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Health Assessment > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What is included in the male external genitalia?

A

Penis
Scrotum

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2
Q

Shaft of penis is composed of three cylindrical masses - what are they?

A

Two corpora cavernous (dorsal side)
One corpus spongiosum (ventral side)

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3
Q

What is the hoodlike fold of skin that an uncircumcised man has called?

A

Foreskin or prepuse

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4
Q

What is the urethral meatus?

A

The slit at the tip of the penis

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5
Q

What is the scrotum?

A

Thin-walled sack that holds and protects the testis

Contains sweat and sebaceous glands and the cremaster muscle

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6
Q

What is the scrotums function?

A

Protective covering for testes, epididymis, and vas deferens

Also helps control temperature to protect sperm

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7
Q

What does the creamaster muscle do?

A

Contracts when cold to bring tested closer to the body for warmth

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8
Q

What are the testes?

A

Pair of oval shaped organs
3.7-5cm long, 2.5 deep and wide

Produce spermatozoa and testosterone

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9
Q

What is the tunica vaginalis

A

Double layered, lubricated, Serious membrane that surrounds the testes for protection and to keep them separated from scrotal wall

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10
Q

What is the spermatic cord?

A

Contains blood vessels, lymphatic vessels, nerves in the vas deferens

They transport sperm away from the testes

The left side is usually a little longer

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11
Q

What is the epididymis?

A

Comma Shaped coiled tubular structure that curves up over the posterior surface of the testis

This is the place where sperm mature 

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12
Q

What is the vas deferens?

A

Provides passage for sperm from the testes to the urethra

Along the route secretions from vas deferens, seminal vesicles, prostate gland, and Cowper gland. Mix with the sperm to form semen.

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13
Q

What is a hernia

A

Protrusion of loops of bowel through weak areas of the muscle

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14
Q

How many sphincters are in the anal canal?

A

Two

External
Internal

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15
Q

What is the external sphincter?

A

Composed of skeletal muscle, and is under voluntary control

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16
Q

What is internal sprinter?

A

Consists of smooth muscle, and it’s under involuntary control by the autonomic nervous system

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17
Q

What is the anorectal Junction?

A

Dividing point of the anal canal in the rectum

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18
Q

What is the prostate gland?

A

-2.5-4cm in diameter
-Surrounds the neck of the bladder and urethra
-Consists of two loaves, separated by the medium sulcus
-chestnut/heart shaped organ

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19
Q

What is the purpose of the prostate gland?

A

It creates a thin milky substance to promote sperm mobility and neutralize, female acidic vaginal secretions

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20
Q

What is prostatic hyperplasia?

A

Enlargement of the prostate gland

Common in men over 40

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21
Q

What do the seminal vesicles do?

A

Rabbit, ear shaped structures that produce the ejaculate that nourishes and protects sperm

Not palpable

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22
Q

What is the Cowper (bulbourethral) glands?

A

Mucus producing pea sized organs that empty into the urethra

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23
Q

What democratic is more likely to have testicular cancer?

A

White males ages 20 to 44

Five times more likely in white males than black males

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24
Q

What is TSE and how often should be done?

A

Testicular self exam
Once per month

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25
Q

How should a TSE be performed?

A

-once per month
-After warm shower or bath
-Check in front of a mirror for scrotal swelling
-Use both hands to palpate the testes
-Roll testes gently in a horizontal plane
-Feel for any evidence of small lumps or abnormalities
-Follow same procedure and poppet upward along the testes
-Locate epididymis
-repeat for other testis

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26
Q

What are normal findings during a TSE??

A

Testicles should be smooth, firm, rubbery, mobile, free of nodules, and uniform inconsistency

Testicles should be same size

There should be no evidence of pea like lumps

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27
Q

What is pediculosis pubis?

A

Crab lice

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28
Q

What is epididymitis?

A

Inflammation of epididymis

Symptoms:
Swollen, discolored, warm scrotum
Testicle pain and tenderness
Usually comes on slowly
Pain during ejaculation

*passive elevation of testes may relieve pain

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29
Q

What is Peyronie disease?

A

Plaque forms under skin of penis

Symptoms:
Significant bend in penis
Pain in penis
ED can occur

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30
Q

What is prostatitis?

A

Swelling of prostate gland

Symptoms:
Difficulty urinating
Pain in groin
Pain in pelvic area
Pain in genitals

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31
Q

What is testicular torsion?

A

When testicle rotates, twisting the spermatic cord that brings blood to the scrotum

Medical emergency

Symptoms
Severe pain
Swelling

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32
Q

What is varicocele?

A

Enlargement of veins, that transport oxygen depleted blood away from the testicles

Symptoms
Heaviness or discomfort of testes

Palpable and can feel like a “bag of worms”

Collapses when client is supine

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33
Q

What is orchitis ?

A

Inflammation of one or both testicles

Can be painful, heavy, and have a fever
-scrotum Appears enlarged and reddened

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34
Q

What is hydrocele

A

Swelling in the scrotum that is produced by fluid in the sack, which normally surround the testes

Often found in newborn boys or premature infants

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35
Q

What is hematocele?

A

Accumulation of blood, in between the layers of the Tunica vaginalis

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36
Q

What happens to the scrotum with age?

A

The scrotum will enlarge

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37
Q

What can cause heaviness in the scrotum?

A

A testicular tumor
A scrotal hernia

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38
Q

How often should a stool test performed?

A

Every year to detect accurate blood, beginning at age 45

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39
Q

How often is a colonoscopy or sigmoidoscopy recommended?

