Unit 3 Test Flashcards
(130 cards)
1
Q
What does it mean when someone has pain that radiates and diaphoresis?
A
heart attack
2
Q
What does it mean when someone has palpitations with heart conduction problem and fatigue?
A
compromised cardiac output.
3
Q
What does shortness of breath indicate?
A
heart disease, heart failure, pulmonary problems.
4
Q
What does swelling/edema indicate?
A
heart failure
5
Q
What is assessed in a focused cardiac assessment?
A
color of skin and mucous membranes, heart sounds, pulse, 02 sat, cap refill, JVD, edema, and/or chest pain.
6
Q
How do you inspect jugular veins?
A
HOB 30-45 degrees. stand on right, patient turn head to left. observe over sternomastoid muscle and suprasternal notch for pulsations. check both sides. palpate one at a time.
7
Q
What to look for with carotid arteries?
A
rate, rhythm, symmetry, strength of pulse, and elasticity of vessel.
8
Q
Abnormals in carotid pulses
A
bounding, weak, beat to beat variations.
9
Q
What does loss of elasticity indicate?
A
arteriosclerosis.
10
Q
Where do you palpate the apical pulse?
A
4th-5th ICS @ MCL
11
Q
If an apical pulse is hard to find, how should you position the patient?
A
left lateral position.
12
Q
Where do you auscultate the aortic area?
A
2nd ICS @ RSB
13
Q
Where do you auscultate the pulmonic area?
A
2nd ICS @ LSB
14
Q
Where do you auscultate the erb’s point?
A
3rd ICS @ LSB
15
Q
Where do you auscultate the tricuspid area?
A
5th ICS @ LSB
16
Q
Where do you auscultate the mitral area (apical)?
A
5th ICS @ LMCL
17
Q
What is the bell used to auscultate?
A
abnormal, low-pitched sounds.
18
Q
What is the normal heart sound S1?
A
closure of AV valves (mitral & tricuspid). heard best at the apex. “Lub” sound. beginning of systole. Louder than S2.
19
Q
What is the normal heart sound S2?
A
Closure of the aortic and pulmonic valves. heard best at the base. “Dubb” sound. beginning of diastole.
20
Q
What is the abnormal heart sound S3?
A
Gallop. Kentucky. made by a large amount of blood hitting the LV. caused by heart failure.
21
Q
What is the abnormal heart sound S4?
A
Tennessee. Stiffened ventricles. Caused by hypertension.
22
Q
What is a heart murmur?
A
swooshing or blowing sound caused by turbulent blood flow.
23
Q
Characteristics of a heart murmur
A
When- systole or diastole.
where
Intensity - grade 1-6
location
24
Q
What are some contributory conditions to a heart murmur?
A
increased blood flow, structural valve defects, valve malfunction, and abnormal chamber openings.
25
What does it mean if a murmur occurs during systole?
usually benign
26
What does it mean if a murmur occurs during diastole?
always indicates heart disease
27
What is bradycardia?
HR <60 bpm
28
What is tachycardia?
HR >100 bpm
29
What is pulse deficit?
difference between radial & apical pulses
30
What does pulse deficits indicate?
a variety of irregularities.
31
What are risk factors for coronary heart disease?
```
Age - male over 45, females over 55
Race- AA, Mexican American, American Indian, native Hawaiian, Asian American.
Family Hx
High cholesterol & triglycerides.
High BP
Diabetes
Obesity - more than 20 lbs
Smoking
Sedentary lifestyle
Poor Diet
```
32
What can you teach to reduce the risk of heart disease?
quit smoking, exercise regularly. take BP & cholesterol meds if prescribed, control diabetes, stress, and anger. Low fat, Low cholesterol diet.
33
What are geriatric considerations with the heart and vascular system?
increased BP (160/90) w/risk of orthostatic hypotension.
decreased exercise tolerance.
decreased distal LE pulses.
prominent bulging veins.
LE hair loss.
overall the heart loses elasticity and works less effectively as a pump.
34
What are normal pediatric considerations with the heart and vascular system?
sounds = louder, higher-pitched and shorter in duration.
physiologic murmurs may be heard.
sinus arrhythmia normal
apical impulse @ 4th ICS until age 7
35
Normal pulse for 3 mo - 2 yr
80-150 bpm
36
Normal pulse 2-10 yr
70-110 bpm
37
Normal pulse for 10-18 yr
55-90
38
Normal systolic BP for 1-7 yrs
age + 90
39
Normal systolic BP for 7-18 yrs
2x age + 90
40
Normal diastolic BP for 1-6 yrs
53-66
41
Normal diastolic BP for 6-18 yrs
age + 52
42
Grading pulses
0 - absent, even with extreme pressure
1+ weak, diminished. light pressure causes pulse to disappear
2+ normal. easily felt, disappears with moderate pressure
3+ bounding. strong, does not disappear with moderate pressure
43
Types of edema
R/T lymphedema
| R/T chronic venous insufficiency
44
What is edema related to lymphedema?
non pitting edema caused by blocked lymph nodes. no skin ulcer or pigmentation.
