Nurs 314- Exam 1 Study Guide
Mental Disorder
"A specific behavior or psychological pattern that is associated with distress or disability and has a significant risk of pain, disability, or death or a loss of freedom" (Jarvis, 2012, p. 71). A response that is: greater or less than expected to the life changing event Includes: organic disorders: b/o brain disease with known organic cause psychiatric mental illness: in which organic cause is unknown
Cardiac conduction
1 Sinoatrial node (Pacemaker) (S/A Node) 2 Atrioventricular node 3 Atrioventricular Bundle (Bundle of His) 4 Left & Right Bundle branches (which fire separately) 5 Bundle Branches Heart has unique ability: automaticity Can contract by itself, independent of any signals or stimulation from body Contracts in response to an electrical current conveyed by a conduction system Specialized cells in sinoatrial (SA) node initiate an electrical impulse. It is called the pacemaker. Current flows in orderly sequence, first across atria to AV node low in atrial septum There, it is delayed slightly so that atria have time to contract before ventricles are stimulated. Then, impulse travels to bundle of His, right and left bundle branches, and then through ventricles via the Purkinje fibers. Electrical impulse stimulates heart to do its work, which is to contract. If S/A node does not stimulate the A/V node, then we could end up with atrial fibrulation
Name the steps to the Nursing Process, based on Jarvis
1. Assessment 2. Diagnosis 3. Outcome ID 4. Planning 5. Implementing 6. Evaluation
Functional Assessment, Functional Assessment approaches ( slide 15):
2 approaches; individual's self report or observing his/her ability to perform tasks ADL Tools- KATZ Index of Independence (0-6 points); Barthel Index (includes definitions & comprehensive assessment of mobility to follow progress); Functional Independence Measure (FIM) (takes formal training & is more sensitive to change); Rapid Disability Rating Scale-2 (RDS-2)- completed by family members IADL Tools- Lawton (scale of 0-8 for women and 0-5 males and measures more complex IADLs)[biased in activities that men and women do]; Mobility- Get up and go test; patient goes from chair and takes 10 steps then back and sits down (note balance, gait, ability to turn safely, & sit-stand ease)
Lung & Thorax Anatomy: Landmarks, reference lines
5 lobes on anterior -3 on right side -2 on left side Anterior Landmarks: Suprasternal Notch: Hollow U-shaped depression just above the sternum, in between the clavicles. Sternum: The "breastbone" has three parts—the manubrium, the body, and the xiphoid process. Sternal Angle (Angle of Louis): Often called the "angle of Louis," is a useful place to start counting ribs, which helps localize a respiratory finding horizontally. Also marks the site of tracheal bifurcation into the right and left main bronchi; it corresponds with the upper border of the atria of the heart, and it lies above the fourth thoracic vertebra on the back. Costal Angle: The right and left costal margins form an angle where they meet at the xiphoid process. Usually 90 degrees or less Reference Lines: MCL: Midclavicular Line MSL: Midsternal Line ALL: Anterior Axilary Line PAL: Posterior Axillary Line MAL: Midaxillary Line
Abdominal Regions...
9 Regions: Right Hypochondriac Region Right Lumbar Region Right Iliac (Inguinal) Region Epigastric Region Umbilical Region Hypogastric Region (aka Suprapubic Region) Left Hypochondriac Region Left Lumbar Region Left Iliac (Inguinal) Region
Definition of mental status
A person's feelings and thinking functions
Pathway of air through the respiratory system, site of oxygen and C02 exchange
ACINUS= Upside down part of the bronchiole tree CO2 and O2 are exchanged at the alveoli Intercostal muscles take more oxygen for us to breath than the diaphragm does People with lung disease / lung problems should breath with their diaphragms instead of their ribs (intercostal muscles)
Identify the development differences in older adults and subjective data
Abdominal obesity (redistribution of subcutaneous fat away from face and extremities to abdomen), decreased salivation, esophageal emptying is delayed, reduced gastric acid secretion Pernicious anemia, iron def. anemia, calcium malabsorption Increase in gallstones Delay in gastric emptying Decreased liver size(by 25%)and hepatic blood flow(33%) Delayed metabolism of drugs Constipation Decrease salivation and decrease taste
Identify the areas of pain for gallbladder, pancreatitis, kidney and kidney stones
After light palpation, do deep palpation (~ 2 cm) Palpate all areas other than the area of pain; do that area last to keep patient from guarding Gallbladder: Cholecystitis is biliary colic, sudden pain in right upper quadrant that may radiate to right or left scapula, and which builds over time, lasting 2 to 4 hours, after ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting and with positive Murphy sign or sudden stop in inspiration with RUQ palpation. Pancreatitis: has acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea, and vomiting. Kidney Stones: Kidney stones prompt a sudden onset of severe, colicky flank or lower abdominal pain. Kidney: Costovertebral Angle
Factors affecting bp
