HA- Final Exam

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Digitalis (Digoxin):

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Health

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1

Digitalis (Digoxin):

  • usually given to patients with congestive heart failure

  • bradycardia possible: if the pulse is less than 60 beats/min, hold the meds!

  • hypokalemia possible: green/yellow halos and visual disturbances = toxicity

  • side effects: decreases weight, edema and HR

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Lasix (furosemide):

  • loop diuretic

  • patient loses potassium in the urine

  • check potassium as both hypo- and hyperkalemia makes patient susceptible to heart arrhythmias

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Heparin (lovenox):

  • anti-coagulant

  • given as a S/C injection (or given IV)

  • for patient with pulmonary embolus

  • improtant to check for side effects of bleeding (gums, IV areas, stools, bruises)

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  • protamine sulphate

Antagonist of heparin (lovenox):

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Warfarin (Coumadin):

  • often for patinets with atrial fibrilaltion (prevent emboli)

  • also for patients after recieving IV heparin after pulmonary embolus

  • given by mouth

  • educate patient to prevent taking asparin (can increase bleeding)

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  • Vitamin K

Antagonist of Warfarin (coumadin):

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Nephrotoxic antibiotics:

  • Vancomycin and Gentamicin

  • can harm the kidneys

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Ototoxic antibiotics:

  • Aminoglycosides and Vancomycin

  • can cause deafness

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  • beta blocker

What kind of drug is Propranolol?

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Beta blockers:

  • for patients with hypertension/tachycardia

  • can cause severe hypertension and tachy if stopped suddenly

  • can lead to bronchospasm and asthma attach in asthmatic patients

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Steroids:

  • prednisone/cortisone

  • can cause bleeding (ecchymosis) and hyperglycemia with long term use

  • striae

  • buffalo-hump (or fat deposit on trunk)

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Subjective signs:

  • perceived by the patient

  • feelings, pain, sore throat, etc.

  • symptom

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Objective signs:

conditions observed by someone other than the patient

  • hyperextension, fever, swelling, etc.

  • sign

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Interviewing pit falls:

  • be sure nothing is in the way of a patient that can cause harm to them

  • i.e. tables, chairs, rugs, etc.

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Acute pain:

  • short-term and self-limiting

  • often follows a predictable trajectory, and dissipates after injury heals

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Chronic pain:

  • 6 months or longer

  • Can last 5, 15, or 20 years and beyond

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Referred pain:

  • felt at a particular site but originates from another location

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Radiating pain:

  • travels from one body part to another

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Mental Status Assessment:

  • consciousness, language, mood and affect, orientation and attention, memory and abstract reasoning, through process, through content, and perception

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Vital Signs:

  • interpretation/prioritize

  • temp, BP, HR, resp, o2 sat, pain

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Respiratory Assessment:

  • effort of respirations

  • accessory muscle use

  • position of patient

  • chest symmetry

  • chest wall shape

  • auscultate and listen for adventitious sounds

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Cardiovascular Assessment:

  • auscultate at aortic, pulmonic, erb's point, tricuspid and mitral points

  • assess rate and rhythm

  • identify extra sounds and murmurs

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Peripheral Vascular System:

  • Blood vessels of the body that together with the heart and the lymphatic vessels make up the body's circulatory system.

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Peripheral Arterial Disease (PAD):

  • blockage of arteries carrying blood to the legs, arms, kidneys and other organs

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Peripheral Vascular disease (PVD):

  • disease of blood vessels away from central region of body, most typically in legs

  • symptoms include pain, numbness, and impaired circulation

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Pneumonia:

  • infection of lower respiratory tract involving the pulmonary parenchyma

  • caused by viruses, fungi, and bacteria

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Pneumonia symptoms:

  • chest pain when breathing/coughing, confusion or changes in LOC, phlegm with cough, fatigue, fever, sweating, shaking chills, lower than normal body temp, nausea, vomiting, diarrhea

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Atelectasis:

  • alveoli or an entire lung is collapsed, allowing no air movement

  • may be post-operatively due to ineffective breathing, anesthesia, pain

  • tracheal deviation towards affected side

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Atelectasis symptoms:

  • dyspnea, anxiety, tachypnea, tachycardia, coughing, chest pain, bluish skin/lips

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Pneumothorax:

  • air enters chest and lung collapses

  • needs chest tube to re-inflate the lung

  • tracheal deviation away from affected side

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Tracheal Deviation Away from Affected Side:

  • pneumothorax, tumor, aortic aneurysm, unilateral thyroid lobe enlargement

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Tracheal Deviation Toward Affected Side:

  • large atelectasis, pleural adhesions, fibrosis

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Incentive Spirometry:

