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NUR 502 > Exam 3 Blueprint > Flashcards

Exam 3 Blueprint Flashcards

1
Q

Cranial Nerve 5: What is it, function and assessment

A

Trigeminal
* Motor and Sensory
* Motor function: Chewing
* Have patient clench teeth
clench, then palpate temporal and masseter muscles
* Sensory function
* Facial sensation
* Taste at anterior tongue

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2
Q

What are the lobes of the cerebral cortex

A

Parietal
Occipital
Cerebellum
Frontal
Temporal
Brain stem

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3
Q

Focused questions- Breast Exam (8)

A

Pain, Lumps, Discharge, Rash, Swelling, Trauma, Hx of breast disease, Surgery

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4
Q

Qualifying sensation: what is anesthesia?

A

no sensation

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5
Q

Neurological injury: stroke

A
  • “3rd most common cause of death in US”
  • Men > women
  • Thrombotic/embolic - clot
  • Hemorrhagic - vessel ruptured/bleeding
  • Often from poor control of modifiable risk factors (diabetes, obesity, HTN)
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6
Q

Qualifying sensation: what is hypoesthesia?

A

loss of sensation

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7
Q

Structure of Nervous system (two parts)

A

CNS
Brain
Spinal cord
PNS
Everything else
All nerve fibers outside brain/spinal cord
includes autonomicNS

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8
Q

romberg

Describing sensory function-testing senses

A

Touch, pain, temperature: light/dull
Vibration
Proprioception: awareness of where you are
Romberg: swaying when standing
Stereognosis
Graphesthesia

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9
Q

Superficial Reflexes(5)

A
  • Plantar
  • Abdominal
  • Anal
  • Cremasteric: males, stroke the inner aspect of
    upper thigh
  • Bulbocavernosus: contraction of the anal sphincter
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10
Q

AROM and PROM

What is ROM

A

Active range of motion (AROM)
- The individual moves a body part on their own without assistance
Passive range of motion (PROM)
-When someone or something else moves the body part for the individual

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11
Q

Deep tendon reflexes: types and grading

A

Grading
* 4+: brisk, hyperactive
with clonus
* 3+: Brisker than average
* 2+: Normal
* 1+: Diminished
* 0: No response

Areas to test
* Biceps
* Triceps
* Brachioradialis
* Quadriceps
* Achilles

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12
Q

Palpation in neurological assessment (not sure)

just added things about sensation, muscle strength and reflexes but idrk

A

superficial and deep sensation
muscle strength and tone
DTRs and superficial reflexes

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13
Q

Testing cerebellar function (4)

A

Test through normal ROM
Testing cerebellar function
- finger to nose
- standing posture
- heel to shin
- gait pace

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14
Q

Hypotonia
Hypertonia
Myoclonus

A

Hypotonia? low muscle tone/strength
Hypertonia? abnormally high muscle tone/stiff
Tics? tremors?
Myoclonus: tremors that can be pathological

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15
Q

What is the palmar grasp in infants?

strongest? disappears?

A

Place baby’s head midline to ensure symmetric response
Offer finger from baby’s ulnar side, away from thumb
Note tight grasp of all baby’s fingers

Present at birth; strongest at 1-2 months; disappears at 3-4 months

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16
Q

Motor function disorders: what is multiple sclerosis?

A

the immune system attacks the myelin sheath

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17
Q

Abnormal postures

A

Decorticate rigidity: body turns in
Decerebrate rigidity: body turns out
Flaccid quadriplegia
Opisthotonos: back arches

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18
Q

Developmental considerations in Male GU assessment: adult and aging men

A
  • testosterone production declines after age 55 to 60 years
  • decline proceeds gradually
  • pubic hair decreases and penis size decreases
  • scrotal contents hand lower, rugae decrease, and scrotum becomes pendulous
  • testes decrease in size and are less firm to palpation
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19
Q

structure and function of male GU

lymphatics

A
  • lymphatics of penis and scrotal surface drain into inguinal lymph nodes
  • lymphatics of testes drain into abdomen
  • abdominal lymph nodes not accessible to clinical exam
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20
Q

Cranial Nerve 4: What is it, function and assessment

A

Trochlear (Motor)
Assessed in extraocular movements (6 cardinal fields of gaze “cat whiskers”)

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21
Q

Types of muscles

A

Skeletal, smooth, cardiac

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22
Q

Neurological injury: Parkinson’s (classic symptom triad)

A
  • Damage to extrapyramidal tracts
    * Dopamine loss
  • Classic symptom triad
    * Tremor
    * Rigidity
    * Bradykinesia (slow walking)
  • Flat facial expression
  • Increased Salivation (drooling)
  • Decreased Eye blink (dry eyes)
  • Ambulation problems (shuffling)
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23
Q

