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Health Assessment Final
Combined Health Assessment Flashcards
428
Nursing
Undergraduate 3
04/28/2013

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Cards

Term
What could cause weight loss?
Definition
-Anorexia
-Dysphagia
-Vomiting or Diarrhea
-Inability to absorb nutrients from GI tract
-Increased metabolic needs
-Food allergies
-Problems chewing
-Peer pressure
Term
What do you ask about during a nutritional ROS?
Definition
Ask about weight changes, fatigue, allergies, or problems in GI
Term
What should you ask about regarding health patterns and nutrition?
Definition
Ask about nutrition and exercise patterns
Term
What are some common or concerning symptoms related to nutrition?
Definition
-Changes in weight (unintended)
-Anorexia
-Changes in sense of taste or smell
-Difficulty chewing and swallowing
Term
A detailed nutrition history includes:
Definition
1. Food pattern
2. Personal food preferences
3. Food preparation
4. Finances
5. Accessibility
6. Patient health
7. Exercise Pattern
8. Body Image
9. Family health
10. Family dietary problems
Term
What are some ways you can do a nutrition screening?
Definition
-Admission nutrition screening tool
-24-hour diet recall
-Food frequency questionnaire
-Food diaries
-Direct observation
Term
What are the types of equipment you need to for a nutrition-related physical exam?
Definition
-Skinfold calipers
-Measurement tape
-Nutrition assessment form
Term
What is skinfold thickness exam?
Definition
Technique of measurement in which you repeat three measurements and then take an average
Term
BMI
Definition
Body mass index = weight in kg divided by height (m)2 or weight in lbs divided by height (in)2 x 703
Term
What are some signs of dehydration?
Definition
-Tachychardia
-Weak pulse
-Turgor on abdomen
Term
What should you look for during cardiovascular and peripheral vascular exam r/t nutrition?
Definition
-Measure pulse rate and amplitude
-Inspect arms and legs for edema (protein deficiency)
-Petechiae and ecchymoses (lack of vitamin A)
Term
What should you look for during HEENT exam r/t nutrition?
Definition
-Note dark circles under eyes
-Inspect mucus membranes for dryness, color, and intactness
-Enlarged thyroid gland
Term
What should you look for during GI exam r/t nutrition?
Definition
-Distension and ascites (protein deficiency)
-Turgor on abdomen (dehydration)
-Measure waist circumference (measure of central body fat)
Term
What should you look for during MSK exam r/t nutrition?
Definition
-Muscle wasting and flaccidity (protein deficiency)
-Bone pain and bowing of legs (lack of vitamin D)
Term
What should you look for during Neurologic exam r/t nutrition?
Definition
-Changes in mental status, irritability, inability to concentrate, paresthesias (dehydration and lack of vitamins)
Term
What are some signs of protein deficiency?
Definition
-Edema in arms and legs
-Distension/ascites of abdomen
-Muscle wasting and flaccidity
Term
What are the measurements of BMI?
Definition
Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25.0-29.9
Obesity I: 30.0-34.9
Obesity II: 35.0-39.9
Extreme Obesity III: >40
Term
What laboratory studies are important in nutritional assessment?
Definition
-Hemoglobin
-Hematocrit
-Cholesterol
-Triglycerides
-Total Lymphocyte count
-Skin Testing
-Serum Proteins
-Nitrogen balance
-Creatinine-height index
Term
Marasmus
Definition
Protein-calorie malnutrition
Term
Kwashiorkor
Definition
protein malnutrition
Term
Abnormal findings caused by nutritional deficiencies
Definition
-Scorbutic gum: Vit C deficiency
-Follicular hyperkeratosis: Vit A deficiency
-Bitot's Spots: Vit A deficiency
-Rickets - Vit D, Calcium deficient
Term
How would you write a chief complaint for an Adult Health History?
Definition
Make every attempt to quote the patient's own words
Term
What is the difference between signs and symptoms?
Definition
Signs = Objective; Symptoms = Subjective
Term
What are the 7 components of a Comprehensive Adult Health History?
Definition
1. Identifying data and source of history
2. Chief Complaints
3. Past History
4. Family History
5. Review of Systems
6. Health Patterns
7. History of present illness
Term
CAGE
Definition
Cutting down, Annoyance if criticized, Guilty feelings, Eye-openers (2 or more of these suggest misuse)
Term
What are ways to approach sensitive topics that call for specific approaches?
Definition
1. Be nonjudgemental
2. Explain why you need to know certain info
3. Find opening questions
4. Consciously acknowledge whatever discomfort you're feeling
Term
What are signs of abuse?
Definition
-Unexplained abuse
-Delayed getting treatment for trauma
-Past history of repeated injuries or "accidents"
-Person close to pt. has history of alcohol and drug abuse
-Partner tries to dominate interview or will not leave room
Term
What are the 7 critical attributes for symptom analysis?
Definition
OLDCART
Onset
Location
Duration
Characteristic Symptoms
Associated Manisfestations
Relieving/Aggravating factors
Treatments tried
Term
Genogram
Definition
Pictorial display of a person's family relations and medical history
Term
Review of Systems
Definition
-Address each body system, from head to toe
-Most questions pertain to symptoms
-May uncover problems patient has overlooked
-Do not use medical terms, use plain English
Term
What do you ask about when discussing Health Patterns?
Definition
Self-perception/self-concept
Value-Belief
Activity-exercise
Sleep-rest
Nutrition
Role-relationship
Coping-stress-tolerance
Term
How should you discuss a patient's mental health history?
Definition
-Be aware of cultural constructs
-Be sensitive to mood changes or symptoms of possible depression
-Aks open-ended questions initially, then move to more specific
-If patient seems depressed, ask about thoughts of suicide
Term
What are the functions of skin?
Definition
1. Protection
2. Temperature Regulation
3. Perception
4. Absorption and excretion
5. Synthesizes vitamin D
6. Identification
Term
Why do we do a skin assessment?
Definition
Look for lesions and underlying systemic disease or disorders
Term
What are the 2 kinds of cyanosis?
Definition
1. Central: oxygen level in arterial blood is low
2. Peripheral: Oxygen level is normal, cutaneous blood flow decreases and slows and tissues extract more oxygen than usual from blood flow
Term
What are the 2 types of hair?
Definition
1. Vellus hair: short, fine, inconspicuous, relatively unpigmented
2. Terminal hair: coarser, thicker, more conspicuous, pigmented
Term
What are we trying to identify when taking an integumentary history?
Definition
1. Diseases of the skin
2. Systemic diseases that have skin manisfestations
3. Physical abuse
4. Risk for pressure ulcer formation
5. Risk for skin cancer
6. Need for health promotion education regarding skin
Term
What are common or concerning symptoms when taking an integumentary history?
Definition
-Rash
-Nonhealing lesions
-Moles
-Lesions
-Bruising (ecchymosis)
-Hair loss
Term
What are some external variables that can influence skin color?
Definition
-Emotional states
-Temperature
-Cigarette smoking
-Prolonged elevation/dependent position of extremities
-Prolonged inactivity
Term
What do we look at when doing a physical examination of the skin?
Definition
1. Color
2. Moisture
3. Vascularity
4. Temperature
5. Texture
6. Mobility or turgor
7. Lesions
8. Nails
9. Hair
Term
What are the two types of edema?
Definition
1. Pitting: interstitial fluid mobile
- pitting edema scale 1-4
2. Nonpitting: local infection or trauma; brawny edema
Term
What should you note when you examine a skin lesion?
Definition
1. Color
2. Elevation or flat; and texture
3. Pattern or shape
4. Size
5. Location and distribution on body (generalized v. localized)
6. Exudate (wet or dry, color, consistency)
7. Bleeding from lesion
Term
What are the different lesion patterns of arrangement?
Definition
-Discrete
-Annular or circular
-Grouped or clustered
-Linear
-Gyrate or snakelike
-Confluent or run together
-Target or Iris
-Nerve root distribution or dermatomal
Term
What are the 3 degrees of a burn?
Definition
1st Degree: red, painful, blanches with pressure, no blistering
2nd Degree: blisters, redness, pain, raw surfaces (partial thickness or to dermis layer)
3rd degree: skin white or charred, not painful (full thickness, all skin elements destroyed)
Term
Macule
Definition
small flat spot, up to 1.0cm
Term
Patch
Definition
flat spot 1.0cm or larger
Term
Plaque
Definition
elevated superficial lesion 1.0cm or larger
Term
Papule
Definition
elevated spot, up to 1.0cm
Term
Nodule
Definition
marble-like lesion larger the 0.5cm, often deeper and firmer than papule
Term
Cyst
Definition
Nodule filled with expressible material, either liquid or semisolid
Term
Wheal
Definition
Somewhat irregular, relatively transcient, superficial area of localized skin edema
Term
Vesicle
Definition
Up to 1.0cm, filled with serous fluid
Term
Bulla
Definition
1.0cm or larger, filled with serous fluid
Term
Scale
Definition
Thin flake of dead exfoliated epidermis
Term
Crust
Definition
Dried residue of skin exudates such as serum, pus, or blood
Term
Lichenification
Definition
visible and palpable thickening of the epidermis and roughening of the skin wih tincreased visibility of normal skin furrows
Term
Erosion
Definition
Nonscarring loss of superficial epidermis, surface is moist but does not bleed
Term
What are the factors that influence how an individual experiences pain?
