exam 2 Flashcards
Understand the names, functions and assessments of the following cranial nerves: CN III
CN III - oculomotor nerve - controls most eye movement. Motor function to elevate the eye, depress the eye, adduct the eye, elevate and abduct the eye, helps to constrict the pupils, and helps with eye accommodation. Also serves parasympathetic functions like pupil constriction and lens accommodation. You can assess it by testing for pupillary response (direct light reflex and accommodation reflex), asking the client to follow your eye movement, looking for drooping of the eyes.
Understand the names, functions and assessments of the following cranial nerves: CN IV
CN IV - trochlear nerve -> the smallest nerve and has primarily motor function. Downward and lateral movement of the eye, depression of the eye. Can assess it by checking for double vision, check eye movement by asking them to follow your fingers (look for abduction and adduction), look for a presence of a head tilt, look for presence of a vertical deviation (misalignment of the eyes)
Understand the names, functions and assessments of the following cranial nerves: CN V
CN V - trigeminal nerve -> the largest cranial nerve and has sensory and motor functions. Sensory - the ophthalmic branch (forehead, scalp, upper eyelid, and cornea), the maxillary branch (cheeks, upper lip, nasal cavity, upper teeth), mandibular branch (sensation from the lower lip, chin, jaw, and lower teeth). Motor function -> controls chewing; masseter, temporalis, medial pterygoid, lateral pterygoid. Can assess by light touches testing for sensation, a gentle pinprick checking for sensation, checking temperature sensation, checking the corneal reflexes. For testing motor reflexes test jaw movement, jaw opening, and jaw reflexes.
Understand the names, functions and assessments of the following cranial nerves: CN VI
CN VI - abducens nerve -> primarily a motor function nerve. Controls the lateral rectus muscle of the eye, and is responsible for abduction. Can be tested by testing lateral eye movement, if the eye turns inward, if the person experiences double vision.
Understand the names, functions and assessments of the following cranial nerves: CN XI
CN XI - accessory nerve -> controls specific muscles involved in head and shoulder movement. Contributes to motor innervation of the larynx, pharynx, and soft palate with help from the vagus nerve. Helps with motor innervation of the sternocleidomastoid and the trapezius
What hormones are secreted by the thyroid gland?
T4 -> thyroxine which is the main hormone secreted by the thyroid gland, crucial in regulating metabolism, growth, and development.
T3 -> triiodothyronine which helps regulate metabolism, increases the rate of cellular processes, and affects the cardiovascular and nervous system.
What is the difference in assessment findings between the different types of headaches?
o Cluster
occurring in cyclical “clusters” with periods of remission in between
- typically characterized by an extremely severe, stabbing pain usually around one eye and is typically the most intense type of headache. Cluster headaches may include watery eyes, nasal congestion, and restlessness. They tend to to occur in short but intense bursts of time lasting for a few hours
What is the difference in assessment findings between the different types of headaches?
o Migraine
o Migraine - unilateral, pulsating pain on one side of the head, moderate to severe intensity, aggravated by physical activity, accompanied by nausea, vomiting, sensitivity to light (photophobia), and sound (phonophobia), and may also present with prodromal symptoms like mood changes, fatigue, or food cravings before the headache onset;
- tend to last several hours to several days
What is the difference in assessment findings between the different types of headaches?
o Tension
o Tension - bilateral, pressing or tightening pain around the head, often described as a band-like sensation, mild to moderate intensity, tenderness in the scalp and neck muscles upon palpation, the pain may be located in the forehead, temples, or back of the head, and is usually not worsened by physical activity
- tend to last for a long period of time but are not typically very severe
What is meningitis? What are the characteristic findings of meningitis?
Meningitis is an inflammation of the membranes that surround the brain and the spinal cord.
Some symptoms include fever, chills, vomiting, headache and sensitivity to light, stiff neck, confusion and altered mental status, rash, limb pain, pale skin, cold hands and feet. Some causes can be fungal infections, viral infections, bacterial infections, parasites, injuries, cancers, certain drugs
What is the temporomandibular joint? How would you assess it on a patient?
