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177 Cards in this Set
- Front
- Back
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aphasia |
-loss of the ability of speak or write coherenty or to understand speech or writing. -due to a brain attack - can be classified as expressive(difficulty producing language), or receptive(difficulty understanding language) |
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3 types of aphasia conditions |
global aphasia - lesion that damages most of anterior and posterior areas broca's aphasia - lesion is in anterior language area called the motor speech cortex or broca's area wernicke's aphasia - lesion in the posterior language area called auditory cortex, or wernicke's area |
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global aphasia |
- most common -spontaneous speech is absent or reduced to a few stereotyped words or sounds -comprehension is absent or reduced to name and a few select words -repetition, reading, and writing are severely impaired |
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broca'a aphasia |
-expressive aphasia -can understand language but cannot express himself by language -repetition and reading aloud are severely impaired -auditory and comprehension is intact
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wernicke's aphasia |
-receptive aphasia -can hear sounds and words but cannot relate them to previous experiences. -speech is fluent, effortless, and well articulated -speech can be totally incomprehensible -great urge to speak -repetition, reading and writing impaired |
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judgment |
when patient can compare and evaluate the alternatives in a situation and reach an appropriate course of action |
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mental status |
a person's emotional (feeling) and cognitive (knowing) function |
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mood |
more durable, a prolonged display of feelings that color the whole emotional life |
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affect |
a temporary expression of feelings or state of mind |
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orientation |
awareness of the objective world in relation to the self |
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perception |
an awareness of objects through the 5 senses |
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behaviors to consider when assessing mental status |
consciousness language mood and effect orientation attention memory abstract reasoning thought process thought content perceptions |
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consciousness |
being aware of ones own existence, feelings, and thoughts aware of own environment |
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language |
using the voice to communicate one's thoughts and feelings basic tool to humans and its loss has a heavy social impact |
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attention |
power to concentrate, ability to focus on one specific thing without distractions by many environmental stiumuli |
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memory |
ability to lay don and store experiences and perceptions for later recall |
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abstract reasoning |
pondering a deeper meaning beyond the concrete and literal |
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thought process |
the way a person thinks, the logical train of thought |
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thought content |
wheat the person thinks - specific ideas, beliefs, the use of words |
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components of the mental status exam |
A,B,C,T appearance behavior cognitive function thought processes and perceptions |
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appearance |
posture, body movements, dress, grooming and hygiene
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behavior |
level of consciousness, facial expression, speech, and mood and affect
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cognitive function |
orientation, attention span, recent memory, remote memory, new learning(say 4 words wait 5 minutes and have the person repeat to you |
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thought processes and perceptions |
thought processes, content, perceptions, screen for anxiety disorders, depression, suicidal thoughts |
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levels of consciousness |
alert lethargic obtunded stupor or semi coma coma |
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alert |
awake and readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interpersonal interactions |
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lethargic |
not fully alert drifts off to sleep when not stimulated can be aroused to name when called in normal voice but looks drowsy thinking seems slow and fuzzy, inattentive loses train of thought spontaneous movements are decreased |
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obtunded |
sleeps most of time, difficult to arouse needs loud shout or vigorous shake acts confused when aroused speech may be mumbled and incoherent required constant stimulation for cooperation |
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stupor or semi-coma |
spontaneously unconscious responds to only persistent and vigorous shake or pain appropriate motor responses can only groan, mumble, move restlessly, reflec activity persists |
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coma |
completely unconscious, no response to pain or other stimuli light coma has some reflex activity but no purposeful movement deep coma has no motor response |
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types of mood and affect |
