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Health Assessment > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Heart health history questions

A

chest pain, SOB, skin color changes, fatigue, edema, past medical/family history

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2
Q

Heart assessment

A
  • look for apical impulse
  • look for heave
  • palpate precordium
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3
Q

Heart assessment: apical pulse

A

4th or 5th intercostal space, midclavicular line

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4
Q

Heart assessment: heave

A

sustained forceful thrusting of ventricle, abnormal

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5
Q

Heart assessment: palpate pericardium

A
  • use palmar aspect of 4 fingers
  • L sternal border, apex, and base
  • search for any pulsations
  • a thrill is a palpable vibration
  • should not feel any pulsations - means turbulent blood flow
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6
Q

Anatomy of the heart

A
  • layers: pericardium, myocardium, endocardium
  • 2 atriums
  • 2 ventricles
  • 2 AV valves
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7
Q

Blood flow through the heart: oxygenated

A

lungs, pulmonary vv, L atrium, bicuspid AV valve, L ventricle, aortic semilunar valve, aorta, body tissues

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8
Q

Blood flow through the heart: deoxygenated

A

body tissues, vena cava, R atrium, tricuspid AV valve, R ventricle, pulmonary semilunar valve, pulmonary aa, lungs

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9
Q

Cardiac cycle

A

Diastole, systole, diastole again

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10
Q

Diastole process

A

ventricles relax, AV valves open, pressure higher in atria, blood pours rapidly into ventricles, toward end, atria contract and push out last amount of blood

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11
Q

Systole process

A
  • ventricles full of blood = higher pressure in ventricles than atria
  • AV valves swing shut (S1) = beginning of systole
  • ventricle walls contract, builds pressure
  • valves open, blood ejected rapidly
  • after ventricle blood is ejected, valves swing shut, closure of SL valves = S2
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12
Q

S1 heart sound

A
  • occurs with closure of AV valves
  • signals beginning of systole
  • usually loudest at apex
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13
Q

S2 heart sound

A
  • occurs with closure of semilunar valves
  • signals end of systole
  • loudest at base
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14
Q

Murmurs

A
  • noisy flow, gentle, blowing, swooshing sound
  • blood circulating normally makes no sound
  • some conditions create turbulent blood flow and collision currents
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15
Q

Auscultation spots

A

aortic valve, pulmonic valve, Erb’s point, tricuspid valve, mitral valve

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16
Q

Aortic valve location

A

2nd ICS - R sternal border

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17
Q

Pulmonic valve location

A

2nd ICS (L sternal border)

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18
Q

Erb’s point lcoation

A

3rd ICS - L sternal border

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19
Q

Tricuspid valve location

A

4th or 5th ICS - L sternal border

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20
Q

Mitral valve location

A

5th ICS (mid-clavicular line)

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21
Q

Heart Auscultation process summary

A

Listen with diaphragm of stethoscope
- firmly on chest, 5 areas
Locate apical pulse: 5th ICS, MCL
- count x 30 seconds
Identify S1 + S2
Listen for murmurs with bell

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22
Q

Heart auscultation pattern

A

z pattern from base to apex

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23
Q

If rate/rhythm of heart is irregular,

A

check for pulse deficit by auscultating the apical beat while simultaneously palpating radial pulse

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24
Q

Carotid arteries assessment

A

palpate each artery one at a time, use gentle pressure

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25
Q

Carotid artery assessment findings

A
  • should be normal strength and same bilaterally
  • diminished pulse
  • increased pulse
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26
Q

Diminished pulse can mean

A

cardiogenic shock

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27
Q

Increased pulse feels

A

full + strong, can be from exercise anxiety fear

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28
Q

Jugular veins

A

lets you assess central venous pressure and judge hearts efficiency as a pump

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29
Q

Jugular veins assessment process

A
  • stand on right side of patient
  • position patient supine at 30-45 degree angle
  • use pen light to see better
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30
Q

Jugular veins findings

A
  • may or may not see jugular
  • should disappear by 45 degrees
  • full distended jugular vv above 45 degrees signify increased CVP and heart failure
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31
Q

PVS

A

vv and aa to perfuse the lower part of the body + carotid and jugular veins

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32
Q

Lymphatic system

A
  • retrieves excess fluid + plasma proteins
  • forms part of immune system
  • absorb lipids from small intestine
  • lymph nodes
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33
Q

Pulse assessment locations

A

brachial, radial, popliteal, posterior tibial

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34
Q

Pulse strength = 0

A

0 = absent

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35
Q

Pulse strength: 1+

A
  • weak or thready
  • hard to palpate
  • associated with decreased PO, peripheral arterial disease, aortic valve stenosis
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36
Q