This is the point that connects the lower jaw to the temporal bone of the skull, which is located in front of the ear. To assess it you would palpate the joint area while having the patient perform jaw movements and listening for clicking or popping sounds. You should also be checking for tenderness or pain, along with assessing range of motion.
- is inferior to the temporal artery and next to the ear
What is a bruit? In what two areas/circumstances (that we have discussed in class) might you auscultate for one? (think neck/vascular assessment) How do you auscultate for one in each of these areas?
Bruit is a whooshing sound that is heard with a stethoscope, it indicates that there is turbulent blood flow within an artery, and most likely a partial obstruction or narrowing of a vessel.
In a clinical setting you would typically assess these in the neck on the carotid arteries and in the abdomen over the aorta, these are looking for potential carotid issues, and a possible aneurysm respectively.
For the carotid, have the person turn their head away from you and place the bell side of the stethoscope over the carotid listening while they hold their breath. For aorta, have them lay in a supine position and place the bell of the stethoscope moving from the epigastric to the umbilic region.
What’re the differences between Bell’s Palsy and a Cerebrovascular Accident (CVA/Stroke)?
Bell’s Palsy is usually weakness or paralysis of one side of the face and is typically caused by inflammation of the facial nerve. Can cause drooping, weakness, or paralysis of one side of the face.
A stroke is typically caused by disruption of blood flow to the brain, often due to a blood clot or bleeding. Can affect one of both sides of the face, can cause weakness, numbness, or paralysis in the face, arm or leg. Stroke is an emergency
What is the correct technique to assess lymph nodes in the head/neck? What’re normal vs abnormal findings with lymph nodes?
To assess lymph nodes in the head and neck, use gentle, circular motions with your fingertips to palpate along the predictable drainage pathways, comparing both sides simultaneously, noting size, consistency, mobility, and tenderness; normal lymph nodes are small, moveable, and not palpable, while abnormal findings include enlarged, firm, fixed nodes, or noticeable asymmetry between sides
what does PERRLA stand for
PERRLA -> pupils equal, round, reacting to light, and accommodating
the types of light reflex tests
Direct light reflex - darken the room and ask them to gaze into the distance to let the pupils dilate, advance a light in from the side and note the response. Normally there will be a constriction of the same-sided pupil, and simultaneous constriction of the other pupil.
Consensual light reflex -> The consensual light reflex is the automatic constriction of the pupil in the eye opposite the one that’s being directly stimulated by light. This reflex helps protect the retina from bright light. Consensual is tested the same way as direct, but is specifically looking at what the other eye will do.
how to interpret a snellen eye chart
A “20/40” result on a Snellen eye chart means that you can see at 20 feet what a person with normal vision can see at 40 feet away; essentially, your vision is slightly less sharp than “normal” vision (20/20), requiring you to be closer to an object to see it clearly compared to someone with typical eyesight.
how to explain the snellen eye chart results to a patient
“Your vision is currently measured as 20/40, which means that you can see at 20 feet what most people can see from 40 feet away.”
“This indicates slightly reduced visual acuity, so you may need corrective lenses to improve your vision.”
“Think of it like this: if you are standing 20 feet away from the eye chart, you can read the same line that someone with normal vision could read if they were standing 40 feet away”
What is another name for ear wax and what purpose does it serve?
Cerumen - Cerumen, also known as earwax, serves the purpose of protecting and lubricating the ear canal by trapping dust, dirt, and bacteria, preventing them from reaching the eardrum, while also acting as a barrier against water and creating an acidic environment that inhibits the growth of harmful microorganisms.
What is the difference between the techniques in assessing an adult’s ear vs a child?
Adults have an S shaped canal so you have to pull the pinna up and back, for infants and children under 3 you must pull the pinna down. Make sure to hold the pinna gently but also firmly and make sure the head is slightly tilted away from you
What are normal assessment findings of the ear when using an otoscope?
The ear canal should be skin-colored but will likely have some hairs and a little cerumen. The eardrum should be a light-gray or pearly-white color and translucent and flat. The eardrum should move in and out. There should be light that reflects off of the eardrum
What might different types of drainage from the ear indicate?