Definition
-Age
-Previous pain experience
-Cultural norms
-Unknown expectations
-History of drug abuse
-Perception of pain
Term
What are the types of pain?
Definition
-Nociceptive: pain r/t tissue damage; responsive to inflammatory mediators
-Neuropathic: Direct or indirect injury to peripheral or CNS
-Idiopathic: without etiology
Term
What are the 3 types of nociceptive pain?
Definition
Visceral: large or deep interior organs
Deep somatic: blood vessels, muscle, joints, tendons, bone
Cutaneous: skin
Term
FLACC
Definition
A way to assess pain in patients who cannot talk. Stands for Face, Legs, Activity, Cry, Consolability
Term
When do you use numeric faces?
Definition
When the patient can speak, but has trouble verbalizing pain, usually a small child.
Term
What are common acute pain behaviors?
Definition
-Guarding
-Grimacing
-Vocalizations
-Agitation
-Stillness
-Diaphoresis
-Change in vital signs
Term
What are common chronic pain behaviors?
Definition
-Bracing
-Rubbing
-Diminished activity
-Sighing
-Change in apetite
-Movement
-Exercise
-Praying
-Sleeping
-Agitation
Term
What are types of joints?
Definition
Immovable joint (ex: skull sutures)
Slightly movable (pivot and gliding)
Freely movable (synovial)
Term
What are the types of synovial joints?
Definition
-Hinge: flat or planar: moves on one plane (flexion and extension only)
-Condylar: convex or concave (knee or TMJ)
-Ball and socket: (hip)
Term
RICE
Definition
Rest, Ice, Compression, Elevation
Term
What is the most active joint in the body?
Definition
TMJ
Term
What do you do for a screening MSK exam?
Definition
-Inspect
-Palpate
-ROM
-Strength
Check for symmetry
Term
What is passive exercise?
Definition
-Carried out by the nurse, without assistance from patient
-Will not preserve muscle mass or bone mineralization because there is no voluntary contraction, lengthening of muscle, or tension on bones
Term
What is active assistive exercise?
Definition
-These exercises are performed by the patient with assistance from the nurse
-Exercises encourage normal muscle function while the nurse supports the distal joint
Term
What is active exercise?
Definition
Performed by patient without assistance, to increase muscle strength
Term
What is resistive exercise?
Definition
Active exercises performed by the patient by pulling or pushing against an opposing force
Term
What is an isometric exercise?
Definition
-Performed by the patient by contracting and relaxing muscle while keeping the part in a fixed position
-Done to maintain muscle strength when a joint is immobilized
-Full patient cooperation is required
Term
What is the order of the MSK physical examination?
Definition
1. TMJ
2. Neck (cervical spine)
3. Upper Extremities:
-shoulders
-elbows
-hands, wrists, fingers
4. Lower Extremities
-Hips
-Knees
-Ankles, feet, toes
5. Spine
Term
What should you do when examining the TMJ?
Definition
-Observe lateral motion and protrusion forward
-Palpate while opening and closing the jaw
Term
What should you do when examining the cervical spine?
Definition
-Palpate spinous processes and paravertebral muscles
-Flexion/Extension/Hyperextension
-Lateral bending or abduction and adduction
-Rotation
Term
Genu Valgus
Definition
knock knees
Term
Genu Varum
Definition
bow legs
Term
What is Phalen's test?
Definition
Test for carpal tunnel, have patient put hands in praying upside down, if they feel numbness before 1 min it is positive
Term
Drop Arm Sign
Definition
Ask patient to fully abduct the arm to shoulder level; if cannot hold arm fully abducted, test is positive indicating rotator cuff tear
Term
What should you think if you notice joint(s) that is/are hot, red, or swollen?
Definition
Injury, Immune, Infected, Inflammation
Term
What is the purpose of ROM exercises?
Definition
-Maintain joint mobility
-Stimulate circulation, preventing thrombus and embolus formation
-Improve coordination
-Increase tolerance for more activity
-Maintain and build muscle strength
-Prevent contracture and atrophy of muscles
Term
Contracture
Definition
-Abnormal, usually permanent condition of a joint, characterized by flexion and fixation
-Possibly caused by atrophy and shortening of muscle fibers resulting from immobilization
-Can be from loss of the normal elasticity of connective tissues or the skin, as from the formation of extensive scar tissue over a joint
Term
Which side of the lungs has 3 lobes?
Definition
Right
Term
What is the leading cause of preventable death?
Definition
Smoking
Term
What are two reference lines you would use on the anterior thorax?
Definition
Midsternal line (MSL)
Midclavicular line (MCL)
Term
What are two reference lines you would use on the posterior thorax?
Definition
Vertebral line
Midscapular line
Term
What are the two reference lines you would use on the lateral thorax?
Definition
Anterior axillary line (AAL)
Midaxillary line (MAL)
Posterior axillary line (PAL)
Term
What anterior rib do the lower lungs rest near?
Definition
6th rib
Term
Inspiration is primarily facilitated by which muscles?
Definition
Diaphragm and intercostal
Term
Orthopnea
Definition
difficulty breathing while recumbent
Term
Hemoptysis
Definition
bloody sputum
Term
Paroxysmal Nocturnal Dyspnea
Definition
difficulty breathing that awakens patient
Term
What should you ask about during the respiratory history?
Definition
Vaccinations
Environmental Factors
Exposure History: inhalants, carcinogens
Past respiratory illnesses
Term
What should you ask children during a respiratory history?
Definition
History of prematurity
History of vent support
Recurrent hospitalizations for pulmonary infection
Term
What should you ask about during family history?
Definition
TB
Allergies
Asthma
Genetic disorders: cystic fibrosis
Term
Tripoding
Definition
Use of accessory respiratory muscles
Term
What does it mean when fremitus is decreased during palpation?
Definition
When anything obstructs transmission of vibrations (e.g. obstructed bronchus, pleural effusion, pneumothorax, or emphysema)
Term
What does it mean when fremitus is increased during palpation?
Definition
Occurs with compression or consolidation of lung tissure (e.g. lobar pneumonia, tumor, Atelectasis, pulmonary fibrosis)
Term
Name the different types of percussion notes.
Definition
Resonance: over normal lung
Hyperresonance: over hyperinflated lung
Flatness/Dullness: over dense tissue or bone
Tympany: thing "tight drum"
Term
Bronchophony
Definition
Sounds are louder and clearer over airless tissue (pleural effusions, thickening, areas of consolidation)
Term
Egophony
Definition
"ee" changes to "aa" over areas of consolidation
Term
Whispered pectoriloquy
Definition
Whispered words sound clearer over areas of consolidation
Term
Crackles (rales)
Definition
fluid in small area
Term
Wheezes
Definition
lunges are clamping down
Term
Rhonchi
Definition
gook in big airways; like snoring or clearing mucous
Term
Pleural friction rub
Definition
low grating noise in peripheral and lateral chest; cough does not clear, noticed on inspiration/expiration; Plurisy
Term
A patient coughing at night signifies what respiratory disease?
Definition
asthma
Term
What does coughing up "grayish-black" mucous signify?
Definition
Smoker
Term
Frank blood
Definition
bright red blood
Term
What coud cause hoarseness?
Definition
Nodules on vocal cords
Term
What are some symptoms of TB?
Definition
Weight loss, night sweats, bloody sputum
Term
Atelectasis
Definition
Collapsed alveoli that open back up after person has been shallow breathing and then takes a deep breath
Term
What would breath and voice sounds sound like when listening to an airless lung (ex: lobar pneumonia)?
Definition
-Spoken words would sound louder and clearer
-Spoken "ee" would change to "aa"
-whispered words would be louder and clearer
Term
Stridor
Definition
High-pitched harsh sound that is entirely or predominately inspiratory
Term
What are the anatomical landmarks for the lungs on the anterior chest?
Definition
-Lung apices (apex) is 3-4cm about clavicle
-Lower lungs rest on diaphragm at 6th rib, midclavicular line
Term
What are the anatomical landmarks for the lungs on the posterior chest?
Definition
-Apices near C7
-Lower lungs near T10
-Trachea bifurcates at T4
Term
How would you evaluate respiratory excursion?
Definition
-place hands on each side near 10th rib
-have pt. take deep breath
-measure distance between thumbs and expiration
Term
List the percussion note, adventitious sounds and tactile fremitus/transmitted voice sounds in early left sided HF.