Age: increases with age Sex: After puberty, females have lower BP; after menopause females have higher BP Race: African-American adult's BP higher than white person of same age; hypertension twice as high in African-Americans than Caucasian-Americans (genetics) Diurnal rhythm: daily cycle of peaks/troughs Weight: BP higher with higher weights Exercise: Increased activity yields increase in BP, lower at rest Emotions: BP increases with fear, anger, pain Stress: BP elevated with continual stress Sodium intake
Know Levels of Consciousness
Alert Lethargic or somnolent - not fully alert, drifts off to sleep when not stimulated, responds appropriately but slow, fuzzy thinking Obtunded - difficult to arouse, roused with shout or vigorous shake, groans, confused, monosyllabic responses, mumbles, needs constant stimulation for marginal cooperation, appropriate motor responses Stupor or semi-coma - roused only with pain or persistent shaking, but eyes remain closed, groans, mumbles, may move restlessly; reflex activity persists, appropriate motor responses Coma - completely unconscious, does not awaken, loss of reflex activity, no response to external stimuli. Light coma- some reflex activity, no purposeful movement; deep coma- no motor response
Difference between peripheral vascular and lymphatic vessels and their location
Arterial system delivers O2 and nutrients - Arteries are elastic - high pressure Venous systems removes O2 and waste - legs have 3 types of veins (deep, superficial, perforators) - Intraluminal valves ensure unidirectional flow - low pressure The lymphatics form completely separate vessel system, which retrieves excess fluid from tissue spaces and returns it to the bloodstream
Cognition assessment
Assess attention, memory, orientation, language, visuospatial skills, higher cognitive functions (i.e. plan and execute functions) Instruments: MMSE (mini-mental state exam), Short Portable Mental Status Questionnaire, etc.
Identify the location for vascular sounds
Auscultate in a pattern
Cause and grading of pitting edema
Bilateral, dependent pitting edema occurs with heart failure, diabetic neuropathy, and hepatic cirrhosis Grading: 1+ Mild pitting, slight indentation, no perceptible swelling of the leg 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation remains for a short time, leg looks swollen 4+ Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted
Describe the components of the Health History.
Biographic data- name, age, DOB, address, phone #, birthplace, race, marital status, ethnic origin, occupation Reason for seeking care- symptom (subjective) vs signs (objective) Present health or history of present illness- chronologic record of reason seeking care, from 1st symptom to now Past history- childhood illness, accidents/injuries, hospitalizations, surgeries, obstetric history (pregnancies), immunizations, allergies Family history- genes & susceptibility (risk factors) associated w/ those genes Review of systems- male/female genitals, sexual health, musculoskeletal system, hematologic/neurologic/endocrine systems Functional assessment or activities of daily living (ADLs)- person's self-care ability (bathing, toileting, dressing, eating, walking)
Auscultory areas
Check at APEToMan: -Aortic Area -Pulmonic Area -Erb's Point -Tricuspid Area -Mitral Area Mnemonic: All Physicians Eagerly Take Money
Subjective/ symptoms of cardiac disease
Chest pain (Angina) Dyspnea (difficulty breathing, SOB) Orthopnea (can only breathe sitting up) Cough (fluid in lungs) (PND) Fatigue (lack of O2) Cyanosis or pallor (blueness in nails) Dizziness (in Women, first sign of MI)
Objective/signs of cardiac assessment and the techniques used
Chest/back/jaw/L shoulder/L arm pain/pressure Dyspnea Pallor Diaphoresis Fatigue Palpitations/tachycardia Anxiety/denial or sleep disturbances Nausea/vomiting Dizziness Exertional pattern Silent MIs
Compare physical, psychological signs and symptoms of chronic and acute pain
Chronic: pain continues 6+ months, doesn't stop after healing injury, can be malignant or non-malignant, behaviors= bracing, rubbing, sighing, diminished activity, loss of appetite Acute: short term, self limiting, dissipates after injury heals, acute pain is meant to warn people of actual/potential tissue damage; behaviors= grimacing, moaning, agitation, restlessness, diaphoresis, vitals signs change
Terminology and symbols of a Genetic Pedigree
Circles represent women Squares represent men Vertical lines are lines of descent and are drawn between biological parents and children. Horizontal lines are relationship lines and indicate mating, not necessarily marriage A horizontal slash through a symbol represents a death A mating, not necessarily a marriage is a solid horizontal line A dashed line indicates a casual or partnership between two people A smaller circle or square indicates a pregnancy loss. A triangle is used if the sex is unknown A inverted "V" shaped lines indicates twins, fraternal. If a line is drawn vertically between the inverted "V" to make an "A" then identical A proband is the person with the genetic concern or, if none, the person for whom the pedigree is constructed. An arrow is drawn on the pedigree that points to the proband.