flat or inappropriate affect depression depersonalization elation euphoria anxiety, fear, irritability, rage ambivalence liability |
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flat or inappropriate affect |
lack of emotional response of feelings -topic varies, expression does not affect clearly discordant with the content to the person's speech -laughs while discussing admission for a liver biopsy |
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depression |
sad gloomy, dejected, symptoms may occur with rainy weather, after a holiday, or with an illness -Ive got the blues |
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depersonalization |
loss of identity, feels estranged, perplexed about own identity and meaning of existence -i dont feel real, i dont feel like i am really here
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elation |
joy and optimism, over confidence, increased motor activity, not necessarily pathologic -im feeling very happy |
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euphoria |
excessive well being, unusually cheerful or elated -im high, feel like im flying, on top of the world |
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anxiety |
worried, uneasy, apprenhensive from the anticipation of a danger whose source is unknown -i feel nervous or high strung, worry all the time, cannot make up my mind |
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fear |
worried, uneasy, apprehensive, external danger is known and identified -fear of flying in airplanes
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irratibility |
annoyed, easily provoked, impatient -internal feeling of tension |
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rage |
furious loss of control -violent behavior towards self or others |
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ambivalence |
existence of opposing emotions toward an idea, object, person -person feels love and hate toward another person at the same time
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labilty |
rapid shift of emotions -person expresses euphoria, tearful, angry feelings in rapid sucession |
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assessing mental status in infant |
-use a,b,c,t guidelines -abnormalities arise when child does not achieve a milestone you would expect for age -parents health, personal, and developmental history yields most of the mental status data -denver II screening for infants - 6 |
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Denver II screening |
-detects developmental delays in infants - 6 -tests gross motor, language, fine motor adaptive, and personal social skills -slow in development in behavior, language, cognitive, and psychosocial areas |
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assesses mental status in children 7-11 |
-beyond the age when developmental milestones are useful -behavioral checklist is used as a tool that can be given to the parent -covers mood, play, school, friends, and family relations -takes 5 minutes to administer |
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assessing mental status in adolescent |
use a,b,c,t guidelines as in adult |
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assessing mental status in aging adult |
-confusion is common and easily misdiagnosed -check sensory status first -vision and hearing may alter alertness and leave person looking confused -cannot hear questions, may test worse than actually are -older people with psychiatric mental illness test significantly better when wearing hearing aids |
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special considerations when using a,b,c,t guidelines in older adults |
-behavior - glascow coma scale -cognitive functions - orientation and new learning -mini-cog - instrument to screen for cognitive impairment in otherwise healthy adults - 3 item recall list and a clock drawing test |
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adventitous sounds |
added sounds that are not normally heard in the lungs. heard as being superimposed on the breath sounds
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angle of louis |
the articulation of the manubrium and body of the sternum. continuous with the 2nd rib |
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atelectasis |
collapse shrunken section of the alveoli or an entire lung as a result of airway obstruction, compression on the lung, or lack of surfactant |
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bradypnea |
slower than normal breathing less than 10 breaths per minute
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bronchial (tracheal) breath sounds |
harsh, hollow tubular sounds heard over trachea and larynx inspiration less than expiration |
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bronchovesicular sounds |
-mixed sound, -heard over major bronchi where fewer alveoli are located posterior - b/w scapulae especially on right; anterior - around upper sternum in 1st and 2nd intercostal space inspiration = expiration |
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vesicular sounds |
-rustling, like the sound of wind in the trees -heard over peripheral lung fields where air flows through smaller bronchioles and alveoli -inspiration is greater than expiration |
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costal angle |
-right and left costal margins form an angle where they meet at the xiphoid process. -usually 90* angle or less -angle increases when the rib cage is chronically overinflated, as in emphysema |
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crackles(fine) |
-popping sounds heard during inspiration but are not cleared by coughing -inspiratory crackles - inhaled air collides with previously deflated airways, airway pops open creating explosive crackling sounds expiratory crackles - sudden airway closing |
