Basic Patient Care - Pierson And Fairchild Book And Hays Lecture - Exam 1

Front 1

What is the most important activity every caregiver should perform before and after contact with a patient?

Back 1

hand hygiene

Front 2

What are the methods of transmission of pathogens?

Back 2

- direct contact
- moisture droplets
- air currents

- contaminated linen or clothing
- inadequately cleansed eating utensils, instruments, or equipment

Front 3

What is the most common method of transmission of pathogens?

Back 3

direct contact

Front 4

What is the single most effective way to protect the patient and caregiver from pathogens?

Back 4

habitual use of proper hand hygiene

Front 5

What are the two primary methods of hand hygiene?

Back 5

- hand rubbing
- hand washing

Front 6

What is hand rubbing?

Back 6

use of an alcohol-based product to decontaminate hands when hand washing is not required

Front 7

What are the advantages of hand rubs?

Back 7

- require less time to use
- more effective than soap and water
- more accessible than sinks
- reduce bacterial counts on hands significantly
- cause less damage to skin than soap and water when an emollient has been added

Front 8

What ingredients should the hand rub contain?

Back 8

- alcohol (60-95%; isopropyl, ethanol, n-propanol)

- skin conditioner (glycerol)

Front 9

Are hand wipes used for hand rubbing?

Back 9

yes, but they are only as effective as hand washing as a decontaminant (which is less effective than an alcohol-based rub)

Front 10

How is a hand rub applied?

Back 10

- small amount (usually premeasured) appied to the palm
- rub briskly over all surfaces of hands
- rub until hands are dry (usually 20-30 seconds)
- do not rinse with water
- allow hands to air dry, do not dry with a towel

Front 11

What may be necessary after several hand rubs?

Back 11

the hands may become sticky and may need a hand wash

(some facilities have policies in place requiring/recommending a hand wash after a certain number of hand rubs, but the CDC makes no such requirement)

Front 12

What should you ensure you avoid at the end of a hand wash?

Back 12

touching a potentially contaminated surface

Front 13

Is hand washing the most effective method to decontaminate hands?

Back 13

no

but it is the preferred method when hands are visibly dirty/soiled or considered to be contaminated

Front 14

How long should hands be washed?

Back 14

15 to 30 seconds

(often represented as singing, "Happy Birthday" twice during the process)

Front 15

What is needed to perform hand washing?

Back 15

ordinary soap and water

Front 16

How does hand washing work to remove bacteria, etc. from the hands?

Back 16

through the mechanical action of the friction while rubbing and scrubbing

Front 17

What may be added to the cleansing medium for hand washing to make it antiseptic?

Back 17

an antimicrobial or germicidal

Front 18

Why should caution be used with bar soap?

Back 18

it is considered contaminated, especially if it has been used by others

pathogens can survive on it, even if it has been rinsed before being replaced on a rack

Front 19

What may contaminate hands during hand washing?

Back 19

- bar soap
- sink rim/basin
- water splashing up from the sink
- towel dispenser
- faucet handles
- operating lever of soap dispenser

Front 20

What should be done before hand washing (or rubbing)? ***

Back 20

remove jewelry from hands and wrists, especially items with settings or irregular or rough surfaces because they may harbor pathogens and cannot be cleansed effectively

Front 21

What is important to remember about fingernails with respect to pathogens?

Back 21

- artificial fingernails and chipped nail polish can harbor pathogens

- to reduce the number of pathogens under the nails, trim them so they are not visible when the fingertips are held at eye level with the palm facing you

Front 22

What puts the caregiver at greater risk for self-contamination or infection?

Back 22

irritations, lesions, or breaks in the skin of the hands

(so take care of your hands!)

Front 23

What temperature should the hand wash water be?

Back 23

warm

Front 24

Why is warm water used for hand wash?

Back 24

- more comfortable
- promotes more lather to cleanse more effectively
- less irritating to skin

Front 25

What are the criteria for hand hygiene?

