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51 Cards in this Set

  • Front
  • Back
fremitus
(vibration)
Crepitus (subcutaneous emphysema)
(air trapped in and under the skin,)
is felt as a crackling sensation beneath the fingertips.
Tactile (vocal) fremitus
is a vibration of the chest wall produced when the patient speaks. This problem can occur when the pleural space is filled with air (pneumothorax) or fluid (pleural effusion) or when the bronchus is obstructed
Adventitious sounds
are additional breath sounds superimposed on normal sounds, and they indicate pathologic changes in the lung.
Autonomic nervous system (ANS)
is composed of two parts: the sympathetic nervous system (SNS), or the “fight or flight system”; and the parasympathetic nervous system.
Motor changes
in late adulthood can cause slower movement and response time and decreased sensation (Chart 43-1). Any problems that affect the nerves, bones, muscles, or joints also affect motor and therefore ADL ability.
Sensory changes
in older adults can also affect their daily activities. Pupils decrease in size, which restricts the amount of light entering the eye, and adapt more slowly. Touch sensation decreases, Vibration sense may be lost in the ankles and feet. Hearing also decreases, especially for high-pitched sounds.
Cognitive functions
______ of perceiving, registering, storing, and using information often change as a normal part of aging. Therefore it is important to differentiate between these expected findings and those of dementia, depression, and delirium (3Ds).
alert
The patient who is described as ? is awake and responsive.
comatose
A patient may be alert but not oriented to person, place, or time. Patients who are less than alert are labeled lethargic, stuporous, or_______; unconscious and cannot be aroused.
lethargic
A patient is drowsy or sleepy but is easily awakened.
stuporous
One who is arousable only with vigorous or painful stimulation is.
Remote, or long-term,
memory can be tested by asking patients about their birth date, schools attended, the city of birth, or anything from the past that can be verified
Recall (recent)
memory can be tested during the history and checked on the medical record: Ex:The accuracy of the medical history, Dates of clinic or physician appointments, The time of admission, Health care providers seen within the past few days,
Immediate (new)
memory is tested by giving the patient two or three unrelated words, such as “apple,” “street,” and “chair,” and asking him or her to repeat the words to make sure they were heard. After about 5 minutes, while continuing with the examination, ask the patient to repeat the words.
Touch discrimination
-Part of the neurologic examination. The patient closes his or her eyes while the practitioner touches the patient with a finger and asks that the patient point to the area touched.
Proprioception
(position sense) below the level of the damage on the same side or on both sides
Proprioceptive
(awareness of body position)
Pronator drift
- Occurs in a patient with muscle weakness due to cerebral or brainstem reasons. The arm on the weak side tends to fall, or “drift,” with the palm pronating (turning inward) after the patient has closed his or her eyes and held the arms perpendicular to the body with the palms up for 15 to 30 seconds; part of the neurologic assessment.
Romberg sign
- Swaying or falling when the patient is standing with arms at the sides, feet and knees close together, and eyes closed; a test of equilibrium in neurologic assessment.
deep tendon reflexes
The ? of the biceps, triceps, brachioradialis, and quadriceps muscles and of the Achilles tendon can be tested as part of the routine neurologic assessment. Striking the tendon with the reflex hammer should cause contraction of the muscle
Glasgow Coma Scale (GCS)
is used in most health care agencies to help describe the patient's level of consciousness (LOC).
Decortication
is abnormal posturing seen in the patient with lesions that interrupt the corticospinal pathwaysThe patient's arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.
Decerebration
is abnormal posturing and rigidity characterized by extension of the arms and legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which body is bowed forward)
• Bronchial
Over large airways like trachea and manubrium
o High pitch, loud, hollow pipe sounds
o Short pause between Inspiration & Expiration
o I < E
• 2:3
• Expiratory sounds last longer than inspiratory sounds
Bronchovesicular

o 2nd/3rd ICS
o Between Scapula
o Softer than bronchial sounds, tubular quality
o Mainstream bronchi
o I = E
• 1:1
Vesicular

o Periphery of Lungs
o Soft, Low pitch
o I > E
• 3:1
Fine Crackles
o High pitch sounds of short duration
o Inspiratory
o Early Inspiration = obstructive disease
(ex: COPD, bronchitis, asthma)
o Late Inspiration= restrictive disease
(ex: pneumonia, heart failure)
o Strand of hair rolled between fingers behind ear
Coarse Crackles
o Low pitch sound of long duration
o Bubbling, gurgling
(blowing through a straw under water)
o Start with Inspiration may progress to Expiration
o May clear with cough/suction
o Pulmonary edema, decreased cough reflex with terminally ill
o Decreased surfactant
Pleural Friction Rub
o Pleural Inflammation
o Pleural surfaces rub together during respiration
o Inspiration and Expiration
o Low pitch, grating quality
o Painful
o Pleurisy, pneumonia, pleural effusion
Rhonchi
o Rumbling, Snoring, Rattling sound
o Large airway obstructed with secretions
o Primarily with exspiration
o Changes with cough, suctioning
o COPD, cystic fibrosis-children
Wheezes
o High pitch
o Vibrations of bronchial walls
o Starts with expiration, may progress to inspiration obstruction increases
o Bronchospasm (asthma induced), COPD
o Sometimes audible without stethoscope
Stridor
o Crowing sound, constant pitch, loud
o Partial obstruction of larynx or trachea (upper airway obstruction)
o Lodged foreign body, croup, epiglottitis, vocal cord edema after extubation
Olfactory
I Sense of smell
Optic
II Visual activity and visual fields
Oculomotor
III.: eye movement, pupil action,
Trochlear
IV eye movement
Trigeminal
V controls muscles of mastication(chew), sensation from skin of face & scalp, corneal reflex
Abducens
VI eye movement
Facial
VII Controls facial movements, taste in anterior 2/3 of toungue, pain & temp from ear area
Acoustic (Vestibulocochlear)
VII hearing & balance
Glossopharyngeal
IX
tested together, gag reflex, articulation, phonation taste in 1/3 of toungue
Vagus
X
pain and temp from ear, ambonal viscera,
Spinal Accessory:
XI.
control neck (sternocleidomastoid muscle) and shoulder (trapezius muscles)
Hypoglossal
XII.: toungue movement
Radial Nerve:
Motor: Dorsiflex wrist
Sensory: touch web space between thumb and index finger
• Median Nerve:
• Motor: oppose thumb and small finger (touch together)
• Sensory: touch the fat pad of index finger
• Ulnar Nerve:
• Motor: abduct fingers
• Sensory: touch distal fat pad of the small finger
Femoral Nerve:

• Motor: straight leg raise
• Sensory: stroke anterior thigh (eyes close)
Peroneal Nerve:

• Motor: dorsiflex foot ( point toes up )
• Sensory: touch web space between large & 2nd toe
• Tibial Nerve:
• Motor: Plantar flex foot point toes down)
• Sensory: touch sole of foot