Assessment Test 4

Glasgow Coma Scale specifics

(1) Alert Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interpersonal interactions. (2) Lethargic (or Somnolent) Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but thinking seems slow and fuzzy, inattentive, loses train of thought, spontaneous movements are decreased. 3) Obtunded (Transitional state between lethargy and stupor; some sources omit this level.) Sleeps most of time, difficult to arouse—needs loud shout or vigorous shake, acts confused when is aroused, converses in monosyllables, speech may be mumbled and incoherent, requires constant stimulation for even marginal cooperation. (4) Stupor or Semi-Coma Spontaneously unconscious, responds only to persistent and vigorous shake or pain; has appropriate motor response (i.e., withdraws hand to avoid pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists. (5) Coma Completely unconscious, no response to pain or to any external or internal stimuli (e.g., when suctioned, does not try to push the catheter away), light coma has some reflex activity but no purposeful movement, deep coma has no motor response.

Ulcer

(arterial ischemic, venous stasis, diabetic)

DTRs Deep tendon reflex

4+ Very brisk, hyperactive with clonus, indicative of disease 3+ Brisker than average, may indicate disease, probably normal 2+ Average, normal 1+ Diminished, low normal, or occurs only with reinforcement 0 No response This is a subjective scale and requires some clinical practice. Even then, the scale is not completely reliable because no standard exists to say how brisk a reflex should be to warrant a grade of 3+. Also, a wide range of normal exists in reflex responses. Healthy people may have diminished reflexes, or they may have brisk ones. Your best plan is to interpret the ? only within the context of the rest of the neurologic examination.

Bradycardia

<50 bpm

Supernumerary nipple

A ? is a normal and common variation. An extra ? along the embryonic "milk line" on the thorax or abdomen is a congenital finding. Usually, it is 5 to 6 cm below the breast near the midline and has no associated glandular tissue. It looks like a mole, although a close look reveals a tiny nipple and areola. It is not significant; merely distinguish it from a mole. Rarely, additional glandular tissue, called a ?, is present.

Ingrown toenail

A misnomer; the ? does not grow in, but the soft tissue grows over the ? and obliterates the groove. It occurs almost always on the great toe on the medial or lateral side. It is due to trimming the nail too short or toe-crowding in tight shoes. The area becomes infected when the ? grows and its corner penetrates the soft tissue.

Peritoneal friction rub

A rough, grating sound, like two pieces of leather rubbed together, indicates peritoneal inflammation. Occurs rarely. Usually occurs over organs with a large surface area in contact with the peritoneum. Liver—over lower right rib cage, from abscess or metastatic tumor. Spleen—over lower left rib cage in left anterior axillary line, from abscess, infection, or tumor.

ADLs

Activities of daily living

Venous Stasis Ulcer

After acute deep vein thrombosis or chronic incompetent valves in deep veins. S:Aching pain in calf or lower leg, worse at end of the day, worse with prolonged standing or sitting. O:Firm, brawny edema; coarse, thickened skin; pulses normal; brown pigment discoloration; petechiae; dermatitis. Venous stasis causes increased venous pressure, which then causes red blood cells (RBCs) to leak out of veins and into the skin. The RBCs break down and leave hemosiderin (iron deposits) behind, which are the brown pigment deposits. A weepy, pruritic stasis dermatitis may be present. Ulcers occur at medial malleolus and are characterized by bleeding, uneven edges.

Degenerative Joint Disease

Aka osteoarthritis

Inframmatory ridge

Also, normally you may feel a firm transverse ridge of compressed tissue in the lower quadrants. This is the ?, and it is especially noticeable in large breasts. Do not confuse it with an abnormal lump.

Hooking technique

An alternative method of palpating the liver is to stand up at the person's shoulder and swivel your body to the right so that you face the person's feet. ?your fingers over the costal margin from above. Ask the person to take a deep breath. Try to feel the liver edge bump your fingertips.

Deviation in nipple pointing

An underlying cancer causes fibrosis in the mammary ducts, which pulls the ? toward it.

