Health Assessment Final

greater trochanter of femur location

normally the width of the person's palm below the iliac crest and halfway between the anterior superior iliac spine and ischial tuberosity

symptoms of hypertension

not many clinical manifestations- silent killer if symptomatic- flushed or headache

accessory muscles use in breathing

not normally needed to augment resp effect. neck muscles can be used momentarily used in exercise

inguinal lymph node palpation

not unusual to find small movable contender nodes

lymphatics function

retrieves excess fluid and plasma proteins from interstitial spaces and returns them to bloodstream

What conditions does hyperthermia occur with?

hyperthyroidism, fever/exercise- exists with increased metabolism. local inflammation

oropharynx

separated from mouth by a fold of tissue on each side, the anterior tonsillar pillar

aging adult pain tolerance

no evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished

isometric contraction

no shortening; muscle tension increases but does not exceed load. builds pressure within itself in ventricles in order to have more pressure than aorta for blood to flow out

Innocent murmur and characteristics

no valvular or pathologic cause general soft (grade 2), midsytolic, short, crescendo-decrescendo, vibratory or musical quality

Flaccid Quadriplegia indicates

nonfunctional brain stem

normal lymph nodes

nonpalpable. non-tender, freely movable, and less than 1cm still normal. larger ones (especially cervical) in kids can still be normal

epstein pearls

normal finding in babies. small white glistening pearly papule that look like teeth on the hard palate- smile retention cysts

Sinus Arrhythmia

normal finding in young adults and kids. rhythm varies with breathing

acrus senilis

normal in the elderly but contributes to decreased accommodation: ring-shaped, grayish-white deposit of phospholipid and cholesterol near the peripheral edge of the cornea. dont mistake for opacity

chronic obstructive lung disease

normal inspiration and prolonged expiration to overcome increased airway resistance. in people with chronic obstructive lung disease, increased heart rate causes dsypneic breathing because they don't have enough time for a full expiration

normocephalic

normal skull smooth and in proportion to side of body

eccrine glands

normal sweat- dilute saline. infants begin this at 2 months

is spleen palpable

normally not palpable- must be enlarged 3x to be felt

cutaneous angiomas and what they are associated with

spider nevi. associated with liver disease/ portal hypertension on chest

sensory pathway types

spinothalmic/anterolateral tract and posterior (dorsal) column

related organs in the lymphatic system

spleen, tonsils, thymus

femoral artery location

the major artery supplying the leg- passes under the inguinal ligament and down the thigh

diastolic pressure

the minimum arterial pressure during relaxation and dilatation of the ventricles of the heart when the ventricles fill with blood

Herniated disk and symptoms

the nucleus pulpous ruptures into the spinal canal and puts pressure on local spine nerve root, causing pain and inflammation. usually occurs from strenuous activities symptoms: sciatic pain, numbness, paresthesia in involved dermatome, listing away from affected side, decreased mobility

forced expiratory time screening

the number of seconds it takes for the person to exhale from total lung capacity to residual volume. screens measure of airway obstruction

transmission phase of pain

the pain impulse moves from level of spinal cord to the brain if not stopped by opioids. goes to thalamus and then dispersed to higher cortical areas (the emotional awareness and identification of pain)

Transillumination

the passage of strong light through a body structure, to permit inspection by an observer on the opposite side

diagnostic reasoning

the process of analyzing health data and drawing conclusions to identify diagnoses

atrophic scar

the resulting skin level is depressed with loss of tissue; a thinning of the epidermis

dental carries indicate

tooth decay

tobacco leads to

tooth loss, coronal and root caries, periodontal disease

Testing extinction

touching both sides and indicating which wide they feel sensation. they won't feel opposite side of lesion

pericardium

tough, fibrous, double-walled sac that surrounds and protects the heart contains a few ml of serous pericardial fluid. adherent to great vessels, esophagus, sternum, and pleurae and anchored to the diaphragm

how to position to auscultate for extra heart sounds

with pt on left side- some sounds only heard here. also auscultate with patient sitting and learning forward

Food diaries

two weekdays and one weekend day used. problems include patient being noncompliant or eating differently than normal

Auscultate the abdomen

use diaphragm of stethoscope and hold lightly begin in RLQ because bowel sounds- high pitched

Palpating interphalangeal joints

use fingers to pinch sides of the joints

how to palpate apical impulse

use one finger pad, ask person to exhale and hold it. palpable in half of adults. should only occupy one interspace (4th or 5th) and be at or medial to midclavicular line. rolling toward left helps to find

technique for palpating tactile fremitus

use palmar base or ulnar edge of a hand to touch chest spots on back while pt says "99" or "blue moon" which are resonant phrases that generate strong vibrations

how to palpate aorta

use your thumb and first finger or use two hands and palpate deeply in the epigastrum, slightly to the left of midline. assess the pulsation of the abdominal aorta

inspection steps

used first. compare left and right side symmetry, good lighting, take is slow, adequate exposure, instrument use

doppler ultrasonic probe

used to detect a weak peripheral pulse by magnifying pulsation sounds from the heart and vessel

modified Allen test

used to evaluate the adequacy of collateral circulation before cannulating the radial artery

reference lines

used to pinpoint a finding vertically on the chest midsternal line, midclavicular line, scapular line, vertebral line, anterior/posterior/midaxillary lines

Iliopsoas muscle test

used when acute abdominal pain suspected- pt supine and lift right leg straight up flexing at the hip and pushing down lower thing as patient tries to hold it up. when ilopsoas muscle inflamed or perforated, pain felt in RLQ

how to do mental status exam for persons with aphasia

word comprehension- having them say items in room pointed at reading writing- ask Pt to write sentence about a given topic

Cause of rhonchal fremitus

vibration felt when inhaled air passes through thick secretions in the larger bronchi. coughing can somewhat decrease

clonic phase

violent muscular contractions, facial grimacing, increased heart rate

Pneumocystis jiroveci pneumonia

virulent form of pneumonia (p. jiroveci or p. carinii) is a protozoal infection associated with AIDS/immunocompromised. cysts containing the organism form in alveloar spaces, alveolar walls ticket, and it spreads to interstitial infiltrates

sources of pain

visceral, somatic (deep somatic or cutaneous) referred

Rickets

vitamin D deficiency causing bowed legs

preload

volume. venous return that builds during diastole. length to which the ventricle muscle is stretched at the end of diastole just before contraction increased stretching beyond normal is preload and leads to an increased SV due to a greater contraction

somatic nerve fibers

voluntary movement that results in skeletal muscle contraction

measures to enhance abdominal wall relaxation

warm room, hands, stethoscope. supine with pillow knees bent and arms across or at side

Direct observation of nutrition and when is it used

watch feeding and eating processes. helps for failure to thrive children and unintentional weight loss of older adults

mandatory reporting

we are legally required to report to authorities when abuse seen or suspected

paresis

weakness caused by disease or ?

medial and lateral menisci

wedge shaped cartilages that cushion tibia and femur

prodromal MI symptoms in women

weeks before acute cardiac syndrome; fatigue, arm and jaw pain, SOB

general overall health state review questions

weight loss/ gain, frequent illness, can't gain weight, energy level/fatigue, behavior change

Somatic pain (two types)- locations, characteristics, causes

well localized and easy to pinpoint: can also cause N/v, sweating, tachycardia, hypertension due to ANS musculoskeletal tissues or the body surface deep and cutaneous somatic pain

objective history

what a healthcare professional notices

subjective data

what the person says about himself or herself during history taking

thought content

what the person thinks- specific ideas, beliefs, the use of words. is what they say logical?

auscultation

what you hear vs what you should be hearing

urticaria

wheals coalesce to form extensive reaction, intensely pruritic

neuropathic pain

when disease/injury causes damage or alters nervous system causing abnormal processing of pain. pain is for no particular reason, usually chronic, and referred to as nerve pain. not typical or predictable phases; can result in continuous firing. chronic diseases or lesion/disease of somatosensory nervous system often cause this

nociceptive pain

when functioning and intact nerve fibers in the periphery and CNS are stimulated- triggered by events outside nervous system from actual or potential nerve damage. develops in response to specific situation and usually acute. goes away as body heals. adding pressure, heat, chemicals worsens the pain

what causes angina

when heart's own blood supply can't keep up with metabolic demand

when does bias exist in interview on behalf of a child

when it comes to caregiver's capabilities and the child's accomplishments

when does arm edema occur

when lymph drainage obstructed after breast surgery or radiation

S2 split

when valve closes significant earlier in aortic valve that pulmonic valve during inspiration the sounds can be heard separate. heard every 3-4 beats

questions to ask about rash or lesions

where it started has it spread anyone else have it changed any meds or skin products alleviating/aggravating/associating factors

what to document about adventitious sounds?

whether inspiratory or expiratory, loudness, pitch, and location on chest wall

whispered voice test purpose

whispering is a high-frequency sound that when not heard, detects high-frequency loss

appearance of candida infection

white coat will rub off with raw denuded surface

what people have visual impairment more?

white people, women, older adults

source of heath history

who provides info and are they reliable? are they sick, as this affects good communication. are interpretation services needed

performing ortolani manuever

with infant supine, flex the knees with thumbs on inner mid thigh and fingers on greater trochanters. adduct until thumbs meet and then gently lift and abduct until lateral aspect touches table. should produce no sound

myocardium

muscular wall of heart that does the pumping

hair distribution alterations are due to

liver disease and hormone abnormalities

How many OM considered recurrent?

3 episodes in 3 months or 4 in one year

semicircular canals

3 fluid-filled structures in the inner ear that house receptors for body position and movement. plumb lines register angle of head in relation to gravity

alveoli number at birth

40 million

Caloric demand of adolescents

4000 calories for boys and 20% less for girls

palpating for kidneys

"duck bill" position at person's right flank and press deeply and have them breathe deeply. nothing usually felt but can occasionally feel lower pole of right kidney as a round smooth mass that slides between fingers

scleroderma

"hard skin". a chronic connective tissue disorder associated with decreased mobility

allergic rhinitis and common causes

"hay fever" abnormal immune response from repeated exposure to antigens with rhinorrhea, itching of nose and eyes, tearing, congestion, sneezing. Note serous edema and turbinate swelling fills air space and appears white, glistening, and smooth. Common allergies- dust mites, animal dander, mold, pollen. Causes disordered sleep, obstructive sleep apnea, sinusitis, avoidance of outdoor activities, and poor work performance.

cholasma

"mask of pregnancy" hyperpigmentation of the skin, characterized by yellowish-brown patches or spots on face. usually fades after childbirth. also in those taking BCP

Cause and location of epistaxis

(nose bleed) commonly comes from the anterior septum occurs with trauma, vigorous nose blowing, foreign objects

recent weight change formula

(usual weight - current weight) / usual weight X 100

Android obesity

Obese persons with a greater proportion of fat in upper body, especially in abdomen

Romberg test

-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds assesses vestibular apparatus ability to help maintain standing balance along with assessing intactness of cerebellum and proprioception

CNS depressants

Opiods, alcohol, benzodiazepines

Testing Cranial Nerve II

Optic nerve: visual acuity charts, visual fields (confrontation test for peripheral vision), papilledema notes with optic disk for increased ICP

incompetent vavles

lumen so wide that valve cusps can't approximate. creating further pressure that dilates even more

ROM motions for spine

-bend forward (concave lumbar should disappear and back should have single shape) -bend sideways and backward (lateral and hyperextension) -twist shoulders to each side (rotation)

ROM motions for wrist and hand

-bend hand up and down (hyperextension and flexion) -bend fingers up and down (hyperextension and flexion) -turn hands out and in (ulnar and radial deviation) -spread fingers and make fist -touch thumb to each finger and base of little finger

ROM motions of Cervical spine

-chin to chest (flexion) -lift chin (hyperextension) -ear to shoulder (lateral bending) -turn chin to each shoulder (rotation)

Radiocarpal joints

-condyloid articulations between the radius and the three carpal bones -articulation of the distal radius (thumb side). Its condyloid action permits flexion/extension and side to side deviation

CNII Oculomotor abnormalities cause

-dilated pupil, ptosis, eyes turn out and slightly down - failure to move eye up, in, or down - absent light reflex

carotid artery pulse coincides with

S1

vital capacity

maximum amount they can expel from lungs after first filling lungs to maximum

5 things to assess individually about heart sounds

1) rate and rhythm 2) identify s1 and s2 3) assess S1 an S2 separate 4) listen for extra heart sounds 5) listen for murmurs

anterior thyroid approach

find ismuth by placing thumb 3cm below thyroid cartilage prominence as person swallows and turns head and check

identify 5 auscultatory areas of the heart

1) second right interspace= aortic valve areas 2) second left interspace= pulmonic valve area 3) left lower sternal border= tricuspid valve area 4) fifth interspace at around MCL= mitral valve area 5)

systolic pressure

maximum pressure felt on artery during left ventricular contraction, or systole

structural changes in the TM of older adults

may appear whiter and more opaque, dull, and possibly thickened

3 causes of murmurs

1) velocity of blood increases= flow murmur (exercise and thryotoxicosis) 2) viscocity of blood decreases (in anemia) 3) structural defects of the valves or unusual openings occur in the chambers

symptoms of cerebral hypoxia

may be reflected by excessive drowsiness, anxiety, restlessness, irritability

Paget's disease of bone

*couldn't find in book so definition from online* (Osteitis Deformans) Skeletal disease of increase bone resorption and formation, which softens, thickens, and deforms bone. Characterized by bowed long bones, sudden fractures, frontal bossing, and enlarging skull bones that forma an acorn-shaped cranium. Can cause: headache, vertigo, tinnitus, progressive deafness, and optic atrophy and compression of the spinal cord.

congenital hypothyroidism

*couldn't find in book so online definition* condition present at birth that results in lack of thyroid hormones; results in poor physical and mental development; formerly called cretinism

Ulnar deviation or drift

fingers drift to the ulnar because of the stretching of the articular capsule and muscle imbalance caused by chronic RA

widened aortic pulse

fingers push apart (lateral pulsation) associated with abdominal aortic aneurism

quadricep location and function

front of thigh muscle that extends the knee

Which sinuses are palpable

frontal and maxillary

vertigo cause

may be related to inflamed labyrinth and can affect the way info is transferred to the brain

ways to palpate for sinusitis

frontal and maxillary sinuses palpated and tender. checking for focal pain when pt bends over

First heart sound

S1, occurs with closure of the atrioventricular valves signaling the beginning of systole. mitral closes just before tricuspid but usually heard as one fused sound

Second heart sound

S2; occurs with closure of the semilunar valves, aortic and pulmonic; signals the end of systole

types of paranasal sinuses

frontal, ethmoid, sphenoid, maxillary

consequences of sighing too much

may indicate emotional dysfunction and may lead to hyperventilation and dizziness

third heart sound and when it occurs

S3. during passive prodiastole- ventricles are resistant which causes vibrations of the chest. occurs right after S2 when AV valves open

fourth heart sound and when it occurs

S4. occurs during active prediastole. atria contract and push blood into a noncompliant ventricle. can be heard right before S1

bodily changes in pregnant female

- hormonal changes -connective tissue changes - dissipate heat through peripheral vasculature dilation- causing visible large veins - sweat and sebaceous glands increase secretion - increased fat deposits in buttocks and hips

hacking cough indicates

mycoplasma pneumonia

influences on temperature

diurnal cycle (1-1.5 change), menstrual cycle (0.5-1), exercise, age (lower in infants that can't shiver and under 2 months can't sweat)

septum

divides nasal cavity into two slit-like air passages

Pathway of heart electrical conduction

SA note near SVC initiated impulse, then goes to AV node low in atrial septum, bundle of His, left and right bundle branches, then through the ventricles

carbon monoxide exposure symptoms

dizziness, h/a, fatigue

Assessing infant cranial nerve I,II,III,IV

- Blink reflex - pupil size, shape, equality - regards face or object - eyes follow movement

What does the biceps reflex test?

- C5 to C6 - contraction of the biceps muscle and flexion of the forearm when striking bicep tendon

What does brachioradialis reflex test

- C5 to C6 - flexion and supination of the forearm strike 2-3cm above radial styloid process

What does the triceps reflex test?

- C7 to C8 - extension of the forearm strike tricep tendon directly above elbow

What does plantar reflex test

- L4 to S2 - slow stroke upside down on ball of foot - Normal is plantar flexion of the toes and inversion and flexion of the foot (Negative Babinski sign)

Assessing infant cranial nerve VIII

- Moro reflex (until 4 months) - acoustic blink reflex- blinks in response to hand clap a foot from head - eyes follow direction of sound

Screening for child abuse

- Obtain a medical history- This should include for any chronic illnesses, injuries, medications (some may cause easy bruising), repeated hospital visits, or delays in seeking care? - Talk to the child without the parents present (if possible and old enough)

common causes of sensorineural hearing loss

- advanced age - noise exposure - ototoxic meds- affect cochleae hair cells - meniere's disease

causes that affect transfer of sound to middle ear

- cerumen impaction - otitis media/ externa - tympanic membrane perforation - foreign body - otosclerosis- due to decrease in mobility of ossicles

ear changes in older adults

- cilia becomes coarse and stiff - impacted cerumen impedes hearing: it oxidizes, causing this impaction and is drier due to apocrine atrophy. - presbycussis

Increased risks of alcohol consumption by older adults

- decreased metabolism- stays in body longer due to metabolism and decline in liver and kidney fx - concentration increases- due to less skin and muscle tissue - medications that interact- Bp meds, blood thinners, antidepressants, pain relievers - cognitive decline- sensory issues -confusion, depression, and risk of fall exists

additional hx for infants and children

- ear infections (amount, frequency, risk factors) - parental impression of hearing fx/concerns

gathering subjective data

- introduce initial question: "do you feel safe at home" - standardized tools used - reassure that help is available and discuss health problems that accompany IPV

Assessing infant cranial nerve IX and X

- swallowing and gag reflex - coordinate sucking and swallowing

screening tools evaluate what about drinking

- tolerance - withdraws signs - drinking despite problems - spends lots of time revolved around drinking - spends less time on important things in life

CN X vagus nerve abnormalities cause

- uvula deviates to side - no gag reflex - voice quality: hoarse/brassy, nasal twang, husky -dysphagia: fluids regurgitate through nose

Alcohol screening tools

-Alcohol Use disorders Identification test (AUDIT) -Cage Questionaire -TWEAK -Short Michigan Alcoholism screening Test- Geriatric (SMAST-G)

What does quadriceps reflex test

-L2 to L4 (knee jerk) -Just below patella and causes extension of lower leg

What does achilles reflex test

-L5 to S2 (ankle jerk) -foot plantar flexes against hand strike achilles tendon while holding foot in dorsiflexion

ROM of ankle and foot

-Point toes down, up (plantar flexion, dorsiflexion) -Turn soles out, in (eversion, inversion) -Flex and straighten toes

CN V trigeminal nerve abnormalities cause

-absent touch and pain; paresthesia - no blink - weakness of masseter or temporals muscle

meds causing hyperpigmentation

-antimalarials -anticancer ascents -hormones -metals -tetracycline

how to interview an anxious pt

-appear unhurried -avoid interview traps -use therapeutic responses

ROM motions for shoulders

-arms forward and up then back (forward flexion and hyperextension) -arms to sides and up over head (abduction) -swing arms across front of body (adduction) -arms behind back and hands up (internal rotation) -touch hands behind head (external rotation)

CN VI Abducens Nerve abnormalities cause

-failure to move laterally - diplopia on lateral gaze

what are the first two statements of the GAD-7?

-feeling nervous, anxious, or on edge -not being able to stop or control worrying

ROM motions elbow

-flex and extend elbow -pronate and supinate hand

ROM motions of knee

-flex knee -extend knee -check knee during ambulation

Types of scoliosis

-idiopathic: shows up during adolescence usually not progressive -functional: flexible; occurs with standing and disappears when bending forward. may compensate for unequal leg lengths -structural: fixed; shown when standing and leaning forward.

Closing the Interview steps

-is there anything else you'd like to mention? -are there any questions you'd like to ask? -follow w a summary

what are the first two statements of the PQH-9?

-little interest or pleasure in doing things -feeling down, depressed, or hopeless

What makes certain people bruise easier

-medication: aspirin, blood thinners, NSAIDs -abnormal blood volumes -nutritional supplements: garlic and ginko

mobility and turgor of skin

-mobility is the skin's ease of rising (decreased with edema) -turgor is the skin's ability to return to place promptly when released this reflects the elasticity. to check mobility and turgot pinch up a large fold of skin on the anterior chest under the clavicle and release

misunderstanding health information can lead to

-noncompliance of health management -increased ER visits -increased readmission rates -inability to effectively recall info or manage chronic disease

Motion and expected range of temporomandibular joint

-open mouth maximally -protrude lower jaw and move side to side- lateral may be lost early and significantly -stick out lower jaw

dysphagia occurs with

-pharyngitis -gastroesophageal reflux disease -stroke & other neurologic diseases -esophageal cancer

ROM motions for hip

-raising leg (flexion) -knee to chest (flexion) -flex knee and hip; swing foot in and out (internal and external rotation) -swing straight leg medial and lateral (abduction and adduction) -stand and swing leg back (hyperextension)

impaired vision results from (three things):

-refractive error -opacity in media (cornea, lens, vitreous) -disorder in retina or optic pathway

meds causing sun sensitivity

-sulfonamides -thiazide diuretics -oral hypoglycemic agents

Top priority questions when interviewing those intoxicated

-time of last drug/drink -how much was taken -name and amount of each drug taken -your safety (dont turn back on them) ask questions in simple nonthreatening way without displaying disapproval

CN XII hypoglossal nerve abnormalities cause

-tongue deviates to side -slowed rate of tongue movement

numeric pain rating scale and minimum age

0-10, ten being worst pain pt has ever been in. consistent test throughout multiple clinicians. must be 9 or older

cognitive development stages

0-2 Sensorimotor, think by touch, taste, smell, etc. presymbolic. reflexive communication 2-7 Preoperational think by symbols from previous experiences. beginning of symbolic thinking 7-11 Concrete Operational, logical and organized not yet abstract. numbers, classification, and conservation 11+ Formal Operational, abstract thinking like adults. futuristic/ theoretic perspecitve

reflex scale

0: no response 1+: diminished response, low normal, or occurs with reinforcement 2+: normal physiologic response 3+: increased response (brisk). may indicate disease 4+: hyper-reactive, often associated with clonus, indicates disease

3 mechanisms that cause venous blood flow

1) Contraction of skeletal muscle tissue brings blood proximally toward heart 2) pressure gradient due to breathing- inspiration makes thoracic pressure decrease and abdominal increase 3) intraluminal valves ensure unidirectional blood flow

Subjective data order for alcohol use

1) ask about alcohol use 2) use screening tools 3) Assess for alcohol use disorders 4) Advise and assist (brief intervention)

6 grades of murmur loudness

1) barely audible- heard only in quiet room 2) clearly audible but faint 3) moderately loud; easy to hear 4) loud. Associated w thrill palpable on chest wall 5) very loud. Heard w/ one corner of scope, thrill 6) loudest; entire stethoscope lifted just off chest wall, thril

functions of the middle ear

1) conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear; 2) it protects the inner ear by reducing the amplitude of loud sounds; and 3) its eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture

reasons its important to review bodily systems w pt

1) evaluate past and present health of each system 2)see if there is anything excluded from present illness section 3) evaluate health promotion practices

3 Erythematous States Common in Neonate

1) first 24 hours- red flush due to vasomotor instability 2) harlequin- on side- lower half reddens and upper blanches line down midline; transient 3) erythema toxicum- common rash in 1st 3-4 days "flea bite" or "newborn rush"- red tiny punctuate macules and papules

TB stages

1) macrophages engulf but don't fill bacilli and tubercle forms around bacilli 2) scar tissue forms and lesion calcifies 3) reactivation of previously healed lesion- multiplication occurs 4)extensive destruction as lesion erodes into bronchus, forming air filed cavity

aspects noticed about source of history of a child

1) person providing info on behalf of child 2) your impression on the reliability of the info 3) need for translator or special services

Pitting Edema Scale

1+ Mild pitting, slight indentation, no perceptible swelling 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation remains, leg looks swollen 4+ Very deep pitting, indentation lasts long time, leg very swollen

tonsil grading scale

1+: visible 2+: halfway b/w tonsillar pillars and uvula 3+: touching uvula 4+: touching each other (1+ or 2+ can be seen in healthy people, particularly kids, who have larger lymph)

drinking correlation with HTN

1-2 drinks daily associated w HTN

ten traps of interviewing

1. Providing false assurance or reassurance 2. Giving unwanted advice- no personal feelings 3. Using authority 4. Using avoidance language- "died" not "passed on"-avoids reality 5. Engaging in distancing- use of interpersonal space to put spare between a threat and self "the" instead of "your" 6. Using professional jargon 7. Using leading or biased questions 8. Talking too much 9. Interrupting 10. Using "why" questions- causes excuses given to try to justify behavior

3 functions of lymphatic system

1. conserves fluid and plasma proteins that leak from capillaries 2. form major part of immune system 3. lipid absorption from small intestines

steps of diagnostic reasoning

1. cue recognition 2. hypothesis formulation 3. data gathering for hypothesis testing 4. hypothesis evaluation

external factors of communication

1. ensure privacy 2. refuse interruptions 3. physical environment: 4-5 ft from pt 4. dress 5. note taking

inspect straightness of spine by:

1. following imaginary line from head through spinous processes down through gluteal cleft 2. noting equal horizontal positions for the bone and bone markings

What waist-to-hip ratio indicates android obesity

1.0 or greater in men and 0.8 or greater in women

Common pigmented areas include (3):

1.Freckles 2.Moles/Nevi 3.Birthmarks

Phsyiological jaundice

1/2 newborns. yellowing after day 3-4 due to increased RBCs hemolyzed. They are metabolized and turned into bilirubin

SMAST-G

10 questions. determines at risk use or abuse of alcohol in older adults

Types of elder abuse and rates

10% of elders. 1 in 14 reported. includes intentional acts and failure to act - physical abuse - sexual -psychological/emotional- controlling or social isolation - neglect - financial abuse or exploitation

what temperature is considered a fever?

