Med/Surg Ch. 4

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nurseheather
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Med/Surg Ch. 4
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2010-09-28 00:16:28
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  1. Objective data as perceived by the examiner?
    Signs
  2. Removal of fluids from a body cavity, wound, or other source of discharge by one or more methods?
    Drainage
  3. Fluid, cells, or other substances that have been slowly discharged from cells or blood vessels through small pores or breaks in cell membrane, usually as a result of inflammation or injury?
    Exudate
  4. Subjective data as perceived by the patient?
    Symptoms
  5. What is pruritus?
    Itching
  6. It is any disturbance of a structure or function of the body; a pathological condition of the body?
    Disease
  7. This disease develops slowly and persists over a long period, often for a person's lifetime?
    Chronic
  8. This disease is partial or complete disappearance of clinical and subjective characteristics of a disease?
    Remission
  9. This disease begins abruptly with marked intensity of severe signs and symptoms and then often subsides after a period of treatment?
    Acute
  10. Results in structural change in an organ that interferes with its functioning?
    Organic diseases
  11. May be manifested as organic disease, but careful examination fails to reveal evidence of structural or physiologic abnormalities?
    Functional disease
  12. Caused by an invasion of microorganisms, such as bacteria, viruses, fungi, or parasites that produce tissue damage?
    Infection
  13. Protective response of the body tissues to irritation, injury, or invasion by disease-producing organisms?
    Inflammation
  14. What are the cardinal signs of infection and inflammation?
    • Erythema
    • Edema
    • Heat
    • Pain
    • Purulent drainage
    • Loss of function
  15. The process of making an evaluation or appraisal of the patient's condition?
    Assessment
  16. What is the initial step in the assessment process?
    Nursing Health History
  17. High-pitched, drumlike sound produced over hollow organs (i.e. stomach)?
    Tympany
  18. Low-pitched, thudlike sound upon percussion of dense organ (i.e. liver)?
    Dullness
  19. Soft, highpitched flat sound produced by percussion over tissue (i.e. muscle)?
    Flatness
  20. What does the PQRST method stand for?
    • P - provocative/palliative
    • Q - quality/quantity
    • R - region/radiation
    • S - severity
    • T - timing
  21. Concentration of attention on the part of the body where signs and symptoms are localized or most active in order to determine their significance?
    Focused assessment
  22. What is the purpose of the nursing physical assessment?
    To determine the patient's state of health or illness
  23. Elasticity of the skin caused by the outward pressure of the cells and interstitial fluid?
    Turgor
  24. Vibrating sensation along the artery?
    Thrill
  25. Abnormal "swishing" sounds heard over organs, glands, and arteries?
    Bruits
  26. Respiratory sounds produced by fluid in bronchioles and alveoli?
    Crackles
  27. Respiratory sounds produced by the movement of air through narrowed passages in the tracheobronchial tree?
    Wheezes
  28. High-pitched, loud rushing sound heard over abdomen?
    Borborygmi
  29. What is the pitting edema scale?
    • 1+ - barely perceptible
    • 2+ - mild (10-15 sec)
    • 3+ - moderate (30sec-1min)
    • 4+ severe (1-5min)
  30. What is the order of which we assess the abdomen?
    • 1. Inspect
    • 2. Auscultate
    • 3. Palpate
    • 4. Percuss
  31. What are the six steps of the Nursing Process?
    • 1. Assessment
    • 2. Diagnosis
    • 3. Identify Outcome
    • 4. Planning
    • 5. Implementation
    • 6. Evaluation

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