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Health Promotion and Assessment > Important concepts for MT1 > Flashcards

Important concepts for MT1 Flashcards

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1
Q

What are the four basic techniques used in physical assessment? Which is ALWAYS completed first?

A

Inspection - completed first
Palpation
Percussion
Auscultation

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2
Q

What are the different lobes of the cerebral cortex? What are two important areas to assess for aphasia?

A

Parietal, occipital, temporal and frontal lobes.

assess Broca’s and Wernicke’s areas

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3
Q

What are the different components of the PNS?

A

12 Cranial nerves
31 spinal nerves
ANS (includes reflexes)

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4
Q

What are the different components of the neurological assessment?

A 
Vitals
GCS - LOC
Cranial Nerves
Cerebellar function
Proximal limb weakness
Sensation
reflexes
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5
Q

What are the different scores to look out for on the GCS?

A

Should be 15 if no issues
13+ - mild impairment
9-12 - moderate
8 or lower indicates coma (cannot protect airway)

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6
Q

What is the GCS score range?

A

3-15

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7
Q

Describe a decerebrate posture.

A

Decerebrate - damage to upper brain stem - extension

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8
Q

Describe a decorticate posture.

A

Decorticate - damage to one or more spinothalamic or dorsal column tracts - flexion

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9
Q

What is receptive aphasia?

What is expressive aphasia?

A

Receptive: isnt processing what is being asked but has no issues producing language

Expressive - understands what is being told to the person, but cannot get the words out

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10
Q

What are the mnemonics for the cranial nerves?

A

On old Olympus towering top a Fin and German viewed some hops
(II -optical, III -
oculomotor, VII - Facial, IX - Glossopharyngeal, X -Vagus)
Some say marry money but my brother says big brains matter more
(II - sensory, III - motor, VII - both, IX - both, X - both)

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11
Q

What is used to test CN II?

A

Snellen Chart

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12
Q

What is done to asses CN III?

A 
PERRLA (pupils equal, round, reactive to light, accomodation)
Direct light reflex
Consensual light reflex
Accomodation
6 cardinal fields of gaze
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13
Q

What are the 6 cardinal signs of gaze for?

A

Exaggerated H - for our case, testing CN III

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14
Q

What is done to assess CN 7?

A

Make the patient make faces (puff out cheeks, raise eyebrows, bare teeth, smile, etc.0

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15
Q

What is done to assess CN 9 and 10?

Why?

A

Make patient say ahh
See if the patient can swallow
This is to see if they can eat on their own - if the nerves are impaired - at huge risk for aspiration

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16
Q

For Cerebellar function, what assessments are done to evaluate balance and proprioception?

A

Evaluate gait
Tandem walking
Romberg’s test
Pronator drift

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17
Q

For cerebellar functioning, what is doe to evaluate coordination and skilled movements?

A

rapid alternating movements
finger to finger test
finger to nose test
heel to shin test

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18
Q

What is the babinski reflex?

A

Take something sharp and drag it along the outside of the foot and over the balls of the feet.
Positive = fanning of feet
negative = contraction of feet

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19
Q

Decreased or loss of motor nerve power due to problem with motor nerve or muscle fibers.

A

paralysis

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20
Q

Rapid, continuous twitching of resting muscle that can be seen or palpated (fine or coarse)

A

fasciculations

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21
Q

involuntary, compulsive, repetitive twitching of a muscle group (e.g. wink, grimace, head movement, shoulder shrug)

A

tic

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22
Q

rapid, sudden jerk at regular intervals (e.g. hiccups)

A

myoclonus

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23
Q

involuntary contraction of opposing muscle groups, results in rhythmic, back and forth movement of one or more joints