Definition
1. Resonant
2. Late inspiratory crackles in dependent portion of lungs, possibly wheezes
3. Normal
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds in consolidation.
Definition
1. Dull over the airless area
2. Late inspiratory crackles over involved area
3. Increased over area with bronchophony, egophony, and whispered pectoriloquy
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds for atelectasis (Lobar obstruction).
Definition
1. Dull over airless area
2. None
3. Usually absent when bronchial plug persists
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds in pleural effusion.
Definition
1. Dull to flat over fluid
2. None, except possible pleural rub
3. Decreased to absent, but may be increased toward top of effusion
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds in pneumothorax.
Definition
1. Hyperresonant or tympanic over pleural air
2. None except possible pleural rub
3. Decreased to absent over pleural air
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds in COPD.
Definition
1. Diffusely hyperresonant
2. None, or crackles, wheezes, and rhonchi of associated chronic bronchitis
3. Decreased
Term
List the percussion note, adventitious sounds, and tactile fremitus/transmitted voice sounds in asthma.
Definition
1. Resonant to diffusely hyperresonant
2. Wheezes, possibly crackles
3. Decreased
Term
Consolidation
Definition
Alveoli fill with fluid or blood cells, as in pneumonia, pulmonary edema, or pulmonary hemorrhage
Term
Pleural effusion
Definition
Fluid accumulates in the pleural space and separates air-filled lung from the chest wall, blocking the transmission of sound
Term
Pneumothorax
Definition
When air leaks into the pleural space, usually unilaterally, the lung recoils from the chest wall. Pleural air blocks transmission of sound
Term
COPD
Definition
Slowly progressive disorder in which the distal air spaces enlarge and lungs become hyperinflated. Chronic bronchitis also associated
Term
Asthma
Definition
Widespread narrowing of the tracheobronchial tree diminishes air flow to a fluctuating degree. During attacks, air flow decreases further, and lungs hyperinflate
Term
What should you ask about during cardiac history?
Definition
Chest pain
Palpitations
Dizzy
Syncope
Dyspnea
Orthopnea - How many pillows?
+/- cough
+/- sweats
+/- nausea
Peripheral edema
SMOKING
Term
How would you know that edema is related to cardiac system?
Definition
If swelling is bilateral and worse in evening
Term
What are 5 major risk factors of heart disease?
Definition
1. Smoking history
2. Diabetes Mellitus
3. Hypertension
4. Obesity (BMI >30 kg/m2)
5. High Cholesterol levels
Term
How do you measure for JVD?
Definition
-Position bed at 30-45 degree angle and look for pulsations and fullness
-A normal reading the vein goes down as the head goes up = not stressed
Term
What would central cyanosis indicate?
Definition
Poor arterial circulation
Term
What would periperal cyanosis indicate?
Definition
Peripheral vasoconstriction
Term
What are you hearing during the "Lub (S1)" part of the heart sound?
Definition
The closure of the tricuspid and mitral vavle (AV valves)
Term
What are you hearing during the "Dub" (S2) part of the heart sound?
Definition
Closure of aortic and pulmonary valves (SL valves)
Term
What is a Split S2 (physiologic split)?
Definition
Aortic valve closes earlier than pulmonic valve during inspiration
Term
What is normal for Split S2?
Definition
-It is normal to hear in athletes < 40 y.o.
-Best heard at base of heart (Mitral, Pulmonic)
-Louder on reclining and disappears during slow breathing or holding breath
Term
What is normal for Split S2?
Definition
-It is normal to hear in athletes < 40 y.o.
-Best heard at base of heart (Mitral, Pulmonic)
-Louder on reclining and disappears during slow breathing or holding breath
Term
What is an abnormal split?
Definition
-Occurs in expiration
-Stays when sitting up
Term
What is S3 sound?
Definition
-S3 occurs when ventricles are resistant in early rapid filling phase = protodiastole
-Not varying with respiration; persists when sitting upright, increases with isotonic exercise
Term
Who would you expect to have an S3 sound?
Definition
-Young adults, children
-Increased heart rate
-Late pregnancy
Term
What would indicate an abnormal S3 sound?
Definition
-Older adult
-Hypertension
-Volume overload (CHF)
-Mitral Regurg
-High output states (thyroid, anemia)
Term
What is an S4 sound?
Definition
Occurs from resistance to filling at end of disatole (at prestole)
Term
List the heart murmur grades:
Definition
I - Very hard to hear
II - Quiet but heard with stethoscope
III - Moderately loud, without a thrill
IV - Loud, may have thrill
V - Very loud, definite thrill, can be heard with stethoscope partly off chest
VI - Heard without stethoscope on chest, obvious thrill
Term
What is intermittent claudication?
Definition
Pain in leg aggravated by walking or activity
Term
What does Homen's test look for?
Definition
DVT (but is only 35% accurate)
Term
What would be worrisome findings during inspection and palpation of lymph nodes?
Definition
-Prolonged swelling over 1.5 cm
-widespread adenopathy
-multiple positive history points
Term
What does an orthostatic reading show?
Definition
How the heard accommodates when the patient changes position
Term
What is PAD?
Definition
Problem with blood oxygen going to the muscle
Term
What is PVD?
Definition
Problem with blood going back to the heart
Term
What are the symptoms of PAD?
Definition
-Pain upon limb elevation (arterial blood cannot get to muscle)
-Pain increased with walking (intermittent claudication)
-Can tell how bad PAD is by how far they can walk
-Increase of pain at at night
-Increase of pain with cool temperature
Term
What would hair loss on a patient's legs be indicative of?
Definition
Loss of oxygen to the area (can happen with PAD or PVD)
Term
What are the anterior landmarks for location of the normal adult heart?
Definition
From the 2nd to 5th intercostal space and from the right border of the sternum to the left mid-clavicular line
Term
Where is the anatomical location of the apical impulse?
Definition
5th intercostal space, mid-clavicular line
Term
In which of the 4 auscultatory will the S1 sound be loudest?
Definition
Mitral area
Term
In which of the 4 auscultatory areas will the S2 sound be the loudest?
Definition
Aortic area
Term
List the 4 precordial areas for ascultation and their anatomical landmarks.
Definition
1. Aortic: Right 2nd intercostal space
2. Pulmonic: Left 2nd intercostal space
3. Tricuspid: Left 5th intercostal space
4. Mitral (PMI): Left 5th intercostal space at midclavicular line
Term
When checking the different peripheral pulses of the arm, what 3 arteries are we feeling?
Definition
1. Brachial
2. Radial
3. Ulnar
Term
When we are feeling the different peripheral pulses of the leg, which 4 arteries are we feeling?
Definition
1. Femoral
2. Popliteal
3. Dorsalis Pedis
4. Posterior tibial
Term
Which pulse do we feel to check peripheral pulses on the neck?
Definition
Carotid
Term
What are the functions of the lymphatic system?
Definition
1. Recycle and conserve fluids and plasma proteins
2. Part of immune system pathway: lymph nodes
3. Absorb lipids from the intestinal tract
Term
List the superficial lymph nodes available for direct examination.
Definition
-Cervical
-Axillary
-Inguinal: upper and lower
Term
What would be worrisome findings during a lymphatic assessment?
Definition
-Prolonged swelling over 1.5cm wide
-Widespread adenopathy
-Multiple positive history points
Term
Atheroma
Definition
fatty thickening in walls of arteries
Term
aneurysmal artery
Definition
widely dilated artery
Term
pulsus alterans
Definition
Alternating force of pulse; almost always indicates severe left-sided heart failure and is usually best felt by applying light pressure on radial or femoral arteries
Term
paradoxical pulse
Definition
Greater than normal drop in systolic pressure during inhalation
Term
Virchow triad
Definition
3 factors that set stage for venous thrombosis
1. Venous stasis
2. Hypercoaguability
3. Vessel wall damage
Term
Lymphedema
Definition
Develops when lymph channes are obstructed by tumor, fibrosis, or inflammation, and in cases of axillary node dissection and radiation.
Term
Lymphedema presentation
Definition
Edema is soft in early stages, then becomes hard and nonpitting. Skin is thickened, ulceration is rare, no pirgmentation and is usually found bilaterally on extremities.
Term
Why might the PMI be felt in the xiphoid process or epigastric area?
Definition
Results from right ventricular hypertrophy, usually as a result of obstructive pulmonary disease
Term
False high blood pressure
Definition
Cuff too small
Cuff too loose or uneven
Arm below heart
Inflating or deflating too slow
Deflating cuff too quickly
Term
False low blood pressure
Definition
Cuff too large
Repeating BP too quickly
Inaccurate level of inflation
Pressing stethoscope too tightly
Term
Stages of hypertension
Definition
- Normal <120, <80
- Prehypertension: S: 120-139, D: 80-89
- Stage 1: hypertension: S: 140-159, D: 90-99
- Stage 2: hypertension: S: 160+, D: 100+
Term
What would you ask for a patient for a head and scalp history?