Pulse strength: 2+

A

expected, normal, easy to palapte, strong

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37
Q

Pulse strength: 3+

A
  • full and bounding
  • pounds under fingertips
  • associated with exercise, anxiety, fever, anemia, hyperthyroidism
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38
Q

Bilateral edema

A

may be related to heart disease

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39
Q

Unilateral edema

A

may be related to DVT

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40
Q

Swelling/edema +1

A

mild pitting, slight indentation, no perception of swelling

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41
Q

Swelling/edema +2

A

moderate pitting, indentation subsides rapidly

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42
Q

Swelling/edema +3

A

deep pitting, indentation remains for a short time, legs swollen

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43
Q

Swelling/edema +4

A

very deep pitting, indentation lasts a long time, legs grossly swollen

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44
Q

Inspect and palapte PVS

A
  • color and temp of extremities
  • hair distribution
  • swelling/edema
  • capillary refill
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45
Q

Unexpected findings of PVS

A
  • PAD arterial
  • PVD venous
  • DVT
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46
Q

PAD arterial

A
  • leg pain/cramps
  • skin changes on arms./legs
  • legs cool to touch
  • swelling in arms/legs
  • lymph node enlargement
  • medications
  • smoking history
  • shiny dry leg skin with sparse hair growth
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47
Q

PVD venous

A
  • aching tiredness in legs
  • varicosities
  • lower leg edema
  • brown discolored skin
  • ulcers at ankles
  • weepy pruritic dermatitis
  • shallow non-healing ulcers in lower leg
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48
Q

DVT

A
  • immobility
  • localized tenderness
  • sharp deep pain
  • warm skin
  • pitting edema in leg
  • tenderness to severe pain in leg
  • cancer
  • obesity
  • hormones
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49
Q

S3 heart sound

A

due to vibration of ventricles that resist early, rapid filling

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50
Q

S4

A

due to vibration of noncompliant ventricles when atria contract and push blood into them

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51
Q

Major risk factors for heart disease and stroke

A

high blood pressure, smoking, high cholesterol, physical inactivity

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52
Q

Developmental changes: before birth

A
  • formaen ovale allows oxygenated blood from placenta to be shunted to L side of heart
  • ductus arteriosus shunts blood into aorta
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53
Q

Developmental cardiovascular system changes: aging adults

A
  • increase in systolic bp
  • increased risk fo dysrhythmias
  • CO decreases
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54
Q

Signs of heart disease in children

A

poor weight gain, DOE, developmental delay, tachycardia, tachypnea, cyanosis, clubbing

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55
Q

In pregnant patients, resting pulse rate

A

increases 10-20bpm
- bp decreases

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56
Q

In older adults, systolic bp

A

rises and orthostatic hypotension may occur

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57
Q

3 mechanisms keep blood moving toward the heart

A
  • contraction of skeletal mm
  • pressure gradient caused by breathing
  • intraluminal valves - one direction
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58
Q

Organs that aid the lymphatic system

A

spleen, tonsils, thymus

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59
Q

Spleen

A
  • destroys old blood cells
  • make antibodies
  • stores RBCs
  • filters organisms
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60
Q

Tonsils

A
  • respond to local inflammation
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61
Q

Thymus

A

develops T lymphocytes

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62
Q

Peripheral artery disease causes

A

smoking, diabetes, obesity, elevated cholesterol, HTN

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63
Q

COVID-19 can increase risk for

A

DVT

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64
Q

In healthy infants and children, lymph nodes are

A

commonly palpable

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65
Q

PVS findings in pregnant women

A
  • diffuse bilateral pitting edema
  • varicose veins
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66
Q

PVS findings in aging adults

A
  • dorsalis pedis + posterior tibial pulses may be hard to find
  • trophic changes
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67
Q

Cranial bones

A

frontal, parietal, occipital, temporal

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68
Q

Sutures

A

coronal, sagittal, lamboid

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69
Q

Skull is supported by

A

cervical vertebrae C1-C7

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70
Q

The face is mediated by

A

CN VII - facial nerve

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71
Q

Parotid gland location

A

cheeks over the mandible

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72
Q

Submandibular gland lcoation

A

beneath mandible at angle of jaw

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73
Q

Neck contains

A

sternomastoid mm, trapezoid mm, vessels, thyroid gland, lymph nodes

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74
Q

Lymph nodes

A

preauricular, posterior auricular, occipital , submental, submandibular, jugulodigastric, superficial cervical, deep cervical, posterior cervical, supraclavicular

