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286 Cards in this Set
- Front
- Back
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What are the 6 ethical principles?
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Autonomy, beneficence, nonmalificence, utilitarianism, fairness and justice, and deontologic imperatives
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What does utilitarianism mean?
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Appropriate use of resources with concern for the greater good of the larger community.
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What does fairness and justice imply?
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Balance between patient's autonomy and interests of family/community
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What does Deontologic imperatives mean?
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Offering care is established by tradition and cultural contexts.
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What does establishing a positive patient relationship depend on?
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Communication
Courtesy Comfort Connection Confirmation |
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What are the types of questions?
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Open-ended
Direct Leading |
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What is the structure of the history?
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Identifiers
Chief complaint History of present illness Past medical history Family history Personal and social history Review of symptoms |
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What are the identifiers?
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Name
Date Time Age Gender Race Occupation Referral source |
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What is the chief complaint?
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Direct quote from pt explaining why they are seeking care
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What is the history of present illness?
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The circumstances that surround the primary reason for the pt's visit
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What is the past medical history?
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past medical and sx. history
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What is the family history?
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Family's health, past medical history, illnesses, deaths, genetic, social, environmental influences of family
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What is the personal and social history?
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Work, family, and school relationships
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What is the review of symptoms?
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Detailed review of possible complaints in each of the body's systems
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What is the iatotropic stimulus?
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The reason for seeking health care
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What is the approach to examining sensitive areas?
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Introduction to the issue
Open-ended questions to explore feelings Interpret and repeat patient's words Patients can ask questions |
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What is the CAGE questionnaire?
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Concerned/cut-down
Annoyed (people criticizing) Guilty Eye-opener (hangover relief) |
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What is TACE used for?
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Adults and pregnant women
T = Tolerance, how many does it Take? |
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What is CRAFFT used for?
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Adolescents
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What is the CRAFFT questionnaire?
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Car (by you or someone)
Relax Alone Forget Family/Friend tell you to cut down Trouble |
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What is the HITS questionnaire?
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Hurt
Insult Threaten Scream |
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What percentage of women suffer from domestic abuse?
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94%
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What is FICA?
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Faith
Importance/influence on your life Community - support Address/action in your health care |
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What percentage of people will have a sexual orientation other than heterosexual?
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10%
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What are similar terms to describe chief complaint?
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Presenting problem
Reason for seeking care |
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What are "gender neutral" questions to lead into sexuality screening?
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Tell me about your living situation
Are you sexually active? In what way? |
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What 4 questions give a basis of understanding of the unique experience of each patient?
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Why is it happening now?
How is this pt different from others? Can I assume what is true for this pt is true for others? How does this bear on my ultimate interpretation? |
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What are factors that affect a patients expression of illness?
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Relationship issues
Illness in family Dysfunction in relationships School problems Stress Self-image issues Drug/alcohol Poor understanding Peer presure Secondary gains |
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What are the risk factors for Type II Diabetes?
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Children: obesity and dyslipidemia
Adults: 1 or more second degree relatives with diabetes or CVD |
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Moments of tension
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o Curiosity about you
o Anxiety o Silence o Depression o Crying and compassionate moments o Physical and emotional intimacy o Seduction o Anger o Avoiding the whole story o Financial considerations |
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What are 2 mnemonics for adolescent screening?
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HEADSSS and PACES
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What is HEEADSSS?
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o Home environment
o Education/employment o Eating o Activities o Drugs o Sexuality o Suicide/depression o Safety from injury and violence |
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What is PACES?
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o Parents, peers
o Accidents, alcohol/drugs o Cigarettes o Emotional issues o School/sexuality |
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What state or federal laws control the need for confidentiality in adolescents?
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Pregnancy
Abortion Substance abuse Physical abuse |
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What takes on a dominant role during late adolescence?
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Understanding of consequences and quest for "self"
establishing intimate relationships career planning |
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What takes on a dominant role during middle adolescence?
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experimentation
risky behavior immature decisions arguments with parents |
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How frequent is postpartum depression?
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1 out of 8 women after delivery
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Why is dental care included in the ROM for pregnant women?
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Possible relationship to poor hygiene with preterm births
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When are advanced directives needed?
