathyroid glands, usually caused by a tumor or vitamin D deficiency High PTH --> hypercalcemia CM: muscle dystonia, nephrolith tx: phosphate supplements
How do lungs decrease CO2 in blood?
hyperventilation
In protein starvation, ___________________ occurs.
hypoalbuminemia (creates low oncotic pressure)
When a patient has severe vomiting, a nurse should be most concerned about...
hypokalemia
low production of TSH causes
hypothyroidism
Obstructive Sleep Apnea (OSA)
hypoventilation syndrome, intermittent cessation of airflow from the nose and mouth during sleep is characterized by recurrent episodes of sleep apnea of 2-3 minutes in duration Airway anatomy (e.g., large tonsils), nasal blockage, presence and distribution of body fat, and muscle tone all contribute to the severity of the disorder Obesity is the most common RG Diagnosed by sleep study (polysomnography)
Pts with massive GI bleed are often...
hypovolemic, first priority: fluids!!! quick, restores volume
During the outcome identification step, nurses should...
identify expected outcomes related to the patient and ensure that outcomes are realistic and measurable
Blepharitis
inflammation of the eyelids, red, watery eyes, dry, gritty sensation of the eyes, burning sensation in the eye, itchy eyelids, flaking of the skin around the eyes, blepharitis is associated with acne Tx: antibiotics or steroid eye drops
iritis
inflammation of the iris, caused by eye trauma, herpes, lyme disease
Otitis media
inflammation of the middle ear, one of the most common illnesses in children (tug on the pinna, press on the tragus, pain = something is wrong w ear)
Aplastic Anemia (without growth, without blood)
idiopathic, perhaps autoimmune?, symptoms caused by suppression all bone elements - pancytopenia, fatigue and dyspnea
Cell injury can be reversible, but...
if the injurious agent is persistent or severe enough, cell injury can lead to cell death
HIV: Late chronic infection (AIDS)
immune system is severely compromised, great risk for opportunistic disease, possible wasting and dementia
MS Treatment
immunomodulators, corticosteroids, treatments are not cures! there are patients who respond well and have a prolonged clinical course and there are some that do not (prob due to genetic variability)
SLE Treatment
immunosuppressants!!! steriods, methotrexate, hydroxychloroquine, monoclonal antibodies
Peripheral Cyanosis
in extremities and fingers, cutaneous blood flow is decreased or slowed and arterial oxygen levels are normal, may be a normal response to anxiety or to a cold environment
Preauricular lymph node
in front of ear
iodine is only used in the body...
in the thyroid to make T3, T4
Glaucoma
increased intraocular pressure results in damage to the retina and optic nerve with loss of vision, very painful
Severe COPD
increased levels of CO2 (hypercapnia) becomes chronic and the arterial chemoreceptors and respiratory center in the medulla become insensitive to high CO2 levels, hypoxia becomes the stimulus for breath
Increased risk for melanoma is related to...
increased number of sunburns during one's lifetime
Tachypnea
increased respiration rate
Sympathetic stimulation...
increases heart rate
Nonmodifiable RF for CHD
increasing age, history of cardiovascular disease, family history of early heart disease
RF for urinary incontinence
increasing age, pregnancy, childbirth, obesity, DM, stroke, neurological impairment, prostrate dz
Passive Acquired Adaptive Immunity
individual is given premade, fully formed antibodies against an antigen through an IV
Regional Skin Exam
individuals may seek health care for skin problems and assessment focused on skin alone, assess skin as one entity - getting overall impression helps reveal distribution pattern. Skills used are inspection and palpation because some skin changes have accompanying signs that can be felt, use the back of the hand and check both sides at the same time
nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of...
individuals, families, communities, and populations.