Definition
-Headaches
-Dizziness
-Lumps or masses
-Surgery
-Allergies
-Medications and/or treatments used
Term
What does the patient do during a facial motor exam?
Definition
-Smile
-Puff cheeks
-Show teeth
-Wrinkle brow
-Squeeze eyes shut against resistance
Term
During a neck exam, what are you palpating for when the patient swallows?
Definition
Isthmus, left and right lobes of thyroid, feel for any nodules, enlargement or tenderness
Term
How do we measure how swollen tonsils are?
Definition
Look inside mouth, measure from 1+(slightly swollen) to 4+ (swollen to tip of uvula)
Term
Deviated septum
Definition
common physical disorder of the nose, involving displacement of the nasal septum
Term
nasal polyps
Definition
sac-like growths of inflamed tissue lining the nose; people with nasal polyps often complain of having cold-like symptoms that have lasted for months or years
Term
Tinnitus
Definition
Ringing in the ears
Term
URI (Upper Respiratory Infection) symptoms
Definition
-Nasal Congestion
-Feverish
-Sore throat
-Toothache
Term
External auditory canal
Definition
S-shaped
2.5cm long
Term
What is the difference between doing an ear exam on an adult and an ear exam on a child?
Definition
In adults you pull the ear up and back to straighten the ear canal while in children you pull the ear down and back
Term
What is the function of the middle ear?
Definition
Conducts sound, equalizes air pressure and reduces loudness
Term
What are the auditory ossicles?
Definition
Composed of the malleus, incus, and stapes, it transmits vibration from the TM to the inner ear
Term
What is the eustachian tube and how does it differ in adults v. children?
Definition
It equalizes aie pressure form middle ear to nasopharynx and is more horizontal in child, more angled in adult
Term
What makes up the inner ear?
Definition
Cochlea - converts vibrations and sends through cochlear nerve to the brain
Labyrinth - responsible for balance
Term
Conductive hearing loss
Definition
-Mechanical dysfunction in external or middle ear
-Foreign object in canal, perforated TM, otosclerosis
-Can still hear if sound is loud enough
Term
Sensorineural hearing loss
Definition
-Cochlear, CN VIII or auditory area of cerebral
-Presbycusis
-Inner ear disease, ototoxic drugs
Term
What is pupil accomodation?
Definition
Pupillary constriction and convergence towards center when looking from far to near
Term
What is eye convergence?
Definition
Eyes move inward
Term
What is PERRLA?
Definition
Pupils
Equal
Round
Reacts to Light
Accommodates
Term
Snellen chart
Definition
Visual accuity chart
-chart is 20 feet away from the patient
-Cover one eye during testing, then switch to other eye, then both eyes
-The larger the denominator, the poorer the vision
-Person is legally blind if vision is 20/200 and cannot be corrected
Term
What are amblyopia, diplopia, myopia, hyperopia, and prebyopia?
Definition
Amblyopia: lazy eye
Diplopia: double vision
Myopia: nearsightedness
Hyperpopia: farsighted
Presbyopia: decreased accommodation with aging
Term
Nystagmus
Definition
A condition in which eyes make repetitive uncontrolled movements. It is normal at extremes of gaze but in Labyrinth disorder, it will be present after eye moves back to normal position
Term
Strabismus
Definition
A condition in which the eyes are not properly aligned with each other
Term
Hydrocephaly
Definition
Buildup of fluid inside the skull, "water heads" usually found in children
Term
What is the number one thing you monitor for after a tonsilectomy and what is the sign for that?
Definition
Bleeding and a sign in constant swallowing is a sign
Term
What should you look for when examining the TM?
Definition
Color should be pearly gray and you should make you see cone-of-light to be sure the TM is not bulging
Term
What two tests should you perform to test conductive hearing loss?
Definition
Weber: Vibrating fork in middle of client's head
Rinne: Vibrating fork on mastoid bone, then in front of ear (air conduction should be greater than bone conduction)
Term
Ataxia
Definition
not being able to walk
Term
Photophobia
Definition
sensitivity to light
Term
What are 3 types of primary headaches?
Definition
1. Migraines
2. Tension
3. Cluster
Term
What are the processes of Migraines, Tension headaches, and cluster headaches?
Definition
M: Primary neuronal dysfunction
T: Unclear-muscle contraction or vasoconstriction unlikely
C: Unclear-possibly extracranial vasodilation from neural dysfunction
Term
What are the different locations of Migraines, tension headaches, and cluster headaches?
Definition
M: Usually unilateral
T: Usually bilateral; may be generalized or localized
C: Unilateral; usually behind or around eye
Term
What are the different qualities and their severities in migraines, tension headaches, and cluster headaches?
Definition
M: Throbbing or aching, variable in severity
T: Pressing or tightening pain, mild to moderate intensity
C: Deep, continuous, severe
Term
Describe the Timing (onset, duration, course) for migraines, tension headaches, and cluster headaches.
Definition
M: Onset is fairly rapid reaching peak in 1-2 hrs, lasts 4-72 hours and peak incidence is in early to mid adolescence, usually in women, usually monthly
T: Onset is gradual, lasts minutes to days, and is often recurrent or persistent over long periods
C: Onset is abrupt, peaks within minutes, lasts up to 3 hours, and is episodic, clustered in time with several each day for 4-8 wks, then relief for 6-12 mos. More common in men.
Term
What are the different associated factors for migraines, tension headaches, and cluster headaches?
Definition
M: Nausea, vomiting, photophobia, phonophobia, visual auras, motor auras affecting hand or arm, sensory auras
T: Sometimes photophobia; phonophobia; nausea absent
C: Lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection
Term
What are the different aggravating/provoking factors for migraines, tension headaches, and cluster headaches?
Definition
M: Alcohol, certain foods, or tension may provoke, more common premenstually, aggravated by noise/bright light
T: Sustained muscle tension, as in driving or typing
C: During attack, sensitivity to alcohol may increase
Term
What are the relieving factors for migaines, tension headaches, and cluster headaches?
Definition
M: Quiet, dark room; sleep; sometimes transient relief from pressure on the involved artery, if early in the course
T: Possibly massage, relaxation
C: ?
Term
What type of headaches are sinusitis headaches and those related to meningitis?
Definition
Secondary headaches
Term
What are the different processes for headaches related to sinusitis and meningitis?
Definition
S: Mucosal inflammation of the paranasal sinuses
M: Infection of the meninges surrounding the brain
Term
Where are the different locations common to headaches related to sinusitis and meningitis?
Definition
S: Usually above the eye or over the maxillary sinus
M: Generalized
Term
Describe the quality and severity of headaches related to sinusitis and meningitis.
Definition
S: Aching or throbbing; variable in severity; consider possible migraine
T: Steady or throbbing, very severe
Term
Describe the Timing (onset, duration, course) for headaches related to sinusitis and meningitis.
Definition
S: Variable onset, often lasts several hours at a time, recurring over days or longer; often recurrent in a repetitive daily pattern
M: Fairly rapid onset, duration is variable, usually days; it is a persistent headache in an acute illness
Term
Describe the associated factors in the headaches related to sinusitis and meningitis.
Definition
S: Local tenderness, nasal congestion, discharge, and fever
M: Fever, stiff neck
Term
Describe the aggravating/provoking factors in headaches related to sinusitis and meningitis.
Definition
S: May be aggravated by coughing, sneezing, or jarring the head
M: none?
Term
Describe the factors that relieve headaches related to sinusitis and meningitis.
Definition
S: Nasal decongestants, antibiotics
M: N/A?
Term
Cushing's syndrome
Definition
Increased adrenal cortisol production produces a round or "moon" face with red cheeks. Excessive hair growth may be present on face.
Term
Acromegaly
Definition
Increased growth hormone produces enlargment of both bone and soft tissue. Head is elongated, with bony prominences fo the forehead, nose, and lower jaw. Facial features appear coarsened.
Term
Parkinson's Disease
Definition
Decreased facial mobility blunts expression. A masklike face may result with decreased blinking and a characteristic stare. Neck and upper trunk flex forward, facial skin becomes oily, and drooling may occur.
Term
What are the symptoms of hyperthyroidism?
Definition
-Nervousness
-Weight loss despite increased appetite
-Excessive sweating and heat intolerance
-Palpitations
-Frequent bowel movements
-Proximal muscle weakness and tremor
Term
What are the signs of hyperthyroidism?
Definition
-Warm, smooth, moist skin
-Increased systolic and decreased diastolic BP
-Tachycardia or A. Fib
-Hyperdynamic cardiac pulsations with an accentuated S1
-Tremor and proximal muscle weakness
-With Graves disease, eye signs such as stare, lid lag, and exopthalmos
Term
What are the symptoms of hypothyroidism?
