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Health Assessment Final > HA Final Exam > Flashcards

HA Final Exam Flashcards

1
Q

Describe the role of assessment as the starting point of all models of clinical reasoning?

A

Collect, organize, validate and document data
Identify chief concern

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2
Q

Describe the use of diagnostic reasoning in clinical judgement

A

Diagnostic reasoning is the process of analyzing health data and drawing conclusion (DIAGNOSIS) to identify diagnose has four major components Attending to initially available cuesFormulating diagnostic hypothesesGathering data relative to the tentative hypothesesEvaluating each hypothesis with the new data collected, thus arriving at a final diagnosis

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3
Q

Describe the nursing process in clinical judgement

A

A systematic method of planning and providing patient care organized around series of phrases that integrate evidence-informed practice and critical thinkingHas five phaseAssessment, nursing diagnosis, planning, implementation and evaluation

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4
Q

Describe the difference between novice, proficient and expert practitioners

A

Novice - No experienceProficient - Understands patient as a whole, can see long term goalsExpert - Arrive at clinical judgement in one leap

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5
Q

Describe critical thinking skills

A

Used as a multidimensional thinking process and not a linear process

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6
Q

Distinguish between first-level, second-level, third-level priority and collaborative problems

A

First level- Emergencies, life threatening. Think ABC plus V (Airway, breathing, cardiac/circulation, Vital signs)Second level - Require prompt intervention to forestall further deteriorationThird level- Important to health but can be addressed later Collaborative problems - problems that the treatment involves multiple disciplines

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7
Q

How does a conceptual framework guide nursing practice?

A

Guides nursing by providing a theoretical framework for generating research questions, designing studies and interpreting findings. Helps build on existing knowledge

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8
Q

Discuss the expanded concept of health and relate it to the process of data collection

A

Health promotion and disease prevention is the core of nursing. About treating the patient through holistic care by addressing mind body and spirit

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9
Q

Describe the different databases

A

Complete health history: Primary care and admission to hospitalFollow-up: History and exam follow direction of presenting concernEpisodic or problem-centered list: Limited or short-term problem, can be collected anywhere but focuses on one part of the bodyEmergency: Rapid collection of data done at same time as life saving meaures

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10
Q

Relate the patient age and health status to the frequency of health assessment

A

Older you are = more health assessment

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11
Q

Consider life cycle approach when performing a health assessment

A

Life-cycle approach is being familiar with the usual and expected developmental tasks for each age group

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12
Q

Define health promotion

A

The process of enabling people to increase control over, and to improve their health. Focus on individual behaviour towards a wide range of social and environmental interventions

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13
Q

Explain 3 levels of disease prevention

A

Primary prevention: promotion of health and the prevention of illness by assisting communities to prevent known health problems, protect existing states of health and promote psychosocial wellnessSecondary prevention: Early detection of disease before symptoms emerge ex; pap tests Tertiary prevention: Prevention when a condition or disease is present or has progressed

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14
Q

Describe health disparities and health inequalities

A

Disparities in health: Occur when the combination and interaction of the determinants of health result in differences in health status between segments of the population and result in health inequalitiesHealth inequalities result from marginalization of groups and are determined to be unjust and unfair, health inequalities exist

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15
Q

Explain the purpose of screening

A

Form of secondary prevention to recognize a disease before symptoms occur

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16
Q

Explain the factors that will inform the health counselling that you offer a patient

A

Developmental levelReadiness of person to engageAvailability of local resourcesThe prevalent health conditions

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17
Q

Describe the key attributes of the Nipissing District Developmental Screen (NDDS)

A

Developmental screening with yes or no checklist for parentsIt is a set of developmental milestones appropriate to the age of the child.

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18
Q

Describe concepts that are central to understanding cultural and social considerations in health assessment

A

Relational, Individual, contextual, interpersonal

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19
Q

Distinguish between cultural sensitivity and cultural safety

A

Cultural sensitivity: being aware that cultural differences and similarities between people exist without assigning them a negative or positive valueCultural safety: Counteracting the everyday impacts of racism and other forms of discrimination on people’s lives

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20
Q

Cultural safety key features are

A

Locates primary responsibility for safety in health care practices and policiesFocuses on strategies to mitigate harmful effects of the health care systemActively counteracts discrimination by working against power differentialsDraws attention to often-harmful effects of cultural sensitivity training which can further entrench sterotypes

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21
Q

What are some factors that affect communication?

A

Internal - Liking others, empathy, ability to listenExternal - Ensure privacy, refuse interruptions, dress, note taking

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22
Q

What are the three phases of the interview

A

Introduction The working phaseTermination phase

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23
Q

List ten traps of interviewing

A

Providing false assurance or reassuranceGiving unwanted adviceUsing authorityUsing avoidance languageEngaging in distancingUsing professional jargonUsing leading or biased questionsTalking too muchInterruptingUsing why questions

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24
Q

When talking with elder individuals we must

A

Speak clearly, don’t elder-speak,

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25
Q

Important things to note when working with and without an interpreter

A

Ideal use of interpreters are those who are trained Children should not be usedBe aware of potential for violation of confidentiality or change of information when using a friend or relative

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26
Q

What is the purpose of the complete health assessment

A

To collect subjective and objective data used to make a judgement or diagnosis about the health status of the individual

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27
Q

List the categories of information contained in a health history

A

Biographic dataReason for seeking carePresent health/history of present illnessPast historyMedicationFamily historyReview of systemsFunctional assessment/ADLS

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28
Q

Describe the eight characteristics included in the summary of each of the patient’s symptoms

A

LocationCharacter or qualityQuantity or severity Timing (onset, duration, frequency)SettingAggravating or reliving factorsAssociated factorsPatients perceptions

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29
Q

When conducting a health history for a children we must include

A

Developmental assessment toolsCurrent health/history of current illness including parents sense of the problemPast historySource of health information

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30
Q

What is the HEEADSS method of interviewing and who is it used for?

A

Adolescents Home environmentEducation and employmentEatingPeer-related activitiesSubstance useSexualitySuicide or depressionSafety from injury and 9

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31
Q

What is the leading cause of disability worldwide?

A

Depression

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32
Q

Define mental health

A

The capacity of each and all of us to feel, think, act

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33
Q

Define mental illness

A

Medical term used to categorize disorders

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34
Q

Describe the elements of a mental health history

A

Interview - gathers the complete health historyObservation - gathers ABCTExamination - Physical symptomsInterview - Gathers subjective and information about ADLS

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35
Q

What is the purpose of the mental status examination

A

Evaluate, quantitatively and qualitatively a range of mental functions and behaviours at a specific point in time

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36
Q

Suicide is the second leading case of death for Canadians aged ?

A

15-19

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37
Q

Half of diagnosable mental health disorders begin by age ?

A

14

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38
Q

What is the third most common chronic illness for Canadian female teens

A

Eating disorders

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39
Q

List the four components of the mental status assessment

A

Health historyMental status examinationSupplement mental status exam Functional assessment of ADLs

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40
Q

When would the MoCA be used

A

Best alternative screening test for mild cognitive impairmentGood for detecting dementia and delirium and differentiating these from psychiatric mental illness

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41
Q

High risk drinkers are predominantly ____ and younger than ____

A

Men and 25

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42
Q

What are the 5 As of substance use and appropriate care

A

Acquire knowledgeAnticipate harm of own practicesAvoid social judgement about substance useAnalyze organizational practices and resourcesApproach patients respectfully

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43
Q

What are three ways to assess for substance use in individuals

A

TWEAK - Identify risk drinking in women especially pregnant women. 7 point scale, 2 or more = at riskTWEAKTolerance: How many?Worry: anyone complain?Eye-opener: Have a drink in the morning?Amnesia: forget while drinking?Kut down: ever feel need to cut down?CAGE - Alcohol and/or drug dependence. Takes less than 1 minute. does not distinguish between past or active drinkingCut downAnnoyedGuiltyEye-opener

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44
Q

What are the three main types of interpersonal violence

A

Sexual assaultChild maltreatmentElder abuse

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45
Q

What is the difference between violence and abuse

A

Violence are violent acts towards an individual physically where as abuse could be a bunch of different types

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46
Q

When should a health care provider report abuse

A

Only require suspicion

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47
Q

Women are ____ x more likely to experience severe forms of violence

A

5x more likely

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48
Q

When assessing Interpersonal partner violence a health care provider can

A

Assume that majority of patients will have a historyAssume some may be currently experiencing abuseProvide care that is appropriate for those with histories of abuse, regardless of abuse has been disclosed

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49
Q

Describe important components of documentation in regards to abuse

A

Must be unbiased and detailed, using verbatim speech. Do not sanitize the words

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50
Q

Describe the different parts of the hands used in palpation and what they are used for

A

Fingertips: Fine, tactile discriminationGrasping action between fingers and thumb: position, shape and consistency of an organ or massDorsa: Determining temperatureBase of fingers or ulnar: Vibration

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51
Q

Describe the differences between light and deep palpation

A

Light palpation detects surface characteristics and accustoms people to being touchedDeep palpation assess an organ or mass deeper in a body cavity

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52
Q

What does percussion yeild

A

Characteristic sounds that determine location, size, density

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53
Q

Describe the different types of percussion

A

Direct percussion: striking hand contacts body wall directlyIndirect percussion: Hits stationary hand

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54
Q

What are the different characteristics of percussion notes

A

Resonance: Low-pitched sound that is hollowHyperresonance: Low-pitched sound but has more of a booming soundTympany: High-pitched and sounds like drumsDullness: Quiet thudFlatness: Very quiet, short duration

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55
Q

Variation of percussion notes are

A

AmplitudePitchQualityDuration

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56
Q

What are four areas of a general survey

A

Physical appearanceBody structureMobilityBehaviour

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57
Q

Describe BMI ranges

A

Underweight = less than 18.5Normal weight 18.5-24.9Overweight 25-29.90Obese class I 30-34.9

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58
Q

What are the different routes of temperature

A

Oral, axillary, rectal, tympanic membrane, temporal

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59
Q

Describe Blood pressure

A

Blood pressure is the force of the blood pushing against the side of the vessel wall

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60
Q

Describe the cardiac cycle

A

The strength of the push changes with the event

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61
Q

Describe the systolic pressure

A

Is the maximum pressure felt on the artery during left ventricular contraction (systole)

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62
Q

Describe diastolic pressure

A

The elastic recoil, or resting, pressure that the blood exerts constantly between each contraction

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63
Q

During the pulse pressure

A

The difference between the systolic and diastolic pressures and reflects the stroke volume

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64
Q

Describe the mean arterial pressure (MAP)

A

The pressure forcing blood into the tissues, averaged over the cardiac cycle

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65
Q

What are the four qualities considered when pulse is assessed

A

RateRhythmForceEquality/elasticity

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66
Q

List the physiological factors controlling blood pressure

A

Cardiac outputPeripheral vascular resistanceVolume of circulating bloodViscosityElasticity of vessel walls

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67
Q

Describe the use of a blood pressure cuff of improper size to the possible findings

A

Cuff too narrow- False high BPCuff too loose- Falsely low

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68
Q

When would you use rectal temperature?