IDA: Oral iron
inexpensive and convenient, enteric coated or SR caps are counter productive, should be taken on an empty stomach, liquid iron should be diluted and ingested through a straw, SE: heartburn, constipation, diarrhea
Prolonged ischemia
infarction (cell death), any tissue that sustains prolonged ischemia is susceptible to infarction, but individual cell teypes have different tolerances - brain (6 min), heart (20 min), skeletal muscles (many hours)
Kidney Transplantation Complications
infection (due to immunosuppression), cardiovascular disease (increases risk of atherosclerotic vascular disease, need to adhere to low sodium restricted diet with lots of fluids), malignancies (immunosuppression, lymphomas are common - PTLD), corticosteroid-related complications, peptic ulcer disease, diabetes
Infective Endocarditis
infection of the inner layer (endocardium) of the heart that usually affects the cardiac valves, was almost always fatal until the development of Penicillin
EBV Infection
infectious mononucleosis, a common infection of adolescents and young adults, by adult hood, more than 90% of individuals have been infected with EBV and have developed antibodies to the virus
pneuomonia
inflammation and infection of alveoli, which fill with pus or inflammatory cells and fibrin, infection by bacteria or viruses is the most common cause
thrombophlebitis
inflammation of a vein associated with a clot formation
Cholecystitis
inflammation of gallbladder, usually associated with cholelithiasis, acute or chronic, gallbladder because distended with bile or pus, pts are fine after removal of gallstones
Acute Pancreatitis
inflammation of pancreas ranging from mild edema to severe necrosis, more common in men, may be life threatening
Pericarditis
inflammation of pericardial sac, can be infectious and non-infectious, affects the right side more than the left because the left side is stronger, eventually affect both sides if bad enough
physical exam - skull
inspect and palpate!!! note the general size and shape, palpate the scalp - should be symmetric and smooth, free of lice and lesions. Cranial bones that have normal protrusions: forehead, lateral edge of parietal bones, occipital bone, mastoid process behind ear, there should be no tenderness palpate the temporal artery, TMJ bilaterally, should have smooth movement with no tenderness
Assessing the Inguinal Area
inspect for inguinal and femoral hernias and enlarged lymph nodes (ask client to turn head and cough or to bear down as if having a BM) palpate for hernias/nodes (ask client to shift weight to left to palpate right and vice versa, place right index finger into right scrotum and press upward, palpate up until the external inguinal ring can be palpated) External inguinal ring can be palpated above and lateral to the symphysis pubis, when in the ring ask the pt to bear down and cough
Inspection of the Spine
inspect from the side and from behind, have pt stand with shirt off or gown positioned to see the spine clearly, observe for symmetry, noting differences in height of shoulders, iliac crests, buttock creases
Assessing Joins
inspect size, shape, color, symmetry, note any masses, deformities, or atrophy, compare bilateral joint findings
Order of Assessment for Abdomen!!!!!!!!!! Test Q!!!!!!
inspection, AUSCULTATION, Percussion, Palpation
Assessment: Penis
inspection/palpation: should be free of excoriation, erythema, infestation, pubic hair is course, may be sparse in older adults, shaft, foreskin, and glans are free of rashes, lesions, lumps, non-tender, if uncircumcised, retract foreskin
Methods of Potassium Removal
kayexalate (oral, rectal, NG), diuretics (if pt is producing urine), dialysis (hides the K in the cells)
Ileoanal Reservoir (J-Pouch)
last option for poorly controlled disease, usually staged with 1-3 procedures, adaption to the pouch takes 3-6 months, 4-8 past stools/day, selective patients potentially replaces ostomy bags Stool is eventually expelled through the rectum. An J pouch is a surgically created ileoanal reservoir in the anal canal that preseves the rectal sphincter muscle, so that stool is eventually expelled through the rectum is the eventual result.
Changes in potassium electrolyte concentration...
leads to changes in heart (disrupts electrical gradient)
Bronchophony
listen to symmetric areas of the chest, ask the pt to say "99" while auscultating, the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue when sounds are louder and clearer d/t increased density = bronchophony
Left Lower Quadrant
left kidney, left ovary and tube, left ureter, left spermatic cord, descending and sigmoid colon
Best location to assess a ventricular lift?
left lower sternal border
Aortic stenosis leads to...
left ventricular hypertrophy which leads to left ventricle failure - if the aortic valve that lets blood out cannot open then it is harder for the left ventricle to pump blood out, after years of hypertrophy the left ventricle can fail
Seconday Hypertension
less common, caused by disease process
Ferrous Gluconate
less iron!!! but easier on the stomach
Hypotonic IV
less tonicity than blood, 0.45% NaCl
Which tests are used to test WBC in urine?
leukocyte esterase test
Objective Neuro Assessment
level of consciousness, mental status, assessment of cranial nerves (usually performed during head, neck, eyes, and ears), motor and cerebellar function (coordination/balance), reflexes
Lice
lice infestation (pediculosis) is associated with lack of cleanliness, lice attach to skin, biting and sucking blood. they can live on clothing for up to a month, produce reddened macules, inflammation, hyperpigmentation and parallel scratch marks
Optimal function is the simultaneous....
