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NSG 2317 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Name the cranial nerves. (there are 12)

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal
  6. abducens
  7. facial
  8. acoustic
  9. glossopharyngeal
  10. vagus
  11. spinal accessory
  12. hypoglossal
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2
Q

function of the olfactory nerve

A

smell

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3
Q

function of optic nerve

A

vision

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4
Q

function of oculomotor nerve

A
  • extraocular motion (EOM)
  • eyelid opening
  • pupil constriction
  • lens shape
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5
Q

function of trochlear nerve

A

downward and inward extraocular motion

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6
Q

function of trigeminal nerve

A
  • sensations of face, scalp, cornea, mucous membranes of mouth and nose
  • muscles of mastication
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7
Q

function of abducens nerve

A

lateral movement of eye

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8
Q

function of facial nerve

A
  • facial movement
  • closing of eyes and mouth
  • speech
  • taste (anterior 2/3 of tongue)
  • saliva and tear produciton
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9
Q

function of acoustic nerve

A
  • hearing
  • equilibrium
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10
Q

function of glossopharyngeal nerve

A
  • production of speech and swallowing
  • taste (posterior 1/3 of tongue)
  • gag & carotid reflex
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11
Q

function of vagus nerve

A
  • talking and swallowing
  • sensation from carotid body & sinus, pharynx, and viscera
  • carotid reflex
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12
Q

function of spinal accessory nerve

A

movement of trapezius/sternomastoid muscles

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13
Q

function of hypoglossal nerve

A

movement of tongue

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14
Q

what to inspect and palpate for muscles in regards to the motor system?

A

inspect: size and presence of involuntary movements
palpate: strength and tone

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15
Q

what are the coordination tests for the motor system?

A
  • rapid alternating movements
  • finger to nose test
  • finger to finger test
  • heel-to-shin test
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16
Q

spinothalamic tract tests

A
  • pain
  • temperature
  • light touch
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17
Q

posterior column tract tests

A
  • vibration
  • position (kinaesthesia)
  • tactile discrimination (fine touch)
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18
Q

spinothalamic tract test - pain

A
  • lightly apply sharpy or dull end at random locations
  • ask pt to identify if it is ‘sharp’ or ‘dull’
  • sharp = test for pain
  • dull = general test for response (control)
  • 2 seconds between stimuli
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19
Q

spinothalamic tract tests - light touch

A
  • apply wisp cotton to skin
  • brush over random locations
  • ask pt to say ‘now’ or ‘yes’ when touch is felt
  • use irregular intervals to avoid pt answering from repetition
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20
Q

spinothalamic tract tests - temperature

A

temperature is omitted unless pain sensation abnormal

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21
Q

posterior column tract tests - vibration

A
  • over distal bony prominences due to (d/t) slower decay of vibrations
  • strike tuning fork on heel of your hand and hold at base of bony prominence
  • ask pt to tell you when it starts and when it stops
  • if they can feel vibration in distal areas, can assume proximal areas are normal
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22
Q

posterior column tract tests - position (kinesthesia)

A
  • with pt’s eyes closed, move their finger or toe up & down
  • ask pt to tell you which way it is moved
  • vary order of movement
    holding digit on side because upward and downward pressure can give pt clue to direction
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23
Q

posterior column tract tests - tactile discrimination (fine touch)

A

all these tests are done while patient has their eyes closed
- stereognosis
- graphaesthesia
- two point discrimmination
- extinction
- point location

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24
Q

stereognosis

A

ability to identify object they are touching

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25
Q

graphaesthesia

A

ability to read number traced on skin

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26
Q

two point discrimination

A

ability to distinguish separation of 2 simultaneous pinpoints on skin

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27
Q

extinction

A

ability to feel touch on both sides of body simultaneously

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28
Q

point location

A

ability to point to spot where they felt touch

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29
Q

deep tendon reflexes

A
  • patient limb relaxed and muscle partially stretched
  • short, snappy blow of reflex hammer onto muscle’s insertion tendon
  • pointed end on smaller targets
  • flat end on wider targets & pain prevention
  • compare right and left sides
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30
Q

grading deep tendon reflexes

A

4+ = very brisk, hyperactive with clonus, indicative of disease
3+ = brisker than average may indicate disease
2+ = average, normal
1+ = diminished, low normal
0 = no response

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31
Q

Deep tendon reflexes - biceps

A

(C5-C6)
- support forearm
- thumb on bicep tendon
- strike your thumb
- normal = forearm flexion

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32
Q

deep tendon reflexes - triceps

A

(C7-C8)
- suspend upper arm
- strike triceps tendon directly
- normal = forearm extension