A

If the person is frozen

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69
Q

What are changes older adults may experience in vital signs

A

Greater risk for hypothermiaPulse rate may be irregularShallower respiratory rateIncrease in blood pressure

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70
Q

Define pain

A

Subjective experience that originates from the CNS, the PNS, or both

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71
Q

Describe the phases of pain and patients sensation of pain

A

Transduction TransmissionPerceptionModulation

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72
Q

Describe and Differentiate between the different types of pain

A

Nociceptive - Aching, throbbing and caused by tissue injury. Can be somatic or visceral Neuropathic - Burning or shooting caused by lesion or disease affecting somatosensory nervous system. Results from damage to nerve pathway.Referred - originates in one location but felt in another site. Innervated by same spinal nerve

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73
Q

Infants and young children are at _____ risk for undertreatment?

A

Higher risk

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74
Q

No

A

Is pain a normal process of aging?

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75
Q

Describe pain assessment

A

OPQRSTOnsetProvokes or palliatesQualityRadiatesSeverityTime

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76
Q

Define nutritional status

A

The degree of balance between nutrient intake and nutrient requirements

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77
Q

What are the purpose of the nutritional assessment

A

Identify individual requirementProvide information for designed a nutritional plan of care that will optimize nutrition meet individual nutrient requirementsEstablish baseline data for evaluating the efficacy of nutritional care

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78
Q

Describe the components of a nutritional assessment

A

Malnutrition screening toolComprehensive nutritional assessment24-hour food recallFood frequency questionnaireFood diariesDirect observationDietary reference intakes (DRIs)

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79
Q

What are essentials of a healthy diet

A

Eating a variety of foods to ensure nutrient adequacyConsuming recommended amounts of fruits and vegetables, whole grains and protein and calcium-rich foodsLimiting intake of highly processed foods high in trans fats, added sugars, salt and EOTHMatching energy intake with energy expenditureEngaging in moderate physical activity most daysFollowing food safety guidelines for handling, preparing and storing foods

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80
Q

How many minutes of physical activity should we do most days

A

30-60 mins

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81
Q

Describe the function of skin

A

Guards the body from environmental stressors, and adapts to environmental influences

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82
Q

Describe changes of the skin in older adults

A

Slow atrophy of skin structuresLoss of elasticity, collagen, subcutaneous fatThinning of stratum corneum and dermisGreater risk for heat strokeIncreased risk for skin disease

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83
Q

How does anemia and shock appear in brown and black skin individuals

A

Brown - Yellow-brownBlack - Ashy grey

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84
Q

State the significance of skin tone changes?

A

Tells us there is an underlying problem

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85
Q

Describe some impairments of older adults in regards to their head, face, and neck

A

sagging facial skinPresence of senile tremorsConcave cervical curveDizziness on ROM

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86
Q

Helmets reduce the risk of head and brain injury by?

A

85-88%

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87
Q

Describe the three types of headaches

A

Tension - band around head, mild pain, non-throbbing, tightness, 30 mins lasting, gradual onset, aggravated by stress, poor posture, NOT Worsened by physical activity, REST and massage helpsMigraine - Localized on one side (can be both), near forehead, pain behind the eyes, Throbbing/pulsating, rapid onset, peaks 1-2 hours and lasts 4-72, moderate, physical activity can cause this, darken room and lying down helpsCluster- One side of head (never both), near forehead behind eye, continuous burning piercing, abrupt onset and peaks in minutes, lasts 45-90 minutes, Sever stabbing pain, Exacerbated by alcohol daytime napping, heat, moving helps

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88
Q

Describe wryneck

A

head and neck of the child are tilted towards their right side

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89
Q

Describe Parkinsons in regards to the facial structure

A

Face appears flat with elevated eyebrows, one corner of the lips contain saliva flowing out of the mouth

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90
Q

What does FAST mean and what does it relate to

A

StrokeFaceArmsSpeechTime

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91
Q

What is a braden skin assessment

A

Risk for pressure Ulcers

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92
Q

Whats the ABCDE for skin and moles

A

AsymmetricalBordersColourDiscretenessElevation

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93
Q

Describe cushings sydrome in regards to the face

A

Shapeless and Moon-like, red cheeks

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94
Q

Describe the facial structure of Bells palsay

A

Smile of the lips are one sided toward the right side resulting in the right eye to appear closed

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95
Q

Describe the facial structures of a person with hyperthyroidism

A

Raised head, neck appears very swollen

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96
Q

What are the three cranial nerves that control extraocular movement

A

Cranial Nerve 3, 4 and 6OculomotorTrochlearAbducent

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97
Q

Describe the function of ciliary body

A

Produces the fluid in the eye called aqueous humour, contains muscle that change shape of lens

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98
Q

Describe the role of the pupil

A

Lets light into your eye

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99
Q

Describe the role of the iris

A

Controls the amount of light that enters the eye by opening and closing the pupil

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100
Q

Define the pupillary light reflex

A

Normal constriction of the pupil when bright light shines on retina

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101
Q

Describe fixataion

A

Eye direction toward an object attracting a persons attention

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102
Q

Describe accommodation

A

Adaption of the eye for near vision. Increases curvature of the lens,

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103
Q

Identify some age-related changes in the eye for older adults

A

PresbyopiaMacular degenerationCataractsGlucomaDiabetic retinopathy

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104
Q

What are the three most common causes of decreased visual functioning in the older adult

A

Muscular degenerationCataract formulationGlaucoma

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105
Q

second

A

Glaucoma is the ___ leading cause of preventable blindness in Canada

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106
Q

Read this snellen eye chart reading 20/40

A

You see at 20 feet what most people see at 40 feet

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107
Q

What is the leading cause of visual impairment in people younger than 65

A

Diabetic retinopathy

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108
Q

What is the medical term for the eardrum and describe it

A

Tympanic membrane, thin circular piece of tissue that separated outer and middle ear, should be pearly gray

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109
Q

List the 3 functions of the middle ear

A

1) Conducts sound vibrations from outer ear to central hearing apparatus2) Protects the inner ear by reducing the amplitude of loud sounds3) Estachian tube allows equalization of air pressure

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110
Q

State the functions of the inner ear that can be assessed

A

Equilibrium and hearing

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111
Q

Differentiate among the types of hearing loss

A

Conductive hearing loss - Mechanical dysfunction of the external or middle earPartial loss - obstruction, foreign bodies or perforatedSensorineural loss (perception) - Pathology of inner ear, cranial nerve VIII, or auditory areas of the cerebral cortexMixed loss - Combination of conductive and sensorineural types in the same ear

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112
Q

Objective information to collect regarding the ears

A

External ear - inspect and palpate- Size and shape- Skin condition- Tenderness- External auditory meatusTympanic membrane - Colour and characteristics- Position- Integrity of membraneTest hearing acuityTest vestibular apparatus via romberg test

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113
Q

Describe microtia verse macrotia

A

Microtia - ears smaller than 4cm verticallyMacrotia - ears larger than 10cm vertically

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114
Q

What are clues that a patient may have hearing loss

A

Leaning towards youAsking to repeat

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115
Q

What are the organs in the RUQ

A

Liver, Gallbladder, Duodenum, Right kidney and adrenal gland, parts of ascending colon

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116
Q

What are the organs in the LUQ

A

Stomach, Spleen, left lobe of liver, pancreas, left adrenal gland and kidney

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117
Q

What organs are in the RLQ

A

Appendix, Cecum, Right reproductive organs

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118
Q

What organs are in the LLQ

A

Sigmoid colon, descending colon, left reproductive organs

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119
Q

Epigastric, flank (L & R), illiac (L & R), umbilical, pubic region

A

What are the names of the nine abdomen regions

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120
Q

What topics should be noted during the interview for the abdomen

A

Appetite, dysphagia, bowel habits, medications and alcohol and tobacco

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121
Q

What measure will enhance abdominal wall relaxation

A

Take a deep breath

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122
Q

What is the correct sequence for examining the abdomen

A

Inspection, Auscultation, percussion, palpation

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123
Q

Describe hyper- and hypoactive bowel sounds

A

Hyperactive- loud, high pitched, rushing sounds indicating early bowel obstructionHypoactive - inflammation of the peritoneum or late bowel obstruction

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124
Q

What organs will be palpable in the abdomen

A

Only if enlarged , liver, spleen, kidneys

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125
Q

What are some developmental considerations related to older adults when completing an abdominal assessment

A

Liver size decreases, Gallstone risk increases, more susceptible to dehydration

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126
Q

What causes lactose intolerance and what are some of the symptoms

A

Lower levels of lactase resulting in lactose not being able to break downBloating, cramping, diarrhea

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127
Q

Describe risk factors for developing GERD

A

Gastroesophageal reflux disease - Age, obesity, smoking, pregnancy

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128
Q

What conditions does obesity predispose an individual to?

