Health Assessment Final
greater trochanter of femur location
normally the width of the person's palm below the iliac crest and halfway between the anterior superior iliac spine and ischial tuberosity
symptoms of hypertension
not many clinical manifestations- silent killer if symptomatic- flushed or headache
accessory muscles use in breathing
not normally needed to augment resp effect. neck muscles can be used momentarily used in exercise
inguinal lymph node palpation
not unusual to find small movable contender nodes
lymphatics function
retrieves excess fluid and plasma proteins from interstitial spaces and returns them to bloodstream
What conditions does hyperthermia occur with?
hyperthyroidism, fever/exercise- exists with increased metabolism. local inflammation
oropharynx
separated from mouth by a fold of tissue on each side, the anterior tonsillar pillar
aging adult pain tolerance
no evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished
isometric contraction
no shortening; muscle tension increases but does not exceed load. builds pressure within itself in ventricles in order to have more pressure than aorta for blood to flow out
Innocent murmur and characteristics
no valvular or pathologic cause general soft (grade 2), midsytolic, short, crescendo-decrescendo, vibratory or musical quality
Flaccid Quadriplegia indicates
nonfunctional brain stem
normal lymph nodes
nonpalpable. non-tender, freely movable, and less than 1cm still normal. larger ones (especially cervical) in kids can still be normal
epstein pearls
normal finding in babies. small white glistening pearly papule that look like teeth on the hard palate- smile retention cysts
Sinus Arrhythmia
normal finding in young adults and kids. rhythm varies with breathing
acrus senilis
normal in the elderly but contributes to decreased accommodation: ring-shaped, grayish-white deposit of phospholipid and cholesterol near the peripheral edge of the cornea. dont mistake for opacity
chronic obstructive lung disease
normal inspiration and prolonged expiration to overcome increased airway resistance. in people with chronic obstructive lung disease, increased heart rate causes dsypneic breathing because they don't have enough time for a full expiration
normocephalic
normal skull smooth and in proportion to side of body
eccrine glands
normal sweat- dilute saline. infants begin this at 2 months
is spleen palpable
normally not palpable- must be enlarged 3x to be felt
cutaneous angiomas and what they are associated with
spider nevi. associated with liver disease/ portal hypertension on chest
sensory pathway types
spinothalmic/anterolateral tract and posterior (dorsal) column
related organs in the lymphatic system
spleen, tonsils, thymus
femoral artery location
the major artery supplying the leg- passes under the inguinal ligament and down the thigh
diastolic pressure
the minimum arterial pressure during relaxation and dilatation of the ventricles of the heart when the ventricles fill with blood
Herniated disk and symptoms
the nucleus pulpous ruptures into the spinal canal and puts pressure on local spine nerve root, causing pain and inflammation. usually occurs from strenuous activities symptoms: sciatic pain, numbness, paresthesia in involved dermatome, listing away from affected side, decreased mobility
forced expiratory time screening
the number of seconds it takes for the person to exhale from total lung capacity to residual volume. screens measure of airway obstruction
transmission phase of pain
the pain impulse moves from level of spinal cord to the brain if not stopped by opioids. goes to thalamus and then dispersed to higher cortical areas (the emotional awareness and identification of pain)
Transillumination
the passage of strong light through a body structure, to permit inspection by an observer on the opposite side
diagnostic reasoning
the process of analyzing health data and drawing conclusions to identify diagnoses
atrophic scar
the resulting skin level is depressed with loss of tissue; a thinning of the epidermis
dental carries indicate
tooth decay
tobacco leads to
tooth loss, coronal and root caries, periodontal disease
Testing extinction
touching both sides and indicating which wide they feel sensation. they won't feel opposite side of lesion
pericardium
tough, fibrous, double-walled sac that surrounds and protects the heart contains a few ml of serous pericardial fluid. adherent to great vessels, esophagus, sternum, and pleurae and anchored to the diaphragm
how to position to auscultate for extra heart sounds
with pt on left side- some sounds only heard here. also auscultate with patient sitting and learning forward
Food diaries
two weekdays and one weekend day used. problems include patient being noncompliant or eating differently than normal
Auscultate the abdomen
use diaphragm of stethoscope and hold lightly begin in RLQ because bowel sounds- high pitched
Palpating interphalangeal joints
use fingers to pinch sides of the joints
how to palpate apical impulse
use one finger pad, ask person to exhale and hold it. palpable in half of adults. should only occupy one interspace (4th or 5th) and be at or medial to midclavicular line. rolling toward left helps to find
technique for palpating tactile fremitus
use palmar base or ulnar edge of a hand to touch chest spots on back while pt says "99" or "blue moon" which are resonant phrases that generate strong vibrations
how to palpate aorta
use your thumb and first finger or use two hands and palpate deeply in the epigastrum, slightly to the left of midline. assess the pulsation of the abdominal aorta
inspection steps
used first. compare left and right side symmetry, good lighting, take is slow, adequate exposure, instrument use
doppler ultrasonic probe
used to detect a weak peripheral pulse by magnifying pulsation sounds from the heart and vessel
modified Allen test
used to evaluate the adequacy of collateral circulation before cannulating the radial artery
reference lines
used to pinpoint a finding vertically on the chest midsternal line, midclavicular line, scapular line, vertebral line, anterior/posterior/midaxillary lines
Iliopsoas muscle test
used when acute abdominal pain suspected- pt supine and lift right leg straight up flexing at the hip and pushing down lower thing as patient tries to hold it up. when ilopsoas muscle inflamed or perforated, pain felt in RLQ
how to do mental status exam for persons with aphasia
word comprehension- having them say items in room pointed at reading writing- ask Pt to write sentence about a given topic
Cause of rhonchal fremitus
vibration felt when inhaled air passes through thick secretions in the larger bronchi. coughing can somewhat decrease
clonic phase
violent muscular contractions, facial grimacing, increased heart rate
Pneumocystis jiroveci pneumonia
virulent form of pneumonia (p. jiroveci or p. carinii) is a protozoal infection associated with AIDS/immunocompromised. cysts containing the organism form in alveloar spaces, alveolar walls ticket, and it spreads to interstitial infiltrates
sources of pain
visceral, somatic (deep somatic or cutaneous) referred
Rickets
vitamin D deficiency causing bowed legs
preload
volume. venous return that builds during diastole. length to which the ventricle muscle is stretched at the end of diastole just before contraction increased stretching beyond normal is preload and leads to an increased SV due to a greater contraction
somatic nerve fibers
voluntary movement that results in skeletal muscle contraction
measures to enhance abdominal wall relaxation
warm room, hands, stethoscope. supine with pillow knees bent and arms across or at side
Direct observation of nutrition and when is it used
watch feeding and eating processes. helps for failure to thrive children and unintentional weight loss of older adults
mandatory reporting
we are legally required to report to authorities when abuse seen or suspected
paresis
weakness caused by disease or ?
medial and lateral menisci
wedge shaped cartilages that cushion tibia and femur
prodromal MI symptoms in women
weeks before acute cardiac syndrome; fatigue, arm and jaw pain, SOB
general overall health state review questions
weight loss/ gain, frequent illness, can't gain weight, energy level/fatigue, behavior change
Somatic pain (two types)- locations, characteristics, causes
well localized and easy to pinpoint: can also cause N/v, sweating, tachycardia, hypertension due to ANS musculoskeletal tissues or the body surface deep and cutaneous somatic pain
objective history
what a healthcare professional notices
subjective data
what the person says about himself or herself during history taking
thought content
what the person thinks- specific ideas, beliefs, the use of words. is what they say logical?
auscultation
what you hear vs what you should be hearing
urticaria
wheals coalesce to form extensive reaction, intensely pruritic
neuropathic pain
when disease/injury causes damage or alters nervous system causing abnormal processing of pain. pain is for no particular reason, usually chronic, and referred to as nerve pain. not typical or predictable phases; can result in continuous firing. chronic diseases or lesion/disease of somatosensory nervous system often cause this
nociceptive pain
when functioning and intact nerve fibers in the periphery and CNS are stimulated- triggered by events outside nervous system from actual or potential nerve damage. develops in response to specific situation and usually acute. goes away as body heals. adding pressure, heat, chemicals worsens the pain
what causes angina
when heart's own blood supply can't keep up with metabolic demand
when does bias exist in interview on behalf of a child
when it comes to caregiver's capabilities and the child's accomplishments
when does arm edema occur
when lymph drainage obstructed after breast surgery or radiation
S2 split
when valve closes significant earlier in aortic valve that pulmonic valve during inspiration the sounds can be heard separate. heard every 3-4 beats
questions to ask about rash or lesions
where it started has it spread anyone else have it changed any meds or skin products alleviating/aggravating/associating factors
what to document about adventitious sounds?
whether inspiratory or expiratory, loudness, pitch, and location on chest wall
whispered voice test purpose
whispering is a high-frequency sound that when not heard, detects high-frequency loss
appearance of candida infection
white coat will rub off with raw denuded surface
what people have visual impairment more?
white people, women, older adults
source of heath history
who provides info and are they reliable? are they sick, as this affects good communication. are interpretation services needed
performing ortolani manuever
with infant supine, flex the knees with thumbs on inner mid thigh and fingers on greater trochanters. adduct until thumbs meet and then gently lift and abduct until lateral aspect touches table. should produce no sound
myocardium
muscular wall of heart that does the pumping
hair distribution alterations are due to
liver disease and hormone abnormalities
How many OM considered recurrent?
3 episodes in 3 months or 4 in one year
semicircular canals
3 fluid-filled structures in the inner ear that house receptors for body position and movement. plumb lines register angle of head in relation to gravity
alveoli number at birth
40 million
Caloric demand of adolescents
4000 calories for boys and 20% less for girls
palpating for kidneys
"duck bill" position at person's right flank and press deeply and have them breathe deeply. nothing usually felt but can occasionally feel lower pole of right kidney as a round smooth mass that slides between fingers
scleroderma
"hard skin". a chronic connective tissue disorder associated with decreased mobility
allergic rhinitis and common causes
"hay fever" abnormal immune response from repeated exposure to antigens with rhinorrhea, itching of nose and eyes, tearing, congestion, sneezing. Note serous edema and turbinate swelling fills air space and appears white, glistening, and smooth. Common allergies- dust mites, animal dander, mold, pollen. Causes disordered sleep, obstructive sleep apnea, sinusitis, avoidance of outdoor activities, and poor work performance.
cholasma
"mask of pregnancy" hyperpigmentation of the skin, characterized by yellowish-brown patches or spots on face. usually fades after childbirth. also in those taking BCP
Cause and location of epistaxis
(nose bleed) commonly comes from the anterior septum occurs with trauma, vigorous nose blowing, foreign objects
recent weight change formula
(usual weight - current weight) / usual weight X 100
Android obesity
Obese persons with a greater proportion of fat in upper body, especially in abdomen
Romberg test
-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds assesses vestibular apparatus ability to help maintain standing balance along with assessing intactness of cerebellum and proprioception
CNS depressants
Opiods, alcohol, benzodiazepines
Testing Cranial Nerve II
Optic nerve: visual acuity charts, visual fields (confrontation test for peripheral vision), papilledema notes with optic disk for increased ICP
incompetent vavles
lumen so wide that valve cusps can't approximate. creating further pressure that dilates even more
ROM motions for spine
-bend forward (concave lumbar should disappear and back should have single shape) -bend sideways and backward (lateral and hyperextension) -twist shoulders to each side (rotation)
ROM motions for wrist and hand
-bend hand up and down (hyperextension and flexion) -bend fingers up and down (hyperextension and flexion) -turn hands out and in (ulnar and radial deviation) -spread fingers and make fist -touch thumb to each finger and base of little finger
ROM motions of Cervical spine
-chin to chest (flexion) -lift chin (hyperextension) -ear to shoulder (lateral bending) -turn chin to each shoulder (rotation)
Radiocarpal joints
-condyloid articulations between the radius and the three carpal bones -articulation of the distal radius (thumb side). Its condyloid action permits flexion/extension and side to side deviation
CNII Oculomotor abnormalities cause
-dilated pupil, ptosis, eyes turn out and slightly down - failure to move eye up, in, or down - absent light reflex
carotid artery pulse coincides with
S1
vital capacity
maximum amount they can expel from lungs after first filling lungs to maximum
5 things to assess individually about heart sounds
1) rate and rhythm 2) identify s1 and s2 3) assess S1 an S2 separate 4) listen for extra heart sounds 5) listen for murmurs
anterior thyroid approach
find ismuth by placing thumb 3cm below thyroid cartilage prominence as person swallows and turns head and check
identify 5 auscultatory areas of the heart
1) second right interspace= aortic valve areas 2) second left interspace= pulmonic valve area 3) left lower sternal border= tricuspid valve area 4) fifth interspace at around MCL= mitral valve area 5)
systolic pressure
maximum pressure felt on artery during left ventricular contraction, or systole
structural changes in the TM of older adults
may appear whiter and more opaque, dull, and possibly thickened
3 causes of murmurs
1) velocity of blood increases= flow murmur (exercise and thryotoxicosis) 2) viscocity of blood decreases (in anemia) 3) structural defects of the valves or unusual openings occur in the chambers
symptoms of cerebral hypoxia
may be reflected by excessive drowsiness, anxiety, restlessness, irritability
Paget's disease of bone
*couldn't find in book so definition from online* (Osteitis Deformans) Skeletal disease of increase bone resorption and formation, which softens, thickens, and deforms bone. Characterized by bowed long bones, sudden fractures, frontal bossing, and enlarging skull bones that forma an acorn-shaped cranium. Can cause: headache, vertigo, tinnitus, progressive deafness, and optic atrophy and compression of the spinal cord.
congenital hypothyroidism
*couldn't find in book so online definition* condition present at birth that results in lack of thyroid hormones; results in poor physical and mental development; formerly called cretinism
Ulnar deviation or drift
fingers drift to the ulnar because of the stretching of the articular capsule and muscle imbalance caused by chronic RA
widened aortic pulse
fingers push apart (lateral pulsation) associated with abdominal aortic aneurism
quadricep location and function
front of thigh muscle that extends the knee
Which sinuses are palpable
frontal and maxillary
vertigo cause
may be related to inflamed labyrinth and can affect the way info is transferred to the brain
ways to palpate for sinusitis
frontal and maxillary sinuses palpated and tender. checking for focal pain when pt bends over
First heart sound
S1, occurs with closure of the atrioventricular valves signaling the beginning of systole. mitral closes just before tricuspid but usually heard as one fused sound
Second heart sound
S2; occurs with closure of the semilunar valves, aortic and pulmonic; signals the end of systole
types of paranasal sinuses
frontal, ethmoid, sphenoid, maxillary
consequences of sighing too much
may indicate emotional dysfunction and may lead to hyperventilation and dizziness
third heart sound and when it occurs
S3. during passive prodiastole- ventricles are resistant which causes vibrations of the chest. occurs right after S2 when AV valves open
fourth heart sound and when it occurs
S4. occurs during active prediastole. atria contract and push blood into a noncompliant ventricle. can be heard right before S1
bodily changes in pregnant female
- hormonal changes -connective tissue changes - dissipate heat through peripheral vasculature dilation- causing visible large veins - sweat and sebaceous glands increase secretion - increased fat deposits in buttocks and hips
hacking cough indicates
mycoplasma pneumonia
influences on temperature
diurnal cycle (1-1.5 change), menstrual cycle (0.5-1), exercise, age (lower in infants that can't shiver and under 2 months can't sweat)
septum
divides nasal cavity into two slit-like air passages
Pathway of heart electrical conduction
SA note near SVC initiated impulse, then goes to AV node low in atrial septum, bundle of His, left and right bundle branches, then through the ventricles
carbon monoxide exposure symptoms
dizziness, h/a, fatigue
Assessing infant cranial nerve I,II,III,IV
- Blink reflex - pupil size, shape, equality - regards face or object - eyes follow movement
What does the biceps reflex test?
- C5 to C6 - contraction of the biceps muscle and flexion of the forearm when striking bicep tendon
What does brachioradialis reflex test
- C5 to C6 - flexion and supination of the forearm strike 2-3cm above radial styloid process
What does the triceps reflex test?
- C7 to C8 - extension of the forearm strike tricep tendon directly above elbow
What does plantar reflex test
- L4 to S2 - slow stroke upside down on ball of foot - Normal is plantar flexion of the toes and inversion and flexion of the foot (Negative Babinski sign)
Assessing infant cranial nerve VIII
- Moro reflex (until 4 months) - acoustic blink reflex- blinks in response to hand clap a foot from head - eyes follow direction of sound
Screening for child abuse
- Obtain a medical history- This should include for any chronic illnesses, injuries, medications (some may cause easy bruising), repeated hospital visits, or delays in seeking care? - Talk to the child without the parents present (if possible and old enough)
common causes of sensorineural hearing loss
- advanced age - noise exposure - ototoxic meds- affect cochleae hair cells - meniere's disease
causes that affect transfer of sound to middle ear
- cerumen impaction - otitis media/ externa - tympanic membrane perforation - foreign body - otosclerosis- due to decrease in mobility of ossicles
ear changes in older adults
- cilia becomes coarse and stiff - impacted cerumen impedes hearing: it oxidizes, causing this impaction and is drier due to apocrine atrophy. - presbycussis
Increased risks of alcohol consumption by older adults
- decreased metabolism- stays in body longer due to metabolism and decline in liver and kidney fx - concentration increases- due to less skin and muscle tissue - medications that interact- Bp meds, blood thinners, antidepressants, pain relievers - cognitive decline- sensory issues -confusion, depression, and risk of fall exists
additional hx for infants and children
- ear infections (amount, frequency, risk factors) - parental impression of hearing fx/concerns
gathering subjective data
- introduce initial question: "do you feel safe at home" - standardized tools used - reassure that help is available and discuss health problems that accompany IPV
Assessing infant cranial nerve IX and X
- swallowing and gag reflex - coordinate sucking and swallowing
screening tools evaluate what about drinking
- tolerance - withdraws signs - drinking despite problems - spends lots of time revolved around drinking - spends less time on important things in life
CN X vagus nerve abnormalities cause
- uvula deviates to side - no gag reflex - voice quality: hoarse/brassy, nasal twang, husky -dysphagia: fluids regurgitate through nose
Alcohol screening tools
-Alcohol Use disorders Identification test (AUDIT) -Cage Questionaire -TWEAK -Short Michigan Alcoholism screening Test- Geriatric (SMAST-G)
What does quadriceps reflex test
-L2 to L4 (knee jerk) -Just below patella and causes extension of lower leg
What does achilles reflex test
-L5 to S2 (ankle jerk) -foot plantar flexes against hand strike achilles tendon while holding foot in dorsiflexion
ROM of ankle and foot
-Point toes down, up (plantar flexion, dorsiflexion) -Turn soles out, in (eversion, inversion) -Flex and straighten toes
CN V trigeminal nerve abnormalities cause
-absent touch and pain; paresthesia - no blink - weakness of masseter or temporals muscle
meds causing hyperpigmentation
-antimalarials -anticancer ascents -hormones -metals -tetracycline
how to interview an anxious pt
-appear unhurried -avoid interview traps -use therapeutic responses
ROM motions for shoulders
-arms forward and up then back (forward flexion and hyperextension) -arms to sides and up over head (abduction) -swing arms across front of body (adduction) -arms behind back and hands up (internal rotation) -touch hands behind head (external rotation)
CN VI Abducens Nerve abnormalities cause
-failure to move laterally - diplopia on lateral gaze
what are the first two statements of the GAD-7?
-feeling nervous, anxious, or on edge -not being able to stop or control worrying
ROM motions elbow
-flex and extend elbow -pronate and supinate hand
ROM motions of knee
-flex knee -extend knee -check knee during ambulation
Types of scoliosis
-idiopathic: shows up during adolescence usually not progressive -functional: flexible; occurs with standing and disappears when bending forward. may compensate for unequal leg lengths -structural: fixed; shown when standing and leaning forward.
Closing the Interview steps
-is there anything else you'd like to mention? -are there any questions you'd like to ask? -follow w a summary
what are the first two statements of the PQH-9?
-little interest or pleasure in doing things -feeling down, depressed, or hopeless
What makes certain people bruise easier
-medication: aspirin, blood thinners, NSAIDs -abnormal blood volumes -nutritional supplements: garlic and ginko
mobility and turgor of skin
-mobility is the skin's ease of rising (decreased with edema) -turgor is the skin's ability to return to place promptly when released this reflects the elasticity. to check mobility and turgot pinch up a large fold of skin on the anterior chest under the clavicle and release
misunderstanding health information can lead to
-noncompliance of health management -increased ER visits -increased readmission rates -inability to effectively recall info or manage chronic disease
Motion and expected range of temporomandibular joint
-open mouth maximally -protrude lower jaw and move side to side- lateral may be lost early and significantly -stick out lower jaw
dysphagia occurs with
-pharyngitis -gastroesophageal reflux disease -stroke & other neurologic diseases -esophageal cancer
ROM motions for hip
-raising leg (flexion) -knee to chest (flexion) -flex knee and hip; swing foot in and out (internal and external rotation) -swing straight leg medial and lateral (abduction and adduction) -stand and swing leg back (hyperextension)
impaired vision results from (three things):
-refractive error -opacity in media (cornea, lens, vitreous) -disorder in retina or optic pathway
meds causing sun sensitivity
-sulfonamides -thiazide diuretics -oral hypoglycemic agents
Top priority questions when interviewing those intoxicated
-time of last drug/drink -how much was taken -name and amount of each drug taken -your safety (dont turn back on them) ask questions in simple nonthreatening way without displaying disapproval
CN XII hypoglossal nerve abnormalities cause
-tongue deviates to side -slowed rate of tongue movement
numeric pain rating scale and minimum age
0-10, ten being worst pain pt has ever been in. consistent test throughout multiple clinicians. must be 9 or older
cognitive development stages
0-2 Sensorimotor, think by touch, taste, smell, etc. presymbolic. reflexive communication 2-7 Preoperational think by symbols from previous experiences. beginning of symbolic thinking 7-11 Concrete Operational, logical and organized not yet abstract. numbers, classification, and conservation 11+ Formal Operational, abstract thinking like adults. futuristic/ theoretic perspecitve
reflex scale
0: no response 1+: diminished response, low normal, or occurs with reinforcement 2+: normal physiologic response 3+: increased response (brisk). may indicate disease 4+: hyper-reactive, often associated with clonus, indicates disease
3 mechanisms that cause venous blood flow
1) Contraction of skeletal muscle tissue brings blood proximally toward heart 2) pressure gradient due to breathing- inspiration makes thoracic pressure decrease and abdominal increase 3) intraluminal valves ensure unidirectional blood flow
Subjective data order for alcohol use
1) ask about alcohol use 2) use screening tools 3) Assess for alcohol use disorders 4) Advise and assist (brief intervention)
6 grades of murmur loudness
1) barely audible- heard only in quiet room 2) clearly audible but faint 3) moderately loud; easy to hear 4) loud. Associated w thrill palpable on chest wall 5) very loud. Heard w/ one corner of scope, thrill 6) loudest; entire stethoscope lifted just off chest wall, thril
functions of the middle ear
1) conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear; 2) it protects the inner ear by reducing the amplitude of loud sounds; and 3) its eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture
reasons its important to review bodily systems w pt
1) evaluate past and present health of each system 2)see if there is anything excluded from present illness section 3) evaluate health promotion practices
3 Erythematous States Common in Neonate
1) first 24 hours- red flush due to vasomotor instability 2) harlequin- on side- lower half reddens and upper blanches line down midline; transient 3) erythema toxicum- common rash in 1st 3-4 days "flea bite" or "newborn rush"- red tiny punctuate macules and papules
TB stages
1) macrophages engulf but don't fill bacilli and tubercle forms around bacilli 2) scar tissue forms and lesion calcifies 3) reactivation of previously healed lesion- multiplication occurs 4)extensive destruction as lesion erodes into bronchus, forming air filed cavity
aspects noticed about source of history of a child
1) person providing info on behalf of child 2) your impression on the reliability of the info 3) need for translator or special services
Pitting Edema Scale
1+ Mild pitting, slight indentation, no perceptible swelling 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation remains, leg looks swollen 4+ Very deep pitting, indentation lasts long time, leg very swollen
tonsil grading scale
1+: visible 2+: halfway b/w tonsillar pillars and uvula 3+: touching uvula 4+: touching each other (1+ or 2+ can be seen in healthy people, particularly kids, who have larger lymph)
drinking correlation with HTN
1-2 drinks daily associated w HTN
ten traps of interviewing
1. Providing false assurance or reassurance 2. Giving unwanted advice- no personal feelings 3. Using authority 4. Using avoidance language- "died" not "passed on"-avoids reality 5. Engaging in distancing- use of interpersonal space to put spare between a threat and self "the" instead of "your" 6. Using professional jargon 7. Using leading or biased questions 8. Talking too much 9. Interrupting 10. Using "why" questions- causes excuses given to try to justify behavior
3 functions of lymphatic system
1. conserves fluid and plasma proteins that leak from capillaries 2. form major part of immune system 3. lipid absorption from small intestines
steps of diagnostic reasoning
1. cue recognition 2. hypothesis formulation 3. data gathering for hypothesis testing 4. hypothesis evaluation
external factors of communication
1. ensure privacy 2. refuse interruptions 3. physical environment: 4-5 ft from pt 4. dress 5. note taking
inspect straightness of spine by:
1. following imaginary line from head through spinous processes down through gluteal cleft 2. noting equal horizontal positions for the bone and bone markings
What waist-to-hip ratio indicates android obesity
1.0 or greater in men and 0.8 or greater in women
Common pigmented areas include (3):
1.Freckles 2.Moles/Nevi 3.Birthmarks
Phsyiological jaundice
1/2 newborns. yellowing after day 3-4 due to increased RBCs hemolyzed. They are metabolized and turned into bilirubin
SMAST-G
10 questions. determines at risk use or abuse of alcohol in older adults
Types of elder abuse and rates
10% of elders. 1 in 14 reported. includes intentional acts and failure to act - physical abuse - sexual -psychological/emotional- controlling or social isolation - neglect - financial abuse or exploitation
what temperature is considered a fever?
