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NRSG 238- Assessment > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

lobes of the brain

A

frontal
temporal
parietal
occipital

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2
Q

CNS

A

brain and spinal cord
inc cerebral cortex
and cerebral hemisphere

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3
Q

cerebral cortex

A

center for highest functioning
controls- thought, mem, reasoning, sensation, volun. mvmnt
covers gray matter (cerebral hemisphere) and white matter (deep to cerebrum)

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4
Q

cerebral hemisphere

A

lobes

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5
Q

frontal lobe

A

personality, emotion, beh, volu skeletal mvmnt (post central gyrus)

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6
Q

temporal lobe

A

hearing, taste and smell, speech

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7
Q

occipital lobe

A

interpretation of vision

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8
Q

parietal lobe

A

processing senation (post central gyrus)

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9
Q

damage to cerebral hemisphere lobes=

A

loss motor function (weakness, paralysis)
loss sensation
diff processing and understanding language

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10
Q

cerebellum

A

balance and coor (motor volun mvmnt)
equilibrium
muscle tone
*not initiate mvmnt only smoothes

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11
Q

thalamus

A

relay station for nervous system
all sensory e/x smell
interprets pain, light touch and pressure sensation

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12
Q

PNS

A

12 pairs cranial n
31 pairs spinal n
ANS- parasym and sympathetic
not include CNS

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13
Q

peripheral n

A

dev from spinal nerves

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14
Q

dermatome

A

area conducted by specific nerve

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15
Q

sensory pathway

A

from periphery to brain

inc. spinothalamic and posterior columns

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16
Q

spinothalamic tracts

A

anterior and lateral

sensory

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17
Q

lateral spinothalamic

A

pain and temp

sensory

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18
Q

anterior spinothalamic

A

light pressure and touch

sensory

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19
Q

posterior column

A

proprioception- area in space
kinesthesia- directional awareness
vibration, fine local touch
sensory

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20
Q

motor pathways

A

corticospinal/ pyramidal tract
extrapyramidal tract
cerebellar system
brain to spinal cord

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21
Q

corticospinal/ pyramidal tract

A

motor
skilled vol mvmnt (writing)
fibers originate in motor cortex (frontal)

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22
Q

extrapyramidal tract

A

motor
macro mvmnt (walking), main muscle tone
fibers originate outside corticospinal tract

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23
Q

cerebellar system

A

coord mvmnt, maintain posture, equilibrium, mvmnt is unconsious
gait

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24
Q

upper motor neuron

A

brainstem to synapse w/ lower motor n

sympt- hyperreflexia, (+) superficial reflexes, musc weakness

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25
Q

lower motor neuron

A 
originate in ant horn cell of spinal cord (bilaterally)
sympt- flaccid, mild musc weakness
hyporeflexia
ex. polio
neuron apparent at each spinal segment
connect to muscle fibers
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26
Q

importance of hx of HTN

A

inc risk for stroke

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27
Q

documenting weakness

A

bilaterally or unilateral

permanent v temporary

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28
Q

warning signs stroke

A

numbness or weakness on one side of body (sudden)
sudden confusion, trouble speaking or understanding
sudden vision changes
sudden trouble walking, dizzy, loss balance or coord
sudden or severe headache (hemorrhagic stroke)

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29
Q

time considerations for stroke

A

<3 hours to get to care

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30
Q

60 second test

A 
for stroke
have pat smile
raise both arms
repeat simple sentence
call 911 if present signs
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31
Q

neuro assessment incl

A 
mental status- cerebral func, orientation
cranial n 2-12
motor system
sensory system
reflexes
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32
Q

motor system test

A 
muscl tone- tension, flaccid?
musc mass
involv mvmnt (tic or tremor)
strength - 0-5+
      5= normal
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33
Q

resting tremor

A

pill rolling
can be familial
not always indicate neuro problem

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34
Q

intention tremor

A

occurs w/ mvmnt

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35
Q

tic

A

usually upper motor problem

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36
Q

fasciculation

A

quiver

ex. eye twitch or after working out

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37
Q

cerebellar function test

A 
gait
tandem walking
ataxia 
RAM
heel-shin
hop on one foot
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38
Q

romberg test

A

feet together, stand, eyes closed 15-20 seconds

negative= normal

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39
Q

proprioception test

A

finger to nose
(eyes closed)
finger to finger
(nose to finger, tracking)

