Final exam Fundamentals

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What side do you listen to a bruit with your stethoscope?

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1

What side do you listen to a bruit with your stethoscope?

bell

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2

what does aerobic exercise benefit

cardiac

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3

Complications of immobility?

osteoporosis, DVT

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4

rule of nurses with holisitic care

mind, body, spirit

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5

ebp

outlines the process of nursing

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6

what do we use to use evidence based skills?

clinical expertise, patients values, patients preferences, research based articles, subjective objective data

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7

what is masslows hierarchy of needs

meeting patient where they are based off of needs

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8

masslows hirearchy of needs

physiological, safety, love/belonging, esteem, self-actualization

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9

what is I's and O's

hydration status

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10

primary prevention

immunizations

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11

secondary preventions

blood pressure, screening

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12

2 ways of communication

verbal and nonverbal

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13

verbal communication

spoken or written words

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14

nonverbal communication

five senses and everything that does not involve spoken or written word

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15

how to deliver cultural competent care

based off how to patient wants to be treated if safe

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16

client confidentiality

only people who are involved in direct care

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17

what should we use when charting about a patient?

initials

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18

what do we do with charts/ computers when we walk away?

close/ log out

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19

subjective data

patient tells you

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20

objective data

observe

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21

negligence

falls below standard of care

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22

first priority with patients

safety

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23

what do we worry about with hygiene?

skin integrity

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24

Assessment order

inspection, aussultaion, percussion, palpation

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25

where does sound travel better?

in solids

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26

how do we do palpation?

light to deep

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27

normal percussion over lungs?

residence

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28

bronchial vesicular

in the middle of the chest anterior

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29

largest part of lung

vesicular

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30

crepitis

crackling air under skin

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31

tactile fermitis

palpable vibration of the chest wall that results from the transmission of sound vibrations through the lung tissue to the chest wall

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32

what are adventitious sounds

abnormal sounds

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33

most common adventitious sounds

strider, wheezing

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34

what does wheezing sound like?

high pitched whistle sound

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35

what does strider sound like?

snoring sound

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36

most common O2 delivery

nasal canula

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37

Diaphoretic breathing

breathing deep into the stomach and fully engaging the diaphragm

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38

tripod

hands on knees to breathe

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39

what does standing straight do to the lungs

compress the lungs

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40

active vs passive ROM

active is doing it themselves. passive is you helping

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41

allens test

tests arterial blood flow in hand. hold wrist for a second and watch

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42

rhomberg test

balence test cerebellar function

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43

how to access bowel habits

how often, consistency

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44

where to listen to bowel sounds?

right lower quadrent

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45

signs of hydration?

skin turger doesnt tent

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46

signs of dehydration

skin truger tents, dizziness, headaches dryness

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47

urniary retention

inability to empty the bladder

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48

pulses

radial, brachial, carotid, popliteal, dorsalis pedis

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49

cranial nerves

olfactory, optic, oculomotor, abducens, trigeminal, facial, acoustic, glossopharyngeal, vagus, spinal accessory, hypoglossal

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50

how to grade reflexes?

0-4, 2+ is normal

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51

mucous membranes

pink

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52

tongue

ventral is rough, dorsal is smooth

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53

vision chart 20/40

they can see at 20 feet when normal can see at 40

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54

corneal light reflex

should appear symmetric and center

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55

RUQ

liver, gallbladder, duedenum, head of pancreas, right kidney & adrenal, part of ascending & transverse colon

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56

RLQ

Cecum, appendix, right ovary, right ureter, right spermatic cord

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57

LUQ

Stomach, spleen, left lobe of liver, body of pancreas, left kidney & adrenal, part of transverse & descending colon

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58

LLQ

part of descending colon, sigmoid colon, left ovary, left ureter, left spermatic cord

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59

typany

hollow, high, drum like sounds, excessive air in chest

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60

over liver and spleen sounds like?

dull

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61

how often should they do breast exams

once a months

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62

occult blood

not visible

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63

head control in babys

by 6 months

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64

roaches 6 C's

compassion, competence, confidence, conscience, commitment, and comportment

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65

what are you looking for in inspection

any visible abnormalities

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66

what is the technique for auscultation

light to deep

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67

what is the normal pattern for listening for ausultation

counter clockwise

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68

what can a skin assessment indicate

skin abnormalities

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69

what is the anatomy of the lungs, shape, configuration of chest

apex at top, base at bottom, left is bigger

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70

what are normal percussion sounds

Resonant sounds are low pitched, hollow sounds

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71

bronchial

expiratory sounds last longer than inspiratory ones

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72

bronchovesicular

inspiratory and expiratory sounds are about equal

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73

vesicular

inspiratory sounds last longer than expiratory sounds

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74

where is the apical impulse the loudest

apex of heart

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75

where does blood flow start and end

right atrium , right ventricle, pulmonary arteries in the lungs, back to the heart through the pulmonary veins, left atrium, left ventricle and the aorta

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76

what does it mean when peripheral pulses are weak

blood flow is reduced to vital organs

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77

if the peripheral pulse is weak what do we check next

apical pulse

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78

what exercise is helpful for cardiovascular system

aerobic exercise

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79

passive ROM technique

2 times a day and 2-5 times each exercise

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80

flexion

flex in

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81

abduction

arms up

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82

adduction

arms in

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83

inversion

turn foot in

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84

supination

hand palm up

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85

circumduction

turn in circle

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86

protraction

shoulders forward

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87

how long for bowel sounds

2 minutes if normal

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88

what is urinary retention

how much urine is left in the bladder after the bladder is emptied spontaneously

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89

how is cerebellar functioning tested

assessment of gait and balance, the finger-to-nose test, heel-to-shin test

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90

what is the frontal lobe for

thinking, memory, behavior and movement

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91

what is the parietal lobe for

language and touch

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92

what is the occipital lobe for

sight

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93

what is the temporal lobe for

hearing, learning and feelings

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94

what is the grading scale for deep tendon reflexes

0-4, 2+ normal

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95

what are mental exams used for

evaluate mental and memory status

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96

how to examine a child ear

down and forward

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97

how to examine ear of adult

up and back

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98

where are lymph nodes accessible on the body

sides of face and neck

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99

describe mucous membrane

moist inner lining of most organs

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100

describe tongue

pink rough on top shiny on bottom

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