Bruit

Arterial- a indicates turbulent blood flow, as found in constricted, abnormally dilated, or tortuous vessels. Listen with the bell. Occurs with the following three conditions: Aortic aneurysm—murmur is harsh, systolic, or continuous and accentuated with systole. Note in person with hypertension. Renal artery stenosis—murmur is midline or toward flank, soft, low to medium pitch. Partial occlusion of femoral arteries. an abnormal blowing or swishing sound or murmur heard while auscultating a carotid artery, the aorta, an organ, or a gland, such as the liver or thyroid, and resulting from blood flowing through a narrow or partially occluded artery. The specific character of the ?, its location, and the time of its occurrence in a cycle of other sounds are all of diagnostic importance. ? are usually of low frequency and are heard best with the bell of a stethoscope.

Phalen's test

Ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand reproduces numbness and burning in a person with carpal tunnel syndrome

Rebound tenderness

Assess when the person reports abdominal pain or when you elicit tenderness during palpation. Choose a site away from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply; then lift up quickly. This makes structures that are indented by palpation rebound suddenly. A normal, or negative, response is no pain on release of pressure. Perform this test at the end of the examination, because it can cause severe pain and muscle rigidity. Pain on release of pressure, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis. Cough tenderness that is localized to a specific spot also signals peritoneal irritation. Refer the person with suspected appendicitis for computed tomography (CT) scanning.

Carpal Tunnel Syndrome

Atrophy occurs from interference with motor function from compression of the median nerve . Caused by chronic repetitive motion; occurs between 30 and 60 years of age and is five times more common in women than in men. Symptoms include pain, burning and numbness, positive findings on Phalen test, positive indication of Tinel sign, and often atrophy of thenar muscles.

Gynecomastia

Benign enlargement of male breast that occurs when peripheral tissues convert androgen hormones to estrogens. It is a mobile disk of tissue located centrally under the nipple-areola. At puberty, it is usually mild and transient. In older men, it is bilateral, tender, and firm but not as hard as breast cancer. ? occurs with obesity, Cushing syndrome, liver cirrhosis (because cannot metabolize estrogens), adrenal disease, hyperthyroidism, and numerous drugs: alcohol and marijuana; estrogen treatment for prostate cancer; antibiotics (metronidazole, isoniazid); digoxin, ACE inhibitors; psychoactive drugs (diazepam, tricyclic antidepressants).16

Fibroadenoma

Benign tumors, most commonly present as self-detected in late adolescence. Solitary nontender mass that is solid, firm, rubbery, and elastic. Round, oval, or lobulated; 1 to 5 cm. Freely movable, slippery, fingers slide it easily through tissue. Usually no axillary lymphadenopathy. Diagnose by triple test (palpation, ultrasound, and needle biopsy); however; adolescents with rapidly growing mass need surgical excision anyway.15

Arterial—Ischemic Ulcer

Buildup of fatty plaques on intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis). S:Deep muscle pain in calf or foot, claudication (pain with walking), pain at rest indicates worsening of condition. O:Coolness, pallor, elevational pallor, and dependent rubor; diminished pulses; systolic bruits; signs of malnutrition (thin, shiny skin; thick-ridged nails; atrophy of muscles); distal gangrene. Ulcers occur at toes, metatarsal heads, heels, lateral ankle, and are characterized by pale ischemic base, well-defined edges, and no bleeding.

Protuberant

Bulging stomach 3rd term pregnancy look

Lumbar curves (cervical, thoracic, lumbar)

Cervical and lumbar appear concave Thoracic and sacral appear convex

Osteoporosis

Decrease in skeletal bone mass occurring when rate of bone resorption is greater than that of bone formation. The weakened bone state increases risk for stress fractures, especially at wrist, hip, and vertebrae. Occurs primarily in postmenopausal white women. risk also is associated with smaller height and weight, younger age at menopause, lack of physical activity, and lack of estrogen in women.

Dysphagia

Difficulty swallowing

Tinel's Sign

Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand. In carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a positive sign.

Breast self-examination (BSE)

Every month

Pronation

Ex. When palm is facing upward and then rotating it to where the palm is facing downward.