100.4 F (38 C)

when to get vaccinated for measles

12-15 months and 4-6 years

Normal respiratory rate

12-20 breaths per minute

24 hour recall

12am to 12am. have problems as pt may not be able to recall all foods/ amount of food or may have had more or less food than normal

What percent of kids have mental/behavioral/development disorders

14% of 2-8 and 20% of 9-17. only 25% get needed help

Low calorie amount for weight loss diet plans

1400-1500kcal/day

normal nail bed angle

160 degrees. curves nails still normal if this angle still is the same

what percent of aging adults have mental disorders?

18.3% and 4.% are serious

What is nail clubbing, when is it most commonly found?

180 and spongy, becomes convex. chronic hypoxia (due to response and cardiac conditions). occurs with lung disease, cyanotic heart disease, pulmonary disease

AP to transverse diameter

1:2 or .70

Normal AP to transverse diameter ratio

1:2 or .70

1st, 2nd, and 3rd priorities of care

1st- emergent and immediately life threatening: airway or breathing 2nd- those requiring prompt intervention to forestall further deterioration- mental status, acute pain, abnormal lab values, UI issues, untreated medical problems, infection risk, risk to safety/security 3rd- can be attended to after urgent things fixed. interventions long term: lack of knowledge, mobility problems, family coping

Umbilical cord consists of

2 arteries and 1 vein

indirect percussion

2 hands. pleximotor (middle finger) stationary hang and plexor (tip of middle finger) striking finger

how many words are used in phases of 2, 3-4, and 5-6 year olds

2- 2 words 3-4- 3-4 words 5-6- 6- 8 words

How wide must an abnormal percussion area be to yield an actual finding?

2-3 cm wide

Nutritional needs of surgery, trauma, burn, infection pts

2-3 times greater than normal caloric and nutrient needs

presbycusis

2/3 over 70. sensorineural high pitched hearing loss affecting middle ear structures or cause damage to nerve cells in the inner ear or to cranial nerve VIII. affects more men than women of same age and more in white/hispanics

Low fat diet %

20-25% of total calories

visual impairment is considered?

20/50 or worse.

risk factors for melanoma

20x higher in white people more common in women under 50 and men later on >50 moles or atypical moles uv radiation family fx advancing age- accumulation of DNA damage

heart ventricle size ratio

2:1 left:right. reaches this by 1 year old

heart borders and where it extends from

2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line.

Dizzy/vertigo/syncope

dizzy- lightheaded/faint vertigo- room spinning syncope- LOC possible due to decreased blood flow

chronic cough

3 months of year for more than two yeers. characteristic of chronic bronchitis

When does salivation begin?

3 months. they drool for a few months before learning to swallow. drooling does herald eruption of first tooth

turbinates function

3 parakeet body projections in nasal cavity: superior, middle, and inferior. they increase surface area so more blood vessels and mucous membranes warm, humidify, and filter air

how long to use glass thermometer

3-4 mins if afebrile and 8 if febrile

normal resting pupil size

3-5mm

How wide should mouth open

3-6cm or 3 fingers sideways

Size of a newborn's chest

30-36cm (2cm smaller than head circumference until age 2)

infant respiratory rate

30-40 normal, but can get up to 60

alveoli number by adolescence

300 million

spinal nerves

31 pairs "peripheral nerves" that are named from the region of the spine that they exit from

intimate partner violence rates and 5 types

33% women and 25% men physical sexual stalking psychological aggression Teen dating violence- above types, cyber bullying, sex trafficking

spine vertebrae number

33: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-4 coccygeal

CRIES pain scale

3pt scale for 0-2 years old. C=crying R=requires o2 I=increased vital signs E-expression S=sleeplessness maximum 10

faces pain scale revised

4 or older pick a face describing how you feel

normal forced expiratory time

4 seconds or less. 6 or more occurs with obstructive lung diease

force or strength of pulse levels

4+ bounding strong 3+ full, easy to palpate 2+ normal, easy to palpate, 1+ diminished, difficult to palpate, weak and thready 0 absent

Regular exercise plan consists of

4-5 times a week for 30 minutes minumum

normal cardiac output

4-6L per minute

Grading Muscle Strength

5 Full ROM against gravity full resistance 100% 4 Full ROM against gravity some resistance 75% 3 Full ROM with gravity 50% 2 Full ROM with gravity eliminated (passive) 25% 1 Slight contraction 10% 0 no contraction 0%

what is considered binge drinking?

5 or more drinks

Normal amount of bowel sounds

5-30 per minute

deep palpation

5-8cm. assesses an organ or mass deeper in a body cavity

Risks of IVP homicide

55% of female homicides due to IVP. highest in black and islander/alaskan women

Inner ear development in gestation

5th week

when to get vaccinated for pertussis

6-8 weeks- need to cocoon to give baby immunity until they can receive vaccine

normal pulse range

60-100 bpm

scoring of apgar

7-10= healthy 3-6= moderately depressed- need more resuscitation/observation 0-2= severely depressed- need full resuscitation, ventilatory assistance, and subsequent intensive care

Prevalence of color blindness

8% white males 4% black males 0.4% females

what age to start palpating sinuses

8. otherwise too small

what degree should the costal angle be

90 or less, increases when rib cage is chronically overinflated

Normal temperature range

96.4-99.1 or 35.8-37.3

apical impulse by age

<4- 4th ICS to left of MCL 4-6- 4th ICS at MCL 7- 5th ICS to right of the MCL

hirshberg in kids

<6 months some asymmetry is normal

what is considered bradycardia and tachycardia

<60 and >100

what MAP is normal

> 60 mmhg needed for adequate perfusion

what is considered elevated jugular venous pressure

>3cm above sternal angle when at 45 degree angle

How many cafe-au-lait spots are necessary for concern of neurofibromatosis

>6 that are >1.6mm diameter

When should the pneumococcal vaccine be given?

>65

Who gets macular degeneration more?

>75yrs or white

Chalazion

A beady nodule protruding on the lid, chalazion is an obstruction and inflammation of a meibomain gland. If chronic, nontender, firm, discreet movable swelling. Acute- tender and inflamed, not on lid margin (stye)

multiple sclerosis

A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech

Metabolic syndrome

A cluster of conditions that increase the risk of heart disease, stroke, and diabetes (3 out of 5). -increased BP -increased fasting glucose -increased triglycerides -increased waist circumference -decreased high density lipoprotein cholesterol

cleft palate and its cause

A congenital defect, the failure of fusion of the maxillary processes.

Cheyne-Stokes respiration

A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. these periods last 30-45 seconds with periods of apnea (20 seconds) alternating the cycle. most commonly caused by HF

Parkinson's Syndrome

A deficiency of the neurotransmitter dopamine and degeneration of the substantia nigra of the basal ganglia in the brain. The immobility of features produces a flat and expressionless face, mask like, elevated eyebrows, staring gaze, oily skin, and drooling

what conditions does a pulse deficit occur with?

A fib, premature beats, HF

aortic stenosis murmur sound

A harsh ejection systolic murmur. Starts after isovolumic contraction and ends before S2.

mitral stenosis murmur sound

A low-pitched, rumbly mid-diastolic murmur that starts near the end of isovolumic relaxation.

How to palpate popliteal pulse

A more diffuse pulse and can be difficult to localize. leg extended but relax. anchor thumbs on knee and curl fingers around into popliteal fossa. often just lateral to the medial tendon

heel to shin test

A neurologic test assessing lower limb coordination and position sense. heel walls off shin with cerebellar disease

gyrus

A ridged or raised portion of a convoluted brain surface.

emphysema

A serious disease that destroys lung connective tissue characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. this increases airway resistant, particularly during expiration

What is used to effectively communicate with other health professions about a patient

SBAR (situation, background, assessment finding, recommendation)

Dietary Reference Intakes (DRIs)

A set of reference values for the intake of energy, nutrients, and food components

Waves of the Jugular pulse:

A wave- reflects atrial contraction bc some blood flows back to vena cava C wave- ventricular contraction, back flow from bulging upward of tricuspid valve when it closes at beginning of ventricular systole X wave- atrial relaxation V wave- passive atrial filling bc of increasing volume and pressure in right aorta Y wave- reflects passive ventricular filling

appearance of the soft and hard palates

hard- lighter bone soft- darker pink mobile muscle

Scleroderma

hardening of the skin. chronic connective tissue disorder associated with decreased mobility

full/bounding pulse occurs with

hyperkinetic states (exercise, anxiety, fever), anemia, and hyperthyroidism

A full, bounding pulse is associated with

hyperkinetic states (exercise, anxiety, fever, hyperthryroidism, anemia).

What to do when a pt cries/ looks like they will cry

do not go onto new topic allow them to cry acknowledge the expression

Rapid Alternating Movements

Assess coordination by asking person to pat the knees with both hands, lift up, turn hands over and pat knees with the backs of the hands. Then ask them to do it faster. Normal Finding: Done with a equal turning and quick rhythmic pace

carotid auscultation

Assess for bruit - loud blowing sound associated with stenosis of an artery (hearing it is a marker for atherosclerotic disease) use the bell to listen at jaw angle, midcervical area, and base of neck; person should hold their breath so you aren't distracted by tracheal sound. heard when lumen occurred from 1/3 to 2/3

blood pressure changes with age

SBP increases due to stiffening of arteries (left ventricular wall thickens to try to compensate for this loss of elasticity) increased pulse pressure as SBP increases and DBP doesn't change significantly

rotator cuff consists of

SITS- supraspinatus, infraspinatus, teres minor, subscapularis muscles

Components of the Mental Status Examination

ABCT Appearance Behavior Cognition Thought processes and perceptions

Lymphedema

Accumulation of protein rich fluid in the interstitial spaces of the arm follow breast surgery or treatment Protein rich lymph builds up in interstitial spaces which raises pressure and promotes more fluid leakage

Optimal nutritional status

Achieved when sufficient nutrients are consumed to support day-to-day body needs on a daily basis

What happens in the eye during accommodation?

Adjusts the curvature by changing the shape of the lens

Conductive hearing loss

Affects the structures that transfer sound to the inner ear. Involves the external and middle ear- typically mechanical dysfunction to it. one or both. partial loss- can hear if sound is amplified enough to reach normal nerve elements in ear

Races with increased stroke risk

African Americans, American Indians, Mexican Americans

Venous (stasis) ulcer cause and appearance

After acute DVT or chronic incompetent valves in deep veins. 80% of lower leg ulcers Occur at medial malleolus and tibia; characterized by bleeding and uneven edges

thyroid-single nodule

Aka simple diffuse goiter. Endemic. Chronic enlargement of thyroid gland in areas where soil is low in iodine, an important element in formation of thyroid hormones

Ortolani maneuver purpose

done at each visit until 1yr. checks for congenital hip displacement

Leukonychia

Also known as white spots, whitish discoloration of the nails caused by injury or picking at cuticle

otitis media with effusion

Amber/yellow drum suggests serum in middle ear that transudes to relieve negative pressure from blocked Eustachian tube. May note air/fluid level. Symptoms are fullness, transient hearing loss, and popping sound with swallowing

what is pulse rhythm

feeling of the pressure wave of arterial walls as heard pumps blood

palmar grasp

An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object.

sternal angle and location

Angle of Louis. continuous with the second rib. useful place to start counting ribs and help find things horizontally. marks site of tracheal bifurcation into the left and right bronchi

Plantar grasp

Apply pressure with thumb on the ball of infant's foot and toes curl down tightly. disappears at 8-10 months

cerebrum

Area of the brain responsible for all voluntary activities of the body

Ateriosclerosis vs. atherosclerosis

Arterio-hardening, thickening of wall narrowing lumen Athero-buildup of cholesterol plaque on inner wall, narrowing lumen

5 A's of smoking cessation

Ask Advise Assess (readiness/ interest in quitting) Assist Arrange

Phalen's test

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

Brief pain inventory

Asks the patient to rate the pain within the past 24 hours using graduated scales (0-10) with respect to its impact on areas such as mood, walking ability, and sleep.

presystole/atrial systole/ atrial kick

At the end of diastole when the atria contracts to actively push the last amount of blood (25% of SV) into the ventricles

Cause and appearance of Arterial (ischemic) ulcer

Atherosclerosis (intimate fatty plague buildup) and arteriosclerosis (hardening/ calcifying of arterial wall) Occurs at toes, metatarsal heads, heels, and lateral ankle. Pale ischemic base well defined edges no bleeding- dry and punched out

hyperthyroidism

Autoimmune disorder with increased production of thyroid hormones causing increased metabolism. Manifested by goiter, eyelid retraction, and exophthalmos (bulging eyes). Nervousness, fatigue, weight loss, muscle cramps, and heat intollerance. Signs- forceful tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair, warm moist skin, infrequent blinking, staring appearance, brisk ankle jerks

Celiac disease and symptoms

Autoimmune disorder. immune mediated inflammation results in damage to small intestines and villi. common symptoms include diarrhea and abdominal pain and distention no wheat, barley, rye, or commercial oats can be eaten

Primative reflexes

Automatic reactions that all healthy babies posses but are not seen in children or adults. as cerebral cortex develops in inhibits the reflexes and they disappear

Romberg test

feet together and eyes closed- slight swaying normal but not separation. Tests sensory loss as eyesight can accommodate for it

palpating for greater trochanter of femur

felt when person is standing in a depression on the upper lateral side of the thigh

Where is S1 loudest?

apex of heart

pupil

Controls the amount of light entering the eye

how do you assess pain in patients with dementia?

assess body language to help determine if pt is in pain. they feel pain but can't self-report it

rooting reflex

Brush the infant's cheek near the mouth. Note whether the infant turns the head toward that side and opens the mouth. Appears at birth and disappears at 3 to 4 months.

jugular veins reflect

assess the central venous pressure CVP and judge the heart's efficiency as a pump and the intravascular volume status

Waist-to-hip ratio purpose

assesses body fat distribution as an indicator of health risk

accommodation reflex

a pupillary response that occurs when you switch focus from a far object to a clot one. Normal response: convergence and pupillary constriction

perforation of the tympanic membrane

Untreated OM or trauma may cause drum rupturing. Usually appears as a round or oval darkened area on the drum Central- pars tensa marginal- annulus marginal perforations called attic perforations and occur in pars flaccida

visual acuity changes with age

both central (>70) and peripheral vision decreases

upper fine crackles indicates

CF

High pitched shrill cry

CNS damage of infants

cherry red lips can be a sign of

CO poisoning, acidosis from aspirin poisoning, ketoacidosis

upward palpebral slant

Can be a normal finding in kids, but when with epicentral folds, hypertelorism (space between eyes) and brush field spots, it indicates Down syndrome

Characteristics of eustachian tubes of babies

Canal slope opposite from adults. shorter, wider, more horizontal, facilitating movement of pathogens to middle ear.

decerebrate rigidity

Upper extremities: stiffly extended, adducted, internal rotation,palms pronated. Lower extremities: stiffly extended, plantar flexion; teeth clenched;hyperextended back

BMI formulas

Weight (kg) / [height (m)]^2 Weight (lb) / [height(in)]^2 * 703

Nonsynovial joints

Cartilaginous/fibrous- bones are united by fibrous tissue or cartilage and are immovable Separated by fibrocartilaginous disks and are only slightly moveable- ex vertebrae

meth mouth cause and what it leads to

Causes dental caries, gingivitis, tooth cracking, edentulism. Meth causes vasoconstriction and decreased saliva and increases urge to consume sugar and starch/ give up oral hygiene. Absence of buffering saliva increases acidity and plague that encourages bacteria growth

carotid artery

Central artery located in the groove between the sternomastoid and the trachea

What can cause asymmetry of facial structures

Central brain lesions (stroke) or peripheral cranial nerve VII damage (Bell's palsy)

Normal Spine Curvature

Cervical concave, thoracic convex, lumbar concave

Scorbutic gums

Deficiency of vitamin C. Gums are swollen, ulcerated and bleeding due to vitamin-C induced defects in oral epithelial basement membrane

atopic facies

Children with chronic allergies often develop characteristic facial features- exhausted face, blue shadows below eyes from sluggish venous return (Morgan lines), central facial pallor, open mouth breathing (allergic gaping), which can lead to malocclusion of the teeth and malformed jaw

monocular blindness

When light directed to the blind eye, no response occurs in either eye. When light directed to normal eye, both pupils constrict as long as the oculomotor nerve is intact

fetal alcohol syndrome

Cognitive and psychosocial impairment and changes in facial and brain structure. Incidence increasing in US. Narrow palpebral fissures, epicanthal folds, thin upper lip, and mid facial hypoplasia. Infants have smaller head circumference, size, feeding problems, and irritablity. Intrusive talking, inattention, poor reasoning, and ADL issues

pleural effusion (fluid) or thickening

Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. gravity settles this fluid in dependent areas of the thorax. presence of fluid subdues lung sounds most common cause HF, cancer, infection

Otomycosis

Colony of black or white dots on drum or canal- yeast or fungal infection

Ecchymosis

a purplish patch resulting from the extravasation of blood into the skin. >3mm in diameter

What is a subcortical reflex?

a reflex we have no control over

Bulge sign test

Confirms the presence of small amounts of fluid in supra patellar pouch as you try to move the fluid from one side of the joint to the other. firmly stroke up medial knee and tap lateral aspect watching medial side in hallow for a bulge of from a fluid wave across the joint

metacarpophalangeal joint

Connects metacarpals to the proximal phalanges. permits finger flexion and extension

tendon

Connects skeletal muscle to bone

Diencephalon

Contains thalamus and hypothalamus

Hirschburg test evaluates what?

Corneal Light reflex to diagnose strabismus. tests alignment of eyes. light 12 inches away. cornea reflection should be on same spot in both eyes. misalignment indicates muscle weakness paralysis

spinous processes

Count down these knobs on the vertebrae, which stack together on form spinal column

Facial nerves mediated by

Cranial nerve VII (facial nerve)

Gower sign

a sign that indicates generalized muscle weakness in children. need all four extremities to climb up

sucking tubercle

a small pad in the middle of the upper lip from friction of breastfeeding or bottle feeding

Plaque

a solid mass greater than 1 cm in diameter. plateau/ disk shaped lesion

Lesion shape: linear

a stretch, streak, line, or stripe

causes of constipation in older adults

Decreased physical activity Inadequate intake of water Low-fiber diet Side effects of medications Irritable bowel syndrome Bowel obstruction Hypothyroidism Inadequate toilet facilities, i.e., difficulty ambulating to toilet may cause person to deliberately retain stool until it becomes hard and difficult to pass

scarred drum

Dense white patches on eardrum are sequelae of repeated ear infections. Dont necessarily affect hearing

mental status exam for children

Denver II- direct test on them

murmur pitch

Describe as "high, medium, or low" Depends on the pressure and rate of blood flow producing the murmur

baby bottle tooth decay cause

Destruction of numerous deciduous teeth may occur in children that take milk, juice, or sweetened drink to bed and use bottles >1. Liquid pools around upper front teeth. Mouth bacteria act on carbs in liquid. This forms metabolic acids that break down tooth enamel and destroy its protein

hypoactive bowel sounds causes

Diminished or absent bowel sounds signal decreased motility as a result of inflammation: peritonitis, paralytic ileum following surgery, late bowel obstruction

tinels sign

Direct percussion of location of median nerve at wrist produces no symptoms in normal hand Percussion of median nerve produces burning and tingling along its distribution, which is a positive Tinel's sign for carpal tunnel syndrome

Which exam (otoscopic or acuity) is done first and why?

Do before hearing acuity test, as cerumen presence can give impression of pathologic hearing loss

peritoneum

Double-layered membrane internal to abdominal muscles that surround the abdominal organs

delayed eruption of teeth may indicate

Down syndrome, cretinism, rickets

dry vs wet macular degeneration

Dry - progressive and slow in one or both eyes due to druse deposits Wet - rapid with visions of wavy lines and loss of central vision usually in one eye. abnormal vessels grown under tissue and leak, causing scaring

Follicular hyperkeratosis

Dry, bumpy skin associated with vitamin A and/or linoleic acid deficiency

What is used to outline cardiac borders

ECG or xrays used instead of percussion as they're more accurate in detecting heart enlargement

Pulses bisferiens and what it occurs with

Each pulse has two strong systolic peaks with a dip in between; best assessed at the carotid artery. associated with aortic valve stenosis with reguritation

verbal response: facilitation

Encourages client to say more: "uh huh" or "go on"

extremely high palate arch may indicate

Ehlers-danlos, turner, marfan, treacher, chronic allergies

Clinical lab data of alcohol impairment

Ethanol (blood or breath) test or biomarkers

Cushing's syndrome

Excessive ACTH secretion and chronic steroid use causes a rounded moonlike face, prominent jowls, red cheeks, hirsutism on upper lip, lower cheese and chin, and acneiform rash on chest

acromegaly

Excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones. Elongated head, massive face, overgrowth of nose and lower jaw, heavy eyebrow ridge, and course facial features

popliteal artery

femoral artery courses posteriorly at the lower thigh- termed popliteal. divides below the knees

breakthrough pain

a transient spike in pain level, moderate to severe in intensity, in an otherwise controlled pain syndrome by meds or internal pain suppression. can be triggered by return to an activity after a surgery. make sure to check pain level within hour of intervention to avoid

Testing Cranial Nerve VII

Facial Nerve: assess facial symmetry for motor function (puff out cheeks, wrinkle eyebrows, tightly closed eyes, show teeth)

Assessing Infant Cranial Nerve VII

Facial movements: wrinkling forehead, nasolabial folds, symmetric face when crying

secondary lesion

changes over time or changes because of scratching or infection

Swan neck deformity

Flexion contracture looks like a swan neck as in a metacarpophalangeal joint. it occurs with chronic RA and is often accompanied by ulnar drift of the fingers

Focused or Problem-Centered Database

For limited or short term problem. Collect "mini" database, smaller in scope, concerns mainly one problem, one cue complex, or one body system

midsternal line

a vertical line down the middle of the sternum dividing the thorax into two equal sides

stage 4 pressure ulcer

Full-thickness tissue loss with exposed bone, muscle, or tendon- often slough or eschar and tunneling

What can occur if cow's milk is introduced too early?

GI and kidney issues, low iron, vitamin C, and vitamin E

causes of n/v

GI disease, pregnancy, medication side effect

abrasion

a wound caused by rubbing the skin or mucous membrane

Water-Hammer (Corrigan) Pulse-3+ and what its associated with

Greater than normal force, then collapses suddenly. Aortic valve regurgitation, patent ductus arteriosus

lower crackles may indicate

HF

elevated jugular pressure associated with

HF, cardiac tamponade, and contstrictive

Poor lifestyle factors can lead to

HTN, obesity, atherosclerosis, cancer, osteoporosis, diabetes

malignant melanoma

Half of these lesions arise from preexisting nevi. many colors possibly and may have scaling, flaking, oozing texture.

submandibular node

Halfway between tip and angle of mandible

Weak "thready" pulse and what its associated with

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

Abusive burns in kids

Immersion pattern, pattern burn, cigarette burns

Thomas test

Hip flexor tightness have patient bring knees to chest in supine and then hold one knee while extending the other leg positive test: extended leg wont be able to touch the table

Stepping reflex

Hold the infant upright under the arms, with the feet on a flat surface. Note regular alternating steps. The reflex disappears before voluntary walking.

pacing reflex

Hold upright under arms let top of foot touch underneath of table. note flexing of hip and knee followed by putting foot on top of table. appears 4 days after birth

HARK tool

Humiliation, Afraid, Rape, Kick

HITS tool

Hurt, Insult, Threaten, Screen 0-5 rated for how often they do one of these things >10 indicates IPV good for adolescents

Myxedema

Hypothyroidism. Reduces met rate, and when severe can cause nonpitting edema and myxedema. Usual cause Hashimoto thryoidosis. Fatigue and cold intolerance, puffy swollen face (esp around eyes), puffy hands and feet, coarse facial features, cool dry skin, dry coarse hair, slow refluxes, sometimes thick speech

What are cranial nerves?