Back 25

before and after
- patient contact
- contact with wounds, dressings, specimens, bed linen, and protective clothing
- toileting
- eating

after
- contact with secretions or excretions
- hands are soiled or considered contaminated
- sneezing or coughing
- nose blowing
- removing gloves

Front 26

What surfaces should be scrubbed when hand rubbing or hand washing? ***

Back 26

- scrub palms together
- scrub webbing between and around each finger by interlacing hands
- scrub dorsum of each hand with opposite palm
- scrub fingertips of each hand in the palm of the opposite hand
- scrub dorsal finger creases with opposite palm
- scrub each thumb by clasping with opposite palm
- scrub each wrist by clasping with opposite palm

Front 27

What are a patient's vital signs? ***

Back 27

measurement of a person's:

- body temperature
- heart rate
- respiration rate
- blood pressure
(- pain level - often considered the "fifth vital")

Front 28

Another name for vital signs ***

Back 28

cardinal signs

Front 29

Why do we take vital signs? ***

Back 29

- they are indicators of general health or physiological status

- significant deviations from the norm may indicate an illness or abnormal condition

Front 30

What is the "norm" for vital signs? ***

Back 30

baseline measurements of the vital signs of a patient at rest

Front 31

How are vital signs used? ***

Back 31

measurements are used to:

- establish goals of treatment
- assist with developing a treatment plan
- assess a patient's response
- assess treatment effectiveness

Front 32

What does body temperature represent? ***

Back 32

a balance between the heat that is produced in the body and the heat that is lost

Front 33

What factors affect body temperature? ***

Back 33

- age
- physical activity
- emotional status

- infection
- site of measurement
- environmental temperature

- time of day
- menstrual cycle
- oral cavity temperature

Front 34

How does time of day affect body temperature? ***

Back 34

body temperature is usually lower in the early morning and higher in the afternoon

Front 35

How does age affect body temperature? ***

Back 35

body temperature is slightly higher in the very young, and tends to decrease slightly with age

Front 36

How does environmental temperature affect body temperature? ***

Back 36

body temperature may increase slightly in a hot environment and decrease slightly in a cold environment

Front 37

How does infection affect body temperature? ***

Back 37

body temperature increases with a major or systemic infectious process

Front 38

How does physical activity affect body temperature? ***

Back 38

body temperature usually increases slightly with physical activity but reaches a plateau as the person becomes better conditioned

Front 39

How does emotional status affect body temperature? ***

Back 39

body temperature increases slightly during stressful or emotional periods (e.g., crying or anger)

Front 40

How does site of measurement affect body temperature? ***

Back 40

body temperature values are slightly higher if measured rectally and slightly lower if measured in the axilla when compared with oral values

Front 41

How does menstrual cycle affect body temperature? ***

Back 41

body temperature is slightly higher at the time of ovulation, and a pregnant person's body temperature tends to be slightly higher than usual

Front 42

How does oral cavity temperature affect body temperature? ***

Back 42

body temperature measurement may be inaccurate if measured orally within 14 to 30 minutes of ingestion of warm or cold substances or smoking (false reading, as the body core temperature is probably not affected)

Front 43

What sites are used to assess a person's body temperature? ***

Back 43

- mouth (oral)
- rectum (rectal)
- ear canal (tympanic)
- axilla/armpit (axillary)
- inguinal fold (inguinal)

Front 44

In what instances would the rectal or tympanic method of temperature taking be preferred? ***

Back 44

- infants, toddlers, and older persons who may find it difficult to use an oral thermometer
- unconscious patients, or patients who are otherwise unable to hold the thermometer under their tongue (e.g., when intubated)
- mouth-breathing patients (due to allergies, deviated septum, etc.)
- when greater accuracy is desired (rectal is best in this case)

Front 45

Which is the most accurate method of measuring body temperature? ***

Back 45

rectally

Front 46

What is the accepted normal temperature range? ***

Back 46

ORAL
96.8° to 99.3° F
(36° to 37.3° C)

Front 47

What is the accepted average temperature? ***

Back 47

98.6° F
(37° C)

Front 48

What is the accepted temperature for a fever? ***

Back 48

100° F (and higher)

Front 49

What temperature is considered hyperpyrexic? ***

Back 49

greater than 106° F

(infants and small children, as adults don't normally reach such temperatures)

Front 50

For what patients is it particularly important to establish baseline vitals?