100.4 F (38 C)
when to get vaccinated for measles
12-15 months and 4-6 years
Normal respiratory rate
12-20 breaths per minute
24 hour recall
12am to 12am. have problems as pt may not be able to recall all foods/ amount of food or may have had more or less food than normal
What percent of kids have mental/behavioral/development disorders
14% of 2-8 and 20% of 9-17. only 25% get needed help
Low calorie amount for weight loss diet plans
1400-1500kcal/day
normal nail bed angle
160 degrees. curves nails still normal if this angle still is the same
what percent of aging adults have mental disorders?
18.3% and 4.% are serious
What is nail clubbing, when is it most commonly found?
180 and spongy, becomes convex. chronic hypoxia (due to response and cardiac conditions). occurs with lung disease, cyanotic heart disease, pulmonary disease
AP to transverse diameter
1:2 or .70
Normal AP to transverse diameter ratio
1:2 or .70
1st, 2nd, and 3rd priorities of care
1st- emergent and immediately life threatening: airway or breathing 2nd- those requiring prompt intervention to forestall further deterioration- mental status, acute pain, abnormal lab values, UI issues, untreated medical problems, infection risk, risk to safety/security 3rd- can be attended to after urgent things fixed. interventions long term: lack of knowledge, mobility problems, family coping
Umbilical cord consists of
2 arteries and 1 vein
indirect percussion
2 hands. pleximotor (middle finger) stationary hang and plexor (tip of middle finger) striking finger
how many words are used in phases of 2, 3-4, and 5-6 year olds
2- 2 words 3-4- 3-4 words 5-6- 6- 8 words
How wide must an abnormal percussion area be to yield an actual finding?
2-3 cm wide
Nutritional needs of surgery, trauma, burn, infection pts
2-3 times greater than normal caloric and nutrient needs
presbycusis
2/3 over 70. sensorineural high pitched hearing loss affecting middle ear structures or cause damage to nerve cells in the inner ear or to cranial nerve VIII. affects more men than women of same age and more in white/hispanics
Low fat diet %
20-25% of total calories
visual impairment is considered?
20/50 or worse.
risk factors for melanoma
20x higher in white people more common in women under 50 and men later on >50 moles or atypical moles uv radiation family fx advancing age- accumulation of DNA damage
heart ventricle size ratio
2:1 left:right. reaches this by 1 year old
heart borders and where it extends from
2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line.
Dizzy/vertigo/syncope
dizzy- lightheaded/faint vertigo- room spinning syncope- LOC possible due to decreased blood flow
chronic cough
3 months of year for more than two yeers. characteristic of chronic bronchitis
When does salivation begin?
3 months. they drool for a few months before learning to swallow. drooling does herald eruption of first tooth
turbinates function
3 parakeet body projections in nasal cavity: superior, middle, and inferior. they increase surface area so more blood vessels and mucous membranes warm, humidify, and filter air
how long to use glass thermometer
3-4 mins if afebrile and 8 if febrile
normal resting pupil size
3-5mm
How wide should mouth open
3-6cm or 3 fingers sideways
Size of a newborn's chest
30-36cm (2cm smaller than head circumference until age 2)
infant respiratory rate
30-40 normal, but can get up to 60
alveoli number by adolescence
300 million
spinal nerves
31 pairs "peripheral nerves" that are named from the region of the spine that they exit from
intimate partner violence rates and 5 types
33% women and 25% men physical sexual stalking psychological aggression Teen dating violence- above types, cyber bullying, sex trafficking
spine vertebrae number
33: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-4 coccygeal
CRIES pain scale
3pt scale for 0-2 years old. C=crying R=requires o2 I=increased vital signs E-expression S=sleeplessness maximum 10
faces pain scale revised
4 or older pick a face describing how you feel
normal forced expiratory time
4 seconds or less. 6 or more occurs with obstructive lung diease
force or strength of pulse levels
4+ bounding strong 3+ full, easy to palpate 2+ normal, easy to palpate, 1+ diminished, difficult to palpate, weak and thready 0 absent
Regular exercise plan consists of
4-5 times a week for 30 minutes minumum
normal cardiac output
4-6L per minute
Grading Muscle Strength
5 Full ROM against gravity full resistance 100% 4 Full ROM against gravity some resistance 75% 3 Full ROM with gravity 50% 2 Full ROM with gravity eliminated (passive) 25% 1 Slight contraction 10% 0 no contraction 0%
what is considered binge drinking?
5 or more drinks
Normal amount of bowel sounds
5-30 per minute
deep palpation
5-8cm. assesses an organ or mass deeper in a body cavity
Risks of IVP homicide
55% of female homicides due to IVP. highest in black and islander/alaskan women
Inner ear development in gestation
5th week
when to get vaccinated for pertussis
6-8 weeks- need to cocoon to give baby immunity until they can receive vaccine
normal pulse range
60-100 bpm
scoring of apgar
7-10= healthy 3-6= moderately depressed- need more resuscitation/observation 0-2= severely depressed- need full resuscitation, ventilatory assistance, and subsequent intensive care
Prevalence of color blindness
8% white males 4% black males 0.4% females
what age to start palpating sinuses
8. otherwise too small
what degree should the costal angle be
90 or less, increases when rib cage is chronically overinflated
Normal temperature range
96.4-99.1 or 35.8-37.3
apical impulse by age
<4- 4th ICS to left of MCL 4-6- 4th ICS at MCL 7- 5th ICS to right of the MCL
hirshberg in kids
<6 months some asymmetry is normal
what is considered bradycardia and tachycardia
<60 and >100
what MAP is normal
> 60 mmhg needed for adequate perfusion
what is considered elevated jugular venous pressure
>3cm above sternal angle when at 45 degree angle
How many cafe-au-lait spots are necessary for concern of neurofibromatosis
>6 that are >1.6mm diameter
When should the pneumococcal vaccine be given?
>65
Who gets macular degeneration more?
>75yrs or white
Chalazion
A beady nodule protruding on the lid, chalazion is an obstruction and inflammation of a meibomain gland. If chronic, nontender, firm, discreet movable swelling. Acute- tender and inflamed, not on lid margin (stye)
multiple sclerosis
A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech
Metabolic syndrome
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes (3 out of 5). -increased BP -increased fasting glucose -increased triglycerides -increased waist circumference -decreased high density lipoprotein cholesterol
cleft palate and its cause
A congenital defect, the failure of fusion of the maxillary processes.
Cheyne-Stokes respiration
A cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. these periods last 30-45 seconds with periods of apnea (20 seconds) alternating the cycle. most commonly caused by HF
Parkinson's Syndrome
A deficiency of the neurotransmitter dopamine and degeneration of the substantia nigra of the basal ganglia in the brain. The immobility of features produces a flat and expressionless face, mask like, elevated eyebrows, staring gaze, oily skin, and drooling
what conditions does a pulse deficit occur with?
A fib, premature beats, HF
aortic stenosis murmur sound
A harsh ejection systolic murmur. Starts after isovolumic contraction and ends before S2.
mitral stenosis murmur sound
A low-pitched, rumbly mid-diastolic murmur that starts near the end of isovolumic relaxation.
How to palpate popliteal pulse
A more diffuse pulse and can be difficult to localize. leg extended but relax. anchor thumbs on knee and curl fingers around into popliteal fossa. often just lateral to the medial tendon
heel to shin test
A neurologic test assessing lower limb coordination and position sense. heel walls off shin with cerebellar disease
gyrus
A ridged or raised portion of a convoluted brain surface.
emphysema
A serious disease that destroys lung connective tissue characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. this increases airway resistant, particularly during expiration
What is used to effectively communicate with other health professions about a patient
SBAR (situation, background, assessment finding, recommendation)
Dietary Reference Intakes (DRIs)
A set of reference values for the intake of energy, nutrients, and food components
Waves of the Jugular pulse:
A wave- reflects atrial contraction bc some blood flows back to vena cava C wave- ventricular contraction, back flow from bulging upward of tricuspid valve when it closes at beginning of ventricular systole X wave- atrial relaxation V wave- passive atrial filling bc of increasing volume and pressure in right aorta Y wave- reflects passive ventricular filling
appearance of the soft and hard palates
hard- lighter bone soft- darker pink mobile muscle
Scleroderma
hardening of the skin. chronic connective tissue disorder associated with decreased mobility
full/bounding pulse occurs with
hyperkinetic states (exercise, anxiety, fever), anemia, and hyperthyroidism
A full, bounding pulse is associated with
hyperkinetic states (exercise, anxiety, fever, hyperthryroidism, anemia).
What to do when a pt cries/ looks like they will cry
do not go onto new topic allow them to cry acknowledge the expression
Rapid Alternating Movements
Assess coordination by asking person to pat the knees with both hands, lift up, turn hands over and pat knees with the backs of the hands. Then ask them to do it faster. Normal Finding: Done with a equal turning and quick rhythmic pace
carotid auscultation
Assess for bruit - loud blowing sound associated with stenosis of an artery (hearing it is a marker for atherosclerotic disease) use the bell to listen at jaw angle, midcervical area, and base of neck; person should hold their breath so you aren't distracted by tracheal sound. heard when lumen occurred from 1/3 to 2/3
blood pressure changes with age
SBP increases due to stiffening of arteries (left ventricular wall thickens to try to compensate for this loss of elasticity) increased pulse pressure as SBP increases and DBP doesn't change significantly
rotator cuff consists of
SITS- supraspinatus, infraspinatus, teres minor, subscapularis muscles
Components of the Mental Status Examination
ABCT Appearance Behavior Cognition Thought processes and perceptions
Lymphedema
Accumulation of protein rich fluid in the interstitial spaces of the arm follow breast surgery or treatment Protein rich lymph builds up in interstitial spaces which raises pressure and promotes more fluid leakage
Optimal nutritional status
Achieved when sufficient nutrients are consumed to support day-to-day body needs on a daily basis
What happens in the eye during accommodation?
Adjusts the curvature by changing the shape of the lens
Conductive hearing loss
Affects the structures that transfer sound to the inner ear. Involves the external and middle ear- typically mechanical dysfunction to it. one or both. partial loss- can hear if sound is amplified enough to reach normal nerve elements in ear
Races with increased stroke risk
African Americans, American Indians, Mexican Americans
Venous (stasis) ulcer cause and appearance
After acute DVT or chronic incompetent valves in deep veins. 80% of lower leg ulcers Occur at medial malleolus and tibia; characterized by bleeding and uneven edges
thyroid-single nodule
Aka simple diffuse goiter. Endemic. Chronic enlargement of thyroid gland in areas where soil is low in iodine, an important element in formation of thyroid hormones
Ortolani maneuver purpose
done at each visit until 1yr. checks for congenital hip displacement
Leukonychia
Also known as white spots, whitish discoloration of the nails caused by injury or picking at cuticle
otitis media with effusion
Amber/yellow drum suggests serum in middle ear that transudes to relieve negative pressure from blocked Eustachian tube. May note air/fluid level. Symptoms are fullness, transient hearing loss, and popping sound with swallowing
what is pulse rhythm
feeling of the pressure wave of arterial walls as heard pumps blood
palmar grasp
An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object.
sternal angle and location
Angle of Louis. continuous with the second rib. useful place to start counting ribs and help find things horizontally. marks site of tracheal bifurcation into the left and right bronchi
Plantar grasp
Apply pressure with thumb on the ball of infant's foot and toes curl down tightly. disappears at 8-10 months
cerebrum
Area of the brain responsible for all voluntary activities of the body
Ateriosclerosis vs. atherosclerosis
Arterio-hardening, thickening of wall narrowing lumen Athero-buildup of cholesterol plaque on inner wall, narrowing lumen
5 A's of smoking cessation
Ask Advise Assess (readiness/ interest in quitting) Assist Arrange
Phalen's test
Ask person to hold both hands back to back while flexing wrists 90 degrees Acute flexion of wrist for 60 seconds produces no symptoms in the normal hand Test reproduces numbness and burning in person with carpal tunnel syndrome
Brief pain inventory
Asks the patient to rate the pain within the past 24 hours using graduated scales (0-10) with respect to its impact on areas such as mood, walking ability, and sleep.
presystole/atrial systole/ atrial kick
At the end of diastole when the atria contracts to actively push the last amount of blood (25% of SV) into the ventricles
Cause and appearance of Arterial (ischemic) ulcer
Atherosclerosis (intimate fatty plague buildup) and arteriosclerosis (hardening/ calcifying of arterial wall) Occurs at toes, metatarsal heads, heels, and lateral ankle. Pale ischemic base well defined edges no bleeding- dry and punched out
hyperthyroidism
Autoimmune disorder with increased production of thyroid hormones causing increased metabolism. Manifested by goiter, eyelid retraction, and exophthalmos (bulging eyes). Nervousness, fatigue, weight loss, muscle cramps, and heat intollerance. Signs- forceful tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair, warm moist skin, infrequent blinking, staring appearance, brisk ankle jerks
Celiac disease and symptoms
Autoimmune disorder. immune mediated inflammation results in damage to small intestines and villi. common symptoms include diarrhea and abdominal pain and distention no wheat, barley, rye, or commercial oats can be eaten
Primative reflexes
Automatic reactions that all healthy babies posses but are not seen in children or adults. as cerebral cortex develops in inhibits the reflexes and they disappear
Romberg test
feet together and eyes closed- slight swaying normal but not separation. Tests sensory loss as eyesight can accommodate for it
palpating for greater trochanter of femur
felt when person is standing in a depression on the upper lateral side of the thigh
Where is S1 loudest?
apex of heart
pupil
Controls the amount of light entering the eye
how do you assess pain in patients with dementia?
assess body language to help determine if pt is in pain. they feel pain but can't self-report it
rooting reflex
Brush the infant's cheek near the mouth. Note whether the infant turns the head toward that side and opens the mouth. Appears at birth and disappears at 3 to 4 months.
jugular veins reflect
assess the central venous pressure CVP and judge the heart's efficiency as a pump and the intravascular volume status
Waist-to-hip ratio purpose
assesses body fat distribution as an indicator of health risk
accommodation reflex
a pupillary response that occurs when you switch focus from a far object to a clot one. Normal response: convergence and pupillary constriction
perforation of the tympanic membrane
Untreated OM or trauma may cause drum rupturing. Usually appears as a round or oval darkened area on the drum Central- pars tensa marginal- annulus marginal perforations called attic perforations and occur in pars flaccida
visual acuity changes with age
both central (>70) and peripheral vision decreases
upper fine crackles indicates
CF
High pitched shrill cry
CNS damage of infants
cherry red lips can be a sign of
CO poisoning, acidosis from aspirin poisoning, ketoacidosis
upward palpebral slant
Can be a normal finding in kids, but when with epicentral folds, hypertelorism (space between eyes) and brush field spots, it indicates Down syndrome
Characteristics of eustachian tubes of babies
Canal slope opposite from adults. shorter, wider, more horizontal, facilitating movement of pathogens to middle ear.
decerebrate rigidity
Upper extremities: stiffly extended, adducted, internal rotation,palms pronated. Lower extremities: stiffly extended, plantar flexion; teeth clenched;hyperextended back
BMI formulas
Weight (kg) / [height (m)]^2 Weight (lb) / [height(in)]^2 * 703
Nonsynovial joints
Cartilaginous/fibrous- bones are united by fibrous tissue or cartilage and are immovable Separated by fibrocartilaginous disks and are only slightly moveable- ex vertebrae
meth mouth cause and what it leads to
Causes dental caries, gingivitis, tooth cracking, edentulism. Meth causes vasoconstriction and decreased saliva and increases urge to consume sugar and starch/ give up oral hygiene. Absence of buffering saliva increases acidity and plague that encourages bacteria growth
carotid artery
Central artery located in the groove between the sternomastoid and the trachea
What can cause asymmetry of facial structures
Central brain lesions (stroke) or peripheral cranial nerve VII damage (Bell's palsy)
Normal Spine Curvature
Cervical concave, thoracic convex, lumbar concave
Scorbutic gums
Deficiency of vitamin C. Gums are swollen, ulcerated and bleeding due to vitamin-C induced defects in oral epithelial basement membrane
atopic facies
Children with chronic allergies often develop characteristic facial features- exhausted face, blue shadows below eyes from sluggish venous return (Morgan lines), central facial pallor, open mouth breathing (allergic gaping), which can lead to malocclusion of the teeth and malformed jaw
monocular blindness
When light directed to the blind eye, no response occurs in either eye. When light directed to normal eye, both pupils constrict as long as the oculomotor nerve is intact
fetal alcohol syndrome
Cognitive and psychosocial impairment and changes in facial and brain structure. Incidence increasing in US. Narrow palpebral fissures, epicanthal folds, thin upper lip, and mid facial hypoplasia. Infants have smaller head circumference, size, feeding problems, and irritablity. Intrusive talking, inattention, poor reasoning, and ADL issues
pleural effusion (fluid) or thickening
Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. gravity settles this fluid in dependent areas of the thorax. presence of fluid subdues lung sounds most common cause HF, cancer, infection
Otomycosis
Colony of black or white dots on drum or canal- yeast or fungal infection
Ecchymosis
a purplish patch resulting from the extravasation of blood into the skin. >3mm in diameter
What is a subcortical reflex?
a reflex we have no control over
Bulge sign test
Confirms the presence of small amounts of fluid in supra patellar pouch as you try to move the fluid from one side of the joint to the other. firmly stroke up medial knee and tap lateral aspect watching medial side in hallow for a bulge of from a fluid wave across the joint
metacarpophalangeal joint
Connects metacarpals to the proximal phalanges. permits finger flexion and extension
tendon
Connects skeletal muscle to bone
Diencephalon
Contains thalamus and hypothalamus
Hirschburg test evaluates what?
Corneal Light reflex to diagnose strabismus. tests alignment of eyes. light 12 inches away. cornea reflection should be on same spot in both eyes. misalignment indicates muscle weakness paralysis
spinous processes
Count down these knobs on the vertebrae, which stack together on form spinal column
Facial nerves mediated by
Cranial nerve VII (facial nerve)
Gower sign
a sign that indicates generalized muscle weakness in children. need all four extremities to climb up
sucking tubercle
a small pad in the middle of the upper lip from friction of breastfeeding or bottle feeding
Plaque
a solid mass greater than 1 cm in diameter. plateau/ disk shaped lesion
Lesion shape: linear
a stretch, streak, line, or stripe
causes of constipation in older adults
Decreased physical activity Inadequate intake of water Low-fiber diet Side effects of medications Irritable bowel syndrome Bowel obstruction Hypothyroidism Inadequate toilet facilities, i.e., difficulty ambulating to toilet may cause person to deliberately retain stool until it becomes hard and difficult to pass
scarred drum
Dense white patches on eardrum are sequelae of repeated ear infections. Dont necessarily affect hearing
mental status exam for children
Denver II- direct test on them
murmur pitch
Describe as "high, medium, or low" Depends on the pressure and rate of blood flow producing the murmur
baby bottle tooth decay cause
Destruction of numerous deciduous teeth may occur in children that take milk, juice, or sweetened drink to bed and use bottles >1. Liquid pools around upper front teeth. Mouth bacteria act on carbs in liquid. This forms metabolic acids that break down tooth enamel and destroy its protein
hypoactive bowel sounds causes
Diminished or absent bowel sounds signal decreased motility as a result of inflammation: peritonitis, paralytic ileum following surgery, late bowel obstruction
tinels sign
Direct percussion of location of median nerve at wrist produces no symptoms in normal hand Percussion of median nerve produces burning and tingling along its distribution, which is a positive Tinel's sign for carpal tunnel syndrome
Which exam (otoscopic or acuity) is done first and why?
Do before hearing acuity test, as cerumen presence can give impression of pathologic hearing loss
peritoneum
Double-layered membrane internal to abdominal muscles that surround the abdominal organs
delayed eruption of teeth may indicate
Down syndrome, cretinism, rickets
dry vs wet macular degeneration
Dry - progressive and slow in one or both eyes due to druse deposits Wet - rapid with visions of wavy lines and loss of central vision usually in one eye. abnormal vessels grown under tissue and leak, causing scaring
Follicular hyperkeratosis
Dry, bumpy skin associated with vitamin A and/or linoleic acid deficiency
What is used to outline cardiac borders
ECG or xrays used instead of percussion as they're more accurate in detecting heart enlargement
Pulses bisferiens and what it occurs with
Each pulse has two strong systolic peaks with a dip in between; best assessed at the carotid artery. associated with aortic valve stenosis with reguritation
verbal response: facilitation
Encourages client to say more: "uh huh" or "go on"
extremely high palate arch may indicate
Ehlers-danlos, turner, marfan, treacher, chronic allergies
Clinical lab data of alcohol impairment
Ethanol (blood or breath) test or biomarkers
Cushing's syndrome
Excessive ACTH secretion and chronic steroid use causes a rounded moonlike face, prominent jowls, red cheeks, hirsutism on upper lip, lower cheese and chin, and acneiform rash on chest
acromegaly
Excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones. Elongated head, massive face, overgrowth of nose and lower jaw, heavy eyebrow ridge, and course facial features
popliteal artery
femoral artery courses posteriorly at the lower thigh- termed popliteal. divides below the knees
breakthrough pain
a transient spike in pain level, moderate to severe in intensity, in an otherwise controlled pain syndrome by meds or internal pain suppression. can be triggered by return to an activity after a surgery. make sure to check pain level within hour of intervention to avoid
Testing Cranial Nerve VII
Facial Nerve: assess facial symmetry for motor function (puff out cheeks, wrinkle eyebrows, tightly closed eyes, show teeth)
Assessing Infant Cranial Nerve VII
Facial movements: wrinkling forehead, nasolabial folds, symmetric face when crying
secondary lesion
changes over time or changes because of scratching or infection
Swan neck deformity
Flexion contracture looks like a swan neck as in a metacarpophalangeal joint. it occurs with chronic RA and is often accompanied by ulnar drift of the fingers
Focused or Problem-Centered Database
For limited or short term problem. Collect "mini" database, smaller in scope, concerns mainly one problem, one cue complex, or one body system
midsternal line
a vertical line down the middle of the sternum dividing the thorax into two equal sides
stage 4 pressure ulcer
Full-thickness tissue loss with exposed bone, muscle, or tendon- often slough or eschar and tunneling
What can occur if cow's milk is introduced too early?
GI and kidney issues, low iron, vitamin C, and vitamin E
causes of n/v
GI disease, pregnancy, medication side effect
abrasion
a wound caused by rubbing the skin or mucous membrane
Water-Hammer (Corrigan) Pulse-3+ and what its associated with
Greater than normal force, then collapses suddenly. Aortic valve regurgitation, patent ductus arteriosus
lower crackles may indicate
HF
elevated jugular pressure associated with
HF, cardiac tamponade, and contstrictive
Poor lifestyle factors can lead to
HTN, obesity, atherosclerosis, cancer, osteoporosis, diabetes
malignant melanoma
Half of these lesions arise from preexisting nevi. many colors possibly and may have scaling, flaking, oozing texture.
submandibular node
Halfway between tip and angle of mandible
Weak "thready" pulse and what its associated with
Hard to palpate, need to search for, may fade in and out, easily obliterated by pressure. Decreased cardiac output, peripheral arterial disease, aortic valve stenosis
Abusive burns in kids
Immersion pattern, pattern burn, cigarette burns
Thomas test
Hip flexor tightness have patient bring knees to chest in supine and then hold one knee while extending the other leg positive test: extended leg wont be able to touch the table
Stepping reflex
Hold the infant upright under the arms, with the feet on a flat surface. Note regular alternating steps. The reflex disappears before voluntary walking.
pacing reflex
Hold upright under arms let top of foot touch underneath of table. note flexing of hip and knee followed by putting foot on top of table. appears 4 days after birth
HARK tool
Humiliation, Afraid, Rape, Kick
HITS tool
Hurt, Insult, Threaten, Screen 0-5 rated for how often they do one of these things >10 indicates IPV good for adolescents
Myxedema
Hypothyroidism. Reduces met rate, and when severe can cause nonpitting edema and myxedema. Usual cause Hashimoto thryoidosis. Fatigue and cold intolerance, puffy swollen face (esp around eyes), puffy hands and feet, coarse facial features, cool dry skin, dry coarse hair, slow refluxes, sometimes thick speech
What are cranial nerves?
