Exam 2 - Ch. 7, 9, 10, 11, 15, 16 Flashcards
Individual’s response to stress
Anxiety
Individual’s perception of and response to stressor
Stress
state of mind, relative to how a person is feeling
mood and affect
dependence on a substance
addiction
mental processing of information and decision making
cognition
state of impaired cognitive function
psychosis
functional ability is affected by
stress, mood and affect, addiction, cognition, anxiety, and psychosis
how is dopamine (DA) associated with mental illness
decreased in depression
increased in schizophrenia and mania
how is norepinephrine (NE) associated with mental illness
decreased in depression
increased in schizophrenia, mania, and anxiety
how is serotonin (5 HT) associated with mental illness
decreased in depression
increased in anxiety
how is histamine associated with mental illness
decreased in depression
Depression risk factors
gender (women are more likely to develop depression)
age - bad experience in childhood
substance abuse
genetics
psychosocial environment
low self-esteem
sexuality (being lesbian, gay, bisexual, or transgender)
medical history
anxiety risk factors
psychosocial environment
genetics
unrelieved stress
other mental health disorders
substance abuse
how to evaluate immediate recall (memory)
ask the patient to repeat the names of three unrelated objects that are spoken slowly (such as “dog”, “cloud”, and “apple”)
how to evaluate recent memory
give the patient short time to view 4-5 objects and explain you will ask about these objects
after about 10 minutes, ask the patient to name the objects - all objects should be remembered
how to evaluate remote memory
ask the patient about his or her mother’s maiden name, high school attended, or subject of common knowledge
alcohol use assessment
AUDIT - 10 questions
1 - 3 frequency and quantity
4 - 6 dependence
7 - 10 alcohol related problems
depression - abnormal indications in patient’s level on consciousness and appearance
slumped posture, slow movements
soiled clothing, lack of hygiene
speaking in monotone, slow, unexpressive speech patterns
decreased respiratory rate
anxiety - abnormal indications
tense muscles, fidgeting, pacing
elevated blood pressure
elevated heart rate
increased respiratory rate
impaired cognition - abnormal findings
shuffling, uncoordinated gait
outlandish dress and makeup
reduced consciousness - abnormal findings
disorientation to time, place, and person
confusion
sleepiness
lack of response to calling patient’s name, to touch, or pain
substance/alcohol use - abnormal findings
changes in pupil size
redness of sclera
glazing of cornea
watering eyes
drooping eyelids
abnormal movements (tremors)
soiled clothing or lack of hygiene may be a symptom of
depression or organic brain syndrome
other mental health abnormal findings
mania, crying, being withdrawn, rapid rate of speech, high-pitched voice, muscle tension, sweaty palms
Major depression clinical findings
depressed mood for at least 2 weeks + at least 5 of the following:
1) depressed mood most of the day
2) diminished interest in almost all activities
3) weight loss
4) psychomotor agitation
5) fatigue or loss of energy
6) feeling of worthlessness
7) decreased ability to think or concentrate
8) recurrent thoughts of death
9) suicide attempt or a specific plan to commit
Bipolar disorder clinical findings
recurrent episodes of depression and mania
manic phase - excessive emotional display, euphoria, hyperactivity, decreased ability to concentrate, decreased need for sleep
depressive phase - apathy, feeling of sadness, loneliness, guilt, low self esteem
Bipolar I disorder is defined by
manic episodes lasting at least 7 days or being severe enough to require hospitalization
depressive episodes lasting at least 2 weeks
Bipolar II disorder is defined by
pattern of depressive and hypomanic episodes (not full-blown manic episodes as seen in Bipolar I)
schizophrenia - clinical findings
3 categories (positive, negative, and cognitive symptoms)
positive - hallucinations, delusions, dysfunctional thinking, movement disorders (agitated body movement)
negative - flat affect, reduced feeling of pleasure, difficulty to begin and sustain activities, reduced speaking
cognitive - difficulty understanding information and using it to make decisions, difficulty paying attention, inability to use information right after learning it
generalized anxiety disorder - 4 levels
mild, moderate, severe, panic
generalized anxiety disorder MILD - clinical findings