Bright-red blood or watery drainage following a trauma can indicate a fracture to the base of the skull. Redness, edema, purulent, or crusty drainage of the ear canal can indicate an infection. Discharge that is yellow, green, or has dried to a crust can indicate an infection or the presence of a foreign body.
When assessing an older adult, what changes would be expected regarding their ears or nose?
May start to see age related hearing loss which is referred to as presbycusis, may decline in ability to hear high-frequency sounds.
With the nose you may see loss in elasticity, loss of collagen, decrease in bone density, change in appearance of the nose, loss of ability to smell.
Technique for trying to control epistaxis (nosebleed)?
The best way to stop a nosebleed is to sit up, lean forward, and pinch the nose
apply direct pressure by pinching the soft part of your nose between your thumb and index finger while leaning slightly forward, breathing through your mouth, and maintaining pressure for at least 10 minutes
Proper technique and precautions when inspecting the inside of the nose with a speculum/otoscope?
Observe the color, consistency, and odor of any nasal drainage that is present. Ensure you do not touch any part of the inside of the nose because it is covered with sensitive mucosa and is highly vascular
sinusitis
Sinusitis is an inflammation of the sinuses, which are air-filled pockets in your face. It can cause pain and pressure in your face, difficulty
Symptoms of sinusitis include facial pain or pressure, nasal congestion, headaches, post-nasal drip, cough, fatigue, sometimes a fever. A healthcare provider can diagnose sinusitis based on symptoms and a physical exam. They may also perform an exam inside the nose with a thin, flexible tube called an endoscope
allergic rhinitis
Allergic rhinitis: is caused by allergies to substances like allergens.
Seasonal allergic rhinitis: when people who have seasonal allergies experience an influx. They do not get a fever and do not have to be exposed to hay like you would to get hay fever.
acute rhinitis
can be caused by:
Viral infections: Common cold, influenza
Allergic reactions: Pollen, dust mites, pet dander
Irritants: Smoke, chemicals, spicy foods
Hormonal changes: Pregnancy, menstruation
candidiasis
A distinctive rash or thick white pasty residue. Most will appear as a white , almost cheesy patches in the mouth. Common after chemotherapy, is an opportunistic infection that occurs after antibiotic and corticosteroid use and in immunosuppressed individuals.
also known as thrush
deep fissures in the tongue
Often from dehydration, people with Down Syndrome will also often have this.
What does GAS stand for when discussing abnormalities of the throat?
Group A Streptococcus (strep)
What are assessment findings associated with this abnormality?
Fever of 100.4 or higher, absence of a cough, tonsillar exudates, and cervical adenopathy.
How is someone tested for strep?
Confirm with a rapid antigen test and a throat culture
What might develop if strep goes untreated?
Untreated will has the possibility of causing tonsillar abscess, rheumatic fever, and glomerulonephritis.
where is the base versus the apex of the heart?
The base of the heart is located at the top, towards the back of the heart, primarily formed by the atria, while the apex is the pointed tip at the bottom of the heart, usually situated on the left side and pointing downwards and slightly forward
- the apex points slightly to the left
How/where do you assess the apical impulse?
To assess the apical impulse, also known as the point of maximal impulse (PMI), you locate the fifth intercostal space at the left midclavicular line on the chest, using a stethoscope to listen for the heart’s strongest beat at that point; this is typically done with the patient in a sitting or lying position, allowing you to best feel the apex of the heart with your fingertips or the stethoscope diaphragm.
What are the anatomical locations of the four valves of the heart?
Tricuspid valve: Located between the right atrium and the right ventricle. Pulmonary valve: Located between the right ventricle and the pulmonary artery. Mitral valve: Located between the left atrium and the left ventricle. Aortic valve: Located between the left ventricle and the aorta
How are the locations of the valves related to the auscultatory areas of the heart?
The auscultatory areas of the heart correspond directly to the anatomical positions of the heart valves, meaning that the best place to listen for each valve’s sound on the chest is the area directly over where that valve is located within the heart; for example, the aortic valve is best heard at the second right intercostal space near the sternum, while the mitral valve is best heard at the fifth intercostal space at the midclavicular line
Aortic is second right, and pulmonary is second left. Tricuspid is fourth left and mitral is fifth left
What’s the technique for auscultating the heart sounds?
