HESI Review- Health Assessment

Conditions that can create turbulent blood flow (heart murmurs)

Turbulent blood flow with a swooshing or blowing sound when doing auscultation 1) increased blood velocity 2) structural valve defects 3) valve malfunction 4) abnormal chamber openings

cloudy urine

UTI or kidney stones

increased RBC occur with

UTI, Glomerulonephritis, renal calculi, trauma, and cancer

PQRST(U)

Understanding Patient's Perception of the problem- What do you think it means?

Friction rub

a coarse, grating, adventitious lung sound heard when the pleurae are inflamed

Chronic obstructive pulmonary disease (COPD)

a functional category of abnormal respiratory conditions characterized by airflow obstruction (e.g., emphysema, chronic bronchitis)

Glaucoma

a group of eye diseases characterized by increased intraocular fundus

claudiaction

a painful, aching or tired feeling in th elegs due to dcreased blood lfow

Fremitus

a palpable vibration from the spoken voice felt over the chest wall

Kussmaul respiration

a type of hyperventilation that occurs with diabetic ketoacidosis

eructaion

belching , burping

Fibroadenoma

benign breast mass

Bruit

blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

Ligaments atach...

bone to bone

grouped

clusters of lesions

Crepitus

coarse, crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue

turbinates

increase surface area for vascularity

shifting level of dullness

indicates the presence of fluid

sac herniates through internal inguinal ring, can remain in canal or pass into scrotum, pain with straining, soft swelling that increases with increased intra-abdominal pressure, may decrease whenl lying down. most common. 60% of all hernias, more common in infants <1 years and in males 16-20. congenital or acquired

indirect inguinal hernia

conjunctivitis

infection of the conjunctiva "pinkeye"

What is the Cochlea

inner ear structure containing the central hearing apparatus

Cranial nerve III - oculomotor nerve

innervates all the rest--the superior, inferior, and medial rectus and inferior oblique muscles

study suggested developmental differences in interactions with

insulin, glucose, androgens, and racial/ethnic differences in diet, lifestyle, and exposure to enviromental factors

what is the expected outcome of the glossopharyngeal nerve in a 14 year old adolescent?

intact gag reflex

what is the expected outcome of the optic nerve in a 14 year old adolescent?

intact visual acuity

Paget's disease

intraductal carcinoma in the breast A malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast.

muscle guarding

involuntary muscle tightening over sensitive areas

E means

examine, check for changes, report changes immediately; the testicle is egg shaped and movable, it feels rubbery with a smooth surface like a peeled boiled egg

Gynecomastia

excessive breast development in the male

skeletal muscle is composed of bundles of muscle fibers called _____. The skeletal muscle is attached to the bone by _____ which is a strong fibrous cord.

fasciculi. tendon.

through femoral ring and canal, below inguinal ligament, more often on right side. pain may be severe, may become strangulated, least common 4% of all hernias, more common in women. acquired due to increased abdominal pressure, muscle weakness, or requent stooping

femoral hernia

Cecum

first or proximal part of large intestine

how can a nurse assist the family of a hospitalized toddler with separation anxiety?

first, have at least one parent stay with the child as much as possible. place the child in a room close to the nurse's desk. finally, explain the concept of separation anxiety to the parents to help them cope with the child's behavior.

a painful longitudinal tear in the superficial mucosa at the anal margin below. fissures often result from trauma, or from irritant diarrheal stools. the person has itching, bleeding, and exquisite pain. a resulting spasm of the sphincters make the area painful to examine

fissure

structural scoliosis

fixed; curvature shows both on standing and on bending forward; note rib hump with forward flexion; when person is standing, note unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level. greatest risk are females 10 years of age through adolescence at the peak of growth spurt

Thymus

flat pink-gray gland behind the sternum and in front of the aorta, has no function as an adult and in kids produces T-lymphocytes

Thomas test

flexion flattens the lumbar spine; if this reveals a flexion deformity in the opposite hip, it is a positive ______

a wave of peristalsis that continues throughout life, although children and adults usually produce no more than one or two stools per day

gastrocolic reflex

thick, profuse, yellow or gray brown discharge

gonococcal urethritis

presbycusis

gradual onset over years, whereas trauma hearing loss is often sudden.

A nurse is teaching a class about nutrition to a high school health class. which of the following foods selected by adolescents indicates and understanding of good nutritional practices?

green salad with low fat dressing, peanut butter and apple slices, pasta and tomato sauce.

Submandibular

halfway between the angle and the tip of the mandible

left lung

has 2 lobes. has no middle lobe. Is narrower than right lung b/c heart bulges to Left

apex (lung border)

highest pt of lung tissue on anterior chest. Posteriorly: C7

Spleen

highly vascular

Acute Venous Vascular Disease

i. Located in the calf ii. Intense, sharp and deep muscle tender to touch iii. Sudden onset iv. Pain may increase with dorsiflexion of foot v. Red, warm, swollen leg are associated factors

1-2 seconds

refill lasting more than ________ signify vasoconstriction

Tic

repetitive twitching of a muscle at inappropriate times

Tic

repetitive twitching of a muscle group at inappropriate times (e.g wink grimacing)

Atrophic Scar

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

Lymphatic

retrieves excess fluid from the tissue spaces and returns it to the blood stream

what illness involves symmetric joints

rheumatoid arthritis

Peritoneal friction rub

rough grating sound heard through the stethoscope over the site of peritoneal inflammation

peritoneal friction rub

rough grating sound,

Deep Veins

run alongside deep arteries and conduct most of the venous return from the legs

Brachial Artery

runs through the biceps-triceps furrow in the upper arm

Aneurysms

sac formed by dialation in the artery wall, most common site is in the aorta, and the most common cause is arthersclerosis

Bradypnea

slow breathing, <10 breaths per minute, regular rate

characteristic of a weak pulse

slow upstroke

Athetosis-

slow, twisting, continuous movement, resembling a snake

Nodule

solid, elevated, hard/soft, >1cm. May extend deeper into dermis than papule.

cloudy urine

suggests presence of WBC, bacteria, casts

costovertebral angle

the twelfth rib forms an angle with the vertebral column, called....

Preload

the venous return that builds during diastole. - the length to which the ventricular muscle is stretched at the end of diastole just before contraction

stage 4

thick hair growth over pubic area but not on thighs, penis grows in length and diameter with development of glans. Testes almost fully grown, scrotum becomes darker

Conjunctiva

thin mucous membrane; transparent protective covering of eyeball and mucous membrane

Colostrum

thin, yellow fluid, precursor of milk, secreted for a few days after birth

Blue Drum (Hemotympanum)

this indicates blood in the middle ear, as in trauma resulting in skull fracture

a double layerd membrane that covers each testis which separates it from the scrotal wall

tunica vaglinalis

Supination

turning the forearm so that the palm is up

What is rooting reflex?

turns head to side when cheek or mouth is touched.

Carcinoma

ulcerated, crusted nodule with indurated base that fails to heal. Bleeds intermittently. Usually occurs on the superior rim of the pinna, which has the most sun exposure

Ataxia-

uncoordinated or unsteady gait.

Jugulodigastric

under the angle of the mandible

BUN measures

urea, an end product of protein metabolism it measures 10-20 mg/dl and rises with a decrease in fluid volume or an increase in protein intake

pinpoint, constricted opening at meatus or inside along urethra. occurs congenitally or secondary to urethral injury. gradual decrease in force and caliber of urine stream is most common symptom

urethral stricture

infection of urethra causes painful, burning urination or pruritus. meatus edges are reddened, everted, and swollen with purulent discharge; urine is cloudy with discharge and mucus shreds; cause determined by culture

urethritis

dark gray urine

urine contains melanin, melanuria

A 9 mont old infant weight 3.86 kg (8.5lbs) at birth. currently, at his well-child check-up, he weighs 8.1kg (18lbs). is this infant weight normal for his age?

yes. an infant should gain 0.7kg (1.5lbs) per month for the first 6 months, and 0.3kg (0.75lbs) per month the last 6 months of the first year. the child gained 4.3 (9.5lbs), which is within the normal range.

Aging Adult

~Pain is NOT A NORMAL PROCESS during this developmental stage

Lordosis

inward or concave curvature of the lumbar spine

acites

is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).

the _____ testis is lower than the other because the spermatic cord is longer

left

Fissure

linear crack with abrupt edges, extends into dermis, dry or moist

parietal pleura

lines insides of chest wall & diaphragm

Costal Margin

lower border of rib margin formed by the medial edges of the 8th, 9th, and 10th ribs

base (lung border)

lower border, rests on diaphragm. Posteriorly: T10

hyperronsance

lower-pitched booming sound when too much air present (e.g., ephysema, pneumothorax)

What is the Angle of Louis

manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib

abdominal breathers

men

Veins

more numerous than arteries and are more parallel to the skin

Graves' disease

most common cause of hyperthyroidism, manifested by goiter and exopthalmos (bulging eyeballs). Symptoms include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance; signs include tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance.

basal cell carcinoma

most common type of skin cancer begin when UV radiation causes epidermal basal cells to form tumor

Lymphocytes

mount an antigen-specific response to eliminate pathogens

Inversion

moving the sole of the foot inward at the ankle

decrease in bone density due to increase bone reabsorption vs bone replacement. skeletal change. kyphosis commonly follows. which group is most effected?

osteoporosis. menopausal white females

Kyphosis

outward or convex curvature of the thoracic spine; hunchback

Peritoneal friction rub--LIVER

over lower right rib cage, from abscess or metastatic tumor

dyspareunia

pain with intercourse due to the decrease in vaginal secretions

Carotid Artery

palpated between the sterno cleomastoid and the trachea

How to test costovertebral angle tenderness

place one hand @ 12th rib on costovertebral angle, thump hand w/ulnar edge of opposite fist -normal: thud but no pain -abnormal: pain via inflammation of kidney or paranepheric area

systolic bruit

plusatile blowing sound and occurs with stenosis or occlusion of an artery

costochondral junctions

points at which ribs join their cartilage. Not palpapable.

prolonged painful erection of penis without sexual stimulation and unrelieved by intercourse or masturbation. most common in men during the 30-40's. rare condition but when lasting 4 hours or longer can cause ischemia of the penis, fibrosis of tissue, erectile dysfunction. can occurs as a side effect of some medications and street drugs and with sickle cell trait or disease.

priaprism

What do you percuss on Posterior Chest?

1) predominant note over lung fields 2) resonance 3) diaphragmatic excursion: ask pt.to "take deep breath & hold it"

What do you palpate on Anterior Chest?

1) symmetric chest expansion 2) tractile (vocal) fremitus 3) anterior chest wall

Match the parenting style to the statement that most reflects the style. 1) democratic. 2) dictatorial. 3) permissive.

1)" Tonight is a school night, so you need to come home by 10 p.m. 2) " your curfew is 10 p.m. you know that" 3) " as long as you have your homework done, I don't care when you come home."

Tonsils

- Located behind the anterior tonsillar pillar - Color is the same pink as the oral mucosa, and their surface is peppered with indentations, or crypts. --- In some people, the crypts collect small plugs of whitish cellular debris. This does not indicate infection. --- There should be no exudate on the tonsils.

Superficial Reflexes

- initiated by gentle cutaneous stimulation Ex) plantar reflex is initiated by stimulating the lateral aspect of the sole of the foot - response is downward flexion of toes - indirectly test for proper corticospinal tract functioning - Babinski's sign: abnormal plantar reflex indicates corticospinal damage where the great toe dorsiflexes and the small toes fan laterally

Factors that could affect interpretation of MSE

- known illness or health problems (alcoholism, renal disease) - current medications w/side effects of depression or confusion - pt's usual educational and behavioral level - responses to personal history questions indicating current stress, rx use, sleep habits etc

accommodation test

- looking for pupil reaction -client looks at object across the room (pupil should dialate) -client shifts focus to close object (pupil should constrict) *normal response is 1)pupillary constriction. 2) convergence of the axes of the eyes

Percussion of abdomen

- percuss lightly on all 4 quadrants - tympany should dominate b/c air rises to GI surface when pt is supine *dullness occurs over a distended bladder, adipose tissue, fluid, or a mass *hyperresonance is present with gaseous distention

Contracture

- permanent shortening of a muscle and subsequent shortening of tendons and ligaments, leading to limited range of motion of joint.

Clonus

- rapid movement marked by muscle contractions and relaxations.

Myoclonus

- rapid, sudden jerk or a short series of jerks at fairly regular intervals.

Preschool child examination

- sit on parent's lap - thorax, ab, extremities, genitalia first - head, ENT last

Jugular venous pulse and pressure

-Inspect the jugular for visibility of pulse, and measure jugular venous pressure

U wave

-May or may not be present -If present, it follows the T wave and represents the final phase of ventricular repolarization

Coronary Heart Disease Risk Factors

-Overview of coronary heart disease -Risk factors -Risk reduction teaching tips -Cultural considerations

ST segment

-Period between ventricular depolarization and the beginning of ventricular repolarization

Purkinje fibers

-Purkinje fibers: in the myocardium of both ventricles cause them to contract almost simultaneously.

SA Node

-Sinoatrial node: generates electrical impulses over both atria, causing them to contract.

Four stages of pressure ulcer development:

1 - intact red skin 2 - partial thickness skin erosion; loss of epidermis and sometimes dermis. 3 - full thickness extending into subcutaneous tissue. 4 - involves all skin layers, even supporting tissue.

A deep recess formed by the peritoneum between the rectum and the cervix is called?

a rectouterine pouch

cluster HA's

alcohol ingestion and daytime napping typically precipitate (hasten) cluster HA's, whereas alcohol, letdown after stress, menstruation, and eating chocolate or cheese precipitate migraines -unilateral -pain is excruciating -eye reddening, eyelid drooping, rhinorrhea and nasal congestion and associated with cluster HA

columns of morgagni. folds of mucosa

anal columns

When auscultating the carotid artery, llisten at 3 places-

angle of jaw, midcervical area, base of neck

Occipital Lobe

Primary visual receptor.

(P)QRSTU

Provocative or palliative- what brings it on? what were you doing when you first noticed it? what makes it better or worse?

What is wernicke's aphasia?

Pt can hear sounds and words but can't relate them to previous experiences (receptive aphasia)

Hypopyon

Purulent matter in anterior chamber. Occurs with iritis and with inflammation in the anterior chamber.

screening for prostate cancer

blood test for prostate-specific antigen (PSA) and a digital rectal exam

genu vaRum

bowlegged APART

genital wars are caused by HPV and are one of the most common STIs. the HPV infection is correlated with

early onset of sexual activity, infrequent use of contraception, and multiple sexual partners

the vas deferens continues back and down behind the bladder where it joins the duct of the seminal vesicle to form the

ejaculatory duct

polyuria

excessive quantity

Cranial bones

frontal, parietal, occipital, temporal

Linea nigra

increased pigmentation of the midline of the abdomen in pregnant women

characteristic of large, bounding pulse

increased pulse pressure

Hyperventilation

increased rate and depth of breathing

What is Hyperventilation

increased rate and depth of breathing

jelly like mucus shreds mixed in stool

indicate inflammation

proteinuria

indicates glomerular disease in the nephron.

Paronychia

infection in the tissues adjacent to a nail on a finger or toe

What is Otitis media

inflammation of the middle ear and tympanic membrane

the lymphatics of the penis and scrotal surface drain into the

inguinal lymph nodes

Tuberculosis

inhalation of tubercle bacilli; apex usually has most damage; initially asympotomatic, showing + on xray. Inspect: initial non-productive cough, later productive & yellow/green. Palpate: skin moist from night sweat. Percuss: resonant initially. Auscultate: normal/decreased vascular sounds. Adventitious sounds: crackles over upper lobes common

Cranial nerve VI - abducens

innervates the lateral rectus muscle (abducts eye)

Estropia

inward turning of the eye

target

iris, resembles iris of eye, concentric rings of color in the lesions ex- lyme disease

Which of the following foods should be introduced into an infant's diet first?

iron-fortified cereals. cereal is the first food introduced to an infant. maternal iron stores in the infant begin to diminish around4 months; therefor, iron-fortified cereal should be used. pureed yellow vegetable followed by pureed fruits are then introduced. whole milk is not given to infants.

normal discharge

is small, clear or cloudy and always non-irritating

avoid the term "having sex"

it is ambiguous, and teens can take it to mean anything from foreplay to intercourse

AAA and organ transplant

it is contraindicated for percussion and palpation

Patella

kneecap

what is common in adolescents due to poor posture?

kyphosis

what is common in the aging adult?

kyphosis.

bright red blood mixed with feces

possible colonic bleeding

fissures

separation of lung lobes

IBS

sharp or burning, crampin pain over a wide area;does not radiate. Brought on by meals, relieved by bowel movement

what is a contracture?

shortening of a muscle leading to a limited range of motion of joint -due to lack of use, muscles atrophy, common in nursing homes

S means

shower, warm water relaxes scrotal sac

Striae

silvery white or pink scar tissue formed by stretching of abdominal skin as with pregnancy or obesity

shingles

similar look to uticaria (hives) but nerves in skin are highly sensitive and painful cause by chicken pox virus

Osteoma

single, stony hard, rounded nodule that obscures the drum; nontender; overlying sking appears normal. Attached to inner third, the body part, of the canal. Benign.

preparation for respiratory exam

sitting upright. mailes: disrobe to waist. females: gown on, open in back. Begin exam after palpating thyroid gland when standing behind person.

VOLUNTARY, muscles--those under conscious control

skeletal

Mechanisms that Help Veins pump blood

skeletal muscles, pressure gradient caused by breathing, intraluminal valves that ensure unidirectional flow

Telangiectasia

skin lesion due to permanently enlarged and dilated blood vessels that are visible

Mobility

skins ease of rising; reflects the elasticity of the skin

What is Bradypnea

slow breathing <10 breaths per minute, regular rate

normal bowel sounds

soft gurgling or bubbling sounds that occur irregularly every 2-12 sec

glycosuria

suggests hyperglycemia

Posterior auricular (mastoid)

superficial to the mastoid process

whispered voice test

test one ear at a time while masking hearing in other ear to prevent sound transmission around head. this is done by placing one finger on tragus and rapidly pushing it in and out of auditory meatus.

sudden twisting of the spermatic cord, occurs in late childhood, early adolesence, rare after age 20. torsion usually on the left side. anterior part of the testis rotates medially. blood supply is cut off, resulting in ischemia and engorgement. emergency requiring surgery, testis can become gangrenous in a few hours

testicular torsion

olecranon bursitis

large, soft knob, "goose egg" and redness from inflammation of olecranon bursa, localized and easy to see because bursa lies just under the skin

Subjective Data for Assessing Peripheral Vascular System

leg pain or cramps, skin changes in the arms or legs, swelling, lymph node enlargement, medications

Frbours bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions.

ligaments

what is carpal tunnel?

median nerve damage/muscle wasting

the two lateral lobes of the prostate gland are separated by a shallow groove called the

median sulcus

pons and medulla

mediates involuntary control of respirations

Discuss cross-cultural-skin care.

melanin protects the skin against harmful rays, so the incidents of melanoma is 20 times higher among whites as blacks. Increased risk in whites

Diastasis recti

midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles

What are Cilia

millions of hairlike cells lining the tracheobronchial tree

LOWER motor Neruron

motor neuron in the peripheral nervous system with its nerve fiber extending out to muscle and only its cell body in central nervous system

Retraction

moving a body part backward and parallel to the ground

Substance p, histamine, prostaglandins, serotonin, and bradykin

neurotransmitters that propagate a pain message, or action potential, along sensory afferent nerve fibers to the spinal cord

gastric ulcer

pain is dull,, aching, gnawing epigastric pain, usually brought on by food, radiates to back or substernal area.

dysmenorrhea

pain or cramping before or during period

Chondrodermatitis Nodularis Helicus

painful nodules develop on the rim of the helix as a result of repetitive mechanical pressure or environmental trauma. They are small, indurated, dull red, poorly defined, and very painful

acute rheumatoid arthritis

painful swelling and stiffness of joints, with fusiform or spindle shaped swelling of the soft tissue of proximal interphalangeal joints. fusiform swelling is usually symmetric, the hands are warm, and veins engorged. inflamed joints have a limited ROM

tactile (or vocal) fremitis

palpable vibration. Sounds generated from larynx transmitted thru bronchi & lung parenchyma to chest wall, where you feel vibrations. Use palmar base (ball) of fingers OR ulnar edge of 1 hand to touch pt's chest while they repeat "99" or "blue moon." Symmetry important. Normally decreases as you palpate down.

Posterior Tibial

palpated behind the medial Malleolus

Quadriplegia-

paralysis in all four in extremities.

Paraplegia-

paralysis in both lower extremities.

Dead space

passageways that transport air but are not available for gaseous exchange (e.g. trachea, bronchi)

Near Vision Test

patient holds card 14 inches from the eye and reads the chart - with glasses on. This test is for patients with poor eye sight. Test results should read "14/14" (Jaeger card is used)

liver or spleen

peritoneal friction rub

Emphsema

permanent enlargement of air sacs. smoking accounts for 80-90% cases. Inspect: barrel chest. Palpate: decreased tactile fremitus & chest expansion. Percuss: hyperresonant. Auscultate: decreased breath sounds, muffled heart sounds. Adventitious sounds: usually none.

blood in urine or for a color change lasting longer than a day

person should seek medical care

hard, nontender, subcutaneous plaques palpated on dorsal or lateral surface of penis. may be single or multiple and asymmetric. They are associated with painful bending of penis during erection. plaques are fibrosis of covering corpora cavernosa. usually occurs after 45 years of age. it cause is trauma to the erect penis, more common in men with diabetes, gout, and dupuytren contracture of the palm

peyronie disease

what two tests are used to check for carpal tunnel?

phalens (hands back to back) and tinel sign (tap wrist for pain)

Middle Ear

tiny air filled cavity. Contains tiny bones or auditory ossicles: the malleus, incus, and stapes. It has several openings. Opening to outer ear is covered by tympanic membrane. THe openings to the inner ear are the oval window at the end of the stapes and the round window. Another opening is the Eustachian tube, which connects the middle ear to the nasopharynx and allows passage of air. This tube is normally closed, but it opens with swallowing or yawning.

Purpose of lymph nodes?

to filter fluid before it is returned to the bloodstream

what is the expected outcome of the hypoglossal nerve in a 14 year old adolescent?

tongue in midline.

Geniometer

tool used to measure joint angles

connective tissue/collagen

tough fibrous protein that enables the skin to resist tearing

Pericardium

tough, inextensible, loose-fitting, fibroserous sac that attaches to great vessels and surrounds the heart

trachea & bronchi

transports gases b/t environment & lung parenchyma; constitute "dead space:" space filled w air but not avail for gas xchange

bednar aphthae

traumatic areas or ulcers on the posterior hard palate on either side of the midline. they are the result from abrasions while sucking

True or False: fruit juices should be limited to 4-6oz per day for toddlers?

true: fruit juices are high in sugar content and should be limited for toddlers.

dunodenal ulcer

typically has dull, aching, gnawing pain,does not radiate, may be relieved by food, and may awaken the person from sleep

Atrophy-

wasting away; decrease in size of organ or tissue

Incompetent valves

where in the lumen is so wide that the valve cusps cannot approximate

ankylosis

wrist in extreme flexion, due to severe rheumatoid arthritis. this is a functionally useless hand because when the wrist is palmar flexed, a good deal of power is lost from the fingers and the thumb cannot oppose the fingers

What is Cerumen

yellow, waxy material that lubricates and protects the ear canal

aneurysm

you are listening to the abdome of a patient and you hear loud bruit over the aorta

abnormal

you palpate the the spleen what are you findings....

S3 may be benign in

youth, some trained athletes and sometimes in pregnancy.

Superficial Veins

the great and small saphenous veins

diaphragm

the part of the stethoscope you use to listen to bowel sounds

What is Egophony

the voice sound of "eeeee" heard through the stethoscope

Adolescents are likely to take risks because...

they see themselves as invincible to bad outcomes.

Arteriosclerosis

thickening and loss of elasticity of the arterial walls

cornea reflex

this is very sensitive to touch. contact with a wisp of cotton stimulates a blink in both eyes.

Orthostatic hypotension

Low blood pressure occurring in some people when they stand up. A comparison of blood pressure and heart rate readings while a patient is supine and while the patient is sitting upright or standing, an increase in heart rate of more than 20 bpm and decrease in blood pressure of more than 20 mmHg when the patient becomes upright is considered a positive orthostatic test.

Vesicular Sound

Low pitch, soft, greater on inspiration, rustling. - Over peripheral lung fields

withdrawal from sexual activity may be due to

loss of spouse, depression, preoccupation with work, martial of family conflict, side effects of medications (hypertensives, psychotropics, antidepressants, antispasmodics, sedatives, tranqulizers or narcotics and estrogens), heavy use of alcohol, lack of privacy, economic or emotional stress, poor nutrition, or fatigue

borborygmus

loud, growling sounds related to incrased motility , such as with diarrhea

Borborygmi

loud, gurgling bowel sounds signaling increased motility or hyper peristalsis, occurs with early bowel obstruction, gastroenteritis, diarrhea

resonance

low-pitched, clear, hollow sound that predominates in healthy lung tissue

What is Rhonchi

low-pitched, musical snoring, adventitious lung sound caused by airflow obstruction from secretions

Rhonchi

low-pitched, musical, snoring, adventitious lung sound caused by airflow obstruction from secretions

Veins

low-pressured system

Pregnant Female

lower blood pressure due to hormonal changes that cause vasodilatation

mediastinum (thoracic cavity)

middle section of thoracic cavity; contains esophagus, trachea, heart & great vessels

pancrease, pancreatitis

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

Submental

midline, behind the tip of mandible

Phoria

mild weakness, apparent only with the cover test and less likely to cause amblyopia than tropia but still possible

Cilia

millions of hairlike cells lining the tracheobronchial tree

Supernumerary nipple

minuet extra nipple along the embryonic milk line

cerebral palsy

mixed group of paralytic neuromotor disorders of infancy and childhood; due to damage to cerebral cortex caused by a developmental defect, intrauterine meningitis or encephalitis, birth trauma, anoxia, or kernicterus

Loger bowel obstruction

moderat, colicky painof gradual onset in lower bdomen, bloating

having no hair or sebaceous glands

modified skin

Abduction

moving a body part away from an axis or the median line

Protraction

moving a body part forward and parallel to the ground

Adduction

moving a body part toward the center or toward the median line

Circumduction

moving the arm in a circle around the shoulder

Epigastrium

name of the abdominal region between the costal margins

External nose

nares, vestibule, columella

stricture

narrowed opening

yellow urine

natural yellow is urochrome excretion, a pigment in blood; bright neon yellow with vitamin supplements;

foreskin is retracted and fixed. once retracted behind the glans, a tight or inflamed foreskin cannot return to its original position. constriction impeded circulation so glans swells. a medical emergency

paraphimosis

Salivary Glands

parotid and submandibular glands

LLQ

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

Subluxation-

partial dislocation of a joint

What is Dead Space

passageways that transport air but are not available for gaseous exchange

when are the sphincters not tightly closed

passing of gas feces

Toxic Alopecia

patchy asymmetric balding accompanying severed illness or use of chemotherapy (growing hairs are lost, resting hairs are spared) regrowth occurs after re-couping from illness

composed of three cylindric columns (2 corpora cavernosa on the dorsal side and corpus spongiosum ventrally)

penis

start with a question like "often boys your age"

permission statement

onycholysis

persistant fungal infection of fingernails and more often toenails

why assess smoking history with contraceptive use?

person at higher risk for blood clots

nonretractable foreskin forming a pointy tip with a tiny orifice. may be congenital or acquired from adhesions secondary to infection. poor hygiene leads to retained dirt and smega, which increase risk for inflammation, calculus formation, and obstructive uropathy

phimosis

Ectropion

Lower lid is loose and rolling out, does not, does not approximate to eyeball. Puncta cannot siphon tears effectively, so excess tearing results. Eyes feel dry and itchy because tears do not drain correctly. Exposed palpebral conjunctiva increases risk for inflammation. Occurs in aging as a result of atrophy of elastic and fibrous tissues. May result from trauma

Entropion

Lower lid rolls in because of spasm of lids or scar tissue contracting. Constant rubbing of lashes may irritate cornea. Person feels a "foreign body" sensation.

Bell's Palsy

Lower motor neuron lesion (peripheral), producing cranial nerve VII paralysis, which is almost always unilateral. Rapid onset; cause herpes simplex virus. Presents with smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind ear.

An enlarged tongue (macroglossia) may accompany:

Macroglossia occurs with Down syndrome; it also occurs with cretinism, myxedema, and acromegaly. A transient swelling also occurs with local infections.

Serum transferrin

Measures total iron-binding capacity - more sensitive indicator of visceral protein status than albumin normal: 170-250 mg/dl mild deficiency: 150-170 moderate deficiency: 100-150 severe deficieny: <100

Biographic data

Name, address, phone number, age, birthdate, gender, marital status, race, ethic origin, occupation, primary language

Enophthalmos

Narrowed palpebral fissures, the eyeballs are recessed. Bilateral enophthalmus is caused by loss of fat in the orbits and occurs with dehydration and chronic wasting illnesses.

Weight gain for pregnant women

National Academy of Science (NAS) recommends a weight gain of 25-35 lbs for women of normal weight -28-40 lb for underweight women -11-20 lb for obese women

Vesicular Breathing

Normal breath sound; low pitch, soft amplitude, inspiration>expiration; rustling like the sound of wind in the trees Location is over peripheral lung fields where air flows through smaller bronchioles and alveoli

Chronic Obstructive Breathing

Normal inspritation and prolonged expiration. Caused by exercise.

respiratory patterns

Normal range of respirations are represented by evenly spaced with uniform rate, depth, and pattern at a rate of 10 - 20 per minute (eupnea: normal patterns) Listen for a full minute! Watch chest expansion: symmetrical? Depth=air moving in and out with each respiration

Brachioradialis Reflex

Normal response is flexion and supination of the forearm

Biceps Reflex

Normal response is the contraction of the biceps muscle and flexion of the forearm.

Abdominal Reflex

Normal response is the ipsilateral contraction of the abdominal muscles with an observed deviation of the umbilicus towards the stroke.

What would a lethargic pt look like?

Not fully alert, drifts off to sleep when not stimulated, looks drowsy, thinking seems slow and fuzzy, inattentive, loses train of thought

COGNITIVE FUNCTIONS

ORIENTATION - knows date, location, etc abn: w/delerium and dementia ATTENTION SPAN - abn: digression from initial thought, irrelevant replies to questions RECENT MEMORY - can recall 24 hrs abn: dementia, delerium, Korsakoffs syndrome REMOTE MEMORY - recalls events in past abn: lost when cortical storage area for memory is damaged (alzheimer, trauma to brain region) NEW LEARNING - 4 unrelated words test abn: alzheimers, dementia, anxiety, depression

abdominal distention

Obesity - uniform roundness Air or Gas - single round curve, tympany over large area Ascites - single curve, everted umbilicus, taut, glistening skin, tympany over top but dull over fluid, no aortic pulsation Ovarian cyst - curve in lower half of abdomen, midline. everted umbilicus; fluid wave and shifting dullness, aortic pulsation Pregnancy Feces - mass palpated in intestines Tumor - localized distention; dull over mass; palpate to define borders

Mental status in infants and children

Object permenance - 18-24 months language as a social tool of communication coincides with cooperative play - 4-5 years logical and systematic thinking - 7 yrs hypothetical thinking - 12-15 years

Testing persons gait/balance

Observe persons gait as they walk 10 to 20 feet, turns and returns to the starting point Normal Finding:The person moves with a sense of freedom; The gait is smooth, rhythmic and effortless, the opposing arm swing is coordinated and the turns are smooth. Step Length about 15inches from heel to heel.

S4

Occurs before S1 and is the vibrations from atria contracting

What is incident pain?

Occurs predictably after specific movements

Decrease in cerebral blood flow

Occurs with aging Can cause dizziness and loss of balance with position change. These people need to be taught to get up slowly to prevent falls.

Loss of vibration sense

Occurs with peripheral neuropathy like Diabetes, and alcoholism *Often first sensation lost

Trendelenburg sign

Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side

Bulge sign

Occurs with very small amounts of effusion, 4-8 ml, from fluid flowing across the joint within the suprapatellar pouch. Assessed by firmly stroking up the medial aspect of the knee 2-3 times to displace any fluid, tapping the lateral aspect, and watching the medial side in the hollow for a distinct bulge from a fluid wave

Cranial Nerve III

Oculomotor Function: Motor Function of extraoccular movement, opening of eyelids Parasympathetic functions of pupil constriction and lens shape.

