Scott Gardner TCC Nursing Q1F04 Unit Four

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Describe SOB: Shortness of breath.
Describe Dyspnea: Difficult or labored breathing; shortness of breath (Lecture).
Describe Pulse Deficit: The difference between the apical pulse and the radial pulse rates -a condition in which the peripheral pulse rate is less than the ventricular contraction rate as assessed by auscultation at the PMI). Indicates a lack of peripheral perfusion.
Describe Pulsations: Throb/rhythmical beat of the heart
Describe Posterior Tibial Pulse: Inner side of ankle, below the medial malleolus. Assess circulation to the foot.
Describe Dorsalas Pedis Pulse: Top of the foot, between extension tendons of great 1st toe. Assess circulation to the foot.
Describe Popliteal Pulse: Behind the knee in the popliteal fossa. Assess circulation to the lower leg.
Describe Femoral Pulse: Femoral artery, below inguinal ligament, midway between symphysis pubis & anterior superior iliac spine. This site is used to assess the character of the pulse during physiological shock or cardiac arrest when other pulses are not palpable. Used to assess circulation to the leg.
Describe Temporal Pulse: Over temporal bone of head. Easily accessible site used to assess pulse in children (Potter p.638).
Describe Ulnar Pulse: Ulnar side of forearm at wrist. Used to perform an AllenÂ’s test (Potter p.638).
Describe Radial Pulse: Pulse of the radial artery palpated at the wrist over the radius; commonly used; easily palpated; if abnormal, intermittent or inaccessible, then the apical pulse is used
Describe Brachial Pulse: Pulse of the brachial artery, palpated in the ante-cubital space. Best for infants and children.
Describe Carotid Pulse: Along medial edge of sternocleidomastoid muscle in neck. Easily accessible site used during physiological shock or cardiac arrest when other sites not palpable (Potter p.638).
Describe Apical-Radial Pulse: Comparison of the apical and radial pulse. One nurse auscultates the apical pulse as another nurse palpates the radial pulse and then the numbers are compared. The difference is the pulse deficit.
Describe Apical Pulse: Heartbeat heard with a stethoscope placed on the chest wall adjacent to the cardiac apex- at the level of the 5th intercostals space just medical to the midclavicular line. May provide a more accurate assessment of the heart function if medications that effect HR have been taken. Assess by auscultation (not palpated). Best place to take pulse on an infant.
Describe Jugular veins: Internal and external jugular veins run bilaterally from the head and neck and drain into the superior vena cava. The internal jugular vein lies deeper, along the carotid artery (Potter p.729).
Describe Bronchovesicular Â– breath sound.: Normal sounds that occur between the sounds of the bronchial tubes and those of the alveoli or a combination of the two sounds.
Describe Vesicular Breath Sound: Normal sounds of rustling or swishing heard with a stethoscope over the lung periphery. It is characteristically higher pitched during inspiration and fades rapidly during expiration.
Describe Accessory muscles: Include sternocleidomastoid, trapezius and abdominal muscles. The accessory muscles move little with normal passive breathing. When a client requires effort to breath as a result of strenuous exercise or disease, the accessory muscles and abdominal muscles contract (Potter p.721-722).
Describe Barrel Chest: An increased anteroposterior chest diameter caused by increased functional residual capacity due to loss of elastic recoil in the lung. It is most often seen in patients with chronic obstructive pulmonary disease (i.e., chronic bronchitis and emphysema).
Describe Cyanosis: Bluish skin color caused by an increased amount of deoxygenated hemoglobin (Potter p.691).
Describe Hypoxia: 1. An oxygen deficiency.
2. A decreased concentration of oxygen in the inspired air.
Describe Somnolence: Sleepiness, the state of feeling drowsy, ready to fall asleep (Medical Dictionary).
Describe Edema: (pitting and non-pitting)
abnormal accumulation of fluid in the interstitial spaces of tissues such as pericardial sac, interstitial space, peritoneal cavity, or joint capsules. Can be caused by CHF or venous obstruction. Pitting edema is characterized by a condition in which pressing on the edema results in a temporary depression (skin does not bounce back right away)
Describe Tactile Fremitus: A tremulous vibration of the chest wall during speaking (99,99,99) that is palpable upon physical exam; decreased when the vibrations from the larynx to the chest wall are impeded by obstruction such as pleural effusion of pneumothorax. Increases in pneumonia.
Describe Orthopnea: The inability to breathe easily unless one is sitting up straight or standing erect (Lecture).
Describe Respiratory excursion: Verify
Describe Breath Sounds: Sounds heard as air moves through the tracheobronchial tree. Includes normal breath sounds (vesicular, broncovesicular and bronchial), as well as adventitious sounds (Potter p.720).
