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123 Cards in this Set
- Front
- Back
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Fatigue |
Normal life situations like stress and grief, depression, anxiety, infections (hepatitis, mono, tb), endocrine disorders (hpothyroidism, adrenal insufficiency, diabetes mellitus, panhypopituitarism), heart failure, chronic lung kidney or liver disease, electrolyte imbalance, anemia, malignancies, nutritional deficits, medications. |
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Fatigue |
Sense of weariness or loss of energy |
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Weakness |
Demonstrable loss of muscle power, neuropathy or myopathy |
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Fever |
abnormal rise in body temperature, hot and sweaty = menopause |
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Night sweats |
TB, malignancy |
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Recurrent shakes and chills |
Bacteremia, extreme temp changes |
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Chilliness vs shaking chills |
chilliness is subjective, shaking chill are an objective shivering or chattering of teeth |
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Getting hot or cold? |
When you are getting hot you feel cold, goosebumps, and shiver Getting cold: feeling hot and sweaty |
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Rapid weight changes |
Likely fluid not tissue |
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Weight gain |
Either caloric surplus or edema, caused by heart failure, nephrotic syndrome, liver failure |
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BMI |
18.5-24.9= normal, 25-29.9=overweight, 30-34.9=obese 1, 35-39.9= obese 2, 40+=extreme obesity |
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Weight gain from meds |
Tricyclic antidepressants, insulin, contraceptives, glucocorticoids, propranolol mirtazapine, paroxetine, gabapentin, valproate |
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Weight loss |
Significant if more than 5 percent of body weight in 6 months GI disease, encocrine disorders (diabetes, hyperthyroidism, adrenal insufficiency), chronic infenction, HIV/AIDS, malignancy, chronic lung, kidney, or heart failure, depression, eating disorders |
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If weight gain despite normal or high eating |
diabetes, mellitus, hyperthyroidism, malabsorption, bulimia |
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Malnutrition could occur |
Poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, and drug abuse |
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Signs of malnutrition |
weakness, easy fatigability, cold intolerance, flaky dematitis, ankle swelling |
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Weight loss drugs |
Anticonvulsants, antidepressants, levodopa, digoxin, metformin, thyroid medication |
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Four steps to promote optimal weight and nutrition |
1. measure bmi and waist circumference, identify risk factors 2. assess dietary intake 3. assess motivation 4. counsel about diet/exercise |
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Risk factors for heart disease |
HTN, high LDL, low HDL, high triglycerides, high blood glucose, family history of premature disease, physical inaccivity, smoking, obesity |
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Weight loss relapse |
Decreased leptin, metabolic plateua, increased feelings of hunger |
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Weight loss strategies |
Realistic goals and exercise/behavior reinforcement, exercise every day, caloric goal, portion control/meal planning, pharmacological intervention in extreme cases consume nutrient dense food! |
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Vitamins to watch for |
Females of child bearing years = iron, vitamin c, folic acid Old people, mayb vitamin b12 or d |
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Salt guidelines/risk |
2300 mg a day or one group says 1500, rises chance of cardivascular disease, affects RAAS system |
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General appearance |
Apparent state of health, level of consciousness, signs of distress, skin color and obvious lesions, dressing, grooming, and personal hygiene, facial expression, odors of the body and breath, posture, gait and motor activity, height and weight, bmi, waist circumference |
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Alert |
Normal |
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Lethargy |
drowsy, looks and responds to questions but returns to sleep |
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obtundation |
looks at you but responds slowly and is confused, disinterest in environment |
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stupor |
aroused only with painful stimuli, slow or absent response, relapse into unresponsiveness. low awareness |
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coma |
unarousable |
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Respiratory/cardiac distress |
clutching of the chest, pallor, diaphoresis, labored breathing, wheezing, coughing |
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Pain |
wincing, sweating, protectivess of a painful area, facial grimacing, unusual posture |