Assessing mental status (9)

A
  • Is change acute or gradual
  • Orientation (person, place, time, situation)
  • Response to pain
  • Speech patterns
  • Person’s appearance
  • Coordination
  • Thought process
  • Level of consciousness (LOC)
    – awake and alert
    – lethargic
    – stuporous: may wake to painful stimuli
    – comatose
  • Speech patterns
    – ability to communicate?
    – appropriate response?
    – speech rhythm
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24
Q

Assessment of the male genitalia: preparation

A
  • position male standing with underwear down and appropriate draping
  • examiner should be sitting (male could also be supine for first part and stand for hernia check)
  • use firm, deliberate touch (not soft)
    – if erection occurs, do not stop exam or leave room
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25
Q

Temporomandibular joint (TMJ) assessment

A

Formed by the fossa and articular tubercle of the temporal bone and the condyle of the mandible.
TMJ Functions
Hinge: Open & close
Gliding: Protrusion & retraction
Gliding: Side-to-side at lower jaw (Lateral)

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26
Q

Inspection in musculoskeletal assessment (5)

A

Joint (Size and contour)
Color (red, pale, echymotic)
Swelling
Deformity including masses
Crepitus (audible grinding of the bone)

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27
Q

Mini Mental Status: Example

ORNR

A

Orientation: what is today’s date?
Registration: i’ll say three words and you say them back to me
Naming: what is this?
Reading: can you read this and do what it says?

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28
Q

Hip; Musculoskeletal/Landmarks

A

Less mobility than shoulder but stronger, has greater weight bearing ability
Landmarks:
- Anterior superior iliac spine (ASIS)
- Ischial tuberosity
- Greater trochanter

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29
Q

What is the moro reflex in infants?

A

Startle infant by jarring crib, making a loud noise, or supporting head and back in semi-sitting position and quickly lowering infant to 30 degrees
(when they fan limbs out)

Present at birth; disappears at 1-4 months

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30
Q

Performing a testicular exam - put in palpation portion too

A
  • feel each testicle with thumb and first two fingers
  • contents should slide easily
  • testes feel oval, firm, rubbery, sooth, equal, freely movable
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31
Q

Brain stem structure/function

Technically - is midbrain, pons, medulla oblongata

A

Midbrain
- Thalamus/hypothalamus (actually part of diencephalon) relay center and hormone regulation, respectively
Pons
- Respiratory centers
Medulla
- Ascending and descending tracts
- Autonomic centers (respiration, heart, GI)
- regulates breathing, BP, HR, swallowing

Central core

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32
Q

Cranial Nerve 6: What is it, function and assessment

A

Abducens: Eye movement (Motor)
* EOMs of cardinal gaze
– technically testing lateral eye movement
* Nystagmus? (back and forth movement)
– Unilateral or bilateral?
– Frequency?
– Plane of movement?
* Strabismus? (One eye wonky)
* Ptosis? (droopy eye lid)

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33
Q

Cranial Nerve 2: What is it, function and assessment

A

Optic
* Vision
* Requires ophthalmoscope
* Sensory

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34
Q

Teaching self-breast exam to patients

A
  • establish a routine
  • best time: right after menstrual period (breasts smallest and least congested)
    – advise pregnant or menopausal women to select familiar date
  • stress it will familiarize woman with own breast and variation
    – encourage to report unusual findings
  • describe correct technique, rational, and expected findings
  • at home: can palpate in shower w soap and water
  • then should also be performed when lying supine
  • encourage woman to palpate own breasts while you monitor technique (teach back method)
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35
Q

Characteristics (types) of joint movements (6)

A

flexion (bending),
extension (straightening),
abduction (movement away from the midline),
adduction (movement towards the midline),
rotation (circular movement),
circumduction (circular movement of a limb),
the most movement occurring in ball-and-socket joints, while hinge joints only allow for flexion and extension in one plane.

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36
Q

Qualifying sensation: what is paresthesia?

A

pins and needles

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37
Q

Motor function disorders: what is muscular dystrophy?

A

progressive weakness and loss of muscle mass

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38
Q

Inspection in neurological assessment

A

cranial nerves?
A&O x3?

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39
Q

Assessment of breasts: patient supine

A
  • palpate the breasts
    – tuck small pad under side to be palpated; raise arm over head to flatten breast tissue and displace; lumps more distinct
  • vertical strip pattern recommended
    – start high in axilla
    – palpate down to lateral to breast, overlap vertical lines, end at sternal edge
  • use pads of first 3 fingers
  • palpate 4 quadrants of breast and nipple (depress nipple and check for discharge)

normal breast: firm, smooth, elastic
premenstrual: engorgement, slight enlarged

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40
Q

Cerebral Cortex

A
  • outer layer of hrain made up of nerve cells- controls most of the conscious processes.
    -Center of functions governing though, memory, reasoning, sensation and voluntary movement.
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41
Q

Motor function disorders: what is Parkinson’s disease?