OD

Oculus dexter or right eye

Chronic nonmalignant pain

Often associated with musculoskeletal conditions such as arthritis, low back pain, and fibromyalgia

Palpation

Often confirms points noticed during inspection, applies sense of touch: texture, temp, moisture, swelling, etc... Fingertips-for fine tactile discriminations, such as skin texture, swelling, pulsatility, and presence of lumps Dorsa of hands-best for determining temperature because the skin here is thinner than on the palms Base of fingers or ulnar surface-to detect vibration

Malignant pain

Often parallels the pathology caused by the tumor cells. Is induced by tissue necrosis or stretching of an organ by the growing tumor. Pain fluctuates within the course of the disease

Cholesteatoma

Overgrowth of epidermal tissue in the middle ear or temporal bone may result over the years after a marginal TM perforation. It has a pearly white, cheesy appearance. Growth can erode bone and produce hearing loss. Early signs include otorrhea, unilateral conductive hearing loss, tinnitus

Referred abdominal pain

Pain location not over the involved organ. Pain is referred to a site where the organ was during fetal development: the organ migrates during fetal development but its nerves persist in referring sensations from the former location

What is modulation?

Pain message is inhibited during this last phase of nociception

Endogenous Obesity - Cushing syndrome

either administration of adrenocorticotropin (ACTH) or excessive production of ACTH by the pituitary will stimulate the adrenal cortex to secrete excess cortisol. this causes cushing syndrome, characterized by weight gain and edema with central trunk and cervical obesity and round, plethoric face (moon face). excessive catabolism causes muscle wasting; weakness; thin arms and legs; reduced height; and thin, fragile skin with purple abdominal striae, burising, and acne.

Right Lymph duct

empties into the right subclavian vein drains the right side of the head and neck, right arm, right thorax, right lung and pleura, right side of the heart, and right upper section of the liver

Cyst

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

hemorrhoid

enlarged anal vein

caps the testis, a markedly coiled duct system and the main storage site for sperm. comma shaped structure, curved over the top and posterior surface of the testis

epididymis

acute infection commonly caused by prostatitis, after prostatectomy because of trauma of urethral instrumentation or due to chlamydia, gonorrhea, or other bacterial infection

epididymitis

meatus opens on the dorsal side of the glans or shaft above a broad spadelike penis. rare; less common but more disabling because of associated urinary incontinence and separation of pubic bones

epispadias

Barrel Chest

equal anteroposterior to transverse diameter and ribs are horizontal. Associated with normal ageing, and emphysema and asthma

what is the expected outcome of the spinal accessory nerve in a 14 year old adolescent?

equal strength of shoulder

Cardiac Output

equals the volume of blood in each systole (called the stroke volume) times the number of beats per minute (rate) SV * R = CO

Confluent

esions run together (hives)

Thirty to 60 min following administration of an oral pain medication to a child, it is important that a nurse....

evaluate the effectiveness of the pain medication.

Gigantism

excessive secretion of growth hormone by the anterior pituitary resulting in overgrowth of entire body. when this occurs during childhood, before closure of bone epiphyses in puberty, it causes increased height and weight and delayed sexual development

acromegaly

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

list several issues that an adolescent who is hospitalized might experience.

feeling of isolation, especially from peers. worries regarding the outcome of the illness and how it may affect activities and school. noncompliance with treatment regimen if it interferes with activities or makes the adolescent appear different. concerns about body image.

objective vertigo

feels like the room is spinning

Rhoncal

felt when inhaled air passes through thick secretions is larger bronchi

inferior to the inguinal canal. This structure is a potential space located 3 cm medial to and parallel to the femoral artery.

femoral canal

stage 2

few straight, slightly darker hairs at base of penis, little or no enlargement of the penis, testes and scrotum begin to enlarge, scrotal skin reddens and changes in texture

fight obesity, stabilize blood sugar, and help with some GI disorders

fiber

Diastole

filling of atria, AV valves open and ventricles fill, presystole (atrial contraction/ atrial kick)

Nodes

filter fluid before it returns to the blood stream and filter out microorganisms that are harmful to the body

Vellus hair

fine, faint hair that covers most of the body

ulnar deviation or drift

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

What is Pectus Carinatum

flattening of the thorax on either side with forward projection of the sternum resembling the keel of a boat

function scoliosis

flexible; apparent with standing and disappears with forward bending, may be compensatory for other abnormalities such as leg length discrepancy

Homan's Sign

flexing the person's knee and gently compressing the calf anteriorly against the tibia..no tenderness should be present if there is pain the test is positive and occurs in 35% of cases of deep vein thrombosis

Behavioral checklist

for children age 7-11 for five areas: mood play school friends family relations 15-22 = close following 22+ = psychiatric evaluation * use ABCT

the skin that folds in and back on itself forming a hood or flap over the glans

foreskin or prepuce

pleurae

form an envelope b/t lung & chest wall; thin & slippery

Exophthalmos

forward displacement of the eyeballs and widened palpebral fissures. Note "lid lag" in which the upper lid rests well above the limbus and white sclera is visible. Associated with thyrotoxicosis.

Pneumothorax

free air in pleural space causes partial/full lung collapse. Inspect: unequal chest expansion. Palpate: tactile fremitus decreased/absent. decreased BP. Percuss: hyperresonant. Auscultate: decreased/absent breath sounds. Adventitious sounds: none

a fold of the foreskin extending from the urethral meatus ventrally

frenulum

otitis media risk factors

frequent URIs passive smoke daycare bottle-feeding chronic health problems sibling with recurrent ear infections males 4 months to 4 years

Thyroid Gland-Posterior Inspection

from behind person. With pt. sitting straight and head bent slightly to right, take left head a gently move trachea, with right fingers bent and placed between trachea and sternomastoid muscle, ask pt. to sip water and feel for presence of thyroid while pt. swallows. Note enlargement, consistency, symmetry, and presence of nodules

PR interval

from the beginning of the P wave to the begining of the QRS complex *This is the time necessary for atrtial depolarization plus the time for the impulse to travel through the AV node to the ventricles

Alveoli

functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen

gastroenteritis

generalized abdominal pain, with nause diarrhea

cerumen

genetically determined and comes in two major types, dry and wet cerumen.

clusters of small vesicles with surrounding erythema, which are often painful, erupt on the glans or foreskin. These rupture to form superficial ulcers. and STI the initial infection lasts 7 to 10 days. the virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms

genital herpes HSV-2

soft, pointed, moist, fleshy painless papules may be single or multiple in cauliflower like patch. occur on shaft of penis, behind corona, or around the anus where they may grow into large grapelike clusters

genital warts

human papillomavirus (HPV)

genital warts - S: painless warty growths, may be unnoticed by women O: pink or flesh colored, soft, pointed, moist, warty papules. single or multiple in a cauliflower-like patch occurs around vulva, introitus, anus, vagina, cervix

The mother is an infant asks a nurse when she can expect her infant to begin walking. what gross motor skills should the infant develop before he begins walking?

getting up to sitting position and sitting alone, pulling up to a standing position, standing holding on/ or standing alone, development is cephalocaudal; therefore, before the infant can walk, he must develop the skills of sitting and standing.

amber urine

gold or concentrated with dehydration; some laxatives; food or supplements with b complex vitamins

stage 5

growth of hair spreads over medial thighs, adult size and shape of penis, adult shape and size of scrotum

Which of the following immunizations should be given to a 4 month old infant?

haemophilus influenzae type B (HIB), polio (IPV), Diptheria and tetanus toxoids and pertussis(DTaP), Pneumonococcal vaccine (PCV), Rotavirus vaccine (Rota).

Epidermal appendages

hair, sebaceous glands, sweat glands (eccrine and apocrine), nails

the deformities in the 2nd, 3rd, 4th, and 5th toes includes hyperextension of the metatarsophalangeal joint and flexion of the proximal interphalangeal joint.

hammertoe

tophi with chronic gout

hard, painless nodule over metatarsophalangeal joint of first toe. tophi are collections of sodium urate crystals due to chronic gout in and around the joint that cause extreme swelling and joint deformityy. they sometimes burst with chalky discharge

right lung

has 3 lobes. Shorter than left b/c of underlying kidney.

list 3 interventions with rational that a nurse can use to decrease the risk of medication errors when administering medication to children.

have a second nurse verify dosage calculation/ adult medication forms may be used requiring calculation of very small doses. obtain accurate weight of child/ dosage are usually based on weight or body surface area. mix medications with small amounts of liquid or soft foods/ if the medication is mixed in large amounts of liquid or foods, the child may refuse to finish the dose.

Veins

have larger diameter and are more distensible they can expand and hold more blood when blood volume increases

Obturator Muscle Test

have patient flex right leg @ hip and knee; then rotate hip externally and lower leg medially

Before cleaning an abrasion on a 3 year old, what diversional activity could a nurse use to help decrease the child's anxiety?

have the child clean the owie on her doll. having the child perform a task on a comfort toy, such as a doll, helps reduce anxiety.

Torticollis

head tilt due to shortening or spasm of one sternomastoid muscle

List five basic assessments that should be included in the physical assessment of a child over 3 years of age.

height, weight, temperature, RR, HR, BP.

beans, prunes, barley, carrots, broccoli, cabbage; lower cholesterol

high fiber foods of the soluble type

whisper

high-frequency sound and is used to detect high-tone loss

Tympany

high-pitched, musical, drum like percussion note heard when percussing over the stomach and intestine

Wheeze

high-pitched, musical, speaking adventitious lung sound

What is a Wheeze

high-pitched, musical, squeaking adventitious lung sound

Torus Palatinus

higher in Asian and women

Chronic Venous Vascular Disease

i. Located on the calf or lower leg ii. Aching, tiredness, feeling of fullness pain iii. Increases at end of day iv. Prolonged standing and sitting irritate pain v. Elevation, lying and walking are irritating factors vi. Edema, varicosities and ulcers at ankles are associated factors

Acute Arterial Vascular Disease

i. Pain distal to occlusion ii. Throbbing pain with sudden onset iii. Pain, pallor, pulselessness, coldness and paralysis are associated factors Causes: - Vascular sugery, arterial invasive procedure, abdominal aneurysm, trauma

Preauricular

in front of ear

Posterior cervical

in the posterior triangle along the edge of the trapezius muscle

Ataxia

inability to PREFORM COORDINATED MOVEMENTS

herniated bowel cannot be returned to abdominal cavity

incarcerated hernia

spina bifida

incomplete closure of posterior part of vertebrae results in neural tube defect. seriousness varies from skin detect above the spine to protrusion of the sac containing meninges, spinal fluid, or malformed spinal cord. the most serious type is myelomeningocele, in which the meninges and neural tissue protrude. child is paralyzed below the level of lesion.

Causes of Murmurs

increase in blood velocity (exercise) viscosity decreases (anemia) structural defects in valves or unusual openings in the chambers

Sebaceous Cyst

location is commonly behind lobule, in the postauricular fold. A nodule with central black punctum indicates blocked sebaceous gland. It is filled with waxy sebaceous material and is painful if it becomes infected.

In pregnancy what does the mom have in the third trimester?

lordosis caused by joint elasticity and softening of cartilage getting ready for labor

Flaccidity

loss of MUSCLE TONE, LIMP!

Analgesia

loss of PAIN SENSATION

Aphasia

loss of POWER OF EXPRESSION by speech, writing, or signs, or loss of comprehension of spoken or written language

Agraphia

loss of ability to EXPRESS thoughts in writing

Apraxia

loss of ability to PERFORM PURPOSEFUL MOVEMENT in absence of sensory or motor damage (e.g inability to use objects correctly)

Agnosia

loss of ability to RECOGNIZE importance of sensory impressions

Anorexia

loss of appetite for food

anorexia nervosa

loss of appetite, psychological disorder voluntary starvation grave wgt loss

what are the most common musculoskeltal concerns?

loss of function and joint pain.

trichomoniasis

S: pruritus, watery and often malodorous vaginal discharge, urinary frequency, terminal dysuria. symptoms are worse during menstruation when the pH becomes optimal for the organism's growth O: vulva may be erythematous. vagina diffusely red, granular. occasionally with red raised papules and petchiae. frothy yellow-green, foul smelling discharge

Pteryguim

Triangular opaque ring of bulbar conjunctiva overgrows toward the center of the cornea. Looks membranous, translucent and yellow to white, usually invades from the nasal side. Usually from chronic exposure to hot, dry, sandy climate.

Cranial Nerve V

Trigeminal Motor Function: Muscles of mastication (chewing) Sensory Function:sensation of face and scalp, cornea, mucous membranes of mouth and nose

Cranial Nerve IV

Trochelear Motor Function: Down and inward movement of the eye

True or False: magical thinking can be the cause of a preschooler's feelings of guilt?

True: words and thoughts are powerful to preschoolers. they believe that others can see the thought they have. therefore, if something bad happens and the child thought bad thoughts, then the child believes he is responsible for the event.

Anisocoria

Unequal pupil size. Occurs normally in 5% of population. Consider CNS disease

localized cavity of pus from infection in a pararectal space. infection usually extends from an anal crypt. characterized by persistant throbbing rectal pain. termed by the space it occupies and appears red, hot, swollen, indurated, and tender.

abscess

Amenorrhea

absence of menstruation; termed secondary amenorrhea when menstruation has begun and then ceases; most common cause is pregnancy

atresia

absence or closure of the ear canal.

clay colored stool

absent bile pigment

Venouse Stasis Ulcer

aching pain in the calf or lower leg, firm brawny edema, coarse, thickened skin, normal pulse, venous stasis has increased venous pressure that causes RBCs to leak out the veins into the skin

Acute Respiratory Distress Syndrome (ARDS)

acute pulmonary insult (trauma, gastric acid, aspiration, shock) that damages alveolar capillary membrane. Inspect: restlessness, disorientation, thin/frothy sputum. Palpate: hypotension. Auscultate: tachycardia. Adventitious sounds: crackles, rhonchi

abrupt inability to pass urine from bladder distention and lower abdominal pain. much more common in men due to bladder outlet obstruction, such as BPH. must catheterize to relieve acute discomfort, then manage underlying problem

acute urinary retention

Accommodation

adaption of the eye for near vision by increasing the curvature of the lens

adventitious lung sounds

added sounds, NOT normally heard1) 1) crackles: fine (formerly called rales) 2) wheeze: (or rhonchi) 3) atelctatic crackles: not pathologic; short, popping, crackling, like "crackles" but don't last beyond few breaths

A 5 year old child is scheduled for a dressing change that will produce moderate pain. what preprocedural interventions should the nurse perform?

administer pain medication prior to the procedure.

Ligaments are stronger than bones until when?

adolescence; result is more fractures

Scar

after a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic change

scrotal skin is deeply pigmented and has large sebaceous follicles

after adolescence

capacitance vessels

aka veins the greater the elasticity the lower the compliance This ultimately describes how volume changes in response to a change in pressure within the blood vessel at hand

Asthma (Reactive Airway Disease)

allergic hypersensitivity causing inflamm/edema in walls of bronchioles. Inspect: severe attack, wheeze, labored. Palpate: tactile fremitus decreased. Percuss: Resonant. Auscultate: diminished air movement. Adventitious sounds: bilateral wheezing.

identify measures that would help a 4 year old with the stressors of hospitalization?

allowing the child to handle equipment if it is safe. therapeutic play. validating the child's fears. explaining all procedures carefully in clear simple language.

Dull

amp: soft pitch: high quality: muffled thud duration: short location ex: dense organ - liver, spleen

Flat

amp: very soft pitch: high quality: dead stop, absolute dullness duration: very short location ex: no air present - thigh muscles, bone, tumor

lordosis

an abnormal inward (forward) curvature of the vertebral column -occurs in pregnancy -toddlers

Marfan's Syndrome

an inherited connective tissue disorder, charactierized by tall, this stature, arachnodactyly, hyperextensible joints, arm span greater than height, pubis-to-sole measurement exceeding crown-to-pubis measurement, sternal deformity, high-arched narrow palate, and pes planus (flat feet). early morbidity and mortality occur as a result of cardiovascular complications such as mitral regurgitation and aortic dissection.

trachea

anterior to esophagus. transports gases b/t environment & lung parenchyma; 10-11 cm in adult; Posteriorly: T4 or T5.

Older Adults (Heart)

arteries stiff, calcified, resistant, 20mmHg increase in systolic by age 50, another 20 by 80yrs, widening pulse pressure, more arrhythmias, heart blocks, sclerosis, EKG changes, murmurs, difficult to palpate PMI - presence of dysrhythmias increases - Prolonged p-r interval and q-t interval - Incidence of heart disease increases

Ilispsoas muscle test

ask patient to raise right leg (flew @ hip) against resistance

Which of the following is appropriate when using and interpreter?

ask the family one question at a time. use lay terms if possible. do not interrupt the interpreter and family as they talk. Asking the family one question at a time, using lay terms, and not interrupting will promote communication between the family and the nurse/interpreter. talking to the interpreter about the family while the family is in the room, and looking at the interpreter instead of the family will hinder communication between the family and the nurse/interpreter.

murphys sign

assess for cholecystitis

romberg test

assesses ability of vestibular apparatus in inner ear to help maintain standing balance

Pressure gradient caused by breathing and the intraluminal valves ensure unidirectional flow both

assist venous return

P. Jiroveci Pneumonia (P. Carinii)

associated w/AIDS infection. Inspect: anxiety, SOB, fever. Palpate: decreased chest expansion. Percuss: dull over areas of diffuse infiltrate. Auscultate: diminished breath sounds. Adventitious sounds: maybe crackles, but often absent

Pregnant woman

at 16 weeks the fundus is palpable halfway between the symphysis and umbilicus at 20 weeks at the lower edge of the umbilicus at 28 weeks halfway between the umbilicus and xiphoid at 34 to 36 weeks alomost to the xiphoid

the prostate gland undergoes a very rapid increase to more than twice its size

at male puberty

what is the nucleus pulposus

at the center of the intervertebral disk ruptures into the spinal canal nad puts pressure on the local spinal nerve root

Striae

atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence

what is an opportunistic infection related to chronic estrogen deficiency?

atrophic vaginitis

coxa plana (legg calve perthes syndrome)

avascular necrosis of the femoral head, occuring primarily in males between 3 and 12 years of age, with peak at age 6. in initial inflammatory stage, interruption of blood supply to femoral epiphysis occurs, halting growth. revascularization and healing occur, but significant residual deformity and dysfunction may be present

frequency

average adult voids 5-6 x a day. varying with fluid intake, individual habits

colorectal cancer guidelines

average risk adults should start being tested at 50 and include health teaching about options for screening

Why do you auscultate the abdomen second

because percussion and palpation can increase peristalsis

vagina

becomes shorter, narrower and less elastic because of increased connective tissue

Flexion

bending a limb at a joint

senile tremors

benign and include head nodding and tongue protrusion

Drusen

benign deposits on the ocular fundus that show as round yellow dots and occur commonly with aging

a symmetric nontender enlargement, commonly occurs in makes beginning in the middle years, the prostate feels smooth, rubbery, or firm with the median sulcus obliterated

benign prostatic hypertrophy

the prostate gland commonly startes to enlarge during the middle adult years. this is present in 1 of 10 males at the age of 40 years and grows larger with age. It is thought that the hypertrophy is caused by hormonal imbalance that leads to proliferation of benign adenomas. these gradually impeded urine output because they obstruct the urethra

benign prostatic hypertrophy

Edema

bilateral when caused by systemic problem such as heart failure, unilateral with local obstruction or inflammation

Visual acuity of infants

birth to 2 weeks- refusal to reopen eyes after exposure to bright light, increasing alertness to object, infant may fixate on object 2-4 weeks-infant can fixate on object 1 month-infant can fixate and follow light or bright toy 3-4 months-infant can fixate, follow, and reach for toy 6-10 months-infant can fixate and follow toy in all directions

Athetosis

bizarre, slow, twisting, writhing movement, resembling a snake or worm

chronic kidney disease is determined by

blood tests, urinalysis, and imaging studies that show decreased kidney function or kidney damage lasting 3 months or longer. this can lead to progressively and irreversibly to ESRD when the person survives only by kidney transplant or dialysis

Bruit

blowing, swooshing sound heard through the stethoscope over an area of abnormal blood flow

Cyanosis

blue

Cyanosis

blue color to skin or mucous membranes due to increased amount of unoxygenated hemoglobin (decreased perfusion). Dark-skinned look for changes in level of consciousness and signs of respiratory distress.

cullens sign

bluish periumbilial color occurs wht intrabdominal bleeding

Action cues

body movements automatic reflexes posture, facial expression, gestures, mannerisms

lithotomy position

body supine, feet in stirrups with knees apart and buttock at the edge of the examining table

What is the Mastoid

bony prominence of the skull located behind the ear

thoracic cage

bony structure w conical shape; defined by sternum, 12 pairs of ribs, & 12 thoracic vertebrae. "Floor" known as diaphragm.

What are the Controls of Respiration

breathing is controlled by the respiratory center in the brainstem (the pons and medulla). Using the feedback loop of humoral regulation, or the change in carbon dioxide and oxygen levels in the blood. The normal stimulus to breathe for most of us is an increase in carbon dioxide in the blood, or hypercapnia. A decrease in oxygen in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia

Acute Tonsillitis and Pharyngitis

bright red throat, swollen tonsils, white or yellow exudate on tonsils and pharynx, swollen uvula, and enlarged, tender anterior cervical and tonsillar nodes. Sore throat, painful swallowing, fever.

glands that are the size of a pea and are located inferior to the prostate on either side of the urethra. they secrete a clear, viscid mucus

bulbourethral (cowper) glands

esophagus esophagitits

buring pain in midepigastrium or behind lower steernum that radiates upwar, or "hearburn". Occurs 30-60 min after eating and aggravted by lying down or bending over

menopause

cessation of the menses around 48 to 51 yrs wide variation of ages 35-60 yrs

Menopause

cessation of the menses, usually occurring around 48 to 51 years of age

Leukoplakia

chalky white, thick raised patch with well-defined borders

tear of rotator cuff

characteristic "hunched" position and limited abduction of arm; occurs from traumatic adduction while arm is held in abduction, or from fall on shoulder, throwing, or heavy lifting. positive drop arm test: if the arm is passively abducted at the shoulder; the person is unable to sustain the position and the arm falls to the side

degenerative joint disease/osteoarthritis

characterized by hard, non tender nodules, 2-3 mm or more; these ostephytes (bony overgrowths) of the distal interphalangeal joints are called Heberden nodes, and those of the proximal interphalangeal joints are called Bouchard nodes

inspiration

chest size increases; increases size of thoracic container. Major muscle responsible is diaphragm.

The most commonly reported sexually transmitted infection in the United States is?

chlamydia.

epicondylitis (tennis elbow)

chronic disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm. pain can be located with one finger. resisting extension of the hand will increase the pain; occurs with activities combining excessive pronation and supination of forearm with an extended wrist; medial ______ is rarer and is due to activity of forced palmar flexion of wrist against resistance

fibromyalgia

chronic disorder of unknow cause characterized by widespread musculoskeletal pain lasting 3 months or longer, associated with fatigue, insomnia, and psychosocial distress. most patients are adult women. examiner presses thumb of dominant hand (blanching pressure)

goiter

chronic enlargement of the thyroid gland that occurs in some regions of the world where the soil is low in iodine. Not due to a neoplasm.

depuytren contracture

chronic hyperplasia of the palmar fascia causes flextion contractures of the digits, first in the 4th digit, then the 5th, then the 3rd. bands extend from midpalm to the digits and the puckering of palmar skin; the condition occurs commonly in men older than 40 and is usually bilateral; occurs with diabetes, epilepsy, alcoholic liver disease and as an inherited trait. painless but impairs hand function

Lymphedema

chronic swelling, non pitting edema, with overlying skin indurated and is demoralizing as a threat to the body and reminder of cancer because lymph tissue was removed and has impeded drainage

anklyosing spondylitis

chronic, progressive inflammation of spine, sacroiliac, and larger joints of the extremities, leading to bony ankylosis and deformity. it is a form of RA; affects men by a 10:1 ratio, in late adolescence and early adulthood. spasm of paraspinal muscles pulls spine into forward flexion, obliterating cervical and lumbar curves. thoracic curve exaggerated into single kyphotic rounding. also includes flexion deformities of hips and knees

muscular dystrophy

chronic, progressive wasting of skeletal musculature, which produces weakness, contractures, and in severe causes respiratory dysfunction and death. onset in childhood. most severe type is Duchenne dystrophy, characterized by waddling gait

multiple sclerosis

chronic, progressive, immune mediated disease in which axons experience inflammation, demyelination, degeneration and finally sclerosis. structures most frequently involved are the optic nerve, oculomotor nerve, corticospinal tract, posterior column tract, and cerebellum. symptoms are varied but include blurred vision, diplopia, extreme fatigue, weakness, spasticity, numbness, and tingling, loss of balance

RA (rheumatoid arthritis)

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

normal urine

clear and slightly acidic (4.5 to 8.0) specific gravity measures the concentration of urine from very dilute at 1.003 to concentrated at 1.030. there is little or no protein, glucose, and fewer than 5 RBC or WBC per high powered field

pale yellow urine

clear, watery with excess liquids; acute viral hepatitis, cirrhosis

What is Crepitus

coarse, crackling sensation palpable over the skin when air abnormally escapes from the lung and enters the subcutaneous tissue

colorectal screening options

colonoscopy every 10 years with bowel preparation and conscious sedation and an annual guaiac based fecal occult blood test or fecal immunochemical test

Fungal Infection (otomycosis)

colony of black or white dots on drum or canal wall suggests a yeast or fungal infection.

Hair

color, texture, distribution, lesions

can be largely prevent by removal of adenomatous polyps

colorectal cancer

Cleft Lip and Palate

common in Asian-american babies

who is gout most common in and what is it

common in middle aged men because of increased uric acid

talipes equinovarus (clubfoot)

congenital, rigid, and fixed malposition of food including inversion, forefoot adduction, and foot pointing downward (equinus). common birth defect; males are affected twice as frequently as females

What are the Eustachian Tubes

connect the middle ear with the nasopharynx and allows passage of air

Perforators

connecting veins that join two sets then also have one way valves that route blood from the tissues and return it to the heart

Function of lymphatic system

conserve fluid and plasma proteins that leak out of the capillaries, ajor part of the immune system, absorb lipids from intestinal tract

acinus

consists of bronchioles, alveolar ducts, alveolar sacs, & alveoli.

Modified allen test

constriction of the radial and ulnar artery while patient makes a fist several times when the had turns blanch have them stop and release the pressure off of the ulnar artery while compressing the radial artery...should refill in 2-5 seconds

pleural cavities (thoracic cavity)

contain lungs

Posterior Lung Lobes

contains almost all lower lobe

Anterior Lung Lobes

contains mostly upper & middle lobes 1) oblique 2) horizontal

osteoporosis

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

Hypoxemia

decreased level of oxygen in the blood

Arteriosclerosis-Ischemic Ulcer

deep muscle pain in the calf, coolness pallor and rubor, diminished pulse, skin is shiny, thick rigid nails, absence of hair, ulcer occurring on the toes, metatarsal heads, lateral ankle, has well defined edge and no bleeding present

Deep Vein thrombophlebitis

deep vein occluded by a thrombus, causing inflammation, blocked venouse return, cyanosis, and edema has a sudden onset of intense, sharp, deep muscle pain has increased warmth, swelling, redness, dependant cyanosis mild or absent tender to palpation...sometimes homan's sign is present

parkinsonism

defect of extrapyramidal tracts, in the basal ganglia, with loss of neurotransmitter dopamine. classic triad of symptoms: tremor, rigidity, bradykinesia. also slower monotonous speech; body immobile, facial expression flat, staring, expressionless. excessive salivation, reduced eye blinking. posture stooped, equilibrium impaired, loses balance easily tremor, cogwheel rigidity on passive range of motion

Aneurysm

defect or sac formed by dialation in artery wall due to atherosclerosis, trauam or defect

Hypopituitary dwarfism

deficiency in growth hormone in childhood results in retardation of growth below the 3rd percentile, delayed puberty, hypothyroidism, and adrenal insufficiency.

Ischemia

deficient supply of oxygenated blood to a tissue caused by obstruction of a blood vessel

Scarred Drum

dence white patches on the eardrum are sequelae of repeated ear infections. They do not necessarily affect hearing.

lack of protest when parents leave is what stage of separation anxiety?

denial

Spleen

destroy old red blood cells, produce anti bodies, store red blood cells, filter microorganisms in blood

Immune system

detects and eliminates foreign pathogens from the environment and those that arise inside the body

Allen Test

determines the patency of teh radial and ulnar arteries by compressing one artery site and observing the return of skin color as evidence of patency of the other artery

Varicose vein

dialted tortuous vein with incompitent valves

Tinel Sign

direct percussion of the median nerve at the wrist produces no symptoms in the normal hand. If positive test, percussion produces tingling and burning along distribution. Sign of carpal tunnel syndrome

What's it called when the bone is completely out of joint?

dislocation

protuberant

distended stomach

tonic clonic or grand-mal seizure

distinct phases: 1.loss of consciousness 2.tonic phase with muscular rigidity, opening of mouth and eyes, tongue biting, and high pitched cry 3.clonic phase with violent muscular contractions, facial grimacing, increased heart rate 4. postictal phase with deep sleeping, disorientation, and confusion

Discrete

distinct, individual lesions that remain separate

which of the following is an appropriate nonpharmacologic pain management technique for a 5 year old child with fracture femur?

distraction, being held or rocked, positioning.

characteristic of bisferiens pulse

double systolic peak

diplopia

double vision

grey turner sign

ecchymosis of the flank area associated with retroperitoneal bleeding (such as with hemorrhagic panreatitis)

caput succedaneum

edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma. feels soft, gradually resolves and needs no treatment

sinus tract. a hair containg cyst or sinus located in the midline over the coccyx or lower sacrum. often opens as a dimple with visible tuft of hair and possibly an erythematous halo. may appear as a palpable cyst. when advanced has a palpable sinus tract. congenital disorder, the lesion is first diagnosed between the ages of 15 and 30

pilonidal cyst

The parents of a preschooler are worried because their child has so much trouble going to sleep at night. what strategies can be used to help a preschool child go to sleep?

place a night light in the child's room, keep a regular bedtime schedule, read a bedtime story to the child, allow the child to play quietly in her room.

examing the liver

place righ hand @ RUQ, with fingers parallel to midling depress deeply down and under right costal margin, asking the patient to take deep breath

Profile sign

placing fingers side to side to help determine early clubbing which can be a sign of heart disease

Atherosclerosis

plaques of fatty deposit formed in the inner layer of the arteries

What activities would adolescents most likely engage in?

playing video games with peers, participating in school sports, reading or listening to music.

A 5 year old child is hospitalized an is in skeletal traction for a fractured femur. which of the following is the most appropriate diversional activity for this child?

playing with puppets.

A 13 month old toddler is being discharged from the hospital. what are potential health risk that should be addressed to the parents?

poisoning, burns, falls. a cholesterol screening may start as early as adolescence. peer pressure usually begins during the school age years, becoming more of a risk during adolescence.

Insertion of tympanostomy tubes

polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Tubes extrude spontaneously in 12 to 18 months

Identify five behavioral changes that may indicate an adolescent is socially isolated or depressed?

poor school performance, lack of interest in things that had been interest to the adolescent in the past, not interacting with other, disturbances in sleep or appetite, expression of scuicidal thoughts.

Raynauds phenomenon

progressive tricolor change in the fingers in response to cold vibration or stress first white then blue and then red

didney stomes

prompt a sudden onset of severe, colickly flank or lower abdominal pain

more common in north america and northwestern europe. less common in central and south america, africa, and asia. the incidence is higher for african american males than an other racial group. african american males are more likely to be diagnosed at an advanced stage of the diease. family history is positively associated; men with first degree relative are 2 to 3 times more likely to develop this diease. men with BRCA2 mutations have increased risk for developing a more aggressive form at a younger age. environmental risk factors include diets high in red meat and processed meat, animal and saturated fats, an dairy products

prostate cancer

lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis. it surrounds the bladder neck and the urethra and has 15 5o 30 ducts that open in to the urethra. secretes a thin, milky, alkaline fluid that helps sperm viability. bilobed with a round or heart shape

prostate gland

fevers, chills, malaise, urinary frequency and urgency, urethral discharge, dull, aching pain in perineal and rectal area. an exquisitely tender enlargement is acute inflammation of the prostate gland yielding a swollen slightly asymmetric gland that is quite tender to palpation

prostatitis

crying is what stage of separation anxiety?

protest.

hernia

protrusion of abdominal viscera through abnormal opening in muscle wall

which of the following nursing interventions is most appropriate for the needs of a 7 year old child being hospitalized for an extended time?

provide play activities that foster a sense of normal routin.

