health assessment 1

Aortic ejection click

Can be caused by aneursym in asc aorta, coarcta of aorta, dilated aorta, aortic stenosis, aortic regurg

wide splitting of S2

Can indicate R bundle branch block or pulmonic stenosis

Which pulse site is most often used in "codes"?

Carotid

Harmful Effects of Unrelieved Pain

Categories: Endocrine Metabolic Cardiovascular Respiratory Gastrointestinal Genitourinary Musculoskeletal Cognitive Immune Developmental Future Pain Quality of Life

Wheezes

Caused by air trying to squeeze through a passage narrowed by bronchospasm, tumor or a foreign body. High pitched, musical sound. Usually expiratory, but can be expiratory or inspiratory.

Occlusion

Caused by atherosclerosis which is the chronic gradual buildup of fatty streaks, fibroid plaque, calcification of the vessel wall and thrombus formation. Reduces blood flow with vital oxygen and nutrients.

Right Lower Quadrant (RLQ)

Cecum, appendix, right ovary and tube, right ureter, right spermatic cord

Carotid Sinus Hypersensitivity

Condition in which pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. May occur in older adults with hypertension or occlusion of the carotid artery

Level of Consciousness - slight decrease in consciousness, slow in mental responses, decreased perception, incoherent In thought

Confused

Chadwick's sign

Dark discoloration of the vulva and vaginal walls - presumptive sign of pregnancy

Pain VS Suffering

Pain is Felt Suffering is Emotion Felt in Pain

Vertigo

Rotational spinning caused by neurologic disease in the vestibular apparatus in the ear, or in the vestibular nuclei in the brain stem

Posterior Reference Lines

Scapular and Vertebral lines

Term referring to a lateral curvature of the spine.

Scoliosis

Voluntary Muscle Guarding

Tense muscles when the person is cold, tense, or ticklish

Allen test

Test for arterial occlusive disease; Hand supine with tight fist, compress arteries, patient opens hand, palm is pale, release pressure over ulnar artery, it patent, palm will flush within 3-5 seconds. May test radial by compressing ulnar artery and releasing radial artery

Hepatojugular reflex

Tested by having the client lie supine, breathing quietly through mouth, and hold your R hand on the upper R quadrant of the person's abdomen. Watch the jugular pulsations as you push in with your hand. Hold for 30 sec, so the venous blood of the liver is drained and additional volume is added to the venous system. If heart is able to pump this additional blood, The veins will rise for a few seconds, and then recede back to previous level.

Romberg test

Tests equilibrium. Normal: person maintains position for 20 seconds without swaying or with minimal swaying. Loss of balance may indicate vestibular disorder.

Chronic Venous Insufficiency

Venous distension noted

Systole

Ventricles contract, closed AV valves

Diastole

Ventricles relax and fill with blood, open AV valves

S3 (third heart sound)

Ventricular filling sound, occurs in early diastole during rapid filling phase. Low pitched distance thunder heard at apex with person in left lateral position.

Pathologic S3

Ventricular gallop, persists in adults and when sitting up, indicates decreased compliance of the ventricles as in heart failure. Also occurs in conditions of volume overload such as regurgitation

empathy

Viewing the world from another's inner frame of reference

Terms used to describe tenacious (glue-like), thin, thick, watery, mucoid, inspissated, & frothy sputum.

Viscosity (Consistency)

Cardiac Output

Volume of blood in each systole times the number of beats per minute. Usually 4-6 Liters

sensory

What type if the Optic nerve?

sensory

What type is is the Olfactory?

motor

What type is the Oculomotor nerve?

motor and sensory

What type is the Trigeminal; mandibular branch?

sensory

What type is the Trigeminal; maxillary branch?

sensory

What type is the Trigeminal; ophthalmic branch?

motor

What type is the Trochlear nerve?

Pyramidal Decussation

Where nerve fibers cross from one lateral part to the other.

Reason for Seeking Care

brief spontaneous statement in the person's own words that describes the reason for the visit; states symptom(s) and duration; subjective data

2+

brisk pulse, expected

Venous ulcer

brown

hydrocephalus

buildup of cerebrospinal fluid in the ventricles of the skull

wheal

a round and temporary elevation of the skin; seen in insect bites, interdermal injections and hives

vesicle

a small blister-like elevation on the skin containing serous fluid; for example herpes, chickenpox, poison ivy, second-degree burn

papule

a small bump or pimple, raised above the surface of the skin, color may range from pale to yellow, red, brown or black; an example is a warts

nodule

a small cluster of cells; for example squamous cell carcinoma

pulsus parvus

a small weak pulse, a common condition with decreased cardiac output

Rinne test

air conduction is twice as long as bone conduction. If conductive loss, bone sound is heard longer. With sensorineural loss, air conduction is heard longer than bone.

dyspnea

air hunger, resulting in labored or difficulty breathing

Popliteal artery

artery found at the back of the knee

Femoral artery

artery that is palpable below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis

Submandibular Gland

beneath the mandible at the angle of the jaw

occlusion

blockage

bruit

blowing or swishing sound

mongolian spots

blue or mulberry-colored spots usually located in the sacral region of infants that usually disappears during childhood

central cyanosis

blue-tinged skin and oral mucosa resulting from a cardiopulmonary problem

periheral cyanosis

blue-tinged skin indicating a local problem resulting from vasoconstriction

macular degeneration

blurred central vision caused by progressive degeneration of the center of the retina, common in those over 50 and most common cause of blindness in older adults

Hypospadias

defect on the ventral surface of the penis so that the urethral meatus is more proximal than normal

orthopnea

difficulty in breathing that occurs when lying down

Papanicolaou (Pap) Test

checks for cervical and vagnial cancer

eczema

chronic skin disorder that involves scaly and itchy rashes, as well as blistering, weeping, or peeling of the skin

syncope

circulatory arrest

S1

the "lub" sound when ventricular pressure rises and closes the mitral and tricuspid valves - (SYSTOLE)

Pansystolic Murmurs (systolic)

the murmur begins with S1 during isovolumetric contraction, S1 will be muffled the murmur. Intensity is constant throughout systole

you find diastolic pressure at the

trough of the wave

polyps

tumorlike growths

hyperhidrosis

excessive perspiration

elevation and enlargement

in the skin self-examination, the "E" in the ABCDE rule

peristalsis

movement of contents through intestines

Diaphragmatic Excursion

movement of the thoracic diaphragm during breathing

osteoporosis

metabolic bone disease that causes decrease in quality and quantity of bone. height loss occurs in the trunk as a result of vertebral fracture and collapse

Intermittent claudication

pain in the leg muscles that occurs during exercise and is relieved by rest

To find Carotid artery

press along medial border of SCM at level of cricoid cartilage

Internal jugular pressure

reflects pressure in right atrium (central venous pressure), important indicator of cardiac function

Multicultural

representing several different cultures

cherry angiomas

ruby red papules

cirrhosis

scarring of the liver and poor liver function as a result of chronic liver disease

chancres

small open ulcers that drain serous fluid

metastasize

spread

General Survey-Body Structure

stature, nutrition, symmetry, posture, position, body build/contour

striae

stretch marks

lordosis

swayback, increased lumbar curvature

vocal fremitus

vibration caused by speaking that is palpable

tacile fremitus

vibration felt by a hand placed on a chest during vocal fremitus

thrills

vibrations felt when palpating similar to that of a cat purring

Common errors in blood pressure measurement

waiting <1 to 2 minutes before repeating the blood pressure reading on the same arm

dermis

well-vascularized connective tissue layer containing collagen and elastic fibers, nerve endings, and lymph vessels. It also is the origin of hair follicles, sebaceous glands, and sweat glands.

Objective Data

what is observed through measurement, inspection, palpation, percussion, and auscultation

Subjective Data

what the person says about himself or herself during interview; what the person perceives his or her health to be

tactile fremitus

"99", vibratory tremors felt through the chest wall by palpation

Infraclavicular

-below the clavicles

Infrascapular

-below the scapulae

Interscapular

-between the scapulae

Thorax (Percussion)

-compare left and right, note tone, intensity, pitch AM (1) "ladder pattern" - compare one side with another (2) posterior approach - resonant tissues, ICS, lung region (3) anterior approach - supraclavicular areas, interspaces, anterior chest SD: hyperresonance (hyperinflation) dullness, tympany, flatness over lung tissue

Blood-tinged (Sputum)

-contains red or dark-coloured blood

Treatments (Adults)

-Pulmo-aid Inhalator

Laboratories (Adults)

-Spirometry -Arterial blood monitoring -Bronchi dilators -Chest X-ray

Hyperventilation (Respiratory Patterns)

-increased rate and depth of respiration

Bases of the lungs

-lowermost portions

Bronchi (Lower Respiratory Tract)

-oblique position in mediastinum

Lifestyle (Adults)

-sedentary -could walk up the stairs without feeling tired -exercise

Scalene muscles and Sternomastoids (Muscles of Respiration)

-serving to raise and push out the upper ribs and the sternum

Visceral Pleura

-side of the pleura that covers the lung

Parietal Pleura

-side of the pleura which covers the chest wall

Thoracic Cage

-surrounds thoracic cavity and supports the pectoral (shoulder) girdle -12 pairs of ribs, sternum, costal cartilages, and thoracic vertebrae

Watery (Sputum)

-thin, colourless, has the appearance of water

Sonorous Wheeze, Gurgles, Ronchi, Coarse Crackles (Adventitious Breath Sounds)

-throughout inspiration and expiration possibility throughout all lung fields P: bubbly and snoring quality, may clear after cough, heard in upper and mid lung fields C: narrow air passages (bronchitis, bonchiectasis, pneumonia, secretions or tumors)

Diagnosis (Pediatric)

-whether premature/term

Purulent (Sputum)

-yellowish or greenish in color, thick in texture, often has foul odor

Scale for pulses

0= absent, +1= thready, +2= weak, +3= normal, +4= bounding. Normal is considered 2-3.

Questions included in initial pregnancy visit

- ASK why pregnant? - Thorough menstrual history * age at menarche * cycle length * first day of LMP * duration menstruation * flow * difficulties (cramps, PMS s/s)

Immunizations (Adults)

-H1N1

Surgeries (Pediatric)

-Chest tube (negative pressure on pleural cavity)

floating ribs

11th and 12th pair of ribs that do not connect to either the sternum or another pair of ribs anteriorly; they are attached posteriorly to the verterbra and are free and palable

Afebrile temperature varies between _____ - ______ celcius.

37 - 37.5

Inferior angle of scapula is located at ____ rib

8th

Afebrile temperature varies between _____ - ______ fahrenheit.

97 - 99.5

Thalamus

Main relay station for the nervous system. Sensory pathways of the spinal cord and brain stem form synapses on their way to the cerebral cortex.

Cornua

A horn like projection - projection off the uterus

Skin Lesion: Keloid

A hypertophic scar. The resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of original injury. May increase long after healing occurs. Looks smooth, rubbery, and "clawlike" and has a higher incidence among blacks.

crackles

adventitous sound produced by air passing over retained airway secretions or the sudden opening of collapsed airways

Hemotympanum

A bluish tinge of the tympanic membrane caused by the presence of blood in the middle ear

Hyperactive precordium

A diffuse inc. movement often seen with left to right shunts

bradycardia

A heart rate less than 60 BPM

Stereotype

A popular belief about specific social groups or types of individuals

Reinforcement

A technique in which isometric exercise is performed in a muscle away from the reflex being tested. ex// "pulling" of locked fingers when assessing patellar reflex

Ethnicity

A term referring to an ethnic group

Denver Development Screening Test

A test that measures the developmental milestones through infancy and childhood (6 yo). Designed to detect delays in 4 developmental domains: personal-social, finemotor - adaptive, language and gross motor

Dicrotic Pulse

A very prominent diacrotic wave, causes are low cardiac output, high resistance, post op cardiac surgery and typhoid fever.

Severe Claudication

ABI 0.4 - 0.3

Moderate to Severe Claudication

ABI 0.7 - 0.4

Mild Claudication

ABI 0.9 - 0.7

Ischemia (with impending loss of tissue)

ABI <0.3

Classification of neonates based on size for gestational age

AGA - average for gestational age SGA - Small for gestational age (caused by mom smoking, cocaine - this causes vasoconstriction and delays baby growth) LGA - large for GA, ? gestational diabetes

What term is seen above the sternum?

Suprasternum

Heave (Lift)

Sustained forceful thrusting of the ventricle during systole. Occurs with ventricular hypertrophy as a result of increased workload. Right ventriclar is seen at the sternal border, left ventricular is seen at the apex.

blood pressure can vary with:

age, gender, race, diurnal rhythm (daily cycle of peak and trough), weight, exercise, emotions, and stress

General Survey-Physical Appearance

age, sex, level of consciousness, skin color, and facial features

Bronchovesicular Breath Sound

Moderate pitch, moderate amplitude, inspiration is equal to expiration, mixed quality, heard over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in first and second intercostal spaces.

Large Bowel Obstruction

Moderate, colicky pain of gradual onset in lower abdomen and bloating

epidermis

outermost layer of the skin, consists of dead, keratinized cells that render the skin waterproof; almost entirely replaced every 3-4 weeks

Anesthesia

Absent touch sensation

Hypochondriasis

Morbid worrying about his or her own health, feels sick with no actual basis for that assumption. ex// Preoccupied with the fear of having cancer, any symptom or physical sign means cancer.

Multigravida

More than one pregnancy

CN VI

Abducens, Motor, Lateral movt of eye

Use of Accessory Muscles - The scalene, serratus, rhomboids, external intercostals, pectorals major, trapezius, & sternocleidomastoid are classified as what type of muscles?

Accessory Muscles

CN VIII

Acoustic, Sensory, Hearing and equilibrium

Base

Anteriorly, rests on the diaphragm at about the sixth rib in the midclavicular line. Laterally, 7th/8th rib. Posteriorly, T10. Drops to T12 with deep inspiration

Midline

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

What is a cessation of breathing?

Apnea

Arterial disorders of vasculature

Atherosclerosis, acute arterial occlusion, Reynaud's, Chronic arterial insufficiency

Components of Health History

BIOGRAPHICAL DATA, REASON FOR SEEKING CARE, HISTORY OF PRESENT ILLNESS, PAST HEALTH HISTORY, FAMILY HISTORY, REVIEW OF SYSTEMS, FUNCTIONAL ASSESSMENT

Pathologic (abnormal) Reflexes

Babinski's or extensor plantar reflex

Erucation

Belching

Temporal lobe

Bottom of brain - Interperats sounds and auditory cortex

What is a decreased respiratory rate?

Bradypnea

Thumb, middle finger, and fifth finger dermatomes

C6, C7, C8

Cerebral Cortex

Cerebrum's outer layer of nerve cell bodies, which looks gray because it lacks myelin. Center for human's highest functions, governing thought, memory, reasoning, sensation, and voluntary movement.

Palpable superficial lymph nodes

Cervical, axillary, arm and leg lymph nodes

Past Health History

Childhood illness, accidents or injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last examination date, allergies, and current medications (including vitamins and herbal supplements), alcohol drug use

Delirium (Acute Confusional State)

Clouding of consciousness (dulled cognition, impaired alertness); inattentive, incoherent conversation, impaired recent memory or confabulatory for recent events, often agitated and having visual hallucinations, disoriented, with confusion worse at night when environmental stimuli are decreased

Diagnosis

Compare clinical findings with normal and abnormal variation and developmental events; interpret data, validate diagnoses; document diagnoses

Flaccid Quadriplegia

Complete loss of muscle tone and paralysis of all four extremities, indicating completely nonfunctional brain stem.

Pansystolic Regurgitant Murmurs

D/T backward flow of blood from area of higher pressure to one of lower pressure ex// Mitral regurgitation, Tricuspid regurgitation

Midsystolic Ejection Murmurs

D/T forward flow through semilunar valves ex// Aortic stenosis, Pulmonic stenosis

Number one cause of blindness

Diabetes

What is normal breathing?

Eupnea

Ying/yang theory of health

Health exists when all aspects of the person are in perfect balance.

What term is seen between the ribs?

Intercostals

Groin dermatome

L1

Heptatomegaly

Liver enlargement, larger than normal liver span

Percussion: Resonant

Low pitched, hollow sounds. Air and tissue. example: lung fields

Recent deep Venous Thrombosis

May have swelling, may have calf tenderness

Moaning

Most notable Sign that pain is being felt

Vertebral Prominens

Most prominent bony spur protruding at the base of the neck. Spinous process of C7.

Irregularly Irregular

No pattern to the sounds, beats come rapidly and at random intervals

Cutis marmorata

Normal, pink marble like mottling of the skin in infants - seen also in kids on exposure to cold

Decreased fremitus indicates _______

Obstructed bronchus, COPD, tumor, very thick chest wall

Level of Consciousness - awakens with difficultly, responds appropriately when aroused

Obtunden

Seizure

Occur with epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscle movements, and sensory disturbances

Salivary glands

Parotid, submandibular, sublingual

Left Lower Quadrant (LLQ)

Part of descending colon, sigmoid colon, left ovary and tube, left ureter, left spermatic cord

Paresis

Partial or incomplete paralysis

Deep Tendon Reflexes (myotatic)

Patellar or Knee Jerk

Congenital Heart Defects

Patent ductus arteriosus, Atrial septal defect, Ventricular septal defect, Tetralogy of fallot, Coarctation of Aorta

Deep Palpation

Performed by depressing tissue approximately 1 inch (2,5 cm) with the forefingers of one or both hands

Term that describes that cool extremities indicate poor circulation.

Peripheral Skin Temerature

Dependence

Physiologic dependence on substance

Percussion (Steps)

Positions Thorax Diaphragmatic Excursion

Term that describes the alternating succession of strong and weak pulse, but not related to respirations (suggests left ventricular failure).

Pulses Alternons

Term that describes when pulse strength decreases in inhalation & increases on exhalation(common in asthma).

Pulses Paradoxus

Tachypnea

Rapid shallow breathing greater than 24 breaths per minute

What temperature site is closest to the actual core temperature?

Rectal

Panic Disorder

Recurrent unexpected panic attacks. At least one of the attacks has been followed by 1 month of 1 of the following: persistent concern about having additional attacks, worry about the implications of the attack, significant change in behavior related to the attacks. Agoraphobia may or may not be present

What color is blood?

Red

Circumlocution

Round-about expression, substituting a phrase when cannot think of name of object. ex// says "the think you open the door with" instead of "key"

What color is pneumoccocal or streptococcal pneumonia?

Rusty

Tanner Stages of Sexual Development for Females

STAGE 1 (prepuberty) - Height increase 5-6 cm/year, breast papilla elevation only, villus hair only STAGE 2 (ages 9 to 13 - median age 11) - Height increase 7-8 cm/year, breast buds and areaola enlarge , minimal coarse pigmented hair only in labia STAGE 3: Height incr 8 cm/year (age 12.5), breast contour elevation and areola enlarge (10-14 yo), pubic hair: darker, coarse and curly over mons pubis (age 10-14), axillary hair develops (13), acne vulgaris (13) STAGE 4: (11-15 yo) Ht growth 7 cm/year, breasts areal forms secondary breast mound, pubic hear spreads to medial thigh/perineal area. STAGE 5: No further ht increase after aget 16, breasts develop the adult breast contour, the areola recesses to general contour of breast, pubic hair adult like

Tanner Stages of Sexual Development for Males

STAGE 1 (prepuberty)- ht 5-6 cm/year, no penis growth, no pubic hair, testes 4 ml or < 2.5 long axis STAGE 2 (average age 11-12 yo), testes 4 ml or long axis 2.5-3.2 cm, minimal coarse pubic hair at penis base, small penis size increase STAGE 3 (avg. age 13-14), ht growth 7-8 cm/year, testes 12 ml or 3.6 long axis, coarse curly pubic hairs, width and length of penis grow, voice changes, incr muscle mass, gynecomastia may occur - NORMAL! STAGE 4: Ht peak 10 cm/year (age 14), adult pubic hair but not in thigh/perineum, penis still growing, testis 4.1-4.5 long, axillary hair, acne, voice changes --> around age 14 STAGE 5: No further ht increase after age 17, mature penis size by age 16/5, adult pubic hair, spreads to thighs, testes > 4.5 cm, facial hair, gynecomastia disappears, mature body

Pulmonic Valve area

Second left interspace

Aortic Valve area

Second right interspace

Heart rate should be evaluated for rate, rhythm, & ________.

Strength

Moro reflex

Symmetric abduction and extension of the arms and legs, fanning fingers, and curling of the index finger and thumb to C position ("tree hugging") when startled

___________ of the chest is normal (bilateral excursion or expansion).

Symmetrical

Physical Assessment

Systematic examination of body structures (one method of gathering health data)

What blood pressure term is used to describe a peak force exerted during the contraction of the left ventricle?

Systolic

Blood pressure norms

Systolic should be under 120, diastolic should be under 80. Prehypertension: sys 120-139 dia: 80-89. Stg 1 htn: sys 140-159 dia: 90-99. Stg 2 htn: sys>160, dia> 100

Axilla dermatome

T1

Umbilicus dermatome

T10

Nipple dermatome

T4

Cardinal field of gaze test

THE "H"

Dermal Segmentation

The cutaneous distribution of the various spinal nerves.

Pons

The enlarged are containing ascending and descending fiber tracts.

Carotid Artery

The major artery that supplies blood to the head and brain, located in neck

Midbrain

The most anterior part of the brain stem that still has the basic tubular structure of the spinal cord. It merges into the thalamus and hypothalamus. Contains many motor neurons and tracts.

Suffering

The unpleasant emotional response to pain

What sense would you use for palpation?

Touch

CN V

Trigeminal, Mixed, Motor: Muscles of mastication, Sensory: sensation of face and scalp, cornea, mucous membranes of mouth and nose.

tachycardia

a heart rate of more than 100 bpm

ulcer

a lesion of the skin or mucous membranes marked by inflammation, necrosis, and sloughing of damaged tissues

cherry angioma

a benign, dome-shaped cherry-red papule on the trunk

Sterognosis

ability to perceive the form of an object by using the sense of touch

Graphesthesia

ability to recognize writing on the skin purely by the sensation of touch.

adventitous

abnormal breath sounds

scoliosis

abnormal curvature of the spine; a lateral or sideways deviation

kyphosis

abnormal curvature of the spine; an increased curve of the thoracic spine, common in older patients

ptosis

abnormal drooping of the lid over the pupil

Cheyne-Stokes

alternating periods of deep, rapid breathing followed by periods of apnea, may result from congestive heart failure, drug overdose, increased intracranial pressure, or renal failure; may also be noticed in elderly persons during sleep

Pulsus alterans

alternating small and large pulse. Cause is advance HF.

