HealthAssessment4

Question 1

Skin Moisture/Dryness

Answer 1

seborrhea = oily

xerosis = dry

dehydration-oral mucous membranes-dry, lips parched and cracked, skin fissured

diaphoresis-increased metabolic rate as with fever, exercise; thyrotoxicosis, stimulation of the nervous system=anxiety, pain

Question 2

Pruritis

Answer 2

Itching-dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice

Scratching-causes excoriation

Question 3

ABCDE

Answer 3

• Asymmetry
• Border irregularity, poorly defined margins
• Color variation
• Diameter greater than 6mm
• Elevation or enlargement

Other-rapidly changing lesion, a new pigmented lesion, development of itching, burning, or bleeding in a mole-suspect malignant melanoma-warrant referral.

Question 4

Skin Color Changes

Answer 4

• pigmentation should be even and consistent with genetic background
• pallor
• erythema
• cyanosis
• jaundice

Question 5

Pallor

Answer 5

When the red-pink tones from oxygenated hemoglobin are lost skin takes on the color of connective tissue (collagen) which is mostly white

Common in high stress states-anxiety/fear because of peripheral vasoconstriction-sympathetic nervous system

Vasoconstriction also occurs with cold exposure and cigarette smoking, and in the presence of edema

Brown skin-will appear more yellow

Black skin-will appear ashen or gray

Generalized pallor can be observed in the mucous membranes, lips and nail beds

Pallor of anemia-palpebral conjuctiva and nail beds

Pallor of impending shock presents with rapid pulse rate, oliguria, apprehension, restlessness

Question 6

Erythema

Answer 6

Intense redness of the skin

Expected with fever (increased rate of blood flow), local inflammation, emotional reactions (blushing - cheeks, neck, upper chest)

Occurs with polycythemia, venous stasis, carbon monoxide poisoning, petechiae, eccymosis, hematoma

Dark Skin-palpate the skin for increased warmth, taut or tightly pulled surfaces that may indicate edema and hardening of deep tissues or blood vessels

Question 7

Cyanosis

Answer 7

Bluish mottled color that indicates decreased perfusion.

A person who is anemic bc of lack of HgB may be hypoxemic without ever looking blue

A person with polycythemia may look ruddy blue at all times and may not be hypoxemic.

Mediterranean descent-normal bluish tone on the lips

Dark skin-difficult to observe-look for other signs of decreased oxygenation to the brain=changes in LOC and signs of respiratory distress

Cyanosis-indicates hypoxemia–occurs with shock, heart failure, chronic bronchitis, congenital heart disease.

Question 8

Jaundice

Answer 8

• yellowish skin color-indicates rsing amounts of bilirubin in the blood
• First noted in the junction of the hard and soft palate in the mouth and sclera-extends up to edge of iris-check sclera for yellow near limbus. also-palms of hands
• do not confuse normal yellow subconjuctival fatty deposits common in outer sclera of dark-skinned people.
• higher levels of serum bilirubin-evident in the skin over the rest of the body
• calluses on palms and soles often look yellow-not jaundice
• occurs with hepatitis, cirrohosis, sickle-cell disease, transfusion rxn, hemolytic disease of the newborn
• light or clay-colored stools and dark golden urine in both light and dk skinned people

Question 9

Hypothermia

Answer 9

• localized hypothermia is expected with an immobilized extremity, Reynauds, peripheral arterial insufficiency
• generalized hypothermia accompanies central circulatory problems-shock

Question 10

Hyperthermia

Answer 10

• generalized hyperthermia occurs with an increased metabolic rate-fever, heavy exercise
• localized-trauma, infection, sunburn
• hyperthyroidism=increased metabolic rate-causing warm, moist skin.

Question 11

Edema

Answer 11

• fluid accumulation in the intercellular spaces
• imprint thumbs firmly against the ankle melleolus or tibia
• rate pitting from 1+ to 4+ (deep pitting, indentation lasts long time, leg is very swollen)
• edema masks normal skin color and obscures pathalogical conditions-jaundice or cyanosis bc fluid lies bt surface and pigmented vascular layer
• makes skin look lighter
• most evident in dependent parts of the body
• makes hair follicles more prominent (peau d’orange)
• unilateral=local cause
• bilateral=generalized (anasarca)-considered a central problem such as heart failure or kidney failure.

