Exam 2 Flashcards
(204 cards)
1
Q
What is the point of a nutritional assessment?
A
- Provides insight into clients overall health status
- Identified risk factors for obesity
- Identified risks for dietary deficits
- Works as a guide to health promotion and disease prevention
2
Q
Essential nutrients
A
-carbohydrates
-protein
-fat
-vitamins
-minerals
-water
3
Q
What is nutritional status ?
A
Relationship or balance between nutrient intake and bodied requirements, and bodies ability to digest, absorb and use nutrients
4
Q
What is optimal nutritional status?
A
- Most beneficial nutritional status
- proper balance of nutrient intake to meet daily metabolic demands.
5
Q
What are factors that can affect nutritional status?
A
High level of exercise
elevated body temperature
certain disease states
developmental
cultural behaviors
economic status
6
Q
If you have an optimal nutritional status, you have:
A
- Improved immune system
- more energy
- you heal more readily.
7
Q
What is undernutrition?
A
Under nutrition is the result of an adequate nutrition, and take on nutritional reserves being depleted 
8
Q
What are causes of under nutrition?
A
- diseases
- disorders
- lifestyle behaviors.
9
Q
What are some risk factors for undernutrition?
A
-lower socioeconomic status (food is unaffordable)
-lifestyle of long work hours (increases eating out)
-Poor food choices by children and teens and adults (fried salty sugary)
-chronic dieting
-chronic disease (crohns, cirrhosis, cancer - can affect nutrients absorption)
-dental factors
-limited access to sufficient food, regardless of socioeconomic status (if you’re physically unable to shop cook or fees self)
-disorders (anorexia, bulimia, depression, dementia)
-illness
-trauma
10
Q
What is overnutrition?
A
Another form of malnutrition, but as when intake of nutrients exceeds them in a bottle need of the body to maintain normal growth, development, and metabolism
11
Q
Overnutrition increases the risk for what chronic diseases?
A
-cardiovascular disease
-type two diabetes
-hypertension
-cancer
-gallbladder disease
-sleep apnea
-weekend immune system
12
Q
What percent over ideal body weight is considered overweight?
A
10%
13
Q
What percent of body weight over ideal body weight is considered obese?
A
20%
14
Q
What percent over ideal body weight is considered morbidly obese
A
30%
15
Q
Risk factors that contribute to overnutrition
A
-Genetics
-family lifestyle
-inactivity
-unhealthy diet and eating habits -Liquid calories
-quitting smoking
-pregnancy
-lack of sleep
-some medications
-Microbiome (gut bacteria)
-social and economic issues (age hormonal changes, less activity, lower muscle mass)
-medical problems
16
Q
What is optimal hydration?
A
Optimal hydration means all body systems and organs are optimally functioning with enough hydration for:
-urination
-bowel elimination
-sweating temperature regulation
-toxin elimination
-metabolism
-enzyme production
-nutrient absorption
-immunity efficiency
-calorie burning efficiency
-the health of skin, nails, and hair 
17
Q
What is the typical recommendation for how much water you should drink per day?
A
Qty 8 of 8 ounce glasses
1500ml
18
Q
What does dehydration cause?
A
-Serious damage to body, cells and execution of body functions
-thirst mechanisms are poorly developed, once thirsty, could already be dehydrated 
19
Q
Overhydration
A
-typically not a huge problem in healthy people because the body is effective at maintaining correct fluid balance
-fluid shifts in an out a physiological Thirdspace (extra cellular tissue, plural and pericardial spaces, tongue and eyes, extra urine and stool, perspiring)
20
Q
Factors that affect, food safety, and put client at risk for poisoning
A
-how food is stored
-how food is prepared (cross-contamination)
*250+ food borne illnesses
21
Q
Signs and symptoms of food poisoning
A
Nausea
vomiting
diarrhea
stomach cramps
22
Q
Causes of / Most common pathogens for food poisoning
A
-infections (bacteria, viruses, parasites)
-poisoning from contaminations with toxins or chemicals
Pathogens:
-Norovirus
-salmonella
-clostridium perfingens
-campylobacter
23
Q
What are anthropometric measurements
A
-height
-weight
-BMI
-waist-to-hip ratio
-MAC (midarm circumference)
-MAMC (midarm muscle circumference)
-triceps skin fold thickness
24
Q
How to calculate BMI
A
Kilograms and meters
Pounds and inches
Total kilograms / height in metered (squared)
(Total pounds / height in inches (squared) ) x 703
25
What are the components of a nutritional assessment?
-nutritional screening
-comprehensive nutritional assessment
-health history
-objective and subjective data -anthropometric measurements
26
What are the warning signs of poor nutrition?
DETERMINE
D= disease
E = eating poorly
T = tooth loss/mouth pain
E = economic hardship
R = reduced social contact
M = multiple medicines
I = involuntary weight loss/gain
N = needs assistance in sept care
E = elder years (80+)
27
What are the different types of body builds? (3)
Ectomorph
Mesomorph
Endomorph
28
What is ectomorph?
A type of body build
Small frame and bone structure, flat chest, small shoulders, thin, lean muscle, mass hard to gain, weight, fast metabolism 
29
What is mesomorph?
Body build type
Athletic, generally hard body, well-defined muscles, rectangular shaped body, strong, gains muscle easily, Gaines fat more easily than ecto
30
What is endomorph?
Body build type
Soft and round body , generally short or stocky build, round physique, hard to lose fat, slow metabolism, Muscles are not well defined
31
How do you assess hydration?