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When cognitive impairment deprives a patient (of any age) of the ability to join in the decision-making process
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What should compliment advanced directives?
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The appointment of a surrogate who has legally executed durable power of attorney for health care
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What is frailty?
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Loss of physical reserve and increased risk of loss of physical function and independance
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What findings suggest frailty?
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3 or more of:
Muscle weakness, fatigue, decline in activity, slow or unsteady gait, unintentional weight loss OR PT needs help with two or more ALDs |
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What describes mobility disability?
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Difficulty walking, climbing stairs, balance.
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What describes housework disability?
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Heavy, light, meal preparation, shopping, medication use, money management
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What describes upper extremity function disability?
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Grasping, opening jars, reaching overhead
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What describes ADL disability?
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Bathing, dressing toileting, moving, eating, walking in home
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What is palliative care?
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Comprehensive management of phys, emotional, spiritual or Pt's with life limiting conditions
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What are the 4 types of histories?
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Complete
Inventory Problem (focused) Interim |
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When is an inventory history taken?
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Touches on major points without going into detail, used when entire history will be taken in more than one session
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When is problem/focused history taken?
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During an acute or possibly life threatening situation
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When is interim history taken?
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Chronicles events that have occurred since your last meeting
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What are standard precautions?
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Hand hygiene
PPE Respiratory hygiene Safe injections Masks for catheter insert/subarachnoid puncture Contaminated surface containment |
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How can health care professionals minimize vulnerability?
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Follow standard precautions, minimize latex exposure, use good body mechanics
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When should hand hygiene be used?
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After touching blood, body fluid, secretions, excretions, contaminated items, after removing gloves, and between patient contacts
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WHen should gloves be used?
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Touching blood, bodily fluids, secretions, excretions, contaminated items, mucous membranes, and nonintact skin
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When should a gown be used?
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When contact of your body is expected with blood/body fluids, secretions and excretions
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When should a mask or goggles be used?
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Splashed or sprays of blood, body fluid, secretions, suctioning, or endotracheal intubation
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How should needles/sharps be handled?
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Do not recap, bend, break, or hand manipulate.
If recapping is required, use a 1-hand scoop technique. |
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What are 3 types of latex reactions?
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Irritant contact dermatitis
Type IV dermatitis Type I systemic reactions |
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What is irritant contact dermatitis?
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Chemical irritation that does not involve the immune system
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What is type IV dermatitis?
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Delayed hypersensitivity: involves immune system, onset 24-48 hrs
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What are the symptoms of type 1 systemic reactions?
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local utricaria (wheals) - hives!
generalized utricaria with angioedema Asthma Eye-nose itching GI symptoms Anaphylaxis Chronic asthma Permanent lung damage |
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What are the symptoms of type IV dermatitis
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Resembles poison ivy and may lead to oozing skin blisters
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What are the symptoms of irritant contact dermatitis?
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Dry, ichy, irritated hands
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What is type I systemic reactions?
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True allergic reaction caused by IgE, releasing histamine, leukotrienes, prostaglandins and kinins
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What is the dorsal recumbent position used for?
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Examination of genital and rectal areas
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What is the lithotomy position used for?
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Pelvic exam
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Describe the sims position?
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Pt is in lateral recumbent position and torso is rolled towards prone.
Top leg is flexed at hips and knee, bottom of leg is flexed slightly. Examination of rectum or rectal temp. |
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What odor can be detected for inborn errors of metabolism?
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PAH defect: mousy
Tyrosinemia: fishy |
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What odor can be detected for infectious diseases?
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TB: Stale beer
Diptheria: Sweetish |
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What odor can be detected for poison/intoxication?
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Cyanide: bitter almond
Chloroform and salicylates: fruity |
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What odor can be detected for physiologic non-disease states?
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Sweaty feet: cheesy
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What odor can be detected for foreign bodies?
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Lodged organic material: foul smelling discharge
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What part of your hand is used for discriminatory touch?
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Palmar surface of fingers and finger pads (not tips)
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What part of your hand is used to sense vibration?
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Ulnar surface of hands and fingers
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What part of your hand is used to sense temperature?
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Dorsal surface
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What depth yields percussion tones?
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4-6cm deep
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What are the percussion sounds from loudest to quietest?
