Chapter 27 - Thorax and Abdomen Flashcards

1
Q

sternal/true ribs

A

7 upper ribs (joined to sternum by costal cartilage)

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2
Q

false ribs

A

ribs 8-10 (common cartilage that joins 7th rib before attaching to sternum)

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3
Q

floating ribs

A

ribs 11-12

unattached to sternum, do have muscular attachments

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4
Q

external intercostals __________ the diaphragm during ________

A

external intercostals elevate the diaphragm during inspiration

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5
Q

internal intercostals _________ the rib cage to assist with _____

A

internal intercostals depress the rib cage to assist with expiration

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6
Q

what nerve innervates the diaphragm

A

phrenic nerve

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7
Q

Right lung, # of lobes

A

3

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8
Q

left lung, # of lobes

A

2

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9
Q

Air transportation system

A

Trachea–> R&L primary bronchi –> secondary bronchi –> alveoli

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10
Q

what happens during diaphragm contraction

A

dome flattens, increases volume of thorax, causes inspiration

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11
Q

flow of blood

A
deoxygenated blood 
to right atrium 
to tricuspid valve 
to right ventricle 
to pulmonary valve 
to pulmonary artery & lungs 
to pulmonary vein 
to left atrium 
to mitral valve 
to left ventricle 
to aortic valve to aorta
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12
Q

thymus function

A

produces lymphocytes, which migrate to other lymphatic tissue to respond to foreign substances

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13
Q

kidneys (location, function)

A

slightly above iliac crest (T12-L3)

fx: filter metabolic wastes, ions, drugs from blood and expels via urination

contains adrenal glands on top

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14
Q

adrenal glands

A

secrete epinephrine, norepinephrine, cortisol, estrogen, aldosterone, androgen

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15
Q

ureters and urinary bladder (location)

A

bladder lies posterior to pubic symphysis

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16
Q

liver (location and functions)

A

upper right quadrant, 2 major right and left lobes

digestive and excretory functions, absorbs and stores excessive glucose, processes nutrients, detoxifies harmful chemicals, secretes bile (neutralize and dilute stomach acid & digest fat)

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17
Q

gallbladder (location and function)

A

inferior surface of liver

stores bile

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18
Q

pancreas (location and function)

A

located between small intestine and spleen

secretes pancreatic juice (critical in digestion), produces insulin and glucagon

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19
Q

stomach location

A

upper left quadrant

makes chyme

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20
Q

small intestine

A

duodenum to jejunum to ileum

digestion and absorption

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21
Q

large intestine

A

cecum to colon to rectum

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22
Q

appendix

A

extends off of cecum

it is where chyme is converted to feces

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23
Q

spleen

A

upper left quadrant, below diaphragm

lymphatic organ

resevoir for RBC’s, regulates # of RBC’s in circulation, destroys ineffective cells, produces antibodies and lymphocytes

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24
Q

prevention of injuries to thorax and abdomen

A

protective equipment,
strengthen core
empty hollow organs prior to practice

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25
Q

important questions to ask in a history

A

difficulty breathing? blood in urine? difficulty or pain with urination?

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26
Q

observations you should notice

A

breathing, symmetry of chest movement, swelling, deformity, cyanotic, guarding ab muscles, lowered BP, rapid weak pulse

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27
Q

Upper Right Quadrant

A

liver, pancreas, kidney, lung

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28
Q

Upper Left Quadrant

A

heart, spleen, kidney, stomach, lung

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29
Q

Lower Right

A

Appendix, ureter, bladder, colon, gonads

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30
Q

Lower Left

A

ureter, bladder, colon, gonads

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31
Q

bleeding or irritation inside abdomen cavity causes

A

board like rigidity in the abdomen, not voluntarily relaxable

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32
Q

cardiac/lung/splenic refers pain

A

left shoulder

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33
Q

diaphragmatic pain refers to

A

shoulders

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34
Q

liver/gallbladder refers pain to pain

A

right shoulder, upper left quadrant

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35
Q

appendix refers pan to

A

McBurney’s point

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36
Q

S1-S2 (heart)

A

systole (blood to body/lungs)

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37
Q

S2-S1 (heart)