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33
Q

deep tendon reflexes - brachioradialis

A

(C5-C6)
- suspend forearms by holding pt’s thumbs
- strike forearm directly, 2-3 cm above radial styloid process
- normal = flexion & supination of forearm

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34
Q

deep tendon reflexes - patellar/quadriceps

A

(L2-L4)
- allow lower leg to dangle
- strike tendon directly just below patella
- normal = extension lower leg

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35
Q

deep tendon reflexes - achilles

A

(L5-S2)
- knee flexed and hip externally rotated
- hold foot in dorsiflexion
- strike achilles tendon directly
- normal = foot plantar flexes against your hand

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36
Q

superficial reflexes

A
  • abdominal
  • plantar or babinski
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37
Q

abdominal reflex

A

(upper T8-T10; lower T10-T12)
- supine, knees bent
- stroke skin with handle of reflex hammer from side of abdomen to midline (in both upper and lower abdominal levels)
- normal = ipsilateral contraction of abdomen muscles & deviation of umbilicus toward stroke

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38
Q

plantar or babinksi reflex

A

(L4-S2)
- thigh in slight external rotation
- stroke lateral side of sole of foot and inward across ball of foot (upside down j)
- normal (in children up to 2 years of age) = plantar flexion of toes
- normal (adult) = no reaction

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39
Q

older adult considerations (neurological system)

A
  • taste CN 7, 9, 10) & (CN 1) reduced
  • decreased muscle bulk (esp in hands)
  • senile tremor (benign)
  • dyskinesia with no associated rigidity
  • gait slower, deliberate, slightly deviated from midline path
  • rapid movements are difficult
  • loss sense vibration at ankles ≥ 65 years old
  • loss ankle jerk reflex
    tactile sensation impaired
  • deep tendon reflexes less brisk
  • absent plantar and superficial abdominal reflexes
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40
Q

flaccidity

A

decreased muscle tone (hypotonia); muscle feels limp, soft, and flabby; muscle is weak and easily fatigued

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41
Q

spasticity

A

increased tone (hypertonia); increased resistance to passive lengthening and then suddenly giving away (clasp-knife phenomenon)

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42
Q

rigidity

A

constant state of resistance (lead-pipe rigidity); resistance to passive movement in any direction; distonia

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43
Q

cogwheel rigidity

A

type of rigidity in which the increased tone lessens by degrees during passive ROM so that it feels like small regular jerks

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44
Q

Multiple Sclerosis (MS)

A
  • chronic, progressive, immune-mediated disease
  • axons become inflamed, demyelinated, degenerated, and undergo sclerosis
  • symptoms: blurred vision, diplopia, extreme fatigue, weakness, spasticity, numbness, loss of balance
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45
Q

paraplegia

A
  • lower motor neuron damage by spinal cord injury
  • initially produces “spinal shock” = no movement or relfexes below lesion
  • gradual return of deep tendon reflexes -> flexor spasms of leg -> extensor spasms of leg
  • spasms lead to extensor tone
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46
Q

flexion

A

bend limb at joint

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47
Q

extension

A

straighten limb at joint

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48
Q

abduction

A

move limb away from midline

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49
Q

adduction

A

move limb towards midline

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50
Q

pronation

A

turn forearm palm down

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51
Q

supination

A

turn forearm palm up

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52
Q

circumduction

A

move arm in circle around shoulder

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53
Q

inversion

A

move sole inward at ankle

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54
Q

eversion

A

move sole outward at ankle

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55
Q

rotation

A

move head around central axis

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56
Q

protraction

A

move body part forward and parallel to ground

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57
Q

retraction

A

move body part backward and parallel to ground

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58
Q

elevation

A

raise body part

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59
Q

depression

A

lower body part

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60
Q

when should we avoid testing cervical spine ROM and strength?

A

when there is a suspected neck injury

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60
Q

inspection & palpation - joints

A
  • size
  • contour
  • skin: colour, swelling, symmetry, masses, deformity
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61
Q

inspection & palpation - ROM

A
  • active: pt replicates movement you show them unassisted
  • passive: you support and move pt’s body part for them
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62
Q

inspection & palpation - muscle testing

A
  • strength (against resistance)
  • graded 0-5 (0 = no contraction, 5 = full ROM against gravity + resistance)
  • symmetry
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63
Q

temporomandibular joint - ROM

A
  • opening & closing mouth
  • lateral jaw movement
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64
Q

cervical spine - ROM

A

extension - 55° backwards
flexion - 45° forwards
lateral bending - 40° left and right
rotation - 70° left and right

