Summary NR 302 Chapter 8,9,10 study guide questions week2 ( 2021 LATEST UPDATE )

NR 302 Chapter 8,9,10 study guide questions week2 ( 2021 LATEST UPDATE )Chapter 8 Study guide questions 1. Define and describe the technique of the 4 physical examination skills: Inspection: inspection mainly concentrates on watching, and means watching surroundings. Inspections begins since the beginning of meeting the client or person. A focused inspection takes time and you have to train yourself not to stare. For inspection, you need good lighting, adequate exposure, and occasional use of certain instruments (otoscope, ophthalmoscope, penlight, nasal and vaginal specula) to enlarge your view. Palpitation: Follows inspection and usually confirms what you’ve noted during inspection. Usually applies your sense of touch to confirm what you’ve noted during inspection. During palpitation you assess texture; temperature; moisture; organ location and size; and any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain. As a nurse you have to remind yourself that this technique is usually slow and calm, and when your touching your patient you want to let them know beforehand what exactly you’re doing. Percussion: Percussion is tapping the person's skin with short, sharp strokes to assess underlying structures. This allows you to hear and identify the different sounds, and you can identify the location. Auscultation: this means using the stethoscope to listen to the heart, etc. 2. Define the characteristics of the following percussion notes: Resonant: Pitch- low Amplitude- medium loud Quality- clear-hollow Duration- moderate Hyperresonant: Pitch- lower Amplitude- louder Quality- Booming Duration- longer Tympany: Pitch- high Amplitude- loud Quality- musical and drum like Duration- sustained longest Dull: Pitch- High Amplitude- soft Quality- muffled thud Duration- short Flat: Pitch- High Amplitude- very soft Quality- a dead stop of sound, absolute dullness Duration- very short 3. Differentiate among light, deep, and bimanual palpitation. light palpation is to detect surface characteristics and accustom the person to being touched, deep palpitation is where you perhaps help the person use relaxation techniques, This study source was downloaded by from CourseH on :48:41 GMT -06:00 or deep breathing. For deep palpitation it is important to note that intermittent pressure, is recommended. Bimanual palpation requires the use of both of your hands to envelop or capture certain body parts or organs, like for example the kidneys. 4. List the two end pieces of the stethoscope and the conditions for which each is best suited. Bell- deep, hollow, cup like shape, on the other side of the diaphragm. Usually is best used for soft, low-pitched sounds, like for extra heart sounds or murmurs. Diaphragm- flat edged, bigger than the bell. Usually used most often, and best for high pitched sounds, like for example heart sounds, or bowel sounds. 5. Describe the environmental conditions to consider in preparing the examination setting. The examination room should be warm and comfortable for the client and everyone else. It is important that all distractions are stopped such as noisy machinery, television, radio, or loud talking. We want the room to be calm and quiet, as well as private. Lighting is also important, when communicating with the client it is important that you are able to see them and them able to see you, so making sure the room is well lit is a good idea as well. Examination table should be properly positioned so that it is easy for the nurse and client. Other factors which contribute to the examination setting is equipment, otoscope, and ophthalmoscope. 6. List 4 situations in which you clean your hands promptly and thoroughly. Before and after every physical patient encounter, after contact with blood, body fluids, secretions, excretions, after contact with any equipment contaminated with bodily fluids, and after removing your gloves. 7. Describe your own preparation as you encounter the patient for examination: your own dress, your demeanor, safety/universal precautions, sequence of examination steps, instructions to patient. First I would take a look at the examination room to make sure that everything is in order and to make sure that the area is private, calm, and quiet. Once I am ready to talk to the patient I will make sure that I am well dressed that my scrubs are in a very great condition. Upon entering the room, I will knock, go in and introduce myself to the patient very kind and nicely. I will discuss with the patient what I will be doing today, letting them know that I am going to assess them. While speaking to the patient I will inspect my surroundings and the patient, whether his or her chest is rising correctly, eye movement, etc. Before beginning palpitation, I am going to wash my hands and then examine the patient through palpitation. If needed I am going to use percussion to determine the sounds and location as well as size of what can be damaged. Then I will use auscultation to listen the breathing and heart sounds. After assessing the patient I am going to remove my gloves and wash my hands and explain to the patient what I did, and that the doctor will be there soon to speak with them or to follow instructions, etc. I will end my conversation with thanking the patient. 