A

Every 10 years
Every 5 years for CT virtual colonoscopy
Every 5 years for sigmoidoscopy

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40
Q

How do you screen for prostate cancer?

A

Blood work: PSA
Digital exam: finger in rectum to palpate prostate
Biopsy

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41
Q

Men with a higher risk of prostate cancer, should begin testing at what age

A

40

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42
Q

How is HIV transmitted?

A

Person-to-person
Body fluid
Sexual transmission
Contact with infected blood
From mother to child during pregnancy, birth, or breast-feeding
Sharing needles

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43
Q

What are the three stages of HIV/aids?

A

Acute HIV infection (2-4 weeks of infection) **highly contagious
Clinical latency (HIV inactivity or dormant)
AIDS

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44
Q

What increases the risk of getting HIV?

A

-having unprotected, anal or vaginal sex
-having another STI
-When injecting drugs, sharing, contaminated needles
-Receiving unsafe injections, blood, transfusion, tissue transfusions
-Experiencing accidental needlestick injuries
-Ethnicity: African-American or Latino, Hispanic

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45
Q

Education for patients to reduce risk of HIV

A

-avoid unprotected sex
-Avoid multiple sex partners
-Avoid anal sex
-avoid drug and alcohol use
-Do not mix sex drugs or alcohol
-use new sterile needles
-Follow guidelines for handling bodily secretions
-Openly discuss HIV risk behavior
-Eat a healthy well rounded diet
-Avoid foods that easily transmit foodborne illness (raw eggs, unpasteurized, dairy products, Rossi, food, undercooked meat)
-Get immunizations

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46
Q

What increases the risk of getting prostate cancer?

A

-Age, Rys is after 50
-Race/ethnicity, highest in African-American in Caribbean males of African origin
-Geography, most common in North America, northwestern Europe, Australia, and Caribbean islands
-Family history
-Certain gene changes
-Exposure to agent orange
-Excessive alcohol consumption
-Working on a farm, tire plant, paint, cardamom, toxic chemicals
-Diet; high in red meat, or high fat daily with fewer vegetables
-Shorter sleep
-Prostatitis
-STI
-Vasectomy
-smoking

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47
Q

Client education to reduce the risk of prostate cancer

A

-Frequent ejaculation
-Eating a diet high in fruits and vegetables
-Taking vitamin E and selenium
-Sleep in a dark room
-Avoid shift work that requires daytime sleep
-Drink green tea daily
-Report if you have trouble urinating
-Report if there is a decreased force in the stream of urine
-Report if there is blood in the semen
-Report if there is discomfort in the pelvic area
-Report if there’s bone pain
-Report if ED

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48
Q

What is colorectal cancer (CRC)?

A

Originates in the large intestine or rectum, begins as a polyp, in the inner lining of the colon or rectum

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49
Q

How to screen for colorectal cancer

A

-start screening at age 50
-Sigmoidoscopy every five years, colonoscopy every 10 years, double contrast, barium enema every five years, or CT colonoscopy every five years

Additionally, Guaiac based decal blood test every year

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50
Q

What increases the risk for CRC?

A

-Age: over 50
-African-American, or eastern European
-Having inflammatory bowel disease
-Having personal history of colorectal polyps
-Family history
-Genetics
-type two diabetes mellitus
-Being overweight
-Being an active
-Diet high in a red meat and processed meat
-Diet of low vegetables, fruits, and whole grains
-smoking
-Alcohol
-HPV
-Night Shift work
-Previous treatment for prostate or testicular cancer

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51
Q

Client teaching to prevent CRC

A

-Contact provider, if any of the following symptoms occur:
Black tarry stools
Blood in bowel movement
Change in bowel habits
Unexplained, weight loss

-Follow preventative screening
-Avoid diet high in red in process meat in high fat and low fiber
-Avoid smoking and alcohol

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52
Q

How to prepare a client for a genital and anus/rectum/prostate exam

A

-Have patient empty bladder
-During Jenna tell your exam patient will typically stand
-During anal/rectum/prostate exam. Patient will be in left lateral position.

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53
Q

How do you exam in the upper rectum and sigmoid colon?

A

Sigmoidoscopy

Too high up to use finger

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54
Q

Older adult considerations when inspecting the penis

A

Pubic hair may be gray and sparse
-Penis become smaller
-Testes hang lower in the scrotum

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55
Q

What is penile subincision?

A

Splitting of the penile shaft, leaving an opening that may extend the entire length of the shaft

Some cultures include us among other genital mutilations

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56
Q

What is phimosis?

A

Tight foreskin that cannot be retracted

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57
Q

What is paraphimosis?

A

Foreskin that has been retracted and cannot be returned to cover glands

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58
Q

What is hypospadias?

A

Displacement of the urinary meatus to the central surface of penis

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59
Q

What is epispadias?

A

Displacement of urinary meatus to the dorsal surface of the penis

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60
Q

What is cryptorchidism

A

Absence of a testis

Could be undescended

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61
Q

What is transillumination?

A

Shining a light from back of scrotum through to assess for masses

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62
Q

Positive transilluminate with red glow can indicate

A

Masses with serous fluid
-hydrocele
-spermatocele

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63
Q

Positive transilluminate tests that do not have a red glow include

A

Masses that are solid or filled with blood:
-tumor
-hernia
-varicocele

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64
Q

What is a scrotal hernia

A

-loop of bowel protrudes into the scrotum to create an indirect inguinal. Hernia
-Hernia peers as swelling in the scrotum
-It is possible as a soft mass and fingers cannot get above. The mass
-Bowls sounds will be present
-Bulge will not disappear if pushed upward into abdomen

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65
Q

What are the types of hernias?