A

uncontrollable movements

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42
Q

Developmental considerations in Male GU assessment: adolescents

A
  • puberty begins between ages 9.5-13.5
  • first sign is enlargement of testes
  • next, pubic hair appears then penis size increases
  • complete change in development from preadolescent to adult takes around 3 years - normal range is 2-5 years
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43
Q

Developmental considerations in Breast assessment: pregnancy

+ colostrum/lactation

A

Breast changes start during 2nd month of pregnancy; are early sign for most women
- breasts enlarge and feel more nodular; nipples are larger, darker, and more erectile
Colostrum may be expressed after 4th month
- thick yellow fluid: precursor for milk
- contains same amount of protein and lactose, but practically no fat
Lactation: milk production begins 1-3 days postpartum (colostrum first)

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44
Q

Joints (two types)

A

Synovial: freely movable, filled with fluid Ex. Knee, shoulder
Non-synovial: Joined by fibrous tissue or cartilage. Immovable

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45
Q

Tendons

A

connect muscle to bone

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46
Q

Developmental considerations in Breast assessment (Pregnancy)

A

 Breast changes start during the second month of
pregnancy and are an early sign for most women
 Breasts enlarge and feel more nodular, nipples are larger,
darker, and more erectile
 Colostrum may be expressed after fourth month
 Thick yellow fluid-precursor for milk
 Contains same amount of protein and lactose, but practically
no fat
 Lactation: milk production
begins 1 to 3 days post partum (colostrum first)

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47
Q

Assessment of the male genitalia: palpation (2)

A

– palpate inguinal lymph nodes
*- palpate horizontal chain along groin inferior to inguinal ligament and -
* -vertical chain along upper inner thigh
- normal to palpate an isolated node on occasion – small, 1cm, soft, discrete, movable
– enlarged, hard, matted, fixed nodes are abnormal findings

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48
Q

Developmental considerations in Breast assessment (Adolescent)

A

Puberty: estrogen stimulates breast changes
 Breast development
 Between 8 and 9 years for African-American girls and
by 10 years for Caucasian girls
 Beginning of breast development precedes menarche
by about 2 years
 Breasts of nonpregnant woman change with
movement and flow of hormones during monthly
menstrual cycle

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49
Q

Preparation for assessment of breasts

A
  • woman sitting up facing examiner
  • when woman is supine, cover one breast with gown while examining other
  • after exam: teach breast self-examination
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50
Q

Signs and symptoms of advanced breast cancer: BREAST

A

BREAST
B: breast mass
R: retraction
E: edema
A: axillary mass
S: scaly nipple
T: tender breast

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51
Q

Developmental considerations in Breast assessment: Older women part 2

A

inspection: breasts look pendulous, flat, and sagging
Nipples may be retracted but can be pulled outward
Palpation: breasts feel more granular; terminal ducts around nipple feel more prominent and stringy

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52
Q

Ligaments

A

bone to bone
connective tissue

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53
Q

Developmental considerations in neurological assessment: elderly patients

A

Physiologic changes:
- general atrophy of neurons
– brain usually decreases in weight
– cerebral cortex thins
- Leads to decreased CBF (cognitive brain function), CSF
- Neural connections slower
- Loss of muscle mass and tone
- Decrease in sensory abilities

Consequences:
- Dizziness
– syncope
- Tremors develop
- Strength (grip) less strong

High risk for falls!

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54
Q

Sign and symptoms of neuro issue (5)

A

Headache
Mental status change - confusion, lethargy, agitation, restlessness
Dizziness, vertigo, syncope
Numbness or loss of sensation
Deficits of the 5 senses

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55
Q

Function of parietal lobe

A

(sensation)

56
Q

7

Tests of balance and sensation: Motor

A
  • gait
  • Romberg test: arms at side and legs together, close eyes and assessed for signs of imbalance
  • Hop in place
  • rapid alternating movements
  • finger to nose
  • finger to finger
  • heel to shin
57
Q

Shoulder

A

Ball-and-socket
Rotator cuff (the most sports injuries)
- Four muscles (supraspinatus, infraspinatus, subscapularis, teres minor)
- Tendons
- Glenohumeral joint
Palpable landmarks
- Acromion process
- Greater tubercle

58
Q

Musculoskeletal abnormalities

A

-Inflammatory conditions
Rheumatoid arthritis
-Degenerative conditions
Osteoarthritis
Osteoporosis
-Dislocation
-Subluxation
-Fracture
-Effusion
-Torn rotator cuff
-Tennis elbow
-Carpal tunnel syndrome
-Scoliosis