Cancer of breast - risk factors

Female gender, age >50 years Personal history of ? ? Mutation of BRCA1 and BRCA2 genes First-degree relative with ? (mother, sister, daughter) High breast tissue density Biopsy-confirmed atypical hyperplasia High-dose radiation to chest Early menarche (<12 years) or late menopause (>55 years) Nulliparity or first child after age 30 years Recent oral contraceptive use Never breastfed a child Recent and long-term use of estrogen and progestin Alcohol intake of ≥1 drink daily Obesity (especially after menopause) and high-fat diet Physical inactivity

Interphalangeal joints-distal

First joint back from fingertip

Weak, thready pulse

Hard to palpate, need to search for it, may fade in and out, easily obliterated by pressure. Decreased cardiac output, peripheral arterial disease, aortic valve stenosis

Lactose intolerance

In some racial groups, ? activity is high at birth but declines to low levels by adulthood. These people are lactose intolerant and have abdominal pain, bloating, and flatulence when milk products are consumed. Millions of American adults have the potential for lactose-intolerance symptoms, and traditional estimated rates were that 15% of whites, 50% of Mexican Americans, and 80% of African Americans had the condition. Yet a recent study found the prevalence rates in practical life settings is significantly lower than previously estimated rates.36 When subjects were screened for symptoms following a typical serving of dairy food in the home setting, lactose-intolerance prevalence estimates were 7.72% for whites, 19.5% for African Americans, and 10% for Hispanics.36 This is clinically significant because dairy foods meet crucial nutritional requirements including calcium, magnesium, and potassium. If people perceive themselves to be lactose intolerant based on racial heritage, the lowered calcium intake may affect bone health. Health care providers should encourage low-fat or fat-free daily foods and monitor any symptoms.

CVA tenderness

Indirect fist percussion causes the tissues to vibrate instead of producing a sound. To assess the kidney, place one hand over the twelfth rib at the ? angle on the back. Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain. (Although this step is explained here with percussion techniques, its usual sequence in a complete examination is with thoracic assessment, when the person is sitting up and you are standing behind.) Sharp pain occurs with inflammation of the kidney or paranephric area.

Murphy's sign

Inspiratory Arrest.Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder (cholecystitis), pain occurs. Hold your fingers under the liver border. Ask the person to take a deep breath. A normal response is to complete the deep breath without pain. (Note: This sign is less accurate in patients older than 60 years; evidence shows that 25% of them do not have any abdominal tenderness.30) When the test is positive, as the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway.

Scoliosis

Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies. Functional ? is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg length discrepancy. Structural ? is fixed; the curvature shows both on standing and on bending forward. Note rib hump with forward flexion. When the person is standing, note unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level. At greatest risk are females 10 years of age through adolescence, during the peak of the growth spurt.

Plantar flexion

Limited to extension

Peau d'Orange (edema)

Lymphatic obstruction produces ?. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look. This condition suggests cancer. ? usually begins in the skin around and beneath the areola, the most dependent area of the breast. Also note nipple infiltration here.

Retraction

Maneuvers to Screen for ? Direct the woman to change position while you check the breasts for skin retraction signs. First ask her to lift her arms slowly over her head. Both breasts should move up symmetrically (Fig. 17-9). ? signs are due to fibrosis in the breast tissue, usually caused by growing neoplasms. The fibrosis shortens with time, causing contrasting signs with the normally loose breast tissue. Note a lag in the movement of one breast.

Aortic Aneurysm

Most (>95%) are located below the renal arteries and extend to the umbilicus. A focal bulging >5 cm is palpable in about 80% of cases during routine physical examination and feels like a pulsating mass in the upper abdomen just to the left of midline. You will hear a bruit. Femoral pulses are present but decreased. Can be sometimes seen in epigastric region.

Benign breast disease (formerly fibrocystic breast disease)

Multiple tender masses. "?" is not accurate because, actually, six diagnostic categories exist, based on symptoms and physical findings: • Swelling and tenderness (cyclic discomfort) • Mastalgia (severe pain, both cyclic and noncyclic) • Nodularity (significant lumpiness, both cyclic and noncyclic) • Dominant lumps (including cysts and fibroadenomas) • Nipple discharge (including intraductal papilloma and duct ectasia) • Infections and inflammations (including subareolar abscess, lactational mastitis, breast abscess, and Mondor's disease) About 50% of all women have some form of benign breast disease. Nodularity occurs bilaterally; regular, firm nodules that are mobile, well demarcated, and feel rubbery, like small water balloons. Pain may be dull, heavy, and cyclic or just before menses as nodules enlarge. Some women have nodularity but no pain, and vice versa. Cysts are discrete, fluid-filled sacs. Dominant lumps and nipple discharge must be investigated carefully and may need biopsy to rule out cancer. Nodularity itself is not premalignant but produces difficulty in detecting other cancerous lumps.

