Abd/GI/GU/Pedi/Geri/OB Flashcards
(115 cards)
1
Q
Age Related GI Changes
A
Motility and peristalsis slows
Constipation increases
Fat becomes more pronounced in the abdomen
Weakening abdominal muscles produces a “potbelly”
Symptoms of acute disease may be diminished
↓ pain
Fever less pronounced
Salivation decreases
Dry mouth, decreased taste
Esophageal emptying slowed
Feed in upright position
Liver size decreases with age
Blood flow to the liver is decreased by 55%
Metabolism of drugs is decreased and/or prolonged with age
2
Q
Pica
A
Eating non-nutritious food substances.
Ex: grass, clay, stones, clothing, starch.
Common in early childhood, pregnancy, psychologically impaired individuals.
Can be due to iron deficiency
3
Q
Food intolerance
A
Foods that cause other symptoms.
Ex: lactose intolerance, wheat intolerance
Some intolerance are also allergies.
4
Q
Melena
A
Blood in the stool. May appear bright red, maroon or black and tarry.
5
Q
Diarrhea
A
Loose, watery stool
6
Q
Constipation
A
Fecal impaction, decrease in stool freq
7
Q
Hemmoroids
A
Varicose veins in the rectal area.
Due to straining, obesity, pregnancy
8
Q
Dysphagia
A
Difficulty swallowing foods, liquids, saliva
9
Q
Dysphasia
A
Partial or complete impairment in the ability to speak
10
Q
Pyrosis
A
Burning, as in heartburn
11
Q
Hematemesis
A
Vomiting of blood
12
Q
When collecting subjective data from your patient re: their PMH, is it important to ask about any recent traveling to a foreign country?
A
Yes
13
Q
Abdomen sequence when collecting objective data
A
Inspection
Auscultation
Percussion
Palpation
14
Q
Why is the abdomen sequency IAPP?
A
Palpation will alter the sounds when auscultating. Will not be accurate.
Can palpate something that shouldn’t be palpated if you don’t listen first!
15
Q
Striae
A
Stretch marks (scars)
Pink- newer
silver/white- older
16
Q
Contour
A
Determine the profile from the rib margin to the pubic bone
Flat
Rounded
Scaphoid
Protuberant (indicates distention)
17
Q
Umbilicus
A
Should be midline and inverted
18
Q
Aorta is slightly _________ of the midline.
A
left
19
Q
Where do bowel sounds originate from?
A
Movement of air and fluids through the small intestine
20
Q
Bowel sounds regular rate
A
Every 5-15 sec or 5-30/min
21
Q
Bowel sounds
A
High pitched, gurgling, cascading
22
Q
Hypoactive bowel sounds
A
Less than 5 sounds per minute
Peritonitis, ileus
23
Q
Hyperactive bowel sounds
A
Loud, high pitched, rushing, tinkling sounds
Gastroenteritis
24
Q
Normoactive bowel sounds
A
Normal
25
Absent
No sounds for over 5 minutes
26
Borborygmus
"Growling" stomach
27
How long should you listen to bowel sounds when you do not hear any sounds?
20 minutes total
5 minutes per quadrant
28
Use the bell to listen for
Bruits
29
Are bruits normal or abnormal?
Abnormal
30
Tympany
Percussion of the abdomen
is the prominent sound
Stomach and intestine
Heard over air filled area
31
What type of sound is heard over organs?
Dull
32
What areas do you percuss last?
the painful areas
33
Hyperresonance is heard over
gaseous distention
34
What side of the patient do you stand on when palpating?
the patient's right side
35
When palpating, should the patient's legs be straight or bent? Why?
Bent; to reduce tension
36
Light palpation of abdomen
Press down 1-2cm in a rotating motion with one hand
37
Deep palpation of abdomen is used to
evaluate organs and find masses
38
Rebound tenderness
Pain increases after releasing from deep palpation
39
Appendicitis pain is felt in which quadrant?
RLQ
40
Palpating the liver
Deep palpation using the hooking technique, RUQ
41
Hooking technique
Stand on client’s right side
Place right hand at the client’s midclavicular line under and parallel to the costal margin
Client inhales and deeply exhales while pressing in and up with the right fingers
42
Palpating the spleen
Not usually palpable, LUQ
Must be enlarged 3x normal size before palpable
43
What causes the spleen to be enlarged?