8. What age specific considerations would you make for the examination of Infant- establishing trust between the nurse and parent, and nurse and infant. For in infant you always want the parent to be in the room so that you can let them know about growths, etc. This study source was downloaded by from CourseH on :48:41 GMT -06:00 Toddler- Often the toddler is at an age where they don’t allow to be examined and cling to the parent. For preparation, allow the toddler to sit on the parent’s lap during examination, aid the parent in assisting child, when doing examination. Preschooler- At this age they are usually wanting to help. So interacting with them makes the process much easier. You can also still tell them to sit in the parent’s lap. Making sure that the parent is in the room is also important, to allow them to build trust with nurse and as well the child. School-age child- should be sitting or lying on examination table. For privacy let the child decide whether they want parent or siblings to be present Adolescent- Should be sitting or lying on exam table, try to keep street clothes on so try to work around them as much as possible, examine alone without parent or sibling present Older adult- should be seated on exam table, may need to be supine, and may also need rest periods Acutely ill person- alter the positions to where they are most comfortable. Chapter 9 1. List the significant information considered in each of the 4 areas of a general survey —physical appearance, body structure, mobility, and behavior. Physical appearance- age, sex, level of consciousness, skin color, facial features, overall appearance. Body structure- stature, nutrition, symmetry, posture, position, body build/ contour, obvious physical deformities. Mobility- Gait, range of motion, no involuntary movement Behavior- facial expression, mood and affect, speech, speech pattern, dress, personal hygiene. 2. Describe the normal posture, body build, and proportions. Normal posture is that the person is standing comfortably, erect as appropriately for the age. Body build or proportions means that the arm span like finger or fingertips are equal heights or are proportional to each other. As well as the body length from crown to pubis is approximately equal to length from pubis to sole. 3. Note aspects of normal gait. Feet approximately shoulder width apart; foot placement is accurate; walk is smooth and even, and person can maintain balance without assistance. Associated movements such as symmetric arm swing are present. 4. Describe the clinical appearance of the following variations in stature Hypopituitary dwarfism- infantile facial features, chubbiness Gigantism- increased height or weight, sloe sex development Acromegaly- overgrowth in face, hands, and feet Achondroplastic dwarfism- Cartilage turns to bone Marfan syndrome- Tall stature, hyper-extensive joints Endogenous obesity (Cushing syndrome)- weight gain or obese, and edema Anorexia Nervosa- life threatening weight loss This study source was downloaded by from CourseH on :48:41 GMT -06:00 5. State the body mass index for a male weighing 190 Ib who is 5’10” tall __27.3 (overweight BMI)______ and for a female weighing 136 Ib who is 5’4” tall ___23.3 (Normal BMI)_______. 6. For serial weight measurements, what time of day would you instruct the person to have his or her weight measured? I would advise the person to aim taking their weight for approximately the same time of day and the same type of clothing worn each time. So for example of the person has set up to do it at 9 AM, then they need to make sure that they do it at 9 AM every day, or whenever scheduled to so that they can get the best accurate results. 