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56 Cards in this Set

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What do you assess in general assesment in vitals flow
Nutritional status - well nourished, malnourished, obese

Level of consciousness - alert, lethargic, obtunded, stuporous

Distress - respiratory, cardiac pain, anxiety

Development - muscle wasting, extremities

Skin coloration - pallor, cyanosis, jaundice

Hygiene - unkempt, malodor, well groomed

Posture/position of comfort - will change for example in kidney stone
This temperature is one degree above oral
Rectal
This temperature is one degree below oral
Axillary
What do you look for when assesing pulse
Rate - measure for 15 seconds and multiply by 4

Rhythm- regular, regular/irregular or irregular/irregular

Character - how strong pulse is - is it weak and thready or strong and bounding
What do you look for when assesing respirations
Check rate for a full minute

Note rhythm

Note character - is it apnea, shallow or deep
BLOOD PRESSURE

- Before taking BP have patient sit for _ minutes

- What question should you ask before taking BP

- Can you take BP over shirt?

- Why do you need to pick appropriate size of the cuff?

- where do you apply the cuff?

- Describe palpatory BP

- Describe auscultatory BP
5 minutes

Question about nicotine/caffeine in past 30 min

Bare arm

Cuff too large --> BP smaller, cuff to small --> BP larger

2.5 cm proximal to antecubital fossa

Inflate while palpating radial artery, note disappearance, deflate and reinflate to 20 mm Hg above disappearance

Auscultate brachial artery - deflate cuff 2-3 mm per second - note 1st sound to return - SYSTOLIC BP - note muffling point - note disappearance point - diastolic pressure, REPEAT IN OTHER ARM
Normal respiratory rate
14-20
What is an auscultatory gap
Silent interval between true systolic and diastolic pressures
How should you measure blood pressure if you suspect blood volume loss or syncope
Take in supine, seated or standing position - if fall is >20 mm Hg = orthostatic hypotension
ABCD of melanoma
A - asymmetry

B - border irregularity

C - color variation

D - diameter greater than 6 mm
In inspection of hair what do you look for in :

Scalp

Eyebrows

Facial hair

What else do you look for ?
Scalp - patterns of loss

Eyebrows - lateral loss = hypothyroidism (myxedema)

Facial hair - maturity, hirsutism

Infestations
In palpation of the hair what are you looking for
Fine, oily abundant = thyrotoxicosis

Dry, course, thinning with easy fragmentation = myxedema
4 steps of inspection of skin
Appropriate exposure

Generalized scanning - symmetry, exposure, tendency toward lesions

Thickness

Color
2 parts of assessing color of the skin
Generalized uniformity

Localized discoloration
Red (erythema) color of skin can indicate _
Polycythemia

CO poisoning,

Drug reaction

Exanthema
White (pallor) color of skin can indicate_
Albinism

Anemia
Blue (cyanosis) color of skin can indicate_
Hypoxia
Yellow (jaundice) color of skin can idicate
Hyperbillirubinemia

Hemolysis

Liver disease
Brown (hyperpigmentation) of the skin can indicate _
Pituitary, adrenal or liver dysfunction
Red localized discoloration indicates _
Inflammation

Hemangioma
White (amelanotic) local discoloaration can indicate _
Vitiligo

Scar
Blue local discoloration of the skin can indicate _
Venous pooling


Nevi
Brown local discoloration of the skin can indicate _
Nevi

Cafe au lait spots

Melanoma
5 things you looking for in palpation of the skin
Moisture

Temperature

Texture

Turgor and mobility

Lesions
How do you palpate skin for moisture
Dry, moist, diaphoretic, oily, examine skin folds
How do you palpate skin for temperature
Palpation with back of hand comparing symmetrically - check if cool, warm or hot
What do you check for in texture of the skin
Soft, rough, smooth, even
How do you test for turgor and mobility of the skin

Delayed turgor =

Decreased mobility =
Pinch skin of forearm and release - DO NOT pinch dorsum of the hand

Dehydration or edema

Connective tissue disease
How do you define lesions (6 characteristics)
Size

Shape/configuration - round, ovoid, annular, linear, clustered, diffused

Color

Type - macule, papule, patch, plaque, vesical, bulla, ulceration, nodule, cyst

Location

Border
Capillary refill > 2 seconds =
Hypoperfusion
What do you check for in nails (6)
Hygiene = clean, bitten, manicured

Color - pink, cyanosis, yellowing (psoriasis), whitening, green (pseudomonas)

Clubbing = hypoxia, cirrhosis, thyroid disorder

Lesions -pigmentation ( melanoma),splinter hemorrhages (endocarditis)

Nail folds - lesions (warts), inflamation

Capillary refill
Inspection of the head includes: (4)
Symmetry and form - normocephalic, micro or macrocephalic

Hair

Scalp - lesions, rash

Face - symetry and lesions
Why do you palpate head?
For masses and boney deformities
In checking position of the eye by light reflection you are trying to rule out _
Strabismus
By looking at visible sclera above the iris you are trying to rule out _
Exophthalmos
Extraocular movements are testing which CN
III, IV and VI
When you are looking at cornea what are you looking for
Clouding

Lesions

Injections
Why are you shining perpendicular light across the iris
Rule out shallow anterior chamber
What are you looking for in pupils (4)
Size

Shape

Symmetry

Reaction - consensual and direct
What are you looking for in sclera (4)
Injection

Icterus

Lesion

Hemorrhage
What are you looking for in conjunctiva? (4)
Injection

Pallor

Foreign body (inverting upper lid)

Exudate
What do you need to identify in ophthalmoscopic exam? (3)
Cup and Disk - note ratio and papilledema

Identify retinal deformities (detachment, lesions)

Identify vascular abnormalities (diabetic retinopathy, HTN changes)
How do you check auditory function (acuity)
By whispered word with contralateral occluded ear
This test compares air conduction with bone conduction
Rhinne test
How do you do Rhinne test
Strike 512 Hz tuning fork and place handle on mastoid process - ask patient if they can hear that and if so when it stops - when sound stops move in front of ear and ask if patient can hear it again
Positive Rhinne test - air conduction is better than bone conduction - what does this mean
Normal or sensorineural hearing loss with impaired air and bone conduction
Bone conduction beter than air conduction - Negative Rinne test - what does this mean
Conductive hearing loss
Compares bone conduction in each air - which test
Weber test
How do you do Weber test
Strike 512 Hz tuning fork, place handle on the center of patients forehead - ask patien which ear sound is heard or felt best - right, left or equally
In Weber test sound is heard or felt midline - what does this mean
Normal, no conductive hearing loss
Sound is heard toward one side in Weber test = lateralization

To _ side in conductive loss

To _ in sensorineural loss
Affected

Unaffected
What do you need to do prior to inserting an otoscope
Palpate targus and pinna for pain - differentiates otitis externa from otitis media
Position of canal for ear exam in adults
up, out and back
Position of canal for ear exam in kids
Down out and back
Parotid gland opening location
Adjacent to 2nd upper molar
Opening of submandibular gland is called _
Wharton duct