A

diastole (filling of heart)

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38
Q

S1 (heart)

A

closing of atrioventricular valves (mitral and tricuspid)

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39
Q

S2 (heart)

A

closing of semilunar valves (aortic & pulmonic)

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40
Q

Aortic valve (where is it located)

A

2-ICS, RSB

2nd intercostal space, right sternal border

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41
Q

tricuspid

A

LLSB

lower left sternal border

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42
Q

Pulmonic valve

A

2ICS, LSB

2nd intercostal space, left sternal border

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43
Q

mitral

A

cardiac apex
5ICS, LSB

5th intercostal space, left sternal border

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44
Q

blood flow

A
body tissues
superior/inferior vena cava
right atrium
tricuspid valve
right ventricle
pulmonary semilunar valves
pulmonary trunk
pulmonary arteries
lung tissue
pulmonary veins
left atrium
bicuspid valve
left ventricle
aortic semilunar valves
aorta 
-body tissues-->vena cava
-(coronary arteries-->heart tissue, coronary sinus cardiac veins, right atrium)
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45
Q

Cheyne-Stokes

A

rate speeds up and then slows down over a 1-3 minute period

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46
Q

Biots

A

a series of breaths at a normal rate are followed by a complete cessation of breathing

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47
Q

Apneustic

A

pauses in the respiratory cycle at full inspiration

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48
Q

thoracic

A

occurs without diaphragmatic breathing

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49
Q

wheezes/rhonchi

A

continuous music-like sounds with a high pitch

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50
Q

rales

A

crackling/bubbly sounds

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51
Q

positions for auscultation of lower lung lobes

A

bottom 3/4 of posterior fields

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52
Q

positions for auscultation for left axilla

A

lingula

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53
Q

positions for auscultation for right axilla

A

right middle lobe

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54
Q

positions for auscultation upper lobes

A

anterior chest and top 1/4 of posterior fields

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55
Q

normal bowel sounds

A

liquid like gurgling sounds created by peristaltic actions

about 8 gurgles per minute

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56
Q

absent or diminished bowel sounds

A

paralytic lieus or peritonitis, swelling

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57
Q

high pitched tinkling bowel sounds

A

intestinal obstruction

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58
Q

Rib contusion etiology

A

blow to ribcage may contuse intercostal muscles or produce a fracture. Breathing is very painful

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59
Q

rib contusion s/sx

A

sharp pain during breathing, point tenderness and pain elicited when rib cage is compressed

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60
Q

rib contusion management

A

rule out fx (x-ray), RICE and anti-inflammatory agents

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61
Q

Rib Fx etiology

A

direct blow, violent muscle contractions, compression of ribcage,
most common: ribs 5-9

stress fx: repeated arm movements/ coughing/laughing

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62
Q

flail chest

A

fracture 3+ consecutive ribs on the same side

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63
Q

rib fx s/sx

A

pn w/ breathing, point tender, crepitus w/ palpation

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64
Q

rib fx management

A

x-ray, rest, bracing or ace wrap,

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65
Q

hypostatic pneumonia

A

occurs when an individual does not take full inspiration because of pain

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66
Q

costochondral separation & dislocation etiology

A

direct blow to anterolateral aspect of thorax or indirectly sudden twist or fall on a ball that compresses the rib cage

pn is localized in junction of rib cartilage and rib

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67
Q

costochondral separation s/sx

A

sharp pain, hard to breathe, point tender, swelling, rib deformity, crepitus

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68
Q

costochondral separation/dislocation management

A

rest and immobilization (healing takes 1-2 months)

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69
Q

sternum fx etiology

A

high-impact blow to the chest (more likely to occur in car accidents than athletics)

may also cause contusion to the underlying cardiac muscle

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70
Q

sternum s/sx

A

point tender at site of fx, exacerbated by deep inspiration or forceful expiration.