A

tremor

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24
Q

involuntary muscle twitching

A

chorea

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25
slow, writhing (twisting), continuous, and involuntary movement of the extremities
athetosis
26
person stumbles and cannot keep in appropriate space
ataxia
27
What does S1 (sound) relate to?
beginning of systole - closing of mitral/tricuspid valve
28
What does S2 (sound) relate to?
Beginning of diastole - closing of aortic and pulmonary semilunar values
29
Where is the PMI?
Apical pulse - between 4th and 5th ICS at the midclavicular line (left nipple for guys, about wire of bra for girls)
30
What is the expected heart rate range for adults? Older adults? Kids?
60-100 | Higher for older adults and kids
31
What is important to document when assessing pulse?
Strength rhythm Rate symmetry and location
32
Bradycardia
slow HR
33
Tachycardia
fast HR
34
pulse deficit
diff in pulse between assessment sites
35
asystole
no pulse
36
dysrhytmia
irregular rhythm
37
Cuff size should be what size?
20% of diameter of upper arm
38
What are the blood pressure sounds called? Which one's are important?
Korotkoff sounds 1 - systolic BP 5 - diastolic BP
39
What are the expected values for BP in adults? | What are the BP of children in relation?
<120/80 | Children usually have a lower BP
40
``` For adults, what ranges constitute: hypotension normotension pre-hypertension hypertension ```
Hypotension: S <90; D <60 Normotension: S <120; D <80 Prehypertension: S: 120-139; D: 80-90 Hypertension: S > 140 or D >90
41
What time of the day is the most common for heart attacks? Why?
Morning - higher amount of stress hormones
42
BP through the day?
Lower in the morning, rises through the day
43
``` How do the following affect BP: diabetes ethnicity gender stress pregnancy ```
diabetes - higher ethincity - blacks have a higher BP, asians and indigenous too gender - males higher after puberty, females higher after menopause stress = up pregnancy = down
44
What is orthostatic hypotension?
Decrease in blood pressure when standing from a lying or seated position
45
What temperature measurements are considered core? | Surface?
Core - tympanic and rectal | Surface - oral, skin, axilla
46
``` What is the expected normal range for oral temperature? Axillary? Tympanic? Temporal? Rectal? ```
``` Oral - 36.5-37.5 Axillary - 35.9-37.2 Tympanic - 36-37.5 temporal -36.5-37.5 Rectal - 37-37.5 ```
47
Expected temperature range for oral temp?
36.5-37.5
48
Expected temperature range for axillary?
35.9-37.2
49
Expected temperature for tympanic?
36-37.5
50
Expected temperature for temporal?
36.5-37.5 | remember TempORAL is the same as oral
51
Expected temperature for rectal?
37-37.5
52
What temperature indicates fever?
38 - anywhere
53
How does age impact temperature?
Geriatrics less able to mount fever. | Kids have more unstable temperatures.
54
Describe how the circadian rhythm affects temperature.
temperature goes down at night, increases during the day (think about metabolism).
55
What does febrile mean?
patient has a fever
56
Afebrile
no fever
57
what is a pyrogen?
substance that induces fever
58
What are rigors?
chills - a step up from shivering
59
Why isnt advil or Tylenol given before vacccinations anymore?
because it might affect the immune response
60
How is ventilation measured/observed?
count rate of breathing, depth and rhythm (As well as effort), symmetry
61
How is diffusion and perfusion measured?
SpO2
62
When inspecting a patient who has respiratory difficulties, what kind of abnormalities could be observed?
use of extra muscles cyanotic poor cap refill
63
Why would one asses respirations for more than 30 seconds?
if anything is irregular or for young children
64
What is apnea?
Period of no breathing
65
What is stridor?
Emergency situation related to narrowing of the airways
66
What is tracheal tug?
Often seen in kids - the use of neck muscles to breathe
67
What is the expected adult respiratory rate?
12-20 bpm | children and elderly people often breathe faster
68
What is tachypnea? Bradypnea? | Dyspnea?
Tachypnea - fast breathing bradypnea - slow breathing rate dyspnea - laboured breathing
69
What is ASEPTIC?
``` A - appearance and behaviour S - speech E - emotion and affect P - perception T - thought process I - insight C - cognition ```
70
What do we assess in a general survey?
``` 1 - General observations (appearance, psychomotor behaviour, attitude toward interviewer) 2 - Mood 3 - Affect 4 - Speech characteristics 5 - Perception 6 - Thought - content, process/form 7 - Sensorium - LOC, orientation, memory, attention and concentration, comprehension and abstract reasoning 8 - Insight 9 - Judgement ```
71
What are the 3 components of the general observations of the general survey?
Appearance - groomed? Hygiene, appropriate? Psychomotor behaviour - posture, gait, coordination, facial expression, maneurisms Attitude towards interviewer - accomodating, cooperative, open, apathetic, bored, guarded, supsicious, hostile
72
What is the difference between mood and affect?
Mood is what the patient tells us - subjective mood is month - more long-term Affect is what we describe the patient as - objective
73
How can emotion be described in the general survey?
Euthymic - normal euphoric - elated Dysphoric - depressed, restless
74
What are the different ways in which affect is described in the general survey?
