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,