A

Cancer, gallstones, fatty liver, cirrhosis of liver

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129
Q

What causes celiac disease and what can happen if it is not treated

A

Inherited autoimmune disease in which intestinal tissue is damaged in response to eating gluten resulting in nutrients not being absorbedCauses colon cancer, lymphoma, malnutrition

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130
Q

What are some abdominal conditions that cause acute abdominal pain

A

All the titis

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131
Q

What are some of the causes of abnormal coloured stool

A

Bleeding, certain foods, iron pills, digestive disorder

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132
Q

What affects does smoking have on the digestive tract

A

Polyps, Cancer, Chrons disease

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133
Q

What can be done to prevent constipation

A

Hydration, exercise, eating a balanced diet

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134
Q

25-38 g

A

When developing a plan of care for someone with a nursing diagnosis of constipation how much fiber would you recommend

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135
Q

What is hepatitis

A

Inflammation of the liver

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136
Q

Why is it so important to have the patient empty their bladder before an abdominal assessment?

A

So they dont piss on you

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137
Q

What are the 6 Fs that can cause an enlarged abdomen

A

Fetus, Fat, Fluid, Flatus, Feces, Fibroids

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138
Q

How are Stools documented

A

Bristol Stool ChartType 1 - solidType 7 - liquid

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139
Q

What percussion sounds would you expect to hear with the abdomen

A

Tympany over air filled surfaces like the intestinesDull over solid structures like organs

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140
Q

What are you checking for when you use light palpation

A

Surface characteristics and pain/tenderness

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141
Q

What symptoms would you expect with appendicitis

A

Sever, sharp, chronic pain and tenderness localized in the RLQ

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142
Q

What causes rebound tenderness

A

Structures that are indented rebound suddenly, should be without pain. If pain it is a positive rebound tenderness likely meaning a peritoneal inflammation

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143
Q

What does a positive murphy’s sign indicate

A

Patient with chloecystis (inflammation of gallbladder)

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144
Q

What is glaucoma

A

Build up of intraocular pressure

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145
Q

What is cataract formation

A

Results from a clumping of proteins in the lens, clouding of the lens

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146
Q

Describe macular degeneration

A

Breakdown of cells in the macula of the retina

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147
Q

What are the two types of aphasia

A

Nonfluent aphasia: Speech is difficult or halting, words may be absent, listen CAN understand somewhatFluent aphasia: Speech flows easily, content lacks meaning

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148
Q

What is difference between decorticate and decerebrate movement

A

Decorticate rigidity: Patient lies supine with elbows, wrists, and fingers flexed tight above their chest.- Indicates lesion on cerebral cortexDecerebrate rigidity: Patient lies supine position with neck raised slightly, elbows, wrists rotated externally. Back Hyperextended- Indicates lesion in brainstem

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149
Q

What movement would you see with athetosis

A

Inward twist on the right wrist and fingers, neck twisted towards the ride side. Resembling snak or worm movements

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150
Q

Describe some abnormal gaits

A

Spastic hemiparesis- No movement on right sideCerebellar ataxia - movement of hands and legs are very slow with long foot steps. Balance loss when eyes closedParkinsonian (festinating) - trunk bent forward, flexion of elbow, knee and hips, slow and short movementSteppage/footdrop - Person lifts right knee as if climbing up stairsWadding - person places right leg forward with short step and tilts body from side-side, protruding abdomenShort leg - right knee is bent backwards and trunk is bent forwards

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151
Q

Positive kernig’s sign raises suspicion for what

A

Meningitis

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152
Q

How are reflexes graded

A

0 - absent1+ - diminished2+ - normal3+ above average4+ hyperactive

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153
Q

DEscribe the biceps reflex

A

C5-C6 - contraction of biceps

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154
Q

Describe triceps reflex

A

C7-C8 - elbow extension or contraction of triceps muscle

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155
Q

Describe the brachioradialis

A

C5-C6 elbow flexion

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156
Q

Describe patellar reflex

A

L2-L4 - Knee jerk

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157
Q

Describe achilles reflex

A

L5 - S2 - Plantar flexion

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158
Q

What tests are done to assess the spinothalamic tract

A

Testing for pain, temp, light touch

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159
Q

What tests are done to assess the sensory system of the posterior column tract

A

Vibration, position, tactile discrimination

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160
Q

What key areas should be included when collecting subjective data for a neurological assessment

A

Head injuryLOCDizzinessTremors

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161
Q

What is a dermatome

A

Areas of the body that correlate to a certain area of the spinal cord

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162
Q

Which dermatome are the followingAxilla, Umbilicus, Groin, Knee, Nipple, fingers

A

Axilia - T1Umbilicus - T10Groin - L1Knee - L4Nipple T4Fingers - C6, C7, C8

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163
Q

How do you test for each of the cranial nerves

A
  1. Olfactory - Smell test2. Optic - Snellen chart3. Oculomotor, 4. Trochlear, 6. Abducens - Penlight check PERRLA, 6 cardinal positions, assess for drooping of the eyes5. Trigeminal - Clench jaw and palpate, try to pull chin down7. Facial Nerve - Ask patient to smile, frown, close eyes tight, lift eyebrows, show teeth, tell patient to puff cheeks then pop it8. Acoustic - rubbing test, whisper test9. Glossopharyngeal, 10. Vagus nerve - Tongue depressor say ahh. test gag reflex. (For sensory we would taste test on posterior tongue)11. Spinal accessory - Put hand on L and R side, push against. Hand on shoulders push against 12. Hypoglossal nerve - Inspect tongue, tell patient to say light, tight, dynamite
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164
Q

What 5 things are included in a complete neurological exam

A

mental statusCranial nervesMotor systemSensory systemReflexes

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165
Q

Differentiate among three types of neurological examinations

A

Screening neurological exam: for seemingly well people who have no significant subjective findings from history (mental status, cranial nerves, motor functions, sensory systems, reflexes)Complete neurologic exam: For those who have neurologic concerns or dysfunctionNeurologic re-check: Those who have neurologic deficits and require periodic assessments (LOC, motor functions, pupillary response, vital signs, GCS

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166
Q

List some developmental considerations for older adults

A

Decrease muscle bulk seen in handBenign tremorsDyskinesias (involuntary erratic movements)Loss of ankle jerk

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167
Q

Relate the name and function of each of the 12 cranial nerves

A
  1. olfactory - smell (sensory)2. Optic - Vision (s)3. oculomotor - eyemovement/pupil reflex (motor)4. trochlear - eye movement (m)5. trigeminal - face sensation/chewing (s/m)6. Abducens - eye movement (m)7. Facial - face movement and taste (S/M)8. Acoustic - Hearing/balance (s)9. glossopharyngeal - throat sensation, taste, swallowing (S/M)10. Vagus - movement, sensation, abdominal organs (M)11. Spinal - Neck movement (m)12. Hypoglossal - tongue movement (M)
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168
Q

Describe the CNS and its function

A

Includes brain and spinal cordMonitors conscious sensations, internal organ function, body position and reflexsContains sensory receptors

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169
Q

Describe the function of meninges and cerebrospinal fluid

A

protect CNS

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170
Q

Describe the PNS and its functions

A

Outside of the CNS contains 12 pairs of cranial nerves, 32 pairs of spinal nerves and the associated branchesCarries sensory messages to CNS from sensory receptorsCarries motor messages from CNS to muscles and glans

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171
Q

Describe the medical term for a bunion

A

Hallux valgus

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172
Q

When would you see swan neck and boutonniere deformities?

A

Chronic rheumatoid arthritis

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173
Q

What causes Gout and how does it present

A

Caused due to accumulation of uric acid crystals (urate) in the jointsWarm, tender, reddness and swelling in jointsW

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174
Q

Which movement is difficult to do with a frozen shoulder/rotator cuff injury

A

Circumcudtion

175
Q

What would you expect to see on a patient who has bursitis

A

Swelling, tenderness of area, loss of movement, redness

176
Q

Why can rheumatoid arthritis affect a variety of body system

A

Its an autoimmune disorder

177
Q

When is osteophytes seen

A

in the formation of new bone

178
Q

What are the differences in pain between osteoarthritis and Rheumatoid arthritis

A

RA morning stiffness lasts longer, affects more than one joint/organ and develops rapidly

179
Q

What tests are specific to the knee

A

Anterior/Posterior drawer test, lachman test, posterior sag sign, varus stress test, Mcmurray, Patellar glide test and patellar tilt test

180
Q

What test is used to assess for a herniated disc

A

MRI

181
Q

How is an individual tested for carpal tunnel

A

Phalen test

182
Q

Why is it important to include a functional assessment

A

Used to assess the safety of independent living, the need for home health care services, and quality life

183
Q

What are the key areas when obtaining subjective data for a musculoskeletal assessment

A

Pain in joints, stiffness, swelling, limitation of movement, ADL impairment, trauma, deformities

184
Q

What are the risks for developing osteoporosis

A

being women after menopause due to decreased estrogen, prolonged use of medications such as glucocorticoids, fragility fracture after 40 years, smoking, high alcohol intake, rheumatoid arthritis, low body weight

185
Q

What are some developmental considerations when assessing the musculoskeletal system of older adults

A

Loss of bone density (osteoporosis), postural changes, decreased height

186
Q

Describe the shape and surface of landmarks of the spine

A

Humans have 7 cervical 12 thoracic 5 lumbar 5 sacral and 3-4 coccygeal vertebraeSpinous processes of C7 and T1 are prominent at the base of the neck

187
Q

Differentiate between synovial and nonsynovial joints

A

Synovial joints allow sliding of opposing surfaces, cartilage covers the surface of opposing bonesNonsynovial joints are united by fibrous tissue or cartilage and are immovable like the sutures in the skill or slightly movable like the vertebrae

188
Q

List the three types of muscles and their movements

A

Cardiac and smooth - involuntary, contraction, relaxationSkeletal everything else

189
Q

List the functions of the musculoskeletal system

A

Support - to standMovementProduce the blood cells in bone marrowReservoir for storage of essential minerals

190
Q

Patient is having stool pass into the vagina, what condition?

A

Rectovaginal fistula

191
Q

What is blood in the stool called?

A

Melena

192
Q

What condition can cause rectal itching?

A

Hemorrhoids

193
Q

What is the significance of clay colored stool?

A

Absence of bile pigment

194
Q

Pain with defecations is called?

A

IBS

195
Q

What is BPH and what symptoms occur ?