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Depression/anxiety |
facial expressions, fidgeting, cold/moist palms, inexpressive or flat affect, poor eye contact, pyschomotor slowing |
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Excessive clothing |
hypothyroidism, hide skin rash/needle marks, mask anorexia, signal lifestyle preferences |
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Shoes |
cut out holes/slippers = gout, bunions, edema, painful foot conditions Run down shoes contribute to foot and back pain, calluses, falls, and infection |
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Jewelry |
Copper bracelet=arthritis |
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Unkept appearnace and dress |
dementia or depression, compare to their normal |
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Facial expressions |
Stare=hyperthyroidism Immobile face=parkinsons flat affect=depression Decreased eye contact=fear, anxiety, sadness |
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Odors of breath/body |
Alcohol, acetones (diabetes), pulmonary infection, uremia, liver failure Don't write off alcoholics cognitive symptons, could be hypoglycemia, subdural hemotoma, postictal state |
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Posture |
sitting upright=left sided heart failure leaning forward=COPD |
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Tremors |
Repetitive movements Resting=happens mostly at rest, not as bad when actively trying to do something, pill rolling=parkinsons postural=when trying to maintain a posture against gravity (holding arms up) fine rapid=hyperthyroidism, also tremors with anxiety and fatuigue, or benign qessential/familial Intention=no tremors at rest, appear when trying to do something. disorders of cerebellar pathway: MS, cerebellar disease |
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Involuntary movements |
Oral-facial dyskinesias, make weird faces, lips, tongue. Old age, psychotropic drugs, long standing pychoses, people with no teeth |
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Other involuntary movements |
Tics=brief, reptitive movements. Tourettes, drugs Athetosis= slower, twisting movements. Usually face or extremities. Cerebral palsy Dystonia=similar to last but involves the whole body. Grotesque postures. Drugs, primary torsion dystonia, spasmodic torticollis chorea=brief, rapid, jerky movements. Rheumatic fever, huntington's disease |
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Spastic hemiparesis |
After stroke, arm is curled against body, leg is weird when walking or pressed against opposite leg |
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Scissor gait |
Cerebral palsy or other spastic disorders, take weird short steps, like walking through water |
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Steppage gait |
Foot drop, peripheral motor unit disease, appear to be walking up stairs or drag foot, slap their feet down, cant walk on heels |
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Parkinsonian gait |
Parkinson, slow shuffling steps, hunched over |
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cerebellar ataxia |
Can't stand steadily with feet together, cerebellar signs, cerebellar diseases cause |
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Sensory ataxia |
Weird throwing legs forward to walk, have to look down to make sure they are walking. Polyneuropathy, posterior column damage. |
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Height disorders |
Short= turners syndrome, childhood renal failure, achondroplastic and hypopituitary dwarfism Tall= marfans, hypogonadonism Loss of height=osteoporesis |
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Fat distribution |
Generalized fat=obesity Truncal fat with thin limbs=cushings, metabolic syndrome |
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Causes of weight loss |
malignancy, diabetes, chronic infenction, hyperthyroidism, depression, diuresis, dieting |
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Waist circumference |
If above 35 in women or 40 in men, raises chances of diabetes, HTN, cardivascular |
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Measured bp is different than true |
Opererator/instrument errors, natural physiologic fluctuations, stress or other situational factors Masked HTN, white coat HTN |
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Types of cuff |
aneroid, electric, hybrid |
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How arm placement effects bp |
higher=lower bp lower=higher bp |
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Repeated bp readings lead to |
venous congestion so artificially low systolic and high diastolic |
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Arm bp difference |
Normally 5 or 10. if higher than 10 could be a sign of aortic dissection or subclavian steal syndrome |
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BP classifications |
normal: less than 120/80 pre HTN: 120-139/90 HTN 1: 140-159/90-99 HTN 2: 160+/100+ Diabetes/renal disease: less than 130/80 Also look for the effects of bp on retinopathy, LVH, neuro deficits due to stroke |
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Orthostatic Hypotension |
Standing after lying down drops systolic by 20 or diastolic by 10 Symptons and tachycardia Causes could be long bedrest, drugs, loss of blood, ANS disease |
