CV/PV 1
How would you auscultate a carotid artery?
Have the patient hold their breath, place the stethoscope over the artery, listen for bruits.
Name the different types of LOC
Alert: Awake and responsive. Responds appropriately
Lethargy: Opens eyes, answers questions but falls back asleep
Stupor: Responds to painful stimuli/extreme shaking but gives inappropriate verbal responses. Falls back asleep
Coma: No arousal. Eyes stay closed
Stupor vs Lethargy
Stupor- Awakens to vigorous shaking/painful stimuli and falls back asleep
Lethargy- Drowsy/sleepy
What does CMST stand for? Give an example for each category.
The acronym you use when completing a Peripheral Neurovascular assessment
Circulation: inspecting hair distribution, skin integrity and nails. Palpating pulses, capillary refill time, and edema.
Movement/Moisture: muscle strength, flexion and extension, and if the area is dry/has moisture
Sensation: light & deep sensation.
Temperature: palpating the skin using the back surfaces of your hands
How do you hold an extremity when preforming passive ROM?
Below the joint, never above.
Where do you auscultate heart sounds?
All People Enjoy Time Magazine
A-Aortic valve (right 2nd intercostal space)
P: Pulmonic Valve (left 2nd intercostal space)
E: Erb's point (left 3rd intercostal space)
T: Tricuspid Valve: (lower left sternal border 4th intercostal space)
M: Mitral Valve: (Left 5th intercostal space, medial to midclavicular area)
What 6 categories do you want to assess during a neuro assessment?
1. Vital signs
2. Mental Status
3. Cranial nerves
4. Motor/cerebellar system
5. Sensory
6. Reflexes
Graphesthesia vs Stereognosis
Graphesthesia- Identifies a number written in their hand with their eyes closed
Stereognosis- Identifies a common object by feeling it with their eyes closed
Heart sounds: S3 and S4. When are they heard? When are they normal/abnormal?
S3: Ventricular gallop heard after S2. Normal in children (<8/yo)/pregnant women, abnormal in older populations (may be a sign of fluid overload/HF)
S4: Atrial gallop, heard before S1. Normal in trained athletes or older adults. It may be a sign of HTN, coronary artery disease, or aortic/pulmonary valve stenosis.
Define Lordosis: When is this usually seen?
Exaggerated curvature of the lumbar spine. Seen with obesity or pregnancy due to the extra weight that is put on the lower abdomen
What is claudication? How do you make it better?
Pain caused by exercise due to a lack of blood flow to that extremity.
Relieved by rest
What 3 categories do you assess during the Glasgow Coma scale? What is the scale?
Eye opening response, motor response, verbal response. Scale is 3-15. 3 is Coma, 15 is alert
Dysphagia vs Dysphasia
DysphaGia- Difficulty swallowing (think g for gag)
DysphaSia- Difficulty speaking (think s for speak)
When would you check for a pulse deficit? What is a pulse deficit?
When you listen to the apical pulse for 60 seconds and notice that it is irregular.
Pulse deficit: Apical pulse is greater than radial pulse. When the HR is irregular and does not pump enough blood to the peripheral extremities. Have one nurse check the radial pulse while you listen to the apical pulse. Subtract apical pulse from radial pulse to determine if there is a pulse deficit (radial less than apical)
Define Kyphosis: When is it usually seen?
Exaggerated curvature of the thoracic spine leading to "hunchback/slouching." Usually related to osteoporosis or osteoarthritis so it is seen in older adults
What are the 6 P's of arterial occlusion=limb ischemia (lack of blood flow through an artery leading to tissue death)
Pallor, pain, paresthesia, paralysis, pulseless, poikilothermic (inability to regulate temperature)
Mini Mental Status Exam. What are the score ranges? What does it test for?
You can score up to 30 points, anything less than 18 is severe cognitive impairment. Tests for recall, orientation, and language. Useful for detecting delirium and dementia.
Aphasia vs Dysarthria
Aphasia- Unable to speak/form words (dysphasia is difficulty speaking)
Dysarthria- Difficulty speaking due to muscle impairment (garbled words)
Arterial Insufficiency vs Venous insufficiency
Arterial Insufficiency: Trouble getting blood to the toes. Pain worsens during activity/subsides with rest (claudication)
Venous Insufficiency: Trouble getting blood from the lower extremities back to the heart. Pain worsens when standing/subsides with elevation and rest.
Muscle Strength Scale: What are the ranges? How do you test it?
0-5. 0: No contraction, 1: Slight contraction, 2: Passive ROM (moves w/ gravity and assistance), 3: Can move against gravity, 4: Moves against some resistance, 5: moves against full resistance
Arterial ulcers vs venous ulcers
What are they caused by? What would they look like?
Venous: Pooling of blood in lower extremity=increased pressure in veins. irregular shape, edema, increased drainage, lower legs/ankles, shallow and superficial
Cranial Nerves: III, IX, X, XII
3- Oculomotor: Controls the reaction to light, pupil constriction/dilation, open and close eyelids
9- Glossopharyngeal: Ability to swallow, gag reflex. Sensory taste on posterior 1/3 of tongue
10- Vagus: Swallowing, sensation of pharynx. Controls upper soft palate. Assess by having them say "ah"
12- Hypoglossal: Movement/strength of tongue (midline, side-side) and movement of food in the mouth
What are the two types of aphasia?
Aphasia- Unable to speak.
Expressive aphasia: You know what to say, but you have trouble expressing it/forming the words
Receptive aphasia: You hear what they are saying, but you have a hard time making sense of the information (receiving the information)
Edema scale vs pulse scale. What are the ranges of the Edema scale? What are the ranges of the pulse scale/what do they mean?
Edema: 1-4 0: No edema 1+: 2mm depression, barely detectable 2+: 4mm depression (rebound is a few seconds), 3+: 6mm pit 10-12 second rebound, 4+: 8mm deep pit, greater than 20 seconds to rebound
Pulse Scale: 0-3. 0: Absent (validate finding), 1+: diminished/weak/thready 2+: Normal/strong 3+: Bounding
Shuffling, uncoordinated gait
Ataxia
(Walking to a taxi while carrying luggage=uncoordinated)