45
What is edema related to chronic venous insufficiency?
pitting edema. caused by obstruction or insufficiency of deep veins. ulceration and pigmentation may occur.
46
Grading of pitting edema
1+ slight pitting, 2mm depression
2+ moderate pitting, 4mm depression
3+ deep pitting, 6mm & ext larger
4+ very deep, 8mm, & gross edema
47
What of you assess in a physical assessment of the musculoskeletal system?
gait, symmetry, tremors deformities, range of motion. muscle strength. palpate for tenderness, swelling, crepitus, or nodules.
48
Scale for Muscle Strength
5- active movement against full resistance
4- active movement against some resistance
3- active movement against gravity
2- passive ROM, assisted by examiner
1- slight flicker of contraction
0- no muscular contraction, paralysis
49
Normal spinal curves
cervical- concave
thoracic- convex
lumbar- concave
50
What is kyphosis?
abnormal curvature of spine. rounded thoracic convexity. common in elderly.
51
What is lordosis?
exaggerated curve of lumbar spine. pregnancy and obesity.
52
What is scoliosis?
s-shaped spine. or lateral curvature of spine. uneven shoulders. prominent scapulae. uneven hips.
53
Symptoms of rheumatoid arthritis
swollen hands and fingers. stiff tender finger joints.
54
What is common with hip disease?
inability to abduct hip
55
What is seen with rotator cuff tears?
painful and limited abduction of shoulder with muscle weakness & atrophy
56
What are the two tests for carpal tunnel?
phalen's test and tinel's test.
phalen's test is positive if tingling and numbness within a minute
tinel's test is positive with tingling or shocking sensation.
57
What is osteoarthritis?
hard painless nodules over distal or proximal joints
58
What are heberden's nodes?
nodes over the distal interphalangeals
59
What is brouchard's nodes?
nodes over the proximal interphalangeals
60
What abnormalities are found with rheumatoid arthritis?
boutonniere deformity-flexion of proximal and hyperextension of distal
swan neck deformity- hyperextension of proximal and flexion of distal
61
What is a ganglion?
nontender, round, fluid-filled cyst
62
Where is gout most common?
in metatarsophalangeal joint of great toe
63
What is flat feet (pes planus)?
no arch of foot. may cause pain and swelling of foot surface.
64
What is a callus?
non painful, thickened skin at pressure points
65
What is hallax valgus?
great toe deviates laterally and my overlap the second toe. bunion may form on medial side.
66
What is a corn?
painful thickening of skin over pressure points. circular, central, translucent core resembles a kernel of corn.
67
What is hammer toe?
hyperextension of metatarsophalangeal and flexion at proximal interphalangeal. commonly on second toe.
68
What is a plantar wart (verruca vulgaris)?
painful, often occur under calluses. appears as tiny dark spots.
69
What is a bunion?
enlarged painful, inflamed bursa
70
What are geriatric considerations with the musculoskeletal system?
```
slower movements
reduced flexibility
decreased strength
decreased bone density
reduced elasticity of tendons (joints stiff)
impaired sense of position
kyphosis (thoracic curve)
bow-legged appearance (due to decreased muscle control)
```
71
What are pediatric considerations with the musculoskeletal system?
growth stimulated by weight bearing.
toddler = lordotic posture, bowlegged, wide-based gait.
ages 2-7 = knock-kneed
green stick fractures can occur w/o knowledge.
scoliosis
72
What are true bowed legs caused by?
rickets or other conditions
73
What are the abnormalities with pediatric musculoskeletal systems?
structural or positional deformities. decreased strength or tone. asymmetry. etc.
74
What causes numbness, tingling, and tremors?
damage to brain, spinal cord, and peripheral nerves.
75
What causes seizures?
epilepsy or head injury
76
What causes headaches and dizziness?
inner ear problems, carotid artery disease
77
What causes change in the senses?
cranial nerve problems
78
What causes difficulty speaking, swallowing?