Describe Adventitious Sounds: Inappropriate sounds heard upon auscultation of the lungs; a breath sound that is not normally hears; crackles, gurgles, or wheezes; may be superimposed or normal breath sounds
Describe Pleural friction rub: Dry grating quality; abnormal coarse grating sound heard on auscultation of the lungs during late inspiration and early expiration occurs when the visceral and parietal pleural surfaces rub against each other; the sound is not affected by coughing; heard over anterior lateral lung field if client is sitting upright.
Describe Rhonchi: Gurgles Â– abnormal sound heard on auscultation of an airway obstructed by thick secretions, muscular spasm, neoplasm or external pressure. The continuous rumbling sound is more pronounced during expiration and characteristically clears on coughing whereas gurgles do not. Primarily heard over trachea & bronchi; loud, low pitched rumbling, coarse; may be cleared by coughing.
Describe Wheezes: High-pitched, continuous musical sounds heard during inspiration or expiration but generally louder on expiration. Caused by high-velocity airflow through severely narrowed bronchus (Potter p.721).
Describe Crackles: rales Â– common, abnormal respiratory sound consisting of discontinuous, bubbling noises heard on auscultation of the chest during inspiration. Most commonly heard in dependent lobes: right and left lung bases.
Describe Menopause: : Disruption of the cyclical rhythm involved in menstruation and ovulation. Occurs mainly because of the inability of the neurohormonal system to maintain its periodic stimulation of the endocrine system. The ovaries no longer produce estrogen and progesterone and the blood levels of these hormones drop markedly. Typically occurs between the ages of 45 and 60 (Potter p.227).
Describe Sexual response cycle: The four phases of biologic sexual response: excitement, plateau, orgasm, ands resolution
Describe Menarche: Onset of menstrual cycle
Describe Menstrual Cycle: Recurring cycle of change in the endometrium layer during which the decidual layer of endometrium is shed, then re-grows, proliferates, is maintained and then is shed again. About 28 days.
Describe Infertility: Condition of being unable to produce offspring (compared to sterility Â– unable to conceive or produce offspring)
Describe Safe Sex Â–: Using condoms or other means to prevent the exchange of body fluids that transmit disease during intimate contact. There is no perfectly safe sex except abstinence.
Describe Prenatal Care: Monitoring and management of the pregnant client to prevent complications with pregnancy and promote healthy outcomes for mother and infant
Describe Puerperium: A period of approximately 6 weeks after delivery. During this time the body reverts to itÂ’s pre-pregnancy physical status (Potter p.224). Also known as post-partum.
Describe Third Trimester: 28 weeks to delivery
Describe Second Trimester: 12 to 28 weeks
(closer to 4 months long)
Describe First Trimester: From the 1st day of the last menstrual period to the end of 12 weeks
Destribe Amniocentesis: Procedure to remove a small amount of amniotic fluid for laboratory analysis performed between 16-20 weeks to dx fetal abnormalities. Ultrasound is used to make sur the needle placement into the uterus does not scratch fetus or puncture the placenta
Describe NST: Non stress test Â– an evaluation of the fetal heart rate response to natural contractile activity or to an increase in fetal activity (aka Fetal Activity Determination)
Describe CST: Oxytocin stress test Â– assesses intrauterine function of the fetus and the placenta; performed to evaluate the ability of the fetus to tolerate the continuation of the pregnancy or the anticipated stess of L&D
Chorionic villi sample: Sampling of placental tissues for prenatal dx of potential birth defects, obtained through inserting a catheter into the womb
Alpha fetoprotein: Blood test used to assist in diagnosing certain neoplastic conditions (new & abnormal development or cells); Elevated AFP may indicate neural tube defects. (It can also indicate hepatoma, some tumors, teratomas, Hodkins, lymphoma, renal cell carcinoma, and cirrhosis, but I donÂ’t think this applies to the fetal monitoring)
Describe Sonogram: Also known as ultrasound. High frequency sound waves (over 20kHz) are used to create an image of the fetus
Describe Diagnostic Tests During Pregnancy: Fill in from Presentations
Describe the primary goal of nursing for the maternity family: Maternity nursing is the care of women and their families during pregnancy and parturition and through the 1st days of puerperium. The goal is to identify existing risk factors and other deviations from normal so that pregnancy outcomes are enhanced.
Describe the family unit and family forms, including:: Current trends- marital roles are changing as two family incomes become more prevalent; increase in adolescent pregnancy; homelessness; family violence