-measuring intake and out take -orthostatic blood pressure
(Laying, sitting, and standing)
-skin turgor
-pitting edema
-skin moisture
-Venus filling
-neck veins
-tongue condition and furrows
-eye positioning and surrounding
-auscultating lung sounds.
32
BMI normal ranges
Adult
Underweight = less than 18.5 kg/m2
Normal weight = 18.5-24.9 kg/m2
Overweight = 25-29.9 kg/m2
Obese = 30 kg/m2 or greater
Child (2-19)
Underweight = less than 5th percentile
Normal weight = 5th to 85th percentile
Overweight = 85th to less than 95th percentile
Obese = equal or greater to 95th percentile
33
Normal ranges for MAC (midarm circumference)
Adult male:
-Standard = 29.3
-90% of standard (moderately malnourished) = 26.3
-60% of standard (severely malnourished = 17.6
Adult female:
-Standard = 28.5
-90% of standard (moderately malnourished) = 25.7
-60% of standard (severely malnourished = 17.1
34
Normal ranges for triceps skin fold and thickness (TSF)
Adult male:
-Standard = 13.5
-90% of standard (moderately malnourished) = 11.3
-60% of standard (severely malnourished = 7.5
Adult female:
-Standard = 16.5
-90% of standard (moderately malnourished) = 14.9
-60% of standard (severely malnourished = 9.9
35
Typical lab tests
Hemoglobin
Protein
High cholesterol
Triglycerides
Albumin
Globulins
Transport proteins
Skeletal muscle proteins
Blood proteins
Immunoglobulins
36
Nutrition: abnormal findings
Obesity
Obesity = excess fat around abdomen
Measurements greater than 130% of standard indicate obesity
Increases risk factors:
-respiratory disease
-obstructing sleep apnea
-surgical complications (stroke, gallbladder, type 2 diabetes, coronary heart disease, hypertension, Breast and colon cancer
37
Nutrition: abnormal findings
Kwashiorkor
Swollen belly
Protein malnutrition
38
Nutrition: abnormal findings
Marasmus
Loose, folded skin
Protruding rib cage
“Old man”
Protein/calorie malnutrition
39
Vitamin A deficiency
-Bitot spot in temporal interpalperbral fissure
-conjunctival and corneal xerosis
-keratomalacia
40
Riboflavin deficiency
Cheilosis and angular stomatitis
Magenta tongue
41
Fluorosis
Brown mottling on teeth
42
Zinc deficiency
White spots on nails
Smooth tongue
43
Vitamin B12 deficiency
Angular stomatitis (inflamed angles of the mouth)
(Side note: this can be masked by too much folic acid intake)
44
How many food borne illnesses are there (according to cdc)
More than 250
Caused by infection or combination with various toxins or chemicals
45
Things to ask for a nutritional health history
-history or present health concern
-personal health history
-family history
-lifestyle and health practices
46
What is a food allergy
An immune system response, food intolerance results from a digestive system irritation or when the digestive system is unable to break down or properly digest food.
47
Foods most likely to cause allergic reaction
Peanuts
Tree nuts
Cows milk
Egg
Wheat
Soy
Fish
Shellfish
Sesame
48
What happens to body overall appearance during aging
-Muscle tone and mass decrease.
-Loss of subcutaneous fat, making bones and muscles more prominent. -Fat is redistributed. Fat is lost from face and neck and moved to arms, abdomen and hips
49
What equipment is needed to perform a physical assessment relating to nutrition?
-Balance beam scale with height attachment
-metric measuring tape
-marking pencil
-skin calipers
50
Difference between nutritional screening vs comprehensive nutrition screening
Nutritional screening: 24 hour recap of food and a nutritional history.
Comprehensive nutritional screening: collection of subjective data through health history interview, collection of objective data. Anthropometric measurements (to evaluate physical growth, development, and nutritional status) lab tests.
51
People at risk for overhydration
Overhydration or fluid retention
Kidney, liver, cardiac disease in which fluid dynamic mechanisms are impaired
52
Findings when assessing older client nutritional status
-tenting can indicate fluid loss, but also present in malnutrition and loss of collagen
-muscle tone and mass decrease
-loss of subcutaneous fat, making bones and muscles more prominent
-fat is redistributed
-fat is lost from face and next and moves to arms, abdomen and hips
53
Describe the structure of the abdomen
-bordered superiorly by the costal margins
-bordered laterally by the flanks
-bordered inferiorly by the symphysis pubis and inguinal canals
-4 quadrants
RLQ
RUQ
LUQ
LLQ
-two imaginary lines (vertical/midline, horizontal/lateral)
-regions
Epigastric
Umbilical
Hypogastric
Suprapubic
54
RUQ of abdomen
Main things to know
Liver
Gallbladder
Right kidney
-ascending and transverse Colon
-Duodenum, gallbladder, hepatic flex Ute of colon, liver
-pancreatic head, pylorus, right adrenal gland
-right kidney, right ureter
55
RLQ of abdomen
-appendix
-ascending colon, cecum
-right lower part of kidney
-right ovary and tube
-right ureter
-right spermatic cord
56
LUQ abdomen
-stomach
-spleen
-pancreas left
-adrenal gland
-left upper kidney
-left ureter
-transverse descending colon
57
LLQ of abdome
-left kidney
-left ovary and tube
-left ureter
-left spermatic cord
-descending and sigmoid colon
58
What are the 9 regions of the abdomen?