Pitting edema from sterling forces

always bilateral, no ulcerations or color changes

pulsus bigeminus may not _____

always transmit a pulse THE HR IS TWICE THE PULSE RATE!!

stroke volume

amount of blood pumped

Dorsalis pedis artery

an artery of the upper surface of the foot that is a direct continuation of the anterior tibial artery (in line with big toe on dorsal surface of foot)

clubbing

an enlarged terminal phalanx of the finger, present with C.O.P.D. and other heart diseases

Biomedical Theory

based on the assumption that all events in life have a cause and effect (that the human body functions more or less mechanically, that all life can be reduced or divided into smaller parts, and that all of reality can be observed and measured)

On PE can be detected if

change is >10mm in pressure, WAX and WANE, normal cardiac rhythm and normal respiratory depth

steroids

can cause edema, acne, ingrown hairs, cysts, lesions, blisters, necrosis and may make you bruise easier

Skin Self Assessment (ABCDE) for Moles and/or Melanoma

can help identify abnormal characteristics of pigmented lesions by assessing: A: asymmetry B: border irregularity C: color D: diameter (greater than 6mm) E: elevation and enlargement

Variable intensity in S1

can indicate atrial fib or complete heart block

Level of blood pressure is determined by:

cardiac output, peripheral vascular resistance, volume of circulating blood, viscosity, and elasticity of vessel walls

Inspection

close, careful scrutiny, first of the individual as a whole and then of each body system

Skin Lesion: Grouped

clusters of lesions, vesicles of contact dermatitis

integument

consists of skin, hair, and nails

thoracic cavity

consists of the mediastinum and the lungs

Increased fremitus indicates _______

consolidation

cyst

encapsulated fluid-filled or semisolid mass located in the subcutaneous tissue or dermis

Habituation

forming a habit

Diplopia

double vision

diplopia

double vision

Exudate

drainage, pus

Lymph System

drains fluid (lymph) from bodily tissues and returns it to venous circulation

hypothermia

due to accidental, prolonged exposure to cold

Causes of elevated JVP or hepatojugular reflex

early cardiac failure, cardiac tamponade, R sided heart failure, constrictive pericarditis, tricupsid stenosis, superior vena cava obstruction, COPD (in expiration only)

4+

edema grading that has an indentation of 10 mm or more

pedigree/genogram

graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least three generations, such as parents, grandparents, and siblings

Changes of Nails in the Older Adult

grow more slowly, surface of nails is lusterless and is characterized by longitudinal ridges resulting from local trauma at the nail matrix

Nullipara

no live births

Major Depressive Disorder

one or more major depressive episodes

Vein valves

one-way valves that allow blood flow from superficial to deep toward heart; aided by muscular activity that squeezes blood upward against gravity

Ethnicity

pertains to a social group within the social system that claims to possess variable traits such as a common geographic origin, migratory status, religion, race, language, shared values

Points of the General Survey

physical appearance, body structure, mobility, and behavior

petechiae

pinpoint-sized, red or purple spots on skin caused by small hemorrhages in the skin layers

scar

secondary skin lesion type, skin mark left after healing of a wound or lesion, composed of connective tissue, may be white or glistening

scales

secondary skin lesion, flakes secondary to desquamated, dead, epithelium, flakes may adhere to skin surface, color varies from silvery to white, texture varies from thick to fine; dandruff, psoriasis, dry skin

scab

secondary skin lesion, large adherent crust

crust

secondary skin lesion; dried residue of serum, blood, or pus on skin surface

Lacrimal gland

secretes tears

Percussion

tapping the person's skin with short, sharp strokes to assess underlying structures; strokes yield a palpably vibration and characteristic sound that depicts the location, size, and density of underlying organ.

leukoplakia

thick white patches

Lymphedema

thickened, hard non-pitting edema

senile keratosis

thickening of skin

epidermis

thin tough layer, cell bound tightly into sheets that form rugged protective layer, has basal cell layer then horny cell layer

arcus senilis

thin white ring (arc) along the margin of the iris. Abnormal in anyone under age 40

atrophy

thin, dry, transparent appearance of epidermis, loss of surface markings, secondary to loss of collagen and elastin; aged skin

alopecia

thinning of the hair

Rectus extraocular muscle moves eye ______&______

up & down

Color vision test

use Ishihara plates

Pulse Technique

using pads of finger palpate wrist for radial pulse, count the beats for 30 seconds and multiply by 2, start with 0 when first pulse is counted, normal for adults is 60-100 (per Ms. Ford)

Retracted tympanic membrane indicates _______

vacuum in middle ear with obstructed eustachian tube

Positive signs of prengancy

- Fetal heart beat (9-12 wks w/ doppler and 16-20 wks w/ stethoscope) - Fetal movement (feel 18-20 wks in primigravida, 15-17 wks in multigravida)

Lungs (Lower Respiratory Tract)

-left lung (two lobes: upper and lower) -right lung (three lobes: upper, middle, and lower)

Eupnea (normal) (Respiratory Patterns)

-normal rate and rhythm -adults and teenagers -12 to 20 breaths/minute -children ages 2 to 12 (20 to 30 breaths per minute) -infants (30 to 50 breaths per minute) -occasional deep breaths (2 to 3 breaths/minute)

Positions (Percussion)

-posterior thorax, head flexed forward and arms crossed on the lap. separates scapulae widely, exposes more lung tissue. -anterior chest, upright position with shoulder arched backward and arms at side. supine for anterior and lateral thorax percussion

S2

2nd heart sound= dub. Occurs with closure of semilunar valves and signals end of systole. Loudest at base.

Normal heart rate for an adult at rest

60-100 bpm

Sponataneous Pneumothorax

Air enters pleural space through rupture in lung wall

Level of Consciousness - awake, responds to stimuli, oriented to time, place, & person

Alert

Isometric (isovolumic) Relaxation

All four valves are closed and the ventricles relax, occurs before rapid filling of ventricles.

Bilateral swelling vs. unilateral swelling of legs

Bilateral: systemic; Unilateral: blockage/infection

What are irregular patterns of breathing with periods of apnea?

Biots

Nerve

Bundle of fibers outside the CNS.

When preparing the physical setting the interviewer:

Ensures privacy and sets room temperature at a comfortable level. Reduces noise, removes distracting objects, and refuses interruptions. Conducts the interview at eye level and at a distance of 4 to 5 feet

Layers of skin

Epidermis:outer layer, basal cell layer, horny cell layer. Dermis: middle layer, connective tissue or collagen. Subcutaenous layer: innermost layer, adipose tissue

CN VII

Facial, Mixed, Motor: facial muscles, close eye, labial speech, close mouth, Sensory: taste on anterior two-thirds of tongue, PNS: saliva and tear secretion

Diastolic Rumbles of AV Valves

Filling murmurs at low pressures, best heard with bell lightly touching skin ex// Mitral stenosis, Tricuspid stenosis

Borborygmus

Hyperperistalsis, stomach growling

What condition is associated caused by long exposure to cold, blood loss, injury to hypothalamus, & causes a decrease in oxygen consumption and CO2 production?

Hypothermia

What condition is when your body temperature is below normal?

Hypothermia

Mitral Prosthetic Valve Sound

Iatrogenic sound gives an early diastolic sound just after S2. Loud heard over the whole precordium and is loudest at the apex and left lower sternal border

Landau Reflex

In infants - baby raises the head and arches the back as in a swan dive.

Bronchial (Breath Sounds)

L: right and left bronchi just above clavicles, above manubrium and between scapulae C: high -pitched, blowing, and muffled, expiration slightly longer than inspiration

Bimanual exam

LUBRICATE - Insert both index finger vagina, middle finger in rectum - Note vaginal wall texture (nodular, tender) - Palpate the cervix (os and fornices: anterior and posterior) - Chandelier sign - jump in pain if vaginal wall tenderness - Palpate the uterus - Palpate each ovary gently - Assess pubocoxygeal muscle strength (cough, Kegel's) * If rectovaginal exam - do hemoccult, remove gloves discretely * Provide tissues, pad, tampon - slight bleeding

Tricuspid Valve area

Left lower sternal border

Palpation

Lightly touching or applying pressure to the body

Summary of Symptoms During Current Health or History of Current Illness--8 Critical Characteristics

Location Character/Quality Quantity/Severity Timing Setting Aggravating/Relieving Factors Patient's Perception

Praying

Most common Filipino practice when it comes to Pain

CN II

Optic, Sensory, Vision

_________ to the brain is necessary for a person to be __________, _________, and well __________.

Oxygen, Alert, Oriented, Perfused

Fine crackles, Rales (Adventitious Breath Sounds)

P: Fine, short, interrupted crackling sounds, high-pitched popping sound. Lower lung fields. AB if persisting during deep breathing. Rolling lock of hair near ear C: air passing through fluid or mucus. Trapped in smaller bronchioles or alveoli (congestive heart failure, pneumonia, atelectasis, pulmonary fibrosis)

Snorting (Adventitious Breath Sounds)

P: elevation of soft palate during nasal inspiration, does not cause sleep apnea

Normal (Adventitious Breath Sounds)

P: low pitch, smooth consistent flow C: N/A

Pleural Friction Fremitus

Palpable vibration with inflammation of the pleura

Pederson vs. Graves speculum

Pederson: flat and narrow speculum (for women with narrow vaginal canals - virgins, elderly) Graves: wider bills (used for wider vaginal canals in sexually active women, s/p baby) * both metal or plastic (metal stronger but cold)

Term used to describe when gas goes from lung to lung rather than in & out.

Pende Luft Respirations

What is the most common pulse site?

Radial

Red reflex

Red glow filling the person's pupil caused by reflection of opthalmoscope light off inner retina.

T wave

Repolarization of the ventricles

Athetoid

Resembling slow, writhing, snakelike involuntary movements involving flexion, extension, pronation and supination of fingers, hands, toes, and feet

Only place where you can view blood vessels directly

Retinal vessels

Pleural Cavities

Right and Left areas containing lungs, on either side of the mediastinum

Anterior lobes of lungs

Right: upper lobe, middle lobe, lower lobe. Left: upper lobe, lower lobe. No left middle lobe because of heart location

Bradypnea

Slow breathing. A decreased but regular rate (less than 10 per minute), as in drug-induced depression of the respiratory center in the medulla, increased cranial pressure, and diabetic coma.

Appendicitis

Starts as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness localized in RLQ (McBurney's pt). Pain aggravated by movement, coughing, deep breathing; associated with anorexia, then N&V, fever

Phobia

Strong, persistent, irrational fear of an object or situation; feels driven to avoid it. ex// dogs, cats, heights, enclosed spaces.

Level of Consciousness - Does not awaken completely, decreased mental & physical activity, responds to pain & deep tendon reflexes, slow to respond to verbal stimuli

Stuporous

What term is seen below the sternum?

Substernum

Enlarged Gallbladder

Suggests acute cholecystitis, felt behind the liver border as a smooth firm mass like a sausage although it may be difficult to palpate because of involuntary rigidity of abdominal muscles. If nontender, gallbladder is filled with stones

Venous disorders of vasculature

Superficial thrombophlebitis, Deep Venous Thrombosis, Chronic Venous Insufficiency, Thromboangitis Obliterans (Buerger's disease)

Skin Lesion: Wheal

Superficial, raised, transient, and erythematous; slightly irregular shape due to edema (fluid held diffusely in the tissues), ie: mosquito bite, allergic reaction, dermographism

Great Vessels

Superior vena cava, inferior vena cava, pulmonary arteries, pulmonary veins, aorta

micrognathia

abnormally small jaw

alopecia

absence or loss of hair

0

absent pulse, unable to palpate

costochondral junction

area where tenderness may be felt by patients with rib fractures or osteoporosis

Raynauds disease

arteriolar vasospasm in response to cold temperature or emotional stress; present w/ cyanosis in fingers and toes

Dorsalis pedis artery

artery that is palpable at the dorsum of the foot, just lateral to the extensor tendon of the big toe

Popliteal artery

artery that is palpable behind the knee

Posterior Tibial artery

artery that is palpable behind the medial malleolus of the ankle

When to wash hands:

before and after every physical patient encounter; after contact with blood, body fluids, secretions, and excretions; after contact with any equipment contaminated with body fluids; and after removing gloves

Systolic Ejection Murmurs

being with the OPENING of aortic and pulm valves. crescendo/decrescendo. the duration is determined by the flow and/or severity of lesion.

benign (fibrocystic) breast disease

bilateral lumpy, painful breasts with nipple discharge at times

Pallor when legs elevated but red normally indicates ______

blockage

trochanter

bony prominences toward the near end of the thigh bone (the femur)

clubbing

bulging of tissues at the nail base due to insufficent oxygenation

causes of pulsus paradoxus

cardiac tamponade, pulmonary emphysema, severe asthma

Culturally Appropriate

caregivers APPLY the underlying background knowledge that must be possessed to provide a given person with the best possible health care.

caries

cavities

precordium

center of chest

Conjuctiva

clear mucous membrane consisting of cells and underlying basement membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. Protects eyes from foreign bodies.

Temperature of legs- arterial vs venous

coolness: arterial blockage; warmness: venous blockage

2+

edema grading that has an indentation of < 5 mm

1+

edema grading that is barely visible

hyperresonance

elicited in cases of trapped air such as emphysema or pneumothorax

Cryptorchidism

failure of one or both testes to descend

Breast adenomas

firm, round masses that are freely mobile, small, but not malignant. Often seen in breasts of younger women

Neonatal period

first 28 days of life - first 3 months biggest transition for both baby and parents - classify by birth weight and gestational age

Nagele's Rule

first day of LMP - 3 months + 7 days + 1 year --> EDC (estimated date of confinement)

diaphragm of stethoscope

flat larger side is for high pitched sounds--breath bowel and normal heart sounds

Erythema toxicum

flushing of the skin due to allergic reaction to toxic subastances

blood pressure

force of the blood pushing against the side of its container, the vessel wall

bromhidrosis

foul-smelling perspiration

Anticipatory guidance

guidance given to teens regarding safety, health habits and behaviors

gingivae

gums

Terminal

hair is darker and grows on the scalp, eyebrows, and pubic areas after puberty.

Vellus

hair is fine and covers most of the body.

Decreased arterial perfusion indicated by

hair loss

epidermal appendages

hair, sebaceous glands, sweat glands, and nails

indurated

hardened

Weber's Test

hearing test for lateralization of sound

dullness

may characterize areas of increased density such as consolidation, pleural effusion, or tumor

Confrontation test

measure peripheral vision, compares clients peripheral vision with your own. Cover opposite eye (clients left, your right), move object inward from peripheral from 2 ft away, have client tell you when they can see the object.

goniometer

measures precise degree of motion in a particular joint

choanal atresia

narrowing of blockage of the nasal airway by tissue

5 to 10 cm

normal measurement of chest expansion when a client takes a deep breath

Normal voice transmission

soft, muffled, and distinct

Late systolic murmur

starts with a click, usually mid systolic. Characteristic of mitral prolapse.

varicosities

swollen, tortuous veins

apnea

temporary cessation of breathing

Shifting Dullness

test for ascities, hear shift from tympany to dullness, the dullness part present for ascites

Ethnocentrism

the belief in the inherent superiority of ones ethnic group or culture

semilunar valve abnormalities (diastolic)

the murmur will start right after S2 sound, usually decrescendo. Caused by aortic regurg, pulm. regurg.

2

the number of lobes the left lung has

Weber test

tuning fork, on top of head

blanch

turn white when you press on them

Trendelenberg test

veins empty, apply tourniquet, slow fill from below= competent valves, rapid fill= incompetent valves

Rusty brown color or cyanotic coloring in legs indicates _____

venous occlusion

Presumptive signs of pregnancy

- Chadwicks sign (vulva darkens, abd and skin pigmentation)

Tips for interviewing a baby/child

- Talk to parent first and gradually glance a baby, wait to make eye contact till they adapt, - Start w/ non threatening maneuvers first - Painful stuff last - Choices for older kid - tummy or heart first?

Signs of a risky pregnancy

- Vaginal bleeding - PIH: edema face, fingers - Cte. headache - Blurring vision - Abd. pain - Hyperemesis gravidarum - Fever/chills - Dysuria - Vaginal fluid escape - Marked change in fetal movements

Gas Transport (Function)

-Exchange of oxygen and carbon dioxide -Adjusts blood's pH 7.0

Laboratories (Pediatric)

-Surfactants -Ultrasound

Surgeries (Adults)

-Test tube

Supraclavicular

-above the clavicles

Apnea (Respiratory Patterns)

-absent periods -may be periodic

Sibilant Wheeze/Ronchus (Adventitious Breath Sounds)

-all that wheeze is not asthma P: High pitched, whistling sounds, during or at the end of expiration. has hissing or shrill quality C: passing through constricted or obstructed bronchus as a result of secretions, swelling, tumors (Asthma, bronchoconstriction/bronchospasm, emphysema, chronic obstructive pulmonary disease, upper airway obstruction, edema, pneumonia)

Angle of Louis

-also called sternal angle -usual place to start counting ribs

Biot's respirations (Respiratory Patterns)

-faster and deeper than normal respirations with abrupt pauses -breaths of equal depth

Mediastinum (Lower Respiratory Tract)

-non-delineated group of structures in thorax -central compartment -contains the heart, great vessels of the heart, esophagus, trachea, thymus, and lymph nodes of the central chest.

Diaphragm (Muscles of Respiration)

-predominant muscle of respiration -contraction: pleural pressure drops lowers alveolar pressure

Pleural Fluid

-produced by the aforementioned membranes -acts as a lubricant

Internal intercostals (Muscles of Respiration)

-pulling ribs down -decreasing thoracic volume

Ethnic cerumen variations

85% of Asians and Native Americans have dry ear wax; 97% of Whites and 99% of Blacks have wet ear wax. Dry ear wax mor likely to become impacted.

Dermatome

A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve

Scoliosis

A lateral S-shaped curvature of the thoracic and lumbar spine, usually involved with vertebrae rotation. Unequal shoulder and scapular height and unequal hip levels, rib interspaces flared on convex side. More prevalent in adolescent age groups, especially girls. Mild deformities are asymptomatic, if severe (greater than 45 degrees) deviation is present, may reduce lung volume, and person is at risk for impaired cardiopulmonary function.

Social Phobia

A marked and persistent fear or more social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others, the individual fears that he or she will act in a way that will be humiliating or embarrassing. Similar in specific phobia as to response and recognition.

Egophony (goat voice) (Auscultation)

AM: Ask the client to say "E" NCF: "eeeee" through stethoscope. soft and muffled SD: "aaaay"

Bronchophony (Auscultation)

AM: Ask the client to stay "ninety-nine" each time you place the stethoscope on the chest NCF: soft, muffled, and indistinct SD: words sound loud and more distinct over areas of lung consolidation (pneumonia, atelectasis, tumor)

Shape of anterior and posterior chest, and lateral areas of thorax (Inspection)

AM: Client sits with arms at sides. Stand in front and back and assess shape. NCF: thorax is symmetrical, and anterior-posterior diameter is less than the transverse diameter (1:2) SD: asymmetrical, barrel chest (over-inflation), pigeon chest (pectus/sternal), funnel chest (lower sternal indentation), kyphosis, scoliosis, equal diameter (COPD in adult)

Cough (Auscultation)

AM: Direct auscultation/ direct hearing (moisture, pitch, quality, frequency. Note causes, type, duration, severity, treatment, production of blood or other secretions with coughing. NCF: no coughing SD: cough with yellow, pink, brown, or gray sputum, productive, non-productive, dry, hacking

Surface Characteristics (Palpation)

AM: Lesions and feel for any unusual masses NCF: Skin and Subcutaneous tissue are free of lesions and masses SD: Mass

In regards to sputum, tsp, ml, cup, small, & large are terms that describe what?

Amount

Acute Respiratory Distress Syndrome (ARDS)

An acute pulmonary insult (trauma, gastric acid aspiration, shock, sepsis) damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium, and to pulmonary edema. Gross examination would show dark red, firm airless tissue, with some alveoli collapsed, and hyaline membranes lining distended alveoli

Regional lymphatics changes in the Aging Adult

An aging person may have prolapse of submandibular glands, which could be mistaken for a tumor, but drooping submandibular glands will feel soft and be present bilaterally.

Premature Beat

An isolated beat is early, or a pattern occurs in which every third or forth beat sounds early

Positions for breast exam

Arms up, arms on waist, palms clasped against each other and leaning forward

Hairless legs, thin shiny skin indicates______

Arterial occlusion

Posterior Tibial artery

Artery supplying the foot, behind the medial ankle.

What temperature site is 2 degrees less than rectal?

Axillary

occipital lobe

Back of brain -- visual cortex

Pulmonic Regurgitation

Backflow of blood through incompetent pulmonic valve, from pulmonary artery to RV

Tricuspid Regurgitation

Backflow of blood through incompetent tricuspid valve into RA

Term referring to increased A-P diameter, typically seen with COPD (due to air trapping).

Barrel Chest

Epigastric

Between the costal margins

Tricuspid Stenosis

Calcification of tricuspid valve impedes forward flow into RV during diastole

Mitral Stenosis

Calcified mitral valve will not open properly, impedes forward flow of blood into LV during diastole. Results in LV enlarged and LA pressure increased

Deep leg veins

Carry 90% of venous return from lower limbs, well supported

Brain stem

Central core of the brain consisting of mostly nerve fibers and contains the midbrain, pons, and medulla.

Withdrawal

Cessation of substance produces a syndrome of physiologic symptoms

COLDSPA

Character Onset Location Duration Severity Pattern Associated Factors

What is the respiratory rate that has a gradually increasing & decreasing rate & depth with periods of apnea? Causes include increased intracranial pressure, meningitis, or drug overdose.

Cheyne Stokes

Muscular Dystrophy

Chronic, progressive wasting of skeletal musculature, which produces weakness, contractures, and in severe cases respiratory dysfunction and death. Onset of symptoms occurs in childhood, most common is Duchenne's Dystrophy

Body Systems Approach

Collecting data according to the functional systems of the body

Pleural Effusion

Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. Effusion may contain watery capillary fluid, protein, purulent matter, blood, or milky lymphatic fluid. Gravity settles fluid in dependent areas of thorax. Presence of fluid subdues all lung sounds.

Rigidity

Constant state of resistance (lead-pipe rigidity); resists passive movt in any direction; dystonia. Associated with injury to extrapyramidal motor tracts, basal ganglia with parkinsonism

Spinothalamic Tract

Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch.

