sem 2 304 exam 2 Flashcards
Inflammation or tenderness, swelling, tuft of hair, or dimple at tip of coccyx may indicate _________
pilonidal cyst
First test for a _______ by standing on the person’s right side. Place the ulnar edge of another examiner’s hand or the patient’s own hand firmly on the abdomen in the midline . (This stops transmission across the skin of the upcoming tap.) Place your left hand on the person’s right flank. With your right hand reach across the abdomen and give the left flank a firm strike.
fluid wave
typically starts as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness localized in RLQ (McBurney point). Pain is aggravated by movement, coughing, deep breathing; associated with anorexia, then nausea and vomiting, fever.
Appendicitis (Appendix.)
you must listen for ______ by your watch before deciding if bowel sounds are completely absent
5 minutes
Testosterone production declines after age ____ but very gradually, so resulting physical changes are not evident until later in life.
30
is excessive fat in the stool, from malabsorption of fat as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn disease.
Steatorrhea
PSA at age 50 & earlier for those w/ family hx & African-American men 45 years of age
Benign Prostatic Hypertrophy (BPH
Abdominal Distention where
Inspection. Uniformly rounded. Umbilicus sunken (it adheres to peritoneum, layers of fat are superficial to it).
Auscultation. Normal bowel sounds.
Percussion. Tympany. Scattered dullness over adipose tissue.
Palpation. Normal. May be hard to feel through thick abdominal wall.
Obesity
The nurse anticipates auscultating hypoactive bowel sounds (BS) when assessing which patient?
A pt. c/o hunger
A pt. w/ diarrhea
A pt. w/ borborygmus
A pt. recovering from abdominal surgery
A pt. recovering from abdominal surgery
Begins as red, raised, warty growth or as an ulcer with watery discharge.
As it grows, may necrose and slough. Usually painless. Almost always on glans or inner lip of foreskin and following chronic inflammation. Enlarged lymph nodes are common.
Carcinoma
Swelling, may have pain with straining
Enlarged, may reduce when supine, does not transilluminate
Soft, mushy mass; palpating fingers cannot get above mass. Mass is distinct from testicle that is normal
Nontender swelling of scrotum
Scrotal Hernia
part of acute renal failure where sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
postrenal
has moderate, colicky pain of gradual onset in lower abdomen and bloating. Irritable bowel syndrome (IBS) has sharp or burning cramping pain over a wide area; does not radiate. Brought on by meals; relieved by bowel movement.
Large bowel obstruction (Colon)
—circumscribed brown macular or papular areas—are common on the abdomen.
Pigmented nevi (moles)
Prolonged painful erection of penis without sexual stimulation and unrelieved by intercourse or masturbation, most common in men in 30s and 40s.
A rare condition but when lasting 4 hours or longer can cause ischemia of penis, fibrosis of tissue, erectile dysfunction.
Can occur as a side effect of some medications and street drugs; with sickle-cell trait or disease; with leukemia in which increased numbers of white blood cells produce engorgement; with malignancy; from local trauma; or as a result of spinal cord injuries with autonomic nervous system dysfunction.
Priapism
The second test for ______ is percussing for shifting dullness. In a supine person ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel to the periumbilical space. You will hear a tympanitic note as you percuss over the top of the abdomen because gas-filled intestines float over the fluid. Then percuss down the side of the abdomen. If fluid is present, the note will change from tympany to dull as you reach its level. Mark this spot.
ascites
blood in urine
Hematuria
—Diminished quantity of urine
Oliguria
Meatus opens on the dorsal (upper) side of glans or shaft above a broad, spadelike penis.
disabling because of associated urinary incontinence and separation of pubic bones.
Epispadias
__________ stool with distinct malodor indicates upper GI bleeding with blood partially digested.
Black tarry
the anterior axillary line, a change in percussion from tympany to a dull sound with full inspiration is a positive spleen percussion sign, indicating ________
splenomegaly.
A small mound of breast and nipple develops; the areola widens.
The breast and areola enlarge; the nipple is flush with the breast surface.
The areola and nipple form a secondary mound over the breast.