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40
Q

sensory system- what to test

A

pain and touch sensation
sharp v dull
distal to medial

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41
Q

abnormal sensory system findings

A

pain-
hyppalgesia
analgesia (absent)
hyperalgesia

touch-
hypoesthesia (common w diab)
anesthesia- absent
hyperesthesia
paresthesia- abnormal sensations (pins, numbness, tingling)
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42
Q

sensation assessment

A

microfilament test
poke bottom foot and hand
assess bilaterally

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43
Q

test for position (kinesthesia)

A

posterior column

grap finger and move up and down

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44
Q

vibration test

A

posterior column
tuning fork on bony prominence
norm= detect start and stop

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45
Q

stereognosis

A

post. column
reg object by feeling
controlled by parietal lobe

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46
Q

graphesthesia

A

post. column

id letters/ numbers drawn on hand

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47
Q

flow chart for deep tendon relfex

A 
afferent fibers
synapse
efferent fibers
neuromuscular junction
muscle fibers
* all steps have to be intact
@lvl spinal cord (brain doesn't initiate)
brain only smoothes mvnt
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48
Q

bicep reflex

A

hold thumb over tendon
palm facing up
norm= flexion arm at elbow

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49
Q

tricep reflex

A

support arm into H shape

norm= extension arm at elbow

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50
Q

patellar reflex

A

above patella and below tibial patella

norm= extension at knee

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51
Q

achilles relfex

A

norm= plantar flexion foot
(toes down)
support foot so bottom is parallel to ground

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52
Q

normal findings for relfex

A

2-3
symmetrical bilaterally
document if reinforcement used

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53
Q

examples of reflex reinforcement

A

clench teeth
hold arms
close eyes

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54
Q

superficial reflex

A

response from skin receptors

ex. plantar or babinski reflex

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55
Q

plantar reflex

A

normal= toes curl down and negative response

infants should fan feet <2yrs

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56
Q

LOC includes

A

x3 place, person, time,

x4 incl event or situation

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57
Q

CMS

A 
circulation
movement
sensation
assess distally to affected region
commonly done for ppl w/ ortho procedures, splint, cast or fracture
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58
Q

inc risk for fall

A 
inc age
fall history within last 6 mon
elim-incontinence, frequ or urgency
meds- diuretics, analgesics, laxatives
equipment- catheter, IV, monitor
mobility- assist visual/auditory, gait
cognition-dev lvl, confusion, orientation
score= low, moderate or high
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59
Q

musculoskeletal assessment incl

A 
temp, tenderness, swelling
strength
ROM
joint pain, crepitus
spasticity, rigidity, atrophy
spine midline/ straight?
fall risk
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60
Q

abdomen assessment order

A

inspection
auscultation
percussion
palpation

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61
Q

abdomen- inpsection

A 
general appearence
eye lvl and above
skin- striae, scars
contour- protuberant or rounded
symmetry
umbilicus- midline w/out discoloration
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62
Q

cause of blue umbilicus

A

internal bleeding

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63
Q

cause asymm abdom.

A

tumor, hernia, bladder distention, uterine disten

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64
Q

RUQ

A

liver, gallbladder, ascending colon

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65
Q

RLQ

A

cecum, appendix, bladder

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66
Q

LUQ

A

spleen, stomach, sm in

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67
Q

LLQ

A

desc colon, sigmoid colon, public symphysis

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68
Q

causes abdom distention

A

fat, fluid, feces, fetus, flatus, fibroid (growth in uterus), fatal tumor, full bladder

69
Q

diastasis recti abdominis

A

seperation ab muscles
not true hernia
can occur in adults
(preg. and obesity)