Superficial Reflexes

Corneal reflex and abdominal reflex

Strong/effective, weak/inadequate, productive, & dry hacking are descriptive words of a _____.

Cough

What is a common symptom in respiratory disease?

Cough

Hemoptysis

Coughing up blood.

Pulse Deficit

Count at apex doesn't perfuse to peripheral pulse. Signals a weak contraction of the ventricles, occurs with arterial fibrillation, premature beats, and heart failure

Skin Color - Decrease in oxygen of arterial blood. Also, discoloration of skin or mucus membranes & evaluate oxygen status with arterial blood gas or pulse oximetry.

Cyanosis

Abuse

Daily use needed to function, inability to stop, impaired social and occupational functioning, recurrent use when it is physically hazardous, substance-related legal problems.

Chronic Venous Insufficiency

Dark bluish, purple discoloration, may have petechiae/brown pigmentation, normal color/cyanotic on dependency, may have aching pain on dependency, pulses normal, stasis dermatitis, thickening of skin and narrowing of leg with scarring, ulceration usually on medial/ lateral malleolus, edema present

Cheyne-stokes

Death rattle- pattern of increased breathing, no breathing

What condition has profuse sweating & is a nonspecific sign of serious cardiopulmonary problems?

Diaphoresis

Use of Accessory Muscles - What is the primary muscle for breathing?

Diaphragm

Muscles of Respiration

Diaphragm Scalene muscles and Sternomastoids Abdominal Wall Internal intercostals

What blood pressure term is used to describe the force occurring while the heart is relaxed?

Diastolic

Orthopnea

Difficulty breathing when supine

Dysarthia

Difficulty forming words

Thoracic Duct

Drains the rest of the body. Empties into the left subclavian vein.

Early Diastolic Murmurs

Due to SL valve incompetence. ex// Aortic regurgitation, Pulmonic regurgitation

Gastric Ulcer

Dull, aching, gnawing epigastric pain, usually brought on by food, radiates to back or substernal area. Pain of perforated ulcer is burning epigastric pain of sudden onset that typically refers to one or both shoulders

Duodenal Ulcer

Dull, aching, gnawing pain, does not radiate, may be relieved by food, and may awaken the person at night

Difficulty breathing or shortness of breath. May be associated with respiratory disease, cardiac disease, neurological or neuromuscular disorder, anxiety, and more.

Dyspnea

Enlarged Liver

Enlarged, smooth and nontender liver occurs with fatty infiltration, portal obstruction or cirrhosis, high obstruction of inferior vena cava and lymphocytic leukemia. Liver feels enlarged and smooth but is tender to palpation with early heart failure, acute hepatits, or hepatic absess

Enlarged Spleen

Enlarges down and to the midline. When splenomegaly occurs, it is moderately enlarged and soft with rounded edges. If chronic, the enlargement is firm or hard. Since acute/chronic don't usually reach peritoneum, no tenderness

Raynaud's Phenomena

Episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration, or stress: first white from arteriospasm and resulting deficit in supply, then blue from slight relaxation of the spasm that allows a slow trickle of blood through capillaries and increased oxygen extraction of hemoglobin, finally red due to return of blood into the dilated capillary bed or reactive hyperemia.

Barrel Chest

Equal anteriorposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. Associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs

Barrel chest

Equal anteriorposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. Associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.

Skin Color - Redness of skin due to capillary congestion, inflammation, or infection.

Erythema

Euphoria

Excessive well-being, unusually cheerful or elated, which is inappropriate considering physical and mental condition, implies a pathologic mood. ex// "I am high." "I feel on top of the world"

Broca's Aphasia

Expressive aphasia. The person can understand language but cannot express him- or herself using language. Characterized by nonfluent, dysarthric, and effortful speech. Speech is mostly nouns and verbs with few grammatic filters, termed "agrammatic." Repetition and reading aloud are severly impaired. Auditory and reading comprehensions are surprisingly intact. Lesion is in anterior language area called the motor speech cortex or Broca's area

Babinski's Reflex

Fanning of toes when stroking lateral edge of baby's foot. Present at birth, disappears (changes to adult response) by 24 months.

Vibration

Feeling vibrating objects

Decreased Fremitus

Felt when anything obstructs transmission of vibrations. ex// obstructed bronchus, pleural effusion or thickening.

Twelfth Rib

Free tip found midway between the spine

Referred Pain

From a disorder in another site

Visceral Pain

From an internal organ (dull, general, poorly localized)

PR interval

From beginning of P wave to the beginning of the QRS complex (the time neccessary for atrial depolarization plus time for the impulse to travel through the AV node to ventricles)

Acinus

Functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli.

Rage

Furious, loss of control. ex// Person has expressed violent behavior toward self or others

Explain Ga Pbcde System

G = Gravid (a # of pregnancies) P = Parity = parent (live birth) b - # of term pregnancies (>37 wks) c - # of preterm pregnancies (<37 wks) d # of abortions/ectopic pregnancies e # of living children Means 2 pregnancies, only 1 live birth/child

HEAAD DSS assessment

H - HOME: where, whom u live with? get along? E - EDUCATION: academic difficulties? bullying? days late? Extracurricular act? A - AFFECT: depressed, hyper, withdrawn, sad... A - ACTIVITIES: after school, stress mgmt D - DIET - soda, fast food, ED D- DRUGS S - SEX HX - Are u sexually active or decided to wait? Has anyone every pressured or forced u to have sex? S - SAFETY? Home, school, neighborhood, bullying

Apgar score

HR - 0 absent, 1 < 100 BPM, 2 > 100 BPM Resp Effort - 0 absent, 1 slow/irregular, 2 good crying Muscle tone - 0 flaccid, 1 some flexion, 2 active movement Reflex irritability - 0 no resp, 1 crying, 2 cry, sneeze, cough Color - 0 blue/pale, 1 pink body w/ blue extremities, 2 pink all over * Done at 1 min and 5 minutes after birth. Range 0-10 (10 best)

Term that describes blood pressure less than 90/60 & results in a decrease in perfusion to vital organs & oxygen delivery to tissues.

Hypotension

Outcome Identification

Identify expected outcomes Individualize to the person Culturally appropriate Realistic and measurable Include a timeline

What makes a mass in the breast concerning for cancer

If a mass is IRREGULAR IN SHAPE, NON-MOBILE (GETS STUCK) - DOESN'T FREELY MOVE CONCERNING FOR MALIGNANCY Most breast cancer is NOT PAINFUL Most breast Ca is in upper outer quadrant

Weber test abnormaities

If client hears lateralization of sound in good ear, it is sensioneural hearing loss. If client hears lateralization to the poor ear, it is conductive hearing loss

Echolalia

Imitation, repeats others' words or phrases, often with a mumbling, mocking, or mechanical tone. ex// Nurse: "I want you to take your pill." Pt: "Take your pill. Take your pill."

Pain (The Definitions and Objectives)

It is perhaps the most Common and the most Important of all signs and symptoms of Illness. Could also be a complaint a client may present in an urgent or emergency situation. Major Protective Mechanism

Skin Color - Yellowish. appears in the face or trunk & increase in bilirubin in blood and tissues.

Jaundice

Elation

Joy and optimism, overconfidence, increased motor activity, not necessarily pathologic. ex// "I'm feeling very happy"

"JVD" is the abbreviation for what term?

Jugular Venous Distention

What condition is commonly seen with chronic lung disease that causes hypoxemia & with right heart failure when pulmonary vascular resistance is chronically elevated?

Jugular Venous Distention

Spinous Processes

Knobs on the vertebrae to T4.

Knee dermatome

L4

Superficial thrombophlebitis

Local swelling, redness, warmth, subcutaneous cord

Hepatojugular reflex

Lower thorax until oscillation in jugular vein just visible above clavicle, pres firmly in RUQ under costal margin for 10-15 seconds, if venous constriction is present, displacement of blood from liver will cause a rise in the column of blood

Hyperresonance

Lower-pitched booming sound when too much air is present, as in emphysema or pneumothorax

Immune role of Lymphatic System

Lymph nodes encompass bacteria and debris, produce antibodies

Inteval physical exam components

MOM: - check BP - actual vs change - Wt: actual vs change - Distance from uterine fundus to symphysis pubis (w empty bladder) - # of cm approximates # weeks of gestation (from 20-31 wks) - Vaginal exam: first visit, late in pregnancy FETUS: - FHT - fetal heart tones, fetal size and rate of change, amniotic fluid volume, fetal activity, presenting part and station

Skin Lesions

Macule - flat, nonpalpable (freckle, petechia) Papule - PALPABLE, solid elevation of skin (elevated nevus) Nodule - elevated solid mass, deeper and firmer than papule (wart) Tumor - solid mass deep in subcutaneous tissue (epithelioma) Wheal - irregularly shaped, elevated area (hive, mosquito bite Vesicle - elevation of skin with serous (clear) fluid Pustule - similar to vesicle but filled with pus (acne) Ulcer - deep loss of skin (venous statis ulcer) Atophy - thinning of skin

Hypothalamus

Major control center with many vital functions: temperature, heart rate, and blood pressure control, sleep center, anterior and posterior pituitary gland regulator, and coordinator of autonomic nervous system activity and emotional status

Amnestic Disorder

Memory impairment in the absence of other significant cognitive impairment. Causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning. Due to pathology (head trauma, surgical interventions, hypoxia, herpes simplex encephalitis) or substance induced

Cognitive

Mental Confusion Reduction in Cognitive Function

Mediastinum

Middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels

Illusion

Misperception of an actual existing stimulus, by any sense. ex// Fold of bedsheets appear to be animated.

Split S1

Mitral and tricuspid components are heard seperately ex// Normal but uncommon

Cerebral Palsy

Mixed group of paralytic neuromotor disorders of infancy and childhood d/t damage to cerebral cortex caused by a developmental defect, interuterine meningitis or encephalitis, birth trauma, anoxia, or kernicterus

Gastrointestinal

Nausea Vomiting Ileus

Nulligravida

No pregnancies

CN I

Olfactory, Sensory, Smell

Inspiratory Arrest (Murphy's Sign)

Pain felt in pts with inflammation of gallbladder or cholecystitis when palpating the liver border upon inspiration

Rhonchal Fremitus

Palpable vibration with thick bronchial secretions

Tactile (vocal) Fremitus

Palpable vibration, sound generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall.

Sinus palpation

Palpate frontal sinus by pressing up under bony brow using thumb on each side of nose. Palpate maxillary sinus by pressing up under zygomatic process using thumb.

Auscultation (Steps)

Position Assessment of Voice Sounds -Bronchophony -Egophony (goat voice) -Whispered pectoriloquy Cough

Inspection (Steps)

Position Clavicles, Sternum, Costal Angle Shape of anterior and posterior chest, and lateral areas of thorax Color Respirations Fingers Lips Nose

Bronchitis

Proliferation of mucous glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. Sections of lung distal to obstruction may be deflated. Maybe acute or chronic with recurrent productive cough. Chronic usually caused by cigarette smoking.

Respiratory breathing with difficulty getting air out (obstruction of intrathoracic airways, asthma, or emphysema).

Prolonged Exhalation

Apical Impulse

Pulsation created as the left ventricle rotates against the chest wall during systole. When visible, occupies the fourth or fifth intercostal space at or inside the midclavicular line.

What term is used to describe the difference between systolic and diastolic & an indicator of the vessels ability to retract and the functioning of the heart's valves?

Pulse Pressure

If JVP stays distended

RHF

Wernicke's Aphasia

Receptive aphasia. The linguistic opposite of Broca's aphasia. The person can hear sounds and words but cannot relate them to previous experiences. Speech is fluent, effortless, and well articulated but has many paraphasias (word substitutions that are malformed or wrong) and neologisms (made up words) and often lacks substantive words. Speech can be totally incomprehensible. Often there is a great urge to speak. Repetition, reading, and writing also are impaired. Lesion is in posterior language area called the Association auditory cortex or Wernicke's area

Chronic Arterial Insufficiency

Relatively pale skin, intermittent claudication progressing to pain at rest, diminished pulses, cool to touch, edema mild or absent, loss of hair over foot/toes, atrophic skin, shiny, ulcerations on toes or points of trauma, thickened nails, postural color changes to rubor

Tolerance

Requires increased amount of substance to produce same effect

Parietal lobe

Sensory, touch, pain, Middle of brain

Position (Auscultation)

Sitting. Zigzag or ladder approach. AM (1) Direct auscultation. Regular, spontaneous, non-labored, intermittent, moist, gasping, stertorous (noisy) or wheezing (2) Indirect auscultation. Auscultate with diaphragm. NOTE: pitch, intensity, duration of inspiration and expiration, and any adventitious sounds SD: diminished, absent or markedly increased breath sounds, adventitious breath sounds, crackles (rales), wheezes, gurgles, (ronchi), friction, squawks

Arm Physical Exam

Size, symmetry, skin color, pulses (radial, brachial), epitrochlear lymph nodes

Dull Note

Soft, muffled thud, signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor

Musculoskeletal

Spasms Impaired Muscle Function Fatigue Immobility

Vital Signs of Older Adult

Temperature: greater risk for hypothermia, sweat gland activity diminished. Pulse: 50-90 bpm, but rhythm may be irregular Respirations: shallower inspiratory phase, increased respiratory phase Blood Pressure: higher systolic and diastolic

Ambivalence

The existence of opposing emotions toward an idea, object, person. ex// A person feels love and hate toward another at the same time

Homans sign

The patient is positioned in supine. The therapist maintains the leg in extension and passively dorsiflexes the patient's foot. A positive test is indicated by pain in the calf and may be indicative of deep vein thrombophlebitis.

Homans' Sign

The patient is positioned in supine. The therapist maintains the leg in extension and passively dorsiflexes the patient's foot. A positive test is indicated by pain in the calf and may be indicative of deep vein thrombophlebitis.

Anterior and Posterior Angles of the Neck

The sternomastoid muscle divides each side of the neck into two triangles. The anterior triangle lies in front, between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its apex down at the suprasternal notch. The posterior triangle is behind the sternomastoid muscle, with the trapezius muscle on the other side and with its base long the clavicle below.

Pneumonocystsis jiroveci (P. carinii) Pneumonia

The virulent form of pneumonia is a protozoal infection associated with AIDS. Common in the US and harmless to most people, except immunocompromised, in whom a diffuse interstitial pneumonitis ensues. Cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid.

Posterior (Dorsal) Columns

These fibers conduct the sensations of postion, vibration and finely localized touch.

Ventricle

Thick-walled muscular pumping chamber

Endocardium

Thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

Pleurae

Thin, slippery, form an envelope between the lungs and the chest wall

Atrium

Thin-walled reservoir for holding blood.

Heritage Consistency

This theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage

Solid Viscera

Those that maintain a characteristic shape - liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus

Term that describes when there is a variable force with each heart beat (sign of heart disease).

Thrady

Palmer grasp

Tight grasp of fingers when object placed ulnar side to baby's hands. Present at birth, strongest at 1-2 months, disappears at 3-4 months. Persistance occurs with frontal lobe lesion.

Obtunded

Transitional state between lethargy and stupor. Sleeps most of the time, difficult to arouse - needs loud or vigorous shake, acts confused when is aroused, converses in monosyllables, speech may be mumbled and incoherent, requires constant stimulation for even marginal cooperation

Schizophrenia

Two or more of the following, each present for a significant part of a 1-month period: 1) delusions 2) hallucinations 3) disorganized speech 4) grossly disorganized or catatonic behavior 5) negative symptoms (affective flattening, alogia, or avolition). One or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to onset of the disturbance. Continuous signs persist for at least 6 months, including 1 month of symptoms from criterion and may include periods of prodromal or residual symptoms

Fixed S2 Split

Unaffected by respiration, split is always there

Ataxia

Uncoordinated or unsteady gait.

Cover test

Uncovered eye does not move when opposite eye is covered. Covered eye does not move as cover is removed.

Trigeminal

What cranial nerve is the Ophthalmic branch?

barrel-chest

a more horizontal position of the ribs and costal angle of more than 90 degrees. This often results from long-standing emphysema

Tactile fremitus

a palpable vibration; sounds generated from the larynx are transmitted through lung parenchyma to the chest wall, where you feel them as vibrations. ("99" test)

Culture

a particular form of stage of civilization, as that of a certain nation or period

Spirituality

a personal effort to find meaning and purpose in life

pustule

a small, elevated skin lesion filled with white blood cells, for example acne

hematoma

a swelling comprised of a mass of extravasated blood (usually clotted) confined to an organ, tissue, or space and caused by a break in a blood vessel

Ballard Scoring system

a system to determine gestational age through neuromuscular and physical assessment tools

rhonchi

a wheezing, snoring sound; indicates partial airway obstruction

decreased fremitus

abnormal vibrations indicating air trapping, pleural effusion, pneumothorax

increased fremitus

abnormal vibrations indicating consolidation or bronchial obstruction

tachypnea

abnormally fast breathing, more than 24 per minute and shallow, may be a normal response to fever, anxiety, or exercise. Can occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy

hypertension

abnormally high blood pressure--more than 140/90

Macrocephaly

abnormally large head

macrosomia

abnormally large size of the body

hypotension

abnormally low blood pressure--less than 120/80

microcephay

abnormally small head

Red tympanic membrane indicates _______

acute otitis media

Adventitious lung sounds

added (abnormal) breath sounds

subcutaneous layer

adipose tissue, which is made up of lobules of fat cells

crepitus

also called subcutaneous emphysema, a crackling sensation that occurs when air passes through fluid

keloid

an exuberant scar that forms at the site of an injury; or incision, and spreads beyond the borders of the original lesion, appears shiny and rubbery

Kussmaul's Sign

an increase in JVP on inspiration signifies heart failure

Goiter

an increase in the size of the thyroid gland and occurs with hyperthyroidism

hyperpnea

an increased respiratory rate that is deeper than that usually experienced during normal activity

primitive reflex

any group of reflexes seen during gestation and infancy that typically become integrated by an early age, seen in adults with neuro injuries

causes of pulsus bisferiens

aortic stenosis with regurg, aortic regurg, hypertrophic subaortic stenosis, hyperthyroid, anxiety, hypertorphic cardiomyopathy

Palpation

applies sense of touch to assess: texture, temperature, moisture, organ location and size, as well as any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain.

murmurs

audible successive sounds with distinct duration as opposed to normal heart sounds. It's produced (audible) when intracardiac energy reaches auditory threshold

Cyanosis

bluish skin due to hypoperfusion, lack of oxygen

exostosis

bony growth

Rhonchi (sonorous rhonchi)

caused by passage of air through an airway obstructed by thick secretions, muscular spasm or new growth. Rumbling or snoring heard. Heard on inspiration or expiration, but usually expiration. Originates in larger airways. Coughing may alter sound or clear it.

Pleural friction rub

caused by rubbing together or inflamed or roughened pleural spaces. Grating sound with the quality of old leather crackling. Heard on inspiration and expiration.

Continuous Murmur

characteristic of patent ductus arteriosus. A pressure gradient exist between the aorta and pulm. artery that causes turbulence across the communication. Will occupy all of systole and diastole, peaks around S2, high frequency. Other causes=aorto-pulm window and arterio-venous fistulas

green or yellow

color of sputum indicating bacterial infection

unclear

color of sputum indicating dehydration

clear

color of sputum indicating hydration or allergic response

white

color of sputum indicating the common cold, viral infections, or bronchitis

pigmentation

coloration of the skin

pitting

common nail disorder that indicates psoriasis

Strabismus

condition in which the eyes are not properly aligned with each other, cross-eyed

lichenification

cutaneous thickening and hardening from continued irritation

causes of small weak pulse

decreased stroke volume! ex. CHF, hypovolemia, severe aortic stenosis. Also with increased peripheral resistance! ex. cold exposure and CHF.

pulmonic ejection click

decreases or disappears with inspiration, increases with expiration. Caused by pulm. stenosis or pulm. a. dilation

systemic venous pressure

dependent on left ventricular contraction, blood volume, capacity of right heart to eject blood into pulmonary arterial system

onycholysis

detachment of nail plate from nailbed

Carotid pulse useful to

detect stenosis or insufficiency of aortic valve, assess amplitude and contour, presence of thrills or bruits

1+

diminished pulse, weaker than expected

Changes of Skin in the Older Adult

epidermis's outer layer thins & flattens, chemicals access body easier-causing wrinkling; loss of elastin, collagen, & subcutaneous fat, & reduction in muscle tone, increase of shearing & tearing injuries; less sebaceous & sweat glands-dry skin

miliaria rubra

eruption of papules and vesicles at the orifices of sweat glands - see redness in skin

hirsutism

excess facial and body hair on women that is dark and coarse

hirsutism

excessive growth of hair

anterior axillary line

extends from the anterior axillary fold along the anterolateral aspect of the thorax

ROM positions

flexion - decreasing angle betwen two adjoining bones; bending of limb (elbow, fingers, knee) extension - increasing angle between two adjoining bones (elbow, fingers, knee) hyperextension - moving a body part beyond its normal resting extended position (head) pronation - front or ventral surface faces downward (hand, forearm) supinaton - front or ventral surface faces upward (hand, forearm) abduction - movement away from midline of body (leg, arm) adduction - movement toward midline of body (leg, arm) internal rotation - rotating a joint inward (knee, hip) external rotation - rotating a joint outward (knee, hip) eversion - turning body part away from midline of body (foot) inversion - turning body part toward midline of body (foot) dorsiflexion - flexion of toes and foot upward plantar flexion - bending of toes and foot downward

Orthopnea

form of dyspnea in which the person can breathe comfortably only when standing or sitting erect (dfficulty breathing lying down)

costal angle

found between the right and left costal margins meeting at the level of the xiphoid process; should be less than 90 degress; greater than 90 degrees indicates emphysema

bell of stethoscope

has a deep, hallow, cuplike shape--for soft low pitched sounds such as extra heart sounds or murmurs

hypotonicity

has little tone and feels flabby

Areas where lymph nodes are palpable

head and neck, arms, axillae, and inguinal region

Presbyopia

health condition where the eye exhibits a progressively diminished ability to focus on near objects with age

ejection sounds

heard best over pulmonic and aortic valves, caused by tension and vibrations against these valves, are of valvular and vascular origin.