Breast bud stage:
The isthmus of the uterus softens at 6 to 8 weeks.
(Hegar sign)
no Pap tests for women under age __ years, regardless of sexual activity
Pap test interval of __years for women ages 21-30 years; (3) HPV and Pap “co-testing”
every __ years for women ages 30 to 65 years.
21 years
3
5
Foreskin is retracted and fixed.
Once retracted behind glans, a tight or inflamed foreskin cannot return to its original position.
Constriction impedes circulation, so glans swells. A medical emergency; the constricting band prevents venous and lymphatic return from the glans and compromises arterial circulation..
Paraphimosis
prompt a sudden onset of severe, colicky flank or lower abdominal pain.
Kidney stones (Kidney)
is a normal and common variation. An extra nipple along the embryonic “milk line” on the thorax or abdomen is a congenital finding.
Usually it is 5 to 6 cm below the breast near the midline and has no associated glandular tissue. It looks like a mole, although a close look reveals a tiny nipple and areola. It is not significant; merely distinguish it from a mole.
A supernumerary nipple
Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years.
Pica:
Striae look purple-blue with____________ (excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching).
Cushing syndrome
is cessation of the menses
Menopause
Pinpoint, constricted opening at meatus or inside along urethra.
Occurs congenitally or secondary to urethral injury. Gradual decrease in force and caliber of urine stream is most common symptom. Shaft feels indurated along ventral aspect at site of stricture.
Urethral stricture
is biliary colic, sudden pain in RUQ that may radiate to right or left scapula and that builds over time, lasting 2 to 4 hours, after ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting and with positive Murphy sign or sudden stop in inspiration with RUQ palpation
Cholecystitis (Gallbladder)
The cervix softens at 4 to 6 weeks
(Goodell sign)
you should urinate __-___ times a day
4-6
(heartburn), a burning sensation in esophagus and stomach, from reflux of gastric acid.
Pyrosis
If the stool is Hematest positive, it indicates _________. The fecal immunochemical test (FIT) is newer and can be used without the diet or medication restrictions of the older guaiac-based tests.
occult blood
is present with gaseous distention.
Hyperresonance
__________—Absent bile pigment (e.g., obstructive jaundice)
Gray, tan stool
may have mild-to-moderate dull pain in right upper quadrant (RUQ) or epigastrium, along with anorexia, nausea, malaise, low-grade fever.
Hepatitis (Liver.)
are benign growths that commonly appear on the cervix after childbirth. They are small, smooth, yellow nodules that may be single or multiple. Less than 1 cm, they are retention cysts caused by obstruction of cervical glands.
Nabothian cysts
With the first four fingers close together, depress the skin about 1 cm. Make a gentle rotary motion, sliding the fingers and skin together. Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen.
light palpation.
Perform when the acute abdominal pain of appendicitis is suspected.
With the person supine, lift the right leg straight up, flexing at the hip then push down over the lower part of the right thigh as the person tries to hold the leg up. When the test is negative, the person feels no change.
Iliopsoas Muscle Test.
The complete rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut with radiating lines.
When incomplete, only the mucosa bulges. When complete, it includes the anal sphincters.
Occurs following a Valsalva maneuver such as straining at stool or with exercise. Caused by weakened pelvic support muscles and requires surgery.
Rectal Prolapse
is persistent passing of stools into clothing in a child older than 4 years, at which age continence would be expected.
Encopresis
—Involuntary urine loss from overactive detrusor muscle in bladder.
Urge incontinence
These painless, flabby papules are caused by a varicose vein.
When thrombosed, it contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation.
When it resolves, it leaves a painless, flabby skin sac around the anal orifice.
When the person performs a Valsalva maneuver, it may appear as a red mucosal mass.
Hemorrhoids
__________—Also occurs with ingesting iron or bismuth preparations.
Black stool
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
are in what portion of the abdomen
Right Lower Quadrant (RLQ)
Match the conditions listed with the appropriate description
____ Diminished urine output
____ Excessive voiding at night
____ Increased frequency & amount of voiding
____ Visible blood in urine
Polyurina
Oliguria
Gross Hematuria
Nocturia
1-a
2-d
3-b
4-c
Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.