I Olfactory II Optic III Oculomotor VI Trochlear V Trigeminal VI Abducens VII Facial VIII Vestibulocochlear IX Glossopharyngeal X Vagus XI Spinal accessory XII Hypoglossal
Korotkoff sounds
I systolic pressure- tapping. fast blood due to small arterial opening and big pressure difference auscultatory gap- silence for 30-40. may occur w hypertension. can result in wrong BP- 5% of ppl II swooshing- still partially occluded artery III knocking- long duration, only closes briefly IV muffling of sounds- artery no longer closes V diastolic pressure
what are the cranial nerves
I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Vestibulocochlear IX. Glossopharyngeal X. Vagus XI. Accessory XII. Hypoglossal
Outcome Identification
Identify expected outcomes, individualize goals to the person that are specific, realistic and measurable, include a timeline
testing hearing acuity of newborns, 3-4 months, 6-8, and preschool aged
In a silent room, with the infant content, make a loud sudden noise like hand clap, note the following: • Newborns- Moro reflex (startle reflex), or acoustic blink • 3-4 months- acoustic blink reflex, stops movement, quiets if crying or cries if quiet • 6-8 months- turns head to sound • Preschool-school age- screened with audiometry
Phosphatidyylethanol (PEth)
characterizes drink patterns = distinguishes light, moderate. lasts 14 days
moro reflex
Infant reflex where a baby will startle in response to a loud sound or sudden movement. baby looks as if they're hugging a tree and then brings in arms and legs. disappears by 1-4 months
cellulitis
Inflammation of loose, subcutaneous connective tissue. Shows as thickening and induration of auricle with distorted contours
pregnancy abdominal distention
fetal heart tones with diminished bowel sounds. dull percussion over enlarging uterus
Order for abdominal assessment
Inspect, Auscultate, Percuss, Palpate- touching it changes bowel sounds
mechanism of fine crackles
Inspiratory crackles: inhaled air collides with previously deflated airways; airways suddenly pop open, creating explosive crackling sound Expiratory crackles: sudden airway closing
anterior axillary, posterior axillary, and midaxillary lines
Lift persons arm 90 degrees and divides the lateral (side of) chest by 3 lines: Anterior- extends down from anterior axillary fold where the pectorals major muscle inserts Posterior- continues down from the posterior axillary fold where the latissimus dorsi muscle inserts Midaxillary- runs down from the apex of the axilla and lies between and parallel to the other two
Types of violence
Intimate partner violence Child abuse/neglect Adolescent Relationship Violence Elder Abuse/neglect
introducing the interview
Introduce yourself and give the reason for the interview. let them know the process and about the physical exam
Tic and its cause
Involuntary compulsive repetitive twitching of a muscle group due to a neurologic or psychogenic cause
testing for color blindness
Ishihara test
Light vs. Deep Palpation
Light palpation detects surface characteristics and gets pt accustomed to being touched. Deeper palpation is for such things as abdominal contents, and is better using intermittent pressure instead of one long, continuous palpation. tender areas done last
what is the review of systems
It is a list of conditions you ASK the patient if they have ever had in each system. purely subjective, and cannot contain noticed info by provider
what to assess when nodes are enlarged
check area they drain for source of problem. explore upstream to enlarged node. all structures eventually drain into the deep cervical vein
Symptoms of stroke
LOC, weakness, sudden vision changes, fleeting balance
Lactose intolerance cause and symptoms
Lactose intolerance results from an inadequate supply of lactase, the enzyme that digests lactose. Symptoms include distention, cramps, flatus, and diarrhea higher in African Americans, asians, America Indians, and mediterranean groups
retracted eardrum
Landmarks look more defined/prominent. Light reflex absent or distorted. Drum dull and doesn't move prominent short process. Indicates negative pressure from obstructed Eustachian tube and serous OM
Scoliosis
Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies.
periorbital edema occurs with
Lids swollen and tissues loosely connected so excess fluid apparent. Occurs w/ local infections, crying, trauma, and systemic conditions such as CHF, renal failure, allergy, and hypothyroidism
Direction of blood flow
Liver to Right Atrium through Inferior Vena Cava Superior Vena Cava drains venous blood from head and upper extremities Right Atrium to Tricuspid Valve to Right Ventricke to Pulmonic Valve to Pulmonary Artery to Lungs Lungs oxygenate blood Pulmonary veins to Left Atrium to Mitral Valves to Left Venticle to Aortic Valve to Aorta to Body
Lower motor neurons function
Located mostly in PNS- cell body in anterior grey column and nerve fiber extends from here to the muscle. Consists of cranial nerves and spinal nerves of the PNS. The nerve fiber extends directly into the muscle
DTRs in aging adults
Loss of ankle and sometimes knee jerk. harder to relax- always use reinforcement, plantar reflex absent or difficult
generalized seizure phases
Loss of consciousness, tonic phase, clonic phase, post-ictal phase
hyperactive bowel sounds causes
Loud gurgling sounds "borborygmi" signal increased motility. Occurs with early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
ecroption
Lower lid loose and rolls out. Does not approximate to eye. Puncta cannot siphon tears effectively, causing excess tearing. Doesn't drain correctly, causing dry/ itching. Increases inflammation risk by being exposed. Occurs in aging from atrophy of tissue but can also result from trauma, chronic inflammation, or bells palsy
entroption
Lower lid rolls in due to spasm of lids of scar tissue contracting. Constant rubbing of lashes may irritate cornea, leading to tearing and red eye. Person feels a "foreign body" sensation.
Bell's palsy
Lower motor neuron lesion (peripheral) producing rapid onset of cranial nerve VII paralysis of facial muscles. Can be latent hsv1. Complete paralysis on one side of face. Usually presents w smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind ear. Greatly improved if corticosteroids and antivirals within 72hrs
S/S of alcohol withdrawal
N/v, tremor, sweating, anxiety, agitation, tactile disturbances, audio/visual disturbances, H/A, disoriented
cleft lip and what it occurs with
Maxillofacial clefts are common congenital deformities and occur w strong family hx, maternal phenytoin/dilantin, alcohol, drug use; maternal diabetes. Early tx preserves fx of speech and language formation, and deglutition (swallowing)
medical diagnosis vs nursing diagnosis
Medical Diagnosis: is used to evaluate the cause or etiology of disease Nursing Diagnosis: clinical judements about a persons response to an actual or potential health state
What raises risk of peptic ulcer disease
NSAIDS, alcohol, smoking, h. pylori
Pellagra
Niacin deficiency. pigmented keratotic scaling lesions in sun exposed areas
Supplemental Mental Status Examinations
Mini-Mental State Exam and Montreal cognitive assessment (MoCA)
CTQ-SF tool
Modified childhood trauma questionnaire- short form
vital signs are used to:
Monitor patient's condition, identify promblems, and evaluate response to intervention.
mood vs affect
Mood= persistent emotional state usually an adjective. Affect= external display of feelings- temporary expression and state of mine
Down syndrome
Most common chromosomal aberration. Upslanting eyes with inner epicanthal folds, flat nasal bridge, small, broad, flat nose. Protruding thick tongue, ear dysplasia, short, broad neck with webbing, small hands with single palmar crease. Often congenital heart deformities
abduction
Movement away from the midline of the body
otitis externa
Movement of ear painful and swelling/redness, purulent discharge, itching, fever, enlarged lymph. More common in hot and humid weather. Skin folds set up for infection
adduction
Movement toward the midline of the body
Thyroid- multiple nodules
Multiple often indicate infection or this, a Multinodular goiter, rather than a neoplasm. But question any rapidly enlarging or firm nodule.
Neurologic recheck consists of
Neuro exam performed on persons with demonstrated neurologic defects who require periodic assessments - Level of consciousness - Motor function - Pupillary response - Vital signs
Osteoarthritis
Noninflammatory, localized, progressive disorder involving deterioration of articular cartilages (cushions between bone ends). asymmetric joint involvement. Affected joints have stiffness, pain with motion, affected ROM
Pregnancy weight gain recommendations
Normal= 25-35lbs Underweight= 28-40lbs Overweight= 15-25lbs Obese= 11-20lbs
atelectatic crackles
Not pathologic; short, popping, crackling sounds that last only a few breaths due to secretions of alveoli not full aerated- occurs in sleepers or older adults as alveoli deflate slightly and accumulate secretions
Posterior (dorsal) column
Note our position/proprioception, identify family objects without looking, vibration, and localized touch
Allergic Conjunctivitis
Note the upper lid, conjunctiva, and cornea are inflamed from seasonal allergen or persistent allergen. Symptoms include itching (eye itch= allergy association), redness, watering, and discomfort. Does not obscure vision. Signs- diffuse conjunctival redness, lid swelling, upper tarsal surface that shows velvety thickening, redness, small papillae
Initial Pain Assessment Tools
OLD CARTS (onset, location, duration, characteristics, aggravating/alleviating factors, radiation, treatment, severity) PQRST (palliation/provocation, quality/quantity, region/radiation, severity scale, timing)
bulging of TM due to
OM increasing pressure
Four major types of malnutrition
Obesity, Marasmus, Kwashiorkor, Marasmus/Kwashiorkor mix
hydrocephalus
Obstruction of drainage of CSF resulting in excessive accumulation causing ICP increase and head enlargement. Creates frontal bossing, downcast of eyes (sclera visible above iris) and dilated scalp veins. The cranial bones thin, sutures separate, and percussion yields a "cracked pot" sound
Pressure Ulcers
Occurs over a bony prominence where circulation is impaired. impedes delivery of blood carried o2 and nutrients to skin, impedes venous drainage carrying metabolic waste away from skin
Testing Cranial Nerve I
Olfactory nerve: recognizing a smell through each nostril
OAS tool
Ongoing abuse screen
OVAT tool
Ongoing violence assessment tool
external auditory canal
Opening of ear canal. 2.5-3cm Cul-de-sac. outer 1/3 cartilage inner 2/3 tunnels through temporal bone and covered by thin sensitive skin. has S shape. allows sound to travel until it reaches tympanic membrane
Assessing infant cranial nerve XII
Opens mouth and tongue rises to midline when nose is pinched
Stridor mechanism
Originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body
middle ear structures
Ossicles- malleus, incus, stapes Eustachian tube
purulent otorrhea suggests
Otitis externa or otitis media if the drum has ruptured
nasal polyp cause and common site
Overgrowths of mucosa appearing as smooth pale gray nodules. Usually caused by chronic allergies. Common site- protrustion from middle meatus. Often multiple, mobile, or nontender and can obstruct air pathways. Symptoms- absence of sense of smell and a "valve that moves" in the nose as the person breathes
heath hx in children
adapted to include specific info for the age and developmental stage of child
palpating carotid artery
Palpate gently to avoid excessive vagal (CN X) stimulation Palpate one at a time to avoid compromising arterial flow to brain should be smooth and fast upstroke and slow downstroke
Strep A Pharyngitis occurs with
fever, absence of cough, tonsillar exudates, cervical adenopathy
Organs in LLQ
Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Myoclonus and examples
Rapid, sudden jerk or a short series of jerks at fairly regular intervals. hiccups are myoclonus of the diaphragm and one single myoclonus common when falling asleep. Severe myoclonus with grand Mal seizures
collateral
connects joint at both sides giving medial and lateral stability and prevent dislocation
Lichenification
Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen)
Epitrochlear lymph node palpation
check in depression 2-3cm above and behind medial condyle of the humerus reach hand under persons elbow to the groove btwn the biceps and triceps above medial condyle. not normally palpable
epigastric hernia
Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.
hernia
Protrusion of an organ through the muscular wall of the cavity that normally contains it
Lesion shape: Discrete
distinct individual lesions that remains separate
HEEADSSS
added psychosocial considerations for adolescents Home environment- support system? fam good? Education and employment Eating- does body cause you stress? any changes? peer related Activities Drugs Sexuality Suicide/ depression Safety from injury and violence
PQRST
Provocation/palliation- what happened when it started, what makes it better or worse, causes it, aggravates it Quality/ quantity- what it feels like Radiation/region- where does it travel or radiate; did it start elsewhere Severity- 0-10, does it interfere with activities, how long it lasts Timing- when did it start, how long it lasts, sudden or gradual, time of day, other symptoms, around meals or certain seasons?
Aspects of the General Survey
Physical appearance, body structure, Mobility, Behavior
Conjunctivitis
Pink eye; red beefy looking periphery vessels but usually clear around iris. Commonly viral or bacterial infection, allergy, or chemically irritated. Preauricular lymph node often swollen and painful with a hx of upper resp infection. Itching, burning, foreign body sensation, eyelids stuck together upon awakening. Normal vision, pupil size, and light rxn
HEEADSSS
added psychosocial considerations for the adolescent in functional assessment Home- support system? Education and employment- safety, happy, belonging Eating- size cause you stress? weight loss or gain? Activities Drugs Sexuality Suicide and depression Safety
Dappled brown patches in buccal mucosa occurs with
addison's disease
Example of superficial (cutaneous) reflex
Plantar reflex
Assessing an aging adult (purpose, position, preparation, sequence)
Purpose= develop a meaning of life position- sitting on exam table. if frail, lay. change positions as little as possible prep- take breaks if needed- go their speed. use physical touch as other senses are diminished sequence- head to toe
progressive lordosis
Posture changes to compensate for the enlarging fetus. Shifts weight back .
Assessing Adolescents (purpose, position, preparation, sequence)
Purpose= develop self-identity using values and social rose position- on table in street clothes. examine alone prep- positive bodily feedback, teach health tips to them sequence- head to toe, genitals last and fast
What do you do if BP is oddly high
check in thigh using palpation of popliteal artery remember that thigh BP diastolic is 10-40 higher but systolic is the same
Bronchophony
check posteriorly and ask them to say "99" to assess voice sounds
Swollen metacarpophalangeal joints occurs with
RA (but not in OA)
assessing for leg color changes
Raise leg 30 cm (1 foot) and ask pt to wag feet for 30 seconds. Skin color now only reflects material blood. Should look slightly pale but marked pallor indicates arterial insufficiency. Should return in 10 seconds. Dependent rubor and delayed venous filling with severe arterial insufficiency
parotid gland enlargement reasons
Rapid painful inflammation of the parotid occurs with mumps. Mumps is a contagious virus of the salivary glands. Swelling can also occur w blockage of a duct, abscess, or tumor. Note swelling anterior to ear lobe. Stensen duct obstruction can occur in aging adults dehydrated from diuretics or anticholinergics
vernix caseosa
cheesy substance covering the skin of the fetus at birth. made up on sebum and skin cells
Who gets cataracts more?
african american
Thalamus
Relay station for sensory information. sensory pathways form synapses on their way to the cerebral cortex integrating system controls emotion and creativity
balottement of patella
Reliable when larger amounts of fluid are present. Use left hand to compress supra patellar pouch to move any fluid into the knee joint. With right hand, push patella sharply against fetus. If no fluid present, patella is already snug against the femur. If fluid has collected, your tap on the patella moves it through the fluid and you will hear a tap as the patella bumps up on the femoral condyles
pressure differences in heart
Right-sided pressures in the heart are lower than left-sided pressures due to less energy needed to pump pulmonary circuit
deep leg veins
Run alongside the deep arteries and conduct most of the venous return from the legs Femoral Vein Popilteal Vein
great vessels of the heart
SVC and IVC Pulmonary Artery Pulmonary Veins Aorta
infant pain capacity
Same capacity. evidence shows that repetitive and poorly controlled pain in skin breaking procedures can result in pain hypersensitivity later in life
cradle cap
Scaly, crusted scalp occurs with seborrheic dermatitis
Scar
after a skin lesion is repaired, normal tissue is lost and replaced with connective tissue
Mini-Cog
Screens for cognitive impairment in otherwise healthy older adults Consists of a 3-item recall test and a clock drawing test (2 indicates dementia) test exec function- planning, managing time, organizing activities, manage working memory
What causes increase in AP diameter
age and COPD
hollow viscera
Shape depends on contents - stomach, gallbladder, small intestine, colon, and bladder
estimating amount of teeth a child should have
age in months minus 6
what can loss of hair be a result of?
chemo or hypothyroidism
Biot's respirations
Similar to cheyne stoke, but the breathing pattern is irregular. a series of 3-4 normal respirations followed by a period of apnea
STaT tool
Slapped, Threatened, and Throw Answering yes to any indicates IPV
tophi
Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.
Macule
Solely a color change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever.
nodule
Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule.
Papule
Something you can feel (i.e., solid, elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in epidermis
Test Cranial Nerve XI
Spinal accessory nerve: tests motor function - examine sternomastoid and trapezius muscles for equal size and strength: test strength by using resistance with shrugging or turning face
How to percuss the posterior chest
Starts at prices and percuss band of normally resonant tissue across tops of shoulders. Percuss at 5cm intervals making side by side comparison. Avoid damping effect of scapula and ribs
what makes up body structure in general assessment?
Stature, nutrition, symmetry, posture, position, body build/ contour, obvious physical deformities
Organs in LUQ
Stomach Spleen Left Kidney Pancreas Splenic flexure of colon Part of transverse and descending colon
Lasegue's test
Straight Leg Raise Test- test often performed to determine whether a patient with low back pain has an underlying herniated nucleus pulposes. straight leg raising while keeping knee extended normally produces no pain. dorsiflex foot right before point of paint
extension
Straightening of a joint
extraocular muscles and what do each of them control
Superior rectus III- look up Inferior rectus III- look down Lateral rectus VI- look outward Medial rectus III- look inward Superior Oblique IV- rotate inferior and laterally Inferior Oblique III- rotate superior and laterally
hemorrhoids
Swollen, painful rectal veins; often a result of constipation
rust colored sputum
TB or pneumococcal pneumonia
Direct injury due to IPV
TBI, h/a, pain
Joint pain worse in the morning and improves through the day
Tendentious
costovertebral angle percussion tenderness
Tenderness to percussion over the costovertebral angle; a common finding in pyelonephritis and other infections of the kidney. place one hand over 12 rib at costovertebral angle on back and thump
tools for determining health literacy
Test of Functional Health Literacy (TOFHLA) Rapid Estimate of Adult Literacy in Medicine (REALM) Newest Vital Sign (NVS)
contracture
The lack of joint mobility caused by abnormal shortening of a muscle
crossed representation
The left cerebral cortex receives sensory information from and controls motor functions to the right side of the body, while the right cerebral cortex receives sensory information from the left side of the body.
Celiac disease causes deficiency of
fiber, vitamin D, vitamin B12, folate, iron, zinc, magnesium, calcium
Undernutrition
The condition in which not enough calories are ingested to maintain health or the reserves are depleted
scaphoid contour
abdomen caves in
Post-ictal phase
The final phase of a generalized seizure, during which the patient becomes extremely fatigued, disoriented, and confused
radial artery
The major artery in the forearm; it is palpable at the wrist on the thumb side just medial to the radius.
involuntary guarding
abdominal wall muscle contraction that the patient cannot control; rigidity
influences on BP
age, race, weight, emotions, gender (none before puberty. female adults lower until menopause where they become higher), diurnal rhythm, exercise, stress
Pingueculae
aging adult finding. yellowish elevated nodules are caused by a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. at 3 and 9 o'clock postion
signs that a dementia pt is in pain
agitation, pacing, repetitive yelling
why is tympany heard over abdomen
air in intestines rise to the surface when the person is supine
What does crepitus indicate?
air in the subcutaneous tissue from a rupture somewhere in the respiratory system
Mechanism of high pitched wheeze (Sibilant)
air squeezed or compressed through narrow close-to-closing passageways
paranasal sinuses and function
air-filled cranial pockets that communicate with the nasal cavity, as they both have the same type of ciliated mucous membrane. they lighten the weight of skull bones, provide mucus, and serve as resonators for sound production
Typhany percussion note
airfilled stomach and intestines. long, loud, carries longest, high pitched, drum-like
mechanism of low-pitched wheeze (Sonorous rhonchi)
airflow obstruction
crackles
aka rales. discontinuous popping sounds heard over inspiration
wheeze
aka rhonchi. continuous musical sounds heard mainly over expiration
nail clubbing cause
The nail appears more convex and wide. The nail angle is greater than 160 degrees. 160 is considered normal. It occurs in chronic respiratory and cardiac conditions in which oxygenation is compromised (emphysema, COPD).
bronchial breath sound location characteristics
aka tracheal or tubule. located in trachea or larynx. high pitched, loud, harsh. inspiration is shorter than expiration
mental status exam tests
alert, oriented, behaving appropriate
when should teeth be all present by
all 20 deciduous teeth by 2.5 years
extrapyramidal system
all motor nerve fiber originating outside of the pyramidal tract. primitive motor movement maintains muscle tone and body control (walking)
Blood pressure definition
The pressure exerted by the blood against the walls of the arteries as the heart pumps and then relaxes
inferior border of scapula
The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib.
Where can S2 be heard?
all over percordium but best at base
Purpose of closed ended questions
fill in any left out details
Allergic salute and crease
The transverse line on the nose is also a feature of chronic allergies. Formed when child chronically uses the hand to push up on the nose and back- "allergic salute" to relieve itching and free swollen turbulences
Why are veins called capacitance vessels?
They can stretch more than arteries
Asthma (reactive airway disease)
allergic hypersensitivity causing bronchospasm and inflammation and edema in walls of bronchioles, causing airway resistance, especially during exhalation. wheezing present
cornea
allows light to enter the eye. covers and protects the iris and pupil. thin, transparent, sensitive (contains nociceptors)
absorption and excretion in skin
allows limited excretion of some metabolic wastes, by products of cellular decompositions: minerals, sugars, uric acid, urea, amino acid, cholesterol
Purpose of open-ended questions
allows narrative of events leading up to present and allows free answers
ChooseMyPlate
practical info, tips, and web-based tools to help individuals build healthier diets
why is otoscopic exam not performed in first few days of life?
although patency of canal determined at birth, it is full of amniotic fluid and vernix caseosa
what are types of ototoxic drugs
aminoglycoside antibiotics and anticancer drug cisplatin
moring/ all day fatigue indicates
anxiety or depression
peripheral arterial disease (PAD) and cause
any disorder of the arteries outside of, or peripheral to, the heart, usually those supplying limbs (non-coronary arteries). typically cause by atherosclerosis
paralysis
Total or partial loss of normal motor function
sucking reflex
Touch the lips and offer your gloved little finger to suck. Note strong sucking reflex. The reflex is present at birth and disappears at 10 to 12 months.