life satisfaction in work, caring relationships, and within the self
Hypertension - Treatment
lifestyle modification such as improved diet, stress reduction, physical activity, and smoking cessation, medications, diuretics are often first prescribed (K supplements are often needed)
Treatment of Heart Failure
lifestyle modifications, low fat diet, nonsmoking, low salt (1,500 mg), walking, physical activity, weight loss if obese, daily weight measurements to measure fluids like BBs, ACEs, dig
Zosteriform lesion
linear arrangement along a unilateral nerve route (herpes zoster)
Parietal pleaura
lines the walls of the thoracic cavity
Tobacco Use
linked to cancer, emphysema, asthma, infertility, preterm birth, low birth weight, SIDS
Respiratory alkalosis
loss of CO2 from lungs faster than it is produced by cells, can be caused by breathing too fast (as in anxiety, hyperventilation, pneumonia), body compensates by kidneys attempting to reabsorb H+ and excrete HCO3-, takes hours or days to do this so medical intervention is needed to decrease client's breathing rate (CO2 rebreathing)
Anaphylactic shock
loss of blood pressure, loss of tissue perfusion, treated with epinephrine, antihistamines, corticosteriods
Atrophy
loss of skin layers
Functional Urinary Incontinence (FUI)
loss of urine due to the inability or unwillingness of a person to use the bathroom facilities prior to involuntary bladder release, can be caused by prolonged immobility, stroke
Hyperlipidemia and Endothelial Cell injury
low density lipoproteins in the bloodstream combine with WBC in the endothelial artery wall to initiate the beginnings of atherosclerosis
Hypopituitarism
low production of TSH, FSH/LH, GH, ACTC, Prolactin d/t tissue destructive tumor, brain surgery complication, radiation, trauma, ischemia/infarction sx varies based on what production is lost
Abdominal Aorta
lower descending aorta, takes blood to lower trunk and legs, use thumb and first finger - about 2.4 - 5 cm wide, strong and regular pulse, pulsations may be visible
Use the term "_____________" rather than "lobes" when documenting auscultation findings -- the location of lobes is difficult to determine
lung fields
sim's position
lying on left side with right knee drawn up and with left arm drawn behind, parallel to the back
deep cervical lymph nodes
lymph nodes of the head and neck drain into the deep cervical lymph nodes
stage 3 lymphedema
lymphostatic elephantiasis; extreme increase in swelling skin changes, affected area is non-pitting often with permanent eczema, skin is firm and thick, irreversible
IgG
main antibody in play at the time of "re-exposure" to the bad guy
When a patient does start ART...
main goals are to decrease viral load, maintain/raise CD4 counts, delay HIV related symptoms and opportunistic infections
Potassium
main intracellular cation, assists in the maintenance of neuromuscular excitability and acid-base balance (norm 3.5-5.1 mEq/L)
Hyperosmolar Hyperglycemic Syndrome (HHS)
major short term complication of DM2, severe hyperglycemia, hyperosmolarity, dehydration key point: the presence of a little bit of insulin prevents fat breakdown, which prevents ketone formation basically DKA without the acidosis Tx: fluids, electrolyte replacement
MIDCABG
minimally invasive version of CABG, location of blocked vessel determines if eligible for this and need a doctor that is able to perform this
angioplasty and atherectomy
minimally invasive, few complications Angioplasty - more common, pushes plaque to the sides and opens up the vessel, uses a balloon, does increase the chance of embolization but pretty rare Atherectomy - removal of atherosclerotic plaque
angioplasty and stent
minimally invasive, few complications, balloon inserted in blood vessel to expand it, then a stent is placed inside to hold the vessel up -- coronary arteries can re-occlude so this method works longer
Hyperacute Rejection
minutes to hours after transplant, no treatment, organ is removed (cross-matching usually prevents this)
Astigmatism
misshapen lens or cornea won't focus light and results in blurred image
Scabies
mite can live on bedding/clothing for several days, mites "burrow" into the skin, sometimes there is a red path under the skin
S3 sound
mitral regurgitation, also known as the "ventricular gallop," occurs just after S2 when the mitral valve opens (early in diastole), allowing passive filling of the left ventricle. The S3 sound is actually produced by the large amount of blood striking a very compliant LV. can be a sign of systolic HF
Following up with an HIV patient means...
monitoring HIV disease progression and immune function, CD4 counts, and viral load
Stridor
monotone, high-pitched sound heard on inspiration usually caused by partial obstruction in the pharynx or larynx, indicates acute respiratory distress
Inspection of External Female Genitalia
mons pubis, labia majora and perineum, labia minora, clitoris, urethral meatus, and vaginal opening
Chronic Rejection
months to years later, T and B cells infiltrate kidney, difficult to treat, immunosuppressants don't work as well, consider re-transplantation, about 10 years of use out of a kidney transplant
Pancreatic Cancer
more than half originate in the head of the pancreas, if in the tail or body, tends cancer tends to remain silent until growth is advanced, symptomless in most until it is too late, majority have metastasized at the time of dx majority die with 5-12 months of dx 5 year survival rate is only about 6%
Colorectal Cancer: Average Risk
no family hx, no symptoms, just need a FOBT every two years
Hair
no longer needed for protection from the cold or trauma, however it is highly significant in most cultures for its cosmetic and psychological meaning
PUD: Clinical Presentation
no pain or symptoms is common d/t few sensory pain fibers
False Low BP
noise in environment, cuff too wide, release valve too quickly
NSTEMI
non-ST elevation myocardial infarction, eventually returns back to the zero line on the EKG
IgA
non-blood "helper" in tears and saliva
Zika Treatment
none, symptoms can be treated with acetaminophen, fluids, and rest
Pulse Oxidation
noninvasive, continuous or spot check, estimates arterial blood oxygen saturation, less than 70% is life threatening, those with poor circulation or peripheral vascular disease -- the pulse ox may not work on the finger (the earlobe can be used too), take off the pulse ox periodically to check circulation
Interview skills include...
