Intro to Clinical Skills

Question 1

pt w/ musculoskeletal complaint

Answer 1

look at joint above and joint below

Question 2

Pt complaining of eye pain

Answer 2

check ENT– i.e. surrounding connected systems

Question 3

OSCE’s

Answer 3

observed structured clinical exams

Question 4

skills focused on

Answer 4

normals

Question 5

who takes vitals

Answer 5

varies–rarely us, but must be able to explain why they’re divergent by end of visit

Question 6

pyrexia

Answer 6

fever= temp over 105 F

Question 7

hypothermia

Answer 7

body temp under 95 rectally

Question 8

euthermic

Answer 8

norma temp in healthy person = roughly 98.2 F

Question 9

Temp–fever is

Answer 9

critical vital sign associated with many infectious and non-infectious diseases

Question 10

Fever causes

Answer 10

bacterial or viral, trauma, surgery, crush, malignancy, blood disorders, rx

Question 11

rectal temps are

Answer 11

1 degree higher than PO

Question 12

thermometer colors

Answer 12

blue=PO

red=rectal rr

Question 13

tympanic temperature

Answer 13

clean cerumen, aim probe at TM,

inaccurate reading if doesn’t hit TM

Question 14

Axillary temp

Answer 14

least reliable

Question 15

Pulse wave

Answer 15

force of ejection PLUS elasticity of arteries

Question 16

vegal stimulation

Answer 16

can decrease HR (breath holding, etc)

Question 17

vol, rate, and rythm

Answer 17

countour of pulse wave (how “big”)

Question 18

best pulse point for contour

Answer 18

carotid pulse

Question 19

if can’t find pulse periferaly

Answer 19

auscultate– w/ stethoscope (often with infants)

Question 20

how long to listen to normal pulse

Answer 20

30 sec X 2

Question 21

in emergency pulse point

Answer 21

carotid

Question 22

normal pulse in adults

Answer 22

50-95 BPM – 95% of people

Question 23

tachypnea

Answer 23

resp rate >27/min predicts cardiopulmonary arrest

Question 24

major factor for innacurate BP

Answer 24

weren’t taught right

Question 25

most frequent BP error

Answer 25

undercuffing big arms--result will be too high

Question 26

BP 2 methodes

Answer 26

direct and indirect

Question 27

Direct BP

Answer 27

intra-arterial catheter

Question 28

Indirect BP

Answer 28

sphygmomanometer

Question 29

inflation of cuff

Answer 29

occludes brachial artery

Question 30

release pressure of cuff

Answer 30

listen for Korotkoff sounds KS

Question 31

phases of Korotkoff sounds

Answer 31

5

Question 32

Korotkoff sound phases

Answer 32

1. appearance of clear tapping--coincides w/ reappearance of palp pulse 2. sounds grow softer and longer 3. sounds again become crisp 4. sounds are muffled, liss distinct, softer 5. sounds disappear completely--when brachial a. is fully unoccluded (diastolic)

Question 33

How high to inflate cuff

Answer 33

1. Inflate cuff until brachial pulse is eradicated (by palpation) 2. deflate cuff and wait 30 seconds 3. reinflate cuff rapidly to 30 mm Hg above eradication point

Question 34

first visit BP

Answer 34

take BP on both arms--in future take on higher side

Question 35

cuff too large

Answer 35

falsely lowers BP

Question 36

cuff too small

Answer 36

Falsely raises BP

Question 37

loose cuff

Answer 37

falsely lowers BP

Question 38

pt has to support own arm during BP

Answer 38

falsely raises BP

Question 39

KS appear then disappear for short segment of time

Answer 39

auscultory gap

Question 40

hypotension

Answer 40

when low systolic BP isn't accompanied by rise in pulse--indicative of autonomic insufficiency.

Question 41

BP normals

Answer 41

140/90 = hypertension

Question 42

measurement of hemoglobin saturated with O2

Answer 42

"pulseox" -- SpO2 -- can diagnose pneumonia

Question 43

Pulseox

Answer 43

finger, toe, earlobe no nailpolish cold extremity/movement make inacurate

Question 44

box at bottom of sphigmomanometer

Answer 44

for calibration--if outside box, needs calibration

Question 45

abnormal SpO2

Answer 45

<90% -- pt will be very sick

Question 46

Normal SpO2

Answer 46

>95% --

Question 47

∆’s in weight

Answer 47

could be intentional (dieting) or unintentional (hormonal, metabolic, bulimia, anorexia)

Question 48

Height important for

Answer 48

young and old -- in inches or metric consistantly--lood for norms

Question 49

for BP where should arm be

Answer 49

at level of heart