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65
Q

elbow - ROM

A

flexion - 160°
extension - 0°
pronation - 90°
supination - 90°

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66
Q

wrist - ROM

A

extension - 70°
flexion - 90°
ulnar deviation - 55°
radial deviation - 20°

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67
Q

fingers - ROM

A

flexion - 90°
hyperextension - 30°
extension - 0°

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68
Q

hips - ROM

A

hip flexion with knee straight - 90°
extension - 0°
hip flexion with knee flexed - 120°
external rotation - 45°
internal rotation - 40°
abduction - 45°
adduction - 30°

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69
Q

knees - ROM

A

extension - 0°
flexion - 130°
hyperextension - 15°

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70
Q

ankles - ROM

A

dorsiflexion - 20°
plantar flexion - 45°
eversion - 20°
inversion - 30°

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71
Q

thoracic and lumbar spine - ROM

A

flexion - 90°
extension - 30°
lateral bending - 35° (left and right)
rotation - 30°

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72
Q

shoulders - ROM

A

forward flexion - 180°
extension - 0°
hyperextension - up to 50°
internal rotation - 90°
abduction - 180°
adduction - 50°
external rotation - 90°

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73
Q

older adult changes - MSK

A
  • decrease in height
  • kyphosis w/ backward head tilt, flexion hips & knees
  • decrease peripheral fat (bony prominences pronounced)
  • increased abdominal and hip fat
  • ROM and muscular strength same if no MSK illnesses or arthritic changes
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74
Q

rheumatoid arthritic

A
  • chronic systemic inflammation of joint & connective tissue
  • limits motion
  • symmetrical & bilateral
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75
Q

osteoperosis

A
  • decrease in skeletal bone mass
  • weakened state - risk stress fractures
  • asymmetrical & unilateral or bilateral
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76
Q

functions of the skin

A
  • protection
  • prevents loss of water & electrolytes
  • perception
  • temperature regulation
  • identification
  • communication
  • wound repair
  • absorption and excretion
  • production of vitamin D
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77
Q

Hx - integumentary

A
  • history of skin disease
  • skin pigmentation
  • moles
  • texture of skin
  • pruritus
  • rash or lesions
  • medications
  • hair loss or growth
  • change in nails
  • environmental or occupational hazards
  • self-care behaviours
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78
Q

inspect & palpate - skin

A
  • colour
  • temperature
  • moisture
  • texture
  • thickness
  • mobility and turgor
  • edema
  • hair
  • nails
  • lesions
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79
Q

4 quadrants of breast

A
  • specify whether left or right
  • upper inner quadrant
  • upper outer quadrant
  • lower inner quadrant
  • lower outer quadrant
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80
Q

central axillary node receives lymph from which nodes?

A
  • pectoral
  • subscapular
  • lateral axillary
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81
Q

where does lymph go from central axillary node?

A
  • infraclavicular area
  • supraclavicular
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82
Q

older female breast

A
  • post-menopause, decreased estrogen and progesterone = glandular tissue atrophies
  • atrophy of fat = decreased breast size and elasticity
  • decrease breast size = more prominent inner structures
  • lactiferous ducts more palpable and change in texture
  • decreased axillary hair
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83
Q

male breasts

A
  • disc of undeveloped tissue underlying the nipple
  • areola developed, nipple small
  • gynecomastia: temporary tissue enlargement
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84
Q

palpation of lumps - characteristics

A
  • location (use clock as reference)
  • size
  • shape (oval =, round)
  • consistency
  • movability
  • distinctness (1 lump or many)
  • nipple
  • skin over lump (red, dimpled, scaly)
  • tenderness (is it sore?)
  • lymphadenopathy (any swelling in are on side where lump was found?)
85
Q

breast cancer

A
  • solitary unilateral non-tender mass
  • mass is sold, hard, dense, fixed to underlying tissues or skin
  • irregular borders, poorly delineated
  • constant growth
  • commonly in upper outer quadrant
  • advanced changes: firm or hard axillary nodes, dimpling of skin; nipple retraction, elevation and discharge
86
Q

skin moisture

A

normally on the face, hands, axilla
- in response to activity, environment, anxiety

87
Q

skin texture

A

normal skin feels smooth and firm

88
Q

skin texture - hyperthyroidism

A

skin feels smoother and softer, like velvet

89
Q

skin thickness

A
  • evenly lean over most of body
  • thicker on palms of hands and soles of feet
90
Q

skin mobility and turgor

A

mobility: skin’s ease in rising
turgor: ability of skin to return to place promptly when released