What type of hearing loss should be referred?
any sudden loss that is not associated with an upper respiratory infection
vitreous chamber
filled with thick fluid. largest chamber at back of eye that protects retina against rapid eye movement. shock absorber
Battle sign
Trauma to the side of the head may lead to basilar skull fracture involving temporal bone, causing mastoid process and behind the ear bruising. May show hemotypanium. Sign of abuse
Cause of decreased tactile fremitus
anything that obstructs transmission of vibration, getting in the way of the sound and your palpating hand can decrease fremitus. obstructed bronchus, pleural effusion, thickening, emphysema
pulmonary embolism
Undissolved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels.
lymphedema symptoms
Unilateral swelling, measurement of arm volume, non pitting brawny edema, overlying indurated skin
Outer layer of eye called what
Tunica Fibrosa
Middle layer of eye is called
Tunica vasculosa
Pustule
Turbid fluid (pus) in the cavity. Circumscribed and elevated.
succession splash
Unreleated to peristalsis- loud splash heard over upper abdomen when infant rocked side to side indicating air and fluid in the stomach as seen with pyloric obstruction or large hiatus hernia
carcinoma
Ulcerated crusted nodule with indurated base that fails to heal- intermittent bleeding. Usually occurs on superior pinna rim (sun exposure) may be in canal and have discharge
Brain attack or cerebrovascular accident
Upper motor neuron lesion (central). Acute neurological deficit caused by blood clot of a cerebral vessel, as in atherosclerosis (ischemic) or rupture in a cerebral vessel (hemorrhagic). Not able to smile if stroke but can still wrinkle forehead and close eye which shows that it is not Bell's palsy
Arm Span or Total Arm Length
Useful for monitoring nutritional status for pts in which height difficult to measure
Organs in the midline
aorta, uterus (if enlarged), bladder (if distended)
profile sign
Viewing finger from the side. Used to detect early clubbing
Bitot's spots
Vitamin A deficiency causing foamy plaques on cornea
Beefy red tongue due to
Vitamin B complex deficiency
thought processes
Way person thinks should be logical, goal directed, coherent, and relevant; should complete thoughts. does what they say make sense/ do you follow?
pilar cyst
Wen. smooth, firm, fluctuant swelling on the scalp containing sebum and keratin. Tense pressure of the contents causes overlying skin to be shiny and taut. Benign
iris
colored part of eye. functions as a diagram varying at the opening at its center, the pupil. its fibers contract the pupil. constricts for close vision and dilates for far
When is clonus tested
When reflexes are hyperactive
dolls eyes
When the head is turned to one side, the eyes should move conjugately to the opposite direction if the brainstem is intact
Brushfield spots
White specks that may appear around the edge of the iris, can be normal. These spots often suggest down syndrome
WAST tool
Women abuse screening tool
Torticollis
Wryneck. A hematoma in one sternomastoid muscles, usually injured by intrauterine malposition, results in head tilt and limited neck ROM to the opposite side. Feeling of firm, discreet, contender mass in mid-muscle on involved side. Requires tx or else muscle can become fibrotic and permanently shorten.
visual analog scale
a pain rating scale using a straight line; the left end of the line represents no pain, the right end represents the worst pain, and patients mark the place on the line that best represents the severity of their pain
fremitus
a palpable vibration from the spoken voice felt over the chest wall as they go from the larynx through the bronchi and lung parenchyma
types of nociceptor axons
a and c
seborrheic keratosis
a benign skin growth that has a waxy or "pasted on" look face, hands, trunk
scotomoa
a blind spot in eye. occurs with optic nerve diseases and glaucoma
torus palatinus
a bony protuberance in the midline of the hard palate arising after puberty. normal finding. higher in women, Indians, and asians
Darwin tubercle
a congenital, small painless nodule at the helix
mesentery
a double layer parietal peritoneum and has pathways for nerves, blood vessels, and lymph. they stabilize and support viscera
Malocclusion
a drift in remaining teeth due to tooth loss. causes further tooth loss and muscle imbalance from bone alignment change causing h/a, tenderness, spasms, and temporomandibular pain
bulla
a large blister that is usually more than 0.5 cm in diameter. superficial in epidermis and thinner walled- ruptures easy
fissure
a linear crack in the skin w/ abrupt edges, extends into dermis. dry or moist
Graphesthesia
ability to "read" a number by having it traced on the skin. good measure of sensory loss if patient can't grasp things for stereognosis. inability to distinguish occurs with central cortex lesions
Position (kinesthesia)
ability to perceive passive movements of extremities, move finger or big toe up and down and ask them to tell you which way it was moved, switch up patterns, eyes closed, normally person can detect movement
stereognosis
ability to recognize objects by feeling their form, size, and weight while the eyes are closed
what is ascites
abnormal accumulation of fluid in the abdomen
plaicephaly
abnormal back of head shape from infant laying on back. mitigated with "tummy time"
parathesia
abnormal sensation (burning, tingling)
Hyperresonant percussion note
abnormal sound in the adult over the lungs with increased amount of air, as in emphysema. Normal lung sound in kids. louder, lower pitch, booming, long
lid lag
abnormal white rim of sclera visible between the upper eyelid and the iris. occurs with hyperthyroidism
how does emphysema affect symmetric chest expansion
abnormally wide angle with little inspiratory variation
hypogastic/suprapubic regions
above pubic bone
atresia
absence or closure of the ear canal
CN XI Spinal Accessory abnormalities cause
absent movement of sternomastoid or trapezius muscles
behavior in patients with peritonitis
absolute stillness/ resistance to movement
Cachectic response
accompanies chronic wasting diseases such as cancer, dehydration, and starvation. includes sunken eyes, hallow cheeks, exhausted appearance
tachypnea causes in babies/children
accompany pneumonia, fever, pain, heart disease, and anemia
Why do floaters appear in eyes?
accumulating debris since vitreous humor is not continuously renewed
Testing Cranial Nerve VIII
acoustic/vestibulocochlear: test sensory function to test hearing acuity with normal convo and whispered voice test
2nd set of pain neurotransmitters
across synaptic cleft to dorsal horn neurons substance P, glutamate, ATP
3rd set of neurotransmitters
act as analgesic effect seratonin, GABA, norepinephrine, neurotensi, own internal opioids
all day cough indicates
acute infection
acute respiratory distress syndrome (ARDS)
acute pulmonary insult (trauma, gastric acid, aspiration, shock) that damages alveolar capillary membrane leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema
hemorrhage stroke cause
acute rupture and bleeding from weakened artery in the brain due to ruptured aneurysm and arteriovenous malformation (congenital network of vessels without capillaries)
residual volume
amount of air remaining in the lungs even after the more forceful expiration
OLD CARTS
an assessment of pain Onset- acute or chronic? when did it start Location Duration- how long does it hurt? Characteristics- what does it feel like. figure out somatic, visceral, neurpathic Aggravating/ alleviating factors Radiation- does it travel or migrate Treatment Severity
palpation
an examination technique in which the examiner's hands are used to feel the texture, size, consistency, and location of certain body parts
corneal abrasion
an injury, such as a scratch or irritation, to the outer layers of the cornea. causes irregular ridges in reflected light, producing a shattered look to light rays
outer canthus pallor can indicate
anemia
Lesion shape: Polycyclic
annular lesions grow together (psoriasis)
what does epitochlear node drain
antecubital fossa and lower arm/hands
Surface Landmarks of the Abdomen
anterior (extends from diaphragm to symphysis pubis) posterior border (vertebral column and paravertebral muscles)
When do the anterior and posterior fontanels close?
anterior (largest) closes at 9months- 2 years posterior closes at 1-2 months
borders of the lung
anterior apex is the highest point and base is the lower border
muscles of hip
anterior flexor- ipopsoas posterior extensions- gluteus maximus adduction/abductor muscles
kiessalbach pexus
anterior part of septum that has rich vascular network- most common nosebleed site
dorsalis pedis
anterior tibial artery travels down the front of the leg on to the dorsum of the foot, where it becomes this
location of trachea
anterior to the esophagus. begins at cricoid cartilage and bifurcates just below sternal angle into left and right bronchi
location of apex and base of lung
apex- 3-4cm above the inner third of the clavicle base- rests on diaphragm at about the 6th rib in the midclavicular line laterally, lung tissue extends from the apex of the axilla down to the 7th or 8th rib. apex at c7 and base at t10, dropping to t12 in expiration
where to auscultate posteriorly?
apices at c7 to bases at t10 and laterally from axilla down to 7th or 8th rib
autonomic hypersensitivity
apparent during both types of alcohol withdrawal causes tachycardia, increased BP, and sweating. can cause hallucinations
Facial remnant and ear deformity
appears as a skin tag and can contain cartilage. typically in preauricular area. when bilateral, increased risk of renal anomalies indicated
Muscle testing technique
apply opposing forces. repeat active ROM asking pt to flex and hold
Umbilical regions
area around umbilicus
epigastric region
area between the costal margins
mediastinum
area between the lungs in the middle third of the thoracic cage. contains the heart and vessels
fovea centralis
area consisting of a small depression in the retina containing cones and where vision is most acute
Wernicke's area
area of temporal lobe responsible for language comprehension. damage to it causes receptive aphasia
Precordium
area on the anterior chest directly overlying the heart and great vessels
dermatome
area supplied from one spinal cord segment through a particular spinal nerve. they overlap so if one if severed most sensations can still be transmitted.
normal gait
arm swing, smooth, rhythmic, effortless, 15inches heel to heel
supraclavicular node
arms up and creates pocked just above and behind clavicle at the sternomastoid
dead space amount in lungs
around 150ml
apical pulse
artery close to the skin and over a bone- not a true pulse site as force not graded. over heart
Glenohumeral joint
articulation of humerus with glenoid fossa of scapula. joint enclosed by a group of four powerful muscle and tendons
tibiotalar joint connects
articulation of the fibula, tibia, and talus
temporomadibular joint structure and funcition
articulation of the mandible and temporal bone. felt in depression anterior to trigus of ear. permits jaw function for speaking and chewing, blowing hinge action to open and close jaws, gliding action for protrusion and retraction and gliding for side to side movement of lower jaw
how does scarring appear in otoscope?
as a dense white patch on the drum
everted umbilicus may indicate
ascites or underlying mass
how does pallor appear in dark-skinned pts?
ashen or grey in black and yellow in brown
Testing active and passive ROM
ask for active ROM and if a limitation is seen, gently attempt passive movement with the person's muscles relaxed by anchoring joint with one hand while other hand slowly moves it to its limit. normal ranges should be the same with active and passive
how to indicate lack of health literacy
ask pt if there are any limitations to their learning and how they learn things best
whispered pectoriloquy
ask the person to whisper a phrase like "one-two-three" as you ascultate. The normal response is faint, muffled, and inaudible.
what tests cranial nerve X
asking pt to say ah to note that soft palate and uvula rise in midline
Testing: Hypoglossal nerve CN XII
asking pt to stick out tongue. it should protrude midline. with damage, tongue goes toward paralyzed side
diaphragmatic excursion
assesses degree and symmetry of diaphragm movement; percuss from areas of resonance to dullness. no longer recommended- in lung disease pts, clinicians overestimate movement (results differ from chest images) and excursion of less than 2cm unreliable and infrequent sign of COPD
Alcohol Use Disorders Identification Test (AUDIT)
assesses problems within last year only Screens and identifies people who are at risk of developing alcohol problems and distinguishes normal low-risk use Three domains used that identify hazardous drinking - consumption (questions 1-3) - drinking behavior or dependance (questions 4-6) - adverse consequences from alcohol (questions 7-10) max score 40. relatively bias free, used in PCP and ED
motor system exam tests what
assesses strength and coordination
Steps of nursing process
assessment, diagnosis, outcome identification, planning, implementation, evaluation
Neovascularity
associated w/ wet macular degeneration. abnormal vessels grow under tissue and leak blood/fluid causing scaring
Joint pain worse later in the day
associated with OA
Joint pain in the morning
associated with RA- also stiffness after rest period
drusen
associated with dry macular degeneration. yellow fatty deposits under the retina
Large amount of fish during pregnancy
associated with maternal, fetal, and newborn mercury toxicity
traffic related pollution exposure raises risk of
asthma and allergic rhinitis
ABCDE
asymmetry, border, color, diameter, elevation and enlargement
Landau reflex
at 3 months infant will raise head and arch back (swan dive position) and persists up to 1.5 years. head lag abnormal and indicates motor weakness or motor neuron disease
criteria for myopia referral in childhood
at 3- 20/50 or less, at 4 and older- 20/40 or less. difference between eyes is one line or more
When does head stop growing?
at 90% of size by 6 yrs
vertebral column changes in development
at birth, C shape. anterior curve develops at 3-4 months (from holding head up) and 1yr-18months standing erect develops anterior lumbar curve
when/where can innocent murmurs be heard?
at the 2nd or 3rd left intercostal space and it disappears when sitting
check expansion lag can indicate
atelectasis, pneumonia, and post-op guarding
p wave
atrial depolarization= contraction of aorta
Pathologic S4 occurs with
atrial gallop, occurs with CAD
Joint crepitation cause
audible and palpable crunching/grating accompanying movement. occurs when articular surfaces in joints are roughened (as with RA)
Structures of the external ear
auricle (pinna), external acoustic meatus (auditory canal), and the tympanic membrane
external ear inspection aspects
auricle size/ shape, skin condition, tenderness (of pinna, mastoid process, and lymph nodes), external auditory meatus
How is a pulse deficit determined?
auscultate apical beat while simultaneously palpating radial pulse. the difference between radial and apical should be none. difference in number signals a weak contraction of the ventricles
egophony
auscultate while person phonates "eee" sound. over consolidation/compression, "eee" sound changes to a long bleeting "aaa" sound
posterior tibeal artery
back of leg artery that travels down behind the medial malleolus and forms the plantar arteries in the foot
Trapezius location and function
back of neck from occipital to clavicle and scapula. moves shoulders and extends and turns head
posterior cervical node
back of neck in the posterior triangles along edge of trapezius
hamstring location and function
back of thigh muscle that flexes the knee
Horny cell layer
basal cells migrate up to this flat layer of dead closely packed cells
occipital node
base of skull
Deep tendon reflexes
basic defense mechanism stimulated by directing short snappy blow of reflex hammer onto muscle's insertion tendor
6 parts of functional assessment
bathing, toileting, derisive, grooming, eating, mobility, communicating
communicating with adolescents
be honest, provide rationale for actions and questions, give direction
Pulses paradoxus and what it occurs with
beats have weaker amplitude with respiratory inspiration, stronger with expiration. common finding in cardiac tamponade (pericardial effusion in which high pressure compresses the heart and blocks cardiac output) and severe bronchospasm
Preauricular nodes
before (in front of the ear)
Stroke belt and belt buckle
belt 20% increased risk mid south region of US. belt buckle GA, NC, and SC with 40% higher risk
patterned injuries
belt buckle, leather mark, iron, cord, immersion burns
flexion
bending a limb at a joint
submandibular gland
beneath the mandible at the angle of the jaw
Keloid
benign excess of scar tissue beyond sites of original injury. most common in 10-30 yrs old
Senile tremors
benign tumors that occur occasionally. intention tremor of hands, head nodding, and tongue protrusion. no rigidity
Benzodiazepine intoxication and withdrawal
benzo contains sedatives and hypnotics. Similar intoxication to alcohol and withdrawal is similar. also causes orthostatic hypotension and grand Mal seizures
Palpation using dorsa of hands and fingers
best for determining temperature because the skin is thinner than on the palms
Palpation with fingertips
best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps
palpation using base of fingers (metacarpophalangeal joints) or ulnar surface of hand
best for vibration
Descriptor scare
better for older pmts and ethnically diverse pick btwn no pain, mild, moderate or severe
verbal pain intensity scale
better for older pts as most will not chose a number uses words to describe Pts feelings and meaning of the pain for the person
ethmoid sinuses
between the orbits- deep and small
semilunar valves
between ventricles and aortic and pulmonic arteries each have 3 cusps
Muscles that flex arm
biceps and brachioradialias
appearance of leukoplakia
bilateral buccal chalky while patch. often goes away when cheeks stretched. more common in blacks and indians
lymph node issues from acute infection feel like
bilateral, enlarged, warm, tender, firm, freely movable
What is considered heavy alcohol use?
binge drinking five days out of the month
aspects of health history
biographic data, source of history, reason for seeking care, present health/ illness, past health, fam hx, cross cultural care, review of systems, functional assessment
components of cross-cultural info of health hx
biographic data, spiritual beliefs, past health in home country
midclavicular line
bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular points
orthostatic vital signs
blood pressure & pulse taken lying, sitting, & standing
pregnant female cardiovascular changes
blood volume increased by 30-40% which causes increased SV, pulse rate (10-20 beats/ min), and cardiac output. arterial blood pressure decrease due to peripheral vasodilation
normal lip finding in African americans
blueish lips and a dark line on the gingival margin
Acrocyanosis
bluish color around the lips, hands, fingernails, feet, and toenails for a few hours and then disappearing
infant fontanels
bone hasn't fused at and structure intersect at these
cause of tooth loss in aging adult
bone resorption (osteoporosis)
Bone conduction hearing pathway
bones of the skull vibrate and transmit to inner ear and CN VIII. occurs through vibration picked up by ear's specialized nervous system.
limbus
border between cornea and sclera at lower lid margin
artery vs vein
both parallel just go opposite directions -Artery - valves are absent; away from the heart; deoxygenated blood from the tissues; high pressure, low volume -Vein - valves are present to prevent backward flow; oxygenated to tissue; back to the heart; high volume and diameter, low pressure
genu varum
bow legged
Abdominal pain cause in infants/children
bowel inflammation, constipation, UTI, and anxiety
Growth differences of adolescent boys and girls
boys- more muscle, taller, less body fat girls- fat raises to 25%
arteries in arm bifurcate
brachial into ulnar and radial that form superficial and deep palmar arches
Central nervous system consists of
brain and spinal cord
Suppression scotoma
brain suppresses weak aye causing acuity in otherwise normal eye to deteriorate from disuse
communicating with toddlers
break things down- they want to always know why. keep explanations and directions simple and one at time. warn before transitions
what does axillary nodes drain
breast and upper arm
alcohol use raises risk for what serious health conditions
breast cancer (with moderate use), cardiovascular (moderate use), and liver disease (heavy drinking)
External nose structures
bridge, tip, nares, ala, columella, vestibule
tonsils during acute infection
bright red, swollen with exudate or large white spots
abnormal voice sounds and what causes them
bronchophony, egophony, and whispered pectoriloquy pathology that increases lung density or consolidation/compression of lung tissue enhances transmission of voice sounds
auscultation findings of infants/children
bronchovesicular breath sounds in peripheral lung fields up to 5-6 years. due to thin chest walls and underdeveloped musculature sounds are louder and harder and more difficult to localize as they can be heard all over the chest
assessing for vascular sounds
bruit using firmer pressure to check over aorta, renal arteries, iliac, and femoral arteries
incisional hernia
bulge near an old operative scar that becomes apparent by a sit-up standing or by valsalva maneuver
movement of lens when seeing
bulges for near items and flattens for far
Exopathalmos
bulging eyes. widened palpebral fissures. Note "lid lag" acquired bilateral exophthalmos associated w/ thyrotoicosis
greater tubercle location
bump on the humerus a few centimeters down and lateral from acromion process
Basal Ganglia
bundle of nerves located deep under the cerebral cortex. helps coordinate movement, control, and posture- controls automatic associated movement of the body
fasciculi
bundles of muscle fibers
subacromial bursa
bursa that helps during abduction of arm so that greater tubercle can move easily under acromion process of scapula
Atypical areas for children to bruise- indicating potential abuse
buttocks, feet, hands, thigh, abdomen. torso, ears, and neck bruises in under 4. any bruises on a non-moving child raise concern (fractures or intercranial injury possible). any bruising in shape of object, defense bruises, and nasal fractures suspicion
when do infants develop ability for pain
by 20th gestational week everything is developed and emotional pain by 30th.
vertebra prominens
c7. feels prominent. if two seem prominent, upper is C7 and lower is T1
shape and configuration of chest wall
cage is an elliptical shape with downward sloping ribs about 45 degrees relative to the spine. skeletal deformities may limit thoracic cage excursion.
Areas of abnormal foot friction
calluses or burial reactions
Unequal pupils
can be normal but also can indicate CNS issues (stroke, head injury)
complications of withdrawal
can cause seizures, which can often lead to lost airways
vision expectations 2-4 weeks
can fixate on an object
vision expectation at 1 month
can fixate or follow a light/toy
vision expectations at 6-10 months
can fixate, follow a toy in all 6 positions of gaze
vision expectations at 3-4 months
can follow, fixate, and reach for toy
receptive aphasia
can hear sound but can't comprehend. due to damage of wernicke's area
Abnormal pubic hair
can indicate endocrine issues
seizures in infants/kids
can occur with high fever or be associated with neuro disease
how far can you percuss
can set into motion outer 5-7cm of tissue
Why is temp regulation ineffective in babies?
can't sweat at all 2 months old and at that point its only minimal, can't shiver, can't show pigment system. subq is ineffective.
physiological factors controlling BP
cardiac output- BP drops as cardiac output decreases peripheral vascular resistance- vasoconstriction raises it and vasodilation lowers it volume of circulating blood- more volume= higher BP viscosity (polycythemia vera)- thicker blood causes high BP- heart has to work harder to push this blood elasticity of vessel walls- more elastic= lower BP
physiologic changes from poorly controlled pain
cardiac- BP, heart rate, o2 demand, and cardiac output rise pulmonary- increased resp rate to increase o2 when in pain or decreased resp rate if it hurts to breath GI- n/v Renal- urinary retention w pain musculoskeletal- spasm or joint stiffness due to not moving hurting body part CNS- anxiety to fear; fatigue
if capillary refill is bad, what might that indicate?
cardio or resp dysfunction, septic shock
Chronic Disease associated with IPV
cardiovascular endocrine- diabetes immune- due to the stress GI reproductive mental health issues
common pulse sites
carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial
Peripheral nerves system
carries sensory (afferent) messages to the CNS from sensory receptors and motor (efferent) messages from the CNS out to the muscles and glands
otosclerosis
cause of conductive hearing loss (20-30 y/o). refers to an abnormal sponge-like bone growth in middle ear. causes footplate of stapes to become fixed in oval window, impeding the transmission of sound
functional murmur
caused by increased blood flow in the heart (anemia, fever, pregnancy, hyperthyroidism). common in kids, as they have a greater contractile heart force which increases blood viscosity.
Mechanism of pleural friction rub
caused when pleura become inflamed and lose their normal lubricating fluid. opposing rough surfaces rub together during respiration
Organs in RLQ
cecum appendix right ovary and tube right ureter right spermatic cord
physiological effects of elevated temp
cellular metabolism increases, increase o2 consumption, increased heart and resp rate, water loss
Basal cell carcinoma
center red ulcer with central yellowing and round pearly border with depression in sun exposed area. rarely spreads. starts as pink/red papule
Two parts of the nervous system
central nervous system and peripheral nervous system
causes of generalized seizures
cerebral trauma, structural lesions, hyponatremia, acute alcohol withdrawal, medication overdose
Spinals regions
cervical, thoracic, lumbar
Guides to determine adequate diet
choosemyplate, dietary guidelines, and dietary reference intake (DRIs)
leg ulcers common with
chronic arterial and venous disease
morning cough indicates
chronic bronchitis, "smokers cough"
rheumatoid arthritis
chronic inflammation of synovial tissue, hyperplasia, and swelling lead to fibrosis, cartilage and bone destruction, which limit motion and show as deformity. joint involvement is symmetric/bilateral with inflammation symptoms and painful motion of affected joints. also causes weakness, fatigue, weight loss, fever, lymphedema. raises stroke and MI risk
cause of brown discoloration in legs
chronic venous stasis from RBC degradetion
optic disc
circular area in the back inside of the eye where optic nerve attaches. fibers in retina converge to form this nerve
Lesion Shape: Annular
circular, begins in center and spreads to periphery
verbal response: confrontation
clarifies inconsistant information
contract terms of health interview
clear expectations- how long, when, where, who you are, purpose, presence of others, confidentiality, costs, expectations from PT
conjuctiva
clear, thin membrane that covers the anterior part of the sclera and the inner surface of the eyelids. keeps surface of eye moist and lubricated
diagnosis
clinical judgement
foramen ovale location and closure
closes in first hour- located between atria in septum
Choanal atresia
closure of nasal cavity due to congenital septum between nasal cavity and pharynx. inability to pass catheter through nasal cavity
cataract
cloudiness of lens due to thickening and yellowing. UV exposure can cause these
Finger to nose: Dysmetria
clumsy movement w/ overshooting the mark
Lesion Shape: Grouped
cluster of lesions (contact dermatitis)
CNS stimulants
cocaine, amphetamine cause agitation and paranoia
inner ear components
cochlea and the bony labyrinth, which holds the vestibular apparatus, which is made up of a vestibule and semicircular canals
southwest/mexico exposure risk
cocidiodmycosis
cerebellum
coiled structure located under the occipital lobe. does not initiate movement but ensures that movements are smooth and coordinated. Controls motor coordination, balance, posture, and muscle tone
white sputum indicate
colds, bronchitis, vital infections
chordae tendineae
collagen cords attach AV valves to papillary muscles embedded in ventricle floor- help maintain leakproof seal
Atelectasis
collapsed shrunken section of alveoli or entire lung as a result of airway obstruction, compression on the lung, or lack of surfactant
characteristics about sputum to document
color, odor, amount, and consistancy
deep somatic pain
comes from sources such as blood vessels, joints, tendons, muscles, and bone. pain may result from pressure, trauma, or ischemia well localized aching or throbbing
absence of sniff during patency may indicate
common cold, nasal polyps, rhinitis
buccal hyperpigmentation occurs in
common in dark-skinned people
setting-sun sign
common in newborns. eye deviates downward, exposing sclera over the iris. may show when as you rapidly change neonate from sitting to supine
sebaceous cyst
commonly behind lobule in post-auricular fold. black central punctum= blocked sebaceous gland
verbal response: silence
communicates that client has time to think and allows provider to assess non-verbal behavior
scale
compact desiccated flakes of skin from shedding of dead skin cells
how do we find nursing diagnosis
compare clinical findings w normal and abnormal variation. interpret data with cues and hypotheses (diagnostic reasoning)
Allis test purpose
compares the length of infant's legs in order to check for hip dislocation
vitiligo
complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices
flaccid quadriplegia
complete loss of muscle tone and paralysis of all four extremities
CNI olfactory abnormalities cause
complete loss of smell due to tobacco, cocaine, or cribriform plate fracture
types of assessment
complete, focused, follow-up, emergency
surfactant
complex lipid substance needed for sustained inflation of alveoli
ABCT
components of a mental status exam Appearance- hygiene, posture, body movements, pupils Behavior- LOC, facial expression, speech, mood and affect Cognitive functions- orientation, attention span, recent and remote memory, new learning thought process and perceptions- anxiety, depression, perceptions, thought processes and content
autonomic nervous system
composed of cranial nerves and spinal nerves
palpating calf muscle
compress gastrocnemius against the tibia
McMurray Test
compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus
Cause of increased tactile fremitus
compression or consolidation of lung tissue (lobular pneumonia) increases density of lung tissue making a better conducting medium for vibrations. only present when bronchus patent and consolidation (pneumonia) extends to lung surface- small areas doesn't significantly affect it
verbal response: summary
condenses facts and validates what was discussed during the interview to allow pts to make any corrections
fetal development at 16 weeks
conducting airways reach same number as in adult
Purpura
confluence and extensive patch of petechiae and ecchymoses. >3mm, flat, red to purple, macular hemorrhage.