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crackles(coarse) |
-gurgling sounds that start in early inspiration and may be present in expiration, sounds like opening a velcro fastener -inhaled air collides with secretions in the trachea and large bronchi |
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atelectatic crackles |
-sounds like fine crackles but do not last, disappear after the 1st few breaths -heard in axillae and bases of lungs -seen in bed ridden aging adults, persons just aroused from sleep |
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crepitus |
-a coarse crackling sensation palpable over the skin surface -occurs in SC emphysema when air escapes from the lung and enters the SC tissue - after thoracic injury or surgery |
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dyspnea |
shortness of breath, difficulty breathing |
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tactile (vocal) fremitus |
- a palpable vibration -sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall -use palmar base of the fingers or the ulnar edge of 1 hand, touch the persons chest while he repeats "99" or "blue moon" -start over lung apices and palpate each side |
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hemoptysis |
act of coughing up blood |
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hypoxemia |
decrease in oxygen in the blood |
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kyphosis |
-outward curvature of the thoracic spine -head is extended forward and tilted back -humpback |
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lordosis |
-inward curve of the lumbar spine -swayback |
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orthopnea |
difficulty breathing when supine |
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pleurae and the 2 types |
-thin, slippery serous membrane that forms an envelope b/w the lungs and the chest wall -visceral pleura - lines the outside of the lung -parietal pleura - lining the inside of the chest wall and diaphragm |
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pleural friction rub |
-produced when inflammation of the parietal and visceral pleura caused decrease in the normal lubricating fluid -opposing surfaces make a coarse grating sound when rubbed together during breathing -best detected by ausculating may be palpable and feels like 2 pieces of leather grating together |
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scoliosis |
a lateral S curvature of the lumbar and thoracic spine, usually with involved vertebrae rotation
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stridor |
-high pitched, monophonic, inspiratory, crowning sound, louder in the neck than over chest wall -originates in larynx or trachea, caused by upper airway obstruction from swollen or inflammed tissues or lodged foreign body -croup or acute epiglottis in children, foreign inhalation, obstructed airway can be life threatening |
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suprasternal notch |
hollow U shaped depression just above the sternum in b/w the clavicles |
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tachypnea |
rapid, shallow breathing, > 24 breaths per minute |
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mechanics of respiration |
-supplying oxygen to the body for energy production -removing carbon dioxide as a waste product of energy reaction -maintaining homeostasis of arterial blood -maintaining heat exchange |
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hypercapnia |
-normal stimulus to breath for most - increase of carbon dioxide in the blood |
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apical impulse |
the pulsation created as the left ventricle rotates against the chest wall during systole |
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afterload |
-the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. -the resistance against which the ventricle must pump its blood
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arrhythmia |
abnormal heart rhythm |
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arteriosclerosis |
-age related condition where peripheral blood vessels grow more rapid - produces a rise is systolic blood pressure |
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bradycardia |
slow heart rate |
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bruit |
-a blowing, swishing sound indicating blood flow turbulance - abnormal finding |
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cardiac output |
-is the volume of blood in each systole(stroke volume) x the number of beats per minute(rate) CO=SV x R -preload and afterload affect the hearts ability to increase cardiac output -normal heart can pump 4-6L of blood per min |
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heave(lift) |
-a sustained forceful thrusting of the ventricle during systole -occurs with ventricular hypertrophy as a result of increased workload -right ventricular heave is seen at sternal border -left ventricular heave is seen at the apex |
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intercostal space |
space b/w the ribs |
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murmur |
-gentle glowing, swooshing sound that can be heart on the chest wall -caused by velocity of blood increases -viscosity of blood decreases -structured defects in the valves or unusual openings occur in the chambers
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innocent murmur vs. functional murmur |
-indicates having no valvular or other pathologic cause - normal murmur -due to increased blood flow in the heart - abnormal |
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preload |