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Tympany, hyperressonance, ressonance, dullness, and flatness
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How do you perform percussion?
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Place distal phaylnx of middle finger nondominant hand over target area and elevate the other fingers.
Snap wrist to bring down dominant hand's middle finger TIP (plexor) down on target finger. IP joint or inbetween - keep consistent, snap wrist back up to avoid it getting in the way of the sound |
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What is the tone, intensity, pitch, duration and quality of a gastric bubble?
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tympanic, loud, high, moderate, drumlike
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What is the tone, intensity, pitch, duration and quality of emphysematous lungs?
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hyperresonant, very loud, low, long, boomlike
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What is the tone, intensity, pitch, duration and quality of healthy lung tissue?
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Resonant, loud, low, long, hollow
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What is the tone, intensity, pitch, duration and quality of the liver?
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Dull, soft to moderate, moderate to high, moderate, thudlike
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What is the tone, intensity, pitch, duration and quality of muscle?
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Flat, soft, high, short, very dull
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How wide should an adult blood pressure cuff be?
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1/3 - 1/2 circumference of the limb
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What is heart rate?
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Number of cardiac cycles/min
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What should the length of the bladder be on a BP cuff?
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twice the width (80% circumference)
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How wide should a child's BP cuff be?
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2/3 upper arm or thigh (40% circumference)
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What will happen with a cuff that is too wide?
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Underestimate BP
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What will happen with a cuff that is too narrow?
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Overestimate BP
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What level should all BP readings be made?
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Eye level, no more than 3 ft away
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How much of the distance between the acromion and olecranon should the child's cuff cover?
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70% of the distance from tip of elbow to acromion
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What should the length of a child's BP cuff bladder be?
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80-100% of arm circumference
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What should the width of a child's BP cuff bladder be?
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40% of arm circumference
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How long should one wait between BP readings?
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15 seconds
Or elevate arm for 1-2 min |
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What method of measuring temperature is best for children 2months - 16 years?
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Tympanic thermometry
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Why does ear temperature reflect body temperature?
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The tympanic membrane shares its blood supply with the hypothalamus in the brain.
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Why does axillary temperature correlate well with a newborn's core temperature?
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The infant's small body mass and uniform skin blood flow.
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How is sPO2 meaured?
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Arterial oxygen saturation - pulse oximetry
97-99% normal |
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What is pulse oximitry?
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Noninvasive measure of relative amount of light absorbed by oxyhemoglobin and unoxygenated hemoglobin
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What are the 4 types of patient transfer?
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Pivot transfer
Cradle transfer Two-person transfer Equipment |
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What is a symptom that physicians need to be careful of with pt's with spinal cord injuries?
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Autonomic hyperreflexia
Where BP spikes |
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What are the 3 types of stethoscopes?
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Acoustic, magnetic, and electronic
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What is the natural frequency of the diaphragm of an acoustic stethoscope?
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300 Hz
Screens out low-pitched sounds and transmit high-pitched sounds best |
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What is the bell of the acoustic stethoscope used for?
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Transmits low-pitched sounds when very light pressure is used.
Firm pressure - converts to a diaphragm endpiece, just like the other side. |
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What are the components of a magnetic stethoscope?
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Single endpiece that is a diaphragm.
Iron disk on the interior surface, behind that is a permanent magnet. Spring keeps diaphragm bowed out, but compression activates the air column and magnetic attraction between iron disk and magnet. |
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How does a pulse oximiter work?
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One diode sends out invisible infrared, and the other visible red. Oxygenated = more red light passes through to other side.
Dependent on strong pulse! |
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How does a doppler detect blood flow?
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Low power, high frequency sound wave is directed into body - reflections occur at tissue interfaces.
Reflections result in audible sounds with shifted frequencies. |
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What frequency does a doppler measure?
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2-10 MHz
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What is used to determine fetal heart rate?
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A fetoscope or Leff scope
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At what age can a fetoscope or Leff scope detect HR?
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17-19 weeks of gestation
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What does the electronic stethoscope pick up?
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Vibrations transmitted to the surface of the body and converts to electrical impulses
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What characteristics should a stethoscope have?