Lacrimal apparatus-

provides constant irrigation to conjunctive and cornea

intense perianal itching manifested by red, raised, excoriated skin around the anus. common causes are pinworms in children and fungal infections in adults. the area is swollen and moist, and with a fungal infection appears dull grayish pink. the skin is dry and brittle with psychosomatic itching

pruritus ani

Anorexia nervosa

psychological disorder characterized by sever and life-threatening weight loss and amenorrhea in an otherise healthy adolescent or young woman. Behavior is characterized by fanatic concern about weight, aversion to food, distorted body image, starvation diets, frenetic sexercise patterns, and striving for perfection

changes in the aging male

pubic hair decreases and the remaining hair turns gray. penis size decreases. due to decreased tone of the dartos muscle, the scrotal content hangs lower, the rugae decrease, and the scrotum looks pendulous. testes decrease in size and are less firm to palpation. increased connective tissue is present int he tubules, so these become thickened and produce less sperm

Heart Failure

pump failure w increasing pressure of cardiac overload; Inspect: increased resp rate, SOB, ankle edema. Palpate: moist skin, clammy. tactile fremitus normal. Percuss: resonant. Auscultate: normal vesicular. Adventitious sounds: crackles at lung bases.

subcutaneous nodules

raised, firm, nontender; occur with rheumatoid arthritis; common sites are olecranon bursa and along extensor surface of arm; skin slides freely over nodules

parotid gland enlargement

rapid painful inflammation of the parotid occurs with mumps. Swelling also occurs with blockage of a duct, abscess, or tumor.

Myoclonus

rapid sudden jerk of a muscle

hyperventilation

rapid, deep breathing; causes CO2 to be blown off

Tachypnea

rapid, shallow breathing, >24 breaths per minute

What is Tachypnea

rapid, shallow breathing, >24 breaths per minute

Clonus

rapidly alternating involuntary contraction & relaxation of a muscle in response to sudden stretch

men at average risk for PC should

receive information at 50 years old, 5 years after men at higher risk (african americans and those that have a family history), 10 years after men at very high risk with multiple family members with PC

bright red blood on stool surface

rectal bleeding

rectal mucous membrane protrudes through the anus, appearing as a moist red donut with radiating lines. when prolapse in incomplete, only the mucosa bulges. when complete it includes the anal sphincters

rectal prolapse

the anterior part of the peritoneum reflects down to within 5.5 cm of the anal opening and then covers the bladder in females

recto-uterine pouch

the anterior part of the peritoneum reflects down to within 7.5 cm of the anal opening in males and then covers the bladder

rectovesical pouch

12 cm long. the distal portion of the large intestines. extends from the sigmoid colon at the level of the 3rd sacral vertebra and ends at the anal canal

rectum

Ruber

red

splinter hemorrhages

red brown linear streaks, embolic lesions occur with subacute bacterial endocarditis, or minor trauma

cheliltis

red, scaling, shallow, painful fissures at corners of mouth

Gingivitis

red, swollen gums, that bleed easily. Exposed roots

Purpura

red-purple skin lesion due to blood in tissues from breaks in blood vessels

Hematuria

red-tinged or blood urine

Pallor

reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color

contents will return to abdominal cavity by lying down or gentle pressure

reducible hernia

liver , hepatitis

referred pain with mild to moderate dull pain in the upper quadrant or epigastrium, along wth anorexia, nause, malaise, low grade fever

Which of the following strategies will help appropriate weight gain in children and adolescents?

regular physical activity. eating low-fat dairy products. encouraging the child/adolescent to participate in shopping and meal preparation.

Pulsus alterans

regular rhythm but force of pulse varies with alternating beats of large and small amplitude

crystals of calcium oxalate or uric acid form in kidney tubules; then migrate and become urgent when pass into ureter, becomes lodged, and obstruct urine flow. causes abrubt severe flank pain with radiation to the groin or abdomen, nausea and vomiting, restlessness, gross or microscopic hematuria

renal calculi

Acute (purulent) Otitis Media

results when the middle ear fluid is infected. An absent light reflex from increasing middle ear pressure is an early sign. Redness and bulging are first noted in superior part of drum (pars flaccida), along with earache and fever. Then fiery red bulging of entire drum occurs along with deep throbbing pain, fever, and transient hearing loss.

Function of the lymphatic system

retrieves excess fluid from tissue spaces and returns it the bloodstream . it conserve fluid and plasma protiens that leak out of the cappillaries - forms a major part of the immune system -absorbs lipids from the intestinal tract

rapid detumescence occurs especially after age 60

return to the flaccid state. occurs in a few seconds as compared with minutes or hours in the younger male

What is Tinnitus

ringing in the ears

MIcroaneurysms

round punctuate red dots that are localized dilations of a small vessel. Their edges are smooth and discrete. Vessel itself is too small ti view with the ophthalmoscope; only the isolated red dots are seen. This occurs with diabetes.

sigmoid colon is named for its _____. it extends from the iliac flexure of the descending colon and ends at the rectum. it is 40 cm long and is accessible to examination only through colonscope. the flexible fiberoptic scope in current use provides a view of the entire mucousal surface of the sigmoid as well as the colon

s shaped course in the pelvic cavity

what age group is most likely to engage in collecting trading cards?

school age child. school age children enjoy collecting various things. early school-age children may not have organization to their collection, while older school age children are organized and specific with their collections.

what is it important to screen for in an adolescent?

scoliosis

Erosion

scooped out, shallow depression. superficial; epidermis lost; moist but not bleeding; heals without scar because is does not extend into dermis

loose protective sac, which is a continuation of the abdominal wall

scrotum

Montgomery's glands

sebaceous glands in the areola, secrete protective lipid during lactation; also called tubercles of Montgomery

excoriation

self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching

Intraductal

serosanguineous nipple discharge

epicardium

serous membrane that covers the outer surface of the heart

External Ear

serves to funnel sound waves into the external auditory canal (its opening); the canal is 2.5-3 cm long in the adults and terminates at the tympanic membrane (eardrum); canal is lined with glands that produce cerumen which protects foreign bodies from entering.

List three guidelines for promoting healthy behaviors in children.

set realistic limits and expectation based on developmental tasks. validate the child's feelings. provide reinforcement for appropriate behavior. focus on the child's behavior when discipling the child. explain expectations to a child in a manner the child can understand.

steppage or footdrop

slapping quality, looks as if walking up stairs when there is no stair. lifts knee and foot high and slaps it down hard and flat to compensate for footdrop causes:weakness of peroneal and anterior tibial muscles, due to lower motor neuron lesion at the spinal cord (poliomyelitis)

peristalsis

slow ripple across the abd, may be seen in very lean individual

hypoventilation

slow, shallow breathing; causes CO2 build up in blood

Lymph Nodes

small oval clumps of lymphatic tissue located at intervals along the vessels

small and soft. indicates atrophy as with cirrhosis, hypopituitarism, following estrogen therapy or as a sqeuelae of orchitis. small and firm; occurs with klinefelter's syndrome (hypogonadism)

small testis

Koplik spots

small, blue-white spots with red halo over oral mucosa; early sign of measles

A caruncle is

small, red mass protruding from the urethral meatus.

Describe appearance of Varicella:

small, shiny, tight vesicles that erupt.

Tophi

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

Alveoli

smallest structures of mammary gland

A mother of an infant tells the nurse that her infant makes many sounds. what should the nurse tell the mother about the language development of an infant?

the infant will first respond to noises and turn her head toward the sound. as she grows she will vocalize "oos" and "aahs", laugh and squeal, pronounce single-syllable words, and then begin to speak two and then three word phrases.

under involuntary control by the autonomic nervous system.

the internal sphincter

Aphasia

the loss of the ability to speak, write, and/or comprehend the written or spoken word; usually caused by damage to left hemisphere

Stenson's duct

the opening of the parotid gland that runs forward to open at the buccal mucosa opposite the upper second molar

wharton's duct

the opening of the submandibular gland as it runs forward to the floor of the mouth and opens at either side of the frenulum

Afterload

the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. - the resistance against which the ventricle must pump its blood

What are the retinal structures viewed through the ophthalmoscope?

the optic disc, the retinal vessels, the general background, and the macula

bell

the part of the stethoscope you use to listen to vascular sound in the abdomen

Vesicular

the soft, low-pitched, normal breath sounds heard over peripheral lung fields

What is Vesicular

the soft, low-pitched, normal breath sounds heard over peripheral lung fields

Consolidation

the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia

What is Consolidation

the solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia

Bronchophony

the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue

Capillary refill

this is an index of peripheral perfusion and cardiac output

What is the corneal light reflex

this tests the parallel alignment of the eye axes by shinning light toward the person's eyes. Looking at the reflection of light on the corneas; it should be in exactly the same spot on each eye

Pulmonary Embolism

thrombus/air bubbles in legs/pelvis detach and travel to R of heart. >95% cases due to deep vein thrombi in lower legs. Inspect: restless, anxiety, mental status change, <80 pulse ox. Palpate: diaphoresis, hypotension. Auscultate: tachycardia. Adventitious sounds: crackles, wheeze

seizure

time limited event due to excessive, hypersynchronous discharge of neurons in the brain. may be due to a clear provocation such as cerebral trauma, structural lesions, hyponatremia, acute alcohol withdrawl, or medication overdose

T means

timing, once a month

a fungal infection in th crural fold, not extending to scrotum, occurring in postpubertal males. "jock itch" after sweating or wearing layers of occlusive clothing. it forma s red brown half moon shape with well defined borders

tinea cruris

gyrate

twisted, coiled spiral, snakelike

herpes simplex virus

type 2 - S: episodes of local pain, dysuria, fever O: clusters of small shallow vesicles with surrounding erythema; erupt on genital areas and inner thigh, also inguinal adenopathy, edema

BMI classifications for adults

underweight <18.5 kg/m^2 normal weight 18.5-24.9 kg/m^2 overweight 25-29.9 kg/m^2 obesity (class 1) 30-34.9 kg/m^2 obesity (class 2) 35-39.9 kg/m^2 extreme obesity (class 3) > or = 40

decorticate rigidity

upper extremities- flexion of arm, wrist, and fingers; adduction of arm. lower extremities- extension, internal rotation, plantar flexion. this indicates hemispheric lesion of cerebral cortex

a conduit for both the genital and urinary systems. it transverses the corpus spongiosum and its meatus forms a slit at the glans tip

urethra

weber test

valuable when a person reports hearing better with one ear than the other. place a vibrating tuning fork in in midline of the persons skull, and it should sound equally on both sides

the rectal interior has three semilunar transverse folds that cross one half the circumference of the rectal lumen. their function is unclear but they may serve to hold feces at the flatus passes. the lowest is palpable usually on the person's left side and must not be mistaken for an intrarectal mass

valves of houston

Dermis

vascular; when you cut yourself its the dermis that bleeds and hurts; connective tissue/collagen and elastic tissue

exopthalmos

bulging eyeballs

Retraction

dimple or pucker on the skin

Veins

drain the deoxygenated blood and it's waste products from the tissues and returns it to the heart

Thoracic duct

drains the rest of the body

Crepitation

dry crackling sound or sensation due to grating of the ends of damaged bone

xerostomia

dry mouth-side effect of many drugs

xerosis

dry skin

aging adult and the ear

during otoscopy, eardrum normally may be whiter in color and more opaque, duller than in younger adult. may also look thickened. a high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging.

pain due to a local condition (hemorrhoid, fissure) or constipation

dyschezia

Lymphadenopathy

enlargement of lymph nodes due to infection, allergy, or neoplasm

the first sign of puberty is

enlargement of the testes

frozen shoulder (adhesive capsulitis)

fibrous tissues form in the joint capsule, causing stiffness, progressive limitation of motion, and pain. motion limited in abduction and external rotation; unable to reach overhead. it may lead to atrophy of shoulder girdle muscles; gradual onset; cause unknown; associated with prolonged bedrest or shoulder immobility; may resolve spontaneously

Mitral-

fifth intercostal space near left midclavical line- apex of heart/ apical impulse

Examinable Lymph Nodes

i. Cervical Nodes ii. Axillary nodes iii. Epitrochlear node iv. Inguinal node

bunion

inflamed bursa that forms at the pressure point; great toe loses power to push off while walking which stresses the second and third metatarsal heads, and they develop calluses and pain; chronic sequellae include corns, calluses, hammertoes, and joint subluxation

Peritonitis

inflammation of peritoneum

Erb's point

is where S2 is best auscultated

The pulse of maximum impulse

is where the apical pulse is palpated the strongest

when in doubt

it is better to ask too many questions than omit something

Amnesia

loss of MEMORY

blue urine

medication side effect (amitriptyline, indocin); foods: asparagus; dye after prostate surgery

orange urine

medications rifampin for meningitis, pyridium, warfarin/coumadin; some foods, food dyes, laxatives; dehydration; jaundice (bilirubinemia)

venous hum

medium pitch, continuous sound, pressure on bell of stehoscope may oblliterate it, may have palpable thrill from portal hypertention or cirrotic liver

black, tarry stool due to occult blood from GI bleeding

melena

Extropia

outward turning of the eye

What is Otalgia

pain in the ear

Describe appearance of Rubella:

pink, papular rash; neck lymphadenopathy; absence of Koplik spots.

T wave

repolarization of the ventricles

Nuchal rigidity

stiffness in cervical neck area

"when did you" rather than "do you"

ubiquity approach

Arterial Deficit

ulcers occur on tips of toes, metatarsal heads, and lateral malleoli

What is the Incus

"anvil" middle ossicle of middle ear

Describe the appearance (signs) of Rubeola:

(measles) red/purple maculopapular blotchy rash; Koplik spots.

Proprioception

- A subconscious sense or perception of the movements and position of body parts independent of vision

Scoliosis

- Abnormal lateral curvature of the vertebral column.

Kyphosis

- An anteriorly concave curvature of the vertebral column or an abnormal exaggeration of the normal forward (flexion) curvature of the thoracic spine. ( Hump-back)

Syndactyly

- Any degree of webbing or fusion of fingers or toes, involving soft parts only or including bone structure.

Arteries vs. Veins

- Arteries are thicker and carry blood away from heart. - Veins bring blood to the heart

Dysarthria

- Difficulty forming words

Tinel sign

- Distally radiating pain or paresthesia caused by tapping over the site of a superficial nerve, indicating inflammation or irritation of the nerve.

Lymphatic Disease

- Edema - infections - blockage

Heberden nodes

- Exostoses no larger than a pea found on the terminal phalanges of the fingers in osteoarthritis, which are enlargements of the tubercles at the articular extremities of the distal phalanges.

Cystocele

- Hernia of the bladder usually into the vagina and introitus.

Genu recurvatum

- Hyperextension of the knee, the lower limb having a forward curvature.

Normal to Hear S3 or S4

- In children and young adults (S3 and S4) - In adults older than 40-50 (S4)

Bursitis

- Inflammation of a bursa.

Fasciculation

- Involuntary contractions, or twitchings, of groups (fasciculi) of muscle fibers, a coarser form of muscular contraction than fibrillation.

Tremors

- Involuntary shaking, vibrating, or trembling up up up movements caused by alternate contraction of opposing muscle groups.

Paralysis

- Loss of any function, such as sensation, secretion, mental ability, voluntary movement in a muscle, through injury to or disease of its nerve supply.

Syncope

- Loss of consciousness and postural tone caused by diminished cerebral blood flow.

Chordee

- Painful erection of the penis in association with gonorrhea or Peyronie disease with curvature resulting from lack of distensibility of the corpora cavernosa of the urethra. Also seen on hypospadias as a ventral curvature of the penis that is most apparent on erection.

Paresis

- Partial or incomplete paralysis.

Menopause

- Permanent cessation of the menses.

Hammer toe

- Permanent flexion at the midphalangeal joint of one or more of the toes.

Polydactyly

- Presence of more than five digits on hand or foot.

Testicular self-examination

- Procedure for detecting tumors and other abnormalities in the testes.

Phalen test

- Procedure in which the wrist is flexed 90 degrees with the hands placed back to back. Paresthesia occurring in the distribution of the median nerve within 60 seconds may be indicative of carpal tunnel syndrome.

Rectocele (Proctocele)

- Prolapse or herniation of the rectum.

Osteoporosis

- Reduction in the quantity of bone or atrophy of skeletal tissue

Older Adult

- Rigid blood vessels (arteriosclerosis) - Enlargement of calf veins

Ankylosis

- Stiffening or fixation of a joint.

Talipes equinovalgus

- Talipes equinus and talipes valgus combined; the foot is plantiflexed, everted, and abducted.

Tennis elbow

- Tension stress injury to the lateral epicondyle

Stereognosis

- The ability to identify an object by means of touch.

Level of consciousness

- The degree of a patient's alertness and awareness of self and environment, varying from wakefulness to coma. (measured with Glasgow Coma Scale)

Kinesthesia

- The sense perception of movement or position.

Deep tendon reflex (myotactic reflex)

- Tonic contraction of the muscles in response to a stretching force, due to stimulation of muscle proprioceptors

Jugular Venus Deistention

- Used to assess the central venous pressure and judge the heart's ability as a pump Procedure: - Look for pulse in jugular vein and measure distance from pulse to angle of Louis. How high is pulse from angle? Less then 2cm is normal. - Elevated pulse indicates heart failure.

Pregnant

- Vasodilation resulting in decreased blood pressure - Edema in legs

Romberg sign

- With feet approximated, the patient stands with eyes open and then closed; if closing the eyes increases the unsteadiness, a loss of proprioceptive control is indicated

Crepitation

- a dry, crackling sound like that of crumpled cellophane, produced by air in the subcutaneous tissue

Dementia

- a permanent progressive global impairment of cognitive function

Orchitis

- acute inflammation of the testes

Tic

- involuntary, compulsive, repetitive twitching of a muscle group

Priapism

- prolonged painful erection of the penis go without sexual desire .

Infants/Children

- respiration does not start until after birth - small, immature; great risk for secondhand smoke, asthma, and SIDS

vertebrae

-5 cervical -12 thoracic -5 lumbar -5 sacral -3 or 4 coccygeal -spinous process of C7 & T1 at the base of the neck -inferior angle of teh scapula at the level of the interspace between T7 & T8 -an imaginary line connecting the top of the iliac crests at L4 -an imaginary line joining the symmetric dimples over the posterior superior iliac spines

Collecting Subjective Data

1. Leg pain or cramps 2. Skin changes on arms/legs 3. Edema 4. Lymph Node Enlargement 5. Medications

Allen Test Procedure

1. Rest hand palm up 2. Make a fist 3. Occlude radial/ulnar arteries with thumb 4. Fist released-pale at first 5. Release ulnar artery-Color should return; then release radial artery.

The ankle-brachial index should normally be?

1..0-1.2 indictaing no flow reduction. the ABI is taken using a doppler

What does 20/20 mean

20/20 is the fraction result of a visual acuity test using the Snellen chart. The 20 on top is the feet from the chart. The bottom number means the distance at which a normal eye could have read that particular line. 20/30 is 20 ft from chart reading what a normal person can read 30 ft from chart.

Hematoma

A localized collection of extravasated blood, usually clotted in an organ, space, or tissue

Senile tremor-

An essential tremor that becomes symptomatic in the elderly.

Landmarks of Thorax

Anterior - Suprasternal Notch - Sternum - Sternal Angle - Costal Angle Posterior - Vertebra Prominens - Spinous Processes - Inferior border of the Scapula - Twelfth Rib

Vaginal lubrication during intercourse is produced by

Bartholin's glands

Hinduism food restrictions

Beef, pork, and some fowl Alcohol Garlic and onions by some Red-colored foods by some

Patterned Injury

Caused by an object that leaves a distinct pattern on the skin and/or organ (whipped by extension cord), or injury caused by unique mechanism ( feet; sock burn)

Right Lower Quadrant Contains

Cecum-Appendix-Right ovary and tube (female)-Right ureter-Right spermatic cord (male)

Annular

Circular; begins in the center and spreads to periphery (ring worm)

Weak "Thready" Pulse-1+

Decreased C.O., peripheral arterial disease, aortic valve stenosis

P Wave

Depolarization of the atria

Extinction

Disappearance of conditioned response

Optic Atrophy

Disc pallor. White or gray color of the disc as a result of partial or complete death of optic nerve. Results in decreased visual acuity, decreased color vision, and decreased contrast sensitivity.

Fine Crackles

Discontinuous, high pitched, short crackling, popping sounds during inspiration, not cleared by coughing. - pneumonia, heart failure, chronic bronchitis, asthma, emphysema

What is dysarthria?

Distorted speech sounds (unintelligible)

Atrial Systole occurs

During Ventricular diastole.

Summary

Final review of what the person has said, condenses the facts and presents a type of survey of how you percieve the health problem or need

Cranial Nerve IX

Glossopharyngeal Nerve - gag reflex

frenulum

Holds the tongue to the bottom of the mouth

What is word salad?

Incoherent mixture of words, phrases, and sentences

Endocrine responses to pain

Increased adrenergic activity

A score of 4 or more on the PAINAD scale

Indicates a need for pain management

Phases of the Interview

Introduction, working phase, and conclusion

What is effusion?

Joint swelling

Infants

Large lymph nodes

Tumor

Larger than a few cms in diameter, firm or soft, deeper into dermis; may be benign or malignant

LMP

Last Menstrual Period

Internal Factors of the interview

Liking others, empathy, and the ability to listen

Tonsils

Located at the entrances to the respiratory and GI tracts and respond to local inflammation

Carotid Pulse vs. Jugular Venous Pulsation

Location - Jugular is lower and more lateral Quality - Carotid is faster and more localized- one wave per cycle Respiration - Jugular varies with respiration and carotid does not Palpable - Carotid is palpable Pressure - Pressure does not change carotid Position - Carotid is unaffected by position of person

8 Critical characteristics of a symptom

Location, Quality, Severity, Timing, Setting, Relieving Factors, Associated Factors, Patients Perception

Patch

Macules that are larger than 1cm

Menarche

Mean age at onset 12-13; delayed onset suggests endocrine or underweight problem.

Types of Heart murmurs (abnormal findings)

Midsystolic Pansystolic Diastolic

What is hypochondriasis?

Morbid worrying about own health

Dementia

Multiple cog deficits in short and long term memory 1. memory impairement 2. one or more of - aphasia - apraxia - cant carry out motor functions - agnosia - cant identify objects - disturbance in executive functioning 3. must cause impairment in occupational or social functioning

Myalgia-

Muscular pain

High-Pitched Wheeze

Musical squeaking sounds predominate in expiration but can occur in both. - diffuse airway obstruction (asthma, chronic emphysema)

Vision screening is done on a preschool child to detect and possibly treat_______ and ________.

Myopia and amblyopia

GI responses to pain

Nausea, vomiting, llieus

Trachea

Normally its midline. Palpate for tracheal shift. The space should be symmetric on both sides.

Epitaxis

Nosebleed. Most common at Kiesselbach plexus

Epitrochlear lymph nodes

Not palpable

Gravida

Number of pregnancies

Cranial Nerve I

Olfactory Function: Smell

Cranial Nerve II

Optic Function: Vision

What is somatic pain?

Originating from muscle, bone, joints, tendons, or blood vessels

Motor Nerve fibers

Origniate in the motor cortex and travel to the brain stem where they cross to the opposite or contralateral side and then pass down in the lateral column of the spinal cord.

Stab Wound

Penetrating,sharp, cutting injury that is deeper than it is wide

What is perseveration?

Persistent repeating of verbal or motor response

General Survey

Physical Appearance Body Structure Mobility Behavior

Nonverbal skills

Physical appearance, Posture, Gestures, Facial Expressions, Eye Contact, Voice, Touch

Pellagra

Pigmented keratotic scaling lesions resulting from a deficiency of niacin. These lesions are especially prominent in areas exposed to the sun, such as hands, forearms, neck, and legs.

Vocal cues

Pitch, tone, quality, loudness, intensity, rate & rhythm, sounds such as groans, laughs, coughs, "um", "uh"

C-reatice protein (CRP)

Plasma protein marker of inflamatory status NOT detectable in healthy individuals - detectable levels = increased risk for antherosclerosis - seen in inflammatory conditions such as infections, RA, TB, also oral contraceptives

Chandelier Sign

Positive Cervical motion tenderness (pain)

Parietal Lobe

Postcentral gyrus: Primary center for sensation

Diagnostic reasoning

Process of analyzing health data and drawing conclusions to identify diagnoses.

Apical Impulse

Pulsation created as the left ventricle rotates aganist the chest wall during systole Located @ 4th intercostal space

What are the two vascular skin lesions?

Purpura and petechiae

P(Q)RSTU

Quality or Quantity- How does it look, feel, sound? How intense/severe is it?

Allergic Rhinitis

Rhinorrhea, itching, sneezing, congestion, turbinates are pale

Triglycerides (TGs)

Screen for hyperlipidemia and risk for coronary artery disease adults: <150 mg/dl >250 in obesity

Proprioception

Sensory info concerning body movement and position of body in space

Labia Majora

Should appear symmetric, plump, and well-formed.

What is global aphasia?

Spontaneous speech and comprehension are absent or reduced to a few stereotyped words or sounds with impaired repetition, reading, and writing

Obtaining data from client's heart and neck vessels

Subjective data: -History of present health concern - chest pain, palpitations -Past health history -Family history -Lifestyle and health practices

Symptom

Subjective sensation that the person feels from the disorder

What is circumstantiality?

Talk with excessive and unnecessary detail

Menarche:

The beginning of menstruation, which usually begins in breast development stage 3 or 4

Strabismus

True disparity of the eye axes. This constant malalignment is also termed tropia and is likely to cause amblyopia.

Rectovaginal Examination

Use this technique to assess the rectovaginal septum, posterior uterine wall, cul-de sac and rectum. Ask patient to bear down as you insert your index finger into the vagina and your middle finger into the rectum

S4

When ventricle contract late in diastole - atrial kick. Immediately before S1

the inflamed bursa that forms at the pressure point is

a bunion

Scaphoid

abnormally sunken abdominal wall as with malnutrition or underweight

Tympany

amp: loud pitch: high quality: musical/kettle drum duration: sustained longest location ex: air-filled viscus - stomach, intestine

each anal column contains

an artery and a vein

normal stimulus to breath

an increase in CO2, or "hypercapnia"

Radial and Ulnar arteries

arteries that run distally from the elbow and supply the hand

A mother of a 2 month old infant asks a nurse when she should introduce solid foods into her infants' diet. which of the following responses by the nurse is most appropriate regarding the mother's question?

" you may fee your baby rice cereal at 6 months." although breast milk is recommended for up to 1 year , infants may be given iron-fortified cereal, such as rice cereal, between 4-6 months. iron-fortified cereal is the first solid food to be introduced, followed by vegetable and fruits.

Presystole

"Atrial Kick" Atria contract and push the last amount of blood, about 25% of the stroke volume into the ventricles

Scleroderma

"Hard skin", connective tissue disease; chronic hardening and shrinking degenerative changes in the skin, blood vessels, synovium, and skeletal muscles. Characteristic facies; hard, shiny skin on forehead and cheeks; thin pursed lips with radial furrowing; absent skinfolds; muscle atrophy on face and neck; absence of expression.

Which of the following statements made by the parent of a preschooler indicates that the parent understands the need her child has for injury prevention?

"I programmed the number to the poison control center into my cell phone." preschoolers are great imitators and may mimic other by taking medications or drinking colored liquids. therefore, having the number to the poison control center available is vital. while preschool children are more independent than they were as toddlers, they still need to be supervised. they may be capable of helping adults tasks but are not able to be in charge of siblings. preschoolers do not have the judgement necessary to be riding a bicycle in the street unsupervised.

Normal Heart Murmur

"Innocent" Murmurs - Someone who has just been exercising - Healthy children/adolescents - Pregnant

When performing the Homan's test,

"ask patient" to flex the knee... detects sign of DVT

sternum

"breastbone," has 3 parts: 1) mabrium, 2) body, 3) xiphoid process

LaSegue's test

(straight leg raising). Positive if reproduces sciatic pain, test to confirm herniated nucleus pulposus; straight leg raises while keeping the knee bent, then dorsiflex the foot

hordeolum

(stye) red, painful pustule that is localized infection of hair follicle at eyelid margin

Physical Appearances

*Age-appears his/her stated age. ABNORM- appears older than stated age, as with chronic illness, chronic alcoholism *Sex- sex development appropriate for gender/age. ABNORM- delayed of precocious puberty *Level of Conscience-alert & oriented. ABNORM- confused, drowsy, lethargic *Skin color-tone even,pigmentation, on lesions. ABNORM- pallor, cyanosis, jaundice, erythema, any lesions *Facial Features-symmetric w/movement. ABNORM-immobile, masklike, asymmetric, drooping *No signs of acute distress present- ABNORM-cardiac or respiratory signs- diaphoresis, clutching the chest, shortness of, wheezing

Behavior

*Facial expression-appropriate to situation. ABNORM- lat, depressed, angry, sad, anxious. note: anxiety is common in ill ppl, some ppl smile when anxious *Mood & affect-comfortable, cooperative,interacts pleasantly. ABNORM- hostile, distrustful, suspicious, crying *Speech-clear & understandable. ABNORM- dysarthria (slurred, difficult to produce), dysphasia (impairment of speech by brain lesion) *Dress- appropriate to weather, clean, fits, etc... ABNORM- clothing too large suggests weight loss, vice versa, consistency in certain clothing may give clues, ex:longs sleeves hiding needle marks *Personal hygiene-clean & groomed appropriately for age, culture, occupation, etc... ABNORM-in a previously groomed woman, unkempt hair and absent makeup may indicate malaise or illness

Mobility

*Gait- normal walking. ABNORM- exceptionally wide base, staggered, stumbling, shuffling, dragging, nonfunctional leg, limping with injury. propulsion-difficulty stopping *Range of motion- full mobility of joints & well *No involuntary movement. ABNORM-limited joint range of motion, paralysis, movement jerky, uncoordinated, tics, tremors, seizures

Body Structure

*Stature- height normal for age & genetics. ABNORM- excessively short or tall *Nutrition-weight appears normal range for height & fat evenly distributed. ABNORM- cachectic, emaciated, simple obesity, with even distribution. centripetal obestity- fat mainly in the trunk of body, thin extremities, like cushing syndrome *Symmetry-body parts equal & proportioned. ABNORM- unilateral atrophy or hypertrophy, asymmetric location of a body part *Posture-stands comfortably erect for age. ABNORM- rigid spine and neck; moves as one unit (e.g. arthritis) stiff and tense, ready to spring from chair, fidgety movements, shoulders slumped; looks deflated (e.g. depression) *Position- sits comfortably arms relaxed, head turned to examiner. ABNORM- tripod- leaning forward with arms braced on chair arms; occurs with chronic pulmonary disease, sitting straight up and resists lying down, curled up in fetal postion *Body build,contour-arm span=height,crown to pubis roughly= pubis to sole. ABNORM-elongated arm span, arm span greater than height, missing extremities or digits; webbed digits; shortened limb

Seizures

- A chronic disorder characterized by paroxysmal brain dysfunction due to excessive neuronal discharge, and usually associated with some alteration of consciousness.

Hydrocele

- A collection of serous fluid in a sacculated cavity.

Genu valgum

- A deformity marked by lateral angulation of the leg in relation to the thigh (knock knee).

Saline

- A salt solution, usually sodium chloride.

pregnant women (mouth)

- stuffy nose - epistaxis (bloody nose) - gum hypertrophy

Murphy sign

- tests for cholecystitis - positive test is inspiratory arrest with deep palpation under liver

Neurogenic anosmia

- unilateral loss of smell in the absence of nasal disease

AV Bundle

-AV bundle (bundle of His): located in the upper interventricular septum, the AV bundle conveys the electrical impulse down the right and left bundle branches and the Purkinje fibers.

QRS complex

-Ventricular depolarization (also atrial repolarization) -Conduction of the impulse throughout the ventricles which triggers contraction of ventricles -measured from the beginning of Q wave to end of S wave

T wave

-Ventricular repolarization -Ventricles return to a resting state

endocardium

-a thin layer of endothelial tissue that forms the innermost layer of the heart -continuous with the endothelial lining of blood vessels

Musculoskeletal changes with age

-decrease in height, kyphosis, lose fat in periphery and deposit it centrally -ROM should not decrease unless they have an underlying disease process like arthritis

reference lines

1) anterior axillary line 2) midclavicular line: disects middle of each clavicle 3) midsternal line 4) vertebral (or midspinal) 5) scapular line 6) posterior anxillary 7) midaxillary

Abnormal Findings - Breath

1. Diabetic ketoacidosis has a sweet, fruity breath odor a. this acetone smell also occurs in children with malnutrition or dehydration. 2. Ammonia breath odor with uremia. 3. Musty odor with liver disease. 4. Foul, fetid odor with dental or respiratory infections 5. Alcohol odor with alcohol ingestion or chemicals 6. Mouse-like smell of the breath with diphtheria.