Definition
-Fatigue, lethargy
-Modest weight gain with anorexia
-Dry, coarse skin and cold intolerance
-Swelling of face, hands, and legs
-Constipation
-Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing
Term
What are the signs of hypothyroidism?
Definition
-Dry, coarse, cool skin, sometimes yellowish from carotene, with nonpitting edema and loss of hair
-Periorbital puffiness
-Decreased systolic and increased diastolic BP
-Bradycardia and, in late stages, hypothermia
-Intensity of heart sounds sometimes depressed
-Impaired memory, mixed hearing loss, somnolence, peripheral neuropathy, carpal tunnel syndrome
Term
Ptosis
Definition
Drooping of the upper lid. Causes can include myasthenia, gravis, damage to the oculomotor nerve, and damage to the sympathetic nerve supply. Senile ptosis can occur with age.
Term
Exophthalmos
Definition
The eyeball protrudes forward. When bilateral, can indicate infiltrative ophthalmopathy of Graves hyperthyroidism. Unilateral is seen in Graves disease or a tumor or inflammation of the orbit.
Term
Conjunctivitis
Definition
Pattern of redness: diffuse dilatation of conjunctival vessels with redness that tends to be maximal perpherally
Pain: mild discomfort
Vision: unaffected except for temporary blurring due to discharge
Discharge: watery, mucoid, or mucopurulent
Pupil: Not affected
Cornea: Clear
Significance: Bacterial, viral, and other infections; allergy; irritation
Term
Cataracts
Definition
Opacities of the lenses visible through the pupil. Most common in old age. Nuclear cataract looks gray when seen by a flashlight.
Term
Anisocoria
Definition
Unequal pupils. When greater in bright light causes could include blunt trauma to eye, open-angle glaucoma, and impaired parasympathetic nerve supply to iris. When greater in dim light caused by interruption of sympathetic nerve supply.
Term
Sty (Hordeolum)
Definition
A painful, tender red infection in a gland at the margin of the eyelid
Term
Vertigo
Definition
Spinning sensation accompanied by nystagmus and ataxia
Term
Presyncope
Definition
a near faint from feeling faint or lightheaded
Term
Dysequilibrium
Definition
unsteadiness or imbalance when walking, especially in older patients
Term
What would be the results of a Weber and Rinne test for an ear that has conductive hearing loss?
Definition
W: Sound lateralizes to impaired ear-room noise not well heard, so detection of vibrations improves
R: Bone conduction longer than or equal to air conduction
Term
What would be the results of a Weber and Rinne test for an ear with sensorineural hearing loss?
Definition
W: Sound lateralizes to good ear-inner ear or cochlear nerve damage impairs transmission to affected ear
R: Air conduction longer than bone conduction
Term
HSV I
Definition
Produces recurrent and painful vesicular eruptions of the lips and surrounding skin. A small cluster of vesicles first develops. As these break, yellow-brown crusts form, and healing ensues within 10-14 days.
Term
Angioedema
Definition
A diffuse, nonpitting, tense swelling of the dermis and subcutaneous tissue. It develops rapidly, and typically disappears over subsequent hours or days. Although usually allergic in nature and sometimes associated with hives, it does not itch.
Term
Thrush
Definition
Yeast infection in the mouth. Thick, white plaques are somewhat adherent to the underlying mucosa. Predisposing factors include: prolonged treatment with corticosteroid or antibiotics; AIDS.
Term
Gingivitis
Definition
Common in teenagers and young adults. Gingival margins are reddened and swollen, adn the interdental papillae are blunted, swollen and red. Brushing teeth often makes the gums bleed. Plaque is not readily visible.
Term
Geographic tongue
Definition
Benign. Dorsum of tongue shows scattered smooth red areas denuded of papillae. Gives a maplike pattern that changes over time
Term
Hairy tongue
Definition
Hairy yellowish to brown or black elongated papillae on tongue's dorsum. Benign condition may follow antibiotic therapy or occur spontaneously.
Term
Fissured tongue
Definition
Fissures appear with age. Food debris may accumulate in crevices and irritate, but condition is benign
Term
Smooth tongue (atrophic glossitis)
Definition
Smooth and often sore tongue that has lost it's papillae. Suggest deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, or iron, or tx with chemo
Term
Candidiasis
Definition
Candida albicans infection of the tongue that is seen in immunosuppressed conditions
Term
Hairy leukoplakia
Definition
These whitish raised areas with a feathery or corrugated pattern most often affect the sides of the tongue. Unlike candidiasis, these areas cannot be scraped off. They are seen in HIV and AIDS
Term
Prodrome
Definition
early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur
Term
Name the physical borders for the anterior triangle of the neck
Definition
1. Mandible above
2. Sternomastoid laterally
3. Midline of the neck medially
Term
What are the anatomical borders for the posterior triangle of the neck?
Definition
1. Sternomastoid muscle
2. Trapezius muscle
3. The clavicle
Term
What does the thyroid feel like in Grave's Disease, Hashimoto Thyroidectomy, malignancy, and thyroiditis?
Definition
Soft in Grave's Disease; Firm in Hashimotos; Firm in malignancy; tenderness in thryroiditis
Term
Rosenbaum chart
Definition
Tests near vision and helps identify the need for reading glasses or bifocals in patients older than 45
Term
What area of the male anatomy is a potential hernia site?
Definition
Juncture of lower abdomen wall and thigh is a potential hernia site in which a loop of bowel (colon) portrudes though a weak spot in musculature
Term
What do the lymphatics of the penis and scrotal surfaces drain into?
Definition
The inguinal lymph nodes
Term
What do the lymphatics of the testes drain into?
Definition
The abdominal lymph nodes (which aren't accessible to exam)
Term
What are the anatomical borders of the inguinal area?
Definition
The anterior superior iliac spine and symphysis pubis
Term
How long is the inguinal canal and what are the openings called?
Definition
4-6 cm in an adult and the two openings are called the internal ring and the external ring
Term
What are 6 important components of a reproductive health history in men?
Definition
1. What may have brought the patient in
2. Sexual preference and sexual response
3. Penile discharge or lesions
4. Scrotal pain or swelling
5. Inguinal pain or swelling
6. Problems with urination
Term
What are the 3 main topics to include in reproductive health promotion for men during visit?
Definition
1. Prevention of HIV/STI's
2. Testicular Cancer Screening
3. Prostate Cancer Screening
Term
What do you ask about when taking male fertility history?
Definition
-Number of children
-Infertility evaluation
Term
What should you ask about when assessing male sexual activity history?
Definition
-Erection and ejaculation history (impotence, dysfuction)
-Partners
-Practices, Protection, Past history of STD/STI
Term
micturition
Definition
urination
Term
What is the Tanner scale?
Definition
Scale of physical development in children, adolescents, and adults
Term
List the Tanner scale stages of pubic hair
Definition
Tanner I: no pubic hair at all
Tanner II: small amount of long down pubic hair with slight pigment
Tanner III: Hair becomes more coarse and curly
Tanner IV: adult-like hair quality, extending across pubis but sparing medial thighs
Tanner V: hair extends to medial surface of the thighs
Term
What should you do if you notice a mass during a scrotal examination?
Definition
Transilluminate it: By holding a light behind the scrotum one can easily determine whether the mass is cystic (light shines through) or solid (light blocked by the mass)
Term
What is the concern if abnormalities are noted in the epididymis and spermatic cord?
Definition
Male factor infertility
Term
Hydrocele
Definition
Pathological accumulation of serous fluid in the scrotum. The main symptom is a painless swollen testicle which feels like water balloon
Term
Orchitis
Definition
Inflammation of the testes
Term
Cremasteric reflex
Definition
The involuntary contraction of the cremaster muscle when the inner thigh is lightly stroked. It can be overactive during adolescence but it's absence in adulthood can indicate health problems (such as testicular torsion or spinal injury)
Term
Hypospadius/Epispadius
Definition
Abnormal location of the urethral opening
Term
What are the signs of testicular cancer?
Definition
unilateral, hard, painless mass
Term
Self exams for testicular and breast cancer are now a Class D recommendation. What does this mean?
Definition
There is moderate to high certainty that the service has no benefit or that harm outweighs the benefit
Term
What positions can the patient be in during an anal and colorectal exam?
Definition
-L lateral recumbent (left side lying)
-Lithotomy
-Standing
Term
During a prostate exam, what would be considered abnormal findings?
Definition
-greater than 2.5cm
- irregular
-"boggy"/very mushy
-very hard
-tender
Term
Fecal Occult Blood Test (FOBT)
Definition
This at home test detects blood in the stool by placing a small sample of stool on a chemically treated card, pad, or wipe. Two separate BMs are tested since cancerous tumors can bleed intermittently.