heightened awareness to sensory stimuli - hearing more, seeing more, and thinking more logically
occurs in the normal experience of daily life
generalized anxiety disorder MODERATE - clinical findings
narrowed field of perception
selective inattention to ignore stimuli and focus on specific concern
generalized anxiety disorder SEVERE - clinical findings
reduced perception of stimuli
compulsive mechanisms to avoid anxiety provoking situation
impaired memory, attention, and concentration
difficulty solving problems
unable to focus on events in the environment
generalized anxiety disorder PANIC - clinical findings
complete disruption of perceptual field
intense terror, inability to think logically, or make decisions
Obsessive-compulsive disorder (OCD) clinical findings
fear of germs or contamination
unwanted thoughts about sex, religion, harm
aggressive toward self or others
excessive cleaning/handwashing
arranging things in particular way
compulsive counting
obsession - definition
thoughts, impulses, or images that persist or recur
compulsions - definition
ritualistic behaviors that individual feels driven to perform
PTSD clinical findings
start within 3 months of traumatic event
must have all of these of at least 1 month:
1) 1 re-experiencing symptom - flashbacks, bad dreams, or frightening thoughts
2) 1 avoidance symptom (staying away from places, events, or objects that are reminders of the experience)
3) 2 arousal and reactivity symptoms - being easily startled, feeling tense, on edge, problems sleeping
4) 2 cognitive/mood symptoms - trouble remembering key features of the event, negative thoughts, distorted feeling (guilt or blame), loss of interest in activities
Delirium vs dementia
delirium - disturbance in attention and awareness, develops over short period of time
dementia - chronic, progressive, failing memory, cognitive impairment, behavioral abnormality
Skin cancer - risk factors
personal history, family history,
older age
exposure to UV radiation
lifetime sun exposure
severe, blistering sunburns
indoor tanning
fair skin, blonde, or red hair
blue or green eyes
health promotion for those at risk of skin cancer
skin should be protected from sun exposure
applying sunscreen (15+)
wearing sunglasses
seeking shade
avoiding sunbathing and indoor tanning
cyanosis - appearance
light skin - grayish/blue tone
dark skin - ashen/gray tone
ecchymosis - appearance
bruise
light skin - dark red, purple, yellow, or green
dark skin - deeper bluish or black tone
erythema - appearance
light skin - reddish tone with raised temp + inflammation
dark skin - deeper brown or purple tone with raised temp + inflammation
jaundice - appearance
light skin - yellowish skin color
dark skin - yellowish/greenish skin color
pallor - appearance
light skin - pale/white skin color
dark skin - skin tone lighter than normal
petechiae - appearance
light skin - small reddish/purple pinpoints
dark skin - difficult to see, evident in buccal mucosa + eyes
rash - appearance
light skin - may be visualized and felt
dark skin - cannot be visualized, may be felt
scar - appearance
light skin - narrow scar line
dark skin - has keloid development
early signs of melanoma (ABCDE)
A - asymmetry
B - border
C - color
D - diameter
E - evolving
how is skin turgor assessed
used to test elasticity and dehydration of the skin: assessed by picking up and slightly pinching the skin
nails - clubbing
no space observed between fingers and the nail beds angle away from one another
base of the nail is enlarged and curved
nails - spooning
thinning of the nail
nails - leukonychia punctata
transverse white bands, result from repeated minor trauma to the nail matrix
skin - macule
flat, circumscribed area - freckles, flat moles
skin - papule
elevated firm, circumscribed area
wart
skin - plaque
elevated, firm, rough, flat
psoriasis, eczema
skin - wheal
elevated, irregular shaped area
insect bites
skin - nodule
elevated, firm, circumscribed, deep
melanoma
skin - tumor
elevated, solid, deep
neoplasms
skin - vesicle
elevated, circumscribed, superficial, filled with serous fluid
varicella (chicken pox)
skin - pustule
elevated, superficial, filled with purulent fluid
acne, folliculitis
skin - cyst
elevated, circumscribed, filled with liquid or semisolid material
cystic acne
skin - scale
flaky skin, keratinized cells
eczema, pityriasis rosea
skin - lichenification
rough, thickened epidermis
chronic dermatitis, psoriasis
skin - keloid