A

Benign prostatic hypertrophy, impedes urine output by obstructing the urethra

196
Q

How is an individual screened for colorectal cancer

A

Stool tests, colonscopy, CT

197
Q

What are the risk factors for developing colorectal cancer

A

Age over 40, family history, IBS, diet low in fiber and high in fat, lack of physical activity

198
Q

What are the risk factors for developing prostate cancer

A

Advanced age, obesity, family history

199
Q

What are the key areas when obtaining subjective data on rectum anus or prostate

A

Bowel routines, change in bowel habits, bleeding

200
Q

Outline structures that can be examined through the rectum

A

Prostate gland (male), anal canal wall, sphincter, bulbourethral glands

201
Q

Describe the purpose of the prostate gland

A

Secretes a thin, milky alkaline fluid that helps sperm viability

202
Q

What does a positive murphy’s sign indicate

A

patient with cholecystis or inflammation in gallbladder. Test is positive with pain

203
Q

If a mass is found in the abdomen what should we document?

A

Size, pain, tenderness, movability, dexterity,

204
Q

What are the characteristics for lumps

A

Location, temperature, discreteness, movability, size and shape, consistency, tenderness

205
Q

What causes rebound tenderness

A

Structures that are indented rebound suddenly, if pain is positive rebound tenderness is positive.IT indicates peritoneal inflammation

206
Q

What symptoms would you expect with appendicitis

A

Sharp, severe chronic pain and tenderness localized in the RLQ

207
Q

What are you checking for when you use light palpation?

A

Surface characteristics and pain/tenderness

208
Q

What percussion sounds would you expect to hear with the abdomen

A

Tympany over air filled surfaces
Dullness over solid sturctures like organs

209
Q

Are there any organs that are palapable in the stomach?

A

No unless theres a problem

210
Q

Describe when you would hear hypoactive and hyperactive bowel sounds

A

Hyperactive - early bowel obstructionHypoactive - surgery or late bowel obstruction

211
Q

What are the 6 F’s that can cause abdomen distinction

A

Fetus, Fat, Fluid, Flatus, Feces, Fibroids

212
Q

What assessment techniques and what order are they in for the abdomen

A

Inspection, ausulation, percussion, palpation

213
Q

Describe hepatitis

A

inflammation of the liver

214
Q

How much fiber would you recommend for someone with constiipation

A

25-38 grams

215
Q

What can be done to prevent constipation

A

Hydration, exercise, eating a balanced diet

216
Q

What affect does smoking have on the digestive tract

A

Polyps, cancer, chrons disease

217
Q

What are some of the causes of abnormal colored stool

A

Bleeding, certain foods, iron pills, digestive disorder

218
Q

What are some abdominal conditions that cause acute abdominal pain

A

Appendicitis, pancreatitis, cholecystitis

219
Q

What key areas should be included when obtaining subjective data related to an abdominal assessment

A

Appetite, Dysphagia, food intolerance, abdominal pain, medications, alcohol and tobacco

220
Q

What causes Celiac disease and what can happen if its not treated

A

Inherited autoimmune disease in which intestinal tissue is damaged in response to eating gluten, presenting nutritients from being properly absorbedCan cause colon cancer, lymphoma, malnutrition

221
Q

What conditions does obesity predispose an individual to in regards to the abdomen

A

Cancer, gallstones, fatty liver, cirrhosis of the liver, diabetes

222
Q

Describe the risk factors and what is GERD

A

Gastroesophageal reflux diseaseAge, obesity, smoking, pregnacy

223
Q

What causes lactose intolerance and what are some symptoms

A

Have lower levels of lactase meaning cant digestBloating, cramping, diarrhea

224
Q

What are some developmental considerations related to older adults when completing an abdominal assessment

A

Liver size decreases, gallstone risk increases, more susceptible to dehydration

225
Q

What is the anatomy of the external eye?

A

EyelidsPalpebral fissureLimbusCanthusCaruncleTarsal platesMeibomian glandsConjunctivaLacrimal apparatus

226
Q

What 3 cranial nerves control the muscle function of the eye?

A

Cranial Nerve 6: abducens nerveCranial Nerve 4: trochlear nerveCranial Nerve 3: oculomotor nerve

227
Q

What are the 3 layers of the eye?

A

Outer fibrous, Middle vascular choroidInner nervous

228
Q

What internal eye structures make up the middle vascular choroid layer?

A

Ciliary body and irisPupilLensAnterior chamber Posterior chamber

229
Q

What internal eye structures make up the nervous system layer?

A

Ciliary body and irisPupilLensAnterior chamber Posterior chamberretina Optic discRetinal vesselsMacula Fovea centralis

230
Q

Name the functions of the ciliary body, the pupil, and the iris.

A

The ciliary body produces the fluid in the eye called aqueous humor. It also contains the ciliary muscle, which changes the shape of the lens when your eyes focus on a near object. This process is called accommodation.Your pupil lets light into your eye as the muscles of your iris change its shape. The lens in your eye focuses light that passes through your pupil. Light then goes to the back of your eye and hits your retina. Your retina turns light into electrical signals.The iris controls the amount of light that enters the eye by opening and closing the pupil. The iris uses muscles to change the size of the pupil. These muscles can control the amount of light entering the eye by making the pupil larger (dilated) or smaller (constricted).

231
Q

structures viewable with the ophthalmoscope.

A

Optic disc, retinal vessels

232
Q

What are some age-related changes that can effect vision?

A

Lens hardens impairing central vision, Macula begin to die further impacting central vision, lens can begin to have protein build up clouding the lens.

233
Q

What are the three most common causes of decreased vision in older folks?

A

Macular degeneration - The breakdown of cells in the macula of the retina Age related – older than 65Loss of central vision, most common cause of blindness.Cataract formation - Results from a clumping of proteins in the lens, clouding of the lens Some formation by 60 years of age Advanced aging remains most common risk factorMost common cause of vision loss Glaucoma - Build up of intraocular pressureSecond leading cause of preventable blindness in Canada

234
Q

Interpret the results of someone utilizing a Snellen eye chart.

A

20/30 -> You can see at 20 feet what people with normal vision can see at 30 feet.

235
Q

What other tests are part of a complete eye exam?

A

Confrontation test (peripheral vision, sheet of paper over pt and your eye), Corneal Light Reflex (shine a light on bridge, the light should be reflected on the same spot in both eyes), Cover-Uncover Test (Cover eye, have them focus on an object, when you remove eye cover, look at pupil it should be focused similarly on the object), Diagnostic Positions test (Cardinal Position Test, 6 directions).

236
Q

How does aging affect our eyes and what impact does this have on the individual?

A

Skin loses elasticity, causing wrinkling and drooping, fat tissues and muscles atrophy, Lacrimal glands roll inward causing decreased tear production and a feeling of dryness and burning. Pupil size decreases, and the lens becomes less elastic becoming harder and glass-like. Macular Degeneration, Presbyopia, Cataracts.

237
Q

How does Diabetes affect an individual’s eyes?

A

Increased blood sugar damages blood vessels causing them to become blocked and damaged, insufficient nutrients reaching the retinal neurons.

238
Q

What causes Macular degeneration and how does this affect a person’s vision? .

A

Caused by aging, Macular degeneration breakdown of cells in the macula of the retina, results in loss of central vision, most common cause of blindness. (Age-related Macular Degeneration). Peripheral vision is unaffected

239
Q

What are the key areas to include when obtaining subjective data for an eye assessment?

A

Changes in vision, pain, Redness or swelling, watering or discharge, Hx of eye problems, Glaucoma, Use of glasses or contacts, self care behaviours, medications, and coping with vision changes

240
Q

Describe the different tests that are done when obtaining objective data for an eye assessment?

A

Snellen-Visual Acuity, Near vision- Checking for Presbyopia or nearsightness, Confrontation test-Peripheral acuity, Corneal Light Reflex- Assess eye alignment on axes, Cover-Uncover-Small degrees of deviation by interrupting fusion relex. Diagnostic Positions- Testing eye muscle strength and Cranial nerves

241
Q

What reflexes are done with an eye assessment?

A

Pupillary Light Reflex, Corneal Light Reflex, Fusion Reflex

242
Q

How do you determine if PERRLA is present?

A

Pupil, equal, round, reactive, light, accommodation. Pupillary light reflex test.

243
Q

Describe abnormal finding: Dacryocystitis

A

Dacryocystitis- Inflammation of Lacrimal Sac, infection or blockage of sac and cut. Pain, warmth, redness, and swelling occur below the canthus. P.348

244
Q

Describe abnormal finding: Daryoadenitis

A

Dacryoadenitis- Inflammation of the Lacrimal gland, pain, redness and swelling.

245
Q

What is an eye emergency?

A

Cuts, scraps, objects in eyes, burns, chemical exposure, trauma, infections, severe pain.

246
Q

List the anatomical landmarks of the external ear.

A

The external ear is called the auricle or pinna. The external ear has a characteristic shape and serves to funnel sound waves into its opening, called the external auditory canal. External auditory meatus Tragus Antitragus Lobule

247
Q

Describe the tympanic membrane and its anatomical landmarks.

A

Tympanic membrane is the medical term for eardrum. This thin, circular piece of tissue separates your outer ear and your middle ear. Translucent and pearly gray. It is oval and slightly concave. Posterior foldUmbo – part of the malleus Annulus – outer fibrous rim of the drum. Pars tensa – remainder of eardrum, which is thicker and more taut. Cone of lightManubrium of malleus Short process of malleus Anterior foldPars falccida – small, slack, superior section of the tympanic membrane

248
Q

State the functions of the inner ear that can be assessed.

A

Within the bony labyrinth(which holds the sensory organs for equilibrium and hearing), the vestibule and the semicircular canals constitute the vestibular apparatus, CochleaThe inner ear is not accessible to direct examination, but its functions can be assessed. Which would be equilibrium and hearing.

249
Q

What causes children to be at a higher risk of ear infection?

A

The Eustachian tube is horizontal and shorter.

250
Q

Discuss clues from normal conversation that would indicate possible hearing loss.

A

patient leaning their ear towards you as to show they cannot hear you. asking for you to repeat what you are saying multiple times.

251
Q

What is included with an external and an internal ear exam?

A

Inspecting the external anatomy of the ear, including behind the ear (mastoid process), internal ear exam using the otoscope, insert it into ear, inspecting the auditory canal and examine the tympanic membrane.