Have the patient sit up or lie down at a 45-degree angle. Place the stethoscope’s diaphragm firmly against the chest wall. Start at the aortic area (upper right sternal edge). Listen for the “lub-dub” sounds of S1 and S2. Listen for the rhythm of the heart. Listen for murmurs
What is automaticity and why is it important?
In the cardiovascular system, “automaticity” refers to the inherent ability of certain cardiac cells, primarily located in the sinoatrial (SA) node, to spontaneously generate electrical impulses, essentially acting as the heart’s natural pacemaker, allowing it to rhythmically contract and pump blood without external stimulation; this is crucial because it enables the heart to maintain a regular heartbeat and effectively circulate blood throughout the body
What increases the risk of someone developing cardiovascular disease (heart disease)? What race/ethnicities are at increased risk?
Factors that increase the risk of cardiovascular disease include high blood pressure, unhealthy cholesterol levels, diabetes, obesity, smoking, physical inactivity, family history of heart disease, and older age; African Americans, Hispanic/Latino individuals, and some Asian American groups are considered to be at a higher risk due to a combination of genetic, environmental, and social factors, often experiencing higher rates of hypertension, diabetes, and obesity compared to other racial group
Hypertension, smoking and tobacco, elevated cholesterol, type 2 diabetes, nutrition and diet, exercise and physical activity, being overweight or obese.
Signs and symptoms of heart failure:
shortness of breath, extreme fatigue, swelling and weight gain (especially sudden), persistent cough, confusion or memory problems, dizziness or lightheadedness
signs and symptoms of a heart attack
Signs and symptoms of heart attack: chest pain (persistent, pressure, tightness, or squeezing), pain that may spread to the left side (arm, shoulder, neck, etc), shortness of breath (typically sudden and unexpected), lightheadedness, cold sweats, indigestion.
some causes of heart failure
one or many heart attacks, coronary heart disease of heart disease in general, heart defects, consistent high blood pressure, valve diseases, bad life style
- essentially the heart weakens and cannot pump enough blood
some causes of a heart attack
coronary artery disease, blood clots, aortic dissections, spasms of arteries causing a blockage in blood flow
Difference between stable vs unstable angina? Examples?
Stable: predictable, usually short lasting, less serious, typically pain brought on by activity (pain from stress, exercise, cold weather)
Unstable: irregular, strong and may last a long time, more serious, typically does not stop with rest and may not be brought on by activity, typically tight or sharp chest pain (new-onset, at rest, worsening over time)
Unstable is typically inconsistent and unpredictable
stable angina is a less severe condition that usually occurs with exertion and can be managed with medication, while unstable angina is considered a more serious warning sign that could potentially lead to a heart attack and requires immediate medical attention
What is a “thrill”? How do you assess one? What might a thrill indicate?
A thrill is a palpable vibration. It often feels like the throat of a purring cat. It signifies turbulent blood flow and directs you to locate the origin of loud murmurs. To assess this you palpate feelings for a vibration or buzzing on the skin over the heart.
Special considerations related to pregnant women regarding their cardiovascular health?
Pregnant women should take special care of their cardiovascular health by eating well, exercising, managing weight, and avoiding harmful substances. They should also monitor for warning signs of problems
Eat a healthy diet, get regular physical activity, manage stress, get enough sleep, do not smoke, avoid alcohol, limit caffeine intake
How do we assess cranial nerve VIII
sensorineural tests
- weber and rinne, whisper test
angina pectoris
a transient imbalance between myocardial oxygen supply and demand (common symptom of coronary artery disease)
- left or substernal chest pain, lasts 3-5 minutes, activities worsen it, anxiety, weakness, sweating, SOB, and fatigue
- often seen as squeezing, pressure, heaviness, tightness, or pain in the chest. Can be sudden or reoccur over time.
Cardiovascular disease
Obesity
Stethoscope
Do not press firmly
Do not press too gently