Identify components of Assessment
Collect data: Review the clinical record, health history, physical examination, functional/risk assessment, review of literature. Use evidence based assessment techniques, document relevant data
Red Flags in the history
Confusion, anorexia (loss of appetite), lethargy, incoherence, agitation, delirium New or suddenly worsening urinary and/or fecal incontinence Dyspnea (shortness of breath [SOB]), syncope (passing out), weakness, vomiting Falls, unsteadiness Failure to thrive
Describe cultural relevance
Cultural Brokering—use of a middleman to connect diverse cultures Patient negotiation—after listening to the client select areas that are non-negotiable and those that are negotiable (i.e. child w/ burn on foot) Acculturation and assimilation—consider the factors that affect both
Steps to cultural competence
Culturally sensitive: Possessing basic knowledge of and constructive attitudes toward diverse cultural populations Culturally appropriate: Applying underlying background knowledge necessary to provide the best possible health care Culturally competent: Understanding and attending to total context of patient's situation including: Immigration status, Stress factors, Social factors, Cultural similarities and differences Understands one's own heritage-based values, beliefs, attitudes, and practices Acquires knowledge about the social background of a patient Identifies the meaning of "health" to a patient Helps the patient understand how the health care system works; advocates for the patient Becomes familiar with languages, interpretive services, and community resources available to nurses and patients.
The components of Heritage
Culture, Ethnicity, Spirituality/Religion, Socialization x3 (Assimilation, Acculturation, Biculturalism), & Time Orientation
Define and describe the components of culture, ethnicity, heritage, heritage consistency, linguistic competence, health and illness
Culture: the sum total ways of living for a group of human beings which is transmitted from one generation to another. Thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Characteristics of culture: Learned from birth, shared with others from their culture, adapted to their situation and environment, dynamic & always changing (not in stone) Ethnicity: a group of people, racially, linguistically, or historically related who have a common and distinctive culture. Much diversity exists between and within groups Heritage: Combination of culture, ethnicity, religion, spirituality, socialization (acculturation, assimilation, biculturalism) and time orientation Heritage Consistency: Degree to which a person's lifestyle reflects his or her traditional heritage; can be modern or traditional Linguistic Competence: Title VI of Civil Rights Act of 1964= services can't be denied to LEP people; some states require providers to offer lang. help Health & Illness: Balance of a person is essential for health; illness is imbalance Causes of illness: biomedical, naturalistic, magicoreligious, healing & culture, folk healers
Pain as it relates to Cultures and Older Adults
Cultures: physiology of pain is universal, perception of pain varies by culture Genetic differences may account for differences in pain perception Older Adults: often deny having pains for fear of dependency. Pain is not a normal process of aging
Difference between delirium and dementia
Delirium - an acute, transient onset of confusion, cognitive impairment, decline of vigilance, increased or reduced psychomotor activity and a disturbed sleep-wake-cycle. Typically has a physical cause (fever, infection, drug interaction). A medical emergency that can be fatal if untreated Dementia - A chronic, slow, progressive, typically irreversible loss of brain function that affects: Language Memory Perception Emotional behavior or personality Cognitive skills (such as calculation, abstract thinking, or judgment)
Purpose and definition of Kleinman's Model
Distinguishes between illness and disease Illness—uniquely personal experience that a sick person has of what is happening to him/her Disease—the health care providers biomedical understanding of the same illness Recognized the various domains of influence on a person's belief and actions regarding illness and disease
Objective data and the assessment techniques used, variations in pulse, normal and abnormal findings