nonverbal communication and verbal communication
We assess vital signs...
on admission to provide a baseline, when there are changes in pt's health state or pt reports symptoms such as chest pain, feeling hot or faint, before and after surgery/invasive procedure/med administration that could affect resp/CV system or after a nursing intervention that could affect vital signs
Focal Seizures
one cerebral hemisphere
Iron Deficiency Anemia
one of the most chronic hematological disorders, iron is present in all RBC as heme in hemoglobin and in a stored form, heme accounts for 2/3 of the body's iron
diabetes insipidus means
one who pees tasteless
STRIVE trial
ongoing trial to develop ebola vaccine
Osmotic pressure __________ hydrostatic pressure.
opposes
The retinal structures viewed through the ophthalmoscope are:
optic disc, retinal vessels, general background, and macula
Hep C Tx
oral antivirals, based on viral genotype, a common side effect is anemia!!! there are no immunizations, prevention is key!!!!!
Bilirubin
orange-yellow pigment in bile; formed by the breakdown of hemoglobin when red blood cells are destroyed
Fluid Homeostasis is maintained by
osmoreceptors, sensation of thirst, renin-angiotensin-aldosterone system (RAAS), antidiuretic hormone (ADH), and natriuretic hormones
Kidney stones may be due to changes in...
pH, (basic --> calcium, acidic --> uric acid)
Cushing's Syndrome
patho: excess ACTH or cortisol/aldosterone, can be caused by use of steroids that mimic the effects of cortisol why: lung cancer, benign tumor, latrogenic, not as common as SIADH, but still common w how many people get lung caner CM: central adiposity, high BP, moon face, red cheeks, red striation, hyperglycemia (steroids jack up the blood sugar) Diagnostics: increased cortisol, alderosterone (failure of dexamethoasone suppression test) Tx: stop meds, treat cancer tumor
Addison's Syndrome
patho: insufficient ACTH, cortisol, or aldosterone why: autoimmune, metastatic cancer CM: weight loss, hypotension, being hypoalderonic means loss of water/sodium, high potassium, Bronze hyperpigmentation, JFK had this bronzed look Diagnostics: decreased cortisol, aldoerstone (ACTH stimulation test failure) Tx: cortisol, aldosterone supps (increased dosage of meds when going through stress surgery to give pt an appropriate stress response)
DI
patho: too little ADH (or bad kidneys - peeing too much) Why: pituitary damage, chronic kidney dz, lithium CM: dehydration!!! hypernatremia, polyuria, urine is very concentrated diagnostics: serum/urine osmolarity, urine specific gravity 0 counting the specific solutes in one cubed ml of urine, water deprivation test tx: fluid replacement, DDAVP (intranasal, v expensive), medical kidney sensitizers
dorsal recumbent position
patient is lying on the back, face up, with the knees bent
male external genitalia
penis and scrotum
You may see increased pigment in the sclera and fundus in
people of color
PUD
peptic ulcer disease, 10% of population of western countries will suffer a duodenal or gastric ulcer during their lifetime ulcer starts small and without symptoms, erosive processes (in garden variety PUD) are slow, thorugh mucosal barrier, endothelial tissue, connective tissue, and blood vessels to cause upper GI bleed
Pain of diverticular disease of transverse colon can simulate the pain of...
peptic ulcer or pancreatitis
Gastric Ulcers
peptic ulcers that occur in the stomach, less common than duodenal ulcers, prevalent in women, older adults, persons from lower SEC, drugs (aspirin, corticosteroids, NSAIDs) can cause acute gastric ulcers, chronic alcohol abuse, chronic gastritis -- all of these are toxic to the stomach in varying degrees in different people H. pylori is present in 60-80% of cases PAIN CAUSED BY EATING, burning/gaseous
Abdominal quadrants are helpful when...
percussing/palpating and noting pain in a certain quadrant
Pts can go septic from what complication of ulcers?
perforations
Hypertension: Exam presentation
point of maximal impulse (PMI) may be palpable further left in the chest at the 5th intercostal space toward the axillary line, may here a S4 sound just before S1 when listening to the heart because of less compliant left ventricle
PMI
point of maximal impulse or apical pulse, locate using the palm of the hand, once located then use the fingertips for finer assessments (ask pt to exhale and hold breath to help locate pulse)
Subarachnoid hematoma
pooling of blood in the subarachnoid space, usually caused by aneurysms and AVMs, less often caused by trauma
Biological valve replacement
porcine or bovine, less durable, does not last as long (only about a decade), does not require anti-coag
Hemangiomas
port-wine stain, strawberry mark, cavernous - birthmarks, caused by a benign proliferation of blood vessels in the dermis
idk yet
position COPD patients often assume
Many lacunar infarcts are only found...