  • used to prevent pneumonia

  • use 10 times every hour while awake

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ABCDE of skin cancer

  • asymmetry

  • border irregularity

  • color variations

  • diameter greater than 6mm

  • elevation/evolution

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A pressure injury may occur if a patient is:

  • immobile

  • very sick

  • can't change positions easily

  • have moist skin

  • poor circulation

  • long term medical devices like O2

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Stage 1 pressure ulcer:

  • nonblanchable erythema of intact skin

<ul><li><p>nonblanchable erythema of intact skin</p></li></ul>
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Stage 2 pressure ulcer:

  • partial thickness skin loss with exposed dermis

  • viable, pink or red, moist, intact or ruptures serum filled blister

<ul><li><p>partial thickness skin loss with exposed dermis</p></li><li><p>viable, pink or red, moist, intact or ruptures serum filled blister</p></li></ul>
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Stage 3 pressure ulcer:

  • full thickness skin loss

  • eschar may be visible

<ul><li><p>full thickness skin loss</p></li><li><p>eschar may be visible</p></li></ul>
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Stage 4 pressure ulcer:

  • full thickness skin and tissue loss

  • can see bone

<ul><li><p>full thickness skin and tissue loss</p></li><li><p>can see bone</p></li></ul>
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<p>Edema Assessment:</p>

Edema Assessment:

  • observe/inspect and palpate for fluid build up in tissues

  • press on bony prominences you see edema in for 30 seconds and grade the indent

  • scale of 0-4

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Dehydration Assessment:

  • do the skin turgor test

  • slow return = dehydration

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Abdominal Assessment: Inspection

  • color

  • vascularity

  • umbilicus

  • symmetry

  • contour

  • movements

  • scars/lesions

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Abdominal Assessment: Ascultate

  • begin in RLQ going clockwise listening to all 4 quadrants

  • note sounds

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Normal bowel sounds:

  • high-pitched, gurgling, cascading, irregular

  • 5-30 per minute

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Borborygmus bowel sounds:

  • loud, gurgling sounds made by the movement of gas through the intestines

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Hyperactive bowel sounds:

  • loud, high-pitched, rushing, tinkling sounds that signal increased motility

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Hypoactive bowel sounds:

  • slow, decreased sounds

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Absent bowel sounds:

  • no sounds in 3-5 minutes

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Abdominal Assessment: Percussion

  • Percuss lightly over each of the four quadrants

  • Normal finding: tympany

  • Abnormal: dullness

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Tympany in abdomen

  • indicates air

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Dullness in abdomen:

  • occurs over a distended bladder, adipose tissue, fluid, or a mass

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Hyperresonance in abdomen:

  • after severe diarrhea

  • gaseous distention

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Abdominal Assessment: palpitation

  • light 1cm

  • deep 5-8cm

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Gastroesophageal reflux disease (GERD):

  • Painful burning feeling in the middle of chest behind breastbone towards throat

  • Regurgitation or stomach contents coming back up through esophagus into throat and mouth

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GERD symptoms:

  • chest pain

  • nausea

  • problems swallowing

  • pain when swallowing

  • heart burn

  • regurgitation

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Peptic Ulcer:

  • open sore in the lining of the stomach or duodenum

  • casued by helicobacter pylori and longterm use of NSAIDS

  • can result in bleeding which is life threatening

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Gastric Ulcer:

  • pain occurs on an empty stomach

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Duodenal Ulcer:

  • pain occurs every 2-3 hours after a meal

  • may be relieved by eating more food

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Ascites:

  • accumulation of fluid in the peritoneal cavity

  • fluid wave test

  • decreased albumin production -> less osmotic pressure

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  • once a month 3-5 days after menses

When to do a self breast exam?

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  • size, shape, contour and symmetry

What to note during a self breast exam?

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During a breast examination, we inspect the skin for:

  • color, pigmentation, vascularity, surface characteristics and lesions

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During a breast examination, we inspect the areolae for:

  • color and surface characteristics

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During a breast examination, we inspect the nipples for:

  • position, symmetry, surface characteristics, lesions, bleeding, and discharfe

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Confrontation Test:

  • Client sits facing examiner 2ft away, eyes should be at the same level, both cover eyes directly opposite of each other and stare at each other's uncovered eye; bring small object into peripheral visual field and test the superior, temporal, inferior and nasal field; have client state when they see object

<ul><li><p>Client sits facing examiner 2ft away, eyes should be at the same level, both cover eyes directly opposite of each other and stare at each other&apos;s uncovered eye; bring small object into peripheral visual field and test the superior, temporal, inferior and nasal field; have client state when they see object</p></li></ul>
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6 cardinal fields of gaze:

  • Use finger through 6 positions of gaze to assess for eye movement related to cranial nerves III, IV, and VI

<ul><li><p>Use finger through 6 positions of gaze to assess for eye movement related to cranial nerves III, IV, and VI</p></li></ul>
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Snellen test:

  • Tests for visual activity and if cranial nerve II is intact

  • Test with glasses first then without

  • Start with right eye, then left, then both

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PEERLA:

  • pupils equal, round, reactive to light and accommodation

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Glaucoma:

  • increased intraocular pressure leading to loss of peripheral vision

<ul><li><p>increased intraocular pressure leading to loss of peripheral vision</p></li></ul>
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Age-related macular degeneration (AMD):

  • loss of central vision

<ul><li><p>loss of central vision</p></li></ul>
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Diabetic Retinopathy:

  • damage to blood vessels in retina

  • causes blindness and black spots in vision

<ul><li><p>damage to blood vessels in retina</p></li><li><p>causes blindness and black spots in vision</p></li></ul>
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  • pull the pinna up and back

How to place an otoscope in an adult?

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  • pull the auricle down and back

How to place an otoscope in a child?

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Normal tympanic membrane:

  • pearly gray, shiny, translucent

<ul><li><p>pearly gray, shiny, translucent</p></li></ul>
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Abnormal tympanic membrane:

  • lesions, edema, erythema, tenderness, blue/pink-red

<ul><li><p>lesions, edema, erythema, tenderness, blue/pink-red</p></li></ul>
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Hearing loss can be caused by:

  • age

  • antibiotic use

  • trauma

  • obstruction

  • prolonged exposure to loud sounds

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Whisper test (CN VIII)

  • stand 1-2 feet away from client; ask them to block 1 external ear canal; whisper a statement and ask client to repeat it

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The Central Nervous System consists of:

  • the brain and spinal cord

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The Peripheral Nervous System consists of:

  • the cranial nerves and spinal nerves

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  • frontal, parietal, temporal, occipital

What are the lobes of the cerebrum?

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What does the frontal lobe control?

  • smell

  • speech

  • concentration

  • planning

  • problem solving

  • motor control

<ul><li><p>smell</p></li><li><p>speech</p></li><li><p>concentration</p></li><li><p>planning</p></li><li><p>problem solving</p></li><li><p>motor control</p></li></ul>
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What does the occipital lobe control?

  • vision

<ul><li><p>vision</p></li></ul>
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What does the parietal lobe control?

  • touch and pressure

  • taste

  • body awareness

<ul><li><p>touch and pressure</p></li><li><p>taste</p></li><li><p>body awareness</p></li></ul>
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What does the temporal lobe control?

  • hearing

  • facial recognition

<ul><li><p>hearing</p></li><li><p>facial recognition</p></li></ul>
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What does the cerebellum control?

  • balance and coordination

<ul><li><p>balance and coordination</p></li></ul>
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  • the left frontal lobe

Where is Broca's area located?

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  • the left temporal lobe

Where is Wernicke's area located?

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Broca's aphasia:

  • inability to produce speech

  • Broken words, Motor, Frontal lobe (Bad Mother F*****)

<ul><li><p>inability to produce speech</p></li><li><p>Broken words, Motor, Frontal lobe (Bad Mother F*****)</p></li></ul>
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Wernicke's aphasia:

  • inability to comprehend speech

  • Wacky words, Sensory, Temporal lobe (Want Some Tea?)

<ul><li><p>inability to comprehend speech</p></li><li><p>Wacky words, Sensory, Temporal lobe (Want Some Tea?)</p></li></ul>
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Proprioception:

  • the sense of body position

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  • Ask patient with eyes closed while you move a thumb or toe and ask patient what way its going

How do we assess proprioception?

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Lethargic:

  • in a state of sluggishness or apathy

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Obtunded:

  • state in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.

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Stupor:

  • state of near-unconsciousness or insensibility

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Coma:

  • state of profound unconsciousness

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Glasgow Coma Scale (GCS)

  • a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints

<ul><li><p>a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints</p></li></ul>
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<ul><li><p>15 possible points</p></li><li><p>GCS of 3-8 = severe</p></li><li><p>GCS of 9-12 = moderate</p></li><li><p>GCS of 13-15 = mild</p></li></ul>
  • 15 possible points

  • GCS of 3-8 = severe

  • GCS of 9-12 = moderate

  • GCS of 13-15 = mild

How to use the Glasgow Coma Scale

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Sympathetic response:

  • fight, flight, fright

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Parasympathetic response:

  • rest and digest

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If sympathetic dominant, what would be the pulse rate, BP, and pupil size?

  • increased pulse

  • increased BP

  • dilated pupils

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