coarction of the aorta (CoA)
congenital aorta narrowing- usually notices by abnormally high BP in young people
Flattening of angle and clubbing occurs with
congenital cyanotic heart disease and cor pulmonale
ophthalmia neonatorum
conjunctivitis of the newborn. purulent discharge due to something present in birth canal
perforator veins
connecting veins- joins the tw sets. contain valves that route blood flow from superficial to deep veins
terms within a mental status assessment
consciousness language mood and affect orientation attention memory- recent and remote abstract reasoning- beyond literal thought process thought content perceptions- awareness to objects through senses
SBAR
consistent, clear, structured, and easy-to-use method of communication between health care personnel Situation-names, units and room #, problem, severity, origin Background- admission diagnosis and immediate assessment findings (vitals) Assessment- what you found and what may be wrong Recommendations- what you think your pt needs
The Short-Form McGill Pain Questionnaire
consists of 78 words that describe pain. person rates own pain by describing words that most closely match up to their feelings
sending in communication
consists of verbal and non-verbal communication given off
Finger to nose: pastpointing
constant deviation to one side
muscle rigidity and its cause
constant resistance to passive movement. due to injury to extrapyramidal motor tracts
parasympathetic nerves have what affect on pupil
constricts
Overnutrition
consuming nutrients more than what body needs- particularly calories, sodium, and fat
spinothalamic tract
contain sensory fibers that transmit sensations such as itching, pain, temp, light nonspecific touch, tickling
medial canthus
contains puncta & caruncle (a small fleshy mass containing sebaceous glands)
medulla
continuation of spinal cord that helps control HR, BP, respirations, and swallowing. Crossing of motor fibers occurs here
nasopharynx
continuous with oropharynx. tonsils and Eustachian tube located here
Assessing pain: objective data of abdomen
contour, symmetry, muscle guarding (spasms), organ size, referred pain
What initiates heart contractions
contracts by itself- doesn't need stimulation before contracts in response to an electrical current conveyed by a conduction system. SA note acts as pacemaker for contractions
arterial vascular smooth muscle
contracts the amount of blood delivered to tissues and contracts or dilates arterial diameter
thyroid gland fx
controls metabolism with thyroxine and triiodothyroine
brocas area
controls speech. damage to it causes expressive aphasia
Pupillary light reflex
controls the diameter of pupil in response to the exposure of intense light. involved a direct and indirect reflex of constriction
upper motor neuron function
convey impulses from the motor areas of cerebral cortex to the lower motor neurons in the anterior horn cells of the spinal cord. Contained in the CNS and influence lower neuron activity
skin changes PAD
coolness. avoid compression stockings which worsens ischemia
corticospinal tract
coordinate fine motor movement. skilled purposeful movements
Cerebellar function test
coordination and skilled movement tests (RAM, finger to nose, heel to shin), balance tests (gait, Romberg, shallow knee bend), anterolateral tract (pain and light touch), and posterial column tract (vibration, position, tactile discrimination, stereognosis, graphesthia, exinction, pain location)
tests that assess extraocular muscle fx
corneal light reflex (hirschberg), cover test, and diagnostic positions test
motor pathways types
corticospinal or pyramidal tract, extrapyramidal tracts, cerebellar system
Sulfur dioxide exposure symptoms
cough and congestion
Rest tumor characteristics
course and slow and occurs when muscles are relaxed and supported against gravity. disappears with voluntary movement
vellus hair
covers most of the body
cartilage in joints
covers the surface of opposing bones in synovial joint giving bones their smooth shape and protect them. receive nourishment from synovial fluid
crackles vs atelectacic crackles (when/where are they heard)
crackles heard when secretions are expanded by a few deep breaths. atelectacic crackles heard only in the periphery, usually in the dependent portions of the lungs, and disappear after a few breaths or a cough
adventitious sounds
crackles/wheezing: added sounds that are not normally heard in the lungs. caused by moving air colliding with secretions in tracheobronchial path or popping open of previously deflated airways
What are the extraocular muscles innervated by?
cranial nerves III, IV, VI
gingival hyperplasia
crevices between teeth and gums, pockets of debris
cruciate ligaments
cross within the knee and give anterior and posterior stability to help and control rotation
strabismus
crossed eyes
proper blood pressure cuff size
cuff width should do 40% around its arm and length should go 80%
Percent usual body weight formula
current weight / usual weight x 100
posterior tibial pulse
curve fingers around medial malleolus. tapping felt behind it in the groove between the malleolus and the achilles. passive dorsiflexion of foot can make more accessible
ovarian cyst distention charactertics
curve in lower half of abdomen toward midline with everted umbilicus
Dermal segmentation
cutaneous distribution of the various spinal nerves
remodeling
cyclic process of bone resorption and deposition
What may barrel shape after 6 years old indicated
cystic fibrosis or chronic asthma
abuse to a substance defined as
daily need used to function, not being able to stop, impaired functioning, using when doing so is hazardous, legal problems
Lower motor neuron diseases
damage to these cause permanent paralysis. issues are directly related to nerve transmission to muscle - bells palsy - spinal cord lesions - poliomyelitis
linea nigra
dark line from umbilicus to pubis during pregnancy
how do opacities in red reflex appear?
dark shadows or black dots (often cataracts)
cultural differences in irises and retinas
darker irises have darker retinas behind them. lighter retinas generally have better night vision but light can cause more pain to them
When do baby teeth erupt?
deciduous teeth appear between 6-24 months
Osteoporosis
decrease in skeletal bone mass leading to low bone mineral density and impaired bone density
anosmia
decrease or lack of smell. due to smoking, colds, cocaine
CN VIII Acoustic nerve abnormalities cause
decrease or loss of hearing
Paralysis cause
decrease or loss of motor power causes by problems with motor nerve or muscle fibers
evening fatigue occurs with
decreased CO
hypo/hyper algesia
decreased and increased sensation of pain
pleural friction fremitus
decreased in the normal lubricating fluid, due to inflammation of the pleura, causes a palpable grating sensation during breathing. best detected by auscultation and it occurs during resp excursion
muscle flaccidity and its cause
decreased muscle tone or hypotonia. weak and easily fatigued- feels like rag doll. due to lower motor neuron injury
Diminished Carotid pulse may indicated
decreased stroke volume
increased small airway closure causes
decreased vital capacity and increased residual volume
types of reflex arches
deep tendon reflex (stretch or myotatic), superficial (cutaneous), visceral (organic)
deep cervical node
deep under the sternomastoid muscle
Ulcer
deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals
Causes of lower back pain
degenerative disc, osteoporosis, lumbar stenosis
caffeinated energy drinks effect on body
dehydration, elevated BP, elevated heart rate, sleep problems
dry mouth occurs with
dehydration, fever; tongue has deep vertical fissures. also medication side effect
Effect of drinking and drugs on adolescents
delays brain development and maturity levels, increases high risk sex behaviors, causes academic performance problems, increases traumatic injuries
Shallow knee bend
demonstrates normal position sense, muscle strength, and cerebellar function. unable to perform if there is weakness in quadricep muscle and hip extensors
Sclera
dense tissue with many blood vessels protective; part of refracting media of eye as it bends incoming light rays to focus on inner retina. provides attachment for external muscles of the eye. provides shape and support
How to assess and grade pitting edema
depress fingers in tissue for 5 seconds 1+ doesn't look swollen; causes slight indent 2+ moderate pitting, returns rapidly 3+ starts to look swollen 4+
light palpation purpose
depress skin about 1 cm. Form an overall impression of the skin surface and superficial musculature. Voluntary muscle guarding vs. involuntary rigidity.
mental health effects of IPV
depression suicidality PTSD substance abuse problems
cutaneous pain
derived from the skin surface and subq tissue. sharp or burning pain
anthropomorphic measures
derived weight measure
nursing diagnosis
describes a health problem that can be treated by nursing measures; a step in the nursing process.
spleen functions
destroy old red blood cells, produce antibodies, store red blood cells, filter microorganism
follow up assessment
determine changes, conditions getting better/ worse, coping strategies
contour of abdomen margins
determine profile from from rib margins to pubic bone
goals of pain-rating scales
determines baseline intensity, tracks changes, and gives some degree of evaluation to a tx modality
cover test
determines deviated alignment or eye weakness. normal= steady fixed gaze in uncovered and covered eyes
Measuring Leg Length Discrepancy
determines if one leg is truly shorter than the other. measure between anterior superior iliac spine and medial malleolus crossing the medial side of the knee
When does lymph develop and stop growing?
developed well by birth and grows to adult size by 6. it exceeds adult size at 10-11, then begins to atrophy
What does diaphoresis occur with
diabetics and MI especially -thyrotoxicosis -heart attack -anxiety -pain
pubic hair distribution
diamond in male and triangle in female
changes in chest cage during pregnancy
diaphragm elevated by 4cm and moves more with breathing. up to 2cm transverse diameter increase. up to 6cm total expansion. compensates for loss of vertical diameter by increasing horizontal. o2 demands increase due to growing fetus. 40% increase in tidal volume
chest size change during inspiration
diaphragm recents and flattens and intercostal muscles raise sternum and ribs, causing negative pressure due to increased lung volume and AP diameter
asymmetric expansion in infants/kids indicates
diaphragmatic hernia and pneumothorax
pulse pressure
difference between systolic and diastolic pressure. represent SV
dysarthria
difficulty forming words
dysphasia
difficulty with language comprehension or expression
what blanches and what doesn't?
dilated blood vessels will blanch and extravasated blood (petechiae) dont
sympathetic nerves have what affect on pupil
dilation
What to include in abuse documentation
direct pt quotes, injury maps, pictures, detailed non biased info (facts only, don't infer anything), forensic terminology
Choleteatoma discharge
dirty yellow-gray discharge with foul odor
Petechiae
discoloration; Minute, pinpoint, nonraised, perfectly round purplish-red spots caused by intradermal or submucous hemorrhage, which later turn blue or yellow.
pleural friction rub
discontinuous sound- A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory
course crackle characteristics
discontinuous sound- low pitched bubbling start in inspiration and may be present in expiration. may decrease some by suctioning or coughing but reappears
atelectatic crackle characteristic
discontinuous sound- sound like fine crackles but don't last and are not pathologic. disappear after a few breaths. usually heard in axilla or bases (dependent) of the lungs
fine crackles characteristic
discontinuous- high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing
tactile discrimination
discriminate sensations of fine touch
what may nystagmus indicate?
disease of semi-circular canals in ears, paretic eye muscle, MS, and brain lesions
Abnormally high BP in the right atrium shows as
distended neck veins and abdomen since there aren't valves between the vena cava and the right atrium
protuberant contour
distention due to air, fluid, or bleeding
inspecting knees
distinct concavities or hollows present on side of patella (peripaterllar grooves)
bilateral diplopia vs unilateral diplopia
double vision in both eyes indicates misalignment unilateral diplopia causes by dry eyes
where do tears drain?
drain into puncta at the inner corner and then empty into the inferior meatus inside nose= Nasolacrimal duct
Ptosis
drooping upper lid. Occurs from neuromuscular weakness, oculomotor damage, or sympathetic nerve damage (Horner syndrome) or congenital. gives person sleepy appearance and impairs vision
xerosis
dry skin
why are murmurs common in newborns
due to closure of shunts
Geographic stroke locations cause
due to increased incidence of traditional risk factors and lack of knowledge about strokes and their warning signs
causes of excessive cerumen
due to narrow cavity or bad cleaning methods- doesn't cause hearing issues until 90-95% blockage
why is pulmonary valve closure later than atrial
due to route of myocardial depolarization
tumor distention characteristics
dull over mass if it reaches surface. define borders to distinguish from an enlarged or normally palpable organ
visceral pain
dull, general, poorly localized
muscle growth during development
during adolescence, marked growth due to response to growth hormone secretion (adrenal androgens and additional testosterone in boys)
What causes the apical impulse?
during contraction, apex beats against the chest wall.
Snellen eye chart
each eye tested independently 20ft away
perforation of the tympanic membrane causes what sensations
ear pain first, stops with popping, then drainage occurs
otalgia
ear pain; occurs from ear disease or referred pain from teeth or oropharynx issues
otoscope
ear/typanic membrane. 5 specula- short and broad used for nares
components of health hx
earaches, past infections, discharge, hearing loss, environmental noise, tinnitus, vertigo, and patient-centered care
dry cough indicates
early HF
kopek spots in buccal occurs with
early measles sign
describing murmur timing
early, mid, or late diastole/systole (or pan diastole/systole or hollow diastole/systole= throughout cardiac cycle)
CAGE questionnaire
easy yes or no questions over a lifetime. less effective with women and minorites C-cut down A-annoyed G-guilty E-eye opener
hypomobility of eardrum indicates
effusion or a high vacuum in middle ear. Can indicate middle ear infection In first 6 weeks
communicating with preschoolers
egocentric/ only see world through their perspective. everything is direct, literal, and present
intervertebral discs
elastic fibrocartilaginous plates that constitute one fourth of the length of the column
EASI tool
elder abuse suspicion index. also monitors for financial abuse
lymph node fx
filter lymph and engulf pathogens to keep them from entering circulation in head, neck, arms, axilla, and inguinal areas
vesicle
elevated cavity containing free fluid up to 1 cm in diameter "blister". contains clear fluid inside
false erythema
embarrassment and dependent position
right lymphatic duct
empties into right subclavian veins Drains the right side of the head, neck, right arm, right thorax, right lung and pleura, right side of heart, upper right liver
jugular vein function and its blood flow
empties unoxygenated blood into the vena cava. reflect filling pressure and volume changes in the right side of the heart since they don't have valves to stop flow. unlike other pulses, it occurs from backwash from upstream events
cyst
encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin
lymphadenopathy
enlarged lymph nodes
HIV nodes feel like
enlarged, firm, non-tender
pseudostrabismus
epicanthal folds give a false appearance of malalignment. corneal light reflex remains normal
layers of skin
epidermis, dermis, subcutaneous
Raynaud's phenomenon
episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration, or stress
barrel chest
equal AP-to-transverse diameter, ribs are horizontal instead of normal downward slope
Hemorrhage
escape of blood afrom a ruptured blood vessel
objective of interview
establish trust gather accurate health data build rapport for therapeutic relationship- set expectations teach client about their health state discuss health promotion and disease prevention
Aspartate aminotransferase (AST)
evaluates liver enzymes to evaluate drinking for months
Danger Assessment (DA)
evaluates risk of person being killed by their abusive partner involves abuse calendar. 19 yes or no questions
Implementation
evidence based interventions done in timely manner
Montreal cognitive assessment (MoCA)
examines more cognitive domains and more sensitive to mild impairment. Free. at least 26 out of 30 is normal
How is vision assessed in infants?
exams not performed at birth. baby's tested by testing reaction to facial expressions and to bright light
epicentral fold
excess skin fold extender over inner corner of eyes, overlapping inner canthus. occurs mostly in asians but also 20% of whites
brown teeth may indicate
excessive fluoride use
kyphosis
excessive outward curvature of the spine, causing hunching of the back. causes back pain and limited mobility. severe deformities impair cardiopulmonary function
epiphora
excessive tearing. caused by irritants or obstruction in tear drainage
factors influencing respiration
exercise- increases acute pain- depends on where. increases unless chest or chest/abdomen where it may hurt to breathe anxiety- increases smoking- increases body position medications- pain meds, anesthetics and others lower, some raise neurological injury- hemoglobin function- may have to breathe more for adequate profusion if inadequate function age- higher in kids sex- females higher after puberty
Cranial nerve function
exit the scull and supply the head and neck
purpose of sighing
expand alveoli
Standard Precautions
expect that all fluids or broken skin may be infectious and you need to be cautious caring
resonent percussion notes
expected lung sounds in adults. Low pitch, medium-loud, clear, hollow, moderate length
stage 3 pressure ulcer
extends through all skin levels (full thickness) and into subq, resembling a crater. see fat, granulation tissue, and round edges
scapular line
extends through the inferior angle of the scapula when the arms are at the sides of the body
acromion process
extension of the scapula, which forms the high point of the shoulder
communicating with infants
face to face non-verbal communication
what makes up behavior in general assessment
facial expression, mood and affect, speech, speech patterns, dress, personal hygiene
elder neglect
failure to prevent harm. failure to provide proper hygiene, nutrition, clothing, shelter, medical care
CN IV trochlear nerve abnormalities cause
failure to turn eye out or down
presbyopia
farsightedness caused by loss of elasticity of the lens of the eye, becoming glass like. occurs typically in middle and old age caused by decrease in accommodation, causing blurred vision
hyperopia
farsightedness. globe shorter than normal- use positive number on ophthalmoscope
Accumulation of fat in older males
fat gain in abdominal area
subcutaneous layer purpose
fat tissue stored for energy, regulates temp, and acts as a protective cushion
reasons an older adult may deny being in pain
fear of dependency, further testing, invasive procedures, cost, fear of taking pair killers or becoming a drug addict
humoral regulation
feedback loop involving co2, o2, and h+ changes in blood
otitis media risk factors
feeding infants in a supine position, environmental smoke exposure, and pacifier use, not breastfeeding, preterm birth, male sex, seasonal, daycare
how is modified Allen test performed
firmly occlude ulnar and radial arteries while pt makes a fist. ask them to open hand without hyperextending- should look blanched. ulnar pressure released while radial maintained and should turn red and then color should return to normal in 5-15 seonds
Protodiastole
first passive filling phase of diastole
Myosis
fixed constriction of the pupil. Occurs with use of pilocarpine drops for glaucome tx, narcotics, iritis, and pons damage
mydriasis
fixed dilated pupils. Occur with stimulation of sympathetic nervous system, rxn to sympathomimetic drugs, use of dilating drops, acute glaucoma, or past or recent trauma. They also herald CNS injury, circulatory arrest, or deep anesthesia
thymus location and function
flat pink/gray gland located in the superior mediastinum behind the sternum and in front of aorta. important in developing T lymphocytes in the immense system of kids (B lymphocytes originate in bone marrow and mature in lymphoid tissue)
Nevus simplex (stork bite)
flat red patch on baby's face or back of neck. present at birth and fades during first year
contour types
flat, rounded, scaphoid, and protuberant
What indicates facial nerve damage
flattened nasolabial fold, drooping of one side, lower eyelid sagging, and escape of air form only one cheek indicates muscle weakness
Sympathetic nervous system
flight or fight response
factors influencing pulse rate
fluid balance- heart rate increases to compensate for loss of blood volume (dehydration) in order to still perfuse o2 temp- fever increases pulse anxiety/emotions and exercise- increase meds- can increase or decrease position changes- orthostatic hypotension: HR increases to compensate for low BP pain- acute pain raises pulse
otitis media complications
fluid often persists in middle ear after tx, imparting hearing and placing child at risk for cognitive developmental delays include rupture of TM, scar tissue formation, and conductive hearing loss
causes of hypoactive bowels
follow abdominal surgery or with peritoneal inflammation
pathway of sensory and motor development
follows a cephalocaudal and proximodistal order
snellen E chart
for 3-6 years old. direction of E noted. standard used after 7yrs
complete musculoskeletal exam
for people with articular disease, history of musculoskeletal symptoms, problems with ADLs
FLACC pain scale
for those unable to cooperate to tell you their pain level- children under 3 based off of face, leg movement, activity, crying, consolability
TWEAK test
for women, particular pregnant women T- tolerance W- worry E- eye opener A- amnesia K- kut down
Measures of pulmonary function status
forced expiratory time, pulse oximeter, 6 minute distance walk (6md), and spirometer
Ciliary body
forms a muscular find around the eyes, controlling shape of the lens by controlling thickness. secretes aqueous humour
rectus abdominis
forms a strip extending midline that protect and hold organs in place
Basal cell layer
forms new skin cells- major ingredient is the protein keratin. also contains melanocytes
Pectus Carniatum
forward protrusion of the sternum with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). less common than pectus excavatum
what may indicate head trauma
frank blood or watery fluid (CSF) after head injury
pnuemothorax
free air in pleural space causes lung collapse. air in pleural space neutralizes the usual negative pressure present can be caused by spontaneous, trauma, or tension
Synovial joints
freely movable because their bones are separated from one another and enclosed in a joint cavity lined with synovial membrane and fluid
pitch
frequency
characteristics of sound
frequency (all low pitched but described as lower or higher), intensity (loud or soft), duration (heart sounds are short), timing (systole or diastole)
Summation
frequent consecutive stimuli are perceived as one strong stimulus. avoid by waiting 2 seconds between each stimulus
Sternomastoid location and function
from clavicle and scapula to mastoid process (behind ear). controls head flexion and rotation
visceral pain location, characteristics, causes
from direct injury to organ, severe contraction or extension of organ, ischemia, distention, stretching from tumor. In larger internal organs described as dull, deep, squeezing, or cramping typically accompanied w n/v, pallor, and diaphoresis due to ANS
parietal pain
from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement)
anicus
functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli. gas exchange occurs here across resp membrane
Brainstem hearing action
fx is binaural interaction, which permits locating the direction of a sound in space and identifying the sound. each ear sends signal to both sides of brainstem which helps differentiate location
what makes up mobility in general assessment?
gait and ROM
how to screen for anxiety and what the scores mean
generalized anxiety disorder scale (GAD-7) 5, 10, 15 indicate mild, moderate, severe
Causes of obesity
genetic, obesogenic (dietary intake), and physical inactivity
excess saliva occurs with
gingivostomatitis and parkinson's
Growth milestones of adolescents
girls double weight from 8 to 14 boys double weight from 10 to 17
skin appearance with ascites
glistening and taut with striae (lineae albicantes)
Testing Cranial Nerve IX and X
glossopharyngeal and vagus nerves: test motor function - palpate and uvula elevate midline and tonsillar pillar move medially - avoid gag reflex when touching the posterior pharyngeal wall - assess smoothness of voice
1st set of pain neurotransmitters
go from skin to dorsal horn substance P, histamine, Prostagladins, serotonin, bradykinin
farmers have increased exposure risk to
grain and pesticide inhalation
arcus senilis
gray-white arc or circle around the limbus of the iris due to deposition of lipid material that is common with aging. no effect on vison
superficial veins in legs
great saphenous and small saphenous
Sulcus
grooves that divide the lobes of the brain
bone growth in length
grows at epiphyses- specialized growth centers of transverse discs located at the end of long bone
unequal respirations cause
guarding from pain or when part of lung is obstructed or collapsed
acute pain behaviors
guarding, grimacing, vocalizations, agitation, restlessness, stillness, diaphoresis. or change in vital signs.
pantomiming
hand gestures and facial expressions as form of non-verbal communication to tell a story
ulnar pulse
hand under pt arm and palpate along medial side of inner forearm. not normally palpated in healthy adults
expressive aphasia
happens with damage to Broca's area of the frontal lobe. can comprehend language but cannot communicate back
chronic inflammation of lymph feels like
hard, >3mm, unilateral, non-tender, matted, fixed to adjacent stuctures. ex: cancer, TB, clumped nodes
Herberden and Bouchard nodules
hard, nontender nodules on fingers, occur with osteoarthritis
What is an organic mental disorder and what are symptoms of it?
has a known cause: caused by illness (delirium, alcohol/drug intoxication, dementia, withdrawal) not psychiatric in nature symptoms: confusion, agitation, irritability, change in behavior, impaired brain function, cognitive ability, or memory
normal tonsils appearance
has indentations or crypto on them that can college small plugs of white cellular debris (does not indicate infection) should be no exudate.