post-mortem
Pancreatic Cancer Tx
radiation may improve pain relief but does not improve survival, chemo has limited effect on survival wipple surgery - a partial pancreatectomy for abscesses/cancers, try to keep as much of the pancreas as possible
High tone frequency loss apparent for those with...
presbycusis, revealed in difficulty hearing whispered words and consonants during conversation, aging adults feel that "people are mumbling" and feels isolated in family/friend groups
Risk Assessment for PUD
presence of H. pylori in GI tract, excessive alcohol intake, regular use of NSAIDs and biphsphonates, smoking or chewing tobacco, serious illness, radiation tx, uncontrolled stress, Zillinger-Ellison syndrome
Osmotic Pressure
pressure exerted by the solutes in the solution, in the bloodstream, osmotic pressure is exerted by electrolytes, mainly sodium ions and plasma proteins
Assessing the Lacrimal gland
pressure over the sac should see no discharge
Chest Pain: Character/Quality
pressure, tightness, crushing, burning, stabbing, aching, dullness, heaviness, "heartburn", pt may have more than one descriptor or problem
Barotrauma
pressure-related ear discomfort that can be caused by pressure changes when flying, driving in the mountains, scuba diving, or when the Eustachian tube is blocked
Cranberry juice can...
prevent UTIs, not a form of treatment!!
Aplastic Anemia: Nurse Management
preventing complications from infections and hemorrhage, untreated prognosis is poor (75% fatal), treatment options are bone marrow transplant and immunosuppressive therapy
Brain Natriuretic Peptide (BNP)
produced by ventricular muscle cells during heart failure as the ventricle stretches in response to increased blood volume, levels of BNP greater than 500 are considered indicative of heart failure
pan-hypopituitarism
production of all hormones low
DM1
production of insulin is LOST 90% of the time this is an autoimmune dx, pancreatic islet almost completely loses the ability to make insulin, occurs mostly in younger adults RF: genetic susceptibility, environmental impact Sx: polydipsia (constant thirst), polyuria, polyphagia (increased appetite) WCS: Diabetic Ketoacidosis
Cystocele
protrusion of the bladder into the anterior wall of the vagina (caused by thickening of the pelvic musculature)
Rectocele
protrusion of the rectum into the posterior wall of the vagina (caused by weakening of the pelvic musculature)
Two point discrimination test
provides a measure of receptive field size for touch receptors.
Purposes of Documentation
provides chronological source of data, prevents fragmentation or repetition, establishes basis for screening, helps diagnose new problems, determines educational needs of the patient, family, establishes eligibility for reimbursement, provides legal record of care
Prepping Pt for Eye Assessment
pt should be standing for vision screening, then sitting up with head at your eye level for everything else
Rejection
pt's immune system attacks the transplant, most common in the first three months
Blood sugar diaries
pts bring these in, help you see long term pattern, early morning sugars, fasting sugars etc, patients can lie on these
Flue treatment
pts do NOT need antibiotics!!! drink lots of water, flu virus needs to run its course
Pupils in Aging Adult
pupil size decreases, lens loses elasticity, becoming hard and glasslike (presbyopia), by age 70 lens begins to thicken and yellow (begining of cataracts), visual acuity may diminish gradually after age 50 and more so after 70
PERRLA
pupils equal, round, reactive to light and accommodation ask person to focus on distant object, then shift gaze to your finger about 3 inches away from nose - there should be pupillary constriction and covergence of the axes of the eyes
Hydrostatic Pressure
pushing force exerted by water in the bloodstream, the heart's pumping action is the source of hydrostatic pressure, exerts and outward force that pushes water through the capillary membrane pores into the ISF and ICF compartments
Normal menstrual cycle
q 18 - 45 days, flow for 3-7 days
An injury to the C8 or higher would result in...
quadriplegia (if its a complete injury)
Post-prandial hypoglycemia
quick, large influx of carbs into small intestine creates a surge of insulin
Kidney stones diagnosis
s&s, dietary/med/family history, KUB, renal ultrasound/CT scan, chemical analysis of stones (if/when it is retrieved), IVP or retrograde pyelogram (used to confirm dx and determine size/location of stones)
Cholera Tx:
salt solution, IV fluids, antibiotics, potassium
Isotonic IV
same tonicity as blood, 0.9% NaCl
Cirrhosis
scarring of the liver, caused by chronic hepatitis, alcohol abuse (due to fatty infiltration), chronic right-sided heart failure
A dense white patch on the tympanic membrane
scarring, a result of perforated ear drum or repeated ear infections
Cerebral contusion
scattered areas of bleeding on the surface of the brain, most commonly in the frontal and temporal lobes, they occur when the brain strikes a ridge on the skull
Unequal leg lengths are associated with
scoliosis
Cystoscopy
scope inserted into the urethra to examine the bladder, uses local or general anesthesia, expect burning, frequency and pink-tinged urine post-op
Tuning Fork Tests
screen for both function of the auditory nerve and ability of ear structures to conduct sound waves to the inner ear, should be heard on both sides, air conduction (neuro) lasts twice as long as bone conduction (sensory) high key inaccurate, rarely used
IgG is a secondary responder to infection, which means that levels rise after a...