signs of shock, weak rapid pulse, could indicate internal injury

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71
Q

sternum management

A

x-rays, monitor for signs of heart trauma

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72
Q

muscle injury etiology

A

direct blows, sudden torsion

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73
Q

muscle injury s/sx

A

pain w/ active motion, pain during breathing, laughing, coughing, or sneezing

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74
Q

muscle injury management

A

apply cold, immobilize

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75
Q

Breast injury etiology

A

violent up and down lateral movements of the breasts can bruise or strain them

stretch cooper’s ligaments

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76
Q

Runner’s nipples

A

shirt causes abrasion when running

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77
Q

bicyclist’s nipples

A

combination of cole and evaporation of sweat

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78
Q

breast injury management

A

wear a sports bra

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79
Q

breast cancer

A

self examinations every month

clinical exams every 3 years

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80
Q

pneumothorax

A

pleural cavity becomes filled with air that has entered through an opening in the chest

may cause pain, difficulty breathing, anoxia

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81
Q

anoxia

A

absence of oxygen

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82
Q

tension pneumothorax

A

pleural sac on one side fills with air and displaces the lung and the heart toward the opposite side, which compresses the opposite lung.

SOB, chest pain on one side of the injury, absence of breath sounds, cyanosis, distention of the neck veins, deviated trachea, total lung collapse

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83
Q

hemothorax

A

presence of blood within pleural cavity

caused by tearing or puncturing

pain, difficulty breathing, cyanosis, violent blow/compression,

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84
Q

traumatic asphyxia

A

violent blow/compression of the rib cage

causes cessation of breathing

s/sx: purple discoloration of upper trunk/head, bright red eye color, mouth-to-mouth resuscitation and medical attention

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85
Q

hyperventilation etiology

A

rapid rate of ventilation due to anxiety-induced stress or asthma

causes decreased CO2 in blood

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86
Q

hypcapnia

A

decreased CO2 in the blood

87
Q

Hyperventilation S/sx

A

struggling to breathe

88
Q

hyperventilation management

A

help them concentrate on breathing in and out

DO NOT BREATHE IN A PAPER BAG

89
Q

heart contusion etiology

A

heart is compressed between sternum and spine by strong outside force

90
Q

heart contusion s/sx

A

severe shock and heart pain possibly arrhythmias that cause a decrease cardiac output - can be followed by death

91
Q

heart contusion management

A

hopsital ER, CPR, treat for shock

92
Q

Sudden Death Syndrome in Athletes

A

most common cause is a type of congenital heart disease

93
Q

Hypertrophic cardiomyopathy

A

thickened cardiac muscle with no chamber enlargement and extensive myocardial scarring

causes increased ventricular arrhythmia

94
Q

Anomalous origin of the coronary artery

A

one of the arteries originates in an unusual spot, causing flow complications

95
Q

Marfan’s Syndrome

A

abnormality of CT that results in weakening of the structure of the aorta and cardiac valves

can lead to rupture

96
Q

mitral valve prolapse associated with

A

HCM, and Marfan’s

97
Q

Coronary Artery Disease

A

atherosclerosis

narrowing of the artery due to hypercholesterolemia

98
Q

Right Ventricular Dysplasia

A

enlargement of the right ventricle causes a disturbance in heart beat

99
Q

Cardiac Conduction System Abnormalities

A

may result from abnormalities of sinus or AV nodes

100
Q

Aortic Stenosis

A

usually associated with a heart murmur

can cause a fall in BP and cardiac collapse during exercise

could also be caused by: drugs, vascular event, head trauma, obstructive respiratory disease

101
Q

Sudden Death Syndrome in Athletes s/sx

A

no sx before death,

cardiac conditions: pain, heart palpitations, syncope, nausea, sweating, heart murmurs, SOB, malice, fever

102
Q

Sudden Death Syndrome in Athletes prevention

A

counseling, screening, early identification, diagnostic test have found to be ineffective

103
Q

Commotio Cordis Etiology

A

Cardiac arrest caused by blunt impact to chest

young athletes at risk

depolarization phase - 15-30 sec prior to the peak of the T-wave

104
Q

Commotio Cordis s/sx

A

ventricular fibrillation
immediate death - 50%
collapsing

105
Q

Commotio cordis management

A

resuscitation of the, CPR, AED

106
Q

Kidney contusion etiology

A

external force

107
Q

kidney contusion s/sx

A

signs of shock, nausea, vomiting, rigidity of black muscles, hematuria

108
Q

kidney contusion management

A

hospital observation, gradual increase of fluid intake,

controllable contusion - 2 weeks of bed rest w/ close surveillance

109
Q

kidney stones

A

crystalline mineral salts (calcium, phosphate, uric acid) in the urinary tract

110
Q

Ureters, Bladder and Urethra contusions etiology

A

only occurs if it is distended by urine.