A
  • Epigastric : assess by medial stomach
  • Incisional: assess by incisional suture
  • Umbilical : assess by belly button area
  • Inguinal : assess near groin
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66
Q

What is a perinatal abscess?

A

Painful mass that is hard and in a reddened

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67
Q

What is a fissure in the anal canal?

A

Swollen skin tag on the anal margin

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68
Q

What is an anorectal fistula?

A

Small opening in the skin that surrounds the anal opening

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69
Q

What is the valsalva maneuver?

A

Straining or bearing down so the anal area can be inspected

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70
Q

What is rectal prolapse?

A

Colleges of red mucosal membrane

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71
Q

What is a pilonidal cyst?

A

Red and swollen or dimpled area, covered by a small tuft of hair located midline on the lower sacrum

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72
Q

What is syphilitic chancre ?

A

-small, silvery – white papule that develops a red oval ulceration
-Painless
-sign of primary syphilis

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73
Q

What is herpes progenitails?

A

-cluster of pimple like clear vesicles that irrupt and become ulcers
-Painful
-Typically caused by HSV, infection can remain dormant

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74
Q

What are genital warts?

A

-Single or multiple moist, fleshy populous
-Painless
-STI caused by the HPV

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75
Q

What is cancer of the glans penis?

A

-Appears as hardened knowledgeable or ulcer on the glands
-Painless
-Occurs primarily an uncircumcised men

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76
Q

What are example of small testees?

A

-< 3.5 cm long and soft can be atriohy
-< 2 cm long and firm can be Klinefelter syndrome

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77
Q

What is spermatocele?

A

Sperm filled cystic mass located on epididymis

Palpable and non tender and movable

Will appear on transillumination

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78
Q

What are the two types of inguinal hernias?

A

-Indirect:

-direct

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79
Q

What is the femoral hernia?

A

Bow herniate through femoral ring, and canal

Least common type of hernia

Mostly occurs in women

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80
Q

What is a hemorrhoid?

A

Painless papule caused by varicose veins

Can be internal or external

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81
Q

What are the three parts of the clitoris?

A

Glands- visible rounded portion
Corpus - body
Crura - two bands of fibrous tissue that attach it to pelvic bone

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82
Q

How will the external OS look for a woman who has not given birth versus woman who has?

A

-Woman who has not given birth: small, round depression

-Woman who has given birth: slit, like due to dilation of cervix

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83
Q

What is nulliparois

A

A woman who has not had kids

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84
Q

What is a transformational zone in females?

A

The squamocolumnar Junction migrates towards the cervical OS with maturation

90% of neoplasms of the lower genital tract originate in this area

This is the area from which cells are obtained for cervical cytology, or the Pap smear

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85
Q

What is the cervix function?

A

-allow entrance if a sperm into uterus
-passage of menstrual flow
-secretes mucus and prevents bacteria
-stretches (dialates) to allow passage of fetus

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86
Q

What is the uterus?

A

Pear-shaped, muscular organ

Two components ;
-Corpus (body) * divided into fundus (upper portion), body (central portion), isthmus (narrow lower portion)
-Neck

Normal size is 7.5 vm long, 5cm wide, 2.5 cm thick

Should move freely and not be tender

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87
Q

What are the three layers of the uterine wall

A

-endometrium
-Myometrium
-Peritoneum

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88
Q

What is the endometrium?

A

Inner mucosal layer of uterine wall

Estrogen and progesterone influence the thickness of this tissue

Composed of epithelium, connective tissue and vascular Nettwerk

Contains uterine glands that secrete alkaline substance to keep cavity moist

Part of this layer sheds during menace in childbirth

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89
Q

What is the myometrium?

A

The middle layer of the uterus

Composed of three layers of smooth muscle fibers that surround blood vessels

Functions to expel the products of conception

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90
Q

What is the peritoneum?

A

The outer uterine layer that covers the uterus and separated from the abdominal cavity

Forms anterior and posterior pouches around the uterus

Posterior pouch is called the Rectouterine pouch or cul-de-sac of Douglas

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91
Q

What are the ovaries?

A

Pair of oval shaped organs

3 cm long, 2 cm wide, 1 cm deep

Develop and release ova
Produce estrogen, progesterone, testosterone

Should be firm, smooth mobile, and somewhat tender on palpation

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92
Q

What are the fallopian tubes?

A

Carry ovum them from the ovary to the uterus

8 to 12 cm long

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93
Q

What is female genitalia mutilation (FGM)

A

Cultural practice that involve total or partial removal of female genitalia

There are four types

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94
Q

What is the normal menstrual cycle?

A

-Occurs approximately every 18 to 45 days
-last approximately 3 to 7 days

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95
Q

Symptoms that may appear before or during. Period.

A

Cramps
Loading
Moodiness
Breast tenderness
Headache
Weight gain

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96
Q

What is menarche?

A

The beginning of menstruation

Tends to begin earlier for women living in developed countries

US age is 11.9 with at least 17% body fat and 22% body fat is needed to maintain menstruation

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97
Q

What is menopause?

A

Absence of minutes for 12 months

Typically occurs in women between the ages of 40 and 58

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98
Q

What is premature menopause?

A

Menopause that occurs before age 30

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99
Q

What is early menopause?