If spinal curvature suspected
have pt bend forward and put a dot on each spinous process and when they stand, dots should form a straight line
anisocoria
having pupils of two different sizes (5% of people)
what does cervical node drain
head and neck
order of musculoskeletal exam
head to toe from proximal to distal inspection, palpation, ROM, muscle testing
head control of the infant
head will hold in same plane as body. it will flop forward when sitting and stay in place starting at 4mo. when in a prone position, holds head at 45 degree angle
subjective questions for head/neck/face
head/ neck ache, dizziness, lumps/swelling, past injury (lose consciousness? complications?), past surgery
core values of health care
health promotion and disease prevention
flat diaphragm of stethoscope
hearing high pitched noises such as breath, bowel, and heart sounds
recruitment
hearing loss with low intensity speech but sound become painful when speaker repeats loudly
bell of stethoscope
hearing low pitched sounds such as extra heart sounds
Air conduction hearing pathway
hearing that occurs through air near the ear. involves ear canal and tympanic membrane
Risks of excess weight in waist
heart disease and type 2 diabetes
A high waist-to-hip raises risk for
heart disease, type 2 diabetes, metabolic syndrome
apex of infant
heart more horizontal- apex located at 4th left ICS lateral to the midclavicular line
cardiac output
heart rate x stroke volume
how to find cardiac output
heart rate x stroke volume
pyrosis
heartburn
Common pressure ulcer sites
heel, ischium, sacrum, elbow, scalpel, vertebra, ankle, knee, hip, rib, shoulder
pons
helps control respirations- contains centers that coordinate with main center in medulla
Spinal cord functions
helps mediate reflexes: posture control, urination, and pain response
lens
helps refract light for near and distant vision. transparent, biconvex structure in the eye
Ecchymosis
hemorrhagic spot or blotch in skin or mucosa. non-elevated patch (bruise)
grey stool indicates
hepatitis
jaundice occurs with
hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn
enlarged, everted umbilicus indicates
hernia
persistant peristaltic sound and diminished breath sounds on same side may indicate
hernia
inspection considerations of infants/children
hernias common. respiratory function can often be seen in those under 7
What maternal infections can affect child's eyesight?
herpes or gonorrhea
senile purpura
r/t ecchymosis discoloration due to increasing capillary fragility
stridor
high pitched inspiratory crowing occurring with upper airway obstruction- croup, foreign body aspiration, acute epiglotitis
Culture, genetic, and sociocultural effects that play into treatment of abuse
higher rates among all minorities societal stressors- daily struggles (poverty) legal status- may not know their rights. VAWA helps immigrants lack of access to culturally appropriate care- believe they are dependent on their abusive husbands and may be accepted as normal in their society
ankle-brachial index
highest ankle pressure divided by highest arm pressure. less than .9 indicates PAD
Advantages of breastfeeding
highly recommended for 1st year- promotes growth, development, and immunity. leads to fewer food allergies and increases bonding
rural midwest exposure risk
histoplasmosis
suprasternal notch
hollow U-shaped depression just above the sternum, in between the clavicles
When can a child hop and balance on one leg
hop by 4, balance on one leg for five seconds by 4, and eight to ten seconds by 5yrs
care planning
how are we going to meet these outcomes. need to set priorities and identify possible nursing interventions
health perception
how does pt describe their health and illness how does the pt see the problems that he or she is experiencing now
What is the nursing process?
how nurses think; standards of practice in nursing
borborygmus
hyper peristalsis "stomach growling"
Skin texture hyper/ hypothyroidism
hyper- smooth and soft hypo- rough and dry
what usually causes us to breathe?
hypercapnia
changes in thoracic cage w/ COPD
hyperinflation causes increased AP diameter and abdominal (rectus abdomens and internal intercostal muscles) and neck muscle hypertrophy from aiding in forced respirations across obstructed airways
full/strong carotid pulse indicates
hyperkinetic states
purpura
r/t petechia
Test Cranial Nerve XII
hypoglossal nerve: - inspect tongue for straight in midline - assess speech "light, tight, dynamite" should be clear and distinct
Conditions that cause excessive sweating in babies and kids
hypoglycemia, heart disease, and hyperthyroidism
numbers for each BP level
hypotension (acc to book)- <95/60 normal= <120 and <80 elevated= 120-129 AND <80 Stage 1 hypertension= 130-139 OR 80-89 Stage 2 hypertension= 140 or more OR 90 or above Hypertension Crisis= >180 and/or >120 (contact HCP immediately)
How is temperature regulated?
hypothalamus is internal thermostat mechanism. it balances heat production and loss produced - lost = body temp
enlarged tongue occurs with
hypothyroidism or acromegaly
blue lips can indicate
hypoxemia and chilling
emergency assessment
identify life-threatening problems. quick, only needed info asked, physical and verbal assessment done at same time by multiple people
measuring calf circumference
if DVT suspected. refer if acute, unilateral painful swelling of 1cm of more 1-3 mild, 3-5 moderate >5 severe. >2 occurs with DVT
when to palpate under the tongue
if they are 50, use alcohol, smoke, or have any other oral lesions
Why do we advance light from the side to test light reflex
if you do from front, pupils constrict to accommodate for near vision, so you wouldn't know what the pure response of light would've been
Medication effect on nutrition
impair metabolism, digestion, absorption, or interact with nutrients
Health implications of undernutrition
impaired growth and development, less resistance to infection/ disease, delayed wound healing, longer hospital stays, higher health costs
Risk factors for pressure ulcers
impaired mobility, age, decreased sensory perception, impaired LOC, moisture, poor nutrition/ infection
Health issues correlated with child abuse
improper brain development cerebral palsy- r/t head trauma delayed language development mental health issues- anxiety and depression
viratility testing
in kids. positive and negative pressure given and TM movement watched
Borders of cardiac dullness
in right hemithorax, upper border of liver dullness located in 5th intercostal space in right midclavicular line. on left, tympani is evident over gastric space
frontal sinus
in the frontal bone above and medial to the orbits
dsymetria
inability to control distance, power, and speed of muscular action
flexion contracture
inability to extend fully
analgesia
inability to feel pain
astereognosis
inability to judge the form of an object by touch
Dysdiadochokinesia
inability to perform rapid alternating movements
contributing factors of Nonmedical psychotherapeutic use
inappropriate prescribing, aggressive marketing for off-label use, belated govt response, increase in prescriptions for pain relief. most given by friends/ fam
comprehensive nutritional assessment
includes dietary history and clinical information, physical examination for clinical signs, anthropometric measures (height and weight), and laboratory tests
Jaundice and where does it occur first
increase in blood bilirubin. picks up early in roof of mouth or mouth sclera
Sinus Arrhythmia
increased HR w inspiration and decreased w expiration- inspiration causes momentary decrease in SV from left side of heart and heart rate increases to compensate. this is a normal variation w kids and young adults.
muscle spasticity and its cause
increased muscle tone or hypertonia. increased resistance to passive lengthening then may suddenly give way like a sprung open pocket knife. due to upper motor neuron injury
hyperventilation
increased rate and depth of breathing. causes alkalosis
Mother rubella exposure in babies
increases risk for damage of corti and hearing impairment
Joint changes in pregnancy
increasing levels of circulating hormones causes increased joint mobility contributing to noticeable changes in maternal posture
murmur radiation
may be transmitted downstream in direction of blood flow and heard in another place on the precordium, neck, back, or axilla
prevalence of drinking during pregnancy and in aging adults
increasing over time increases for older people, as population increases and people live longer. more drink now than 20 years ago and women do more
capillary refil indicates
index of peripheral perfusion and cardiac output
Pain location test
indicate where touched at/ if pt can localize sensation
What does decorticate posturing indicate?
indicates hemispheric lesion of cerebral cortex
deviation of uvula and what it occurs with
indicates nerve damage which occurs with poliomyelitis and diphtheria
bulging of rib interspaces cause
indicates trapped air as the forced expiration associated with emphysema or asthma
Dietary Guidelines
individualized nutrition and health plans
Risk factors for undernutrition
infants, children, low income immigrants, pregnant women, hospital patients, aging adults
Lobal Pneumonia
infection in lung parenchyma leaves alveolar membrane edematous and porous allowing blood cell and debris buildup
Enlargement of epitrochlear nodes indicate
infection of the hand or forearm or general lymphadenopathy
white tonsillar membrane may accompany
infectious mono, leukemia, and diptheria
landmarks of the spine
inferior angle of scapula at t7-8 interspace and highest iliac crest point L4
Common sites of referred pain
inflamed appendix or gallbladder- periumbilical area acute coronary syndrome- left arm or neck
Blepharitis
inflammation of the eyelid. Red, scaly, greasy flakes and thickened, crusted lid margins occur w/ staph infections or seborrheic dermatitis of lid edge. Symptoms- itch, burning, tearing, foreign body sensation
Dacryoadenitis
inflammation of the lacrimal gland. outer lid inflammation associate with mumps, measles, mono, trauma
Dacrocystitis
inflammation of the lacrimal sac and duct due to infection or blockage. inflammation and tearing. pressure causes purulent dischage
plantar fasciitis
inflammation of the plantar fascia on the sole of the foot
otitis media cause
inflammation/infection of the middle ear. caused by the Eustachian tubes not draining adequately from the middle ear or passage of nasopharyngeal secretions into middle ear, creating ripe environment for bacterial growth
gender differences in pain and what they're influenced by
influenced by societal expectations, hormones, and genetics hormone affects strongest influences on pain sensitivity for women migraine 2-3x more likely in women chronic pain more prevalent in women
Incus appearance in otoscope
infrequently seen, but appears as whitish haze in upper posterior TM
TB
inhalation of tubercle bacilli into alveolar wall starts process
Spirometer and what it measures
inhale into device as fast as possible. FEV, or forced vital capacity, is the volume expelled. FEV1, or forced expiratory volume in 1 second FEV1 to FVC ratio should be 75% or more
Mechanism of coarse crackles
inhaled air collides with secretions in the trachea and large bronchi
hypertrophic cardiomyopathy
inherited thickening of the myocardium. venous return changes with position- grows softer when standing to squatting and grows lower with squatting to standing
ROM with articular disease
injury inside of joint produces swelling and tenderness around whole joint limiting all planes of active and passive ROM
extraartiular disease ROM
injury to a specific tendon or ligament- produce swelling and tenderness in one spot in vein only affecting certain ROM planes, especially active
cochlea
inner ear structure containing the central hearing apparatus. it allows the formation of nerve impulses to travel to the brain by vestibulocochlear nerve (VIII)
vestibule
inner ear structure providing sense of balance, direction, and spatial orientation
great saphenous vein and where it can be seen
inside the leg, starts at the medial side of the dorsum of the foot. can be seen ascending in front of medial malleolus then crosses tibia obliquely and ascends along medial side of the thigh
Inspecting muscles
inspect all muscle groups bilaterally for size, strength, tone, involuntary movements
assessing the lacrimal apparatus
inspect for visual bulge in outer upper corner and lower orbital rim pressure to look for excessive tearign
Murphy's sign
inspiratory pause during RUQ palpitation when gallbladder is inflamed, palpating liver causes pain. put fingers under liver border and ask pt to breathe deeply- they will stop inhaling in painful
How to auscultate breath sounds?
instruct to breath through mouth and a little deeper/longer than normal. side to side comparison is important
duck walk shows
intact ligaments and no effusion or arthritis
Stage 1 pressure ulcer
intact skin with nonblanchable redness
parietal lobe
integrates sensory information- touch, position, vibration, pain, temperature
amplitude
intensity
murmur pattern
intensity may follow a pattern during the cardiac phase. Grows louder (crescendo), tapering off (decrescendo) or increases to a peak, then decreasing (crescendo-decrescendo or diamond shaped)
contusion
interchangeable with bruise
what is an opthamoloscope and what is it composed of
internal eye structures through funds (background behind/ through pupil). 5 head parts: viewing aperture, selector dial, mirror window, lens selector dial, lens indicator. black is positive numbers and red negative. checks near and far sighted-ness but not astigmatism
aspects of a Childs functional assessment
interpersonal relationships, activity/ rest, economic status, home environment, environmental hazards, stress management, habits, health promotion
Cortex hearing action
interprets meaning of sound and begins response
interpersonal distance levels
intimate= 0-1.5ft- visual distortion occurs personal= 1.5-4ft- perceived as extension of self used for physical assessment social distance= 4-12ft most of interview done here public distance= 12ft or more
where do lymph vessels empty
into two main trunks (right lymphatic and thoracic) that empty into the venous system at the subclavian veins
bluish umbilicus indicates
intraperitoneal bleeding
tremor cause
involuntary contraction of opposing muscle groups resulting in back and force shaking, vibration, trembling movements of one or more joints may occur at rest or with voluntary movement and disappears while sleeping
Control of Respiration
involuntary control by resp center of brainstem- medulla and pons
autonomic nerve fibers
involuntary movement that regulates our internal organs divided into sympathetic and parasympathetic
Sensorineural (perceptive) hearing loss
involves damage to inner ear (VIII). CN VII transmits sound and equilibrium info to the brain
esotropia
inward turning of the eye r/t strabismus and corneal light reflex
Pale tongue due to
iron deficiency
Black non-tarry stool indicates
iron medications
vitamins/ minerals needed during pregnancy
iron, folate, and zinc
hypoventilation and its cause
irregular shallow pattern caused by OD of narcotics/anestheics, prolonged bed rest, or splinting of chest to avoid resp pain
lacriminal apparatus
irrigation with tears to the eyes
Potential adverse effects of alcohol to fetus
issues happen often as alcohol slips easily through placenta. FASD and physical, learning, or behavior problems
cause of cerumen impaction in older adults
it oxidizes, causing this impaction and is drier due to apocrine atrophy.
interphalangeal joints
joints between phalanges. permit flexion and extension of fingers
Where is waist circumference measured?
just above the level of the iliac crest
femoral pulse
just below inguinal ligament midway between pubic and anterior iliac spine
dorsalis pedis pulse
just lateral and parallel with extensor tendon of the big toe
Where can the aorta be palpated?
just to the left of the midline in the upper abdomen
skin conditions found in black pts
keloids, post inflammatory color changes (hypo/hyper pigmentation), pseudofolliculitis (razor bumps/ ingrown hairs), chloasma
genu valgum
knock knees
Boutinniere deformity
knuckle looks as if it is being rushed through a buttonhole
hypoflexia
lack of reflex- LMN problem
Anterior and posterior triangles
landmarks in finding the neck anterior- between sternomastoid and midline of body posterior- behind sternomastoid w/ the trapezius on the other side
acetabulum
large socket in the pelvic bone for the head of the femur
internal jugular vein location
larger and lies deep and medial to sternomastoid. not usually visible
Tumor
larger than a few centimeters in diameter, firm or soft, deeper into dermis; may be benign or malignant
Knee Joint Connects
largest and most complex joint in the body. connects femur, tibia, and patella
where is hip circumference measured?
largest circumference of the buttocks
scoliosis
lateral S shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. note unequal shoulder and scapular height and unequal hip level, rib interspaces flared on convex side. if severe (>45 degrees), it may reduce lung volume, hurting cardio function
common spots for oral cancer
lateral and ventral tongue and floor of mouth any lesion more than two weeks old should be seen
How to calculate BMI
lbs/ inches x 703 or kg/meters squared
dark line on gingival margins occurs with
lead and bismuth poisoning
Organs in RUQ
liver gallbladder duodenum head of pancreas right kidney and adrenal hepatic flexure of colon part of ascending and transverse colon
diagnostic positions test
lead the eyes through the six cardinal positions of gaze will elicit any muscle weakness or paralysis during movement. ask person to hold head steady and follow finger. progress clockwise in each direction. a normal response is parallel tracking of the object with both eyes
diabetic retinopathy
leading cause of blindness. damage to retinal blood vessels
Costal angle
left and right costal margins form angle at the xiphoid process. increases when rib cage chronically overinflated
where are on the heart are left and right heaves seen
left at apex and right at sternal border
typical liver palpation technique
left hand on patients back parallel to 11th and 12th rib and right on RUQ with fingers parallel to midline and press deeply, move up 1-2cm with each breath
palpating for the spleen
left hand over abdomen behind left side at 11th at 12th ribs and right hand on LUQ with fingers toward axilla just inferior to rib margin and deep breathe
Displacement of apical impulse and increases sound to multiple spaces occurs with
left ventricular dilation= volume overload impulse moves down and to left >4cm likely dilated heart (HF and cardiomyopathy)
A sustained impulse with increased force and duration but no change in location occurs with
left ventricular hypertrophy= pressure overload (no dilation)
Growth milestone of infants
length increased by 50% during first year and doubles by four weight is doubled by 4 months old and tripled by one healthy newborn expect to lose weight at birth but should regain during first 7-10 days
duration
length sound lingers
What does decerebrate posturing indicate?
lesion in brain stem at midbrain or upper pons
primary lesion
lesions arising from previously normal skin
Lesion Shape: Confluent
lesions run together (hives)
Why is number of pregnancies an important question during nutritional assessments
less than one year apart multiparous causes increased risk of nutritional deficit. hx of low birth weigh infants suggest past nutritional issues
ischial tuberosity
lies under the gluteus maximus muscle and is palpable when the hip is flexed
parotid gland
lies within cheek in front of ears from zygomatic arch to angle of the jaw
sublingual duct
lies within floor of mouth under the tongue. has many small openings along the sublingual fold under the tongue. almond shaped
inspecting abdomen for symmetry
light on stomach will cast off a shadow on any non-symmetric area and deep breathing and sit-ups allow bulging to show and abnormalities
sensory assessment tests
light touch, pain, temp, position
internal factors of communication
liking others- feel unconditionally accepted; see people optimistically empathy- viewing the word from the other person's inner frame of reference while still remaining you. understanding feelings without losing yourself in them ability to listen self-awareness- recognizing personal biases
internal factors of communication
liking others- making them feel unconditionally accepted; view people in an optimistic way empathy- viewing the world from the other persons inner frame of reference but remaining you. understanding their feelings without losing yourself in them ability to listen self-awarness- being aware of own biases
Hormonal changes during pregnancy causes
linea nigra, cholasma, and increase metabolism
Lesion Shape: Zosteriform
linear arrangement along a unilateral nerve route (herpes)
visceral pleura
lines outside of lungs
parietal pleura and its function
lines the inside of the chest wall and diaphragm. contains a small amount of fluid. negative pressure holds lungs against chest wall
verbal response: interpretation
links aspects together
hooking technique
liver palpation technique- stand at shoulder facing pt's feet and hook fingers over costal margin and ask pt to breathe trying to feel liver edge bump your fingertips
senile lentigines
liver spots nonmalignant melanocyte clusters (esp after extensive sun exposure). no tx needed
fecal distention characteristics
local distention. scattered dullness over fecal mass. palpate rope-like mass with feces in intestines
hematoma
localized collection of extravised blood under skin, often blunt force trauma
deep tissue pressure injury
localized nonblanchable color change to red, maroon, or purple in intact and nonintact skin. Dark skin appears darker but doesn't blanch. Or epidermis may separate, revealing dark wound or blood-filled blister. Causing pain and temp change. Begins in the muscle closest to the bone, in older adults and those w a lower BMI
ductus arteriosus location and closure
located between pulmonary artery and aorta. closes within 10-15 hours
bladder location of infants and children
located higher
maxillary sinuses
located in the maxillary bones along the side walls of the nasal cavity
what to note about masses palpated
location, size, shape, consistency, surface, mobility, pulsatility, tenderness
Sudden locking or buckling of the knee
locking- The pt is unable to extend the knee fully. This usually occurs with a painful and audible pop or click. Sudden buckling or giving away occurs with ligament injury which causes weakness and instability
What makes up physical appearance during general survey?
look their age age, sex (development), LOC (alert and oriented, answers questions), skin color (even and intact?), facial features (symmetric, moves properly), overall appearance (look in pain?)
bifid uvula
looks as if it is split in two; more common in American Indians
appearance of nasal deviation
looks like a hump or shelf in nasal cavity- deviation only significant if air flow is obstructed
age-related macular degeneration
loss of central vision caused by yellow deposits and neovascularity in the macula
aging adult skin changes
loss of elasticity, thinning/loss of all skin layers, sweat gland decrease, decreased thermoregulation, vascular fragility (minor bumps can make a huge impact due to lost collagen), decreased melanocyte fx, increased facial hair growth in women (due to lowered estrogen), nails grow slower
glaucoma
loss of peripheral vision due to buildup of fluid that damages the optic nerve
what causes halos around light?
loss of peripheral vision due to increased pressure
aphasia
loss of speaking, writing, and understanding ability due to stroke/ brain damage
hyperactive bowel sounds
loud, high-pitched, rushing, tinkling sounds that signal increased motility
resonant sound
loud, lower pitch, long duration, clear, hollow quality normal healthy lung tissue
Normal infant crying characteristics
loud, lusty, angry
more air filled structures give off what sound
louder, deeper, longer- due being able to freely vibrate
hyperresonance
low pitched booming when too much air Dull note- abnormal density in lungs
testing vibration
low pitched tuning fork over body prominences. patient indicates when it starts and stops
red blood in stool indicates
lower GI bleeding or hemorrhoids
expiratory wheezing may indicate
lower airway obstruction: asthma or bronchiolitis
presyncope
lowered blood flow to brain or heart causing lightheaded swimming sensation
Cyanosis reason
lowered o2 perfusion. if you can't tell, check LOC and resp status
depression
lowering a body part
dyspnea with age reason
lung bases become less ventilated as a result of closing off of a number of airways, increasing risk of exertional dyspnea
fetal lung development at 5 weeks
lung but emerges
what can cause tracheal shift
lung issues or collapse tumor, aortic aneurism, unilateral thyroid enlargement pushes to unaffected side ataelectasis pushes to diseased side aortic arch aneurism and tracheal tug pull downward
Emphysema changes in percussion
lungs are hyper-inflated, resulting in hyperresonance where you'd expect cardiac dullness
How does fetal circulation differ from adult circulation?
lungs don't function in utero, so blood doesn't go to lungs as is it is received oxygenated from the mother. instead, it reroutes to the aorta with the foramen oval and ductus arteriosus
Movement of lymph from lymphatic capillaries to bloodstream
lymphatic capillaries siphon interstitial fluid and converge to form vessels. they contain many one way valves that make it look beaded toward blood stream in a similar way to how blood moves through veins
unilateral or bilateral edema occurs with
lymphatic obstruction - with these factors it is brawny or non pitting and feels hard to the touch
compound nevus
macular and papular
junctional nevi
macular only and occurs in children and adolescents. turn into compound with age
Patch
macules that are larger than 1 cm
tarsal plates
main structural component of the eyelids. give eyelids shape. contain meibomian glands
Fixation reflex
maintaining a visual gaze on a single location. rapid movement to put target on fovea centralists and slower movement to keep track of the target
brachial artery location
major artery supplying the arm. runs in the biceps-triceps furor of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon
Ischemic stroke cause
majority of strokes: sudden interruption of blood flow to the brain
vision expectations at 6 weeks
makes visual response to your face
intoxication
maladaptive behavior changes due to CNS changes
types of chronic pain
malignant- stretching of organ or tissue and lack of blood which kills tissue and in turn causes pain non- fibromyalgia, arthritis, back pain
small tongue occurs with
malnutrition
sternum parts
manubrium, manubriosternal angle (angle of Louis), costochondral junction, sternum body, xiphoid process
7 categories of drugs
marijuana- 80% of illegal use cocaine heroin hallucinogens inhalants methamphetamines Nonmedical psychotherapeutic use- 2nd most used and high fatality
Craniosynostosis
marked asymmetry. Severe deformity caused by genetic premature closure of the sutures, causing a distinctive head shape that correlates w the specific closed suture
pectus excavatum
markedly sunken sternum and adjacent cartilages. becomes depressed at second intercostal and becomes more and more depressed and is more noticeable upon inspiration
tonsils and their appearance
mass of lymphoid tissue behind anterior tonsillar pillar fold. same color as the rest of the mouth and appears more granular and surface should deep crypts. posterior pharyngeal wall is being this
Pain at the mastoid process may indicate
mastoiditis or enlarged posterior auricular node
causes of decreased respirations during immediate newborn period
maternal drug use, interruption of uterine blood supply, or obstruction of tracheaobronchial tree with mucus/fluid
risks for child to experience hearing deficits
maternal rubella, maternal ototoxic drugs, premature/ low birth weight, trauma/ hypoxia at birth, congenital liver or kidney diseases. any fever diseases (measles, mumps, OM)
Which sinuses are present at birth?
maxillary and ethmoid.
development age of sinuses
maxillary reach full size after eruption of permanent teeth. ethmoid grown btwn 6-8 and after puberty frontal well developed by 7-8 and finish after puberty sphenoid develop after puberty
Biomarkers
measurable indicator of some biological state or condition
6 minute walk test
measure of functional status in older adults. monitor o2 sat during and stop if under 85-88%. walking as much as possible in 6 minutes. >300 meters is good
pulse oximeter and how its evaluated for each pt
measures arterial oxygen saturation (SpO2). normal person with no lung disease or anemia has 97-99%. evaluated in context on the person's hemoglobin level, acid base balance, and ventilatory status
Gamma-glutamyl transferase (GGT)
measures for chronic heavy drinking. conditions such as fatty liver, liver disease, obesity, and diabetes can falsely raise these
audiometric testing
measures how well a person can hear, the threshold of hearing of the individual's ear for that frequency
Apgar scale and what it assesses
measures the successful transition to extrauterine life assesses heart rate, resp effort, muscle tone, reflex irritability, color scored at 1 and 5 minutes after birth. healthy= 7-10
elbow landmarks
medial and epicondyles of humerus and olecranon process of ulna
spinal cord goes from
medulla to L1-2
Skin color determined by
melanin, carotene, and underlying vascular bed
Where are common melanoma locations on men, women, old, and black pts?
men- trunk and back women- legs and feet old- head and neck black- soles of feet and nails
Opisthotons indicates
meningeal irritation
Sequence for complete neurologic examination
mental status cranial nerves motor system sensory system reflexes
midbrain
merges into hypothalamus and thalamus. regulates auditory and visual function
Upper motor neuron dysfunction indicates
message isn't getting sent to motor neurons - weakness/paralysis -hyperactive reflexes -decreased motor control -abnormal muscle tone
microtia/macrotia
microtia <4cm and macro >10cm
Brain Stem consists of
midbrain, medulla, and pons. consists of nerve fibers CNIII to XII
which turbinates are visible
middle and inferior
retracted TM due to
middle ear vacuum with obstructed eustachian tube
mediastinum and what it contains
middle of chest cavity containing esophagus, trachea, heart, and great vessels
tibial tuberosity
midline bony prominence of the knee
diastasic recti
midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles. ridge revealed when intra-abdominal pressure increased while raising head supine. occurs congenital or as a result of pregnancy and marked obesity
linea alba
midline tendinous seam joining the abdominal muscles
vertebral line
midspinal line
most common extra heart sound
midsystolic click (associated with mitral valve prolapse)
Normal tone of muscles
mild resistance to passive stress tested by passive ROM
phoria
mild weakness in eye muscles only when fusion is blocked
Rotator cuff purpose
muscles enclose the shoulder joint forming a cover over the humerus head. they rotate the arm laterally and stabilize the head of the humerus against the small glenoid fossa
tonic phase
muscular rigidity, opening mouth and eyes, tongue biting, and high pitched cry
past health- childhood illnesses
mmr, chicken pox, strep, pertussis any w later in life sequence- rheumatic fever, scarlet fever, polionephritis
nevus
mole; circumscribed skin lesion due to excess melanocytes
what is the purpose of the functional assessment during the health hx process?