the venous return that builds during diastole, length to which the ventricular muscle is stretched at the end of the diastole just before contraction |
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pulse deficit |
-signals a weak contraction of the ventricles -occurs with atrial fibrillation -premature beats and heat failure |
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pulse pressure |
the difference b/w the systolic and diastolic pressures and reflects the stroke volume
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sinus arrhythmia |
-rhythm varies with the person's breathing -increases at the peak of inspiration and slowing with expiration |
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tachycardia |
fast heart rate |
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thrill |
-a palpable vibration -feels like the throat of a purring cat -signifies turbulent blood flow and accompanies loud murmurs |
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Heart sounds |
S1 S2 S3 S4 |
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S1 |
-closure of the AV valves contribute to the first heart sound -signals the beginning of systole -hear over all of the precordium but loudest at the apex
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S2 |
-occurs with closure of the semilunar valves, and signals the end of systole -heard over all of precordium, but loudest at the base |
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S3 |
-ventricular filling creates vibrations that can be heard over the chest -ventricles are resistant to filling during the early rapid filling phase -AV valves open and atrial blood first pours into the ventricles |
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S4 |
-end of diastole, at presystole, when the ventricle is resistant to filling -atria contracts and push blood into a noncompliant ventricle -heard as vibration just before S1 |
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heart disease risk factors |
hypertension, elevated cholesterol, heart murmur, congenital heart disease, rheumatic fever, unexplained joint pains as youth, recurrent tonsilitis, anemia, obesity, diabetes, cigarette smoking |
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ausculatory areas |
-aortic - 2nd intercostal space - right side -pulmonic -2nd intercostal space -left - erb's point - 3rd intercostal space -left -tricuspid - 5th intercostal space -mitral - 5th intercostal space - left midclavicular line |
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assess for murmurs |
listen, timing, loudness, pitch, pattern, quality, location, radiation, posture |
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timing of murmur |
-define the murmur by its occurrance in the systole or diastole -systolic murmur - occurs with normal heart or with heart disease diastolic murmur - always indicates heart disease |
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loudness |
-grade i - barely audible, heard only in quiet room and then with difficulty -grade ii - clearly audible, but faint -grade iii - moderately loud, easy to hear -grade iv - loud, associated with a thrill palpable on the chest wall -grade v-very loud, heard with corner of stethoscope lifted off of chest wall grade vi -loudest, heard with entire stethoscope lifted just off the chest wall |
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pitch |
high, medium, or low |
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pattern |
-may follow a pattern during the cardiac phase -crescendo - growing louder and louder -decrescendo - tapering off -crescendo-decrescendo or diamond shaped - increases to a peak and then decreases |
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quality |
musical, blowing, harsh, rumbling |
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location |
-maximum intensity of the murmur - valve area where heard best |
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radiation |
can be transmitted downstream in the direction of blood flow or another place in precordium, neck , back, axilla |
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posture |
may disappear for enhance by change in position |
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hemodynamic changes with aging - increases |
-increase in systolic blood pressure- due to stiffening of large arteries due to calcification of vessel walls -left ventricular wall thickness increases - mechanism to accommodate the vascular stiffening -increase in muscle fatigue |
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hemodynamic changes with aging -no change or decreases |
-no change in diastolic so increase in pulse pressure -no change in resting heart rate or cardiac output -decrease in ability of the heart to augment cardiac output with exercise -decrease in skeletal muscle
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flow of blood through the heart right side |
-oxygen poor blood from vena cava flows into right atrium then right ventricle -pumped through the pulmonary arteries to your lungs -oxygen rich blood is pumped back to the heart in pulmonary veins |
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flow of blood through the heart left side |
-oxygen rich blood from pulmonary veins enters the left atrium, then left ventricle -left ventricle pumps blood to the rest of the body |
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symptoms for heart attacks in women |
-chest pain or discomfort in center or left side of chest, lasts for more than a few minutes or goes away and comes back, can feel like pressure, squeezing, fullness, pain, heartburn, indigestion -upper body discomfort - pain in 1 or both arms, back, shoulders, neck, jaw, upper part of stomach -shortness of breath
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less common symptoms for heart attacks in women |