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Heavy diaphragm and bell
Rigid diaphragm cover Bell is large enough for intercostal Pediatric sized Rubber ring around bell Tubing is thick, stiff and heavy Proper lenght Earpieces Angled binaurals |
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How long is the tubing of a steth?
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30.5-40 cm (12-18 inches)
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How does a stereophonic steth work?
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Single tube, two channel design that can differentiate between right and left auscultatory sounds.
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Sites for pulse oximetry?
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finger, toe, pinna, lobe of ear.
Infant: foot, palm of hand, big toe or thumb. |
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What is the doppler used for?
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Detect systolic BP in patients with weak sounds.
Fetal heart, locate vessels, take weak pulses, vessel patency. Occlusions, DVT, valvular incompetancy. Testicles |
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What age can the doppler method pick up frequencies from the beating fetal heart?
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10-12 weeks gestation
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What is the small aperture of hte opth used for?
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Small pupils
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What is the red-free filter aperture of the opth used for?
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Green beam for exam of optic disc.
Pallor and minute vessel changes. Recognition of retinal hemorrhages with blood appearing black. |
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What is the slit aperture of the opth used for?
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Anterior eye to determine lesion
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What is the grid aperture of the opth used for?
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Size of fundal lesions
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What is the magnification power (diopter) of an opth?
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+ or - 20
+ or - 140 |
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Can an opth compensate for myopia or hyperopia?
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Yes, using + and - lenses.
NO compensation for astigmatism |
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Clockwise rotation of the lens selector on an opth does what?
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Brings + sphere into place
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Counterclockwise rotation of the lens selector on an opth does what?
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Brings the - sphere into place
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How should an opth be seated in the handle?
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Fit adapter of handle into head receptacle and push down while turning the head in a clockwise direction.
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How do you use a strabismoscope?
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Have child focus on accomodative target, cover one eye with scope, watch for movement in both eyes, switch.
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What does the numerator and denominator of visual acuity represent?
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Numerator: distance in feet between patient and chart
Denominator: distance from which a person with normal vision could read the lettering |
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What is an LH (LEA) symbols chart?
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Presents 4 ototypes: circle, square, apple, house
Recorded as smallest symbol/testing distance |
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What is a broken wheel (Landolt) test?
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Child must identify broken wheel on a card.
Each card has a different size card to ID different acuitites. |
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What does a Snellen chart measure
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Far vision, ages 6 and up
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When should the Tumbling E or HOTV tests be used?
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Children aged 3-5 years - has the letter E facing different directions
Usually stand 10 feet away with patch over eye |
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What is the distance of the snellen chart?
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20 feet
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What does a measurement other than 20/20 indicate?
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Refractive error or an optic disorder.
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How do you record a value other than 20/20
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Add the number of letters read correctly on the next line.
20/25 +2 |
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What tests are used for near vision?
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Rosenbaum or Jaeger chart
Series of numbers, E, X, and O in graduated sizes |
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What is used to test macular degeneration?
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Amsler grid - line distortion indicates degeneration
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Which otoscope speculum is used for naris?
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Shortest and widest speculum
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What evaluates the fluctuating capacity of the tympanic membrane?
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The pneumatic attachment that applies puffs of air.
The air causes the membrane to move. |
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What does tymanometry assess?
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The functions of the ossicular chain, Eustachian tube, and tympanic membrane, as well as the interrelation of all the parts.
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What is a nasal speculum used for?
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Used to visualize the lower and midde turbinates of the nose.
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What frequency tuning fork is used for auditory evaluation?
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500-1000 HZ
Estimates hearing loss in the range of normal speech (300-3000) Hold fork at base, activate by stroking or squeezing |
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What frequency tuning fork is used for vibratory sensation?
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100-400 HZ
Activate by tapping, apply base to bony prominence. |
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What are the 3 types of vaginal specula?
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Graves: 3.5-5 in length x .75-1.25 in in width. Bottom blade is 1/4 in longer than top blade.
Penderson: narrower and flatter Pediatric: smaller all around |
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What is a Goniometer used for?
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To determine the degree of joint flexion and extension.
Center goes over joint. |
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What does a Wood's lamp do?
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360 nm - UV "blacklight"
Determines the presence of fungi on skin lesions. Yellow/green = FUNGUS |
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What extras does a neurological hammer have on it?