Osteoarthritis

Noninflammatory, localized, progressive disorder involving deterioration of articular cartilages and subchondral bone and formation of new bone (osteophytes) at joint surfaces. Aging increases incidence; nearly all adults older than 60 years have some radiographic signs of osteoarthritis. Asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard, bony protuberances, pain with motion, and limitation of motion (see Table 22-4).

Lordosis

Pronounced lumbar curve

Range of Motion

ROM

Blumberg's Sign

Rebound Tenderness

Interphalangeal joints-proximal

Second joint back from fingertip

Tanner staging

Stage 1 Preadolescent: Only a small elevated nipple 2 Breast bud stage: A small mound of breast and nipple develops; the areola widens 3 The breast and areola enlarge; the nipple is flush with the breast surface 4 The areola and nipple form a secondary mound over the breast 5 Mature breast: Only the nipple protrudes; the areola is flush with the breast contour (the areola may continue as a secondary mound in some normal women)

Inguinal lymph nodes

The ? in the groin drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall. not unusual to find palpable nodes that are small (1 cm or less), movable, and nontender.

Nipple retraction

The ? looks flatter and broader, like an underlying crater. A recent ? suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It also may occur with benign lesions such as ectasia of the ducts. Do not confuse retraction with the normal long-standing type of nipple inversion, which has no broadening and is not fixed.

Clinical breast examination (CBE)

The American Cancer Society recommends that women ages 20 to 39 years have a ? every 3 years; women ages 40 years and older should perform BSE, with an annual mammogram and an annual ? conducted close to the same time.4

Dimpling

The shallow ? (also called a skin tether) shown here is a sign of skin retraction. Cancer causes fibrosis, which contracts the suspensory ligaments. The dimple may be apparent at rest, with compression, or with lifting of the arms. Also note the distortion of the areola here as the fibrosis pulls the nipple toward it.

Costovertebral angle (CVA)

The twelfth rib forms an angle with the vertebral column, the costovertebral angle.

RA

This is a chronic, systemic inflammatory disease of joints and surrounding connective tissue. Inflammation of synovial membrane leads to thickening; then to fibrosis, which limits motion; and finally to bony ankylosis. The disorder is symmetric and bilateral and is characterized by heat, redness, swelling, and painful motion of the affected joints. is associated with fatigue, weakness, anorexia, weight loss, low-grade fever, and lymphadenopathy.

Metacarpophalangeal joint

This joint is between the carpals and metacarpal or where the finger meets the palm.

Extension

To extend or stretch

Doppler Ultrasonic Stethoscope

Use this device to detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity magnifies pulsatile sounds from the heart and blood vessels. Position the person supine, with the legs externally rotated so you can reach the medial ankles easily. Place a drop of coupling gel on the end of the handheld transducer. Place the transducer over a pulse site at a 90-degree angle. Apply very light pressure; locate the pulse site by the swishing, whooshing sound.

Arteriosclerosis

a common disorder characterized by thickening, loss of elasticity, and calcification of arterial walls. It results in a decreased blood supply, especially to the cerebrum and lower extremities. The condition often develops with aging and in hypertension, nephrosclerosis, scleroderma, diabetes, and hyperlipidemia. Typical signs and symptoms include intermittent claudication, changes in skin temperature and color, altered peripheral pulses, bruits over an involved artery, headache, dizziness, and memory defects. Vasodilators and exercise may relieve symptoms, but there is no specific treatment. Preventive measures include therapy for predisposing diseases, adequate rest and exercise, avoidance of stress, and discontinuation of tobacco use