Question 12

Turgor

Answer 12

pinch a large fold of skin under the clavical

reflects the elasticity of the skin

poor turgor with severe dehydration, or extreme weight loss

pinched skin recedes slowly or “tents”

Question 13

Medications causing Photosensitivity

Answer 13

• sulfonamides
• thiazide diuretics
• oral hypoglycemic agents
• tetracycline

Question 14

Eldery Skin Conditions

Answer 14

• Lentigines=liver spots-small, flat, brown macules. Circumscribed areas=clusters of melanocytes that appear after extensive sun exposure; forearms and dorsa of hands. not malignant. require no treatment
• seborrheic keratosis-raised thickened areas of pigmentation that look crusted, scaly, warty, greasy, stuck on. Develop mostly on the trunk but also face and hands-sun exposed and unexposed-do NOT become cancerous.
• xerosis-decline in size, number, and output of sweat glands and sebaceous glands
• acrochordons=skin tags

Question 15

Clubbing

Answer 15

occurs with congenital cyanotic heart disease and neoplastic and pulmonary disease. COPD, emphysema

early clubbing angle straigtens (from 160 to 180) and nail base feels spongy to palpation. then the nail becomes convex

Question 16

Signs of Physical Abuse

Answer 16

bruises in multiple stages (red/blue/purple-blue/purple-blue/green-yellow-brown) or that cannot be explained by normalevents. (hematoma is a bruise you can feel)

Pattern injuries which suggest a shape: Bite marks,
cigarette burns, belt marks, “socked hands or feet” from scalding water.

deformity of an untreated fracture.

Question 17

Pressure Ulcers

Answer 17

I. intact skin-red but unbroken-will blanch (light skin, dk skin-does not blanch)

III. partial skin-thickness erosionII. with loss of epidermis or also dermis-looks shallow like an abrasion or open blister with red-pink wound bed.

III. full thickness pressure ulcer extending into the subQ tissue and resembling a crater. May see sub Q fat but NOT muscle, bone or tendon

IV. full thickness-involves all skin layers and extends into supporting tissue. Exposes muscle, tendon or bone, and may show slough or eschar-nerves are damaged-gone!!

Braden Scale-nutrition, meds, bedrest, age

Question 18

ROM/Joint Movement

Answer 18

Flexion—bending a limb at a joint

Extension—straightening a limb at a joint

Abduction—moving a limb away from the midline of the body

Adduction—moving a limb toward the midline of the body

Pronation—turning the forearm so that the palm is down

Supination—turning the forearm so that the palm is up

Circumduction—moving the arm in a circle around the shoulder

Inversion—moving the sole of the foot inward at the ankle

Eversion—moving the sole of the foot outward at the
ankle

Rotation—moving the head around a central axis

Protraction—moving a body part forward and parallel to the ground

Retraction—moving a body part backward and parallel to the ground

Elevation—raising a body part

Depression—lowering a body part

The normal ranges of active and passive range of motion should be the same!

Question 19

Myalgia

Answer 19

muscle pain-felt as cramping or aching

can be associated with intermittent claudication if it is alleviated with rest and with many viruses (fever and chills as well as myalgia)

claudication= pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest

Question 20

Fracture

Answer 20

Sharp pain that increases with movement. Other bone pain usually feels dull and deep and is unrelated to movement.

Question 21

Crepitation

Answer 21

An audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened as with rheumatoid arthritis.

Question 22

Osteoporosis

Answer 22

New bone appears at a slower rate than the old bone disappears. Bones become spongy, weak and more likely to break.

Bones of the wrist, hip and spine are most often affected.

Prevention:

1. Diet-milk, fish, leafy greens, soy, onions, limit caffeine.(vitamin D need to absorb Ca-found in dairy, oily fish; potassium and vit K in green leafy-help block Ca loss from bones; caffeine causes body to excrete Ca more readily; onions reduce bone breakdown process)
2. Exercise-weight bearing-30 minutes 3x per week
3. Lifestyle-no smoking, excess alcohol (smokers-more likely to have hip fx and fx heal slower; too much alcohol prevents absorption of Ca; clinical depression correlates with lower bone density)
4. medical options-height loss of 1-2 inches is an early sign of undiagnosed vertebral fx and osteoporosis. conditions that threaten bone density=thyroid disease, intestinal and kidney diseases, some cancers. Meds that can cause bone loss=corticosteroids, anticoagulants, thyroid supplements, anticonvulsants.
5. supplements-with vitamin D-most people do not get enough calcium

Bone density tests are the only way to predict fx risk and diagnose osteoporosis.

Question 23

Carpal Tunnel Syndrome

Answer 23

Caused by chronic repetitive motion-bt age 30-60, 5X more common in women.

S/S=pain, burning, numbness, positive Phelan test, positive Tinel sign, often atrophy of thenar muscles.