252
Q

What are we looking for when we are viewing the tympanic membrane?

A

Perforated Tympanic membrane, color of Tympanic Membrane (Pearly Grey) and presence of white scarring (chronic history of ear infections), light reflex.

253
Q

What are the different types of hearing loss?

A

Conductive- Outer or Middle ear blockage or damage, sound is not being transduced to the Cochlea.Sensorineural- Inner ear damage, sound is not being transduced to Cranial Nerve 8 (Acoustic)

254
Q

What are the symptoms of an external ear infection and an internal ear infection?

A

External Ear Infection- Discharge, swollen Mastoid ProcessInternal Ear Infection- Pain

255
Q

How do we promote hearing health?

A

Don’t listen to loud fucking music, don’t use ear buds, instead pay Glenn to follow you around and sing for you, or use headset or over ear headphones.

256
Q

Describe the correct way of utilizing an otoscope.

A

Get a new otoscope covering for each ear, pull back and up Pinna, insert otoscope slowly while holding it upside down?

257
Q

Describe when you would use a whisper test, What is a Rhinne test and a Weber test and what can they tell us?

A

You would use the whisper test when you find they have trouble hearing, this test can tell you the extent of their hearing.Rhinne and Weber test do not yield precise or reliable date, but they are used to determine if the hearing loss is conductive or sensorineural.

258
Q

Name the paranasal sinuses and their functions.

A

air filled pockets within the cranium communicate with the nasal cavity and are lined with same type of ciliated mucous membrane. lighten the weight of the skull serve as resonators for sound production two frontal sinuses (in frontal bone above and medial to the orbits)two maxillary sinuses (in the maxilla (cheekbone) along the side walls of the nasal cavity) ethmoid sinuses - smaller and deeper than above - between the orbitssphenoid sinuses - smaller and deeper than above - deep within the skull in the spenoid bone.

259
Q

Describe the nasal cavity.

A

It extends back over the roof of the mouth anterior edge lined with numerous coarse hairs (vibrissae) rest of cavity lined with blanket of ciliated mucous membrane nasal hairs filter coarse matter from inhaled air mucous blanket filters out dust and bacteria nasal mucosa appears redder than oral mucosa because of the rich blood supply present to warm the inhaled air. divided by septum into 2 slitlike passages anterior part of septum holds rich vascular network, kiesselbachs plexus. lateral walls of each nasal cavity contain three parallel bony projections 1. superior 2. middle and 3. inferior turbinates.

260
Q

List the anatomical landmarks of the external nose.

A

the external nose is triangular, with one side attached to the face. on its leading edge, the superior part is the bridge, and the free corner is the tip. oval openings at base are the nares. just inside, each naris widens into the vestibule. columella divides the two nares. the ala is the lateral outside wing of the nose. upper third of the external nose is made up of bone. the rest is cartilage.

261
Q

Collect subjective data related to the nose, mouth, and throat.

A

nose: discharge, frequent colds (URI’S), sinus pain, trauma, epistaxis, allergies, altered smellmouth and throat: sores or lesions, sore throat, bleeding gums, toothache, sugar consumption, bruxism (teeth grinding), hoaresness, dysphagia, altered taste, tobacco consumption, alcohol consumption, sleep apnea, self care behaviours: oral care pattern, mouthwash, teeth whiteners, dentures or appliances, aligners.

262
Q

Dry air

A

What is the most common cause of nose bleeds?

263
Q

Turbinates

A

What part of the nose allow for more space for air to be warmed and humidified?

264
Q

What sinuses are accessible to examination and how are they assessed?

A

Maxillary Sinus-Press thumbs on cheek bones check for tenderness. Frontal Sinus- Press thumbs on eyebrows.

265
Q

What structures are examined within the mouth?

A

Tongue, Buccal Membrane, Uvula, Sublingual gland, palate, tonsils.

266
Q

What changes occur with older adults that can affect an assessment? What key components should you include when collecting subjective data about the nose and mouth? Any sensory changes, do you smoke, pain, current illnesses, substance use.

A

Subcutaneous fat is gradually lost making nose appear more prominent, nasal hairs grow coarser and stiffer and may not be able to filter out air, sense of smell may diminish due to decreased olfactory nerves, soft tissues atrophy and epithelium thins in mouth, loss taste buds, atrophic tissues ulcerate increasing risk of yeast infection (thrush or Candidiasis).

267
Q

What key components should you include when collecting subjective data about the nose and mouth?

A

Any sensory changes, do you smoke, pain, current illnesses, substance use.

268
Q

What is considered abnormal when looking in the mouth?

A

unexpected nose: Choanal atresia, Epistaxis, Foreign body, Perforated septum, Furuncle, Acute rhinitis, Allergic rhinitis, Sinusitis, Nasal polyps.unexpected mouth: (Lips) Cleft lip, Herpes simplex I, Angular cheilitis (stomatitis, perlèche), Carcinoma, Retention “cyst” (mucocele), (Teeth) Baby bottle tooth decay, Malocclusion, Dental caries, Epulis, Gingival hyperplasia, Gingivitis, Meth mouth, (Inside Mouth, Buccal) Aphthous ulcers, Koplik’s spots, Leukoplakia (white stuff on tongue), Candidiasis or monilial infection, Herpes simplex I(Tongue) Ankyloglossia, Fissured or scrotal tongue, Geographic tongue (migratory glossitis), Smooth, glossy tongue (atrophic glossitis), Black hairy tongue, Enlarged tongue (macroglossia), Carcinoma (Back of the Mouth) Cleft palate, Bifid uvula, Oral Kaposi’s sarcoma, Acute tonsillitis and pharyngitis unexpected Throat: (Acute Infection) Bright red, Swollen, Exudate, Large white spots, (Mononucleosis, leukemia, diphtheria) White Membrane

269
Q

What assessment techniques are used when collective objective data for nose and mouth?

A

Nose: Inspect external nose, shine light in nose, inspect septum, nasal pathway, palpate sinuses (maxillary on cheeks and frontal on eye brows bilaterally).Mouth: Inspect inside mouth looking at gums, teeth, buccal epithelium, palate, tongue top and bottom, uvula. Palpate the Buccal epithelium, paratoid gland. Use tongue depressor to see tonsils, grade them and look at uvula, have them say “Ahh” uvula should rise and fall and same thing with the hard palate.

270
Q

How are tonsils assessed, graded and documented?

A

0-4, 0 absent, 1 slightly visible, 2 half way in middle, 3 touching uvula, 4 touching each other.

271
Q

What assessment techniques are used when collective objective data for nose and mouth?

A

Nose: Inspect external nose, shine light in nose, inspect septum, nasal pathway, palpate sinuses (maxillary on cheeks and frontal on eye brows bilaterally).Mouth: Inspect inside mouth looking at gums, teeth, buccal epithelium, palate, tongue top and bottom, uvula. Palpate the Buccal epithelium, paratoid gland. Use tongue depressor to see tonsils, grade them and look at uvula, have them say “Ahh” uvula should rise and fall and same thing with the hard palate.

272
Q

What are some early sign of oral cancer?

A

Leukoplakia (White shit on the side of tongue), carcinoma on tongue or lip

273
Q

Describe abnormal finding: Leukoplakis

A

Leukoplakis- Chalky white thick raised patch with well defined borders, firmly attached and can’t be scraped off. Due to heavy alcohol and smoking. They are precancerous. P.421

274
Q

Describe abnormal finding: Herpes

A

Herpes- Red bump, painful blister. Can be clustered.

275
Q

Describe abnormal finding: Candidiasis

A

Candidiasis- (Yeast infection) White, cheesy, curd like patch on tongue and buccal mucosa. Does scrap off, but bleeds easily leaving a raw, red surface.

276
Q

Describe abnormal finding: Aphthous Ulcers

A

Aphthous Ulcers (cancer sores)- small, rounded ulcers with a white base surrounding a red halo. Associated with stress, fatigue and food allergy.

277
Q

Describe abnormal finding: Fissured Tissue

A

Fissured Tissue- Deep furrows divides by papillae into small irregular rows. Sign of down’s syndrome, age and dehydration.

278
Q

Describe abnormal finding: Black Hairy Tongue

A

Black hairy tongue- Black appearance not actually hair, can occur after use of antibiotics, due to inhibited normal bacteria which causes a proliferation of fungus.

279
Q

Describe abnormal finding: Glossitis

A

Glossitis- Occurs on tongue, bright and red as a result of decreased papillae, if Atrophic Glossitis (smooth glossy tongue) sign of B12, folic acid and/or iron deficiency.

280
Q

Describe the composition of breast glandular tissue.

A

Glandular tissueLobes, lobules, and alveoliLactiferous ducts and sinusesFibrous tissueSuspensory ligaments(Cooper’s ligaments)Adipose tissue

281
Q

Relate the changes that occur in Cooper’s ligaments with cancer.

A

Coopers ligaments begin to be displaced as a result of the cancer growth resulting in dimpling on the breasts.

282
Q

Describe the ways of documenting clinical findings from a breast examination.

A

If a lump is found, the 7 criteria (Discreteness, shape and size, moveability, tenderness, warmth, location, consistency.) When describing position of lump, imagine breast as a clock.

283
Q

Relate the anatomy of the breast lymphatic system. (Relate it to what?)

A

Lymphatic systemAxillary nodesCentralPectoral (anterior)Subscapular (posterior)LateralDrainage patterns

284
Q

Review breast development in the adolescent female.

A

Breast development is triggered by onset of puberty with hormone change. Tenderness in developing breasts is common, goes through 5 stages Table 18.1 on P. 431

285
Q

Review breast changes that occur during pregnancy..

A

Changes start during the second month and are an early sign of pregnancy, breasts enlarge and feel nodule, nipples become larger, darker and more erectile. Colostrum begins expressing after 4th month

286
Q

Collect subjective data related to the breasts and regional lymphatic system.

A

Breast- Pain, Lump, Discharge, Rash, Swelling, Trauma, Hx of Breast Disease, Surgery and Self care Behaviours.Axilla- Tenderness, lump or swelling

287
Q

Identify expected and unexpected findings related to the breasts and regional lymphatic system.