thin-to-thick fibrous tissue
healed wound, or surgical incision
skin - fissure
linear crack or break from epidermis to dermis
athlete’s foot, cracked skin
skin - crust
dried drainage or blood
scab on abrasions
skin - ulcer
loss of epidermis + dermis, concave
pressure injury, stasis ulcers
stages of pressure injuries
1) intact skin with non blanchable redness - may be painful, firm, soft, warm, cool
2) partial thickness, loss of dermis
3) full thickness skin loss involving damage or necrosis to subcutaneous tissue
4) full thickness loss with exposed bone, tendon, or muscle
unstageable pressure injury
full thickness tissue loss in which base of the wound is covered by slough
suspected deep tissue presure injury
localized area of discolored intact skin or blood-filled blister
atopic dermatitis vs contact dermatitis
atopic - chronic superficial inflammation of the skin with unknown cause
contact - inflammatory reaction of the skin that develops in response to irritant or allergens
herpes simples, herpes varicella, and herpes zoster
simplex - chronic, non curable condition transmitted by contact during outbreak
varicella (chicken pox) - viral infection that spreads by droplets
zoster (shingles) - acute inflammation by reactivation Herpes Varicella virus
psoriasis, candidiasis, and cellulitis
psoriasis - chronic skin disorder, inflammatory process causes lesions
candidiasis - fungal infection caused by candida albicans found on skin, mucous membranes, gastrointestinal tract and vagina
cellulitis - acute infection of the skin caused by strep or staph pathogens
scabies
skin condition, highly contagious infestation associated with mite sarcoptes scabiei
pediculosis (lice)
parasites that invade the scalp, body, or pubic hair regions
hirsutism
increased growth of facial, body, or pubic hair in women
alopecia areata
chronic inflammatory disease or hair follicles resulting in hair loss on the scalp
presyncope, disequilibrium, and vertigo
presyncope - feeling of faintness (cardiovascular symptom)
disequilibrium - feeling of falling (vestibular function disorder)
vertigo - sensation of movement, rotational motion (cardinal symptom of vestibular dysfunction)
microcephaly vs macrocephaly
microcephaly - abnormally small head
macrocephaly - abnormally large head
visual acuity test (Snellen eye chart) - how to perfrom
place chart 20ft away
have the patient sit at eye level and cover one eye
ask the patient to read the smallest line they can see clearly
record
repeat with other eye
record
what may yellow sclera indicate
jaundice
what does PERRLA in pupils stand for
Pupils (are)
Equal (and)
Round (and)
React (to)
Light (and)
Accommodation
normal findings for pupil diameter
2-6mm, round and equal
dilate in the dark
constrict in light
eyes - nystagmus vs strabismus
nystagmus - involuntary movement of the eyeball
strabismus - when eyes do not align
cataract vs glaucoma - difference and risk factors
cataract: opacity of the crystalline lens caused by denaturation of lens protein. Risk: age, trauma, congenital
glaucoma: group of diseases caused by increased intraocular pressure, damages optic nerve.
Risk: age, gender, ethnicity, family history, medication, chronic disease
subtle indications of hearing loss
patient asks you to repeat questions
misunderstanding questions asked
gargled speech sounds
word distortion
tilts to hear/leans forward
reads lips
speaks in loud monotone voice
discharge from ears (color + indication)
bloody - head trauma
yellow/green - bacterial infection
how to inspect adult ear using otoscope
outer+middle ear
1) pull top of the ear upward and toward back of the head
2) hold otoscope vertically or upside down
3) stabilize by resting back of your hand against patient’s temple area
normal findings for tympanic membrane
color: pearly gray, slightly pink, translucent
light reflex: cone of light
mobility: mobile when tested with pneumatic otoscopy
borders: well-defined visible, no swelling
abnormal findings for tympanic membrane and causes
yellow/amber: otitis media with effusion
redness: infection
chalky white: infection
blue or deep red: blood behind TM, injury
red streaks: allergy
dullness: repeated infections
white flecks: healed inflammation
purpose of Rinne test
assessing hearing by comparing air conduction of sound to bone conduction of sound (AC to BC)
how is thyroid assessed
palpate the thyroid gland for size, consistency, tenderness, and nodules
what is a goiter
hypertrophy of thyroid gland (increase in size)
