dmrn106l

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Author:
blkbunny20
ID:
39109
Filename:
dmrn106l
Updated:
2010-10-07 18:24:36
Tags:
fundamental
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Description:
Fundamentals Final
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  1. Heart sounds best heard at base
    • Aortic
    • Pulmonary
  2. How to asses for jugular venous distension (JVD)
    Normal jugular venous pulsation is 2cm or less above sternal angle
  3. Physiological changes in elderly:expected cardiovascular changes
    • Age 20-60 years systolic BP increases by about 20 mmHg
    • Age 60-80yrs another 20 mmHg
    • No chane in resting heart rate diastole
  4. Orthopnea signs/symptoms
    • Difficulty breathing when supine
    • State # of pillows needed to achieve comfort
    • the need to assume a more upright position to breathe.
  5. Characteristics sounds of murmur
    A blowing swooshing sound that occurs with turbulent blood flow in the heart or great vessels
  6. MS ARD
    • M itral
    • S tenosis
    • A trial
    • R egurgitation
    • D iastole
  7. MR PASS
    • M itral
    • R egurgitation
    • P hysiologic
    • A trial
    • S tenosis
    • S ystolic
  8. How to asses for systolic vs diastolic murmurs
    • Systole - the midsystolic click(which is associated with mitral valve prolapse) is the most common sound)
    • Diastole - the third and fourth heart sound occurs
  9. Types of murmurs
    • Sysytolic
    • May occur with normal heart or heart disease
    • Diastole
    • Always indicates heart disease
  10. How to rate a pulse
    • Rate
    • Rhythm
    • Force
    • Elasticity
  11. How to rate a pulses strength
    • Force-shows the strength of the heart stroke volume
    • +3=full, bounding
    • +2=normal
    • +1=weak/thready
    • 0=absent
  12. Range of motion
    (ROM)
    moving body parts (joint) right. left. forward, backward, circular motion depends on what is being tested
  13. ROM is documented as:
    • Limited
    • Pain with
    • Limited rotation
    • Limited abduction
  14. Raynaud syndrome
    • Change of color in response to cold, vibration, or stress
    • 1-white(pallor)
    • 2-blue(cyanosis)
    • 3-red (rubor)
  15. Manual Compression Test
    • No wave felt = Competent valve
    • Wave felt = Incompetent valve
  16. Causes for hyperactive bowel sounds
    Loud high-pitched, rushing tinkling sound that signals increased motility
  17. Causes of hypoactive bowel sounds
    Absent sound followed by abdominal sugery or with inflammation of the peritoneum
  18. How to test for Appendecitis
    • Illiopsoas Muscle Test
    • Rebound Tenderness (blumberg's Sign)
    • Obturator Test
  19. how to perform the rebound tenderness test
    (Blumberg's sign)
    • A site away from painful area
    • Hold hand 90o or perpendicular to the abdomen
    • Push down slowly and deeply then lift up quickly
  20. How to perform Illiopsoas muscle test
    (Appendicitis)
    • Person supine, lift the right leg straight up flexing at the hip
    • Push down over the right thigh as the person tries to hold his leg up
    • Person should feel no pain
  21. How to perform Obturator test
    (Appendicitis)
    • With the person supine
    • lift right leg, flexing the hip 90o at the knee hold the ankle and rotate the leg internally and externally
  22. How to test for Cholecystitis
    (Inflammed Gallbladder)
    • Murphy's sign
    • Hold fingers under the liver border.