A

Menopause that occurs between ages 31 and 40

100
Q

What is delayed menopause?

A

Menopause that occurs after 58

101
Q

What are symptoms of menopause?

A

Hot flashes
Night sweats
Mood swings
Irritability
Decreased appetite
Vaginal dryness
Spotting
Irregular bleeding

102
Q

What is HRT?

A

Hormone replacement therapy

Used to help with symptoms of menopause

103
Q

What is posthysterectomy

A

No uterus

104
Q

Why is vaginal infection more common in older adults?

A

Because of atrophy of the vaginal mucosa associated with aging

105
Q

What is infertility?

A

The failure to conceive (regardless of the cause) after one year of unprotected intercourse.

Six months for women over 35

Affects about 10% of women in the US

106
Q

What is dysuria?

A

Pain during urination

107
Q

What is assessed during a pelvic rectal exam?

A

Used to assess for masses, ovarian tenderness, organ enlargement

108
Q

What is a Pap smear test used for?

A

Screening for cervical cancer
Testing for STI

109
Q

At what age and how often are Pap smear test recommended?

A

Starting at age 21 (or once a woman become sexually active)

Should be completed once per year

110
Q

What is PID?

A

Pelvic inflammatory disease

Typically caused by infection of the fallopian tubes, or ovaries with STI

Leads to scarring and adhesions of the fallopian tubes, which can increase the risk for infertility, and ectopic pregnancy

111
Q

What are minor side effects of oral contraceptive?

A

Weight gain
Breast tenderness
Headache
Nausea

Typically subside after third cycle

112
Q

Major side effects of oral contraceptives

A

Thromboembolic disorders
Cerebrovascular accident
Myocardial infarction

113
Q

What is TSS?

A

Toxic shock syndrome

A life-threatening infection associated with high absorbency tampons, prolonged and continually use

Has been associated with the use of menstrual cup

114
Q

Why should women not frequently douche?

A

Frequent douching changes the natural floor of the vagina predisposing a vagina taste infection

115
Q

What increase the risk for hemorrhoids?

A

-Age: 45 and 65
-Prolong sitting on the toilet
-Chronic diarrhea or constipation
-Obesity
-Pregnancy
-Anal intercourse
-Eating a low fiber diet
-Regular heavy, lifting

116
Q

Client education on hemorrhoids

A

Hemorrhoids are normal condition, unless complications develop

See healthcare provider, if rectal bleeding occurs, lightheadedness, dizziness, or faintness, extreme pain

-Avoid straining with BM
-avoid standing or sitting for prolonged periods
-Try to use bathroom as soon as feeling occurs
-Avoid anal intercourse
-Avoid rubbing or cleaning too hard
-high-fiber diet
-Drink 68 glasses of water a day
-Exercise
-Avoid long periods of sitting
-Use OTC creams or soothing pads
-soak anal area in plain warm water 10 to 15 minutes 2 to 3 times per day
-Bathe daily
-Do not use dry toilet paper
-Apply ice pack

117
Q

What is cervical cancer?

A

Third, most common cancer in females originates in uterine cervix:

Approximately eight out of 10 cervical cancer’s originate in the surface sell lining of the cervix (squamous cells)

Slow developing cancer, preceded by pre-cancerous stage of dysplasia, which can be diagnosed with Pap smear

118
Q

What is displasic?

A

When cells become abnormal, can’t be diagnosed with a Pap smear and is 100% treatable

If not treated, it could become malignant

119
Q

What is carcinoma in situ (CIS)

A

First deductible stage of dysplastic cells

Noninvasive cervical cancer
“Sitting in place”
a group of abnormal cells that are found only in the place where they first formed in the body. These abnormal cells may become cancer and spread to nearby normal tissue (see right panel).

120
Q

How to screen for cervical cancer

A

-screening is between age of 21 and 65
-Should be screened every 3 to 5 years
-HPV testing
-Cytology

Ages for screening via cervical cytology
21 to 29 ; every three years
30 to 65 ; every three years, or HPV testing alone every five years
65 and older with adequate prior : no testing
Post hysterectomy with service : no testing

121
Q

What increases risk for cervical cancer?

A

HPV
Smoking
Immunosuppression
Chlamydia
Diet, low and fruits and vegetables
Being overweight
Intrauterine device use
Having multiple full term pregnancy’s
Being younger than 17 at first full term pregnancy
Poverty
Having a mother who took DES while pregnant
Family history of cervical cancer

122
Q

Client education for cervical cancer

A

-Avoid risky sexual practices
-Don’t have sex with an early age
-don’t have multiple sex partners
-Avoid high risk, sexual activities and partners
-Consult professional about having HPV vaccine
-follow Pap smear screening guidelines
-If mother took DES, maintain careful preventative screening schedule
-eat nutritious food and have routine care for illness
-Talk to partner about expectations of sexual health

123
Q

What can untreated STI’s lead to?

A

Pelvic inflammatory disease

124
Q

What STI can lead to cervical cancer

A

HPV: human papilloma virus

125
Q

How to prepare a client for a genital & anus/rectum exam

A

-do not douche 4 to 5 days before exam
-Do not use vaginal cream’s, Jilly’s, medicines, or spermicidal foams 2 to 3 days before exam (these can interfere with cells)
-Do not have sex within 24 hours of the exam (can cause tissue information)
-Urinate before exam
-Dorsal lithotomy position (supine with feet in stirrups)
-do not put hands overhead (titans, abdominal muscles)
-Can hand client Amir so they can view the examination

126
Q

What is vaginal atrophy?