Phelan test=hold both hands back to bak withile flexing the wrists 90 degrees for 60 seconds-no sx for normal hand; produces numbness and buring in person with carpal tunnel syndrome.

Tinel Sign=direct percussion of the location of the median nerve at the wrist-no sx in normal hand; produces burning and tingling along its distribution is positive tinel sign.

Question 24

McMurray Test

Answer 24

• perform when the person has a hx of trauma followed by locking, giving way, or local pain in the knee.
• pt lying supine
• hold heel, flex knee and hip, other hand on knee
• rotate leg in and out to loosen joint
• externally rotate the leg and push inward stress on knee
• slowly extend the knee-should extend smoothly with no pain
• if you hear or feel a click=positive McMurray test=torn meniscus

Question 25

Hip

Answer 25

1. lying supine-raise leg with knee extended (straight)-expect hip flexion=90 degrees 2. bend knee up to chest-expect hip flexion=120 degrees 3. flex knee and hip to 90 degrees-swing foot outward, inward-expect internal rotation 40 degrees, external rotation 45 degrees. 4. let straight-swing laterally, then medially-expect abd of 40-45, add of 20-30 5. while standing-swing straight leg back behind body-expect hyperextension of 15 degrees Abnormal findings=limited motion, pain with motion, flexion flattens the lumbar spine. **Limited internal rotation** is an early and reliable sign of **hip disease**. **Limitation of abduction** of the hip while supine is the most common motion dysfunction found in hip disease.

Question 26

Gout

Answer 26

Metabolic disorder of disturbed purine metabolism associated with elevated serum uric acid. It occurs primarily in men older than 40. Usually involves first metatarsophalangeal joint. Clinically-redness, swelling, heat, extreme tenderness

Question 27

Ballottement of the Patella

Answer 27

Reliable test when larger amts of fluid are present. Use left hand to compress the suprapatellar pouch to move any fluid into the knee joint. Use right hand to push the patella sharply against the femur. If no fluid is present, patella is already snug against the femur. If fluid is present, your tap on the patella moves it thru the fluid and you will hear a tap as the patella bumps up on the femoral condyles.

Question 28

Bulge Sign

Answer 28

Tests for swelling in the suprapatellar pouch-confirms presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other. Firmly stroke up on the medial aspect of the knee 2 or 3 times to diplace any fluid. Tap the lateral aspect. Watch the medial side in the hollow for a distinct bulde from a fluid wave. Normally-none present. Bulge sign occurs with very small amts of effusion (4-8 mL) from fluid flowing across the joint.

Question 29

Kyphosis

Answer 29

an outward curvature of the thoracic spine person compensates by holding the head extended and tilted back

Question 30

CKD (Chronic Kidney Disease)

Answer 30

decreased kidney function or kidney damage lasting 3+ months. Can lead progressively and irreversibly to end-stage renal disease (ESRD)-when person survives only by dialysis or kidney transplant. Much higher among African Americans-likely due to underutilization of antihypertensives and RAAS inhibitors.

Question 31

Kidney Function

Answer 31

**pH 4.5-8.0** **Sp. Gravity 1.003 to 1.030** **little/no protein** **no glucose** **fewer than 5 RBCs/WBCs** **Blood Tests:** **creatnine** (end product of muscle metabolism) normal = 0.7-1.5 mg/dL (measuer of GFR) **BUN** (measures urea, an end-product of protein metabolism) normal = 10-20 mg/dL (rises with decreased fluid volume or increase in protein intake)

Question 32

Renal Calculi

Answer 32

renal stones-crystals of **calcium oxalate** or **uric acid**-form in kidney tubules then migrate and become urgent when pass into ureter, become lodged and obstruct urine flow. cause severe flank pain with radiation to the groin or abdomen, N/V, restlessness, gross or microscopic hematuria.

Question 33

Aging Adult Male Genitourinary System

Answer 33

- sperm production decreases after 40 (increased connective tissue present in tubules) - testosterone declines very gradually after 55-60-phys changes not evident until later in life - pubic hair decreases - penis size and testes decrease in size, testes less firm - slower, less intense sexual respnse, refractory period lasts longer (12-24 hours) - side effects of meds: antihypertensives, psychotropics, antidepressants, antispasmodics, sedatives, tranquilizers, narcotics, estrogens, heavy alcohol

Question 34

BPH

Answer 34

benign prostatic hyperplasia gradual enlargement of the prostate-considered to be a normal part of aging **s/s** of BPH and prostate cancer are simlar=**hesitant, interrupted, or weak urinary stream, urinary urgency, leaking or drbbling, increased frequency of urination, especially at night.**