I Olfactory II Optic III Oculomotor VI Trochlear V Trigeminal VI Abducens VII Facial VIII Vestibulocochlear IX Glossopharyngeal X Vagus XI Spinal accessory XII Hypoglossal

Korotkoff sounds

I systolic pressure- tapping. fast blood due to small arterial opening and big pressure difference auscultatory gap- silence for 30-40. may occur w hypertension. can result in wrong BP- 5% of ppl II swooshing- still partially occluded artery III knocking- long duration, only closes briefly IV muffling of sounds- artery no longer closes V diastolic pressure

what are the cranial nerves

I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Vestibulocochlear IX. Glossopharyngeal X. Vagus XI. Accessory XII. Hypoglossal

Outcome Identification

Identify expected outcomes, individualize goals to the person that are specific, realistic and measurable, include a timeline

testing hearing acuity of newborns, 3-4 months, 6-8, and preschool aged

In a silent room, with the infant content, make a loud sudden noise like hand clap, note the following: • Newborns- Moro reflex (startle reflex), or acoustic blink • 3-4 months- acoustic blink reflex, stops movement, quiets if crying or cries if quiet • 6-8 months- turns head to sound • Preschool-school age- screened with audiometry

Phosphatidyylethanol (PEth)

characterizes drink patterns = distinguishes light, moderate. lasts 14 days

moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement. baby looks as if they're hugging a tree and then brings in arms and legs. disappears by 1-4 months

cellulitis

Inflammation of loose, subcutaneous connective tissue. Shows as thickening and induration of auricle with distorted contours

pregnancy abdominal distention

fetal heart tones with diminished bowel sounds. dull percussion over enlarging uterus

Order for abdominal assessment

Inspect, Auscultate, Percuss, Palpate- touching it changes bowel sounds

mechanism of fine crackles

Inspiratory crackles: inhaled air collides with previously deflated airways; airways suddenly pop open, creating explosive crackling sound Expiratory crackles: sudden airway closing

anterior axillary, posterior axillary, and midaxillary lines

Lift persons arm 90 degrees and divides the lateral (side of) chest by 3 lines: Anterior- extends down from anterior axillary fold where the pectorals major muscle inserts Posterior- continues down from the posterior axillary fold where the latissimus dorsi muscle inserts Midaxillary- runs down from the apex of the axilla and lies between and parallel to the other two

Types of violence

Intimate partner violence Child abuse/neglect Adolescent Relationship Violence Elder Abuse/neglect

introducing the interview

Introduce yourself and give the reason for the interview. let them know the process and about the physical exam

Tic and its cause

Involuntary compulsive repetitive twitching of a muscle group due to a neurologic or psychogenic cause

testing for color blindness

Ishihara test

Light vs. Deep Palpation

Light palpation detects surface characteristics and gets pt accustomed to being touched. Deeper palpation is for such things as abdominal contents, and is better using intermittent pressure instead of one long, continuous palpation. tender areas done last

what is the review of systems

It is a list of conditions you ASK the patient if they have ever had in each system. purely subjective, and cannot contain noticed info by provider

what to assess when nodes are enlarged

check area they drain for source of problem. explore upstream to enlarged node. all structures eventually drain into the deep cervical vein

Symptoms of stroke

LOC, weakness, sudden vision changes, fleeting balance

Lactose intolerance cause and symptoms

Lactose intolerance results from an inadequate supply of lactase, the enzyme that digests lactose. Symptoms include distention, cramps, flatus, and diarrhea higher in African Americans, asians, America Indians, and mediterranean groups

retracted eardrum

Landmarks look more defined/prominent. Light reflex absent or distorted. Drum dull and doesn't move prominent short process. Indicates negative pressure from obstructed Eustachian tube and serous OM

Scoliosis

Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies.

periorbital edema occurs with

Lids swollen and tissues loosely connected so excess fluid apparent. Occurs w/ local infections, crying, trauma, and systemic conditions such as CHF, renal failure, allergy, and hypothyroidism

Direction of blood flow

Liver to Right Atrium through Inferior Vena Cava Superior Vena Cava drains venous blood from head and upper extremities Right Atrium to Tricuspid Valve to Right Ventricke to Pulmonic Valve to Pulmonary Artery to Lungs Lungs oxygenate blood Pulmonary veins to Left Atrium to Mitral Valves to Left Venticle to Aortic Valve to Aorta to Body

Lower motor neurons function

Located mostly in PNS- cell body in anterior grey column and nerve fiber extends from here to the muscle. Consists of cranial nerves and spinal nerves of the PNS. The nerve fiber extends directly into the muscle

DTRs in aging adults

Loss of ankle and sometimes knee jerk. harder to relax- always use reinforcement, plantar reflex absent or difficult

generalized seizure phases

Loss of consciousness, tonic phase, clonic phase, post-ictal phase

hyperactive bowel sounds causes

Loud gurgling sounds "borborygmi" signal increased motility. Occurs with early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus

ecroption

Lower lid loose and rolls out. Does not approximate to eye. Puncta cannot siphon tears effectively, causing excess tearing. Doesn't drain correctly, causing dry/ itching. Increases inflammation risk by being exposed. Occurs in aging from atrophy of tissue but can also result from trauma, chronic inflammation, or bells palsy

entroption

Lower lid rolls in due to spasm of lids of scar tissue contracting. Constant rubbing of lashes may irritate cornea, leading to tearing and red eye. Person feels a "foreign body" sensation.

Bell's palsy

Lower motor neuron lesion (peripheral) producing rapid onset of cranial nerve VII paralysis of facial muscles. Can be latent hsv1. Complete paralysis on one side of face. Usually presents w smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind ear. Greatly improved if corticosteroids and antivirals within 72hrs

S/S of alcohol withdrawal

N/v, tremor, sweating, anxiety, agitation, tactile disturbances, audio/visual disturbances, H/A, disoriented

cleft lip and what it occurs with

Maxillofacial clefts are common congenital deformities and occur w strong family hx, maternal phenytoin/dilantin, alcohol, drug use; maternal diabetes. Early tx preserves fx of speech and language formation, and deglutition (swallowing)

medical diagnosis vs nursing diagnosis

Medical Diagnosis: is used to evaluate the cause or etiology of disease Nursing Diagnosis: clinical judements about a persons response to an actual or potential health state

What raises risk of peptic ulcer disease

NSAIDS, alcohol, smoking, h. pylori

Pellagra

Niacin deficiency. pigmented keratotic scaling lesions in sun exposed areas

Supplemental Mental Status Examinations

Mini-Mental State Exam and Montreal cognitive assessment (MoCA)

CTQ-SF tool

Modified childhood trauma questionnaire- short form

vital signs are used to:

Monitor patient's condition, identify promblems, and evaluate response to intervention.

mood vs affect

Mood= persistent emotional state usually an adjective. Affect= external display of feelings- temporary expression and state of mine

Down syndrome

Most common chromosomal aberration. Upslanting eyes with inner epicanthal folds, flat nasal bridge, small, broad, flat nose. Protruding thick tongue, ear dysplasia, short, broad neck with webbing, small hands with single palmar crease. Often congenital heart deformities

abduction

Movement away from the midline of the body

otitis externa

Movement of ear painful and swelling/redness, purulent discharge, itching, fever, enlarged lymph. More common in hot and humid weather. Skin folds set up for infection

adduction

Movement toward the midline of the body

Thyroid- multiple nodules

Multiple often indicate infection or this, a Multinodular goiter, rather than a neoplasm. But question any rapidly enlarging or firm nodule.

Neurologic recheck consists of

Neuro exam performed on persons with demonstrated neurologic defects who require periodic assessments - Level of consciousness - Motor function - Pupillary response - Vital signs

Osteoarthritis

Noninflammatory, localized, progressive disorder involving deterioration of articular cartilages (cushions between bone ends). asymmetric joint involvement. Affected joints have stiffness, pain with motion, affected ROM

Pregnancy weight gain recommendations

Normal= 25-35lbs Underweight= 28-40lbs Overweight= 15-25lbs Obese= 11-20lbs

atelectatic crackles

Not pathologic; short, popping, crackling sounds that last only a few breaths due to secretions of alveoli not full aerated- occurs in sleepers or older adults as alveoli deflate slightly and accumulate secretions

Posterior (dorsal) column

Note our position/proprioception, identify family objects without looking, vibration, and localized touch

Allergic Conjunctivitis

Note the upper lid, conjunctiva, and cornea are inflamed from seasonal allergen or persistent allergen. Symptoms include itching (eye itch= allergy association), redness, watering, and discomfort. Does not obscure vision. Signs- diffuse conjunctival redness, lid swelling, upper tarsal surface that shows velvety thickening, redness, small papillae

Initial Pain Assessment Tools

OLD CARTS (onset, location, duration, characteristics, aggravating/alleviating factors, radiation, treatment, severity) PQRST (palliation/provocation, quality/quantity, region/radiation, severity scale, timing)

bulging of TM due to

OM increasing pressure

Four major types of malnutrition

Obesity, Marasmus, Kwashiorkor, Marasmus/Kwashiorkor mix

hydrocephalus

Obstruction of drainage of CSF resulting in excessive accumulation causing ICP increase and head enlargement. Creates frontal bossing, downcast of eyes (sclera visible above iris) and dilated scalp veins. The cranial bones thin, sutures separate, and percussion yields a "cracked pot" sound

Pressure Ulcers

Occurs over a bony prominence where circulation is impaired. impedes delivery of blood carried o2 and nutrients to skin, impedes venous drainage carrying metabolic waste away from skin

Testing Cranial Nerve I

Olfactory nerve: recognizing a smell through each nostril

OAS tool

Ongoing abuse screen

OVAT tool

Ongoing violence assessment tool

external auditory canal

Opening of ear canal. 2.5-3cm Cul-de-sac. outer 1/3 cartilage inner 2/3 tunnels through temporal bone and covered by thin sensitive skin. has S shape. allows sound to travel until it reaches tympanic membrane

Assessing infant cranial nerve XII

Opens mouth and tongue rises to midline when nose is pinched

Stridor mechanism

Originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body

middle ear structures

Ossicles- malleus, incus, stapes Eustachian tube

purulent otorrhea suggests

Otitis externa or otitis media if the drum has ruptured

nasal polyp cause and common site

Overgrowths of mucosa appearing as smooth pale gray nodules. Usually caused by chronic allergies. Common site- protrustion from middle meatus. Often multiple, mobile, or nontender and can obstruct air pathways. Symptoms- absence of sense of smell and a "valve that moves" in the nose as the person breathes

heath hx in children

adapted to include specific info for the age and developmental stage of child

palpating carotid artery

Palpate gently to avoid excessive vagal (CN X) stimulation Palpate one at a time to avoid compromising arterial flow to brain should be smooth and fast upstroke and slow downstroke

Strep A Pharyngitis occurs with

fever, absence of cough, tonsillar exudates, cervical adenopathy

Organs in LLQ

Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord

Myoclonus and examples

Rapid, sudden jerk or a short series of jerks at fairly regular intervals. hiccups are myoclonus of the diaphragm and one single myoclonus common when falling asleep. Severe myoclonus with grand Mal seizures

collateral

connects joint at both sides giving medial and lateral stability and prevent dislocation

Lichenification

Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen)

Epitrochlear lymph node palpation

check in depression 2-3cm above and behind medial condyle of the humerus reach hand under persons elbow to the groove btwn the biceps and triceps above medial condyle. not normally palpable

epigastric hernia

Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.

hernia

Protrusion of an organ through the muscular wall of the cavity that normally contains it

Lesion shape: Discrete

distinct individual lesions that remains separate

HEEADSSS

added psychosocial considerations for adolescents Home environment- support system? fam good? Education and employment Eating- does body cause you stress? any changes? peer related Activities Drugs Sexuality Suicide/ depression Safety from injury and violence

PQRST

Provocation/palliation- what happened when it started, what makes it better or worse, causes it, aggravates it Quality/ quantity- what it feels like Radiation/region- where does it travel or radiate; did it start elsewhere Severity- 0-10, does it interfere with activities, how long it lasts Timing- when did it start, how long it lasts, sudden or gradual, time of day, other symptoms, around meals or certain seasons?

Aspects of the General Survey

Physical appearance, body structure, Mobility, Behavior

Conjunctivitis

Pink eye; red beefy looking periphery vessels but usually clear around iris. Commonly viral or bacterial infection, allergy, or chemically irritated. Preauricular lymph node often swollen and painful with a hx of upper resp infection. Itching, burning, foreign body sensation, eyelids stuck together upon awakening. Normal vision, pupil size, and light rxn

HEEADSSS

added psychosocial considerations for the adolescent in functional assessment Home- support system? Education and employment- safety, happy, belonging Eating- size cause you stress? weight loss or gain? Activities Drugs Sexuality Suicide and depression Safety

Dappled brown patches in buccal mucosa occurs with

addison's disease

Example of superficial (cutaneous) reflex

Plantar reflex

Assessing an aging adult (purpose, position, preparation, sequence)

Purpose= develop a meaning of life position- sitting on exam table. if frail, lay. change positions as little as possible prep- take breaks if needed- go their speed. use physical touch as other senses are diminished sequence- head to toe

progressive lordosis

Posture changes to compensate for the enlarging fetus. Shifts weight back .

Assessing Adolescents (purpose, position, preparation, sequence)

Purpose= develop self-identity using values and social rose position- on table in street clothes. examine alone prep- positive bodily feedback, teach health tips to them sequence- head to toe, genitals last and fast

What do you do if BP is oddly high

check in thigh using palpation of popliteal artery remember that thigh BP diastolic is 10-40 higher but systolic is the same

Bronchophony

check posteriorly and ask them to say "99" to assess voice sounds

Swollen metacarpophalangeal joints occurs with

RA (but not in OA)

assessing for leg color changes

Raise leg 30 cm (1 foot) and ask pt to wag feet for 30 seconds. Skin color now only reflects material blood. Should look slightly pale but marked pallor indicates arterial insufficiency. Should return in 10 seconds. Dependent rubor and delayed venous filling with severe arterial insufficiency

parotid gland enlargement reasons

Rapid painful inflammation of the parotid occurs with mumps. Mumps is a contagious virus of the salivary glands. Swelling can also occur w blockage of a duct, abscess, or tumor. Note swelling anterior to ear lobe. Stensen duct obstruction can occur in aging adults dehydrated from diuretics or anticholinergics

vernix caseosa

cheesy substance covering the skin of the fetus at birth. made up on sebum and skin cells

Who gets cataracts more?

african american

Thalamus

Relay station for sensory information. sensory pathways form synapses on their way to the cerebral cortex integrating system controls emotion and creativity

balottement of patella

Reliable when larger amounts of fluid are present. Use left hand to compress supra patellar pouch to move any fluid into the knee joint. With right hand, push patella sharply against fetus. If no fluid present, patella is already snug against the femur. If fluid has collected, your tap on the patella moves it through the fluid and you will hear a tap as the patella bumps up on the femoral condyles

pressure differences in heart

Right-sided pressures in the heart are lower than left-sided pressures due to less energy needed to pump pulmonary circuit

deep leg veins

Run alongside the deep arteries and conduct most of the venous return from the legs Femoral Vein Popilteal Vein

great vessels of the heart

SVC and IVC Pulmonary Artery Pulmonary Veins Aorta

infant pain capacity

Same capacity. evidence shows that repetitive and poorly controlled pain in skin breaking procedures can result in pain hypersensitivity later in life

cradle cap

Scaly, crusted scalp occurs with seborrheic dermatitis

Scar

after a skin lesion is repaired, normal tissue is lost and replaced with connective tissue

Mini-Cog

Screens for cognitive impairment in otherwise healthy older adults Consists of a 3-item recall test and a clock drawing test (2 indicates dementia) test exec function- planning, managing time, organizing activities, manage working memory

What causes increase in AP diameter

age and COPD

hollow viscera

Shape depends on contents - stomach, gallbladder, small intestine, colon, and bladder

estimating amount of teeth a child should have

age in months minus 6

what can loss of hair be a result of?

chemo or hypothyroidism

Biot's respirations

Similar to cheyne stoke, but the breathing pattern is irregular. a series of 3-4 normal respirations followed by a period of apnea

STaT tool

Slapped, Threatened, and Throw Answering yes to any indicates IPV

tophi

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.

Macule

Solely a color change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever.

nodule

Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule.

Papule

Something you can feel (i.e., solid, elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in epidermis

Test Cranial Nerve XI

Spinal accessory nerve: tests motor function - examine sternomastoid and trapezius muscles for equal size and strength: test strength by using resistance with shrugging or turning face

How to percuss the posterior chest

Starts at prices and percuss band of normally resonant tissue across tops of shoulders. Percuss at 5cm intervals making side by side comparison. Avoid damping effect of scapula and ribs

what makes up body structure in general assessment?

Stature, nutrition, symmetry, posture, position, body build/ contour, obvious physical deformities

Organs in LUQ

Stomach Spleen Left Kidney Pancreas Splenic flexure of colon Part of transverse and descending colon

Lasegue's test

Straight Leg Raise Test- test often performed to determine whether a patient with low back pain has an underlying herniated nucleus pulposes. straight leg raising while keeping knee extended normally produces no pain. dorsiflex foot right before point of paint

extension

Straightening of a joint

extraocular muscles and what do each of them control

Superior rectus III- look up Inferior rectus III- look down Lateral rectus VI- look outward Medial rectus III- look inward Superior Oblique IV- rotate inferior and laterally Inferior Oblique III- rotate superior and laterally

hemorrhoids

Swollen, painful rectal veins; often a result of constipation

rust colored sputum

TB or pneumococcal pneumonia

Direct injury due to IPV

TBI, h/a, pain

Joint pain worse in the morning and improves through the day

Tendentious

costovertebral angle percussion tenderness

Tenderness to percussion over the costovertebral angle; a common finding in pyelonephritis and other infections of the kidney. place one hand over 12 rib at costovertebral angle on back and thump

tools for determining health literacy

Test of Functional Health Literacy (TOFHLA) Rapid Estimate of Adult Literacy in Medicine (REALM) Newest Vital Sign (NVS)

contracture

The lack of joint mobility caused by abnormal shortening of a muscle

crossed representation

The left cerebral cortex receives sensory information from and controls motor functions to the right side of the body, while the right cerebral cortex receives sensory information from the left side of the body.

Celiac disease causes deficiency of

fiber, vitamin D, vitamin B12, folate, iron, zinc, magnesium, calcium

Undernutrition

The condition in which not enough calories are ingested to maintain health or the reserves are depleted

scaphoid contour

abdomen caves in

Post-ictal phase

The final phase of a generalized seizure, during which the patient becomes extremely fatigued, disoriented, and confused

radial artery

The major artery in the forearm; it is palpable at the wrist on the thumb side just medial to the radius.

involuntary guarding

abdominal wall muscle contraction that the patient cannot control; rigidity

influences on BP

age, race, weight, emotions, gender (none before puberty. female adults lower until menopause where they become higher), diurnal rhythm, exercise, stress

Pingueculae

aging adult finding. yellowish elevated nodules are caused by a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. at 3 and 9 o'clock postion

signs that a dementia pt is in pain

agitation, pacing, repetitive yelling

why is tympany heard over abdomen

air in intestines rise to the surface when the person is supine

What does crepitus indicate?

air in the subcutaneous tissue from a rupture somewhere in the respiratory system

Mechanism of high pitched wheeze (Sibilant)

air squeezed or compressed through narrow close-to-closing passageways

paranasal sinuses and function

air-filled cranial pockets that communicate with the nasal cavity, as they both have the same type of ciliated mucous membrane. they lighten the weight of skull bones, provide mucus, and serve as resonators for sound production

Typhany percussion note

airfilled stomach and intestines. long, loud, carries longest, high pitched, drum-like

mechanism of low-pitched wheeze (Sonorous rhonchi)

airflow obstruction

crackles

aka rales. discontinuous popping sounds heard over inspiration

wheeze

aka rhonchi. continuous musical sounds heard mainly over expiration

nail clubbing cause

The nail appears more convex and wide. The nail angle is greater than 160 degrees. 160 is considered normal. It occurs in chronic respiratory and cardiac conditions in which oxygenation is compromised (emphysema, COPD).

bronchial breath sound location characteristics

aka tracheal or tubule. located in trachea or larynx. high pitched, loud, harsh. inspiration is shorter than expiration

mental status exam tests

alert, oriented, behaving appropriate

when should teeth be all present by

all 20 deciduous teeth by 2.5 years

extrapyramidal system

all motor nerve fiber originating outside of the pyramidal tract. primitive motor movement maintains muscle tone and body control (walking)

Blood pressure definition

The pressure exerted by the blood against the walls of the arteries as the heart pumps and then relaxes

inferior border of scapula

The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib.

Where can S2 be heard?

all over percordium but best at base

Purpose of closed ended questions

fill in any left out details

Allergic salute and crease

The transverse line on the nose is also a feature of chronic allergies. Formed when child chronically uses the hand to push up on the nose and back- "allergic salute" to relieve itching and free swollen turbulences

Why are veins called capacitance vessels?

They can stretch more than arteries

Asthma (reactive airway disease)

allergic hypersensitivity causing bronchospasm and inflammation and edema in walls of bronchioles, causing airway resistance, especially during exhalation. wheezing present

cornea

allows light to enter the eye. covers and protects the iris and pupil. thin, transparent, sensitive (contains nociceptors)

absorption and excretion in skin

allows limited excretion of some metabolic wastes, by products of cellular decompositions: minerals, sugars, uric acid, urea, amino acid, cholesterol

Purpose of open-ended questions

allows narrative of events leading up to present and allows free answers

ChooseMyPlate

practical info, tips, and web-based tools to help individuals build healthier diets

why is otoscopic exam not performed in first few days of life?

although patency of canal determined at birth, it is full of amniotic fluid and vernix caseosa

what are types of ototoxic drugs

aminoglycoside antibiotics and anticancer drug cisplatin

moring/ all day fatigue indicates

anxiety or depression

peripheral arterial disease (PAD) and cause

any disorder of the arteries outside of, or peripheral to, the heart, usually those supplying limbs (non-coronary arteries). typically cause by atherosclerosis

paralysis

Total or partial loss of normal motor function

sucking reflex

Touch the lips and offer your gloved little finger to suck. Note strong sucking reflex. The reflex is present at birth and disappears at 10 to 12 months.