A

A condition in which the vagina becomes thinner and dryer

Occurs when the body lacks estrogen

127
Q

Changes in cervix during inspection

A

-Typically cervix is smooth, pink, and even
-Midline position and Projects one to 3 cm into the vagina

-In pregnant women the cervix may appear blue (Chadwick sign)

-In older women the cervix may appear pale after menopause

128
Q

What is an indication of cervical cancer?

A

Hard, immobile cervix

129
Q

What is cervical motion tenderness CMT?

A

“chandler sign”
Pain with movement of the cervix may indicate infection

130
Q

What is myomas?

A

Fibroid tumors that appear in uterus

s/s
Heavy mentral bleeding
Prolonged periods
Pelvic pain

131
Q

What is endometriosis?

A

Disease characterized by the presence of tissue resembling endometrium that occurs outside the uterus

Uterus is fixed and tender

S/S
Pain in menstrual irregularities

132
Q

What are the bartholin glands?

A

Pea sized glands found just behind and either side of the lips that surround the entrance into the vagina

133
Q

Neisseria Gonorrhoeae?

A

STI
Sign could be abscess of Bartholin gland
Painful

134
Q

What are the two types of speculums used for vaginal inspection

A

Graves speculum: appropriate for most adult woman, and available in various length and width

Pederson speculum: appropriate for virgins, and some post menopausal women, who have a narrow vaginal orifice 

135
Q

endocervical specimen vs ectocervical specimen

A

The ectocervix (also called exocervix) is the outer part of the cervix that can be seen during a gynecologic exam.

The ectocervix is covered with thin, flat cells called squamous cells. The endocervix is the inner part of the cervix that forms a canal that connects the vagina to the uterus.

136
Q

What is cervical eversion?

A

A normal, finding in many women that can occur after childbirth, or when women takes oral contraceptives

The columnar epithelial from within the Endocervical canal is everted and appears as a deep red, rough ring around the cervical OS surrounded by normal pink color of cervix

137
Q

What are nabothian (retention) cysts?

A

Normal findings after childbirth
Less than 1 cm
Yellow, translucent nodules on the cervical surface

Odorless, and non-irritating

138
Q

What is bilateral transverse laceration

A

A laceration that may go across the cervix for women who have given birth vaginally

139
Q

What is unilateral transverse laceration

A

Vaginal birth may cause trauma to the service, and produce tears or lacerations

140
Q

What is stellate laceration?

A

Laceration on cervix to a woman who has given child birth vaginally this version is not uniform

141
Q

What is an anteverted uterus?

A

Most typical position of the uterus

Cervix is pointed posteriorly in the body of the uterus is at the level of the pubis over the bladder

142
Q

What is a mid position uterus?

A

Normal variation

Cervix is pointed, slightly more anteriorly, and the body of the uterus is positioned more posteriorly midway between the blood are in the rectum

May be difficult to palpate the body through the abdominal and rectal walls

143
Q

What is an anteflexed uterus?

A

Normal variation

Uterine body flexed, anteriorly, and relaxation to the cervix

144
Q

What is a retroverted uterus?

A

Normal variation

uterus is tilted backwards

Uterine wall may not be palpable through the abdominal wall or the rectal wall

Uterus is prominently retroverted the wall may be fell through the posterior fornix of the rectal wall

145
Q

What is a Retroflexed uterus

A

Normal variation

Uterine body being flexed, posteriorly in relation to the cervix

146
Q

What is cystocele?

A

Bulging in the interior, vaginal wall cost by thickening of pelvic musculature

As a result, the bladder, covered by vaginal mucosa prolapses into the vagina

147
Q

What is rectocele?

A

Bulging in posterior vaginal wall cost by weakening of the pelvic musculature

Part of the rectum protrudes into the vagina

148
Q

What is uterine prolapse?

A

When the uterus protrudes into the vagina

Is graded by how far is protrudes?

First-°, the cervix is seen at the vaginal opening

Second-degree the uterus bulges outside of the vaginal opening

Third-degree the uterus bulges completely out of the vagina

149
Q

What is cyanosis of the cervix?

A

When the service appears blue, and the client is not pregnant

Can indicate venous, congestion, or a diminished oxygen supply to the tissue

150
Q

What is cancer of the cervix?

A

Hardened ulcer is usually the first indication of cervical cancer, but may not be visible on the ectocervix

In later stages, the Legion may develop into a large cauliflower like growth

151
Q

What is a cervical polyp?

A

A polyp typically develops in the Endo cervical canal, and may portrait visibly out the cervical OS

Soft, red, rather fragile

They are benign

152
Q

What is cervical erosion?

A

Normal tissue around the external OS is inflamed and eroded, appearing reddened, and a rough

Usually occurs with mucopurulent cervical discharge

153
Q

What is mucopurulent cervicitis?

A

Produces mucopurulent yellowish discharge from external OS

Indication of chlamydia, or gonorrhea

STI’s may also occur with no visible sign. Discharge can change cervical pH.

154
Q

Malformations from exposure to DIETHYLSTILBESTROL (DES)

A

DES was a drug used more than 50 years ago to prevent spontaneous abortion and premature labor

Abnormalities associated include columnar epithelium, that covers most or all of the active cervix. The columnar epithelium extends into the vaginal wall.

155
Q

What does teratogenic mean?