Back 50

- elderly patients (over 65)
- very young patients (under 2)
- debilitated patients
- patients who have performed limited aerobic activities for several weeks or months
- patients with a previous or current history of cardiovascular problems
- patients recovering from recent trauma, major surgery, or those with a condition or disease that affects the cardiopulmonary system (e.g., spinal cord injury, cerebrovascular injury, hypertension, peripheral vascular disease, COPD)

Front 51

What should be done if abnormal vital sign values are found on examination?

Back 51

the cause of the deviation should be determined before initiation of activity that could affect the vital signs

patients with abnormal resting values are frequently less able to tolerate physical activity or stress-producing events

Front 52

What are some possible adverse and potentially dangerous responses to activity?

Back 52

- mental confusion
- fatigue
- exhaustion
- lethargy
- slow reactions of movement or response to commands
- decreased response to verbal and tactile stimuli
- complaints of nausea, syncope or vertigo
- diaphoresis
- change in appearance (pallor, erythema)
- decrease in BP
- pupil constriction or dilation
- loss of consciousness

(many of the above responses may be caused by anoxia)

Front 53

In humans, body temperature remains relatively constant regardless of....

Back 53

environmental temperature
(unless extreme)

Front 54

Why are axillary or inguinal temperature readings the least desirable?

Back 54

air currents may reduce the accuracy of the measurement

Front 55

If temperature is measured rectally, tympanically or axillary/inguinally it should be....

Back 55

so noted on the patient's record

Front 56

The pulse is an indirect measure of.... ***

Back 56

the contraction of the left ventricle of the heart

Front 57

The pulse indicates.... ***

Back 57

the rate at which the heart is beating

Front 58

What is the accepted resting pulse rate for: ***
- an adult?
- a child between 1 and 7 years of age?
- an infant?

Back 58

- 60 to 100 bpm
- 80 to 120 bpm
- 100 to 130 bpm

Front 59

What is important to establishing a baseline heart rate?

Back 59

measuring the pulse at the same site and under the same conditions

Front 60

Do wide variations in pulse rate indicate abnormalities?

Back 60

not necessarily, but unusual or abnormal findings in a specific patient should be evaluated for their potential cause and effect on treatment

Front 61

Why do we measure the pulse rate? ***

Back 61

- to establish a patient's baseline recording

- to assess the heart's reaction to special procedures, physical activity, medications, or to check for disease processes affecting the heart

Front 62

What factors can affect pulse? ***

Back 62

- age
- physical activity
- emotional status

- infection
- cardiopulmonary disease
- environmental temperature
- medications

- gender
- physical conditioning

Front 63

How does age affect pulse rate? ***

Back 63

persons over 65 years of age may exhibit a decreased pulse rate

adolescents and younger usually exhibit an increased rate

Front 64

How does gender affect pulse rate? ***

Back 64

male pulse rates are usually slightly lower than female rates

Front 65

How do environmental factors affect pulse rate? ***

Back 65

the pulse rate tends to increase with high temperature and decrease with low temperature

Front 66

How does infection affect pulse rate? ***

Back 66

the pulse rate tends to increase with a major infectious process

Front 67

How does physical activity affect pulse rate? ***

Back 67

normally, the pulse rate should:
- rise rapidly in response to vigorous physical activity
- plateau or stabilize as the intensity or severity of the exercise plateaus
- decline as the intensity of the exercise declines

Front 68

How quickly should the post-exercise pulse rate revert to the resting pulse rate?

Back 68

within 3-5 minutes after cessation of exercise

Front 69

How is the pulse rate of a person with a conditioned cardiopulmonary system affected by exercise?

Back 69

- (s)he will experience less change in the pulse rate, and
- pulse rate should return to normal in a shorter time

than that of an unconditioned or debilitated person

Front 70

How does emotional status affect pulse rate? ***

Back 70

the pulse rate increases during episodes of high stress, anxiety, or emotion (e.g, fear or anger) and may decrease when the person is asleep or in a state of extreme calm

Front 71

How does medication affect pulse rate? ***

Back 71

some medications may increase or decrease the pulse rate

Front 72

How does cardiopulmonary disease affect the pulse rate?