Epigastric Hernia
Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon
are in what portion of the abdomen
Right Upper Quadrant (RUQ)
2 Auscultation techniques for abdomen
Bowel sounds (4 quadrants), vascular sounds (bruit)
occurs with stomach or duodenal ulcers and esophageal varices.
Hematemesis
is a hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary. or pancrea
Sister Mary Joseph nodule
Black stools may be tarry due to occult blood from GI bleeding or nontarry from iron medications. Gray stools occur with hepatitis.
melena
_______________—Increased fat content (steatorrhea), as occurs with malabsorption syndrome.
Pale yellow, greasy stool
Treatable Factors
Contributing to Incontinence
“DIAPPERS”
Delirium Infection – Urinary, Symptomatic Atrophic Urethritis and Vaginitis Pharmaceuticals Psychologic Disorders Excessive Urine Output (Heart Failure/ Hyperglycemia) Restricted Mobility Stool Impaction
Any pain or burning with urinatin
Dysuria
The nurse is examining a pt. with suspected peritoneal inflammation. How does the nurse elicit rebound tenderness?
Using lt. palpation noting tenderness over area
Using deep palpation over the affected area
Pressing the area firmly w/ one hand & releasing pressure while maintaining fingertip contact
Pressing the area firmly w/ one hand, releasing pressure quickly & noting tenderness on release
Pressing the area firmly w/ one hand, releasing pressure quickly & noting tenderness on release
silvery white, linear, jagged marks about 1 to 6 cm long. They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching as in pregnancy or excessive weight gain. Recent striae are pink or blue; then they turn silvery white.
striae (lineae albicantes)
for BSE, with fingertips close together in which 3 motions
down, up, down
in toward nipple
circular motion
, abdominal distention
Protuberant abdomen
The nurse is assessing a 51 year- old female experiencing an increased involuntary loss of urine with physical activity and sneezing. Her PMH is significant for abdominal surgery. What type of incontinence does the nurse know this patient is experiencing?
Urge
Functional
Stress
Reflex
Stress
when Palpateing the Anus and Rectum Ask the man to take a deep breath and hold it. Place the pad of your index finger gently against the ______ You will feel the sphincter tighten and then relax.
As it relaxes ask the man to exhale and flex the tip of your finger and slowly insert it into the anal canal in a direction toward the _________
Never approach the anus at ________ with your index finger extended. Such a jabbing motion does not promote sphincter relaxation and is painful.
Rotate your examining finger to palpate the entire muscular ring. The canal should feel _____&______
Note the intersphincteric groove circling the canal wall. To assess tone, ask the person to tighten the muscle. The sphincter should tighten evenly around your finger with no pain to the person.
anal verge
umbilicus.
right angles
smooth and even.
2 Palpation techniques for abdomen
Light and deep palpation.
if you feel an enlarged ______ refer the person but do not continue to palpate it. An enlarged _____ is friable and can rupture easily with overpalpation.
spleen,
Inability of the intestine (bowel) to contract normally and move waste out of the body.
Paralytic Ileus
A urine filled bladder is __________ to percussion,
while an empty bladder is __________.
Dull, unavailable to percussion
Resonant, flat
Tympanic, dull
Dull, unavailable to percussion
Episodes of local pain, dysuria, fever.
This STI often presents as clusters of small, shallow vesicles with surrounding erythema; erupts on genital areas and inner thigh. Also inguinal adenopathy, edema. Vesicles on labia rupture in 1 to 3 days, leaving painful ulcers. Initial infection lasts 7 to 10 days. Virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.
Herpes Simplex Virus—Type 2 (Herpes Genitalis)
:This STI begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge.
Palpation—Nontender indurated base; can be lifted like a button between thumb and finger. Nontender inguinal lymphadenopathy. May go unnoticed; resolves spontaneously. But secondary syphilis follows: fever, lymphadenopathy, mucocutaneous red rash, sore throat.
Syphilitic Chancre
when you feel your “stomach growling,” termed _______
borborygmus.