7. Describe the technique for measuring head circumference and chest circumference on an infant. Head circumference-. Use a retractable plastic tape measure because it is more accurate than a paper tape measure. Circle the tape around the head aligned with the eyebrows at the prominent frontal and occipital bones; the widest span is correct. Plot the measurement on standardized growth charts. Compare the infant's head size with that expected for age. The head circumference should be measured from when the infant is born to 2 years of age. Chest circumference- Measurement of the chest circumference is valuable in a comparison with the head circumference but not necessarily by itself. Encircle the tape around the chest at the nipple line. It should be snug but not so tight that it leaves a mark on the infant. Note at some time between 6 months and 2 years of age the head and chest are about the same, and after age 2 the chest circumference is greater than the head. 8. What changes in height and in weight distribution would you expect for an adult in his or her 70s and 80s? Aging person appears sharper in contour, more prominent bony landmarks. Body weight decreases during the 80s and 90s. Subcutaneous fat is lost from face and periphery, whereas additional fat is deposited to abdomen and hips. By their 80s and 90s many people are shorter than they were in their 70s because of thinning of the vertebral disks, shortening of the individual vertebrae, postural changes of kyphosis, and slight flexion in the knees and hips. 9. Describe the tympanic membrane and temporal artery thermometers, and compare their use with other forms of temperature measurements. The tympanic membrane thermometer- senses infrared emissions of the tympanic membrane (eardrum). The tympanic membrane shares the same vascular supply that perfuses the hypothalamus (the internal carotid artery); thus it is an accurate measurement of core temperature. Temporal artery thermometers- used by sliding the probe across the forehead and behind the ear. The thermometer works by taking multiple readings and providing an average. The reading takes approximately 6 seconds. This approach is well tolerated and is more accurate than TMTs; however, there are conflicting reports about accuracy of thermometer. Both of these methods are fast procedures that help with getting accurate temperature results. 10. Describe 3 qualities to consider when assessing the pulse. This study source was downloaded by from CourseH on :48:41 GMT -06:00 Palpating the peripheral pulse gives the rate and rhythm of the heartbeat and local data on the condition of the artery. The 30-second interval is most accurate and efficient when heart rates are normal or rapid and when rhythms are regular. However, if the rhythm is irregular, count for a full minute. Assess the pulse, including rate, rhythm, and force. 11. Relate the qualities of normal respirations to the appropriate approach for counting them. Normally when breathing people are calm, and relaxed. So when assessing a patient for their respirations try not to make them aware that you are counting because that can alter their breathing. You count for 30 seconds, but count for a full minute if you suspect an abnormality. Avoid the 15-second interval. The result can vary by a factor of +4 or −4, which is significant with such a small number. If you are having difficulty seeing the chest rise, which can be especially difficult in obese individuals and children, you can place a hand on the upper chest or abdomen. 12. Define and describe the relationships among the terms blood pressure, systolic pressure, diastolic pressure, pulse pressure, and mean arterial pressure. BP is the force of the blood pushing against the side of, the vessel walls. The strength of the push changes with the event in the cardiac cycle. The systolic pressure is the maximum pressure felt on the artery during left ventricular contraction, or systole. The diastolic pressure is the elastic recoil, or resting, pressure that the blood exerts constantly between each contraction. The pulse pressure is the difference between the systolic and diastolic pressures and reflects the stroke volume. (MAP) is the pressure forcing blood into the tissues averaged over the cardiac cycle. 13. List factors that affect blood pressure. Some factors that affect blood pressure are age, sex, race, weight, exercise, emotions, and lastly stress. All these are factors that can affect blood pressure in bad ways. 14. Relate the use of the wrong size blood pressure cuff to the possible findings that might be obtained. There are 6 sizes to blood pressure cuffs, you want to match the appropriate cuff to the persons arm size not age. The cuff size is important; using a cuff that is too narrow yields a falsely high BP because it takes extra pressure to compress the artery. So using the wrong cuff on the wrong person can give you false readings. 15. Explain the significance of phase I, phase IV, and phase V korotkoff sounds during blood pressure measurement. the points at which you hear the first appearance of sound, the muffling of sound, and the final disappearance of sound. These are phases I, IV, and V, the fifth is now used to define diastolic pressure. 