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Flashcards in Mod 2 Deck (149):
1

What are the three type of nociceptors?

Mechanisensitive nociceptors- A-delta fibers- which are sensitive to mechanical stimulation ( pinching skin) Thermosensitive nociceptors-a-delta fibers sensitive to hot/cold Polymodal nonciceptors- C fibers sensitive to noxious stimuli of mechanical, thermal, or chemical

2

When does transduction of pain begin?

When a mechanical, thermal, chemical stimulus result in tissue injury or damage

3

What nociceptor active the inflammatory response?

A-delta and C fibers

4

Describe a-delta fibers?

Small in diameter, lightly myelinated fibers and transmit fast pain within 1second ( sharp, pricking or electric sensation)

5

Describe C fibers?

Unmyelinated transmit slow pain with in one second( burning throbbing or aching)

6

What parts of the brain are responsible for the perception of pain?

Hypothalamus and limbic system- for emotional response Frontal cortex- for the rational response

7

What are physiological response to pain?

Anxiety, fear, hopelessness, sleeplessness, thoughts of suicide Focuses on pain, reports pain, cries and moans, frowns and facial grimaces Decrease cognitive function, mental confusion, altered temperature, high somatization and dilated pupils Increased heart rate peripheral and systemic and coronary vascular resistance, increased blood pressure Increased respiratory rate and sputum retention, resulting in infection and atelectasis

8

What classification of pain has a rapid onset and short course?

Acute pain

9

What transmits the sensation of pain to the central nervous system?

Peripheral nerve endings (nonciceptors)

10

What classification of pain is know as a constant pain that persists for more than 6 months?

Chronic nonmalignant pain

11

What classification of pain can be acute or chronic?

Cancer pain

12

What are the types of cancer pain?

Aromatic pain, visceral pain, and neuropathic pain

13

What triggers cancer pain?

Blocked blood vessels or pressure on a nerve from a tumor Side effects of surgery, chemotherapy,radiation

14

What are the pain location classification?

Cutaneous pain (skin or subcutaneous tissue) Visceral pain (abdominal cavity, thorax, cranium) Deep somatic pain (ligament, tendons, bones, blood vessels, nerves)

15

What is phantom pain?

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

16

What type of pain originates in peripheral never or the CNS and is caused by shingle, herpes zoster, diabetic neuropath and described as burning tingling, stabbing, electrical pin and needles?

Neuropathic pain

17

Intractable pain is resistant to what?

Pain relief

18

What are the 7 dimensions of pain?

Physical- clients perception of pain and the body's reaction to the stimulus Sensory- quality of the pain/ how severe the pain is perceived Behavioral- verbal and nonverbal response to the pain Sociocultural- influence of cultural background Cognitive- beliefs, attitudes, intentions and motivations related to pain Affective-feeling, sentiments and emotions related to the pain experience Spiritual- meaning and purpose that the person attributes to the pain, self, others and divine

19

What does the mnemonic QUESTT stand for?

Questions the child Use pain rating scales Evaluate behavior and physiologic changes Secure parents involvement Take cause of pain into account Take action and evaluate results

20

What cultural group are against narcotics?

Asian and Asian Americans

21

What cultural group believes that pain response is very expensive?

Hispanics

22

When collecting subjective data of pain what must you do?

Use the exact words that the client uses to describe experienced pain it help diagnosis and management

23

What does the COLDSPA mnemonic stand for?

Character Onset Location Duration Severity Pattern Associated factors

24

What are the three most popular pain assessment tools?

Numeric rating scale Verbal descriptor scale Faces pain scale

25

What pain scales are best for older adults with no cognitive impairment?

Numeric pain scale and faces pain scale

26

What pain scale do you use for neonatal?

N-PASS Neonatal pain agitation & sedation scale

27

What scale do you used to assess pediatric pain?

Face, legs, activity, cry and consolability

28

Explain the numeric pain intensity scale

0 being no pain and 10 being the worst pain possible

29

Explain the simple descriptive pain intensity scale

No pain, mild pain, moderate pain, severe pain, very severe pain, very severe pain, worst possible pain

30

Explain the face, legs, activity, cry, consolability behavioral scale

Five categories face, legs, activity, cry, consolability is scored 0-2 to reach a total score Revised FLACC can be used for children with cognitive disabilities Patient awake observe for 1-2 min Asleep at least 2 min

31

Explain the memorial pain assessment chart

Four parts pain scale, pain describe scale, relief scale, mood scale Draw a line on 1,3,4 Circle 2 Fold on broken line so only one part is presented at a time

32

Explain the mcaffrey initial pain scale

Mark pain on the drawings and answer Questions

33

What are risk diagnosis for pain?