    • Ask person to take a deep breath
    • If normal no pain is felt when deep breathing
  23. How to test for Kidney Inflammation
    • Place one hand over the 12th rib at the costovertebral angle on the clients back thump that hard with your fist
    • Normally client feel thud no pain
    • sharp pain occurs with inflammation
  24. Normal Bowel Sounds
    • Normal value from 5-30 min
    • Listen 5 min by your watch before deciding bowel sounds are absent completely
  25. Define Crepitation
    • Audible and palpable crunching or grating that accompanies movement
    • Occurs when the articular surfaces in the joints are roughened as w/rhematoid arthritis
  26. What area do bone growth occur
    • Epiphysis - lenghtning growth plate
    • Shaft - increases diameter of bone
  27. Cerebellum
    Concerned with motor coordination
  28. Midbrain
    • Contains many motor neurons and tracts
    • Merges into thalamus and hypothalamus
  29. Pons
    Enlarged area containing ascending and descending fiber tract
  30. Medulla
    Connects the brain and spinal cord
  31. Hypothalamus
    • Controls:
    • Temperature
    • HR
    • BP
    • Sleep center
    • Pituitary gland regulation
  32. How to assess for Peripheral Neuropathy
    (Posterior Column Tract Test)
    • Vibration
    • Position (kinesthesia)
    • Tactile Discrimination (fine touch)
    • Caused by Diabetes Mellitus
  33. Peripheral neuropathy is worse at the feet and gradually improves as you move up the leg
    As opposed to a specific nerve lesion, which has a clear zone of deficit for its dermatome
  34. Posterior column tract
    (Vibration test)
    • Using a tuning fork on the big toe
    • If no vibration felt go to ulnar process, ankles, patellae, illiac crests
  35. Stereognosis
    Tests a persons ability to recognize objects by feeling their form, shape, size
  36. Graphesthesia
    • Ability to read a number by having it traced on skin.
    • With persons eyes clsoed
    • Use blunt object to trace a number or letter in palm of hand
  37. Decerbrate Rigidity
    • Upper extremeties stiffly extended,
    • Adducted internal rotation
    • Indicates lesion in brain stem at midbrain or upper pons
  38. Decortocate Rigidity
    • Upper extremity flexion of arms, wrist, fingers.
    • Adduction of arms
    • Indicates hemispheric lesion of cerebral cortex
  39. Areas of Glasgow Coma Scale
    • Eye opening (1-4)
    • Motor response (1-5)
    • Verbal response (1-6)
  40. Glasgow Coma Scale
    • Each area is rated separately
    • # given for persons best response
    • # added up
    • The total reflects person functional status
  41. Normal Glasgow Score
    • 15 - normal
    • 7 > coma
  42. Osgood Schlatter Disease:
    • Painful swelling of the tibial tubercle, just below the knee
    • Occurs during puberty
    • More in males
    • Symptoms resolve with rest
  43. The need for a mastecomy and complications
    • Lymphedema
    • Is unilateral swelling, nonpitting brawny edema, with overlaying skin indurated
  44. Peripheral Arterial Disease
    Characteristics
    • Intermittent claudication
    • Cramps
    • Numbness
    • Tingling
    • cold
  45. Peripheral Venous Disease
    Characteristics
    • Brownish color variation
    • Aching
    • Tiredness
    • Fullness
  46. Visual Acuity Test
    Snellen Eye Chart
  47. What does 20/30 mean
    You can read at 20 feet what the normal eye could read at 30 feet
  48. How to assess hearing
    • Whispered voice test
    • Tunning fork test
    • Weber test
    • Rinne test
    • *Audiometer*
  49. Cranial nerve involved in hearing
    • CN VIII
    • Acoustic
  50. pupillary constriction involves what nerve
    • CN III
    • Oculomotor
  51. Correct time to do BSE
    4th to 8th day after menses
  52. Cranial Nerves Mnemonic
    • Oh
    • Oh
    • Oh
    • To
    • Touch
    • And
    • Feel
    • A
    • Good
    • Vein
    • Ah
    • Heaven
  53. How to assess JVD
    • Position client at 30 to 45 degree angle
    • Remove pillow
    • To avoid flexing neck as person is raised to sitting position external jugulars flatten and disappear
    • Unilateral distetion of vein is due to local cause(kinking and aneurysm)
    • Full distention signify increased CVP as with heart failure

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