second exposure to an antigen, IgG levels indicate prior exposure and immune competence to a particular antigen
Acute pancreatitis: diagnostics
serum amylase, lipase, hypo/hyperglycemia (checking glucagon, insulin, somatostatin levels), hyperlipidemia (free fatty acids in the blood) and hypocalcemia in worse case scenarios
Hypopituitarism: Diagnostics
serum measurement of "tropic" hormones, target organ testing, cranial imagining looking for benign tumor
Shock =
severe hypotension, increased pulse and decreased blood perfusion
Many pts with peripheral vascular disease report minimal symptoms bc...
severe symptoms may not occur until extensive damage has occurred
Modes of Transmission: HIV
sex with infected person (tears in vagina), exposure to infected blood or blood products (IV drug use), pregnancy, delivery, or breastfeeding
High risk HIV behaviors
sex with multiple partners, IV drug use (esp sharing needles), mixing sex and alcohol/drugs, anal intercourse
Vellus Hair
short, fine, inconspicuous, relatively unpigmented, covers most of the body
Increased creatinine indicates
sign of renal injury, hyperkalemia, possible oliguira
Examination of the Skill reveals...
signs of systemic disease or physical abuse, dehydration or over-hydration, medication side effects, early identification of potentially cancerous lesions and formation of pressure ulcers, identifies the need for education regarding hygiene and health promotion
Diabetics are prone to...
silent MIs, only found later on and may have non-textbook presentation
Zika virus
sime virus family as west nile, transmitted via mosquitoes (most common) or through body fluids, symptoms of infection occur in about 20% (low grade fever, maculopapular rash, painful joints in hands and feet, conjunctivitis In pregnancy, may cause congenital microcephaly or fetal loss
NHL - Diagnostics
similar to Hodgkin's lymphoma, lymph node biopsy (establishes cell type and pattern), staging guides therapy, prognosis for NHL is generally not as good as that for Hodgkin's lymphoma
Fissure
skin crack
MS Findings in Older Adults
slower movements, reduced flexibility, decreased muscle strength, kyphosis is common, bones lose their density with age, putting older clients at risk for bone fractures, esp of wrists, hips, and vertebrae joint stiffening conditions may be misdiagnosed as arthritis, osteoporosis is more common as a person ages b/c bone resorption increases, Ca absorption decreases, and production of osteoblasts decreases some older clients have an impaired sense of position in space, which may contribute to risks of falling
Appendicitis Patho
small tube that extends from the inferior part of the cecum becomes obstructed by a hardened mass of stool, can be caused by tumors, foreign bodies, kinks obstruction results in distention, venous engorgement, accumulation of mucus and bacteria, can result in gangrene and necrosis complications include perforation, peritonitis, or abscesses
Cardiac Risk Factors
smoking (packs per day, number of years), nutrition, stress, alcohol (# drinks per day/wk), lack of exercise, antihypertensives, beta blockers, calcium channel blockers, diuretics
Women's Lifestyle and Health Practice Qs
smoking, sexual partners, contraceptives, genitalia problems, sexual preference, comfort level in communicating about sexuality, fears about stress with sex, fertility concerns, menopause concerns, genital self exam, HIV results, estrogen replacement, toxic shock syndrome, STDs, loss of libido
Nodule
solid lesion greater than 0.5 cm (big)
mouth and throat subjective data
sores or lesions sore throat bleeding gums toothache hoarseness dysphagia altered taste smoking/alcohol consumption dental care pattern dentures altered taste look under the tongue, inside of cheeks
Diabetics can get an interesting form of liver disease...
steatohepatitis aka fatty liver disease
Phimosis
stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis
Autonomic Dysreflexia Steps
step 1: stimulus below level of injury (ex: distended bowel or bladder) step 2: afferent stimulus step 3: massive sympathetic response step 4: widespread vasoconstriction step 5: hypertension step 6: baroreceptors detect hypertensive crisis (tells cranial IX, X) Step 7a: cranial nerve X slows the heart rate Step 7b: descending inhibitory signals are blocked at level of injury (hypertension continues) Look at slide with pictures
DM2: Tx
stepwise approach that begins with lifestyle modification, oral anti-diabetic agents (sometimes in combo) are needed when lifestyle modification isn't enough to maintain glycemic control DM2 is "potentially curable" if pt can master all the lifestyle changes (not easy)
Hollow viscera
stomach, gallbladder, small intestine, colon, bladder (change shape)
DIC Management
stop the coagulation to stop the bleeding!! treat the cause, Heparin (blood thinners)
ART treats HIV by...