A

Capable of causing malformations in the fetus

156
Q

What is tRICHOMONIASIS (trichomonas vaginitits)

A

A vaginal infection caused by a protozoan organism, and is usually sexually transmitted

Discharge may appear yellow/green, frothy, foul-smelling

Labia may appear swollen and red

Vaginal walls may be Read, rough, covered with small red spots (petechiae)

Infection causes itching an increase in urinating

Vaginal pH will be greater than 4.5 (typically 7.0 or more.)

157
Q

What is Atrophic vaginitis?

A

Occurs after menopause when estrogen production is low

Discharge produced may be blood tinged and usually minimal

The labia and vaginal mucosa appear atrophic

Vaginal mucosa is typically pale and dry

S/S itching, burning, dryness, painful urination

158
Q

What is candidal vaginitis (moniliasis)

A

Infection caused by an overgrowth of yeast

Sick, white, cheesy discharge
Labia may be inflamed and swollen
Vaginal mucosa may be reddened, and typically contains patches of the discharge

S/S itching and discomfort

159
Q

Bacterial vaginitis

A

Cause is unknown (possibly anaerobic) thought to be sexually transmitted

Discharge is thin and gray white and has a positive Amine (fish smell) coats, the vaginal walls and EXO cervix

Labia and vaginal walls usually appear normal and pH is greater than 4.5.

160
Q

When is the only time that a uterus should be enlarged?

A

During pregnancy

Isthmus feels soft (hegar sign)

161
Q

What is uterine fibroids (myomas)

A

Fibroid tumors on the uterus

Firm nodules that are continuous with the uterine surface they can grow quite large and will appear Fuhrman and Mobil

162
Q

Uterine cancer (cancer of the endometrium)

A

Uterus may be enlarged with a malignant mass

Irregular bleeding, leading between periods, or postmenopausal bleeding maybe the first sign

163
Q

What is an ovarian cyst?

A

Masses on the ovary, usually smooth, mobile round compressible, and nontender

164
Q

What does ovarian cancer?

A

Masses that are cancerous usually solid, irregular nontender and fixed

165
Q

What is an a ectopic pregnancy?

A

Pregnancy occurs when a fertilized egg attaches to the fallopian tube and begins to develop

Solid, mobile, tender, and unilateral mass may be palpated

Movement of uterus will cause pain

166
Q

What does taking estrogen replacement therapy put a patient at risk for?

A

Yeast infections
Breast cancer

167
Q

What disease predisposes women to yeast infections and why?

A

Diabetes mellitus because the increased glucose levels are a good medium for yeast to grow

168
Q

What does frail elderly mean?

A

The vulnerability of the “Old-old” (starting at 85)

They have poor health because they tend to have multi system. Chronic disabilities that interfere with their ability to fully function independently.

169
Q

What is a functional assessment of the elderly

A

Persons, ability to carry out the basic function of activities and ADLs

170
Q

What tool is used to assess an older adults ADLs?

A

Katz activity of daily living

171
Q

What are examples of ADLs?

A

Activities necessary for well-being

Bathing
Eating
Toileting
Emulating

172
Q

What are examples of IADLs?

A

Focus on household chores, mobility related, and cognitive abilities

Cooking
Cleaning
Laundry
Shopping
Transportation
Money
Using the telephone

173
Q

Understand how the “Katz activities of daily living” assessment tool works

A

Six activities are rated as one or zero

Bathing
Dressing
Toileting
Transferring
Continents
Feeding

Highest a person can score is six lowest a person can score is zero

174
Q

Understand how to use the Lawton scale for IADLs

A

Eight abilities are assessed and rated

Ability to telephone: 1-4
Shopping 1-4
Food preparation 1-4
Housekeeping 1-5
Laundry 1-3
Mode transportation 1-5
Responsibility for your own medicine 1-3
Ability to handle finances 1-3

Total scores can range between 8 to 28 the lower the score the more independent

175
Q

Changes for elderly women and their genitalia

A

-labia and tissue covering the pubic bone loses firmness
-Vaginal walls become less elastic
-Vagina becomes dryer
-Clitoris may become overly sensitive
-Uterine contractions with orgasms may be painful

176
Q

Changes for elderly men and their genitalia

A

-sexual response slows
-Delay in erection, need for more manual stimulation
-prolong plateau phase
-Shorter and less forceful orgasm
-Rapid loss of furnace after orgasm
-Increase in the time before another erection can be achieved after orgasm

177
Q

When should a nurse acquire information about a patient from their family or professional caregiver regarding their current cognition and behavior

A

If patient is:
-lethargic
-agitated
-Mentally unstable to respond
-Appears, excessively distracted
-Offers inconsistencies
-Not answer specific questions or describe daily activities

178
Q

How is delirium categorized?

A

Rapid onset of cognitive change along with level of alertness from extreme lethargy to agitation

179
Q

Understand Depression and the elderly

A

Depression is not more common in old age… But symptoms of depression in older adults, more commonly manifest as changes in cognition and physical symptoms

Aka pseudodementia

180
Q

What does spices stand for?

A

S - sleep disorders
p - problems with feeding
I - incontinence
C - conditions
E - evidence of falls
S - skin breakdown

181
Q

Why is aids difficult to diagnose an older adults?

A

Because his symptoms, and they make the natural aging process and other diseases

Night sweats, chronic fatigue, weight loss, dementia, and swollen lymph nodes

182
Q

What body system is most effective due to loss of muscle tone and atrophy

A

G.I. mobility

Needs to dehydration, immobility, port intake, exasperated the likelihood of constipati adequate fluid intake, dietary fiber, and moderate exercise our key factors in maintaining efficient elimination

183
Q

What is urge incontinence?