monitor ADLS which maintain health and wellbeing ADL used to monitor functional status and changes over time
tropia
more severe, constant malalignment of the eyes
Skin of infants and children
more smooth, thin, and permeable permeability creates greater risk for fluid loss temp regulation is ineffective
chronic shortness of breath
more than a month. may indicate neurogenic, resp, or cardiac origin
effect of respiration on volume of blood pumped
more to left less to right during inspiration, more blood pushes into vena cava, increasing venous return. the increased volume prolongs right ventricular systole and pulmonary valve closure meanwhile, blood in left is sequestered in the lungs during inspiration causing decreased left sided SV
GI changes in pregnancy
morning sickness, acid indigestion due to esophageal reflux, decreased GI motility, hemorrhoids, diminished bowel sounds (due to enlarging uterus), striae, and linea nigra
Benign Paroxysmal Positional Vertigo
most common cause of vertigo. less than one minute spinning. occurs with labyrinth disfunction
Oral Kaposi Sarcoma occurs with
most common early lesion in people with AIDS
what does inguinal notes drain
most of lower extremity, external genitalia, and anterior abdominal wall
Basal cell carcinoma of eye
most often on the lower lid and presents as a small painless nodule with central ulceration and sharp rolled out pearly edges occurs in older adults associated with UV exposure and light skin locally invasive, metastasis is rare
Muscular changes with aging
mostly influenced by lifestyle- sedentary lifestyle hastens changes of aging and physical exercises prevents or delays bone loss
mental status changes associated with aging
mostly stays same and intact. response time slows and recent memory can decline. sensory perception changes, which can make them appear confused. new learning ability declines in four unrelated words test in people of normal cognitive function
supination
movement that turns the palm up
retraction
moving a body part backward and parallel to the ground
protraction
moving a body part forward and parallel to the ground
circumduction
moving the arm in a circle around the shoulder
rotation
moving the head around a central axis
inversion
moving the sole of the foot inward at the ankle
parotid swells with
mumps and AIDS
changes over age in lung strength and elasticity
muscle strength declines after 50 and continues to decline into 70s. elastic changes make them less distensible and lessens their tendency collapse and recoil
morning sickness
n/v between first and second missed periods due to hormone changes- human chorionic gonadotropin
biographic data about a patient
name, address, phone number, age, birthdate, gender, marital status, race, ethic origin, occupation, primary language
esophoria
nasal (inward) drift r/t cover test
nasal changes in pregnancy
nasal stiffens and epistaxis may occur due to increased vsacularity in upper resp tract. gums may become hyperemic and may soften and bleed easier
Hypothalamus
near base and pituitary. major respiratory center with basic vital function. regulates temp, water metabolism, appetite, emotional expression, sleep-wake cycle, and thirst. coordinates autonomic nervous system function and stress responses: digestion, temp, HR
myopia
nearsightedness. globe longer than normal- use neg number on ophthalmoscope
Bilateral arm pitting edema calls for? what may it indicate?
neck vein exam. if distended, heart disease or pulmonary HTN. If normal, live or kidney issues, chronic venous insufficiency
palpation of knee swelling
need to distinguish between soft tissue swelling and increased joint fluid- done by comparing legs and bulge sign and ballottement test
Dermis made up of
nerves, sensory receptors, blood vessels, lymphatics, hair follicles, glands connective tissue or collagen- resists skin tearing and allows stretching
unilateral loss of smell
neurogenic anosmia
neurologic systems at birth
neurons not yet myelinated so motor activity is controlled by spinal cord and medulla
Resting posture of infant
newborn favors a flexed position: folded in extremities, hips slightly abducted, fists flexed. after two months, flexion gives way to gradual extension
pain related health hx questions in kids
note effect on usual behavior- do they still play how do they react when in pain relation to activity, eating, and body position
Inspecting hip
note symmetric levels of iliac crests, gluteal folds, and equally side buttocks. a smooth even gait, reflexes, and equal leg lengths indicate functional hips
claudation distance
number of blocks walked or stairs climbed to produce pain
child abuse and neglect types
numbers increasing neglect physical abuse- even if unintentional if done purposefully sexual abuse emotional abuse- belittling, rejection, threats, withholding love/support
nail lines, grooves, or pits may indicate what?
nutritional deficiency or acute illness
Gynoid obesity
obesity pattern seen in people who store fat primarily around the hips and thighs
causes of abdominal distention
obesity, air/gas, ascites, ovarian cyst, pregnancy, feces, tumors
Health implication of over-nutrition
obesity, heart disease, type 2 diabetes, osteoarthritis, sleep apnea, CKD, gallbladder disease, GERD
communicating with school-aged kid
objective and realistic- interview them and caregiver together
signs
objective evidence of a disease; measurable
Objective vertigo vs. Subjective vertigo
objective- room spinning subjective- you're spinning
Retraction of rib interspaces cause
obstruction of resp tract or increased inspiratory effect is needed (atelectasis)
Unilateral edema occurs with
occlusion of a deep vein
black tarry stool indicates
occult blood (melena) from GI bleeding
isometric/ isovolumic relaxation
occurs after systole, all valves are closed and atria begin to fill with blood
Facial edema characteristics
occurs first around eyes and cheeks in subq
Complicated alcohol withdrawal
occurs in 1 week cessation and can cause coarse irregular tremor
transduction phase of pain
occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery (skin and somatic and visceral structures) causing tissue damage neurotransmitters send a pain message, or action potential, along fiber
voluntary guarding
occurs when the person is cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation.
costal cartilage calcification
occurs with age- thorax becomes less mobile for expansion
unequal chest expansion occurs with
occurs with atelectasis, lobar pneumonia, pleural effusion, thoracic trauma
causes of dysphagia
occurs with esophageal problems: obstruction, infection, stroke, thrush
Paroxsmal nocturnal dyspnea:
occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Typically the person awakens after 2 hours of sleep with the perception of needing fresh air.
Inequality of bony landmarks occurs with
occurs with scoliosis
Circumoral pallor can be a sign of
occurs with shock and anemia
Testing cranial nerve III, IV, and VI
oculomotor, trochlear, and abducens: assessing extraocular movements (by cardinal position of gaze/ diagnostic positions test and assessing for nystagmus or strabismus) and PERRLA (pupils, equal, round, reactive to light and accommodation)
Percussion use in infants/children
of little use. hyerresonance normal in children
seborrhea
oily skin
who gets glaucoma more?
older adults, African Americans, women (since they live longer)
pleural cavity
on both sides of the mediastinum and contain the lungs
how to palpate deep cervical lymph nodes
one at a time; gently bend the patient's head forward and roll your fingers over the deeper muscles along the carotid arteries
When to introduce cow's milk?
one year
Why does thyroid enlarge during pregnancy?
result of hyperplasia of tissue and increased vascularity
amount of words spoken at each age
one year= more than 4 two= more than 200 two to six= grammar, language, and pronouns used six= more than 10,000 seven= passive tense ten= complex grammar
how are s2 splits heard
only in pulmonic valve areas- second left interspace don't ask pt to hold breath as this causes synchrony of the sounds
Carbohydrate-deficient transferrin (CDT)
only last 15 days. women numbers are higher, so combine with GGT for adequate testing
Where is the apical pulse felt?
only visible or palpable on some people. usually palpable at 5th intercostal space 7-9cm from the midsternal line
eustachian tubes
opening that connects middle ear with nasopharynx. acts as a pressure valve- allows air to flow in and out of inner ear, equalizing internal and external pressure of tympanic membrane
night blindness occurs with
optic atrophy, glaucoma, vitamin A deficiency
what can opthalmoscope view
optic disk, retinal vessels, and macular
ocular structure appearance in aging adult
orbital fat atrophy causes sunken look
Effects of babies and children having less muscular abdominal walls
organs easily palpated, they are more prone to hernias, abdomen is protuberant
swelling of external canal may suggest
otitis externa or frostbite
What might crusts and scaling of external ear indicate?
otitis external, eczema, contact dermatitis, seborrhea
positioning of ears in child
outer canthus aligned with pinna and positioned within 10 degrees from lateral
Annulus
outer fibrous rim encircling the eardrum
small saphenous vein
outside the leg, starts on the lateral side of the dorsum of the foot, ascends behind the lateral malleolus, up the back of the leg where it joins the popliteal vein. blood flows from superficial veins into deep leg veins
kyphosis
outward or convex curvature of the thoracic spine; hunchback. body compensates by holding head extended and tilted back
exophoria
outward turning of the eye r/t cover test
exotropia
outward turning of the eye r/t strabismus and corneal light reflex
where can s1 be heard
over all precordium, but loudest at apex
flat percussion note
over bone, especially ribs- causes a dead stop. high pitched, soft, short. can be over tumor
normal bruit
over celiac artery systolic, medium to low in pitch, heard between the xiphoid process and the umbilicus
dull percussion note
over dense organs. short, soft, high pitched, soft/muffled
bronchovesicular breath sound location and characteristics
over major bronchia where fewer alveoli are located: posterior between scapula, esp on right. moderate pitch and amplitude. inspiration and expiration duration is the same
vesicular breath sound location and characteristics
over peripheral lung fields where air flows through smaller bronchioles and alveoli. low pitch, soft, rustling sound. inspiration longer that expiration
keloid
overgrowth of scar tissue which invades original trauma site. more common in darker skinned people
superficial cervical node
overlying the sternomastoid muscle
Where is the external jugular venous pulse seen at?
overlying the sternomastoid muscle or pulsation of the internal jugular vein in the sternal notch
causes of laryngitis
overuse, URI, chronic inflammation, lesions, or neoplasm
PAINAD pain scale
pain assessment in advanced dementia 4 pts or more requires pain assistance breathing, vocalization, body language, consolable, facial expression
wells score
predicts pretest probability of DVT- usually presents w/ unilateral swelling and inflammation of affected leg
chronic (persistant) pain
pain continues for 6 months or longer after initial injury, not stopping when it heals. originates from abnormal processing of pain fibers (neuropathic pain) two types- malignant and non
pathway of pain stimulus from pain receptors to brain
pain receptors, a and C fiber, posterior root ganglion, tract of lissauer, anterolateral spinthalmic tract, spinal cord segment, medulla, thalamus, cerebral cortex
referred pain
pain that is felt in a location other than where the pain originates due to possessing the same spinal nerve
what is considered the 5th vital sign?
pain, the "gold standard" of pain assessment
Hodgkin lymphoma nodes feel like
painless, rubbery, discrete
types of pigmentation changes
pallor, erythema, cyanosis, jaundice, hypo/hyper pigmentation
thrill cause
palpable vibration on the chest wall accompanying severe heart murmur. feels like purring cat. signifies turbulent blood flow and directs you to locate the murmur origin
palpating mastication muscles
palpate contracted temporals and masseter muscles as the person clenches teeth, comparing size, firmness, and strength. ask pt to move jaw forward, laterally, and open against resistance
twelfth rib
palpate midway between the spine and the person's side to identify its free tip
assessing temporal area
palpate temporal artery and temporomandibular joint
when to assess brachial pulse
palpated if you suspect atrial insufficiency- should be equal force bilaterally
temporal artery
palpated in front of the ear
tongue characteristics
papillae create roughness on top and underneath is vascular with the frenulum that connects it to the floor
stensen's duct
parotid gland duct. runs forward to open on buccal mucosa opposite second molar. appears as a small red dimple with mumps
3 salivary glands
parotid, submandibular, sublingual
subluxation
partial dislocation
chest size change during expiration
passive- as diaphragm relaxes, positive pressure in lungs occur causing pressure in alveoli and air flows
how to screen for depression and what the scores mean
patient health questionnaire (PHQ-9) 5-9 minimal, 10-14 mild, 15-19 moderate severe major, >20 severe major
Uncomplicated alcohol withdrawal
peaks at day 2, improves by 4-5. typical hangover s/s
Nociception
perception of pain or injury
Tinnitus and what it occurs with
perception of sound without external source. occurs with senroineural hearing loss, middle ear infection, cerumen impaction, and other ear disorders
Percussing the abdomen
percuss in all 4 quadrants, in a systematic, clockwise matter to identify fluid, masses or air tympany is heard over most of the abdomen dullness is heard over the liver, full bladder, fat, or a mass
The layers of the heart wall from superficial to deep are:
pericardium, myocardium, and endocardium
loss of vibration occurs with
peripheral neuropathy-diabetes and alcoholism
How developed is a newborns vision and how do their eyes appear?
peripheral vision intact at birth, while macular vision is not. Macular vision is strengthened around 3-4 months and mature by 8 months. foveal light reflection formed at one year. eyeball structure at adult size by 8. at birth, iris has little pigment, pupils are small, and lens is nearly spherical. fundis appears pale in babies as vessels not fully developed. permanent eye color by 6-9 months
three levels of auditory system
periphery, brainstem, cerebral cortex
untreated strep can cause
peritonsillar abscess, rheumatic fever, and glomerulonephritis
Steroid use causes what
personality disorders (agression) and liver damage
frontal lobe
personality, behavior, emotions, intellectual function
dependence on a drug
physiological dependence on stomach
gums should appear
pink with strippled/ dotted surface
Swollen lymph nodes might be r/t
pinna or mastoid process inflammation
Opiates Intoxication and withdrawal
pinpoint pupils, lowered vitals, lethargy, slurred speech, somnolence, initial euphoria then apathy, dsyphoria, psychomotor retardation, inattention, lowered memory, judgement, and functioning WD- dilated pupils, lacrimination, runny nose, tachycardia, raised BP, piloerection, n/v, depression, diarrhea, insomnia/restless, flu symptoms
palpating anterior chest for symmetric chest expansion
place hands on anterolateral wall with the thumbs along costal margins pointing to xiphoid process
Performing Allis test
place infant's feet flat on table with knees flexed up. inspect the top of the knees- should be at same elevation. if one is lower, it suggests hip dislocation
Palpating temporomandibular joint
place tips of first two fingers in front of ear and ask pt to open and close mouth. then drop finger into depressed area over the joint and note smooth motion of the mandible
Posterior chest: palpating symmetric expansion
placing hands on posterolateral chest wall with thumbs pointing at level of t9 oe t10. slide hards medially to pinch up a small fold of skin. Ask pt for breath deeply, and as pt inhales, thumbs should move apart symmetrically
costodiaphragmatic recess
pleura extend 3 cm below level of lung; potential space for fluid/air which may compress lung, hindering expansion
pain with deep breathing occurs when
pleurae are inflammed
congested cough indicates
pneumonia
Crepitus all over may indicate
pneumonia, bronchiolitis, atelectasis
what does hyperesonance indicate
pneumonia, pleural effusion, atelectasis
coal miners environmental risk of
pneuomococcus
erythema occurs with
polycythemia, venous stasis, carbon monoxide poisoning, and extravascular presence of red blood cells
Insertion of tympanostomy tubes
polyethylene tubes relieve middle ear pressure and promote drainage. improved aeration causes less acute OM occurrence. tube extrude spontaneously in 12-18 months
Physiological changes with age that affect nutrition
poor dentition, lowered visual acuity, less saliva, decreased GI absorption and motility, smell and taste sensitivity
causes of esophageal emptying delay in older adults
poor muscle tone, poor contractility, poor sphincter opening- increases aspiration risk
prominent veins occurs with
portal hypertension, cirrhosis, ascites, or vena cava obstruction
Assessing an ill Individual
position that helps them feel best given their illness. adapt assessment to Pt's comfort level- mini database if needed
night cough indicates
postnasal drip, sinusitis
what can sudden floaters indicate?
retinal detachment
aspects of childhood past health hx
prenatal status, labor and delivery, postnatal status, childhood illnesses, accidents, chronic illnesses, hospitalizations, immunization record, medication hx
forms of teaching health literacy
present only the info needed -oral teaching -written teaching- 5th grade level or under, at least 12 pt font, in appropriate language, limiting medical jargon -teach back- to reassess understanding of pt
palpating maxillary sinuses
pressing below cheekbones
palpating frontal sinuses
pressing firmly up and under eyebrows
Mean Arterial Pressure (MAP)
pressure forcing blood into tissues, averaged over cardiac cycle
carotid sinus hypersensitivity
pressure over the carotid sinus leads to a decreased heart rate, decreased BP, and cerebral ischemia with syncope. may occur in older adults with HTN or occlusion of carotid
what causes a pulse
pressure wave generated by each style pumping blood through the aorta
afterload
pressure. the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. ventricle tenses itself to overcome pressure differences
Prinzmetal or varient angina
pressurelike discomfort at rest. Retrosternal and can radiate. Palpitations, syncope, feelings of syncope
prepatellar bursa
prevents friction between the patella and the skin
postcentral gyrus
primary sensory cortex in parietal lobe
three types of stimulus
primary- thermal and mechanical secondary- chemical mediators- sent from site of tissue damage in body
immigrant nutrition considerations
prior poverty, poor, sanitation, war/political strife incases risk. at an increased risk of htn, diarrhea, lactose intolerance, osteomalacia, scurvy, dental caries
damage to basal ganglia causes
problems with involuntary tremors, delays, or ??
Temporal lobe
processes auditory information, taste, and smell
Occipital lobe
processes visual information
sebaceous glands function
produce oil which slows water loss from skin
intention tremor
produced by purposeful movement toward an object
evaluation
progress toward outcomes using ongoing assessment to revise prior systems if needed
bronchitis
proliferation of mucous glands in passage ways resulting in excessive mucus secretion. inflammation of bronchi with partial obstruction of brochi
EKG changes in older adults
prolonged PR and QT but QRS unchanges
Opisthotonos
prolonged arching of the back with head and knees bent backwards
bronchial tree tree function
protects alveoli from small particulate matter in inhaled air. bronchi contain goblet cells and cilia that rid lungs of particles
Cerumen function
protects and lubricates the ear by keeping microorganisms from reaching TM
Kwashiorkor
protein malnutrition high calorie diet with low protein decreased visceral protein levels no change in anthropometric measures may appear obese
Marasmus
protein-calorie malnutrition decreased anthropometric measurements weight loss, muscle wasting, and decreased subq fat - starved appearance visceral protein may remain normal
Why should babies have whole milk?
provides calories and essential fatty acids for growth and CNS development
what does the retina contain
retinal vessels, optic disc, optic nerve, neurons
Abnormally high blood pressure in left side indicates
pulmonary congestion
Hemoptysis is often seen with
pulmonary diseases or mitral stenosis
Pink frothy sputum
pulmonary edema, some sympathomimetic medications have a side effect of pink-tinged mucus
Heart failure
pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. dependent air sacs deflated, pulmonary capillaries engorged, and bronchial mucosa may be swollen
Gastric acid changes with age
pumps that release acid decrease with age which decreases acid secretion- hurts digestion
Cocaine intoxication and withdrawal
pupil dilation, tachy/Brady cardia, high or low BP, sweating, chills, n/v, pacing, psychomotor agitation, impaired functioning, hyper vigilance, hallucinations. WD- dsyphoric mood (anxiety, depression, irritability), fatigue, insomnia, hypersomnia, psychomotor agitation
PERLA documentation includes
pupils equal, round, and reactive to light and accommodation
Assessing a toddler (purpose, position, preparation, sequence)
purpose= develop autonomy- difficult since they're still dependent on parents position- sitting up on caregivers lap. does not usually like to be naked prep- ignore kid at first to let them adjust and then try to engage and gauge response sequence- least evasive to most
Assessing a school-aged child (purpose, position, preparation, sequence)
purpose= develop industry. school competency and social networks. desire for success and pride when successful postion- on table. slight modesty at 5ish. let 11-12 decide if parent stays prep- talk to break ice, demonstrate equipment and comment on body and how it works sequence- as with adults, head to toe
Assessing a preschooler (purpose, position, preparation, sequence)
purpose= initiative starts being developed position- 3: on lap 4-5: table. usually willing to be naked preparation- explain steps to child. don't give choice when there isn't one, but offer choice when there is one. let them help/ play w equipment sequence- usually cooperative, but thorax, abdomen, genitals, extremities first. then do facial features and throat
Assessing an infant (purpose, position, preparation, sequence)
purpose= task: establishing trust by being properly taken care of position- flat on table or against caregivers chest (esp >6 months) preparation- 1-2 hours after feeding, warm, soothing voice, facial expressions and eye contact sequence- least distressing to most (facial steps) moro/ startle test done last as it makes them cry
How does pursed lip breathing work?
pursed lips cause presssure in bronchial tree to remain positive and fewer airways collapse
acute OM w perforation discharge
purulent
external otitis discharge
purulent, sanguineous, or serous
posterior thyroid approach
push trachea to tilted side to check for enlargement or lumps. have them drink water. often can't palpate, especially lateral lobes. often feel bismuth over tracheal rings
hyperthermia cause
pyrogens secreted by toxic bacteria during infections or tissue breakdown following illness/ trauma. neuro issues can reset temp inaccurately
deflating BP cuff too quickly or slowly
quickly- falsely low systolic or high diastolic slowly- false high diastolic- venous congestion muffles sound
subcutaneous elbow nodules
raised firm nontender freely moving nodules overlying skin. occur with RA and are common in olecranon bursa and along extensor surface of ?
Sebaceous hyperplasia
raised yellow papules with a central depression on face
Keratoses
raised, thickened areas of pigmentation that look crusted, scaly, and warty
elevation
raising a body part
where are splits heard
rapid and heard at tricuspid valve area/ left lower sternal boarder
Reflex arc
rapid involuntary predictable response to stimulus which helps with balance and muscle tone
The pallor of shock presents with?
rapid pulse rate, oliguria, apprehension, and restlessness
Tachypnea amount and what its associated with
rapid shallow breathing. >24 a minute. increases with resp insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons
characteristics of carotid pulse wave
rapid smooth upstroke, rounded summit, and gradual downstroke with a notch due to aortic valve closure
Fasciculation and cause
rapid, continuous twitching of resting muscle or part of muscle without movement of limb. fine is associated with atrophy and weakness and coarse is not significant (cold exposure or fatigue)
blumberg sign
rebound tenderness push at 90 degrees angle slowly and then lift quickly. rebound tenderness occurs in RLQ when pressure applied to LLQ may indicate appendicitis
cerebellar system
receives info about the position of muscle of muscles and joints and what kind of motor messages are being sent from the cortex to the muscles. coordinates movement, maintains balance, equilibrium, posture
thoracic duct
receives lymph from the left side of the head, neck, chest, abdomen, left arm, and lower extremities. empties into left subclavian veins
Why does nocturia occur in patients with heart failure?
recumbency at night promotes fluid resorption and excretion. occurs with HF in the person who is ambulatory during the day
path of bruise coloration
red and purple 12-36 hours after, blue- green, green-brown, brown-yellow, yellow, then fades
tonsil appearance with strep
red enlarged w/exudate
tonsil appearance with viral infection
red w/ no exudate or enlargement
senile keratosis
red/tan scaly patches that grow over time and become rough, raised, and have silvery-white adherent. only on sun exposed areas. theses can turn into squamous carcinoma
frostbite
reddish-blue discoloration and swelling of auricle after exposure to extreme cold. vesicles or bullae may develop. causes tenderness and pain. ear necrosis may ensue
squamous cell carcinoma
redness around, scaly, central ulcer develops in sun exposed areas. less common than basal, but grows faster.