Back 72

the condition of the heart and the peripheral vascular system and their ability to function affect the pulse rate

(e.g., a patient with hypertension may have a lower pulse rate and a patient with hypotension may have a higher pulse rate to compensate for the effects of the blood pressure)

Front 73

How does physical conditioning affect the pulse rate?

Back 73

persons who perform frequent, sustained, vigorous aerobic exercise will exhibit a lower-than-normal pulse rate

Front 74

What are the most common sites for measuring pulse rate? ***

Back 74

- temporal

- carotid
- brachial
- radial

- femoral
- popliteal

- dorsal pedal
- posterior tibial
- apex of the heart

Front 75

What are the most common sites for measuring pulse? Why? ***

Back 75

- radial
- carotid

because of their ease of access

Front 76

What sites are typically used to measure pulse rate when access to the radial site is restricted? ***

Back 76

- temporal
- carotid

Front 77

What sites are normally preferred by patients measuring their own pulse rates? ***

Back 77

- radial
- carotid

Front 78

When is the apical site typically used to measure the pulse rate? ***

Back 78

- when the peripheral sites are inaccessible
- when the pulse is difficult to palpate

Front 79

What sites are primarily used to test for PVD? ***

Back 79

- femoral (inguinal)
- popliteal
- dorsal pedal
- posterior tibial

Front 80

Why are the femoral, popliteal, dorsal pedal, and posterior tibial sites normally used to measure pulse rate? ***

Back 80

to test for vascular patency (e.g., if there is no dorsal pedal pulse, circulation to the area may be compromised)

Front 81

The pulse is often subjectively described according to its...
***

Back 81

- rate
- rhythm, and
- volume

Front 82

What is a "strong and regular" pulse? ***

Back 82

- good force to each beat
- even beats

Front 83

What is a "weak and regular" pulse? ***

Back 83

- poor force to each beat
- even beats

Front 84

What is an "irregular" pulse? ***

Back 84

strong and weak beats occur during the period of measurement

Front 85

What is a "thready" pulse? ***

Back 85

- weak force to each beat
- irregular beats

Front 86

Tachycardia

Back 86

rapid heart rate
(>100 bpm)

Front 87

Bradycardia

Back 87

slow heart rate
(< 60 bpm)

Front 88

How is target heart rate calculated? ***

Back 88

(220 - age) X 70% to 90%

Front 89

What typically occurs in apical and radial pulse rates in patients with cardiac disease or PAD?

Back 89

they differ (pulse deficit)

if they do, only the apical pulse is used to evaluate the patient

Front 90

A patient with resting tachycardia or bradycardia should be

Back 90

carefully evaluated by an appropriate practitioner to determine the limitations or tolerance to exercise

Front 91

During exercise or other treatment activities, the therapist should monitor the pulse rate for....

Back 91

abnormal responses and be prepared to modify or terminate treatment if severe or persistent

Front 92

What are some abnormal responses of the pulse rate? ***

Back 92

- slowly increases during active exercise
- does not increase during active exercise

- continues to increase or decreases as exercise intensity plateaus

- slowly declines as intensity of exercise or activity declines and terminates
- does not decline as intensity of exercise or activity declines

- declines during exercise before intensity of exercise or activity declines

- increased pulse rate or amount of increase exceeds expected level

- pulse rhythm becomes irregular during or after exercise (e.g., dysrhythmia, arrhythmia, or ectopic beats occur)

Front 93

How may a patient be positioned for measuring the pulse?

Back 93

- recumbent
- seated
- standing

Front 94

Why should you not use your thumb to measure a patient's pulse rate?

Back 94

- you may perceive your own pulse rather than that of the patient

- the thumb pad is less sensitive

Front 95

What are the margins for error in pulse rate if you measure for less than a minute?