-epigastric
-umbilical
-hypogastric
-right and left hypochondriac
-right and left lumbar
-right and left iliac (lnguinal)
59
What are the 3 layers of the abdomen?
(From back around flanks to front)
1. External abdominal oblique
2. Internal abdominal oblique
3. Transverse abdominis
60
What do the abdominal wall muscles do?
-Protect internal organs
-allow normal compression of internal organs during functional activities
61
Internal anatomy of abdomen
-Parietal peritoneum, visceral peritoneum
-body systems it controls/regulates
Gastrointestinal
Reproductive (female)
Lymphatic
Urinary
-solid viscera
Liver
Pancreas
Spleen
Adrenal glands
Kidneys
Ovaries
Uterus
Hollow viscera
Stomach
Gallbladder
Small intestine
Colon
Bladder
62
What is the peritoneum of the abdomen
Serious membrane that lines the abdominal cavity (parietal)
Protective covering for most internal organs (visceral peritoneum)
63
Viscera’s of the abdomen
-solid
-hollow
*palpation of abdominal viscera depends on location, structural consistency, and size
*viscera normally not palpable
Pancreases, spleen, stomach, gallbladder, small intestine
64
What are the vascular structures of abdomen?
Abdominal aorta
Right and left iliac arteries
65
Peptic ulcer disease
-presence of heliconacter pylori (h. Pylori) in GI tract
-excess alcohol intake
-regular use of nonsteroidal anti-inflammatory drugs (NSAIDs)
-regular use of bisphosphonates (Actonel, fosamax, etc)
-smoking or chewing
-seriously illness (especially if on respirator)
-radiation treatment
-zollinger-Ellison syndrome (rare condition of tumor in pancreas *releases high level of an acid-producing hormone)
-uncontrolled stress
66
Risk factors that increase chance of GERD (Gastroesophageal reflux disease)
Increased risk factors:
Obesity
Hiatal hernia
Pregnancy
Smoking (weakens esophageal sphincter)
Dry mouth
Asthma
Diabetes
Delayed stomach emptying
Connective tissue disorders
Alcohol
67
How to prepare an abdomen
-empty bladder
-remove clothes and put on gown
-lie supine with arms folded across the chest or resting at sides
-drape the client
-breathe through mouth, slow, deep breath
68
Equipment needed for abdominal exam
-small pillow or rolled blanket
-centimeter ruler
-stethoscope (warm the diaphragm and bell)
-marking pen
-gown and drapes
69
Order of techniques for physical
-inspection
-auscultation
-palpation
-percussion
70
What is ascites and what is the test for it?
Build up of fluid in belly, often due to severe liver disease. The extra fluid makes the belly swell
Test by shifting dullness and perform fluid wave test
71
Five tests used to detect appendicitis
1) Assess for rebound tenderness (Blumberg sign)
How: pain/tenderness test for rebound tenderness by palpating deeply at 90 degrees into the abdomen halfway between the umbilicus and anterior iliac crest. Then suddenly release pressure.
***should be done at end bc positive response produced pain and muscle spasms that can interfere with the remaining examination
2) assess for psoas sign
How: life on left side and hyperextended the clients right leg. Pain in RLQ
3) assess for obturator sign
How: support clients right knee and ankle. Flex the hip and knee, rotate. The leg internally and externally. pain or discomfort by the subject/patient on the slow internal movement of the hip joint, while the right knee is flexed
4) perform hypersensitivity test
How: stroke abdomen with a sharp object (broken cotton tipped applicator) or grasp a fold of skin with your thumb and index finger and quickly let go. Do this several times along abdominal wall
5) test for referred rebound tenderness. Palpate deeply in the LLQ and quickly release pressure.
72
Test used to detect cholecystitis
1) assess RUQ pain or tenderness
2) Murphy sign
73
What is Murphy sign
1) used to assess cholecystitis
2) pain when pressure applied under liver border of right coastal margin and client inhaled deeply.
74
What is rovsing sign
Pain in RLQ during pressure in LLQ
-also appendicitis
75
Blumberg sign
Pain or tenderness when tests for rebound tenderness by palpating deeply at 90 degree into abdomen between umbilicus and anterior iliac crest
76
Differentiate between visceral, parietal, and referred pain in the abdomen
Visceral: occurs when hollow abdominal organs become distended or contract forcefully or when the capsules of solid organs are stretched.
Parietal: occurs when the parietal peritoneum becomes inflamed. This type of pain tends to localize more to the source and is characterized as a more severe and steady pain.
Referred: occurs at distant sites that are innervated at approximately the same levels as the disrupted abdominal organ. Pain travels, or refers, from the primary site and becomes highly localized at the distant site
77
Abdominal distention
-pregnancy
-fat
-feces
-fibroids and other masses
-flats
-ascetic fluid
78
Abdominal bulges
Umbilical hernia
Epigastric hernia
Diastasis recti
Incisional hernia
79
Abnormal findings of the abdomen
-Enlarged liver
-enlarged nodular liver
-liver higher than normal
-enlarged spleen
-aortic aneurysm
-enlarged kidney
-enlarged gallbladder
80
Findings seen when assessing older clients abdomen
-dilated superficial capillaries without a pattern may be seen in older clients (more visible in sunlight).
