TEST 3 Flashcards
1
Q
abdomen location
A
from the diaphragm to the brim of the pelvis
2
Q
what makes up the abdominal wall
A
four layers of muscles
3
Q
linea alba
A
midline seam
4
Q
rectus abdominis
A
muscle with palpable midline strip
5
Q
solid viscera of the abdomen
A
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, & uterus
6
Q
hollow viscera of the abdomen
A
stomach, gallbladder, small intestine, colon, & bladder
7
Q
what is the spleen made of
A
lymphatic tissue
8
Q
where is the spleen located
A
Located on posterolateral region of the abdominal cavity beneath the diaphragm, from the 9th to 11th rib lateral to the midaxillary line (approximately 7 cm in length)
TOP LEFT SIDE
9
Q
is the spleen palpable
A
not normally
10
Q
where is the aorta located
A
left of the midline in the upper region of the abdomen
*BEGINS AT LEFT VENTRICLE, EXTENDS UP, ARCHES AND CONTINUES DOWN TO WHERE IT BRANCHES RIGHT ABOVE THE PELVIS
11
Q
what does the aorta bifurcate into
A
the right and left iliac arteries opposite the 4th lumbar vertebrate
12
Q
what do the right and left iliac arteries turn into
aorta
A
the right and left femoral ateries in the groin
13
Q
what about the aorta is palpable
A
aortic pulsations
14
Q
pancreas
A
A soft gland consisting of lobules
*BIG ROLL IN DIGESTION PRODUCES ENZYMES THAT BREAK DOWN SUGARS, STARCHES, AND FATS
15
Q
where is the pancreas located
A
Lies obliquely across the posterior abdominal wall, behind the stomach
16
Q
what are the kidneys shaped like
A
beans
17
Q
how are the kidneys positioned
A
Positioned in the retroperitoneal region of the abdominal cavity
*JUST BELOW THE RIB CAGE ON EITHER SIDE OF THE SPINE
18
Q
costovertebral angle
kidneys
A
angle formed by the joining of the 12th rib and the vertebral column
19
Q
where is the left kidney located
A
at the 11th & 12th ribs
20
Q
where is the right kidney located
A
1 to 2 cm lower than the left due to position of the liver
21
Q
abdoman anatomic locations
A
RUQ
LUQ
RLQ
LLQ
MIDLINE
EPIGASTRIC
UMBILICAL
HYPOGASTRIC
SUPRAPUBIC
22
Q
UMBILICAL CORD IN INFANTS
A
more prominent in newborn,
contains two arteries and one vein
23
Q
LIVER IN INFANTS
A
proportionally takes up more space at birth
24
Q
URINARY BLADDER IN INFANTS/CHILDREN
A
positioned higher in the abdomen, between the symphysis and the umbilicus
25
ABDOMINAL WALL IN INFANTS/CHILDREN
less muscular, easier to palpate abdominal organs
26
morning sickness
| pregnant women
Cause ? Thought due to human chorionic gonadotropin (hCG)
27
abdominal considerations for pregnant women
Heartburn (pyrosis) from esophageal reflux
- Decreased GI motility, longer time for gastric emptying
- Constipation & hemorrhoids
- Skin changes: striae & linear nigra
28
abdominal considerations for older adults
- Females: decreased estrogen -->suprapubic fat
- Males: “spare tire”
- Relaxed abdominal muscle
- Decreased salivation
29
abdominal considerations in older adults (cont)
- Delayed emptying of esophagus
- Decreased gastric acid secretion
- Increased risk of gallbladder disease
- Decreased liver size
- Constipation
30
appetite
| abdominal subjective data
any changes, anorexia, change in weight, dieting
31
dysphagia
| abdominal subjective data
any disorder of throat or esophagus that makes it difficult to swallow. can be painful
32
food intolerance
| abdominal subjective data
lactose intolerance, pyrosis (heartburn), eructation (belching)
33
abdominal pain
| subjective data
any pain ?, location, quality, severity, precipitating, aggravating & alleviating factors
34
visceral pain
relating to the organ
dull, general, poorly located
35
parietal pain
peritoneum
sharp, precisely located, increased with movement
36
referred pain
caused by pathology in another site
37
nausea and vomitting
n&v
| abdominal subjective data
Frequency, amount, color, odor hematemesis (bloody emesis), any associated S/S, diet for the last 24 hrs, food poisoning
38
bowel habits
| abdominal subjective data
normal pattern, frequency, color, odor, consistency, any diarrhea or constipation, any recent change in bowel habits, use of laxatives (type & frequency
39
past abdominal Hx
| abdominal subjective data
any GI problems, gallbladder disease, any abdominal surgery or diagnostic procedures (and results)
40
medications
| abdominal subjective data
nsaids
alcohol
cigarettes (packs per day/years)
41
nutritional assessment
part of the abdominal subjective data
42
abdominal assessment objective data order
Inspection
Auscultation
Percussion
Palpation
43
where to stand in order to inspect the abdomen
Stand on the patient’s right side while inspecting
44
inspecting the contour of the abdomen
describe as one of the following:
- Flat
- Scaphoid
- Rounded
- Distended
- Protuberant
45
inspect the symmetry of the abdoment
assess for bulges, masses, asymmetry, hernias
46
inspect the umbilicus of the abdomen
midline, inverted or everted, Cullen’s sign (bluish periumbilical color from intraabdominal bleeding)
47
inspect the skin of the abdomen
homogeneous color, redness, jaundice, striae, scars, lesions, angiomas, rashes, dilated veins, skin turgor
48
inspect the aortic pulsation or peristaltic movement in the abdomen
looking for intestinal obstruction
49
inspect the demeanor while assessing the abdomen
relaxed, signs of pain such as restlessness, absolute stillness (with peritonitis), knees flexed up, facial grimacing, uneven respirations
50
how to auscultate bowel and vascular sounds
Hold stethoscope lightly against skin using the diaphragm endpiece
51
where to assess bowel sounds
in the following order: RLQ at ileocecal area, RUQ, LUQ, LLQ
52
considerations for auscultating bowel sounds
Note frequency & character:
Hypoactive or hyperactive
If silent bowel sounds, listen for 5 minutes
53
* Borborygmus
“stomach growling” from
hyperactive bowels
54
listen for bruits
with the bell of the stethoscope over the abdominal aorta, renal arteries, iliac and femoral arteries
* Normal finding: absence of bruits
55
percuss the four quadrants of the abdomen
- Normal finding: tympany
- Dullness heard over adipose tissue,
distended bladder, fluid or a mass
- Hyperresonance with gaseous distension
56
percuss the liver span