During a complete physical examination, examine arms at very beginning when you are checking vital signs and person is sitting Examine legs directly after abdominal examination while person is still supine; then stand person up to evaluate leg veins Examination of arms and legs includes peripheral vascular characteristics Room temperature should be about 22° C (72° F) and free of drafts to prevent vasodilatation or vasoconstriction Compare your findings with opposite extremity Lift both person's hands in your hands Inspect, then turn person's hands over, noting color of skin and nailbeds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing Use profile sign (viewing finger from side) to detect early clubbing Normal nail bed angle is 160 degrees
Definition of dyspnea, orthopnea
Dyspnea: shortness of breath Orthopnea: difficulty breathing when supine. State number of pillows needed to achieve comfort
Know similarities and differences between cultural and ethnic groups
Ethnicity: Describes a group united by: Common geographic origin Migratory status Religion Race Language Shared values, traditions, or symbols Food preferences Culture: Characteristics of culture Learned from birth Shared with others from their culture Adapted to their situation and environment Dynamic & always changing (not in stone)
Abnormal Heart sounds
Extra heart sounds Third heart sound (S3)—a ventricular filling sound occurring in early diastole with rapid filling Fourth heart sound (S4)—ventricular filling sound occurring with atrial contraction late in systole Any sound other than Lub-dub or Lub-da dub is an abnormal heart sound and needs to be reported. You will have to know where the sound occurs in the cardiac cycle but not know the cause and significance of the sound
Korotkoff sounds - which ones to record for bp reading
First K sound is systole No more K sounds mean diastole
Understand affects of Time Orientation
Focus on past: Traditions and ancestors play important role in person's life Focus on present: Little attention paid to past or future; concerned with now, and future perceived as vague or unpredictable Focus on future: Progress and change highly valued; person may express discontent with both past and present
Appropriate assessment techniques for anterior and posterior chest and what you are assessing with each technique
For smooth choreography in a complete examination, begin the respiratory examination just after palpating thyroid gland when you are standing behind person Perform inspection, palpation, percussion, and auscultation on posterior and lateral thorax Then move to face person and repeat four maneuvers on anterior chest Palpate: Symmetric expansion, tactile fremitus (say 99),
Components of a general survey
General survey gives overall impression of pt. @ first encounter Physical Appearance Body Structure Mobility Behavior Measurement Vital Signs
Recognize Erickson's developmental tasks for each age range—from infancy
Infant- An infant is completely dependent on the parent for his or her basic needs. If these needs are met promptly and consistently, the infant feels secure and learns to trust others. Toddler- stage of developing autonomy. However, the need to explore the world and be independent is in conflict with the basic dependency on the parent. This often results in frustration and negativism Preschooler- The child at this stage displays developing initiative. The preschooler takes on tasks independently and plans the task and sees it through. May see illness as punishment for being bad. School Aged Child- the major task of the child is developing industry. The child is developing basic competency in school and in social networks and desires the approval of parents and teachers (wants feeling of accomplishment) Adolescent- The major task of adolescence is developing a self-identity. Is increasingly self-conscious and introspective. Peer group values and acceptance are important. Aging Adult- During later years, the tasks are developing the meaning of life and one's own existence and adjusting to changes in physical strength and health.
Identify the sequence of examining technique
Inspection Auscultation (manipulation changes bowel sounds) Percussion Palpation (most uncomfortable/painful)
Know the four assessment techniques and when and how they are used
Inspection- Concentrated observation; observe the whole then each body system Palpation- slow & systemic; Start with light palpation, then deep; palpate tender areas last Percussion- can use to map out organ; strokes produce a vibration that depicts the location, size, density of an underlying organ Auscultation- Listening to sounds produced by body through a stethoscope; eliminate environment sounds, patient shivering & other artifacts b4 listening, wet chest hair Performed one at a time; in order Exception - the abdominal assessment: Inspection, auscultation, percussion, palpation
What to ask about suicidal and homicidal ideation
Is there a plan? Is there a means to carry out the plan? How would you do it?
