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