-assess for acute abdominal conditions as sensitivity to pain may diminish with aging
-65-75 years men who have smoked should have one time screening for abdominal aortic aneurysm
-selective for 65-75 who have never smokes
-not recommended for women
81
Head = cranium
Describe bones in the skull (8 bones)
1. Frontal (1) *
2. Parietal (2)
3. Temporal (2) *
4. Occipital (1) *
5. Ethmoid (1)
6. Sphenoid (1)
82
Facial bones
1. Maxilla (2)
2. Zygomatic (2)
3. Inferior conchae (2)
4. Nasal (2)
5. Lacrimal (2)
6. Palatine (2)
7. Vomer (1)
8. Mandible (1)
83
Suture lines
-the lines between cranial bones
-Adults = closed
-infants = soft and open
84
What are the muscles that produce facial movement and expressions
85
What are the largest blood vessels of neck
Internal jugular veins
Carotid arteries
Located: bilaterally, parallel and anterior to the sternomastoid muscles
86
What are the main muscles of the neck?
1. Sternocleidomastoid
Allows for rotation and flexure
2. Trapezius
Allows shrugging of shoulders
Allows additional movement of head
87
Lymph nodes
Lymph nodes should be:
Round and soft, less than 1cm, mobile from side to side, soft, no tender
-pre-auricular
-post-auricular
-tonsillar
-occipital
-submandibular
-submental
Extra
-superficial cervical
-posterior cervical
-deep cervical
-supraclavicular
88
Glands in the face
-parotid glands
-submandibular salivary glands
89
Structures of the neck
-cervical vertebrae (C1-C7)
-hyoid bone: allows movement of tongue and ability to speak
-larynx :
-trachea: made of cricoid cartilage, thyroid cartilage, no bone!
-Thyroid Glands: found at front of the neck.
90
What are the thyroid glands for?
1. Thyroid gland issues = not having enough iodine
2. Control metabolic rate in cells of the body
3. Enlargement means not enough hormone production bc it is trying to make more.
91
Main bones that hold up the head
C1 = Atlas
C2 = Axis
C7 = landmark at top of back
92
Risk factors associated with head and neck disorders across cultures
-Binding the head
-no touching the head or feet
-gray hair changes by cultural group and genetics
-face structures and features vary widely
93
TBI : traumatic brain injuries
-results from a blow to the head:
Bump, jolt, blow, or penetrating injury to head
-Major cause of death and disability
-ranges from mild to severe
-prevalent among adolescents, young adults, persons over 75
-falls leading cause for those over 65
-second cause is motor vehicle accident or traffic-related incidents
-culture may contribute
94
Risk assessment for TBI
-mental health status
-Lifestyle
-Age
Infants/toddlers:
-environmental (fall risks)
-lack of parental knowledge of shaken baby syndrome
-caregivers risk of shaken baby syndrome
Children and teens
-knowledge and use of protective equipment in sports and bicycle use
-knowledge and use of safety practices when driving
Adults and older adults
-knowledge and use of safety practices when driving
-impairment of physical or mental stability
-potential for maltreatment or domestic violence
95
Risk reduction for TBI
-Buckling child in seat properly
-birth - 2 years old
-2 years - 4 years (until 40lbs)
-4 years - 8 years (or until 4’9” tall)
-after age 8 and/or 4’9” tall
-seat belt
-No DUII
-wear helmet
-environmental safety
96
Headache impact test to determine how headaches affect clients activities of daily living
Headache impact test (HIT-6TM)
-when do you have headaches?
-how often is the pain severe
-how often do headaches limit your ability to do usual daily activities (including household work, work, school, or social activities)
-when you have a headache, how often do you wish you could lie down?
-in the past 4 weeks, how often have you felt too tired to do work or do activities bc of headaches
-past 4 weeks, how often have you felt fed up or irritated bc of headaches
-past 4 weeks, how often do the headaches limit your ability to concentrate on work or daily activities
-difficulty moving?
-lumps, lesions on head or neck, cough, difficulty swallowing
-dizziness, lightheaded ness , spinning sensation, blurred vision, level of consciousness
-change in skin, hair, energy level, sleep habits, emotional stability, palpitation
-weakness or numbness
97
How to perform a physical assessment of the heart and neck
-describe prep for client
-list equipment required for examination of head and neck
-describe techniques used to examine head for size, shape, configuration, and consistency
-palpate temporal arteries
-palpate TMJ for swelling, tenderness, crepitation
-inspect neck movement, position, symmetry, lumps, masses
-palpate trachea for position
-palpate thyroid for enlargement, lumps, masses
-palpate for any enlargement or tender lymph nodes
-auscultation bruits over thyroid if enlarged
98
Hypo-thyroidism (Myxedema)
-Increases sensitivity to cold
-constipation
-depression
-fatigue
-heavier menstrual periods
-pale, dry skin
-thin, brittle hair or nails
-weakness
-unintentional weight gain
99
Hyper-thyroidism (thyrotoxicosis)
-Nervousness
-fatigue
-weakness
-palpitations
-heat intolerance
-excessive sweating
-Dyspena (shortness of breath)
-diarrhea
-insomnia
-poor concentration
-oligomenorrhea (infrequent or abdominal menstruation)
-weight loss
-hair loss
-tachycardia
-proximal myopathy
-warm, moist skin
-hyperkinesis (increase in muscular movements)
-stare, lid lag, lid retraction, exophthalmos (bulging eyes)
-emotional liability
-hyperactive reflexes
-thyroid enlargement
100
Types of headaches
-Sinus
-cluster
-tension
-migraine
-tumor related
101
Acromegaly
Enlargement of facial features (nose, ears) and hands and feet
102
Crushing syndrome
Moon shaped face, with reddened cheeks and increased facial hair
103
Scleroderma
Tightened, hard face with thinning facial skin
104
Bell palsy
-Begins suddenly and reaches a peak within 48 hours.