16. Given an apparently healthy 20-year-old adult, state the expected range for oral temperature, pulse, respirations, and blood pressure. Oral temp- 98.6 F Pulse-50-95 bpm Respirations-10-20 bpm BP-120/80 17. List the parameters of prehypertension, stage 1 hypertension, and stage 2 hypertension. This study source was downloaded by from CourseH on :48:41 GMT -06:00 Prehypertension- SBP- 120- 139, DBP- 80-89 Stage 1 hypertension- SBP- 140-159, DBP- 90-99 Stage 2 hypertension- SBP- greater than or equal to 160, DBP- greater than or equal to 100 Chapter 10 1. Describe the process of nociception using the four phases of: Transduction-occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery. The periphery includes the skin and the somatic and visceral structures. These injured tissues then release a variety of chemicals, including substance P, histamine, prostaglandins, serotonin, and bradykinin. These chemicals are neurotransmitters that transmit a pain message, or action potential, along sensory afferent nerve fibers to the spinal cord. These nerve fibers terminate in the dorsal horn of the spinal cord. Because the initial afferent fibers stop in the dorsal horn, a second set of neurotransmitters carries the pain impulse across the synaptic cleft to the dorsal horn neurons. These neurotransmitters include substance P, glutamate, and ATP. Transmission-the pain impulse moves from the level of the spinal cord to the brain. Within the spinal cord, at the site of the synaptic cleft, are opioid receptors that can block this pain signaling with our own endogenous opioids or with exogenous opioids if they are administered. However, if not stopped, the pain impulse moves to the brain via various ascending fibers within the spinothalamic tract to the thalamus. Once the pain impulse moves through the thalamus, the message is dispersed to higher cortical areas via mechanisms that are not clearly understood. Perception- signifies the conscious awareness of a painful sensation. Cortical structures such as the limbic system account for the emotional response to pain, and somatosensory areas can characterize the sensation. Only when the noxious stimuli are interpreted in these higher cortical structures can this sensation be identified as “pain.” Modulation- If not for pain modulation, the experience of pain would continue from childhood injuries to adulthood. To inhibit and block the pain impulse, descending pathways from the brainstem to the spinal cord release a third set of neurotransmitters that produce an analgesic effect. These neurotransmitters include serotonin, norepinephrine, neurotensin, γ-aminobutyric acid (GABA), and our own endogenous opioids—β-endorphins, enkephalins, and dynorphins. 2. Identify the differences between nociceptive and neuropathic pain. Which words will people use to describe nociceptive and neuropathic pain? Neuropathic pain is associated with damage to the neurons in the body, following an infection of injury to the area, resulting in messages of pain being sent to the central nervous system and brain regardless of noxious stimuli. This type of pain is often described as shooting pain, as it travels along the nerves in an abnormal manner causing abnormal sensations of pain. Some patients with neuropathic pain report a constant sensation of pain, whereas other experience intermittent episodes, which may or may not be aggravated by stimuli or touch. Nociceptive pain occurs when nociceptors in the body detect noxious stimuli that have the potential to cause harm to the body. This includes This study source was downloaded by from CourseH on :48:41 GMT -06:00 mechanical pressure, chemical toxins and extreme temperatures, all of which may harm the body. The receptors then send electrical signals via the nervous system to the brain, leading to the perception of pain. 3. List various sources of pain. Visceral pain, somatic pain, deep somatic pain, Cutaneous pain, referred pain 4. Explain how acute and chronic pain differ in terms of nonverbal behaviors. Acute pain is usually short term, and sudden. Like for example, surgery, trauma, kidney stones. Chronic pain is long lasting, continues 6 months or longer, and occurs usually over time. 5. Identify the most reliable indicator of a person’s pain. The subjective report, or what the patient tells you is the most reliable indicator of pain 6. Recall questions for an initial pain assessment. Do you have pain? Where is your pain? When did your pain start? What does your pain feel like? How much pain do you have now? What makes your pain better or worse? How does pain limit your functions or activities? How do you usually react when in pain? What does this pain mean to you? 7. Describe physical examination findings that might indicate pain. Discomfort. soreness, stabbing, throbbing, cramping, shooting, This study source was downloaded by from CourseH on :48:41 GMT -06:00 Powered by TCPDF ()