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A brush at the base of the handle
A needle under the knob of the head |
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What is the motion used with a percussion hammer?
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Hold hammer between thumb and index finger.
Use rapid downward snap of wrist, tap quickly and firmly, snap wrist back so hammer does not linger on tendon. |
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How wide should a tape measurer be?
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7-12 mm wide
Circumference, length, diameter |
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Transillumination is used for?
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Air, fluid, tissue abnormalities.
Cranium of infants. |
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What does a dermatoscope measure?
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Uses epiluminescence microscopy (ELM) with or without oil to allow for a more detailed inspection of the surface of pigmented skin lesions.
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What do Lange and Harpenden calipers measure?
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Thickness of subcutaneous tissue
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What does a monofilament test?
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For loss of protective sensatoin, particularly on plantar surface of foot.
Perpendicular to skin, press and bend. |
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What is the necessary equipment needed to purchase?
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Sethoscope, opthalmoscope, otoscope, BP cuff, manometer, centimeter ruler, tape measure, reflex hammer, both tuning forks, penlight, near vision screening chart
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Which phase of heart contraction produces a pressure wave resulting in an arterial pulse?
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Ventricular systole
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How much time does it take for an impulse from ventricular systole to be felt as the dorsalis pedis pulse?
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.2 secs
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How long does it take for an RBC in the aorta to reach the dorsalis pedis?
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2 seconds
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What are the 3 factors that influence systolic pressure?
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Cardiac output
Blood volume Compliance of the arterial tree |
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How is pulse affected when the aortic valve closes?
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Dicrotic notch - increase in aortic pressure when the valve closes, upstroke in decending pulse
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What factor influences diastolic pressure?
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Peripheral vascular resistence
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Systole - diastole = ?
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Pulse pressure
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What 4 factors contribute to the characteristics of the pulses?
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Volume of blood ejected (stroke volume)
Distensibility of the aorta and large arteries Viscosity of blood Peripheral arteriolar resistance |
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Where are the external jugular veins most visible?
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Above the clavicle, close to the insertion of the SCM muscles.
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The activity of the right side of the heart is transmitted back through the ______ as a pulse?
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Jugular veins
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What do the 3 peaks of the jugular vein pulse represent?
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A - Atrial contraction, pressure on VC's
C - Closing of the tricuspid valve V - Filling of the atria |
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When does the ductus arteriosus close?
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Within 12-24 hours of birth.
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In the infant, what causes blood to flow into the pulmonary arteries rather than across the foramen ovale?
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Drop in pulmonary resistance is lower than systemic – blood flows into pulmonary arteries rather than across the foramen ovale.
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What closes the foramen ovale?
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Foramen ovale is closed by shifting pressures between right and left sides of heart
Pressure on left side becomes higher than the right |
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How is systemic vascular resistance altered in pregnant women?
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Decreases
Causes peripheral vasodilation Palmar erythema Spider telangietasias |
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What changes are seen in the arterial walls of the elderly?
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Calcification and changes in walls of arteries:
Dilation and toruosity of aorta, aortic branches, carotid arteries Also superficial vessles of forehead, neck, extremities Walls lose elasticity and vasomotor tone Increased peripheral resistance and elevated blood pressure |
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What are the risk factors for preeclampsia?
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o Older than 40
o First pregnancy o Preexisting chronic hypertension o Renal disease or diabetes mellitus o Multifetal gestation o Family history of preeclamsia or gestational hypertension o Previous preeclampsia or gestational hypertension o Obesity |
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What are the risk factors for varicose veins?
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o Gender (women more likely than men)
o Pregnancy o Genetic predisposition (Irish or Germen) o Birth control pills o Other variscosities o Sedentary lifestyle o Age |
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A healthy pulse contour should be ______.
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Smooth, rounded, domed
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What is a possible cause of an alternating pulse (pulsus alternans)?
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Left ventricular failure
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What is a possible cause of a pulsus bisiferans?
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aortic stenosis combined with insufficiency
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What are possible causes of a large, bounding pulse?
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Exercise
• Anxiety • Fever • Hyperthyroidism • aortic rigitidy • stenosus |
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What is a possible cause of a bigeminal pulse?