S3 or ventricular gallop

heard during rapid ventricular filling, extra sound occurring just after S2... "Ken-tuck-y"

Physiologic S3

heard frequently in children and young adults, occassionaly persists after 40 especially in women. Usually disappears when the person sits up

Rinne Test

hearing test that compares air and bone conduction

Rinne test

hearing test, tuning fork, vibrating air

bronchial

high pitched, loud, harsh or hollow sounding, short during inspiration, long expiration, auscultated on the trachea and thorax

Hyperthermia

high temperature

conjunctivitis

highly contagious infection of the conjunctiva

kyphosis

hunchback, exaggeration of the posterior curvature of the thoracic spine

borborygmi

hyperactive bowel sounds that are loud and growling

JVP high

hypervolemic or high pressure patient

JVP low

hypovolemic patient

Pagpapakasakit

implies a heroic side to suffering, both physical and emotional

Harlequin dyschromia

in newborsn, a remarkable color change appears, with transient cyanosis of one half of the body or of one extremity

asymmetry

in the skin self-examination, the "A" in the ABCDE rule

border

in the skin self-examination, the "B" in the ABCDE rule

color

in the skin self-examination, the "C" in the ABCDE rule

diameter

in the skin self-examination, the "D" in the ABCDE rule

causes of large bounding pulses

inc stroke volume, dec peripheral resistance, fever, anemia, hyperthyroidism, aortic regurg, AV fistulas, PDA, or inc stroke vol due to slow HR such as bradycardia or heart block, stiffness or decreased compliance of aortic walls such as aging or atherosclerosis.

hyperpigmentation

increased color

Diaphoresis

increased moisture, sweaty

cataracts

increased opacity of the lens, blocks light from entering eye

Bulging tympanic membrane indicates _______

increased pressure in otitis media

3+

increased pulse

hyperventilation

increased rate and increased depth, usually occurs with extreme exercise, fear, or anxiety. May also be caused by overdose of salicylate

Egophony

increased resonance of voice sounds heard when auscultating the lungs. Over area of consolidation or compression, the spoken "eee" sound changes to a bleating long "aaaa" sound

hypertonicity

increased tone in muscle which has considerable resistance

A loud S1

indicated hyperdynamic heart (fever, exercise), mitral stenosis, atrial myxoma

A sustained apical impulse

indicates concentric hypertrophy, or dec. compliance.

Soft S1

indicates low CO (HF), severe mitral regurg, Long PR interval

Cellulitis, thrombophlebitis indicated by

inflammation

phlebitis

inflammation of a veins

dermatitis

inflammation of skin

cholecystitis

inflammation of the gallbladder

ototoxicity

injury to the auditory nerve, sometimes by high doses of antibiotics

dermis

inner supportive layer consisting mostly of connective tissue or collagen

Skills for physical examination

inspection, palpation, percussion, and auscultation

pulsus paradoxus

inspiratory decrease in BP/pulse >10mmgHg, caused by cardiac tamponade (when you breath in more the tamponade prevents heart from being able to contract so pulse dec. rather than inc.) or large pulm embolus

opthalmoscope

instrument that inspects parts of the eye

otoscope

instrument used to examine external and middle ear

glaucoma

introcular structual damage resulting from elevated introcular pressure

Dehydration

lack of moisture

strabismus

lack of parallelism of the visual axes of the eyes

rapid rise and fall, peak may be brief

large bounding pulses

bullae

large fluid filled blister

Saphenous

large superficial leg vein (largest vein)

scoliosis

lateral spinal curvature

Ambylopia

lazy eye - loss of one of the eyes ability to see details

Auscultation

listening to sounds produced by the body such as the heart and blood vessels and the lungs and abdomen--use stethoscope

vesicular

low pitched, breezy sounding, soft, long inspiration and short expiration, auscultated over the peripheral lung fields

Hypothermia

low temperature

pursed lip breathing

may be seen in asthma, emphysema, or CHF as a physiologic response to help slow down expiration and keep alveoli open longer

parietal pleura

membrane that lines the chest cavity

visceral pleura

membrane that lines the external surface of the lungs

fontanelle

membranous intervals at the margins of the cranial bones of the infant

Normal nasal mucosa findings

mucosa is deep pink and glistening, turbinates are same color as mucosa & have firm consistency. Nasal septum should not be deviated, perforated or bleeding.

thoracic muslces

muscles that may be tender from exercising

pulsus alternans is a sign of

myocardial weakness

stenosis

narrowing

bronchophony

normal voice sounds heard when auscultating the posterior thorax. These sounds should be muffled. The clarity indicates an abnormality such as fluid.

eupnea

normal, unimpaired respiration

Percussion: Dull

normally heard over dense areas such as the heart or liver

Epistaxis

nose bleed

cranial nerves

olfactory - sense of smell optic - visual acuity oculomotor - extraocular movement of eye trochlear - pupil constriction and dilation, upward and downward movement of eyeballs trigeminal - sensory nerve to skin of face, motor nerve to jaw muscles abducens - lateral movement of eyeballs facial - facial expressions auditory - hearing glossopharyngeal - taste, ability to swallow vagus - sensation of pharynx, movement of vocal cords spinal accessory - movement of head and shoulders hypoglossal - position of tongue

The P's of arterial occlusion

pain, pallor, pulselessness, paresthesias (tingling, pricking, or numbness sensation in skin), and paralysis

Thrills

palpable vibrations on the thorax caused by severe turbulent flow across a major pressure gradient. They are always systolic. Rarely diastolic-only in severe stenosis. A grade 3 or greater murmur.

McEwen's sign

percussion of the skull produces a cracked pot sound in cases of hydrocephalus

Dark oval area/opening on tympanic membrane indicates _______

perforation

Magicoreligious Therapy

premise that the world is seen as an arena in which supernatural forces dominate; the fate of the world and those in it depends on the action of supernatural forces for good or evil. (voodoo, witchcraft)

Stage III

pressure ulcer classification that involves the epidermis, dermis, and subcutaneous tissue. This ulcer resembles a crater. Hidden areas of damage may extend through the subcutaneous tissue beyond the borders of the external lesion but not through the underlying fascia.

Stage IV

pressure ulcer classification that involves the epidermis, dermis, subcutaneous tissue, bone and other support tissues. This ulcer resembles a massive crater with hidden areas of damage in adjacent tissue

Stage II

pressure ulcer classification where skin is broken, and there is superficial skin loss involving the epidermis alone or also the dermis. These lesions resemble a vesicle, erosion, or blister.

Stage I

pressure ulcer classification where the skin is unbroken but appears red; no blanching when pressed.

Apocrine glands

produce a milky secretion and open into the hair follicles with emotional or and sexual stimulation.

Causes of pitting edema from sterling forces

prolonged sitting/standing, CHF, nephrotic syndrome, cirrhosis, malnutrition

hernia

protrusion of abdominal organs through the muscle wall

normal rhythm, normal interval between beats, pulse waves alternate between larger and smaller

pulsus alternans

coupled rhythm (2nd or PVC may have less volume)

pulsus bigeminus

increased arterial pulse with double systolic peak, dicrotic, can be felt with light palpation on the carotid artery

pulsus bisferiens

Closed-Ended Questions

questions that ask for specific information; elicit a short, one-two-word answer, a "yes" or "no," or a forced choice

capillary refill

rate at which blood refills empty capillaries performed by blanching a nail bed by applying pressure for several seconds and then releasing it

Arterial ulcer

red

erythema

red discoloration

Erythema

redness of the skin

hyperemia

redness; excess of blood

atrophied

reduced in size

hypoventilation

reduced rate and depth, irregular breathing pattern that causes an increase of carbon dioxide usually associated with overdose of narcotics or anthetics

mediastinum

refers to a central area in the thoracic cavity that contains the trachea, esophagus, heart, and great vessels

Attitude

relationship of fetal parts to one another

Femoral artery

runs from groin down inner leg

midaxillary line

runs from the apex of the axillae to the level of the 12th rib

posterior axillary line

runs from the posterior axillary fold down the posterolateral aspect of the chest wall

lanula

semilunar, whitish area at base of nail bed

aphasia

sensory (receptive) - person cannot understand written or verbal speech motor (expressive) - understand written or verbal speech but cannot write or speak appropriately when communicating

Air/fluid level or air bubbles behind drum indicates _______

serous otitis media

Yellow-amber tympanic membrane indicates _______

serous otitis media

Normal tympanic membrane appearance

shiny, translucent with pearl-gray color. Cone shaped light reflex is at 5 o'clock position in right ear and 7 o'clock position in left ear.

Current Health or History of Current Illness

short statement about the general state of health; or chronological record of the reason for seeking care, from the first time the symptom first started until now.

Leg Physical Exam

size, symmetry, skin color, pulses (femoral, popliteal, dorsalis pedis, posterior tibial), inguinal lymph nodes, peripheral edema

General Survey

study of the whole person, covering the general health state and any obvious physical characteristics

ecchymosis

superficial bleeding under the skin or mucous membrane; a bruise

adventitious sounds

superimposed sounds over normal sounds. 4 types of adventitious sounds are crackles, rhonchi, wheezes, and pleural friction

distention

swelling

Lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

Otitis externa

swimmers ear- infection of outer ear

murmur

swishing or blowing sounds heard at the beginning, middle, or end of the systolic, or diastolic phase. Those occuring between S1 and S2 are systolic. Those occuring between S2 and S1 and diastolic.

edema

swollen from buildup of fluid

lesser degrees of pulsus alternans my not be palpable, you must

take BP, as the cuff is deflated from high pressure you hear the sounds of the 1st beats as pressure declines the beats DOUBLE

Hepatojugular Reflex

tested by having the pt lie supine, breathing quietly through mouth, and hold your R hand on the upper R quadrant of the person's abdomen. watch the jugular pulsations as you push in with your hand. hold for 30 sec, so the venous blood of the liver is drained and additional volume is added to the venous system. it heart is able to pump this additional blood, the veins will rise for a few seconds, and then recede back to previous level.

capillary refill

tested by pressing the nail tip briefly and watching for color change. A normal finding is the pink tone returns immediately when pressure is released. An abnormal finding is slow (greater than 2 seconds) return of pink tonewith respiratory or cardiovascular diseases that cause hypoxia.

Diabetic retinopathy refers to

the changes that occur in the retina and vasculature of the retina including microaneurysms, hemorrhage, macular edema and retinal exudates

manual compression test

the client has varicose veins perform manual compression to assess competence of the vein valves. Have person stand - firmly compress lower portion of varicose vein with one hand. Place other hand 6-8 inches above first hand. Feel for a pulsation to your fingers in the upper hand. Repeat this test in other leg if varicose veins are also present. You will feel a pulsation with your upper fingers if the valves in the veins are incompetent.

Diastolic Pressure

the elastic recoil, or resting, pressure that the blood exerts constantly between each contraction

sternal angle

the location of the second pair of ribs and is a reference point for counting ribs and intercostal spaces

Systolic Pressure

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

resonance

the percussion tone elicited over normal lung tissue

turgor

the resistance of the skin to deformation

Cisterna chyli

the sac from which the Thoracic duct originates

Desquamation

the shedding of the cuticle in scales or of the outer layer of any surface

fissure

type of secondary skin lesion, linear crack in the skin, may extend to the dermis; athlete's foot and chapped lips

erosion

type of secondary skin lesion, loss of superfical epidermis, does not extend to the dermis, depressed moist area

primary skin lesion

type of skin lesion arising from previously normal skin

secondary skin lesion

type of skin lesion that originates from a primary lesion

Chronic venous insufficiency

ulcers or brownish color

Lung auscultation sound locations: vesicular, bronchial/tubular, bronchovesicular

vesicular: heard over periphery of lung. Bronchial/Tubular: heard over trachea. Bronchovesicular: Heard over mainstream bronchi.

photophobia

when eyes are sensitive to light

Dolichocephay

when the head is longer than expected, relative to the width of the head

apical impulse or point of maximal impulse (PMI)

where the apex touches the anterior chest wall at approximately the fourth or fifth intercostal space just medial to the left midclavicular line

wheezing

whistling sounds heard during difficult breathing such as asthma

Pallor

white skin

Family History

will highlight those diseases and conditions for which a particular patient may be at increased risk.

Paradoxical Splitting of S2

will split on expiration, can indicate aortic stenosis, or left bundle branch block

Jaundice

yellow skin, due to build up of bilirubin

cerumen

yellow, waxy substance usually found in ears

jaundice

yellow-orange discoloration

jaundice

yellowing of body tissues and fluids as a result of excessive levels of bilirubin

Dysphonia

disorder of voice; difficulty or discomfort in talking, with abnormal pitch or volume, due to laryngeal disease. Voice sounds hoarse or whispered, but articulation and language are intact

Clubbing of Nails

early signs are 180 degree flattening at nail base, and nail base feeling spongy to palpation; normal nails have a 160 degree angle at nail base,

3+

edema grading that has an indentation of 5 to 10 mm

Functional Assessment

measures a person's self-care ability in the areas of general physical health or absence of illness; ADL's; instrumental activities of daily living, may organize entire assessment around functional "pattern areas;" supplements health history

Sebaceous gland

microscopic glands in the skin which secrete an oily/waxy matter, called sebum, to lubricate the skin and hair

bronchovesicular

moderate pitched, equal inspiration and expiration, auscultated over the major bronchi

Pulse Oximetry

monitor the saturation of oxygen in a person's blood; sensor attached to a person's finger or earlobe has a diode that emits light and a detector that measures the relative amount of light absorbed by oxyhemoglobin and unoxygenated (reduced) hemoglobin

myopia

nearsightedness, ray of light focuses in front of the retina, can see close up but not distant

retinopathy

noninflammatory eye disorder resulting from changes in the retinal blood vessels. Leading cause of blindness

normal lymph nodes should feel:

nontender, discrete, movable and soft

Tortuosity

normal blood vessel twisting as seen in retinal vessels, normal.

7 to 8 cm

normal diaphragmatic excursion measure for athletes

rebound against closing aortic valve that is normally not palpable

normal dicrotic wave

3 to 5 cm

normal excursion of the diaphragm measure in adults

swift upstroke to peak of syst pressure, gradual decline, secondary smaller upstroke

normal primary wave

pulse contour round and smooth

normal pulse

Changes of the Hair in the Older Adult

number of functioning melanocytes decrease, so hair looks gray or white and feels thin and fine; hair distribution changes--less hair on head, females with facial hair

opening snap sound during diastole

occurs about 40-90mec after S2, has a higher frequency than S3, indicates that valve leaflets are mobile. Causes are mitral or tricuspid stenosis

Temperature

oral sublingual site, rectal temp only when other sites are impractical or unavailable, temperature can also be taken at ear with a tympanic membrane thermometer, normal temp should be 35.8-37.3 C (96.4-99.1F). rectal temp 0.4-0.5C (0.7-1.F) higher.

General Survey of Aging Adult

physical appearance: sharper body contour, more angular features, body proportions are redistributed. Posture: general flexion occurs by 8th or 9th decade. Gait: diminished balance, arms my be held out to help balance, and steps may be shorter or uneven

high pulse pressure found with AORTIC REGURG, HTN, throtoxicosis, and anemia that is especially heard in the femoral artery

pistol shot sound

Blood Pressure Technique

place cuff around arm, palpate brachial artery, place stethoscope, listen for pulse, inflate cuff until sound no longer heard, note mm Hg, deflate cuff, wait 1 min, reinflate 30mm Hg past first inflation, release air and listen for first and last korotkoff

Primigravida

pregnant for the first time

pulse

pressure wave cause by the force of blood pumping and flaring the arterial walls

Gestational age classification

preterm < 37 weeks term 37-42 weeks postterm > 42 weeks Can do NB Ballard scoring if suspect gestational age is incorrectly calculated

pulsus tardus

pulse where you see delayed systolic upstroke as seen in sever stenosis

arterial pressure falls less than 10mm Hg in systolic pressure and fluctuation is almost undetectable on PE

pulsus paradoxus

exudate

pus or clear fluid

anteroposterior diameter of ribs compared to transverse diameter

ratio of 1:2

pulse bispherians

se a double systolic peak. The causes are aortic regur, hyperkinetic stages, obstructive cardiomyopathy

Kusmaul respirations

seen in diabetic pts. Fast, deep, no pauses in between breaths. Get rid of acid build up.

Oblique extraocular muscle moves eye ______&______

side to side & lateral

Suprapubic

Above the public bone

Flight of Ideas

Abrupt change, rapid skipping from topic to topic, practically continous flow of accelerated speech; topics usually have recognizable associations or are plays on words. ex// "Take this pill? This pill is blue. I feel blue. She wore blue velvet"

Hyporeflexia

Absence of a reflex, is a lower motor neuron problem. Occurs with interruption of sensory afferents or destruction of motor efferents and anterior horn cell ex// spinal cord injury.

Analgesia

Absent pain sensation

Signs and Symptoms of Respiratory Problems (Adults)

-labored breathing -nasal flaring -orthopnea -smoking

Use of ___________ muscles is common in patients with increased ______ ___ __________.

Accessory, Work of Breathing

S1

1st heard sound = lub, Occurs with closure of AV valves and signal beginning of systole. Loudest at apex

Afebrile is normal or abnormal?

Normal

Skin Color - Pink, tan, brown, or black.

Normal

Dyspnea when sitting up (easier to breathe when lying down).

Platypnea

Pleural membranes (Lower Respiratory Tract)

Pleura Visceral Pleura Parietal Pleura Pleural fluid

Presbyopia

(age-related condition in which the lens of the eye loses the ability to accommodate. As a result, light is focused behind the retina, and focus near objects becomes difficult

hyperopia

(farsightedness) is also inherited condition in which the eye is shorter than normal

National Standards for Culturally and Linguistically Appropriate Services in Health Care (2001)

"Health care organization should ensure that patients receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language."

Sternum

"breastbone" made up three parts, manubrium, body, and xiphoid process

Ankle-brachial index

(ABI) %= ankle systolic pressure divided by arm systolic pressure. ABI of 90% or less indicates presence of PVD.

Pericardial landmarks

(APE to Man) Aortic, Pulmonic, Erb's point, Tricuspid, Mitral

What causes gynecomastia in men

- Prepubertal stage - Tanner stage 3, gone in 6 months when reach Tanner stage 5 - Steroids, Cimetidine, older antipsychotics (Haldol) - pituitary tumors (also see vision disturbances)

Describe steps in the sports physical

- Routine physical with chief complain, HPI, PMX, Social Hx, Fam Hx, ROS, Head to toe physical exam. - Heart sounds, listen for murmurs - echo if murmur present - Pulmonary: eval for asthma, wheezes - GI: r/o organomegaly: spleen and liver - Musculoskeletal: check muscles and joints of neck, shoulder, elbow, wrist, fingers, scoliosis screen (back), duck walk is good way to assess knee, ankle and hips - Vision: check acuity - Neuro: ? hx concussions, seizures, etc

What issues should be raised before performing a vagourinary and rectal exam

- Sexual activity / sexual orientation - STI's - Protection/birth control - Pregnancy * Exam is important to screen for tumors/ CA or structural abnormalities

Newborn physical tests

- chest auscultations (murmurs, gallops?) - abdominal palpation - inspeact head, face, oral cavity, extremities, genitalia, back, perineum - Holes - check patency of nares, nasopharynx, esophagus and anus - Eval hips for congenital hip displasia Do immediately at birth, 12 hours after (more thorough) and 72 hours after (pedi office)

RED FLAGS FOR BREAST CARCINOMA

- irregular shape - non mobile - non painful - Upper outer quadrant (near axilla) most common - Young women have adenomas - firm, round basses but freely mobile so non malignant - Cysts are tender on PMS period (non malgnant)

Immunizations (Pediatric)

-BCG -Flu Vaccine

Medications (Pediatric)

-Compliant/not compliant

Allergies (Adults)

-Narrows (bronchoconstriction)

Cough Reflex (Function)

-Removes dislodged materials in the windpipe

Olfaction (Function)

-Sense of smell -No sense of taste without olfaction

Describe characteristics of the typical teen

-Underdeveloped frontal lobe - poor decision making/restraint - Image anxiety - Peer/ pop culture influence - Higher risk for risky behaviors (drugs, ETOH) - Potential culture tensions with parents

Palpate: Internal exam

1) digital exam first - LUBRICATE, locate external cervix wall (all the way in the back of vaginal opening) 2) Assess support of vaginal walls - note nodularity or tenderness of vaginal wall 3) Insert speculum - find cervix and os - lock in place. Stretched in multiparous vs nulliparous 4) Wipe discharge from cervical os prn 5) Get specimens: wet prep, cultures, pap 6) Inspect cervix/vagina as remove the speculum 7) Close speculum before removal

Review of Systems

1) evaluates the past and present health state of each body system, 2) double-checks in case any significant data was omitted in the Present Illness section 3) evaluates health promotion practices--lists systems from head to toe

Lymph nodes of head location

1) preauricular 2) postauricular 3) occipital 4) submental 5) submandibular 6) Jugulodigastric (tonsillar) 7) Superficial 8) Deep cervical chain 9) Posterior cervical 10) Supraclavicular

Tetralogy of Fallot

1) right ventricular outflow stenosis 2) VSD 3) right ventricular hypertrophy 4) overriding aorta --> Shunts a lot of venous blood directly into aorta away from pulmonary system so blood never gets oxygenated. On observation, thrill palpable at left lower sternal border, S1 normal, S2 has loud A2 and diminished P2, murmur is systolic, loud, crescendo-decrescendo

Percussion

1) striking or tapping a part of the body 2) type of chest physiotherapy performed by rhythmically striking the chest wall (Least used)

Tonsil size grading

1+ Tonsils are visible, 2+ Tonsils are midway between tonsillar pillars and uvula, 3+ Tonsils touch the uvula, 4+ Tonsils touch eachother

Tips for doing a female genital exam

1st) Have u ever had a pelvic exam before? Always interview pt with clothes on Observe nonverbal cues for anxiety, embarassment, 2) Explain anatomy and show equipment 3) Have pt empty bladder 4) Drape, positioning (arms by side or across chest, move buttocks to edge of bed while legs in stirrups) 5) Explain as you go, warn before touch - give pt control 6) Warm speculum, touch thighs first Metal vs plastic speculum

What's a normal respiratory rate, how many breathes per minute?

12 - 20

What is an absolute normal blood pressure (bp)?

120/80 mm Hg

Nail base angle

160 degrees. 180 degrees or more, known as clubbing, seen in chronic hypoxia. Spoon nails indicate iron deficiency anemia.

Cerebellar System

A complex motor system that coordinates movement, maintains equilibrium, and helps maintain posture. Receives information about the position of muscles and joints, the body's equilibrium, and what kind of motor messages are being sent from the cortex to the muscles.