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Pulseless pateitns |
Takayasu arteritis, giant cell arteritis, atherosclerosis |
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Irregularly irregular pattern |
A fib, for all irregulars get an EKG |
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Difference in femoral and brachial BP/pulse |
Coarctation of the aorta and occlusive aortic disease |
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Normal HR |
60-90 bpm |
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Causes of fever |
infection, surgery or crush injuries, malignancy, blood disorders such as anemia, drug reactions, and immune disorders such as collagen vascular disease |
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Causes of hypothermia |
Cold, reduced movements (paralysis), interference with vasocontriction due to sepsis or alcohol, starvation, hypothyroidism, hypoglycemia. Older age are at risk. |
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What method of temp is best during rapid respiration? |
Rectal |
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Chronic pain |
Pain not associated with cancer or other disease that persists more than 3-6 months, pain 1 month after a disease, or pain that recurs for months or years |
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What kinds of pain? |
Nociceptive (somatic) - tissue damage, neurons are fine neuropathic - sensory nervous system is damaged, CNS damage from trauma or stroke, PNS disorders that entrap nerves of spinal cord, referred pain Central sensitization - The CNS becomes more sensitive to pain, such as with fibromylagia Pyshchogenic- Affected by mental/cultural factors Idiopathic - unknown cause |
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4 A's of pain management |
Analgesia, activities of daily living, adverse effects, aberrant drug-related behavior. |
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Anorexia |
Refusal to maintain adequate body weight, depressive symptoms, refuse to eat food can can also do other things to maintain a low weight. |
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Bulimia |
Normal weight or even above normal, but afraid of being fat. Binge then stave themselves or then try to purge or exercise. |
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Normal breathing |
14-20/min |
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Bradypnea |
Slow breathing, diabetic coma, drug-induced respiratory depression, increased intercranial pressure |
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Sighs |
Occasional sighs, dizziness or dyspnea=hyperventilation syndrome |
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Tachypnea |
Increased breathing, restrictive lung disaese, pleuritic chest pain, elevated diaphragm |
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Cheynes-Stokes |
Crescendo, decresendo, apnea. HF, uremia, drugs, brain damage |
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Obstructive |
Longer expiration, COPD, asthma |
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Hyperventilation |
Exercise, anxiety, metabolic acidosis (kussmaul) |
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Normal vitals |
Pulse rate: 50-90 Blood pressure: Less than 120/80 BMI: 18.5-24.9 Temperature: 98.6 Respiration: 14-20 |
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Generalized itching without rash |
Dry skin, pregnancy, uremia, jaundice, lymphoma and leukemia, drug reaction, lice, diabetes and thyroid disease |
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Basal cell carcinoma |
Commonly pearly erythematous translucent papules or red macules. |
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Squamous cell carcinoma |
Crusted hyperkeratotic lesions with a rough surface or flat reddish patches with an inflamed or ulcerative appearance |
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HARMM risk factors for melanoma |
History of previous melanoma Age over 50 Regular dermatologist absent Mole changing Male gender |
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Other risk factors |
a ton |
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Pallor |
Anemia and decreased perfusion |
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Central cyanosis causes |
Lung disease, like COPD or pulmonary edema, hemoglobin disease, congenital defects |
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Peripheral cyanosis |
The nails being blue could be central or peripheral. Heart failure cyanosis is peripheral |
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Jaundice |
Look for it particularly in the sclera, result of liver disease or excessive red cell lysis |
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Moisture |
Dryness: hypothyroidism Oily: acne |
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Temperature |
Generalized warmth: fever, hyperthyroidism Generalized coolness: hypothyroidism Localized warmth: inflammation, cellulitis |
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Texture: |
Smooth: Hyperthyroidism Rough: Hypothyroidism |
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Mobility and turgor: |
Mobility decreased in edema and sceroderma, turgor decreased in dehydration |
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Anatomic location |