91
Q

nails - inspect & palpate

A
  • consistency
  • cap refill
  • shape/contour
    normal: 160°
    curved nail: 160°≥
    early clubbing: 180°
92
Q

lesions - characteristics

A
  • colour
  • elevation
  • pattern or shape
  • size
  • location
  • distribution
93
Q

lesions - shapes

A
  • annular
  • target
  • linear
  • gyrate
94
Q

lesions - patterns/distribution

A
  • polycyclic
  • grouped
  • discrete
  • zosteriform
  • confluent
95
Q

ABCDE - skin

A

A: asymmetrical
B: borders
C: colour
D: diameter
E: evolution - most important

96
Q

older adult consideration - skin

A
  • slow atrophy of structures
  • thinning of skin
  • subcutaneous fat & muscle tone are lost
  • environmental trauma (sun exposure & cigarette smoking)
  • increased risk for shearing & tearing injuries (when skin breakdown occurs, wound healing is delayed
96
Q
A
97
Q

older adult considerations - hair & nails

A

hair:
- hair loss on the scalp is genetically determined
- grey/white hair feels thin & fine
- males have symmetrical balding in frontal areas
- females may have some bristly facial hair (decr. estrogen)
nails:
- growth rate decreases
toe nails thicken

98
Q

pressure ulcers - definition

A

skin defect that extends into dermis or deeper structures

99
Q

pressure ulcers - pathophysiology

A
  • pressure distorts capillaries
  • this occludes blood flow / O2 delivery
100
Q

pressure ulcers - locations

A

appear over bony prominences

101
Q

pressure ulcers - risk factors

A
  • impaired mobility
  • decr. sensory perception
  • impaired LoC, poor nutrition, shearing injury
  • thin, fragile skin of aging, moisture from incontinence
102
Q

head - inspect & palpate

A
  • general size & shape
  • any deformities, lumps, tenderness
  • palpate temporal artery and TMJ
103
Q

face - inspect

A
  • facial structures (eyeballs aligned normally)
  • symmetry of movement, noting any abnormal swelling
  • look for any involuntary movement (ex. twitching)
  • facial expression (CN 7 - facial nerve)
104
Q

physical exam - neck

A

symmetry:
- when head is held upright and centered in the midline, the accessory muscles of the neck should be arranged symmetrically
- head should remain straight
- trachea & thyroid should be midline
- note any pulsations
ROM:
- observe any movement limitations
- test CN 11 by resisting pt’s movement with your hands

105
Q

headaches - primary

A
  • tension
  • migraine
  • cluster
106
Q

headaches - secondary

A
  • head trauma
  • vascular disorders
  • substance or their withdrawal
  • systemic infection
  • problems of the skull, neck, eyes, ears, nose, teeth, mouth
  • neuralgia headaches (or occipital neuralgia)
107
Q

central visual acuity

A
  • snellen eye chart
  • most commonly used and accurate measure of visual acuity
  • if they wear glasses or contacts - keep them on
  • stand 20 feet from chart
  • cover 1 eye and read each line
108
Q

testing visual fields

A
  • test peripheral vision
  • line up ~60 cm from each other and direct pt to cover 1 eye and you cover opposite eye of the pt
  • slowly advance your flickering finger inward from the periphery in several directions
  • ask pt to saw ‘now’ when they first see the target
109
Q

what does 20/20 vision mean?

A

you can read at 20 feet, what the normal eye can read at 20 feet

110
Q

what does 20/30 vision mean?

A

you can read at 20 feet what the normal eye can read at 30 feet

111
Q

corneal light reflex

A
  • assesses parallel alignment of eyes
  • shine light toward pt eyes aimed at bridge of nose ~30cm away
  • ask pt to stare straight ahead
  • note reflection in corneas
  • reflection should be in same spot in both eyes
112
Q

what could asymmetry in corneal light reflex exam signify?

A
  • deviation in alignment d/t eye muscle weakness or paralysis
113
Q

cover-uncover test

A
  • ask pt to stare straight ahead
  • take piece of paper, cover 1 eye, then remove paper
  • covered eye should remain straight and focused
  • if you notice, reestablishing fixation or jumping; indicates eye muscle weakness
114
Q

which cranial nerves are you assessing when you assess extraocular muscle function?