Upper Motor Neurons

A complex of all the descending motor fibers that can influence or modify the lower motor neurons. Located completely within the CNS. Ex// corticospinal, corticobulbar, and extrapyramidal tracts. Ex of diseases// CVA, cerebral palsy, and multiple sclerosis

Right lymphatic duct

Drains lymph from the right upper quadrant

Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week. 3 or more of the following symptoms 1) inflated self-esteem 2) decreased need for sleep 3) more talkative than usual 4) flight of ideas or subjective experience that thoughts are racing 5) distractibility 6) increase in goal-directed activity or psychomotor agitation 7) excessive involvement in pleasurable activities that have a high potential for painful consequences. Disturbance is severe enough to cause marked impairment in occupational functioning or in usual social activities or relationships with others. Not due to direct physiologic effects of a substance or a general medical condition

Pactus Carinatum

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon brest). Less common than pectus excavatum, this minor deformity requires no treatment. If severe, surgery may be indicated.

Pectus Excavatum

A markedly sunken sternum and adjacent cartilages (also called a funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticable on inspiration. Congenital, usually not symptomatic. When severe, sternal depression may cause embarrassment and a negative self-concept. Surgery may be indicated.

Pleural Friction Rub

A very superficial sound that is coase 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. Caused when pleurae become inflamed and lose their normal lubricating fluid. Their opposing roughened pleural surfaces rub together during respiraion; heard best in anterolateral wall where greatest lung mobility exists. Heard in pleuritis, accompanied by pain with breathing.

Pain

Actual physical sensation of Discomfort

Two Types of Pain

Acute Pain Chronic Pain

Pancreatitis

Acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea and vomiting

Adventitious Sounds

Added sounds that are not normally heard in the lungs. ex// crackles and wheeze

Basal Ganglia

Additional bands of gray matter buried within the two cerebral hemispheres that form the subcortical associated motor system. They control automatic associated movements of the body ex// the arm swing alternating with the legs during walking.

Parturient

About to give birth, in labor

Fingers (Inspection)

AM: Note color and shape of nails. Use Schamroth's sign - evaluate late clubbing, first phalanges of the forefingers together NCF: uniform, pink tones in nail beds, nail bases are concave, create small, diamond-shaped space when first phalanges are opposed SD: early or late clubbing (>180°) in emphysema, chronic bronchitis, lung cancer, chronic heart failure, pale or cyanotic

Color (Inspection)

AM: Observe color of face, lips, and chest NCF: pink SD: cyanosis (oxygen deprivation), blue-bloaters in chronic bronchitis, pink puffers in emphysema; pallor, esp. of lips, nails, and gums

Developmental

Altered Temperaments Higher stomatization Increased behavioral and physiological response to pain Increased Vulnerability to stress disorders Addictive behaviors

Symptoms of pregnancy

Amenorrhea, increased urinary frequency, breast engorgement, nausea/vomiting, tiredness, weight gain, implantation bleeding?

Cultural competence

An ability to interact effectively with people of different cultures

Asthma (reactive airway disease)

An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microorganisms, stress, or exercise that produces a complex response characterized by bronchospasm, and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into airways. Produce airway resistance, especially during expiration.

Kyphosis

An exaggerated posterior curvature of the thoracic spine that causes significant back pain and limited mobility. Sever deformities impair cardiopulmonary function. If the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision. Associated with aging, especially miliar "dowager's hump" of post-menopausal osteoporotic women.

Generalization

An extension of the concept to less specific criteria

Ankle-Brachial Index

Ankle systolic pressure/Arm systolic pressure

Irritability

Annoyed, easily provoked, impatient. ex// internalizes a feeling of tension. mild stimuli "sets them off"

Lateral Reference Lines

Anterior axillary, Midaxillary, and Posterior axillary lines.

Apex Lung Border

Anteriorly, 3-4 cm above the inner third of the clavicles. Posteriorly, location of C7

Oblique Fissure

Anteriorly, crosses the 5th rib in the midaxillary line and terminates at the sixth rib in the midclavicular line.

Agoraphobia

Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack. Situations are avoided, are endured with marked distress or with anxiety about having a panic attack, or require presence of a companion

What respiratory breathing is prolonged, gasping inhalation with short, insufficient exhalation caused by CNS disorder.

Apneustic

What color is haemophilus influenza?

Apple Green

Umbilical

Area around the umbilicus

Precordium

Area on the anterior chest overlying the heart and great vessels

Manubriosternal Angle

Articulation of the manubrium and body of the sternum. Continuous with the second rib.

Nursing Process

Assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

Midsystolic Click

Associated with mitral valve prolapse in which the mitral valve leaflets not only close with contraction but balloon back up into left atrium and create a click. Heard in mid- to late systole and is short and high pitched best heard at apex

____________ is abnormal & signifies a unilateral disorder (atelectasis, pneumothorax, hemothorax, pleural effusion).

Asymmetrical

A wave

Atrial contraction. Contributes +/- 20% to ventricular filling. Not present in atrial fib. Increased with tricupsid stenosis or a dec in right ventricle compliance (RVH)

Alert

Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interpersonal interactions

Nocturia

Awakening at night with an urgent need to urinate. Recumbency at night promotes fluid reabsorption and excretion; this occurs with heart failure in the person who is ambulatory during the day.

Paroxysmal Noctural Dyspnea

Awakening from sleep with SOB and needing to be upright to achieve comfort.

Steps to cultural competence

Awareness, acknowledgment, honest validation, negotiation, action

Horizontal lymph nodes

Drains the lower abdomen, buttocks, external genitalia, anal canal, perianal area, and lower vagina

Skin Malignancies

Basal cell carcinoma - most common in sun-exposed areas. Rolled, scaly border. Slow-growing. Sqamous cell carcinoma - more serious than basal cell. Develops more often on mucosal surfaces. Scaly, ulcerated, or crusty. More aggressive than Basal Cell. Melanoma - deadly. Appears on sun-exposed or non exposed skin. Variegated pigmentation, irregular borders, indistinct margins. Mets easily.

Cerebellum

Coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium, and muscle tone. It does not initiate movements, but coordinates and smooths it ex// the complex and quick coordination of many different muscles needed in playing the piano, swimming, or juggling; the "autopilot" that adjusts and corrects the voluntary movements but operates entirely below the conscious level.

Neologism

Coining a new word; invented word has no real meaning except for the person; may condense several words. ex// "I'll have to turn on my thinkilator."

Chordea Tendineae

Collagenous fibers that anchor valve leaflets to papillary muscles

Atelectasis

Collapsed shrunken section of alveoli, or an entire lung, as a result of 1) airway obstruction, the alveolar air beyond it is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in 2) compression on the lung, and 3) lack of surfactant, hyaline membrane disease

Level of Consciousness - unconsciousness, no response to stimuli, no voluntary movement, loss of reflexes with deep or prolonged coma

Comatose

Central Venous Pressure

CVP, pressure w/i the superior vena cava, reflects the pressure under which the blood is returned to the right atrium

A muscle wasting condition, where malnutrition is commonly seen in patients with chronic lung disease.

Cachetic

Aortic Stenosis

Calcification of aortic valve cusps resticts forward flow of blood during systole; LV hypertrophy develops

Pulmonic Stenosis

Calcification of pulmonic valve restricts forward flow of blood

Stridor

Caused by a foreign body, tumor, or severe bronchospasm. Musical sound of constant pitch that is predominantly inspiratory. Often louder in the neck than over the chest wall.

Emphysema

Caused by destruction of pulmonary connective tissue. Characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. Increased airway resistance especially on expiration producing a hyperinflated lung and increase in lung volume.

What color is normal sputum?

Clear or White

Dysmetria

Clumsy movement with overshooting the mark and occurs with cerebellar disorders or acute alcohol intoxication

Rest Tremor

Coarse and slow; partly or completely disappears with voluntary movement

Crepitus

Coarse crackling sensation palpable over the skin surface. Occurs with subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.

Term referring to severe funnel chest.

Cobblers Disease

v wave

Completed at the end of isovolumetric relaxation. It's atrial filling, increased atrial volume increases the velocity of atrial emptying (y descent)

Coma

Completely unconscious, no response to pain or to any external or internal stimuli, light coma has some reflex activity but no purposeful movement, deep coma has no motor response

Surfactant

Complex lipid substance needed for sustained inflation of the air sacs

Involuntary Rigidity

Constant boardlike hardness of the muscles. Protective mechanism accompanying acute inflammation of the peritoneum. May be unilateral and in the same area, usually becomes painful when the person increases intraabdominal pressure by attempting to sit-up

Immune

Depression of the Immune Response Delay in healing

Hemiplegia

Damage to corticospinal tract. Initially flaccid when lesion is acute, later the muscles become spastic, and abnormal reflexes appear.

Anosmia

Decrease or loss of smell occurs bilaterally with tobacco smoking, allergic rhinitis, and cocaine use

Flaccidity

Decreased muscle tone or hypotonia; muscle feels limp, soft, and flabby; muscle is weak and easily fatigued. Associated with lower motor neuron injury, early CVA and spinal cord injury

Hypoalgesia

Decreased pain sensation

Hypoesthesia

Decreased touch sensation

Hyperventilation

Deep rapid breathing

Parkinsonism

Defect of extrapyramidal tracts, in the region of the basal ganglia, with loss of the neurotransmitter dopamine. Classic triad of symptoms: tremor, rigidity, akinesia. Also slower monotonous speech and diminutive writing. Body tends to stay immobile, facial expression is flat, staring, expressionless. Excessive salivation occurs; reduced eye blinking. Posture is stooped, equilibrium is impaired.

Ischemia

Deficient supply of oxygenated arterial blood.

Level of Consciousness - easily agitated, irritable, hallucinations

Delirious

P wave

Depolarization of atria

QRS complex

Depolarization of the ventricles

Dysphagia

Difficulty swallowing, occurs with disorders of the throat or esophagus

Dysphasia

Difficulty with language comprehension or expression

Gastroenteritis

Diffuse, generalized, abdominal pain, with nausea, diarrhea

What condition has abnormal thickening of the ends of fingers and/or toes, and commonly seen in patients with COPD, lung cancer, and sarcoidosis?

Digital Clubbing

Raynaud's disease indicated by

Digital blanching followed by cyanosis, rubor with cold exposure

Lower Respiratory Tract

Distal portion of Trachea Bronchi Lungs Pleural membranes Muscles of respiration Mediastinum

Pelvic Outlet

Distance between ischial tuberosities, estimates the shape of the subpubic arch. It's measured as part of the obstetric exam. > 8 cm adequate for birth

Diagnoal conjugage

Distance from the inferior border of the symphysis pubis to the sacral promontory. The measurement, which averages around 12.5 to 13.0 cm in adult women, may also be determined by vaginal examination. Done as part of the obstetric exam, > 10 cm is adequate for live birth

Delirium Disorder

Disturbance of consciousness, change in cognition, acute. Related to general medical condition or substance-induced.

Six cardinal positions of gaze

Elicits any muscle weakness during movement. Have client follow finger using only eyes.

Right Lymphatic Duct

Empties into the right subclavian vein. Drains the right side of the head and neck, right arm, right side of thorax, right lung and pleura, right side of the heart, and right upper section of the liver

Presystole (atrial kick)

End of diastole, atria contract and push last amount of blood (25% of CO) into the ventricles

Percussion: Flat

Heard over bones

Term associated with chest pain and dyspnea with purulent (puss-like), blood streaked severe coughing.

Hemoptysis

Opening Snap

In the presence of stenosis, increasily higher atrial pressure is required to open the valve and creates a noise. Sharp and high pitched with snapping quality after S2 at the third or forth interspace at the sternal border.

Dysmetria

Inability to control range of motion of muscles

Astereognosis

Inability to identify object correctly. Occurs in sensory cortex lesions ex// brain attack (stroke)

Extrapyramidal Tracts

Include all the motor nerve fibers originating in the motor cortex, basal ganglia, brain stem, and the spinal cord that are outside the pyramidal tract. Lower, more primative motor system. Maintain muscle tone and control body movements, especially gross automatic movements such as walking.

Central Nervous System

Includes the brain and spinal cord

Tuberculosis

Inhalation of tubercle bacilli into the alveloar wall starts 1) initial complex is acute inflammatory response - macrophages engulf bacilli but do not kill them. Tubercle forms around bacilli 2) scar tissue forms, lesion calcifies and shows on x-ray 3) reactivation of previously healed lesion. Dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue 4) extensive destruction as lesion erodes into bronchus, forming air-filled cavity. Apex usually has the most damage

Precentral Gyrus of the Frontal Lobe

Initiates voluntary movement.

Skills of Physical Assessment

Inspection, Palpation, Percussion, Auscultation, and Olfaction. Abdominal Examination - Inspection, Auscultation, and Palpation

Breathing

Inspiration and Expiration

Assisting the Narrative during Interview

Interviewers reaction to the patient: Facilitation, silence, reflection, empathy, clarification Interviewers thoughts and feelings: confrontation, interpretation, explanation, and summary

paralytic ileus

Intestinal obstruction is a partial or complete blockage of the bowel

Americans with disability Act

Investigates violations of the ADA submitted to him, submits a report with written methods of accomodations that are suggested. Compliance Officer is responsible for ensuring that all programs, services, and activities provided by an organization are accessible to people with disabilities. The ADA Compliance Officer also assists architects, developers, business owners, landlords and others in designing or redesigning their facilities so that they are usable by all persons, including those with disabilities.

Tremor

Involuntary contraction of opposing muscle groups. Results in rhythmic, back-and-forth movement of one or more joints. May occur at rest or with voluntary movement. All disappear while sleeping

What is a respiratory breathing with an increased rate & depth? Can be caused by diabetic ketoacidosis (due to renal failure), or metabolic acidosis.

Kussmauls

Term used to describe a lateral curvature combined with A-P curvature of the spine. It may cause severe restrictive lung defect

Kyphoscoliosis

Term that describes exaggerated curvature of the upper portion of the spine (hunchback/humpback).

Kyphosis

Resonant (Percussion Sounds)

L: (air-filled tissue) all of lung field C: Loud, low-pitched, hollow tone of long duration, normal finding over lungs

Dull (Percussion Sounds)

L: (solid or fluid filled tissue) heart, liver C: high-pitched tone that is soft and of short duration

Bronchovesicular (Breath Sounds)

L: SB between scapula, audible below clavicles C: sounds of inspiration and expiration are equally long

Tympanic (Percussion Sounds)

L: Stomach C: Loud, high-pitched, drum-like tones of medium duration; characteristic of an organ filled with air

Flat (Percussion Sounds)

L: large muscles, viscera, bones C: high-pitched, very soft, and very short duration

Tracheal (Breath Sounds)

L: over trachea C: high-pitched, loud, harsh, and hollow sounding, with inspiration and expiration of equal duration

Spinal Cord

Long cylindrical structure of nervous tissue about as big as the little finger. Occupies the upper 2/3 of the vertebral canal from the medulla to lumber vertebrae L1-L2.

Term that describes an exaggerated curvature of the lower spine.

Lordosis

Anorexia

Loss of appetite that occurs with gastrointestinal disease, a side effect of some medications, with pregnancy, or with psychological disorders

Geriatric changes

Loss of high - frequency hearing Gradual hearing loss Decreased sense of taste and smell Decreased production of saliva Receding gums Tooth loss

Depersonalization

Loss of identity, feels estranged, perplexed about own identity and meaning of existence. ex// "I don't feel real"

Paralysis

Loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation

Peripheral Neuropathy

Loss of sensation involves all modalities. Loss is most severe distally, response improves as stimulus is moved proximally. Caused by diabetes, chronic alcoholism, nutritional deficiency

Resonance

Low-pitched, clear, hallow sound that predominates in healthy lung tissue in the adult

Dementia

Memory impairment and one or more of the following: Aphasia, Apraxia, Agnosia, Disturbance in executive functioning. Must be sufficiently sever to cause impairment in occupational or social functioning. Commonly caused by Alzheimer's, cerebrovascular disease, HIV, head trauma, Parkinson's disease, and others.

Anterior Reference Lines

Midsternal, Midclavicular, and Anterior axillary lines

Hepatits

Mild to moderate, dull pain in RUQ or epigastrum along with anorexia, nausea, malaise, low-grade fever

Global Aphasia

Most common and severe form. Spontaneous speech is absent or reduced to a few stereotyped words or sounds. Comprehension is absent or reduced to only the person's own name and a few select words. Repetition, reading, and writing are severely impaired. Prognosis for language recovery is poor. Caused by large lesion that damages most of combined anterior or posterior language areas.

Myocardium

Muscular wall of the heart, does the pumping

Diaphragmatic Excursion (Percussion)

NCF: 3 to 5 cm or up to 7 or 8 cm client. Right side may be 1-2 cm higher because of location of liver SD: low position on inspiration and expiration (atelectasis, ascites, or pregnancy) decreased in pleural effusion and emphysema

Lips (Inspection)

NCF: no effort in breathing, relaxed, pink SD: mouth breathing, pursing, cyanosis

Nose (Inspection)

NCF: no flaring SD: flaring noses

Continued tissue deoxygenation may lead to ___________.

Necrosis

Left Ventricular Hypertrophy

Pressure overload from thickening of LV myocardium, increases force and duration of apical impulse but no change in location

Occipital Lobe

Primary visual receptor center

Evaluation

Progress toward outcomes Conduct systematic, ongoing, criterion-based evaluation Include patient and significant others Use ongoing assessment to revise diagnoses, outcomes and plan Disseminate results to patient and family

Respiratory breathing with acute upper airway obstruction (croup, epiglottis, or foreign body aspiration).

Prolonged Inhalation

Venous obstruction indicated by

Prominent veins in an edematous arm

Kidney Stones

Prompt a sudden onset of severe, colicky flank or lower abdominal pain

Lymphedema

Protein-rich lymph builds up in the interstitial spaces, which further raises local colloid oncotic pressure and promotes more fluid leakage. Caused by removal or damage of lymph nodes which impede drainage of lymph.

PQRSTU

Provocative/Palliative-what brings it on? Quality/Quantity-how does it look, feel, sound? Region/Radiation-where is it? Severity Scale-how bad? Timing-onset Understand Patient's Perception-what do you think it means?

Using otoscope: ear positioning

Pull pinna up and back on an adult and older child. Pull pinna down on an infant and child under 3. Don't release traction on ear until examination is finished and otoscope removed.

Sigh

Punctuate the normal breathing pattern and are purposeful to expand alveoli. Frequency may indicate emotional dysfunction, and may lead to hyperventilation and dizziness.

Visceral (organic) Reflexes

Pupillary response to light and accommodation

PERRLA

Pupils Equal Round Reactive to Light & Accommodation. Normal pupil size 3-5mm. Accommodation: proper focusing, Pupils converge and constrict as object moves toward the nose; pupil responses are uniform.

PERRLA

Pupils Equal, Round, and Reactive to Light and Accomodation

Inspection

Purposeful observation (Most used, examining particular body parts, looking for specific normal and abnormal characteristics)

Term used to describe when a patient inhales through nose & exhales against pursed lips to prevent premature airway closure, allowing patient to exhale more fully & maintain better gas exchange.

Pursed-lipped Breathing

Skin Lesion: Excoriation

Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching, ie: insect bites, scabies, dermatitis, varicella

Coarctation of the Aorta

Severe narrowing of descending aorta, usually at the junction of the ductus arteriosus and the aortic arch, just distal to the origin of the left subclavian artery. Results in increased work load on left ventricle. Associated with defects of aortic valve in most cases, as well as associated ventricular septal defect. On observation, upper extremity hypertension over 20mmHg higher than lower extremity measures. Absent or greatly diminished femoral pulses. Systolic murmur heard best at the left sternal border, radiating to the back

Hollow Viscera

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

Irritable Bowel Syndrome

Sharp, burning, cramping pain over a wide area that does not radiate, brought on by meals, relieved with bowel movement

Drape

Sheet of soft cloth or paper ( warn when assessment takes place while clients are naked or have minimal clothing on)

Loosening Associations

Shifting from one topic to an unrelated topic; person seems unaware that topics are unconnected. ex// "My boss is angry with me and it wasn't even my fault. I saw that movie too. She kept trying to land the airplane and she never knew what was going on."

Atelectatic Crackles

Short popping crackling sounds that sound like fine crackles but do not last beyond a few breaths. Heard only in the periphery, usually in dependent portions of the lungs, and disappear after the first few breaths or after a cough. Not pathologic.

Ductus Arteriosus

Shunt through pulmonary artery into aorta

Visual Acuity test: near vision

Similar to Snellen except use a Jaeger card, hold 14 inches from eye.

Dysdiadochokinesia

Slow, clumsy, and sloppy response during RAM test, occurs with cerebellar disease

Athetosis

Slow, twisting, writhing, continuous movement, resembling a snake or worm. Involves distal part of limb more than the proximal part. Occurs with cerebral palsy.

Lymph Nodes

Small oval clumps of lymphatic tissue located at intervals along the vessel. Filter the fluid before it is returned to the bloodstream and filter out microorganisms that could be harmful to the body. Pathogens are then exposed to lymphocytes.

Lanugo

Soft, fine lightly pigmented fetal hair

Umbilical Hernia

Soft, skin-covered mass which is the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical area

CN XI

Spinal, Motor, Movt of trapezius and sternocleidomastoid muscles.

Left Upper Quadrant (LUQ)

Stomach, spleen, left lobe of pancreas, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon

Mitral Regurgitation

Stream of blood regurgitates back into LA during systole through incompetent mitral valve. In diastole, blood passes back into LV again along with new flow results in LV dilation and hypertrophy

Aortic Regurgitation

Stream of blood regurgitates back through incompetent aortic valve into LV during diastole. LV dilation and hypertrophy due to increase LV stroke volume. Rapid ejection of large stroke volume into poorly filled aorta, then rapid runoff in diastole as part of blood pushed back into LV

What condition is the first sign of hypoxemia & has a heart rate greater than 100/min?

Tachycardia

Signs of decreased oxygen to the brain are ____________, ___________, and __________.

Tachyphylaxis, Disoriented, Cyanotic

Elements to include in breast palpation

Tenderness Nodules/Masses (fixed, movable, hard vs soft) discharge from nipple Consistency Elasticity Nipple and areaola compression too Nodes: axillary, subclavicular and infraclavicular

Palpation (Steps)

Tenderness and sensation Surface Characteristics Thorax Tactile (or vocal) fremitus Anterior excursion/expansion Posterior excursion/expansion

Consolidation (concept)

The normal non-diseased lung is a porous structure of solid and air that is constantly undergoing change in density. Normal lung tissue does not conduct sound as well as the consolidated tissue does. Pneumonia changes lung tissue from porous to solid and conducts sounds through it much more clearly; this is consolidation.