Abnormal Findings - Teeth

1. Discolored teeth appear brown with excessive fluoride use, yellow with tobacco use 2. Grinding down of tooth surface; plaque—soft debris; caries—decay. 3. Malocclusion (poor biting relationship), protrusion of upper or lower incisors 4. Baby bottle tooth decay

Abnormal Findings - Gums

1. Gingival hyperplasia (see Table 16-3), crevices between teeth and gums, pockets of debris. 2. Gums bleed with slight pressure, indicating gingivitis. 3. Dark line on gingival margins occurs with lead and bismuth poisoning.

Veins Accessible for Examination

1. Jugular Veins 2. Superficial and deep veins of the arm 3. Superficial, deep, and perforator veins in the legs

Arteries Accessible for Examination

1. Temporal 2. Carotid 3. Brachial, Radial, and Ulnar 4. Femoral, popliteal, posterior tibial, and dorsalis pedis

exam steps

1. inspect size and shape of the ear 2. inspect skin condition and that it is same color as facial color 3. move pinna and push on tragus. palpating mastoid process should produce no pain or tenderness. 4. note size of opening of auditory meatus and of opening to direct size of speculum for otoscope. 5. tilt person's head slightly away toward their opposite shoulder and pull pinna up and back (adult), down and back (child). 6. hold otoscope upside down 7. in the external canal note any redness and swelling.8. note color and characteristics of the tympanic membrane. 9. also avoid middle ear insufflation in person with upper respiratory infxn because it could propel infectious matter into middle ear.

What are some skin conditions particular to blacks?

1. keloids (scars that form at the site of wounds & grow beyond the normal boundary of the wound) 2. hypopigmenation or hyperpigmentation 3. pseudofolliculitis (razor bumps caused by shaving too close) 4. melasma ("the mask of pregnancy" a patchy tan to dark brown discoloration of the face)

order of neurologic examination

1. mental status 2. cranial nerves 3. motor system 4. sensory system 5. reflexes

Identify the order of sexual maturation in males....

1.size of testes increase. 2. pubic hair appears. 3. rapid growth of genitalia occurs. 4. axillary hair grow. 5. downy hair appears on upper lip. 6. voice changes.

PNS

12 Pairs of Cranial Nerves 31 Pairs of the spinal nerves Carries sensory afferent messages to the CNS from sensory receptors.

ribs

12 pairs. 1-7 attach directly to sternum. 8-10 attach to costal cartilage.. 11-12 are "floating"

the median age for attaining stage 2 for pubic hair development

12 years old

Average BP

120/80

Bifid Uvula

18% Native Americans and 10% Asians

normal size of aorta-

2.5cm-4

the peritoneum covers only the upper

2/3 of the rectum

prostate cancer screening guidelines were updated in

2010 and state the ages at which men should receive health information about benefits and risks

Skin

3 layers: epidermis, dermis, subcutaneous layer

Pulse Strength

3+ is full, bounding 2+ is normal 1+ is weak 0 is absent

Bone mass is complete at what age?

35

Infant/Child PMI

4th intercostal space, left midclavicular line (until 7 yrs-old)

How long do you auscultate bowel sounds

5 minutes

Binge drinking

5+ drinks in a sitting

Muscle ROM grading

5-full ROM against gravity, full resistance 4- full ROM against gravity, some resistance 3- full ROM with gravity 2- full ROM with gravity eliminated 1- slight contraction 0- no contration

Benign breast disease:

50% of women have it Breasts sore & tender Can have bumpy consistency

Adult PMI

5th intercostal space, left midclavicular line

Current dietary guidelines for complex carb intake

60% of total caloric intake

puberty begins sometime between the ages of

9.5 and 13.5

What is the normal range for oral temperature?

96.4-99.1

constipation

<3 stools/week and is a common concern among aging adults

Any health evaluation for known or suspected elder abuse and neglect should include baseline lab testing including

A CBC with platelet level, basic blood chemistry BUN, creatinine, protein, albumin, serum liver function tests, a coagulation panel, and a UA

Chalazion

A body nodule protruding on the lid. Infection or retention cyst of a meibomian gland. Nontender, firm, discrete swelling with freely movable skin overlying the nodule.

Choanal Atresia

A boney or membraneous septum between the nasal cavity and the pharynx of the newborn. Whenthe conditionis bilateral it requires the immediate insertion of an oral airway to gprevent asphysia because most newborns are obligate nose breathers. When the condition is unilateral, the infant may be asymptomatic until the onset of the first respiratory infection.

Hematoma

A bruise you can feel. It elevates the skin and is seen as swelling

Contusion

A bruise; injury to tissues without breakage of skin; blood from broken vessels accumulates, producing pain, swelling and tenderness

Interview with School-age child

A child 7-12 years can tolerate and understand others viewpoints. Is more objective and realistic. He or she wants to know functional aspects--how things work and why things are done.

Callus-

A composite mass of tissue that forms at a fracture site to establish continuity between the bone ends

Mammary Duct ectasia:

A condition in which there is dilation of the lactiferous duct, caused by stagnation of cellular debris. Occurs in women who have lactated. Signs of duct ectasia can include nipple retraction, inversion, pain, and sometimes a bloody discharge.

Women are significantly more likely to be physically or sexually assaulted by-

A current or former intimate partner

Incision

A cut or wound made by a sharp instrument; the act of cutting

Deep Vein Thrombophlebitis (DVT)

A deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema. *****increased warmth, swelling, redness, tender palpation, homan sign is present only in a few cases

Values

A desirable or undesirable state of affairs and a universal feature of all cultures.

Title VI of the Civil Rights Act of 1964

A federal law that mandates that when people with limited English proficiency (LEP) seek health care in health care settings such as hospitals, nursing homes, clinics, daycare, and mental health centers, service cannot be denied.

Ecchymosis

A hemorrhagic spot or blotch, larger than petechia, in the skin or mucous membrane, forming a nonelevated, rounded or regular, blue or purplish bruise

Contusion/bruise

A large patch of capillary bleeding into tissues. Color is red-blue or purple immediately after or within 24hrs >blue to purple>blue-green> yellow >brown-disappearing. Bruise in dark skinned is deep dark purple. Pressure on bruise does not cause it to blanch

What is Pectus Excavatum

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

Spirituality

A personal effort to find meaning and purpose in life

Leading question

A question that implies that one answer would be better than another

24-hour recall of dietary intake

A questionaire or interview of everything eaten within the last 24 hours

Cultural and Linguistic Competence

A set of congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations.

Magenta Tongue

A sign of riboflavin deficiency. In contrast, a pale tongue is probably attributable to iron deficiency; a beefy red-colored tongue is caused by vitamin B-complex deficiency.

Ethnicity

A social group within the social system that claims to possess variable traits such as common geographical origin, migratory status, and religion.

Trousseau sign

A test for latent tetany in which carpal spasms are induced by inflating sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for three minutes; used in hypocalcemia and hypomagnesemia.

Abrasion

A wound caused by rubbing the skin or mucous membrane

What are the four main headings of mental status assessment?

A-appearance B-behavior C-cognition T-thought process

5 Areas of Pericardium to Auscultate

APETM Aortic - R. 2nd ICS near sternum Pulmonary - L 2nd ICS near sternum Erb's Point - F 3rd ICS near sternum (best for auscultating S2 Tricuspid - L 5th ICS near sternum Mitral - L 5th ICS midclavicular line (apex)

Normal factors varying BP

Age- rise thru childhood into adulthood Gender- after puberty females lower Race-black adults higher than whites Diurnal rhythm-daily cycle- BP climbs to high in afternoon and low in morning Weight-higher in obese Exercise-increased activity yields higher BP Emotions- momentarily rises w/ fear, anger, pain Stress-elevated w/ continual tension

Senile purpura

Aging adult: seen in elderly, due to vascular fragility increased; a minor trauma may cause dark red discolored areas

2 pathways of hearing

Air conduction (AC), at the peripheral level, the ear transmits sound and converts its vibrations into electrical impulses, which can be analyzed by the brain. The sound waves produce vibrations on your tympanic membrane. These vibrations are carried by the middle ear ossicles to your oval window. then the sound waves travel through your cochlea, which is coiled like a snail's shell, and are dissipated aganist the round window. ALong the way, the basilar membrane vibrates at a point specific to the frequency of the sound.The numerous finers along the basilar membrane are receptor hair cells of the organ of Corti, the sensory organ of hearing. As the hair cells bend, they mediate the vibrations into electric impulses. The electrical impulses are conducted by the auditory portion of cranial nerve VIII to the brianstem. Finally the function of the cortex is to interpret the meaning of the sound and begin the appropiate response. ALl this happens in the split second it takes you to react to a sound. Bone Conduction (BC) the bones of the skull vibrate. Those vibrations are transmitted directly to the inner ear and to cranial nerve VIII

AUDIT

Alcohol Use Disorders Identification Test - Quantitative questionnaire used to detect less severe alcohol problems as well as alcohol abuse and dependence disorders Score: 8 or above for men, 4 or above for women, 60+, adolescents - covers consumption, drinking behavior/dependence, and adverse consequences from alcohol

Mormon food restrictions

Alcoholic beverages Caffeinated beverages and medicines containing caffeine, stimulants or alcohol Food and beverages on first Sunday of each month

Nosocominal infection

An infection that is obtained while a patient is in a hospital or as a result of being in a hospital(unrelated to the patient's primary condition)

Ophthalmoscope

An instrument for viewing the interior of the eye or examining the retina

The ability to listen

An internal factor that is essential for a successful interview. it is an active and demanding communication process and requires your complete attention. It is the route to understanding.

Ankle-Brachial Index (ABI)

Ankle SBP divided by Arm SBP Ankle slightly greater than brachial Normal reading= 1.0-1.2

Borders of the lungs

Anterior - above clavicle - 6th rib (midclavicular line) - sternum - anterior axillary line Posterior - first rib - 10th intercostal space - posterior axillary line - vertebrae

Lesion

Any pathologic or traumatic discontinuity of tissue or loss of function of a part

Midline Contains

Aorta-Uterus (female(If enlarged))-Bladder (if distended)

Order to Auscltate Heart

Aortic Pulmonic Erbs Point Triscupid Mitral

Before a woman gets pregnant her cervix is.

Appears as a smooth doughnut-shaped area with a small circular hole (an "os")

Urethral Opening

Appears slit-like and is midline

Light Touch

Apply a wisp of cotton to the skin Brush it over the skin in a random order of sites and at irregular intervals. Ask person to say now when felt

Fallopian Tubes

Are two pliable, trumpet shaped tubes. Highway for the sperm to travel through

throat

Area behind mouth and nose Contains lots of lymph capilaries

Frontal Lobe

Areas Concerned with personality, behavior, emotions, and intellectual function. PRECENTRAL GYRUS: Initiates voluntary movement.

Axillary temp

Armpit- safe & accurate for infants & young children when environment reasonably controlled

Most common pain conditions for aging adult

Arthritis, osteoarthritis, osteoporosis, PVD, cancer, neuropathies, angina, and chronic constipation

Numeric rating scales

Ask the patient to choose a number that rates the level of pain, with 0 being no pain and 10 being the worst.

Nursing process

Assessment, diagnosis, planning, implementation, evaluation

Occipital

At base of skull

Crepitation

Audible and palpable crunching or grating that accompanies movement. Occurs when the articular surfaces in the joints are roughened like in RA

Thoracic Exam

Auscultation - Auscultate across and compare bilaterally - Posterior - 7 areas down back and on sides at 7th or 8th rib - Anterior - 5 bilateral areas

Identify three strategies parents can use to decrease the risk of obesity in school age children.

Avoid or reduce fast-food meals, encourage physical activities, do not use food as rewards, provide nutritious meals.

What would an alert pt look like?

Awake, oriented, fully aware of external and internal stimuli with appropriate response

What is perceptions?

Awareness of objects through any of the five senses

What is orientation?

Awareness of the objective world in relation to the self

Nociceptors carry the pain signal to the CNS by two primary sensory (afferent) fibers

Aδ and C fibers

Pulsus Paradoxus

Beats have weaker amplitude with inspiration, stronger with expiration. Best determined during B/P measurement; reading decreases (>10 mm Hg) during inspiration and increases with expiration. Common finding in cardiac tamponade and with severe bronchospasm of acute asthma

Psychological abuse

Behaviors that result in mental anguish

Posterior Triangle

Behind sternomastoid muscle, trapezius muscle on one side, base along clavicle

What is consciousness?

Being aware of one's own existence, feelings, and thoughts and being aware of the environment

Anatomical landmarks

Between the lungs in the middle third of the thoracic cage (mediastinum). - Extends from the 2nd to 5th intercostal space from the right border of the sternum to the left midclavicular line.

Components of Health History

Biographic data, reason for seeking care, present health or history of present illness, past history, family history, review of systems, functional assessment or activities of daily living

Thrombophlebitis

Blood clots (Inflammation, warm, pain, edematous)

Hyphema

Blood in anterior chamber is a serious result from herpes zoster infection. Also from blunt trauma or spontaneous hemorrhage. Suspect scleral rupture or major intraocular trauma.

Systole

Blood is pumped from the ventricles and fills the pulmonary and systemic arteries Ventricular pressure is higher that that in the atria. so AV valves slam shut Contraction occurs here

Pregnancy (Heart)

Blood volume increases 30-40%. Increased stroke volume and cardiac output. Increased pulse rate (by about 10bpm). Arterial blood pressure decreased.

Wound

Bodily injury caused by physical means

Infant and children Head and neck

Bones of the neonate are separated by sutures and fontanels, the spaces where the sutures intersect. this allows for growth the 1st year. They gradually ossify The triangle shaped posterior fontanel is closed by 1-2 months -the diamond shaped anterior fontanel closes between 9 months and 2 years -head is 90% its adult size by age 6

Equal-status seating

Both you and the patient should be comfortably seated at eye level, about 4-5 feet apart. Avoid standing which communicates haste and superiority

CNS

Brain and Spinal Cord

What are the nutrition needs of infants and children?

Breast milk for immunity and growth/development. Fat for optimal growth and central nervous system development

Reason for seeking care

Brief, spontaneous statement in the person's own words that describes the reason for the visit

Oral karposi sarcoma

Bruiselike, dark red or violet confulsent macule, usually on the hard palate, may be on soft palate, or gingival marign. Oral lesions may be among the earlies lesions to develop with aids.

Pattern of Injuries

Bruises and fractures, in various stages or healing

An 8 month old infant is brought into the health facility by his parent. the nurse notes several bruises on the infant's abdomen, legs, and arms. the infant also has a cut on his scalp, hi clothes are dirty, and he has areas of redness and skin breakdown around his buttocks and scrotum. when assessing this infant for abuse, the nurse should look for which of the following manifestations?

Bruising, welts, and lacerations, poor hygiene, and fear of strangers may be indications of abuse. a child who is abused does not usually demonstrate normal growth and development and positive interaction with caregivers.

Arterial-Ischemic Ulcer

Buildup of fatty plaques on intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis) objective- coolness, pallor, diminshed pulse, signs of malnutrition, distal gangrene. ulcers at toes, metatarsal heads, leteral ankle ****ulcers are well-defined, no bleeding, occur at the lateral malleoulous

An enclosed sac filled with viscous synovial fluid, much like a joint.

Bursa- help muscles and tendons to glide smoothly over bone

Pain rating scales

Can indicate a baseline intensity, track changes, and give some degree of evaluation to a treatment modality.

nitrosamines

Cancer producing chemicals present in chewing tobacco and Snuff ("spitting") tobacco

Oral Cancer

Carcinoma - with rolled edges at side, base or under tongue

Five determining factors of BP

Cardiac output Peripheral vascular resistance Volume of circulating blood Viscosity Elasticity of vessel walls

Assessing Carotid Artery and Jugular Venous Pulse and Pressure

Carotid artery: Pulse Vessel elasticity Thrills -Auscultate and palpate the carotid arteries for bruits, amplitude, regularity, and contour of the pulse, vessel elasticity, or presence of thrills.

Arteries

Carries blood from the heart. Function= Supplying oxygen and essential nutrients to the tissues

Most common causes of decreased visual function in elderly

Cataract, Glaucoma and Macular degeneration

Carotid Artery

Central artery (close to the heart) Smooth rapid upstroke and gradual down stroke in the pulse tracing

Four groups of axillary nodes in breast:

Central axillary nodes, pectoral (anterior) nodes, subscapular (posterior) nodes & lateral nodes.

Nuclear Cataract

Central gray opacity. Opaque gray surrounded by black background as it forms in the center of lens nucleus. Through ophthalmoscope, it looks like a black center against the red reflex. Begins after 40 and develops slowly, gradually obstructing vision.

Past Health questions

Childhood Illnesses, Accidents or Injuries, Serious or Chronic Illnesses, Hospitalizations, Operations, Obstetric History, Immunizations, Last examination date, Allergies, Current Medications

Papilledema

Choked Disc. Increased intracranial pressure causes census stasis in the globe, showing redness, congestion, and elevation of the disc. Serious sign of intracranial pressure, usually caused by a space occupying mass. Visual acuity not affected.

Acute Rhinitis

Clear, watery discharge (Rhinorrhea) Swollen mucosa and sneezing Turbinates are dark red and swollen

Initial Pain Assessment

Clinician asks the patient to answer eight questions concerning location, duration, quality, intensity, and aggravating/relieving factors.

S1

Closing of mitral and tricuspid valve

S2

Closing of the pulmonary and aortic valves

Cerebellar System Location

Coiled structure under the occipital lobe. Receives information about what kind of motor messages are being sent from the cortex to the muscles.

Inspection

Concentrated watching, first at person as a whole then each body system

In addition to the AAS, providers need to be alert in terms of the conditions particularly associated with IPV

Conditions include gynecologic problems, chronic irritable bowel syndrome, back pain, depression, and the presenting symptoms of PTSD

How to Inspect anterior eyeball structures

Conjunctiva s/b clear and pink over lower lid and white over the sclera Sclera s/b "china" white; gray-blue or muddy in dark-skinned Cornea s/b smooth, clear, and no irregularities Iris s/b flat w/ round, regular shape Pupils s/b round, regular, equal size

Miosis

Constricted and fixed pupils. Occurs with use of pilocarpine drops for glaucoma treatment, the use of narcotics, with iritis, and with brain damage of pons

Inner Ear

Contains the bony labyrinth which holds the sensory organs for equilibrium and hearing. Within the bony labyrinth, the vestibule and the semicircular canals make up the vestibular apparatus and the cochlea-- here sound vibrations are converted into electric impulses that travel through a nerve to the brain

Each culture has its own healers who usually

Cost less than traditional or biomedical providers.

language acquisition and socialization

Culture is learned from birth and through life. What is the modes that culture is acquired for an individual?

Menstruation-

Cyclic endometrial shedding and discharge of a bloody fluid from the uterus.

Paralysis

DECREASED or loss of motor function due to problem with motor nerve or muscle fiber

What immunizations should a preschool child receive if all immunizations have been kept up to date?

DTaP, Inactivated poliovirus (IPV), measles, mump, and rubella (MMR), and varicella. in addition, yearly trivalent inactivated influenza vaccine (TIV) for preschoolers 36-59month.

decorticate rigidity

Decorticate rigidity occurs when there are lesions of the cerebral hemispheres. Damage to the brain occurs above the brainstem and cerebellum (i.e., above the tentorium). There is upper extremity flexion (arms in fetal position) and lower extremity extension.

Fissured or scrotal tongue

Deep furrows divide the papillae into small irregular rows. The condition occurs in 5% of the general poulation and in Down synrome. The incidence increases with age (vertical, or longitudinal fissures also aoccur with dehydration because of reduced volume of tongue).

Stethoscope bell

Deep hallow cup like shape For soft, low pitched sounds (extra heart sounds or murmurs) Hold lightly against skin

What is aphasia?

Defect in word choice and grammar or defect in comprehension

Scorbutic Gums

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

Neglect can manifest itself with symptoms of

Dehydration and malnutrition. it can be intentional or unintentional

Knee Bend/Hop in Place

Demonstrates normal position sense, muscle strength and cerebellar function.

Documentation of IPV and elder abuse must include

Detailed, nonbiased progress notes, the use of injury maps, and photographic documentation in the health record *prior written consent to take photos should be obtained from all cognitively intact, competent adults *if a patient is unconscious or cognitively impaired the taking of photographs without consent is generally viewed as ethically sound because it is a noninvasive, painless intervention that has high potential to help a suspected abuse victim

Denver II screening

Detects developmental delays in infants and preschoolers w/in four functions: gross motor language fine motor - adaptive personal - social skills - performance is scored "normal" "abnormal" or "questionable"

Hemoglobin (Hb)

Detects iron deficiency anemia males: 14-18 g/dl females: 12-16 g/dl increased Hb = polycythemia vera or dehydration decreased Hb = anemia, recent hemorrhage, fluid retention

Conditions that may cause neuropathy include

Diabetes mellitus, herpes zoster, HIV/AIDS, sciatica, trigeminal neuralgia, phantom limb pain, and chemo. further examples include CNS lesions such as stroke, MS, and tumors

What is dysphonia?

Difficulty or discomfort in talking with abnormal pitch or volume

lethargy

Drowsy state, Pt can awaken, but not completely to stimulation, may also follow commands but his responses may be slow and inattentive

Follicular Hyperkeratosis

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

Pulsus Bisferiens

Each pulse has two strong systolic peaks, with a dip in between. Best assessed at carotid artery. Aortic valve stenosis + Regurgitation

Premature thelarche:

Early breast development w/no other hormone-dependent signs.

Impaired Circulation in the leg results in:

Edema

What should be avoid in speaking with elders?

Elder speak, inappropriate plural pronouns, tag questions, shortened sentences, slow speech rate

AV Node

Electrical current delayed slightly so the atria have time to contract before the ventricles are stimulated

Bulla

Elevated cavity containing free fluid larger than 1cm diameter; usually single chambered (unilocular); superficial in epidermis; it is thin walled, so it ruptures easily (burns)

Vesicle

Elevated cavity containing free fluid, up to 1cm; a blister. Clear serum flows if wall is ruptured (herpes)

Pustule

Elevated cavity containing turbid fluid (pus); acne

Thyroid

Endocrine gland, synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolism

Arteriosclerosis

Enlargement of the intramuscular calf veins Loss of lymphatic tissue

External Factors of the interview

Ensure privacy, refuse interruptions, physical environment, dress, note taking, tape and video recording

Aging Adult Skin

Epidermis's outer layer thins and flattens. Wrinkling occurs bc the underlying dermis thins and flattens. Less elasticity/elastin, collage, and subcutaneous fat. Reduction in muscle tone. Sweat glands and sebaceous glands decrease in number and function, leaving dry skin.

Raynaud's Phenomenon

Episodes of abrupt, progressive tricolor (pallor-blue-red) of the fingers in response to cold, vibration, or stress. Smoking can increase symptoms. Occurs bilaterally and may last hours

What is Barrel Chest

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

Angular chelititis (Stomatitis, Perleche)

Erythema, scaling, shallow and painful fissures at the corners of the mouth occur with excess salivationa nd canidia infection. It is often seen in edentulous persons and in those with poorly fitting dentures causing olding in of the corners of mouth, creating a warm, moist enviornment favoring growth of eyast.

Third step of nutritional assessment

Establish base line data for effectiveness of nutritional plan.

Cholesterol

Evaluates fat metabolism and risk for cardiovascular disease adult LDL-C (bad) - <130 mg/dl male HDL-C - 35-65 mg/dl female HDL-C - 35-80 mg/dl 200 mg/dl in obesity

Contour of Normal Cervix

Evenly rounded

Annual Pap Smear

Every 2 years if liquid based tests

3+ Reflex

Exaggerated Response

Kyphosis

Exaggerated posterior curvature of the thoracic spine; - aging, related to physical fitness. - causes back pain and immobility

Clarification

Examiner's response used when the patient's word choice is ambiguous or confusing

Visceral Reflex

Example: Pupillary response to light and accommodation

Pleural Effusion (Fluid) or Thickening

Excess fluid in intrapleural space. Inspect: increased respirations, dyspnea. Palpate: tactile fremitus decreased or absent. Percuss: dull to flat. Auscultate: decreased breath sounds or absent. Adventitous sounds: none

Bronchitis

Excessive mucous secretion, inflammation of bronchi w/partial obstruction. Usually caused by smoking. Inspect: hacking, rasping, productive cough, chronic dyspnea, cyanosis. Palpate: tactile fremitus normal. Percuss: resonant. Auscultate: normal vesicular. Adventitious sounds: crackles over deflated area, may wheeze.

Bronchial Breathing

Expiratory sound is higher pitched and louder than vesicular. NORMAL over Trachea and Larynx. ABNORMAL if heard over peripheral part of lungs.

Verbal communication

Expressing ideas to others by using spoken words

When the nurse is testing the triceps reflex, what is the expected response?

Extension of the arm

what is asymmetric tonic neck reflex?

Extension of the arm and leg on the side when the head is turned to that side with flexion of the arm and leg of the opposite side.

Quadriceps Reflex

Extension of the lower leg is the expected response

Functional vs innocent heart murmur

FUNCTIONAL- due to the increased blood flow in the heart (anemia, fever, pregnancy, hyperthyroidisM INNOCENT- indicates having no valvular or other pathologic cause

What is confabulation?

Fabricates events to fill in memory gaps

How do we interview with hearing impaired individuals?

Face directly so mouth and face are visible, do not shout, speak slowly, use hand gestures

Cranial Nerve VII

Facial Motor Function: facial muscles, close eye, labial speech, close mouth Sensory Function: Taste (sweet, salty, sour, bitter) on the anterior 2/3 of the tongue Parasympathetic function-saliva and tear secretion

Respones-assisting the narrative

Facilitation, silence, reflection, empathy, clarification, confrontation, interpretation, explanation, summary

CNS responses to pain

Fear, anxiety, fatigue

Consistency of Normal Cervix

Feels smooth and firm (Goodells sign is when it feels soft and velvety at 5-6 weeks of pregnancy)

Lymphatic system

Filter station, whose second function is immunity Without this fluid would build up in the interstitial spaces and produce edema

Lymph Nodes

Filter the fluid before it's returned to the bloodstream and filter out microorganisms that could be harmful to the body.

Conclusion

Final statement of what you and the patient agree his or her health state to be. a summary or recap of what you have learned during the interview

What is top priority during drug consumption?

Finding out the time of the person's last drink or drug and how much

Lanugo

Fine, downy hair of the newborn

Which of the following play activities is expected for a preschooler?

Finger painting. finger painting is a creative activity for the preschooler. playing on a sports team, reading, and or playing a musical instrument are activities for older children.

What are delusions?

Firm, fixed, false beliefs, irrational

What is transduction?

First phase of nociception where painful stimulus is changed into an action potential

mouth

First segment of digestive system Airway for respiratory system

macule

Flat skin lesion with only a color change. < 1cm (freckles)

Clubbing

Flattening of the angle between the nail and its base to 180 degrees *normal is 160 degrees

Edema

Fluid accumulating in the intercellular spaces

Bitot's Spots

Foamy plaques of the cornea that are a sign of Vitamin A deficiency. Severe depltion may result in conjunctival xerosis and progress to corneal ulceration and, finally, destruction of the eye.

Chronic pain originates

From abnormal processing of pain fibers from peripheral or central sites. because the pain is transmitted on a cellular level, our current technology cannot reliably detect this process

Infants nutritional status

From birth-4 months is most rapid growth period. Infants lose weight first few days of life, but regain it by the 7th-10th day. -double their birth weight by 4 months, and triple itby 1 year -increase their length by 50% during the first year and double it by age 4 -By age 2 the brain has reached 50% of adult size which is why children under the age of 2 should not drink skim or low-fat milk.

Narrowed (Attenuated) Arteries

Generalized decrease in arteriole diameter. The light reflex also narrows. Occurs with sever hypertension and with occlusion of the central retinal artery and retinitis pigmentosa.

3 tissues of breast:

Glandular, Fibrous and Adipose

Aging Adult Considerations- nose mouth, throat

Gradual loss of sub- Q fat causes nose to look more prominent Nasal hairs become course, stiff; losing filtration function; protrude; cause itching/sneezing Decreased sense of smell from decreased olfactory nerve fibers (starts ~ 60) In oral cavity, soft tissue atrophies, epithelium thins, and taste buds decrease (taste function decreases by 80% ) Saliva production decreases.. loss of interest in food ...malnourish Atrophic tissues ulcerate more readily; increased risk infection and oral lesions Dental changes: gum recession, tooth loss, malocclusion etc.

What is dementia?

Gradual progressive process, causing decreased cognitive function

Pedigree or genogram

Graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least three generations, also highlights health issues and diseases of family members

Water-Hammer (Corrigan) Pulse-3+

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

The abuse assessment screen (AAS)

Has been used in many different health care settings, has been translated into at least seven different languages, and has strong support for reliability and validity. It has never been copyrighted, with the intention that nurses be able to revise and reformat its contents to be adaptable to their own health care setting

Spinothalmic tract

Has sensory fibers that transmit the sensations of pain, temperature, and light touch

Speculum Examination

Have one hand on the patient and one hand on the equipment Tilt the width of the blades obliquely and insert past your right fingers, applying any pressure downward. After blades are fully inserted, open them by squeezing the handles together. The cervix should be in full view.

Automaticity

Heart can contract itself, independent of any signals or stimulation from the body. Contracts in response to electrical current

What is coarctation of the aorta?

High BP in the arm due to a CONGENITAL FORM OF NARROWING, must check thigh pressure bc it will be lower note: in normal cases, thigh pressure will be higher than the arm

Kwashiorkor (protein malnutrition)

High calorie diet but without protein - looks well nourished but edematous - wieght and height are normal serum albumen <3.5 serum transferrin <150

Bronchial Sound

High pitch, loud, greater on inspiration, harsh, hollow. - Over trachea and larynx

Stridor

High-pitched, monophonic inspiratory, crowing sound - croup, acute epiglottitis, foreign inhalation, obstructed airway

Lymphedema

High-protein edema of the limb, most commonly due to breast cancer treatment protein rich lymph builds up in the interstitial spaces

Corticospinal/Pyramidal Tract

Higher motor system that humans have that permits very skilled and purposeful movements. Example: Writing

Evaluation for DVT

Homan's sign

Full, Bounding Pulse-3+

Hyperkinetic states, anemia, hyperthyroidism

4+ Reflex

Hyperreflexia with clonus

Cranial Nerve XII

Hypoglossal Motor Function: Movement of the tongue

Immune responses to pain

Impaired cellular immunity and wound healing

Paraplegia

Impairment or loss of motor and/or sensory function in lower half of body

Wernicke's area

In Temporal lobe Associated with language comprehension. When damaged, receptive aphasia results meaning the person hears sound, but it has no meaning (Like hearing a foreign language)

Broca's area

In frontal lobe, mediates motor speech. When injured, expressive aphasia results meaning the person cannot talk. (Can understand language and know what he or she wants to say but can produce it)

Genitalia in children

In girls 7-10 mons pubis thickens, labia majora thickens, pubic hair appears around 11 y/o

Skills requisite for examination are:

In order- inspection, palpation, percussion, auscultation For the abdominal region it is- inspection, auscultation, palpation, percussion

Marasmus (protein-calorie malnutrition)

Inadequate intake of protein and calories or prolonged starvation - starved appearance - weight <80% of normal, low height no labs

Superficial Varicose Veins

Incompetent valves permit reflux of blood, producing dilated, tortuous veins. Unremitting hydrostatic pressure causes distal valves to be incompetent and causes worsening of the varicosity. ****dilated, tortorous veins

Hyperventilation

Increase in both rate and depth. Occurs with fear, anxiety, DKA, hepatic coma, salicylate overdose, lesions of midbrain, alteration of blood gass

Pregnant women need what for fetal tissues?

Increased calories, protein, vitamins, and minerals

Sleep habits change with puberty due to ________ and _________.

Increased metabolism and rapid growth.

What is hyperalgesia?