Term
How frequently should a patient get:
1. FOBT
2. Flex Sig
3. Colonoscopy
Definition
1. Once a year (unless done in combo with Flex Sig, then every 3 years)
2. Every 5 years
3. Every 10 years
Term
Flexible Sigmoidoscopy
Definition
Doctor looks for polyps/cancer in rectum and lower third of colon with a small, thin, lighted tube inserted into rectum. Pt. must take enema/laxative night before procedure
Term
Colonoscopy
Definition
Similar to flex sig, except the doctor uses longer lighted tube, checks for polyps/cancer in rectum and entire colon, and during test doctor can find and remove most polyps and some cancers. Pt. is slight sedated during test.
Term
A young man feels a sharp pain in his testicle. At what point does he go to a doctor? How long does he have before serious damage occurs? How much time is too long?
Definition
1. If the pain lasts for more than one hour
2. If he does not see a doctor within 6 hours, chances that his testicle will have permanent damage rise
3. If he does not go to a doctor within 24 hours
Term
What is the most current US Preventative Services Task Force stance on prostate-specific antigen (PSA) based screening for prostate cancer?
Definition
It recommends against it, stating the potential benefit does not outweigh the risk. Only 1 out of 1000 men every 10 years are thought to be helped by PSA screeening, yet 120 out of every 1000 men receive a false-positive test, thereby leading to overdiagnoses and overtreatment.
Term
What is the most common cancer in men?
Definition
Prostate cancer
Term
What does the prostate do?
Definition
Produces fluid that makes up a part of the semen
Term
How does the prostate change as men age? How does this relate to urination?
Definition
It enlarges and causes the urethra to narrow, thereby decreasing urine flow
Term
What are some of the symptoms of prostate cancer?
Definition
-Difficulty starting urination
-Weak or interrupted urine flow
-Frequent urination, especially at night
-Difficulty emptying the bladder completely
-Pain or burning during urination or ejaculation
-Pain in the back, hips, or pelvis that doesn't resolve
Term
What are risk factors for prostate cancer?
Definition
1. Age: the older the man, the higher the risk
2. Family History
3. Race: more common in African Americans
Term
What are symptoms of colon cancer?
Definition
There may not be any, but if there are:
1. Blood in or on stool
2. Stomach pains, aches, or cramps that don't resolve
3. Unexplained weight loss
Term
What are the risk factors associated with colon cancer?
Definition
1. Age: 90% cases occur in 50 yrs of age or older
2. Inflammatory Bowel Diseaes
3. Family History
4. Lifestyle Factors: low fiber/high fat intake, low physical activity; alcohol/tobacco use
Term
What is the best way to prevent colorectal (colon) cancer?
Definition
Screening. Precancerous polyps can be present in the colon for years before they turn into cancer, and we can find these polyps and destroy them before that during a screening.
Term
How would you set a comfortable environment while taking a female reproductive history?
Definition
1. Collect history while patient is dressed
2. Understand anxieties, discomfort, embarrassments
3. Treat patient with respect and patience
Term
What structural and functional changes occur in a woman's body during pregnancy?
Definition
1. Breast enlargement and milk production
2. Uterine size increases
3. Changes in vaginal secretions, mucosa, and color
Term
What structural and functional changes occur in an elderly woman druing/after menopause?
Definition
1. Pubic hair gradually decreases
2. Skin is thinner and fat deposits decrease, leaving mons pubis smaller, and labia flatter
3. Clitoris size also decreases after age 60
4. Uterus reduces in size
Term
Who should be screened for cervical cancer and how often should screening be done?
Definition
Women 21 to 65 years old with Pap smear every 3 years; For women 30-65 who want to lengthen screening time, they can get a combination HPV test/Pap smear every 5 years
Term
pyuria
Definition
urine containing pus
Term
Cystocele
Definition
Occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina
Term
Rectocele
Definition
Occurs when the end of the large intestine (rectum) pushes through the back wall of the vagina
Term
Uterine prolapse
Definition
Falling or sliding of the womb (uterus) from its normal position into the vaginal area. Symptoms: Feeling like you are sitting on a small ball; Difficult or painful sexual intercourse
Term
Obstetric history (GPA)
Definition
Gravida: total number of pregnancies
Para: total number of deliveries after 20 wks gestational age
Abortus: Number of pregnancy losses (elective, spontaneous before 20 weeks gest. age, induced)
Term
Benign Breast Disease (formerly Fibrocystic Breast Disease)
Definition
-Multiple tender masses
-Cyclic discomfort
-Lympiness
Term
Concerning signs that may indicate breast cancer?
Definition
-Signs of retraction
-Abnormal contours
-Skin dimpling
-Nipple retraction/deviation
-Edema of the skin
-Paget disease of the nipple
Term
Paget's disease of the nipple
Definition
Rare form of breast cancer in which the nipple and areola become scaly, red, itchy, and irritated
Term
What are the anatomical borders of the average female breast?
Definition
Extends from clavicle down to the 6th rib and from the sternum to the midaxillary line
Term
Which axillary lymph nodes are most palpable?
Definition
Central nodes
Term
When is nipple retraction concerning?
Definition
When it is a recent change because it could indicate breast cancer or adhesions below the surface
Term
While doing a breast exam, you notice a nodule. What characteristics do you document?
Definition
Location (which breast, quadrant or clock site, cm from nipple)
Size (in centimeters)
Shape
Consistency
Delineation (well circumscribed or not)
Tenderness
Mobility
Term
What are the 3 most common kinds of breast masses?
Definition
1. Fibroadenoma
2. Cysts
3. Breast Cancer
Term
What is the usual age for a woman to have a fibroadenoma, cyst, and breast cancer?
Definition
F: 15-25; usually puberty and young adulthood, but up to 55
Cyst: 30-50, regress after menopause except with estrogen therapy
Cancer: 30-90; most common over age 50
Term
What is the usual number of fibroadenomas, cysts, or cancerous lumps found at one time?
Definition
F: Usually single, may be multiple
Cyst: Single or multiple
Cancer: Usually single
Term
What is the common shape of fibroadenomas, cysts, or cancerous masses found in the breast?
Definition
F: Round, disc-like, or lobular
Cyst: Round
Cancer: Irregular or stelate
Term
What is the usual consistency of fibroadenoma, cyst, or cancerous mass found in the breast?
Definition
F: May be soft, usually firm
Cyst: Soft to firm, usually elastic
Cancer: Firm or hard
Term
Of the 3 most common breast masses (fibroadenoma, cyst, and cancerous) which one is not clearly delineated upon examination?
Definition
Cancer
Term
Of the 3 most common breast masses (fibroadenoma, cyst, and cancerous) which one is usually immobile and fixed to underlying tissues?
Definition
Cancer
Term
Of the 3 most common breast masses (fibroadenoma, cyst, and cancerous) which one is often tender?
Definition
cyst
Term
Of the 3 most common breast masses (fibroadenoma, cyst, and cancerous) which one may show signs of retraction?
Definition
Cancer
Term
What are indications for a pelvic examination during adolescence?
Definition
-Amenorrhea
-Excessive bleeding
-dysmenorrhea
-Unexplained abdominal pain
-Bacteriologic and cytologic studies in sexually active girl
-prescription of contraceptives
-Patient's own desire for assessment
Term
dyspareunia
Definition
pain or discomfort during intercourse
Term
dysmenorrhea
Definition
pain with menses
Term
What are the 5 phases of a women's reproductive health?
Definition
1. Prepuberty (premenstruation)
2. Puberty (menarche)
3. Childbearing (menstruation)
4. Perimenopausal
5. Menopausal
Term
What are the 3 types of hernias during reproductive examination?
Definition
1. Indirect inguinal hernia (most common)
2. Direct inguinal hernia
3. Femoral hernia (more common in women)
Term
Peritoneum
Definition
Membrane lining the walls of the abdominal and pelvic cavities
Term
Retroperitoneal
Definition
Refers to the space near the posterior abdominal wall and the peritoneum
Term
List the 3 abdominal quadrants.
Definition
1. Epigastric
2. Umbilical
3. Hypogastric/Suprapubic
Term
Organs by Quadrant: Right Upper Quadrant
Definition
Ascending colon
Duodenum
Gallbladder
Right kidney
Liver
Pancreas (head)
Transverse colon
Ureter (right)
Term
Organs by quadrant: Left Upper Quadrant
Definition
Descending Colon
Left kidney
Pancreas (body and tail)
Spleen
Stomach
Transverse colon
Ureter (left)
Term
Organs by quadrant: Right Lower Quadrant
Definition
Appendix
Ascending Colon
Bladder
Cecum
Rectum
Ovary, uterus and fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Ureter (right)
Term
Organs by quadrant: Left Lower Quadrant
Definition
Bladder
Descending Colon
Ovary, uterus, fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Sigmoid colon
Ureter (left)
Term
Hematemesis
Definition
Blood in vomit
Term
Melena
Definition
Tarry stools
Term
Hematochezia
Definition
bright red blood in stool
Term
What is the "normal" range for bowel elimination frequency?
