HA- Final Exam

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

Lasix (furosemide):

• loop diuretic

• patient loses potassium in the urine

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

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)

- protamine sulphate

Antagonist of heparin (lovenox):

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)

- Vitamin K

Antagonist of Warfarin (coumadin):

Nephrotoxic antibiotics:

• Vancomycin and Gentamicin

• can harm the kidneys

Ototoxic antibiotics:

• Aminoglycosides and Vancomycin

• can cause deafness

- beta blocker

What kind of drug is Propranolol?

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

Steroids:

• prednisone/cortisone

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

• striae

• buffalo-hump (or fat deposit on trunk)

Subjective signs:

• perceived by the patient

• feelings, pain, sore throat, etc.

• symptom

Objective signs:

conditions observed by someone other than the patient

• hyperextension, fever, swelling, etc.

• sign

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.

Acute pain:

• short-term and self-limiting

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

Chronic pain:

• 6 months or longer

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

Referred pain:

- felt at a particular site but originates from another location

Radiating pain:

- travels from one body part to another

Mental Status Assessment:

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

Vital Signs:

• interpretation/prioritize

• temp, BP, HR, resp, o2 sat, pain

Respiratory Assessment:

• effort of respirations

• accessory muscle use

• position of patient

• chest symmetry

• chest wall shape

• auscultate and listen for adventitious sounds

Cardiovascular Assessment:

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

• assess rate and rhythm

• identify extra sounds and murmurs

Peripheral Vascular System:

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

Peripheral Arterial Disease (PAD):

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

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

Pneumonia:

• infection of lower respiratory tract involving the pulmonary parenchyma

• caused by viruses, fungi, and bacteria

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

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

Atelectasis symptoms:

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

Pneumothorax:

• air enters chest and lung collapses

• needs chest tube to re-inflate the lung

• tracheal deviation away from affected side

Tracheal Deviation Away from Affected Side:

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

Tracheal Deviation Toward Affected Side:

- large atelectasis, pleural adhesions, fibrosis

Incentive Spirometry:

• used to prevent pneumonia

• use 10 times every hour while awake

ABCDE of skin cancer

• asymmetry

• border irregularity

• color variations

• diameter greater than 6mm

• elevation/evolution

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

Stage 1 pressure ulcer:

- nonblanchable erythema of intact skin

Stage 2 pressure ulcer:

• partial thickness skin loss with exposed dermis

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

Stage 3 pressure ulcer:

• full thickness skin loss

• eschar may be visible

Stage 4 pressure ulcer:

• full thickness skin and tissue loss

• can see bone

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

Dehydration Assessment:

• do the skin turgor test

• slow return = dehydration

Abdominal Assessment: Inspection

• color

• vascularity

• umbilicus

• symmetry

• contour

• movements

• scars/lesions

Abdominal Assessment: Ascultate

• begin in RLQ going clockwise listening to all 4 quadrants

• note sounds

Normal bowel sounds:

• high-pitched, gurgling, cascading, irregular

• 5-30 per minute

Borborygmus bowel sounds:

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

Hyperactive bowel sounds:

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

Hypoactive bowel sounds:

- slow, decreased sounds

Absent bowel sounds:

- no sounds in 3-5 minutes

Abdominal Assessment: Percussion

• Percuss lightly over each of the four quadrants

• Normal finding: tympany

• Abnormal: dullness

Tympany in abdomen

- indicates air

Dullness in abdomen:

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

Hyperresonance in abdomen:

• after severe diarrhea

• gaseous distention

Abdominal Assessment: palpitation

• light 1cm

• deep 5-8cm

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

GERD symptoms:

• chest pain

• nausea

• problems swallowing

• pain when swallowing

• heart burn

• regurgitation

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

Gastric Ulcer:

- pain occurs on an empty stomach

Duodenal Ulcer:

• pain occurs every 2-3 hours after a meal

• may be relieved by eating more food

Ascites:

• accumulation of fluid in the peritoneal cavity

• fluid wave test

• decreased albumin production -> less osmotic pressure

- once a month 3-5 days after menses

When to do a self breast exam?

- size, shape, contour and symmetry

What to note during a self breast exam?

During a breast examination, we inspect the skin for:

- color, pigmentation, vascularity, surface characteristics and lesions

During a breast examination, we inspect the areolae for:

- color and surface characteristics

During a breast examination, we inspect the nipples for:

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

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

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

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

PEERLA:

- pupils equal, round, reactive to light and accommodation

Glaucoma:

- increased intraocular pressure leading to loss of peripheral vision

Age-related macular degeneration (AMD):

- loss of central vision

Diabetic Retinopathy:

• damage to blood vessels in retina

• causes blindness and black spots in vision

- pull the pinna up and back

How to place an otoscope in an adult?

- pull the auricle down and back

How to place an otoscope in a child?

Normal tympanic membrane:

- pearly gray, shiny, translucent

Abnormal tympanic membrane:

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

Hearing loss can be caused by:

• age

• antibiotic use

• trauma

• obstruction

• prolonged exposure to loud sounds

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

The Central Nervous System consists of:

- the brain and spinal cord

The Peripheral Nervous System consists of:

- the cranial nerves and spinal nerves

- frontal, parietal, temporal, occipital

What are the lobes of the cerebrum?

What does the frontal lobe control?

• smell

• speech

• concentration

• planning

• problem solving

• motor control

What does the occipital lobe control?

- vision

What does the parietal lobe control?

• touch and pressure

• taste

• body awareness

What does the temporal lobe control?

• hearing

• facial recognition

What does the cerebellum control?

- balance and coordination

- the left frontal lobe

Where is Broca's area located?

- the left temporal lobe

Where is Wernicke's area located?

Broca's aphasia:

• inability to produce speech

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

Wernicke's aphasia:

• inability to comprehend speech

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

Proprioception:

- the sense of body position

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

How do we assess proprioception?

Lethargic:

- in a state of sluggishness or apathy

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.

Stupor:

- state of near-unconsciousness or insensibility

Coma:

- state of profound unconsciousness

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

• 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

Sympathetic response:

- fight, flight, fright

Parasympathetic response:

- rest and digest

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

• increased pulse

• increased BP

• dilated pupils