Increased pain sensation

Chloasma

Increased pigmentation of the face in pregnant women

Fully Distended JVP

Indicates pulmonary hypertension, cardiac tamponade, right side heart failure Patient will exhibit restlessness and anxiety

Infants and neuro

Infant is born alert, loud, angry by 2 months old- the baby smiles and recognizes parents face, flexion turns into extension with the joints 3 months- fists hold on with tight flexion 4 months-babbling occurs, babies start to reach for an object, can hold there head inline with the body 7 months- a transfer of an object from hand to hand occur 9 months- one or 2 words are used, grasp using an opposing thumb occurs 18 months- babies are ambidextrous

Cellulitis

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

Blepharitis

Inflammation of the Eyelids. Red, scaly, greasy flakes and thickened crusted lid margins occur with staphylococcal infection or seborrheic dermatitis of the lid edge. Symptoms: burning, itching, tearing, foreign body sensation, and some pain

Pleural Friction

Inflammation of visceral or parietal pleura

SA Node

Initiates and electrical impulse. "Pacemaker"

Cervical Scrape

Insert the spatula into the vagina into the cervical os. The spatula scrapes the surface of the squamocolumnar junction and cervix.

Assess the urethra and Skenes glands by

Insert your index finger into the vagina and gently "milk" the urethra by applying pressure up and out. Procedure should produce no pain If discharge appears culture it.

In Assessing Neck Vessels...

Inspection: -Observe the jugular venous pulse -Evaluate jugular venous pressure -Auscultation and palpation -Auscultate the carotid arteries -Palpate the carotid arteries

Otoscope

Instrument used for visual examination of the ear

Standard Precautions

Intended fpr use with all patients regardless of their risk or presumed infection status1) Wash hands 2) Wear clean gloves 3) Wear mask and eye protection 4) Wear a gown 5) Be careful with used patient care equipment 6) Design/follow adequate hospital procedure 7) Be careful with used linen 8) Place infectious in private room

Erythema

Intense redness of the skin from excess blood (hyperemia) in the dilated superficial capillaries, as in fever or inflammation. Dark skinned can't see redness so palpate the skin for increased warmth, taut or tightly pulled surfaces, hardening of deep tissues or blood vessels.

The national research council's definition of elder abuse

Intentional actions that harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or person who stands in a trust relationship to the elder. failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm

Financial abuse

Intentional misuse of the elderly's financial/material resources without the informed consent of the person

What is neologism?

Inventing word that has no real meaning except for the person

Tremor

Involuntary contraction of opposing muscle groups resulting in rhythmic movement of one or more joints

Positive babinski sign

Is present in babies from birth-2 years. If it is still present after 2 years old it indicates pyramidal tract disease

A new bruise

Is red and will often develop a purple or purple blue appearance 12 to 36 hours after blunt force trauma

Graphesthesia

Is the ability to "read" a number by having it traced on the skin. With the person's eyes closed, use a blunt instrument to trace a single digit number or a letter on the palm. Ask the person to tell you what it is. This is a Good measure of sensory loss if the person cannot make the hand movements needed for stereognosis.

Cerebral Cortex Function

Is the center for humans highest functions governing thought, memory, reasoning, sensation and voluntary movement.

Cerebral Cortex

Is the cerebrum's outer layer of nerve cell bodies which look like "gray matter" because it lacks myelin

Pain

It is very private and a subjective experience greatly influenced by cultural heritage. greatly where expectations manifestations, and management of this symptoms are all embedded in a cultural context

Jugular Venous Pulse

Judges the hearts efficacy as a pump.

BEHAVIOR

LEVEL OF CONSCIOUSNESS - awake alert aware FACIAL EXPRESSION - appropriate abn: masklike expression in parkinsonism, depression SPEECH - MOOD+AFFECT - appropriate abn: mood swings with mania; bizarre w/schizophrenia

Muscles

Labored Breathing - - Diaphragm - Intercostal Muscles - Accessory neck muscles Expiration - abdominal muscles

Folk Healer

Lay healer in the person's culture apart from the biomedical/ scientific healthcare system.

Elevated JVPressure

Level of pulsation that is more than 3cm above the sternal angle while @ 45 degrees Occurs w/ Heart Failure

Periorbital edema

Lids are swollen shut and puffy. Lids are loosely connected so excess fluid is easily apparent. Occurs with local infections; crying; and systemic conditions such as congestive heart failure, renal failure, allergy, hyperthyroidism (myxedema)

parotid gland

Lies within the cheeks Largest salivary gland Two other glands: - Submandibular - Sublingual

Interpretation

Links events, makes associations, or implies cause

Right Upper Quadrant Contains

Liver-Gallbladder-Duodenum-Head of Pancreas-Right Kidney and adrenal-Hepatic flexure of colon-Part of Ascending and transverse colon

Hordeolum

Localized staphylococcal infection of the hair follicles at the lid margin. Painful, red, and swollen-a postulate at the lid margin. Rubbing eyes can cause cross-contamination and development of another stye

Diffuse pain

Localized, aching, cramping

Radial pulse

Located at the inner aspect of the wrist (thumb side)

meatus

Located beneath the turbinates - Middle meatus drains sinuses - Inferior meatus drains tears from the nasolacrimal duct

Heart

Located in the mediastinum in between the lungs. Extends from the 2nd-5th Intercostal spce -Base (upper portion)=2nd -Apex (bottom portion) =5th space

Thymus

Located in the superior mediastinum behind the sternum and in front of the aorta. It's important in developing T lymphocytes of the immune system in children

Positive Romberg Sign

Loss of balance that occurs when closing the eyes. Occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication) loss of proprioception and vestibular function

Traumatic Alopecia

Loss of hair from pulling and yanking or by other traumatic means

Abnormal Findings in Oral Exam

Malocclusion, dental carries, gingivitis, candidiasis, monilial infection, cheilits/stomatitis (sores at corners of mouth), geographic tongue (migratory glossitis), smooth glossy tongue (atrophic glossitis), cleft palate, carcinoma, carcinoma

Newborn and their eyes

May have transient chemical conjunctivitis from the instillation of silver nitrate-this appears within 1 hour but should NOT last more than 24 hours The iris is normally blue or gray in whites and brown in blacks. By 6-9 months the permanent color is identified.

Liver span

Measure height of liver in the R midclavicular line. Begin at area of lung resonance & percuss down the interspaces until sound changes to dull. Mark spot. Find abdominal tympany and percuss up midclavicular line. Mark where sound changes from tympany to dull- normally at right costal margin. Measure distance between two. Normal- 6-12 cm. Taller ppl have longer livers. Males have larger liver span. Mean 10.5 cm- male, 7 cm- female.

Hematocrit (HCT)

Measure of cell volume males: 37-49% females: 36-46% low value = insufficent Hb formation so check it with Hb

Serum albumin

Measures visceral protein status - better indicator of long-term protein status rather than acute protein malnutrition due to disease normal: 3.5-5.5 g/dl moderate depletion: 2.8-3.5 severe depletion: <2.8

Petechiae

Minute, Pinpoint, nonraised, perfectly round, purplish red spots caused by intradermal or submucous hemorrhage which later turns blue or yellow

What is an illusion?

Misperception of an actual existing stimulus

Bronchovesicular Sound

Moderate pitch and volume, equal on inspiration & expiration. - Over major bronchi (upper sternum and 1st and 2nd ICS)

Impetigo

Moist, thin-roofed vesicles with thin, erythematous base, rupture to form honey-colored crusts. contagious most common in infants and children

Corneal Abrasion

Most common result of a blunt eye injury. Irregular ridges usually visible only when fluorescein stain reveals yellow-green branching. Intense pain, foreign body sensation, and lacrimation, redness and photophobia

During an assessment of the cranial nerves, the nurse finds the following; lack of blinking in the right eye with corneal reflex, intact ability to sense light touch on face, loss of movement with facial features on the right side. This would indicate dysfunction of which cranial nerves?

Motor component of VII

Nutrient considerations for pregnant women

Need an additional 300 - 500 cal/day

UPPEr motor Neuron

Nerve Located entirely w/in CENTRAL nervous system!

Argyll Robertson Pupil

No reaction to light, pupil does not constrict with accommodation. Small and irregular bilaterally. CNS syphilis, brain tumor, meningitis, and chronic alcoholism

Interview with infant

Nonverbal communication is the primary method of communicating with infants. They respond best to firm, gentle handling and a quiet, calm voice.

Muscles

Normal Breathing - Diaphragm Intercostal Muscles

Triceps Reflex

Normal response is extension of the forearm

Renal responses to pain

Oliguria, urinary retention

What is visceral pain?

Originating from interior organs Aching, Poorly localized, Often accompanied by autonomic responses (vomiting, nausea, pallor, diaphoresis)

After menopause:

Ovarian secretion of estrogen & progesterone decreases causing breast glandular tissue to atrophy.

You will feel these slip right through your fingers when palpating the uterus/cervix?

Ovaries

Nociceptive pain can change into neuropathic pain

Over time when pain has been poorly controlled

APPEARANCE

POSTURE - erect and position is relaxed abn: restlessness w/hyperT or anxiety; slumped w/depression or organic brain disease BODY MOVEMENTS - voluntary, deliberate, coordinated, smooth and even abn: bizarre gestures ~ schizophrenia DRESS - appropriate for season, age, gender, setting abn: inappropriate dress w/organic brain syndrome; eccentric dress w/schizophrenia or mania GROOMING+HYGIENE abn: unilateral neglect post-CVA; lack of concern for appearance in depression and alzheimers;

What is chronic pain?

Pain continues for 6 months or longer

What is referred pain?

Pain felt at a particular site but originates from another location Example:inflammated appendix-->pain in periumbilical area. This is due to both sites being innervated by the same spinal nerve

Displaced PMI

Palpate chest flipped heart, enlarged heart, etc

Plaque

Papules coalesce (come together) to form surface elevations wider than 1cm. A plateaulike, disk-shaped lesion.

Left Lower Quadrant

Part of descending colon-Sigmoid colon-Left ovary and tube (female)-Left ureter-Left spermatic cord (male)

Babinskis sign

Pathologic Reflex Abnormal response is dorsiflexion of the big toge and fanning of all toes. "Upgoing toes" Occurs with upper motor neuron disease of the corticospinal tract.

Process of testing visual acuity

Patient stands 20 feet from chart and covers eyes one at a time. Patient reads the smallest line they can. If they wear glasses or contacts allow them to continue wearing them. Result is recorded using a numeric fraction at the end of the last successful line read. Should indicate whether any letters were missed and if corrective lenses were worn. (Right 20/30 -1, with glasses) or (The right eye scored 20/30, missing one letter. Pt. wearing glasses)

Biot's Respiration

Pattern is irregular. Caused by head trauma, brain abcess, heat stroke, spinal meningitis, encephalitis

Uterus

Pear-shaped, thick-walled, muscular organ. Its freely movable and not fixed and usually tilts forward and superior to the bladder.

Thoracic Exam

Percussion - Percuss across back, comparing bilaterally. Resonance across back. Flat on scapula. Dull on lower lungs

Normal Findings

Percussion - Resonance is heard across lungs except dull on lower lungs and flat over scapulae

How to Inspect EOM function

Perform Corneal light reflex (Hirschberg test) Assesses parallel alignment of eye axes by shining light towards person's eye. 1. Have patient stares straight ahead 2. Hold light ~ 12 inches away 3. Shine a light towards person's eyes Normal findings: Reflection on cornea should be in exactly the same spot on each eye. Abnormal findings: Asymmetry of the light reflex = deviation in alignment due to eye muscle weakness or paralysis

Auscultatory gap

Period during which sound disappears then reappears when taking a blood pressure measurement ( temporary disappearance of sound when taking a patient's BP)

Plantar Reflex

Position the thigh in a slight external rotation. With the reflex hammer, draw a light stroke up the lateral side of the sole of the food AND inward across the ball of the foot like in an upside down J shape. Normal Response: Plantar flexion of the toes (toes curl) and inversion and flexion of the forefoot.

Tanners maturity rating scale:

Preadolescent-small elevated nipple Breastbud stag-small mound breast/nipple; areola widens breast//areola enlarge-nipple flush w/surface Areola & Nipple form secondary mound over breast Mature Breast--Only nipple protrudes; areola flush w/breast

Past Health for children (extra)

Prenatal status, Labor and delivery, Postnatal status, are to be asked of the mother

Protodiastolic filling

Pressure in the atria is higher than that in the ventricles, so blood poors rapidly into the ventricles.

What is a person's mood?

Prolonged display of a pt's feelings

Marasmus/kwashiorkor mix

Prolonged inadequate intake of calories and protein due to severe starvation or severe catabolic states - emaciated appearance - weight <70% serum albumin <2.8 serum transferrin <100

Opisthotonos

Pronlonged arching of back with head & heels bent backward and meningeal irritation

10 traps of interviewing

Providing false assurance or reassurance, giving unwanted advice, using authority, using avoidance language, engaging in distancing, using professional jargon, using leading or biased questions, talking too much, interrupting, using "why" questions

Emergency database

Rapid collection of the database, usually compiled concurrently with life-saving measures

Fasciculation

Rapid continuous twitching of resting muscle without movement of limb

What is lability?

Rapid shift of emotions

Tachypnea

Rapid, shallow breathing. Response to fever, fear, exercise, respiratory insuffieicency, pneumonia, alkalosis, pleurisy, lesions in pons

Basal Cell Carcinoma

Rare, but occurs most often on the lower lid and medial can thus. Looks like a papule with an ulcerated center. Metastasis is rare but should be referred for removal.

Right Cerebral Cortex

Receives sensory information from and controls motor function on the left side of the body.

Left Cerebral Cortex

Receives sensory information from and controls motor function to the right side of the body

Patients should be instructed to consume alcohol in moderation:

Recommendations for moderate drinking patterns for men is 2 or fewer drinks per day; for women the recommendation is 1 or fewer drinks per day.

Breastfeeding recommendations

Recommended for full-term infants for the 1st year because it is ideally formulated to promote normal infant growth and development and natural immunity and has: 1. fewer food allergies and intolerances 2. reduced likelihood of overfeeding 3. less cost than commercial infant formulas 4. increased mother-infant interaction time

Source of History

Record who furnishes the information, judge how reliable the informant seems and how willing, note any special circumstances

Pallor

Red-pink tones of oxygenated hemoglobin in blood is lost, skin takes on the color of CT/collagen. Looks pale/white. Dark-skinned absence of underlying red tones that normally give it luster. Looks yellowish-brown, ashen, or gray.

PQ(R)STU

Region or radiation- Where is it? Does it spread anywhere?

characteristic of pulsus alternans?

Regular Rhythm

What is echolalia?

Repeats other's words or phrases

Cheyne-Stokes Respiration

Respirations gradually wax and wanein a regular pattern. Caused by severe heart failure, renal failure, meningitis, drug overdose, increased intracranial pressure

Reflection

Response echos patient's words, is repeating part of what the person says

Confrontation

Response in which examiner gives honest feedback about what he or she has seen or felt after observing a certain patient action, feeling, or statement

Facilitation

Response that encourages patient to say more, continue with story, shows person you are interested and will listen further

S3

Result from vibrations that occur during protodiastole (ventricular filling) occurs right after S2

Lymph Node Function

Retrieves excess fluid from tissue spaces and returns it to the blood stream

Cardiac Cycle

Rhythmic movement of blood through the heart 2 Phases consisting of diastole/systole

Scoliosis

S-shaped curvature of the thoracic spine

Heart Sounds

S1 is the first heart sound and it signals the beginning of systole. Closing of the AV valves produces the first heart sound. The closing of the semilunar valves produces the second heart sound known as S2. S2 signals the beginning of diastole. Sometimes there are extra heart sounds known as S3 and S4. If present, S3 can be heard early in diastole after S2. If present, S4 can be heard late in diastole, just before S1. S3 may be associated with ischemic heart disease, hyperkinetic states (e.g. anemia), or restrictive myocardial disease. S4 (atrial gallop) toward the left side of the precordium may be associated with coronary artery disease, hypertensive heart disease, cardiomyopathy and aortic stenosis. S4 toward the right side of the precordium may be heard with pulmonary hypertension and pulmonic stenosis.

chlamydia

S: 3 of 4 women have no symptoms. may have urinary frequency, dysuria or vaginal discharge, postcoital bleeding O: yellow or green mucopurulent discharge, friable cervix, cervical motion tenderness.

urethritis

S: dysuria O: palpation of anterior vaginal wall shows erythema, tenderness, induration along urethra, purulent discharge from meatus caused by neisseria gonorrhea, chlamydia or staphylococcus infection

Claudication

SEvere, cramp-like pain in the legs that occurs during exercise

Separate the ventricles and the arteries

SL Valves

In addition to initiating digestion of food, saliva also:

Saliva moistens and lubricates the food bolus, starts digestion, and cleans and protects the mucosa.

TWEAK

Screen for women with alcohol problems, esp pregnant women: Tolerance Worry Eye-opener Amnesia Kut down

What is transmission?

Second phase of nociception where pain impulse moves from the spinal cord to the brain

Functional Assessment

Self esteem, Self concept, Activity/exercise, Sleep/rest, Nutrition/elimination, Interpersonal relationships/resources, Spiritual resources, Coping and stress management, Personal Habits, Alcohol, Illicit or street drugs, Environment/hazards, Intimate partner violence, Occupational health

Tympanic membrane thermometer

Senses infrared emissions of the eardrum, which shares the vascular supply with the hypothalamus

Pre-albumin

Sensitive to acute changes in protein status normal: 15-25 mg/dl mild depletion: 10-15 moderate: 5-10 severe: <5

What is a hallucination?

Sensory perceptions for which there are no external stimuli

Deviated Septum

Septum leans to one side. Not significant unless obstructing.

Neurotransmitters that slow down or impede the pain impulse producing a analgesic effect

Serotonin, norepinephrine, neurotensin, GABA, and our own endogenous opioids, beta endorphins, enkephalins, and dynorphins

If patient says they have pain/tenderness during Homan's sign

Sign of DVT

What kinds of developmental competence does a nurse need to consider when assessing an aging adult skin, hair, nails?

Skin and Pigment changes: 1. Senile lentigines ("liver spots" small, flat, brown macules appear after extensive sun exposure; forearms and dorsa of hands 2. Seborrheic Keratoses (raised, thickened areas of pigmentation that looks crusted, scaly, warty, on trunk, face hands) dark, greasy, "stuck on" 3. Actinic Keratosis (lesions are red-tan scaly plaques over time become raised and roughened. are premalignant Moisture: xerosis (dry skin); itches; looks flaky Texture: acrochordons (skin tags) an overgrowth of skin Mobility & Turgor: skin "tents" Nails: brittle, peeling, yellowed, thickened, grow mishappen, decreased growth

What would an obtunded pt look like?

Sleeps most of time, difficult to arouse, confused when aroused, converses in monosyllables, mumbled and incoherent speech

After childbirth the os of the cervix is?

Slightly enlarged and irregular. "Smiley Faced/ Sad Faced"

Ulcer

Sloughing of necrotic inflammatory tissue that causes a deep depression in skin. Extending into dermis; irregular shape; may bleed; leaves scar when heals

Bradypnea

Slow breathing. Caused by drug-induced, increased intracranial pressure, diabetic coma

Tonic Pupil (Adie's Pupil)

Sluggish reaction to light accommodation. usually Unilateral, a large regular pupil that does react, but sluggishly after long latent time. No pathological significance

Cherry (senile) angiomas

Small (1-5 mm), smooth, slightly raised bright red dots, that commonly appear on the trunk in all adults older than 30 years. Not significant and normally increase in size

Bullous Myringitis

Small vesicles containing blood on the drum; accompany mycoplasma pneumonia and virus infections. May have blood-tinged discharge and sever otalgia

Normal Vaginal Discharge

Small, clear, or cloudy and always non-irritating.

Cervical Cancer Screening

Start 3 years after beginning vaginal intercourse but no later than 21 **After age 30 and 3 yearly normal tests in a row

Neck Muscles

Sternomastoid (head rotation and flexion) and trapezius (move the shoulders and extend and turn the head)

Components of Thoracic Cage

Sternum Ribs Vertebrae Diaphragm

Balance Test Abnormal Findings

Stiff, immobile posture. Staggering or reeling. Wide base of support. Lack of arm swing or rigid arms. Unequal rhythm of steps Slapping of foot. Scraping of toe of shoe.

Left Upper Quadrant Contains

Stomach-Spleen-Left lobe of liver-Body of pancreas-Left kidney and adrenal-Splenic flexure of colon-Part of transverse and descending colon

an 18 month old child is admitted to the hospital for pneumonia. the child is in a mist tent with 24% O2 and has an IV of D5W 0.2 NS at 45 mL/hr infusing in his right arm . what are stressors this child and his family might experience?

Strange environment, lack of control, separation anxiety. toddlers are developing a sense of autonomy so lack of control and strange environment are threatening. fear of bodily harm occurs with preschoolers, and concern about body image is associated with adolescents.

Striae gravidarum

Stretch marks that occur from a pregnant women. Metabolism is also increased to dissipate heat

Indirect/mediate percussion

Striking hand contacts the stationary hand on the pt's skin to produce a subtle vibration - stationary finger struck at distal interphalangeal joint - more common

What is a phobia?

Strong, persistent, irrational fear of an object or situation

Pain is always

Subjective

What is circumlocution?

Substituting a phrase when can't think of name of object (ex: that thing you open the door with; key)

What is blocking?

Sudden interruption in train of thought, unable to complete sentence

Bruise (Contusion)

Superficial discoloration due to hemorrhage into the tissues from ruptured blood vessels beneath the skin surface, without the skin itself being broken

It is mandatory to report abuse even if you only have a-

Suspicion that elder abuse and/or neglect may have occurred in order to generate a call to the authorities

Bruit

Swishing, blowing sound indicating blood flow turbulence *Audible when the lumen is occluded...and increases as atherosclerosis worsens.

Changes with Aging Adult- Heart Problems

Systolic BP increases due to stiffening of the large arteries Left ventricular wall thickens Heart has to work harder to increase CO

Triceps skinfold (TSF)

TSF values 10% below or above standard = undernutriton and overnutrition

Cardiac responses to pain

Tachycardia, elevated bp, increased cardiac output, increased myocardial O2 demand

Percussion

Tapping skin w/ short, sharp strokes to assess structures, yield vibration to depict location,size, and density of organ

oral cavity

Teeth (32 permanent) Tongue Gums Palate Cheeks Lips Salivary Glands

What is affect?

Temporary expression of feelings or state of mind

Ethnocentrism

Tendency to view your own way of life as the most desirable, acceptable, or best and to act superior to another culture's lifestyle.

Objective Data for Eye

Test central vision acuity and near vision Test visual fields Inspect EOM function Inspect anterior eyeball structures Test for P E R R L A

What is the Mini-Cog?

Test pt's executive function, ability to plan, manage time, organize activities, manage working memory

Kinesthesia

Test the persons ability to perceive passive movements of the extremities. (Positions) Move a finger on the big toe up and won and ask the person to tell you which way it moved. Make sure the persons's eyes are closed and that they understand the test.

Stereognosis

Test the persons ability to recognize objects by feeling their forms, sizes and weights. Example: With person's eyes closed place a familiar object like a paper clip, key, coin, cottonball or pencil in their hands and ask them to identify it. Normal Finding: Person will explore it with fingers and correctly name it. Assess with a different object in each hand.

Pain

Tested by the person's ability to perceive a pinprick.

What can be used to screen older persons who are cognitively intact for abuse?

The AMA nine question clinically effective screen

Laceration

The act of tearing or splitting; a wound produced by the tearing and/or splitting of body tissue, usually from blunt impact over a bony surface

Who has a developmental task of finding the meaning of life and the purpose of his or her own existence, and adjusting to the inevitability of death?

The aging adult

apical pulse

The apical pulse may or may not be visible. If apparent, it would be in the mitral area (left midclavicular line, fourth or fifth intercostal space). The apical impulse is the result of the left ventricle moving outward during systole.

Health

The balance/imbalance of a person, both withing one's being (physical, mental, and or spiritual) and in the outside world, ( natural, communal, and/or metaphysical)

IPV may be more difficult to distinguish in other cultures because

The battering may be hidden, covered by clothing, and heavy facial makeup by many chinese women

Religion

The belief in a divine or superhuman power or powers to be obeyed and worshiped as the creator(s) and ruler(s) of the universe; and a system of beliefs, practices, and ethnic values.

melena

The black, smelly and tarry stool is called

Techniques of Carotid Artery Examination

The carotid artery supplies blood to the brain - Palpate artery: Feel contour and amplitude of pulse. - Auscultate: Look for a bruit, which indicates a local vascular disease.

Lithotomy

The client is lying on back, w/ knees bent, thighs apart, and feet resting in stirrups. The position is used for pelvic exams in females,rectal exams& some operations.

Working phase

The data-gathering phase, includes two question types: open and closed

Heritage Consistency

The degree to which a person's lifestyle reflects his or her traditional heritage, whether it is American Indian, European, Asian, African, or Hispanic.

Pulse pressure

The difference between the systolic and diastolic pressures and reflects the stroke volume

Hemorrhage

The escape of blood from a ruptured vessel, which can be external, internal. and/or into the skin or other organ

Avoidance language

The use of euphemisms to avoid reality or hide feelings - ex: saying someone "passed on" instead of "died"

What is thought process?

The way a person thinks (logical train of thought)

Vernix caseosa

Thick cheesy substance present at birth that is made of sebum and shed epithelial cells

Crust

Thick, dried-out exudate left when vesicles/pustules burst or dry up. Color red-brown, honey, or yellow, depending on the fluids ingredients

Black hairy tongue

This is not really hair but, rather, the elongation of filiform papilale and painless overgrowth of mycelial threads of fungus infection on the tongue. Color varies from black brown to yellow. It occurs after use of antibiotics, which inhibit normal bacteria and allow proliferation of fungus.

What is accommodation

This is the adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of ciliary muscles. Lens cannot be observed directly--Are looking for convergence of the axes of the eyeballs and pupillary constriction

First level priority problems

Those that are emergent, life threatening, and immediate(establishing and airway, breathing)

Third level priority problems

Those that are important to the patient's health but can be addressed after more urgent health problems are addressed. (Knowledge deficit, altered family processes, and low self esteem)

Second level priority problems

Those that are next in urgency requiring your prompt intervention to forestall further deterioration. (mental status change, acute pain, acute urinary elimination problem, untreated medical problems, abnormal lab test results

Lichenification

Tightly packed set of papules that thickens skin. From prolonged intense scratching. Looks like surface of moss (or lichen)

PQRS(T)U

Timing- Onset, exactly when did it first occur? Duration, How long did it last? Frequency, How often does it occur?

Purpose of the assessment

To collect information and data from the patient in order to make a judgement or diagnosis

Purpose of functional assessment

To determine if patient is able to carry out ADLs (Activities of daily living) -dress, bathe, toilet, and feed self? -can they use the phone, see tv? -drive a car? -write a check?

A parent of a 20 month old toddler is concerned about how often the child seems to be getting hurt. why are toddlers prone to accidents?

Toddlers are still developing their fine and gross motor skills, while at the same time trying to exert their independence through movement. developmental tasks include developing autonomy, independence, the desire to try things along, wanting to explores more of the world away from parents, walking well, and beginning to run and climb.

CRIES Score

Tool developed for postoperative pain in preterm and term neonates. It measures physiologic and behavioral indicators on a 3-point scale. 0 is the lowest-3 is the highest in terms of pain. Measures crying, O2 stat, vitals, sleep pattern

Swan-neck deformity-

Traumatic deformity of a finger involving hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint

Lesions

Traumatic or pathological changes in previously normal structures

Trichotillomania

Traumatic self-induced hair loss...result of compulsive twisting or plucking, or child rubs head while reading or watching TV -in adults can be a sign of a personality disorder -irregularly shaped patch, with broken-off, stub-like hairs of varying lengths

True of False: school age children should be screened for scoliosis.

True: Scoliosis can be detected during the school age years and will allow for early intervention.

True or False: when a child is admitted to the pediatric unit, the nurse should keep in mind that the family of the child also needs nursing care.

True: although the child is priority, the family also needs nursing care.

Vaginal Pool

Type of Pap Smear -Gently rub the blunt end of a spatula over the vaignal wall under and lateral to the cervix.

Cranial nerve III damage

Unilateral dilated pupil with no reaction to light or accommodation, occurs with oculomotor nerve damage. May also have ptosis with eye deviating down laterally.

Horner's Syndrome

Unilateral, small, regular pupil does react to light and accommodation. A lesion of the sympathetic nerve. Ptosis and absence of sweat (anhidrosis) on same side.

What is obsession?

Unwanted, persistent thoughts or impulses

What is compulsion?

Unwanted, repetitive, purposeful act

decerebrate rigidity

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

Stroke or Cerebrovascular Accident

Upper motor neuron lesion (central). Acute neurologic deficit caused by an obstruction of a cerebral vessel or rupture in a cerebral vessel. Paralysis of lower facial muscles; upper half of face not affect. Patient can still wrinkle forehead and close eyes.

Follow up database

Used in all settings to monitor progress on short-term or chronic health problems

Stethoscope diaphragm

Used most often For high pitched sounds (breath, bowel, and normal heart sounds) Hold firmly against patient's skin

Descriptor scale

Useful for older adults, this scale lists words to indicate pain intensity, such as no pain, mild pain, moderate pain, and severe pain.

Engaging in distancing

Using impersonal speech to put space between a threat and the self by using "the" instead of "my" or "your"; blunt specific terms in preferable to defuse anxiety

Cranial Nerve X

Vagus Motor Function: Pharynx and Larynx (talking and swallowing) Sensory Function: General sensation from carotid body, carotid sinus, pharynx , viscera Parasympathetic function: carotid reflex

Cranial Nerve X

Vagus Nerve - gag reflex - midline movement (rising) of the soft palate and uvula --- say "ahhh"

which of the following sites is the most appropriate for administering an immunization to an infant?

Vastus lateralis is the most developed muscle in the infant; therefore, it is the site of choice for administering IM injections in infants.

S3

Ventricle filling sound, occurs immediately after S2

Diastole

Ventricles relax and fill with blood AV Valves are open

Empathy

Viewing the world from the other person's inner frame of reference while remaining yourself; recognizing and accepting the other person's feelings without criticism

Holistic health

Views the mind, body, and spirit as interdependent and functioning as a whole within the enviroment

Physical abuse

Violent acts that result or could result in injury, pain, impairment, and/or disease

Subjective Data for Eyes

Vision difficulty (decreased acuity, blurring, blind spots) Pain Strabismus Diplopia Redness, swelling Watering, discharge Past history of ocular problems Glaucoma Use of glasses or contact lenses Self-care behaviors

Floaters

Vitreous fluids (from debris accumulation) these are normal

What would a pt with dysphonia sound like?

Voice sounds hoarse or whispered but articulation and language are intact

Objective data

What the health professional observe by inspecting, percussing, palpating, and auscultating during the physical exam

Subjective data

What the person says about himself or herself during history taking

What is thought content?

What the person thinks (specific ideas, beliefs, use of words)

Secondary Lesions

When a lesion changes over time or changes because of a factor such as scratching or infection

Primary Lesions

When a lesion develops on previously unaltered skin

Assessment

When a nurse uses evidence-based techniques and then documents the data she is performing what part of the nursing process?

Summation

When frequent consecutive stimuli are perceived as one strong stimulus. Avoid this by letting 2 seconds elapse between each stimulus.

What is clanging?

Word choice based on sound, not meaning (includes nonsense rhymes and puns)

Jaundice

Yellow color to skin, palate, and sclera due to excess bilirubin in blood. Early jaundice in sclera and hard palate.

Explanation

You inform the patient, you share factual and objective information

What is Whispered pectoriloquy

a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue

Cardiac History Questions

a. Any chest pain or tightness? b. Any shortness of breath? c. How many pillows do you sleep on? d. Do you have a cough? e. Do you seem to tire easily? f. Ever notice your face turn blue? g. Any swelling of feet and legs? h. Do you pee at night? i. Any past history of hypertension, elevated cholesterol or triglycerides, heart murmur, congenital heart disease, rheumatic fever, unexplained joint problems, anemia? j. Any family history of hypertension, obesity, diabetes, coronary heart disease, sudden death?