A

Abnormal nipple dischargeMammary duct ectasiaIntraductal papillomaCarcinomaPaget’s disease (intraductal carcinoma)Disorders during lactationPlugged ductBreast abscessMastitisMale Breast Gynecomastia Carcinoma

288
Q

Collect objective data related to the breasts and regional lymphatic system using physical examination techniques.

A

Use technique A, covers entire breast. Look for dimpling and or lumps. Examine nipple for discharge and scabbing.

289
Q

Analyze subjective and objective data from assessment of the breasts and regional lymphatic system and consider initial interventions.

A

Plugged duct during lactation, have them empty the breast, should resolve itself. Lumps use the 7 characteristics.

290
Q

What is a common location of the breast for breast cancer?

A

Tail of spence

291
Q

What key components are required when collecting subjective data about breasts?

A

Pain, family history of breast cancer, pregnancy

292
Q

Why is it important to include the axilla when assessing the breasts?

A

The lymphatic system runs through the tail of spence and in the axilla, where most breast cancers are found.

293
Q

What is important to document on when a breast lump is found?

A

7 Characteristics, Warmth, location, discreteness, consistency, shape and size, moveability, tenderness.

294
Q

What are signs of retraction and inflammation?

A

Pain, swelling, warmth and redness.

295
Q

What positions should a patient be in when performing a breast exam?

A

Supine with a towel elevating shoulder to flatten breast tissue.

296
Q

List the contents of the mediastinum

A

Esophagus, trachea, heart, greater vessels

297
Q

Describe the borders of the lung

A

Right lobe, 3 lobes, shorter due to liver. Left lobe, 2 lobes, narrower due to heart.Anterior: Apex 3-4cm above clavicle, base rests on diaphragm 6th rib. Laterally, from apex down axilla 7th or 8th rib. Posterior: C7 to T10

298
Q

Describe the pleurae and their function

A

Pleura- Forms an envelope between lung wall and chest wall Visceral- Lines outside of lungsParietal- Lines inside of chest wall and diaphragm.

299
Q

List the structures that compose the respiratory dead space

A

Nose, mouth, trachea, bronchus, broncioles, terminal broncioles

300
Q

Summarize the mechanics of respiration

A

Respiration rate is controlled by the equilibrium of Carbon Dioxide in the lungs, when CO2 level becomes to high or O2 becomes too low, it triggers a respiration. Chest expands during inhalation to allow more air to enter the lungs. Inhalation occurs as air rushes into the lungs to increase O2 level in the blood, expiration takes place when CO2 levels become too high in the bloodstream.

301
Q

What are the anterior and posterior landmarks for a lung assessment?

A

Anterior: Clavicle, Angle of Louis, T6Posterior: C7 to T10

302
Q

Where is the best place to assess the middle lobe?

A

Right Lateral side

303
Q

What changes occur with the respiratory system in older adults and how does this impact the individual?

A

●Older adultsLungs more rigid and harder to inflateDecrease in vital capacityIncrease in residual volumeDecrease in number of alveoliIncreased shortness of breath on exertionIncreased risk for postoperative complications Oxygen Saturation decreases, higher risk of cyanosis, poor circulation and oxygenation to extremities.

304
Q

What assessment techniques are used when performing a complete respiratory assessment?

A

Inspection, Palpation, Percussion, Auscultating

305
Q

What are key areas to include when collecting subjective data for a respiratory assessment?

A

Cough, SOB, Chest pain with breathing, Hx of Respiratory infections, smoking, environmental exposures.

306
Q

Discuss developmental care associated with the thoracic cavity.

A

●Older adultsLungs more rigid and harder to inflateDecrease in vital capacityIncrease in residual volumeDecrease in number of alveoliIncreased shortness of breath on exertionIncreased risk for postoperative complications

307
Q

What are key areas to include when collecting subjective data for a respiratory assessment?

A

Cough, SOB, Chest pain with breathing, Hx of Respiratory infections, smoking, environmental exposures.

308
Q

What sound is expected when percussing over a pneumothorax?

A

Hyper resonance

309
Q

What are adventitious sounds and when would you hear them?

A

Adventitious sounds are abnormal breathing sounds, they are heard mostly during inhale but sometimes exhale. (Fine or Coarse Crackles, Stridor, Wheezing)

310
Q

Where would you hear bronchial and bronchovesicular sounds?

A

Bronchial sounds over trachea, bronchovesicular sounds over sternal border of angle of louis (T1-2)

311
Q

What breath sounds do you expect to hear over the peripheral lung fields?

A

Vesicular sounds

312
Q

What are you assessing for when palpating the chest?

A

Tactile fermitus, tenderness, warmth, equal bilateral lung expansion.

313
Q

What are you looking for during inspection?

A

Skin color, lumps, bumps, lesions, accessory muscles with breathing.

314
Q

What assessment techniques are used when performing a complete respiratory assessment?

A

Inspection, Palpation, Percussion, Auscultating

315
Q

What types of scoliosis are seen?

A

Degenerative Scoliosis, Congenital Scoliosis, Neuromuscular Scoliosis, Idiopathic Scoliosis

316
Q

What can cause increased or decreased fremitus?

A

Increased: Inflamed Lung tissue, such as PneumoniaDecreased: Pleural effusion, pneumothorax.

317
Q

What causes a pneumothorax?

A

Pneumothorax- air outside lung. Caused by chest trauma, excessive pressure, lung disease, COPD, asthma, cystic fibrosis, TB or Whooping cough.

318
Q

What causes unsymmetrical lung expansion?

A

Decreased ventilation in one lung, usually due to structural immobility such as broken rib or defect.

319
Q

What causes a dowager’s hump?

A

Poor posture, osteoporosis, congenital problem, Schuerman’s Kyphosis.

320
Q

What causes a pleural friction and what would this sound like when auscultating?

A

Inflammation in the Pleural causes the roughened edges to rub together. Sounds like a coarse windy day, localized to area of rubbing.

321
Q

Why is it important to assess the color of phlegm?

A

Color of the phlegm indicates what is going on with the body, clear - viral infection, green/yellow - bacterial infection, red - lung injury, cancer or malignancy, Brown - Chronic lung disease.

322
Q

Why is a 6 minute walk done?

A

It assess functioning of heart and lung capacity, failing this test will lead to further testing.

323
Q

What symptoms are seen with difficulty breathing?

A

Tripod position, accessory muscles engaged with breathing, inability to complete a sentence, nose flaring, RR, sweating, wheezing.

324
Q

How might your patient present who was having cerebral hypoxia?

A

Hard time paying attention, Poor judgement, memory loss, hard time controlling movement, a change in skin color.

325
Q

Describe the difference between pectus excavatum and pectus carinatum..

A

Pectus Excavatum- Breast bone grows inward causing an indent in chest.Pectus Carinatum- Breast bone grows outward cause a jutting out of the chest

326
Q

What assessment findings are likely to be present on a patient with Emphysema?

A

Inspection: Increased Anteroposterior diameter, barrel chest, use of accessory muscles, tripod position, SOB, Tachyonea.Palpation: Decreased Tactile Fermitus.Percussion: Hyper-resonanceAuscultation: Decreased breathing sounds, extended expiration.

327
Q

What are the different voice sounds that are assessed and how would you know there was an abnormal response?

A

Bronchophony, Egophony, and Whispered Pectoriloquy. Being able to hear the words clearly is an abnormal response.

328
Q

What different respiratory conditions have dyspnea as a symptom?

A

Emphysema, Asthma, Pleural Effusion, Heart Failure, Pneumocystis jiroveci Pneumonia, TB, Chronic Bronchitis.

329
Q

What other diagnostic tests are done when completing a respiratory assessment?

A

Diaphragmatic Excursion, symmetrical chest expansion, tactile fermitis.

330
Q

What assessment findings are likely to be present with a patient with Bronchitis?

A

Inspection: Hacking, raspy cough, thick mucoid sputumPalpation: Tactile Fremitus normalPercussion: ResonanceAuscultation: Normal Vesicular, Crackles over deflated area and wheezing may be present.

331
Q

Relate anatomical structures to the correct landmark or anatomical location.

A

Angle of Louis (Intercoastal 2) Right side sternal border Aortic Area, Angle of Louis (Intercoastal 2) Left side sternal border Pulmonic Area, Intercoastal 3 sternal border Ebbs point, Intercoastal 4 sternal point Tricuspid area, Intercoastal 5 midclavicular mitral area.

332
Q

Relate the name of the hear sound to the physiological cause.

A

S1 Tricuspid valve and mitral valve closure. S2 Pulmonary valve and Aortic valve.

333
Q

Incorporate health promotion concepts when performing an assessment of the heart and neck vessels.

A

Diet, exercise, substance use, smoking, sedentary lifestyle.

334
Q

Summarize the spread of the cardiac impulse through the heart.

A

Starts at the SA node, travels to AV node down Bundle of His in atrial septum, travels down the bundle branches and through the Purkinje fibers.

335
Q

Describe the carotid artery pulse.

A

Displays functioning of the heart, do not palpate bilaterally.

336
Q

Cite the risk factors associated with heart disease and stroke

A

Being in poor shape, lack of physical activity, High BP, smoking, high cholesterol, being overweight, and diabetes.

337
Q

List the hemodynamic changes that occur with aging.

A

Ventricle wall thickens, systolic blood pressure increases, increased HR.

338
Q

What occurs with the heart during systole and diastole?

A

Systole- pushes blood out of heart, ventricles contract.Diastole- ventricular relaxation and refilling, blood being returned to the heart.

339
Q

What are risk factors to the development of cardiovascular disease?

A

Poor shape, sedintary lifestyle, high BP, Smoking, high Cholesterol, overweight, and diabetes.

340
Q

What cardiac changes occur with the older client?

A

Chest wall - kyphosisHeart - Myocardial hypertrophy, downward placement, cellular aging and vascular rigidity, decrease Cardiac output, HR, stroke volume in response to exercise or stress.Blood Vessels - Arterial Stiffening

341
Q

What changes within the heart are reflected with the jugular veins?

A

Changes in blood volume and cardiac function of right ventricle.

342
Q

What is preload and afterload?

A

Preload: Venous return, build up during diastole.Afterload: Opposing pressure that ventricles must generate to open aortic valve.