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disorder of rhythm
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What are the possible causes of a paradoxic pulse? (pulsus paradoxus)
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Premature cardiac contraction
• Tracheobronchial obstruction • Bronchial asthma • Emphysema • Pericardial effusion • Constrictive pericarditis |
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What are the possible causes of a Water-hammer (corrigan pulse)?
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Patent ductus arteriosus
• Aortic regurgitation |
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What is normal resting HR?
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60-100 bpm
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What is the pulse rate of tachycardia?
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Over 100 bpm
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What is the pulse rate of bradycardia?
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Under 60 bpm
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A heart rate that is irregular but that occurs in a repeated pattern may indicate?
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Sinus arrhythmia
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Lack of pulse symmetry between right and left may indicate?
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Impaired circulation
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What arteries can be auscultated for bruits?
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Temporal, carotid, subclavian, abdominal aorta, renal iliac and femoral
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What is the venous hum?
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Clinically insignificant sound that can be auscultated at the medial clavicle anterior to SCM, can be confused with other pathologies
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What can cause carotid artery bruits?
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Valvular aortic stenosis
Mitral valve damage Aortic regurgitation Stenosis |
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What is claudication?
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o Dull ache with accompanying muscle fatigue and cramps
o Appears during exercise – walking/stairs o Rest will relieve it o Pain gets worse with continued activity o Pain is distal to stenosis |
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What are the 5 P's of arterial occlusion?
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Pallor
Pain Pulselessness Paresthesia Paralysis |
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Where would pain be present in an obstructed superficial femoral artery?
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Calf muscle
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Where would pain present in an obstructed common femoral or external iliac artery?
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Thigh
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Where would pain present in an obstructed common iliac artery or distal aorta?
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Butt
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What sound is produced during a blood pressure reading?
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Korotkoff sounds
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What indicates the beginning of Korotkoff sounds?
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2 consecutive systolic beats
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What is the term for when Korotkoff sounds appear, disappear, and reappear?
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Auscultory gap
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How much lower do the Korotkoff sounds appear?
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10-15 mm Hg
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Laying supine will do what to a BP reading?
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Lower it
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What can cause the auscultory gap to widen?
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Widens in the instance of systolic hypertension in older people (loss of arterial pliability)
Chronic severe aortic regurgitation |
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What can cause the auscultory gap to narrow?
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Pulsus paradoxis with cardiac tamponade or other cardiac constrictions
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Define phases 1 of K sounds?
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First 2 beats = Systolic BP
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Define phases 2 of K sounds?
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Reappearance of sounds after auscultory gap
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Define phases 3 of K sounds?
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Point at which sounds are first crisp
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Define phases 4 of K sounds?
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Point at which crisp sounds become muffled = 1st Diastole BP
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Define phases 5 of K sounds?
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Disappearence of sound = 2nd Diastole BP
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What is optimal BP?
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Less than 120/80 mm HG
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What is the range of prehypertension?
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120-139/80-89
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What is the range of stage 1 hypertension?
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140-159/90-99
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What is stage 2 hypertension?
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Greater than 160/100
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What is considered an exaggerated paradoxical pulse?
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> 10 mm Hg difference in systolic pressures between inhalation and exhalation
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What can cause exaggerated paradoxical pulse?
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Cardiac tamponade, pericarditis, emphysema
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How is postural hypotension defined?
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Slight drop in systolic - (> 15 mm Hg)
Also drop in diastolic when patient stands up after being supine. |
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What can cause portal hypertension?
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Blood loss, drugs, ANS disease
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What can undermine the accuracy of BP readings?
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• Cardiac dysrhythmias
o Take several readings • Aortic regurgitation o Obscures diastolic pressure • Venous congestion o Lower systolic o Higher diastolic o Repeated inflation of cuff can make it worse o Sluggish blood flow • Valve replacement o Phase 4 compensated • Paradoxical pulse |
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What is the expected value for JVP?
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9 cm H2O
Divide by 1.3 for mm Hg = 6.923 |
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What is the quality and character of a jugular vs. carotid pulse?
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3 undulating waves/ one brisk wave
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What is the effect of venous compression on a jugular vs. carotid pulse?