Back 95

plus/minus your multiplier

(e.g., measure for 10 seconds and multiply by 6 - margin of error is plus or minus 6 beats; measure for 15 seconds and multiply by 4 - margin of error is plus or minus 4 beats)

Front 96

How is pulse rate recorded?

Back 96

- beats per minute
- variations in rhythm or volume
- identify location (side as well)
- patient position

[e.g., 68 bpm, irregular (every 4th beat absent), L radial pulse, patient sitting]

Front 97

What does blood pressure measure? ***

Back 97

the pressure or force exerted on the walls of the arteries by the blood

(reflects the effects of cardiac output, peripheral vascular resistance, and other hemodynamic factors)

Front 98

What is systolic pressure? ***

Back 98

the BP at the time of contraction of the left ventricle of the heart (top number)

Front 99

What is diastolic pressure? ***

Back 99

the BP at the time of the rest period of the heart (bottom number)

Front 100

What is normal resting BP for an adult? ***

Back 100

- normal: below 120/80 mmHg
- high-normal: 130-139/85-89 mmHg

- elderly (over age 65) 120-140/80-90 mmHg

Front 101

What is the prehypertensive BP range for an adult? ***

Back 101

120-139/80-89 mmHg

Front 102

List the hypertension stages ***

Back 102

Stage 1: 140 to 159/90 to 99 mmHg
Stage 2: 160 to 179/100 to 109 mmHg
Stage 3: 180 to 209/110 to 119 mmHg
Stage 4: > 210 systolic mmHg; > 120 diastolic

Front 103

What factors affect blood pressure? ***

Back 103

- age
- physical activity
- emotional status

- site of measurement
- medications

- size and condition of arteries
- arm position
- muscle contraction
- blood volume
- dehydration
- cardiac output

Front 104

How does age affect BP? ***

Back 104

- younger patients exhibit lower values (systolic and diastolic)

elderly patients (65 and over) may exhibit slightly higher systolic and slightly lower diastolic pressure

Front 105

How does physical activity affect BP? ***

Back 105

- systolic pressure should gradually increase with exercise, plateau as the exercise intensity plateaus, and gradually decline as exercise intensity declines, returning to normal resting value within 3-5 minutes after exercise

- diastolic pressure should remain essentially unchanged, although an increase of 10-15 mmHg is not usually considered abnormal; over 15 mmHg increase is abnormal

Front 106

How does emotional status affect BP? ***

Back 106

BP increases during episodes of high stress, anxiety, or emotion (e.g., anger or fear)

Front 107

How does medication affect BP? ***

Back 107

- some medications may increase or decrease BP

Front 108

How does size and condition of arteries affect BP? ***

Back 108

- arteries with reduced lumina will have higher BP values

- arteries with reduced elasticity will have increased systolic and decreased diastolic values

these two factors tend to account for the changes that occur in the BP values of the elderly

Front 109

How does arm position affect BP? ***

Back 109

- BP may increase if arm is too low
- BP may decrease if arm is too high

Front 110

How does muscle contraction affect BP? ***

Back 110

contraction of the upper extremity musculature may produce an increase in BP due to increased resistance to blood flow

Front 111

How does blood volume affect BP? ***

Back 111

BP decreases with loss of blood and increases with increase in blood volume

Front 112

How does dehydration affect BP? ***

Back 112

a significant decrease of body fluids may cause low blood pressure

Front 113

How does cardiac output affect BP? ***

Back 113

systolic BP increases with increased cardiac output and decreases with decreased cardiac output

(diastolic should remain normal, or within 15 mmHg)

Front 114

How does site of measurement affect BP? ***

Back 114

- BP values are often higher in the left upper extremity than in the right

- if the thigh is used, the systolic pressure is usually higher than in the arm, partly due to the need to use a wider bladder in the cuff, but diastolic should be essentially the same as in the arm

Front 115

What phases of Korotkoff's Sounds are most important to identify?

Back 115

I and V

(although in a patient with a known or suspected cardiovascular condition, it may be important to identify most or all of the phases)

Front 116

What is Phase I of Korotkoff's Sounds?

