ch 43 potter sleep Flashcards
is a cyclical physiological process that alternates with longer periods of wakefulness.
Sleep
familiar rhythm is the 24-hour, day-night cycle known as the
diurnal or circadian rhythm
nerve cells in the hypothalamus control the rhythm of the sleep-wake cycle and coordinate this cycle with other circadian rhythms
suprachiasmatic nucleus (SCN)
influence the pattern of major biological and behavioral functions.
- sleep disorders are caused by a misalignment between the timing of sleep and individual desires or the societal norm.
Circadian rhythms
predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the
24-hour circadian cycle
Factors such as light, temperature, social activities, and work routines
affect circadian rhythms and daily sleep-wake cycles
All people have biological clocks that synchronize their sleep cycles
biological clocks
, which measures electrical activity in the cerebral cortex;
electroencephalogram (EEG)
which measures muscle tone
electromyogram (EMG)
which measures eye movements provide information about some structural physiological aspects of sleep.
electrooculogram (EOG)
major sleep center in the body is the
hypothalamus
hypocretins (orexins) that promote wakefulness and rapid eye movement (REM) sleep.
hypothalamus secretes
Prostaglandin D2, L-tryptophan, and growth factors
control sleep
located in the upper brainstem contains special cells that maintain alertness and wakefulness
reticular activating system (RAS)
receives visual, auditory, pain, and tactile sensory stimuli.
- cerebral cortex (e.g., emotions or thought processes) stimulate RAS
RAS (reticular activating system)
- The homeostatic process (Process S), which primarily regulates the length and depth of sleep;
- circadian rhythms (Process C: “biological time clocks”), which influence the internal organization of sleep and the timing and duration of sleep-wake cycles, operate simultaneously to regulate sleep and wakefulness
2 processes help to regulate sleep/wake cycles.
nonrapid eye movement (NREM) sleep and rapid eye movement (REM) sleep
two sleep phases
sleep, people progress through four stages during a typical 90-minute sleep cycle.
NREM ( nonrapid eye movement)
Lighter sleep is characteristic of ? when a person is more easily arousable.
stages 1 and 2, NREM ( nonrapid eye movement)
involve a deeper sleep called slow-wave sleep, from which a person is more difficult to arouse
-Called slow-wave sleep.
Combined stages 3 and 4 NREM ( nonrapid eye movement)
sleep is the phase at the end of each 90-minute sleep cycle.
-Stage usually begins about 90 minutes after sleep has begun.
REM (rapid eye movement)
decreases the last sleep stage
Hypothyroidism
causes people to take more time to fall asleep.
hyperthyroidism
which occurs before sleep onset
- CNS disorder.
- risk of lower levels of iron, pregnancy, renal failure, stress, diet, Parkinson’s disease, or a side effect of drugs
restless legs syndrome (RLS)
often awaken in the middle of the night
peptic ulcer disease
gastric acid secretion and stages of sleep are conflicting.
GI conflict with sleep
three problems:
insomnia, abnormal movements or sensation during sleep or when waking up at night, or excessive daytime sleepiness (EDS)
Sleep disorders
which classifies sleep disorders into eight major categories
International Classification of Sleep Disorders version 2 (ICSD-2)
are sleep disturbances that result in daytime sleepiness and are not caused by disturbed sleep or alterations in circadian rhythms
Hypersomnias
are undesirable behaviors that occur usually during sleep.
parasomnias
involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep.
polysomnogram
provides objective information about sleepiness and selected aspects of sleep structure by measuring eye movements, muscle-tone changes, and brain electrical activity during at least four napping opportunities spread throughout the day.
-takes 8 to 10 hours to complete
Multiple Sleep Latency Test (MSLT)
on the wrist to measure sleep-wake patterns over an extended period of time such as one week.
-data provide information about sleep time, sleep efficiency, number and duration of awakenings, and levels of activity and rest
Actigraph device
is symptomatic, including improved sleep-hygiene measures, biofeedback, cognitive techniques, and relaxation techniques
Treatment for insomnia
is a disorder in which an individual is unable to breathe and sleep at the same time
-lack of flow 10 seconds to 1 to 2 minutes in length.
Sleep apnea
obstructive; central; and mixed apnea, which has both an obstructive and a central component.