A

Involuntary loss of urine associated with an abrupt and strong desire to void

184
Q

What is stress incontinence?

A

Involuntary loss of urine during coughing, sneezing, or laughing or physical activities that increase abdominal pressure

185
Q

What is overflow incontinence?

A

Involuntary loss of urine associated with over distention of bladder

186
Q

What is functional incontinence?

A

Inability to get to the bathroom in time or understand accused avoid due to problems with mobility or cognition

187
Q

What is the tug test?

A

“ timed up and go”

Time how long it takes a patient to stand up, walk 10 feet and back, and sit down

If they take longer than 12 seconds to complete, then they are risk for falling

188
Q

What are indicators of malnutrition?

A

Poor wound healing, bruising, dental deterioration, poor appetite, and fluid intake, weight loss

189
Q

What laboratory test values indicate poor nutritional status

A

Hemoglobin: lower than 12 G/dL
Hematocrit: lower than 35
Vitamin B12: lower than 100 ug/mL
Serum cholesterol: lower than 160 mg/dL
Serum albumin: lower than 3.5 g/dL
Serum potassium : do not increase 1 mg per day

190
Q

What are signs of dehydration in the older adult?

A

-Sudden weight loss
-Fever
-Dry, warm skin
-Furrowed, swollen, red tongue
-Decreased urine output
-Lethargy
-Weakness

191
Q

What may indicate severe dehydration?

A

Acute change in mental status (particularly confusion), tachycardia, hypertension

192
Q

What are Venus lakes?

A

Reddish vascular, lesions on ears or other facial areas, resulting from dilation of small red blood cells

Looks like a dark purple under the skin mole (also found on lips)

193
Q

What are skin tags?

A

Acrochordons, flesh colored, pedunculated lesions

194
Q

What are seborrheic keratoses

A

Tan, brown, or reddish flat lesions commonly found on fair skinned person and sun exposed areas

195
Q

What are cherry angiomas?

A

Small round red spots “red moles”

196
Q

What are senile purpura?

A

Vivid, purple patches (legions do not Blanche when touched)

Looks like big purple bruise

197
Q

What are lentigines / solar lentigines ?

A

Hyper pigmentation in San exposed areas that appears brown pigment in around reticular patches

“ liver spots”

198
Q

What are Actinic keratoses?

A

Round or irregular shaped tan, scaly lesions, that may bleed or be inflamed

Kind of look like scabs or skin cancer that’s light in color

199
Q

What are herpes zoster vesicles?

A

Shingles

Draining clear fluid or pustules a top an erythematous base following a clear linear pattern and accompanied by pain

200
Q

Why is pinching skin not an accurate test of turgor in older adults?

A

-Wrinkly skin
-Less elastic skin
-Elastic collagen is replaced with more fibrous tissue
-loss of subcutaneous tissue

201
Q

What are signs of dysphasia?

A

Decision is difficulty swallowing

Coughing, drooling, pocketing, spitting out food after intake

Drooping mouth, chronic congestion, weak, or hoarse voice (especially after eating or drinking)

202
Q

How can a nurse assisted client who reports dysphasia

A

Lean forward slightly and keep chin talked in towards the neck when swallowing

Offer food that has putting like consistency, 10 minimize risk of aspiration

203
Q

What are cataracts

A

-Yellowish or brownish discoloration of the lens
-S/S: painless blurring of vision, glare, and halos around lights, poor vision at night, colors that look dull or brownish

204
Q

What is arcus senilis?

A

-Cloudy or grayish ring around the iris
-Decrease pigmentation in Iris
-Normal age related change

205
Q

What is presbyopia?

A

-lens loses elasticity
-Leads to decreased ability to change shape
-Louis ability to see near
-Normal age related change

206
Q

What is pterygium?

A

Thickening of the bulbar conjunctiva that grows over the cornea

May interfere with vision

Normal age related change

207
Q

What is macular degeneration?

A

Patient has difficulty seeing with one eye… Disorder almost always becomes bilateral

Other finance include flurry words at the center of the page or door frames that don’t appear straight

208
Q

What is diabetic retinopathy

A

Noticeable loss of vision-including cloudiness distortion of familiar objects, and occasional blind spots or floaters

209
Q

What are the parameters for orthostatic hypertension? 

A

20-mmHg decrease in systolic
10-mmHg decrease in diastolic

210
Q

What is an indicator of exercise intolerance?

A

Raise in pulse rate more than 20 bpm that does not return to baseline within two minutes

211
Q

What are symptoms of a hip fracture?

A

-inability to get up from a fall or to walk
-Severe pain in hip or groin
-inability to put weight on affected hip
-Bruising or swelling around hip area
-Shorter leg on affected side
-Our turning of the leg on the right side of hip/leg injury

212
Q

What is a Hallux Valgus

A

Bunion

A great toe overriding, or underline the second toe

Pain in difficulty walking

213
Q

What is glaucoma?

A

Pressure that can destroy the optic nerve and cause blindness

Rainbow like halos are circles around lights, severe pain in the eyes or forehead, nausea, and blurred vision

214
Q

What is retinal detachment?

A

Vitreous pulls away from the attachment to the retina at the back of the eye, causing the retina to tear in one or more places

215
Q

How long is a rhythm strip

A

Six seconds

216
Q

What are the shockable rhythms?