A

CN 3, 4, 6 - oculomotor, trochlear, abducens

115
Q

six cardinal positions test

A
  • perform this test to assess any eye muscle weakness during movement
  • perform 6 cardinal positions by asking pt to hold head straight & steady and follow your finger/pen with their eyes
  • hold pen/finger ~30cm away
  • move finger out and back in for each position
  • should that eyes have normal, parallel tracking
116
Q

physical exam - eyeballs

A

aligned normally in their sockets with no protrusion or sunken appearance

117
Q

physical exam - conjunctiva

A
  • ask pt to look up and inspect the eyeball
  • it should be moist and glossy
  • note any colour change, swelling, or lesions
118
Q

physical exam - sclera

A

white (light-skinned0, grey-blue (dark skinned)

119
Q

physical exam - anterior eye structures

A
  • using pen light, shine light across cornea from the side
  • check for smoothness and clarity
  • note pupil size, shape, and if pupils are equal in size & shape
120
Q

pupillary light reflex

A
  • darken room
  • ask pt to stare straight ahead
  • shine pen light from side
  • note pupil response
  • perform on both side
  • pupils should constrict with light
121
Q

accommodation - eye exam

A
  • ask pt to stare at object in the distance and then to shift their gaze to your pen/finger which is in front of their face
  • eyes should slightly cross, and pupils should contrict
122
Q

PERRLA

A

Pupils
Equal
Round
React to
Light and
Accommodation

123
Q

older adult considerations - eyes

A
  • skin loses elasticity, causing wrinkling and drooping
  • pts may complain of dry eyes d/t fewer lacrimal secretions
  • impaired visual acuity impact quality of life
124
Q

what eye diseases does aging increase the risk of developing?

A
  • macular degeneration
  • cataracts
  • glaucoma
  • diabetic retinopathy
125
Q

Hx - ears

A
  • earache
  • discharge
  • hearing loss
  • environmental noise
  • tinnitus
  • vertigo
  • self-care behaviours
126
Q

ear - size & shape

A

should be equal with no swelling

127
Q

ear - skin colour

A

colour should be consistent with skin tone

128
Q

ear - lumps/lesions

A

skin should be intact with no lumps/lesions

129
Q

ear - pain test

A
  • move pinna and push on the tragus
  • should not cause any pain
  • mastoid process should also produce no pain
130
Q

ear- opening of the ear

A

should be no redness, swelling, or drainage

131
Q

how would you perform a physical ear exam on an adult vs. a young child?

A

for an adult: pull ear up and out (backwards)
for child under 3: pull pinna straight down

132
Q

whispered voice test

A
  • ensure room is quiet
  • stand arms length behinf pt
  • test on ear at a time
  • whisper slowly a set of 3 random letters and numbers
  • ask pt to repeat what you said
133
Q

older adult considerations - ear

A
  • hearing acuity usually declines with age
  • early losses (strt in young adulthood) involve primarily the high-pitched sounds, but gradually, losses extend to sounds in the middle and lower ranges
134
Q

what happens to the cilia lining the ear canal with age?

A

become coarse and stiff impeding sound waves traveling toward eardrum

135
Q

what happens when a person fails to hear higher tones of words but can still hear lower tones?

A

words sound distorted and difficult to understand, especially in noisy environments

136
Q

Hx - nose

A
  • discharge
  • frequent colds
  • sinus pain
  • trauma
  • epistaxis
  • allergies
  • altered smell
137
Q

what is epistaxis?

A

nosebleeds

138
Q

Hx - mouth & throat

A
  • sores or lesions
  • sore throat
  • bleeding gums
  • toothache
  • sugar consumption
  • bruxism
  • hoarseness
  • dysphagia
  • altered taste
  • tobacco/heavy alcohol consumption
  • self-care behaviours
139
Q

what is bruxism?

A

teeth grinding

140
Q

inspect & palpate - nose

A

external structures: symmetrical, midline, proportion to other facial features
patency: gently push one nasal wing shut when asking pt to sniff & repeat

141
Q

inspection - nasal cavity

A
  • tilt pt’s head back (observe for nasal septum deviation or polyps)
  • gently insert otoscope head into nasal vestibule
  • inspect nasal mucosa (noting any swelling, discharge, bleeding, or foreign body
142
Q

physical exam - sinuses

A
  • air-filled pockets within cranium
  • only 2 pairs accessible for examination (frontal and maxillary)
  • use thumbs to press over frontal sinuses right below eyebrows
  • press over maxillary sinuses just below cheek bone
  • should not cause any pain
143
Q

physical exam - lips/tongue

A

move anterior to posterior
- start with lips (check for any cracking, lesions)
- teeth (absent, lose, abnormally placed teeth)
- gums (pink in colour, remove dentures)
- tongue (pink and even)
- ask pt to touch tongue to roof of mouth (assess bottom part of tongue; check for moisture)

144
Q

physical exam - oral cavity / pharynx

A

uvula:
- should be hanging midline
- ask pt to say ah and watch uvula & soft palate (should stay midline)

tonsils:
- should be granular
- crypts should be present
- graded in size
1+: visible
2+: halfway between side of mouth and uvula
3+: tonsils are touching the uvula
4+: tonsils are touching each other

  • notice any breath odour
145
Q

what does ketoacidosis do to a person’s breath?