3 types of sleep apnea
, which is a cessation or stopping of airflow despite the effort to breathe
most common form is obstructive sleep apnea (OSA
hypoxic and must awaken to breathe. Structural abnormalities such as a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils sometimes
-Obesity and hypertension major risk
leads to obstructive sleep apnea:
involves dysfunction in the respiratory control center of the brain.
- impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease
- common in brainstem injury, stroke, obesity, muscular dystrophy, and encephalitis.
- Mild and intermittent snoring is also present.
Central sleep apnea (CSA)// type of sleep apnea
is a common complaint in people experiencing OSA and CSA.
Excessive daytime sleepiness (EDS)
bilevel positive airway pressure (BPAP or BiPAP), continuous positive airway pressure (CPAP),
- weight-reduction program in people who are obese, improved sleep hygiene
- surgery, and oral repositioning devices for the jaw and tongue
treatments for OSA
is a dysfunction of the processes that regulate sleep and wake states
- most complaint is . Excessive daytime sleepiness
- REM sleep occurs within 15 minutes of falling asleep.
- vivid dreams
- symptom: Sleep paralysis, or the feeling of being unable to move or talk just before waking or falling asleep,
- treated wtih stimulants, antidepressant meds
Narcolepsy
, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter that occurs at any time during the day, is a symptom of narcolepsy type 1, differentiating it from narcolepsy type 2
-lasts only a few seconds
Cataplexy (symptom of Narcolepsy type 1)
is severe, a patient loses voluntary muscle control and falls to the floor
cataplectic attack
associated w/ obesity, type 2 diabetes, poor memory, depression, digestive problems, and the development of cardiovascular disease
sleep deprivation
Physiological Symptoms • Ptosis, blurred vision • Fine-motor clumsiness • Decreased reflexes • Slowed response time • Decreased reasoning and judgment • Decreased auditory and visual alertness • Cardiac arrhythmias
sleep deprivation physiological symptoms
Psychological Symptoms • Confused and disoriented • Increased sensitivity to pain • Irritable, withdrawn, apathetic • Agitated • Hyperactive • Decreased motivation • Excessive sleepiness
sleep deprivation psychological symptoms
are sleep problems that are more common in children
-hypothesized that sudden infant death syndrome (SIDS)
parasomnias
occur among older children include confusional arousals, somnambulism (sleepwalking), night terrors, nightmares, nocturnal enuresis (bed-wetting), body rocking, and bruxism (teeth grinding).
Parasomnias (older children)
they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day.
rest (does not imply inactivity)
age of 3 months averages about 16 hours of sleep a day
-REM sleep which stimulates the higher brain centers
Neonates sleep
usually develop a nighttime pattern of sleep by 3 months of age
- 8 to 10 hours during the night for a total daily sleep time of 15 hours
- 30% of sleep is in REM cycle
Infants
2 children usually sleep through the night and take daily naps
- 12 hours day sleep
- after age 3> give up day time sleep
- fear of sleep bc autonomy or fear separation from their parents
Toddlers
sleeps about 12 hours a night
- REM 20%
- age 5 rarley takes day naps
- awake period the child exhibits brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting.
preschooler
6-year-old averages 11 to 12 hours of sleep nightly, whereas an 11-year-old sleeps about 9 to 10 hours
-older child often resists sleeping because he or she is unaware of fatigue or has a need to be independent.
school age
teenagers get about 7 hours or less of sleep per night, although the recommended requirement is 8 to 10 hours
-school demands, after-school social activities, and part-time jobs, which reduce the time spent sleeping
Adolescent
6 to 8½ hours of sleep a night
- 20% sleep time REM
- common for the stresses of jobs, family relationships, and social activities to frequently lead to insomnia, and some may use medication to help them sleep
- Pregnancy increases the need for sleep and rest
young adult
First-trimester sleep disturbances include a reduction in overall sleep time and quality
First-trimester sleep disturbances//young adult
Daytime drowsiness, insomnia, and nighttime awakenings also increase because of frequent nocturnal voiding.
second trimester//young adult
Insomnia, periodic limb movements, RLS, and sleep-disordered breathing are common problems during the
third trimester of pregnancy //young adult
7 to 9 hours per night
- night begins to decline.