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75
Q

Preauricular lymph node location

A

in front of ear

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76
Q

Posterior auricular lymph node location

A

superficial to mastoid process

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77
Q

occipital lymph node location

A

base of skull

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78
Q

Submental lymph node location

A

midline, behind tip of mandible

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79
Q

Submandibular lymph node location

A

halfway between angle and tip of mandible

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80
Q

Jugulodigastric lymph node location

A

under angle of mandible

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81
Q

Superficial cervical lymph node location

A

overlying sternomastoid mm

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82
Q

Deep cervical lymph node location

A

deep under sternomastoid mm

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83
Q

Posterior cervical lymph node location

A

in posterior triangle along edge of trapeqius mm

84
Q

Supraclavicular lymph node location

A

just above and behind clavicle, at sternomastoid muscle

85
Q

Fontanels

A
  • soft spots
  • gradually ossify
  • posterior (closed by 1-2 months)
  • anterior (closed between 9 months-2 years)
86
Q

Inspect and palpate skull

A
  • note general size and shape
  • palate temporomandibular joint
  • inspect face
87
Q

Inspect/palpate skull: size/shape

A
  • normocephalic
  • assess shape: place fingers in person’s hair and palpate scalp
  • skull normally feels symmetric and smooth
  • no tenderness
88
Q

Inspect/palpate skull: temporomandibular joint

A

have person oepn mouth and note normally smooth movement with no limitation or tenderness

89
Q

Inspect/palpate skull: inspect face

A
  • facial expressions should be appropriate to mood
  • symmetry
  • note any involuntary movements
90
Q

Neck examination

A
  • symmetry
  • assess ROM
  • advance practice provider might assess lymph nodes and thyroid
91
Q

Infant/children assessment

A
  • measure infant head size
  • note shape or deformities (caput succedaneum, cephalhematoma, positional plagiocephaly)
  • fontanels
  • head posture and control
92
Q

Inspection: eyelids

A
  • eyelids approximate completely when eyes closed
  • no swelling, discharge, lesions
93
Q

Ptosis

A

drooping of upper lid

94
Q

If eyelids do not close completely

A

risk for corneal damage

95
Q

Inspection: eyeballs

A
  • aligned normally
  • no protrusion or sunken appearance
96
Q

Exophthalmos

A

protruding eyes

97
Q

How to inspect sclera

A
  • have patient look up, using thumbs, slide lower lids along bony orbital mm
98
Q

Expected sclera findings

A
  • china white
  • dark skinned patients may have brown macules, yellow deposits, gray-blue, muddy
99
Q

Abnormal sclera findings

A

redness, scleral icterus (yellowing), tenderness, foreign body, discharge

100
Q

Inspect lacrimal apparatus by

A

pressing index finger against sac, just inside lower orbital rim

101
Q

Abnormal lacrimal apparatus findings

A

red, swollen, tender to pressure, regurgitation of fluid, may indicate blocked duct

102
Q

How to inspect eye movement

A
  • have patient hold head steady
  • follow your finger only with eyes
  • finger should be 12 in away from face
  • progress clockwise, coming back to center after each movement
103
Q

Expected eye movement findigns

A

parallel tracking of finger with both eyes

104
Q

Abnormal eye movement findings

A
  • eye movement not parallel
  • could indicate weak mm or cranial n dysfunction
  • nystagmus
105
Q

nystagmus

A

fine, oscillating movements

106
Q

Consensual light reflex

A

constricts pupil, opposite eye

107
Q

Direct light reflex

A

efferent n constricts pupil, same eye

108
Q

PERRLA

A

pupils, equal, round, reactive to light, accommodate

109
Q

Assessing PERRLA

A
  1. darken room
  2. have client stare into distance
  3. are pupils equal size - use penlight (expected 3-5 mm)
  4. are both pupils round
  5. advance light from the side and note response
    - advance light from side twice on each side
    - pupils should decrease in response to light
    - 1st time, look for direct light reflex
    - 2nd time, look for consensual light reflex
  6. note measurement of pupils with constriction
110
Q

Abnormal PERRLA response

A

dilated pupils, dilated and fixed, unequal or no response

111
Q

Accommodation assessment

A
  1. have patient focus on distant object - dilates pupil
  2. have patient shift gaze to near object
    - should see pupillary constriction and convergence of eye axis
112
Q

External ear has

A

auricle and auditory canal

113
Q

Auricle

A

moveable cartilage and skin, funnels sound waves into opening

114
Q

Auditory canal

A

terminates at eardrum, lined with glands that secrete cerumen

115
Q

Tympanic membrane

A

separates external/middle ear, translucent pearly gray, oval and slightly concave