Atheroclerosis

a common disorder characterized by yellowish plaques of cholesterol, other lipids, and cellular debris in the inner layers of the walls of arteries. may be induced by injury to the arterial endothelium, proliferation of smooth muscle in vessel walls, or accumulation of lipids in hyperlipidemia. It usually occurs with aging and is often associated with tobacco use, obesity, high homocysteine levels from eating red meat, hypertension, elevated low-density lipoprotein and depressed high-density lipoprotein levels, and diabetes mellitus. The condition begins as a fatty streak and gradually builds to a fibrous plaque or atheromatous lesion. The vessel walls become thick, fibrotic, and calcified, and the lumen narrows, resulting in reduced blood flow to organs normally supplied by the artery. The plaque eventually creates a risk for thrombosis and is one of the major causes of coronary heart disease, angina pectoris, myocardial infarction, and other cardiac disorders. Plaque rupture is usually provoked by activation of the sympathetic nervous system, such as sudden awakening, heavy physical exertion, or anger. Antilipemic agents do not reverse atherosclerosis. Segments of arteries obstructed or severely damaged by atheromatous lesions may be replaced by patch grafts or bypassed, as in coronary bypass surgery; the lesion may be removed from the vessel via endarterectomy; or obstructed arteries may be opened by balloon angioplasty or by the insertion of stents. A diet low in cholesterol, calories, and saturated fats, together with avoidance of smoking, stress, and a sedentary lifestyle, may help prevent the disorder

Involuntary rigidity

a constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum. It may be unilateral, and the same area usually becomes painful when the person increases intra-abdominal pressure by attempting a sit-up.

Ischemia

a decreased supply of oxygenated blood to a body part. The condition is often marked by pain and organ dysfunction, as in ischemic heart disease. Some causes of ischemia are arterial embolism, atherosclerosis, thrombosis, and vasoconstriction.

Anorexia

a lack or loss of appetite, resulting in the inability to eat. The condition may result from poorly prepared or unattractive food or surroundings, unfavorable company, or various physical and psychologic causes

Lymphedema

a primary or secondary condition characterized by the accumulation of lymph in soft tissue and the resultant swelling caused by inflammation, obstruction, or removal of lymph channels. Congenital ? (Milroy's disease) is a hereditary disorder characterized by chronic lymphatic obstruction. ? praecox occurs in adolescence, chiefly in females, and causes puffiness and swelling of the lower limbs, apparently because of hyperplastic development of lymph vessels. Secondary ? may follow surgical removal of lymph channels in mastectomy, obstruction of lymph drainage caused by malignant tumors, or the infestation of lymph vessels with adult filarial parasites. ? of the lower extremities begins with mild swelling of the foot, gradually extends to the entire limb, and is aggravated by prolonged standing, pregnancy, obesity, warm weather, and the menstrual period. The disorder has no cure, but lymph drainage from the extremity can be improved if the patient sleeps with the foot of the bed elevated 4 to 8 inches, wears elastic stockings, and takes moderate exercise regularly. Light massage in the direction of the lymph flow and thiazide diuretics may be prescribed. Constricting clothing and salty or spicy foods that increase thirst are contraindicated. Surgery may be performed to remove hypertrophied lymph channels and disfiguring tissue.

Striae

a streak or a linear scar that often results from rapidly developing tension in the skin, such as seen on the abdomen after pregnancy. Purplish are among the classic findings in hyperadrenocorticism. Also called stretch mark.

Varicose Veins (superficial)

a tortuous, dilated vein with incompetent valves. Causes include congenitally defective valves, thrombophlebitis, pregnancy, and obesity. ? are common, especially in women, and are usually painless. The saphenous veins of the legs are most often affected. Elevation of the legs and use of elastic stockings are frequently sufficient therapy for uncomplicated cases. Ligation of the vein above the ? and removal of the distal part of the vessel may be indicated for more severe cases if deeper vessels can maintain the return of venous blood. Injection of sclerosing solutions helps prevent or treat postphlebitic syndrome.

Hepatomegaly

abnormal enlargement of the liver that is usually a sign of disease, often discovered by percussion and palpation as part of a physical examination. In ? the liver is easily palpable below the ribs in the right upper quadrant of the abdomen and may be tender to the touch. may be caused by hepatitis or other infection; fatty infiltration, as in alcoholism; biliary obstruction; or malignancy.