What type of hearing loss should be referred?

any sudden loss that is not associated with an upper respiratory infection

vitreous chamber

filled with thick fluid. largest chamber at back of eye that protects retina against rapid eye movement. shock absorber

Battle sign

Trauma to the side of the head may lead to basilar skull fracture involving temporal bone, causing mastoid process and behind the ear bruising. May show hemotypanium. Sign of abuse

Cause of decreased tactile fremitus

anything that obstructs transmission of vibration, getting in the way of the sound and your palpating hand can decrease fremitus. obstructed bronchus, pleural effusion, thickening, emphysema

pulmonary embolism

Undissolved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels.

lymphedema symptoms

Unilateral swelling, measurement of arm volume, non pitting brawny edema, overlying indurated skin

Outer layer of eye called what

Tunica Fibrosa

Middle layer of eye is called

Tunica vasculosa

Pustule

Turbid fluid (pus) in the cavity. Circumscribed and elevated.

succession splash

Unreleated to peristalsis- loud splash heard over upper abdomen when infant rocked side to side indicating air and fluid in the stomach as seen with pyloric obstruction or large hiatus hernia

carcinoma

Ulcerated crusted nodule with indurated base that fails to heal- intermittent bleeding. Usually occurs on superior pinna rim (sun exposure) may be in canal and have discharge

Brain attack or cerebrovascular accident

Upper motor neuron lesion (central). Acute neurological deficit caused by blood clot of a cerebral vessel, as in atherosclerosis (ischemic) or rupture in a cerebral vessel (hemorrhagic). Not able to smile if stroke but can still wrinkle forehead and close eye which shows that it is not Bell's palsy

Arm Span or Total Arm Length

Useful for monitoring nutritional status for pts in which height difficult to measure

Organs in the midline

aorta, uterus (if enlarged), bladder (if distended)

profile sign

Viewing finger from the side. Used to detect early clubbing

Bitot's spots

Vitamin A deficiency causing foamy plaques on cornea

Beefy red tongue due to

Vitamin B complex deficiency

thought processes

Way person thinks should be logical, goal directed, coherent, and relevant; should complete thoughts. does what they say make sense/ do you follow?

pilar cyst

Wen. smooth, firm, fluctuant swelling on the scalp containing sebum and keratin. Tense pressure of the contents causes overlying skin to be shiny and taut. Benign

iris

colored part of eye. functions as a diagram varying at the opening at its center, the pupil. its fibers contract the pupil. constricts for close vision and dilates for far

When is clonus tested

When reflexes are hyperactive

dolls eyes

When the head is turned to one side, the eyes should move conjugately to the opposite direction if the brainstem is intact

Brushfield spots

White specks that may appear around the edge of the iris, can be normal. These spots often suggest down syndrome

WAST tool

Women abuse screening tool

Torticollis

Wryneck. A hematoma in one sternomastoid muscles, usually injured by intrauterine malposition, results in head tilt and limited neck ROM to the opposite side. Feeling of firm, discreet, contender mass in mid-muscle on involved side. Requires tx or else muscle can become fibrotic and permanently shorten.

visual analog scale

a pain rating scale using a straight line; the left end of the line represents no pain, the right end represents the worst pain, and patients mark the place on the line that best represents the severity of their pain

fremitus

a palpable vibration from the spoken voice felt over the chest wall as they go from the larynx through the bronchi and lung parenchyma

types of nociceptor axons

a and c

seborrheic keratosis

a benign skin growth that has a waxy or "pasted on" look face, hands, trunk

scotomoa

a blind spot in eye. occurs with optic nerve diseases and glaucoma

torus palatinus

a bony protuberance in the midline of the hard palate arising after puberty. normal finding. higher in women, Indians, and asians

Darwin tubercle

a congenital, small painless nodule at the helix

mesentery

a double layer parietal peritoneum and has pathways for nerves, blood vessels, and lymph. they stabilize and support viscera

Malocclusion

a drift in remaining teeth due to tooth loss. causes further tooth loss and muscle imbalance from bone alignment change causing h/a, tenderness, spasms, and temporomandibular pain

bulla

a large blister that is usually more than 0.5 cm in diameter. superficial in epidermis and thinner walled- ruptures easy

fissure

a linear crack in the skin w/ abrupt edges, extends into dermis. dry or moist

Graphesthesia

ability to "read" a number by having it traced on the skin. good measure of sensory loss if patient can't grasp things for stereognosis. inability to distinguish occurs with central cortex lesions

Position (kinesthesia)

ability to perceive passive movements of extremities, move finger or big toe up and down and ask them to tell you which way it was moved, switch up patterns, eyes closed, normally person can detect movement

stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

what is ascites

abnormal accumulation of fluid in the abdomen

plaicephaly

abnormal back of head shape from infant laying on back. mitigated with "tummy time"

parathesia

abnormal sensation (burning, tingling)

Hyperresonant percussion note

abnormal sound in the adult over the lungs with increased amount of air, as in emphysema. Normal lung sound in kids. louder, lower pitch, booming, long

lid lag

abnormal white rim of sclera visible between the upper eyelid and the iris. occurs with hyperthyroidism

how does emphysema affect symmetric chest expansion

abnormally wide angle with little inspiratory variation

hypogastic/suprapubic regions

above pubic bone

atresia

absence or closure of the ear canal

CN XI Spinal Accessory abnormalities cause

absent movement of sternomastoid or trapezius muscles

behavior in patients with peritonitis

absolute stillness/ resistance to movement

Cachectic response

accompanies chronic wasting diseases such as cancer, dehydration, and starvation. includes sunken eyes, hallow cheeks, exhausted appearance

tachypnea causes in babies/children

accompany pneumonia, fever, pain, heart disease, and anemia

Why do floaters appear in eyes?

accumulating debris since vitreous humor is not continuously renewed

Testing Cranial Nerve VIII

acoustic/vestibulocochlear: test sensory function to test hearing acuity with normal convo and whispered voice test

2nd set of pain neurotransmitters

across synaptic cleft to dorsal horn neurons substance P, glutamate, ATP

3rd set of neurotransmitters

act as analgesic effect seratonin, GABA, norepinephrine, neurotensi, own internal opioids

all day cough indicates

acute infection

acute respiratory distress syndrome (ARDS)

acute pulmonary insult (trauma, gastric acid, aspiration, shock) that damages alveolar capillary membrane leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema

hemorrhage stroke cause

acute rupture and bleeding from weakened artery in the brain due to ruptured aneurysm and arteriovenous malformation (congenital network of vessels without capillaries)

residual volume

amount of air remaining in the lungs even after the more forceful expiration

OLD CARTS

an assessment of pain Onset- acute or chronic? when did it start Location Duration- how long does it hurt? Characteristics- what does it feel like. figure out somatic, visceral, neurpathic Aggravating/ alleviating factors Radiation- does it travel or migrate Treatment Severity

palpation

an examination technique in which the examiner's hands are used to feel the texture, size, consistency, and location of certain body parts

corneal abrasion

an injury, such as a scratch or irritation, to the outer layers of the cornea. causes irregular ridges in reflected light, producing a shattered look to light rays

outer canthus pallor can indicate

anemia

Lesion shape: Polycyclic

annular lesions grow together (psoriasis)

what does epitochlear node drain

antecubital fossa and lower arm/hands

Surface Landmarks of the Abdomen

anterior (extends from diaphragm to symphysis pubis) posterior border (vertebral column and paravertebral muscles)

When do the anterior and posterior fontanels close?

anterior (largest) closes at 9months- 2 years posterior closes at 1-2 months

borders of the lung

anterior apex is the highest point and base is the lower border

muscles of hip

anterior flexor- ipopsoas posterior extensions- gluteus maximus adduction/abductor muscles

kiessalbach pexus

anterior part of septum that has rich vascular network- most common nosebleed site

dorsalis pedis

anterior tibial artery travels down the front of the leg on to the dorsum of the foot, where it becomes this

location of trachea

anterior to the esophagus. begins at cricoid cartilage and bifurcates just below sternal angle into left and right bronchi

location of apex and base of lung

apex- 3-4cm above the inner third of the clavicle base- rests on diaphragm at about the 6th rib in the midclavicular line laterally, lung tissue extends from the apex of the axilla down to the 7th or 8th rib. apex at c7 and base at t10, dropping to t12 in expiration

where to auscultate posteriorly?

apices at c7 to bases at t10 and laterally from axilla down to 7th or 8th rib

autonomic hypersensitivity

apparent during both types of alcohol withdrawal causes tachycardia, increased BP, and sweating. can cause hallucinations

Facial remnant and ear deformity

appears as a skin tag and can contain cartilage. typically in preauricular area. when bilateral, increased risk of renal anomalies indicated

Muscle testing technique

apply opposing forces. repeat active ROM asking pt to flex and hold

Umbilical regions

area around umbilicus

epigastric region

area between the costal margins

mediastinum

area between the lungs in the middle third of the thoracic cage. contains the heart and vessels

fovea centralis

area consisting of a small depression in the retina containing cones and where vision is most acute

Wernicke's area

area of temporal lobe responsible for language comprehension. damage to it causes receptive aphasia

Precordium

area on the anterior chest directly overlying the heart and great vessels

dermatome

area supplied from one spinal cord segment through a particular spinal nerve. they overlap so if one if severed most sensations can still be transmitted.

normal gait

arm swing, smooth, rhythmic, effortless, 15inches heel to heel

supraclavicular node

arms up and creates pocked just above and behind clavicle at the sternomastoid

dead space amount in lungs

around 150ml

apical pulse

artery close to the skin and over a bone- not a true pulse site as force not graded. over heart

Glenohumeral joint

articulation of humerus with glenoid fossa of scapula. joint enclosed by a group of four powerful muscle and tendons

tibiotalar joint connects

articulation of the fibula, tibia, and talus

temporomadibular joint structure and funcition

articulation of the mandible and temporal bone. felt in depression anterior to trigus of ear. permits jaw function for speaking and chewing, blowing hinge action to open and close jaws, gliding action for protrusion and retraction and gliding for side to side movement of lower jaw

how does scarring appear in otoscope?

as a dense white patch on the drum

everted umbilicus may indicate

ascites or underlying mass

how does pallor appear in dark-skinned pts?

ashen or grey in black and yellow in brown

Testing active and passive ROM

ask for active ROM and if a limitation is seen, gently attempt passive movement with the person's muscles relaxed by anchoring joint with one hand while other hand slowly moves it to its limit. normal ranges should be the same with active and passive

how to indicate lack of health literacy

ask pt if there are any limitations to their learning and how they learn things best

whispered pectoriloquy

ask the person to whisper a phrase like "one-two-three" as you ascultate. The normal response is faint, muffled, and inaudible.

what tests cranial nerve X

asking pt to say ah to note that soft palate and uvula rise in midline

Testing: Hypoglossal nerve CN XII

asking pt to stick out tongue. it should protrude midline. with damage, tongue goes toward paralyzed side

diaphragmatic excursion

assesses degree and symmetry of diaphragm movement; percuss from areas of resonance to dullness. no longer recommended- in lung disease pts, clinicians overestimate movement (results differ from chest images) and excursion of less than 2cm unreliable and infrequent sign of COPD

Alcohol Use Disorders Identification Test (AUDIT)

assesses problems within last year only Screens and identifies people who are at risk of developing alcohol problems and distinguishes normal low-risk use Three domains used that identify hazardous drinking - consumption (questions 1-3) - drinking behavior or dependance (questions 4-6) - adverse consequences from alcohol (questions 7-10) max score 40. relatively bias free, used in PCP and ED

motor system exam tests what

assesses strength and coordination

Steps of nursing process

assessment, diagnosis, outcome identification, planning, implementation, evaluation

Neovascularity

associated w/ wet macular degeneration. abnormal vessels grow under tissue and leak blood/fluid causing scaring

Joint pain worse later in the day

associated with OA

Joint pain in the morning

associated with RA- also stiffness after rest period

drusen

associated with dry macular degeneration. yellow fatty deposits under the retina

Large amount of fish during pregnancy

associated with maternal, fetal, and newborn mercury toxicity

traffic related pollution exposure raises risk of

asthma and allergic rhinitis

ABCDE

asymmetry, border, color, diameter, elevation and enlargement

Landau reflex

at 3 months infant will raise head and arch back (swan dive position) and persists up to 1.5 years. head lag abnormal and indicates motor weakness or motor neuron disease

criteria for myopia referral in childhood

at 3- 20/50 or less, at 4 and older- 20/40 or less. difference between eyes is one line or more

When does head stop growing?

at 90% of size by 6 yrs

vertebral column changes in development

at birth, C shape. anterior curve develops at 3-4 months (from holding head up) and 1yr-18months standing erect develops anterior lumbar curve

when/where can innocent murmurs be heard?

at the 2nd or 3rd left intercostal space and it disappears when sitting

check expansion lag can indicate

atelectasis, pneumonia, and post-op guarding

p wave

atrial depolarization= contraction of aorta

Pathologic S4 occurs with

atrial gallop, occurs with CAD

Joint crepitation cause

audible and palpable crunching/grating accompanying movement. occurs when articular surfaces in joints are roughened (as with RA)

Structures of the external ear

auricle (pinna), external acoustic meatus (auditory canal), and the tympanic membrane

external ear inspection aspects

auricle size/ shape, skin condition, tenderness (of pinna, mastoid process, and lymph nodes), external auditory meatus

How is a pulse deficit determined?

auscultate apical beat while simultaneously palpating radial pulse. the difference between radial and apical should be none. difference in number signals a weak contraction of the ventricles

egophony

auscultate while person phonates "eee" sound. over consolidation/compression, "eee" sound changes to a long bleeting "aaa" sound

posterior tibeal artery

back of leg artery that travels down behind the medial malleolus and forms the plantar arteries in the foot

Trapezius location and function

back of neck from occipital to clavicle and scapula. moves shoulders and extends and turns head

posterior cervical node

back of neck in the posterior triangles along edge of trapezius

hamstring location and function

back of thigh muscle that flexes the knee

Horny cell layer

basal cells migrate up to this flat layer of dead closely packed cells

occipital node

base of skull

Deep tendon reflexes

basic defense mechanism stimulated by directing short snappy blow of reflex hammer onto muscle's insertion tendor

6 parts of functional assessment

bathing, toileting, derisive, grooming, eating, mobility, communicating

communicating with adolescents

be honest, provide rationale for actions and questions, give direction

Pulses paradoxus and what it occurs with

beats have weaker amplitude with respiratory inspiration, stronger with expiration. common finding in cardiac tamponade (pericardial effusion in which high pressure compresses the heart and blocks cardiac output) and severe bronchospasm

Preauricular nodes

before (in front of the ear)

Stroke belt and belt buckle

belt 20% increased risk mid south region of US. belt buckle GA, NC, and SC with 40% higher risk

patterned injuries

belt buckle, leather mark, iron, cord, immersion burns

flexion

bending a limb at a joint

submandibular gland

beneath the mandible at the angle of the jaw

Keloid

benign excess of scar tissue beyond sites of original injury. most common in 10-30 yrs old

Senile tremors

benign tumors that occur occasionally. intention tremor of hands, head nodding, and tongue protrusion. no rigidity

Benzodiazepine intoxication and withdrawal

benzo contains sedatives and hypnotics. Similar intoxication to alcohol and withdrawal is similar. also causes orthostatic hypotension and grand Mal seizures

Palpation using dorsa of hands and fingers

best for determining temperature because the skin is thinner than on the palms

Palpation with fingertips

best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps

palpation using base of fingers (metacarpophalangeal joints) or ulnar surface of hand

best for vibration

Descriptor scare

better for older pmts and ethnically diverse pick btwn no pain, mild, moderate or severe

verbal pain intensity scale

better for older pts as most will not chose a number uses words to describe Pts feelings and meaning of the pain for the person

ethmoid sinuses

between the orbits- deep and small

semilunar valves

between ventricles and aortic and pulmonic arteries each have 3 cusps

Muscles that flex arm

biceps and brachioradialias

appearance of leukoplakia

bilateral buccal chalky while patch. often goes away when cheeks stretched. more common in blacks and indians

lymph node issues from acute infection feel like

bilateral, enlarged, warm, tender, firm, freely movable

What is considered heavy alcohol use?

binge drinking five days out of the month

aspects of health history

biographic data, source of history, reason for seeking care, present health/ illness, past health, fam hx, cross cultural care, review of systems, functional assessment

components of cross-cultural info of health hx

biographic data, spiritual beliefs, past health in home country

midclavicular line

bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular points

orthostatic vital signs

blood pressure & pulse taken lying, sitting, & standing

pregnant female cardiovascular changes

blood volume increased by 30-40% which causes increased SV, pulse rate (10-20 beats/ min), and cardiac output. arterial blood pressure decrease due to peripheral vasodilation

normal lip finding in African americans

blueish lips and a dark line on the gingival margin

Acrocyanosis

bluish color around the lips, hands, fingernails, feet, and toenails for a few hours and then disappearing

infant fontanels

bone hasn't fused at and structure intersect at these

cause of tooth loss in aging adult

bone resorption (osteoporosis)

Bone conduction hearing pathway

bones of the skull vibrate and transmit to inner ear and CN VIII. occurs through vibration picked up by ear's specialized nervous system.

limbus

border between cornea and sclera at lower lid margin

artery vs vein

both parallel just go opposite directions -Artery - valves are absent; away from the heart; deoxygenated blood from the tissues; high pressure, low volume -Vein - valves are present to prevent backward flow; oxygenated to tissue; back to the heart; high volume and diameter, low pressure

genu varum

bow legged

Abdominal pain cause in infants/children

bowel inflammation, constipation, UTI, and anxiety

Growth differences of adolescent boys and girls

boys- more muscle, taller, less body fat girls- fat raises to 25%

arteries in arm bifurcate

brachial into ulnar and radial that form superficial and deep palmar arches

Central nervous system consists of

brain and spinal cord

Suppression scotoma

brain suppresses weak aye causing acuity in otherwise normal eye to deteriorate from disuse

communicating with toddlers

break things down- they want to always know why. keep explanations and directions simple and one at time. warn before transitions

what does axillary nodes drain

breast and upper arm

alcohol use raises risk for what serious health conditions

breast cancer (with moderate use), cardiovascular (moderate use), and liver disease (heavy drinking)

External nose structures

bridge, tip, nares, ala, columella, vestibule

tonsils during acute infection

bright red, swollen with exudate or large white spots

abnormal voice sounds and what causes them

bronchophony, egophony, and whispered pectoriloquy pathology that increases lung density or consolidation/compression of lung tissue enhances transmission of voice sounds

auscultation findings of infants/children

bronchovesicular breath sounds in peripheral lung fields up to 5-6 years. due to thin chest walls and underdeveloped musculature sounds are louder and harder and more difficult to localize as they can be heard all over the chest

assessing for vascular sounds

bruit using firmer pressure to check over aorta, renal arteries, iliac, and femoral arteries

incisional hernia

bulge near an old operative scar that becomes apparent by a sit-up standing or by valsalva maneuver

movement of lens when seeing

bulges for near items and flattens for far

Exopathalmos

bulging eyes. widened palpebral fissures. Note "lid lag" acquired bilateral exophthalmos associated w/ thyrotoicosis

greater tubercle location

bump on the humerus a few centimeters down and lateral from acromion process

Basal Ganglia

bundle of nerves located deep under the cerebral cortex. helps coordinate movement, control, and posture- controls automatic associated movement of the body

fasciculi

bundles of muscle fibers

subacromial bursa

bursa that helps during abduction of arm so that greater tubercle can move easily under acromion process of scapula

Atypical areas for children to bruise- indicating potential abuse

buttocks, feet, hands, thigh, abdomen. torso, ears, and neck bruises in under 4. any bruises on a non-moving child raise concern (fractures or intercranial injury possible). any bruising in shape of object, defense bruises, and nasal fractures suspicion

when do infants develop ability for pain

by 20th gestational week everything is developed and emotional pain by 30th.

vertebra prominens

c7. feels prominent. if two seem prominent, upper is C7 and lower is T1

shape and configuration of chest wall

cage is an elliptical shape with downward sloping ribs about 45 degrees relative to the spine. skeletal deformities may limit thoracic cage excursion.

Areas of abnormal foot friction

calluses or burial reactions

Unequal pupils

can be normal but also can indicate CNS issues (stroke, head injury)

complications of withdrawal

can cause seizures, which can often lead to lost airways

vision expectations 2-4 weeks

can fixate on an object

vision expectation at 1 month

can fixate or follow a light/toy

vision expectations at 6-10 months

can fixate, follow a toy in all 6 positions of gaze

vision expectations at 3-4 months

can follow, fixate, and reach for toy

receptive aphasia

can hear sound but can't comprehend. due to damage of wernicke's area

Abnormal pubic hair

can indicate endocrine issues

seizures in infants/kids

can occur with high fever or be associated with neuro disease

how far can you percuss

can set into motion outer 5-7cm of tissue

Why is temp regulation ineffective in babies?

can't sweat at all 2 months old and at that point its only minimal, can't shiver, can't show pigment system. subq is ineffective.

physiological factors controlling BP

cardiac output- BP drops as cardiac output decreases peripheral vascular resistance- vasoconstriction raises it and vasodilation lowers it volume of circulating blood- more volume= higher BP viscosity (polycythemia vera)- thicker blood causes high BP- heart has to work harder to push this blood elasticity of vessel walls- more elastic= lower BP

physiologic changes from poorly controlled pain

cardiac- BP, heart rate, o2 demand, and cardiac output rise pulmonary- increased resp rate to increase o2 when in pain or decreased resp rate if it hurts to breath GI- n/v Renal- urinary retention w pain musculoskeletal- spasm or joint stiffness due to not moving hurting body part CNS- anxiety to fear; fatigue

if capillary refill is bad, what might that indicate?

cardio or resp dysfunction, septic shock

Chronic Disease associated with IPV

cardiovascular endocrine- diabetes immune- due to the stress GI reproductive mental health issues

common pulse sites

carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial

Peripheral nerves system

carries sensory (afferent) messages to the CNS from sensory receptors and motor (efferent) messages from the CNS out to the muscles and glands

otosclerosis

cause of conductive hearing loss (20-30 y/o). refers to an abnormal sponge-like bone growth in middle ear. causes footplate of stapes to become fixed in oval window, impeding the transmission of sound

functional murmur

caused by increased blood flow in the heart (anemia, fever, pregnancy, hyperthyroidism). common in kids, as they have a greater contractile heart force which increases blood viscosity.

Mechanism of pleural friction rub

caused when pleura become inflamed and lose their normal lubricating fluid. opposing rough surfaces rub together during respiration

Organs in RLQ

cecum appendix right ovary and tube right ureter right spermatic cord

physiological effects of elevated temp

cellular metabolism increases, increase o2 consumption, increased heart and resp rate, water loss

Basal cell carcinoma

center red ulcer with central yellowing and round pearly border with depression in sun exposed area. rarely spreads. starts as pink/red papule

Two parts of the nervous system

central nervous system and peripheral nervous system

causes of generalized seizures

cerebral trauma, structural lesions, hyponatremia, acute alcohol withdrawal, medication overdose

Spinals regions

cervical, thoracic, lumbar

Guides to determine adequate diet

choosemyplate, dietary guidelines, and dietary reference intake (DRIs)

leg ulcers common with

chronic arterial and venous disease

morning cough indicates

chronic bronchitis, "smokers cough"

rheumatoid arthritis

chronic inflammation of synovial tissue, hyperplasia, and swelling lead to fibrosis, cartilage and bone destruction, which limit motion and show as deformity. joint involvement is symmetric/bilateral with inflammation symptoms and painful motion of affected joints. also causes weakness, fatigue, weight loss, fever, lymphedema. raises stroke and MI risk

cause of brown discoloration in legs

chronic venous stasis from RBC degradetion

optic disc

circular area in the back inside of the eye where optic nerve attaches. fibers in retina converge to form this nerve

Lesion Shape: Annular

circular, begins in center and spreads to periphery

verbal response: confrontation

clarifies inconsistant information

contract terms of health interview

clear expectations- how long, when, where, who you are, purpose, presence of others, confidentiality, costs, expectations from PT

conjuctiva

clear, thin membrane that covers the anterior part of the sclera and the inner surface of the eyelids. keeps surface of eye moist and lubricated

diagnosis

clinical judgement

foramen ovale location and closure

closes in first hour- located between atria in septum

Choanal atresia

closure of nasal cavity due to congenital septum between nasal cavity and pharynx. inability to pass catheter through nasal cavity

cataract

cloudiness of lens due to thickening and yellowing. UV exposure can cause these

Finger to nose: Dysmetria

clumsy movement w/ overshooting the mark

Lesion Shape: Grouped

cluster of lesions (contact dermatitis)

CNS stimulants

cocaine, amphetamine cause agitation and paranoia

inner ear components

cochlea and the bony labyrinth, which holds the vestibular apparatus, which is made up of a vestibule and semicircular canals

southwest/mexico exposure risk

cocidiodmycosis

cerebellum

coiled structure located under the occipital lobe. does not initiate movement but ensures that movements are smooth and coordinated. Controls motor coordination, balance, posture, and muscle tone

white sputum indicate

colds, bronchitis, vital infections

chordae tendineae

collagen cords attach AV valves to papillary muscles embedded in ventricle floor- help maintain leakproof seal

Atelectasis

collapsed shrunken section of alveoli or entire lung as a result of airway obstruction, compression on the lung, or lack of surfactant

characteristics about sputum to document

color, odor, amount, and consistancy

deep somatic pain

comes from sources such as blood vessels, joints, tendons, muscles, and bone. pain may result from pressure, trauma, or ischemia well localized aching or throbbing

absence of sniff during patency may indicate

common cold, nasal polyps, rhinitis

buccal hyperpigmentation occurs in

common in dark-skinned people

setting-sun sign

common in newborns. eye deviates downward, exposing sclera over the iris. may show when as you rapidly change neonate from sitting to supine

sebaceous cyst

commonly behind lobule in post-auricular fold. black central punctum= blocked sebaceous gland

verbal response: silence

communicates that client has time to think and allows provider to assess non-verbal behavior

scale

compact desiccated flakes of skin from shedding of dead skin cells

how do we find nursing diagnosis

compare clinical findings w normal and abnormal variation. interpret data with cues and hypotheses (diagnostic reasoning)

Allis test purpose

compares the length of infant's legs in order to check for hip dislocation

vitiligo

complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices

flaccid quadriplegia

complete loss of muscle tone and paralysis of all four extremities

CNI olfactory abnormalities cause

complete loss of smell due to tobacco, cocaine, or cribriform plate fracture

types of assessment

complete, focused, follow-up, emergency

surfactant

complex lipid substance needed for sustained inflation of alveoli

ABCT

components of a mental status exam Appearance- hygiene, posture, body movements, pupils Behavior- LOC, facial expression, speech, mood and affect Cognitive functions- orientation, attention span, recent and remote memory, new learning thought process and perceptions- anxiety, depression, perceptions, thought processes and content

autonomic nervous system

composed of cranial nerves and spinal nerves

palpating calf muscle

compress gastrocnemius against the tibia

McMurray Test

compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus

Cause of increased tactile fremitus

compression or consolidation of lung tissue (lobular pneumonia) increases density of lung tissue making a better conducting medium for vibrations. only present when bronchus patent and consolidation (pneumonia) extends to lung surface- small areas doesn't significantly affect it

verbal response: summary

condenses facts and validates what was discussed during the interview to allow pts to make any corrections

fetal development at 16 weeks

conducting airways reach same number as in adult

Purpura

confluence and extensive patch of petechiae and ecchymoses. >3mm, flat, red to purple, macular hemorrhage.

coarction of the aorta (CoA)

congenital aorta narrowing- usually notices by abnormally high BP in young people

Flattening of angle and clubbing occurs with

congenital cyanotic heart disease and cor pulmonale

ophthalmia neonatorum

conjunctivitis of the newborn. purulent discharge due to something present in birth canal

perforator veins

connecting veins- joins the tw sets. contain valves that route blood flow from superficial to deep veins

terms within a mental status assessment

consciousness language mood and affect orientation attention memory- recent and remote abstract reasoning- beyond literal thought process thought content perceptions- awareness to objects through senses

