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Course loud rumbling sounds resulting from fluid or mucus
What are Ronchi?
Eyes blink when touched with cotton wisp
What is coronary reflex?
Gently work with the fingers around and into the hardened mass to break it up and then remove piece
What is digital removal of stool?
Have client turn head and shrug shoulders against the resistance
What is assessing the function of cardinal nerve XI (spinal accessory)
Client is able to open eyes and respond, but is drowsy and falls asleep read readily
What is lethargic level of consciousness?
Cough that produces frosty pink tinged sputum
What is a sign of pulmonary edema?
Identifies with the way another person feels
What is empathy?
A screening performed with the client seated or standing to test for balance
What is the Romberg test?
A shared system of beliefs, values and behavioral expectations provide social structure for daily living
What is culture?
Pearly, gray intact, and taut
What is the tympanic membrane?
A nurse threatens a patient. She will put a diaper on the patient if he does not use the urinal more carefully.
What is assault?
A vibrating tuning fork is placed on top of the clients head to assess hearing
What is the weber test?
Up with a good leg down with the bad leg
What is crutch walking on stairs?
This tool scores mental status, moisture mobility activity nutrition, friction, and sheer for pressure ulcer assessment
What is the Braden scale?
Bathing, oral care foot care and perineal care
What is personal hygiene?
Bathing, ambulation toileting, measuring vital signs
What are duties they are can delegate to unlicensed assistive personnel
The force the blood exerts against the wall of the arteries during constriction and relaxation of the heart
What is blood pressure?
Living will in healthcare proxy (durable power of attorney)
What are advanced directives?
Series of intermittent soft, clicks and gargles heard at a rate of 5 to 30 or 35/minutes
What are normal expected bowel sounds
A group of actions that include hand, hygiene, PPE and negative pressure rooms
What are airborne isolation precautions?
Client follows your finger with his eyes in an H pattern
What are the six cardinal fields of gaze
crackles riles wheezes rhonchi
What are adventitious’s breath sounds
Drainage with a mixture of serum and red blood cells appears light pink to blood tinge
What is serosanguineous drainage?
Illegal process by which a client has given written permission for treatment
What is informed consent?
Have client smiled, frown, puff out her cheeks, raise her eyebrows, close her eyes tightly and show her teeth
What assessment do you perform to test motor function of CN VII (facial)