- At the midclavicular line, measure height of the liver
- Start with lung resonance to liver dullness, than liver dullness to abdominal tympany
57
liver span
- Normal liver span in adult: 6–12cm
- Mean liver span:
* Males: 10.5 cm
* Females: 7 cm
58
hepatomegaly
liver enlargement
59
normal finding of percussion of spleen
dull note from 9th to 11th intercostal space just below the left midaxillary line
60
spleen percussion that indicates enlargement
dull note forward of the midaxillary line (with mononucleosis, trauma, & infection)
61
where to percuss the spleen
Percuss in lowest interspace in left anterior axillary line during inspiration: normally tympany
* Positive spleen percussion sign: dullness with splenomegaly
62
how to assess costovertebral angle tenderness
Use indirect fist percussion to vibrate over the 12th at the costovertebral angle (CVA)
* Hold one hand over the CVA, then thump hand with the ulnar edge of your other fist
63
findings in assessment of costovertebral angle tenderness
Normal finding: patient feels only the thud but no pain
* Sharp pain (costovertebral angle tenderness) indicates inflammation of the kidney or paranephric region
64
when palpating the abdoment, you should note
size, location, and consistency of any abnormal masses or tenderness
Review the measures for relaxation of abdominal muscles
65
light versus deep palpation of the abdomen
Start with light palpation: depress skin 1 cm & use gentle rotating motion in clock-wise pattern
66
order of palpation of the abdomen
Palpate tender areas last (avoids pain & muscle guarding)
67
voluntary vs involuntary guarding of the abdomen
Distinguish between voluntary guarding & involuntary guarding of abdominal muscles
* Involuntary guarding (constant board-like hardness): sign of peritonitis
68
deep palpation of the abdomen
depress skin 5-8cm using same technique
69
abnormal findings of palpation of the abdomen
muscle rigidity, muscle guarding, masses, tenderness
70
if any mass is found in the abdomen, what should you first distinguish
if it's associated with a normal palpable organ or an enlarged organ
71
if any mass is found in the abdomen, what should you note
1. Location 6. Mobility
2. Size 7. Pulsatility
3. shape 8. Tenderness
4. Consistency
5. Surface
72
palpation of the liver
refer to page 547)
- Remember to ask the pt. take a deep breath as you palpate
- Alternate method: hooking technique
73
abnormal finding in palpation of the liver
liver palpated more than 1-2 cm below the right costal margin
74
when can you palpate the spleen
when it's 3x the normal size
75
do you continue to palpate an enlarged spleen
Do not continue to palpate an enlarged spleen as it is friable (bleeds easily) & can rupture
76
what should you note about an enlarged spleen
Note how many centimeters it extends below the left costal margin
77
how to palpate the kidneys
- Use deep palpation with bimanual “duck- bill technique
- Ask the patient to take a deep breath as you palpate
78
how are the kidneys positioned
Left kidney is positioned 1 cm higher than the right kidney, so you are more apt o palpate the lower pole of the right kidney
79
abnormal findings when palpating the kidney
enlarged kidney,
kidney mass
80
where do you palpate the aorta pulsation
located in the upper abdomen slightly left of the midline
81
findings in palpating the aorta pulsation
Normal finding: aorta pulsation 2.5-4cm in adult; pulsation in an anterior direction
- Abnormal finding: prominent lateral pulsation, indicates aortic aneurysm
82
rebound tenderness
blumberg's sign
- https://www.youtube.com/watch?v=1weCV9pGqFM
- Perform when pt. complains of any abdominal pain or has tenderness with palpation
83
findings of palpating rebound tenderness
- Negative or normal finding: no pain on release of pressure
- Abnormal finding: pain on release of pressure; sign of peritoneal inflammation
84
inspiratory arrest
murphy's sign
- https://www.youtube.com/watch?v=w4_D0peTmw8
- PAIN- INFLAMMATION- ABRUPTLY STOPS INHALING
- Press up against the liver’s lower border as the pt. takes a deep inspiration (liver pushes up against the gallbladder)
85
findings of assessing for inspiratory arrest
- Normal finding: complete inspiration without any pain
- Abnormal finding/positive test: pt. abruptly stops inspiration midway due to pain; sign of gallbladder inflammation
86
external ear
auricle or pinna
87
6 landmarks of the ear
helix
antihelix
external auditory meatus
tragus
antitragus
lobule
mastoid process
88
internal anatomy of the ear
tympanic membrane
cone of light
manubrium
89
middle ear
- Tiny air-filled cavity located inside the
temporal bone
90
what does the middle ear contain
- Contains tiny bones (auditory ossicles): malleus, incus, stapes
91
openings to the inner ear
* Eustachian tube
* Round & oval windows
92
3 functions of the middle ear
* The three functions of the middle ear
1. Conducts sound vibrations from the outer ear to the inner ear
2. Protects the inner ear
3. Equalization of air pressure on each side of the TM by the eustachian tube
93
purpose of the inner ear
- Sensory organs for equilibrium & hearing
94
vestibule and semicircular canals
| inner ear
Vestibule & Semicircular canals (in the bony labyrinth) make up the vestibular apparatus
SENSE OF BALANCE AND BODY POSITION
95
cochlea
| inner ear
snail shell
contains the central hearing apparatus
96
3 levels of the auditory system
1. Peripheral
2. Brainstem
3. Cerebral cortex
97
how is sound transmitted
Sound is transmitted & converted to vibrations TM middle ear ossicles to oval window cochlear basilar membrane that contains the organ of Corti hair cells (sensory organ of hearing) electrical impulses the brain
98
pathways of hearing
air conduction (ac)
bone conduction (bc)
99
air conduction (ac)
normal pathway of hearing
100
bone conduction (bc)
alternate pathway of hearing that directly transmit vibrations to inner ear and to CN VIII
101
conductive hearing loss
from mechanical dysfunction of external or middle ear
102
cause of conductive hearing loss
*Causes: impacted cerumen, foreign bodies,
perforated TM, fluid in the middle ear,
otosclerosis
103
sensorineural (perceptive) hearing loss