New family forms- family forms are patterns of people considered by family to be included in the family. New family forms include cohabitating couples, couples with no children, nuclear families, single parent families, extended families, reconstituted families (also known as blended families), multi adult families, skip generation (grandparents raising their grandchildren), communal groups with groups, homosexual families

Factors influencing family forms: people marrying later in life, divorce and remarriage, single parent families, families having fewer children or no children, marital roles changing, adolescent pregnancy
Describe Internal and External Male Reproduction: Male Reproduction
What do pregnency tests check for?: Chorionic Gonadotropin. HCG
When are OTC Pregnancy Test first accurate, and what do they use as a test medium?: After 26 Days
When can HGC be detected in the blood?: 3 Days
Name the 3 General Topics for Fetal Assessment?: Amniotic Testing

Doppler

Bio Physical Profile
Normal Growth and Development of Unborn Child During 1st Trimester: Fill In From Presentations
Normal Growth and Development of Unborn Child During 2nd Trimester: Presentation Fill In
Normal Growth and Development of Unborn Child During 3rd Trimester: Fill In From Presentations
Describe Epigastric area: Superior to the umbilical region
The upper middle region of the abdomen.
Describe Erbs Point: L 3rd ICS

Murmurs best heard here
Describe Pulmonic Area: L 2nd ICS (right ventricle to lungs)
Describe Mitral area: L 5th ICS, mid clavicular line
(left atrium to left ventricle)
Describe Tricuspid area: L 5th ICS (right atrium to right ventricle)
Describe Apical Area: A pulse felt or heard over the apex of the heart.
Describe Palpitations: Unpleasant sensations of irregular and/or forceful beating of the heart.
Describe PMI: Point of maximal impulse. Where the apex of the heart touches the anterior chest wall at approximately the 4th to 5th intercostal space just medial to the left midclavicular line (Potter p.723).
Describe Murmur: Sustained swishing or blowing sounds heard at the beginning, middle of end of the systolic or diastolic phase. Caused by increased blood flow through a normal valve, forward flow through a stenotic valve or into a dilated vessel or heart chamber, or a backward flow through a valve that fails to close (Potter p.726).
Describe S4: Fourth heart sound that may be heard. Caused by the atria contracting to enhance ventricular filling. Abnormal and should be reported to the physician (Potter p.724). Â“TennÂ” in Â“TennesseeÂ”
Describe S3: Third heart sound that may be heard. Caused by the rapid refilling of the ventricle (Potter p.724). Â“ckyÂ” in Â“KentuckyÂ”
Describe S2: The second heart sound, desribed as Â“dubÂ”. Occurs as the aortic valve closes.
Describe S1: The first heart sound, described as Â“lubÂ”. Occurs just before the ventricle contracts, as the mitral valve closes to prevent regurgitation of blood into the atrium
(Potter p.724).
Describe Doppler: A form of ultrasound that can detect and measure blood flow. Doppler ultrasound depends on the Doppler effect, a change in the frequency of a wave resulting here from the motion of a reflector, the red blood cell (Medical dictionary).
Describe Claudication: An aching, crampy, tired, and sometimes burning pain in the legs that comes and goes. The usually intermittent nature of the pain is due to narrowing of the arteries that supply the leg with blood, limiting the supply of oxygen to the leg muscles, a limitation that is felt especially when the oxygen requirement of these muscles rises with exercise (Medical Dictionary).
Describe Dysrhythmia: Failure of the heart to beat at regular successive intervals. A dysrhythmia threatens the hearts ability to provide adequate cardiac output (Potter p.644,725).
Describe Split heart sounds: Verify
Describe Diastole: The other phase of the cardiac cycle. During diastole the ventricles relax and the atria contract to move blood into the ventricles and fill the coronary arteries (Potter p.724).
Describe Systole: One of the two phases of the cardiac cycle. During systole the ventricles contract and eject blood from the left ventricle into the aorta and from the right ventricle into the pulmonary artery (Potter p.724).
Describe Lymphatics: Superficial inguinal nodes palpated during examination (Potter p.735). The vertical group is located close to the upper portion of the great saphenous vein. The horizontal group lies below the inguinal ligament.
Describe Phlebitis: Inflammation of a vein that occurs commonly after trauma to the vessel wall, infection, prolonged immobilization and prolonged insertion of IV catheters (Potter p.734).
Describe Varicosity: Superficial veins that become dilated, especially when the legs are in a dependant position (Potter p.734).
Describe Pedal Pulse: A Pulse of the foot.
Describe Peripheral pulse: Palpable bounding of blood flow noted at various peripheral points on the body. An indicator of circulatory status
(Potter p.637).
