319 Exam 3 Flashcards
During childhood, long bones
Increase in diameter and length
During adolescence, rapid growth occurs. Bone growth is completed by age
20
Ligaments and cartilage soften and become elastic in who?
Pregnant women
Fetus at 3 months has “scale model” and skeleton is made of
Cartilage
Subjective ROS Musculoskeletal (5)
Bones
Joints
Muscles
ADLs
Self-care
Genu ValGum
Knees toGether
Genu vaRum
Knees apaRt
With adolescent musculoskeletal, keep in mind
Sports injuries
Nutrition
Lordosis
Kyphosis
Loose joints
Should be considered in who?
Pregnant women
Nutrition
Kyphosis
Falls
Should be considered for who?
Elderly
This test should be conducted on people over 60
Get up and go test
The Get up and go test should be completed in under
10 seconds
Inspection for most joints includes (6)
Size Contour Color Swelling Masses Deformity
Palpation for most joints includes (5)
Temperature Bony articulations Muscles Tenderness Swelling
If active ROM is limited, then use
Passive ROM
Normal range of motion should have no
Limitations
Pain
Tenderness
Crepitation
What is done for muscle strength?
The same ROM with resistance
Lowest to highest, what is the muscle strength scale
0-5
What is the biggest sign of joint disease?
Limited ROM
Anything below 2 means
No motion
Difference between 1 and 0?
Zero means no contraction
Palpate as person opens mouth
TMJ
Palpate muscles of mastication
TMJ
Hands back to back with no problems indicates a normal
Phalen Test
Percussing the median nerve produces no symptoms in a normal
Tinel Sign
Inspect hip while person
Stands
Palpate hip with person
Supine
3 steps of the bulge sign
Stroke up medial aspect 3 times
Tap lateral aspect
Look for bulge on medial side
2 steps of Ballottement
Compress suprapatellar pouch
Push patella into femur
If there is no fluid, then the patella is already snug against the
Femur
It is also important to check the knee while the patient is
Walking
Inspect the ankle and foot in these 3 positions
Sitting
Standing
Walking
Inspect the spine while the patient
Stands
For the spine what should be palpated?
Spinous processes
Which arthritis is autoimmune and has inflammation and hyperplasia?
Rheumatoid arthritis
Which arthritis involves articular cartilage degeneration, bone against bone, and new bone formation?
Osteoarthritis
Drugs that increase fall risk (8)
Antihypertensives Diuretics Digoxin/anti-arrhythmics Psychotropic drugs Antidepressants Antihistamines Benzodiazepines Anticoagulants
Digestive organs begin to form at
4 weeks gestation
Infants abdomen less
Muscular
During pregnancy (7)…
Abdominal muscles lose tone Hemorrhoid formation Stomach displaced upward Reduced peristalsis Increased water absorption Decreased gallbladder emptying Bladder compression
Liver size decreases leading to altered metabolism in what population?
Elderly
Esophageal emptying is decreased in the
Elderly
Altered intestinal motility is observed in the
Elderly
ROS concerns specifically for elderly (LID)
Laxatives
Incontinence
Dietary intake
Abdominal inspection components (7)
Contour Symmetry Umbilicus Skin Pulsations Hair distribution Demeanor
Cullen sign indicates
Intraabdominal bleeding
Auscultate for (2)
Bowel sounds
Vascular sounds
What part of the stethoscope should be used for abdominal?
Diaphragm
Bowel sounds can only be deemed absent after
5 minutes
High pitched bowel sounds may indicate
Obstruction
What are the 4 vascular sounds?
Aorta
Renal
Iliac
Femoral
Percuss abdomen for (3)
General tympany
Liver span
Spleen span
If you percuss and hear hyperresonance, it means
Gaseous distention
If you hear dullness, it may be (2)
Liver
Full bladder
What is located right MCL at the 5-7 intercostal space?
Liver
Liver span range
6-12cm
Place the stethoscope over the liver
Scratch upward from the RLQ
When sound is magnified, you are at the liver
What is this?
Scratch test
What intercostal space is the spleen located at?
9-11 behind axillary line
The patient takes a deep breath while percussing for the spleen and it should remain
Tympanic
The _______ form the CVA with the spine
12th rib
Put one hand over the 12th rib and thump for
CVA tenderness
2 tests for Ascites
Fluid Wave
Shifting Dullness
Fluid wave steps
Have patient hold hand midline
Strike left side
Feel tap of fluid wave on the right side
Bottle up bottle down is used to remember
Shifting dullness
When palpating abdomen do it both
Light
Deep
How deep is light palpation?
1 cm
When palpating lightly, use
Finger pads
How deep is deep palpation?
4 cm
Palpate deeply using fingertips or
bimanual technique
What is felt during light palpation? (2)
Masses
Tenderness
What is felt during deep palpation? (4)
Liver
Spleen
Kidneys
Aortas
Three steps for liver palpation
Place left hand under patient at 11/12 ICS and lift
Place hand parallel to midline in RUQ
Press deeply down and under while pt inhales
Another acceptable method of liver palpation is
Hooking
For palpating the spleen do
Exact same thing on opposite side
Which kidney uses duckbill?