-S/S twitching, weakness, paralysis, drooping eyelid, or corner of the mouth, drooling, dry eye, dry mouth, decreased ability to taste, eye tearing, and facial distortion, one-side paralysis
105
Older clients head and neck
-arthritis
-osteoarthritis
-neck pain or decreased ROM
-facial wrinkles due to fat decreases with age. In addition, the lower face may shrink mouth may be drawn in
-strength and pulsation of temporal artery may decreased in the older client
-cervical curvature may increase bc of kyphosis of the spine. Fat May accumulate around the cervical vertebrae (especially women) “dowagers hump”
-decreased flexi on, extension, lateral bending, rotation of neck (usually caused by arthritis)
-thyroid may be more modular or irregular bc of fibrotic changes
106
Assess for stroke
FAST
F: facial droop
A: arms (raise yo and down)
S: speech (difficulty)
T: time (act fast)
107
Structures of the mouth (oral cavity)
-lips (entrance to mouth, protective gateway to digestive and respiratory tracts)
-cheeks (lateral walls)
-hard and soft palates (roof)
-uvula (hangs in midline if oropharynx)
-tongue (muscles to move food, swallowing, speaking)
-lingual frenulum (tongue tie)
-mandible (jaw bone = support)
108
What are the nose and paranasal sinuses for?
Responsible for receiving, filtering, warning, and moistening air to be transported to the lungs.
Cranial nerve I (olfactory)
109
The mouth purpose
Beginning of the digestive tract and serves as an airway for the respiratory tract.
Responsible for ingestion, tasting, preparing food for digestion, aiding in speech
Cranial nerves = V (Trigeminal) , VII (facial), Or IX (Glossopharyngeal), and XII (Hypoglossal)
110
Structure and function of the throat
Throat = pharynx
Muscular passage for food and air.
Upper part = nasopharynx
Under nasopharynx = oropharynx
Under oropharynx = laryngopharynx
111
Different tonsils and where they are located
-palatine tonsils = both sides of oropharynx
-lingual tonsils = base of tongue
-pharyngeal tonsils (adenoids) = high in the nasopharynx
112
Nose
External and internal cavity
Bone and cartilage lined with a mucous membrane.
External = bridge (upper portion), tip, nares
Septum contains rich supply of blood vessels known as kiesselbach area
Superior, middle, inferior turbinates are bony lobes, called conchae, project from lateral walls. = increase area that is exposed to incoming air.
113
Sinus (4)
1) paranasal sinuses
-frontal (above eyes)
-maxillary (upper jaws)
-ethmoidal (smaller deeper in skull)
-Sphenoidal (smaller deeper in skull)
Air filled sacs that decreased weight of the skull
Can be primary set of infection bc they catch a lot.
114
Risk factors for oropharyngeal cancer (cancer of oral cavity)
-tobacco use (could be caused by secondhand smoke)
-alcohol
-Sun
-HPV (oral sex)
-gender (more common in men)
-fair skin
- age (over 45)
-poor oral hygiene
-poor diet
-weakened immune system
-marijuana
-chewing betel nut
115
Reduce risk factors for oral mouth cancer
Education!
-stop smoking
-avoid alcohol
-avoid chewing betel nuts
-avoid HPV
-avoid excess sun
-eat diet rich in fruit, veggies, vitamin A
-practice regularly oral hygiene
-extra precautions with Eakins immune systems
116
Subjective data for mouth, throat, nose, sinuses
-history of present health concern
-past health history
-family history
-lifestyle and health practices
General routine screening:
-inspect lips
-note odor from mouth
-inspect teeth, gums, tongue, and buccaneers mucosa
-inspect external nose
-check latency of airflow through nostrils
-inspect throat
117
Abnormal findings in the mouth
1) Herpes simplex type 1 (cold sores)
-clear vesicles surrounded by red indurates base
2) cheilosis of lips
-scaling painful fissures at corner of lips
3) carcinoma of lip
-round, undulated lesion becomes crusted and ulcerated with elevated boarder
4) Leukoplakia (ventral surface)
-thick raised patch does not scrape off, seen in heavy tobacco or alcohol
5) hairy leukoplakia (lateral surface)
6) Candida albicans infection (thrush)
7) Vitamin B12 deficiency = smooth, reddish, shiny tongue, without papillae
8) black hairy tongue: not hair, but elongated filiform papillae seen with use of antibiotics that inhibit normal bacteria
9) Carcinoma of tongue = round indurated lesion becomes crusty and uncreated with elevator boarder
10) canker sore = painful small ulcers inside mouth, do not occur on lip surface (non contagious)
11) gingivitis = red swollen gums that easily bleed
12) receding gums = gum tissue surrounding tooth pulls exposing more of tooth or root of tooth
13) kaposi sarcoma lesions = advanced lesions seen in HIV
14) acute tonsillitis = secondary to infectious mononucleosis. Enlarged tonsils and white gray patches
15) streptococcal pharyngitis = -erythematous posterior pharynx
-palatal petechiae
-white strawberry tongue
118
Tonsillitis = detecting and grading
1+ tonsils are visible
2+ tonsils are midway between tonsillar pillars and uvula
3+ tonsils touch uvula
4+ tonsils touch each other
119
Old adult considerations for mouth, nose, throat, sinuses
-ability to smell and taste decrease (could be due to multiple meds or neurodegenerative diseases)