Definition
2-3 times a day to 3 times a week
Term
What is Gastroenteritis?
Definition
Inflammation of the GI tract (mouth, esophagus, stomach, and intestines)
Term
What are the causes and symptoms of gastroenteritis?
Definition
-Multiple causes such as: virus, bacteria, parasite, medications, food intolerances
-Symptoms include:
Nausea and/or vomiting
Diarrhea
Abdominal cramping
Fever
Term
List the solid viscera
Definition
These are organs that maintain a characteristic shape.
Liver
Pancreas
Kidney
Adrenal glands
Spleen
Ovaries and Uterus
Term
List the hollow viscera
Definition
Organs whose shape depends on their contents.
Stomach
Gallbladder
Colon
Small intestine
Bladder
Term
What is the order of an abdominal assessment exam?
Definition
Inspect
Auscultate
Percuss
Palpate
Term
What are the 4 contours of the abdomen?
Definition
1. Flat
2. Scaphoid
3. Rounded
4. Protuberant
Term
What are the 6 F's of a protuberant abdomen?
Definition
1. Fat
2. Fluid
3. Flatus
4. Fetus
5. Feces
6. Fatal growths
Term
What kind of sound would you hear upon percussion of a protuberants abdomen due to ascitic fluid?
Definition
With the patient in a supine position, you would hear tympany in the center of the abdomen and dullness along the sides (where the fluid is).
Term
What are abnormal bowel sound classifications?
Definition
-Absent (obstruction): listen for full 4-5 min
-Hypoactive (decreased motility): Low gurgling <4 in 1 min
-Hyperactive (increased motility): High pitched, loud
Term
What do bruits indicate?
Definition
Turbulent flow or stenosis
Term
What is the normal span of the liver?
Definition
6-12 cm
Term
Rovsing sign
Definition
-Push on LLQ then quickly remove hand
-Rebound tenderness in RLQ or pain in RLQ durring LLQ pressure (appendicitis)
Term
Psoas muscle test
Definition
Pt. lays supine and examiner pushes down on patient's right thigh and asks pt. to raise leg. Pt. has pain in RLQ (appendicitis)
Term
Murphy's sign/Inspiratory arrest
Definition
Sharp pain upon inspiration when examiner's hand is palpating the liver (cholecystitis)
Term
Fluid wave test
Definition
If ascites is present, the push will generate a fluid wave through the abdomen and you will feel a positive fluid wave. Distention is due to gas or adipose tissue, you will feel no change.
Term
What are classes physical findings of alcohol abuse?
Definition
1. Hepatosplenomegaly (HSM)
2. Ascites
3. Caput medusa
4. Spider angiomas
5. Peripheral edema
6. Palmar erythema
7. Erythematic or bulbous nose
Term
What should you teach someone at risk for Hep A?
Definition
-Transmission via fecal-oral
-Children often asymptomatic
-Vaccine available
-Prophylaxis: serum globulin
-Stess good handwashing techniques
Term
What are the 3 risk categories for Hep B?
Definition
1. Sexual contacts
2. People with percutaneous or mucosal exposure to blood
3. Others: travelers, patients with chronic liver disease or HIV infection
Term
Who does the CDC recommend get Hep B vaccine?
Definition
1. All adults in high-risk settings
2. In primary care or specialty settings
3. Adults in occupations involving exposure to blood or other potentially infectious body fluids
4. All pregnant women at first prenatal visit
Term
What are risk factors for Hep C?
Definition
-Repeated percutaneous exposure
-IV drug users
-Transfusion with clotting factors before 1987
-Hemodialysis
-Sex partners using IV drugs
-Blood transfusion or organ transplant before 1992
-Occupational exposure
-Multiple or infected sex partner
Term
Risk factors for colorectal cancer
Definition
-Past colorectal cancer or adenomatous polyp
-History of inflammatory bowel disease
-Family history of colorectal cancer or adenomatous polyp
Term
Screening for colorectal cancer
Definition
-Fecal occult blood test annually
-Flexible sigmoidoscopy every 5 years
-Colonoscopy every 10 years
Term
Prevention of urinary incontinence
Definition
-Pelvic muscle training
-Pelvic muscle exercises
-Biofeedback
-Incontinence is not normal
Term
Peptic Ulcer and Dyspepsia process
Definition
Peptic ulcer refers to a demonstrable ulcer, usually in the duodenum or stomach. Dyspepsia causes similar symptoms but no ulceration. Infection by H. Pylori is often present.
Term
Peptic Ulcer and Dyspepsia (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: Epigastric, may radiate to back
Q: Variable: gnawing, burning, pressing or hunger-like
T: Intermittent. Duodenal ulcer more likely to cause pain that 1) wakes at night, 2) occurs intermittently over a few weeks, then disappears for months, then recurs.
AF: Variable
RF: Food and antacids may bring relief
AS&S: N&V, Belching, bloating; Heartburn, weight loss. Dyspepsia is more common in the young (20-29), and gastric ulcer in those over 50, and duodenal ulcer in those 30-60.
Term
The processes of acute and chronic pancreatitis
Definition
Acute: An acute inflammation of the pancreas
Chronic: Fibrosis of the pancreas secondary to recurrent inflammation
Term
Acute pancreatitis (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: Epigastric, may radiate to the back or other parts of the abdomen; may be poorly localized
Q: Usually steady
T: Acute onset, persistent pain
AF: Lying supine
RF: Leaning foward with trunk flexed
AS&S: N&V, abdominal distention, fever. Often a history of previous attacks and alcohol abuse or gallstones.
Term
Chronic pancreatitis (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: Epigastric, radiating through to the back
Q: Steady, deep
T: Chronic or recurrent course
AF: Alcohol, heavy or fatty meals
RF: Possibly leaning forward with trunk flexed; often intractable
AS&S: Symptoms of decreased pancreatic function may appear: diarrhea with fatty stools (steatorrhea) and diabetes mellitus
Term
Acute cholecystitis process
Definition
Inflammation of the gallbladder, usually from obstruction of the cystic duct by a gallstone
Term
Acute cholecystitis (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: RUQ or upper abd; may radiate to the right scapular area
Q: Steady, aching
T: Gradual onset
AF: Jarring, deep breathing
AS&S: Anorexia, N&V, fever
Term
Acute diverticulitis process
Definition
Acute inflammation of a colonic diverticulum, a sac-like mucosal outpouching through the colonic muscle
Term
Acute diverticulitis (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: LLQ
Q: May be cramping at first, but becomes steady
T: Often gradual onset
AS&S: Fever, constipation. There may be initial brief diarrhea.
Term
Acute appendicitis
Definition
Acute inflammation of the appendix with distention or obstruction
Term
Acute appendicitis (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: Poorly localized periumbilical pain, followed by RLQ pain
Q: Mild but increasing, possibly cramping; becomes steady and more severe
T: Lasts roughly 4-6 hours; then when it moves to RLQ it depends on intervention
AF: Movement or cough
RF: If it subsides temporarily, suspect perforation of the appendix
AS&S: Anorexia, nausea, possibly vomiting, which typically follows onset of pain, low fever
Term
Acute Mechanical Intestinal Obstruction process
Definition
Obstruction of the bowel lumen, most commonly caused by 1) adhesions or hernias (small bowel) or 2) cancer or diverticulitis (colon)
Term
Acute Mechanical Intestinal Obstruction (Location, quality, timing, aggravating factors, relieving factors, and associated symptoms and setting)
Definition
L: Small bowel: periumbilical or upper abdominal; Colon: lower abdominal or generalized
Q: Cramping
T: Paroxysmal
AS&S: Small bowel: Vomiting of bile and mucus or fecal material. Obstipation develops; Colon: Obstipation early. Vomiting later ir at all. Prior symptoms of underlying cause.
Term
What are some problems that cause constipation?
Definition
1. Lifestyle Activities and Habits
2. Irritable Bowel Syndrome
3. Mechanical Obstruction
4. Painful Anal Lesions
5. Drugs
6. Depression
7. Neurologic Disorders
8. Metabolic Conditions
Term
Acute diarrhea (2 processes)
Definition
1. Secretory Infection: Infection by viruses, preformed bacterial toxins, cryptosporidium
2. Inflammatory Infection: Colonization or invasion of intestinal mucosa
Term
Acute Diarrhea: Secretory Infection (Characteristics of Stool, Timing, Associated Symptoms, Setting/Persons at Risk)
Definition
CoS: Watery, without blood, pus, or mucus
T: Duration of a few days, possibly longer. Lactase deficiency may lead to a longer course.
AS: N&V, periumbilical cramping pain. Temperature normal or slightly elevated.
S/PaR: Often travel, a common food source, or an epidemic
Term
Acute Diarrhea: Inflammatory Infection (Characteristics of Stool, Timing, Associated Symptoms, Setting/Persons at Risk)
Definition
CoS: Loose to watery, often with blood, pus, or mucus
T: An acute illness of varying duration
AS: Lower abdominal cramping pain and often rectal urgency, tenesmus; fever
S/PaR: Travel, contaminated food or water. Men and women who have had frequent anal intercourse
Term
What are the 6 components for a neurological physical examination?
