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Flashcards in Exam 1 Deck (49):
0

What things assist the narrative during an interview?

Facilitation, silent attentiveness, reflection, empathy, clarification, confrontation, interpretation, explanation, summary

1

The nursing process

ADPIE
Assess
Diagnos
Plan
Implement care
Evaluate care

2

Prioritizing data

Primary- life threatening problems
Secondary- require prompt attention to stop progression
Tertiary-important but doesn't require immediate attention

3

Types of assessments

Complete- full physical
Focused- specific area
Follow up- reevaluate problem
Emergency-life saving

4

What is inspection?

1st step, inspect client, looking for symmetry, be organized

5

Light palpation

Less than 1/2 inch
Temp, pulses, Edema

6

Deep palpation

Greater than 1/2 inch
Organ location, masses/lumps

7

Bellotment Palpation

Swelling, shape of floating object, pregnancy, kneecap fluid

8

Percussion

Touch & hearing

9

Auscultation

Listening with stethoscope

10

Order of physical assessment

Inspection, palpation, percussion, auscultation

11

What is the dorsal part of hand used for?

assessing temperature

12

What are the balls and ulnar parts of the hand used for?

Vibrations

13

What are the fingertips used for?

Swelling, texture, lumps

14

Why is b/p cuff size important?

Obtain accurate bp
Bladder Should be 80% length and 40% width of arm

15

Mechanisms of heat loss

Radiation, convection, conduction, evaporation

16

Visceral pain

Organs

17

PQRSTU

Provocation/palliation
Quality
Region/radiation
Severity
Timing
How does it make client feel?

18

Importance of health history

Gather subjective/ objective data
General idea of health
Assess actual/potential health problems

19

What to look for in lesions

Color, elevation, pattern, size, location, drainage

20

Clubbing

Nails greater than 180 degrees

21

Alopecia

Hair loss

22

Deep somatic pain

Joints, vessels, bones

23

Cutaneous pain

Superficial (Sunburn)

24

Referred pain

Pain not where injury is

25

Central nervous system

Brain and spinal cord
12 pairs of cranial nerves

26

Peripheral Nervous System

32 pairs of spinal nerves

27

Cerebral cortex: frontal lobe functions

Personality, behavior, emotions, voluntary movement, writing, speech

28

Cerebral cortex: parietal lobe functions

Sensation, recognize body parts

29

Cerebral cortex: temporal lobe functions

Hearing, smell, taste, language comprehension

30

Cerebral cortex: occipital lobe functions

Visual reception, understanding written material

31

What is vertigo?

Rotating/spinning sensation

32

What is syncope?

Sudden loss of consciousness/strength

Lack of blood flow to brain

33

Cranial nerve 1

Olfactory- smell

34

Cranial nerve 2

Optic-vision

35

Cranial nerve 3

Oculomotor- pupillary constriction, accommodation

36

Cranial nerve 4

Trochlear- eye movement

37

Cranial nerve 5

Trigeminal- facial sensations, mastication muscles

38

Cranial nerve 6

Abducens- eye movement

39

Cranial nerve 7

Facial- taste, facial muscles

40

Cranial nerve 8

Acoustic- hearing, balance

41

Cranial nerve 9

Glossopharyngeal- gag

42

Cranial nerve 10

Vagus- swallowing

43

Cranial nerve 11

Spinal-neck muscles

44

Cranial nerve 12

Hypoglossal- tongue muscles

45

Expressive aphasia

Knows what to say but can't express it

Brocus

46

Receptive aphasia

Can hear or read but does not understand it

Wernicke

47

Direct percussion

Direct tapping of non dominant hand

48

Indirect percussion

Dominant hand bouncing off plexor of dominant hand