343
Q

What is a cardiac cycle?

A

Full heart contraction cycle, PQRST ECG wave.

344
Q

What changes within the heart are reflected with the jugular veins?

A

Changes in blood volume and cardiac function of right ventricle.

345
Q

What makes up the QRSTU in an EKG?

A

QRS-Ventricular systole, T Ventricular diastole

346
Q

When would you expect to see paroxysmal nocturnal dyspnea? Why does angina occur?

A

PND occurs 1 to 2 hours after falling asleep and is relieved by sitting upright. Angina occurs because some part of the heart is being damaged due to not getting enough oxygen.

347
Q

What assessment findings would you expect to see in a patient with heart failure?

A

Dyspnea, Orthopnea, Cough with frothy pink or white sputum, decreased BP, nausea and vomiting, ascites, pitting edema, anxiety, Falling O2, confusion, Jugular vein distention, infarct, fatigue, S3 gallup, enlarged spleen and liver, decreased urine output, weak pulse.

348
Q

Where do we hear S1 and S2?

A

S1 Apex of the heart S2 Base of the heart

349
Q

How do we find the apical impulse?

A

Have the patient lay on their left side in the recovery position, place finger over mitral area.

350
Q

What are risk factors to the development of cardiovascular disease?

A

Poor shape, sedintary lifestyle, high BP, Smoking, high Cholesterol, overweight, and diabetes.

351
Q

What are you assessing for when inspecting the chest in a cardiac assessment?

A

Facial expression, Color, elevated sternum, thrill

352
Q

What else do we palpate for when assessing the heart?

A

Carotid artery and carotid artery pulse.

353
Q

What areas do we auscultate the carotid artery?

A

3 spots, at chin, half way down artery and above clavicle.

354
Q

What cardiac changes occur with the older client?

A

Chest wall - kyphosisHeart - Myocardial hypertrophy, downward placement, cellular aging and vascular rigidity, decrease Cardiac output, HR, stroke volume in response to exercise or stress.Blood Vessels - Arterial Stiffening

355
Q

What assessment techniques are used when collecting objective data for a heart assessment?

A

Inspect, Palpation, Percussion, Auscultating

356
Q

Why is heart disease a leading cause of death in women> 55 years of age?

A

Symptoms easily attributed to something else, and often ignored, menopause.

357
Q

What are key factors to assess when collecting subjective data related to heart assessment?

A

Chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis, edema, nocturia, cardiac history, family cardiovascular history, personal habits.

358
Q

How do you differentiate between cardiac, respiratory and muscular chest pain?

A

Does the pain get worse with breathing, or limb movements.

359
Q

What is the significance of nocturia?

A

Occurs with heart failure patients who are ambulatory during day, heart failure makes it hard for the body to release fluids, lying down reactivates kidneys processing urine.

360
Q

What are the characteristics of Arteries?

A

Carries oxygenated blood, high pressure, movement of blood by ventricle contraction.

361
Q

List the pulses accessible to examination.

A

Carotid, Temporal, Brachial, Radial, Ulnar, Apical, Aortic, Iliac, Renal, Femoral, Popiliteal, Dorsalis Pedis, Posterior Tibial

362
Q

Explain the term capacitance vessels.

A

Blood vessels contain most of the blood and that can readily accommodate changes in blood volume.

363
Q

Incorporate health promotion concepts when performing an assessment of the peripheral vascular system.

A

Physical activity, taking breaks and elevate legs if on feet all day, harms of smoking, obesity.

364
Q

What do lymph nodes do?

A

Filter fluid before it returns to blood stream, captures microorganisms and pathogens exposing them to lymphocytes.

365
Q

What physiological changes occur when arteries and veins are not working properly?

A

Arteries: Ischemia occurs if the artery is partially obstructed, tissue death if full blockage occurs.Veins: Varicose veins, causing a backflow of deoxygenated blood which impacts the preload amount.

366
Q

When would you expect to see someone with lymphedema?

A

Swelling in the extremities due to build up of lymph in the body.

367
Q

What are important aspects of a pulse to document and how are pulses draded?

A

Rate, Rhythm, elasticity of vessel and equal force. 3: Increased, full and bounding, 2: Normal, 1: Weak, 0: Absent

368
Q

How does arteriosclerosis and atherosclerosis contribute to peripheral vascular disease?

A

Prevents adequate blood flow, causing ischemia and tissue death if the arteriosclerosis is blocking the blood flow, causing chronic insufficiency.

369
Q

What could be happening if someone’s capillary refill was greater than 2 seconds?

A

Dehydration, shock, hemorrhage, hyper or hypothermia or decreased peripheral perfusion.

370
Q

What causes the brown discoloration see on lower limbs?

A

Legs turn brown as blood begins to pool and break down releasing the iron.

371
Q

How is pitting edema graded?

A

1: Mild pitting, slightly indentation, no swelling in the legs2: Moderate pitting, indentation that subsides rapidly3: Deep pitting, indentation remains for a short time, swelling in leg.4: Very deep pitting, indentation, lasts longer, gross swelling of the leg.

372
Q

How would you know if someone’s peripheral vascular problems were related to chronic arterial or chronic venous problems?

A

Arterial: Deep muscle pain in Calf, lower leg or bottom of foot, Intermittent Claudication (pain during exercise), Chronic pain that gets worse after exertion, cool pale skin.Venous: Pain in Calf, Lower leg, Aching, Tiredness, feeling of fullness, Chronic pain that increased during day, Edema, varicosities, weeping ulcers at ankles.

373
Q

What are the presenting symptoms of Raynaud’s disease and lymphedema?

A

Raynauds’s Disease: Cold fingers and toes, areas of skins that turn white and then blue when exposed to cold and red when warm with numb prickly pain.Lymphedema: Extremity starts with a little swelling but increases over time, skin feels tight and tingling on extremity, extremity feels heavy.

374
Q

How would you know if your patient was having a claudication (pain in thigh from walking)?

A

Have them attempt to walk and watch the face for pain or grimacing, ask them to point to where the pain is felt.

375
Q

When would you expect to see pretibial edema?

A

Someone that has been on their feet all day, DVT, Venous statsis

376
Q

What are you inspecting when assessing the peripheral vascular and lymphatic system?

A

Symmetry of the extremities, skin color changes, Varicose veins, Nondiscrete lymph node enlargement.

377
Q

Describe the differences between arterial ulceration and venous ulcerations.

A

Arterial: Result from Arteriosclerosis and Atherosclerosis, Deep pain in muscle and claudication, pain at rest, coolness and paleness, decreased pulses, Thin shiny skin on legs, thick rigid nailbeds, absence of hair, atrophy of muscles. Ulcers occur at toes, metatarsal heads, heels and ankle characterized by pale ischemic base, no bleeding.Venous: Occurs after acute DVT or chronic incomplete valves in deep veins, aching pain in lower calf, worse at end of day with prolonged standing or sitting, firm brawny edema, course thickened skin, pulses normal, brown pigment discoloration, petechiae dermatitis (pinpoint nonblanching spots).

378
Q

When would you see bilateral pitting edema? What causes unilateral swelling of the feet?

A

Bilateral is a systems problem, ie Venous insufficiency and unilateral is a localized problem such as a blocked lymph node ie Lymphodema.

379
Q

What would you expect to see when assessing a patient who has peripheral arterial disease?

A

Skin changes on legs or arms, Leg pains or cramping, lymph node enlargement, swelling in arms or legs and impotence.

380
Q

What are risk factors for the development of deep vein thrombosis?

A

Prolonged bed rest and immobility, and heart failure.

381
Q

What areas of the body do the cervical nodes, axillary nodes, epitrochlear nodes and inguinal nodes drain?

A

Cervical nodes drain up into Cranial sinusesAxillary nodes drain into the wall of the thorax, breast, arm and upper abdominal wall above the umbilicus.

382
Q

What role does the lymphatic system have?

A

Major role in Immune system, conserves fluid and plasma proteins that have leaked out of capillaries.

383
Q

What are the key areas to collect subjective data from when assessing the peripheral vascular system and the lymphatic system?

A

Leg pain or cramps, Skin changes on arms or legs, swelling in arms or legs, lymph nodes enlargement, medication, lifestyle.

384
Q

How do you landmark and palpate for the accessible pulses?

A

Popiliteal Behind Patella in Knee, deep in therePosterior Tibial - medial side of ankle under calcaneusDorsalis pedis- Top of foot, in line with big toe up to ankle.

385
Q

What changes occur with the peripheral vascular system with older adults?

A

Arteriosclerosis, Atherosclerosis, Increased risk of DVT, Dorsalis Pedis and Posterior Tibial pulses harder to locate, Trophic changes associated with Arterial insufficiency.

386
Q

How do you landmark and palpate for the accessible pulses?

A

Popiliteal Behind Patella in Knee, deep in therePosterior Tibial - medial side of ankle under calcaneusDorsalis pedis- Top of foot, in line with big toe up to ankle.

387
Q

What do lymph nodes do?

A

Filter fluid before it returns to blood stream, captures microorganisms and pathogens exposing them to lymphocytes.

388
Q

What role does the lymphatic system have?

A

Major role in Immune system, conserves fluid and plasma proteins that have leaked out of capillaries.

389
Q

What is the differences between arteries and veins?

A

Arteries carry oxygenated blood away from the heart, veins bring deoxygenated blood to the heart.

390
Q

Collect subjective data related to the peripheral vascular system and lymphatic system.

A

Leg pain or cramping, skin changes on arms or legs, swelling in arms or legs, lymph node enlargement, medications.

391
Q

Describe the mechanisms that keep blood moving toward the heart in the venous system.

A

Muscle contraction, Pressure gradient caused by breathing, Intraluminal valves.

392
Q

Name the related organs and functions of the lymphatic system.

A

Spleen- Controls level of blood cellsTonsils- Help filter out germs that enter your nose and mouthThymus Gland- Production and maturation of immune cells

393
Q

Collect objective data related to the peripheral vascular system and lymphatic system using physical examination techniques.

A

Temperature in extremities, measure the extent of edema, grading pitted edema, checking pulses (Femoral, popliteal, pedis and posterior tibial).

394
Q

Cite the location of superficial groups of lymph nodes that are accessible to examination.