-gums recede, become ischemic, undergo fibrotic changes, tooth surfaces may be worn, more susceptible to periodontal disease and tooth loss
-difficulty caring properly for teeth or dentures due to poor vision or dexterity
-teeth can look longer bc of receding gums
-oral mucosa is drier and more fragile due to degeneration of epithelial lining of salivary glands
-may have varicose veins on ventral surface of tongue
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General routine screening mouth, throat, nose, sinuses
-inspection of lips
-note order from mouth
-Inspection of teeth, gums, and tongue, and buccal mucosa, inspection of the external nose, checking for patency of airflow through nostrils, inspection of throat
121
Focused specialty screening mouth, throat, nose, sinuses
Palpation of the buccal mucosa and tongue, assessment of ventral surface, sides of the tongue, inspection for Wharton ducts and stensen ducts, checking strength of tongue and anterior tongue ability to taste, inspection of hard and soft palate, and uvula, asssessment of uvula, tonsils, and posterior pharyngeal wall, inspect internal nose with otoscope and nasal speculum. Palpation, percussion and trans illumination of the sinuses
122
Parts of the eye
Upper eyelid
Eyelash
Lower eyelid
Palpebral fissure
Pupil
Iris
Sclera
Medial canthus
Caruncle
Puncta
123
6 muscles control the eyes
-Superior oblique
-inferior oblique
-superior rectus
-inferior rectus
-medial rectus
-lateral rectus
124
Internal structure of eye
Cornea
Iris
Pupil
Lenses
125
Lacrimal
-lacrimal gland
-lacrimal canal (x2)
-lacrimal sac
-nasolacrimal duct
-opening of dust
126
Visual pathways
-visual perception
-optic chiasma
127
Visual reflexes
1) light reflexes = when you shine light into one eye, both pupils will construct
2) accommodation = vision and light (cones and rods). Look at something far away and then close up
128
Leading causes of visual disease
-cataracts
-glaucoma
129
Diseases of the eyes in older adults
1) Presbyopia
-over 45
-loss of eyes ability to focus on nearby objects
2) entropion
-eyelid turns in and causes eyelashes to rub against cornea
3) pinguecula
-yellowish nodules on Bullar conjunctiva
-first appears on medial side
-second appears on lateral side
4) Arcus senilis
-half-circle of gray, white or yellow deposits on outer edge of your cornea
-clear outer layer on front of eyes = fat cholesterol
130
Eye exam charts
Snellen = eye exam, 20 feet away
Ishihara = colorblind test
131
Physical assessment of eyes
Evaluate vision
-distance (near and far)
-gross peripheral
-corneal light reflex
-cover test
-cardinal fields of gaze
-physical
132
Physical assessment of eyes: external
Eyelids/lashes
Eyeball
conjunctiva
sclera
Lacrimal glands
Iris
pupil
133
Physical assessment of eye = internal
Eye grounds
Optic disc
Retina
Fovea
Anterior chamber
134
Tools to inspect the eyes
Ophtalmoscope
Start about 10-15 inches away
15 degree angle
Pretend opht is extension of eye
Don’t Use opposite eye
Don’t Move Opth around
Don’t Have client look into light
135
Parts of the ear: external
1) Auricle (Pinna)
-can be inspected without tools
2) external auditory canal
3) cone of light
-shine light, it should reflect
-right side = 7
-left side = 5
136
Parts of the ear; middle
1) tympanic cavity
-small
-air filled chamber into temporal bone
-separated from external ear by tympanic membrane (eardrum)
2) tympanic membrane
-pearly grayish color
-round and oval windows
-three ossicles
A) malleus
B) incus
C) stapes
-Eustachian tube
137
Parts of the ear: inner ear
Aka labyrinth
-fluid filled
-Boney and inner membranous labyrinth (3 parts)
1) cochlea = contains spiral organ of corti
2) vestibule = vestibular nerve and cochlear nerve (8th cranial nerve)
3) semicircular canals
138
How to test for Hearing
Romberg test
-inner ear
-check for balance
Weber test (fork tune test)
-feeling for vibration
-place at top of head
-Rinne test (fork tune test)
Feel for vibration
Place on mastoid bone behind ear 
139
Types of Hearing loss
1) conductive hearing loss
-something blocks or impairs the passage of vibrations going into inner ear
2) Sensorineural or perceptive hearing loss
-damage is located in inner ear
3) presbycusis
-progressive loss
-affects high pitched frequencies
4) otosclerosis
-abnormal bone growth inside ear
140
Otitis media risk factors
Age
Babies drinking laying down
Group childcare
Poor air quality
Seasons (flue and allergies)
Family history
Cleft
Down syndrome
Ethnicity
Enlarged adenoids
141
Ear / hearing risk assessment
Aging
Heredity
Occupational loud noises
Recreational loud noises
Ototoxic meds
Illness (especially with high fever)
142
Abnormal external ear and ear canal findings
Malignant
Otis externa
Build up of cerumen in canal
Polyp
Tophi
143
Abnormal findings in tympanic membrane
-acute otitis media
-blue/dark red tympanic membrane
-perforated tympanic membrane
-serous otitis media
-scarred tympanic membrane
-retracted tympanic membrane
-chronic suppurative otitis media with cholesteatoma
144
Neurological system
Responsible for coordinating and regulating body functions
Composed of
Central nervous system
Peripheral nervous system