from pathology of inner ear or cerebral cortex (auditory center)
104
causes of sensorineural (perceptive) hearing loss
*Causes: Presbycusis, ototoxic drugs
105
labyrinth in the inner ear
| equalibrium
establishes verticality & depth
106
inflammation
| equilibrium
inaccurate information received by the brain -> staggering gait, vertigo
107
infant/child
| hearing/ear developmental considerations
- maternal rubella can result damage to the organ of Corti and impaired hearing
- increased risk of otitis media due to shorter, wider & more horizontal, plus lymphoid tissue surrounds the lumen
108
adult
| ear/hearing developmental considerations
conductive loss from otosclerosis between ages 20 and 40
109
aging adult
| hearing/ear developmental considerations
risk of decreased hearing due to:
- coarse stiff cilia in the ear canal
- drier cerumen
- scarring of TM (long history of frequent ear
infections)
- presbycusis:
110
presbycusis
gradual sensorineural hearing loss
111
earache
| ear subjective data
any earache, pain in ears (otalgia); note the specific characteristics of any pain; history of trauma or URI infections
112
infections
| ear subjective data
history of ear infections
113
discharge
| ear subjective data
any discharge from the ears (otorrhea) and its appearance & any odor
114
hearing loss
| ear subjective data
onset (sudden or slow); characteristics of loss
* Refer pt. if sudden onset not related to upper respiratory infection
115
115
observe for signs of hearing loss
lip reading, frowning or straining forward, posturing of head, misunderstanding of questions or frequent requests for you to repeat, irritability or startle reflex to your voice (recruitment), garbled speech, inappropriately loud voice, voice has a flat, monotonous
116
environmental noises
| ear subjective data
any exposure to loud noises
117
tinnitus
| ear subjective data
ringing, crackling, or buzzing in ears; medications currently taking (ototoxic meds)
118
vertigo
| ear subjective data
true vertigo (from dysfunction of labyrinth) versus dizziness or lightheadedness
* Objective vertigo: rooms appears to be spinning
* Subjective vertigo: feels like the person is spinning
119
self care behaviors
| ear subjective data
method for cleaning ears (cotton-tipped applicators can cause impaction of cerumen); last hearing test, hearing aid
120
infants/children
| ear subjective data
risks for ear infections:
- exposure to passive smoke
- attendance at group day care centers
- bottle fed
121
inspect/palpate the external ear for size and shape
| ear objective data
microtia, macrotia
122
Inspect and palpate the external ear for:
skin condition
| ear objective data
redness, heat, crusts, scaling, enlarged lymph node, frostbite, tophi, sebaceous cysts, keloid, carcinoma
123
Inspect and palpate the external ear for:
tenderness
| ear- objective data
pain with movement of tragus or pinna
124
Inspect and palpate the external ear for:
external auditory
| ear-objective data
meatus: atresia (closure or
absence of ear canal), discharge, cerumen
125
how to perform otoscopic exam in an adult
| ear-inspect with the otoscope
* Adults - pinna is pulled up & back
126
how to perform otoscopic exam in a child under 3
| ear-inspect with the otoscope
pinna is pulled straight down
127
inspection of the ear with the otoscope
Inspect the external canal for any redness, swelling, lesions, foreign objects, or discharge
* Watery drainage indicates CSF from head
trauma (basal skull fracture)
* Purulent otorrhea indicates otitis externa or otitis
media (with ruptured drum)
* Frank blood (from trauma)
128
normal appearance of the tympanic membrane (drum)
Normal appearance is shinny, translucent, pearly gray color
129
cone of light reflex (COL) from the reflection of the otoscope light on the drum
* In the right ear: it is at 5 o’clock
* In the left ear: it is at 7 o’clock
130
note the specific landmarks of the tympanic membrane
The umbro, manubrium, and short process of the malleus should be visible
131
abnormal eardrum colors
Yellow-amber drum indicates serous otitis media
* Redness indicates acute otitis media
132
absent or distorted landmarks in assessment of the eardrum
Absent or distorted landmarks: bulging drum with increased pressure in otitis media
133
what causes a retracted eardrum
obstructed eustachian tube from vacuum in middle ear
134
air/fluid level or air bubbles behind the eardrum indicate what
serous otitis media
135
abnormal findings of assessment of the eardrum
perforations or vesicles
136
whispered voice test
| ear-objective data
test one ear at a time, whisper two syllable word as you mask hearing in the other ear
* Abnormal finding: pt. unable to hear whispered words
137
138
tuning fork tests
| ear-objective data
weber test
rinne test
139
weber test
| ear-objective data
tests bone conduction of tone through the skull:
140
rinne test
| ear-objective data
compares air conduction and bone conduction sound
141
findings of the weber test
| ear-objective data
Normal – sound is heard the same in both ears
Conductive loss – sound goes toward the poorer ear
Sensorineal loss – sound lateralizes to the unaffected or better ear
142
findings of the rhinne test
Normal – sound is heard twice as long by air conduction (AC) as bone conduction (BC)
AC>BC
Conductive loss – BC>AC
Sensorineal – AC>BC but reduced overall
143
143
vestibular apparatus
- Aids in maintaining standing balance
- Assessed with the romberg test (included in the neuro assessment- discussed later in semester)
144
considerations with children
| ear-objective data
* Low set ears or deviation in alignment seen with developmental delays (Down’s syndrome)
145
external anatomy of the eye
Bony orbit
Eyelids
Palpebral fissure
Eyelashes
Limbus
Canthus
Caruncle
146
external anatomy of the eye (cont)
Conjunctiva clear
- Palpebral
- Bulbar
Lacrimal apparatus
Puncta
Lacrimal Gland
Six muscles
147
review visual guides in eye powerpoint
148
what do the extraocular muscles do
Provide straight & rotary movement of the eyes
149
how do the extraocular muscles work
The muscle is coordinated with the one in the other eye so that the eyes movement is on a parallel axis (conjugate movement)
150