A

Inguinal nodes, axillary and cervical

395
Q

List the risk factors for venous stasis.

A

Hx DVT, Varicose veins, obesity, pregnancy, not getting enough physical activity, smoking

396
Q

What are the characteristics of Veins?

A

Carries unoxygenated blood, low pressure system, moved by skeletal muscle contraction and respiration.

397
Q

What is cardiac output?

A

Volume of blood pumped out each minute. CO=SV*HR

398
Q

Discuss the significance of jugular vein assessment.

A

It assesses the hearts efficiency as a pump.

399
Q

State why two distinct components to each heart sound exists.

A

Valves opening and closing

400
Q

List three conditions that result in cardiac murmurs.

A

Aortic stenosis or regurgitation, Mitral stenosis or regurgitation, Hypertrophic Cardiomyopathy

401
Q

What is the predominant sound heard when percussing over lung fields?

A

Resonance.

402
Q

What are the mechanisms of respiration?

A

Inspiration and expiration, chest expands to allow more oxygen to enter lungs, Increased CO2 triggers expiration.

403
Q

Discuss the locations and functions of the trachea and the bronchial tree.

A

Trachea- Carry air in and out of lungs, found in neck.Bronchial Tree- Provide air to pass in and out of each lung, branches at T2-T3.

404
Q

What types of abnormal findings can occur with a male breast?

A

Gynecomastia- One sometimes two enlarged breastsBreast cancer

405
Q

Describe abnormal finding: Kopilik’s spots

A

Kopilik’s spots- Small, blue white spots with irregular red halo, scattered over mucosa opposite the molars. Early sign of Measles.

406
Q

What cranial nerves are tested when doing a mouth assessment?

A

Cranial Nerve 10.

407
Q

Collect objective data related to the nose, mouth, and throat using physical examination techniques.

A

inspect and palpate the nose. nose should be midline, symmetrical, in proportion to other facial features. inspect for deformity, inflammation, lesions. test patency of nostrils by pushing each nasal wing shut with finger ask person to breatheobserve nasal septum for deviation -epistaxis commonly originates from the anterior septum palpate the sinus area - abnormally tender to palpation with chronic allergies and acute infectioninspect mouth, lips, teeth and gumscompare number of teeth with expected number. check colour of tongue - should be pink and even grade for tonsils

408
Q

Identify the effects of some of the age-related changes that take place in the mouth.

A

salivation starts at 3 months of age teeth begin development in utero older adults - oral cavity soft tissues atrophy and epithelium thins in cheek and tongue, loss of taste buds. decreased salivary secretion. with aging, tooth surfaces are abraded. gums recede. teeth begin to erode at gum line. malloclusion in older adults - tooth loss occurs and remaining teeth drift causing upper and lower incisors to protrude.

409
Q

Identify expected and unexpected findings related to the nose, mouth, and throat.

A

unexpected nose: Choanal atresia, Epistaxis, Foreign body, Perforated septum, Furuncle, Acute rhinitis, Allergic rhinitis, Sinusitis, Nasal polyps.unexpected mouth: (Lips) Cleft lip, Herpes simplex I, Angular cheilitis (stomatitis, perlèche), Carcinoma, Retention “cyst” (mucocele), (Teeth) Baby bottle tooth decay, Malocclusion, Dental caries, Epulis, Gingival hyperplasia, Gingivitis, Meth mouth, (Inside Mouth, Buccal) Aphthous ulcers, Koplik’s spots, Leukoplakia (white stuff on tongue), Candidiasis or monilial infection, Herpes simplex I(Tongue) Ankyloglossia, Fissured or scrotal tongue, Geographic tongue (migratory glossitis), Smooth, glossy tongue (atrophic glossitis), Black hairy tongue, Enlarged tongue (macroglossia), Carcinoma (Back of the Mouth) Cleft palate, Bifid uvula, Oral Kaposi’s sarcoma, Acute tonsillitis and pharyngitis unexpected Throat: (Acute Infection) Bright red, Swollen, Exudate, Large white spots, (Mononucleosis, leukemia, diphtheria) White Membrane

410
Q

List the functions of the mouth.

A

first segment of the digestive system and an airway for the resp system, eating, speaking, breathing

411
Q

Identify the structures of the oral cavity.

A

short passage bordered by lips, palate, cheeks and tongue contains the teeth, gums, tongue, salivary glands

412
Q

Name the functions of the nose.

A

first segment of the respiratory system. It warms, moistens and filters inhaled air and is the sensory organ for smell.

413
Q

What is a positive Romberg?

A

While testing for balance, if the person begins to fall forward or is very unstead. Demonstrates an issue with Semicircular canals or Cranial Nerve 8.

414
Q

What are the key areas to assess when collecting subjective data?

A

Earache, infections, discharge, hearing loss, environmental noise, Tinnitus, Vertigo, Self-care behaviours.

415
Q

What contributes to hearing changes in older adults?

A

Loss of elasticity of pinna, Eardrum whiter, more opaque, duller, Loss of hearing of high-tone frequencies and consonants in whispered voice test, presbycusis due to living in a quiet environment, Impacted cerumen.

416
Q

What does each of those tests tell you?

A

Whisper test - Hearing acuity. Tunning Forks- testing for conductive hearing loss

417
Q

What tests are included when doing a full ear exam?

A

Whisper test, tunning forks.

418
Q

Document and communicate data from the assessment of ears using appropriate terminology and principles of recording.

A

subjective: states hearing is good, no earaches, infections, discharge, hearing loss, tinnitus, or vertigo objective: pinna - skin is intact with no masses, lesions, tenderness, or discharge otoscope- external canals are clear with no redness, swelling, lesions, foreign body, or discharge. both eardrums are pearly grey in color, with light reflex and landmarks intact, no perforations. hearing - responds appropriately to conversation assessment: healthy ear structures hearing accurate

419
Q

Relate the anatomical developmental differences that alter hearing.

A

Infants and childrenShorter, more horizontal eustachian tubeLumen easily occludedGreater risk for middle ear infectionsAdultsOtosclerosisOlder adultsAccumulation of cerumen (impacted)Presbycusis*Recommendations for regular hearing tests

420
Q

Differentiate among the types of hearing loss.

A

Conductive hearing loss – mechanical dysfunction of the external or middle ear. Partial loss. Maybe caused by impacted cerumen, foreign bodies, a perforated eardrum, pus or serum in the middle ear, or osteosclerosis (decreased mobility of ossicles). Increased amplitude can hear. Sensorineural hearing loss (perceptive loss) – pathology of inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex.Mixed loss – combination of conductive and sensorineural types in the same ear.

421
Q

Identify expected and unexpected findings related to the ears.

A

Expected: ears are of equal size bilaterally with no swelling or thickening. Skin color is consistent with the patients facial skin color. Some cerumen is usually present. Abnormal Microtia : ears smaller than 4cm vertically Macrotia : ears larger than 10cm vertically EdemaTragus – pain with movementPain at mastoid processAtresiaOtitis media – ear infection

422
Q

Collect subjective and objective data related to the ears.

A

SubjectiveInfections – childhood or adults. How frequent. Earaches – otalgia(ear pain) – location. Does it hurt when you push on the ear. Character of pain. Is it constant. What have you tried to relieve pain. DischargeHearing lossEnvironmental noise – loud nose at work. TinnitusVertigoSelf-care behavioursObjectiveExternal ear – inspect and palpateSize and shape Skin conditionTendernessExternal auditory meatusOtoscope examinationPosition of head and ear Method of holding and inserting otoscope Tympanic membraneColour and characteristics PositionIntegrity of membraneTest hearing acuityVestibular apparatus Romberg test

423
Q

List the functions of the middle ear.

A

Middle ear – tiny air-filled cavity inside the temporal bone contains tiny ear bones, the malleus, incus, and stapes. 3 Functions of the Middle EarConducts sound vibrations from the outer ear to the central hearing apparatus in the inner earProtects the inner ear by reducing the amplitude of loud soundsEustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture

424
Q

What are some indications of an eye infection?

A

Pain, redness, swelling, warmth and discharge.

425
Q

Describe abnormal finding: Conjunctivitis

A

Conjunctivitis- Infection of the conjunctiva, causes vessels in the periphery to appear red and beefy, the iris is clear. Common side effects of bacterial or viral infection, allergy or chemical irritation.

426
Q

Describe abnormal finding: Sty

A

Sty- Infection of hair follicles at eyelid margin, painful, red and swollen with a pustule at eyelid margin. P. 348

427
Q

Describe abnormal finding: Chalazion

A

Chalazion- Beady nodule protruding on eyelid, is an infection or retention cyst of meibomian gland. P. 347

428
Q

Describe abnormal finding: Belpharitis

A

Blepharitis- Inflammation of eyelids, red, scaly, greasy flakes and thickened, crusted eyelid. P. 347

429
Q

How do you inspect the eyes and what would indicate abnormalities?

A

Look into their eyes, pull down on skin upper cheek to access sclera underneath. Abnormalities would include any redness, or presence of blood, anything that looks like it should be there.

430
Q

What are the risk factors that are associated with glaucoma?

A

Risk factors: Age > 60 years, African descent, Female, Increased intraocular pressure, Family history, Steroid use, Decreased central corneal thickness, Hypertension, Eye injury, Severe myopia, Diabetes, Use of certain medications.

431
Q

What nerves innervate the extraocular muscles to allow for both eyes to move at the same time – what type of movement is this called?

A

Cranial nerve 3 (Oculomotor), 4 (Trochlear) and 6 (Abducens). Fixation

432
Q

Define the pupillary light reflex, fixation and accommodation.

A

Pupillary light reflexNormal constriction of the pupils when bright light shines on the retina FixationEye direction toward an object attracting a person’s attention Impaired by medications, alcohol, fatigue, and inattention AccommodationAdaption of the eye for near vision Increasing curvature of the lens through movement of ciliary muscles

433
Q

What are the 6 extrinsic eye muscles?

A

Superior rectusInferior rectusLateral rectusMedial rectusSuperior obliqueInferior oblique

434
Q

What Internal eye structures make up the outer fibrous layer?

A

Sclera and Cornea

Health Assessment Final (4 decks)

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