Cholecystitis

acute or chronic inflammation of the gallbladder. Acute ? is usually caused by a gallstone that cannot pass through the cystic duct. Pain is felt in the right upper quadrant of the abdomen, accompanied by nausea, vomiting, eructation, and flatulence. The patient may exhibit a positive Murphy's sign. Diagnosis is usually made with ultrasound. Surgery is the preferred mode of treatment. Chronic ?, the more common type, has an insidious onset. Pain, often felt at night, may follow a fatty meal. Complications include biliary calculi, pancreatitis, and carcinoma of the gallbladder. Again surgery is the preferred treatment.

Venous Insufficiency

an abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk of the body. Edema is usually the first sign of the condition. Pain, varicosities, and ulceration may follow. Treatment usually consists of elevation of the legs, use of elastic hose, and correction of the underlying condition.

Splenomegaly

an abnormal enlargement of the spleen, as is associated with portal hypertension, hemolytic anemia, Niemann-Pick disease, or malaria.

Reinforcement (in assessing DTRs)

an abnormal neurologic condition in which language function is disordered or absent because of an injury to certain areas of the cerebral cortex. The deficiency may be sensory aphasia, in which language is not understood, or motor aphasia, in which words cannot be formed or expressed. Aphasia may be complete or partial, affecting specific language functions. Most commonly, the condition is a mixture of incomplete sensory and motor aphasia. It may occur after severe head trauma, prolonged hypoxia, or cerebrovascular accident. It is sometimes transient, as when the swelling in the brain that follows aphrasia or injury subsides and language returns

Contracture

an abnormal, usually permanent condition of a joint, characterized by flexion and fixation. It may be caused by atrophy and shortening of muscle fibers resulting from immobilization or by loss of the normal elasticity of connective tissues or the skin, as from the formation of extensive scar tissue over a joint

Peritonitis

an inflammation of the peritoneum. It is produced by bacteria or irritating substances introduced into the abdominal cavity by a penetrating wound or perforation of an organ in the GI tract or the reproductive tract. caused most commonly by rupture of the appendix but also occurs after perforations of intestinal diverticula, peptic ulcers, gangrenous gallbladders, gangrenous obstructions of the small bowel, or incarcerated hernias, as well as ruptures of the spleen, liver, ovarian cyst, or fallopian tube, especially in ectopic pregnancy. In some cases, ? is secondary to the release of pancreatic enzymes, bile, or digestive juices of the upper GI tract, and there are reports of postoperative peritonitis caused by cornstarch used to powder surgical gloves. The bacteria most frequently identified as causative agents in peritonitis are Escherichia coli, Bacteroides, Fusobacterium, and anaerobic and aerobic streptococci. Pneumococci occasionally found in peritonitis in girls are thought to enter the abdominal cavity via the vagina and fallopian tubes.

Mammogram (mammography)

an x-ray film of the soft tissues of the breast.

Inverted nipple Lymphadenopathy

any disorder characterized by a localized or generalized enlargement of the lymph nodes or lymph vessels.

Borborygmi

audible abdominal sounds produced by hyperactive intestinal peristalsis. are very loud rumbling, gurgling, and tinkling noises heard in auscultation, often without a stethoscope. The increased intestinal activity noted at times in cases of gastroenteritis and diarrhea result in ? that do not have the intensity or the episodic character of "normal ?." ? that are high-pitched and accompanied by vomiting, distension, and intestinal cramps suggest a mechanical obstruction of the small intestine and often precede complete bowel obstruction.

Flexion

bending a limb at a joint

Intermittent claudication and claudication distance

cramplike pains in the calves caused by poor circulation of the blood to the leg muscles. The condition is commonly associated with atherosclerosis. The disorder is usually manifested after walking and is relieved by rest. may require arterial bypass grafting, such as femoral popliteal bypass. ? must be differentiated from rest pain, a condition that requires surgical intervention and signals limb threat.

DVT

deep vein thrombosis

Diabetes ulcers

hastens changes described with ischemic ulcer, with generalized dysfunction in all arterial areas: peripheral, coronary, cerebral, retina, kidney. Peripheral involvement is associated with diabetic neuropathy. Without careful vigilance of pressure points on the feet, ulcer may go unnoticed. Pain and sensation are decreased, and surrounding skin is calloused.