Describe pulsation: The rhythmic beat, as of the heart and blood vessels; a throbbing.
Describe Dorsalis pedis pulse: Along top of foot, between extension tendons of great and first toe. Used to assess circulation to foot (Potter p.638).
Describe Bronchovesicular: Normal breath sound. Blowing sounds that are medium pitched and medium intensity. Inspiratory phase is equal to expiratory. Created by air moving through large airways. Best heard posteriorly between capulae and anteriorly over bronchioles lateral to sternum and first and second intercostal spaces (Potter p.720).
Describe Vesicular: Normal breath sound. Soft, breezy and low pitched. Inspiratory phase is three times longer than expiratory. Created by air moving through smaller airways. Best heard over lungs periphery (Potter p.720).
Describe Edema (pitting and non-pitting): Condition caused by a buildup of fluid in the tissues. Causes swelling. When pressure from the examinerÂ’s fingers leaves an indention in the edematous area, it is called pitting edema. The degree of pitting is graded on a 1+ to 4+ scale, with 4+ being the most pitting (Potter p.691).
Describe Tactile Femitus: Vibrations caused by sound waves transmitted through the lung to the chest wall. The accumulation of mucus, the collapse of lung tissue, or the presence of lung lesions can block the vibrations from reaching the chest wall. To palpate for tactile fremitus, the nurse places the hand over symmetrical intercostal spaces and asks the client to say Â“ninety nineÂ” (Potter p.718).
Describe Rhonchi (gurgles): Loud, low-pitched, rumbling coarse sounds heard most often during inspiration or expiration; may be cleared by coughing. Caused by muscular spasm, fluid or mucus in larger airways causing turbulence (Potter p.721).
Describe Coarse crackles: Loud, bubbly sounds heard most often during inspiration or expiration; may be cleared by coughing.
Describe Medium crackles: Lower, more moist sounds heard during middle of inspiration; not cleared with coughing.
Describe Fine crackles: High pitched, short, interrupted crackling sounds heard during end of respiration, usually not cleared with coughing.
Describe Crackles (rales): Caused by random, sudden reinflation of groups of alveoli (Potter p.721).
Describe Sterilization: Aside from abstinence, sterilization is the most effective contraceptive method. Female sterilization, or tubal ligation, involves cutting or tying the fallopian tubes. Male sterilization, or vasectomy, the vas deferens which carries sperm away from the testicles, is cut and tied.
Describe Cervical cap: Similar to a diaphragm except it only fits over the cervix (82-95%).
Describe Diaphram: Round rubber dome that has a flexible spring around the edge. It must be used with a contraceptive cream or jelly and is inserted into the vagina so that it provides a barrier over the cervical opening (82-97% effective).
Describe IUD: Plastic device inserted into the uterus through the cervical opening. Results in the lining of the uterus being less favorable for the implantation of the fertilized ovum.
Describe Hormonal contraception: Includes oral contraceptive pills (97-99% effective), intramuscular injection, subdermal implant, and transdermal skin patches. Hormonal contraceptives alter the hormonal environment to prevent ovulation and thicken cervical mucus.
Describe Barrier methods:: Include condoms, which prevent entrance of sperm into the vagina and spermicidal products (i.e. creams, jellies, foams, and sponges), which create a spermicidal barrier between the uterus and ejaculated sperm. For maximum effectiveness condoms and spermicides should be used together.
Describe Sexual response cycle:: Involves three phases: desire, arousal, and orgasm. All three phases are the result of vasocongestion and myotonia, the basic physiological responses of sexual arousal
(Potter p.525).
Describe Infertility:: The persistent inability to conceive a child. Refers to a prolonged time to conceive. An estimated 10-15% of reproductive couples are infertile. However, about half are able to conceive after being treated at an infertility clinic (Potter p.222).
DEscribe Safe sex: Sexual activity in which safeguards, such as the use of a condom and the avoidance of high-risk acts, are employed to reduce the chance of acquiring or spreading a sexually transmitted disease (yahoo reference dictionary).
Describe First trimester:: The first 3 calendar months of pregnancy. Includes conception through the 12th week (Potter p.174).
Define a Thrill: An abnormal tremor accompanying a vascular or cardiac murmur felt on palpation.
Defint Bruit: An adventitious sound of venous or arterial origin heard on auscultation.
When auscultating for Heart Sounds what pitch is heard with the bell?: Low Pitched Sounds.
When auscultating for Heart Sounds what pitch is heard with the diaphram?: High Pitched Sounds
Name the Six Cardinal Cardial Areas: Aortic
Pulmonic
Erbs Point
Tricuspid
Mitral
Define Murmurs: Defined by: Sustained swishing or blowing sounds
Can be asymptomatic or have Sn/Sx
Caused by:
Increased blood flow through a normal valve