Risk for activity intolerance related to chronic pain Risk for constipation related to nonsteroidal anti- inflammatory agents or opiated intake or poor eating habits Risk for spiritual distress related to anxiety, pain life change, and chronic illness Risk for powerlessness related to chronic pain, health care environment, pain treatment- related regimen

34

What are actual diagnosis for pain?

Acute pain related to injury agent Chronic pain related to chronic inflammatory process of rheumatoid arthritis Ineffective breathing pattern related to abdominal pain and anxiety Disturbed energy field related to chronic pain Impaired physical mobility related to chronic pain Bathing/ hygiene self-care deficit related to severe pain

35

What is the outer layer of the skin?

Epidermis

36

What are the four layers of the epidermis?

Stratum corneum Stratum lucidum Stratum granulosum Stratum germinativum

37

How often is the epidermal layer replaced?

Every 3 to 4 weeks

38

What is the only layer of the epidermis that undergoes cell division and contains melanin?

The innermost layer of the epidermis the stratum germinativum

39

What determines skin color?

Melanin

40

What is the inner layer of the skin?

Dermis

41

What connects the dermis to the epidermis?

Papillae connect

42

What do the dead keratinized cell of the epidermis do?

Water proof the skin

43

What are the two types of sweat glands?

Eccrine glands- all over the body Apocrine glands- hair follicles in the axillae, perineum, and areoles of the breast

44

What produces body odor?

The interaction of sweat and the bacteria of the body

45

What tissue lies beneath the dermis and contains loose connective tissue, fat, blood vessels, nerves and sweat glands?

Subcutaneous tissue

46

What is hair made up of?

Terminal layers of dead keratinized cells

47

Melanoma, basal cell carcinoma and squamous cell carcinoma are what?

The most common types of skin cancer

48

What type of skin cancer is the most serious?

Malignant melanoma

49

What is the most common types of skin cancer in Caucasians?

Basal cell carcinoma

50

What is the most common type of skin cancer in dark skinned people?

Squamous cell carcinoma

51

What does the ABCDE mnemonic stand for?

Asymmetry Border Color Diameter Elevation

52

What kind of light is best for inspecting the skin?

Sunlight

53

What culture has the lowest rate of skin cancer?

Asian

54

What culture has the highest rate of skin cancer?

White/ Australians

55

Who tend to present with a more advanced disease diagnosis of skin cancer?

African American, Asians, and Hispanics

56

What equipment is need for a physical assessment of the skin?

Examination light Penlight Mirror Magnifying glass Centimeters ruler Gloves Woods light Examination gown Braden scale Pressure ulcers scale for healing

57

What are you examining during the physical examination of the skin?

Skin color, temp, moisture, texture, integrity,skin lesions

58

What is pallor?

Loss of color

59

What might cyanosis cause?

White skin to appear blue

60

Jaundice can be recognized by what?

Yellow skin tones and yellow sclera

61

How can you recognize acanthosis nigricans?

By roughening and darkening of skin in localized areas especially posterior of the neck

62

What is the localized problem from vasoconstriction called?

Peripheral cyanosis

63

What is central cyanosis?

Cardiopulmonary problem

64

Skin redness associated with warmth seen in inflammation, allergic reaction or trauma is know as what?

Erythema

65

What tool is use to measure pressure ulcer healing?

PUSH tool

66

What is signs of hypothyroidism?

Rough, flaky, dry skin,

67

On what parts of the body do you palpate turgor?

Pinch the skin over the clavicle or back of the hand

68

To palpate detect edema you do what?

Use thumbs to press down on the skin of the feet or ankles

69

How do you palpate the scalp?

At 1 inch intervals separate the hair to inspect for cleanliness, parasites and lesions

70

What is tinea capitis?

Scalp ringworm

71

What is hirsutism?

Excessive hair Characteristic of Cushing disease

72

What may result from an infection in the scalp?

Patchy hair loss

73

Normal nail should have what degree angle?

160 degrees

74

When assessing the nail you notice clubbing what is this a sign of?