CVA or Parkinson's
79
What causes muscle weakness?
nerve injury or CVA
80
What causes recent memory loss?
dementia
81
What causes remote memory loss?
cerebral cortex
82
What is tingling or burning?
paresthesia
83
What is the purpose of checking one's mental status?
cerebral abnormalities can affect intellectual function, communication ability, emotional behaviors, often done at the beginning of assessment to determine validity of client's responses
84
Level of Conciousness
```
Alert
Lethargic - alert to voice
Obtunded - alert to touch/pain
Stuporous - doesn't fully awake
Coma - no purposeful response
```
85
cranial nerves
1. olfactory
2. optic
3. oculomotor
4. trochlear
5. trigeminal
6. abducens
7. facial
8. acoustic
9. glossopharyngeal
10. vagus
11. accessory
12. hypoglossal
86
Function of Olfactory Nerve (CN I)
carries smell impulse from nasal mucosa to brain
87
Function of Optic Nerve (CN II)
carries visual impulses from eye to brain
88
Function of Oculomotor Nerve (CN III)
contracts eye muscles to control eye movements, constricts pupils, and elevates eye lids
89
Function of Trochlear Nerve (CN IV)
contracts one eye muscle to control inferomedial eye movement
90
Function of Trigeminal Nerve (CN V)
carries sensory impulses of pain, touch, and temperature from the face to the brain. influences clenching and lateral jaw movements.
91
Function of Abducens Nerve (CN VI)
controls lateral eye movements
92
Function of Acoustic/Vestibulochoclear Nerve (CN VIII)
fibers for hearing and balance
93
Function of Facial Nerve (CN VII)
sensory fibers for taste on anterior 2/3 of tongue. stimulates secretions from salivary glands and tears.
94
Function of Facial Nerve (CN VII)
affects facial expressions (smiling, frowning, closing eyes)
95
Function of Glossopharyngeal Nerve (CN IX)
sensory fibers for taste on posterior 1/3 of tongue and sensory fibers of the pharynx that result in gag reflex
Secretory fibers to the parotid salivary glands. promotes swallowing movements
96
Function of Vagus Nerve (CN X)
sensations from throat, larynx, heart, lungs, bronchi, GI tract, viscera, swallowing, talking, and production of gastric juices.
97
Function of Spinal Accessory Nerve (CN XI)
innervates neck mucles (sternocleidomastoid and trapezius) promote movement of shoulders and head rotation
98
Function of Hypoglossal Nerve (CN XII)
innervates tongue muscles
99
What is aphasia/dysphasia?
impaired ability to use language
100
What is dysarthria?
mechanical difficulty speaking. slurred speech.
101
What is dysphagia?
difficulty swallowing
102
What is anisocoria?
unequal pupils
103
What is ptosis?
drooping eyelid
104
What is strabismus?
misalignment of eyes
105
What is nystagmus?
repetitive, uncontrolled movement of eyes
106
What is miosis?
constricted pupils <3mm
107
What is mydriasis?
dilated pupils >5 mm
108
What is myopia?
difficulty seeing at a distance. nearsighted.
109
What is presbyopia (hyperopia)?
difficulty seeing up close. farsighted.
110
What is presbycusis?
hearing loss associated with aging
111
What is proprioception?
sense of the relative position of one's own body
112
What is atrophy?
loss of muscle
113
What is brudzinski's sign?
severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. sign of meningitis
114
What is kernig's sign?
severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. sign of meningitis.
115
What is fasciculation?
rapid twitching of a resting muscle. indicates fatigue or lower motor neuron disease.
116
What is a tic?
twitch of face, head, or shoulder from stress or neurologic disorder.
117
What is a tremor?
rhythmic, oscillating movements often found with Parkinson's disease, multiple sclerosis, or cerebellar disease.
118
What is chorea?
brief, rapid, irregular, jerky movements at rest. associated with Huntington's disease.
119
What is anesthesia?
absence of touch sensation
120
What is hyperalgesia?
increased sensitivity to pain
121
What is stereognosis?
ability to identify familiar objects when placed in the hand, without looking
122
What is graphesthesia?
abilty to identify numbers written in palm of hand, without looking
123
What is babinski's sign?
reflex action of the toes, normal during infancy but abnormal after two years of age. indicative of abnormalities in the motor control pathways. elicited by on the sole of the foot, results in dorsiflexion of the great toe and fanning of the smaller toes.
124
Grading system for reflexes
```
4+ hyperactive
3+ more brisk than usual
2+ normal
1+ decreased
0 no response
```
125
Deep Tendon Reflexes
biceps, triceps, brachioradialis, patellar, Achilles.
126
If DTR are diminished or absent, what are the reinforcement techniques you might try?
upper reflexes- clench teeth
| lower reflexes- interlock hands
127
Superficial Reflexes
Plantar, abdominal, and cremesteric
128
Warning signs of CVA/Stroke
```
numbness- especially one sided
confusion or trouble speaking
vision problems
trouble walking, dizziness, loss of balance
severe headache of unknown cause
```
129
Testicular Cancer
most common cancer in young men ages 15-34.
no early symptoms
high mortality rate
prognosis improved with early detection
130
Testicular Self Exam
do monthly after warm bath, shower.
roll testis between thumb and first two fingers. should be movable, rubbery, egg-shaped, and smooth.
Epididymis should be nontender, smooth, softer.
call MD for firm, painless lump, hard area, overall enlargement.