SBAR

consistent, clear, structured, and easy-to-use method of communication between health care personnel Situation-names, units and room #, problem, severity, origin Background- admission diagnosis and immediate assessment findings (vitals) Assessment- what you found and what may be wrong Recommendations- what you think your pt needs

The Short-Form McGill Pain Questionnaire

consists of 78 words that describe pain. person rates own pain by describing words that most closely match up to their feelings

sending in communication

consists of verbal and non-verbal communication given off

Finger to nose: pastpointing

constant deviation to one side

muscle rigidity and its cause

constant resistance to passive movement. due to injury to extrapyramidal motor tracts

parasympathetic nerves have what affect on pupil

constricts

Overnutrition

consuming nutrients more than what body needs- particularly calories, sodium, and fat

spinothalamic tract

contain sensory fibers that transmit sensations such as itching, pain, temp, light nonspecific touch, tickling

medial canthus

contains puncta & caruncle (a small fleshy mass containing sebaceous glands)

medulla

continuation of spinal cord that helps control HR, BP, respirations, and swallowing. Crossing of motor fibers occurs here

nasopharynx

continuous with oropharynx. tonsils and Eustachian tube located here

Assessing pain: objective data of abdomen

contour, symmetry, muscle guarding (spasms), organ size, referred pain

What initiates heart contractions

contracts by itself- doesn't need stimulation before contracts in response to an electrical current conveyed by a conduction system. SA note acts as pacemaker for contractions

arterial vascular smooth muscle

contracts the amount of blood delivered to tissues and contracts or dilates arterial diameter

thyroid gland fx

controls metabolism with thyroxine and triiodothyroine

brocas area

controls speech. damage to it causes expressive aphasia

Pupillary light reflex

controls the diameter of pupil in response to the exposure of intense light. involved a direct and indirect reflex of constriction

upper motor neuron function

convey impulses from the motor areas of cerebral cortex to the lower motor neurons in the anterior horn cells of the spinal cord. Contained in the CNS and influence lower neuron activity

skin changes PAD

coolness. avoid compression stockings which worsens ischemia

corticospinal tract

coordinate fine motor movement. skilled purposeful movements

Cerebellar function test

coordination and skilled movement tests (RAM, finger to nose, heel to shin), balance tests (gait, Romberg, shallow knee bend), anterolateral tract (pain and light touch), and posterial column tract (vibration, position, tactile discrimination, stereognosis, graphesthia, exinction, pain location)

tests that assess extraocular muscle fx

corneal light reflex (hirschberg), cover test, and diagnostic positions test

motor pathways types

corticospinal or pyramidal tract, extrapyramidal tracts, cerebellar system

Sulfur dioxide exposure symptoms

cough and congestion

Rest tumor characteristics

course and slow and occurs when muscles are relaxed and supported against gravity. disappears with voluntary movement

vellus hair

covers most of the body

cartilage in joints

covers the surface of opposing bones in synovial joint giving bones their smooth shape and protect them. receive nourishment from synovial fluid

crackles vs atelectacic crackles (when/where are they heard)

crackles heard when secretions are expanded by a few deep breaths. atelectacic crackles heard only in the periphery, usually in the dependent portions of the lungs, and disappear after a few breaths or a cough

adventitious sounds

crackles/wheezing: added sounds that are not normally heard in the lungs. caused by moving air colliding with secretions in tracheobronchial path or popping open of previously deflated airways

What are the extraocular muscles innervated by?

cranial nerves III, IV, VI

gingival hyperplasia

crevices between teeth and gums, pockets of debris

cruciate ligaments

cross within the knee and give anterior and posterior stability to help and control rotation

strabismus

crossed eyes

proper blood pressure cuff size

cuff width should do 40% around its arm and length should go 80%

Percent usual body weight formula

current weight / usual weight x 100

posterior tibial pulse

curve fingers around medial malleolus. tapping felt behind it in the groove between the malleolus and the achilles. passive dorsiflexion of foot can make more accessible

ovarian cyst distention charactertics

curve in lower half of abdomen toward midline with everted umbilicus

Dermal segmentation

cutaneous distribution of the various spinal nerves

remodeling

cyclic process of bone resorption and deposition

What may barrel shape after 6 years old indicated

cystic fibrosis or chronic asthma

abuse to a substance defined as

daily need used to function, not being able to stop, impaired functioning, using when doing so is hazardous, legal problems

Lower motor neuron diseases

damage to these cause permanent paralysis. issues are directly related to nerve transmission to muscle - bells palsy - spinal cord lesions - poliomyelitis

linea nigra

dark line from umbilicus to pubis during pregnancy

how do opacities in red reflex appear?

dark shadows or black dots (often cataracts)

cultural differences in irises and retinas

darker irises have darker retinas behind them. lighter retinas generally have better night vision but light can cause more pain to them

When do baby teeth erupt?

deciduous teeth appear between 6-24 months

Osteoporosis

decrease in skeletal bone mass leading to low bone mineral density and impaired bone density

anosmia

decrease or lack of smell. due to smoking, colds, cocaine

CN VIII Acoustic nerve abnormalities cause

decrease or loss of hearing

Paralysis cause

decrease or loss of motor power causes by problems with motor nerve or muscle fibers

evening fatigue occurs with

decreased CO

hypo/hyper algesia

decreased and increased sensation of pain

pleural friction fremitus

decreased in the normal lubricating fluid, due to inflammation of the pleura, causes a palpable grating sensation during breathing. best detected by auscultation and it occurs during resp excursion

muscle flaccidity and its cause

decreased muscle tone or hypotonia. weak and easily fatigued- feels like rag doll. due to lower motor neuron injury

Diminished Carotid pulse may indicated

decreased stroke volume

increased small airway closure causes

decreased vital capacity and increased residual volume

types of reflex arches

deep tendon reflex (stretch or myotatic), superficial (cutaneous), visceral (organic)

deep cervical node

deep under the sternomastoid muscle

Ulcer

deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals

Causes of lower back pain

degenerative disc, osteoporosis, lumbar stenosis

caffeinated energy drinks effect on body

dehydration, elevated BP, elevated heart rate, sleep problems

dry mouth occurs with

dehydration, fever; tongue has deep vertical fissures. also medication side effect

Effect of drinking and drugs on adolescents

delays brain development and maturity levels, increases high risk sex behaviors, causes academic performance problems, increases traumatic injuries

Shallow knee bend

demonstrates normal position sense, muscle strength, and cerebellar function. unable to perform if there is weakness in quadricep muscle and hip extensors

Sclera

dense tissue with many blood vessels protective; part of refracting media of eye as it bends incoming light rays to focus on inner retina. provides attachment for external muscles of the eye. provides shape and support

How to assess and grade pitting edema

depress fingers in tissue for 5 seconds 1+ doesn't look swollen; causes slight indent 2+ moderate pitting, returns rapidly 3+ starts to look swollen 4+

light palpation purpose

depress skin about 1 cm. Form an overall impression of the skin surface and superficial musculature. Voluntary muscle guarding vs. involuntary rigidity.

mental health effects of IPV

depression suicidality PTSD substance abuse problems

cutaneous pain

derived from the skin surface and subq tissue. sharp or burning pain

anthropomorphic measures

derived weight measure

nursing diagnosis

describes a health problem that can be treated by nursing measures; a step in the nursing process.

spleen functions

destroy old red blood cells, produce antibodies, store red blood cells, filter microorganism

follow up assessment

determine changes, conditions getting better/ worse, coping strategies

contour of abdomen margins

determine profile from from rib margins to pubic bone

goals of pain-rating scales

determines baseline intensity, tracks changes, and gives some degree of evaluation to a tx modality

cover test

determines deviated alignment or eye weakness. normal= steady fixed gaze in uncovered and covered eyes

Measuring Leg Length Discrepancy

determines if one leg is truly shorter than the other. measure between anterior superior iliac spine and medial malleolus crossing the medial side of the knee

When does lymph develop and stop growing?

developed well by birth and grows to adult size by 6. it exceeds adult size at 10-11, then begins to atrophy

What does diaphoresis occur with

diabetics and MI especially -thyrotoxicosis -heart attack -anxiety -pain

pubic hair distribution

diamond in male and triangle in female

changes in chest cage during pregnancy

diaphragm elevated by 4cm and moves more with breathing. up to 2cm transverse diameter increase. up to 6cm total expansion. compensates for loss of vertical diameter by increasing horizontal. o2 demands increase due to growing fetus. 40% increase in tidal volume

chest size change during inspiration

diaphragm recents and flattens and intercostal muscles raise sternum and ribs, causing negative pressure due to increased lung volume and AP diameter

asymmetric expansion in infants/kids indicates

diaphragmatic hernia and pneumothorax

pulse pressure

difference between systolic and diastolic pressure. represent SV

dysarthria

difficulty forming words

dysphasia

difficulty with language comprehension or expression

what blanches and what doesn't?

dilated blood vessels will blanch and extravasated blood (petechiae) dont

sympathetic nerves have what affect on pupil

dilation

What to include in abuse documentation

direct pt quotes, injury maps, pictures, detailed non biased info (facts only, don't infer anything), forensic terminology

Choleteatoma discharge

dirty yellow-gray discharge with foul odor

Petechiae

discoloration; Minute, pinpoint, nonraised, perfectly round purplish-red spots caused by intradermal or submucous hemorrhage, which later turn blue or yellow.

pleural friction rub

discontinuous sound- A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory

course crackle characteristics

discontinuous sound- low pitched bubbling start in inspiration and may be present in expiration. may decrease some by suctioning or coughing but reappears

atelectatic crackle characteristic

discontinuous sound- sound like fine crackles but don't last and are not pathologic. disappear after a few breaths. usually heard in axilla or bases (dependent) of the lungs

fine crackles characteristic

discontinuous- high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing

tactile discrimination

discriminate sensations of fine touch

what may nystagmus indicate?

disease of semi-circular canals in ears, paretic eye muscle, MS, and brain lesions

Abnormally high BP in the right atrium shows as

distended neck veins and abdomen since there aren't valves between the vena cava and the right atrium

protuberant contour

distention due to air, fluid, or bleeding

inspecting knees

distinct concavities or hollows present on side of patella (peripaterllar grooves)

bilateral diplopia vs unilateral diplopia

double vision in both eyes indicates misalignment unilateral diplopia causes by dry eyes

where do tears drain?

drain into puncta at the inner corner and then empty into the inferior meatus inside nose= Nasolacrimal duct

Ptosis

drooping upper lid. Occurs from neuromuscular weakness, oculomotor damage, or sympathetic nerve damage (Horner syndrome) or congenital. gives person sleepy appearance and impairs vision

xerosis

dry skin

why are murmurs common in newborns

due to closure of shunts

Geographic stroke locations cause

due to increased incidence of traditional risk factors and lack of knowledge about strokes and their warning signs

causes of excessive cerumen

due to narrow cavity or bad cleaning methods- doesn't cause hearing issues until 90-95% blockage

why is pulmonary valve closure later than atrial

due to route of myocardial depolarization

tumor distention characteristics

dull over mass if it reaches surface. define borders to distinguish from an enlarged or normally palpable organ

visceral pain

dull, general, poorly localized

muscle growth during development

during adolescence, marked growth due to response to growth hormone secretion (adrenal androgens and additional testosterone in boys)

What causes the apical impulse?

during contraction, apex beats against the chest wall.

Snellen eye chart

each eye tested independently 20ft away

perforation of the tympanic membrane causes what sensations

ear pain first, stops with popping, then drainage occurs

otalgia

ear pain; occurs from ear disease or referred pain from teeth or oropharynx issues

otoscope

ear/typanic membrane. 5 specula- short and broad used for nares

components of health hx

earaches, past infections, discharge, hearing loss, environmental noise, tinnitus, vertigo, and patient-centered care

dry cough indicates

early HF

kopek spots in buccal occurs with

early measles sign

describing murmur timing

early, mid, or late diastole/systole (or pan diastole/systole or hollow diastole/systole= throughout cardiac cycle)

CAGE questionnaire

easy yes or no questions over a lifetime. less effective with women and minorites C-cut down A-annoyed G-guilty E-eye opener

hypomobility of eardrum indicates

effusion or a high vacuum in middle ear. Can indicate middle ear infection In first 6 weeks

communicating with preschoolers

egocentric/ only see world through their perspective. everything is direct, literal, and present

intervertebral discs

elastic fibrocartilaginous plates that constitute one fourth of the length of the column

EASI tool

elder abuse suspicion index. also monitors for financial abuse

lymph node fx

filter lymph and engulf pathogens to keep them from entering circulation in head, neck, arms, axilla, and inguinal areas

vesicle

elevated cavity containing free fluid up to 1 cm in diameter "blister". contains clear fluid inside

false erythema

embarrassment and dependent position

right lymphatic duct

empties into right subclavian veins Drains the right side of the head, neck, right arm, right thorax, right lung and pleura, right side of heart, upper right liver

jugular vein function and its blood flow

empties unoxygenated blood into the vena cava. reflect filling pressure and volume changes in the right side of the heart since they don't have valves to stop flow. unlike other pulses, it occurs from backwash from upstream events

cyst

encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin

lymphadenopathy

enlarged lymph nodes

HIV nodes feel like

enlarged, firm, non-tender

pseudostrabismus

epicanthal folds give a false appearance of malalignment. corneal light reflex remains normal

layers of skin

epidermis, dermis, subcutaneous

Raynaud's phenomenon

episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration, or stress

barrel chest

equal AP-to-transverse diameter, ribs are horizontal instead of normal downward slope

Hemorrhage

escape of blood afrom a ruptured blood vessel

objective of interview

establish trust gather accurate health data build rapport for therapeutic relationship- set expectations teach client about their health state discuss health promotion and disease prevention

Aspartate aminotransferase (AST)

evaluates liver enzymes to evaluate drinking for months

Danger Assessment (DA)

evaluates risk of person being killed by their abusive partner involves abuse calendar. 19 yes or no questions

Implementation

evidence based interventions done in timely manner

Montreal cognitive assessment (MoCA)

examines more cognitive domains and more sensitive to mild impairment. Free. at least 26 out of 30 is normal

How is vision assessed in infants?

exams not performed at birth. baby's tested by testing reaction to facial expressions and to bright light

epicentral fold

excess skin fold extender over inner corner of eyes, overlapping inner canthus. occurs mostly in asians but also 20% of whites

brown teeth may indicate

excessive fluoride use

kyphosis

excessive outward curvature of the spine, causing hunching of the back. causes back pain and limited mobility. severe deformities impair cardiopulmonary function

epiphora

excessive tearing. caused by irritants or obstruction in tear drainage

factors influencing respiration

exercise- increases acute pain- depends on where. increases unless chest or chest/abdomen where it may hurt to breathe anxiety- increases smoking- increases body position medications- pain meds, anesthetics and others lower, some raise neurological injury- hemoglobin function- may have to breathe more for adequate profusion if inadequate function age- higher in kids sex- females higher after puberty

Cranial nerve function

exit the scull and supply the head and neck

purpose of sighing

expand alveoli

Standard Precautions

expect that all fluids or broken skin may be infectious and you need to be cautious caring

resonent percussion notes

expected lung sounds in adults. Low pitch, medium-loud, clear, hollow, moderate length

stage 3 pressure ulcer

extends through all skin levels (full thickness) and into subq, resembling a crater. see fat, granulation tissue, and round edges

scapular line

extends through the inferior angle of the scapula when the arms are at the sides of the body

acromion process

extension of the scapula, which forms the high point of the shoulder

communicating with infants

face to face non-verbal communication

what makes up behavior in general assessment

facial expression, mood and affect, speech, speech patterns, dress, personal hygiene

elder neglect

failure to prevent harm. failure to provide proper hygiene, nutrition, clothing, shelter, medical care

CN IV trochlear nerve abnormalities cause

failure to turn eye out or down

presbyopia

farsightedness caused by loss of elasticity of the lens of the eye, becoming glass like. occurs typically in middle and old age caused by decrease in accommodation, causing blurred vision

hyperopia

farsightedness. globe shorter than normal- use positive number on ophthalmoscope

Accumulation of fat in older males

fat gain in abdominal area

subcutaneous layer purpose

fat tissue stored for energy, regulates temp, and acts as a protective cushion

reasons an older adult may deny being in pain

fear of dependency, further testing, invasive procedures, cost, fear of taking pair killers or becoming a drug addict

humoral regulation

feedback loop involving co2, o2, and h+ changes in blood

otitis media risk factors

feeding infants in a supine position, environmental smoke exposure, and pacifier use, not breastfeeding, preterm birth, male sex, seasonal, daycare

how is modified Allen test performed

firmly occlude ulnar and radial arteries while pt makes a fist. ask them to open hand without hyperextending- should look blanched. ulnar pressure released while radial maintained and should turn red and then color should return to normal in 5-15 seonds

Protodiastole

first passive filling phase of diastole

Myosis

fixed constriction of the pupil. Occurs with use of pilocarpine drops for glaucome tx, narcotics, iritis, and pons damage

mydriasis

fixed dilated pupils. Occur with stimulation of sympathetic nervous system, rxn to sympathomimetic drugs, use of dilating drops, acute glaucoma, or past or recent trauma. They also herald CNS injury, circulatory arrest, or deep anesthesia

thymus location and function

flat pink/gray gland located in the superior mediastinum behind the sternum and in front of aorta. important in developing T lymphocytes in the immense system of kids (B lymphocytes originate in bone marrow and mature in lymphoid tissue)

Nevus simplex (stork bite)

flat red patch on baby's face or back of neck. present at birth and fades during first year

contour types

flat, rounded, scaphoid, and protuberant

What indicates facial nerve damage

flattened nasolabial fold, drooping of one side, lower eyelid sagging, and escape of air form only one cheek indicates muscle weakness

Sympathetic nervous system

flight or fight response

factors influencing pulse rate

fluid balance- heart rate increases to compensate for loss of blood volume (dehydration) in order to still perfuse o2 temp- fever increases pulse anxiety/emotions and exercise- increase meds- can increase or decrease position changes- orthostatic hypotension: HR increases to compensate for low BP pain- acute pain raises pulse

otitis media complications

fluid often persists in middle ear after tx, imparting hearing and placing child at risk for cognitive developmental delays include rupture of TM, scar tissue formation, and conductive hearing loss

causes of hypoactive bowels

follow abdominal surgery or with peritoneal inflammation

pathway of sensory and motor development

follows a cephalocaudal and proximodistal order

snellen E chart

for 3-6 years old. direction of E noted. standard used after 7yrs

complete musculoskeletal exam

for people with articular disease, history of musculoskeletal symptoms, problems with ADLs

FLACC pain scale

for those unable to cooperate to tell you their pain level- children under 3 based off of face, leg movement, activity, crying, consolability

TWEAK test

for women, particular pregnant women T- tolerance W- worry E- eye opener A- amnesia K- kut down

Measures of pulmonary function status

forced expiratory time, pulse oximeter, 6 minute distance walk (6md), and spirometer

Ciliary body

forms a muscular find around the eyes, controlling shape of the lens by controlling thickness. secretes aqueous humour

rectus abdominis

forms a strip extending midline that protect and hold organs in place

Basal cell layer

forms new skin cells- major ingredient is the protein keratin. also contains melanocytes

Pectus Carniatum

forward protrusion of the sternum with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). less common than pectus excavatum

what may indicate head trauma

frank blood or watery fluid (CSF) after head injury

pnuemothorax

free air in pleural space causes lung collapse. air in pleural space neutralizes the usual negative pressure present can be caused by spontaneous, trauma, or tension

Synovial joints

freely movable because their bones are separated from one another and enclosed in a joint cavity lined with synovial membrane and fluid

pitch

frequency

characteristics of sound

frequency (all low pitched but described as lower or higher), intensity (loud or soft), duration (heart sounds are short), timing (systole or diastole)

Summation

frequent consecutive stimuli are perceived as one strong stimulus. avoid by waiting 2 seconds between each stimulus

Sternomastoid location and function

from clavicle and scapula to mastoid process (behind ear). controls head flexion and rotation

visceral pain location, characteristics, causes

from direct injury to organ, severe contraction or extension of organ, ischemia, distention, stretching from tumor. In larger internal organs described as dull, deep, squeezing, or cramping typically accompanied w n/v, pallor, and diaphoresis due to ANS

parietal pain

from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement)

anicus

functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli. gas exchange occurs here across resp membrane

Brainstem hearing action

fx is binaural interaction, which permits locating the direction of a sound in space and identifying the sound. each ear sends signal to both sides of brainstem which helps differentiate location

what makes up mobility in general assessment?

gait and ROM

how to screen for anxiety and what the scores mean

generalized anxiety disorder scale (GAD-7) 5, 10, 15 indicate mild, moderate, severe

Causes of obesity

genetic, obesogenic (dietary intake), and physical inactivity

excess saliva occurs with

gingivostomatitis and parkinson's

Growth milestones of adolescents

girls double weight from 8 to 14 boys double weight from 10 to 17

skin appearance with ascites

glistening and taut with striae (lineae albicantes)

Testing Cranial Nerve IX and X

glossopharyngeal and vagus nerves: test motor function - palpate and uvula elevate midline and tonsillar pillar move medially - avoid gag reflex when touching the posterior pharyngeal wall - assess smoothness of voice

1st set of pain neurotransmitters

go from skin to dorsal horn substance P, histamine, Prostagladins, serotonin, bradykinin

farmers have increased exposure risk to

grain and pesticide inhalation

arcus senilis

gray-white arc or circle around the limbus of the iris due to deposition of lipid material that is common with aging. no effect on vison

superficial veins in legs

great saphenous and small saphenous

Sulcus

grooves that divide the lobes of the brain

bone growth in length

grows at epiphyses- specialized growth centers of transverse discs located at the end of long bone

unequal respirations cause

guarding from pain or when part of lung is obstructed or collapsed

acute pain behaviors

guarding, grimacing, vocalizations, agitation, restlessness, stillness, diaphoresis. or change in vital signs.

pantomiming

hand gestures and facial expressions as form of non-verbal communication to tell a story

ulnar pulse

hand under pt arm and palpate along medial side of inner forearm. not normally palpated in healthy adults

expressive aphasia

happens with damage to Broca's area of the frontal lobe. can comprehend language but cannot communicate back

chronic inflammation of lymph feels like

hard, >3mm, unilateral, non-tender, matted, fixed to adjacent stuctures. ex: cancer, TB, clumped nodes

Herberden and Bouchard nodules

hard, nontender nodules on fingers, occur with osteoarthritis

What is an organic mental disorder and what are symptoms of it?

has a known cause: caused by illness (delirium, alcohol/drug intoxication, dementia, withdrawal) not psychiatric in nature symptoms: confusion, agitation, irritability, change in behavior, impaired brain function, cognitive ability, or memory

normal tonsils appearance

has indentations or crypto on them that can college small plugs of white cellular debris (does not indicate infection) should be no exudate.