tension headache, migraine, cluster headache, and posttraumatic headache
tension - frontal, temporal, parietal, or occipital area (tight band around head)
migraine - throbbing unilateral distribution
cluster - most painful, intense episodes of unilateral excruciating pain, pain behind the eyes
posttraumatic - secondary to head trauma, dull generalized head pain
hydrocephalus - clinical findings
enlargement of the head, bulging fontanelle, dilated scalp veins
otitis media - clinical findings
infection of middle ear
ear pain, fever, vomiting, decreased hearing, inflammation, bulging, discoloration
conductive vs sensorineural hearing loss
conductive - interference in air conduction, caused by blockage, decreased ability to hear, muffled tones
sensorineural - caused by structural changes, disorders of inner ear, auditory nerve problems, progressive bilateral deafness and loss of high-pitched tones
herpes simplex clinical findings
groups of vesicular lesions with erythematous base
gingivitis clinical findings
hyperplasia of the gums, erythema, and bleeding with manipulation
tonsillitis clinical findings
sore throat, painful swallowing, fever, chills, and tender lymph nodes
candidiasis (thrush) clinical findings
soft, white plaques on the tongue, buccal mucosa, or posterior pharynx
hyperthyroidism clinical findings
increased metabolism, enlarged thyroid gland, and exophthalmos, goiter
hypothyroidism clinical findings
decreased metabolism, patients seem to be “slow motion”
routine lung assessment
inspect patient (visually)
count respirations
observe breathing patterns
inspect nails, skin, lips
inspect the thorax
auscultate thorax
special circumstances - lung assessments
palpate thoracic muscles, wall, trachea
risk factors for lung cancer
tobacco smoking
second-hand smoke
environmental exposure
personal + family history
risk factors for tuberculosis
contact with someone with TB
recent travelers
people with HIV
cigarette smokers
drug abusers
how is tobacco use recorded
pack-years
number of years x number of packs smoked per day
ex: 1/2 pack a day x 40 years = 20 pack/year
abnormal breathing patterns
bradypnea - less than 12 bpm
tachypnea - more than 20 bpm
hyperventilation - more than 20 bpm (deep)
sighing - frequently interspersed deep breath
air trapping - difficulty getting breath out
Cheyene strokes - varying periods of increased depth with apnea
Kussmaul - rapid, deep, labored
Biot - irreg interspersed periods of apnea and disorganized breaths
ataxic - disorganization with irregular and varying depths
abnormal findings for nail color and angle
cyanosis or pallor (inadequate oxygenation)
yellow discoloration (cigarette smoking)
clubbing (chronic hypoxia)
adventitious breath sounds and what condition is it related to
Crackles: fine, high pitched crackling and popping (pneumonia, heart failure, restrictive pulmonary disease)
Wheeze: high pitched squeak (asthma)
Rhonchi: low pitched, coarse, loud snoring or moaning (bronchitis, COPD)
Pleural friction rub: superficial, low pitched, coarse rubbing or grating sound (pleurisy, pericarditis)
Barrel chest - what is it and what is it caused by
horizontal ribs, coastal angle, greater than 90 degrees
caused by emphysema
what is funnel chest
sternum is indented above xiphoid
what is fremitus
provides information about the density of underlying lung tissue and thorax
what is vocal fremitus
vibrations resulting from verbalization
normal appearance of the trachea
palpable, midline, slightly movable
what is tracheal deviation
displacement of the trachea
caused by medical conditions, large masses, tension pneumothorax, lung collapse
what is pneumonia
infection of terminal bronchioles and alveoli
what is asthma
hyperactive airway disease
bronchoconstriction, airway obstruction, and inflammation
what is tuberculosis
contagious, bacterial infection caused by mycobacterium tuberculosis
transmitted by airborne droplets
what is pleural effusion
accumulation of serous fluid in the pleural space between visceral and parietal pleurae
what is emphysema
permanent abnormal enlargement of the air spaces caused by destruction of alveolar walls
what is chronic bronchitis
hypersecretion of mucus by the goblet cells of the trachea and bronchi
pneumothorax - what is it + 3 types
air in the pleural spaces
3 types: closed, open, tension
hemothorax
blood in the pleural spaces
what is atelectasis + 2 types
collapsed alveoli caused by external pressure
types: compression, absorption