Forward flow through a stenotic valve or a dilated vessel or heart chamber
Backward flow through a valve that fails to close
Grading Scale for Murmors: Grading Scale
Scale is 1 to 6
1: Very faint, heard only after listener tuned in, may not be heard in all positions
2: Quiet, but heard immediately after stethoscope place on chest
3: Moderately loud
4: Loud
5: Very Loud can be heard with stethoscope partly off chest
6: Very Loud can be heard with stethoscope completely off chest
Define Clicks: High pitched extra heart sounds created by:
Mitral valve prolaspe
Aortic stenosis
Prosthetic valves
Pulmonic disease
Inspection of Jugular Veins: Inspect in both lying and sitting positions

Supine the external jugular distends and is easily visible

Sitting/Standing should flatten
Observe for jugular vein distention
Define Grading for Periferial Arteries: Grading criteria
0 = absent
1 = weak
2 = normal
3 = full
4 = bounding
Describe Developmental Considerations for Infants in Respiration.: Nose breathers
Irregular respiration patterns
Abdominal breathers
AP:lateral ration 1:1
Describe Developmental Considerations for Pregnant Women in Respiration.: Increased oxygen demands
Diaphragm rises
Describe Repiratory Considerations for Older Adults.: Decreased surface area
Decreased breathing and lung capacity
Increased dead space
Describe Cultural Considerations in Respiration: Chinese Americans have smaller chests than Caucasians