Six muscles (innervated by cranial nerves):
| eye
Superior rectus (CN III)
- Inferior oblique (CN III)
- Medial rectus (CN III)
- Superior oblique (CN IV)
- Inferior rectus (CN III)
- Lateral rectus (CN VI)
151
why do the eyes move together
(conjugate gaze/movement) b/c humans can only focus on one item at a time (i.e. right eye and left eye should be looking at the same object)
152
eom
| eye
extra ocular muscles
153
how do the 6 eom work together
to attach the eyeball to its orbit and to direct eye to points of interest
154
how are the 6 eom stimulated
stimulated by 3 cranial nerves, we will go into more details about the jobs on the cranial nerves when we complete the neuro chapter
155
3 concentric layers
| internal eye anatomy
- Sclera
- Choroid
- Retina
156
outer layer
| internal eye anatomy
- Sclera
- Cornea
157
middle layer
aka choroid
| eye
dark pigment and vascular
158
cilliary body and iris
| choroid of the eye
varies the opening of the pupil
159
Pupil:
| choroid of the eye
opening in the iris, normally round & regular
160
- Lens:
| choroid of the eye
biconvex disc posterior to the pupil,
functions as a refractory medium
(thickness controlled by the ciliary body)
161
- Anterior chamber:
| choroid of the eye
posterior to the cornea, contains the aqueous humor (produced by the ciliary body, its amount & outflow determine intraocular pressure)
162
inner layer of the eye
retina
163
retina
inner layer provides for visual reception; light waves are converted into nerve impulses here.
164
optic disc
| retina
oval or round shape, located in the nasal side of the retina, this is where the retinal fibers converge to form the optic nerve
* Color varies from creamy yellow-orange to pink
* Margins normally distinct & sharply demarcated
* Physiologic cup: smaller, inner circular area, site where blood vessels exit & enter
165
general background of the retina
varies in color with skin tone
166
macula and fovea centralis
| retina
located temporally ( site of keenest vision)
167
pupillary light reflex
normal constriction of the pupils when bright light shines on the retina
can be direct or consensual
168
direct light reflex
constriction of that pupil exposed to the bright light
169
consensual light reflex
simultaneous constriction of the other pupil
170
accomodation
| eye
refers to the adaptation of the eye from far to near vision
- Results from the increased curvature of the lens by movement of the ciliary muscles
- Normal finding: convergence of the axis of the eyeball & pupillary constriction
171
infants/children developmental considerations at birth
| eye
- Limited eye movement at birth but peripheral vision is intact; iris less pigmented
- Macula is absent at birth; developing by age 4 months & mature by 8 months
172
infants/children developmental considerations
| eye
- Binocularity and the ability to fixate on a single object by 3-4 months
- Eyeball is adult size by age 8
173
aging adult
| eye-developmental considerations
- Lacrimal glands involute
- Arcus senilis: infiltration of degenerative lipid material around the limbus
- Pupil size decreases
- Loss of elasticity of the lens
174
presbyopia
| Common causes of decreased visual functioning in the aged adult
the lens decreased ability to change shape in order to accommodate for near vision
175
senile cataract
| Common causes of decreased visual functioning in the aged adult:
lens opacity, fibers of the lens thickens & yellows (nuclear sclerosis)
176
floaters
| Common causes of decreased visual functioning in the aged adult:
from debris accumulating in the vitreous
177
glaucoma
| Common causes of decreased visual functioning in the aged adult:
increased ocular pressure
178
macular degeneration
| Common causes of decreased visual functioning in the aged adult:
loss of central vision (area of clearest vision); inability to read fine print; peripheral vision is unchanged
* Most common cause of blindness (greater incidence in woman)
179
eye: subjective data
Visual difficulties (decreased acuity, blurring, blind spots)
History of ocular problems
Pain
Photophobia
Night blindness
Halos
180
eye subjective data (cont)
Floaters
Scotoma
Stabismus or diplopia
Redness or swelling
Use of glasses/contact lens
Self-care behaviors
Watering or discharge
181
Test for central visual acuity:
Top number (numerator) notes the distance the person is standing from the chart; the bottom number (denominator) gives the distance at which a normal eye could read that particular line
182
snellen chart
for far vision: normal vision is 20/20 (you can read at 20 feet what the normal eye could read at 20 feet)
* Refer to an ophthalmologist or optometrist anyone with vision poorer than 20/30
183
when to test for near vision
for persons over age 40 or anyone complaining of increasing difficulty reading
184
how to test for near vision
with a handheld vision screener (Jaeger card) held 14 inches from the eye
* Use magazine or newspaper if a near vision card unavailable
185
results of near vision test
* Normal vision is 14/14 in each eye
* Moving the card farther away suggests Presbyopia
186
what is a jaeger card used for
testing near vision
187
Test visual fields with the confrontation test
Indication of peripheral field loss: person unable to see the object as the examiner does
188
- Corneal light reflex (Hirschberg test)
| Inspect extraocular muscle (EOM) function:
* Assess the parallel alignment of the eye axes
* Asymmetry of the light reflex indicates deviation in alignment from muscle weakness or paralysis perform the cover test
189
cover test
| Inspect extraocular muscle (EOM) function:
detects small degrees of deviated alignment
* Abnormal finding: eye jumps to fixate on the designated point (indicates muscle weakness)
190
details of the confrontation test
assesses peripheral vision, client covers one eye and examiner covers opposite eye so when they are facing each other it is a mirror image, examiner slowly moves fingers to midline from several different directions, examiner and client should see fingers at approximately the same time. Remember this is to assess peripheral vision so you must be looking forward focused on an object for this to work.