Mono, trauma, lymphoma, leukemia
Do not continue to palpate if enlarged; can rupture easily
44
When do you percuss using Murphey's punch?
When evaluating the kidneys
Should feel thud, no pain
Pain present with inflammation of the kidneys
45
Are kidneys usually palpable?
No
46
Palpating the bladder
Deep palpation is used in the hypogastric region, superior to suprapubic bone
Empty bladder- unable to palpate
Full bladder- enlarged
If tender, suspect UTI
47
Ascites
Fluid in the abdomen
Protuberant abdomen w/ bulging flanks
Tympany to dullness
Usually happens w/ liver disease
48
Do men experience a definite end to fertility (similar to women)?
No, but there is a definite decline
49
Erectile Dysfunction causes
Psychological: stress, anxiety, fatigue
Physical: diabetic neuropathy, CV disorders, spinal cord injuries
Non-physical: medications (anti-hypertensive)
50
As men age, do testosterone levels increase or decrease?
Decrease
51
Decrease in testosterone levels can cause
Fatigue, decreased libido, decreased sexual function, decrease in penis size
52
When do testosterone levels start to decrease?
Begins mid-late 30's
Not a rapid process like menopause
53
Polyuria
excessive urination
54
Oliguria
low urine output
55
Nocturia
Get up at night on a regular basis to urinate
56
Hematuria
Blood in urine
57
Dysuria
Painful urination
58
Urgency
sudden, intense need to urinate
59
Hesitancy
Dribbling, difficulty starting stream
60
When collecting subjective data from both male and female patients you should
Gain trust
Build relationship with patient
Make them comfortable
Provide for privacy
Reassurance of confidentiality
61
What is the most common form of cancer in men ages 15 to 35?
testicular cancer
62
Risk factors for testicular cancer
un-descended testicle
prior hx of cancer in one testicle
family history of testicular cancer
More common in white males than in black males
63
In what area do hernias often occur?
Inguinal area
64
Characteristics of a hernia
Typically painless round, swollen area close to the pubis. Reduces w/ supine positioning.
Feel abnormal bulge/protrusion when palpating the inguinal area
65
Testicular torsion
Testicle rotates, twisting the spermatic cord that brings blood to the scrotum
Medical emergency
66
Benign Prostatic Hyperplasia (BPH)
Imbalance of cell proliferation and programmed cell death
Creates urine outlet obstruction, impeding urine output
Present in about 80% of men >60 yrs old
67
Signs and symptoms of BPH
Blood in the urine (Hematuria). Not a gross amount.
The need to urinate frequently, especially at night (Nocturia)
Weak or interrupted urine flow
Urgency
Pain or burning feeling while urinating
The inability to urinate
Constant pain in the lower back, pelvis, or upper thighs
Never feel like voided fully
68
Risk factors of Prostate cancer
Increasing age
Family history (brother or father)
African-American & African Caribbean men (inherited genetic factor)
Obesity
Smoking
69
How can we check for prostate cancer?
Digital rectal exam and Prostate-Specific antigen test
70
Menopause
Cessation of menses. Rapid decrease in female hormones.
48-51 typical age range
Effects of menopause:
Vaginal infections – pH becomes more alkaline
UTI’s
Dyspareunia – pain with intercourse
Lowered libido
71
Perimenopause
40-55 age range
Hot flashes
Mood swings
Menstrual irregularity
72
Dysmenorrhea
Painful menses
73
Polymenorrhea
Menstruation less than 21 days
74
Oligomenorrhea
Infrequent bleeding
75
Metrorrhagia
Intermenstrual bleeding
76
Postcoital bleeding
Bleeding after intercourse
77
Pelvic pain could indicate
ectopic pregnancy
78
How many months w/o menstruation to be considered menopausal?
12 consecutive months
79
Stress
Urinary incontinence
Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
80
Urge
Urinary incontinence
Leakage of large amounts of urine at unexpected times, including during sleep.
81
Overflow
Urinary incontinence
Unexpected leakage of small amounts of urine because of a full bladder.