Subjective data
Leg pain or cramps Skin changes on arms or legs Swelling Lymph node enlargement Medications
BP: Effects of big BP cuff, little cuff
Little Cuff- false high BP reading Big Cuff- false low BP reading
Identify the organs within the abdominal cavity
Liver Spleen Gallbladder Pancreas (deep) Stomach Small Intestine Large Intestine - Ascending Colon - Transverse Colon - Descending Colon - Sigmoid Colon - Cecum - Appendix Bladder Kidneys (deep) Sex Organs
Describe the Cultural Assessment Framework and its components
Looks into culture-specific epidemiological and environmental factors/influences Explores the following five (5) areas Culture-specific demographic factors Culture-specific epidemiological and enviroment factors Cultural characteristics Health Care Beliefs Western health care organizations and service delivery variables
Lymphatic system and its organs and their location
Lymphatics (cont.) Lymph nodes are small oval clumps of lymphatic tissue located at intervals along vessels Most nodes are arranged in groups, both deep and superficial, in body Nodes filter fluid before it is returned to bloodstream and filter out microorganisms that could be harmful to body Pathogens are exposed to lymphocytes in lymph nodes Lymphocytes mount an antigen-specific response to eliminate pathogens; with local inflammation, nodes in that area become swollen and tender
Identify the Health related beliefs and practices
Meditating Exercising/physical fitness Sleep habits Vaccinations Willingness to undergo physical examination Pilgrimage Truthfulness about how patient feels Maintenance of family viability Hoping for recovery Coping with stress Genetic screening and counseling Living with a disability Caring for children Differing views of epilepsy: Uganda: contagious, untreatable Greece: source of family shame Mexican-American community: evidence of physical imbalance Hutterites: evidence of having endured trial by God
Be able to differentiate between the MMSE and MSE
Mental Status Exam (MSE) - quick but thorough assessment of mental function Mini Mental Status Exam (MMSE) - quick screen of cognitive impairment typically used with older adults
Heart & Neck: Position and surface landmarks
Neck vessels— coronary arteries, carotid & subclavian arteries. Internal and external jugular veins Precordium— is the area on the anterior chest directly overlying the heart and great vessels Mediastinum— the middle third of the thoracic cage where the heart and great vessels are located Apex and base of heart— apex found @ bottom near left MCL @ 5th intercostal space, base found at the top near 2nd intercostal space by clavicle Right and left cardiac borders— R cardiac border formed by R-atrium, L cardiac border formed by L-ventricle Great vessels— Great vessels lie bunched above base of heart Superior and inferior vena cava return deoxygenated venous blood to right side of heart. Pulmonary artery leaves right ventricle, bifurcates, and carries venous blood to lungs Pulmonary vein carries oxygenated blood to the left atrium
Importance of palpating arterial pulse before taking BP
Need to ensure that the cuff is correctly placed in order to completely occlude artery. Failure to place correctly can lead to incorrect auscultation.
Anatomy: Structure of skin and nails
Need to know these structures... Epidermis Dermis Adipose Subcutaneous tissue Sebaceous glands
Define types of pain: nociceptive & neuropathic
Nociceptive: dull, cramping, crushing, throbbing Pain develops when nerve fibers in the PNS and in CNS are functioning and intact; starts outside of the nervous system from actual or potential tissue damage. Nociception can be divided into four phases: (1) transduction, (2) transmission, (3) perception, and (4) modulation Neuropathic: shooting, stabbing, burning, tingling An abnormal processing of the pain message from an injury to the nerve fibers. It is this type of pain that is most difficult to assess and treat. Pain is often perceived long after the site of injury heals and can start 2 to 3 years after an initial injury.
Identify pertinent topics to review while obtaining subjective data
OLD CAART- Onset, Location, Duration, Character, Associated symptoms, aggravating symptoms, relieving, treatment COLDSPA- Character, Onset, Location, Duration, Severity, Pattern, Associated factors, Affects patient PQRSTU- Provocative or Palliative, Quality or quantity, Region or Radiation, Severity Scale, Timing, Understand patients perception Appetite (gain or loss), anorexia=decrease in desire for food Early satiety (feeling of fullness) Weight change (unintentional gain or loss of >5lbs. over what time period) Can be increase or decrease in weight Dysphagia (difficulty swallowing) - Odynophagia: painful swallowing Chronic Indigestion Nausea and vomiting Indigestion, eructation (belching) Food intolerances Bowel habits Abdominal history
Changes of skin in older adults
Older Adults Atrophy, thinning and flattening of epidermis and dermis Loss of elasticity, subcutaneous fat, collagen Increased fragility, risk for shearing, breakdown Decreased number and function of sebaceous, eccrine and apocrine glands Dryness (xerosis) Decreased thermoregulation, increased risk of heat stroke Capillary fragility (easy bruising) Senile purpura Speckling, uneven pigmentation, leathery texture UV exposure Slowed growth of hair, nails Changes in distribution of hair Delayed cell replacement, wound healing
When to assess VS
On admission to healthcare agency to gather baseline data Agency policy and procedures Changes in patient's condition Before and after surgery or invasive procedures Before and after surgical activity that may increase risk Before administering meds that affect cardiovascular or respiratory functioning
General position of the lobes of the lung
On the anterior chest, the oblique (the major or diagonal) fissure crosses the fifth rib in the midaxillary line and terminates at the sixth rib in the midclavicular line. The right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. This fissure extends from the fifth rib in the right midaxillary line to the third intercostal space or fourth rib at the right sternal border
Know types of interview questions - slide 11 Introduction to Communication...