Acne: face, psoriasis: extensor surfaces, knees and elbows, candida: intertriginous |
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Differente patterns and shapes |
Linear, annular (ring), clustered, arciform, geographic, serpiginous (serpent like), dermatomal Dermotomal vesicles: herpes zoster |
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Hair changes |
Alopecia-hair loss Hyperthyoidism-fine hairs Hypothyroidism- course, sparse hair |
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Pigmentation changes |
Addison's disease/pituitary tumors: widespread change Cafe au lait spot - .5-1.5 cm light pigmented macules, many are a sign of neurofibromatosis Tinea versicolor: Hyper or hypo, fungal, short sleeve shirt distribitution Vitiligo: Depigmented macules, can be widespread Cyanosis: Blue color, detected at nails/lips |
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More pigmentation changes: |
Jaundice: yellowing of sclera due to billyrubin build up either liver disease to excess hemomptisis Carotenemia: Yellowing of palms, not seen in sclera. Diet high in carrots/vegetables Erythema: redness, increased red flow, slapped cheek: fifths disease or erythema infectiosum Heliotrope: violaceous patches over eyelids in dermatmyositis |
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Locations of derm disorders: |
Psoriasis: red scaly plaques, extensors Pityriasis rosea: herald page/christmas tree rash, trunk. Atopic eczema: flexor surfaces Tinea versicolor: shoulders/neck |
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Spider angioma |
Small, red, looks like a spider. Liver disease, Vit. B deficient, pregnancy, normal |
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Spider vein |
bluish, differnet patterns, venous pressure buildup, varicose veins. |
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cherry angioma |
bright red, flat, normal aging sign |
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Petechia |
Blood leaked outside of the vessel, bleeding disorder maybe, vasculitis |
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Ecchymosis |
petechia but bigger, greater than 3mm |
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Paronychia |
strep or staph infection of lateral and proximal nail folds, often secondary to trauma. can enter pulp |
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Clubbing |
Nail base swells, 180 degree or more angle. Secondary to congenital heart disease, lung cancer, interstitial lung disease, malignancies, inflammatory bowel disease. |
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Onycholysis |
Nail seperates from bed, manicurng, psorasis, fungal infection, allergic reaction, diabetes, anemia, drug reaction, hyperthyroidism, ischemia, bronchiectasis, syphilis |
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Terry's Nails |
Ground glass appearance, no lunula, red bands near end of nail. From liver disease, usually cirrhosis, heart failure, and diabetes. |
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Leukonychia |
White spots in response to trauma |
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Mee's lines |
White line paralel to lunula. Chemotherapy, arsenic poisoning, hodgkins lymphoma, carbon monoxide poisioning, leprosy, heart failure |
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Sudden painless unilateral visual loss |
vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, central retinal artery occlusion. |
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Sudden painful unilateral visual loss |
corneal ulcer, uveitis, traumatic hyphema, acute glaucoma, optic neuritis from MS |
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Sudden painful bilateral |
Radiation or chemicals |
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Sudden painless bilateral |
Medications: cholinergic, anticholinergic, steroids |
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Gradual bilateral |
macular degeneration, cataracts |
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Affecting only parts of visual field |
Central loss: nuclear cataract, macular degeneration Peripheral loss: open-angle glaucoma one sided: hemianapsia, quadrantic defect |
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Specks in vision |
Moving: vitreous floaters, if with flash of light: vitreous detachment Fixed: scotoma lesions in the retina or visual pathway |
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Diplopia |
Brainstem/cerrebellar lesion, extraocular muscle weakness, Horizontal: 3 or 6 Vertical: 3 or 4 One eye: issue with cornea/lens |
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Hearing loss |
Conductive: outter or middle ear, noisy environ help Sensorineaural: inner ear, neurons, can't understand speech, noise bothers them |
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Hearing loss meds |
NSAIDS, aminogylcosides, furesemide, quinine, aspirin |
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Hearing loss plus vertigo |
Menieres disease |
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Facial pain and purulent drainage |
Acute bacterial sinusitis |
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Nasal stuffiness drugs |
Contraceptives, reserpine, guanethidine, alcohol, cocaine |
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One sided stuffiness |
Deviated setpum, forign body, granuloma (wegeners), polp/ulcer,carcinoma |