Hypoxia- lack of O2

75

Why do beau's lines occur?

Trauma or acute illness

76

If you find spooning in the nails it might be because of what?

koilonychia Iron deficiency anemia

77

When upswing the push tool what will you measure?

Lenght x widthExudate amount Tissue type

78

When using the push tool for accessing pressure ulcers healing what are the different tissues rated?

4- necrotic tissue- black, brown or tan3- slough- white or yellow 2- granulation tissue- pink or beefy red tissue 1- epithelial tissue- new pink shiny tissue 0- closed/ resurfaced the wound is completely covered with new skin

79

What is central cyanosis?

Cardiopulmonary problem

80

Skin redness associated with warmth seen in inflammation, allergic reaction or trauma is know as what?

Erythema

81

What tool is use to measure pressure ulcer healing?

PUSH tool

82

What is signs of hypothyroidism?

Rough, flaky, dry skin,

83

On what parts of the body do you palpate turgor?

Pinch the skin over the clavicle or back of the hand

84

To palpate detect edema you do what?

Use thumbs to press down on the skin of the feet or ankles

85

How do you palpate the scalp?

At 1 in intervals separate the hair to inspect for cleanliness, parasites and lesions

86

What is tinea capitis?

Scalp ringworm

87

What is hirsutism?

Excessive hair characteristics of Cushing disease

88

What may result from a infection in the scalp?

Patchy hair loss

89

Normal nail should have what degree angle?

160 degrees

90

When assessing the nail you notice clubbing what is this a sign of?

Hypoxia- lack of O2

91

Why do beau's lines occur?

Trauma or acute illness

92

If you find spooning in the nails it might be because of what?

Iron deficiency anemia

93

When using the push tool what will you measure?

Lenght x width Exudate amount Tissue type

94

When using the push tool for accessing pressure ulcers healing what are the different tissues rated?

4- necrotic tissue- black, brown or tan 3- slough- white or yellow 2- granulation tissue- pink or beefy red tissue 1- epithelial tissue- new pink shiny tissue 0- closed/ resurfaced the wound is completely covered with new skin

95

Intact skin with a non-blanchable redness of a localized area is what stage of pressure ulcer?

stage I

96

Partial thickness loss of dermis presenting a shallow open ulcer with a red-pink wound bed is what stage pressure ulcer?

stage II

97

full thickness tissue loss subcutaneous fat may be visible but bone tendon or muscle is not exposed is what stage pressure ulcer?

stage III

98

Full thickness tissue loss with exposed bone tendon or muscle is what stage pressure ulcer?

Stage IV

99

what is an unstagable pressure ulcer?

it is a ulcer that is covered with so much slough/eschar that it cannot be staged until the slough/eschar is removed

100

what are macule and patches?

Small/flat/less than 1 cm/brown-white-tan-purple-red/patch greater than 1cm/irregular border-freckles-flat mole-petechiae-rubella-vitiligo-port wine stains-ecchymosis

101

what are Papule and plaque?

Elevated/palpable/solid mass/border less than 0.5 cm/may have flat top-psoriasis-keratosis

102

what are Pustule?

Pus-filled vesicle/bulla-impetigo-furuncles-carbuncles

103

what are Petechiae?

Round red/purple macule that is 1-2 mm/secondary to blood extravasations associated with bleeding tendencies/emboli to skin

104

what is wheal?

elevated mass with transient boarders often irregular in size and color caused by movement of fluid into the dermis

105

what type of carcinoma has raised edges?

basal cell carcinoma

106

What are the 8 bones that create the cranium house?

Frontal Parietal Temporal Occipital Ethmoid Sphenoid

107

What are the 14 bones that make up the face?

Maxilla (2) Zygomatic (cheeks)(2) Inferior conchae(2) Nasal(2) Lacrimal (2) Palatine (2) Vomer (1) Mandible (1)

108

The sternocleidomastoid and trapezius allow for what?

Movement of the head

109

What cranial nerve is responsible for muscle movement that allows for shrugging of the shoulders?

The 11th cranial nerve

110

What must you remember when palpating the carotid arteries?

Avoid bilaterally compressing it will block circulation to the brain and stimulate the vagus nerve

111

What is the largest of the endocrine glands?

Thyroid gland

112

What landmark do you use when accessing the vertebrae of the neck?

C7

113

What is the most common causes of a traumatic brain injury?