145
Central nervous system
-Brain
-Spinal cord
-Covered with meanings (protect and nourish the CNS)
-subarachnoid space (surrounds brain and spinal cord, filled with CSF, cushions, neurishes, and removes waste products)
-neurons (govern activity throughout sensory and motor neural pathways)
-upper neurons in CNS influence lower motor neurons in PNS
146
Peripheral nervous system
-Carries info to CNS
-12 pairs of cranial nerves
-31 pairs of spinal nerves
-type
1) somatic
2) Autonomic
147
Peripheral nervous system: Somatic
-Carrie’s CNS impulses to voluntary skeletal muscles
-mediates conscious or voluntary activities
148
Peripheral nervous system: Autonomic
-Carries CNS impulses to smooth involuntary muscles
-mediates unconscious or involuntary activities
149
The brain: composition
-cerebrum (4 lobes)
1. Frontal
2. Parietal
3. Temporal
4. Occipital
-Diencephalon
1. Thalamus
2. Hypothalamus
-Brain stem
1. Midbrain, pons, medulla oblongata
-cerebellum: two hemispheres
150
The brain: frontal lobe
Directs voluntary, skeletal actions, communication, emotions, intellect, judgement
151
The brain: parietal
Interpret tactile sensations
152
The brain: temporal
Receives and interprets impulses from the ear
153
The brain: occipital
Primary visual receptor
154
Spinal cord
Location: vertebral canal
Extends from Medulla oblongata to first lumbar vertebra
-2 pairs of columns
Conducts nerve impulses
“H” shaped appearance
-sensory neuron = afferent
-motor neuron = efferent
-synapse = junction
155
Spinal nerves
-31 nerves
(8) cervical
(12) Thoracic
(5) Lumbar
(1) Coccygeal
-attached to the spinal cord with 2 nerve roots
1. Sensory (afferent) - enters through dorsal root
2. Motor (efferent) - exists through ventral root
-dermatome = where sensory root of each spinal nerve intervenes
156
Autonomic nervous system
-impulses carried to smooth, involuntary muscles of heart and glands
-maintains internal homeostasis of body
-incorporates sympathetic and parasympathetic nervous system
157
Sympathetic nervous system
Fight or flight
Activated during stress
Arise from T1 to L2 level
158
Parasympathetic nervous system
-restore and maintain normal body functions
-arise in S1 to S4 and cranial nerves (3, 6, 9, 10)
159
Neurological Older adult considerations
1. Normal decreases in
-hearing
-sight
-taste
-smell
2. Tremors
-when extending hands, nodding yes or no, extending tongue
-hand or dead or dyskinesia
3. Reduced muscle mass / degeneration of muscle fibers
4. Slow and uncertain gait, wider, slower, hips, and knees may be flexed for vent forward
5. Walking heel to toe may be difficult
6. Unable to hop from one foot to another
7. Rapid alternating movements become harder
8. Light touch and pain sensation may decrease
9. Increases risk for foot and ankle pathologies
10. Sensation in great toe may be reduced
11. Intact deep tendon reflexes (DTRs) but decrease in reaction time May slow response
12. Achilles reflex may be absent or difficult to elicit
13. Flexion of the toes may be difficult to elicit and may be absent
160
Neurological health history
Headaches
seizures
dizziness
numbness
tingling
prickling (parenthesis’s)
senses
difficulty speaking
difficulty swallowing (dysphasia)
muscle control
memory loss
161
What is the purpose of the skin?
Physical barrier that protects underlying tissues and structures from
Microorganisms
trauma
Ultraviolet radiation
Temperature maintenance
162
What are the three types of skin cancer
1. Melanoma
2. Basal cell carcinoma: more common in white people
3. Squamous cell carcinoma: more common in darker skin people
163
What is the most serious skin cancer?
Malignant melanoma
164
What factors increase the chance of getting skin cancer?
-sun
-ultraviolet radiation
-medical therapies
-genetics / family history
-moles
-fair skin, freckles, burns easily
-age
-actinic keratosis
-pigmentation irregularities
-gender (male is more common)
-chemical exposure
-HPV
- xeroderma pigmentosum
-injury (long term skin inflammation)
-alcohol/smoking
-diet (inadequate niacin B3)
-Bowen disease (scaly or thick patch)
-depressed immune system
165
What to education a patient on regarding skin cancer and sun exposure
-wear sunscreen
-wear long sleeve shirts/hats when in sun
-wear sunglasses
-try to stay out of the sun
-examine skin
-understand sun and cancer association
166
What are the ABCDE’s for assessing skin?
A: asymmetry
B: border shape
C: color
D: diameter
E: elevated / evolving
167
Collecting subjective data for the skin: what do you need to obtain?
-current health history (skin, hair and nails)
*when did it start?
*how long has it been going on?
*where is it located?
*symptoms
*exposure?
*have you tried any treatments? If yes, what?
*coldpa
-personal health history
*chronic illnesses?
*history of skin cancer?
*suspicious lesions
*skin concerns?
* allergic reactions
*past exposures? Past sun burns?
-family history
*skin disorders
*caner
*allergies
*asthma
-lifestyle and health problems : exposure to chemicals
hygiene
Diet
exercise
Tanning
Sunscreen use
168
Equipment needed for a physical exam for skin
-gloves
-pen light
-mirror (self examination)
-magnifying glass
-centimeter ruler
-wood light?