Back 116

- the first faint, clear tapping sounds are detected and gradually increase in their intensity

- these are the initial indication of systolic pressure in an adult

Front 117

What is Phase II of Korotkoff's Sounds?

Back 117

the sounds have a murmur or swishing quality to them

Front 118

What is Phase III of Korotkoff's Sounds?

Back 118

the sounds become crisp and louder than those previously heard

Front 119

What is Phase IV of Korotkoff's Sounds?

Back 119

- there is a distinct and abrupt muffling of the sounds until a soft, blowing quality is heard

- this phase is the initial indication of the diastolic pressure and is the best indicator of diastolic pressure in adults

Front 120

What is Phase V of Korotkoff's Sounds?

Back 120

- the sounds essentially disappear completely

- also referred to as the "second diastolic pressure phase"

Front 121

What factors contribute to or are associated with hypertension?

Back 121

- obesity
- physical inactivity
- race (esp. African American)
- advanced age

- arteriosclerosis
- diabetes mellitus
- kidney disease

- diet
- excessive use of nicotine, alcohol, or salt
- oral contraceptives

Front 122

To what can untreated hypertension lead?

Back 122

- coronary artery disease
- CVA
- peripheral vascular disease
- congestive heart failure

Front 123

What is hypotension?

Back 123

systolic BP consistently under 100 mm Hg

Front 124

Is hypotension dangerous?

Back 124

not usually, but the person can be at increased risk of dizziness or syncope when abruptly standing from a squatting, sitting, or lying position

Front 125

Why would the femoral artery be used to take BP?

Back 125

in patients with known or suspected lower extremity peripheral vascular disease

Front 126

What occurs if the BP cuff is too wide? Too narrow?

Back 126

- the reading will be erroneously low

- the reading will be erroneously high

Front 127

How wide should the cuff be?

Back 127

40% of the circumference of the midpoint of the limb

for an average adult: 3-6 inches
for a large adult: 6-8 inches

(which makes a circumference of 15 inches the "break point" between a 3-6 inch and a 6-8 inch cuff)

Front 128

If it necessary to repeat a BP measurement, what should you do?

Back 128

- completely deflate the cuff
- wait while patient sits quietly for 1-2 minutes to allow any blood trapped in the veins to be released and circulation to return to normal

Front 129

What should be done to reduce the chance of error in BP recording?

Back 129

- practice listening for the sounds, reading the value, and properly operating the valve to control the pressure release

- do not round the values

- do not bias the findings by expecting a certain value

Front 130

If the patient has exercised, ambulated, or experienced emotional stress, how long should they rest before BP is taken?

Back 130

15-30 minutes

Front 131

What should be recorded with BP?

Back 131

- values
- extremity
- patient position

(e.g., 140/80, LUE, standing)

Front 132

What is MAP?

Back 132

mean arterial pressure

Front 133

How is MAP calculated?

Back 133

(diastolic X 2 + systolic)/3

(80 X 2 + 120)/3 = 280/3 = 93.3

Front 134

How is MAP used?

Back 134

MAP of 60 or greater is needed to maintain body's organs

thus some facilities prohibit physical therapy treatment of patients with MAP under 60

Front 135

What are some abnormal responses exhibited by BP?

Back 135

- systolic rapidly increases during active exercise
- systolic does not increase during active exercise

- systolic continues to increase or decreases as intensity of exercise plateaus

- systolic declines during exercise before the intensity of the exercise declines
- systolic rapidly declines as intensity of exercise or activity declines and terminates
- systolic does not decline as intensity of exercise or activity declines

- systolic declines significantly below its resting level at end of exercise or activity
- systolic pressure rate or amount of systolic pressure increase is excessive during exercise or activity
- diastolic increases by more than 10-15 mmHg during the exercise or activity

Front 136

What is normal resting respirations for an adult? An infant? ***

Back 136

- 12-18 per minute

- 30-50 per minute

Front 137

What are abnormal resting respirations per minute for adults? ***

Back 137

- greater than 20
- less than 10

Front 138

What else is recorded along with respirations per minute? ***

Back 138

- rhythm (regularity)
- depth (amount of air exchanged)
- character (deviations from normal)