A

makes it smell sweet

146
Q

older adult considerations - nose, mouth, throat

A
  • sense of smell may diminish after age 60 d/t decr. # of olfactory nerve fibers
  • decr. salivary secretions and loss of taste
  • diminished senses of taste and smell
  • decr. in appetite (may contribute to malnutrition)
  • d/t absence of some teeth, many eat soft foods, decr. meat and fresh veggie intake, may lead to risk for nutritional deficits
147
Q

organs with solid viscera

A
  • liver
  • spleen
  • right & left kidneys
  • pancreas
  • uterus
  • ovaries
148
Q

organs with hollow viscera

A
  • gallbladder
  • stomach
  • ascending colon
  • cecum
  • appendix
  • bladder
  • small intestine
  • descending colon
  • sigmoid colon
  • duodenum
  • rectum
  • bladder
149
Q

organs in RUQ

A
  • liver
  • gallbladder
  • duodenum
  • head of pancreas
  • right kidney & adrenal gland
  • hepatic flexure of colon
  • parts of ascending & transverse colon
150
Q

organs in LUQ

A
  • stomach
  • spleen
  • left lobe of liver
  • body of pancreas
  • left kidney/adrenal gland
  • splenic flexure of colon
  • parts of transverse & descending colon
151
Q

organs in RLQ

A
  • cecum
  • appendix
  • right ureter
  • right ovary & fallopian tube
  • right spermatic cord
152
Q

organs in LLQ

A
  • sigmoid colon
  • part of descending colon
  • left ureter
  • left ovary & fallopian tube
  • left spermatic cord
153
Q

older adult considerations - abdomen

A
  • changes in accumulation of adipose tissue
  • delayed esophageal emptying = incr. risk of aspiration
  • decr.: salivation, gastric acid production, liver size, & renal function
  • incr. risk: dehydration, gallstones, constipation, & colorectal cancer
154
Q

for older adults, what are the change in the accumulation of adipose tissue?

A
  • adipose tissue is redistributed away from extremities and face to the abdomen and hips
  • women: incr. in suprapubic area (d/t decr. estrogen)
  • men: incr. in abdominal area
155
Q

what is aspiration?

A

when food, liquid, or other material enters a person’s airway and eventually the lungs by accident

156
Q

Hx - abdomen

A
  • appetite
  • difficulty swallowing
  • food intolerance
  • abdominal pain
  • nausea/vomiting
  • bowel habits
  • previous abdominal hx
  • medications
  • alcohol & tobacco
  • nutrition
157
Q

inspection - abdomen - contour & symmetry

A
  • contour should be flat
  • not scaphoid (sucked in), rounded, or protuberant
158
Q

inspection - umbilicus

A

colour, position, orientation

159
Q

abdomen - inspection - skin

A
  • colour
  • striae
  • presence of veins
  • rashes
  • lesions
  • turgor
160
Q

abdomen - inspection - other

A
  • pulsation or movement
  • hair distribution
  • demeanor
  • ostomies & percutaneous tubes
161
Q

auscultation - bowel sounds

A
  • peristalsis of intestines
  • diaphragm end
  • begin in RLQ
  • high-pitched, gurgling, cascading sound that is irregular in rhythm
  • normal: 5-30 sounds/min
162
Q

auscultation - abdomen - vascular sounds

A
  • bell end
  • place stethoscope gently against skin
  • listen over areas below
  • normal: no vascular sound
163
Q

hyperactive bowel sounds

A
  • increased motility
  • normal: stomach growling
  • abnormal: loud, high-pitched, rushing, tinkling sounds
  • cause: bowel obstruction
164
Q

hypoactive or absent bowel sounds

A
  • decreased or absent motility
  • listen for full 5 minutes
  • total absence is rare
  • causes: post-abdominal surgery, inflammation or peritoneum
165
Q

systolic bruit

A
  • pulsing blowing sound
  • pitch dependent on cause
  • causes: renal artery stenosis, abdominal aortic aneurysm, partial occlusion of femoral arteries
166
Q

venous hum

A
  • soft, continuous humming noise of medium pitch
  • heard between xiphoid process and umbilicus
  • causes: portal HTN, liver cirrhosis
167
Q

percussion - abdomen

A
  • assess density & location of organs
  • screen for abnormal fluid or masses
  • percuss in clockwise direction
168
Q

what does the sound ‘tympany’ signify?

A

hollow organs

169
Q

what does a dull sound signify?

A

solid organs

170
Q

what are some important findings when percussing the abdomen?

