Chapters 8-9

Question 1

Observe a client for significant abnormalities in any of these 8 areas:

Answer 1

1) Skin color
2) Dress
3) Hygiene
4) Posture/ gait
5) Physical development
6) Body build
7) Age
8) Gender

Question 2

Vital signs provide data that reflect status of what 4 body systems?

Answer 2

Cardiovascular, neurologic, peripheral vascular, respiratory

Question 3

List the 4 vital signs

Answer 3

Temperature, pulse, respirations, blood pressure

Question 4

What vital sign should you take first?

Answer 4

Temperature

Question 5

What amplitude indicates a weak or diminished pulse?

Answer 5

1+

Question 6

What amplitude indicates a normal pulse?

Answer 6

2+

Question 7

What amplitude indicates a bounding pulse that can’t be obliterated?

Answer 7

3+

Question 8

Define systolic blood pressure

Answer 8

Measurement of the pressure of the blood in the arteries when the ventricles are contracted

Question 9

Define diastolic blood pressure

Answer 9

Measurement of the pressure of the blood in the arteries when the ventricles are relaxed

Question 10

What is considered the “fifth vital sign”?

Answer 10

Pain

Question 11

Normal temperature in older clients may range from ___-___

Answer 11

95.0 - 97.5

Question 12

What 2 occurrences, second to bone loss, may result in kyphosis. in older adults?

Answer 12

Osteoporotic thinning, collapse of vertebrae.

Question 13

Arteries of older clients may feel

Answer 13

Rigid, hard, bent

Question 14

What qualifies for isolated systolic hypertension?

Answer 14

Systolic pressure over 140; diastolic pressure under 90

Question 15

The respiratory rate of older patients may range from ___-___

Answer 15

15 - 22

Question 16

T/F: Pulse pressure widens with age

Answer 16

True

Question 17

List 4 causes of a rise in temperature

Answer 17

1) Strenuous exercise
2) Stress
3) Ovulation
4) Hyperthermia (resulting from viral/ bacterial infections, malignancies, trauma, various disorders)

Question 18

List 5 factors affecting blood pressure

Answer 18

1) Cardiac output
2) Elasticity of arteries
3) Blood volume
4) Blood velocity (HR)
5) Blood viscosity (thickness)

Question 19

What 4 characteristics should you consider when taking a patient’s pulse?

Answer 19

Rate, rhythm, amplitude/ contour, elasticity

Question 20

Define acute pain

Answer 20

Usually associated with recent injury

Question 21

Define chronic nonmalignant pain

Answer 21

Usually associated with specific cause or injury; described as constant and persistent (6+ months)

Question 22

Define cancer pain

Answer 22

Often results from compression of peripheral nerves/ meninges, or from damage to these structures following surgery, chemotherapy, radiation, or tumor growth/ infiltration

Question 23

What does cutaneous pain refer to?

Answer 23

Skin or subcutaneous

Question 24

Where is visceral pain felt?

Answer 24

In the abdominal cavity thorax, cranium

Question 25

Where is deep somatic pain found?

Answer 25

Ligaments, tendons, bones, blood vessels, nerves

Question 26

Describe radiating pain

Answer 26

Perceived at both the pain source, and extending to other tissues

Question 27

Describe referred pain

Answer 27

Perceived in body areas away from the pain source

Question 28

Describe phantom pain

Answer 28

Perceived in nerves left by a missing, amputated, or paralyzed body part

Question 29

Anxiety, sleeplessness, grimaces, decreases in cognitive function, confusion,, increased HR/ BP/ RR, decreased output/ urinary retention - these are all physiological responses to ___

Answer 29

Pain

Question 30

List the 7 dimensions of pain

Answer 30

Physical, sensory, behavioral, sociocultural, cognitive, affective, spiritual (PSCABSS)

Question 31

QUESTT Principles for Pain in Children - what does QUESTT stand for?

Answer 31

``` Question the child Use pain-rating scales Evaluate behavior, physiologic changes Secure parents' involvement Take cause of pain into account Take action and evaluate results ```

Question 32

Pain source stimulates ___ which are peripheral nerve endings that transmit the sensations to the CNS

Answer 32

Nociceptors

Question 33

List 3 types of nociceptors stimulated by different stimuli

Answer 33

``` Mechanosensitive (of A-delta fibers) Thermosensitive (of A-delta fibers) Polymodal nociceptors (of C fibers) ```

Question 34

Mechanosensitive nociceptors are sensitive to what kind of stimulation?

Answer 34

Intense mechanical stimulation

Question 35

Thermosensitive nociceptors are sensitive to -

Answer 35

Intense heat and cold

Question 36

Polymodal nociceptors are sensitive to -

Answer 36

Noxious stimuli that is mechanical, thermal, or chemical in nature

Question 37

Transduction of pain begins when?

Answer 37

When a mechanical, thermal, or chemical stimulus results in tissue injury or damage, stimulating nociceptors

Question 38

A-delta primary afferent fibers transmit what kind of pain, where, and how fast?

Answer 38

A-delta fibers transmit fast pain to spinal cord within 0.1 second

Question 39

What does pain stemming from A-delta fibers feel like?

Answer 39

Prickling, sharp, electric

Question 40

What stimulates A-delta fibers?

Answer 40

Mechanical or thermal stimuli

Question 41

C fibers transmit what kind of pain, and how fast?

Answer 41

C fibers transmit slow pain within 1.0 second

Question 42

What does pain stemming from C-fibers feel like?

Answer 42

Burning, throbbing, aching; usually results in tissue damage

Question 43

What stimulates C-fibers?

Answer 43

Mechanical, thermal, or chemical stimuli.

Question 44

Define hypothermia and its causes

Answer 44

Definition: abnormally low body temperature Causes: prolonged exposure to cold, hypoglycemia, hypothyroidism, starvation

Question 45

Define hyperthermia and its causes

Answer 45

Definition: an abnormally high body temperature Causes: viral or bacterial infections, malignancies, trauma, various disorders

Question 46

Blood pressure reflects what pressure in the body?

Answer 46

The pressure exerted on the walls of the arteries

Question 47

What does blood pressure measure?

Answer 47

The pressure of the blood in the arteries when the ventricles are contracted (systolic) and relaxed (diastolic)

Question 48

What is the term for the difference between systolic and diastolic blood pressure?

Answer 48

Pulse pressure

Question 49

Pulse pressure reflects the amount of blood ejected with each heartbeat - what is the term for this?

Answer 49

Stroke volume