70
Q

types possible hernias in abdom

A

umbilical, inguinal and femoral

71
Q

perastalsis in abdom

A

not normal

72
Q

diaphram and bell in abdom

A

dia- bowel sounds

bell- vascular sounds

73
Q

absent bowl sounds

A

not norm

74
Q

bowl sound factors

A

time since last ate (4/7hrs)

75
Q

borborygmi

A

hyperactive bowl sounds (diahrr)

76
Q

spots listen for bruits

A

femoral artery and abdominal aorta

77
Q

pupose percussion in abdom

A

id pain

78
Q

costal vert. angle tenderness (CVA)

A

12th rib post

place hand flat and hit with fist

79
Q

abdom palpation

A

light- 1-2cm
deep 5-8cm
specific organs- liver, spleen and kidney
lymph nodes- femoral, inguinal

80
Q

palpation liver location

A

costal margin

81
Q

palpation spleen and kidney

A

abnormal if felt

82
Q

norm abdominal results

A

soft, non-tender, bowl sounds present, tympanic to percussion

83
Q

rebound tenderness

A

=more pain after touch
ex. present w/ appendix
only assess if complain about abdom. pain

84
Q

anatomical location of breast

A 
2nd rib (by manubriosternal junction) to 6th
sternal border to midaxillary line
85
Q

func of montgomery’s glands

A

secrete lubricant or protective lipid material during lactation

86
Q

nipple color variation due to

A

race, pregnancy, number of deliveries

87
Q

lobes in breast and milk flow

A

15-20
extend from nipple
composed of milk producing acini cells
milk produced, lactiferous ducts, sinus duct, nipple

88
Q

nodes associated w breast

A 
supraclavicular
infraclavicular
lateral (brachial)
central axillary
sub scapular (posterior)
pectoral (anterior)
drain ipsilaterally
89
Q

breast lymph node locations

A

lateral- inside upper arm along humerous
central axillary- high in axilla
subscapular- inside posterior axillary fold along lateral edge of scapula
pectoral- inside axil. fold along pec major musc

90
Q

supernumerary nipple

A

2nd nipple

resembles mole, can be assoc. w/ renal abnormalities

91
Q

mammary ridge

A

“milk line”

axilla through nipple to inguinal ligament

92
Q

gynecomastia

A

male breast tissue
1/3 adolescents
temporary 1-2 yrs

93
Q

gynecomastia- causes

A

hormonal puberty changes, inc adipose tissue, dec testosterone w age, meds

94
Q

quadrants of the breast

A 
lower inner q
upper inner q
axillary tail of spence
upper outer q
lower outer q
95
Q

common location for breast tumors in women v men

A

women- upper outer q

men- behind nipple

96
Q

nipple discharge

A

milky is norm w/ lactation

blooduy- always abnorm

97
Q

breast cancer stats

A 
most common cancer in wmn besides skin
2nd major cause death from cancer in wmn
90% survival rate
80% lumps non-cancerous
1-8 lifetime risk
men can dev CA too- not as common
98
Q

risk factors- breast cancer general

A

not automatically mean will get CA
anything inc person’s chance getting disease
most wmn have no risk factors but get CA
factors can change overtime

99
Q

risk factors- breast cancer

A 
female gender 
>50 yrs old
personal hx breast CA
family hx breast CA
 1st degree= 2x and 2 ppl 1st degree= 4x
genetic mutation 
 braca gene 1 or 20 (35-85%) inc risk
100x more likely get in 60s v 20s (wmn)
hx uterine, ovarian, colon CA
early menarche <12, late menopause >55 (prolonged exposure to estrogen)
high breast density
breastfeeding dec risk
hormone therapy around menopause time (if taken < 4/5 yrs risk will dec)
birth control (goes away in 10yrs after stop taking)
100
Q

breast cancer- risk reduction strategies

A 
limit alcohol (inc estrogen lvl)
breast feed
control weight
be physically active
limit hormone therapy around menopause
don't smoke
101
Q

benign breast syndrome

A

“fibrocystic syndrome”
50% wmn
not precancerous
common in younger childbearing wmn
can cause mastalgia (pain), swelling and discomfort
lumps bilaterally, firm, mobile and rubbery, and can be tender after menstruation