82
Human Papillomavirus (HPV)
HPV causes almost all cervical cancers
2 FDA approved vaccines- Gardasil & Cervarix
83
Health History Sequence
Biographic data
Reason for seeking care
Present health or history of present illness
Past history
Medication reconciliation
Family history
Review of systems
Functional assessment or activities of daily living (ADLs)
84
Neonate/Infant Sequence
** When assessing an infant or neonate the order is different. It is NOT a typical Head to Toe Assessment **
Vital Signs
Measurement
Appearance
Chest & Heart
Abdomen
Head & Face
Eyes
Ears
Nose
Mouth and Throat
Neck
Upper extremities
Lower extremities
Genitalia
Neuro
Spine & Rectum
85
Adolescent Sequence
Same as adult sequence
For well visits, keep in street clothes and work around them
86
Young Child Sequence
Health history
Vital Signs
Appearance
Measurement
Upper extremities
Head, Face & Neck
Eyes
Nose
Mouth and throat
Ears
Posterior Thorax
Anterior Thorax, Heart, Lungs
Abdomen
Genitalia
Lower extremities
87
Presumptive signs of pregnancy
Breast tenderness
Nausea
Fatigue
Urinary frequency increased
88
Probable signs of pregnancy
Items detected by the examiner:
Enlarged uterus
89
Positive signs of pregnancy
Direct evidence:
Auscultation of fetal heart sounds
Cardiac activity on ultrasound
HCG urine test
90
Gravida
pregnancies
91
Para
Births >20 weeks
92
Term
Births >37 weeks
93
Preterm
Births >20 weeks, <37 weeks
94
Abortion
miscarriages, surgical
95
Living children
Children alive
96
How to determine weeks of gestation
Use Naegle's rule
97
Calculate due date using Naegle's rule
Calculate the patient’s due date based on the following:
Begin on the first day of the last menstrual period. Subtract three months. Add 7 days. Add one year.
Example:
LMP 1st Day: 01/01/2020
LMP Last Day: 01/04/2020
01/01/20 (-) 3 months --> 10/01/19
10/01/19 (+) 7 days --> 10/08/19
10/08/19 (+) 1 Year --> 10/08/20 is the due date
98
What subjective data do you collect from a pregnant patient?
-Menstrual hx: LMP, # of days in cycles, and certainty of LMP
-Gyn hx: Surgeries, pap, STD/STI, breast hx
-OB hx
-Current preg: Planned? Bleeding? Pain? Edema? Baby moving?
-All other subjective: Med hx, ROS, nutrition, family hx, environment
Differentiate between subjective and objective
99
Chloasma
Butterfly shaped pigmentation of face
"mask of pregnancy"
100
Linea nigra
hyperpigmented line sternal notch, past umbilicus to pubis
101
Striae
stretch marks
bright red then lighten post-partum
102
Are chloasma, linea nigra, and striae normal findings in a pregnant patient?
Yes
103
Fundus
top of uterus
104
When is fundus palpable?
12 weeks gestation
105
Fundal height
Cm from symphysis to fundus
106
Young old
65-74 years old
107
Middle old
75-84 years old
108
Old old
85+ years old
109
Examples of ADLs
Eating, bathing, grooming, dressing, toileting, walking
110
Examples of iADLs
Instrumental ADLs
Shopping, meal prep, housekeeping, laundry, managing finances, taking meds, using transportation
111
Tests for mental status/cognition
MMSE and MOCA
Both the MMSE and the MoCA are routine cognitive screening tests rated on a 30-point scale. They are both brief, though the MMSE is a little shorter, taking about 7 to 8 minutes to administer. The MoCA takes approximately 10 to 12 minutes.
MMSE is relatively insensitive to mild disease (Patients with only minor cognitive impairment may be overlooked if this is the principal screening tool used).
For mild impairment, the MoCA is the better. It’s the more sensitive of the two and also more difficult. The MoCA discriminates very well between normal cognition and mild impairment or dementia, but it’s too difficult for moderate to severe conditions.
112
MoCA is best for
Mild cognitive impairment
113
Warning signs to stop driving in the geriatric population
Freq close calls, accidents
Finding dents, scrapes on car
Getting lost easily
Responding slower (brake vs gas)
Misjudging gaps in traffic
Driving too slow or too fast
Easily distracted
Having physical constraints (turning head)
Trouble maintaining correct lane
114
Relationship between fundal height and weeks of gestation
In normal, singleton pregnancy after 20 weeks, cm = weeks of gestation
115
MMSE
Mild impairment
