Neuro
How would you assess CN XI (11) spinal accessory?
Shrug shoulders and turn head against resistance
Explain the difference of when a person would feel increased shortness of breath if they have heart failure versus respiratory dysfunction
Heart failure: laying down or increased fluid retention
Respiratory: with exertion
What sound do you expect to hear when percussing the abdomen?
Tympany
pH 7.35
PCO2 55
HCO3 28
Compensated Respiratory Acidosis
What type of sound would you expect to hear over a solid organ when percussing the thorax?
Dullness
A client is exhibiting decorticate posturing. This indicates damage to which area of the brain?
Cerebrum
What change would you expect on an ABG if someone is hyperventilating
Decreased PaCo2: Respiratory Alkalosis
What assessment "sign" could indicate cholelithiasis and how is it performed
Murphy sign
PaO2 85
PaCO2 44
pH 7.43
HCO3 25
normal ABGs
May have decreased hearing, sight, taste, and smell
May notice intentional tremors
Reduced muscle mass
Slower gait, my have difficulty walking heel to toe
Pain sensation and coordination may be decreased
May have decreased response to DTR tests
Thinking and reasoning would be difficult for a client with damage to what area of the brain?
Frontal lobe
Explain inspiratory reserve volume.
Volume of air forcefully able to breathe in after normal inhalation
In what order do you complete a comprehensive abdominal assessment?
inspection, auscultation, percussion, palpation
PaO2 72
pH 7.31
PaCO2 33
HCO3 17
metabolic acidosis, partially compensated with hypoxemia
List 3 of the 4 reasons that hemoglobin increases it's affinity for oxygen
alkalosis (increased pH)
decreased PaCO2
Decreased temp
decreased 2, 3 DPG
A resident fell at the nursing home, how would you complete a neuro check?
LOC/orientation
VS
Pupils
Strength/movement of extremities
When could make SaO2 monitoring inaccurate?
(give 3 examples)
carboxyhemoglobin (smoking)
methemoglobin (nitrate/lidocaine therapy)
vasoconstriction
shock
severe anemia
What are various causes of abdominal distention? Name 4
Fetus, Fat, Flatus, Fibroid, Fluid, Feces
Which of the following ABG results are most concerning:
pH: 7.35 PaCO2: 52
PaO2: 82 HCO3: 22
PaCO2
What are 3 ways to test for meningeal irritation
Neck mobility
Brudzinski sign
Kernig sign
(pg 602)
Ask the client to identify the number of points when touched by 2 ends of the applicator at the same time.
What are 3 of the 4 factors that affect alveolar-capillary gas exchange
surface area
thickness of aveolar-capillary membrane
Partial pressure of gas
solubility of gas
Explain rebound tenderness.
Performing moderate to deep palpation in the RLQ at 90 degrees, with the expectation that pain will increase when pressure is removed.
pH: 7.54 PaO2: 84
PaCO2: 30
HCO3: 28
Metabolic and Respiratory Alkalosis
When hyper-resonance is noted during percussion of the lungs, what does that indicate?
Air-trapping such as COPD or pneumothorax