Report or Not report!
new onset of pain
pain is local, throbbing in the lower leg
What is report?
*Nociceptive - somatic
A client that reports smoking 2 packs a day for 31 years
What is 62 pack years?
Delay in the skin returning to normal place...
Can be caused by dehydration
What is tenting?
Fine to course bubbly sounds in the lungs
What are crackles?
Sit at "this" angle when communicating with your clients
What is at an angle facing your client?
pulse oximetry 95%
A client that reports smoking 1/2 pack a day for 44 years
What is 22 pack years?
Accumulation of fluid in the tissues
What is edema?
High pitched whistling, musical sounds in the lungs
What are wheezes?
guides conversations to important areas especially if patient is rambling – “Let’s talk more about …”
What is focusing?
What is report?
Clients respirations
regular rate
counted "8 for 30 seconds"
What are 16 respirations per minute?
When assessing upper and lower extremities, think CMS!
What is circulation, motion and sensation?
Bowel sounds that occur irregularly 5 to 35 in a minute
What are normoactive bowel sounds?
Restating the client’s feelings and thoughts more briefly in your own words to confirm understanding of what they said
What is paraphrasing?
Apical pulse 94 for adult
What is do not report?
39.2 degrees Celsius is "-----" Fahrenheit
What is 102.6 degrees Fahrenheit?
Apply firm pressure to nail bed to blanch it. Releasing pressure should lead to a quick return of color to nail bed. Should be less than 3 seconds.
What is capillary refill?
Listen to me for one full minute: left midclavicular line at the fifth intercostal space
What is the apical heart rate?
“Everything will be alright.” “There’s no need to worry.” Discourages open communication and does allow patient to express feelings
What is false resssurance?
PERRLA
What is (pupils, equal, round, react to light, and accommodate)?
103.2 degrees Fahrenheit is "-----" Celsius
What is 39.6 degrees Celsius?
Remember to do "this" for abdominal assessment...
What is inspect, auscultate and then palpate?
LOOK, LISTEN AND THEN FEEL
dry, grating, or rubbing sound in the lungs
What is a pleural friction rub?
These type of questions invite patients to take the conversational lead and elaborate on their thoughts.
What are open ended questions?