Open-ended Closed-end Validating (confirming) Clarifying Reflective (This one is hard to do well as it is the repetition of words just spoken.) Sequencing Directing
Two types of circulation
Oxygenated and Deoxygenated Circulation Pulmonary veins return freshly oxygenated blood to left side of heart, and aorta carries it out to body Aorta ascends from left ventricle, arches back at level of sternal angle, and descends behind heart
Components of a symptom analysis, PQRSTU, vs OLD CAART vs COLDSPA
Pain Scale: PQRSTU— Provocative/Palliative, Quality/Quantity, Region/Radiation, Severity scale, Timing, Understand patient's perception OLD CAART- Onset, Location, Duration, Character, Associated symptoms, aggravating symptoms, relieving, treatment COLDSPA- Character, Onset, Location, Duration, Severity, Pattern, Associated factors, Affects patient
Pain as a subjective symptom
Pain= highly complex & subjective experience coming from the (CNS) central nervous system or peripheral nervous system (PNS), or both. Pain is exactly what the pt. says it is (subj. report= most reliable indicator of pain)
Causes of pallor, cyanosis, jaundice, erythema
Pallor: When the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of connective tissue (collagen), which is mostly white (can result from high stress, fear, anxiety, cold, cigarette smoking, and edema) Cyanosis: blueness around mouth/nails indicates poor oxigenation (hypoxia); signifies decreased perfusion Jaundice: A yellowish skin color indicates rising amounts of bilirubin in the blood; Liver dysfunction, red blood cell destruction Erythema: Erythema is an intense redness of the skin from excess blood (hyperemia) in the dilated superficial capillaries. This sign is expected with fever, with local inflammation, or with emotional reactions such as blushing in vascular flush areas (cheeks, neck, and upper chest)
Know the difference between light and deep palpation
Palpable: muscles, liver, and aorta, small and large intestines, kidneys, partially full or full bladder, pregnant uterus, femoral arteries, feces (LLQ) Not usually palpable: stomach, gallbladder, spleen, pancreas, adrenal glands, renal arteries, iliac arteries, appendix, ovaries*, non-pregnant uterus*, empty bladder, prostate* Common abnormal findings: enlarged liver, enlarged spleen, and aortic aneurysm, masses, fluid in the peritoneum, excess air (distention), adhesions (internal scars), hernias
Identify the percussion sounds found in the abdomen
Percuss- dullness over solid organs (spleen, liver, sigmoid, full bladder) Tympany over hollow organs Tympany over bowel, gall bladder, stomach
Pericardium
Pericardium: tough, fibrous, double-walled sac that surrounds and protects heart Has two layers that contain a few milliliters of serous pericardial fluid; this ensures smooth, friction-free movement of heart muscle Pericardium: adherent to great vessels, esophagus, sternum, and pleurae and anchored to diaphragm
How to assess skin turgor
Pinch up a large fold of skin on the anterior chest under the clavicle (Fig. 12-5). Mobility is the skin's ease of rising, and turgor is its ability to return to place promptly when released. This reflects the elasticity of the skin. Poor turgor is evident in severe dehydration or extreme weight loss; the pinched skin recedes slowly or "tents" and stands by itself.
Identify the activities for promoting a healthy life style
Practice safe sex. Do not have unprotected sex with a male or female. • Do not share items that may have bodily fluids on them. • Be aware of your environment. Be careful with aerosol cleaners. Make sure rooms are well ventilated. • Watch your diet and weight. • Travel wisely. • Use medications wisely. Use prescription and over-the-counter medications only when needed. Be sure to take only the recommended doses and strengths. • Do not mix medications without consulting a health care provider. • Drink alcohol only in moderation. • Do not mix medications and alcohol. • Do not use illegal drugs. • Get vaccinated. • Be aware of your risk for hepatitis.