Right kidney
Which kidney should not be palpable?
Left kidney
Should feel round and smooth
Kidney
Use your thumb and fingers to palpate
Aorta
How wide is the aorta normally?
2.5-4cm
Press deeply into abdomen away from painful area, then withdrawl rapidly and assess for sharp pain. This is called…
Rebound tenderness
Two steps of Murphy’s sign
Hold finger under liver border
Ask the patient to breathe deeply
Normally performing the Murphy’s sign should cause
No pain
The iliopsoas muscle test is for
Appendicitis
Which test is for ruptured appendix or pelvic abscess?
Obtuator muscle test
The Ballottement technique (abdomen) is for a
Floating mass
Abdominal diagnosis (3)
Altered urinary elimination r/t catheterization
Self concept disturbance r/t loss of bowel or bladder control
Altered patterns of elimination r/t urinary tract infection
Newborn skin is (3)
Thin
Smooth
Elastic
Sebaceous glands develop during
Adolescence
Sweat/eccrine glands mature at
2 months
Increased pigmentation
Both type gland activity increased
Subcutaneous development in butt and hips
Striae gravidarium
In who?
Pregnant women
Epidermis and dermis thinner in
Elderly
Decreased function of sweat and sebaceous glands in
Elderly
Melanocytes decrease function in
Elderly
Older females may develop facial hair. This condition is called
Hirsutism
Elderly nails become (4)
Thick
Brittle
Yellow
Hard
Two most important review of systems
Change in mole
Medications
An acquired condition involving absence of melanin in patchy pattern
Vitiligo
Turgor can reveal
Dehydration
Where to pinch for turgor?
Anterior chest under the clavicle
What is the scale for pitting edema?
+1 to +4
What scale is for pressure ulcers?
Braden Scale
Ulcer stage I
Non blanching erythema
Ulcer stage II
Blister
Ulcer stage III (2 things)
As deep as SQ fat
Potential tunneling and undermining
Stage 4 ulcer (2)
As deep as bone
Slough and/or eschar
Not palpable, simply a color change
Macule
A macule greater than 1cm
Patch
Elevated palpable mole less than 1 cm
Papule
Elevated psoriasis >1cm
Plaque
Raised, erythema, irregular. Example mosquito bite
Wheal
Collection of wheals. Example hives
Urticaria
Elevated cavity containing clear fluid
Vesicle
Elevated cavity with clear fluid >1cm, blisters
Bulla
Elevated cavity containing pus
Pustule
Examples of pustule
Acne
Impetigo
Encapsulated fluid filled cavity in dermis or subcutaneous
Cyst
Expected with fever, local inflammation, and emotional reaction
Erythema
Solid, elevated, larger than 1 cm
Nodule
Larger than a few cm. firm or soft. Deeper into dermis. Benign or malignant.
Tumor
When skin lesions run together they are described as
Confluent
When skin lesions standalone, they are called
Discrete
Depressed scar
Atrophic scar
Hypertrophic scar
Keloid
Prolonged intense scratching causes these tightly packed papules
Lichenification
Small purple and red dots from points of blood
Petechiae
Large purple spots caused by internal bleeding
Purpura
Echymosis
Bruise
Term for abrasion
Excoriation
Example of fissure
Chelitis
Sunspots/liver spots
Solar lentigo
What color is kaposi’s sarcoma?
Purple
A B C D E
For melanoma
Assymetry Border Color Diameter Elevation
How many calories to gain/lose a pound?
3500
Spinothalamic tract tests (3)
Superficial pain
Temperature
Superficial touch
Superficial pain
Distinguish between sharp and dull
Only done if superficial pain is impaired
Temperature
Have client identify area touch with cotton
Superficial touch
Posterior column tests (3)
Vibration
Proprioception
Tactile discrimination
Five examples of tactile discrimination
Stereognosis Graphesthesia Point to location 2 point discrimination Extinction
What do we do for tone?
Passively move joints for resistance
Heel to toe tandem walking for
Gait
Romberg test for
Equilibrium
REMEMBER cerebellum for both balance and coordination
Did I stutter?!?
Superficial reflexes (2)
Plantar
Achilles
DTR (4)
Biceps
Triceps
Brachioradialis
Quadriceps
Ranking for DTR
0-4+
Normal value for DTR
2+
What do we do for tone?
Passively move joints for resistance
Heel to toe tandem walking for
Gait
Romberg test for
Equilibrium
REMEMBER cerebellum for both balance and coordination
Did I stutter?!?
Superficial reflexes (2)
Plantar
Achilles
DTR (4)
Biceps
Triceps
Brachioradialis
Quadriceps
Ranking for DTR
0-4+
Normal value for DTR
2+