If spinal curvature suspected

have pt bend forward and put a dot on each spinous process and when they stand, dots should form a straight line

anisocoria

having pupils of two different sizes (5% of people)

what does cervical node drain

head and neck

order of musculoskeletal exam

head to toe from proximal to distal inspection, palpation, ROM, muscle testing

head control of the infant

head will hold in same plane as body. it will flop forward when sitting and stay in place starting at 4mo. when in a prone position, holds head at 45 degree angle

subjective questions for head/neck/face

head/ neck ache, dizziness, lumps/swelling, past injury (lose consciousness? complications?), past surgery

core values of health care

health promotion and disease prevention

flat diaphragm of stethoscope

hearing high pitched noises such as breath, bowel, and heart sounds

recruitment

hearing loss with low intensity speech but sound become painful when speaker repeats loudly

bell of stethoscope

hearing low pitched sounds such as extra heart sounds

Air conduction hearing pathway

hearing that occurs through air near the ear. involves ear canal and tympanic membrane

Risks of excess weight in waist

heart disease and type 2 diabetes

A high waist-to-hip raises risk for

heart disease, type 2 diabetes, metabolic syndrome

apex of infant

heart more horizontal- apex located at 4th left ICS lateral to the midclavicular line

cardiac output

heart rate x stroke volume

how to find cardiac output

heart rate x stroke volume

pyrosis

heartburn

Common pressure ulcer sites

heel, ischium, sacrum, elbow, scalpel, vertebra, ankle, knee, hip, rib, shoulder

pons

helps control respirations- contains centers that coordinate with main center in medulla

Spinal cord functions

helps mediate reflexes: posture control, urination, and pain response

lens

helps refract light for near and distant vision. transparent, biconvex structure in the eye

Ecchymosis

hemorrhagic spot or blotch in skin or mucosa. non-elevated patch (bruise)

grey stool indicates

hepatitis

jaundice occurs with

hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn

enlarged, everted umbilicus indicates

hernia

persistant peristaltic sound and diminished breath sounds on same side may indicate

hernia

inspection considerations of infants/children

hernias common. respiratory function can often be seen in those under 7

What maternal infections can affect child's eyesight?

herpes or gonorrhea

senile purpura

r/t ecchymosis discoloration due to increasing capillary fragility

stridor

high pitched inspiratory crowing occurring with upper airway obstruction- croup, foreign body aspiration, acute epiglotitis

Culture, genetic, and sociocultural effects that play into treatment of abuse

higher rates among all minorities societal stressors- daily struggles (poverty) legal status- may not know their rights. VAWA helps immigrants lack of access to culturally appropriate care- believe they are dependent on their abusive husbands and may be accepted as normal in their society

ankle-brachial index

highest ankle pressure divided by highest arm pressure. less than .9 indicates PAD

Advantages of breastfeeding

highly recommended for 1st year- promotes growth, development, and immunity. leads to fewer food allergies and increases bonding

rural midwest exposure risk

histoplasmosis

suprasternal notch

hollow U-shaped depression just above the sternum, in between the clavicles

When can a child hop and balance on one leg

hop by 4, balance on one leg for five seconds by 4, and eight to ten seconds by 5yrs

care planning

how are we going to meet these outcomes. need to set priorities and identify possible nursing interventions

health perception

how does pt describe their health and illness how does the pt see the problems that he or she is experiencing now

What is the nursing process?

how nurses think; standards of practice in nursing

borborygmus

hyper peristalsis "stomach growling"

Skin texture hyper/ hypothyroidism

hyper- smooth and soft hypo- rough and dry

what usually causes us to breathe?

hypercapnia

changes in thoracic cage w/ COPD

hyperinflation causes increased AP diameter and abdominal (rectus abdomens and internal intercostal muscles) and neck muscle hypertrophy from aiding in forced respirations across obstructed airways

full/strong carotid pulse indicates

hyperkinetic states

purpura

r/t petechia

Test Cranial Nerve XII

hypoglossal nerve: - inspect tongue for straight in midline - assess speech "light, tight, dynamite" should be clear and distinct

Conditions that cause excessive sweating in babies and kids

hypoglycemia, heart disease, and hyperthyroidism

numbers for each BP level

hypotension (acc to book)- <95/60 normal= <120 and <80 elevated= 120-129 AND <80 Stage 1 hypertension= 130-139 OR 80-89 Stage 2 hypertension= 140 or more OR 90 or above Hypertension Crisis= >180 and/or >120 (contact HCP immediately)

How is temperature regulated?

hypothalamus is internal thermostat mechanism. it balances heat production and loss produced - lost = body temp

enlarged tongue occurs with

hypothyroidism or acromegaly

blue lips can indicate

hypoxemia and chilling

emergency assessment

identify life-threatening problems. quick, only needed info asked, physical and verbal assessment done at same time by multiple people

measuring calf circumference

if DVT suspected. refer if acute, unilateral painful swelling of 1cm of more 1-3 mild, 3-5 moderate >5 severe. >2 occurs with DVT

when to palpate under the tongue

if they are 50, use alcohol, smoke, or have any other oral lesions

Why do we advance light from the side to test light reflex

if you do from front, pupils constrict to accommodate for near vision, so you wouldn't know what the pure response of light would've been

Medication effect on nutrition

impair metabolism, digestion, absorption, or interact with nutrients

Health implications of undernutrition

impaired growth and development, less resistance to infection/ disease, delayed wound healing, longer hospital stays, higher health costs

Risk factors for pressure ulcers

impaired mobility, age, decreased sensory perception, impaired LOC, moisture, poor nutrition/ infection

Health issues correlated with child abuse

improper brain development cerebral palsy- r/t head trauma delayed language development mental health issues- anxiety and depression

viratility testing

in kids. positive and negative pressure given and TM movement watched

Borders of cardiac dullness

in right hemithorax, upper border of liver dullness located in 5th intercostal space in right midclavicular line. on left, tympani is evident over gastric space

frontal sinus

in the frontal bone above and medial to the orbits

dsymetria

inability to control distance, power, and speed of muscular action

flexion contracture

inability to extend fully

analgesia

inability to feel pain

astereognosis

inability to judge the form of an object by touch

Dysdiadochokinesia

inability to perform rapid alternating movements

contributing factors of Nonmedical psychotherapeutic use

inappropriate prescribing, aggressive marketing for off-label use, belated govt response, increase in prescriptions for pain relief. most given by friends/ fam

comprehensive nutritional assessment

includes dietary history and clinical information, physical examination for clinical signs, anthropometric measures (height and weight), and laboratory tests

Jaundice and where does it occur first

increase in blood bilirubin. picks up early in roof of mouth or mouth sclera

Sinus Arrhythmia

increased HR w inspiration and decreased w expiration- inspiration causes momentary decrease in SV from left side of heart and heart rate increases to compensate. this is a normal variation w kids and young adults.

muscle spasticity and its cause

increased muscle tone or hypertonia. increased resistance to passive lengthening then may suddenly give way like a sprung open pocket knife. due to upper motor neuron injury

hyperventilation

increased rate and depth of breathing. causes alkalosis

Mother rubella exposure in babies

increases risk for damage of corti and hearing impairment

Joint changes in pregnancy

increasing levels of circulating hormones causes increased joint mobility contributing to noticeable changes in maternal posture

murmur radiation

may be transmitted downstream in direction of blood flow and heard in another place on the precordium, neck, back, or axilla

prevalence of drinking during pregnancy and in aging adults

increasing over time increases for older people, as population increases and people live longer. more drink now than 20 years ago and women do more

capillary refil indicates

index of peripheral perfusion and cardiac output

Pain location test

indicate where touched at/ if pt can localize sensation

What does decorticate posturing indicate?

indicates hemispheric lesion of cerebral cortex

deviation of uvula and what it occurs with

indicates nerve damage which occurs with poliomyelitis and diphtheria

bulging of rib interspaces cause

indicates trapped air as the forced expiration associated with emphysema or asthma

Dietary Guidelines

individualized nutrition and health plans

Risk factors for undernutrition

infants, children, low income immigrants, pregnant women, hospital patients, aging adults

Lobal Pneumonia

infection in lung parenchyma leaves alveolar membrane edematous and porous allowing blood cell and debris buildup

Enlargement of epitrochlear nodes indicate

infection of the hand or forearm or general lymphadenopathy

white tonsillar membrane may accompany

infectious mono, leukemia, and diptheria

landmarks of the spine

inferior angle of scapula at t7-8 interspace and highest iliac crest point L4

Common sites of referred pain

inflamed appendix or gallbladder- periumbilical area acute coronary syndrome- left arm or neck

Blepharitis

inflammation of the eyelid. Red, scaly, greasy flakes and thickened, crusted lid margins occur w/ staph infections or seborrheic dermatitis of lid edge. Symptoms- itch, burning, tearing, foreign body sensation

Dacryoadenitis

inflammation of the lacrimal gland. outer lid inflammation associate with mumps, measles, mono, trauma

Dacrocystitis

inflammation of the lacrimal sac and duct due to infection or blockage. inflammation and tearing. pressure causes purulent dischage

plantar fasciitis

inflammation of the plantar fascia on the sole of the foot

otitis media cause

inflammation/infection of the middle ear. caused by the Eustachian tubes not draining adequately from the middle ear or passage of nasopharyngeal secretions into middle ear, creating ripe environment for bacterial growth

gender differences in pain and what they're influenced by

influenced by societal expectations, hormones, and genetics hormone affects strongest influences on pain sensitivity for women migraine 2-3x more likely in women chronic pain more prevalent in women

Incus appearance in otoscope

infrequently seen, but appears as whitish haze in upper posterior TM

TB

inhalation of tubercle bacilli into alveolar wall starts process

Spirometer and what it measures

inhale into device as fast as possible. FEV, or forced vital capacity, is the volume expelled. FEV1, or forced expiratory volume in 1 second FEV1 to FVC ratio should be 75% or more

Mechanism of coarse crackles

inhaled air collides with secretions in the trachea and large bronchi

hypertrophic cardiomyopathy

inherited thickening of the myocardium. venous return changes with position- grows softer when standing to squatting and grows lower with squatting to standing

ROM with articular disease

injury inside of joint produces swelling and tenderness around whole joint limiting all planes of active and passive ROM

extraartiular disease ROM

injury to a specific tendon or ligament- produce swelling and tenderness in one spot in vein only affecting certain ROM planes, especially active

cochlea

inner ear structure containing the central hearing apparatus. it allows the formation of nerve impulses to travel to the brain by vestibulocochlear nerve (VIII)

vestibule

inner ear structure providing sense of balance, direction, and spatial orientation

great saphenous vein and where it can be seen

inside the leg, starts at the medial side of the dorsum of the foot. can be seen ascending in front of medial malleolus then crosses tibia obliquely and ascends along medial side of the thigh

Inspecting muscles

inspect all muscle groups bilaterally for size, strength, tone, involuntary movements

assessing the lacrimal apparatus

inspect for visual bulge in outer upper corner and lower orbital rim pressure to look for excessive tearign

Murphy's sign

inspiratory pause during RUQ palpitation when gallbladder is inflamed, palpating liver causes pain. put fingers under liver border and ask pt to breathe deeply- they will stop inhaling in painful

How to auscultate breath sounds?

instruct to breath through mouth and a little deeper/longer than normal. side to side comparison is important

duck walk shows

intact ligaments and no effusion or arthritis

Stage 1 pressure ulcer

intact skin with nonblanchable redness

parietal lobe

integrates sensory information- touch, position, vibration, pain, temperature

amplitude

intensity

murmur pattern

intensity may follow a pattern during the cardiac phase. Grows louder (crescendo), tapering off (decrescendo) or increases to a peak, then decreasing (crescendo-decrescendo or diamond shaped)

contusion

interchangeable with bruise

what is an opthamoloscope and what is it composed of

internal eye structures through funds (background behind/ through pupil). 5 head parts: viewing aperture, selector dial, mirror window, lens selector dial, lens indicator. black is positive numbers and red negative. checks near and far sighted-ness but not astigmatism

aspects of a Childs functional assessment

interpersonal relationships, activity/ rest, economic status, home environment, environmental hazards, stress management, habits, health promotion

Cortex hearing action

interprets meaning of sound and begins response

interpersonal distance levels

intimate= 0-1.5ft- visual distortion occurs personal= 1.5-4ft- perceived as extension of self used for physical assessment social distance= 4-12ft most of interview done here public distance= 12ft or more

where do lymph vessels empty

into two main trunks (right lymphatic and thoracic) that empty into the venous system at the subclavian veins

bluish umbilicus indicates

intraperitoneal bleeding

tremor cause

involuntary contraction of opposing muscle groups resulting in back and force shaking, vibration, trembling movements of one or more joints may occur at rest or with voluntary movement and disappears while sleeping

Control of Respiration

involuntary control by resp center of brainstem- medulla and pons

autonomic nerve fibers

involuntary movement that regulates our internal organs divided into sympathetic and parasympathetic

Sensorineural (perceptive) hearing loss

involves damage to inner ear (VIII). CN VII transmits sound and equilibrium info to the brain

esotropia

inward turning of the eye r/t strabismus and corneal light reflex

Pale tongue due to

iron deficiency

Black non-tarry stool indicates

iron medications

vitamins/ minerals needed during pregnancy

iron, folate, and zinc

hypoventilation and its cause

irregular shallow pattern caused by OD of narcotics/anestheics, prolonged bed rest, or splinting of chest to avoid resp pain

lacriminal apparatus

irrigation with tears to the eyes

Potential adverse effects of alcohol to fetus

issues happen often as alcohol slips easily through placenta. FASD and physical, learning, or behavior problems

cause of cerumen impaction in older adults

it oxidizes, causing this impaction and is drier due to apocrine atrophy.

interphalangeal joints

joints between phalanges. permit flexion and extension of fingers

Where is waist circumference measured?

just above the level of the iliac crest

femoral pulse

just below inguinal ligament midway between pubic and anterior iliac spine

dorsalis pedis pulse

just lateral and parallel with extensor tendon of the big toe

Where can the aorta be palpated?

just to the left of the midline in the upper abdomen

skin conditions found in black pts

keloids, post inflammatory color changes (hypo/hyper pigmentation), pseudofolliculitis (razor bumps/ ingrown hairs), chloasma

genu valgum

knock knees

Boutinniere deformity

knuckle looks as if it is being rushed through a buttonhole

hypoflexia

lack of reflex- LMN problem

Anterior and posterior triangles

landmarks in finding the neck anterior- between sternomastoid and midline of body posterior- behind sternomastoid w/ the trapezius on the other side

acetabulum

large socket in the pelvic bone for the head of the femur

internal jugular vein location

larger and lies deep and medial to sternomastoid. not usually visible

Tumor

larger than a few centimeters in diameter, firm or soft, deeper into dermis; may be benign or malignant

Knee Joint Connects

largest and most complex joint in the body. connects femur, tibia, and patella

where is hip circumference measured?

largest circumference of the buttocks

scoliosis

lateral S shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. note unequal shoulder and scapular height and unequal hip level, rib interspaces flared on convex side. if severe (>45 degrees), it may reduce lung volume, hurting cardio function

common spots for oral cancer

lateral and ventral tongue and floor of mouth any lesion more than two weeks old should be seen

How to calculate BMI

lbs/ inches x 703 or kg/meters squared

dark line on gingival margins occurs with

lead and bismuth poisoning

Organs in RUQ

liver gallbladder duodenum head of pancreas right kidney and adrenal hepatic flexure of colon part of ascending and transverse colon

diagnostic positions test

lead the eyes through the six cardinal positions of gaze will elicit any muscle weakness or paralysis during movement. ask person to hold head steady and follow finger. progress clockwise in each direction. a normal response is parallel tracking of the object with both eyes

diabetic retinopathy

leading cause of blindness. damage to retinal blood vessels

Costal angle

left and right costal margins form angle at the xiphoid process. increases when rib cage chronically overinflated

where are on the heart are left and right heaves seen

left at apex and right at sternal border

typical liver palpation technique

left hand on patients back parallel to 11th and 12th rib and right on RUQ with fingers parallel to midline and press deeply, move up 1-2cm with each breath

palpating for the spleen

left hand over abdomen behind left side at 11th at 12th ribs and right hand on LUQ with fingers toward axilla just inferior to rib margin and deep breathe

Displacement of apical impulse and increases sound to multiple spaces occurs with

left ventricular dilation= volume overload impulse moves down and to left >4cm likely dilated heart (HF and cardiomyopathy)

A sustained impulse with increased force and duration but no change in location occurs with

left ventricular hypertrophy= pressure overload (no dilation)

Growth milestone of infants

length increased by 50% during first year and doubles by four weight is doubled by 4 months old and tripled by one healthy newborn expect to lose weight at birth but should regain during first 7-10 days

duration

length sound lingers

What does decerebrate posturing indicate?

lesion in brain stem at midbrain or upper pons

primary lesion

lesions arising from previously normal skin

Lesion Shape: Confluent

lesions run together (hives)

Why is number of pregnancies an important question during nutritional assessments

less than one year apart multiparous causes increased risk of nutritional deficit. hx of low birth weigh infants suggest past nutritional issues

ischial tuberosity

lies under the gluteus maximus muscle and is palpable when the hip is flexed

parotid gland

lies within cheek in front of ears from zygomatic arch to angle of the jaw

sublingual duct

lies within floor of mouth under the tongue. has many small openings along the sublingual fold under the tongue. almond shaped

inspecting abdomen for symmetry

light on stomach will cast off a shadow on any non-symmetric area and deep breathing and sit-ups allow bulging to show and abnormalities

sensory assessment tests

light touch, pain, temp, position

internal factors of communication

liking others- feel unconditionally accepted; see people optimistically empathy- viewing the word from the other person's inner frame of reference while still remaining you. understanding feelings without losing yourself in them ability to listen self-awareness- recognizing personal biases

internal factors of communication

liking others- making them feel unconditionally accepted; view people in an optimistic way empathy- viewing the world from the other persons inner frame of reference but remaining you. understanding their feelings without losing yourself in them ability to listen self-awarness- being aware of own biases

Hormonal changes during pregnancy causes

linea nigra, cholasma, and increase metabolism

Lesion Shape: Zosteriform

linear arrangement along a unilateral nerve route (herpes)

visceral pleura

lines outside of lungs

parietal pleura and its function

lines the inside of the chest wall and diaphragm. contains a small amount of fluid. negative pressure holds lungs against chest wall

verbal response: interpretation

links aspects together

hooking technique

liver palpation technique- stand at shoulder facing pt's feet and hook fingers over costal margin and ask pt to breathe trying to feel liver edge bump your fingertips

senile lentigines

liver spots nonmalignant melanocyte clusters (esp after extensive sun exposure). no tx needed

fecal distention characteristics

local distention. scattered dullness over fecal mass. palpate rope-like mass with feces in intestines

hematoma

localized collection of extravised blood under skin, often blunt force trauma

deep tissue pressure injury

localized nonblanchable color change to red, maroon, or purple in intact and nonintact skin. Dark skin appears darker but doesn't blanch. Or epidermis may separate, revealing dark wound or blood-filled blister. Causing pain and temp change. Begins in the muscle closest to the bone, in older adults and those w a lower BMI

ductus arteriosus location and closure

located between pulmonary artery and aorta. closes within 10-15 hours

bladder location of infants and children

located higher

maxillary sinuses

located in the maxillary bones along the side walls of the nasal cavity

what to note about masses palpated

location, size, shape, consistency, surface, mobility, pulsatility, tenderness

Sudden locking or buckling of the knee

locking- The pt is unable to extend the knee fully. This usually occurs with a painful and audible pop or click. Sudden buckling or giving away occurs with ligament injury which causes weakness and instability

What makes up physical appearance during general survey?

look their age age, sex (development), LOC (alert and oriented, answers questions), skin color (even and intact?), facial features (symmetric, moves properly), overall appearance (look in pain?)

bifid uvula

looks as if it is split in two; more common in American Indians

appearance of nasal deviation

looks like a hump or shelf in nasal cavity- deviation only significant if air flow is obstructed

age-related macular degeneration

loss of central vision caused by yellow deposits and neovascularity in the macula

aging adult skin changes

loss of elasticity, thinning/loss of all skin layers, sweat gland decrease, decreased thermoregulation, vascular fragility (minor bumps can make a huge impact due to lost collagen), decreased melanocyte fx, increased facial hair growth in women (due to lowered estrogen), nails grow slower

glaucoma

loss of peripheral vision due to buildup of fluid that damages the optic nerve

what causes halos around light?

loss of peripheral vision due to increased pressure

aphasia

loss of speaking, writing, and understanding ability due to stroke/ brain damage

hyperactive bowel sounds

loud, high-pitched, rushing, tinkling sounds that signal increased motility

resonant sound

loud, lower pitch, long duration, clear, hollow quality normal healthy lung tissue

Normal infant crying characteristics

loud, lusty, angry

more air filled structures give off what sound

louder, deeper, longer- due being able to freely vibrate

hyperresonance

low pitched booming when too much air Dull note- abnormal density in lungs

testing vibration

low pitched tuning fork over body prominences. patient indicates when it starts and stops

red blood in stool indicates

lower GI bleeding or hemorrhoids

expiratory wheezing may indicate

lower airway obstruction: asthma or bronchiolitis

presyncope

lowered blood flow to brain or heart causing lightheaded swimming sensation

Cyanosis reason

lowered o2 perfusion. if you can't tell, check LOC and resp status

depression

lowering a body part

dyspnea with age reason

lung bases become less ventilated as a result of closing off of a number of airways, increasing risk of exertional dyspnea

fetal lung development at 5 weeks

lung but emerges

what can cause tracheal shift

lung issues or collapse tumor, aortic aneurism, unilateral thyroid enlargement pushes to unaffected side ataelectasis pushes to diseased side aortic arch aneurism and tracheal tug pull downward

Emphysema changes in percussion

lungs are hyper-inflated, resulting in hyperresonance where you'd expect cardiac dullness

How does fetal circulation differ from adult circulation?

lungs don't function in utero, so blood doesn't go to lungs as is it is received oxygenated from the mother. instead, it reroutes to the aorta with the foramen oval and ductus arteriosus

Movement of lymph from lymphatic capillaries to bloodstream

lymphatic capillaries siphon interstitial fluid and converge to form vessels. they contain many one way valves that make it look beaded toward blood stream in a similar way to how blood moves through veins

unilateral or bilateral edema occurs with

lymphatic obstruction - with these factors it is brawny or non pitting and feels hard to the touch

compound nevus

macular and papular

junctional nevi

macular only and occurs in children and adolescents. turn into compound with age

Patch

macules that are larger than 1 cm

tarsal plates

main structural component of the eyelids. give eyelids shape. contain meibomian glands

Fixation reflex

maintaining a visual gaze on a single location. rapid movement to put target on fovea centralists and slower movement to keep track of the target

brachial artery location

major artery supplying the arm. runs in the biceps-triceps furor of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon

Ischemic stroke cause

majority of strokes: sudden interruption of blood flow to the brain

vision expectations at 6 weeks

makes visual response to your face

intoxication

maladaptive behavior changes due to CNS changes

types of chronic pain

malignant- stretching of organ or tissue and lack of blood which kills tissue and in turn causes pain non- fibromyalgia, arthritis, back pain

small tongue occurs with

malnutrition

sternum parts

manubrium, manubriosternal angle (angle of Louis), costochondral junction, sternum body, xiphoid process

7 categories of drugs

marijuana- 80% of illegal use cocaine heroin hallucinogens inhalants methamphetamines Nonmedical psychotherapeutic use- 2nd most used and high fatality

Craniosynostosis

marked asymmetry. Severe deformity caused by genetic premature closure of the sutures, causing a distinctive head shape that correlates w the specific closed suture

pectus excavatum

markedly sunken sternum and adjacent cartilages. becomes depressed at second intercostal and becomes more and more depressed and is more noticeable upon inspiration

tonsils and their appearance

mass of lymphoid tissue behind anterior tonsillar pillar fold. same color as the rest of the mouth and appears more granular and surface should deep crypts. posterior pharyngeal wall is being this

Pain at the mastoid process may indicate

mastoiditis or enlarged posterior auricular node

causes of decreased respirations during immediate newborn period

maternal drug use, interruption of uterine blood supply, or obstruction of tracheaobronchial tree with mucus/fluid

risks for child to experience hearing deficits

maternal rubella, maternal ototoxic drugs, premature/ low birth weight, trauma/ hypoxia at birth, congenital liver or kidney diseases. any fever diseases (measles, mumps, OM)

Which sinuses are present at birth?

maxillary and ethmoid.

development age of sinuses

maxillary reach full size after eruption of permanent teeth. ethmoid grown btwn 6-8 and after puberty frontal well developed by 7-8 and finish after puberty sphenoid develop after puberty

Biomarkers

measurable indicator of some biological state or condition

6 minute walk test

measure of functional status in older adults. monitor o2 sat during and stop if under 85-88%. walking as much as possible in 6 minutes. >300 meters is good

pulse oximeter and how its evaluated for each pt

measures arterial oxygen saturation (SpO2). normal person with no lung disease or anemia has 97-99%. evaluated in context on the person's hemoglobin level, acid base balance, and ventilatory status

Gamma-glutamyl transferase (GGT)

measures for chronic heavy drinking. conditions such as fatty liver, liver disease, obesity, and diabetes can falsely raise these

audiometric testing

measures how well a person can hear, the threshold of hearing of the individual's ear for that frequency

Apgar scale and what it assesses

measures the successful transition to extrauterine life assesses heart rate, resp effort, muscle tone, reflex irritability, color scored at 1 and 5 minutes after birth. healthy= 7-10

elbow landmarks

medial and epicondyles of humerus and olecranon process of ulna

spinal cord goes from

medulla to L1-2

Skin color determined by

melanin, carotene, and underlying vascular bed

Where are common melanoma locations on men, women, old, and black pts?

men- trunk and back women- legs and feet old- head and neck black- soles of feet and nails

Opisthotons indicates

meningeal irritation

Sequence for complete neurologic examination

mental status cranial nerves motor system sensory system reflexes

midbrain

merges into hypothalamus and thalamus. regulates auditory and visual function

Upper motor neuron dysfunction indicates

message isn't getting sent to motor neurons - weakness/paralysis -hyperactive reflexes -decreased motor control -abnormal muscle tone

microtia/macrotia

microtia <4cm and macro >10cm

Brain Stem consists of

midbrain, medulla, and pons. consists of nerve fibers CNIII to XII

which turbinates are visible

middle and inferior

retracted TM due to

middle ear vacuum with obstructed eustachian tube

mediastinum and what it contains

middle of chest cavity containing esophagus, trachea, heart, and great vessels

tibial tuberosity

midline bony prominence of the knee

diastasic recti

midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles. ridge revealed when intra-abdominal pressure increased while raising head supine. occurs congenital or as a result of pregnancy and marked obesity

linea alba

midline tendinous seam joining the abdominal muscles

vertebral line

midspinal line

most common extra heart sound

midsystolic click (associated with mitral valve prolapse)