191
details of the hirschberg test
have client stare straight ahead, shine light towards client’s eyes, you should see the light reflex at the same spot on both corneas (symmetrical
192
details of the cover test
frequently done on children, have child stare straight ahead at your nose or some object to focus on, using opaque card (think index card) cover one eye, the uncovered eye should stay steady and fixed on object if the uncovered eye started jumping/moving this is an abnormal finding, shows EOM weakness)
193
- Diagnostic position test (Six cardinal positions of gaze)
normal vs abnormal
* Normal response: parallel tracking of the object with both eyes
* Abnormal finding: unparallel movement of the eyes (indicates extraocular muscle weakness or dysfunction of the cranial nerve)
194
nystagmus
(fine oscillating movement, observed best near the iris), normal to have mild nystagmus with extreme lateral gaze
195
lid lag
| eye
(normally should not see sclera above the iris)
196
strabismus
crossed eye, one eye deviates off fixation point, can disconjugate vision
197
general
| Inspect external ocular structures:
objective data
Initially observe the person’s ability to move around the room
198
eyebrows
| Inspect external ocular structures:
objective data
abnormal findings include absent lateral third of brow (seen with hypothyroidism), scalling, unequal movement
199
eyelids and lashes
| Inspect external ocular structures:
objective data
abnormal findings include lid lag, incomplete closure; drooping of upper lid (ptosis)
200
eyeballs
| Inspect external ocular structures:
objective data
abnormal findings include protrusion (exophthalmus) and sunken eyes
201
Conjunctiva and sclera
| eye
objective data
normally conjunctiva are clear & pink over lover lids and white over the sclera; sclera is normally china white (dark-skinned persons may have gray-blue or muddy color)
202
abnormal findings of conjunctiva and sclera
reddened, cyanotic or pale conjunctiva; scleral icterus (yellowing of sclera); tenderness, foreign body, discharge, lesions
203
lacrimal apparatus
observe for any redness or swelling of lacrimal gland and puncta
204
anterior eyeball structures
cornea
lens
iris
pupil (pupillary light reflex)
205
cornea and lens
abnormal findings include corneal abrasion, opacity (arcus senilis is normal with aging)
206
how to assess the cornea and lens
shine penlight from the side across the cornea checking for smoothness and clarity
207
iris and pupil
| inspection
iris is normally flat, round regular shape with even coloration; abnormal finding is irregular shape “anisocoria” (normal in only 5% of people)
208
pupillary light reflex
include both direct and consensual light reflex
*Abnormal: dilated, dilated & fixed, or constricted pupils
209
how to test pupillary light reflex
-have room darkened and have client look into the distance to dilate pupil, shine light from side you should see constriction of the same side pupil (direct light reflex) and simultaneous constriction of the other pupil (consensual light reflex) Ballpark measure the pupil size in millimeters
210
test for accomodation
Normal response=
1. pupillary constriction and
2. convergence of the axis of the eyes
* Abnormal finding: absence of constriction or convergence, asymmetric response
* Record normal response as PERRLA
211
PERRLA
Pupils
Equal, Round, React to Light and Accommodation
212
Study how to use the ophthalmoscope
Direct the beam of light through the pupil to illuminate the inner structures
Select the large round aperture with white light
Match sides with patient (ex. use your right eye for viewing pt’s right eye
Start at 10 inches away from pt. at an angle 15% lateral to the pt’s person’s line of vision
Note the red reflex filling the pt’s pupil and steadily move closer to the eye, keeping sight of the red reflex
213
diopters
| opthalmoscope
unit of strength of each lens
* black (positive): focus on closer objects
* red (negative): focus on distant objects
214
myopia
nearsighted (able to see near objects); use a negative diopter (red numbers)
215
hyperopia
farsighted (able to see objects in the distance); use a positive diopter (black numbers)
216
retinal structures
optic disc
retinal vessels
macula
217
general background
| retina
color varies from light red to dark brown (depends on skin color)
218
optic disc
(nasal side)
| retina
normally oval or round, creamy, yellow- orange to pink with distinct margins; physiologic cup is brighter yellow-white with a width ½ the disc diameter; abnormal: blurred margin
219
retinal vessels
paired artery & vein pass to each quadrant (straighter at the nasal side)
- arteries are brighter and smaller in diameter (A:V ratio is 2:3 or 4:5)
220
macula
| retina
(located on the temporal side); is 1 DD in size
221
foveal light reflex
| retina
tiny glistening dote within the macula
222
Abnormal findings of the ocular fundus include:
abnormal lesions,
hemorrhages, exudates, microaneurysms
223
abnormal findings of the optic disc
pallor, irregular color, blurred margins, cup extending to disc border
224
abnormal findings of blood vessels
| ocular fundus
absence of major vessels, focal constriction, dilated veins, nicking, extreme tortuosity, engorgement
225
periorbital edema
| eyelid abnormalities
swelling around the eye
226
exopthalmos
| eyelid abnormalities
protrusion of eyes
227
enophthalmos
| eyelid abnormalities
sunken eyes
228
ptosis
| eyelid abnormalities
drooping eyelid
229
anatomical structures of the head/neck
Skull
Cranial bones (frontal, parietal, occipital, temporal)
Sutures
Facial bones
Cervical vertebra
Salivary glands (parotid, sublingual, submandibular)
Temporal artery
230
structures and landmarks of the head/neck
Carotid artery
Jugular veins (internal/external)