Falling (35.2%) Motor vehicle accident (17.5%) Being struck against solid surfaces(16.5%) Assault (10%)

114

What equipment is needed for an aces ament of the head and neck?

Small glass of water Stethoscope

115

What is an abnormally small head called?

Microcephaly

116

Acorn- shape, enlarged skull bones are seen in what disease?

Paget's disease of the bone

117

Dropping or paralysis of one side of the face as a result of neurological condition is what?

Bell's palsy

118

A "mask- like" face marks what disease?

Parkinson's

119

What do you need to do to assess the temporomandibular joint?

Place your index finger over the front of each ear and ask the client to open their mouth

120

Who are you more likely to find a dowagers hump on while accessing the vertebrae?

Older female clients

121

A stiff neck is often a late symptoms seen in what disease?

Meningitis

122

When do you auscultate the thyroid gland?

Only if you find an enlarged thyroid gland during inspection or palpation

123

What would you hear during auscultation of the thyroid gland if hyperthyroidism is suspected?

Soft blowing, swishing cause by increased blood flow through the thyroid arteries

124

What is the size of a normal lymph node?

Smaller than 1 cm When enlargement exceeds 1 cm it is called lymphadenopathy and may be caused by acute/ chronic infection,an autoimmune disorder or metastatic disease

125

If two groups of lymph nodes are enlarged it's called what?

Regional lymphadenopathy

126

If three groups of lymph nodes are enlarged it's called what?

Generalized lymphadenopathy

127

A headache that is deep constant throbbing, occurs with a cold, acute sinusitis, allergies is what kind?

Sinus

128

Stabbing pain, tearing, eyelid drooping is what type of headache?

Cluster Occurs in the evening

129

Tension headaches have what types of symptoms?

Dull, thought,diffuse Last days months or years

130

Migraines cause what?

Vomiting,sensitivity to light and noise Last up to 3 days

131

Tumor related headaches have what symptoms?

Aching, steady with neurologic and mental symptoms may be accompanied by nausea and vomiting

132

What is CAGE used for?

It is a quick questionnaire used to determine if an alcohol assessment is needed

133

What are factors for mental health and substance abuse?

A history of early aggressive behavior Lack of parental supervision A history of substance abuse Drug availability Proverty

134

What are the 10 most abused substances?

Tobacco Alcohol Marijuana Prescription drugs Methamphetamine MDMA (ecstasy) Crack/ cocaine Heroin Steroids Inhalants

135

What is the difference between decorticate posture and decerebrate posture?

Decorticate is when the person has their arms adducted and flexed inward toward the body And Decerebrate posture is when the person has their arms adducted extended and pronated outward

136

When do you use the Glasgow scale?

For people who are at high risk for rapid deterioration of the nervous system

137

When using the GCS what indicates optimal level of consciousness?

A score of 14 A score of 3 is the lowest possible score ( indicative of a deep coma)

138

If someone scores a 10 on the Glasgow scale what will they need?

Emergency attention

139

What are the scores of the depression questionnaire?

0-5 no risk 6-10 mild risk 11-15 moderate risk 16-20 severe risk 21-27 very severe risk of depression

140

What does SADPERSONNA access?

The likely hood of a suicide attempt Sex Age Depression Previous attempts Ethanol abuse Rational thinking loss Social support lacking Organized plan No spouse Sickness

141

What is the SLUMS test used for?

Quick measure to evaluate congnitive ability for dementia/Alzheimer's 27-30 for clients with a high school education normal 20-27 MCI 1-19 dementia 20-30 with less than high school education 14-19 MCI 1-14 dementia

142

What is the difference between delirium and dementia?

Delirium is reversible Dementia is not

143

Difficulty producing or understanding language caused by motor lesions in the dominant cerebral hemisphere is what?

Aphasia

144

Lethargy is what?

Client opens eyes answers questions and falls back to sleep

145

Obtained is what?

Client opens eyes to loud voices responds slowly with confusion and seems unaware of environment

146

When a client awakens to a vigorous shake or painful stimuli but returns to unresponsive sleep it is called what?

Stupor

147

Cerebellum dysarthria is what?

Irregular, uncoordinated speech caused by multiple sclerosis

148

What is voice volume disorder caused by laryngeal disorders or impairment of cranial nerve X ( vagus nerve)

Dyshonia

149

Dysarthria is what?

Is a defect in muscular control of speech