111
Q

hematuria

A

usually seen with running

“runner’s bladder”

112
Q

Proteinuria

A

abnormal concentrations of protein in urine.

113
Q

Ureters, bladder, and urethra contusion s/sx

A

pain/discomfort, rigidity, nausea, vomiting, signs of shock

114
Q

kidney injury s/sx

A

blood coming from urethra and passing of a great quantity of bloody ruine

115
Q

Bladder contusion refers pain

A

to lower trunk (upper thigh)

116
Q

Cystitis

A

inflammation of the bladder (UTI).

acute cystitis (painful urination, chills, fever)

tx with antibiotics

117
Q

Urinary Tract Infection

A

caused by staphylococcus bacteria or chlamydia

118
Q

UTI s/sx

A

frequent, burning, painful urination

tx w/ antibiotix

119
Q

Preventing UTI

A

fluid intake, sanitary habits,

120
Q

Urethritis

A

inflammation of the urethra, caused by gonorrhea or non-gonococcal organisms.

s/sx: include pain on urination along with urethral discharge

tx w/ antibiotics

121
Q

GI Bleeding

A

bloody stools;

caused by: gastritis, iron-deficiency anemia, ingestion of aspirin, stress, bowel irrigation, colitis

122
Q

colitis

A

inflammation of the colon caused by ulceration of the mucosal lining of the colon

123
Q

colitis s/sx

A

abdominal pain w/ colic, watery stools that contain pus

dehydration, intermittent fever, and possible hemorrhage and perforation

124
Q

liver contusion etiology

A

hard blow to the right side of the rib cage

can cause tear or contusion (esp if enlarged)

125
Q

hepatitis

A

inflammation of the liver due to viral infection or alcohol consumption

can lead to cirrhosis

126
Q

liver contusion s/sx

A

hemorrhage and shock

127
Q

liver contusion refers pain to

A

pain below right scapula, right shoulder, and substernal area

sometimes to left side of the chest

immediately refer to physician

128
Q

Pancreatitis etiology

A

may be acute or chronic and often related to blockage of pancreatic duct

129
Q

acute pancreatitis s/sx

A

necrosis, suppuration, gangrene, hemorrhage

130
Q

suppuration

A

undergo the formation of pus

131
Q

chronic pancreatitis s/sx

A

jaundice, diarrhea, mild to moderate pain that radiates to the back

132
Q

acute pancreatitis management

A

rehydrate, reduce pain, tx for shock, medication, prevention of secondary infection; surgery if duct is blocked

133
Q

chronic pancreatitis management

A

difficult to manage; large doses of analgesics, administer pancreatic enzymes, low fat diet

134
Q

Dyspepsia

A

indigestion

135
Q

dyspepsia etiology

A

digestive upset, emotional stress, esophageal and stomach spasms, inflammation of mucosal lining of the esophagus or stomach

136
Q

dyspepsia s/sx

A

increased secretion of HCl, nausea, flatulence

137
Q

dyspepsia management

A

eliminate certain foods, avoid stressors,

138
Q

management of vomiting

A

drink fluids to prevent dehydration, anti nausea medications

139
Q

gastroenteritis

A

food poisoning

140
Q

food poisoning etiology

A

infectious organisms from food or drink

141
Q

food poisoning s/sx

A

nausea, vomiting, cramps, diarrhea, anorexia

142
Q

staph infections can last

A

3-6 hours

143
Q

salmonella infections may last

A

24-48 hours

144
Q

food poisoning management

A

fluid replacement, electrolyte replacement, may need an IV, bed rest,

foods: clear strained broth, bouillon, soft cooked eggs, bland cereals may be given