(also the amount of effort required and sound produced)

Front 139

What factors affect respiration? ***

Back 139

- age
- physical activity
- emotional status

- air quality
- altitude
- disease

Front 140

How does age affect respiration? ***

Back 140

respiration rates tend to be higher in the
- very young (birth to 3 years)
- elderly (65 and older)

Front 141

How does physical activity affect respiration? ***

Back 141

rate and depth of respiration increase during exercise

Front 142

How does emotional status affect respiration? ***

Back 142

rate and depth of respiration increase during episodes of high stress, anxiety or emotion (e.g., anger or fear)

Front 143

How does air quality affect respiration? ***

Back 143

impurities in the atmosphere may cause the respiration rate to increase or decrease, depending on the effects of various components of the person's pulmonary system

Front 144

How does altitude affect respiration? ***

Back 144

high altitudes cause the respiration rate to increase until a person is acclimated

Front 145

How does disease affect respiration? ***

Back 145

disease that affects components of the pulmonary system usually increases the respiratory rate and may also affect the depth of respiration

Front 146

What are abnormal responses exhibited by respiration rate?

Back 146

- rate slowly increases during exercise or activity
- rate does not increase during exercise or activity

- rate increases as intensity of exercise or activity plateaus
- rate declines during exercise or activity before intensity declines

- rate slowly declines as intensity of exercise or activity declines and terminates
- rate does not decline as the intensity of exercise or activity declines

- increase in rate or amount of increase in rate is excessive during exercise
- rhythm becomes irregular during or after exercise or activity

Front 147

What is the fifth vital sign? ***

Back 147

in many hospital environments, pain is considered the fifth vital sign

Front 148

How is pain commonly documented? ***

Back 148

often by asking the patient for a number 0-10 and documenting as 4/10, 8/10, etc.

best to have patient physically document the level on a VAS (without the numbers)

Front 149

What three types of pain scales were used in lecture? ***

Back 149

- Simple Descriptive Pain Distress Scale

- 0-10 Numerical Pain Distress Scale

- Visual Analog Scale

Front 150

What is the size recommended for the Simple Descriptive Pain Distress Scale, 0-10 Numerical Pain Distress Scale, and the Visual Analog Scale? ***

Back 150

10 cm baseline

Front 151

What type of structure would cause pain that is "cramping," "dull," and/or "aching"? ***

Back 151

muscular pain

Front 152

What type of structure would cause pain that is "sharp," and/or "shooting"? ***

Back 152

nerve root pain

Front 153

What type of structure would cause pain that is "sharp," "bright," and/or "lightninglike"? ***

Back 153

nerve pain

Front 154

What type of structure would cause pain that is "burning," "pressurelike," "stinging," and/or "aching"? ***

Back 154

sympathetic nerve pain

Front 155

What type of structure would cause pain that is "deep," "nagging," and/or "dull"? ***

Back 155

bone pain

Front 156

What type of structure would cause pain that is "sharp," "severe," and/or "intolerable"? ***

Back 156

fracture pain

Front 157

What type of structure would cause pain that is "throbbing," and/or "diffuse"? ***

Back 157

vasculature pain

Front 158

What should be determined and documented in the initial assessment of pain? ***

Back 158

- pain onset
- pain intensity
- exact location of pain

- pattern of pain
- whether the pain radiates or spreads to other parts of the body

- description of the pain (when it is best/worst, is it constant/intermittent, what activities make it better/worse, time of day pain is better/worse, sleep pattern)
- what work or social activity is affected by the pain

- results of pain questionnaire (if available)
- rate 1-10 (least to worst pain experienced)

Front 159

What is pain?

Back 159

an unpleasant sensory AND emotional experience associated with actual or potential tissue damage or described in terms of such damage

Front 160

Normal respiration requires _____ effort for inspiration and _____ effort for expiration.

Back 160

minimal

essentially no

Front 161

How are breathers classified?