-breaking out in cold sweat -nausea -light headedness -sudden dizziness -unusually tired for no reason |
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atherosclerosis |
deposition of fatty plaques on the intima (innermost portion) on the arteries |
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capillary refill |
-an index of peripheral perfusion and cardiac output -skew findings will be seen if in a cool room, decreased body temp, cigarette smoking, peripheral edema, anemia |
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cyanosis |
blue mottled color due to decrease in oxygen to the tissues |
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edema |
fluid accumulation |
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homan sign |
pain in the calf when the ankle is slowly and gently dorsiflexed, indicated for dvt |
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ischemia |
deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel |
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lymphedema |
-high protein swelling of the limb -most commonly due to breast cancer treatments |
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modified allen test |
-evaluate the adequacy of collateral circulation before cannulating the radial artery -firmly occlude both ulnar and radial arteries while person making fist several times. hand will blanch -open hand w/out hyperextending, then release pressure on ulnar artery -hand's normal color should return in 2-5 secs
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problem with modified allen test |
subject to error b/c you must occlude arteries uniformly with 11 pounds of pressure for it to be accurrate |
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profile sign |
-detects early signs of clubbing, -normal nail bed angle is 160 degrees |
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venous (stasis) ulcer |
-ulcers that occur at medial malleolus and are characterized by bleeding and uneven edges -occurs after dvt or chronic incompetent valves in deep veins |
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significance for assessing fingernails for clubbing |
occurs with congential cyanotic heart disease and cor pulmonale |
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pulse grading scale |
-0 absent -1+ weak, tready -2+ normal -3+ increased, full, bounding |
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pitting edema scale |
1+ mild pitting, slight indention, no swelling seen 2+ mod pitting, indention subsides rapidly 3+ deep pitting, remains for a short time, looks swollen 4+very deep pitting, last long time, grossly swollen and distorted |
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amnesia |
loss of memory |
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anosmia |
loss of smell |
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aphasia |
inability to communicate, often following a stroke |
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apraxia |
difficult of impossible to make certain motor movements
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ataxia |
lack of muscle coordination which may affect speech, eye movements, ability to swallow, walking, picking up objects and other voluntary movements |
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aura |
a subjective sensation that precedes a seizure -could be auditory, visual, or motor |
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babinski reflex |
-stoke finger up the lateral edge and across the ball of infants foot -note fanning of the toes |
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clonus |
set of rapid, rhythmic contractions of the same muscle |
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dysarthia |
difficulty forming words |
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graphesthesia |
-ability to recognize writing on the skin purely by the sensation of touch -measure of sensory loss if the person cannot make the hand movements for stereognosis as occurs in arthritis |
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nystagmus |
commonly causes the eyes to look involuntarily from side to side in a rapid motion rather than staying fixed on an object or person |
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paralysis |
loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innovation |
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paresis |
partial or complete paralysis |
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paresthesia |
in an abnormal sensation - burning, tingling |
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ptosis |
drooping of upper eyelid |
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romberg test |
-stand up with feet together and arms at the sides -once stable ask person to close eyes -hold position for 20 secs -test for balance |
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stereognosis |
-test person's ability to recognize objects by feeling their form, size, and weight -have person close eyes and place object in hand to identify -get new object for other hand -left hand tests right parietal lobe functioning |
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strabimus |
cross-eyed, squint |
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syncope |
sudden loss of strength, temporary loss of consciousness, due to lack of cerebral blow flow -as in blood pressure |
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vertigo |
rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or in the vestibular nuclei in the brainstem |
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CN I |
-olfactory nerve- sense of smell - sensory -check patency of nostril, then present an aromatic substance
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CNII |
-optic nerve - vision - sensory -test visual acuity and visual fields by confrontation