- Anxiety, depression, or certain physical illnesses cause sleep disturbances.
- Women experiencing menopausal symptoms often experience insomnia.
Middle adults
spend more time in stage 1 and less time in stages 3 and 4
- REM sleep tend to shorten. Older adults experience fewer episodes of deep sleep and more episodes of lighter sleep
- Changes in sleep pattern are often caused by changes in the CNS that affect the regulation of sleep.
- insomnia have co-morbid psychiatric illness or medical conditions, take medications that disrupt sleep patterns, or use drugs or alcohol.
- Sensory impairment reduces an older person’s sensitivity to time cues that maintain circadian rhythms.
older adults
subjective experience
sleep
Hunger, excessive warmth, and separation anxiety
disturb infant sleep
contains eight questions about the likeliness of a patient being sleepy during certain activities (e.g., watching television, reading, sitting and talking with someone) on a scale of 0 (would never doze or sleep) to 3 (high chance of dozing or sleeping). A score of 0 to 5 indicates lower normal daytime sleepiness; 6 to 10 is considered higher than normal daytime sleepiness; a score of 11 or 12 is mild excessive daytime sleepiness; 13 to 15 is moderate excessive daytime sleepiness; and a score of 16 to 24 is severe excessive daytime sleepiness
Epworth Sleepiness Scale (tool assess sleepiness)
assesses sleep quality and patterns
Pittsburgh Sleep Quality Index(tool assess sleepiness)
effective method for assessing sleep quality is the use of a
-straight horizontal line 100 mm (4 inches) long. Opposing statements such as “best night’s sleep” and “worst night’s sleep” are at opposite ends of the line. Ask patients to place a mark on the horizontal line at the point corresponding to their perceptions of the previous night’s sleep
visual analog scale. (assess quality of sleep)
-used for individual pt not comparison
is a reliable evidence-based tool used to screen for OSA and is frequently used in preanesthesia and/or preoperative assessments
STOP-BANG sleep assessment tool
irritability, disorientation (similar to a drunken state), frequent yawning, and slurred speech
-sometimes delusions and paranoia
sleep deprivation behaviors
dairy product such as warm milk or cocoa that contains L-tryptophan is often helpful in promoting sleep.
snacks increase sleep
Coffee, tea, colas, and chocolate
drinks act as stimulants (dont have before bed time)
Caffeinated foods and liquids and alcohol act as
caffeine act as diuretics
is a neurohormone produced in the brain that helps control circadian rhythms and promote sleep
Melatonin
dose is 0.3 to 3 mg taken 2 hours before bedtime
side effects of nausea, headache, and dizziness being infrequent.
receptor agonist: ramelteon or tasimelteon-// side effect : diarrhea, drowsiness, tiredness and dizziness.
Melatonin supplement (promote sleep/ herbal)
who have decreased levels of melatonin find it beneficial as a sleep aid
Older adults melatonin
effective in mild insomnia and RLS. (restless leg syndrome)
Valerian (herbal product help sleep)
essential oil may improve sleep quality
Lavender (oil help w/sleep)
has mild sedative effects and is used as a natural sleep aid
Passionflower (maypop) //herb
an herbal tea, has a mild sedative effect that may be beneficial in promoting sleep
Chamomile
because of their long duration of action, which can cause confusion, constipation, urinary retention, and an increased risk of falls
Caution older adults about using over-the-counter antihistamines
sleep deprivation
cause delirium
Teach the patient to elevate the head of the bed and use a side or prone position for sleep.
OSA
use CPAP
sleep apnea
Elevating their feet on an ottoman or small bench may help to position them safely.
people experience EDS
- become easily fatigued and experience periods of insomnia
- shorten activities and visits to allow patients to maintain an adequate energy level
- wakes up during the night, keeping the lights at a low level
- use music technique or back rub
pt w/ dementia >help improve sleep
- after meals experience gastric reflux
- prevent sleep disturbances: eat small meal several hrs before bed time
- sleep in semi-sitting position
- time medications
hiatal hernia
need to be used sparingly and under medical management
CNS stimulants such as amphetamines, caffeine, nicotine, terbutaline, theophylline, and modafinil
such as alcohol, barbiturates, tricyclic antidepressants (amitriptyline, imipramine, and doxepin), and triazolam causes insomnia
CNS depressants cause insomnia
Medications that induce sleep are called
hypnotics
are medications that produce a calming or soothing effect
Sedatives
are commonly used to treat sleep problems and are intended for short-term use
- treat insomnia
- relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the CNS =decrease level of arousal
Benzodiazepines and benzodiazepine-like drugs
acting medication such as ? for short-term use (no longer than 2 to 3 weeks)
zolpidem (Ambien)
at the lowest possible dose for short-term treatment of insomnia are recommended.