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• Venous compression eliminates pulse wave
• Venous compression has no effect |
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What is effect of abdominal pressure on a jugular vs. carotid pulse?
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• Abdominal pressure in right upper quadrant for ½ min
o Increased prominence o Jugular vein more visible No effect on carotid |
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What can the hepatojugular reflex measure?
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Reflex is exaggerated with right sided heart failure, so this JVP will be elevated. This reflex is used to measure how bad the heart failure is.
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How do you perform the hepatojugular reflex?
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1. Hand applies firm and sustained pressure to abdomen in the midepigastric region
2. Patient breathes regularly 3. Neck is observed for elevated JVP 4. Hand pressure is released 5. Neck is observed for fall in JVP 6. JVP should equilibrate immediately after removal of pressure No JVP = pressure is much higher or much lower 7. Repeat movement with patient more supine = lower 8. Repeat movement with patient more upright = higher |
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What measurement in the hands is taken that is equivalent to mean JVP?
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Elevation of hand - midaxillary line at nipple to level of collapsed hand veins
Used as an “auxiliary manometer” of right heart pressure. • Only used in absence of thrombosis, arteriovenosus fistula in arm, or SVC syndrome. |
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What are the signs of acute venous obstruction?
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Constant pain with swelling & tenderness
Engorgement of superficial veins Erythmia and Cyanosis |
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What is a Homan sign?
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Patients knee is flexed with one hand
Other hand dorsiflexes foot Positive sign of calf pain – indicates thrombosis Absence does not rule out thrombosis |
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Edema with skin thickening and ulceration indicates?
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Deep vein thrombosis
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Unilateral edema indicates?
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Occlusion of a major vein
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Bilateral pitting edema indicates?
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CHF
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Nonpitting edema indicates?
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Arterial insufficiency or lymphedema.
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What is the effect of respiration of a jugular vs. carotid pulse?
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decreased on inspiration/
increased on expiration Should have no effect on arterial system |
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Describe grade 1 edema?
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1+ slight pitting, no visible distortion, disappears rapidly (2mm deep)
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Describe grade 2 edema?
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2+ deeper pit, no distortion, 10-15 seconds to disappear (4mm deep)
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Describe grade 3 edema?
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3+ Deep pit lasting more than a min, extremity looks swollen (6mm deep)
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Describe grade 4 edema?
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4+ Very deep pit that lasts 2-5 min, gross distortion (8mm deep)
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How can the presence of varicose veins in the leg be tested?
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1. Patient is standing for inspection
2. Stand on toes 10 times in a row • Palpable pressure build up in veins 3. Pressure should disappear in a few seconds 4. Incompetent = sluggish return |
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How can the presence of collateral veins be tested? Competancy?
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1. Distend visible veins by putting limb in dependent position
2. Compress vein with finger or thumb of one hand 3. Strip blood by compressing it with fingers of second hand 4. Compressed vessels should fill before either finger is released = collateral circulation 5. Nearest heart release = vessel should fill backward to first valve only 6. If entire column fills = incompetent valves |
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What should also be tested with blood pressure in the infant?
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Capillary refill should be less than 1 second.
2 seconds issue. 4-6 serious issue |
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What does a bounding infant pulse indicate?
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Patent ductus arteriosus
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What type of specialized sphygomomanometer can be used for infants and children?
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One that includes Doppler or other oscillometric technique
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What is usual newborn BP?
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• 60-96/30-62 mm Hg = expected
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What can capillary refill time greater than 2 seconds in an infant indicate?
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dehydration or hypovolemic shock
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What can newborn hypertension indicate?
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• Thrombosis after umbilical catheter
• Stenosis of renal artery • Coarctation of aorta • Cystic disease of kidney • Neuroblastoma • Wilms tumor • Hydronephrosis • Adrenal hyperplasia • CNS disease |
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Which phase of the Korotkoff sounds is the apropriate for diastole for 3-adolescence?
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Phase 4
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In children, radial artery BP will read ______ less than brachial artery BP?
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10 mm Hg
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50% of the time, hypertension in adolescence is?
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Primary
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Hypertension in children younger than 10 is?
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Secondary: OBESITY
kidney disease, renal artery disease, coarctation of aorta, or pheochromocytoma |
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Hyportension in pregnant women peaks at?
