Cardiac
The spots you listen for cardiac sounds
what is aortic, pulmonary, erbs point, tricuspid, and mitral
air moving through narrow airways; high pitched musical sound
Wheezes
SWADDLES
size, wound edges, approximation, drainage, dressing, location, edema, surrounding skin color
flexion at the ankle
dorsiflexion
sensory stimulation increases, may motivate people to make changes or engage in goal directed activity
mild
Name the sounds heard by the heart
S1 lub S2 dub
collapse of the alveoli, results in poor gas exchange
atelectasis
bone may visible, tissue loss with slough or eschar present
stage 4 pressure ulce
extends at the ankle, foot points inferiorly
plantar flexion
focus on self, loss of rational thought, some cant communicate verbally, delusions or hallucinations or suicidal
panic
abnormal heart sound
Cheyne Stokes
intact skin, may be darker skin color,
Stage 1
increased thoracic curvature, normal finding in older adults
kyphosis
primitive survival skills take over, cognitive skills decrease, chest pain
4+ is equal to how many millimeters for pitting edema?
8 mm
rapid respiration usually deep and regular
Kussmaul
avoid scrubbing, pat dry, clean with gentle surfactants
cleaning of wounds
exaggerated lumbar curve, common in pregnant and obesity
lordisis
difficulty concentrating, nervous or agitated
moderate
how to chart pulse strength
equal and bilaterally
inspiration only;harsh, loud, high pitched, generally a blockage of the airway
stridor
wound bed is visible, pink or red, moist and slough not present
stage 2 pressure ulcer
lateral curvature, common in school age kids
scolisosis
illness, death in family, surgery, divorce, or chronic problems
risk factors for depression