Functions of skin
Protection- primary function to prevent infection Barrier- prevents organisms from entering body Temperature regulation- if hot the skin sweats and chills itself Absorption- Vitamin D (sun) & medications Excretion- H2O, toxins, oils Perception- what we feel (proprioception) Production- oils, melatonin, melanin Self repair- scars (ability to heal itself) Most wounds heal from bottom up Communication- nerve impulses, pain (1st/2nd degree burns) Identification- fingerprints
Traps of interviewing
Providing false assurance Giving unwanted advice Using authority Using avoidance language Engaging in distancing (using "the" instead of "my"; using pass away) Using professional jargon Using leading or biased questions Talking too much Interrupting Using "Why" questions
Identify and locate the organs within the various quadrants
RIGHT UPPER QUADRANT (RUQ) Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon LEFT UPPER QUADRANT (LUQ) Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon RIGHT LOWER QUADRANT (RLQ) Cecum Appendix Right ovary and tube Right ureter Right spermatic cord LEFT LOWER QUADRANT (LLQ) Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Location of pulse points and what is assessed for
Radial Ulnar Brachial Carotid Femoral Popliteal Posterior Tibial Dorsalis Pedis
What does RESPECT mean (last slide)
Realize you must know heritage of yourself and patient Examine patient within cultural context Select simple questions and speak slowly Pace questioning throughout exam Encourage patient to discuss meaning of health and illness with you Check patient's understanding and acceptance of recommendations Touch patient within boundaries of his or her heritage
Know Orientation to person, place and time, difference between short and long term memory
Recent, remote - or - short-term, long-term Recent memory - 3 words at 1, 5, 10 min. Remote memory is assessed during history taking. Examples of variations: Recent and remote memory intact Recalls 2/3 words at 1 and 5 min, 1/3 at 10 min. MMSE- orientation to time and place, naming, reading, copying or visuospatial orientation (What year, season, date, day, and month is it? What state, county, town, hospital, floor?)
Difference between religion and spirituality
Religion is a system of beliefs, practices and ethical values usually with a deity; provides a shared experience of spirituality Spirituality comes from each person's life experiences in an effort to find purpose or meaning to life
Know the notes/sounds heard during percussion
Resonant: medium loud: low pitch; clear, hollow; moderate duration (ex. Over lung tissue) Hyperresonant: louder; lower pitch; booming, longer duration (ex. Over child's lung) Tympany: loud; high pitch; musical or drum-likel sustained longest duration (ex. Over air-filled viscous; stomach or intestine) Dull: Soft; high pitch Flat: over bone? tumor? muscles?
Factors affecting respiration
Respiration controlled by Medulla & Pons Age -respiratory rate decreases with age starting with newborns who have a RR of 30 - 60/min. Gender - men tend to have more diaphragmatic movements and women use more intercostal movement. Exercise- increases RR during exertion, decreases it at rest. Pathological conditions- will effect the rate, depth and movements of respiration. Alterations in fluid, electrolyte and acid balances such as acidosis and hyperventilation affect the PH balance that how the body's regulatory systems attempts to compensate through the respiratory center. Medications (narcotics) and trauma such as head injury can slow the RR down. Infection will speed up body metabolism causing fever and increase the RR. Pain and anxiety activate the sympathetic nervous system that increases the RR.
Heart sounds and their location
S2 heart sounds are always loudest at the base of the heart (2nd intercostal space) S1 heart sounds are loudest at the apex of the heart (5th intercostal space) S1 correlates with the pulse beat, you can listen on the carotid arteries
How to approach an interview with an older adult - slides 10
Show respect, take time (don't hurry), evaluate and optimize hearing, eyesight and comprehension, show respect, speak clearly/slowly, reassure
Know the functions of the small and large intestine
Small Intestine: Is about 20ft long. Its job is to absorb most of the nutrients from what we eat and drink. Velvety tissue lines the small intestine, which is divided into the duodenum, jejunum, and ileum Large Intestine: The large intestine (colon or large bowel) is about 5 feet long and about 3 inches in diameter. The colon absorbs water from wastes, creating stool. As stool enters the rectum, nerves there create the urge to defecate
Social and Spiritual Assessment
Social- Who is social support, relationship w/ caregiver, caregiver trained?, potential for falls, bathroom, stairways safe, safe neighborhood?, transportation? Spiritual- is person spiritual/religious, involve chaplain?, do health decisions have spiritual implications
Define Socialization and differences between acculturation, assimilation and biculturalism
Socialization: Process of being raised w/in a culture and acquiring characteristics of that group. Acculturation: process of adapting to and acquiring another culture Assimilation: process of developing a new cultural identity & becoming like members of the dominant society Biculturalism: dual pattern of identification & often divided loyalty
Recognize difference between subjective and objective data, identify examples of each
Subjective data- what the person say about him/herself (pain) Objective data- what can be observed by healthcare professional by percussing, auscultating...