Pulses

a. Brachial Pulse b. Radial Pulse c. Ulnar Pulse d. Femoral Pulse e. Popliteal Pulse f. Posterior Tibial Pulse g. Dorsalis Pedis Pulse h. Carotid Pulse i. Temporal Pulse

Pregnancy's Effects

a. Diaphragm is pushed up b. Increase in estrogen relaxes chest ligaments c. Increase in tidal volume d. Deeper breathing e. Increased lateral expansion

Questions for Respiratory History

a. Do you have a cough? b. Ever had shortness of breath? c. Any chest pain with breathing? d. Any past history of breathing trouble? e. Do you smoke? f. Are there environmental conditions that may affect your breathing? g. Last PPD test or chest x-ray?

the lymphatics of the testes drain into the

abdomen

Dysnmenorrhea

abdominal cramping and pain associated with menstruation

Point Localization

ability of person to DISCRIMINATE exactly where on body the skin has been touched

Paresthesia

abnormal sensation (such as burning, prickling, or tingling sensation, often in the extremities; may be caused by nerve damage or peripheral neuropathy

dysuria (painful urination) is common with

acute cystits, prostatitis, urethritis

What is Asthma

an abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by bronchospasm, wheezing, and dyspnea

Atelectasis

an abnormal respiratory condition characterized by collapsed, shrunken, deflated section of alveoli

What is Atelectasis

an abnormal respiratory condition characterized by collapsed, shrunken, deflated section of alveoli

What is the Braden Scale?

an evidence-based tool that looks at various factors that put patients at risk for developing a pressure ulcer. Includes: sensory perception moisture activity mobility nutrition friction shear

the outlet of the GI tract, 3.8 cm long in the adult. lined with modified skin that merges with rectal mucosa at the anorectal junction. the canal slants forward towards the umbilicus, forming a distinct right angle with the rectum, which rests back in the hollow of the sacrum.

anal canal

Arrythmia

any variation from the heart's natural rhythm

Increased Tactile Fremitus

anything that increases lung density (consolidation) - pneumonia

midline abd

aorta, uterus and bladd if enlarged

Decerebrate Rigidity

arms stiffly EXTENDED, Adducted, internally roated; legs extended, internally rotated, plantar flexed

production of sperm begins to decrease

around age 40

Posterior Tibial pulse

around the medial Malleolus and the Achilles tendon

carpal tunnel syndrome with atrophy of thenar eminence

atrophy occurs from interference with motor function from compression of the median nerve inside the carpal tunnel. caused by chronic repetitive motion; occurs between 30 and 60 years of age and is 5 times more common in women. symptoms of carpal tunnel syndrome include pain, burning and numbness, positive findings on Phalen test, positive indication of Tinel sign, and often atrophy of thenar muscles

What is the Pinna

auricle, or outer ear

Epidermis

avascular; just a protective layer; uniformly thin; derivation of skin color; 2 layers-stratum germinativum and stratum corneum

Nystagmus

back & forth oscillation of eyes

nasal cavity

back over roof of mouth. Kiesselbach plexus is on anterior septum and most common spot for nosebleeds.

nystagmus

back-and-forth oscillation of the eyes; occurs with disease of the vestibular system, cerebellum, or brainstem

Stratum Germinativum

basal cell layer; inner layer; forms new skin cells; produce melanin

Pulsus paradoxus

beats have a weaker amplitude with respiratory inspiration, stronger with expiration

puberty

beginning between the ages 8 to 13

menarche

beginning of menstrual cycle

perforated ulcer

buring epigastric pain of sudden onset that refers to one or both shoulders

Homan's sign

calf pain that occurs when the foot is sharply dorsiflexed - may occur with deep vein thrombosis, phlebitis, tendinitis or muscle injury

use of oral contraceptive and antibiotics may cause?

candidiasis

a malignant neoplasm in the rectum is asymptomatic, thus the importance of routine rectal palpation. and early lesion may be a single firm nodule. you may palpate a ulcerated center with rolled edges. as the lesion grows it has an irregular cauliflower shape and is fixed and stone hard

carcinoma

begins as red, raised, warty growth or as an ulcer with watery discharge. As it grows, may necrose and slough. Usually painless, almost always on glans or inner lip of foreskin and following chronic inflammation. enlarged lymph nodes are common

carcinoma

Covers teh surface of opposing bones. Avascular. Recieves nourishment from synovial fluid that circulates during joint movement

cartilage - tough firm consistency yet flexible

Occlusions

caused by artherosclerosis which reduces blood flow with vital oxygen and nutrients

black tarry stool

caused from occult blood; melena

RLQ

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

Superficial groups of nodes accessible to inspection/palpation

cervical nodes, axillary, epitrochlear, inguinal

Apnea

cessation of breathing

What is Apnea

cessation of breathing

rhinne test

compares air conduction and bone conduction. place stem of the vibrating tuning fork on the person mastoid process and ask him or her to signal when the sound goes away.

flaccid quadriplegia

complete loss of muscle tone and paralysis of all four extremities, indicating completely nonfunctional brainstem

scaphoid

concave shape of stomach

Venous Stasis

condition of slow blood flow in the veins

traveled to a foreign country during the past 6 months

consider parasitic infection

miosis

constricted pupils

Spasticity

continuous resistance of stretching by a muscle due to abnormally increased tension, w/ increased deep tendon reflexes

Systole

contraction of ventricles (AV valves close, semilunar valves open)

Canthus

corner of eye; angle where lids meet

the shoulder where the glans meets the shaft

corona

serum analysis of kidney function is measured with

creatinine, an end product of muscle metabolism. Normal levels range from 0.7 to 1.5 and are fairly constant from fay to day.

controls the size of the scrotum by responding to ambient temperature. this is to keep the testes at 3 degrees C below abdominal temperature the test temperature for producing sperm

cremaster muscle

A-V crossing

crossing paths of an artery and vein in the ocular fundus

testes that have never descended.

cryptorchidism

How does a nurse assess an abnormal pigmentation of a lesion that is suspicious for malignant melenoma?

danger signs for abnormal characteristics or pigmented lesions A-asymmety: not regularly round or oval, two halves of lesion do not look the same B-border irregularity: notching, scalloping, ragged edges or poorly defined C-color variation: areas of brown,tan, black, blue, red, white, or combination D-diameter greater than 6mm E-elevation and enlargement

Areola

darkened area surrounding nipple

Leukoedemia

darkly pigmented people

presbyopia

decrease in power of accommodation that occurs with aging

Deep cervical

deep under the sternomastoid muscle

Three types of veins

deep, superficial, perforators

QRS complex

depolarization of the ventricles

occur with gastroenteritis, colitis, irritable colon syndrome

diarrhea

Dyspnea

difficult, labored breathing

What is Dyspnea

difficult, labored breathing

Dysphagia

difficulty swallowing

Hypoactive bowel sounds

diminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis; from paralytic ileus as following abdominal surgery; or from late bowel obstruction. Also occurs with pneumonia.

oliguria

diminished quantity, <400 mL in 24 hours

directly behind and through external inguinal ring, rarely enters the scrotum, usually painless, round swelling close to the pubis in area of internal inguinal ring; easily reduced when supine. less common, more often in men older than 40 rare in women. acquired weakness brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites

direct inguinal hernia

Dorsal

directed toward or located on the surface

What is Otorrhea

discharge from the ear

Palpebral fissure

elliptical open space between eyelids

Acromegaly (hyperpituitarism)

excessive secretion of growth hormone in adulthood, after normal completion of body growth, causes overgrowth of bone in the face, head, hands, and feet but no change in height. internal organs also enlarge, and metabolic disorders may be present

Furuncle

exquisitely painful, reddened, infected hair follicle. It may occur on the tragus on the cartilaginous part of the ear canal. Regional lymphadenopathy often accompanies a furuncle.

Tail of Spence

extension of breast tissue into the axilla

Vulva

external genitalia of female

under voluntary control and surrounds the internal sphincter

external sphincter

normal finding for the liver

feeling the border of the liver, firm with smooth ridge or not palpable

What are alveoli

functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen

Pseudostrabismus

has the appearance of strabismus because of epicanthic fold but is normal for a young child.

Pediculosis capitis

head lice, common among school-age children. causes intense itching of the scalp

Stratum Corneum

horny cell layer; cells constantly shed

two main causes of chronic kidney disease

hypertension and diabetes

meatus opens on the ventral side of the glans, shaft, or at the penoscrotal junction. a groove extends form the meatus to the normal location at the top. this is a congenital defect that is important to recognize at birth. the newborn should not be circumcised because surgical correction may use foreskin tissue to extend urethral length

hypospadias

Chronic Arterial Vascular Disease

i. Deep muscle pain in calf or lower leg ii. "cramping" or "tingling" of affected area iii. Walking or elevation irritate pain iv. Cool, pale skin is an associated factor Causes: - Old people, Males, Hypotension, Smoking, Diabetes, hypercholesterolemia, obesity, vascular disease

ballottement of patella

if fluid has collected, tap on the patella will be heard against femoral condyle

vertigo

if labyrinth ever becomes inflamed, it feeds the wrong info to the brain, creating a staggering gait and a strong, spinning, whirling sensation

Perforation

if the acute otitis media is not treated, the drum may rupture from increased pressure. Perforations also occur from trauma. Usually the perforation appears as a round or oval darkened area on the drum. Central perforations occur in the pars tensa. Marginal perforations occur at the annulus. Marginal perforations are called attic perforations when they occur in the superior part of the drum, then pars flaccida

a full 5 min

if you find absent bowel sound you have to listen for ...

Vertigo

illusory sensation of either the room or one's own body spinning; its not the same as dizziness

dysphasia

impairment in speech consisting of lack of coordination and inability to arrange words in their proper order

Dysarthria

imperfect articulation of speech

hypercapnia

increase of CO2 in blood

Vaginitis

inflammation of vagina

nontarry, black stool

ingestion of iron medications

pica

irregular eating patterns are common and a source of parental anxiety

Hemiplegia

loss of motor power (paralysis) on one side of the body

hyperactive Bowel sound

loud gurgling "borborygmi", high pitched, rushing, tinlking sounds signaling increase motality

Eversion

moving the sole of the foot outward at the ankle

Inverted

nipples that are depressed or invaginated

exudate

note any color or odor

OS

oculus sinister, or left eye

Dysuria

painful urination

Arterisclerosis

peripheral blood vessels that grow more rigid with age

how can prior experiences with pain influence current sensitivity to pain?

prior experience can decrease sensitivity if prior pain relief measure were effective. prior experience can increase sensitivity if prior pain relief measure were ineffective.

Sebaceous glands

produce a protective substance that is secreted through hair follicles, which oils and lubricates the skin and hair and retards water loss from skin

apocrine glands

produce a thick milky secretion and produces a musky odor

Excessive Cerumen

produced or is impacted because of narrow, tortuous canal or poor cleaning method.

eccrine glands

produces dilute saline solution (sweat)

Diaphoresis

profuse perspiration, accompanies an increased metabolic rate, such as in heavy activity or fever

Near vision

pupils constrict

Far vision

pupils dilate

Wheal

raised red skin lesion due to interstitial fluid(erythematous); transient(lasting a short time); slightly irregular shape due to edema (mosquito bite)

project like rabbit ears above the prostate. secrete a fluid that is rich in fructose, which nourishes the sperm and contains prostaglandins

seminal vesicles

Smooth glossy tongue (atrophic glossitis)

surface is slick and shiny, mucosa thins and looks red from decreased papillae. Occurs from vit. b12 deficiency-pernicious anemia, folic acid deficiency and iron deficiency

Plantar

surface of the sole of the foot

Cooper's ligaments

suspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles

joint effusion

swelling from excess fluid in joint capsule. best observed anteriorly; fluctuant to palpation; considerable fluid must be present to cause a visible distention because the capsule is normally so loose

Lymphedmea

swelling of an extremity due to obstructed lymph channel - nonpitting

Systolic Murmur

swooshing sound after S1

Diastolic Murmur

swooshing sound after S2

What is the Xiphoid Process

sword-shaped lower tip of the sternum

Xiphoid process

sword-shaped lower tip of the sternum

what is the expected outcome of the facial nerve in a 14 year old adolescent?

symmetrical facial movements

Free movable because they have bones that are separated from each other and are closed in a joint cavity

synovial joints aka diarthrosis

tension HA

tend to be occipital, frontal or bandlike tightness viselike feeling -anxiety and stress are associated with them

Vital capacity

the amount of air following maximal inspiration that can be exhaled

the anal columns extend vertically down from the rectum and end in ______________. not palpable but visible on protscopy

the anorectal junction

Which of the following activities demonstrates that a school-age child is working toward a healthy achievement of Erikson's developmental task of industry?

the child brings home completed school work to show parents. school age children are working on developing a sense of industry, which becomes inferiority when the child does not achieve the tasks. school age children are proud of their academic achievements. while it may be easier to watch TV or to let others help decide what to wear, those activites do not demonstrate industry. following the rules helps the child develop feelings of accomplishment and achievement.

Fissure

the narrow crack dividing the lobes of the lungs

Bronchovesicular

the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration

What is Bronchovesicular

the normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration

What is the Pupillary Light Reflex?

the normal constriction of the pupils when bright light shines on the retina

how does elderly hair gray?

the number of functioning melanocytes decrease

The mother of a 9 year old child reports that her son develops stomach cramping every sunday night before school how can the nurse assist this parent and child?

the nurse can explore with the child's mother possible reasons for this behavior. the child may be experiencing difficulties with academics, peers, and or teachers. the nurse can give the mother guidance as to how to talk with her child. follow-up may be necessary to determine the need for referrals for additional help for the child.

Egophony

the voice sound of "eeeeee" heard through the stethoscope

what is plantar grasp?

toes will curl downward when sole of foot is touched.

Vessels

tubules for transporting fluid

Pronation

turning the forearm so that the palm is down

decerebrate rigidity

upper extremities stiffly extended, adducted, internal rotation, palms pronated. lower extremities stiffly extended, plantar flexion; teeth clenched, hyperextended back. ominous. indicates lesion in brain stem at midbrain or upper pons

assessing rebound tenderness

using the tips of fingers pressed deeply into area opposit of that identified as tender---and them quickly removed

occult bleeding

usually indicates colon cancer

voice sounds

usually not done in routine exam. Test for presence of bronchophony, egophony, & whispered pectoriloquy

Venous Ulcers

usually occure at the medial Malleolus

Adnexa is/are

uterine accessory organs.

in females this structure lies in front of the anterior rectal wall and may be palpated through it

uterine cervix

muscular duct that is continuous with the lower part of the epididymis.

vas deferens

Profile sign

view the index finger at its profile and note the angle of the nail base; Normal 160 degrees or less.

Profile Sign

viewing the finger from the side to detect early clubbing

The parents of a 14 month old toddler want to know why their daughter has not been responsive to toilet training. the toddler is standing by herself but still crawls for locomotion. her vocabulary is developing, but she does not seem to understand what it means to go "potty". what skills will this toddler need to develop before she is able to achieve toilet training?

voluntary control of anal and urethral sphincters; gross motor skills of sitting, walking and squatting; fine motor skills for removing clothing; communication skills to indicate toileting need; cognitive skills to follow directions; and the ability to recognize the urge for toileting.

Tandem walking-

walking in a straight line in a heel to toe fashion

Pallor

white

Candidiasis

white, cheesy, curdlike patches on tongue and buccal mucosa - aka "thrush"

Which of the following foods are introduced into an infants diet after 1 year.

whole milk, eggs, peanuts. food that may be introduced during infancy include iron-fortified cereals, most green and yellow vegetable, most fruits, and meat. whole milk is not given due to the infant's need for iron, which is not part of a whole milk. eggs may cause an allergic reaction; therefore, they are delayed and then introduced slowly. nut products present a choking hazard.

what is palmar grasp?

will grasp object when palm is touched.

Cushing syndrome

with excessive secretion of corticotropin hormone (ACTH) and chronic steroid use, the person develops a plethoric, rounded, "moonlike" face; prominent jowls; red cheeks; hirsutism on upper lip, lower cheeks, and chin; and acneiform rash on chest.

pink urine

with menses; some foods like beets, berries, food dyes; some laxatives; kidney stones; UTI

what test do you use in adolescents to screen for scoliosis?

with the forward bend test

thoracic breathers

women

Phalen test

wrists are bent down with backs of each hand touching / carpal tunnel sufferers feel tingling or pain within 60 seconds

A nurse suspects that a 15 year old adolescent is experiencing pain. the nurse ask if the adolescent would like her pain medication. the adolescent tells the nurse that she will wait until the pain worsens. which of the following statements by the nurse is most appropriate in response to the adolescent's pain?

" If you let the pain get too bad, the medication will not work as well." giving medication when pain is perceived keeps the pain under control. it is easier to prevent pain than to treat it. the adolescent should be able to understand this concept.

infants (mouth)

- Salivation at 3 months, drool - 20 baby teeth 6mo-2.5yrs --- start falling out and being replaced by 32 permanent teeth 6-12yrs - Ebstine pearls- normal finding in newborns and infants, small whitish pearly papules along hard palate and on gum. Look like teeth, but are cysts and disappear within few weeks - bednaaphtahe (traumatic areas on palate from sucking) - tonsils not visible.

Aphasia

- any defects in or loss of the power to express oneself by speech, writing, or signs

Anosmia

- decreased or loss of smell.

aging adult

- decreased taste buds - decreased saliva - tooth loss - malocclusion - pursed string lips - yellow teeth - receding gumlines - thin buccal (shiny) mucosa - Xerostomia - dry mouth

Dysphasia

- difficulty with language comprehension or expression.

AV Node

-AV node: slightly delays incoming electrical impulses from the atria, then relays the impulse to the AV bundle.

Electrical Conduction of the Heart

-Cardiac cycle: the events associated with the filling and emptying of the cardiac chambers.

Cardiac Cycle

-Filling and emptying of the heart's chamber -Two phases: diastole and systole Diastole - relaxation of the ventricles Systole - contraction of the ventricle

The rectovaginal septum should be:

-Smooth, thin, firm and pliable -Rectovaginal pouch is usually not palpable -Uterine wall and fundus should feel smooth and firm.

Equipment for Heart and Neck Vessels Assessment

-Stethoscope with a bell and diaphragm -Small pillow -Penlight or movable examination light -Watch with second hand -Centimeter rulers

QT interval

-Total time for ventricular depolarization and repolarization -from the beginning of Q wave to the end of T wave -Varies with heart rate

TMJ

-temporal mandibular joint. Open mouth wide, move side to side, palpate TMJ. Is there crepitus or tenderness?

Systemic circulation

-the right side of the heart pumps blood to the lungs for gas exchange -the left side of the heart pumps blood to all other parts of the body

1=Hypoalgesia 2=Hyperalgesia 3=Analgesia

1=decreased pain sensation 2=increased pain sensation 3=absent paint sensation

1=Hypoesthesia 2=Anesthesia 3=Hyperesthesia

1=decreased touch sensation 2=absent touch sensation 3=increased touch sensation

When can infants lift their head when prone?

2 months

Genu varum

- A deformity marked by medial angulation of the leg in relation to the thigh; an outward bowing of the lower extremities (bowleg).

Hallux valgus

- A deviation of the tip of the great toe, or main axis of the toe, toward the outer or lateral side of the foot.

Ballottement

- Maneuver used to estimate the size, shape, or consistency of an organ not near the surface, particularly when there is ascites, by a rhythmic, thrusting motion of the hand or fingers similar to that involved in bouncing a ball.

Boutonnière deformity

- Rupture of the central slip of a digital extensor tendon at the middle phalanx, marked by extension of the metacarpopophalangeal and distal interphalangeal joints and flexion of the proximal interphalangeal joint.

P E R R L A

P, Pupils; E, Equal; R, Round; R, React to light; A, Accommodate to test for this use:Inspect both for round and equal Test Pupillary light reflex Test Accommodation

Cryptorchism

- Failure of one or both of the testes to descend.

Hypertrophy

- General increase in bulk of a part or organ, due to increase in size

A nasal polyp may be distingished from the nasal turbinates for 3 of the following reasons:

The polyp is movable The polyp is pale gray in color The polyp is nontender

Mean arterial pressure (MAP)

The pressure forcing blood into the tissues, averaged over the cardiac cycle

Socialization

The process of being raised within a culture and aquiring the characteristics of that group.

Sinus arrhythmia

The rate usually increases with inspiration and decreases with expiration (towards normal). , irregular heartbeat originating in the sinoatrial node

Pulse rhythm

The regularity of the time between each heartbeat

what is the expected outcome of the abducens nerve in a 14 year old adolescent?

able to look laterally with eyes

Ascites

abnormal accumulation of serous fluid within the peritoneal cavity, associated with congestive heart failure, cirrhosis, cancer, or portal hypertension

Pleural effusion

abnormal fluid between the layers of the pleura

Hernia

abnormal protrusion of bowel through weakening in abdominal musculature

Paresthesia

abnormal sensation (i.e burning, numbness, tingling, prickling, crawling skin sensation

Cotton-wool area

abnormal soft exudates visible as grey- white areas on the ocular fundus

Pulse ratings

0= absent 1+= weak, thready 2+= normal 3+= bounding

red urine

blood in urine; nephritis, cystits; cancer; following prostate surgery

hematemesis

blood in vomiting (esophageal varisises, ulcer upper GI)

Subcutaneous layer

made up of adipose tissue (fat), aids protection by cushioning,

Femoral Artery

major artery in the leg that passed under the inguinal ligament

humoral regulation

major feedback loop

Postioning for Auscultation

making abnormal heat rhythms more audible - Leaning forward in the sitting position (aortic) - laying on left side (S3 & S4)

penis and scrotum

male external genital structures

testis, epidydymis, and vas deferens

male internal genital structures

Angle of Louis

manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib

When administering oral medications to a child with a feeding tube, the nurse knows to....

check tube placement, administer medication by gravity flow, flush adequately , and clamp tubing.

expiration

chest recoils; passive

what causes conductive hearing loss?

may be causes by impacter cerumen, foreign bodies, a perforated tympanic membrane, pus or serum in the middle ear and otosclerosis (decrease in mobility of the ossicles.)

when can the deltoid be used for injections?

may be used for toddlers and older children. less local side effects than with vastus lateralis. may use the sitting position.

when can the ventrogluteal site be used for injection?

may be used for toddlers and older children. may use the prone position

When can the vastus lateralis injection site be used?

may be used for toddlers and older children. recommended site for infants < 2 years. may use the sitting position.

tuning fork tests

measure hearing by air conduction or by bone conduction, in which the sound vibrates through the cranial bones to the inner ear.

rinne and weber test

measures hearing by air conduction (AC) or bone conduction (BC) in which the sound vibrates through the cranial bones to the inner ear. AC route through ear canal is usually most sensitive route. evidence shows both weber and rinne are inaccurate and do not yield precise data and should not be used for general screening.

Raynauds phenomenon

occurs in te hands and feet when exposed to cold, stress or vibration

Venous hum

occurs rarely. Heard in periumbilical region. Originates from inferior vena cava. Medium pitch, continuous sound, pressure on bell may obliterate it. May have palpable thrill. Occurs with portal hypertension and cirrhotic liver.

decreased fremitus

occurs when anything obstructs transmission of vibrations (e.g., obstructed bronchus)

increased fremitus

occurs when compression or consolidation of lung tissue (e.g., lobar pneumonia). Creates loud, low-pitched voice.

Brown discoloration in the leg

occurs with chronic venous stasis due to hemosiderin deposits from red blood cell degradation

dysphagia

occurs with disorders of throat or esophagus, difficulty swallowing

scrotal swelling may be taut and pitting

occurs with heart failure, renal failure, or local inflammation

Enlarged epitrochlear node

occurs with infection of the hand or forearm

bulge sign

occurs with very small amounts of effusion, 4-8 ml from fluid flowing across joint Within the suprapatellar pouch, this confirms the presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other. Occurs with very small amounts of effusion.

at birth, the external genitalia are engorged because

of the presence of maternal estrogen

Bronchiole

one of the smaller respiratory passageways into which the segmental bronchi divide

What are Bronchioles

one of the smaller respiratory passageways into which the segmental bronchi divide

Menarche

onset of first menstruation, usually occurring around 11 to 13 years of age

Peau d'orange

orange-peel appearance of the breast due to edema

painless flabby papules are due to a varicose vein. external

originates below the anorectal junction and is covered by anal skin. when thrombosed it contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation. internal - originates above the anorectal junction and is covered by mucous membrane - hemorrhoid

Superior/Inferior Vena Cava

return blood to the right atrium from the upper and lower torso respectively

inflammation joint changes. morning-stiffness. commonly seen in hands.

rheumatoid arthritis

Artery walls

strong tough tense and can withstand pressure demands

when the bone is partially out of joint?

subluxation. common in baby. alignment is off.

Paroxysmal nocturnal dyspnea

sudden awakening from sleeping with shortness of breath

What is Paroxysmal nocturnal dyspnea

sudden awakening from sleeping with shortness of breath

Chroea

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face

Gout

- A disorder characterized by a raised blood uric acid level and severe recurrent acute arthritis of sudden onset resulting from deposition of crystals of sodium urate in connective tissues and articular cartilage

Claw foot

- A fixed contracture of the foot characterized by hyperextension at the metatarsophalangeal joint and flexion at the interphalangeal joints.

Epispadias

- A malformation in which the urethra opens on the dorsum of the penis; frequently associated with exstrophy of the bladder.

Plantar wart

- A painful wart on the sole; usually caused by human papillomavirus

Glasgow Coma Scale

- A scale used to assess level of consciousness and reaction to stimuli in a neurologically impaired patient based on performance in three categories: eye opening, verbal response-performance, and motor responsiveness.

Papanicolaou (Pap) smear

- A smear of vaginal or cervical cells obtained for cytologic study.

nasopharynx

- Behind the nasal cavity - Above the oropharynx, but also continuous with the oropharynx - pharyngeal tonsils and eustachian tube openings located here

Functions of the Lymphatic System

1. Conserve fluid and plasma proteins that leak out of the capillaries. 2. To form a major part of the immune system that defends the body against disease. 3. To absorb lipids from the intestinal tract

Phimosis

- Condition in which the foreskin (prepuce) opening cannot be drawn back over the penis glans.

Aphthous ulcers

"canker sores"--small, painful, round ulcers in the oral mucosa of unknown cause

smegma

"cheesy substance" that may have collected under the foreskin

herpes simplex

"cold sores"--clear vesicles with red base that evolve into pustules, usually at sip-skin junction

What is the Tympanic Membrane

"eardrum" thin, translucent, oval membrane that stretches across the ear canal and separates the middle ear from the outer ear

What is the Malleus

"hammer" first of 3 ossicles (bones) of the middle ear

Extra heart sounds (S3-S4)

-diastolic filling sounds -result from ventricular vibration secondary to rapid ventricular filling -S3: ventricular gallop -S4: atrial gallop

Buddhist food restrictions

All meat

Cachectic Appearance

accompanies chronic wasting diseases such as cancer, dehydration, and starvation. Features include sunken eyes; hollow cheeks, and exhausted, defeated expression.

olfactory receptors

Hair cells located at the roof of the nasal cavity and in the upper one third of the septum. - They merge into the olfactory nerve, which transmits to the temporal lobe of the brain

Infants and Children skin

Hair follicles develop in the fetus at 3 months. newborns skin is thin, smooth and elastic, and more permeable causing the infant to be at a greater risk for dehydration -Temp regulation is ineffective

What is the yin/yang theory of health?

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

Infant (Heart)

Heart beats 3 weeks. Foramen Ovale is present before breathing to circulate blood. Foramen Ovale closes 1 hr after birth. Ductus arteriousus (closes 10-15hrs later), Murmurs if don't close. More horizontal heart position.

Keloid

Hypertrophic scar. Elevated beyond site of original injury by excess scar tissue. May increase long after healing occurs. looks smooth, rubbery, "clawlife", and has a higher incidence among blacks.

Cranial Nerve XII

Hypoglossal Nerve - have person stick out their tongue --- it should protrude midline with no tremor or deviation

Pulmonary responses to pain

Hypoventilation, hypoxia, decreased cough, atelectasis

Shallow Anterior Chamber

Iris pushed anteriorly because of increased intraocular pressure. When light is shined on temporal side, it casts a shadow on the nasal side, "shadow sign." Sign of acute angle-closure glaucoma; the iris looks bulging because aqueous humor cannot circulate.

Dehydration

Look in oral mucous membranes. Normally looks smooth and dry. Dark skin may look dry and flaky but thats normal. Abnormal looks dry and lips look parched and cracked.

Infants/childhood may have what development issue with their spinal cord?

Lordosis

Lifestyle modifications for high BP

Lose weight Limit alcohol Regular exercise Cut sodium Recommended daily potassium, Ca, magnesium Stop smoking Reduce saturated fat and cholesterol

2+ Reflex

Normal Response

What is breakthrough pain?

Pain restarts or escalates before next schedule analgesic dose

Thrill or Heave (Lift)

Palpate chest "purring" is a thrill Thrill cause: turbulent blood flow; accompanies murmurs

Thoracic Exam

Palpation - - expansion (anterior and posterior), - tactile fremitus (5 areas bilaterally on posterior, 4 areas bilaterally anteriorly) - have person repeat phrase

Normal Findings

Palpation - Hands should separate symmetrically and feel tactile fremitus equal bilaterally. No tenderness, lumps or masses and lesions.

Temporal Lobe

Primary auditory receptor

CAGE

Questionnaire for busy settings for lifetime alcohol abuse/dependence: Cutdown Annoyed Guilty Eye-opener

Deep tendon reflex

Reveals the intactness of the reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels. Consists of: Biceps, Triceps, Brachioradialis, Quadriceps, Achilles Reflexes

oropharynx

Right behind the oral cavity/mouth Contains the tonsils

Mons Pubis

Round firm pad of adipose tissue, after puberty hair is distributed here.

candidiasis (moniliasis)

S: intense pruritus, thick whitish discharge O: vulva and vagina are erythematous and edematous. discharge is usually thick, white, curdy "Like cottage cheese"

What is allodynia?

Severe pain sensation evoked with a stimulus that doesn't normally induce pain

Otitis Externa

Severe swelling of canal, inflammation, tenderness. Canal lumen is narrowed to 1/4 of it's normal size

PQR(S)TU

Severity scale- How bad is it (on a scale of 1 to 10)? Is it getting better, worse, or staying the same?

What is loosening associations?

Shifting from one topic to an unrelated topic

Bullous myringitis

Small vesicles containing blood on the drum; accompany mycoplasma pneumonia and virus infections. may have blood-tinged discharge and severe otalgia

Exotosis

Small, bony hard, rounded nodules of hypertrophic bone, covered with normal epithelium. They arise near the drum but usually do not obstruct the view of the drum. Usually multiple and bilateral. May occur more in cold water swimmers

Newborns genitalia

Somewhat engorged, labia majora are swollen, labia minora are prominent and protrude beyond the labia majora, hymen appears thick

Musculoskeletal responses to pain

Spasm, joint stiffness

You should turn this at 2 and 8 o' clock once your inside the vagina then you can turn it back straight up and down?

Speculum

Cranial Nerve XI

Spinal Motor Function: Movement of the trapezius and sternomastoid muscles

Koilonychia

Spoon nails. Could be hereditary or due to an iron deficiency

True of False: the need for an interpreter may inhibit the support that families need during the illness of a child.

True: language and cultural barriers may impede the support structure that families need during the illness or death of a child.

increased WBC occur with

UTI

Jargon

Using medical vocabulary with patient in an exclusionary and paternalistic way

Nose

Warms, moistens and filters inhaled air Sensory organ for smell

Risk for DVT

With an impairment in the lymphatic system

amenorrhea

absent menses

2-Point discrimination

ability to distinguish the separation of 2 simultaneous pinpricks on skin

what is the expected outcome of the trigeminal nerve in a 14 year old adolescent?

able to clench teeth together.

Waist-to-hip ratio

waist circumferance/hip circumferance - assesses body fat distribution men > 1.0 or women > 0.8 = android (upper body) obesity = greater risk of obesity related disorders and mortality

myopia

"nearsighted"; refractive error in which near vision is better than far vision

Nevus

(mole) circumscribed skin lesion due to excess melanocytes

glasgow coma scale

15 = no coma, 7 coma, 3 profound coma. Eye opening, verbal response, motor response

Reflexive sympathetic dystrophy or complex regional pain syndrome

A chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration of the affected extremity. If affects both men and women, usually around 40-60 and occurs weeks to months after a nerve inury. involves a complex interaction of sensory, motor, and autonomic nerves, as well as the immune system. Nerve injury may modify the usual pain pathway causing a neuropathic windup or short circuit mechanism. KEY FEATURE: typically innocuous stimulus can create a sever, intense painful response.

Ad hoc

A relative or friend used as an interpreter

Korotkoff's sounds

A series of five sounds produced by blood within the artery with each ventricular contraction

Neuropathic pain implies

An abnormal processing of the pain message from an injury to the nerve fibers. it is the most difficult pain to assess and treat

Paresthesia-

An abnormal sensation (e.g., burning, pricking, tickling, or tingling).

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

What is flight of ideas?

Abrupt change, rapid skipping from topic to topic

What is analgesia?

Absent pain sensation

Cranial Nerve VIII

Acoustic Sensory Function: Hearing and equilibrium

Puncture

Act of piercing or penetrating with a pointed object or instrument

What is delirium?

Acute confusional change or loss of consciousness and perceptual disturbance

Introduction

Address the patient using his or her surname. Introduce yourself and state your role in the agency. Give reason for the interview

Sutures

Adjacent cranial and facial bones (except mandible) unite at meshed immovable joints

Separate the atria and the ventricles

AV Valves

Cranial Nerve VI

Abducens Motor Function: Lateral movement of the eye

What is a normal finding in the Mini-Cog?