Kyphosis

humpback

Raynaud's phenomenon

intermittent attacks of ischemia of the extremities of the body, especially the fingers, toes, ears, and nose, caused by exposure to cold or by emotional stimuli. The attacks are characterized by severe blanching of the extremities, followed by cyanosis, then redness; they are usually accompanied by numbness, tingling, burning, and often pain. Normal color and sensation are restored by heat. The attacks usually occur secondary to such conditions as scleroderma, rheumatoid arthritis, systemic lupus erythematosus, thoracic outlet syndrome, drug intoxications, dysproteinemia, myxedema, primary pulmonary hypertension, and trauma. The condition is called ? disease when there is a history of symptoms for at least 2 years with no progression of symptoms and no evidence of an underlying cause. Therapy for the secondary form depends on recognition and treatment of the underlying disease. Idiopathic forms, which occur most frequently in young women 18 to 30 years of age, may be controlled by protecting the body and extremities from the cold, by the use of mild sedatives and vasodilators, and by avoiding smoking. Biofeedback techniques are useful in training the client to increase the temperature of the affected extremity, ears, or nose. Drug therapy can also relieve symptoms.

Shifting dullness

is positive with a large volume of ascitic fluid: it will not detect less than 500 mL of fluid.

Dorsiflexion

limited to flexion

Hyperextension

movement at a joint to a position beyond the joint's normal maximum extension.

Abduction

movement of a limb away from the midline or axis of the body

Retraction

moving a body part backward and parallel to the ground

Adduction

moving a limb toward the midline of the body

Circumduction

moving the arm in a circle around the shoulder

Rotation (external, internal)

moving the head around a central axis

Inversion

moving the sole of the foot inward at the ankle

Eversion

moving the sole of the foot outward at the ankle

Suprapubic dullness

occurs over a distended bladder, adipose tissue, fluid, or a mass.

Voluntary guarding

occurs when the person is cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation. Use the relaxation measures to try to eliminate this type of guarding, or it will interfere with deep palpation.

Diastasis recti (infant)

or a midline longitudinal ridge, is a separation of the abdominal rectus muscles. Ridge is revealed when intra-abdominal pressure is increased by raising head while supine. Occurs congenitally and as a result of pregnancy or marked obesity in which prolonged distention or a decrease in muscle tone has occurred. It is not clinically significant.

Homan's sign

pain in the calf with dorsiflexion of the foot, indicating thrombophlebitis or thrombosis. It is not, however, a reliable indicator of either medical problem.

Hernias

protrusion or projection of an organ through an abnormal opening in the muscle wall of the cavity that surrounds it. may be congenital, may result from the failure of certain structures to close after birth, or may be acquired later in life as a result of obesity, muscular weakness, surgery, or illness.

Lymph Nodes

small, oval clumps of lymphatic tissue located at intervals along the vessels. Most ? are arranged in groups, both deep and superficial, in the body. ? filter the fluid before it is returned to the bloodstream and filter out microorganisms that could be harmful to the body. The pathogens are exposed to B and T lymphocytes in the ?. The lymphocytes mount an antigen-specific response to eliminate the pathogens. With local inflammation, the ? in that area become swollen and tender.

Temporomandibular Joint

the articulation of the mandible and the temporal bone. You can feel it in the depression anterior to the tragus of the ear. The TMJ permits jaw function for speaking and chewing. The joint allows three motions: (1) hinge action to open and close the jaws; (2) gliding action for protrusion and retraction; and (3) gliding for side-to-side movement of the lower jaw.

Tail of Spence

the cone-shaped breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes. The upper outer quadrant is the site of most breast tumors.

Supination

turning the forearm so that the palm is up

Allen Test (modified)

used to evaluate the adequacy of collateral circulation before cannulating the radial artery . (A) Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. (B) Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the hand's normal color in approximately 2 to 5 seconds. Although this test is simple and useful, it is relatively crude and subject to error—that is, you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate.

Non-pitting edema

usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. Another cause of ? of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. ? of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling. Unilateral or bilateral ? occurs with lymphatic obstruction. With these factors, it is "brawny" or nonpitting and feels hard to the touch.

Crepitation

with the normal discrete "crack" heard as a tendon or ligament slips over bone during motion, such as when you do a knee bend. is an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened, as with rheumatoid arthritis