Neck muscles
Trapezius
Trachea
Thyroid cartilage
231
- Sternomastoid
| neck muscle
two triangles- anterior &
posterior
232
review graphics in head/neck powerpoint
233
preauricular lymph node
right in front of your ears
234
posterior auricular (mastoid) lymphnodes
right behind your ears
235
occiptal lymph node
base of skull
236
submental lymph node
base of chin
237
submandibular lymph node
down your jawline
238
jugulodigastric (tonsilor) lymph nodes
like when you have strept throat-- at your neck
239
superficial cervical lymph node
down your neck
turn your head to side
there is a muscle band, these are on top of it
240
deep cervical lymph nodes
down your neck
turn your head to side
there is a muscle band, these are below it
241
posterior cervical lymph nodes
back of neck
242
supraclavicular
clavicle
hunch shoulders up
243
infants/children
| developmental considerations of the head/neck
Sutures & fontanels “soft spots” enables growth of the brain & safe passage thru birth canal
head size: head size is larger than chest circumference at birth; grows to 90% of adult size by age 6
244
anterior fontanel
normally closes between 9 months and 2 yrs
245
posterior fontanel
normally closes by 1-2 months
246
lymphoid tissue
| infants/children
* Well developed at birth
* Reaches adult size by age 6
* Rapid growth until age 10-11 (larger than adults & normally palpable)
* At puberty, slowly atrophies
247
facial hair on boys
1. above lips
2. cheeks and below lip
3. chin
248
thyroid gland
| infants/children
enlarges at puberty with deepening of the voice
249
pregnant female
| head/neck
Changes in the thyroid gland: hyperplasia of the tissue & increased vascularity results in an enlarged gland
250
aging adult
| head/neck
Facial bones & skin changes: sagging of the skin & more prominent appearance of facial bones and orbits from decreased elasticity & subcutaneous fat & moisture of the skin
251
headache
| subjective data
onset, location, character, severity, course & duration, precipitating factors, associated factors, other diseases, efforts to treat, coping strategies
* Migraines, cluster HA, tension HA or CVA (review symptoms of each type)
* Red flag: a severe headache of new onset
252
head injury
| subjective data
onset, setting, loss of consciousness, associated symptoms, pattern, effort to treat
253
dizziness
| subjective data
Dizziness: vertigo or lightheaded, onset, assoc. symptoms
254
other subjective data of the head/neck
neck pain
decreased rom
Hx of head/neck surgery
255
lumps/swelling
| head/neck subjective data
tenderness, persistent, hard or soft, fixed or mobile, thyroid problem, dysphagia
256
Inspect and palpate the skull:
Size,shape (normacephalic, microcephalic or macrocephalic)
- Symmetry
257
- Temporal area for the temporal artery
| Inspect and palpate the skull:
abnormal finding if tortuous, hardened or tender (signs of temporal arteritis)
258
Temporomandibular joint (TMJ):
| Inspect and palpate the skull:
Palpate for crepitation, tenderness, limited range of motion
259
Inspect the face
note facial expression, appropriateness to behavior or mood, signs of anxiety, pain, embaressment, hostility
260
symmetry
| inspect the face
asymmetry with central brain lesion, damage to the CN VII (Bell’s palsy)
261
abnormalities
| inspect the face
note any abnormal facial structures, edema, involuntary movements (tics, fasciculations, excessive blinking, grinding of jaws)
262
Inspect and palpate the neck:
- Symmetry
- Range of motion
- Thyroid enlargement (unilateral or diffuse)
263
lymph nodes
| Inspect and palpate the neck:
(use gentle, circular motion with your fingerpads; start with preauricular)
264
deep cervical chain
| inspect/palpate the neck
tip pt’s head toward side being examined
265
supraclavicular nodes
| inspect/palpate the neck
tell pt to hunch shoulders & elbows forward
266
abnormalities of the lymph nodes
| palpate/inspect the neck
Abnormal to palpate nodes in adults; when palpable, note location, size, shape, delimitation (discrete or matted), mobility,consistency, and tenderness
267
Lymphadenopathy
enlargement of lymph nodes (>1cm)
268
when lymph nodes are palpable, you should note
location, shape, size, discrete or matted, mobility, consistency, and tenderness
* Note the source by check the area they drain
* Refer pt for follow-up care
* Abnormal findings:
Pay particular Attention to differences between acute infection & cancer or HIV
269
Inspect and palpate the trachea for any tracheal shift:
- Normal finding: trachea is midline
- Note any deviations: abnormal finding
270
Inspect and palpate the thyroid:
Initially inspect the neck as the pt. swallows a sip of water
- Posterior approach (preferred method)
- Anterior approach (alternate method)
271
other areas to inspect/palpate when checking the thyroid
- Locate the isthmus and the lobes & note enlargement, consistency, symmetry, nodules or lumps
- Abnormal findings: enlarged lobes, tender, presence of nodules or lumps
272
auscultate the thyroid for
bruit with bell: abnormal for presence of bruit
273
Head: Abnormalities of Size and Contour in Infants
Caput succedaneum
Cephalhematoma
Hydrocephalus (macrocephaly)
Macrocephaly
Microcephaly
Torticollis (Wryneck)
Fetal Alcohol Syndrome
Down Syndrome
274
caput succedaneum and cephalhematoma
similar
both due to trauma at birth
275
caput succedaneum
presenting part of the head is swollen and red and possible bruising. resolves over the first few days. no Tx needed
276
cephalhematoma
hemmorhage
difference is timeline
can keep building in size for days and then is absorbed
generally no Tx needed
277
macrocephaly
enlarged skull
278
hydrocephalus
common cause of macrocephaly
due to fluid buildup
279
microcephaly
small head
associated with a syndrome