Ability to recall all three words and draw a complete, round, closed clock circle with all face numbers present

Stereognosis

Ability to recognize objects by feeling their form, sizes, and weights while eyes closed

Peripheral Neuropathy

Abnormal Finding for Vibration Test Is worse at the feet and gradually improves as you move up the leg.

Venous (Stasis) Ulcer

After acute DVT or chronic incompetent valves in deep veins objective-firm, brawny edema, course, thickened skin *****ulcers occur at the medial malleoulous and have uneven edges that bleed

Silence

After open ended questions, communicates that the patient has time to think and organize what he or she wishes to say

Islamic food restrictions

All pork and pork products Meat not slaughtered according to ritual Alcoholic beverages and alcohol products, coffee and tea. Food and beverages before sunset during ramadan

Seventh-Day Adventist food restrictions

All pork and pork products Shellfish Meat, dairy products, and eggs by some Alcoholic beverages, coffee and tea Highly seasoned foods

Otitis Media with Effusion (OME)

An amber-yellow drum suggests serum in middle ear that transudates to relieve negative pressure from the blocked eustachian tube. you may note an air/fluid level with fine black dividing line or air bubbles visible behind drum. Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also called serous otitis media (glue ear)

Mydriasis

Dilated and fixed pupils. Enlarged pupils occur with stimulation of the sympathetic nervous system, reaction to sympathomimetic drugs, use of dilating drops, acute glaucoma, or past or recent trauma. CNS injury, circulatory arrest, or deep anesthesia

People with dementia

Do feel pain, the somatosensory cortex is generally unaffected by dementia of the Alzheimer type. PAINAD scale is used-evaluates five common behaviors of breathing, vocalization, facial expression, body language, and consolability

What is cutaneous pain?

Pain originating from skin surface or subcutaneous structures

Intraretinal Hemorrhages

Dot-shaped hemorrhages, deep intraretinal hemorrhages that look splattered on. May be distinguished from micro aneurysms by the blurred irregular edges.

When instilling an otic solution into a child's ear, the nurse should pull the auricle________.

Down and back. pulling the auricle down and back, instead of up and back as in an adult will help open the ear canal and facilitate administration of the medication. this method straightens the child's ear canal, making it easier to instill the otic solution.

Veins

Drain deoxygenated blood and waste products from the tissues and return it to the heart. They are called Capacitance Vessels because they can stretch and hold more blood when blood volume increases which= less stress on the heart

What is nociception?

Process where noxious stimuli are perceived as pain Example:skinned knee, kidney stones, menstrual cramps, muscle strain, venipuncture, or arthritic joint pain

Nociception

Process whereby noxious stimuli are perceived as pain; central and peripheral nervous systems are intact

Cultural Care Nursing

Professional health care that is culturally sensitive, appropriate, and competent.

T/F: The Pulmonary Artery returns oxygenated blood to the left atrium

False. -The pulmonary artery carries blood to the lungs.

T/F: Physiologic murmur is not associated with any physical abnormality; it occurs when the ejection of blood into the aorta is turbulent.

False. Physiologic murmur is caused by a temporary increase in blood flow; it can occur with anemia, pregnancy, fever, and hyperthyroidism.

Achilles Reflex

Foot plantar flexing againist your hand is the normal response

Abuse during pregnancy is also a significant health problem with serious consequences

For both mother (depression, substance abuse) and baby (low birth weight, increased risk for child abuse)

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

Pulse

Force of pumping heart flares the arterial walls, generating a pressure wave which is felt in periphery

Pulse force

Force shows the strength of the heart's stroke volume. "weak thready" pulse reflects a decreased SV (i.e. occurs with hemorrhagic shock) "full, bounding" pulse denotes increased SV: anxiety, exercise, and some abnormal conditions. Recorded using a three-point scale: 3+ full, bounding 2+ normal 1+ weak, thready 0 absent Scale is somewhat subjective

Heaves/Lifts

Forceful thrusting of the ventricles. May not be visible

Cranial Nerve IX

Glossopharyngeal Motor Function-pharynx including swallowing and phonation Sensory Function- taste on posterior one-third of the tongue, pharynx (gag reflex)

Multiple factors can contribute to older adults more readily or more severely than younger people

Medications and abnormal blood values related to medidation side effects and underlying hematologic disorders can affect ease of bruising or the formation of ecchymosis Meds include: aspirin, ibuprofen, any of the NSAIDS, warfarin, heparin, valproic acid, prednisone, and clopidogrel Herbal remedies include:bilberry, garlic, ginger, and ginkgo

5 phases of Korotkoff's sounds

I - Tapping- soft clear increasing intensity (SYSTOLIC) II - Swooshing - soft murmur follows tapping III - Knocking - crisp high pitched sound IV - Abrupt muffling- mutes to low-pitched cushioned murmur; blowing quality V- Silence (DIASTOLIC)

Dacryocystitis

Infection and blockage of sac and duct. Pain, warmth, redness, and swelling occur below the inner can thus, toward the nose. Tearing is present. Pressure on sac yields purulent discharge from puncta.

Lobar Pneumonia

Infection in lung parenchyma; bacteria, debris, & fluid replace alveolar air leading to hypoxemia. Inspect: increased resp rate. lag on infected side. Palpate: chest expansion on affected side. Tactile fremitus increased if bronchus patent, decreased if bronchus obstructed. Percuss: dull over lobar pneumonia. Asucultate: louder breath sounds w patent bronchus. Adventitious sounds: crackles fine - medium.

Dacryoadenitis

Infection of the lacrimal gland. Pain, swelling, and redness occur in the outer third of the upper lid. Occurs with mumps, measles, and infectious mononucleosis or trauma.

an adolescent visits the school nurse because of pain in his shoulder. the nurse discovers that the adolescent has been lifting weights daily as he prepares for baseball. what should the nurse include in her discussion with the adolescent to help reduce the risk for further injury?

Instruct the adolescent to consult with his coach to make sure the proper technique is being used for weight lifting. adolescents need to know how to properly use the sporting equipment to prevent injuries. weight lifting can be continued if the equipment is properly used. even if braces are used when lifting weights, if the equipment is not properly used, injury can occur. discussing arthritis is not appropriate at this time since specific injuries have not been identified.

Hypoventilation

Irregular, shallow pattern. Caused by overdose of narcotics, prolonged bedrest, conscious splinting of chest

Auscultation

Listening to sounds of the body, such as heart, blood vessels, lungs, abdomen, etc...

What is a proper position for vaginal exams?

Lithotomy position

Spleen

Located upper left quad. of the abdomen 1. Destroys old RBCs 2. Produces antibodies 3. Stores RBCs 4. Filters microorganisms from the blood

Mobility of normal cervix

Move the cervix gently from side to side and their should be no pain.

Bronchovesicular Breathing

Normal breath sound that is moderate pitch and amplitude that is heard EQUALLYduring inspiration and expiration. Location is over Major Bronchi where fewer alveoli are located such as posterior between the scapula; anterior around the upper sternum in first and second intercostal spaces

Plasma glucose level

Normal fasting levels: 0-18 yr - 60-110 mg/dl adults - < 100 mg/dl prediabetes - 100-125 mg/dl

Sign

Objective abnormality that you as an examiiner could detect on physical examination or in laboratory reports

Cranial Nerve I

Olfactory Nerve - sense of smell

Hyperresonant

amp: louder pitch: lower quality: booming duration: longer location ex: (normal) child's lung (abnormal) adult's lungs = increased air in emphysema

Excessive Cup-Disc Ratio

Primary open-angle glaucoma. Increased intraocular pressure decreases blood supply to the retinal structures. The physiologic cup enlarges to more than half of the disc diameter, vessels appear to plunge over the edge of cup. Asymptomatic, although the person may have decreased vision or visual field defects in the late stages of glaucoma.

Blood Flow Through Heart

R. atrium (deoxygenated), R. ventricle, pulmonary arteries, lungs, pulmonary veins (now oxygenated), L. atrium, L ventricle, aorta, body

Resonant

amp: med-loud pitch: low quality: clear, hollow duration: moderate location ex: (normal) lung tissues

atrophic vaginitis

S: postmenopausal vaginal itching, dryness, burning sensation, dyspareunia, mucoid discharge (may be flecked with blood) O: pale mucosa with abraded areas that bleed easily; may have bloody discharge

bacterial vaginosis

S: profuse discharge, "constant wetness" with foul, fishy, rotten odor O: thin, creamy, gray-white, malodorous discharge. no inflammation on vaginal wall or cervix because it is a surface parasite

gonorrhea

S: variable- vaginal discharge, dysuria, abnormal uterine bleeding, abscess in bartholin's or skene's glands. majority of cases are asymptomatic O: often no signs are apparent. may have purulent vaginal discharge.

Substance p, glutamate, and ATP

Second set of neurotransmitters carry the pain impulse across the synaptic cleft to the dorsal horn neurons

AUDIT-C

Shorter version of AUDIT for acute and critical care units - screening test for heavy drinking and/or active abuse Score: 3 or above = heavy or at-risk drinking

Bimanual Examination

Stand and use both hands to palpate the internal genitalia to assess their location, size and mobility and to screen for any tenderness or masses. Have one hand inside the woman and the other placed on the abdomen.

Direct/immediate percussion

Striking hand directly contacts the body wall to produce a sound - used in percussing the infant's thorax or adult's sinus areas

Vibration Test

Testing the persons ability to feel ______ of a tuning fork over the body prominences. Strike the turning fork with the heel of your hand and place it on the person's fingers or great toe. Normal Finding: Feels buzzing sensation on these distal areas, you may assume proximal spots are normal and move on.

What immunizations should a school age child receive between the ages of 11-12?

Tetanus and diphtheria toxoids and pertussis vaccine (Tdap), measles, mumps, & rubella vaccine (MMR), human papillomavirus vaccine (HPV) in 3 doses, and meningococcal vaccine (MCV4)

Aging adult and the head and neck

The facial bones and orbits appear more prominent and the facial skin sags as a result of decreased elasticity and subcutaneous fat

most occur between the ages of 18 and 35. occur in whites, rarely in blacks, mexican americans, and asians.

early testicular tumor

While evaluating the health history, the nurse determines that the patient subscribes to the hot/cold theory of health. Which of the following will most likely describe this patient's view of wellness?

The humors must be balanced.The hot/cold theory of health is based on humoral theory; the treatment of disease is based on the balance of the humors.

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.

Testing the Deep tendon reflex

The limb should be relaxed and the muscle partially stretched. Stimulate the reflex by directing a short, snappy blow of the hammer onto the muscles insertion tendon. Example: Knee Jerk or Patellar Area

Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand

The logic of the traditional belief systems

Systolic pressure

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

What is the Snellen Eye Chart

The most commonly used and accurate measure of visual acuity. Consists of letters arranged in decreasing size

Asthma

an abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by bronchospasm, wheezing, and dyspnea

Pulse rate

The number of heartbeats or pulses felt in 1 minute NORM-60-100 bpm

Diastolic pressure

The resting pressure that the blood exerts constantly between each contraction

Avulsion

The tearing away of a structure or part

Pregnancy and the thyroid gland

The thyroid gland enlarges as a result of hyperplasia

Eyes in Aging Adult

Visual fields narrow and depth perception is distorted (especially climbing/descending stairs) Pupils are smaller, reducing night vision Lens yellow and become opaque, resulting in distortion of green, blue and violet tones; and increased sensitivity to glare Production of tears decrease so eyes feel dry or burn prevention:ask about last vision test for glaucoma S/S: pain around eyes; loss of peripheral vision ask about beginning of cataracts S/S loss or progressive blurring ask about decrease in usual activities, eg. reading or sewing S/S central vision acuity lost w/macular degeneration

Five types of nonverbal behaviors that convey information about the person

Vocal cues (crying & moaning), action cues(posture facial expression), object cues (clothes), use of personal and territorial space, touch

Match the following play activities with the appropriate age group.

Watching black and white mobiles=birth to 3 months. playing peek-a-boo= 6-9 months. holding a soft rattle=3-6months. playing with cloth books=1-3 years. banging large blocks=9-12months.

1+Reflex

Weak Response

Review client records Health History Physical Exam Functional assessment Risk management Review literature

What does the initial assessment include

Airway, breathing, cardiac

What is ABC

Learned from birth Adapted to specific conditions environment and technical factors, and natural resource availability Dynamic and ever changing Shared by all members of same culture group

What is culture? (LADS)

ABCDE

When considering cultural competence, there are discrete areas that the nurse must develop knowledge of to understand the health care needs of others. These discrete areas include understanding of: Select all that apply A) the heritage of the health care system. B) the heritage of the nursing profession. C) the heritage of the patient. D) his or her own heritage. E) cultural and ethnic values.

Monocular blindness

When light is directed into blind eye, no response in either eye. When it is directed to normal eye, both pupils constrict.

Rectal temp

When other routes are not practical, coma, shock, confused, etc...

Heritage consistency

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

Brushfield spots

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

Finger to finger test

With person's eyes open, ask that he or she use the index finger to touch your finger, then his or her own nose. After a few times move your finger to a different spot. Normal Finding: Persons movement smooth and accurate

Proprioception

Without looking you know where your body parts are in relation to space and each other, vibration and finely localized touch.

You collect the pap smear first so that?

You will not disrupt or remove cells.

Erikson's Developmental Tasks

Young adult: Intimacy versus isolation. The hallmark of this stage is the ability to have close, caring relationships—it also focuses on the desire to have a permanent love relationship. Middle-aged adult: Generativity versus stagnation. This stage involves mentoring and giving to future generations. Older adult: Integrity versus despair. In this stage the person looks back and either finds that life was good or despairs because goals were not met.

subjective vertigo

____ is present when the patient experiences the sensation of turning or moving around in space. Objective vertigo is the sensation of objects moving around the patient.

the space above the anal valve is a small recess

anal crypt

at the lower end of each column is a small crescent fold of mucous membrane

anal valve

a chronically inflammed GI tract creates a abnormal passage from inner anus or recut out to skin surrounding anus. usually originates from a local abscess. the red, raised tract oepning may drain serosanguineous or purulent matter when perssure is applied.

anorectal fistula

dislocated shoulder

anterior dislocation (95%)is exhibited when hunching the shoulder forward and the tip of the clavicle dislocates; occurs with trauma involving abduction, extension, and rotation

signs are subtle and easily mistaken for gonorrhea

chlamydia

Atelectasis (collapse)

collapsed shrunken condition of alveoli or entire lung due to airway obstruction, lung compression, or lack of surfactant. Inspect: cough, cyanosis, lag on affected side, increased res rate & pulse. Palpate: Tactile fremitus decreased/absent over area. Percuss: dull over area. Auscultate: decreased breath sounds. Occasional fine crackles.

hypoxemia

decrease of O2 in blood

hypoacitve bowel sounds

decrease or absent bowel sounds following agdominal surgher or wiht inflammation of the peritoneum

Atherosclerosis

deposition of fatty plaques on the intima of the arteries

Capillary refill

depress the nail edge to blanch and then release, noting the return of color in 1-2 seconds

habit tic dystrophy

depression down middle of nail or multiple horizontal ridges, caused by continuous picking of cuticle by another finger or same hand

Umbilicus

depression on the abdomen marking site of entry of umbilical cord

withdrawal and quietness is what stage of separation anxiety?

despair

menorrhagia

heavy menses

Confrontation test

is used to test visual fields (peripheral vision) You position yourself at eye level about 2 feet away. Have the patient cover one eye with an opaque card. And look straight at you with the other eye. Hold a pencil or your finger as a target midline between you and the other person and slowly advance it in from the periphery in several directions (upward, downward, temporally, and nasally). Ask the person to say now when the object is first seen

it is normal to palpate an isolated inguinal lymph node on occasion

it feels small <1 cm, soft, discrete, and movable

tendons attach...

muscle to bone

Intermittent claudication is

muscular pain brought on by exercise

Suprapubic

name of abdominal region just superior to pubic bone

osteoarthritis (degenerative joint disease)

noninflammatory, localized, progressive disorder involving deterioration of articular cartilages and subchondral bone and formation of new bone (osteophytes) at joint surfaces; aging increases incidence; nearly all adults older than 60 have some signs of it; asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine; affected joints have stiffness, swelling with hard, bony protuberances, pain with motion, and limitation of motion

para

number of births

skin functions

protective barrier, prevents penetration, perception (self concept), temp regulation, identification (ethnic groups), communication, wound repair, absorption and excretion, production of vit D

diaphragm

separates thoracic cavity from abdomben

A nurse is providing nutritional teaching to a group of parents whose children attend a local day care. which of the following is the most effective way to encourage good nutritional habits for preschool children?

server nutritious foods that all family member will eat. preschoolers learn by example. seeing family member eat healthy food will encourage them to do the same. offering snacks as alternative and allowing the child to eat only what she asks for will not promote good nutritional habits. insisting that the child eat all of the food served even if she is no longer hungry can lead to feelings of guilt and overeating.

Nails

shape and contour, consistency, color

papule

something you can feel (solid, elevated, circumscribed, <1cm); caused by superficial thickening in epidermis (moles)

corpus spongiosum expands into a cone of erectile tissue

the glans

Structure of Neck Vessels

-Carotid artery, jugular veins -Carotid artery pulse - ventricular systole -Level of the jugular venous pressure reflects right atrial (central venous) pressure

PNS

-Carries sensory messages to the CNS from sensory receptors -Carries motor messages from the CNS out to the muscles and glands -Controls autonomic messages that govern the internal organs and blood vessels.

Venous Insufficiency

-Cyanosis -Brown Pigment (Blotchy) changes in the ankle area -Ulcers usually painless and on the medial side of the foot

Electrocardiogram (ECG, EKG)

-Electrical activity of heart measured by electrocardiography (ECG) -Phases of ECG - P, Q, R, S, T -Records depolarization and repolarization

In Assessing heart...

-Inspect pulsations -Palpate the apical impulse -Palpate for abnormal pulsations -Auscultate heart rate and rhythm -If you detect an irregular rhythm, auscultate for a pulse rate deficit -Auscultate to identify S1 and S2 -Listen to S1 and S2 -Auscultate for extra heart sounds -Auscultate for murmurs -Auscultate in with the client assuming other positions

Structure of Heart

-Located in mediastinum -Four chambers - left atrium and ventricle, right atrium and ventricle -Two atrioventricular valves, two semilunar valves -Three layers - epicardium, myocardium, endocardium -The two AV valves are located at the entrance into the ventricles. They are called the tricuspid valve and the bicuspid (mitral) valve. The tricuspid valve is located between the right atrium and the right ventricle; the bicuspid (mitral) valve is located between the left atrium and the left ventricle. -The semilunar valves are located at the exit of each ventricle at the beginning of the great vessels. They are known as the pulmonic valve and the aortic valve. The pulmonic valve is located at the entrance of the pulmonary artery as it exits the right ventricle. The aortic valve is located at the beginning of the ascending aorta as it exits the left ventricle.

Second heart sound

-S2: results from closer of the semilunar valves (aortic and pulmonic) -marks the start of diastole ("dubb") -one or two sounds -from aortic valve closure and pulmonic

Arterial Insufficiency

-Skin changes in color, temp, extremity may be cold, pale and clammy -Ulcers on the toes, and lateral side of the foot and Painful -Hair loss

Posterior Thoracic Landmarks

1) vertebra prominens: spinous process of C7 2) spinous processes 3) inferior border of spacula 4) 12th rib

1)Arteries 2)Veins 3)Aorta

1)Carry blood away from the heart 2)Carry blood toward the heart 3)Carries blood out to the body

Palpation production of sound

Amplitude (intensity) loud or soft Pitch ( vibrations) high (more) or low (less) pitch Quality (timbre) diff. due to distinct overtones Duration length of time the note lingers

What are some factors seen in aging adults that affect their nutritional status?

Loss of energy requirement do to slower metabolism. loss of lean body mass, and more fat. use of more medications (polypharmacy).

Paralysis

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

A parent of a 17 month old toddler is frustrated with the toddler's behavior. the parent tells the nurse that the child is "bad" but doesn't know how to make the toddler behave better. which of the following responses should the nurse make to this patient?

"consistently enforce well-defined limits, such as no climbing on the counters." toddlers need to have consistent boundaries enforced for discipline to be effective. behavior should not be enforced with only rewards or only punishments. trial and error lacks consistent boundaries and may allow the toddler to experience unhealthy consequences.

What is the Stapes

"stirrup," most inner of the 3 ossicles of the middle ear

Myxedema

(Hypothyroidism) Deficiency of thyroid hormone; causes non-pitting edema or myxedema. Puffy, edematous face, coarse facial features, dry skin, and dry, coarse hair and eyebrows.

Paget's Disease of Bone

(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.

Hordeolum

(STYE); red, painful pustule that is localized infection of the hair follicle at the eyelid margin

Pilar Cyst

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

torticollis

(Wryneck) Hematoma in one sternomastoid muscle results in head tilt to one side and limited neck ROM to the opposite side.

pyrosis

(heart burn) a burning sensation in esophagus and stomach from GERD

Hypercapnia

(hypercarbia) increased levels of carbon dioxide in the blood

sensorineural hearing loss

(or perceptive) signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex.

Crackles

(rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration

Tinea Capitis

(scalp ringworm) rounded, patchy hair loss, leaves broken-off hairs, pustules and scales -caused by fungal infection -highly contagious (person to person) children/farmers -lesions may fluoresce blue-green under woods lamp

Hypospadias

- condition in which the urethral meatus is more proximal than normal in the male and may be associated with chordee or in the female the urethra opens into the vagina

Vertigo

- dizziness or a sensation of spinning or whirling

Toddler examination

- erikson's task is developing autonomy - sit on parent's lap - head, ENT last

Infant examination

- erikson's task is establishing trust position: newborn - flat on exam table 6 months - sitting on parent's lap 9-12 months - parents must be in full view preparation: 1-2 hrs after feeding nude, use soft voice sequence: if sleeping listen to lungs, heart abdomen first less distracting first ear, nose, eyes, throat last

Adolescent examination

- erkison's task is developing self identity - head-to-toe

Paraphimosis

- foreskin is retracted and fixed. Foreskin cannot return to original position.

Dysmetria

- inability to control range of motion of muscles.

Older Adult

- muscle strength decreases, ribs calcify, lungs are less elastic, don't fill to max, decreased number of aveoli, risk for complication after surgery (decreased reflexes and cough). - decreased vital capacityand increased residual volume

Dislocation

- one or more bones in a joint being out of position.

Hemiplegia

- paralysis on one side of the body.

Cardiac Output (CO)

-Amount of blood pumped by the ventricles during a given period of time -SV × HR = CO -Stroke volume (SV) -Heart rate (HR) -Normal adult CO: 5 to 6 L/min

What are the different type of uterine positions?

-Anteverted -Midposition -Anteflexed -Retroflexed -Retroverted

P wave

-Atrial Depolarization -conduction of the impulse throughout the atria

Procedure for checking neck vessels

-You should auscultate the carotid arteries for bruits if the client is middle aged or older or if you suspect cardiovascular disease - Place the bell of the stethoscope over the carotid artery and ask the client to hold his or her breath for a moment so breath sounds do not conceal any vascular sounds. -Palpate each carotid artery alternately (never palpate both at once) and note the amplitude and contour of the pulse, elasticity of the artery, and any thrills. -Pulses should be equally strong, 2+, with no variation in strength from beat to beat. -Contour is normally smooth and rapid on the upstroke and slower and less abrupt on the downstroke. -Arteries are elastic and no thrills are noted. -You should evaluate jugular venous pressure by watching for distention of the jugular veins. - It is normal for the jugular veins to be visible when the client is supine. -To evaluate for jugular vein distention, place the client in a supine position with the head of the bed elevated to 45-degrees. -Have the client's head turned slightly away from the side being evaluated. - Using tangential lighting, observe for distention, protrusion or bulging of the jugular vein. Note: in the acute care setting, there will be invasive cardiac monitors (pulmonary artery catheters) that can measure pressures.

sensorineural hearing loss causes

-presbycusis, a gradual nerve degeneration that occurs with aging, and by ototoxic drugs, which affect the hair cells in the cochlea.

external anatomy of eye

-protected by bony orbital cavity -eyelids further protect the eye from injury, strong light, and dust. -Eyelashes curve outward from the lid margin to filter out dust and dirt. -canthus is the corner of the eye, where the lids meet. -The caruncle (a small fleshy mass containing sebaceous glands) is located at the inner canthus. -The conjunctiva, a thin mucous membrane, is a transparent protective covering of the exposed part of the eye. -The lacrimal apparatus provide constant irrigation. Tears drain into the puncta, located on the upper and lower lids at the inner canthus. -Six muscles attach the eyeball to its orbit: the superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles. These muscles direct eye movement and are stimulated by cranial nerves three, four, and six.

First Heart Sound

-result of closure of the AV valves (mitral and tricuspid valves) -S1 ("lub") marks start of systole -usually heard as one sound but may be heard as 2 sounds -sounds when mitral valve and triscuspid valve closes

migraines

-tend to be supraorbital, or frontotemporal -throbbing feeling -pain is severe -nausea, vomiting, and visual disturbances with migraines -associated with family history people usually lie down to feel better whereas cluster headaches they need to move to feel better

myocardium

-the thickest layer of the heart -made up of contractile cardiac muscle cells

PR interval

-time from beginning of atrial depolarization to the beginning of ventricular depolarization -from the beginning of P wave to the beginning of the QRS complex

What are three types of malignant lesions?

1) Basal cell cancer 2) maligmant melanoma 3) Squamous cell cancer

Why use percussion?

1) Map organ location 2) Density (air, fluid, or solid) 3) Detect superficial abnormal mass 4) Elicit pain if structure is inflamed 5) Elicit deep tendon reflex

What do you auscultate on Anterior Chest?

1) breath sounds 2) forced expiratory time: # of seconds it takes for person to exhale from total lung capacity to residual vol.

What do you auscultate on Posterior Chest?

1) breath sounds: instruct pt to breathe thru mouth, little bit deeper than usual. pt. leans fwd. listen to 1 full resp in ea. location. 2) adventitous sounds 3) voice sounds

3 types of normal breath sounds

1) bronchial (tracheal): high pitch, trachea & larynx 2) bronchovesicular : moderate pitch, over major bronchi 3) vesicular: low pitch, over peripheral lung fields

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

Criteria for a diagnosis of alcohol abuse, the patient must report that alcohol has repeatedly caused or contributed to one+ of the following

1) risk of bodily harm (drinking and driving, operating machinery, swimming); 2) relationship trouble (family or friends); 3) role failure ((interference with home, work, or school obligations); or 4) run-ins with the law (arrests or other legal problems).

What do you inspect on Anterior Chest?

1) shape & configuration 2) facial expression 3) LOC 4) color & condition 5) quality of respirations

What do you inspect on Posterior Chest?

1) shape & configuration 2) position 3) skin color & condition

4 major functions of resp system

1) supply O2 to body for energy 2) remove CO2 3) maintains homeostasis (acid-base balance) 4) maintains heat xchange

Anterior Thoracic Landmarks

1) suprasternal notch 2) sternum 3) manubriosternal angle: "angle of Louis" 4) costal angle

What do you palpate on Posterior Chest?

1) symmetric chest expansion 2) tactile fremitus 3) entire chest wall

Scenario: A 5 year old with autism lives with her mother, two brothers, and grandmother. the child was recently hospitalized with a respiratory infection and has special needs because of her autsim..1) which of the following describes this family's composition? 2) what would be the best approach for the nurse to take when first assessing this child?

1)extended family. an extended family includes one or more parents, one or more children, and other family members, such as a grandmother. a nuclear family includes two parents and their children. a blended family includes at least one step parent, step sibling, and or half sibling. a same sex family includes a common-law tie between two members of the same sex who may or may not have children. 2) Ask the child's mother what approach would work best. the family is the expert regarding the child's usual behaviors and routine needs, especially when a child has special needs.

Tonsils - Grading

1+ Visible 2+ Halfway between tonsillar pillars and uvula 3+ Touching the uvula 4+ Touching each other

Grading Edema

1+= Mild pitting, slight indentation, no perceptible swelling of the leg 2+= Moderate pitting, indentation subsides rapidly 3+= Deep Pitting, indentation remains for a short time, leg looks swollen 4+= Very deep pitting, indentation lasts a long time, leg is very swollen

Glascow coma scale

1-15 15- full consciousness 7-less is in coma

Abnormal Findings - Tongue

1. Beefy red, swollen tongue. Smooth glossy areas. 2. Enlarged tongue occurs with mental retardation, hypothyroidism, acromegaly; a small tongue accompanies malnutrition. 3. Dry mouth occurs with dehydration, fever; tongue has deep vertical fissures. 4. Saliva is decreased when taking anticholinergic and other medications. 5. Excess saliva and drooling occur with gingivostomatitis and neurologic dysfunction.

Mechanisms in the Venous System

1. Blood moves from the low-pressure system of the veins through the contraction of skeletal muscles that milk the blood back toward the heart. 2. Blood moves because of the pressure gradient caused by breathing. 3. Blood moves because intraluminal valves keep it flowing in 1 direction.

Abnormal Findings - Buccal Mucosa

1. Dappled brown patches are present with Addison's disease (chronic adrenal insufficiency). 2. Orifice of Stensen's duct looks red with mumps. 3. Koplik spots—early prodromal (early warning) sign of measles. 4. Candida infection will usually rub off, leaving a clear or raw denuded surface. 5. The chalky white raised patch of leukoplakia is abnormal

Hyperactive bowel sounds

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

Coarse Crackles

Loud, low pitched, bubbling and gurgling, start early in inspiration - pulmonary edema, pneumonia, pulmonary fibrosis

Abnormal Findings - Palate and Uvula

1. The hard palate appears yellow with jaundice. In Blacks with jaundice, it may look yellow, muddy yellow, or green-brown. 2. Oral Kaposi sarcoma is the most common early lesion in people with AIDS. 3. A bifid uvula looks like it is split in two; more common in American Indians. 4. Any deviation to the side or absent movement of uvula indicates nerve damage, which also occurs with poliomyelitis and diphtheria.

Early signs of oral cancer

1. a sore that does not heal 2. a smooth or leathery white patch or lump 3. a prolonged sore throat or feeling that something is in the throat 4. difficulty chewing 5.restricted movement of the tongue or jaw

Glascow Coma Scale

1. alert - awake or readily aroused, oriented 2. lethargic (somnolent) - not fully alert, drifts to sleep when not stimulated, answers questions but thinking is slow and fuzzy 3. obtunded - sleeps most of the time, difficult to arouse 4. stupor or semi-coma - spontaneously unconscious, responds only to persistent and vigerous shake/pain 5. coma - completely unconscious, no response to pain

When teaching a class about pubertal changes in girls, a question is asked about when development appears. number the following changes in the order they occur. menarch, breast buds, appearance of pubic hair.

1. breast buds, 2. appearance of pubic hair, 3. Menarche.

What areas will a nurse look at during a skin assessment?

1. color (normal: even and consistent skin tone with genetic background; sun-exposed areas are darker) 2. temperature (use back (dorsa) of hand to palpate bilaterally: skin should be warm equal bilaterally Hypothermia expected: extremity in cast, immobilized Hypothermia expected: fever, trauma, infections, sunburn 3. moisture (diaphoresis normal with heavy activity or fever dehydration check in oral MM normally none/smooth/moist. In dark skin may look dry & flaky 4. texture (normal smooth, even surface, and firm) 5. thickness (uniformly thin, thickened callus areas are normal on palms and soles) 6. edema (not present normally: imprint thumb in ankle maleolus or the tibia, normally the skin surface stays smooth **edema makes dark skin look lighter 7. mobility and turgor (pinch up skin at the anterior chest under the clavicle: mobility is ease of skin rise & turgor is return of skin) 8. vascularity or bruising (Cherry (senile) Angiomas 1-5 mm smooth, raised bright red on trunk >30 yrs Not significant) (consistent with trauma, normally not venous dilation or varicosities) 9. lesions

What kinds of developmental competence does a nurse need to consider when assessing a infants skin, hair, nails?