Medulla

The continuation of the spinal cord in the brain that contains all ascending and descending fiber tracts connecting the brain and spinal cord. It has vital autonomic centers as well as nuclei for cranial nerves VIII thru XII. Pyramidal decussation occurs here.

Head, Face, and Neck Changes in the Aging Adult

The facial bones and orbits appear more prominent, and the facial skin sags as a result of decreased elasticity, decreased subcutaneous fat, and decreased moisture in the skin. The lower face may look smaller if teeth have been lost.

Intensity of a murmur is influenced by

The flow per beat across the valve determined by pressure gradient across valve and flow. and The duration of the cardiac cycle: Faster HR's shorten diastole and not systole and inc. the intesity of the murmur of something like mitral stenosis.

Vitiligo

a condition in which the skin turns white due to the loss of melanocytes

Allen test

The patient is positioned in sitting or standing. The patient is asked to open and close the hand several times in succession and then maintain the hand in a closed position. The therapist compress the radial and ulnar arteries. The patient is then asked to relax the hand and the therapist releases pressure on one of the arteries while observing the color of the hand and fingers. A positive test is indicated by delayed or absent flushing of the radial or ulnar half of the hand; may be indicative of an occlusion in the radial or ulnar artery.

Acculturation

The process of cultural and psychological change that results following meeting between cultures

Orientation - Patient knows date, day of week, & time of day.

Time

Inferior Border of the Scapula

Tip located around 7th or eighth rib, symmetrically in each hemithorax

Plantar grasp

Toes curl down tightly when thumb placed at ball of baby's foot. Present at birth, disappears at 8-10 months.

Pericardium

Tough, fibrous, double-walled sac that surrounds and protects the heart. Contain pericardial fluid

Tension Pneumothorax

Trapped air in pleural space increases, compressing lung and shifting mediastinum to the unaffected side

CN IV

Trochlear, Motor, Down and inward movt of eye

Cogwheel Rigidity

Type of rigidity in which the increased tone is released by degrees during passive range of motion so it feels like small regular jerks. Associated with Parkinsonism

suprasternal notch

U-shaped indention located on the superior border of the manubrium

Evaluation of sensorium is helpful in determining patient's ability to __________, _________ _________, and for Respiratory Therapists to determine the _______ needed.

Understand, Follow Directions, Care

Pulmonary Embolism

Undissolved materials (thrombus, air bubbles, fat globules) originating in legs or pelvis, detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels. Over 95% arise from deep vein thrombi in lower legs as a result of stasis of blood, vessel injury, or hypercoagulation. Pulmonary occlusion results in ischemia of downstream lung tissue, increased pulmonary artery pressure, decreased cardiac output, and hypoxia. Rarely a saddle embolus in bifurcation of pulmonary arteries leads to sudden death from hypoxia. More often, small to medium pulmonary branches occlude, leading to dyspnea, may resolve by fibrolytic activity.

Neurogenic Anosmia

Unilateral loss of smell in the absence of nasal disease

tenting

a delay in the return of pinched skin to a flat position

macule

a flat spot on the skin whose color may be lighter or darker than the surround skin; common examples are freckles, petechiae, and vitiligo

Compulsion

Unwanted repetitive, purposeful act; driven to do it; behavior thought to neutralize or prevent discomfort or some dreaded event. ex// hand washing, counting, checking and rechecking.

Obsession

Unwanted, persistent thoughts or impulses, logic will not purge them from consciousness, experienced as intrusive and senseless. ex// Contamination - becoming infected by shaking hands

Decorticate Rigidity

Upper extremities - flexion of arm, wrist and fingers; adduction of arms. Lower extremities - extension, internal rotation, plantar flexion. Indicates hemispheric lesion of cerebral cortex

Decerebrate Rigidity

Upper extremities - stiffly extended, adducted, internal rotation, palms pronated. Lower extremities - stiffly extended, plantar flexion, teeth clenched, hyperextended back. Indicates lesion of brain stem at midbrain or upper pons.

Visual Acuity test: Distance

Use Snellen Chart. Person stands 20 ft away , reads chart to smallest line able to read completely. Record result using numeric fraction: numerator is distance person standing from chart, denominator is distance at which a normal eye could have read that particular line. Variations used for those who cannot read (E chart, Allen chart using symbols)

pectus carinatum

a forward protrusion of the sternum causing adjacent ribs to slope backward

Hegar's sign

Uterine consistency is softer allowing the connection between the cervix and fundus to be palpated or compressed - probable sign of pregnancy

CN X

Vagus, Mixed, Motor: Pharynx and larynx (talking and swallowing), Sensory: general sensation from carotid body, carotid sinus, pharynx, viscera, PNS: carotid reflex

Incompetent Valves

Valve cusps cannot approximate because the vein lumens are so wide. Seen in varicose veins

S4 (forth heart sound)

Ventricular filling sound occurs when the atria contract late in diastole, heard immediately before S1. Very soft, low pitch, may be physiologic in older adults after exercise or pathologic when occuring with decreased compliance of ventricles and high systolic overload, including outflow obstruction to the ventricle and systemic hypertension

edema

a local or generalized condition in which body tissues contain excessive amounts of fluid

Left Ventricular Dilation

Volume overload in systemic circulation, displaces apical impulse down and to the left and increases size to more than one space

pectus excavation

a markedly sunken sternum and adjacent cartilages. It is a congential malformation that seldom causes symptoms other than self-consciousness

Trigeminal; Ophthalmic

What is the name and branch of the nerve are you doing an assessment on if while client looks upward, lightly touch the lateral sclera of the eye with sterile gauze to elicit blink reflex. To test light sensation, have client close eyes, wipe a wisp of cotton over client's forehead and paranasal sinuses. To test deep sensation, use alternation blunt and sharp ends of a safety pin over same areas?

trigeminal; mandibular

What is the name and branch of the nerve are you doing an assessment on if you ask client to clench teeth?

trigeminal; maxillary

What is the name and branch of the nerve are you doing an assessment on if you assess skin sensation as for the ophthalmic branch?

Olfactory

What is the name of the nerve are you doing an assessment on if you ask the client to close eyes and identify different mild aromas, such as coffee, vanilla, peanut butter, orange/lemon, chocolate?

Optic

What is the name of the nerve you are doing an assessment on if you ask the client to read Snellen-type chart; check visual fields by confrontation; and condust an opthalmoscopic examination?

Trochlear

Which cranial nerve function is EOM, specifically moves eyeball downward and laterally?

Oculomotor

Which cranial nerve function is extraocular eye movement (EOM); movement of sphincter of pupil; movement of ciliary muscles of lens?

Olfactory

Which cranial nerve function is smell?

Optic

Which cranial nerve function is vision and visual fields?

Olfactory

Which cranial nerve is I?

Optic

Which cranial nerve is II?

Oculomotor

Which cranial nerve is III?

Trochlear

Which cranial nerve is IV?

Trigeminal

Which cranial nerve is V?

III

Which cranial nerve is the Oculomotor?

V

Which cranial nerve is the Trigeminal?

IV

Which cranial nerve is the Trochlear?

mandibular

Which trigeminal branch function is muscles of mastication; sensation of skin of face?

maxillary

Which trigeminal branch function is sensation of face and anterior oral cavity (tongue and teeth)?

Ophthalmic

Which trigeminal branch function is sensation of the cornea, skin of face, and nasal mucosa?

Hearing tests

Whisper test, Weber test, Rinne test

Proprioception

Without looing, you know where your body parts are in space and in relation to each other.

Stereognosis (Finely Localized touch)

Without looking, you can identify familiar objects by touch.

Clanging

Word choice based on sound, not meaning. Includes nonsense rhymes and puns. ex// "My feet are cold. Cold, bold, told. The bell tolled for me."

"WOB" is an abbreviation for what phrase?

Work of Breathing

Anxiety

Worried, uneasy, apprehensive from the anticipation of danger whose source is unknown. ex// "I feel nervous and high strung"

Fear

Worried, uneasy, apprehensive; external danger is known and identified. ex// Fear of flying in airplanes

What color is a new infection?

Yellowish

nevi

a birthmark or mole; a congenital discoloration of a circumscribed area of the skin due to pigmentation

cyanosis

a blue, gray, slate or dark purple discoloration of the skin or mucous membranes caused by deoxygenation or reduced hemoglobin in the blood

cyanosis

a bluish or purplish discoloration due to deficient oxygenation of the blood

Isometric Contraction

a brief moment when all 4 valves are closed, the ventricle walls begin to contract, and the system works to build pressure inside the ventricles to a high level.

pneumothorax

a collection of air or gas in the pleural cavity

rust

color of sputum indicating TB pneumonia

Cross- cultural

combining, pertaining to or contrasting 2 or more cultures or cultural groups

paronychia

common nail disorder that indicates a local infection

beau's lines

common nail disorder that indicates an acute illness

early clubbing

common nail disorder that indicates an oxygen deficiency, nail is 180 degrees

spoon nails

common nail disorder that indicates deficiency anemia

late clubbing

common nail disorder that indicates oxygen deficiency, over 180 degrees

GERD

complex of symptoms of esophagitis, including burning pain in midepigastrum or behind lower sternum that radiates upward. Occurs 30-60 minutes after eating, aggrevated by lying down or bending over.

Blood flow generated by _________

contracting skeletal muscle, pressure gradient caused by breathing and intraluminal valves.

torticollis

contraction often spasmodic of the neck muscles

Respiratory Technique

count respirations for a full 30 seconds or a full minute if abnormalities are suspected; constant ratio of pulse to rate is 4:1, for adults normal rate is 10-20

crepitus

crackling sounds

strabismus

crossing of eyes

Term used to describe holding the abdomen due to pain?

Splinting

_________ is a helpful aid during deep breathing or coughing especially following surgery.

Splinting

pulse deficit

difference between the radial (or other periphery pulse) and the apicle pulse

Myocardial infarction

Decrease in perfusion to tissue. Causes chest pain due to decrease in blood flow, jaw pain, arm pain.

Pulse Pressure

difference between the systolic and diastolic pressures and reflects the stroke volume (subtract diastolic from systolic)

Dysphasia

difficulty speaking

Probable signs of pregnancy

* All related to enlargement of uterus - Piskacek's sign (one cornua of uterus enlarges slightly) - Hegar's sign (softer uterus and cervix) - palpable uterine contractions - mapping of fetal outline on palpation

Dysphagia

difficulty swallowing

Varicose veins

dilated and tortuous veins due to incompetent valves.

hemorrhoids

dilated veins that appear as reddened protrustions

Pulse findings in arterial occlusion from atherosclerosis or embolism

diminished pulses

acromegaly

disorder caused by excessive growth hormone causing enlarged jaws and facial bones

peritonitis

inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

neoplasm

lump, growth, or tumor

Radial artery

main blood vessel of lateral aspect of forearm, lies over radius.

Ulnar artery

main blood vessel of medial aspect of forearm, lies over ulna.

Brachial Artery

major blood vessel of upper arm

Guiding Principles

1) client's self report of pain 2) searches for potential causes of pain/discomfort 3) observation of client behaviors 4) surrogate reporting of pain ( e.g. family, caregiver) 5) Attempt at analgesic trial (medical trial) 6) Changes in Vital Signs

Functions of lymphatic system

1) conserve fluid and plasma proteins that leak out of capillaries. 2) Defend body against disease. 3) Absorb liquids from the intestinal tract

Position (Inspection)

AM: Observe client's position. NOTE: posture and ability to support weight. Compare heights of two shoulders (gives hint of shape of spine) NCF: sitting and relaxed, breathing easily with arms on sides or lap SD: tripod position (leans forward and uses arms to support weight to increase breathing capacity)

Clavicles, sternum, costal angle (Inspection)

AM: Observe sternum from anterior and lateral view NCF: Clavicles - same height. Sternum - midline and straight. Costal angle - <90 degrees. SD: Sternal retractions

Baby stool :)

1st stool - meconium: black, tarry, sticky (colostrum has laxative effect) Transitional stools - loose/ green Breasfed baby stools - yellow/curdly, sweet smelling

Respirations (Inspection)

AM: Rate, depth, rhythm, and pattern NCF: unlabored, 12-20 breaths/min. symmetrical expansion. Women, thoracic. Men, abdominal. Inspire<expire. Older client increase in resp. SD: shallow, labored, gasping, bradypnea, nasal flaring, use of accessory muscles, hyperpnea (sighing)

Thorax (Palpation)

AM: Stand behind client. NOTE: tenderness, motion, pulsation, and crepitus NCF: symmetrical, firm shape, elastic motion, no pulsations or crepitations SD: Pain, tenderness, crepitus, friction rub, kyphosis, scoliosis

Posterior excursion/expansion (Palpation)

AM: Stand behind client. Warm hands. Place thumbs at 10th spinal rib T₁₀. NCF: symmetrical expansion, 1¼ - 2 inches. decreased in older though symmetric SD: <2 in.

Tenderness and sensation (Palpation)

AM: Start forward at midline level of left scapula. (Ladder) NCF: No tenderness, pain, or unusual sensation. Temperature should be equal bilaterally SD: Tenderness or painful areas, muscle soreness, decreased warmth, and crepitus

Anterior excursion/expansion (Palpation)

AM: Warm hands. Place palms of both hands on lower thorax (T₉, T₁₀) Pinch some skin between thumbs. Instruct client to take deep breath NCF: smooth and even, full, thumbs separate 3 to 5 cm. decreased in older client but still symmetric SD: asymmetrical expansion, decreased respiratory excursion

Myopia

(nearsightedness) inherited and occurs with the eye is longer than normal

Pitting edema scale

+1= mild pitting, slight indentation, no perceptible leg swelling. +2= moderate pitting, indentation subsides rapidly. +3= deep pitting, indentation remains a short time, leg looks swollen. +4= very deep pitting, indentation lasts a long time, leg is very swollen.

IPPA - Inspect: External Exam

- Assess Tanner stage - Find mons pubis, labia majora, perineum, labia minora, clitoris - retract hood of clitoris, urethral meatus and vaginal opening - palpate any lessions - if swelling or hx gonorrhea: check Bartholin's glands - If PMX, milk Skene's glands (aka female prostate - paraurethral location) - Culture any vaginal, gland discharge

Clinical Pelvimetry

- Measure lower border of the pubis to sacral promotory - Assess curvature of the anterior surface of the sacrum - Determine if the ischial spines (aka pelvic side walls) are parallel - Assess pelvic outlet - place a fist between the iscial tuberosities - Measure pubic arch

Challenges for the patient with disabilities

- social isolation, potential social rejection - multiple comorbidities, fragile health - High needs: extensive services and coordination of care involved - Higher risk for substance abuse, sedentary lifestyle - Less options for work, recreation - esp. in rural areas - High cost of medical care --> lower discretionary income

Hypoventilation (Respiratory Patterns)

-decreased rate & depth & irregular pattern of respiration

Bradypnea (Respiratory Patterns)

-decreased regular respirations (<10 breaths/minute in adults)

Hyperpnea (Respiratory Patterns)

-deeper-than-normal respirations at normal rate

Abdominal Wall (Muscles of Respiration)

-drive intra-abdominal pressure up when they contract, pushing the diaphragm, raising pleural pressure and driving air out

Kussmaul's respirations (Respiratory Patterns)

-faster and deeper than normal respirations without pauses -over 20 breaths/minute in adults -breathing sounds labored with deep breaths that resemble sighs

Cheyne-Stokes respirations (Respiratory Patterns)

-faster and deeper than normal respirations, followed by slower respirations, over a 30 to 170 second period -alternates with period of apnea lasting 20-60 seconds -may be noted in older client during sleep

Thoracic Cavity

-first 7 pairs of ribs attach to sternum or breastbone by cartilage -5 do not attach -8th, 9th, and 10th are attached to each other by costal cartilage -11th and 12th "floating ribs"

Immunization (Gerontologic)

-has a lifetime effect

Tachypnea (Respiratory Patterns)

-increased regular respirations (>20 breaths/minute in adults) - fever +4 breaths/minute for each ℉ increase above normal

Carina

-last tracheal cartilage -separates openings of the two main bronchi -lined with mucous-producing membrane -most sensitive to foreign objects -has coughing and cilia (help sweep debris toward the mouth for removal

Frothy (Sputum)

-light and aerated, contains bubbles

Trachea (Lower Respiratory Tract)

-located in the mediastinum -10 to 12 cm (4 in) long and 2.5 cm (1 in) in diameter -T₃ to T₅ -16 to 20 rings of hyaline -C-shaped rings maintain shape of trachea

Friction rub (Adventitious Breath Sounds)

-repeated non-musical sounds of short duration and low frequency similar to creaking of leather P: superficial grating or creaking sounds heard during inspiration and expiration, heard often in areas of great thoracic expansion, not relieved by coughing C: rubbing together of inflamed pleural surfaces

Pleura

-thin membrane which invests the lungs and lines the walls of thoracic cavity

Diminished S2

1) A fall in systemic blood pressure causes a decrease in valve strength ex// shock 2) Semilunar valves thickened and calcified, with decreased mobility ex// aortic or pulmonic stenosis

Describe techniques to handle a difficult patient

1) Communication - listen, elicit a hx, express empathy, give info, reassure 2) Procedures: Be at eye level, be quiet, non verbal communication, open ended questions, summarize 3) Build rapport: culture, language, emotions 4) Approach: recognize feelings, reflect, identify and obtain confirmation * Validate the patient

Functions of the Lymphatic System

1) Conserve fluid and plasma proteins that leak out of the capillaries 2) Form a major part of the immune system that defends the body against disease 3) Absorb lipids from the intestinal tract

List and describe the developmental tasks of adolescents

1) Early adoles (10-14 y.o): Physical puberty onset is variable, Cognitive: better understanding of mental operations, begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts. Social: identity and independence 2) Middle teens (15-16 yo): Physical body: females more comfortable, males still awkward. Congitive - transition, Social: identity and idependence 3) Late teens (17-20 yo): Adult apperance, Cognitive: formal operational: develop the ability to think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage. Social: identity and idependence

Accentuated S2

1) Higher closing pressure ex// systemic hypertension 2) Exercise and excitement increase pressure in aorta 3) Pulmonary hypertension ex// mitral stenosis, heart failure 4) Semilunar valves calcified but still mobile ex// aortic or pulmonic stenosis

Chronic Pain

1) Mild to Severe 2) Parasympathetic Response: VS Normal 3) Skin is warm and dry 4) Pupils normal or dilated 5) Continues beyond healing 6) Depressed, withdrawn, no mention of pain 7) Disrupted social relationships and activities 8) Pain Behavior may be absent -but may also exhibit weight and sleep pattern changes

Acute Pain

1) Mild to Severe 2) Sympathetic Response: Increased PR, RR, BP, diaphroresis, dilated pupils BP= ≥15% from baseline PR= ≥15% from baseline RR= >20% from baseline 3) Decrease (<) of 5% or greater in O2 concentration 4) Restless, anxious, reports pain 5) crying, rubbing/holding area Others: fear, nausea/vomiting, immobility, impaired verbal communications

Function of Respiratory System

1) Olfaction 2) Cough Reflex 3) Gas Transport

Loud (accentuated) S1

1) Position of AV valve at start of systole is wide open and no time to drift together ex// increased blood velocity - exercise, fever, anemia, hyperthyroidism 2) Change in valve structure d/t calcification of valve, increased ventricular pressure to close valve against increased atrial pressure ex// mitral stenosis with leaflets still mobile

Varying Intensity of S1

1) Position of AV valve varies before closing from beat to beat ex// AFib - irregulary irregular 2) Atria and ventricles beat independently ex// complete heart block with changing PR interval

Faint (diminished) S1

1) Position of AV valve-delayed conduction from atria to ventricles. Mitral valve drifts shut before ventricular contraction closes it ex// first-degree heart block 2) Change in valve structure - extreme calcification which limits mobility ex// mitral insufficiency 3) More forceful atrial contraction into noncompliant ventricl - delays or diminishes ventricular contraction ex// severe hypertension - systemic or pulmonary

Aphasia

Disorder of language comprehension and production secondary to brain damage. True language disturbance, defect in word choice and grammar or defect in comprehension; defect is in higher integrative language processing

Penlight test's of the cornea affect what nerves

3,4,6

Normal JVP

3-5 cm

S3

3rd heart sound. Usual cause is myocardial failure. Occurs immediately after S2 (early diastole). Heard best at apex with bell. Low pitch.

S4

4th heart sound occurrs when ventricles are resistant to filling. Occurs just before S1 (late diastole or early systole). Heard best at apex with bell. Low pitch.

What is a normal heart rate?

60-100

Cheyne-Stokes Respiration

A cycle in which respirations gradually wax and wane in a regular pattern, increasing rate and depth and then decreasing. The breathing periods last 30-45 seconds, with periods of apnea alternating the cycle. Most common cause is severe heart failure. Others: renal failure, meningitis, drug overdose, and increased intracranial pressure. Occurs normally in infants and aging persons during sleep.

Deep Vein Thrombophlebitis

A deep vein occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema. Cause may be prolonged bed rest, history of varicose veins, trauma, infection, cancer, and in younger women, the use of oral estrogenic contraceptives. Requires emergency referral because of risk of pulmonary embolism

Tactile (or vocal) fremitus (Palpation)

AM: displace female breast. "99", "one, two, three", "eee, eee, eee" or "blue moon", compare right and left sides. use two hands NCF: more in male than woman because of deeper male voice. diminished from large to small airways. SD: decreased, absent, asymmetrical, coarsened, obstructed bronchus, emphysema

Whispered pectoriloquy (Auscultation)

AM: whisper "one, two, three" NCF: sound will be faint, almost indistinguishable, and inaudible SD: high-pitched consonant that make speech intelligible are transmitted through consolidated lung and can be clearly heard

Ventricular Septal Defect

Abnormal opening in septum between the ventricles, usually subaortic area. The size and exact position vary considerably. On observation, harse holosystolic murmur, best heard at left lower sternal border may be accompanied by thrill. Large defects also have sof diastolic murmur at apex d/t increased blood flow through mitral valve

Atrial Septal Defect

Abnormal opening in the atrial septum resulting in usually in left-to-right shunt and causing large increases in pulmonary blood flow. On observation, sternal lift is present, S2 has fixed split, murmur caused by increased blood flow through pulmonic valve

Opisthotonos

Abnormal posture in infants where head is arched back, stiffness of neck, and extension of arms and legs, occurs with meningeal or brain stem irritation and kernicterus.

Frog position

Abnormal posture in infants where hips are abducted and almost flat against the table, externally rotated.

Parasthesia

Abnormal sensation ex// tingling or burning

Bronchophony

Abnormal transmission of sounds from the lungs or bronchii. Pathology that increases lung density will enhance transmission of voice sounds ex// you hear a clear "nighty-nine"

Atrophy

Abnormally small muscle with a wasted appearance; occurs with disuse, injury, lower motor neuron disease.