145
Q

peptic ulcer etiology

A

acids secreted in the stomach destroy mucous lining (stomach or small intestine); often occur in those people who experience extreme anxiety for a long period of time

146
Q

peptic ulcer s/sx

A

gnawing pain in the epigastric region (1-3 hours after a meal)

Dyspepsia, heartburn, nausea, vomiting

pain lasts minutes not hours

147
Q

peptic ulcer managment

A

antacids can help neutralize gastric secretions

surgery

148
Q

Gastroesophageal Reflux

A

backward flow of acidic gastric contents into the esophagus

malfunction of lower esophageal sphincter

may cause inflammation

149
Q

Gastroesophageal Reflux s/sx

A

heartburn, retrosternal pain, can progress to gripping chest pain, burning feeling, sour liquid taste in throat

difficulty swallowing

150
Q

Gastroesophageal Reflux management

A

medication, surgery if medication does not help

151
Q

diarrhea etiology

A

abnormal stool looseness or passage of a fluid, unformed stool

problems in diet, inflammation of intestinal lining, GI infection, ingestion of certain drugs

152
Q

diarrhea s/sx

A

abdominal cramps, nausea, vomiting, frequent elimination of stools (3-20/day), loss of appetite, light brown/gray foul smelling stool;

weakness due to dehydrations

153
Q

Constipation etiology

A

lack of abdominal muscle tone, insufficient moisture in the feces, not enough fiber, poor bowel habits, nervousness

154
Q

constipation s/sx

A

feeling of fullness, cramping or pain in lower abdomen, straining to defecate, may rupture vessel and cause anal bleeding

155
Q

constipation management

A

eat cereals, fruits, vegetables, fats

determine cause of emotional stress

avoid laxatives

156
Q

IBS

A

Irritable Bowel Syndrome

157
Q

IBS etiology

A

psychological factors often determine how the individual experiences and handles the condition

158
Q

IBS s/sx

A

abdominal pain relieved with defecation, alteration in stool frequency, form, passage; passage of mucus and abdominal bloating and distention

159
Q

IBS management

A

modify diet, antidiarrheal or antispasmodic meds, psychological counseling

160
Q

appendicitis etiology

A

can be chronic or acute
caused by fecal obstruction, lymph swelling, cardioid tumor

often occurs in males age 15-25

could rupture and cause peritonitis

161
Q

appendicitis s/sx

A

mild to severe pain in the lower abdomen, nausea, vomiting, low grade fever

rigidity at McBurney’s point,

162
Q

appendicitis management

A

surgical removal

163
Q

hemorrhoids etiology

A

varicosities of the hemorrhoidal venous plexus of the anus

chronic constipation or straining may stretch anal veins resulting in protrusions and bleeding or a thrombus

164
Q

hemorrhoids s/sx

A

painful nodular swelling swear the sphincter of the anus; slight bleeding and itching;

self limiting will healing 2-3 weeks

165
Q

hemorrhoids management

A

palliative and serves to eliminate discomfort until healing occurs

166
Q

scrotal contusion etiology

A

very painful, nauseating, disabling condition

167
Q

scrotal contusion s/sx

A

hemorrhage, fluid effusion, muscle spasm

168
Q

scotal contusion management

A

reduce testicular spasm by having athlete in a seated position, apply cold pack

169
Q

spermatic cord torsion etiology

A

results from the testicle’s revolving in the scrotum after a direct blow; or from coughing or vomiting

170
Q

spermatic cord torsion s/sx

A

acute testicular pain, nausea, vomiting, inflammation

171
Q

spermatic cord torsion management

A

immediate medical attention (could cause atrophy of testicle)

172
Q

Traumatic Hydrocele of the Tunica Vaginalis etiology

A

excessive fluid accumulation caused by a severe blow to the testicluar region; venous plexus on posterior aspect of testicle can become engorged, creating a varicocele; rupture of venous plexus results in accumulation of blood in scrotum (hematocele)

173
Q

Traumatic Hydrocele of the Tunica Vaginalis s/sx

A

pain, swelling in the scrotum

174
Q

Traumatic Hydrocele of the Tunica Vaginalis management

A

cold packs applied to scrotum, refer to physician

175
Q

Vaginitis etiology

A

inflammation caused by microorganisms; non STI causes include bacterial infections, strong chemicals from douching, irritation from tampon, poor hygiene habits