A

hyper-resonance or dullness where there should be tympany

171
Q

palpation (light) - abdomen

A

assess: texture, temperature, moisture, swelling, rigidity, pulsation, presence of tenderness/pain

steps:
1. ensure pt is relaxed
2. use first 4 fingers together and depress 1cm
3. move fingers in gentle circular motion
4. lift fingers off before moving to next spot
5. move in clockwise direction
6. examine painful/tender area last

172
Q

abdomen - palpation - important findings

A
  • involuntary rigidity
  • guarding
  • tenderness
  • masses
  • organomegaly
173
Q

ascites

A
  • fluid collection in the peritoneal cavity d/t portal HTN and low albumin in blood
  • causes: liver cirrhosis, congestive heart failure, cancers
174
Q

bowel obstruction

A
  • history of previour abdominal surgery with adhesions
  • vomiting
  • absence of stool or gas passage
  • distended abdomen (after 2nd day)
  • radiograph shows dilated air-filled loops of small bowel with multiple air-fluid levels
  • hyperactive bowel sounds in early obstruction; hypoactive or silent in late obstruction
  • dehydration and loss of electrolytes
  • accumulation of fluid and gas in bowel proximal (above) to obstruction
  • colicky pain from strong peristalsis above the obstruction
  • fever
  • pressure from excess fluid and gas may lead to leaking fluid into peritoneum
  • hypovolemic shock
175
Q

what happens in hypovolemic shock?

A
  • decr BP
  • incr pulse
  • cool skin if left untreated
176
Q

older adult considerations - anus, rectum, prostate

A
  • prostate gland enlarge
  • hormonal imbalance that causes the production of adenomas
  • incr risk of prostate cancer & colorectal cancer
177
Q

anus, rectum, prostate - Hx (important findings)

A
  • usual bowel routine: constipation, dyschezia
  • changes in bowel habits: gastroenteritis, colitis, IBS, parasite
  • rectal bleeding, blood in stool: GI bleed, cancer, infection
  • medication use: constipation, melena
  • rectal conditions: hemorrhoids, fecal incontinence
  • family history: colon cancer, rectal cancer, prostate cancer
  • self-care behaviours: low fiber diet
178
Q

what is dyschezia?

A

difficulty pooping

179
Q

britol stool chart - type 1

A
  • separate hard lumps, like nuts
  • hard to pass
  • severe constipation
180
Q

bristol stool chart - type 2

A
  • sausage shaped but lumpy
  • mild constipation
181
Q

bristol stool chart - type 3

A
  • like sausage but with cracks on the surface
  • normal
182
Q

bristol stool chart - type 4

A
  • like sausage or snake
  • smooth and soft
  • normal
183
Q

bristol stool chart - type 5

A
  • soft with blobs with clear-cut edges
  • passed easily
  • lacking fiber
184
Q

bristol stool chart - type 6

A
  • fluffy pieces with ragged edges
  • a mushy stool
  • mild diarrhea
185
Q

bristol stool chart - type 7

A
  • watery
  • no solid pieces
  • entirely liquid
  • severe diarrhea
186
Q

inspection - anus, sacrococcygeal area, anal opening

A
  • spread buttocks apart to observe perianal region

anus: moist, hairless, coarse folded skin, increased pigmentation

sacrococcygeal area: smooth, even

anal opening: valsalva manoeuvre produces no break in skin integrity or protrusion

187
Q

hemorrhoids

A
  • flabby papules that are painless

cause: varicose vein from increased portal venous pressure

  • external and internal
188
Q

hemorrhoids - external

A
  • below anorectal junction and covered by anal skin
  • if thromboses contains clotted blood and is painful, swollen, shiny, blue, itchy, bleeding during defacation
189
Q

what is pruritis?

A

itchy

190
Q

hemorrhoids - internal

A
  • above the anorectal junction and covered by mucous membrane
  • red mucosal mass seen during valsalva manoeuvre
191
Q

what is the valsalva manoeuvre?

A
  • pt in supine position
  • ask pt to exhale against closed glottis for 10-15 seconds
192
Q

fecal impaction

A
  • complete colon blockage from hard, immovable stool in rectum
  • can produce constipation or overflow incontinence
  • community-dwelling older adults at risk

cause: decreased bowel mobility (hospitalized patients and spinal cord injury patients), low-fiber diet

193
Q

older adult changes - male GU system

A
  • no end to fertility, but sperm production decr ≥ 40 years old
  • gradual decr in testosterone production ≥ 55 years old
  • decr amount of pubic hair & color change to grey/white
  • decr in penis and testes size
  • decr in tone of dartos muscle = scrotum hanging lower
  • decr rugae = pendulous look to scrotum
  • decr testosterone = slower and less intense sexual response
  • may become demoralized d/t changes in sexual activity
194
Q

Hx (important findings) - male GU

A
  • frequency, urgency, nocturia: polyuria, oligura, infection
  • dysuria: acute cystitis, prostatitis, urethritis
  • hesitancy & straining: prostate enlargement, acute cystitis
  • urine colour: dehydration, UTI, hematuria, cancer
  • past GU history: incontinence, kidney disease, prostate disease
  • penis: infection
  • scrotum/testes: hernia, cancer, hydrocele
  • sexual activity & contraceptive use: risky sexual activity, STIs, erectile dysfunction
  • STI contact: STI
  • STI risk reduction: risky sexual activity, no contraceptive use
195
Q

what is polyuria?