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16-20 weeks gestation
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What does a weak/thin pulse indicate in a child?
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cardiac output diminished, vasoconstriction present
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What does a difference in amplitude of pulse indicate in a child?
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coarctation of aorta
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What does the absence of femoral pulses indicate in a child?
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coarctation of aorta
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Things that undermine JVP readings?
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• Elevation of the JVP – wont see until patient is upright
o Severe right heart failure o Tricuspid insufficiency o Constrictive pericarditis • Cardiac tamponade o No detection of JVP • Severe volume depletion o Obscured JVP pulsations o Severe obesity |
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Expected value with hand raise for JVP?
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Distance should be identical to mean JVP
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Mean JVP with severe right heart failure?
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Severe right heart failure = 20-30 cm H2O
• Not evident with patient upright • Not evident with patient supine • Not evident with volume depletion |
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What is considered elevated BP in a 2nd trimester preggo?
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>125/75
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What is considered elevated BP in a 3rd trimester preggo?
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>130/85
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During preg a rise in ______ above the 1st trimester baseline should be monitored, but a sustained pressure of ____ indicates a BP disorder!
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30/15
140/90 |
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Hypertension in older adults is defined as:
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Over 140/90
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What is the traditional and essential component of critical thinking?
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Evidenced based practice
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What is CFM Saint's philosophy of medicine?
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Many diagnoses can be made
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What defines a problem?
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Uncertain diagnosis
New findings related to a previous diagnosis New findings of unknown etiology Unusual findings revealed Personal or social difficulties |
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How is Occam's razor applied to medicine?
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Plurality (of diagnoses) must not be posited without necessity
Cliche - all findings unified into one diagnosis, favor the simplest one |
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What is Bayes Theorem?
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Diagnosis is based on probablilites
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What are prohibited abbreviations?
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U, IU, QD, QOD or any varient
Trailing zero X.0 Lack of leading zero .25 MS MSO4 MgSO4 |
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What is the difference between pain and tenderness?
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Pain is a symptom
Tenderness is a sign |
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What is objective data?
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What you can see, hear and touch
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What are the 6 components of POMR?
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Comprehensive health history
Physical exam Problem list Assessment and plan Needed lab and imaging tests Progress notes |
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What are "red herrings"?
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bits of information that are distracting and draw your thinking away from central issues
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What does the Assessment include?
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Your interpretations and conclusions, their rationale, the diagnostic strategy, present and anticipated problems, needs of ongoing and future care.
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What does the Plan include?
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Diagnostic
Therapeutics Patient education |
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What is sensitivity?
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Observation to identify correctly those who have a disease
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What is specificity?
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Observation to identify correctly those who do not have the disease
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What is true positive?
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Expected observation found when disease is characterized by the observation present
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What is true negative?
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Observation that is not found when the disease characterized by observation is not present
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What is false positive?
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Observation made that suggests a disease when that disease is not present
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What is false negative?
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Disease is present but observation is there to be made and it is not appreciated
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What is positive predicted value?
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Observation = disease
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What is negative predictive value?
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Observation is not the disease
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What is included in an interval history?
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Subjective: Status of problem, current meds, ROS
Objective: vitals, exam, results since last visit Assessment: diagnosis Plan: 3 components |
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What is a PAM list?
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Previous history/problems
Allergies Medications |
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How many generations should a family history include?
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3
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What obstetric information is taken for women?
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Preterm pregnancies
Term pregnancies Abortions/miscarriages Living children |
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What is included in the general statement of the PE?
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Age, race, gender, general appearance, weight, height, BMI, vitals
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What is Romburg test used for?
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Assess equilibrium = neurological
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When do vital signs coordinate with other symptoms?
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fever elevation of 1 degree C should increase heart rate 10 beats/minute, 12 diseases don’t: malaria, typhoid, legionnaires
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What is the most common time of day to have a heart attack?
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Morning
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Normal pulse pressure
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40 mm
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What is Weber's test?
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test for lateralization Strike the fork and place it on the vertex of the skull.
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What is the Rinne test?
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test to compare air and bone conduction Strike the fork and place it on the mastoid bone behind the ear. When the sound is no longer heard, place it next to the ear with the U facing forward.
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