A

V-Fib
V-Tach
Torsade de Pointes (type of ventricular tachycardia)

217
Q

V-Fib (ventricular Fibrillation)

A

Irregular
No P wave
No QRS

Random squiggle lines all over the place with no consultancy

218
Q

What is the P wave?

A

-atrial contraction
-DE-polarization
-DE-compressing

One P wave before every QRS complex

219
Q

What is the QRS complex?

A

-Ventricle contraction
-DE-polarization
-DE-compressing

*note: atrial repolarization also happens during this time, but is overshadowed by contraction

220
Q

What is the T-wave?

A

-Ventricles, relaxing
-RE-polarizing
-RE-filling with blood

221
Q

What is the PR interval?

A

Movement of electrical activity from atria to ventricles

222
Q

What is the ST segment

A

The time between ventricle depolarization, and re-polarization
(Ventricle contraction)

223
Q

What is the QT interval?

A

Time it takes from ventricles to depolarize, contract, and atrial to repolarize

224
Q

What is a normal sinus rhythm?

A

60 to 100 BPM

225
Q

Sinus tachycardia

A

> 100 BPM

226
Q

Sinus bradycardia

A

< 60 BPM

227
Q

Measuring box sizes on a strip

A

1 small box = 0.04 seconds
1 large box = 0.20 seconds
5 large boxes = 1 second

Strip = 6 seconds, 30 large boxes

228
Q

How to determine heart rate via strip

A

Count the number of “R’s” in between the 6 seconds strip and multiply it by 10

  • must make sure that a six second strip is being used
229
Q

Describe a normal sinus rhythm

A

-Rate: 60-100 BPM
-rhythm: regular
-P-wave: upright & uniform for for each QRS (normal)
-PR interval: normal: .12 - .20
-QRS complex: normal : .04 - 0.12

230
Q

Describe a sinus Brady rhythm strip

A

-Rate: < 60 BPM
-rhythm: regular
-P-wave: upright & uniform for for each QRS
-PR interval: normal
-QRS complex: normal

231
Q

Describe sinus tachy rhythm strip

A

-Rate: > 100 BPM
-rhythm: regular
-P-wave: upright & uniform for for each QRS
-PR interval: normal
-QRS complex: normal

232
Q

Describe ventricular tachycardia rhythm strip

“V-Tach”

A

-Rate: 100 - 250 BPM
-rhythm: regular
-P-wave: not visible
-PR interval: none
-QRS complex: wide (like tombstone)

No contraction or cardiac output

This is fatal : patient is usually awake

233
Q

Describe ventricular fibrillation
(V-fib)

A

-Rate: unknown
-rhythm: chaotic & irregular
-P-wave: not visible
-PR interval: not visible
-QRS complex: not visible

Rapid, disorganized pattern
Loss of consciousness
May not have pulse or blood pressure
Respirations have stopped
Cardiac arrest and death

Defib the Vfib

234
Q

Describe atrial fibrillation

(A-Fib)

A

-Rate: usually over 100 BMP
-rhythm: irregular
-P-wave: none (irregular fibrillary waves)
-PR interval: visible
-QRS complex: normal

*the atria is quivering

Uncoordinated electrical activity in the atria that causes rapid and disorganized fitting of the muscles in the atrium

235
Q

Describe premature ventricular contractions

(PVCS)

A

-Rate: depends on the underline rhythm
-rhythm: regular, but interrupted do too early P waves
-P-wave: visible, but depends on timing a PVC (maybe hidden)
-PR interval: slower than normal
-QRS complex: sharp, bizarre, and abnormal

PVC appears as QRS complex goes down

236
Q

Describe Asystole rhythm strip

A

-Rate: N/A
-rhythm: N/A
-P-wave: N/A
-PR interval: N/A
-QRS complex: N/A

Flatline

237
Q

Describe arterial flutter rhythm strip

A

-Rate: 75 - 150 BPM
-rhythm: regular
-P-wave: sawtooth shaped flutter waves
-PR interval: unable to measure
-QRS complex: usually normal and upright

Similar to a fib, but the Hartz electrical signals spread through the atria. The Harts upper chambers to quickly but at a regular rhythm.

238
Q

What are the 5 steps for rhythms analysis?

A

1) calculate rate (BPM)
2) determine regularity (R)
3) assess p-waves (present, regular)
4) PR interval (3-5 boxes)
5) QRS (1-3 boxes)

239
Q

Atrial dysfunction (P-wave) that is firing on a continuous looping re-entry will lead to what kind of RS?

A

Atrial flutter

240
Q

Atrial dysfunction continuously from multiple areas or continuously due to multiple micro re-entrance “wave let’s) is what kind of RS?

A

Arterial fibrillation

241
Q

AV junctions problems: blocking impulses coming from SA node is what kind of RS?

A

AV junctional Block

242
Q

AV junctional Problems: firing continuously due to loop re entrance is what kind of RS?

A

PST = paroxysmal supraventricular tachycardia

243
Q

Ventricular dysfunction: fire occasionally from 1 or more foci is what kind of RS?

A

PVC ; premature ventricular contraction

244
Q

Ventricular dysfunction: fire continuously from multiple foci is what kind of RS

A

V-Fib

245
Q

Ventricular dysfunction: continuing on a loop is what kind of RS?

A

V-tach

246
Q

What is sinus arrest?

A

More than 2 normal R-R

247
Q

Atrial dysfunction: furring occasionally is what RS?

A

PAC - premature atrial contraction

Health Assessment (3 decks)

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