- -cause also cause respiratory depression; next-day sedation; amnesia; rebound insomnia; and impaired motor functioning and coordination, which leads to an increased risk of falls
- contraindicated in infants less than 6 months old.
Short-acting benzodiazepines (e.g., oxazepam, lorazepam, or temazepam)
sulfonamides, thiazide diuretics, oral hypoglycemic agents, tetracycline.
Drugs may increase sunlight sensitivity and give burn response
antimalarials, anticancer agents, hormones, metals, and tetracycline.
cause hyperpigmentation
is a problem after stopping a medication, particularly the benzodiazepines
Rebound insomnia
, produced by the kidneys, stimulates red blood cell production and maturation in bone marrow.
Erythropoietin
(decreased blood supply), renin is released from juxtaglomerular cells.
renal ischemia
renin is released from
juxtaglomerular cells.
can have problems such as anemia, hypertension, and electrolyte imbalances.
Patients with kidney impairment
- a fixed base called the trigone
- distensible body called the detrusor.
bladder has 2 parts
Urination, micturition, and voiding are
all terms that describe the process of bladder emptying.
.-one coordinates inhibition of bladder contraction;
-other coordinates bladder contractility
2 micturition centers in the spinal cord
, most people experience a strong sensation of urgency
bladder fills to approximately 400 to 600 mL
is the inability to partially or completely empty the bladder
Urinary retention
is the amount of urine left in the bladder after voiding and is measured either by ultrasound or straight catheterization
Postvoid residual (PVR)
Incontinence caused by urinary retention is called
overflow incontinence or incontinence associated with chronic retention of urine.
In the absence of symptoms, the presence of bacteria in the urine as found on a urine culture is called
-not infection
asymptomatic bacteriuria
Symptomatic infection of the bladder can lead to a serious upper UTI
(pyelonephritis)
can include burning or pain with urination (dysuria)
Symptoms of a lower UTI (bladder)
irritation of the characterized by urgency, frequency, incontinence, or suprapubic tenderness; and foul-smelling cloudy urine
bladder (cystitis)
are the presence of an indwelling urinary catheter and the length of its use
catheter-associated urinary tract infection (CAUTI)
is defined as the “complaint of any involuntary loss of urine”
Urinary incontinence (UI)
is defined as urinary urgency, often accompanied by increased urinary frequency and nocturia that may or may not be associated with urgency incontinence and is present without obvious bladder pathology or infection.
Overactive bladder
UI associated with chronic retention of urine (formally called ?is urine leakage caused by an overfull bladder.
overflow UI)
is caused by factors that prohibit or interfere with a patient’s access to the toilet
Functional UI
This describes incontinence that has multiple interacting risk factors, some within the urinary tract and others not, such as multiple chronic illnesses, medications, age-related factors, and environmental factors
multifactorial incontinence
Patients who have had the bladder removed (cystectomy) because of cancer or significant bladder dysfunction related to radiation injury or neurogenic dysfunction with frequent UTI require surgical procedures that divert urine to the outside of the body through an opening in the abdominal wall called a stoma
(cystectomy)
- a continent urinary reservoir
- Ureterostomy (ileal conduit).
- which is created from a distal part of the ileum and proximal part of the colon
2 types of continent urinary diversions
. The first is called a continent urinary reservoir
2 types of continent urinary diversions
creates a one-way valve in the pouch through which a catheter is inserted through the 1155stoma to empty the urine from the pouch
ileocecal valve
are small tubes that are tunneled through the skin into the renal pelvis.
-These tubes are placed to drain the renal pelvis when the ureter is obstructed
Nephrostomy tubes
are small tubes that are tunneled through the skin into the renal pelvis.