child will have developmental problems because brain is limited or not fully developed
280
torticollis aka wryneck
head is tilted to the side and stuck in that position
no full rom
can be Tx over time through pt
281
fetal alcohol syndrome
down syndrome
distinct facial characteristics
282
fetal alcohol syndrome characteristics
short palpebral fissures
flat midface
short nose
indistinct philitrum
thin upper lip
epicanthal folds
low nasal bridge
minor ear anomalies
micrognathia
283
Head/Neck Abnormalities in Adults
Parotid Gland Enlargement
Hyperthyroidism
Goiter
Atopic (Allergic) Facies
Allergic Crease
284
parotid gland enlargement
one of the main saliva glands
in front of ear at cheek
due to infection, virus, mumps
285
hyperthyroidism
goiter
associated with thyroid gland
easier to see at neck
286
atopic (allergic) facies
allergic crease
kids with allergies
287
atopic (allergic) facies
discoloration around the eyes
looks like makeup-- pink/blue discoloration
288
allergic crease
line across bridge of the nose from them rubbing their nose and pushing up on it
289
external anatomy of the nose
Bridge
Tip
Nares
Vestibule
Collumella
290
nose internal anatomy
septum
turbinatos
paranasal sinuses
291
paranasal sinuses
frontal
maxillary
ethmoid
sphenoid
292
anatomy of the mouth
lips
Hard & soft palate, uvula, buccal mucosa
tongue
teeth
gums
293
frenulum
| tongue
tissue fold, midline on floor of mouth
Salivary glands
294
parotid
| tongue
Stenson’s duct (located opposite second molar)
295
submandibular
| tongue/salivary glands
Wharton duct (located on either side of frenulum)
296
teeth and gums
32 permanent, 20 deciduous (temporary)
297
throat
tonsils
nasopharnyx
oropharnyx
298
tonsils
masses of lymphoid tissue, located between the anterior & posterior pillars
299
grading the size of tonsils
1+: visible
2+: halfway between tonsillar pillars & uvula
3+: touching the uvula
4+: touching each other
300
nasopharnyx
continuous with the oropharynx, behind the nasal cavity (location of adenoids & eustachian tube)
301
oropharnyx
located behind the anterior tonsillar pillars
302
| Developmental Considerations- mouth/nose/throat
- Salivation begins at 3 months
- Drooling- occurs from inability to swallow, not from eruption of teeth
303
pregnant females
developmental considerations
| mouth/nose/throat
- Increased occurrence of nasal stuffiness & epistaxis (from increased vascularity in the upper respiratory tract
- Hyperemic & softened gums: bleeding of the gums can occur with brushing of the teeth
304
The aging adult:
| developmental consideration of the nose/mouth/throat
- More prominent appearance to nose from decreased subcutaneous fat
- Coarser, stiffer nasal hairs: decreased filtering, hairs may protrude
- Decreased sensation of smell from a decrease in olfactory nerve fibers
- Atrophy of soft tissue & epithelium in oral cavity-->decreased taste buds & decreased saliva -->decreased taste
305
Continued changes with the aging adult:
| nose/mouth/throat
- Changes in gums: recede-->erosion of teeth
- Loss of teeth malocclusion
- Increased bone resorption
- TMJ
- Changes in mastication-->risk of nutritional deficits
306
Transcultural Considerations
| nose/mouth/throat
bifid uvula
cleft lip/palate
oral hyperpigmentation
thorus palatinus
leukodema
307
bifid uvula
increased occurrence in Asians & Native Americans
308
cleft lip/palate
increased occurrence in Asians & Native Americans
309
oral hyperpigmentation
varies with race
310
torus palatinus
bony ridge in middle of the hard palate, increased occurrence in Native Americans, Inuits, & Asians
311
leukoedema
a grayish white benign lesion on the buccal mucosa, occurs more in Blacks
312
Continued transcultural considerations:
| nose/mouth/throat
newborns with teeth
poor dental hygiene
oral and pharyngeal cancer
313
newborns with teeth
rare occurrence, higher incidence in the Tlingit Indians (1 in 11) & the Canadian Inuits (1 or 2 in 100)
314
poor dental hygiene
increased incidence in Blacks, Hispanics, Native Americans, and Alaska Natives
315
oral and pharyngeal cancer
higher incidence in Blacks
316
nose: subjective data
Discharge- any rhinorrhea (nasal discharge), watery, mucoid, purulent, or bloody
Frequent or severe colds
Sinus pain – sinusitis, postnasal drip
Trauma – deviated nasal septum with obstruction
317
nose (cont)
| subjective data
Epistaxis – nosebleeds, amount, frequency, one or both nostrils, nose picking, difficulty in stopping
Allergies – or hay fever, allergens, medications used
Altered smell – any decrease in smell
318
epistaxis
– nosebleeds, amount, frequency, one or both nostrils, nose picking, difficulty in stopping
319
mouth and throat
| subjective data
Sores or lesions – note history, precipitating factors & any treatment
Sore throat – frequency, precipitating factors, strep throat, treatment
Bleeding gums
Toothache
Hoarseness
320
mouth and throat (cont)
| subjective data
dysphagia
altered taste
smoking/alcohol consumption
self care behaviors
321
dysphagia
any difficulty swallowing
painful
322
smoking/alcohol consumption
| mouth/throat subjective data
note packs per day, how many years, amount of alcohol consumption, last drink
323
sell care behaviors
| mouth/throat subjective data
dental care, last dental visit, dentures & their fit, any sores or irritation from dentures
324
infants and children
| mouth/throad subjective data
thumb sucking, use of bottle, eruption or loss of teeth, temporary or permanent teeth
325
Inspect and palate the nose
external nose
test patency of the nostrils (absence of sniff with obstruction)
assess smell
nasal cavity
326
external nose
| Inspect and palate the nose
for any deformity, symmetry, midline or deviated, inflammation, lesions
327
assess smell
| inspect/palpate the nose