parasympathetic nervous system
rest-and-digest response: relaxes GI sphincter, increases gland and GI movement, conserves energy to lower heart rate
colicky pain behavior
restlessness and turning
what/ where is the cone of light
reflection of otoscope light in anteroinferior quadrant
red reflex
reflection off of inner retina that appears as a reddish orange glow filling person's pupil. can reveal problems with cornea, lens, and vitreous
infant vision birth to 2 weeks
refusal to open eyes after bright light exposure. increasing alertness to object
Cause of bone loss in older adults
remodeling
interviewing people with hearing impairment
repeat, speak loud, watch lips. ask them to repeat back to ensure they understand
Dyskinesias
repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present
Epidermis replacement and vasularity
replaces itself every 4 weeks. avascular- nourished by blood vessels in the dermis
Clinical Institute Withdrawal Assessment (CIWA)
requires subjective data to be done. determines management of withdrawal symptoms using specific meds and prevents over medication by evaluating symptoms. 0-9 absent or mild, 10-19 mild to moderate, more than 20 severe
bimanual palpation
requires use of both hands to envelop or capture certain body parts or organs
clinical decision in healthcare depends on
research evidence, pt preference, clinician's experience/expertise, physical exam/assessment
Lesion Shape: Target
resembles iris of eye, concentric rings of color in lesions
Weak groaning cry
respiratory distress
tonsil function
respond to local inflammation
sensory response of infants
respond to pain by crying and may withdrawal from stimulus. they can localize by 7-9 months. Infants have hypoesthia which requires strong stimulus to elect a response
mental disorder
response much greater than expect reaction to a traumatic life event- associated w distress and disability
optic nerve
responsible for carrying visual images to the brain
Macula
responsible for central clear vision
Choroid
responsible for the vasculature of the eye- helps O2 perfusion to retina and absorbs light to prevent internal reflection. located deep in sclera
Pulses bigeminus and cause
rhythm coupled, every other beat comes early, or normal beat followed by premature beat; force of premature beat decreased because of shortened cardiac filling time. due to conduction disturbances (premature contraction)
pulses alternans and what it occurs with
rhythm regular but force varies with alternating beats of large and small amplitude. when HR normal, it occurs with left ventricular failure
Magenta tongue due to
riboflavin deficiency
right bronchi vs left bronchi
right is shorter, wider, and more vertical
Assessing infant cranial nerve V
rooting and sucking reflexes
shoulder atrophy can signal
rotator cuff problems or disuse
Thoracic cage appears of infants/children
rounded thorax and equal AP-transverse diameter (until age 6)
suprapatellar pouch
sac of synovial membrane at the superior border of the patella which extends as much as 6cm behind the quadricep muscle
ulnar artery
same relation to the ulna but deeper and difficult to feel
terminal hair
scalp, eyebrows, pubic, axilla, face/chest in men
Shoulder joint consists of which bones
scapula, clavicle, humerus
coracoid process and location
scapula. a few cm medial to greater tubercle. projections anterior and laterally from neck of scapula and surround the deeply situated joint
Outer layer of eye contains
sclera and cornea
cultural differences in appearance of eye
sclera can be gray/blue or muddy color in darker skinned people. maculas (freckles) can exist normally on sclera. may also have fatty yellow deposits beneath lids
3 concentric coats of the eye
sclera, choroid, retina
erosion
scooped out, shallow depression in skin. epidermis lost. moist but no bleeding
screening musculoskeletal exam involves
screening suffices for most people inspection, palpation, ROM observation, and age specific screening measures
confrontation test
screens for peripheral vision. one eye at a time. tester stands 2 feet away (also covering an eye for reference) wiggling fingers advancing from periphery in several directions. assesses disconnect in pathway to brain
Functional assessment purpose
screens the safety of independent living, the need for home health services, and quality of life (ADLs)
milia/ cradle cap
sebum in infant holds in H2O causing it. sebaceous glands decrease after and don't resume until puberty
meibomian glands
secrete oil onto surface of eye, stopping tears from overflowing and helps create airtight deal when lids are closed
mechanism of atelectatic crackles
sections of alveoli are not fully aerated, they deflate and accumulate secretions, crackles heard when these sections reexpand in first few breaths
appearance of nasal perforation
seen as spot of light from penlight shining in the other naris- occurs with cocaine use
functional assessment components
self-esteem, activity/exercise (adl ability), sleep, nutrition/elimination, interpersonal relationships and support systems, spiritual resources involvement in health care, stress management, personal habits (drinking, drugs, alcohol), alcohol, environmental/ occupational hazards (safe house, neighborhood, and work; utilities and transportation present), intimate partner violence, occupational health
Excoriation
self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching
hyper/hypo/ an esthia
sensations of touch- use wisp of cotton to skin
AV valves
separate the atria from the ventricles. tricuspid (right AV) and mitral (left AV)
tympanic membrane and its appearance
separates the outer ear from the middle ear. oval and slightly concave, as pulled in at center by malleus. shiny, translucent, pearly gray. may have pink or yellow tinge. vibrations created here from sound waves
pleurae
serous membranes that form an envelope between the lungs and the chest wall
clonus
set of rapid, rhythmic contractions of the same muscle
verbal response: explanation
setting expectations for future events in the care process/ what comes next
anascara and what it may indicate
severe generalized edema. may be HF or kidney failure
hirsutism
shaggy or excessive hair
disequilibrium
shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits
What to look for during thoracic cage inspection
shape and configuration of the chest wall
Dull/deep vs sharp bone pain
sharp w/ movement- fracture dull/deep not affected by movement- other bone pain
assessing cornea and lens
shining light from side across, creating an oblique view. should be smooth and clear.
Tympanic membrane otoscopic characteristics
shiny, translucent, pearly gray cone of light reflex (5 in right, 7 in left).
mechanisms of heat conservation
shivering/muscle contraction and vasoconstriction
A weak, thready pulse occurs with
shock and PAD
What conditions cause hypothermia?
shock, cardiac arrest, peripheral artery insufficiency, raynauds, when induced, when immobilized
cyanosis occurs with
shock, heart failure, chronic bronchitis, and congenital heart disease.
anklyoglossia
short lingual frenulum that can limit protrusion and impair speech development
AUDIT-C
shortened form- consumption questions only. used in acute care settings
environmental exposure symptoms
shortness of breath and cough
Pica in children
should end by age 2 when child begins to recognize what is edible
Effusion or synovial thickening of elbow occurs where/how....
shows as a bulge or fullness in groove on either side of olecranon process and occurs with gouty arthritis and bursitis
Anterior Thoracic Landmarks
signpost for underlying respiratory structure suprasternal notch, sternum, sternal angle, costal angle
Amphetamine intoxication and withdrawal
similar to cocaine but causes low BP, pulse, resp, and temp. Behavior same as coke and so is withdrawal
Ascites distention characteristics
single curve and everted umbilicus. flanks bulge when supine. taut skin with increased pressure
air/gas distention characteristics
single round curve appearance. affects auscultation and may cause muscle spasm on abdominal wall
Assessing pain: objective data of Joints
size, contour, circumference, active/passive range of motion assessment, erect and relaxed posture
diabetic neuropathy screening
skin sensation tested on soles of feet- ten spots on feet with filament. refer pt if you can't feel one of them
acrochordons
skin tags
where are the specialized nerve endings located
skin, joints, muscles, connective tissue viscera
what effects an infants respiratory rate
sleeping, feeding, room temp. apnea for under 10-15 normal findin
Normal position of wrist
slight extension- in order for fingers to work correctly
bradypnea and what causes it
slow breathing but regular <10 per minute as in a drug-induced depression of the respiratory center in the medulla, increased ICP, and diabetic coma
athetosis
slow, continuous, writhing involuntary movements occurring with cerebral palsy
modulation phase of pain
slows down and stops the process of a painful stimulus
acquired nevi
small <6mm, symmetric, smooth, uniform color
lymph nodes
small oval clumps of lymphatic tissue located at intervals along the vessels. they filter out fluid before it enters the blood stream
sphenoid sinuses
small sinuses deep within skull in the sphenoid bone
Fordyce granules
small, isolated, white or yellow papules on oral mucosa- painless and insignificant
Pars flaccida
small, slack, superior section of tympanic membrane
C-fibers
smaller in diameter, unmyelinated and conducts a signal much more slowly; associated w diffuse pain- aching dull pain secondary long after initial injury
biggest PAD risk factor
smoking
False pallor
smoking, fear/anger, prolonged elevation, immobilization
atrophic glossitis and what it occurs with
smooth glossy tongue. Surface slick and shiny- mucosa things and looks red from decreased papillae. Accompanied by dryness of tongue and burning. Occurs w/ B12 deficiency (pernicious anemia), folic acid deficiency, and iron defiency anemia
turbinate polyps appear
smooth, pale, gray, avascular, non-tender- accompany chronic allergies
what affects expression of pain
social, cultural, emotional, spiritual concerns
plague on teeth can indicate
soft debris
nucleus pulposus structure and function
soft semi-fluid mucoid material in each disc center that cushion the spine and help it move. acts as a shock absorber and allows compression to one side. if too much compression, disc can rupture and leak fluid
more solid structures give what sound
soft, higher pitch, shorter sound as its harder to vibrate
normal voice sounds
soft, muffled, and indistinct. can hear sound, but can't tell exactly what is being said
Xanthelasma
soft, raised yellow plaques occurring on the skin at the inner corners of the eyes. cholesterol doesn't affect. more common in those over 50 and women
umbilical hernia
soft, skin covered mass, the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring. common in premes and resolved by 1 yr old
how to clean cerumen
soften with mineral oil and peroxide and irrigate by directing fluid to posterior wall
parts of the autonomic nervous system
somatic nerve fibers and autonomic nerve fibers (which is divided into sympathetic and parasympathetic nervous system)
thoracic origin chest pain occurs with
soreness from coughing or inflammation of pleura or pneumonia
quality
sound overtones
peripheral hearing action
sound waves travel to ear (including amplitude and frequency info.) Waves produce vibrations on tympanic membrane, carried by middle ear ossicles to oval window, then through cochlea, and are dissipated against round window.
paradoxical split
sounds fuse on inspiration and split on expiration
anterior chamber
space between cornea and iris
posterior chamber
space between iris and lens
greater omentum
specialized fatty mesentery that overlies the ventral abdomen
Angina pectoris
stable (no change in 60 days) pressure like pain precipitated by activity and fixes with rest. Substernal or retrosternal and can radiate. N/a, sweating, dyspnea, fatigue
S/s of vertigo
staggering gait, strong spinning, whirling sensation
How to inspect jugular venous pulse
stand on pt's right side as the veins there have a direct route to the heart. may use internal or external. pt at 30-45 angle supine w/ no pillow. turn their head slightly away from you and use light to view pulsations can be any strength when supine but normally disappears once 45 degrees. the higher the venous pressure, the higher the position you need
Glascow Coma Scale
standard objective assessment that defines level of consciousness by giving it a numeric value based on opening, motor response, and verbal response 15 in fully alert person and under 7 indicates coma assesses functional state of brain as a whole
What are threats of violent pts
staring, pacing, confusion, clenched fists/jaw, drug use
How to use the opthalmoscope
start 10 inches away and angle 15 degrees lateral to persons line of vision. advance closer after finding red reflex
palpating shoulders
start at clavicle and explore acromioclavicular joint, scapula, greater tubercle, subacromial bursa, biceps groove, glenohumeral joint, axilla area
Palpation of abdomen
start light and start in non affected area. moving clockwise. use first four fingers to press highly
ankylosis
stiff joint condition
hematemesis occurs with
stomach or duodenal ulcers and esophageal varices
A fibers
straight to CNS, larger in diameter and and have a fatty myeline sheath surrounding the axon allowing faster transmission of signals. they serve to receive and transmit info primarily relating to acute pain- local, short, sharp
striae gravidarum
stretch marks in abdomen, thighs, and breast from connective tissue becoming more fragile
striae
stretch marks. begin pink and blue and then turn silvery white
Babinski reflex
stroke finger up lateral foot and across ball. note fanning of toes which disappears and changes to adult response by 24 months
Upper motor neuron diseases
stroke, cerebral palsy, multiple sclerosis
What causes hip stability
strong muscles, strong fibrous articular capsule, and deep insertion of femur head
medial and lateral malleolous
strong tight medial and lateral ligaments extend from each malleolus onto the foot and help the lateral stability of the ankle joint
what is general survey?
study of the whole person, covering the general health state and any obvious physical characteristics. starts being made upon first pt interaction
Hordeolum
style. infected hair follicle with fluid surrounding at lid margin. usually staph infection- contagious
symptom
subjective evidence of disease as sensed by the patient
Wharton's duct
submandibular duct- on each side of frenulum
diseases characterized by petechiae
such as thrombocytopenia, subacute bacterial endocarditis, and septicemias
yellow teeth can indicate
tobacco use
acute pain
sudden onset, usually the result of a clearly defined cause, such as injury, and has predicable trajectory, usually stopping when cause treated/ heals. self-protective- warns individual of potential tissue damage
hemorrhagic stroke symptoms
sudden severe headache, N/V, sudden loss of consciousness, and focal seizures
chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face at irregular intervals and can be spontaneous or initiated
Calf pain with activity
suggests intermittent claudation
pallor or sluggish return in Allen test
suggests occlusions of collateral arterial flow equivocal result- 8-14 negative over 15
Enophalmos
sunken eyes. Narrowed palpebral fissures in which eyeballs are recessed. Bilateral enophthalmos caused by loss of fat in orbits and occurs w/ dehydration and chronic wasting illnesses
two sets of veins in arms
superficial and deep superficial in subq and are responsible for most of venous return
posterior auricular (mastoid) node
superficial to the mastoid process
stage 2 pressure ulcer
superficial ulcer is shallow. epidermis lost and exposed dermis
Wheal
superficial, raised, transient, and erythematous; slightly irregular shape from edema
Example of superficial and visceral reflex
superficial- corneal (blink) visceral- pupillary reflex
external jugular veins location
superficial; lie lateral to the sternomastoid muscle above the clavicle
Position for assessing jugular veins and precordium
supine and head and chest elevated 30-45 degrees
four functions of the respiratory system
supply o2, remove co2, maintain arterial blood homeostasis (pH/ acid base balance), and maintain heat exchange
Testing Clonus
support lower leg in one hand and with other hand move foot up and down to relay muscle and then stretch muscle by briskly dorsiflexing foot and hold stretch. Normal- feel no movement when callus present, you'll note rapid rhythmic contractions of calf muscle and movement of foot
function of musculoskeletal system
support to stand, movement, protect organs, produce bone cells, mineral storage
Accumulation of fat in older females
suprapubic fat gain due to decreased estrogen
where is the internal jugular venous pulse seen at?
suprasternal notch or around origin of sternomastoid muscle around the clavicle
fetal development at 32 weeks
surfactant production is adequate
tympanostomy tubes
surgically inserted to equalize pressure and drain secretions
heave or lift
sustained forceful thrusting of the ventricle during systole. occurs with ventricular hypertrophy as a result of increased workload
mechanisms of heat loss
sweating and vasodialation
jugulodigastric node
tonisillary node- under the jaw
assessing for joint irritation
swelling signals irritation. assess joint fluid (effusion), thickening of synovial lining (synovial membrane usually not palpable), inflammation of surrounding soft tissue (bursae and tendons) or bony enlargement
appearance of rhinitis
swollen and bright red
nasal appearance of chronic allergies
swollen, boggy, pale, pray
systolic vs diastolic murmur
systolic- may be a healthy heart or heart disease diastolic murmur always indicates heart disease
cannabis intoxication and withdrawal
tachycardia, increased perceptions, social withdrawal, anxiety. only withdrawal if chronic- weight loss, sleep issues, irritability, sweating
What is percussion?
tapping on a surface to determine the difference in the density of the underlying structures. vibration creates sound that depicts location, size, and density of orgam
laceration
tearing/splitting of body tissue, usually from blunt impact over a bony surface
child abuse increases risk for what risky behaviors
teen pregnancy, juvenile arrest, adult criminal behavior
facial expression of an emphysema pt
tense strained face and pursed lips
Mini Mental State Exam
test of cognitive function of the mental status exam. 11 questions. allows for multiple measurements over time to evaluate better or worsening conditions. costs $
CAGE test
test to monitor and self-reflect on drinking habits:`` Have you ever thought you should Cut down your drinking? Have you ever been Annoyed by criticism of your drinking? Have you ever felt Guilty about your drinking? Do you drink in the morning, an Eye opener?
testing for near vision
test with handheld vision screener 14 inches away
testing CN IX and X
testing pt's gag reflex
cardiac output
the amount of blood pumped by the heart per minute
Perception phase of pain
the conscious awareness of pain cortical structures identify it as pain somatosensory- characterize pain
canthus
the corner of the eye, the angle where the lids meet.
why can't transillumination be used to diagnose sinusitis
the diagnosis requires distinct illumination differences on one of the sinus parts. doesn't help in chronic sinusitis as there is diffuse swelling
hallux valgus
the distal part of the great toe is directed away from the body midline
palpebral fissure
the elliptical open space between the eyelids. When closed, the lid margins approximate completely. When open, the upper lid covers part of the iris
hyperflexia
the exaggerated reflex seen when the monosynaptic reflex arc is released from the usually inhibiting influence of higher cortical levels.
child neglect
the failure to provide for a child's basic needs- medical, physical, supervision, drug exposure, abandonment, in some places failure to educate
thenar eminence
the fleshy mass at the base of the thumb
ligaments
the joint is surrounded by a fibrous capsule and supported by ligaments, fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable direction
telegraphic speech
the kind of verbal utterances in which words are left out, but the meaning is usually clear
when/where can functional murmurs be heard?
the soft diastolic murmur of aortic regurgitation can only be heard when person is leaning forward when sitting
precentral gyrus
the strip of frontal cortex, just in front of the central sulcus, that is crucial for motor control by initiating voluntary area movement
avulsion
the tearing away of a structure or part; r/t laceration
stroke volume
the volume of blood pumped out by left ventricle with each heartbeat
What is a person's mental status?
their emotional and cognitive function
patients perception of illness
their opinion on how their symptoms affect them and what it means and that they can do about it
physiologic changes due to pain in infants
they are due to sympathetic nerve presence in acute pain sweating- check body temp. if normal, why are they sweating? n/v changes in o2 sat assess for changes in temperament, expression, and activity
Why does skin look blue in polycythemia
they can't oxygenate all of the RBCs
9 verbal responses
they lead: facilitation, silence, reflection, empathy, we lead: clarification, confrontation, interpretation, explanation, summary
Pars tensa
thick, taut, remainder section of tympanic membrane
Crust
thickened, dried out exudate left when vesicles/pustules burst or dry up
what does TM look like in newborns?
thickened, opaque, "injected" after crying (mild redness from increased vascularity). goes from horizontal to vertical at one month
apocrine glands
thicker, milkier sweat starting after puberty. mixes with normal flora, causing body rod. occurs in axilla, urogenital area, nipples, naval. secretion stimulated by emotional and sexual situations
endocardium
thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
aqueous humor
thin transparent fluid similar to plasma that gives eye its shape. produced by ciliary body and resides in eye chambers. helps to deliver nutrients to tissue and drain metabolic wastes. balance between production and drainage determines IOP
thoracic changes in pregnant women
thoracic cage appears wider and costal angle may feel up to 50% wider. 40% increase in tidal volume
Solid viscera organs
those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus)
when is purpura seen
thrombocytopenia and scurvy. Also occurs in old age as blood leaks from capillaries in response to minor trauma and diffuses through dermis
two types of ischemic stroke
thrombotic (from atherosclerotic plague) and embolic (a traveling clot)
deep cervicle chain
tilt head and press under muscle omohyoid crosses posterior triangle so dont mistake as lymph node
Petechiae and cause
tiny punctuate hemorrhages (1-3mm) round and discrete. Dark red, purple or brown. Caused by bleeding from superficial capillaries and won't blanch. May indicate abnormal clotting factors
olecranon process
tip of elbow between medial and lateral epicondyles. ulnar nerve runs between medial epicondyle and olecranon process
Palpation using grasping action of fingers and thumb
to detect position, shape, and consistency of an organ or mass
Why would hypothermia be induced?
to lower body's O2 requirements during certain surgeries
phases of nociceptive pain
transduction, transmission, perception, modulation
retina
transforms light stimulus into nerve impulses (via its neurons) that are conducted through the optic nerve and the optic tract to the visual cortex of the occipital lobe light sensitive tissue that lines the inside of the eye. light sensitive
Cutis marmorata
transient mottling in the trunk and extremities in response to cooler room temperatures
Basilar membrane
transmits sound and converts into electrical impulses vibrates to a specific point to the sound frequency and has receptor hair cells, called organ of court, which acts as the sensory organ of hearing. As hairs bend, they mediate vibrations into electric impulses. These impulses are conducted by the auditory portion of cranial nerve VIII to the brainstem The closer to the base of the basilar membrane, the higher frequency the sound is
tongue tremors may occur with
tremor- hyperthyroidism coarse tremor- cerebral palsy and alcoholism
Muscles that extend arm
triceps and brachialis
Test Cranial Nerve V
trigeminal nerve: motor function by assessing jaw strength and movement (palpate temporal and masseter muscles as person clenches teeth and try to separate jaws by pushing on cheeks) sensory function by assessing facial sensation on forehead, cheek, chin (cotton to test eye, maxillary, and mandible)
Weber and Rinne tests
tuning fork tests weber- not reliable, as normal hearing people hear it at different volumes in each ear rinne test- more accurate in detecting conductive hearing loss neither can distinguish normal hearing from sensorineural loss
a bruit indicates
turbulence due to a local vascular cause, such as atherosclerotic narrowing/ partial occlusion
murmur
turbulennt blood flow and collision currents. gentle blowing/ swooshing that can be heard on chest wall
auscultation of thyroid indicates
turbulent blood flow due to plague present. use bell of stethoscope to hear for blowing and ask pt to hold breath
Tonic Neck reflex
turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side "fencing position" appearing at 2-3 months and disappearing by 4-6months
pronation
turning the palm downward
eversion
turning the sole of the foot outward
Lesion Shape: Gyrate
twisted, coiled spiral, snakelike
cogwheel rigidity and its cause
type of rigidity in which increased muscle tone is released by degrees during passive ROM- small regular jerks. Associated with Parkinsonism
indirect fist percussion purpose
ulnar aspect of fist percussed against non-dominant hand already laid against body. causes tissue to vibrate instead of producing a sound
woods light
ultraviolet light used for diagnosing fungal skin conditions
What parts show through TM
umbo, manubrium, and short process
fixed split
unaffected by respiration; the split is always there
Elder financial abuse
unauthorized use of resources for personal or financial gain or improper use of power of attorney
Ataxia
uncoordinated or unsteady gait
submental node
under chin
clefts for turbinates and what drains into them
under each turbinate there is a cleft (meatus) named for the above turbinate. sinuses drain into middle meatus and tears into inferior
where to look for widespread color change in darker skinned pts?
under tongue, cheek, sclera, and palpebral conjunctiva
hypoactive
underactive; sluggish
What is psychiatric mental disorder along with symptoms of it?
underlying cause can't be identified- ADHD, OCD, PTSD, anxiety, schizophrenia symptoms: backache, headache, fatigue, high BP, Indigestion, shortness of air, dizziness
BMI values for underweight, healthy, overweight, obese
underweight <18.5 normal 18.5-24.5 overweight 25-29.9 obese 1 30-34.9 obese 2 35-39.9 extreme obesity >40
BMI interpretation
underweight= <18.5 normal= 18.5-24.8 overweight= 25-29.9 obesity= 30-30.9 obesity= >40
symptoms of ischemic stroke
unilateral facial droop, arm drift, weakness or paralysis on one half of body, difficulty speaking or understanding speech, confusion, sudden onset of dizziness, loss of balance, visual problems
foreign body causes
unilateral mucopurulent drainage and foul odor
reproductive health issues from IPV
unintended pregnancy negative consequences during pregnancy- miscarriage, stillbirth, premature, low birth weight. Depression/substance abuse affects chronic pelvic pain STIs UTIs
diopter
unit of strength of the lens settings on the ophthalmoscope that changes focus on the eye structures. black= near objects red= far objects
Acute coronary syndrome (ACS)
unstable angina/ MI heaviness. Heaviness, pain, tightness. Substernal or retrosternal and can radiate. Indigestion feeling, n/v, dizzy, flushing, sweat, palpitations
ROM assessment in neck
up and down, side to side, ear to shoulder. notice any enlargement or obvious pulsation
decorticate rigidity
upper extremities: flexion of arm wrist and fingers and adduction of arm tight against thorax lower extremities: extension, internal rotation, and plantar flexion
scratch test
using auscultation to detect lower border of the liver. place stethoscope over the xiphoid process while lightly stroking skin with one finger up the MCL from the RLQ and parallel to the liver border. sound is magnified when you reach liver edge
critical thinking
using current knowledge available to evaluate situations in order to make the best decision possible
how to palpate across the precordium
using palmar aspects of all four fingers, gently palpate the apex, left sternal border, and base (can use carotid as a guide or auscultate as you palpate)
food frequency questionnaire
usual frequency and portion size over a designated amount of time. requires a good memory and info about food prep details
complete assessment (total health database)
usually PCP. health history and full physical exam
Mongolian Spots
usually gradual fade over 1st year and appear at birth
chronic pain behaviors (persistent)
variable behaviors related to adaptation of pain bracing, rubbing, diminished activity, sighing, and change in appetite
decreased capillary refill indicattes
vasoconstriction or decreased cardiac output
Pallor can be caused by
vasoconstriction when cold or areas of edema
What occurs during diastole
ventricles relaxed, AV valves open, blood pours into ventricles since pressure higher in atria than in ventricle
QRS complex
ventricular depolarization= ventricular contraction
Pathologic S3 occurs with
ventricular gallop, occurs with heart failure and volume overload
what occurs during systole
ventricular pressure now higher than atrial, and AV valves close. for a brief second all valves are closed. ventricular walls contract building closed pressure (isometric contraction)
Posterior Thoracic Landmarks
vertebra prominens, spinous processes, inferior border of scapula, twelfth rib
what are nystagmus associated with
vertigo
receiving in communication
words and gestures must be interpreted in a specific context to have meaning receivers test is to interpret the senders messages, both verbal and nonverbal
evening cough indicates
work irritants
Carotenemia
yellow-orange color in light-skinned persons from large amounts of foods containing carotene. goes away in 2-6 weeks
Optic disc appearance
yellow/orange to pink. round or oval with clear margins
indications of hearing loss
• Person lip-reads or watches you face and lips • Frowns or strains forward to hear • Postures head to catch sounds in better ear • Misunderstands/asks to repeat your questions • acts irritable/startled when you raise your voice • speech garbled or distorted • inappropriate loud noise • flat monotonous tone of voice