Exam 3 Flashcards
what are some age-related eye changes
presbyopia, fibers thicken and yellow, cataract formation, Glaucoma, macular degeneration
Explain how to assess the pupillary light reflex and consensual light reflex
- the pupillary reflex occurs in darken room and examiner shines light from side and directly into the eye, pupil constricts 2. the consensual light reflex is the constriction of the other pupil (if it doesn’t problem with the CN III
test for accommodation
focus on distant object than shifts to close object, at near distance pupils should constrict and axes should converge
snellen test
top number- distance from chart, bottom number- normal distance an eye can see the chart line, large denominator= poorer vision refer for worse than 20/30
hand held vision screener
for near vision, 14 inches away, normal is 14/14
confrontation test
gross measure of peripheral vision, use finger to look six different ways
corneal light test
called Hirschberg test, tests parallel alignment of eye axes, same level of light shining in both eyes
cover test
used if fails corneal light reflex test, stare at nose cover one eye, both eyes should be looking in the direction of the nose
6 cardinal positions of gaze
tests EMO’s- extraoccular movements
conductive hearing loss
dysfunction because of impact of cerumen
sensorineural or perceptive loss
pathology of inner ear CN8, age related nerve damage, or ototoxic drugs called presbycusis
Vertigo
spinning twirling b/c dysfunction of labyrinth, Obj= feels room spinning Sub= feels like individual is spinning
Age related hearing changes
cilia lining of ear becoming more coarse and stiff accumulation of cerumen, cerumen gets drier b/c of atrophy of apocrine glands, frequent ear infections, presbycusis- nerve degenerations
types of cercumen
- dry gray flaky (thin masses in ear cannel) found in Asian and Native Americans
- wet honey brown to dark brown found in Caucasians and African Americans
tinnitus
ringing crackling and buzzing in ears caused by ototoxic meds(damage inner ear), ear infections, Meniere’s disease
proper way to clean the ear canal
warm mineral oil and hydrogen peroxide then irrigate using warm water (with bulb or water pick) never irrigate w/ infection
meaning of tragus or pinna being tender
otalgia (pain in the external ear) from otitis externa or swimmers ear (inflammation of outer ear and canal) and furuncle (pain, redness, infected hair follicle on tragus)
Romberg test
assesses CN8 and intactness of the cerebellum and proprioception, client stand straight with hands at sides and open and close eyes for 20 seconds normal is no swaying and keeps balance
age related changes in mouth nose and throat
nose seems more prominent, loss of taste and smell, tooth loss
Assess CN 1
only assessed with complaint of loss of smell, client close eyes and hold a cotton ball with alcohol or coffee
deviated septum
have client close one nostril and sniff in check for airflow
grading system for tonsils
1+ visible (normal) 2+halfway between tonsillar pillars and uvula 3+touching uvula 4+touching each other
cleft lip and palate
most common in Asian American and American Indians less common in Caucasians and least common in African American
torus palatinus
boney ridge in middle of hard palate, higher in Asians and women
Leukoedema
milky blusish white opaque buccal membranes, seen more in dark pigmented people
whisper test is used to
detect high tone loss with a high frequency
PERRLA
pupils, equal, round, reaction, light, accommodation
apex of lung
located above clavicle anterior, c7 posterior
base of lung
level of diaphragm, 6th rib anterior, 8th rib lateral, 10th posterior
lobes of the lung
right lung= RUL RML RLL, Left lung= LUL LLL
bronchial breath sounds
high, in>ex
bronchovesicular breath sounds
in=ex
vesicular breath sounds
lower in<ex
normal finding for palpation of chest
resonance- low pitch clear hollow sound
hyperresonance
abnormal, lower pitch, too much air is present, such as emphysema or pneumothorax
dull
abnormal, thud, sign of density as with pneumonia, pleural effusion, atelectasis or tumor
hyperinflation
with chronic emphysema
right middle lobe pneumonia
occurs with dullness behind the right breast
fine crackles
heard in inspiration sounds like rolling strands of hair together, partly from collapsed aveoli reopening
coarse crackles
loud low gurgling sound like Velcro opening from inhaled air touching secretions, called rhonhi
wheeze high pitched
musical sound may occur with narrow airways with asthma upper portion of airway
wheeze low pitch
musical snoring heard throughout respiration from airflow obstruction, may clear with cough (productive sputum)
stridor
high pitched crowing sound louder in neck, obstruction of upper airway from allergic reaction
atelectatic crackles
common in older adults, disappear with a few deep breaths
Rust color sputum
Sign of infection
Risk factors for breast cancer
Older than 50, history of breast cancer, BRAC gene, first degree relative, dense breast tissue, positive biopsy, high dose radiation to chest, early menarche, oral contraceptive, never breast fed, long term use of estrogen, greater than one alcohol drink, obesity
History of present health concern with the breast
Lumps swelling thickening redness warmth dumpling rash pain tenderness nipple discharge
Past history for health concern with breast
History of breast disease, injury, trauma, surgery, menarche, menopause, childbirth, LMP
Best time for a self breast exam
After menstrual cycle, non tender less firm, or pick a consistent day
Clinical exam of the breast
Have another nurse present, inspect( sitting and laying down- arms over head then with hands on hips), palpate (3 fingers light medium and deep, tail of spence-most breast cancer occurs, axilla areola and lymph nodes), instruct to self exam
Assessing a man versus a women for a breast exam
Less tissue, important to check nodes and nipple
What is gynecomastia
Age related hormone changes in adolescent boys and older men; with obesity, Cushing syndrome, liver cirrhosis, hyperthyroidism, or adrenal disease. Can also be from medications
Changes in older women’s breast
After menopause estrogen decrease which leads to atrophy of the glandular tissues replaced by fibrous connective tissue. This causes decreased breast size and sagging. Softer and easier to find lumps
Signs of retraction and inflammation of the breast
Dimpling, fixation, edema, deviation in nipple pointing, nipple retracting