Inappropriate affect

Affect clearly discordant with the content of the person's speech. ex// Laughs while discussing admission for liver biopsy.

Venous (stasis) Ulcer

After acute deep vein thrombosis or chronic incompetent valves in deep veins. Occur at medial malleolus and are characterized by bleeding, uneven edges.

Traumatic Pneumothrorax

Air enters through opening or injury in chest wall

Hypoventilation

An irregular shallow pattern cause by an overdose of narcotics or anesthetics. May also occur with prolonged bead rest or conscious splinting of the chest to avoid respiratory pain.

In regards to heart rate, this is a greater than normal force (sign of hypertension).

Bounding

Arm arteries

Brachial, Radial, Ulnar, 2 Vascular arches in hands

What condition is normal in well conditioned athletes & has a heart rate less than 60/min?

Bradycardia

Breast physiology

Breast composed of glandular tissue surrounded by fat and supported by suspensory ligaments. Glandular tissue converges into ducts that open into the nipple via duct openings. Smooth muscle is found in the nipple (erectile), Under it is the pectoral muscle.

Elements of breast inspection

Breast size (large, small), shape (conical, convex, pendulous), symmetry (R larger than L), contour, abnormalities. Nipple - size, shape, direction, rashes, ulcerations, inverted/everted, discharge

What color is old blood?

Brown

Arteriosclerosis-Ischemia Ulcer

Buildup of fatty plaques on intima plus hardening and claudication of arterial wall. Occurs at toes, metatarsal heads, heels, lateral ankle, and are characterized by pale ischemic base, well defined edges and no bleeding.

Stupor or Semi-Coma

Spontaneously unconscious, responds only to persistent and vigorous shake or pain; has appropriate motor responses (withdraws from pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists

Superficial Varicose Veins

Incompetent valves permit reflux of blood, producing dilated, tortuous veins. Unremitting hydrostatic pressure cause distal valves to be incompetent and cause worsening of the varicosity. Over the age of 45, occurrence is three times more common in women than in men.

Enlarged Kidney

Caused by hydronephrosis, cysts, or neoplasm. May be difficult to distinguish an enlarged kidney from an enlarged spleen because they have a similar shape. Both extend forward and down. Kidney will never have sharp edge, or palpable notch. Percussion is tympanic because of overriding bowel

Murmurs

Caused by turbulent blood flow and collision currents during diastole and systole. Heard around area of sound transmission. Gentle blowing, swooshing sound. Causes: Increased velocity of blood (exercise, pregnancy, thyrotocicosis); decreased viscosty (anemia); structural defects in valves or unusual openings in chambers.

Hyperventilation

Increase in both rate and depth. Normally occurs with extreme exertion, fear, anxiety. Also occurs with diabetic ketoacidosis (Kussmaul's respirations), hepatic coma, salicylate overdose, lesions in the midbrain, and alteration in blood gas concentration.

Endocrine

Increased in: Adrenocorticotropic hormone cortisol antidiuretic hormone epinephrine and norepinephrine gonadotropic hormone catecholamines RAAS hormones glucagon interleukin Decreased in: insulin testosterone

Cardiovascular

Increased in: Heart rate Pulse Rate Blood Pressure Cardiac Output Hypertension Hypercoagulation Deep Vein Thrombosis

Tonic Neck Reflex

Ipsilateral extension of arm and leg, and flexion of opposite arm and leg when head turned to one side with chin over shoulders.

Genitourinary

Decrease Urine Output Urinary Retention Fluid Overload Hypokalemia

Respiratory

Decrease flow and volume Atelectasis Hypoxemia Decrease Cough Sputum retention and infection

Future Pain

Debilitating Chronic Pain Syndromes Phantom Limb Neuropathies

Clinical Portrait of Heart Failure

Dilated pupils, skin pale, gray or cyanotic, dyspnea, orthopnea, crackles, cough, decreased BP, N&V, ascites, pitting edema, anxiety, falling O2 sat, confusion, JVD, MI, fatigue, S3 gallop, enlarged spleen, decreased urine output, weak pulse.

Crackles - fine

Discontinous high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing. Inhaled air collides with previously deflated airways; airways suddenly pop open, creating crackling sound as gas between the two compartments equalize.

Panic Attack

Discrete period of intense fear or discomfort in which 4 or more of the following symptoms developed abruptly and reached a peak within 10 minutes: 1) palpitations 2) sweating 3) trembling/shaking 4) sensations of SOB 5) feeling of choking 6) chest pain 7) nausea/abdominal distress 8) feeling dizzy, or faint 9) derealization or depersonalization 10) fear of losing control/going crazy 11) fear of dying 12) parethesia 13) chills or hot flashes

Dysarthia

Disorder of articulation. Distorted speech sounds; speech may sound unintelligible; basic language (word choice, grammar, comprehension) intact

Hypoactive Bowel Sounds

Dminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis from paralytic ileus as following abdominal surgery, or from late bowel obstruction. Occurs also with pneumonia

Epitrochlear lymph nodes

Drain lymph from the ulnar surface of the forearm and hand, little and ring fingers; located on medial surface of arm approximately 3 cm above the elbow

Axillary lymph nodes

Drain most of the lymph from the arm

Vertical lymph nodes

Drains leg corresponding to great saphenous vein

Thoracic Duct

Drains lymph from the rest of the body, begins in the abdomen as a sac

Biot's Respiration

Irregular pattern of Cheyne-Stokes breathing. A series of normal respirations is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Seen with head trauma, brain abscess, heat stroke, spinal meningitis and encephalitis

Stoic

Is the term that best describes Filipinos when it Comes to pain Have high pain tolerance which is why they do not request any pain medication

Vesicular (Breath Sounds)

L: remainder of the lungs C: soft, low-pitched, rustling, swishing, or breezy sound. compared to the sound of wind. sound of inspiration is three times longer than that of expiration

Flat affect

Lack of emotional response; no expression of feelings; voice monotonous and face immobile. ex// topic varies, expression does not

Birth weight classification

ELBW - extreme low birth wt < 1000 g VLBW - very low bw 1000-1499 g LBW - 1500-2499 g NBW - normal BW > 2500 g

What temperature site is least accurate according to some text?

Ear

Normal Cerumen

Ear wax: color varies from gray-yellow to light brown and black. Texture varies from moist and waxy to dry and desicated. Large amount of cerumen obscures visualization of canal and drum. 90-95% of ear canal can be blocked by cerumen and person will still hear.

Sweat glands

Eccrine: numerous sweat glands found all over body. Apocrine: Sweat glands that release their secretions into hair follicles in the axillae (armpits), around the nipples (areolae), and in the groin

Caput succedanum

Edematous swelling formed on the presenting portion of the scalp of an infant during birth

Physiological Split of S2

Effect of respiration on valve closing. Aortic valve closes earlier due to decreased volume in ventricles because blood is sequestered into lungs upon inspiration.

Systolic Extra Sounds

Ejection click, aortic prosthetic valve sounds, midsystolic click

Deviance

Escribes actions or behaviors that violate cultural norms including formally-enacted rules (ie crime) as well as informal violations of social norms (ie burping in public?)

Planning

Establish priorities Develop Outcomes Set timelines for outcomes Identify interventions Integrate evidence-based trends and research Document plan of care

Jugular Venous Pressure

Estimation of CVP, elevated if a level of pulsation that is more than 3 cm above the sternal angle while at 45 degrees, occurs with heart failure.

Hyperreflexia

Exaggerated reflex seen when the monosynaptic reflex arc is released from the usually inhibiting influence of higher cortical levels. Occurs with upper motor neuron lesions ex// brain attack.

Equipments needed

Exam gown Drape Gloves Stethoscope Light Skin marker Metric Ruler

Generalized Anxiety Disorder

Excessive anxiety and worry occuring more days than not for at least 6 months about a number of events or activities (such as work or school performance). The person finds it difficult to control the worry. The anxiety and worry are associated with 3 or more of the following: 1) restlessness or feeling keyed up or on edge 2) being easily fatigued 3) difficulty concentrating or mind going blank 4) irritability 5) muscle tension 6) sleep disturbance

Jugular veins

External jugulars: not visible in some people; in others they are full in supine position. They flatten and disappear, usually at 45 degrees. Internal jugulars: easy to confuse with carotid artery as they lie close together.

Confabulation

Fabricates events to fill in memory gaps. ex// Gives detail description of long walk around the hospital although you know they remained in bed all afternoon

General Survey-Behavior

Facial expression, mood and affect, speech, dress, and personal hygiene

Chvostek's sign

Facial irritability in latent tetany, unilateral spasms of the orbicularis oculi or orbicularis oris muscle being excited by a slight tap over the facial nerve just anterior to the external auditory meatus.

Leg arteries

Femoral, Popliteal, Dorsalis pedis, Posterior tibial, 2 arterial arches to foot

Mitral Valve area

Fifth interspace at around left midclavicular line

Filipino Culture

Filipinos tolerate pain

Posturally induced crackles

Fine crackles that appear with a change from sitting to the supine position, or with a change from supine to supine with legs elevated. If appear after acute MI, associated with increased mortality

Late inspiratory crackles

Fine crackles that occur with restrictive disease: pneumonia, heart failure, and interstitial fibrosis

Early inspiratory crackles

Fine crackles, occur with obstructive disease: chronic bronchitis, asthma, and emphysema

Delusions

Firm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contrary. ex// Grandiose - person believes he or she is God. Persecution - "They are out to get me"

Protodiastolic (early) Filling

First passive filling from ventriclar pressure < atrial pressure so blood pour rapidly into ventricles.

Major Depressive Episode

Five or more of the following symptoms present during the same 2-week period and represent a change from previous functioning: 1) depressed mood most of the day 2) markedly diminished interest or pleasure 3) significant weight loss 4) Insomnia or hypersomnia 5) psychomotor agitation 6) fatigue 7) feelings of worthlessness 8) diminished ability to think or concentrate 9) recurrent thoughts of death. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms are not due to direct physiologica effects of a substance, medical condition, or accounted for by bereavement.

Where to measure in legs for edema

Forefoot, smallest circumference of ankle, largest circumference of calf, midthigh (above patella with knee extended)

Pneumothorax

Free air in the pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present; thus lung collapses. Usually unilateral

Parietal Pain

From inflammation of overlying peritoneum (sharp, precisely located, aggravated by movement)

General Survey-Mobility

Gait, and range of motion

Head-to-toe approach

Gathering data from the top of the body to the feet

Murmur

Gentle, blowing, swooshing sound that can be heard on the chest wall resulting from turbulent blood flow and collision currents.

CN IX

Glossopharyngeal, Mixed, Motor: Pharynx (phonation and swallowing), Sensory: taste on posterior one-third of tongue, gag reflex, PNS: parotid gland, carotid reflex

Metabolic

Glucogenesis Hepatic glycogenolysis Hyperglycemia Glucose intolerance Insulin resistance muscle protein catabolism Increase Lipolysis

Pericardial friction rub

Grating sound; may obscure heart sounds (pericarditits).

Superficial leg veins

Great saphenous, small saphenous. These are poorly supported

What color is an old infection?

Green

Pelvis type

Gynaecoid (good for baby to come out - apple shape) Anthropoid (egg/oval shaped) Platypelloid - flat opening Android (inverted pear)

Normal newborn findings

HR 90-190 Resp rate 30-60 bpm starfish fingers skin: cutis marmorata (patchy/,marbled skin), mongolian spots in asian/african babies, lanugo, desquamation of skin, vernix caseosa, may have acrocyanosis in toes, milaria rubra (pimples) - jaundice - appears day 2-3, peaks on days 4-5 and resolves in 7-30 days. - sucking blisters - Head: molding, soft fontanelles, trismus: spasm of TMJ muscles - Eyes: nystagmus (normal), strabismus (abnormal), congenital cataracts, subconjunctival or scleral hemorrhage - Ears: low ear placement suspect Down syndrome, FAS or kidney disease - Pharynx: supernumerary teeth (removed), thrush - Chest - supernumerary nipples, fremitus, murmurs, hyperresonance, witch's milk, clavicle fx at birth - Abd: hernias, bowel sounds - Genitalia: central urethral meatus, hymen, normal edema - Back: Tuft of hair at the spinal column is a red flag for a spinal defect

Major risk factors for heart disease

HTN, smoking, hyperlipidemia, obesity, diabetes

Hemisphere

Half of the cerebrum. Left is dominant in 95% of people.

Pyrosis

Heart burn

Heart Failure

Heart isn't pumping effectively- overload of fluid. Left side failure: relates back to lungs, frothy sputum Cough, SOB. Right side failure: Back flow failure, JVD, peripheral edema.

Summary of Tanner Staging for girls

Height spurt first 9.5-14.5 y.o., menarche occurs after ht spurt. Ht development stops approx 1 year after onset of menarche. Heavy girls have menarche first, likely shorter

Term used to describe the action of coughing up blood.

Hemoptysis

some signs of PIH (pregnancy induced HTN)

High Bp Edema Varicose veins hyperreactive reflexes (> 2+)

Bronchial Breath Sound

High pitch, loud, inspiration is less than expiration, harsh, hallow quality, heard at the trachea and larynx

Wheeze - high pitched

High pitched, musical squeaking sounds that sound polyphonic; predominate in expiration but may occur in both. Air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors; the passageway walls oscillate in apposition between the closed and barely open positions, reulting sound is similar to a vibrating reed. Heard in diffuse airway obstruction from acute asthma or chronic emphysema

Stridor

High-pitched inspiratory crowing sound heard without the stethoscope, occurring with upper airway obstruction. ex// croup, foreign body aspiration, or acute epiglottitis

Frontal Lobe

Includes area concerned with personality, behavior, emotions, and intellectual function.

Postcentral Gyrus of the Parietal Lobe

Includes the primary center for sensation

Word Salad

Incoherent mixture of words, phrases, and sentences; illogical, disconnected, includes neologisms. ex// "Beauty, red based five, pigeon, the street corner, sort-of"

Suprasternal Notch

Hollow, U-shaped depression just above the sterum, in between clavicles

Percussion: Tympany

Hollow, high, drumlike sounds. Fluid and air. Normally heard over stomach. If heard over lungs, indication of large pneumothroax.

Venous stasis ulcers indicated by

Hyperpigmentation, edema and cyanosis

Term that describes blood pressure persistently greater than 140/90.

Hypertension

Term used to describe a febrile & elevated body temperature.

Hyperthermia

What condition is associated with fever, shaking chills, & causes an increase in oxygen consumption and CO2 production?

Hyperthermia

CN XII

Hypoglossal, Motor, Movt of tongue

Aortic Prosthetic Valve Sounds

Iatrogenically induced early systolic sounds from opening of prosthetic valves

Asphyxia

Impairment of ventilatory exchange of O2 and CO2 - death if not corrected

Implementation

Implement in a safe and timely manner Use evidence-based interventions Collaborate with colleagues Use community resources Coordinate care delivery Provide health teaching and health promotion Document implentation and any modification

Where Brachial artery can be felt

In and above the bend of the elbow, just medial to the biceps tendon

Peripheral Nervous System

Includes 12 pairs of cranial nerves, 31 pairs of spinal nerves, and all their branches

Whispered Pectoriloquy

Increased loudness of whispering "1-2-3" while the physician is listening using a stethoscope on the lung fields on a patient's back. Usually it is not heard when whispered With small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint: it sounds as if the person is whispering right into stethoscope "one-two-three"

Hyperalgesia

Increased pain sensation

Hypertrophy

Increased size and strength; occurs with isometric exercise

Spasticity

Increased tone or hypertonia; increased resistance to passive lengthening; then may suddenly give way (clasp-knife phenomenon). Associated with upper motor neuron injury to corticospinal motor tract, paralysis with CVA

Hyperesthesia

Increased touch sensation

Fixed splitting of S2

Indicates atrial septal defect

Rooting reflex

Infant turns head toward the brushed side and opens mouth. Appears at birth, disappears at 3-4 months.

Lobar Pneumonia

Infection in lung parachyma leaves alveolar membrane edematous and porous, so red blood cells and white blood cells pass from blood to alveoli. Alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris, fluid, and blood cells, all of which replace alveolar air. Results in decreased surface area of the respiratory membrane, which causes hypoxemia

Pericardial Friction Rub

Inflammation of the precordium gives rise to a high pitched scrathy sound. Best heard with the diaphragm with the person sitting up and leaning forward, at the apex and left lower sternal border.

Intoxication

Ingestion of substance produces maladaptive behavior changes due to effects on the central nervous system.

Crossed Representation

Notable feature of the nerve tracts; the left cerebral cortex receives sensory information from and controls motor function to the right side of the body, while the right cerebral cortex likewise interacts with the left side of the body.

Tremor

Involuntary shaking, vibrating, or trembling

Tic

Involuntary, compulsive, repetitive twitching of a muscle group.

Light Palpation

Involves fingertips, back of the hand, or palm of hand (It is best used when feeling the surface of the skin, structures that lie just beneath the skin, pulsations fro peripheral arteries, and vibrations in the chest)ly

How to deal with the psychotic/potentially dangerous patient

Leave door open Never let the patient get between you and the door Scan the environment things that could be used as weapons Ask for a chaperone or someone waiting outside the door Watch for escalation of behavior - louder voice, increased intensity in the patient - talk very softly and slowly - stay calm, use their name

Posterior lobes of lungs

Left upper lobe, left lower lobe, right upper lobe, right lower lobe

Cerebellar Dysfunction

Lesion in one hemisphere produces abnormalities on ipsilateral side. Characterized by ataxia, lurching forward of affected side while walking, rapid alternative movements are slow and arrythmic, finger to nose test reveals ataxia and tremor with overshoot ot undershoot, and eyes display coarse nystagmus.

Level of Consciousness - sleepy but arouses easily, responds appropriately when aroused

Lethargic

Snellon test.

Letters on a sign, just like the one in the dmv.

Term that describes a heart rate that is normal while sitting or resting, but standing causes a rate increase.

Libile

Claudication Distance

Number of blocks walked or stairs climbed to produce pain

Brushfield spots

Light colored condensations of the surface of the mid iris - seen in Down's Syndrome

3 internal factors that the nurse brings into the interview

Liking others Empathy The ability to listen

Visceral Pleura

Lines the outside of the lungs, dipping down into the fissures

Parietal Pleura

Lining the inside of the chest wall and diaphragm

Auscultation

Listening to body sounds (used Frequently, most often to assess the heart, lungs, and abdomen)

Right Upper Quadrant (RUQ)

Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, part of ascending and transverse colon

Temporal Lobe

Located behind the ear, includes the primary auditory reception center.

Aortic Aneurysm

Located below the renal arteries and extend to the umbilicus. 80% are palpable during routine physical exam and feel like a pulsating mass in the upper abdomen just to the left of midline. Bruits are heard, but femoral pulses are weakened.

Lower Motor Neurons

Located mostly in the PNS. Cell body is located in the anterior gray column of the spinal cord, but the nerve fiber extends from here to the muscle. Is the "final common pathway." Ex// Cranial Nerves, and Spinal Nerves of the PNS. Ex of diseases// Spinal cord lesions, poliomyelitis, and amyotrophic lateral sclerosis.

Broca's Area

Located within the frontal lobe, mediates motor speech. When injured in the dominant hemisphere, expressive aphasia results - the person cannot talk, the person can understand language and knows what he or she wants to say, but can produce only garbled sound.

Wernicke's Area

Located within the temporal lobe, is associated with language comprehension. If damage occurs, receptive aphasia results - the person hears the sound, but it has no meaning, like hearing a foreign language.

Spinal Cord Hemisection (Brown-Sequard Syndrome)

Loss of pain and temperature, contralateral side, starting one or two segments below the level of lesion. Loss of vibration and position discrimination on the ipsilateral side below the level of lesion. Caused by meningioma, multiple sclerosis

Hyperactive Bowel Sounds

Loud, gurgling sounds, signal increased motility. The occur with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus

Crackles - coarse

Loud, low pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somwheat by suctioning or coughing but will reappear shortly. Inhaled air colides with secretions in the trachea and large bronchi. Heard in pulmonary edema, pneumonia, pulmonary fibrosis, and terminally ill who have a depressed cough reflex.

Percussion: Hyperresonant

Louder and lower pitched than resonant sounds. Mostly air. example: COPD

Vesicular Breath Sound

Low pitch, soft amplitude, inspiration is greater than expiration, rustling quality, heard over peripheral lung fields where air flows through smaller bronchioles and alveoli.

Wheeze - low pitched

Low pitched, monphonic single note musical snoring, moaning sounds; they are heard throughout the cycle although they are more prominent on expiration; may clear somewhat by coughing. Air flow obstruction as described by the vibrating reed mechanism. The pitch of the wheeze cannot be correlated to the size of the passageway that generates it. Heard in bronchitis, single bronchus obstruction from airway tumor.

Implications of a low Apgar score

Low score on 1 minute test - neonate needs medical attention, no necessarily indication of long term problems, esp if improve in 5 min Low score (less thn 3) at 10, 15 or 30 min --> higher risk for long term neurologic damage

Paraplegia

Lower motor neuron damage caused by spinal cord injury; produces "spinal shock" - no movement or reflex activity below the level of lesion.

Forced Expiratory Time

Number of seconds it takes for the person to exhale from total lung capacity to residual volume. It is a screening measure of air flow obstruction.

Specific Phobia

Marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation. Exposure to the phobic stimulus almost invariable provokes immediate anxiety response. Person recognizes the fear is excessive or unreasonable. The phobic situation is avoided or endured with intense anxiety or distress. This interferes with person's normal routine.

Skin Color - Decrease in normal color due to anemia or blood loss.

Pallor or Ashen

Apical Impulse

Palpable only systolic, mid clavicular line 5th intercostal.

Thrill

Palpable vibration on the precordium. Feels like the purring of a cat, and signifies turbulent blood flow.

Corticospinal (Pyramidal Tract)

Motor nerve fibers originate in the motor cortex and travel to the brain stem, where they cross to the opposite or contralateral side and then pass down in the lateral column of the spinal cord. It is a newer "higher" motor system that humans have that permits very skilled and purposeful movements. The tract's orgin in the motor cortex is arranged in a specific pattern called somatotopic organization.

Multipara

Multiple live births

Pulse Oximeter

Noninvasive method to assess arterial oxygen saturation.