176
Q

Vaginitis s/sx

A

purulent, bloody, vaginal discharge. Strong odor with itching. frequent urination (painful), vagina is red and painful to touch

177
Q

vaginitis management

A

STI: antibiotic/antifungal meds

educate about correct hygiene and cleanliness

178
Q

Spleen Injury etiology

A

due to fall or direct blow on spleen,

mono will cause the spleen to enlarge

179
Q

spleen injury s/sx

A

shock, abdominal rigidity, nausea, voming

180
Q

spleen injury management

A

conservative, non-op tx w/ a week of hospitalization.

full return at 4 weeks

surgery: 3 months recovery
removal: 6 months recovery

181
Q

Abdominal Muscle strains MOI

A

sudden twisting of trunk or reaching overhead;

causes severe pain or hematoma formation

182
Q

Abdominal wall contusion etiology

A

common in collision sports; catchers/goalies

183
Q

abdominal wall contusion s/sx

A

hematoma, pressure causing pain and tightness

184
Q

abdominal wall contusion management

A

cold pack, ace wrap,

check for signs of internal injury

185
Q

Hernia etiology

A

portrusion of abdominal viscera through a portion of the abdominal wall

186
Q

inguinal hernia

A

most common in males

187
Q

femoral hernia

A

most common in females

188
Q

hernia s/sx

A

natural weakness aggravated by either strain or a direct blow

pain and prolonged discomfort, superficial protrusion in groin area, pain increased with coughing, feel weak and pulling sensation in groin area

189
Q

hernia management

A

surgery

190
Q

blow to solar plexus etiology

A

transitory paralysis of the diaphragm “wind knocked out”

191
Q

blow to solar plexus s/sx

A

stops respiration and leads to anoxia, athlete is unable to inhale- may cause hysteria

192
Q

blow to solar plexus management

A

loosen nothing, talk to athlete, bend athletes knees, encourage them o relax by initiating short inspirations and long expirations

193
Q

stitch in side etiology

A

constipations, gas, overeating, spasm of diaphragm, poor conditioning, weak abdominal muscles, distended spleen, breathing issue

194
Q

stitch in side s/sx

A

cramp like pain that develops on either left or right costal angle during hard physical activity

195
Q

management

A

relaxation of spasm

stretch arm on affected side or flex trunk forward while tightening abdominal muscles

196
Q

hypochondriac region

A
below cartilage (ribs-costocartilage)
R and L
197
Q

epigastric region

A

between hypochondriac regions

198
Q

lumbar region

A

middle L and R

above iliac crests

199
Q

umbilical region

A

middle section, over umbilicus

200
Q

iliac region

A

L and R on top of iliac crests

201
Q

hypogastric

A

below umbilicus

202
Q

accelerated pulse is described as

A

> 150 bpm, casuses pressure on the base of the brain and shock

203
Q

bounding pulse

A

pulse that quickly reaches a higher intensity than normal then quickly disappears

causes: ventricular systole and reduced peripheral pressure

204
Q

deficit pulse

A

pulse in which the number of beats counted at the radial pulse is less than that counted over the heart itself

cardiac arrhythmia

205
Q

high tension pulse

A

force of the beat is increases; increased amount of pressure is required to inhibit the radial pulse

cerebral trauma

206
Q

low tension pulse

A

short, fast, faint pulse having rapid decline

heart failure; shock

207
Q

rate of fewer than 10 breaths per minute

A

bradypnea

208
Q

rate of more than 30 breaths per minute

A

tachypnea

209
Q

labored breathing

A

dyspnea

210
Q

explain the electrical wiring of the heart

A

signal starts at SA node - triggers atriums to contract, travels to AV node, triggers the ventricles to contract, signal runs through bundle of His to Purkinje fibers.

211
Q

P wave

A

represents atria contracting to pump blood into ventricles

212
Q

QRS complex

A

The QRS complex represents ventricular depolarization and contraction

213
Q

T wave

A

is normally a modest upwards waveform representing ventricular repolarization