stopping HIV from reverse transcribing itself, inhibiting protease and integrate which help HIV build new proteins and integrate into CD4 DNA
Anterior Pituitary Dx
stores oxytocin and ADH, growth hormone excess dx originate here
Treatment of COPD
stpwise approach that begins with short-acting bronchodilator agents for pts with mild disease and incorporates long acting agents into the tx plan as disease progresses in severity -- ADVAIR!!! -- beta-2 adrengeric agonists (-terol) --inhaled corticosteroids (-sone) --phosphodiesterase inhibition (theophylline) --Leukotriene antagonists (-lukast)
Tenderness, swelling, heat of shoulder joint may be seen with...
strains, sprains, arthritis, bursitis, and degenerative joint disease
Objective Data - Skin Equipment
strong direct lighting, gloves, penlight, and small centimeter rule, Wood's light, magnifying glass, materials for lab tests
Hordeolum
stye
Subdural hematoma
sub = below, collection of blood under the dura
Review of Systems
subjective data obtained from the patient about general body parts - skin, hair head, eyes, eats, nose, mouth, neck, breast, axilla, cardiovascular, peripheral vascular, GI, urinary, genital system, sexual health, musculoskeletal, neurological, hematological, and endocrine systems
Free radicals and endothelial cell injury
substances in the environment that attack endothelium and disrupt its integrity
Chest Pain: Location
substernal/retrosternal, precordial (over the heart), diffused or localized (left lateral or right chest), radiation to jaw, neck, back, shoulder, or arm
Many IDA patients are asymptomatic and may recognize that they were fatigued, weak, exercise intolerant, and/or had pica only after...
successful treatment with iron
paroxysmal nocturnal dyspnea
sudden awakening from sleeping with shortness of breath
Fx of Respiration
supply oxygen level to support cellular life, removes CO2 as a waste product, maintains the acid-base balance of the arterial blood (?), maintains heat exchange
Kidney Palpation
support right posterior flank with left hand, place right hand in RUQ below costal margin, have client inhale, compress fingers deeply, Reverse for left kidney
Thoracic Cage
supports and protects the contents of the thorax, sternum, 12 ribs, 12 thoracic vertebrae, muscles, and cartilage
internal arteriovenous fistula (AVF)
surgical connection of a vein and an artery, less costly and less likely to embolize than AVG, long term patency is better, fewer infections sites: radiocephalic (wrist), brachiocephalic (elbow) downsides: takes a long to be usable (1.5-3mon), can develop an aneurism,
Cholecystectomy
surgical removal of the gallbladder, one of the most common surgical procedures, laparoscopic is preferred vs and "open" surgery
lymphedema
swelling due to an abnormal accumulation of lymph fluid within the tissues, may be bilateral or unilateral, may be non-pitting, no skin ulceration or pigmentation, diuretic meds are generally ineffective, although elevation of the legs periodically and compressive devices may reduce swelling
Hemorrhoids
swollen, twisted, varicose veins in the rectal region caused by constipation, straining during defecation, high pressure with portal vein of the liver, pregancy
Pulse Deficit
the differences between two different pulse rates, apical pulse rate - radial pulse rate
hydronephrosis
the dilation (swelling) of one or both kidneys (complication of kidney stones)
hydroureter
the distention of the ureter with urine that cannot flow because the ureter is blocked (complication of kidney stones)
Vasculitis
the inflammation of arterial vessels that most often occurs as a result of an autoimmune disorder, categorized according to their involvement of either large, medium, or small arterial vessles - Temporal arteritis (giant cell arteritis, involves temporal artery) - Takayasu arteritis (involves the aorta and its main branches) - Polyarteritis nodosa (PAN) (inovles medium sieze arteries, often involves extremeties
Acalculous cholecystitis
the inflammation of the gallbladder without associated gallstones trauma, infection, extensive burns, recent surgery, prolonged immobility and fasting, prolonged TPN, DM, or cancer
Macular degeneration and glaucoma start in which layer of the eye?
the inner layer (there is three total)
visceral peritoneum
the inner layer of the peritoneum that surrounds the organs of the abdominal cavity
The pH of the body is determined by...
the kidneys and the lungs
Deep inspiration
the lungs extend down to about the 9 ICS anteriorly and 1th ICS posteriorly
Influenze Virus
these viruses possess surface antigens known as hemagglutinin and neuraminidase (proteins that facilitate entry into respiratory cells and enhance the release of viral particles), the most extensive and severe outbreaks are caused by Influenza A viruses b/c of their ability to undergo mutation, Influenza B causes outbreaks with less severe disease because genetic mutation causing variation in their hemagglutinin and neuraminidase antigens is less common
Why do pregnant women's feet swell?
they have low vena cava return, which causes high hydrostatic pressure in the legs and feet
If pt is on mechanical ventilation...