African Americans in urban areas have higher incidence of respiratory disease

Appalachians have high incidence of black lung, TB and emphysema

Irish have higher incidence of respiratory disease from coal mining

Navajo Indians have increased risk related to close living quarters
Describe the function of respiration.: Exchange of gases between air and body

Warms, moisten, and filter air

Assist with acid-base balance

Assists with maintaining water balance

Assist with speech
Define Egophony: An abnormal change in tone, somewhat like the bleat of a goat, heard in auscultation of the chest when the subject speaks normally.

It is associated with bronchophony and may be heard over the lungs of persons with pleural effusion, or occasionally pneumonia.
Define Bronchophony: An abnormal increase in tone or clarity in vocal resonance.
Defing Whispered Pectoriloquy: A sound heard in auscultation of the chest over a lung with a cavity of limited extent when the patient whispers.
Why is folate important in Pregnancy?: Helps prevent Spina Bifida, Cleft Palate and Heart Defects.
Which of the three trimesters are teratogens the MOST Dangerous?: The first when rapid organ development is taking place.
How can poor dental care (gum disease) affect pregnancy?: Premature delivery with low birth weight.

Might be due to microbes from gum disease affecting the placenta in 3rd Trimester
How early do brests begin to tingle during pregnancy?: Sixth Week
What happens to the Uterus between the 1st and 2nd Trimester?: It is no longer considered a Pelvic Organ, bur rather an abdominal one.
What happens to the Vagina during pregnancy?: The vaginal mucosa thickens.
Connective Tissue loosens.
Smooth muscle hypertrophies
Becomes more sensitive
Mucus fills the endocervical canal creating the mucus plug
When are contractions considered Preterm Labor?: Before 37 Weeks of Pregnancy
Define Leukorrhea: Yellowish White Vaginal Discharge
When can fetal heart sounds begin to be heard with an ultrasound stethoscope?: By the end of the 3rd Month.
What is appropriate Weekly Weight Gain during pregnancy?: 0.3 to 0.5kg per week.
How much does the Basic Metabolid Rate of the mother increase during the second trister?: The BMR increase is between 15-20%1
What does the term Quickening refer to during pregnancy?: The feeling of life in the womb.
Describe Bladder "Fullness" during the 3 stages of pregnancy.: 1st Trimester uterine expansion puts pressure on bladder.
2nd Trimester uterus expands into abdominal cavity relieving pressure temporarily
3rd Trimester, fetus settles back on bladder causing pressure again
What does Progesterone do to the bladder during pregnancy?: It causes smooth muscle to relax, which allows the urinary bladder capacity to double.
How much does glomerular filtration increase during pregnancy?: As much as 50%
Define Acroesthesia: Pain, numbness or tingling in the extrematies.
What happens to heartrate during pregnancy?: Increases 10-15 BPM
What is Preeclampsia, and when can it develop?: A complication of pregnancy characterized by increasing hypertension, proteinuria, and edema.

The condition develops between the 20th week of gestation and the end of the first postpartum week; however, most commonly it occurs during the last trimester
What are striae gravidarum?: Stretch Marks
What is the first system to function in the developing human?: Respiration. Begins week 4-17. Earliest respiration seen is 11th week.
When does embryonic sex differentiation begin?: During the 7th Week.
Define Amnion: The innermost fetal membrane that holds the fetus suspended in the famiotic fluid.
When during development does the fetus have enough surfactant to provide a good chance of survival?: After 32 weeks
What is meconium?: Dark Green to black tarry substance that accumulates in the intestines of the infant.

GI System mature by 36 weeks.
How many days and weeks is full gestation?: 266 Days
38 Weeks

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