Abnormalities of Nail Bed

Normal - 160 degree angle between nail plate and nail Clubbing - change in angle between nail and nail base, eventually larger than 180 degrees. (Chronic lack of oxygen; heart of pulmonry disease) Beau's lines - transverse depressions in nails (systemic illness or nail trauma) Koilonychia - "spoon nail" Splinter hemorrhages - red or brown linear streaks in nail bed (trauma, sub-acute bacterail endocarditis, trichinosis Paronychia - inflammation of skin at base of nail (local infection, trauma

Chronic Onstructive Breathing

Normal inspiration and prolonged expiration to overcome increased airway resistance. In a person with COPD any situation called for increased heart rate may lead to dyspneic episode because then the person does not have enough time for full expiration

Eupnea

Normal respirations

Pupillary Light Reflex

Normal response is constriction of same-sided pupils (direct) and simultaneous constriction of the other pupil (consensual) when light is advanced across pupil.

Upper Respiratory Tract

Nose Mouth Sinuses Pharynx Larynx Portion of Trachea

Lethargic (Somnolent)

Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions and commands but thinking seems slow and fuzzy, inattentive, loses train of thought, spontaneous movements are decreased

Decreased or Absent Breath Sounds

Occur 1) when the bronchial tree is obstructed at some point by secretions, mucus plug, or foreign body 2) In emphysema as a result of loss of elasticity in the lung fibers and decreased force of inspired air; also the lungs are already hyperinflated so the inhaled air does not make as much noise 3) When anything obstructs transmission of sound between the lung and your stethoscope, such as pleurisy or pleural thickening, or air (pneumothorax) or fluid (pleural effusion) in the pleural space

Ejection Click

Occurs early in systole at the start of ejection because it results from opening of the semilunar valves in the presence of stenosis. Aortic is heard at second right interspace, and loudest at base. Pulmonic is heard is heard at second left interspace and grows softer with inspiration

Summation Sound

Occurs with both pathologic S3 and S4 resulting in a quadruple rhythm. Often in cases of cardiac stress and tachycardia

S2 (second heart sound)

Occurs with closure of the semilunar valves and signals the end of systole. Usually loudest at base.

Increased Fremitus

Occurs with compresion or consolidation of lung tissue. Presnt only when the bronchus is patent and when the consolidation extends to the lung surface.

Bronchophony

Occurs with increased transmission of sound as in consolidation. Client says "99", words heard clearly and distinctly.

Enlarged Nodular Liver

Occurs with late portal cirrhosis, metastatic cancer, or tertiary syphilis

S1 (first heart sound)

Occurs with the closure fo the AV valves and thus signals the beginning of systole. Usually loudest at apex

CN III

Oculomotor, Mixed, Motor: most EOM movt, opening of eyelids, PNS: pupil constriction, lens shape

What is a foul smell indicating lung abscess, bronchiectasis, and/or aspiration?

Odor

Where Radial artery can be felt

On the flexor surface of the wrist laterally

Primipara

One live birth

Bipolar Disorder

One or more manic episodes usually accompanied by major depressive episodes

Horizontal Fissure

Only in right lung. Extends from the 5th space in the right midaxillary line to the 3rd intercostal space or fourth rib at the right sternal border.

Foramen Ovale

Opening in the atrial septum, 2/3 of shunted oxygenated blood flows through here

Diastolic Extra Sounds

Opening snap, mitral prosthetic valve sound, third heart sound, summation sound, fourth heart sound, pacemaker-induced sound

Paradoxical S2 Split

Opposite of what you would expect, the sounds fuse on inspiration and split of expiration.

What temperature site is 1 degree less than rectal?

Oral

Preferable Routes of Medications

Oral Intravenous

Dyspnea when lying flat (must sit or stand to breathe comfortably). Associated with congestive heart failure (left heart failure).

Orthopnea

Snoring (Adventitious Breath Sounds)

P: pharyngeal muscles tones decreases during sleep and allows the area of the pharynx or hypopharynx to narrow, profound REM sleep, apneic episode >60 seconds followed by loud snoring, hundred times at night, daytime somnolence, loss of memory, personality deterioration, driving fatalities C: upper airway sounds, increased airway resistance and obstructive sleep apnea

Coughing (Adventitious Breath Sounds)

P: reflex associated with paroxysms of expiratory flow

Absent (Adventitious Breath Sounds)

P: throughout all lung fields C: pneumothorax, airway obstruction, respiratory arrest

Diminished (Adventitious Breath Sounds)

P: throughout all lung fields, may be isolated to specific lobes C: pneumonia, inability to take deep breath, COPD

Term used to describe upper ribs bent inward thrusting sternum outward (pigeon chest).

Pectus Carinatum

Term used to describe upper ribs bent outward causing sternum to "sink" in (funnel chest).

Pectus Excavatum

Gynecologic Hx

Pelvic surgery Age at first intercourse Number of sexual partners Hx STD's? Frequency and results of pelvic exams Previous Pap testing results SBE and mammography * Also include contraceptive hx (all methods used, how long, ? unprotected sex and how long) + PMH, meds, social hx, fam hx ROS... the usual * PHysical - do thorough head to toe exam - perform cytologic test unless normal pap smear in the past 6 months.

Changes of ear in elderly

Pendulous ear lobe with linear wrinkling due to loss of elasticity of pinna. Coarse wiry hairs may be present at the opening of the ear canal. Ear drum may be whiter in color, more opaque, thicker, and duller than in younger adult. Harder, drier cerumen. High-tone frequency loss for those affected with prebycusis.

Sinus percussion

Percuss sinus areas using direct percussion (lightly tap over each area with index finger)

Sinus Transillumination

Performed if sinuses tender of infection suspected. Maxillary sinus- place light source lateral to nose, just beneath medial aspect of eye. View illumination of hard palate through patient's open mouth. Frontal sinus- place light source against medial aspect of each supraorbital rim. View illumintation as a dim red glow just above eyebrow.

Patent Ductus Arteriosus

Persistence of the channel joining left pulmonary artery to aorta. Normal in fetus and usually closes within a few hours of birth. On observation, BP has wide pulse pressure and bounding peripheral pulses from rapid runoff of blood into low-resistance pulmonary bed

Perseveration

Persistent repeating of verbal or motor response, even with varied stimuli. ex// "I'm going to lock the door, lock the door. I walk every day and I lock the door. I usually take the dog and I lock the door."

Orientation - Patient knows name & name of obviously important people.

Person

What color is a pulmonary edema?

Pink or White Froth

Edema

Pitting: indentation stays in, more common with fluid. Non-pitting: swollen, bounces back, inflammation

Orientation - Patient knows where where he/she is.

Place

Term defined as three or more ribs broken in 2 or more places. The flail segment moves in opposite direction from the rest of the chest (paradoxical movement).

Plail Chest

Presentation

Position of the fetus descending through the birth canal (head, breech, mental)

Describe anatomical landmarks of the breast

Split in 4 clockwise - 12, 3, 6, 9. Upper outer quadrant, lower outer quadrant, upper inner quadrant and lower inner quadrant. Tail of breast near axilla. Areola with outer sebaceous glands (bumps around it), multiple duct openings

Tachypnea

Rapid shallow breathing. Increased rate > 24 per minute. Normal response to fever, fear, or exercise. Rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons.

Lability

Rapid shift of emotions. ex// Person expresses euphoric, tearful. angry feeling in rapid succession.

Fasciculation

Rapid, continuous twitching of resting muscle or part of muscle, without movement of limb, that can be seen or palpated.

Myoclonus

Rapid, sudden jerk or a short series of jerks at fairly regular intervals. ex// hiccup

Intention Tremor

Rate varies; worse with voluntary movement. Occurs with cerebellar disease and multiple sclerosis. May be essential or benign

Supplies

Specula, gloves, lubricant (non vaseline), pap supplies, wet prep supplies, culture supplies, good light source

Corneal Light reflex

Reflections of light noted at same location on both eyes

Doll's eyes

Reflex movement of the eyes in opposite direction to that in which the head is turned - indication of the functional integrity of the brainstem pathways and cranial nerves involved in eye movement

Sucking reflex

Reflex to suck finger when touching lips. Present at birth, disappears at 10-12 months.

Infantile Automatisms

Reflexes that have a predictable timetable of appearance and departure

Lie

Relationship of long axis of fetus to long axis of the mother (longitudinal, transverse or oblique)

What are seen when the need to generate more negative intrathoracic pressure is required to overcome an increase in airway resistance, or a decrease in lung compliance, or both?

Retractions

Aneurysm

Sac formed by dilation in the artery wall. Atherosclerosis weakens the middle layer of the vessel wall. This stretches the inner and outer layers and the effect of blood pressure creates the balloon enlargement. Most common site in the aorta, and most common cause is atherosclerosis. Incidence increases rapidly in men over 55 and women over 70.

Depression

Sad, gloomy, dejected; symptoms may occur with rainy weather, after a holiday, or with an illness; if the situation is temporary, symptoms fade quickly. ex// "I've got the blues"

Describe ADA friendly facilities

Safety: Grab bars, raised toilet seats, shower chairs, train staff re transfers and guarding. Facility access: Wide doors, wide halls Large exam rooms High/low tables Accessible call buttons Exam equipment that's accessible Ramps/parking/escorts

Hallucination

Sensory perception for which there are no external stimuli; may strike any sense; visual, auditory, tactile, olfactory, gustatory. ex// visual - seeing an image of a ghost

Atrioventricular Valves

Separate the atria and the ventricles. Right sided tricuspid, left sided mitral

Semilunar Valves

Separate the ventricles from arteries. Right sided pulmonic, left sided aortic. Open during systole to allow blood to be ejected from the heart.

Clonus

Set of rapid, rhythmic contractions of the same muscle

Condition that helps determine adequate hydration & is normal when the skin on the back of the hand returns to formation after being pinched.

Skin Turgor

Quality of Life

Sleeplessness Anxiety Fear hopelessness increased thoughts of suicide

Bradypnea

Slow breathing less than ten breaths per minute, seen in drug use or other cause of depression of resp. Center

Skin Lesion: Macule

Solely a color change, flat and circumscribed, of less than 1cm, freckles, flat nevi, hypopigmentation, petichiae, measles, scarlet fever

Skin Lesion: Papule

Something you can feel (solid, elevated, circumscribed, less than 1cm diameter) caused by superficial thickening in the epidermis, like elevated nevus (mole), lichen planus, molluscum, wart (verruca)

Increased Breath Sounds

Sounds are louder than they should be. They have a high-pitched tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration. They occur when consolidation or compression yields a dense lung area that enhances the transmission of sound from the bronchi. When the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.

Thyroid palpation

Stand behind client, position hands with thumb on nape of client's neck. Client flexes neck forward and to the right. Use fingers of left hand to displace thyroid to the right. Palpate the right lobe using right fingers, while asking client to swallow. Repeat procedure to examine left lobe on left side.

Romberg test

Stand still, feet together. Observe for 1 minute for swaying

Automatism

State of being independent of the will or of central innervation

Blocking

Sudden interruption in train of thought, unable to complete sentence, seems related to strong emotion. ex// "Forgot what I was going to say"

Syncope

Sudden loss of strength, a temporary loss of consciousness due to lack of cerebral blood flow

Cholecystitis (biliary colic)

Sudden pain in right upper quadrant that may radiate to right or left scapular, and which builds over time, lasting 2-4 hours, after ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting and positive Murphy's sign

Chorea

Sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face. Occurs at regular intervals, not rhythmic or repetitive, more convulsive than a tic. Spontaneous or initiated, all accentuated by voluntary acts

What is an increased respiratory rate?

Tachypnea

Circumstantiality

Talks with excessive and unneccessary detail, delays reaching point; sentences have a meaningful connection but are irrelevant (this occurs normally in some people). ex// "When was my surgery? Well I was 28, living with my aunt, the one with psorasis, it was so bad that year..."

Trochlear

What is the name of the nerve you are doing an assessment on if you assess the six cardinal fields of gaze with the emphasis on the superior oblique?

Posttraumatic Stress Disorder

The person has been exposed to a traumatic event in which 1) the person experiences, witnessed, or confronted with the actual or threatened death or serious injury of self or others 2) the person's response involved intense fear, helplessness, or horror. The traumatic event is persistently reexperienced by: 1) recurrent and intrusive distressing recollections of the event, including images, thoughts, and perceptions 2) recurrent distressing dreams of the event 3) acting of feeling as if the traumatic event were recuurring. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness. Persistent symptoms of increased arousal: 1) difficulty falling or staying asleep 2) irritability or outbursts of anger 3) difficulty concentrating 4) hypervigilance 5) exaggerated startle response

Obsessive-Compulsive Disorder

The person has either obsessions or compulsions. At some point the person has recognized that the obsessions or compulsions are excessive or unreasonable. The obsessions or compulsions caused marked distress, are time consuming, or significantly interfere with the person's normal routine.

Varicose veins

The result of incompetent valves leading to increased pressure

V; mandibular

What is the number and branch of the nerve are you doing an assessment on if you ask client to clench teeth?

Strabismus

True disparity of the eye axes

Rebound Tenderness (Blumberg's Sign)

Use when ab pain or when elicit tenderness during palpation; 1. choose site away from painful area; hold hand 90 degrees, or perpendicular, to the abdomen; 3. push down slowly and deeply; then lift up quickly

Costal Angle

Usually 90 degrees or less, where the right and left costal margins form an angle where they meet at the xiphoid process.

Oculomotor

What is the name of the nerve you are doing an assessment on if you assess the six cardinal fields of gaze with the emphasis on superior rectus, inferior rectus, inferior oblique and the medial rectus?

V; Ophthalmic

What is the number and branch of the nerve you are doing an assessment on if while client looks upward, lightly touch the lateral sclera of the eye with sterile gauze to elicit blink reflex. To test light sensation, have client close eyes, wipe a wisp of cotton over client's forehead and paranasal sinuses. To test deep sensation, use alternation blunt and sharp ends of a safety pin over same areas?

V; maxillary

What is the number and branch of the nerve you are doing an assessment on if you assess skin sensation as for the ophthalmic branch?

I

What is the number of the Olfactory nerve?

II

What is the number of the Optic nerve?

I

What is the number of the nerve you are doing an assessment on if you ask the client to close eyes and identify different mild aromas, such as coffee, vanilla, peanut butter, orange/lemon, chocolate?

II

What is the number of the nerve you are doing an assessment on if you ask the client to read Snellen-type chart; check visual fields by confrontation; and condust an opthalmoscopic examination?

III

What is the number of the nerve you are doing an assessment on if you assess the six cardinal fields of gaze with the emphasis on superior rectus, inferior rectus, inferior oblique and the medial rectus?

IV

What is the number of the nerve you are doing an assessment on if you assess the six cardinal fields of gaze with the emphasis on the superior oblique?

skin

a physical barrier that protects the underlying tissues and structures from microorganisms, physical trauma, ultraviolet radiation, and dehydration. It plays a vital role in temperature maintenance, fluid and electrolyte balance, absorption, excretion, sensation, immunity, and vitamin D synthesis. It also provides individual identity to a person's appearance

Costodiaphragmatic Recess

a potential space at the posterior most tips of the pleural cavity, located at the junction of the costal pleura and diaphragmatic pleura.

nasal flaring

abnormal finding, seen with labored respirations (especially in small children) and is indicative of hypoxia

dysrhythmia

abnormal heart rhythm

bradypnea

abnormally slow breathing, less than 10 per minute and regular, may be normal in well-conditioned athletes. Can occur with medication induced depression of the respiratory center, diabetic coma, and neurologic damage

tumor

an abnormal mass(swelling or enlargement) of cells with proliferation that is independent of neighboring tissues; may be benign or malignant

atherosclerosis

artery wall thickens as a result of the accumulation of fatty materials such as cholesterol

Open-Ended Questions

asks for narrative information; unbiased, leaves the person free to answer in any way; states the topic to be discussed, but only in general terms

Inspection/palpation abnormalities in breast

asymmetry edema --> Peau d' Orange high suspicion CA, Nipple and areola: Inverted nipple (esp if used to be everted or asymetric one) Paget's dz of breast (eczema > 1 month), abnormal nipple discharge skin retraction (mass pulling breast in), hyperpigmentation supernumerary nipples dimpling when lift breast (concern CA) - palpate lump - concerning if non mobile and rubbery consistency

Dysthymic Disorder

at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms

causes of arterial bruits

atherosclerosis congenital constriction aneuryism thyrotoxicosis AV fistula coarctation of aorta

4+

bounding pulse

Pulse findings in aortic insufficiency

bounding radial, carotid and femoral pulses

exopthalmos

bulging eyes

Whispered pectoriloquy

client whispers a phrase such as "a-b-c". Sound heard clearly and distinctly. Occurs with dense lung tissue.

Eccrine glands

coiled tubules that open directly onto the skin surface to produce sweat

Assessment

collect data, use evidence-based assessment techniques, document relevant data

Culturally Sensitive

caregivers POSSESS some basic knowledge of and constructive attitudes toward the diverse cultural populations found in the setting in which they are practicing

Culturally Competent

caregivers UNDERSTAND and attend to the total context of the individual's situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences

Crackles (rales)

caused by air passing through moisture in air passages. Ususally inspiratory, not usually cleared by coughing. Fine rales= small airways; course rales= large airways.

whispered pertoriloquy

clean and distinct sounds from a whispered voice that indicate lung abnormalities

tripod position

client leans forward and uses arms to support weight and lift chest to increase breathing capacity; often seen in COPD

Egophony

client says "ee-ee-ee", heard as "ay," occurs as lung becomes more dense.

pink

color of frothy sputum indicating pulmonary edema

Cranial Nerve III damage

damage results in a unilaterally dilated pupil There is no reaction to light. Ptosis may be seen

Mongolian spots

dark-blue colored spots on skin in the sacral region due to the ectopic prescence of scattered melanocytes in the dermins- gradually recede

hypopigmentation

decreased color

hyperopia

farsightedness, ray of light focuses behind retina, can see distance but not close up

vernix caseosa

fat cheesy substance, consisting of dequamated epithelial cells, lanugo and sebacous matter that covers fetus skin and makes it waterproof

hyperthermia

fever, caused by pyrogens secreted by toxic bacteria during infections or from tissue breakdown

stridor

harsh, honking wheeze; may indicate severe broncholaryngospasm and croup

S4 or atrial gallop

heard when the atria contract to enhance ventricular filling just before S1..."Ten-es- see"

prebyopia

impaired near vision in middle age or older caused by loss of elasticity in the lens

Biographical Data

includes name, address, and phone number, age and birth date, birthplace, gender, marital status, race, ethnic origin, and occupation--should include primary language spoken as well.

A diffuse apical impulse

indicated dilated ventricle/inc compliance

pancreatitis

inflammation of the pancreas

nystagmus

involuntary, rhymical oscillation of the eyes...initiated by having patient gaze to the far left or right

Biot's respiration

irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea; may be seen with meningitis or severe brain damage

hepatitis B virus

irritation and swelling (inflammation) of the liver spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone who already has a hepatitis B infection

Biculturalism

is a dual pattern of identification to a culture and often divided loyalty to the 2 cultures

Religion

is the belief in a divine or superhuman power or ruler(s) of the universe; organized system of beliefs concerning the cause, nature, and purpose of the universe, especially belief in our worship of God or gods.

Assimilation

is the process by which a person develops a new cultural identity and becomes like the members of the dominate culture

Acculturation

is the process of adaption to and acquiring another culture.

Sinus arrythmia

is when the heart rate varies with the respiratory cycle, speeding up at the peak of inspiration and slowing to normal with expiration

orthopnea

labored breathing that occurs when lying flat and is relieved by sitting up

pallor

lack of color; paleness

Skin Lesion: Confluent

lesions run together; urticaria--hives

ankle edema measurements

less than 1 cm difference is normal

calf edema measurements

less than 2 cm difference is normal

entropion

lid margins that turn in

ectropion

lid margins that turn out

pleural space

lies between the membrane that lines the chest cavity and the membrane that lines the external surface of the lungs; filled with serous fluid that allows for movement and ventilation without friction

Atherosclerosis indicated by

limb ischemia with exertion

Skin Lesion: Zosteriform

linear arrangement along a unilateral nerve route, herpes zoster

senile lentigines

liver spots; yellow-brown patches

aneurysm

localized dilation of vessel wall

vitiligo

localized loss of melanocytes; flat and pale surrounded by normal pigmentation

Temporal artey

located behind temple region of head

Frontal lobe

located in front - associated with reasoning, skills, and expressive language

Parotid Gland

located in the cheeks over the mandible, anterior to and below the ear.

vertibra prominens

located on the C7 vertebra of your neck, and is palpable when the head is flexed

terminal hair

long, coarse, thick hair visible on the scalp, axillae, public areas, and beards in men.

subcutaneous tissue

loose connective tissue containing fat cells, blood vessels, nerves, and the remaining portions of sweat glands and hair follicles. It assists with heat regulation and contains the vascular pathways for the supply of nutrients and removal of waste products from the skin

pleural friction rub

low pitched, dry, grating sound, heard during inspiration and expiration indicates pleuritis

excoriation

skin breakdown

tugor

skin's elasticity

petechiae

small purplish, hemorrhagic spots on the skin that appears in patients with platelet deficiencies and in many febrile illnesses

Milia

small subepidermal keratin cysts

pulse pressure is diminished in a

small weak pulse

floaters

small, black spots that seem to FLOAT across the field of vision

vellus hair

small, soft, tiny hairs covering the whole body except palms and soles.

Lymphedema

soft early on, then hard and indurated, nonpitting, skin thickens, ulcerations rare, often bilateral. Due to lymph channels being obstructed

Fluid Wave

test if you suspect ascites (an abnormal collection of fluid in the intra-abdominal cavity) on the basis of bilateral flank bulging or dullness to percussion

S2

the "dub" sound when ventricular pressure falls (after emptying) below the pressure in the aorta and pulmonary artery allowing the aortic and pulmonic valves to close - (DIASTOLE)

3

the number of lobes the right lung has

stratum germinativum

the only layer of the skin that undergoes cell division and contains melanin and keratin-forming cells

you find systolic pressure at

the peak of the wave

vertebra prominens

the spinous process of the seventh cervical vertebra (C7)

bifurcation

the splitting of a main body into two parts

Capacitance Vessels

the term for veins because they have the ability to stretch. they have a large diameter and are more distensible to hold more blood. this reduces stress on the heart.

Naturalistic Theory

those who believe that human life is only one aspect of nature and a part of the general order of the cosmos; believe that the forces of nature must be kept in natural balance or harmony; seen among American Indians, and Asians

Veins that drain into the superior vena cava

veins from arms, upper trunk, head and neck

Veins that drain into the inferior vena cava

veins from legs and lower trunk