Gathereing of subjective and objective information (slides 8-27)
Subjective information may be what the patient says Objective Info: ABCT Appearance Behavior Cognitive Functions Thought Processes and Perceptions Appearance Additional Attitude Culture Behavior Aging Mood and Affect Speech Thought Process Thought Content Perceptions Cognition, LOC (Level of Consciousness: alert, comatose, semi comatose...) Insight Judgment
Normal values of T-P-R-BP
T: 98.6°F or 37°C P: 60-100 bpm R: 12-20 BP: 120/80
Landmarks of the heart
The precordium is the area on the anterior chest directly overlying the heart and great vessels. The great vessels are the major arteries and veins connected to the heart. The heart and great vessels are located between the lungs in the middle third of the thoracic cage (mediastinum). The heart extends from the 2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line.
Pulse Pressure -definition, significance
The pulse pressure is the difference between the systolic and diastolic pressures and reflects the stroke volume Represents the force that the heart generates each time it contracts
Recognize Therapeutic versus Non-therapeutic communication techniques.
Therapeutic communication includes nonverbal communication that allows patient to feel at ease (posture, active listening, equal status seating, etc.) and involves empathy. Non-therapeutic communication can involve excessive note taking, asking closed-ended questions, and leading questions.
Definitions of adventious sounds: fine and coarse crackles, wheezing, stridor
These are added sounds that are not normally heard in the lungs. If present, they are heard as being superimposed on the breath sounds. They are caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways Fine Crackles: Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing Coarse Crackles: Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration Wheezing: High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord); predominate in expiration but may occur in both expiration and inspiration. Can also be low-pitched; monophonic single note, musical snoring, moaning sounds Stridor: High-pitched, monophonic, inspiratory, crowing sound, louder in neck than over chest wall
Cardiac cycle, pathway of blood through the heart
Two phases Systole: Hearts contraction, blood pumped from ventricles fills pulmonary and systemic arteries; this is one third of the cardiac cycle (heart pushing) Diastole : ventricles relax and fill with blood; this takes up two thirds of cardiac cycle (heart @ rest) Diastole and systole occur simultaneously on the right and left side of the heart
The meaning and use of ABCDE
Use the following mnemonic when assessing skin lesions: A- Asymmetry B- Border C- Color D- Diameter (use small ruler; mm) E- Elevation/Enlargement
Sources of heat loss, other factors affecting body temp
Vasodilation Diaphoresis (sweating profusely), evaporation Increased respiration Excretion of urine and feces
Know sources of pain and characteristics (i.e., visceral, cutaneous, deep somatic, neuropathic, psychogenic, radiating)
Visceral: originates from larger internal organs (kidneys, stomach, pancreas). Pain can stem from direct injury to organs resulting from tumor, ischemia, distention (reason why often presents w/ vomiting, nausea, pallor...) Cutaneous: derived from skin surface and subcutaneous tissues; injury is superficial, with a sharp, burning sensation (abrasion, laceration) Deep Somatic: comes from sources such as blood vessels, joints, tendons, muscles, and bone; may result from pressure, trauma, or ischemia (sprain, fracture) Neuropathic: Conditions that may cause neuropathy include diabetes mellitus, herpes zoster (shingles), HIV/AIDS, sciatica, trigeminal neuralgia, phantom limb pain, and chemotherapy Psychogenic: linked to strong emotion or a mental disorder, can influence a person's physical pain report (grief, heartache) Radiating:
Know information about assessing liver span and normal/abnormal
Where you hear the dull sound you will put a mark (from upper you go from resonance to dull) Percuss from bottom up and you should go from tympany to dull, draw mark Measure distance between lines
Myocardium
muscular wall of heart; it does pumping
Endocardium
thin layer of endothelial tissue that lines inner surface of heart chambers and valves