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CNIII |
-oculomotor - motor- opening eyeylids -parasympathetic - pupil constriction and lens shape -PEERLA |
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CNIV |
-trochlear - down and inward movement of the eye -motor -cardinals position of gaze |
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CNV |
-trigeminal - motor-muscle of masticulation -sensory - sensation of face, scalp, cornea -clench teeth and palpate muscle -light touch on skin on each side |
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CNVI |
-abdunces -lateral movements of eye - cardinals position of gaze |
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CN VII |
-facial -motor - facial movements, close eye and mouth, labial speech, sensory - taste on anterior 2/3 of tongue -parasympathetic - saliva and tear secretion -facial symmetry - smile, frown, close eye tight, lift eyebrows, show teeth, puff cheeks -sense of taste by placing (salty, sweet, or sour) on tongue |
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CNVIII |
-acoustic - hearing and equilibrium - sensory -test hearing acuity by the whisper test |
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CN IX |
-glossopharyngeal - motor -pharynx swallowing, sensory - taste on posterior 1/3 on tongue, parasympathetic - parotid gland and carotid reflex -gag reflex depressing tongue and having pt. yawn or say ahh - uvula and soft palate should rise in midline and tonsillar pillar should move medial |
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CN X |
-vagus - motor - pharynx and larynx, swallowing and talking, sensory - general sensation from carotid body, carotid sinus, pharynx, viscera, -parasympathetic - carotid reflex -same test as CN IX |
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CN XI |
-spinal - movement of trap and sternomastoid muscles -examine muscles of each, look for symmetry |
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CN XII |
-hypoglossal - movement of tongue -forward thrust on tongue -have the person say light, tight, dynamite - test lingual speech |
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deep tendon reflex |
bicep C5-6 tricep C7-8 brachioradalis C5-6 quadricep L2-4 achilles - L5-S2 |
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biceps |
-place hand on bicep muscle and strike thumb with hammer -contraction of bicep muscle and flexion of forearm |
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triceps |
- hold upper arm with lower arm dangling down -strike tricep tendon just above the elbow -extension of elbow |
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brachioradalis |
-hold thumb to suspend forearm in relaxation, strike forearm 2-3 cm above radial styloid process -flexion and supination of forearm |
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quadricep |
-strike tendon below patella -extension of lower leg, and palpate contraction of quad |
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achilles |
-knee flexed and hip externally rotated, hold foot in dorsiflexion and strike achilles tendon -foot plantar flexes against your hand |
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superficial reflexes |
-abdominal - upper - t8-10 lower - t10-12 -plantar reflex L4-S2 |
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abdominal reflex |
-lay supine with knees slightly bent, stroke abdomen from each corner to midline -test upper and lower -ipsilateral contraction of abdominal muscle |
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plantar reflex |
-position thigh with slight external rotation with reflex hammer draw a light stroke up the lateral side of the sole of the foot and inward across the ball of foot making a "J" -plantar flexion of the toes and inversion and flexion of the forefoot
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reflex grading scale |
4+ very brisk, hyperactive with clonus 3+ brisker than average, may indicate disease but probably normal 2+ average, normal 1+diminished, low normal, or occurs only with reinforcement 0 - no response |
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glascow coma scale |
-standarized objective assessment that defines the level of consciousness by giving it a numerical value -assesses the functional state as a whole -fully alert person score 15, 7 or less reflects coma -divided into 3 areas - eye opening (4 points), verbal response (5), motor response (6)
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neurologic re-check |
-used in persons with head trauma or neurologic deficit due to a systemic disease process -monitoring for improvement or deterioration in neurologic status for indication of increased cranial pressure
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abbreviated neuro exam |
-level of consciousness -motor function -pupillary function -vital signs
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level of consciousness |
-note the ease of arousal, state of awareness, or orientation -persons name, place, and time -if not fully alert you increase stimulus in this order - name called, light touch on arm, vigorous shake of shoulder, pain applied
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motor function |
-check voluntary movement of each extremity of conscious pt. -if decreased level on consciousness - note if movement is spontaneous and as result of noxious stimuli such as pain or suctioning
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pupillary response |
-size, shape, and symmetry of pupils -both should constrict briskly with bright light |
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vital signs |
-pulse and blood pressure are notoriously unreliable parameters of CNS deficit -any changes are late consequences of intracranial pressure |