-gown / drape
169
When assessing skin: what are you looking for *during physical inspection
-color (general color and variations)
-odors
-lesions
-skin integrity
-patches of hair loss
-infestations
-shape of nails
170
When assessing skin: what are you looking for *during physical palpation
-texture
-thickness
-moisture
-temp
-mobility and turgor
-edema
-cap refill
171
Older adult considerations regarding skin
-perspiration will decrease
-decrease in hygiene (due to poor flexibility)
-increased risk for pressure injury
-pale skin due to decreased melanin and decreased dermal vascularity
-skin lesions
-drier skin
-decreased turgor due to decreased elasticity
-hair is more coarse and dry
-hair can be thin and grow slower
-nails may be thick, yellow, brittle
172
Risk factors a for pressure injuries
-prolonged pressure
-reduced feeling/sensation
-decreased mobility
-increased moisture
-malnutrition
-friction or shearing
-fragile tissues (due to age)
173
What are the pressure injury stages
Stage one
Stage two
Stage three
Stage four
Unstageable
174
Preventative measures for pressure injuries
1. Move patient every 2 hours (minimum)
2. Inspect skin daily (more if needed)
3. Bathe with mild soap, warm water *not hot
4. For dry skin: use moisturizers, avoid low humidity and cold air
5. Avoid vigorous massage
6. Used pillows, proper cushions, sheets, beds
175
What can skin in children can be affected by
-breastfed Vs formula fed
-introduction if new foods
-pets/animals in home
-goes to school/daycare
-has sibling at home
176
Things that can affect skin in pregnancy
-how far along she is (weeks of gestation)
-did you have any skin issues before pregnancy?
177
Things that can affect skin in elderly
-touch and sensation may be decreases
-higher risk for falls
-are they vaccinated or were they recently vaccinated
178
What characteristics for skin / lesions do you report?
-size: measure it
-shape: circular, angular, linear, regular, irregular
-color: Black, dark, red, purple, Central clearing (dark on border, but pale in the center)
-Texture
-Elevation/depression
-Configurations: groups (clusters), spread out (diffused), dense, linear(straight)
Location : be specific, and use proper Termanology
179
What are the different types of skin lesions
Macule
Papule
Patch
Plaque
Pustule
Vesicle
Bulla
180
What is a macule?
Discrete flat lesion
<1cm
Color: brown, white, tan, purple, red
Examples: Freckle, flat moles, petechiae, rubella
181
What is a patch?
Larger macule
Flat
>1cm
Mongolian spot, birthmark, angel kiss, stork bite
182
What is a papule?
Slightly raised / elevated
Solid mass
Circumscribed border
<1cm
Examples: warts, elevated nevi, lichen planus
183
What is a plaque?
Slightly raised
>5cm
Could be scaly
Examples: psoriasis, actinc keratosis
184
What is a pustule?
Raised lesion
Fluid filled (yellow, puss)
<5cm
185
What is a vesicle?
Raised lesion
Circumscribed
Clear fluid
<5cm
Examples: blister, poison ivy, herpes simplex/zoster, varicella (chickenpox), second degree burn
186
What is a bulla
Large vesicle
>5cm
Example: large blister from burn or friction
187
What is vitiligo ?
Depigmentation of the skin in spots
188
What is striae
Stretch marks
189
What is a cyst?
Cells that were broke down that turned into tissue
Has a sac that must be removed during excise or it will come back
190
What is a nodule?
Elevated
Palpable
Deeper in skin
<2cm
Example: Lycoma, squamous cell carcinoma
191
What is a tumor?
Pigmented
Asymmetrical
Pearly appearance / grey
Example: basal cell carcinoma
192
What is a wheal?
Inflammation
-Could be caused by: allergic reaction, hive, contact territories
-looks like a welt
193
What is a secondary lesion?
Skin lesion that starts one way and develops as a result of something else
Examples:
-Atrophy = no elasticity so skin is tight
-Excoriation = from scratching with nails or against something
-keloid= overgrowth of cells
-scale: bottom of feet
-crust
-fissure : bottom of feet
-lichenification : epidermis of the skin is dried out and thick
-scar: develop of previous wound
-ulcer: pressure sore
194
What is Milina?
Little white pimples ; baby acne
195
What is a salmon patch / stork bite
Birthmark behind neck of baby
196
What is a Mongolian spot?
Darkening if skin in patch form, typically found at creases of skin, above tailbone
197
PUPPP what does it stand for?)
*hint skin during pregnancy
P= Pruritc
U = Urticarial
P= Plaques
P= Papules
P= pregnancy
198
Who has the highest risk for Melanoma ?
Caucasians (20 times more likely)
Ages 20-40
12% higher if family history
Worst prognosis in African Americans (due to late detection)
Risk factors:
Race/ethnicity
Genetics
New mole/existing mole that has changed
Fair skin, light eyes, freckling
Increase # of moles (nevi)
Severe blistering sunburn
199
What is folliculitis ?
Inflammation of follicle
Hairy people are a huge risk
200
Herpes Zoster (shingles)
Follows along dermatome
Unilateral (one side of the body)
Painful
Pyuritic
201
What is onychomycosis ?
Nail fungus
202
What is psoriasis
Grey/pearly/scaly
203
What is rosacea?
Red face
204
What does “tinea” mean?
Fungus