they're likely to have at least one set of Arterial Blood Gases done
Labia minora
thin, hairless folds inside the labia majora
Cognitive function
thinking, knowledge, problem solving ability
frontal lobe
thinking, memory, behavior, movement
A thrombolytic agent may be used for those with MI and Unstable Angina if...
the patient is eligible, must be used within 4 hours of beginning of MI, very dangerous drugs, benefits must outweigh the risks
Low blood pressure isn't bad unless
the patient is symptomatic (syncope, dizziness, lightheadedness)
Pointing to the pain saves considerable time as...
the patient's description of the pain may be vague or confusing
Assessment of the MS system helps evaluation...
the patient's level of functioning with ADLs, it is important to remember that the neuro system is responsible for the function of the skeleton and muscles
Tinnitus
the perception of abnormal sounds in the head or the ear, often described as ringing, buzzing, humming, or hissing in the ear Causes: CN VIII disorders, prolonged noise exposure, infection, medications such as AMINOGLYCOSIDES!(Otic toxic ), aspirin, Meniere's disease
Air conduction
the process by which sound waves enter the ear through the pinna, most efficient
Ventricular fibrillation (V-fib)
the rapid, irregular, and useless contractions of the ventricles - blood is not pumped out of the chamber, not compatible with life, reduced cardiac output and ventricular filling time,
Atrophic scars
the resulting skin level is depressed with loss of tissue; a thinning of the epidermis
S3 Gallops
the third heart sound in the cardiac cycle. Normally, it is audible only in children and physically active young adults and usually disappears with age, in adults older than 40 the presence of an S3 is abnormal and indicative of heart failure
Lacunar Infarcts
the true "mini stroke", small areas in the deep brain (aka the pons) that endure ischemia from occluded tiny blood vessels, often associated with HTN, smoking, and diabetes, only about 30% result in functional loss, possible source of dementia?
When you have a patient with seizures, make sure to ask them about...
their aura!!!
Surgery is needed to treat acute pancreatitis if...
there are gallstones present, the diagnosis is uncertain, pt is unresponsive to conservative therapy, there is an abscess, pseudocyst, or peritonitis
A person is considered to have AIDS when...
there has been a diagnosis of HIV PLUS they have experienced ONE opportunistic infection OR they have a CD4 count <200 OR the presence of any AIDS defining condition regardless of CD4 count
Pupils constrict when
there is a lot of light (pupillary light reflex)
WCS: Hyperthyroidism
thyrotoxicosis = worst case scenario of hyperthyroidism just before thyroid storm, treated with beta-blockers to let heart rest, slows heart rate Thyroid storm - heart is beating so fast it stops functioning effectively, may lead to shock (heart just stops), hyperthermic - pt's temp needs to be brought down, pts are in ICU
Hypothyroidism: Tx
thyroxine (when you aren't demanding a lot from the heart, the heart begins to atrophy. Treatment of thyroxine needs to be monitored carefully, slowly - cardiology should take a look before treatment, it will ask the heart to do a lot of work), supportive care, fluids, fiber, blankets
Factors that cause hypothermia
time of day (4 am - 6 am), prolonged exposure to the cold, hypoglycemia, hypothyroidism, starvation
Factors that Cause Hyperthermia
time of day (8 pm to midnight), strenuous exercise, stress, ovulation, viral or bacterial infection, malignancies, trauma, various blood, endocrine, or immune disorders
Narcotics cause what change in pupils?
tiny pinpoint pupils
Ischemic CVA Tx
tissue plasminogen activator, anti-platelet tx (aspirin), (clot busting drugs - side effect is increased bleeding) intra-arterial thrombectomy (for pts who meet the criteria)
Why do infections need to be treated STAT in those with AVG?
to salvage the graft
Use the fingerpads to...
to sense pulse, texture, size, consistency, shape
Snellen eye chart
tool for assessing far vision, pt keeps lenses on
Base of the Heart
top of the heart
Pericardium
tough, fibrous, double-walled sac that surrounds and protects the heart, usually contains about 30-50 cubic cm of fluid
Sepsis
toxic inflammatory condition arising from the spread of microbes, especially bacteria or their toxins, from an infection
Respiratory Problems that can cause Chest Pain
trauma - pneumothroax, hemothorax, bronchitis, pulmonary embolus, pneumonia, pleurisy, costrochondritis
Liver Transplant
usually for cirrhosis and HCC, cadaver or living donor transplant, may be denied if other co-morbidies, c/i with widespread malignant disease, multidisciplinary teams evals the recipient
third degree prolapse
uterus and cervix protrude through the vaginal orifice
Female Internal Genitalia
vagina, cervix, uterus, fallopian tubes, ovaries
Why are arterial walls able to withstand high pressures?
walls are thick and strong, elastic fibers allow stretching with systole and recoiling during diastole, muscle fibers within the walls (vascular smooth muscle) contract or dilate to control blood flow,