clinical findings of lung cancer
persistent cough, pain in chest, shoulder, or back, wheezing, loss of appetite, weight loss, fatigue
functions of upper airway
air conduction, filtration, protection, humidification, warming, smell, speech, swallowing
where does gas exchange take place in the body
mostly in alveoli
Cranial Nerve I
Olfactory
Cranial Nerve I function
smell - sensory
Cranial Nerve II
Optic
Optic Nerve function
vision - sensory input
Cranial Nerve III
Oculomotor
Oculomotor function
eve movement - motor
Cranial nerve IV
Trochlear
Trochlear nerve function
eve movement up and down - motor
cranial nerve V
trigeminal
trigeminal nerve function
jaw, mastication - sensory and motor
cranial nerve VI
abducens
abducens nerve function
lateral movement of the eye - motor
cranial nerve VII
facial
facial nerve function
movement of facial muscles and taste in first 2/3 of tongue - sensory and motor
cranial nerve VIII
vestibulochlear
Vestibulocochlear nerve function
hearing and equilibrium - sensory
cranial nerve IX
glossopharyngeal
glossopharyngeal nerve function
taste in posterior 1/3 of tongue and tongue movement - sensory and motor
cranial nerve X
vagus
vagus nerve function
respiration, digestion, and heart rate - sensory and motor
cranial nerve XI
accesory
accessory nerve function
movement of shoulders - motor
cranial nerve XII
hypoglossal
hypoglossal nerve function
tongue movement - motor
motor cranial nerves
III - Oculomotor
IV - trochlear
VI - abducens
XI - accessory
XII - hypoglossal
sensory cranial nerves
I - olfactory
II - optic
VIII - vestibulochlear
cranial nerves names 1-12
olfactory
optic
oculomotor
trochlear
trigeminal
abducens
facial
vestibulochlear
glossopharyngeal
vagus
accessory
hypoglossal
Nerves that are both sensory and motor
V. Trigeminal
VII. Facial
IX. Glossopharyngeal
X. Vagus
cerebrovascular (stroke) risk factors
age, genetics, family history, race, tobacco, alcohol use, physical inactivity, high blood pressure, high cholesterol, diabetes, obesity, heart disease
What does Romberg test assess, how to perform it
to assess balance and body’s ability to sense its position in space
have patient stand feet together, arms at side, eyes open and then eyes closed
watch for balance
Babinski reflex - how to assess, what does it assess
meaning: plantar flexion of all toes
use the reflex hammer, stroke the lateral aspect of the foot - heel to ball, curving medially
describe Glasgow coma scale
tool to assess person’s level of consciousness
1) eye opening (1-4 points)
2) verbal response (1-5 points)
3) motor response (1-6 points)
total score 3-15 points, lower score indicates lower level of consciousness
clinical findings of meningitis
severe headache, fever, nausea, vomiting, stiff neck
encephalitis - clinical findings
fever, headache, nausea, vomiting, changes in mental status, possible coma
Parkinson’s disease - clinical findings
tremors, bradykinesia, limb rigidity, gait and balance problems
chronic and progressive movement disorder
stroke (CVA) clinical findings
impairment of motor function, bowel and bladder elimination, intellectual function, spatial-perceptual alterations, personality, sensations, swallowing, and communication
occurs when brain cells die from ischemia
Myasthenia Gravis clinical findings
chronic autoimmune neuromuscular disease
ocular - muscle weakness in the eye causing ptosis and diplopia
weakness of the face, arms, hands, legs, trunk, thorax
clinical findings of Guilian-Barre syndrome
acute, widespread demyelination of the motor nerves
ascending paralysis that begins with weakness, paresthesia in lower extremities
risk factors for breast cancer
gender (females)
age (more than 45, peak 65-84)
genetics (mutations BRCA1 or BRCA 2)
family history
long menstrual history
first pregnancy after 30
increased breast density
estrogen replacement therapy
physical inactivity
alcohol intake
obesity
describe the methods for breast palpation
circular - press finger pads of 3 middle fingers against outer edge of breast, press gently in circular motion until you reach nipple
wedge - middle 3 fingers on areola, palpate from center outward, repeat until entire breast is covered
vertical strip method - 3 finger pads pressed against the top outer edge of breast, palpate downward and then upward, until you cover the entire breast
what is mastitis
inflammatory condition of the breast - occurring mostly in lactating women
what is gynecomastia
noninflammatory enlargement of one or both male breasts