Normal tone of muscles

mild resistance to passive stress tested by passive ROM

phoria

mild weakness in eye muscles only when fusion is blocked

Rotator cuff purpose

muscles enclose the shoulder joint forming a cover over the humerus head. they rotate the arm laterally and stabilize the head of the humerus against the small glenoid fossa

tonic phase

muscular rigidity, opening mouth and eyes, tongue biting, and high pitched cry

past health- childhood illnesses

mmr, chicken pox, strep, pertussis any w later in life sequence- rheumatic fever, scarlet fever, polionephritis

nevus

mole; circumscribed skin lesion due to excess melanocytes

what is the purpose of the functional assessment during the health hx process?

monitor ADLS which maintain health and wellbeing ADL used to monitor functional status and changes over time

tropia

more severe, constant malalignment of the eyes

Skin of infants and children

more smooth, thin, and permeable permeability creates greater risk for fluid loss temp regulation is ineffective

chronic shortness of breath

more than a month. may indicate neurogenic, resp, or cardiac origin

effect of respiration on volume of blood pumped

more to left less to right during inspiration, more blood pushes into vena cava, increasing venous return. the increased volume prolongs right ventricular systole and pulmonary valve closure meanwhile, blood in left is sequestered in the lungs during inspiration causing decreased left sided SV

GI changes in pregnancy

morning sickness, acid indigestion due to esophageal reflux, decreased GI motility, hemorrhoids, diminished bowel sounds (due to enlarging uterus), striae, and linea nigra

Benign Paroxysmal Positional Vertigo

most common cause of vertigo. less than one minute spinning. occurs with labyrinth disfunction

Oral Kaposi Sarcoma occurs with

most common early lesion in people with AIDS

what does inguinal notes drain

most of lower extremity, external genitalia, and anterior abdominal wall

Basal cell carcinoma of eye

most often on the lower lid and presents as a small painless nodule with central ulceration and sharp rolled out pearly edges occurs in older adults associated with UV exposure and light skin locally invasive, metastasis is rare

Muscular changes with aging

mostly influenced by lifestyle- sedentary lifestyle hastens changes of aging and physical exercises prevents or delays bone loss

mental status changes associated with aging

mostly stays same and intact. response time slows and recent memory can decline. sensory perception changes, which can make them appear confused. new learning ability declines in four unrelated words test in people of normal cognitive function

supination

movement that turns the palm up

retraction

moving a body part backward and parallel to the ground

protraction

moving a body part forward and parallel to the ground

circumduction

moving the arm in a circle around the shoulder

rotation

moving the head around a central axis

inversion

moving the sole of the foot inward at the ankle

parotid swells with

mumps and AIDS

changes over age in lung strength and elasticity

muscle strength declines after 50 and continues to decline into 70s. elastic changes make them less distensible and lessens their tendency collapse and recoil

morning sickness

n/v between first and second missed periods due to hormone changes- human chorionic gonadotropin

biographic data about a patient

name, address, phone number, age, birthdate, gender, marital status, race, ethic origin, occupation, primary language

esophoria

nasal (inward) drift r/t cover test

nasal changes in pregnancy

nasal stiffens and epistaxis may occur due to increased vsacularity in upper resp tract. gums may become hyperemic and may soften and bleed easier

Hypothalamus

near base and pituitary. major respiratory center with basic vital function. regulates temp, water metabolism, appetite, emotional expression, sleep-wake cycle, and thirst. coordinates autonomic nervous system function and stress responses: digestion, temp, HR

myopia

nearsightedness. globe longer than normal- use neg number on ophthalmoscope

Bilateral arm pitting edema calls for? what may it indicate?

neck vein exam. if distended, heart disease or pulmonary HTN. If normal, live or kidney issues, chronic venous insufficiency

palpation of knee swelling

need to distinguish between soft tissue swelling and increased joint fluid- done by comparing legs and bulge sign and ballottement test

Dermis made up of

nerves, sensory receptors, blood vessels, lymphatics, hair follicles, glands connective tissue or collagen- resists skin tearing and allows stretching

unilateral loss of smell

neurogenic anosmia

neurologic systems at birth

neurons not yet myelinated so motor activity is controlled by spinal cord and medulla

Resting posture of infant

newborn favors a flexed position: folded in extremities, hips slightly abducted, fists flexed. after two months, flexion gives way to gradual extension

pain related health hx questions in kids

note effect on usual behavior- do they still play how do they react when in pain relation to activity, eating, and body position

Inspecting hip

note symmetric levels of iliac crests, gluteal folds, and equally side buttocks. a smooth even gait, reflexes, and equal leg lengths indicate functional hips

claudation distance

number of blocks walked or stairs climbed to produce pain

child abuse and neglect types

numbers increasing neglect physical abuse- even if unintentional if done purposefully sexual abuse emotional abuse- belittling, rejection, threats, withholding love/support

nail lines, grooves, or pits may indicate what?

nutritional deficiency or acute illness

Gynoid obesity

obesity pattern seen in people who store fat primarily around the hips and thighs

causes of abdominal distention

obesity, air/gas, ascites, ovarian cyst, pregnancy, feces, tumors

Health implication of over-nutrition

obesity, heart disease, type 2 diabetes, osteoarthritis, sleep apnea, CKD, gallbladder disease, GERD

communicating with school-aged kid

objective and realistic- interview them and caregiver together

signs

objective evidence of a disease; measurable

Objective vertigo vs. Subjective vertigo

objective- room spinning subjective- you're spinning

Retraction of rib interspaces cause

obstruction of resp tract or increased inspiratory effect is needed (atelectasis)

Unilateral edema occurs with

occlusion of a deep vein

black tarry stool indicates

occult blood (melena) from GI bleeding

isometric/ isovolumic relaxation

occurs after systole, all valves are closed and atria begin to fill with blood

Facial edema characteristics

occurs first around eyes and cheeks in subq

Complicated alcohol withdrawal

occurs in 1 week cessation and can cause coarse irregular tremor

transduction phase of pain

occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery (skin and somatic and visceral structures) causing tissue damage neurotransmitters send a pain message, or action potential, along fiber

voluntary guarding

occurs when the person is cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation.

costal cartilage calcification

occurs with age- thorax becomes less mobile for expansion

unequal chest expansion occurs with

occurs with atelectasis, lobar pneumonia, pleural effusion, thoracic trauma

causes of dysphagia

occurs with esophageal problems: obstruction, infection, stroke, thrush

Paroxsmal nocturnal dyspnea:

occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air.

Inequality of bony landmarks occurs with

occurs with scoliosis

Circumoral pallor can be a sign of

occurs with shock and anemia

Testing cranial nerve III, IV, and VI

oculomotor, trochlear, and abducens: assessing extraocular movements (by cardinal position of gaze/ diagnostic positions test and assessing for nystagmus or strabismus) and PERRLA (pupils, equal, round, reactive to light and accommodation)

Percussion use in infants/children

of little use. hyerresonance normal in children

seborrhea

oily skin

who gets glaucoma more?

older adults, African Americans, women (since they live longer)

pleural cavity

on both sides of the mediastinum and contain the lungs

how to palpate deep cervical lymph nodes

one at a time; gently bend the patient's head forward and roll your fingers over the deeper muscles along the carotid arteries

When to introduce cow's milk?

one year

Why does thyroid enlarge during pregnancy?

result of hyperplasia of tissue and increased vascularity

amount of words spoken at each age

one year= more than 4 two= more than 200 two to six= grammar, language, and pronouns used six= more than 10,000 seven= passive tense ten= complex grammar

how are s2 splits heard

only in pulmonic valve areas- second left interspace don't ask pt to hold breath as this causes synchrony of the sounds

Carbohydrate-deficient transferrin (CDT)

only last 15 days. women numbers are higher, so combine with GGT for adequate testing

Where is the apical pulse felt?

only visible or palpable on some people. usually palpable at 5th intercostal space 7-9cm from the midsternal line

eustachian tubes

opening that connects middle ear with nasopharynx. acts as a pressure valve- allows air to flow in and out of inner ear, equalizing internal and external pressure of tympanic membrane

night blindness occurs with

optic atrophy, glaucoma, vitamin A deficiency

what can opthalmoscope view

optic disk, retinal vessels, and macular

ocular structure appearance in aging adult

orbital fat atrophy causes sunken look

Effects of babies and children having less muscular abdominal walls

organs easily palpated, they are more prone to hernias, abdomen is protuberant

swelling of external canal may suggest

otitis externa or frostbite

What might crusts and scaling of external ear indicate?

otitis external, eczema, contact dermatitis, seborrhea

positioning of ears in child

outer canthus aligned with pinna and positioned within 10 degrees from lateral

Annulus

outer fibrous rim encircling the eardrum

small saphenous vein

outside the leg, starts on the lateral side of the dorsum of the foot, ascends behind the lateral malleolus, up the back of the leg where it joins the popliteal vein. blood flows from superficial veins into deep leg veins

kyphosis

outward or convex curvature of the thoracic spine; hunchback. body compensates by holding head extended and tilted back

exophoria

outward turning of the eye r/t cover test

exotropia

outward turning of the eye r/t strabismus and corneal light reflex

where can s1 be heard

over all precordium, but loudest at apex

flat percussion note

over bone, especially ribs- causes a dead stop. high pitched, soft, short. can be over tumor

normal bruit

over celiac artery systolic, medium to low in pitch, heard between the xiphoid process and the umbilicus

dull percussion note

over dense organs. short, soft, high pitched, soft/muffled

bronchovesicular breath sound location and characteristics

over major bronchia where fewer alveoli are located: posterior between scapula, esp on right. moderate pitch and amplitude. inspiration and expiration duration is the same

vesicular breath sound location and characteristics

over peripheral lung fields where air flows through smaller bronchioles and alveoli. low pitch, soft, rustling sound. inspiration longer that expiration

keloid

overgrowth of scar tissue which invades original trauma site. more common in darker skinned people

superficial cervical node

overlying the sternomastoid muscle

Where is the external jugular venous pulse seen at?

overlying the sternomastoid muscle or pulsation of the internal jugular vein in the sternal notch

causes of laryngitis

overuse, URI, chronic inflammation, lesions, or neoplasm

PAINAD pain scale

pain assessment in advanced dementia 4 pts or more requires pain assistance breathing, vocalization, body language, consolable, facial expression

wells score

predicts pretest probability of DVT- usually presents w/ unilateral swelling and inflammation of affected leg

chronic (persistant) pain

pain continues for 6 months or longer after initial injury, not stopping when it heals. originates from abnormal processing of pain fibers (neuropathic pain) two types- malignant and non

pathway of pain stimulus from pain receptors to brain

pain receptors, a and C fiber, posterior root ganglion, tract of lissauer, anterolateral spinthalmic tract, spinal cord segment, medulla, thalamus, cerebral cortex

referred pain

pain that is felt in a location other than where the pain originates due to possessing the same spinal nerve

what is considered the 5th vital sign?

pain, the "gold standard" of pain assessment

Hodgkin lymphoma nodes feel like

painless, rubbery, discrete

types of pigmentation changes

pallor, erythema, cyanosis, jaundice, hypo/hyper pigmentation

thrill cause

palpable vibration on the chest wall accompanying severe heart murmur. feels like purring cat. signifies turbulent blood flow and directs you to locate the murmur origin

palpating mastication muscles

palpate contracted temporals and masseter muscles as the person clenches teeth, comparing size, firmness, and strength. ask pt to move jaw forward, laterally, and open against resistance

twelfth rib

palpate midway between the spine and the person's side to identify its free tip

assessing temporal area

palpate temporal artery and temporomandibular joint

when to assess brachial pulse

palpated if you suspect atrial insufficiency- should be equal force bilaterally

temporal artery

palpated in front of the ear

tongue characteristics

papillae create roughness on top and underneath is vascular with the frenulum that connects it to the floor

stensen's duct

parotid gland duct. runs forward to open on buccal mucosa opposite second molar. appears as a small red dimple with mumps

3 salivary glands

parotid, submandibular, sublingual

subluxation

partial dislocation

chest size change during expiration

passive- as diaphragm relaxes, positive pressure in lungs occur causing pressure in alveoli and air flows

how to screen for depression and what the scores mean

patient health questionnaire (PHQ-9) 5-9 minimal, 10-14 mild, 15-19 moderate severe major, >20 severe major

Uncomplicated alcohol withdrawal

peaks at day 2, improves by 4-5. typical hangover s/s

Nociception

perception of pain or injury

Tinnitus and what it occurs with

perception of sound without external source. occurs with senroineural hearing loss, middle ear infection, cerumen impaction, and other ear disorders

Percussing the abdomen

percuss in all 4 quadrants, in a systematic, clockwise matter to identify fluid, masses or air tympany is heard over most of the abdomen dullness is heard over the liver, full bladder, fat, or a mass

The layers of the heart wall from superficial to deep are:

pericardium, myocardium, and endocardium

loss of vibration occurs with

peripheral neuropathy-diabetes and alcoholism

How developed is a newborns vision and how do their eyes appear?

peripheral vision intact at birth, while macular vision is not. Macular vision is strengthened around 3-4 months and mature by 8 months. foveal light reflection formed at one year. eyeball structure at adult size by 8. at birth, iris has little pigment, pupils are small, and lens is nearly spherical. fundis appears pale in babies as vessels not fully developed. permanent eye color by 6-9 months

three levels of auditory system

periphery, brainstem, cerebral cortex

untreated strep can cause

peritonsillar abscess, rheumatic fever, and glomerulonephritis

Steroid use causes what

personality disorders (agression) and liver damage

frontal lobe

personality, behavior, emotions, intellectual function

dependence on a drug

physiological dependence on stomach

gums should appear

pink with strippled/ dotted surface

Swollen lymph nodes might be r/t

pinna or mastoid process inflammation

Opiates Intoxication and withdrawal

pinpoint pupils, lowered vitals, lethargy, slurred speech, somnolence, initial euphoria then apathy, dsyphoria, psychomotor retardation, inattention, lowered memory, judgement, and functioning WD- dilated pupils, lacrimination, runny nose, tachycardia, raised BP, piloerection, n/v, depression, diarrhea, insomnia/restless, flu symptoms

palpating anterior chest for symmetric chest expansion

place hands on anterolateral wall with the thumbs along costal margins pointing to xiphoid process

Performing Allis test

place infant's feet flat on table with knees flexed up. inspect the top of the knees- should be at same elevation. if one is lower, it suggests hip dislocation

Palpating temporomandibular joint

place tips of first two fingers in front of ear and ask pt to open and close mouth. then drop finger into depressed area over the joint and note smooth motion of the mandible

Posterior chest: palpating symmetric expansion

placing hands on posterolateral chest wall with thumbs pointing at level of t9 oe t10. slide hards medially to pinch up a small fold of skin. Ask pt for breath deeply, and as pt inhales, thumbs should move apart symmetrically

costodiaphragmatic recess

pleura extend 3 cm below level of lung; potential space for fluid/air which may compress lung, hindering expansion

pain with deep breathing occurs when

pleurae are inflammed

congested cough indicates

pneumonia

Crepitus all over may indicate

pneumonia, bronchiolitis, atelectasis

what does hyperesonance indicate

pneumonia, pleural effusion, atelectasis

coal miners environmental risk of

pneuomococcus

erythema occurs with

polycythemia, venous stasis, carbon monoxide poisoning, and extravascular presence of red blood cells

Insertion of tympanostomy tubes

polyethylene tubes relieve middle ear pressure and promote drainage. improved aeration causes less acute OM occurrence. tube extrude spontaneously in 12-18 months

Physiological changes with age that affect nutrition

poor dentition, lowered visual acuity, less saliva, decreased GI absorption and motility, smell and taste sensitivity

causes of esophageal emptying delay in older adults

poor muscle tone, poor contractility, poor sphincter opening- increases aspiration risk

prominent veins occurs with

portal hypertension, cirrhosis, ascites, or vena cava obstruction

Assessing an ill Individual

position that helps them feel best given their illness. adapt assessment to Pt's comfort level- mini database if needed

night cough indicates

postnasal drip, sinusitis

what can sudden floaters indicate?

retinal detachment

aspects of childhood past health hx

prenatal status, labor and delivery, postnatal status, childhood illnesses, accidents, chronic illnesses, hospitalizations, immunization record, medication hx

forms of teaching health literacy

present only the info needed -oral teaching -written teaching- 5th grade level or under, at least 12 pt font, in appropriate language, limiting medical jargon -teach back- to reassess understanding of pt

palpating maxillary sinuses

pressing below cheekbones

palpating frontal sinuses

pressing firmly up and under eyebrows

Mean Arterial Pressure (MAP)

pressure forcing blood into tissues, averaged over cardiac cycle

carotid sinus hypersensitivity

pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. may occur in older adults with HTN or occlusion of carotid

what causes a pulse

pressure wave generated by each style pumping blood through the aorta

afterload

pressure. the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. ventricle tenses itself to overcome pressure differences

Prinzmetal or varient angina

pressurelike discomfort at rest. Retrosternal and can radiate. Palpitations, syncope, feelings of syncope

prepatellar bursa

prevents friction between the patella and the skin

postcentral gyrus

primary sensory cortex in parietal lobe

three types of stimulus

primary- thermal and mechanical secondary- chemical mediators- sent from site of tissue damage in body

immigrant nutrition considerations

prior poverty, poor, sanitation, war/political strife incases risk. at an increased risk of htn, diarrhea, lactose intolerance, osteomalacia, scurvy, dental caries

damage to basal ganglia causes

problems with involuntary tremors, delays, or ??

Temporal lobe

processes auditory information, taste, and smell

Occipital lobe

processes visual information

sebaceous glands function

produce oil which slows water loss from skin

intention tremor

produced by purposeful movement toward an object

evaluation

progress toward outcomes using ongoing assessment to revise prior systems if needed

bronchitis

proliferation of mucous glands in passage ways resulting in excessive mucus secretion. inflammation of bronchi with partial obstruction of brochi

EKG changes in older adults

prolonged PR and QT but QRS unchanges

Opisthotonos

prolonged arching of the back with head and knees bent backwards

bronchial tree tree function

protects alveoli from small particulate matter in inhaled air. bronchi contain goblet cells and cilia that rid lungs of particles

Cerumen function

protects and lubricates the ear by keeping microorganisms from reaching TM

Kwashiorkor

protein malnutrition high calorie diet with low protein decreased visceral protein levels no change in anthropometric measures may appear obese

Marasmus

protein-calorie malnutrition decreased anthropometric measurements weight loss, muscle wasting, and decreased subq fat - starved appearance visceral protein may remain normal

Why should babies have whole milk?

provides calories and essential fatty acids for growth and CNS development

what does the retina contain

retinal vessels, optic disc, optic nerve, neurons

Abnormally high blood pressure in left side indicates

pulmonary congestion

Hemoptysis is often seen with

pulmonary diseases or mitral stenosis

Pink frothy sputum

pulmonary edema, some sympathomimetic medications have a side effect of pink-tinged mucus

Heart failure

pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. dependent air sacs deflated, pulmonary capillaries engorged, and bronchial mucosa may be swollen

Gastric acid changes with age

pumps that release acid decrease with age which decreases acid secretion- hurts digestion

Cocaine intoxication and withdrawal

pupil dilation, tachy/Brady cardia, high or low BP, sweating, chills, n/v, pacing, psychomotor agitation, impaired functioning, hyper vigilance, hallucinations. WD- dsyphoric mood (anxiety, depression, irritability), fatigue, insomnia, hypersomnia, psychomotor agitation

PERLA documentation includes

pupils equal, round, and reactive to light and accommodation

Assessing a toddler (purpose, position, preparation, sequence)

purpose= develop autonomy- difficult since they're still dependent on parents position- sitting up on caregivers lap. does not usually like to be naked prep- ignore kid at first to let them adjust and then try to engage and gauge response sequence- least evasive to most

Assessing a school-aged child (purpose, position, preparation, sequence)

purpose= develop industry. school competency and social networks. desire for success and pride when successful postion- on table. slight modesty at 5ish. let 11-12 decide if parent stays prep- talk to break ice, demonstrate equipment and comment on body and how it works sequence- as with adults, head to toe

Assessing a preschooler (purpose, position, preparation, sequence)

purpose= initiative starts being developed position- 3: on lap 4-5: table. usually willing to be naked preparation- explain steps to child. don't give choice when there isn't one, but offer choice when there is one. let them help/ play w equipment sequence- usually cooperative, but thorax, abdomen, genitals, extremities first. then do facial features and throat

Assessing an infant (purpose, position, preparation, sequence)

purpose= task: establishing trust by being properly taken care of position- flat on table or against caregivers chest (esp >6 months) preparation- 1-2 hours after feeding, warm, soothing voice, facial expressions and eye contact sequence- least distressing to most (facial steps) moro/ startle test done last as it makes them cry

How does pursed lip breathing work?

pursed lips cause presssure in bronchial tree to remain positive and fewer airways collapse

acute OM w perforation discharge

purulent

external otitis discharge

purulent, sanguineous, or serous

posterior thyroid approach

push trachea to tilted side to check for enlargement or lumps. have them drink water. often can't palpate, especially lateral lobes. often feel bismuth over tracheal rings

hyperthermia cause

pyrogens secreted by toxic bacteria during infections or tissue breakdown following illness/ trauma. neuro issues can reset temp inaccurately

deflating BP cuff too quickly or slowly

quickly- falsely low systolic or high diastolic slowly- false high diastolic- venous congestion muffles sound

subcutaneous elbow nodules

raised firm nontender freely moving nodules overlying skin. occur with RA and are common in olecranon bursa and along extensor surface of ?

Sebaceous hyperplasia

raised yellow papules with a central depression on face

Keratoses

raised, thickened areas of pigmentation that look crusted, scaly, and warty

elevation

raising a body part

where are splits heard

rapid and heard at tricuspid valve area/ left lower sternal boarder

Reflex arc

rapid involuntary predictable response to stimulus which helps with balance and muscle tone

The pallor of shock presents with?

rapid pulse rate, oliguria, apprehension, and restlessness

Tachypnea amount and what its associated with

rapid shallow breathing. >24 a minute. increases with resp insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons

characteristics of carotid pulse wave

rapid smooth upstroke, rounded summit, and gradual downstroke with a notch due to aortic valve closure

Fasciculation and cause

rapid, continuous twitching of resting muscle or part of muscle without movement of limb. fine is associated with atrophy and weakness and coarse is not significant (cold exposure or fatigue)

blumberg sign

rebound tenderness push at 90 degrees angle slowly and then lift quickly. rebound tenderness occurs in RLQ when pressure applied to LLQ may indicate appendicitis

cerebellar system

receives info about the position of muscle of muscles and joints and what kind of motor messages are being sent from the cortex to the muscles. coordinates movement, maintains balance, equilibrium, posture

thoracic duct

receives lymph from the left side of the head, neck, chest, abdomen, left arm, and lower extremities. empties into left subclavian veins

Why does nocturia occur in patients with heart failure?

recumbency at night promotes fluid resorption and excretion. occurs with HF in the person who is ambulatory during the day

path of bruise coloration

red and purple 12-36 hours after, blue- green, green-brown, brown-yellow, yellow, then fades

tonsil appearance with strep

red enlarged w/exudate

tonsil appearance with viral infection

red w/ no exudate or enlargement

senile keratosis

red/tan scaly patches that grow over time and become rough, raised, and have silvery-white adherent. only on sun exposed areas. theses can turn into squamous carcinoma

frostbite

reddish-blue discoloration and swelling of auricle after exposure to extreme cold. vesicles or bullae may develop. causes tenderness and pain. ear necrosis may ensue

squamous cell carcinoma

redness around, scaly, central ulcer develops in sun exposed areas. less common than basal, but grows faster.

parasympathetic nervous system

rest-and-digest response: relaxes GI sphincter, increases gland and GI movement, conserves energy to lower heart rate

colicky pain behavior

restlessness and turning

what/ where is the cone of light

reflection of otoscope light in anteroinferior quadrant

red reflex

reflection off of inner retina that appears as a reddish orange glow filling person's pupil. can reveal problems with cornea, lens, and vitreous

infant vision birth to 2 weeks

refusal to open eyes after bright light exposure. increasing alertness to object

Cause of bone loss in older adults

remodeling

interviewing people with hearing impairment

repeat, speak loud, watch lips. ask them to repeat back to ensure they understand

Dyskinesias

repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present

Epidermis replacement and vasularity

replaces itself every 4 weeks. avascular- nourished by blood vessels in the dermis

Clinical Institute Withdrawal Assessment (CIWA)

requires subjective data to be done. determines management of withdrawal symptoms using specific meds and prevents over medication by evaluating symptoms. 0-9 absent or mild, 10-19 mild to moderate, more than 20 severe

bimanual palpation

requires use of both hands to envelop or capture certain body parts or organs

clinical decision in healthcare depends on

research evidence, pt preference, clinician's experience/expertise, physical exam/assessment

Lesion Shape: Target

resembles iris of eye, concentric rings of color in lesions

Weak groaning cry

respiratory distress

tonsil function

respond to local inflammation

sensory response of infants

respond to pain by crying and may withdrawal from stimulus. they can localize by 7-9 months. Infants have hypoesthia which requires strong stimulus to elect a response

mental disorder

response much greater than expect reaction to a traumatic life event- associated w distress and disability

optic nerve

responsible for carrying visual images to the brain

Macula

responsible for central clear vision

Choroid

responsible for the vasculature of the eye- helps O2 perfusion to retina and absorbs light to prevent internal reflection. located deep in sclera