A

urinate more than usual

196
Q

what is oliguria?

A

urinate less than usual

197
Q

inspection - penis

A
  • penis: wrinkled, hairless, no lesions
  • glans: smooth, no lesions, easy retraction and sliding back when uncircumsized
  • urethral meatus central
    hair distribution consistent with age
198
Q

palpation - penis

A
  • compress glans anteroposteriorly between thumb and forefinger
  • meatus edge pink, smooth, no discharge
  • palpate shaft between thumb and 2 first fingers
  • penis smooth, semi-firm, nontender
199
Q

what is hypospadias?

A

birth defect in boys where the opening of urethra is not located at tip of penis

200
Q

what is epispadias?

A

birth defect in boys where urethra does not form fully and urethra typically is found in abnormal location

-typically on bottom side of penis

201
Q

inspection & palpation - scrotum

A
  • pt to hold penis out of the way (if unable to, use back of gloved hand)
  • size dependent on room temp
  • left typically lower than right
  • lift scrotal soc for posterior view
  • palpate each scrotal half gently
  • should slide easily, be freely movable, rubbery, smooth, oval, firm
202
Q

inguinal & femoral hernias

A

hernia: bulging of internal organs or fatty tissue through on opening in muscle anterior to it

  • most common indirect inguinal hernia
  • visually see bulge when pt stands
  • palpate bump/mass
203
Q

older adult considerations - female GU

A
  • menopause = cessation of menses
    • occurs ~48-51 years old
    • preceding 1-2 years irregular menses (lighter flow, further apart)
    • ovaries stop producing progesterone and estrogen
    • physical changes d/t change in hormone levels
  • uterus shrinks and may droop (prolapsed uterus)
  • vagina atrophies to 1/3 length and width
  • decr vaginal secretions
  • decr mons pubis d/t sucr fat pads
  • decr labia & clitoris
  • decr amount of pubic hair & colour change to grey/white
204
Q

Hx (important findings) - female GU

A
  • menstrual history: amenorrhea, menorrhagia
  • obstetrical history (GTPAL): difficulty conceiving
  • menopause: hormone replacement side effects
  • self-care behaviours: irregular PAP test
  • urinary symptoms: dysuria, nocturia, hematuria, incontinence
  • vaginal discharge: vaginal infection
  • gynecological history: surgery on uterus, ovaries, vagina
  • sexual activity & contraceptive use: risky sexual activity, STIs
  • STI contact: STI
  • STI risk reduction: risky sexual activity, no contraceptive use
205
Q

female GU - inspection (preparation)

A
  • lithotomy position
  • arms at side or across chest
  • drape appropriately
  • trauma and violence informed care
  • provide mirror for teaching
206
Q

female GU - inspection (external genetalia

A
  • skin colour & texture
  • hair distribution
  • labia majora symmetrical, plump, well formed
  • gloved hand, separate labia majora
  • labia minora dark pink, moist, symmetrical
  • urethra opening slit like and midline
  • vaginal opening narrow or large
  • perinium smooth
  • anal skin coarse and dark pigmentation
207
Q

urethritis

A
  • inflammation of urethra d/t infection
  • same bacteria can cause UTI and STI
  • subjective: dysuria, pruritis, pain during sex
  • objective: purulent discharge from meatus, fever (erythemia, tenderness and induration of urethra in anterior vaginal wall)
208
Q

what is erythema?

A

redness of the skin caused by injury or another inflammation-causing condition

209
Q

urine assessment

A
  • normal urine output: 1200-1500 mL/day
  • clear, pale yellow/amber, very slight urine odor
  • bladder capacity = 600 - 1000 mL
    • moderate distension ≥200mL
    • discomfort ≥ 400 mL
  • indwelling catheters: anchored, not kinked, placed below bladder level
    • meatus pink, smooth, no discharge
210
Q

urine assessment - important findings

A
  • oliguria
  • polyuria
  • change in urine colour
  • suprapubic tenderness
  • costovertebral angle pain/tenderness
  • fever
  • discharge from meatus
  • change in. mental status

NSG 2317 (1 decks)

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