102
Q

5 positions for breast examination

A

sitting arms overhead (breast move symmetrically)
sitting arms at sides
hands on hips (contract pectoralis, helps id dimpling)
bending from waist (b should fall freely/ equally from chest wall)
supine (use palpation, raise cooresponding arm overhead and support with pillow)

103
Q

abnormalities with breast inspection

A

rash, sores dont heal, lesions, unequal venous patterns (visability), edema, masses, dimpling, unequal nipple directional pointing

104
Q

unequal sized breasts

A

common

if sudden change or not usually like that- analyze further

105
Q

plugged breast duct

A

happens w lactation
nipple can become hard and dry
erythema

106
Q

breast dimpling/retraction

A

abnorm

pot cause- mass affecting coopers ligaments

107
Q

breast induration

A

abnorm

area hardness w/ inflamm

108
Q

breast peau d’orange

A

“peel of an orange”

pitted, dimpled hair follicles from swelling

109
Q

nipple inversion

A

abnorm if not symm bilaterally
or a new change
or if nipple do not point in the same direction

110
Q

breast palpation-non nipple

A

bimanual (sitting/standing compress btw hands) if large
pads three fingers
pillow under shoulder when supine
start below clavicles

111
Q

breast palpation techniques

A

vertical strip
concentric circles
chest wall sweep (recommended, clavical to nipple or sternum to nipple inc under armpit)
spoke

112
Q

inframammary ridge

A

compressed tissue
normal at bootom breast btw 4-8 oclock
can feel like rib poking up

113
Q

granular consistency of breasts

A

normal for post meopausal women

114
Q

masses classification

A

quadrant and clock location

size, consistency, mobility, borders, tenderness, bilaterall

115
Q

a mass that is fixed, hard, unilateral, and undefined

A

concerning

116
Q

palpation of nipple

A

push nipple down

squeeze behind areola

117
Q

axillary lymph node exam

A

sitting and support arm
start high up in axilla, include sub/infra scapular
enlarged or palpable= abnorm

118
Q

breast pain

A

abnorm if not around time of period

119
Q

breast exam reccom

A

mammograms and exam= best outlook
25-40 every 1/3 yrs
> 40 yrly
early detection= best for improving qual. of life and survival

120
Q

male breast cancer

A

1% of all breast CA
most common site- nipple
often painless mass
common signs- scaly nipple, lesion, discharge

121
Q

testicular CA

A

curable
1% CA in males
50% within 15-35 yrs
inc (dont know why)

122
Q

testicular CA risk factors

A

undescended testicles
personal/family hx of testicular CA
whites 5x risk v black and 3x risk v indians/ mexican
age 15-35

123
Q

cryptorchidism

A

undesc. testes

124
Q

testicular CA symp

A

common asympt

nodules, one side lrger than other, painless lumps, dull ache in groin, enlrged/ swollen breasts

125
Q

normal findings of testes

A

firm, rubbery, non-tender

126
Q

leading causes CA in men v women

A

men- prostate
wmn- breast
b/= lung (2)
colon and rectum (3)

127
Q

prostate CA risk factors

A 
1-7 lifetime risk
1-36 die
>80% in age 65 or greater
black> white
family hx
hereditary breast and ovarian CA
128
Q

prostate CA sympt

A

early- none

problems urinating, cant erect, blood in urine

129
Q

prostate CA screening

A

talk w doctor around age 45-50
45 if high risk or black
50 if at normal risk
screening= psa blood test

130
Q

causes of high psa lvl

A

prostate ca
begning prostatic hypertrophy
UTI
enlrged prostate

131
Q

consideration w/ prostate ca screening

A

early detection not always matter

25% get biopsy bc inc psa have cancer, o/ 75% dont

132
Q

colon cancer-incidence

A

3 most common in b

133
Q

colon cancer screening causes

A 
look at prostate func
chronic constipation
check for compaction
rectal tone check
around age 50 (every 10 yrs)
134
Q

colon cancer risk factors

A

> 50, family hx, personal hx breat CA or polyps, physic inactivity, obesity, smoking, alcoh