Nephrostomy tubes
foreskin will become tight and cannot be retracted
(phimosis)
Retracted foreskins can cause dangerous swelling
(paraphimosis) of the penis
are used to treat urinary urgency.
antimuscarinics (e.g., oxybutynin and trospium)// medication
is an autoimmune disorder
-Affected persons are permanently intolerant of gluten, a protein found in wheat, barley, rye, and some commercially produced oats.
-When gluten is ingested, immune-mediated inflammation results in damage to the small intestine and in malabsorption
common symptoms of diarrhea, abdominal pain, and abdominal distention
Celiac disease
examination of blood serum, esp regard to response of immune system to pathogens.
serology testing
is a loss of appetite from GI disease as a side effect to some medications, with pregnancy, or with mental health disorders.
Anorexia
occurs with disorders of the throat or esophagus, such as thrush (candida infection), neurologic changes (e.g., stroke), or obstruction (e.g., solid mass or tumor).
Dysphagia
(e.g., lactase deficiency resulting in bloating or excessive gas after taking milk products).
Food intolerance
(heartburn), a burning sensation in esophagus and stomach from reflux of gastric acid.
Pyrosis
(belching).
Eructation
(dull, general, poorly localized)
visceral from an internal organ (pain description)
(sharp, precisely localized, aggravated by movement); or referred from a disorder in another site
parietal from inflammation of overlying peritoneum (pain description)
appendicitis, cholecystitis, bowel obstruction, or a perforated organ.
Acute pain requiring urgent diagnosis occurs with
occurs with stomach or duodenal ulcers and esophageal varices.
Hematemesis
occurs with GI bleeding or localized bleeding around the anus (e.g., hemorrhoids).
Red blood in stools
Irregular eating patterns are common and a source of
parental anxiety (infants)
Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years.
Pica (infants)
inflammation of the bowel, constipation, urinary tract infection, and anxiety.
Abdominal pain accompanies
anorexia nervosa.
Amenorrhea is common with
caves in
Scaphoid abdomen
abdominal distention
Protuberant abdomen indicates
—Protrusion of abdominal viscera through abnormal opening in muscle wall
Hernia
is a hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas.
Sister Mary Joseph nodule
with ascites or underlying mass
Everted with (umbilicus)
(though rarely) with intraperitoneal bleeding (Cullen sign)
Bluish periumbilical color occurs
Enlarged, everted with
umbilical hernia.
Normally it is midline and inverted, with no sign of discoloration, inflammation, or hernia. It becomes everted and pushed upward with pregnancy.
normal umbilicus
Skin glistening and taut with
ascites. (skin appearance)
(lineae albicantes)—silvery white, linear, jagged marks about 1 to 6 cm long
One common pigment change is striae
excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching
Striae look purple-blue with Cushing syndrome (
—circumscribed brown macular or papular areas—are common on the abdomen.
Pigmented nevi (moles)
occur with portal hypertension or liver disease.
Spider angiomas
occur with portal hypertension, cirrhosis, ascites, or vena caval obstruction.
Prominent, dilated veins (caput medusae)
as a result of thinned adipose tissue.
Veins are more visible with malnutrition
dehydration, which often accompanies GI disease.
Poor turgor occurs with
Patterns alter with endocrine or hormone abnormalities,
chronic liver disease.
pattern of pubic hair growth normally has a diamond shape in adult males and an inverted triangle shape in adult females
pattern of pubic hair growth in male n female (endocrine)
comfortable person is relaxed quietly on the examining table and has a benign facial expression and slow, even respirations.
demeanor (way of looking or behaving)
follow abdominal surgery or with inflammation of the peritoneum
Hypoactive or absent sounds
is are loud, high-pitched, rushing, tinkling sounds that signal increased motility.
Hyperactive sound
It is systolic, medium to low in pitch, and heard between the xiphoid process and the umbilicus.
(usually younger than 40 years) may have a normal bruit originating from the celiac artery.
is a pulsatile blowing sound and occurs with stenosis, partial occlusion, or aneurysm of an artery.
systolic bruit
contents and to screen for abnormal fluid or masses.
Percuss to assess the relative density of abdominal
over a distended bladder, adipose tissue, fluid, or a mass.
Dullness occurs
is present with gaseous distention.
