Exam 1 Review What hand hygiene would you use with a patient who has c.diff? - Hand soap & water How long will you wash your hands? - 15 seconds lather & 15 seconds hand wash 60 % - 90 % ethanol is always preferable?? If hands are dirty, how will you wash them? - Water & soap What type of hand rub will you use when entering a patient’s room? - Antiseptic hand rub when entering and before & after gloves What are 2 patient identifiers? - Name & DOB What is a pulse pressure difference? - Systolic – Diastolic = PP (30-50) is normal What is a pulse deficit? - It’s the difference between the radial and apical When will you take a pulse deficit? - Anytime there is an irregular heart rate on the radial, if your difference is 6+ = BAD Why do we do a 2 step BP? - To make sure what the true systolic # is & if it’s your first time checking their BP How would you take someone’s BP if your concerned about orthostatic hypertension? - Take when laying, sitting, and standing What are the categories of hypertension? - Hypertension stage 1 (130-139) - Hypertension stage 2 (140 +) - Crisis (180+) What does systolic & diastolic mean? - Systolic # means that the max pressure is felt on the artery during ventricle contraction - Diastolic # means the ventricle is relaxed Who would you not apply a BP cuff? - A person who had a double mastectomy or a kidney shunt dialysis (you would want to use wrist BP or check the thigh) How do you check to see what size of BP cuff you need? - Circumference of arm x .40 = width of cuff (40% rule) Know the parts of the stethoscope! - Bell (Low pitch sounds, ex. carotid arteries) & Diaphragm (High pitch sounds, ex. breathing) Know what a sphygmomanometer is! - The meter on the BP machine, only has even numbers because short lines are 2 and long lines are 10 Know the 5 cardiac pulses? - Aortic, Pulmonic, Erb’s Point, Tricuspid, Mitral aka Apical What is a PMI? - Point Max Impulse, it’s found in the mitral/apical & you would want to check for 1 full minute and note if it’s regular or irregular If you were going to give a cardiovascular medication, what site is preferred to check for bpm? - Apical Know the difference between tachy & bradycardia - Tachycardia = FAST HR > 100 - Bradycardia = SLOW HR < 60 Know how to rate the strength of pulses - 0 = no pulse - 1+ = minimal pulse - 2+ = normal pulse - 3+ = increased pulse - 4+ = bounding pulse What is jugular vein distention (JVD) - Right sided heart failure, you would want to raise the head of the bed at 45 degrees to check for JVD What is respiration rate? - The rise & fall of the chest, you would check for 1 full minute & normal rate is 12-20 Know between tachy & bradypnea - Tachypnea = FAST RR > 20 bpm - Bradypnea = SLOW RR < 12 bpm What is diaphragmatic excursion? - The lungs expanding symmetrically Know tactile fremitus - Vibrations on the back when your patient says 99, 99, 99. Vibrations will be stronger on the top then slowly go away Where would you take a pulse for an adult & child? - Adult patient would be on the radial but if unconscious do carotid - Child patient would be on the brachial When palpating the carotid arteries palpate one at a time and check for any thrills, when auscultating with your bell check for any bruits If someone has got done smoking or eating, wait about 20-30 minutes to check for temperature Know that a temperature over 100.4 is considered Febril (-1 degree if its rectal) (+1 degree if its auxillary) Know how to figure out a patients BMI? - (weight/ height sq inches x 703) - Underweight < 18.5 - Normal is 18.5- 24.9 - Overweight 25 – 29.9 Know medical terminology? - Apnea = cessation of respiration of airflow - Hypoxia = when there is not enough oxygen to the tissue - Dyspnea = difficult/ labored breathing - Cyanosis = bluish discoloration on mouth/ fingers resulting in poor circulation Carbon monoxide will result in cherry red lips on individuals Know your cranial nerves! - CN 3 (111) = PERRLA - CN 4 (IV) = EOM x 6 - CN 6 (VI) = Accommodation Know your body systems - Starting in your right lower quadrant you have your ascending colon and appendix, right upper quadrant has your transverse colon and liver, left upper quadrant has your spleen, and left lower quadrant has your sigmoid colon Know that all quadrants should have bowel sounds present but if not, there could be some blockage What is borborygmi? - Hyperactive bowel gurgling sounds What does alert & oriented x 4 mean? - Patient knows their name, where they are, time/date & why they are there Know what the Glasgow coma scale is - Neuro exam that is based off your verbal, eye & mobility responses - Normal number is 15, anything less than 7 is coma Know your 6 pulses sites? - Radial - Brachial - Femoral - Popliteal - Dorsal pedis - Posterior tibial What is the sound when percussing lungs? - RESONANCE SOUNDS What is the sound when auscultating lungs? - VESICULAR SOUNDS , you do not want to hear crackles or bronchi sounds What is the sounds when percussing abdomen? - TYMPANIC SOUNDS Know your 9 lymph nodes - Preauricular - Postauricular - Occipital - Submandibular - Submental - Superficial cervical - Deep cervical - Supraclavicular
