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Comprehensive asses
- -history and physical
- - more specific
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emergency assesment
ABC's
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subjective
pt verbal description
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objective
observations or measurment
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PQRST
- point: what makes pain better or worse
- Quality: describe
- Radiation: Where
- Severity: 1-10
- Time: does it change w/ time
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types of assesment
- Emergency
- comprehensive
- focused
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assesment technique
- inspect
- palpatate
- ascultate
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bell of stethescope
- low pitched
- vascular sounds
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diaphragm of stethescope
- high pitched
- bowl and lung
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describe sounds using
- frequency
- loudness
- quality
- duration
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PERRLA
pupil equal, round, reactive to light, accomodation
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extraoccular function
follow finger or pen
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myopia
- near sighted
- can see close up
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hyperopia
- far sighted
- can see distant
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snellen chart
- used to check distant vision
- numerator: distance pt stands
- denominator: distance normal person can read from
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otoscope
used to check hearing
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tympanic membrane
should be intact, pearly, gray, translucent, shiny
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patency
can you breath equally on both sides
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how to check pharynx
say "ahhhh"
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when describing lesions
- general description
- shape
- distribution
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turgor
hydration status, pinch skin
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cardiovascular inspection
- cap refill, clubbing
- JVD
- Edema
- color of skin
- statis ulcer
- varicose veins
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JVD
- HOB 30-45
- side of neck
- could mean heart disease
- raised vein reflects right side heart failure
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cartoid artery
middle of neck
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clubbing
- -change in angle between nail and nail base
- -larger than 180 degree
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cap refill
under 3 seconds
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AP diameter
- anterior posterior diameter
- 1/3 - 1/2 of transverse
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3 normal breath sounds
- Bronchial:over trachea, loud/high pitched
- Bronchiovesicular: Anterior(sides of sternum) Posterior( b/t scapulae) blowing sounds, medium pitched
- Vesicular: periphery of lung, soft, breezy, low
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3 adventitious breath sounds
- Crackles:
- -Fine high
- -Medium: low, moist
- -Coarse: bubbly, loud, low
- Rhonchi: loud, low pitched, rumbling, cleared w/ cough
- Wheezes: musical
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systole
- contract
- eject blood from L vent into aorta
- from R vent into pulm artery
- pressure builds
- mitral and tricuspid close
- aortic and pulmonary open
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diastole
- vent relax
- atria contract to move blood into vent and fill coronary arteries
- preasure drops
- aortic and pulm close
- mitral and tricusp open
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cardio vascular areas
- -angle of louis
- -R side 2nd ICS= aortic
- - L side 2nd iCS= pulmonic
- - L side 3rd ICS= ERBS
- 4th or 5th ICS= tricuspid
- 5th ICS just left of sternum= mitral
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S1
- -systole
- -best heard at apex(mitral)
- "lub"
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S2
- -diastole
- -heard at aortic and pulmonic
- -"dub"
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when assessing PMI
- -at mitral site
- -apical pulse
- - listen for 30 seconds
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how do you know when pt has a pulse deficit?
when radial is slower than apical
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PMI
point of maximul impulse
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S3
- ventricullar gallop
- premature rush
- heart failure or hypertension
- S1, S2, S3 "Ken-TUCK-y"
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S4
- atrial gallop
- just before S1
- "TEN-nes-see"
- atrial contraction
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murmer
- heard best at ERBS
- swishing or blowing
- caused by increased blood flow
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pulse grade
- 1+ palpale but weak
- 2+ normal
- 3+ increased
- 4+ Bounding
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bowl sounds
- -listen for 30 seconds in each quad
- -listen for 5 continuous min before charting absent bowl sounds
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describe bowel sounds
normal, audible, absent, hyperactive, hypoactive
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ascites
abdominal swelling caused by accumulation of fluid; liver disease
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ileus
inability of bowel to contract normally and remove waste
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borborygmi
hyperactive loud growling sounds
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rebound tenderness
during deep palp, if pt feels pain after release of hand
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rebound tenderness causes
apendicites, pancreatitis,
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paralytic ileus
obstruction of intestine, due to paralysis of intestinal muscles
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neuro assesment
- subjective
- objective
- mental status
- intellectual
- sensory
- motor
- reflex
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scolliosus
lateral spine curvature
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subluxation
incomplete or partial dislocation of joint or organ
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crepitus
crackling or grating sounds
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glasgow coma scale
evaluate pt neuro status
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reflex assesment
helps to asses peripheral spinal nerve function
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expresive aphasia
cant produce words
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receptive aphasia
can talk a lot but makes no sense
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cranial nerve pneumonic
on old Olympus towering top a Finn and German views some hops
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occulo motor and trochlear
- eye movements
- PERRLA
- eyelids
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trigemineal
- facial sensations
- corneal reflex
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Abducens
extraoccular eye movement
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facial
Taste,smile,frown,close eyes
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glossopharyngeal and Vegas
- Gag reflex swallow taste
- bradycardia
- increase gastric secretion
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spinal accesory
- Shrug shoulders
- turn head against resistance
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Presbyopia
Impaired near vision
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retinopathy
Non inflammatory eye disorder
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strabismus
- Eye appears cross
- both eyes do not focus simultaneously
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cataracts
- Increase opacity
- blocks light
- cloudy
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glaucoma
- Intaocular structural damage
- dialated
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macular degeneration
Damaging shaarp and central vision
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RUQ
RLQ
- small intestine
- ascending colon
- Apendex
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LUQ
LLQ
- sigmoid colon
- decending colon
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Affect vs mood
Affect(weather): immediate
mood(season): emotional experience
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