1. examination: undressed (removed diaper) -general pigmentation (lighter than parents for black newborns at birth) 2. Hyper-pigmentation -Mongolian spot (blue-black to purple macular area at the sacrum or buttocks, but can be on abdomen, thighs, shoulders, or arms): common in blacks, asian, american indian, hispanic -Cafe-au-lait spot (large round or oval patch of light brown pigmentation usually present at birth 3. Color Change -acrocyanosis (newborn: bluish color around lips, hands, fingernails, feet, and toe nails. disappears in a few hrs.) -erythema toxicum (common rash at 3rd or 4th day of life; "flea bite" rash it consists of tiny punctate red macules and papules on cheek, trunk, chest, back, buttocks -physiologic jaundice (only develops after the 3rd/4th day of life) -cutis marmorata-mottling in trunk & extremities 4. Texture (Milia: tiny white papules on the cheeks and forehead, sebum that occludes opening of follicles, resolve in a few weeks) 5. Thickness (normally thin, no breaks in skin *check spine* well defined subcutaneous fat) 6. Mobility and Turgor (in infant, test over the abdomen) 7. Vascularity storkbite (flat, irregulary shaped red or pink patch found on the forehead, eyelids, upper lip, back of neck most commonly hemangiomas is NOT abnormal! 8. Moisture (Verix Caseosa: moist, white, cream cheese-like substance that covers part of the skin in all newborns

S1

Loudest at the apex. Lub sound AV valves closed

S2

Loudest at the base. Dubb Sound SL valves closed

What general areas of questioning would you address if a nurse was trying to collect subjective data about the skin, hair, nails.

1. past history of skin dz. (allergen, nonsterile equipment for tatoos) 2. Change in pigmentation 3. change in moles (tenderness, sores that don't heal) 4. excessive dryness or moisture 5. pruritus (can even be from uremia or obstructive jaundice. 6. excessive bruising (bruising above knees and elbows consider physical abuse. falls= dizziness or alcohol) 7. rash or lesion (consider stress, copying strategies, what they think rash means) 8. medication (increase sun exposure: sulfonamides, thiazide diuretics, oral hypoglycemic agents, tetracycline; hyperpigmentation: antimalarials, antineoplastic, hormones, metals, tetracycline 9. hair loss 10. change in nails 11. environmental or occupational hazards (at risk for sun exposure: over 40 yrs., light-skin, regularly in sun 12. self-care behavior

Describe what a nurse would consider when assess a patient's nails.

1. shape and contour (nail surface is normally slightly curved or flat, smooth and rounded fail folds, and nail edges) 2. profile sign (note the nail angle of the nail base: normally approx. 160 normal; clubbing 180 or more) 3. consistency (smooth, uniform thickness) 4. color (pink nail bed underneath, dark skinned may have brown-black pigment streaks on nail edge this is normal but NOT for light skinned, white hairlines from trauma) 5. capillary refill on finger nail (depress nail edge to blanch and then release; less than 2 seconds normal) with thickened nails use skin at tip of finger -note grooves, depressions, pitting, ridges -inspect toenails (smooth skin in between) 6. palpate: nail base (firm/adheres to bed)

List the immunizations that should be given to each of the age groups...

12-15months: Hib, PCV, IPV, MMR, and Varicella. 12-18months: Hep A, given in two doses, at least 6 months apart. 12-23months: DTaP. 12-36months-yearly TIV.

the combined length of the anal canal and rectum in the adult

16 cm

By the what age should the anterior fontanel be closed?

18months. the posterior fontanel usually closes by 2 months, and the anterior fontanel usually closes by 18 months.

Danger assessment

19 item yes/no instrument that has been used extensively by nurses in the health care system as well as advocates in other settings with battered women. starts with acalendar so that women can more accurately see for themselves how frequent and severe the violence has become over the past year. the DA is copyrighted. women with an average score of 7.1 on the original 15 item survey were victims of homicide

Rank the following assessments in the order they should be performed on a 9 month old.

1: RR, 2: HR, 3: Weight, 4: Axillary temp. perform a physical examination on a child starting with the least invasive, progressing towards the most invasive. assessing the respiratory rate is the least invasive, followed by the HR, which requires touching the child with a stethoscope, followed by the weight, which requires picking up the child and placing him on a scale, followed by obtaining an axillary temperature.

For which of the following children should a nurse use the child's behavior s as an indication of pain verses self-report?

2 year old is not able to verbalize pain. however, this child may exhibit signs of distress such as crying, irritability, and restlessness.

Pulse amplitude normal rating is

2+

During the assessment of deep tendon reflexes, the nurse finds that a patients responses are normal bilaterally. Indicate what number is used to indicate normal deep tendon reflexes when documenting this finding?

2+ Reflex

Interview with Preschooler

2-6 yr old is egocentric. Sees the world mostly from his or her own point of view. can have animistic thinking about unfamiliar objects. May imagine unfamiliar inanimate objects can come alive and have human characteristics

Orthodox Judaism food restrictions

All pork and pork products Meat not slaughtered according to ritual All shellfish Dairy products and meat at the same meal Leavened bread and cake during passover Food and beverages on Yom Kippur

Evaluates the Patency of Radial/Ulnar Arteries

Allen Test

Stroke volume

Amount of blood pumped out of the heart with each beat

What is Kyphosis

Abnormal increase in the outward curvature of the thoracic spine as viewed from the side...humpback

What is neuropathic pain?

Abnormal processing of pain message-feels like it is burning or shooting

Tachycardia

Abnormally rapid heartbeat (over 100 beats per minute)

Bradycardia

Abnormally slow heartbeat ( in adult less than 60 bpm, and not an athelete.

Which age group needs more protein, calories, iron and calcium? and needs snacks?

Adolescence

Interview with adolescent

Adolescence begins with puberty which is a time of dramatic physiological change. Adolescents want to be adults but lack cognitive ability. Must consider attitude...needs to be one of respect. Adolescent needs to feel validated as a human being. Communication must be honest.

Polyps

Arises in canal from granulomatous or mucosal tissue; redder than surrounding skin and bleeds easily; bathed in foul, purulent discharge; indicates chronic ear disease. Benign, but refer for excision.

Decorticate Rigidity

Arms adducted and FLEXED, wrists and finders flexed; legs extended, internally rotated, plantar flexed

Finger to nose test

Ask the person to close their eyes and to stretch out the arms. Then ask person to touch the tip of their nose with each index finger, alternating hands and increasing speed.

Romberg Test

Ask the person to stand up with feet together and arms at the sides. Once in a stable position, wait 20 seconds. Normal Finding: a person can maintain posture and balance even with visual orienting information blocked, although slight swaying may occur.

Routine, universal assessments for IPV means

Asking every woman at every health care encounter if she has been abused by a boyfriend, husband, or other intimate partner or ex partner

Open ended questions

Asks for narrative information, is unbiased, states the topic to be discussed but only in general terms, ex. Tell me how can I help you?

Closed or direct questions

Asks for specific information, usually illicit a short 1 or 2 word answer, limits the patient's answer, use to fill in details after open ended questions

The Short-Form McGill Pain Questionnaire

Asks the patient to rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain.

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.

Tandem walking

Assess balance by asking person to walk a straight line in a heel-to-toe fashion. This decreases the base of support and will accentuate any problem with coordination. normal finding:The person can walk straight and stay balanced.

Pulsus Bigeminus

Rhythm is coupled, every other beat comes early, or normal beat followed by premature beat. Force of premature beat is decreased because of shortened cardiac filling time. (Premature Ventricular or atrial contraction)

tinea versicolor

Common superficial fungal infection of the skin, causing hypopigmented, slightly scaly macules on the trunk, neck, and upper arms (short-sleeved shirt distribution). They are easier to see in darker skin and in some are more obvious after tanning. In lighter skin, macules may look reddish or tan instead of pale.

Nonverbal communication

Communication using body movements, gestures, and facial expressions rather than speech

Scale

Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells

Complete database

Complete health history and physical examination. It describes current and past health state and forms a baseline against which all future changes can be measured. Yields first diagnoses

What would a pt in a coma look like?

Completely unconscious, no response to pain or stimuli

Cerebellar System

Complex motor system coordinates movement, maintains equilibrium and helps maintain posture and maintains muscle tone.

Pulsus Alternans

Rhythm is regular, but force varies with alternating beats of large and small amplitude. Occurs with severe left ventricular failure

Ausculate Carotid

Do so for those who show symptoms of CV disease and middle aged/old people Checking for presence of bruit

Palpate Carotid

Do so gently so you wont stimulate a vagal response and decrease heartrate Do only one at a time Normal Strength Pulse- 2+ or moderate

Psychological neglect

Failing to provide basic social stimulation

Physical neglect

Failure of the family member and/or caregiver to provide basic goods and/or services such as food, shelter, health care, and medication

Financial neglect

Failure to use the assets of the elderly person to provide services needed by the person

True or false: if an infant is sleeping, a nurse may ask the parents at the bedside to verify his name.

False: a client identity should always be verified by the hospital id band.

True of False: children are not affected by cultural barriers.

False: children may not be able to work through their worries or grief if cultural barriers are present.

True or False: when providing care to a child, the nurse should not be concerned about what the child thinks about the care.

False: the child's opinion should be considered when providing care.

True or False: when working with a child who is developmentally delayed, the nurse should use diversional activities appropriate for the child's age.

False: the nurse should determine the developmental level of the child, and then select activities appropriate to that child's level of development.

True or False: Toddlers should not be allowed to eat sandwiches.

False: toddlers enjoy eating finger foods. these food provide them with a sense of autonomy.

paranasal sinuses

Frontal - accessible to examination - absent at birth Maxillary - accessible to examination - present at birth Ethmoid - not accessible to examination - present at birth Sphenoid - not accessible to examination - minute at birth

Most common lab test to identify chronic alcohol drinking

Gamma glutamyl transferase (GGT)

Second step of nutritional assessment

Gather data for a nutritional plan that will prevent or stop disease.

Review of Systems

General overall health state, Skin, Hair, Head, Eyes, Ears, Nose and Sinuses, Mouth and throat, Neck, Breast, Axilla, Respiratory system, Cardiovascular, Peripheral vascular, Gastrointestinal, Urinary System, Male genitals, Female genitals, Sexual Health, Musculoskeletal system, Neurologic system, Hematologic system, Endocrine system

Which of the following should be included in a family assessment?

Genogram, structure, developmental task, family function/roles, family stressors. These should all be included in a family assessment. the child's physical growth is part of that child's individual assessment.

A parent asks the nurse at a well child visit why his 4 year old sone is always talking about "George". the parent tells the nurse that the family does not even know anyone named "George". the child tells his parents about George's escapades, such as climbing on to the counter to raid the cookie jar. what explanation can be given to the parent about his son's behavior?

George is most likely an imaginary friend or playmate. imaginary playmates help children in many ways. when the child is lonely, and imaginary playmate can be companion. an imaginary friend also experiments with things that the child is afraid of trying.

Mini mental state examination (MMSE)

Give you a quantifiable measureof cognitive functions of MSE - valid detector of organic disease - normal = 27 - 18-23 = mild cog dysfunction - 0-7 = severe cog dysfunction 1. orientation to time - what's the date? 2. registration - repeat back 3 words 3. naming - what is this object? 4. reading - please read this paper and do what it says 5. attention and calculation - spell this word backwards 6. langauge - repeat the following sentence....

Risk factors present in metabolic syndrome (MetS)

Glucose more than 110; bp higher than 130/85; waist more than 40" in men and 35" in women; HDL lower than 40 in men and 50 in women; triglycerides levels more than 150.

Developmental History for children

Growth, Milestones, Current development (children 1-preschool)

Tonsils

located at the entrance of the respiratory system and respond to local inflammation

First step of nutritional assessment

Identify persons that are malnourished or at risk for malnourishment.

lymph nodes

If any are palpable, note their location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness. Normal nodes feel movable, discrete, soft, and nontender. If enlarged or tender, check the area they drain for the source of the problem.

pulse deficit

If the client's heartbeat is irregular, you should assess for a pulse deficit. To assess for a pulse deficit, you palpate the radial pulse while you auscultate the apical pulse. Count for a full minute. The radial and apical pulses should be identical. We say there is a pulse deficit when there is a difference between the apical and peripheral/radial pulse. A pulse deficit may indicate atrial fibrillation, atrial flutter, premature ventricular contractions, and varying degrees of heart block.

Test for scoliosis

If you suspect a spinal curvature during inspection, this may be more clearly seen when the person touches the toes. While the person is bending over, mark a dot on each spinous process. When the person resumes standing, the dots should form a straight vertical line. If the dots for a slight S-shape when the person stands, a spinal curve is present.

Meth mouth

Illicit methamphetamine abuse (crystal meth, meth ice) leads to extensive dental caries, gingivitis, tooth cracking, and edentulism. Methamiphetamine causes vasocaonstriction and decreased saliva and is used to increase the urge to consumse sugars and starches and to give up oral hygiene. Absence of the buffereing saliva leads to increased acicdity in the mouth and the ncreased plaque encourages bacterial growht. These conditions and the prsence of carbohydrates set up oral envionment prone to caries, cracking of ename and damage.

Apical pulse

Located at the 5th intercostal space, midclavicular, to the left of the sternum, at the apex of the heart. *Use thisfor patients with irregular heart rate, bradycardia, tachycardia, faint radial pulse patients taking cardiac medications infants and young children

Dental caries

Progressive destruction of tooth. Dacy initially looks chalky white. Later it turns bron or black and forms a cavity. Early decay is apparent only on x ray study. Suceptible sites are tooth surfaces where food debris, bacterial plaque and saliva collect.

stupor

Pt arouses to vigorus and continuous stimulation which is typically painful in nature; may moan briefly but does not follow commands; only response may be withdrawal from the painful stimulus

What is broca's aphasia?

Pt can understand language but can't express himself using language (expressive aphasia)

obtundation

Pt is difficult to arouse and needs constant stimulus to follow commands; may verbally respond to stimuli with a few words but drifts back to sleep when stimulus is removed

deep tendon reflex

Reveals the intactness of the reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels. Consists of: Patella, Biceps, Triceps, Brachioradialis, Quadriceps, Achilles Reflexes

Transmission-Based Precautions

Second tier of CDC guidelines that applies to specific categories of patients and that include air, contact, and droplet precautions. Used in addition to Standard Precautions.

SMAST-G

Short Michigan Alcohol Screening Test - Geriatric Version - yes/no questions to address aging adults' specific emotional and physical reactions to drinking any amount of alcohol Score 2+/10 = alcohol problem

What is acute pain?

Short-term, self-limiting, stops after after injury heals Behaviors include:bracing, rubbing, diminished activity, sighing, change in appetite, being with other people, movement, exercise, prayer, sleeping, or inactivity.

Radial and Brachial Artery

Should be equal strength

Capillary refill

Should occur in less than 1-2 seconds

Rickets

Sign of Vitamin D and calciium deficiencies in children and adults

When interviewing a person currently under the influence of alcohol or illicit drugs ask what?

Simple and direct questions

Low-Pitched Wheeze

Single note, musical snoring, moaning sounds, throughout cycle, more prominent on expiration, clear with coughing, - obstruction (bronchitis, single bronchus obstruction from tumor)

School age child examination

Sitting or lying head-to-toe examination

Venous Return

Skeletal muscles contract with movement and squeeze blood toward the heart

Percussion of spleen

Spleen is usually obscured by stomach contents. Percuss for a dull note from the 9th to 11th intercostal space just behind the left midaxillary line. Usually not wider than 7 cm in the adult

What would a pt in a stupor or semi-coma look like?

Spontaneously unconscious, responds only to persistent and vigorous shake or pain; can only groan, mumble, or move restlessly

Cortical Cataract

Star-Shaped opacity. Cortical cataract shows asymmetric, radial, white spokes with black center. Through ophthalmoscope, black spokes are evident against the red reflux. Forms in outer cortex of lens, progressing faster than nuclear cataract.

A 10 year old child has just had an appendectomy following a ruptures appendix. a nurse is monitoring the child's response to antibiotics, posoperative healing, and pain control. which of the following tools is most appropriate for assessing the child's pain?

Visual analogue scale (VAS). this is the most appropriate for this child. the FLACC scale is used for infants and children up to 7 years. the FACES and CHEOPS scales are appropriate for early childhood.

What is Cheyne-Stokes

a breathing cycle characterized by increasing depth and rate that then decrease. These periods are alternated with periods of apnea lasting 20 seconds.

Emphysema

a chronic obstructive pulmonary disease characterized by enlargement of alveoli distal to terminal bronchioles

mixed hearing loss

a combination of conductive and sensorineural types in the same ear.

What is Friction Rub

a course, grating, adventitious lung sound heard when the pleurae are inflamed

Parkinson Syndrome

a deficiency of the neurotransmitter dopamine and degeneration of the basal ganglia in the brain. The immobility of features produces a face that is flat and expressionless, "mask-like" with elevated eyebrows, staring gaze, oily skin and drooling.

Branchial Remnant and ear Deformity

a facial remnant of leftover of the embryological branchial arch usually appears as a skin tag. When bilateral, there is increased risk for renal anomalies.

Achondroplastic Dwarfism

a genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature. it is characterized by a relatively large head with frontal bossing and midplace hypoplasia and, often, thoracic kyphosis, prominent lumbar lordosis, and abdominal protrusion. the mean adult height in men is about 131.5 cm and in woman about 125 cm

What is Fremitus

a palpable vibration from the spoken voice felt over the chest wall

fluid wave

a positive test occurs with large amout of ascitic fluid

Fixation

a reflex directing eye towards an object attracting that person's attention Impaired by drugs, alcohol, fatigue

Rebound tenderness

a sign of inflammation of the peritoneum in which increased pain is elicited by the sudden release of the fingertips pressing on the abdomen.

Acanthosis Nigricans

a skin disorder characterized by dark, thick, velvety skin in body folds, and creases (band of increased melena) -screening for diabetes

darwins tubercle

a small painless nodule at the helix. congenital variation and is not significant

Clitoris

a small, elongated erectile tissue in the female, located at anterior juncture of labia minora

Murmur

a swishing sound caused by turbulent blood flow through the heart valves or great vessels. Auscultate for murmurs across the entire heart area. Use the diaphragm and the bell of the stethoscope in all areas of auscultation because murmurs have a variety of pitches.

Cover Test

a test that detects a small degree of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel. ask the person to stare straight ahead at your nose, place a card in front of one eye and note the uncovered eye. A normal response is a steady fixed gaze. if the uncovered eye jumps to reestablish fixation, eye muscle weakness exists

Waist circumference

a waist circumference (WC) > or = 35" in women and > or = 40" in men increases the risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease (CVD) in persons with a BMI between 25 and 35 kg/m^2

Whispered pectoriloguy

a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue

Respiratory and Cardiac Clinical Manifestations of Heart Failure (CHF)

a. Dilated pupils b. Skin pale, gray or cyanotic c. Dyspnea, Orthopnea, Crackles, Wheezing, Cough d. Decreased Blood Pressure e. Nausea and Vomiting f. Ascites (fluid in pleural cavity) g. Pitting Edema h. Anxiety i. Falling O2 saturation j. Confusion k. Jugular Vein Distension l. Infarct m. Fatigue n. S3 gallop/ tachycardia o. Enlarged spleen and liver p. Decreased urine output q. Weak Pulse r. Cool, Moist skin.

Graphesthesia

ability to "read" a number by having it traced on skin

Orthopnea

ability to breathe easily only in an upright position

What is Orthopnea

ability to breathe easily only in an upright position

what is the expected outcome of the trochlear nerve in a 14 year old adolescent?

able to look down with eyes

The parent of a 2 year old toddler tells the nurse that she is frustrated with her child's behaviors. the child throw temper tantrums and says "No" every time she tries to help her. although the parent knows toddlers do this, she cannot understand why. the nurse explains that toddlers are often negative, which is the normal expression of their desire to....

increase their independence. the drive for independence is express by the toddler opposing the desire of those in authority and attempting to do everything for herself.

what is the expected outcome of the olfactory nerve in a 14 year old adolescent?

individually identifies smells through each nostril.

subacromial bursitis

inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion, localized under deltoid muscle may increase by partial passive abduction of the arm; caused by direct trauma, strain during sports, local or systemic inflammatory process, or repetitive motion with injury

Thrombophlebitis

inflammation of teh vein associated with thrombus formation

Mastitis

inflammation of the breast Inflammatory mass before abscess formation usually occuring in one quadrant; area is red, swollen, tender, hard and very hot. Most common in women who are lactating.

Bronchitis

inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion

What is Otitis externa

inflammation of the outer ear and ear canal (swimmers ear) infxn of outer ear, redness and swelling of pinna and canal, inflammation and tenderness more common in hot weather, prevent by using rubbing alcohol after every swim

the juncture of the lower abdominal wall and the thigh. Its diagonal borders are the anterior superior iliac spine and symphysis pubis

inguinal area

superior to the inguinal ligament. Structure is a narrow tunnel passing obliquely between layers of the abdominal muscle. It is 4 to 6 cm long in the adult. Its openings are an internal ring, located 1-2 cm above the midpoint of the inguinal ligament and an external ring located just above and lateral to the pubis

inguinal canal

Cranial nerve IV - trochlear nerve

innervates the superior oblique muscle

cereals, wheat germ; reduce risk for colon cancer

insoluble fiber foods

abortions

interrupted pregnancies including elective abortions and spontaneous miscarriages

separates the internal and external sphincters and is palpable

intersphincteric groove

otosclerosis

is common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. It is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness.

difference in language, habits, customs, attitudes, and beliefs can lead to feelings of___________ and ____________in children.

isolation and loneliness

Turgor

it's ability to return to place promptly when released; reflects the elasticity of the skin; used to determine dehydration

Pruritus

itching

gouty arthritis

joint effusion or synovial thickening, seen first as bulge or fullness in grooves on either side of olecranon process; redness and heat can extend beyond area of synovial membrane; soft boggy or fluctuant fullness to palpation; limited extension of elbow

Supraclavicular

just above and behind the clavicle, at the sternomastoid muscle

scissors gait

knees cross or are in contact, like holding an orange between the thighs. person uses short steps, and walking requires effort from:paraparesis of legs, multiple sclerosis

What is the Umbo

knob of the malleus that shows through the tympanic membrane

genu valGum

knock knees; stuck together TOGETHER

Retracted Drum

landmarks look more prominent and well defined. Malleus handle looks shorter and more horizontal than normal. Short process is very prominent. Light reflex is absent or distorted. The drum is dull and lusterless and does not move.

Scoliosis

lateral S-shaped curvature of the thoracic and lumbar spine usually with vertebrae rotation. Causes low self concept

What is Scoliosis

lateral curve-entire spine can be affected more common in girls, adolescents observe gait (indicate uneven hip ht) severe curvature >45° THIS CAN DECREASE LUNG VOLUME

Dorsalis Pedis Pulse

lateral to and parallel the the extensor tendon of the big toe

declining testosterone level

leaves the older male with a slower and less intense sexual response, and an erection takes longer to develop and is less full or firm. ejaculation is shorter and less forceful and the volume of seminal fluid is less than when the man was younger.

what is moro reflex?

legs flex, arms and hand extend when startled by a loud noise.

Presbyopia

lens loses ability to change shape to accommodate near vision ( loses elasticity; lens becomes hard, glasslike; begins ~40 yrs old)

Anterior Triangle

lies in the front btw sternomastoid and midline of body, base along lower border of mandible, and apex at suprasternal notch

visceral pleurae

lines outside of lungs

surfactant

lipid substance needed for sustained inflation of air sacs; presented at 32 wks in infants

tea colored urine

liver disease, especially with pale stools and jaundice; myoglobinuria; some medications and food dyes; blood in urine

RUQ

liver, gallbladder, duodenum, duodenum, head of pancreas, right kidney and adrenal, hepaticflexure of colon, part of ascending and transverse colon

To test hearing acuity... making a loud sound out of the baby's peripheral range of vision of about 30 cm (12in.) causes what effects in ages in infants

newborn- startle (moro) reflex, acoustic blink reflex 3 to 4 months, acoutstic blink reflex, infant stops movement and appears to "listen" halts sucking, quiets if crying, cries if quiet 6 to 8 months-infants turns head to localize sound, responds to own name ABNORMAL FAILURE TO LOCALIZE SOUND preschool and school age child- child must be screened with audiometry ABNORMAL INTELLIGIBLE SPEECH BY AGE 2YR

what is the expected outcome of the oculomotor nerve in a 14 year old adolescent?

no nystagmus

stage 1

no pubic hair, fine body hair on abdomen. penis is preadolescent in size and proportion. scrotum is preadolescent in size and proportion

what is the expected outcome of the acoustic nerve in a 14 year old adolescent?

no vertigo

what is the breakdown of cartilage, bony overgrowht in joints. use/overuse diase. who is it most common in?

non inflammatory osteoarthritis common in middle age

pulse oximeter

noninvasive method; assesses arterial O2 saturation

may have similar discharge as gonococcal urethritis but often has scanty, mucoid discharge

nonspecific urethritis

Bones that are united by fribrous tissue or cartilage and are immovable ie sutures in the skull or only slightly movable vertebrae is what?

nonsynovial joints

negative romberg sign

normal positive indicates loss of balance that occurs when closing the eyes. eliminate the advantage of orientation with the eyes. occurs with cerebelar ataxia (multiple sclerosis, alcohol intoxication), loss of position, and loss of vestibular function

Upward Palpebral Slant

normal in many children, when combined with epicentral folds, hypertelorism, and Brushfield spots, indicates Down syndrome.

inspect the inguinal region for a bulge as the person stands and as he strains down

normally none are present

Claudication Distance

number of blocks walked or stairs climbed to produce pain

gravida

number of pregnancies

although the rectum contains only autonomic nerves,

numerous somatic sensory nerves are present in the anal canal and external skin

The seven warnings signs of Alzheimer's disease

o Repeatedly asks the same questions o Becomes lost or disoriented in familiar places o Cannot follow directions o Is disoriented as to the date or time of day o Doesn't recognize and is confused about familiar people o Has difficulty with routine tasks such as paying bills o Neglects personal safety, hygiene, and nutrition

when working with a child from a culture different from the nurse's, what nonverbal actions should the nurse take to promote culturally sensitive interactions?

observer for clues regarding appropriate use of eye contact; determine whom to address information or questions; allow the family to determine the distance between parties in the room; take time and do not appear rushed; actively listen; and determine the meaning of pauses, silence, and interruptions for different cultures.

Decreased Tactile Fremitus

obstruction - bronchus, pleural effusion, pneumothorax, emphysema

hydrocephalus

obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure and enlargement of the head

hydrocephalus

obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head. Dilated scalp veins, frontal bossing, and downcast or "setting sun" eyes.

and adolescent fractures his left leg. the leg is surgically repaired, and a long-leg cast is applied. during the first night in the hospital, the adolescent calls the nurse to the room and states. "my leg hurst really bad." the next action the nurse should take is to.

obtain more information regarding the adolescent report. a complete assessment of the pain should be performed before taking any action.

Sigh

occasional exaggerated breath. Purposeful to expand alveoli

Enlarged Lymph nodes

occur with infection, malignancies, and immunologic diseases

mucoid discharge and soiled underwear

occur with prolapsed hemorrhoids

Ptosis

occurs from neuromuscular weakness, oculomotor cranial nerve III damage, or sympathetic nerve damage (e.g., Horner's syndrome) or congenital. A positional defect that gives the person a sleepy appearance and impairs vision.

Risk factors for venous stasis

occurs from red blood cell degredation so anything that destroys red blooed cells

Peritoneal friction rub--SPLEEN

over lower left rib cage in left anterior axillary line, from abscess, infection, or tumor

Keloid

overgrowth of scar tissue, which invades original site of trauma. It is more common in dark skinned people,

superficial cervical

overlying the sternomastoid muscle

osgood-schlatter disease

painful swelling of the tibial tubercle just below the knee, probably from repeated stress on the patellar tendon. occurs most in puberty during rapid growth and most often in males; pain increases with kicking, running, bike riding, stair climbing, or kneeling; condition is usually self limited and symptoms resolve with rest

Temporal Artery

palpated in front of the ear

Dosalis Pedis

palpated on the dorsum of the foot

Popliteal artery

palpated posterior to the knee

Coronary Heart Disease-

some of the risk factors include metabolic syndrome, increased body weight, high blood pressure, high cholesterol, diabetes, smoking, sedentary lifestyle, excessive alcohol consumption, and increased stress. Some risk reduction tips: stop smoking, lower high cholesterol, control high blood pressure, maintain tight control of diabetes, exercise regularly, achieve and maintain your ideal body weight, control stress and anger, and many more...(see the table). Ethnicity also plays a role. African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans have a higher risk of heart disease. These rates are thought to be due to more severe hypertension, and higher rates of obesity and diabetes in these populations.

Intercostal space

space between the ribs

stage 3

sparse growth of hair over entire pubis, hair is darker, coarser, and culry. Penis begins to enlarge, especially in length, scrotum is further enlarged

Chvostek's sign

spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia

what is the expected outcome of the vagus nerve in a 14 year old adolescent?

speech is clear

suspends the testis vertically

spermatic cord

the vas deferens approximates with other vessels (arteries, veins, lymphatics, nerves) to form this structure. It ascends along the posterior border of the testis and runs through the tunnel of the inguinal canal into the abdomen

spermatic cord

anal canal is surrounded by two concentric layers of muscle

sphincters

related organs in the lymphatic system

spleen, tonsils, thymus

Thyroid Glad-Anterior Inspection

standing in front of pt. with their tilting forward and to the right, use right thumb to move trachea to the right. Take left thumb and fingers and place around the sternomastoid muscle. Feel for lobe enlargement as pt. swallows

appedicitis

stars as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, perisistent pain and tenderness localized in RLQ (McBurneys point). pain is aggravated by movement, coughing, deep breathing; associated with anorexia, then nausea and vomiting and fever

coma

state of profound unconsciousness from which person cannot be aroused

excessive fat in the stool as in malabsorption of fat

steatorrhea

ankylosis

stiffness or fixation of a joint

LUQ

stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transeverse and descending colon

Illiopsoas muscle test

straight leg raise - sign of appendicitis - push down on their leg - if positive they will have right lower pain

what confirms the presence of a herniated nucleus pulposus?

straight leg raising test

Extension

straightening a limb at a joint

blood supply to hernia is shut off, accompanied by nausea, vomiting, and tenderness

strangulated hernia

Percussion

striking over the chest wall with short, sharp blows of the fingers to determine the size and density of the underlying organ

gallbladder, cholecystits

sudden pain in right upper quadrant tht may rdiate to right or left scapular, occures after eating fatty food, alcohol, or caffeine. nV, positive Murphys sign or sudden stop in inspiration with RUQ paplaption

begins within 2-4 weeks of infection, as a small solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. palpation reveals a nontender, indurated base that can be lifted like a button. lymph nodes enlarge early but are nontender. this is an STI easily treated with penicillin G but untreated cases lead to cardiac and neurologic problems, blindness

syphilitic chancre

Manual Compression Test

testing for valves that are incompetent, have the patient stand still place one hand on the lower part of the varicose vein and another hand and 20 cm higher..if you feel a wave that means there are incompetent valves

solid oval shaped structure that produces sperm. compressed laterally and measures 4 to 5 cm long by 3 cm wide

testis

mcmurray test

tests for meniscal tears; if click is heard= positive Perform this when the person has reported a history of trauma followed by locking, giving way or local pain in the knee. Position the person supine as you stand on the affected side. Hold the heel and flex the knee and hip Externally rotate the leg and push inward stress on the knee Then slowly extend knee. Abnormal Finding: Hear or feel a click indicates a torn meniscus.

appendicitis

the Ilisoas and Obturator tests test for....

Graphesthesia-

the ability to read a number by having it traced on the skin.

Lid Lag

the abnormal white rim of sclera visible between the upper eyelid and the iris when a person moves the eyes downward

Terminal hair

the darker thicker hair that grows on the scalp, eyebrows, pubic area, axillae, face, and chest

When should the effectiveness of nonpharmacologic pain interventions be evaluated?

the effectiveness of nonpharmacologic pain interventions should be evaluated around 30-60 min following interventions. it usually takes about 30-60 mins for the body to adjust to the interventions for pain reduction.

Pulse

the expanding and recoiling of arteries from the pressure wave that is sent throughout their length and can be felt at body sites

What should be included in a course on safety during the school age years?

wearing helmets when riding bicycles or skateboarding. firearm safety. wearing seat belts. school age children are active and need to take precautions, such as wearing helmets and pads when skateboarding or bicycling, as well as wearing seat belts when in the car. they are also able to understand rules for fire arm safety. there is not safe play on trampolines. school age children are coordinated enough to climb and descend stairs.

nocturnal emissions

wet dreams

tympany

what is heard when percussing the abdomen

the refractory state lasts longer

when the male is physiologically unable to ejaculate, from 12 to 24 hours as compared with two minutes in younger males

as an aging person performs the valsalva maneuver

you may note relaxation of the perianal musculature and decreased sphincter control

When auscultating the carotid artery

you should ask your patient to "hold" his/her breath

To improve ability to hear heart sounds

you should listen to apex with bell while patient is left lateral and listen to base with diaphragm while patient is sitting up and leaning forward.