Hyperresonance
if chronic obstructive lung disease is present
upper liver border is overestimated if
are obscured if obesity or ascites is present.
both upper and lower edges (liver)
the upper and lower borders of the liver were identified by
percussion to estimate liver span
palpation is more reliable than percussion
-if percussed= dull
Screening for splenomegaly
Detection of a distended bladder through percussion is also omitted due to unreliability.10 Bedside bladder scanning with ultrasound is commonly used to estimate bladder volume.
screening for bladder
and to screen for an abnormal mass or tenderness.
Perform palpation to judge the size, location, and consistency of certain organs
when the person is cold, tense, or ticklish.
Voluntary guarding occurs
uterus
gravid
abnormally firm liver may indicate (palpating)
cirrhosis
The researchers recommend the scratch test if the abdomen is distended, obese, or too tender for palpation or if muscles are rigid or guarded.7
Scratch Test recommended when
Normally the spleen is not palpable and must be enlarged 3 times its normal size to be felt
Spleen (imp info) not palpable
returning from travel to areas where malaria is endemic
malaria in persons with fever and splenomegaly
Occasionally you may feel the lower pole of the right kidney as a round, smooth mass that slides between your fingers. (normal)
right kidney palpation description
Using your opposing thumb and fingers, palpate the aortic pulsation in the upper abdomen slightly to the left of midline
aortic pulsation in the upper abdomen slightly to the left of midline
he blow will generate a fluid wave through the abdomen, and you will feel a distinct tap on your left hand
If ascites is present, you will feel
when you elicit tenderness during palpation. Choose a site remote from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply; then lift up quickly. This makes structures that are indented by palpation rebound suddenly.
-A normal, or negative, response is no pain on release of pressure. Perform this test at the end of the examination because it can cause severe pain and muscle rigidity.
Rebound Tenderness
Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis.
positive Rebound Tenderness
that is localized to a specific spot also signals peritoneal irritation.
Cough tenderness
inflammation of the gallbladder, pain occurs.
cholecystitis
- This sign is less accurate in patients older than 60 years
- test is positive, as the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway.
Inspiratory Arrest (Murphy Sign)
Draw a straight line from the anterior superior spinous process of the ileum to the umbilicus. McBurney point is located 1.5 to 2 inches from the ileum along this line. (McBurney point is at the hand placement in
McBurney Point Tenderness
Perform the iliopsoas muscle test when the acute abdominal pain of appendicitis is suspected. With the person supine, lift the right leg straight up, flexing at the hip
Iliopsoas Muscle Test (appendix test)
(which occurs with an inflamed or perforated appendix), pain is felt in the RLQ, and the test is positive
iliopsoas muscle is inflamed
lift the person’s right leg, flexing at the hip, and 90 degrees at the knee. Hold his or her ankle, and rotate the leg internally and externally. There should be no pain.
Obturator Test. (appendix test)
inflamed appendix irritates the obturator muscle, and this leg movement produces pain in a positive finding.
Obturator Test.
- Alvarado score of ≥7 increases the probability of appendicitis.
- score of 4 or less significantly decreases the probability of appendicitis
Alvarado Score aka MANTRELS score (appendix test)
- contour of the abdomen is protuberant because of the immature abdominal musculature.
-The skin contains a fine, superficial venous pattern.
-Abnormalities: Scaphoid shape occurs with dehydration.
Dilated veins.
infant abdomen
presence of only one artery signals the risk for congenital defects.
abnormal finding of infant abdomen
- umbilical hernia- disappears by 1 yr age (2.5 cm/1 in)
2. diastasis recti- (bulge out mainly in black infants n disappear by early childhood)
abdomen should be symmetric, although two bulges are common.
Refer diastasis recti lasting more than 6 years.
refer abdomen bulge of diastasis recti
larger than 2.5 cm; continuing to grow after 1 month; or lasting for more than 2 years in a white child or for more than 7 years in a black child.
Refer any umbilical hernia
Marked peristalsis with
pyloric stenosis (gastric outlet obstruction)
normal to percuss dullness over the bladder. This dullness may extend up to the umbilicus.
infant percussion over bladder
- is normal to feel the liver edge at the right costal margin or 1 to 2 cm below
- you may palpate the spleen tip and both kidneys and the bladder
- easily palpated are the cecum in the RLQ and the sigmoid colon, which feels like a sausage in the left inguinal area.
palpate organs in infant (GO OVER)
.-a sticky, greenish-black meconium stool within 24 hours of birth.