Pulses bigeminus and cause

rhythm coupled, every other beat comes early, or normal beat followed by premature beat; force of premature beat decreased because of shortened cardiac filling time. due to conduction disturbances (premature contraction)

pulses alternans and what it occurs with

rhythm regular but force varies with alternating beats of large and small amplitude. when HR normal, it occurs with left ventricular failure

Magenta tongue due to

riboflavin deficiency

right bronchi vs left bronchi

right is shorter, wider, and more vertical

Assessing infant cranial nerve V

rooting and sucking reflexes

shoulder atrophy can signal

rotator cuff problems or disuse

Thoracic cage appears of infants/children

rounded thorax and equal AP-transverse diameter (until age 6)

suprapatellar pouch

sac of synovial membrane at the superior border of the patella which extends as much as 6cm behind the quadricep muscle

ulnar artery

same relation to the ulna but deeper and difficult to feel

terminal hair

scalp, eyebrows, pubic, axilla, face/chest in men

Shoulder joint consists of which bones

scapula, clavicle, humerus

coracoid process and location

scapula. a few cm medial to greater tubercle. projections anterior and laterally from neck of scapula and surround the deeply situated joint

Outer layer of eye contains

sclera and cornea

cultural differences in appearance of eye

sclera can be gray/blue or muddy color in darker skinned people. maculas (freckles) can exist normally on sclera. may also have fatty yellow deposits beneath lids

3 concentric coats of the eye

sclera, choroid, retina

erosion

scooped out, shallow depression in skin. epidermis lost. moist but no bleeding

screening musculoskeletal exam involves

screening suffices for most people inspection, palpation, ROM observation, and age specific screening measures

confrontation test

screens for peripheral vision. one eye at a time. tester stands 2 feet away (also covering an eye for reference) wiggling fingers advancing from periphery in several directions. assesses disconnect in pathway to brain

Functional assessment purpose

screens the safety of independent living, the need for home health services, and quality of life (ADLs)

milia/ cradle cap

sebum in infant holds in H2O causing it. sebaceous glands decrease after and don't resume until puberty

meibomian glands

secrete oil onto surface of eye, stopping tears from overflowing and helps create airtight deal when lids are closed

mechanism of atelectatic crackles

sections of alveoli are not fully aerated, they deflate and accumulate secretions, crackles heard when these sections reexpand in first few breaths

appearance of nasal perforation

seen as spot of light from penlight shining in the other naris- occurs with cocaine use

functional assessment components

self-esteem, activity/exercise (adl ability), sleep, nutrition/elimination, interpersonal relationships and support systems, spiritual resources involvement in health care, stress management, personal habits (drinking, drugs, alcohol), alcohol, environmental/ occupational hazards (safe house, neighborhood, and work; utilities and transportation present), intimate partner violence, occupational health

Excoriation

self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching

hyper/hypo/ an esthia

sensations of touch- use wisp of cotton to skin

AV valves

separate the atria from the ventricles. tricuspid (right AV) and mitral (left AV)

tympanic membrane and its appearance

separates the outer ear from the middle ear. oval and slightly concave, as pulled in at center by malleus. shiny, translucent, pearly gray. may have pink or yellow tinge. vibrations created here from sound waves

pleurae

serous membranes that form an envelope between the lungs and the chest wall

clonus

set of rapid, rhythmic contractions of the same muscle

verbal response: explanation

setting expectations for future events in the care process/ what comes next

anascara and what it may indicate

severe generalized edema. may be HF or kidney failure

hirsutism

shaggy or excessive hair

disequilibrium

shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits

What to look for during thoracic cage inspection

shape and configuration of the chest wall

Dull/deep vs sharp bone pain

sharp w/ movement- fracture dull/deep not affected by movement- other bone pain

assessing cornea and lens

shining light from side across, creating an oblique view. should be smooth and clear.

Tympanic membrane otoscopic characteristics

shiny, translucent, pearly gray cone of light reflex (5 in right, 7 in left).

mechanisms of heat conservation

shivering/muscle contraction and vasoconstriction

A weak, thready pulse occurs with

shock and PAD

What conditions cause hypothermia?

shock, cardiac arrest, peripheral artery insufficiency, raynauds, when induced, when immobilized

cyanosis occurs with

shock, heart failure, chronic bronchitis, and congenital heart disease.

anklyoglossia

short lingual frenulum that can limit protrusion and impair speech development

AUDIT-C

shortened form- consumption questions only. used in acute care settings

environmental exposure symptoms

shortness of breath and cough

Pica in children

should end by age 2 when child begins to recognize what is edible

Effusion or synovial thickening of elbow occurs where/how....

shows as a bulge or fullness in groove on either side of olecranon process and occurs with gouty arthritis and bursitis

Anterior Thoracic Landmarks

signpost for underlying respiratory structure suprasternal notch, sternum, sternal angle, costal angle

Amphetamine intoxication and withdrawal

similar to cocaine but causes low BP, pulse, resp, and temp. Behavior same as coke and so is withdrawal

Ascites distention characteristics

single curve and everted umbilicus. flanks bulge when supine. taut skin with increased pressure

air/gas distention characteristics

single round curve appearance. affects auscultation and may cause muscle spasm on abdominal wall

Assessing pain: objective data of Joints

size, contour, circumference, active/passive range of motion assessment, erect and relaxed posture

diabetic neuropathy screening

skin sensation tested on soles of feet- ten spots on feet with filament. refer pt if you can't feel one of them

acrochordons

skin tags

where are the specialized nerve endings located

skin, joints, muscles, connective tissue viscera

what effects an infants respiratory rate

sleeping, feeding, room temp. apnea for under 10-15 normal findin

Normal position of wrist

slight extension- in order for fingers to work correctly

bradypnea and what causes it

slow breathing but regular <10 per minute as in a drug-induced depression of the respiratory center in the medulla, increased ICP, and diabetic coma

athetosis

slow, continuous, writhing involuntary movements occurring with cerebral palsy

modulation phase of pain

slows down and stops the process of a painful stimulus

acquired nevi

small <6mm, symmetric, smooth, uniform color

lymph nodes

small oval clumps of lymphatic tissue located at intervals along the vessels. they filter out fluid before it enters the blood stream

sphenoid sinuses

small sinuses deep within skull in the sphenoid bone

Fordyce granules

small, isolated, white or yellow papules on oral mucosa- painless and insignificant

Pars flaccida

small, slack, superior section of tympanic membrane

C-fibers

smaller in diameter, unmyelinated and conducts a signal much more slowly; associated w diffuse pain- aching dull pain secondary long after initial injury

biggest PAD risk factor

smoking

False pallor

smoking, fear/anger, prolonged elevation, immobilization

atrophic glossitis and what it occurs with

smooth glossy tongue. Surface slick and shiny- mucosa things and looks red from decreased papillae. Accompanied by dryness of tongue and burning. Occurs w/ B12 deficiency (pernicious anemia), folic acid deficiency, and iron defiency anemia

turbinate polyps appear

smooth, pale, gray, avascular, non-tender- accompany chronic allergies

what affects expression of pain

social, cultural, emotional, spiritual concerns

plague on teeth can indicate

soft debris

nucleus pulposus structure and function

soft semi-fluid mucoid material in each disc center that cushion the spine and help it move. acts as a shock absorber and allows compression to one side. if too much compression, disc can rupture and leak fluid

more solid structures give what sound

soft, higher pitch, shorter sound as its harder to vibrate

normal voice sounds

soft, muffled, and indistinct. can hear sound, but can't tell exactly what is being said

Xanthelasma

soft, raised yellow plaques occurring on the skin at the inner corners of the eyes. cholesterol doesn't affect. more common in those over 50 and women

umbilical hernia

soft, skin covered mass, the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring. common in premes and resolved by 1 yr old

how to clean cerumen

soften with mineral oil and peroxide and irrigate by directing fluid to posterior wall

parts of the autonomic nervous system

somatic nerve fibers and autonomic nerve fibers (which is divided into sympathetic and parasympathetic nervous system)

thoracic origin chest pain occurs with

soreness from coughing or inflammation of pleura or pneumonia

quality

sound overtones

peripheral hearing action

sound waves travel to ear (including amplitude and frequency info.) Waves produce vibrations on tympanic membrane, carried by middle ear ossicles to oval window, then through cochlea, and are dissipated against round window.

paradoxical split

sounds fuse on inspiration and split on expiration

anterior chamber

space between cornea and iris

posterior chamber

space between iris and lens

greater omentum

specialized fatty mesentery that overlies the ventral abdomen

Angina pectoris

stable (no change in 60 days) pressure like pain precipitated by activity and fixes with rest. Substernal or retrosternal and can radiate. N/a, sweating, dyspnea, fatigue

S/s of vertigo

staggering gait, strong spinning, whirling sensation

How to inspect jugular venous pulse

stand on pt's right side as the veins there have a direct route to the heart. may use internal or external. pt at 30-45 angle supine w/ no pillow. turn their head slightly away from you and use light to view pulsations can be any strength when supine but normally disappears once 45 degrees. the higher the venous pressure, the higher the position you need

Glascow Coma Scale

standard objective assessment that defines level of consciousness by giving it a numeric value based on opening, motor response, and verbal response 15 in fully alert person and under 7 indicates coma assesses functional state of brain as a whole

What are threats of violent pts

staring, pacing, confusion, clenched fists/jaw, drug use

How to use the opthalmoscope

start 10 inches away and angle 15 degrees lateral to persons line of vision. advance closer after finding red reflex

palpating shoulders

start at clavicle and explore acromioclavicular joint, scapula, greater tubercle, subacromial bursa, biceps groove, glenohumeral joint, axilla area

Palpation of abdomen

start light and start in non affected area. moving clockwise. use first four fingers to press highly

ankylosis

stiff joint condition

hematemesis occurs with

stomach or duodenal ulcers and esophageal varices

A fibers

straight to CNS, larger in diameter and and have a fatty myeline sheath surrounding the axon allowing faster transmission of signals. they serve to receive and transmit info primarily relating to acute pain- local, short, sharp

striae gravidarum

stretch marks in abdomen, thighs, and breast from connective tissue becoming more fragile

striae

stretch marks. begin pink and blue and then turn silvery white

Babinski reflex

stroke finger up lateral foot and across ball. note fanning of toes which disappears and changes to adult response by 24 months

Upper motor neuron diseases

stroke, cerebral palsy, multiple sclerosis

What causes hip stability

strong muscles, strong fibrous articular capsule, and deep insertion of femur head

medial and lateral malleolous

strong tight medial and lateral ligaments extend from each malleolus onto the foot and help the lateral stability of the ankle joint

what is general survey?

study of the whole person, covering the general health state and any obvious physical characteristics. starts being made upon first pt interaction

Hordeolum

style. infected hair follicle with fluid surrounding at lid margin. usually staph infection- contagious

symptom

subjective evidence of disease as sensed by the patient

Wharton's duct

submandibular duct- on each side of frenulum

diseases characterized by petechiae

such as thrombocytopenia, subacute bacterial endocarditis, and septicemias

yellow teeth can indicate

tobacco use

acute pain

sudden onset, usually the result of a clearly defined cause, such as injury, and has predicable trajectory, usually stopping when cause treated/ heals. self-protective- warns individual of potential tissue damage

hemorrhagic stroke symptoms

sudden severe headache, N/V, sudden loss of consciousness, and focal seizures

chorea

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face at irregular intervals and can be spontaneous or initiated

Calf pain with activity

suggests intermittent claudation

pallor or sluggish return in Allen test

suggests occlusions of collateral arterial flow equivocal result- 8-14 negative over 15

Enophalmos

sunken eyes. Narrowed palpebral fissures in which eyeballs are recessed. Bilateral enophthalmos caused by loss of fat in orbits and occurs w/ dehydration and chronic wasting illnesses

two sets of veins in arms

superficial and deep superficial in subq and are responsible for most of venous return

posterior auricular (mastoid) node

superficial to the mastoid process

stage 2 pressure ulcer

superficial ulcer is shallow. epidermis lost and exposed dermis

Wheal

superficial, raised, transient, and erythematous; slightly irregular shape from edema

Example of superficial and visceral reflex

superficial- corneal (blink) visceral- pupillary reflex

external jugular veins location

superficial; lie lateral to the sternomastoid muscle above the clavicle

Position for assessing jugular veins and precordium

supine and head and chest elevated 30-45 degrees

four functions of the respiratory system

supply o2, remove co2, maintain arterial blood homeostasis (pH/ acid base balance), and maintain heat exchange

Testing Clonus

support lower leg in one hand and with other hand move foot up and down to relay muscle and then stretch muscle by briskly dorsiflexing foot and hold stretch. Normal- feel no movement when callus present, you'll note rapid rhythmic contractions of calf muscle and movement of foot

function of musculoskeletal system

support to stand, movement, protect organs, produce bone cells, mineral storage

Accumulation of fat in older females

suprapubic fat gain due to decreased estrogen

where is the internal jugular venous pulse seen at?

suprasternal notch or around origin of sternomastoid muscle around the clavicle

fetal development at 32 weeks

surfactant production is adequate

tympanostomy tubes

surgically inserted to equalize pressure and drain secretions

heave or lift

sustained forceful thrusting of the ventricle during systole. occurs with ventricular hypertrophy as a result of increased workload

mechanisms of heat loss

sweating and vasodialation

jugulodigastric node

tonisillary node- under the jaw

assessing for joint irritation

swelling signals irritation. assess joint fluid (effusion), thickening of synovial lining (synovial membrane usually not palpable), inflammation of surrounding soft tissue (bursae and tendons) or bony enlargement

appearance of rhinitis

swollen and bright red

nasal appearance of chronic allergies

swollen, boggy, pale, pray

systolic vs diastolic murmur

systolic- may be a healthy heart or heart disease diastolic murmur always indicates heart disease

cannabis intoxication and withdrawal

tachycardia, increased perceptions, social withdrawal, anxiety. only withdrawal if chronic- weight loss, sleep issues, irritability, sweating

What is percussion?

tapping on a surface to determine the difference in the density of the underlying structures. vibration creates sound that depicts location, size, and density of orgam

laceration

tearing/splitting of body tissue, usually from blunt impact over a bony surface

child abuse increases risk for what risky behaviors

teen pregnancy, juvenile arrest, adult criminal behavior

facial expression of an emphysema pt

tense strained face and pursed lips

Mini Mental State Exam

test of cognitive function of the mental status exam. 11 questions. allows for multiple measurements over time to evaluate better or worsening conditions. costs $

CAGE test

test to monitor and self-reflect on drinking habits:`` Have you ever thought you should Cut down your drinking? Have you ever been Annoyed by criticism of your drinking? Have you ever felt Guilty about your drinking? Do you drink in the morning, an Eye opener?

testing for near vision

test with handheld vision screener 14 inches away

testing CN IX and X

testing pt's gag reflex

cardiac output

the amount of blood pumped by the heart per minute

Perception phase of pain

the conscious awareness of pain cortical structures identify it as pain somatosensory- characterize pain

canthus

the corner of the eye, the angle where the lids meet.

why can't transillumination be used to diagnose sinusitis

the diagnosis requires distinct illumination differences on one of the sinus parts. doesn't help in chronic sinusitis as there is diffuse swelling

hallux valgus

the distal part of the great toe is directed away from the body midline

palpebral fissure

the elliptical open space between the eyelids. When closed, the lid margins approximate completely. When open, the upper lid covers part of the iris

hyperflexia

the exaggerated reflex seen when the monosynaptic reflex arc is released from the usually inhibiting influence of higher cortical levels.

child neglect

the failure to provide for a child's basic needs- medical, physical, supervision, drug exposure, abandonment, in some places failure to educate

thenar eminence

the fleshy mass at the base of the thumb

ligaments

the joint is surrounded by a fibrous capsule and supported by ligaments, fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable direction

telegraphic speech

the kind of verbal utterances in which words are left out, but the meaning is usually clear

when/where can functional murmurs be heard?

the soft diastolic murmur of aortic regurgitation can only be heard when person is leaning forward when sitting

precentral gyrus

the strip of frontal cortex, just in front of the central sulcus, that is crucial for motor control by initiating voluntary area movement

avulsion

the tearing away of a structure or part; r/t laceration

stroke volume

the volume of blood pumped out by left ventricle with each heartbeat

What is a person's mental status?

their emotional and cognitive function

patients perception of illness

their opinion on how their symptoms affect them and what it means and that they can do about it

physiologic changes due to pain in infants

they are due to sympathetic nerve presence in acute pain sweating- check body temp. if normal, why are they sweating? n/v changes in o2 sat assess for changes in temperament, expression, and activity

Why does skin look blue in polycythemia

they can't oxygenate all of the RBCs

9 verbal responses

they lead: facilitation, silence, reflection, empathy, we lead: clarification, confrontation, interpretation, explanation, summary

Pars tensa

thick, taut, remainder section of tympanic membrane

Crust

thickened, dried out exudate left when vesicles/pustules burst or dry up

what does TM look like in newborns?

thickened, opaque, "injected" after crying (mild redness from increased vascularity). goes from horizontal to vertical at one month

apocrine glands

thicker, milkier sweat starting after puberty. mixes with normal flora, causing body rod. occurs in axilla, urogenital area, nipples, naval. secretion stimulated by emotional and sexual situations

endocardium

thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

aqueous humor

thin transparent fluid similar to plasma that gives eye its shape. produced by ciliary body and resides in eye chambers. helps to deliver nutrients to tissue and drain metabolic wastes. balance between production and drainage determines IOP

thoracic changes in pregnant women

thoracic cage appears wider and costal angle may feel up to 50% wider. 40% increase in tidal volume

Solid viscera organs

those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus)

when is purpura seen

thrombocytopenia and scurvy. Also occurs in old age as blood leaks from capillaries in response to minor trauma and diffuses through dermis

two types of ischemic stroke

thrombotic (from atherosclerotic plague) and embolic (a traveling clot)

deep cervicle chain

tilt head and press under muscle omohyoid crosses posterior triangle so dont mistake as lymph node

Petechiae and cause

tiny punctuate hemorrhages (1-3mm) round and discrete. Dark red, purple or brown. Caused by bleeding from superficial capillaries and won't blanch. May indicate abnormal clotting factors

olecranon process

tip of elbow between medial and lateral epicondyles. ulnar nerve runs between medial epicondyle and olecranon process

Palpation using grasping action of fingers and thumb

to detect position, shape, and consistency of an organ or mass

Why would hypothermia be induced?

to lower body's O2 requirements during certain surgeries

phases of nociceptive pain

transduction, transmission, perception, modulation

retina

transforms light stimulus into nerve impulses (via its neurons) that are conducted through the optic nerve and the optic tract to the visual cortex of the occipital lobe light sensitive tissue that lines the inside of the eye. light sensitive

Cutis marmorata

transient mottling in the trunk and extremities in response to cooler room temperatures

Basilar membrane

transmits sound and converts into electrical impulses vibrates to a specific point to the sound frequency and has receptor hair cells, called organ of court, which acts as the sensory organ of hearing. As hairs bend, they mediate vibrations into electric impulses. These impulses are conducted by the auditory portion of cranial nerve VIII to the brainstem The closer to the base of the basilar membrane, the higher frequency the sound is

tongue tremors may occur with

tremor- hyperthyroidism coarse tremor- cerebral palsy and alcoholism

Muscles that extend arm

triceps and brachialis

Test Cranial Nerve V

trigeminal nerve: motor function by assessing jaw strength and movement (palpate temporal and masseter muscles as person clenches teeth and try to separate jaws by pushing on cheeks) sensory function by assessing facial sensation on forehead, cheek, chin (cotton to test eye, maxillary, and mandible)

Weber and Rinne tests

tuning fork tests weber- not reliable, as normal hearing people hear it at different volumes in each ear rinne test- more accurate in detecting conductive hearing loss neither can distinguish normal hearing from sensorineural loss

a bruit indicates

turbulence due to a local vascular cause, such as atherosclerotic narrowing/ partial occlusion

murmur

turbulennt blood flow and collision currents. gentle blowing/ swooshing that can be heard on chest wall

auscultation of thyroid indicates

turbulent blood flow due to plague present. use bell of stethoscope to hear for blowing and ask pt to hold breath

Tonic Neck reflex

turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side "fencing position" appearing at 2-3 months and disappearing by 4-6months

pronation

turning the palm downward

eversion

turning the sole of the foot outward

Lesion Shape: Gyrate

twisted, coiled spiral, snakelike

cogwheel rigidity and its cause

type of rigidity in which increased muscle tone is released by degrees during passive ROM- small regular jerks. Associated with Parkinsonism

indirect fist percussion purpose

ulnar aspect of fist percussed against non-dominant hand already laid against body. causes tissue to vibrate instead of producing a sound

woods light

ultraviolet light used for diagnosing fungal skin conditions

What parts show through TM

umbo, manubrium, and short process

fixed split

unaffected by respiration; the split is always there

Elder financial abuse

unauthorized use of resources for personal or financial gain or improper use of power of attorney

Ataxia

uncoordinated or unsteady gait

submental node

under chin

clefts for turbinates and what drains into them

under each turbinate there is a cleft (meatus) named for the above turbinate. sinuses drain into middle meatus and tears into inferior

where to look for widespread color change in darker skinned pts?

under tongue, cheek, sclera, and palpebral conjunctiva

hypoactive

underactive; sluggish

What is psychiatric mental disorder along with symptoms of it?

underlying cause can't be identified- ADHD, OCD, PTSD, anxiety, schizophrenia symptoms: backache, headache, fatigue, high BP, Indigestion, shortness of air, dizziness

BMI values for underweight, healthy, overweight, obese

underweight <18.5 normal 18.5-24.5 overweight 25-29.9 obese 1 30-34.9 obese 2 35-39.9 extreme obesity >40

BMI interpretation

underweight= <18.5 normal= 18.5-24.8 overweight= 25-29.9 obesity= 30-30.9 obesity= >40

symptoms of ischemic stroke

unilateral facial droop, arm drift, weakness or paralysis on one half of body, difficulty speaking or understanding speech, confusion, sudden onset of dizziness, loss of balance, visual problems

foreign body causes

unilateral mucopurulent drainage and foul odor

reproductive health issues from IPV

unintended pregnancy negative consequences during pregnancy- miscarriage, stillbirth, premature, low birth weight. Depression/substance abuse affects chronic pelvic pain STIs UTIs

diopter

unit of strength of the lens settings on the ophthalmoscope that changes focus on the eye structures. black= near objects red= far objects

Acute coronary syndrome (ACS)

unstable angina/ MI heaviness. Heaviness, pain, tightness. Substernal or retrosternal and can radiate. Indigestion feeling, n/v, dizzy, flushing, sweat, palpitations

ROM assessment in neck

up and down, side to side, ear to shoulder. notice any enlargement or obvious pulsation

decorticate rigidity

upper extremities: flexion of arm wrist and fingers and adduction of arm tight against thorax lower extremities: extension, internal rotation, and plantar flexion

scratch test

using auscultation to detect lower border of the liver. place stethoscope over the xiphoid process while lightly stroking skin with one finger up the MCL from the RLQ and parallel to the liver border. sound is magnified when you reach liver edge

critical thinking

using current knowledge available to evaluate situations in order to make the best decision possible

how to palpate across the precordium

using palmar aspects of all four fingers, gently palpate the apex, left sternal border, and base (can use carotid as a guide or auscultate as you palpate)

food frequency questionnaire

usual frequency and portion size over a designated amount of time. requires a good memory and info about food prep details

complete assessment (total health database)

usually PCP. health history and full physical exam

Mongolian Spots

usually gradual fade over 1st year and appear at birth

chronic pain behaviors (persistent)

variable behaviors related to adaptation of pain bracing, rubbing, diminished activity, sighing, and change in appetite

decreased capillary refill indicattes

vasoconstriction or decreased cardiac output

Pallor can be caused by

vasoconstriction when cold or areas of edema

What occurs during diastole

ventricles relaxed, AV valves open, blood pours into ventricles since pressure higher in atria than in ventricle

QRS complex

ventricular depolarization= ventricular contraction

Pathologic S3 occurs with

ventricular gallop, occurs with heart failure and volume overload

what occurs during systole

ventricular pressure now higher than atrial, and AV valves close. for a brief second all valves are closed. ventricular walls contract building closed pressure (isometric contraction)

Posterior Thoracic Landmarks

vertebra prominens, spinous processes, inferior border of scapula, twelfth rib

what are nystagmus associated with

vertigo

receiving in communication

words and gestures must be interpreted in a specific context to have meaning receivers test is to interpret the senders messages, both verbal and nonverbal

evening cough indicates

work irritants

Carotenemia

yellow-orange color in light-skinned persons from large amounts of foods containing carotene. goes away in 2-6 weeks

Optic disc appearance

yellow/orange to pink. round or oval with clear margins

indications of hearing loss

• Person lip-reads or watches you face and lips • Frowns or strains forward to hear • Postures head to catch sounds in better ear • Misunderstands/asks to repeat your questions • acts irritable/startled when you raise your voice • speech garbled or distorted • inappropriate loud noise • flat monotonous tone of voice