116
Q

Middle ear

A
  • air filled cavity in temporal bone
  • malleus, incus, stapes
  • opens to outer ear and eustachian tube
117
Q

Middle ear functions

A
  • conducts sound vibrations from outer to inner ear
  • protects ear by reducing amplitude of noise
  • eustachian tube allows equalization of air pressure to prevent rupture
118
Q

Eustachian tube

A

connects middle ear with nasopharynx and allows passage of air - opens when swallowing or yawning

119
Q

Inner ear

A
  • has sensory organs for equilibrium and hearing
  • vestibule, semicircular canals
  • cochlea
120
Q

Inspection + palpation of ear

A
  • size and shape
  • skin condition
  • tenderness
121
Q

Abnormal ear findings

A

redness, swelling, foreign bodies, discharge, irritation from hearing aids

122
Q

Darwin’s tubercle

A

small painless nodule at helix - not concerning

123
Q

Checking for ear tenderness

A
  • move pinna and push on tragus
  • palpate mastoid process
124
Q

Expected findings for tympanic membrane

A

shiny, translucent, pearl-gray

125
Q

Unexpected findings for tympanic membrane

A

red color = ottis media = ear infection

126
Q

Section of malleus are visible through translucent drum

A

umbo, manubrium, short process

127
Q

Testing for hearing acuity

A
  • begins during history
  • ask directly if there is hearing difficulty
128
Q

If patient reports hearing difficulty

A

perform audiometric testing

129
Q

If patient reports no hearing difficulty

A

use whispered voice test

130
Q

Whispered voice test

A
  1. test one ear at a time while masking the other
  2. shield your lips
  3. with your head 30-60cm away from the ear, whisper slowly a two-syllable word
  4. expected: person can repeat words correctly
131
Q

Rhinorrhea

A

runny nose

132
Q

Epistaxis

A

nosebleed

133
Q

Dysphagia

A

difficulty swallowing

134
Q

Teeth malocclusion

A

misaligned teeth

135
Q

Pertussis

A

whooping cough

136
Q

Xerostomia

A

dry mouth

137
Q

Nasal cavity

A

warms, moistens, filters air

138
Q

Kiesselbach’s plexus

A

vascular network in anterior septum - common site of nosebleeds

139
Q

Lateral walls of each nasal cavity contain 3 bony projections

A

superior, middle, inferior turbinates

140
Q

Turbinates function

A

increase surface area for vessels and mucous membranes

141
Q

Olfactory receptors are located

A

roof of nasal cavity in upper 1/3 of septum

142
Q

Sinuses function

A

lighten weight of skull, resonate sound provide mucous

143
Q

Which pairs of sinuses are examinable

A

frontal, maxillary

144
Q

Inspect/palpate external nose

A
  • should be symmetric, midline, in proportion
  • note deformity, asymmetry, inflammation, skin lesions
  • palpate gently for any pain or break in contour
145
Q

Inspect nostrils for

A

patency

146
Q

Inspect/palpate nasal cavity

A
  • pen light, view each cavity with head erect and tilted back
  • inspect nasal mucosa - normal red, smooth, moist
  • note swelling, discharge, bleeding, foreign body
147
Q

Inspect/palpate nasal septum

A

observe for deviation, perforation, bleeding

148
Q

Palpation of sinus areas

A

using thumbs, pressure frontal sinuses by pressing up and under eyebrows and over maxillary sinuses below cheekbones

149
Q

Mouth function:

A

first part of digestive system, airway

150
Q

Oral cavity includes

A

lips, palate, uvula, cheeks

151
Q

Hard palate

A

anterior, made of bone

152
Q

Soft palate

A

posterior, arch made of mobile mm

153
Q

Frenulum

A

midline fold of tissue connecting tongue and bottom of mouth

154
Q

Salivary glands

A

parotid, submandibular, sublingual

155
Q

Mouth inspection

A

begin anterior and move posteriorly
- use penlight and tongue blade

156
Q

Lips inspection

A

color, moisture, cracking, lesions, retract lips

157
Q

African americans lips normally ahve

A

bluish tint and dark line on gingival margin

158
Q

Teeth inspection

A
  • condition is index of general health
  • note diseased, absent, loose, or abnormally positioned
159
Q

Tongue inspection

A

color, surface, moisture

160
Q

Uvula inspection

A
  • ask to say “ahhh” and note soft palate and uvula and rise in midline
  • tests one function of vagus nerve
161
Q

Oropharynx

A

separated from mouth by fold of tissue on each side, the anterior tonsillar pillar