Question 35

Prostate Cancer

Answer 35

**S/S**=frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination, continous pain in lower back, pelvis, thighs malignant neoplasm often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone-hard and fixed. The medican sulcus is obliterated. **PSA**=prostate specific antigen-made by prostate gland; increases as prostate cancer develolps; BPH, age and prostatitis can also cause PSA to increase; ejaculation causes temporary rise **DRE**=digital rectal exam-prostate located just in front of the rectum Increased risk=African Americans, men with first degree relatives DRE offered yearly after 40 PSA yearly beginning at 50 Stone-hard, irregular, fixed nodule indicates carcinoma diet-high in red meat, processed meat, saturated fat, dairy products may increase risk decreased risk-diet high in fiber, fruits, vegetables

Question 36

Prostate

Answer 36

2.5-4 cm wide should not protrude more than 1 cm into the rectum heart shaped with palpable center groove smooth elastic, rubbery slightly movable non-tender to palpation

Question 37

TSE (Testicular Self-Exam)

Answer 37

**T**iming=once a month S=slow, warm water relaxes scrotal sac E=examine, check for changes, report changes immediately Hold scrotum in palm of hand, gently feel each testicle using thumb and first 2 fingers. Testicle is egg shaped and movable, feels rubbery with a smooth surface (like peeled hardboiled egg). Abnormal lumps are rare and usually not worrisome. Watch for firm, painless lump, hard area, enlarged overall testicle--call physician.

Question 38

Testicular Cancer

Answer 38

Rare. Rare before 15, peaks during 20-39, then declines. Most-age 18 to 35. Associated with hx of cryptorchidism. No early symptoms When detected early and tx bf metastasis, cure rate is almost 100% palpation-painless firm nodule or harder than normal section of testicle or enlarging testis (most common symptom)-non-tender swelling of testis firm palpation doesn't cause usual sickening discomfort as with normal testis.

Question 39

Colorectal Cancer (CRC)

Answer 39

20% higher rate for African-American women and men than whites prevented by removal of adenomatous polyps colonoscopy every 10 years beginning at age 50 guaiac-based fecal occult blood test or fecal immunochemical test yearly (occult bleeding=cancer) 2nd leading cancer killer often asymptomatic-symptoms include-blood in stool, pain, aches, abd cramping, change in bowel habits, iron deficiency anemia, unexplained weight loss hereditary nonpolyposis colon cancer-related to endometrial, ovarian and gastrc cancer.

Question 40

Ovarian Cancer

Answer 40

* may experience abdominal pain, pelvic pain, increased abdominal size, bloating, non-specific GI symptoms * may be asymptomatic * biopsy necessary * high risk-annual transvaginal ultrasonography

Question 41

Postmenopause

Answer 41

* age 48-51 (range from 35-60) * preceded by 1-2 yr decline in ovary function-irreg menses, farther apart, lighter flow * ovaries stop producing progesterone/estrogen * cells in reproductive tract are estrogen dependent-dramatic physical changes * uterus shinks * ovaries atrophy, not palpable * ovulation may occur sporadically after menopause * cervix shrinks, paler, thick glistening epithelium * vagina-shorter, narrower, lest elastic bc of increased connective tissue * increased risk for vaginitis * decreased vaginal secretions * vasomotor instability (hot flashes)

Question 42

HRT

Answer 42

**Side Effects of HRT** fluid retention breast pain vaginal bleeding breast cancer risk

Question 43

Breast Cancer

Answer 43

* Tail of Spence=site of most breast tumors * BRCA1 and 2-genes mutations * white women have higher incidence * western diet, high fat * obesity * age \> 50 * first degree relative * high breast tissue density * early menarche, late menopause * nulliparity or 1st child after age 30 * oral contraceptive use * estrogen and progestin use * alcohol \> 1 per day * solitary, unilateral, non-tender mass * solid, hard, dense * fixed to underlying tissue * women age 30-80 * advanced cancer-firm or hard irregular axillary nodes, skin dimpling, nipple retraction, elevation and discharge

Question 44

Cervical Cancer

Answer 44

cervical cancer screenings should begin within 3 years after first intercourse or by age 21, continue annually (after age 30-screen every 2-3 years after 3 consecutive normals) PapSmear HPV vaccine

Question 45

Incontinence-female

Answer 45

urgency, dysuria, nocturia, hematuria urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder (contracts-causing urgent need to void) stress incontinence-involuntary urine loss with physical strain (sneezing/coughing)