Health Assessment & Basic Nursing Concepts

Vocabulary flashcards covering skin assessment, wound staging, respiratory and neurologic evaluation, and basic math review from lecture notes.

Normal Skin Findings

Benign variations such as alopecia (baldness), freckles (ephelides), skin tags, and benign moles that require no treatment.

ABCDE Rule

Skin‐cancer screening mnemonic: Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolution/Enlargement.

Jaundice

Yellow discoloration of skin and sclera from elevated bilirubin; best seen in sclera and hard palate.

Cyanosis in Dark Skin

Look for grayish or whitish mucous membranes, conjunctiva, or nail beds rather than skin surface color change.

Petechiae

Pinpoint (1–3 mm) non-blanching red-purple dots caused by capillary hemorrhage.

Cherry Hemangioma

Small, bright-red papule of dilated dermal capillaries; benign, common after age 30.

UV Protection Measures

Broad-spectrum SPF ≥ 30 sunscreen, reapply q2h, wide-brim hat, UV-blocking clothes, sunglasses, seek shade 10 AM–4 PM.

Pressure Injury Stage I

Intact skin with non-blanchable erythema over a bony prominence.

Pressure Injury Stage II

Partial-thickness skin loss; pink/red wound bed or intact serum-filled blister.

Pressure Injury Stage III

Full-thickness skin loss; visible subcutaneous fat, no exposed bone/tendon.

Pressure Injury Stage IV

Full-thickness tissue loss with exposed bone, tendon, or muscle.

Unstageable Pressure Injury

Full-thickness tissue loss obscured by slough or eschar; depth undeterminable until debrided.

Contracture Prevention

Frequent repositioning, active/passive range-of-motion exercises, proper alignment, splints, and functional positioning.

Vesicular Breath Sounds

Soft, low-pitched sounds heard over peripheral lung fields; inspiration > expiration.

Bronchial Breath Sounds

Loud, high-pitched sounds heard over trachea; expiration ≥ inspiration.

Bronchovesicular Breath Sounds

Medium-pitched sounds over major bronchi; inspiration = expiration.

Crackles (Rales)

Discontinuous, popping sounds on inspiration from fluid in alveoli; not cleared by cough.

Wheezes

High-pitched musical sounds from narrowed airways, usually on expiration.

Rhonchi

Low-pitched, snoring sounds from airway secretions; may clear with coughing.

Pleural Friction Rub

Grating sound from inflamed pleural surfaces rubbing together; heard on inspiration and expiration.

Bradypnea

Respiratory rate < 12 breaths/min in adults.

Tachypnea

Respiratory rate > 20 breaths/min in adults, shallow.

Kussmaul Respirations

Rapid, deep, labored breathing pattern associated with metabolic acidosis (e.g., DKA).

Signs of Respiratory Distress

Use of accessory muscles, nasal flaring, retractions, tripod posture, tachypnea, cyanosis, agitation.

Prefix

Word element placed before a root to modify its meaning (e.g., brady-, tachy-).

Suffix

Word element added after a root to modify meaning (e.g., ‑pnea, ‑itis).

Subjective Data

Information stated by the patient (symptoms), e.g., "I feel short of breath."

Objective Data

Observable or measurable findings (signs), e.g., respiratory rate 28/min, SpO₂ 89 %.

Levels of Consciousness

Continuum from alert → lethargic → obtunded → stuporous → comatose.

Orientation Status

Assessment of person, place, time, and situation (A&O × 4).

Glasgow Coma Scale (GCS)

Neurologic scale scoring eye (4), verbal (5), motor (6) responses; total 3–15.

Neurologic Assessment

Systematic review of mental status, cranial nerves, motor/sensory function, reflexes, coordination, and gait.

Unsteady Gait

Abnormal walking pattern with poor balance or rigidity; may indicate neurologic or musculoskeletal disorder.

Ratio

Comparison of two numbers expressed as a:b or a/b.

Fraction

Part of a whole expressed as numerator/denominator (e.g., ¾).

Percentage

A fraction expressed per 100 (e.g., 25 % = 25/100).

Rounding

Adjusting a number to a specified degree of accuracy (e.g., 3.786 → 3.79 to 2 decimals).