Definition
1. Mental Status: Cerebral Cortex
2. Cranial Nerves: Brainstem
3. Cerebellum and Motor system: Cerebellum, cerebral cortex, corticospinal and extrapyramidal tracts
4. Sensory system: Cerebral cortex, spinal cord/spinothalamic tract and posterior columns
5. Reflexes
Term
What are the two major divisions to the nervous system?
Definition
1. Central Nervous system: brain and spinal cord
2. Peripheral Nervous system: 12 pairs cranial nerves and 31 pairs of spinal nerves
Term
What are the central components of the CNS?
Definition
1. Brain and brainstem
2. Cerebellum
3. Spinal cord
Term
Peripheral nerve
Definition
Bundle of fibers outside the CNS
Term
2 types of peripheral nerve fibers are:
Definition
1. Efferent: motor messages from the CNS out to muscles, organs, and glands
2. Afferent: sensory messages to the CNS from sensory receptors
Term
What are the 2 main functions of the peripheral nervous system?
Definition
1. Somatic: skeletal muscles (voluntary movement)
2. Autonomic: smooth muscles (involuntary movement)
Term
List the 12 cranial nerves.
Definition
CNI-Olfactory
CNII-Optic
CNIII-Oculomotor
CNIV-Trochlear
CNV-Trigeminal
CNVI-Abducens
CNVII-Facial
CNVIII-Acoustic
CNIX-Glossopharyngeal
CNX-Vagus
CNXI-Spinal-Accessory
CNXII-Hypoglossal
Term
Vasovagal response
Definition
Autonomic nervous system reacts causing bradycardia AND allows vasodilation in the extremity vessels - decrease blood - decrease O2 - on floor
Term
What are the symptoms of expressive dysphagia?
Definition
-Can understand what others are saying
-Words are slow and laborious, but meaningful
-Often gets frustrated
Term
What are the symptoms of receptive dysphagia?
Definition
-Little or no comprehension of words
-Spoken words are fluent and nonsensical
-No idea the words and language are wrong
Term
Glasgow Coma Scale
Definition
A neurological scale that aims to give a reliable, objective way of recording the conscious state of a person. The score ranges between 3 (deeply unconscious) and 15
Term
What part of the nervous system does each vital sign correlate to?
Definition
HR = Vagus
Respiratory = Medulla, pons
BP=Medulla
Temp = Hypothalamus
Term
How do you test each of the cranial nerves?
Definition
1. Olfactory: smell
2. Optic: snellen
3, 4, and 6. Oculomotor, Trochlear, Abducens: PERRLA, EOM
5. Trigeminal: clench teeth, light touch on face
7. Facial: Smile, frown, puff cheeks out
8. Acoustic: Whisper test, Rinne, Weber
9, 10. Say "Ahh," Gag reflex, taste
11. Spinal accessory - turn head and shrug shoulders against resistance
12. Hypoglossal - stick out tongue, speaking
Term
What would an abnormal finding during rapid rhythmic alternating movements be indicative of?
Definition
Possible cerebral disease . . . or drunk. Either one.
Term
What would an inability to walk straight be indicative of?
Definition
Cerebral Disease (MS) . . . or he's drunk.
Term
Romberg test
Definition
Stand upright, place feet together, then close eyes for 20 sec
Positive test menas loss of balance - cerebellar disorder (MS, drunk) altered proprioreception
Term
Pronator drift
Definition
Pt holds a "pizza box" at chest level - with supinated palms, close eyes and holds for 20 sec.
Term
What would abnormal muscle tones indicate?
Definition
-Flaccid: polio, Guillan-Barre
-Spastic: cerebral palsy, spinal cord injury
-Rigid: tetanus
-Cogwheel rigidity: parkinonism
Term
Stereogenosis
Definition
Familiar item in hand. If unable to ID, it means sensory cortex lesion
Term
Graphesthesia
Definition
"Write" number in palm and ID. If unable to ID, it indicates sensory cortex lesion
Term
Reflexes are:
Definition
1. Involuntary
2. Helps maintain muscle tone
3. Permits quick response to bad stimuli
Term
5 components needed for DTR response (IMPORTANT TO KNOW HINT HINT!)
Definition
1. Intact sensory nerve (afferent)
2. A functional synapse in the cord
3. An intact motor nerve fiber (efferent)
4. Neuromuscular joint
5. A competent muscle
Term
Charting deep tendon reflexes
Definition
Rated from 0 (no response) and 4+ (very brisk - clonus present)
Term
If reflexes are hyperactice, what should you do?
Definition
Check for clonus
Term
If assessing a comatose patient for deterioration, what should you do?
Definition
Check for Babinski response
Term
Order of the deterioration of LOC
Definition
1. A&O alters
2. Lose ability obey simple commands
3. Then responses deteriorate from purposeless responses to pain
4. Then absence of response to pain
5. Then loss of corneal and gag reflexes
Term
What would cause sudden pupillary dilation and nonreactive pupil?
Definition
Pressure on the brainstem
Term
Decerebrate posturing
Definition
Involuntary extension of the upper extremities as a response to external stimuli
Term
Decorticate posturing
Definition
Arms are flexed toward chest, fists are clenched, legs are extended, feet turned inward. A person decorticating in response to pain gets a 3 on the Glasgow Coma Scale
Term
Brudzinski's Sign
Definition
Positive if hips and knees flex as you flex pt.'s neck, is meningeal sign
Term
Kernig's sign
Definition
Flex pt.'s leg at hip and knee, then try to straighten (neck adn back pain & resistance occurs). Positive Kernig's bilateral suggests meningeal irritation
Term
Stroke
Definition
Sudden neurologic deficit caused by ischemia or hemorrhage
Term
Transient Ischemic Attack (TIA)
Definition
Focal neurologic deficit lasting <1hr without underlying structural defects, highest risk of stroke within next 30 days
Term
Warning signs of stroke
Definition
-Sudden numbness or weakness of the face, arm, or lef
-Sudden confusion or trouble speaking or understanding
-Sudden trouble walking, dizziness, or loss of balance
-Sudden trouble with vision in one or both eyes
-Sudden severe headache
Term
Aphonia
Definition
Loss of voice that accompanies disease affecting the larynx or its nerve supply
Term
Dysphonia
Definition
Refers to less severe impairment in the volume, quality, or pitch of the voice. For example, a person may be hoarse or only able to speak in a whisper.
Term
Dysarthria
Definition
Refers to a defect in the muscular control of the speech apparatus. Words may be nasal, slurred, or indistinct, but central symbolic aspect of language remains intact.
Term
Aphasia
Definition
Refers to a disorders in producing or understanding language. It is often caused by lesions in the dominant cerebral hemisphere, usually the left.
Term
Partial seizures
Definition
Start with focal manifestations. Divided into simple partial seizures, which do not impair consciousness, and complex partial seizures, which do.
Term
Generalized seizures
Definition
Begin with bilateral body movements, impairment of consciousness, or both. They suggest widespread, bilateral cortical disturbance that may be either hereditary or acquired.
Term
Pseudoseizures
Definition
May mimic seizures but are due to a conversion reaction (a psychological disorder)
Term
Aortic stenosis and hypertrophic cardiomyopathy
Definition
Vascular resistance falls with exercise, but cardiac output cannot rise
Term
Bradykinesia
Definition
Abnormal slowness of movement
Term
Dysmetria
Definition
Refers to a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand
Term
What is often the first sense lost in peripheral neuropathy?
Definition
Vibration sense
Term
Temporal lobe
Definition
Responsible for hearing, taste, and smell
Term
Frontal lobe
Definition
Emotions/Personality
Term
Paresthesia
Definition
Numbness, tingling, burning, crawling
Term
Dysphasia vs. Dysphagia
Definition
Dysphasia: Partial or complete impairment of the ability to communicate resulting from a brain injury
Dysphagia: difficulty swallowing
Term
Fasciculation
Definition
Eye twitching because you're tired
Term
Acute care neuro assessment (Glasgow coma)
Definition
-LOC
-Motor function
-Pupillary response
-Vital sets
-Add score for each thing, gives you an objective level of deterioration
-If you want neuro checks q15, this is what you would do
Term
Spinal injury
Definition
L1 or below: paraplegic
T6 and below: paraplegic
C6 and above: tetraplegia
C4 and above: tetraplegia, ventilator
Term
Obtunded
Definition
Difficult to arouse (loud noise, vigorous shaking or pain), sleeps most of the time, speech affected
Term
Lethargic
Definition
Not fully alert, drifts off when not stimulated
Term
Stupor
Definition
Need persistent, loud noise or pain for arousal, may respond to stimuli with a groan
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