- 4th day, stools of breastfed babies are golden yellow, pasty, and smell like sour milk
- formula-fed babies are brown-yellow, firmer, and more fecal smelling
newborn’s first stool
- Younger than 4 years, the abdomen looks protuberant when the child is both supine and standing.
- After age 4 years the potbelly remains when standing because of lumbar lordosis, but the abdomen looks flat when supine.
- Normal movement on the abdomen includes respirations, which remain abdominal until 7 years of age
children abdomen development at different ages/stages
On the left the spleen also is easily palpable with a well-defined movable edge. Usually you can feel 1 to 2 cm of the right kidney and the tip of the left kidney.
child organs that able to be palpable
objective signs to aid assessment, such as a cry changing in pitch as you palpate, facial grimacing, moving away from you, and guarding.
assessing abdominal tenderness in child
-liver is easier to palpate. Normally you will feel the liver edge at or just below the costal margin. With distended lungs and a depressed diaphragm, the liver is palpated lower, descending 1 to 2 cm below the costal margin with inhalation. The kidneys are easier to palpate.
Aging adult organs to palpate
, which is a liver infection.
viral hepatitis
A, B, and C.
3 major types of hepatitis:
are spread through blood and body fluids, for example by sharing contaminated needles or by sexual contact.
-cause a brief period of illness, then either be cleared from the body entirely or go on to cause a long-term, or chronic, infection.
Hepatitis B and C spread by
is especially common with hepatitis C
Chronic infection (hepatitis C)
Chronic hepatitis can eventually cause the liver to fail by causing liver scarring
-increase risk liver cancer
(fibrosis and cirrhosis).//hepatits C
through blood testing
screening for hepatitis B and C
is highest among people born in countries with high HBV infection prevalence, people born in the United States but not vaccinated in infancy with parents who were born in high-risk countries, people with HIV-positive status, users of injection drugs, men who have sex with men, and people with sexual partners with HBV or who have household contacts with HBV.
risk for hepatitis B (HBV)
include people with a current or past history of injection drug use and people with additional risk factors: blood transfusion before 1992, birth year between 1945 and 1965, unregulated tattoos, birth to an HCV-infected mother, and long-term hemodialysis.
highest risk for HCV
Inflammation of the appendix usually produces RLQ pain to palpation, with maximal tenderness sometimes occurring over McBurney point
McBurney Point Tenderness (appendix test)
Rebound tenderness occurring in the right lower quadrant when pressure is applied to the left lower quadrant may indicate appendicitis
-refer to screen for computed tomography (CT) scanning.
Blumberg sign
In a supine person ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel to the periumbilical space.
- fluid is present, the note will change from tympany to dull
- level of dullness is higher, upward toward the umbilicus.
- it will not detect less than 500 to 1100 mL of fluid
second test for ascites is percussing for shifting dullness.
sits 1 cm higher than the right kidney and is not palpable normally
left kidney description
This traditional technique uses auscultation to detect the lower border of the liver. Place the stethoscope over the xiphoid process while lightly stroking the skin with one finger up the MCL from the RLQ and parallel to the liver border. When you reach the liver edge, the sound is magnified in the stethoscope.
Scratch Test
is a constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum.
involuntary rigidity
Sharp pain occurs with
inflammation of the kidney or paranephric area, as in pyelonephritis.
clear to green or brown.
fasting gastric secretions range from
, produced by the kidneys, stimulates red blood cell production and maturation in bone marrow.
Erythropoietin
(decreased blood supply), renin is released from juxtaglomerular cells.
renal ischemia
renin is released from
juxtaglomerular cells.
can have problems such as anemia, hypertension, and electrolyte imbalances.
Patients with kidney impairment
In the absence of symptoms, the presence of bacteria in the urine as found on a urine culture is called
-not infection
asymptomatic bacteriuria
foreskin will become tight and cannot be retracted
(phimosis)
Retracted foreskins can cause dangerous swelling
(paraphimosis) of the penis