Range - full or constricted Intensity - heightened, blunted, flat Appropriate - stability - stable or labile
75
How are speech characteristics charted or observed in the general survey?
Quantity - talkative vs. subdued Rate of speech production - slow, fast, pressured Quality - monotone, staccato, loud
76
What are two perceptual disturbances?
Hallucinations - feeling stimuli when they are absent | Illusions - misrepresenting actual stimuli
77
What are the two components of thought that are assessed in the general survey?
content - what the person is thinking about | process/form - manner in which thoughts are formed and expressed
78
What are the superficial aspects of cognition that are assessed in the general survey?
LOC - arousal or wakefulness | Orientation - ability to grasp the significance of environmental information - time, place, person
79
What are the in-depth assessments of cognition in the general survey?
memory attention and concentration comprehension and abstract reasoning
80
How is STM evaluated in the general survey?
3 unrelated words
81
how is attention and concentration evaluted in the general survey?
serial 7s
82
How is abstract reasoning evaluated in the general survey?
similarity between objects - train and bike
83
Understanding the reality of a set of circumstances. | Awareness of own thoughts and feelings and an ability to compare them with the thoughts and feelings of others.
Insight
84
ability to reach a logical decision about a situation and to choose course of action
judgement
85
When you evaluate someone's problem solving abilities and capacity to learn from the past, you are evaluating what?
judgement
86
What are critiques of the general survey?
highly subjective, affected by SES and demographic factors, changes with experience of nurse
87
Free nerve endings/receptors capable of responding to painful stimuli.
nociceptors
88
nociceptors are located where? | What are they activated by?
throughout the body tissues | activated by thermal, mechanical and chemical stimuli
89
Describe the transmission of pain.
pain stimulus in periphery --> impulse --> SC --> brain stem --> thalamus --> central structures of brain --> pain is processed
90
What is nociceptive pain?
Normal processing of stimulus.
91
What is neuropathic pain?
abnormal processing of sensory input
92
What are examples of nociceptive pain? neuropathic?
Nociceptive - cutaneous, somatic, visceral, referred, parietal, phantom limb pain Neuropathic - diabetic neuropathy, phatom limb pain
93
Why is phantom limb pain considered both nociceptive and neuropathic?
because there was a trauma assocaited to the pain, but is the result of abnormal processing of stimuli.
94
Pain can be classified by duration or frequency. Elaborate (i.e. what are the different subcategories)
duration = chronic or acute frequency - continuous or intermittent
95
What are some physiological responses that go along with the pain response?
``` increase in HR increase Respiratory rate diaphoresis vomitting pallor muscle tension ```
96
If a person is unconscious, what do we assume in regards to pain?
present and needs to be treated
97
What conditions of pain would be considered an emergency?
unexpected intense pain, particularly if sudden or associated with increased pulse, decrease pressure or fever
98
What does OLDCARTS stand for?
onset, location, duration, charactierstics, aggravating, relieving, timing, severity, self-preception
99
What does OPQRTSU stand for?
``` Onset provoking quality radiate timing severity understanding ```
100
Regarding bronchi, what is important anatomically and its relation to healthcare/
right bronchi is shorter and wider than the left one - greater risk for aspiration
101
Where would a tracheotomy be performed? | What breathing abnormality occurs there?
Suprasternal notch | tracheal tug
102
Why is C7 important?
Around where the lung apices are
103
What is important about the costal angle?
Location of base of lung for posterior aspect
104
What are some respiratory risk factors?
Smoking environmetnal factors (occupational, travel, home) determinants of health
105
How is smoking reported in the history?
Pack years - number of packs smoked per day * number of years smoking
106
How should the client be positioned for a respiratory assessment?
sit up, slightly hunched forward with rolled shoulders | (if they have to lie down, will assess laterally
107
What is the normal anterior-posterior to lateral size ratio for the chest:?
1:2
108
What is the anterior-posterior to lateral size ration for the chest in barrel chest patients?
1:1
109
What is palpation in a respiratory assessment used for?
Find chest tenderness Extra assessments (if no x-ray) - tactile fremitus, chest excursion (pneumo) Abnormal findings - crepitus (rice krispies)
110
Where would you hear bronchial sounds? Bronchovesicular? | Vesicular?
B - near the neck region BV - sternal border V - peripheral lung fields
111
What is the general inspiration to expiration ratio for vesicular sounds?
3:1
112
What are abnormal breath sounds called?
Adventitious sounds - when airways narrow or there is fluid or mucus or inflammation of airways
113
Lack of oxygen perfusion
hypoxemia
114
eupnea
unlaboured breathing
115
expectorate
coughing
116
hemoptysis
coughing up blood

Health Promotion and Assessment (13 decks)

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