Neuro
What are three changes in elderly adults that may alter an assessment of the cranial nerves?
1)Decrease in taste and scent sensations
2)Decrease in ability to see
3)Decrease in ability to hear
4)Presence of intentional tremors
5)Reduced muscle mass/degeneration of muscle fibers
6) Diminished DTR
Explain three points to differentiate types of chest pain.
Pleuritic pain: Sharp, knifelike, persistent, aggravated by inspiration, coughing
Cardiac pain: Retrosternal, radiates, pressing, squeezing, heavy, aggravated by exertion
Gastrointestinal: Retrosternal, may radiate to back, burning, squeezing, aggravated by large meal, bending over or lying down
What are two positive findings or "signs" that indicate an inflamed appendix?
2. Positive obturator sign (pain in RLQ) when flexing hip and knee and rotating
3. Positive Rebound tenderness or Blumberg sign
Interpret the following
pH 7.35
PCO2 55
HCO3 28
Compensated Respiratory Acidosis
WHY?
1) Chest trauma/dysfunction
2) Chest muscle weakness
3) Chronic lung disease
4) Neuromuscular disorders
5) Oversedation (dampened respiratory effort)
What is the love of the brain affecting communication, emotions, reasoning ability, judgment and behavior?
Frontal
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
By pressing your fingertips under the liver boarder at the right costal margin, asking the client to inhale deeply, causing an accentuated sharp pain.
PaO2 85
PaCO2 44
pH 7.43
HCO3 25
normal ABGs
1) Hypertension
2) Diabetes
3) Heart Disease
4) Obesity
5) Medications: NSAIDS, birth control pills
6) Smoking
F-Face drooping
A-Arm Weakness
S-Speech Difficulties
T-Time to call: Time loss is brain loss
Decreased or limited breath sounds over lung fields during auscultation may indicate (list 2)?
1) Decreased tidal volume
2) Mucous plug or blockage by secretions
3) Pneumothorax
4) Pleural effusion
In what order do you complete a comprehensive abdominal assessment?
inspection, auscultation, percussion, palpation
What underlying conditions may be present with this patient?
PaO2 85
pH 7.31
PaCO2 38
HCO3 17
1) Renal Dysfunction
2) Diabetic Ketoacidosis
3) Lactic Acidosis r/t sepsis or trauma
4) Diarrhea
5) Severe Dehydration
List 2 reasons that pulse oximeters may be inaccurate:
1)Carboxyhemoglobin
2) Melanotic Skin
3) Poor peripheral perfusion
4) Clinical situation (inaccurate reading due to inaccurate assessment techniques or malfunction of equipment) *ABG Quick Interp handout
A resident fell at the nursing home, how would you complete a neuro check?
LOC/orientation
VS
Pupils
Strength/movement of extremities
List one indication leading to subcutaneous emphysema or crepitus within the thorax
1) Open injury to thorax
2) Chest tube placement
3) Extreme consolidation or congestion
What are various causes of abdominal distention? Name 4
Fetus, Fat, Flatus, Fibroid, Fluid, Feces
List four points that may have a negative impact on oxygenation and gas exchange:
1) Fluid overload
2) Decreased Hemoglobin
3) Constricted airway
4) Hypo/Hyper ventilation
What are 3 ways to test for meningeal irritation?
Neck Mobility (With consideration for stability)
Brudzinski sign
Kernig sign
(pg 602)
What are some indications of increased Intracranial pressure?
1) Headaches that subside after arising
2) Restlessness following a traumatic brain injury
List two older adult considerations that may impact respiration and gas exchange.
2) Loss of lung resiliency and increased rigidity
3)Fewer functional capillaries
4)Loss of elasticity
5) Calcification of cartilage and decreased muscle
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.
Pick your Priority:
pH: 7.54 PaO2: 35
PaCO2: 30
HCO3: 28
Pa02 < 40 is emergent and requires at minimum supplemental 02 and possible mechanical ventilation
When hyper-resonance is noted during percussion of the lungs, what does that indicate?
Air-trapping such as COPD or pneumothorax