135
Q

polyps (colon)

A

growth inside colon

if present, screen more frequently

136
Q

cervical cancer risk factor

A 
HPV infection
smoking
hx STIs
long term use of oral contraceptive (returns norm after 10 yrs)
family hx multiple full term pregnancys
death risk has dec w/ pap test
137
Q

cervical cancer ages

A

frequently 35-45

rare <20 or >65

138
Q

cervical cancer screening

A

pap every 3 yrs starting at 21 (3 yrs if norm)
5 yrs 30-65
> 65 if norm results no futher paps
still need screening even if have HPV vaccine

139
Q

HPV vacc ages

A

11-12 or early as 9

140
Q

when is birth history necessary to review

A

kids < 6 yrs

dev or neuro concern

141
Q

peds nutritional hx

A 
allergies
breast v bottle
solids no earlier 4/6 m
no honey before 1
juice intake- 8-12 oz per day max
142
Q

peds oral care

A

around 6-12mon

when first tooth appears

143
Q

exposure 2nd hand smoke in kids inc risk

A

asthma

ear infection

144
Q

tooth decay risk

A

parent tooth decay < 6months
juice
frequent snacking

145
Q

peds assessment incld

A

weight- lying < 2 yrs
height- recumbent (supine) < 2 yrs
head circum till 2 yrs
chest circum till 18mon (across niples)

146
Q

peds vital signs

A 
heart r and respirations for 1 min
heart rate- 130 norm
apical pulse for kids < 2yrs
bp lower than adults
respir r- 28-20 norm
bp- 98/60 norm
147
Q

milia, lanugo, mongolian spots

A

milia- white pimple like dots of cebum (norm)
lanugo- excess hair (norm) common in premies
Mongolian spots- common darker ethnicities/races (90%)
inc distribution of melanocytes

148
Q

thyroid and lymph nodes in peds

A

usually not palpable

149
Q

anterior fontanel

A 
"soft spot"
closes 9-18 mon
abnorm- firm, elevated, sunken
sunken- dehydr
elevated if not crying= inc ICP
150
Q

posterior fontanel

A

closes 2-3 months

151
Q

peds vision

A

6-7 20/20
newborn 20/200
EOM’s important!!
red reflex = normal

152
Q

retinoblastoma and congenital cataracts

A

retinoblastoma- cancer

cataracts- cloudy lens

153
Q

peds ears

A

pull down and back
5 oclock- R and 7 oclock R
eustachian tube wider, shorter, and more horizontal

154
Q

peds teeth eruption and saliva

A

saliva- drooling 3 months
tooth- 6-24 months
don’t lose all till 6-12 yrs

155
Q

peds tonsils

A

max size 10-12
small at birth
cannot see adenoids

156
Q

peds sinuses

A

cannot see

not fully developed

157
Q

peds respiratory

A 
faster respir rate
abdom breathing till 6-7
barrel chest normal till 6
hypperresonance common
breath sounds- louder bronchovesicular
158
Q

peds cardiac

A 
heart sounds louder and higher pitched (norm)
split s2 common during inspiration
s3 norm
sinus dysryth norm
inc pulse rate- 120-160 newb
dec 80s by 8 yrs
159
Q

thelarche

A

breast budding females

onset puberty 8-14

160
Q

gynecomastia

A

males

away w 1-2 yrs

161
Q

peds abdomen

A

cylindrical/ protuberant abdomen is norm
organs not palpable
nb may feel liver

162
Q

testicular growth

A

9-13 months

163
Q

cryptorchidism

A

testicles do not descend

164
Q

menarche

A

begins 2-2.5 yrs after onset puberty

menstrual cycle is irregu first year or two

165
Q

full ossification of bones

A

18 yr old

growth spurt btw 12 girls and 14 in boys

166
Q

genu varum and valgum

A

varum- bow legs till 2

valgum- knock knees till 7

167
Q

scoliosis

A

curved spine

uneven hips/ shoulders

168
Q

peds babinski

A

norm till 2 yrs

if fanning after 2= upper motor neuron dis.

NRSG 238- Assessment (11 decks)

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