Back 161

- thoracic (upper chest expands, abdomen relatively motionless)

- abdominal (abdomen expands, thorax relatively motionless)

Front 162

Should any sound be heard during normal, resting respiration?

Back 162

no

Front 163

What are some abnormal sounds of respiration?

Back 163

- wheezing
- rales
- stridor

Front 164

What are some signs and symptoms of abnormal breathing?

Back 164

- gasping
- panting
- open-mouth breathing
- use of accessory neck muscles

Front 165

Response to pain is highly....

Back 165

personal and subjective

Front 166

What is the most reliable indicator of pain?

Back 166

self- report

it is what the patient says it is, and exists wherever and whenever (s)he says it does

Front 167

Effective pain management should include...

Back 167

a means for addressing the emotional and/or spiritual responses (e.g., suffering and anguish) that accompany pain

Front 168

What is a pain screen?

Back 168

a quantitative rating of the intensity of pain as reported by the patient using a standardized instrument that has demonstrated reliability and validity

Front 169

What is pain management?

Back 169

use of pharmacological and nonpharmacological interventions to control a patient's identified pain

Front 170

Adverse effects of pharmacological treatment

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- respiratory depression
- respiratory distress

- uncontrolled nausea and/or vomiting
- urinary retention
- constipation

- change in mental status
- myoclonus (twitching)

- uncontrolled pruritus (itching)
- sensory/motor changes

Front 171

Nonpharmacological treatments for pain

Back 171

used based on patient preference and degree of relief

- heat or cold
- positioning
- massage
- distraction (e.g., music, reading, relaxation techniques)
- TENS

Front 172

Pain management extends beyond pain relief, encompassing:

Back 172

- quality of life
- ability to work productively
- ability to enjoy recreation

Front 173

Anoxia

Back 173

absence of oxygen in the tissues

Front 174

Apical pulse

Back 174

pulse that is found when a stethoscope is placed on the chest wall over the apex of the heart; may also be found by palpation

Front 175

Apnea

Back 175

absence of breathing

Front 176

Auscultation

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listening for sounds produced within the body using the unaided ear or a stethoscope

Front 177

Arrhythmia

Back 177

variation from the normal rhythm

Front 178

Bradycardia

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slow heartbeat (i.e., less than 60 bpm; may be normal in a well-conditioned person or an abnormal finding)

Front 179

Cardiac output

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the amount of blood that is pumped from the heart during each contraction

Front 180

Diaphoresis

Back 180

profuse perspiration

Front 181

Diastole

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period when the least amount of pressure is exerted on the walls of the arteries during the heartbeat; usually indicates the resting phase of the heart

Front 182

Dyspnea

Back 182

labored or difficult breathing

Front 183

Dysrhythmia

Back 183

disturbance of rhythm

Front 184

Ectopic

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arising or produced abnormally

Front 185

Korotkoff's sounds

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sounds heard during auscultatory determination of blood pressure; believed to be produced by vibratory motion of the arterial wall as the artery suddenly distends when compressed by a pneumatic blood pressure cuff

the origin of the sound may be within the blood passing through the vessel or within the wall itself

Front 186

Pyrexia

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fever

body temperature above the normal level

Front 187

Occlude

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- to fit close together
- to close tight
- to obstruct or close off

Front 188

Orthopnea

Back 188

a condition in which breathing is easier when the person is seated or standing

Front 189

Rale (a.k.a. crackle)

Back 189

an abnormal, discontinuous non-musical sound heard on auscultation of the chest, primarily during inhalation

Front 190

Sphygmomanometer

Back 190

an instrument used to measure blood pressure

Front 191

Stridor

Back 191

a shrill, harsh sound, especially the respiratory sound heard during inspiration in laryngeal obstruction

Front 192

Syncope

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a temporary suspension of consciousness caused by cerebral anemia

fainting

Front 193

Systole

Back 193

the period when the greatest amount of pressure is exerted on the walls of the arteries during heartbeat; usually indicates the contractile phase (left ventricle) of the heartbeat

Front 194

Tachycardia

Back 194

abnormally fast heartbeat (>100 bpm)

Front 195

Another name for vital signs

Back 195

cardinal signs