Exam 3 Flashcards
Breast Exam Inspection Positions
- Arms extended over head or behind neck
- Hands on hips w/ shoulder rolled forward
- seated and leaning over
- recumbent position
Breast Inspection (What to look for)
Compare both sides:
- size
- symmetry
- contour
- retractions or dimpling
- skin color and texture
- venous patterns
- lesions
- supernumerary nipples
Nipple Inspection (What to look for)
Compare both sides:
- shape
- symmetry
- color
- smoothness
- size
- inversion, eversion, retraction
Chest Wall Sweep
with the palm, sweep from the clavicle to the nipple, covering area from the sternum to midaxillary
Bimanual digital palpation
walk fingers across the breast tissue, compressing it between your fingers and the palmar surface of your hand that is cupping below the breast
Palpate Breasts
- palpate while seated: lymph nodes in axilla, epitrochlear, clavicular
- palpate breast tissue while supine: light, medium, and deep pressure
- Depress the nipple into the well
Fibrocystic Changes
-fluid filled cyst caused by ductal enlargement
usually bilateral multiple or single Round soft to firm, tents Mobile absent retraction signs usually tender borders are well delineating varies with menses
Fibroadenoma
-Benign tumors composed of stomal and epithelial elements in a single terminal ductal unit
15-55 usually bilateral usually single but maybe multiple Round or discoid firm, rubbery Mobile absent signs of attraction usually non-tender borders are well delineating no variation with menses
Breast Cancer
-ductal carcinoma arises from duct lining; lobular carcinoma originates in gland tissue of lobules
30-80 usually unilateral single Mass irregular or stellate shape consistency is hard or Stone Lake Mobility is fixed retraction is often present usually non-tender poorly delineated no variation with menses
Normal Breast Exam Findings
Inspection: Bilaterally symmetric with an even contour and absence of dimpling, retraction, or deviation.
Palpation: (women) dense, firm and elastic; may have normal variations
Three Routine Questions
- Have you been sexually active in the past year?
- Do you have vaginal, oral, or anal sex with men, women, or both?
- How many people have you had sex with in the past year? Men and Women
5 P’s of Sexual Health
- Partners (type and #)
- Practices (oral, vag, anal)
- Past Hx of STIs
- Protection from STIs
- Pregnancy Status
cultural competence
sensitivity to heritage, sexual orientation, SE, ethnicity, and cultural background
health literacy
degree to which individuals have the capacity to obtain, process, and understand basic health info and services needed to make appropriate health decisions; Dependent on individual and systemic factors: communication skills of lay persons and professionals
High Context Cultures
There is less need for formal, direct, and written communication, as communication is more about process and relationship than problem solving. In high context cultures the group has a strong external boundary, so outsiders must work harder to earn trust.
- relationships build slowly
- space is communal
- change is slow
Low Context Cultures
members have many superficial connections in which the goal of communication is specific and task oriented so as to clarify rules and procedures and solve problems
- relationships are quick
- nonverbal elements are not significant
- privacy is important
- events are schedule for specific times
Components of Health Literacy
Reading writing listening speaking numeracy critical analysis communication interaction skills
Six Skin Inspection Characteristics
- color
- uniformity
- thickness
- symmetry
- hygiene
- Presence of any lesions, which are any pathologic skin change or occurrence.
Five Skin Palpation Characteristics
- moisture
- temp
- texture
- turgor
- mobility
Six Lesion Characteristics
- size (measured in centimeters in all dimensions)
- shape
- color
- texture
- elevation or depression
- attachment at the base
- Exudate
- location
- distribution pattern
annular
ring shaped
arciform
bow-shaped
chloasma
hypermelanosis of sun-exposed areas occurring during pregnancy
confluent
asymptomatic, hyperpigmented papules and plaques that have a peripheral, net-like pattern
Morbilliform
Maculopapular lesions that become confluent on the face and body; ex: measles
reticulate
-Netlike or lacy
Ex: Polyarteritis nodosa, lichen planus, lesions of erythema infectiosum
Serpiginous
Snakelike or wavy line track
Stellate
Star-shaped
Vesicle
Elevated, circumscribed, superficial, not into dermis
-serous fluid-Ex: herpes zoster
Papule
Elevated, firm, circumscribed area
-ex: wart
Macule
Flat, circumscribed area that is a change in the color of the skin
-Ex: Freckle
Nodule
Elevated, firm, circumscribed lesion, larger, deeper than papule
Pustule
Elevated, superficial lesion
- purulent fluid
- ex: acne
Patch
Flat, nonpalpable, irregularly shaped macule
Ex: port-wine stains
Lichenification
Rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation
-Ex: chronic dermatitis
Wheal
Elevated, irregular-shaped area of cutaneous edema; solid, transient, variable diameter
Bulla
Vesicle greater than 1cm in diameter
MMSE
- measures orientation, registration, attention and calculation, recall, ability to follow commands, and language
- takes 5 to 10 minutes to administer
- maximum score is 30
- Score <20 = dementia
- score of 26 or higher is not associated with dementia
- has been translated into multiple languages and adapted for many cultures
- sensitivity of 71 to 92%
- specificity of 50 to 96%
- higher education is associated with higher mmse scores even when dementia is present
Mini-Cog
- brief screening tool for measuring cognitive function that takes up to 5 minutes to administer-involves immediate and delayed recall of three unrelated words and a clock drawing test
- a score of 0 to 5 Points as possible and a score of 2 or less may be associated with dementia
- 76-99% sensitivity
- specificity of 89 to 96%
- has been used successfully in non-english-speaking and culturally diverse populations
PHQ-9
- interest or pleasure
- feelings of depression
- trouble falling asleep or too much sleep
- energy level
- Appetite
- feeling like a failure
- Concentration
- moving or speaking slowly/ Restless
- Suicidal Thoughts
- if you checked any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Moderate Depression Score on PHQ-9
10-14
Mod-Severe Depression Score on PHQ-9
15-19
Severe Depression Score on PHQ-9
20-27
Normal 2 Month Cognitive Milestones
infant should appear alert, quiet, content; should Recognize primary caregiver face; should be able to coax a smile from primary caregiver
Normal 3 Month Cognitive Milestones
cooing
Normal 4 Month Cognitive Milestones
babbling
Normal 10-12 Month Cognitive Milestones
imitates speech sounds, has one or two words but may not be clear