(not routinely done) unless suspect dysfunction of cranial nerve I (olfactory); discussed in neuro assessment)
328
nasal cavity
| inspect/palpate the nose
inspect for any swelling, discharge, bleeding, or foreign object
329
mucosa
| inspect/palpate the nose
Note if discharge is watery, purulent or bloody (epistaxis usually from anterior septum)
* Swollen, boggy, pale and gray mucosa with chronic allergy
* Assess for deviated septum, perforation
* Inspect turbinates (able to view the inferior & middle turbinate but the superior turbinate is not visible)
330
palpate the sinus area
Tender to palpation indicates chronic allergies and acute sinusitis
331
inspect the mouth
lips
teeth
gums
tongue
palate
uvula
vagus nerve
332
lips
| Inspect the mouth
for color, moisture, cracking, or lesions
* Bluish lips are normal finding with Black persons
333
teeth
| inspect the mouth
for any missing teeth, caries (decay), malocclusion
334
gums
| inspect the mouth
for gingival hypertrophy, retraction, bleeding, lesions, swelling
* Dark melanotic line near gingival margin is a normal finding with Black persons
335
tongue
| inspect the mouth
for color, surface characteristics, and moisture
* Normal appearance of dorsal surface is roughened with papillae with a pink even color
* Ventral surface is normally smooth, glistening with visible veins
336
dry mouth indicates
| inspect the mouth
dehydration
fever
337
large tongue seen in what
| inspect the mouth
mental retardation, hypothyroidism, acromegaly; small tongue with malnutrition
338
when do you see excess saliva and drooling
neurologic dysfunction & gingivostomatitis
339
buccal mucosa
| inspect the mouth
(normally pink, smooth and moist)
* Patchy hyperpigmentation normal finding in dark- skinned persons
340
stensen's ducts
| inspect the mouth - buccal mucosa
normally small dimple appearance (opposite upper second molars)
341
fordyce's granules
| inspect the mouth- buccal mucosa
small white or yellow painless papules (little sebaceous cysts on mucosa),not significant
342
leukoplakia
| inspect the mouth- buccal mucosa
a chalky white raised patch, abnormal & precancerous lesion
343
palate
| inspect the mouth
anterior hard palate normally whitish with irregular ridges; soft palate normallly pinkish color
* Yellow with jaundice
344
torus palatinus
| inspect the mouth- palate
benign nodular bony ridge down middle of hard palate (a normal variation)
345
bruiselike, dark red/violet confluent macule indicates what
| inspect the mouth-palate
oral kaposi's sarcoma
346
uvula
| inspect the mouth
normal appearance is fleshy pendant hanging down on the midline on soft palate
347
how to test the vagus nerve
| inspect the mouth
aka cranial nerve x
by having patient say ahhh
348
abnormal finding of inspection of the uvula
| inspect the mouth
Abnormal finding: deviation of uvula to the side or absence of movement (from damage to CN X)
349
tonsils
| inspect the throat
normally same pink color as oral mucosa with indentations (crypts) without any exudate
350
tonsil size grading scale
1+ Visible just beyond the anterior pillar (normal)
2+ Halfway between tonsillar pillars and uvula
3+ Touching the uvula
4+ Touching each other
351
abnormalities of inspecting the tonsils
Bright red swollen (2+, 3+, 4+) tonsils indicate an acute infection; white membrane covering tonsils indicate mononucleosis, leukemia, and diptheria
352
Inspect the posterior pharyngeal wall
for color, exudate, or lesions
353
eliciting of the gag reflex
by touching the posterior pharyngeal wall; generally not performed in the routine exam
354
CN IX
MAKE SURE TO TEST
GLOSSOPHARYNGEAL
355
CN X
MAKE SURE TO TEST
VAGUS
356
TEST THE CN XII
HYPOGLOSSAL
normal finding is the pt. ability to stick his/her tongue out straight without any deviations or tremors
357
INFANTS/YOUNG CHILD
| CONSIDERATIONS IN EARS/NOSE/THROAT
remember to examine ears, nose, & throat towards the end of the examination
358
NOSE
| Assessment of Abnormalities
Epistaxis
Foreign body
Acute rhinitis
Allergic rhinitis
Sinusitis
Nasal polyps
359
LIPS
| Assessment of Abnormalities
Cleft Lip
Angular Chelitis
Herpes Simplex I
360
oropharynx
| Assessment of Abnormalities
Cleft palate
Bifid Uvula
Oral Kaposi’s sarcoma
AcuteTonsilitis/Pharyngitis
361
teeth/gums
| Assessment of Abnormalities
Baby bottle tooth decay
Malocclusion
Dental caries
Gingival hyperplasia
Gingivitis
Aphthous ulcers
Koplik’s spots
Leukoplakia
Candidiasis (Monilial) infection
362
tongue
| Assessment of Abnormalities
Fissured or scrotal tongue
Geographic tongue
Smooth, glossy tongue (Atrophic glossitis)
Black hairy tongue
Enlarged tongue (macroglossia)
Carcinoma
363
ORGANS OF THE RUQ
LIVER
GALLBLADDER
DUODENUM
COMMON BILE DUCT
364
ORGANS OF THE RIGHT LOWER QUADRANT
TRANSVERSE COLON
ASCENDING COLON
CECUM
APPENDIX
365
ORGANS OF LEFT UPPER QUADRANT
STOMACH
PANCREATIC DUCT
366
ORGANS OF THE LEFT LOWER QUADRANT
SPLEEN
ILEUM
DESCENDING COLON
367
EPIGASTRIC
SPLIT ABDOMEN IN THIRDS
MIDDLE TOP SECTION
368
HYPOGASTRIC
MAKE TIC TAC TOE
;THE VERY CENTER
369
HYPOGASTRIC
MAKE TIC TAC TOE
MIDDLE BOTTOM
370
SUPRAPUBIC
AKA HYPOGASTRIC
371
HEARTBURN
372
LINEA NIGRA
PREGNANCY LINE
DARK LINE FROM BELLY BUTTON TO PUBIC AREA
373
LINEA ALBA
BAND OF CONNECTIVE TISSUE THAT RUNS FROM A PERSON'S STERNUM TO THEIR PUBIC BONE
374
cullen's sign
superficial oedema with bruising in the peri umbilical region. sign of haemorrhagic pancreatitis
375
helix
OUTER BACK EDGE THAT ROLLS IN
376
antihelix
RIGHT INSIDE HELIX
PROTRUDES OUT
377
external auditory meatus
OUTER PASSAGE TO THE CANAL
378
tragus
TONGUE LIKE PROJECTION THAT YOU CAN PUSH AND COVERS EAR CANAL
379
antitragus
HARD PART RIGHT OVER WHERE PIERCING WOULD BE
380
lobule
EAR LOBE
381
mastoid process
BONE RIGHT BELOW/BEHIND EAR
382