162
Q

Tonsils

A
  • behind folds
  • mass of lymphoid tissue
  • granular and surface shows deep crypts
163
Q

Tonsillar tissues enlarges during

A

childhood until puberty

164
Q

Nasopharynx

A

continuous with oropharynx, above oropharynx, behind nasal cavity

165
Q

Throat inspection

A
  • enlarge view of posterior pharyngeal wall by depressing tongue with tongue blade
  • scan posterior wall for color, exudate, lesions
  • notice any halitosis
  • observe tonsils
166
Q

Halitosis causes

A

poor oral hygiene, smelly foods, alcohol, smoking, dental infection

167
Q

Expected tonsils observations

A

pink, surface peppered with indentations/crypts, no exudate

168
Q

Tonsils grading: 1+

A

visible

169
Q

Tonsils grading: 2+

A

halfway between tonsillar pillars and uvula

170
Q

Tonsils grading: 3+

A

touching uvula

171
Q

Tonsils grading: 4+

A

touching each other

172
Q

Tonsil infection

A
  • swollen to 2-4+
  • bright red, exudate, large white spots
173
Q

HEENT: infants

A
  • obligatory nose breathers
  • sucking tubercle presents in middle of the lip
174
Q

HEENT: infants and toddlers

A

20 deciduous teeth begin showing at 6 months and finish by 2 years

175
Q

HEENT: older adults

A
  • gums recede
  • teeth wear down
  • taste reduction
  • saliva decreases
  • dry mouth
176
Q

HEENT: pregnancy

A

nasal stuffiness, epistaxis, swollen gums

177
Q

During pregnancy, the thyroid gland

A

enlarges due to hyperplasia of tissue and increased vascularity

178
Q

In aging adults, facial bones and orbits

A

appear more prominent - skin sags from decreased elasticity, moisture, subq fat

179
Q

To obtain subjective data about HEENT, ask about

A

headache, head injury, dizziness, neck pain, ROG, lumps, swelling, surgery

180
Q

If palpation reveals lymph node abnormalities

A

explore area proximal to affected ndoe

181
Q

If thyroid is enlarged,

A

auscultate for bruits and a soft pulsatile, whooshing sound

182
Q

Tonic neck reflex

A

fencing posture - newborn reflex

183
Q

HEENT: in pregnant women, assess for

A

chloasma and thyroid gland enlargement

184
Q

Chloasma

A

blotchy, hyperpigmented area over cheeks and forehead

185
Q

HEENT: in aging adults, observe for

A

prominent temporal arteries, spine kyphosis, senile tremors

186
Q

Canthus

A

corner of eye where lids meet

187
Q

Caruncle

A

located at inner canthus

188
Q

Tarasal plate

A

strip of CT that gives shape to upper lid

189
Q

Meibomian glands

A

secrete oily lubricant onto the lids

190
Q

Newborn vision

A
  • eye function is limited
  • peripheral vision is intact
  • macula is absent, mature by 8months
191
Q

Infant eye movement is

A

poorly coordinated by matures by age 3-4 months

192
Q

Eye reaches adult age by

A

8 years old

193
Q

Eye changes during aging

A
  • decreased tear production
  • pupil decreases
  • losses elasticity
  • presbyopia
  • cataracts
  • visual acuity diminishes
194
Q

In older adults, the most common causes of decreased vision are

A

cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy

195
Q

Confrontation test

A

assess visual fields for loss of peripheral vision

196
Q

Diagnostic positions test

A

6 cardinal positions of gaze

197
Q

Hirschberg test

A

assess corneal light reflex and extraocular mm function

198
Q

Conductive hearing loss

A
  • partial hearing loss
  • dysfunction of external or middle ear
199
Q

Sensorineural loss

A
  • perceptive hearing loss
  • dysfunction of inner ear
200
Q

Infant ears

A
  • eustachian tube is short and wide
  • easier to get infections
201
Q

Adult ears <40

A
  • otosclerosis is common cause of conductive hearing loss
202
Q

Aging adults ears

A
  • hearing acuity may decrease from stiff cilia lining ear, compact cerumen, nerve degeneration
203
Q

Romberg test

A

assess vestibular apparatus - standing balance

204
Q

Older adult tympanic membrane

A

appears whiter, more opaque, duller

205
Q

Gag reflex tests cranial nerves

A

IX, X

206
Q

In neonates, palpate nose/mouth/throat for

A

integrity of palate and sucking reflex

207
Q

In pregnant women, assess nose/mouth/throat for

A

gum hypertrophy, epistaxis, nasal stuffiness

Health Assessment (4 decks)

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