59
Q

Sensory and motor function - neurological assessment

A

Sensory assessment:
- Superficial
– pain, temperature, light touch (cotton ball)
- Deep Sensation
– vibration
– position (kinesthesia)
– tactile discrimination
– stereognosis: identify item in hand
– graphesthesia: drawing number

Motor:
motor damage related to level of lesion injury
- assess muscle strength and tone
– test balance
– assess coordination and skilled movement
– test reflexes

60
Q

Cerebellum function

A

(“auto pilot”, voluntary movement, equilibrium, coordination)

61
Q

Assessment of breasts with patient supine: if you feel a lump -

A

note:
- location
- size: width, length, thickness
- shape: oval, round, lobulated, indistinct
- consistency: soft, firm, hard
- movable or fixed
- distinctness: solitary or multiple
- nipple: displaced or retracted
- skin over lump: erythematous, dimpled, retracted?
- tenderness: lump tender to palpation?
- lymphadenopathy: are any regional lymph nodes palpable?

62
Q

Knee

3 bones/ landmarks

A

Largest joint in the body
- Three bones involved
Femur
Tibia
Patella
-Hinge joint
-Landmarks
Patella
Tibial tuberosity
Quadriceps muscle
Ligament supports

63
Q

Assessment of the breasts: sitting

A
  • inspect and palpate axillae
  • inspect skin; note rash or infection; lift woman’s arm and support it so muscles loose and relaxed - use right hand to palpate left axillar
  • reach fingers high into axilla; move them firmly down in four directions
64
Q

Motor function disorders: what is cerebral palsy?

A

damage that occurs to the developing brain, usually in utero

65
Q

Abnormal findings in movement

A

Paresis
Paralysis
Myoclonus
Fasciculation/tic/tremor
- resting
- intention: tic when moving
- chorea: Tourette’s
- athetoid: cerebral palsy

66
Q

Sensory pathways

A

skin, muscles, tendons, mucous membranes, viscera: afferent fibers

spinothalamic tract: sensory fibers transmit pain, temperature, touch

posterior columns: position, vibration, fine touch

67
Q

Cranial Nerve 12: What is it, function and assessment

A

Hypoglossal
Motor
* Tongue movement

68
Q

Tests for balance and sensation: sensation

A
  • pain
  • light touch
  • vibration
69
Q

Ankle and Foot

A

Total weight of the body is transmitted through the ankle and foot
Balance the body and absorbs the impact of walking
-Hinge joint
Tibia, fibula, and talus
-Landmarks
Medial malleolus and lateral malleolus

70
Q

Developmental considerations in Male GU assessment: infants

A
  • prenatally: testes develop in abdominal cavity near kidneys
  • at birth: testis measure 1.5-2 cm long and 1 cm wide
  • only slight increase in size occurs during prepubertal years
71
Q

Developmental considerations: Musculoskeletal assessment (older adult)

A

 Osteoporosis
 Postural change
 Loss of height & sub-Q fat
 Postural changes
 Decreased height
 Kyphosis
 Decreased fat in periphery with re-deposition to abdomen and hips
 Bony prominences become more obvious
Aging changes in the bones - muscles - joints Information
 Decreased muscle strength and decreased bone strength
 Increased risk for weakness which leads to reduced ability to function
 Person less willing to walk
 Results in immobility issues
 Walking: one of the most important methods of sustaining independence

72
Q

Reflexes and posture Abnormal Findings

A

Pathologic reflexes
* Babinski
* Brudzinski: flex the neck - meningitis
* Kernig: extension of the knee - meningitis

Abnormal postures
* Decorticate rigidity (turned in and up)
* Decerebrate rigidity (neck back/knees up)
* Flaccid quadriplegia
* Opisthotonus (back/neck arches back)

73
Q

Cranial Nerve 9: What is it, function and assessment

A

Glossopharyngeal
Both Sensory and Motor

  • Sensory: taste (posterior tongue)
  • Motor: pharyngeal muscles (swallowing)
74
Q

Developmental considerations: Musculoskeletal assessment (Pediatric)

A

Concern for damage to
epiphyseal plate (growth plate)

75
Q

Pathologic reflexes

A

Babinski: toes fanning out
Brudzinski: flex the neck - meningitis
Kernig: extension of the knee - meningitis

76
Q

Structure and function of the penis

A

should be without lesions
discharge: collect for microscopic exam

77
Q

Developmental Considerations Neruo- elderly

A
  • General atrophy of neurons
  • Brain actually decreases in weight
  • Cerebral cortex thins
  • Leads to decreased CBF, CSF
  • Neural connections slower
  • Loss of muscle mass and tone
  • Decrease in sensory abilities Consequences
  • Dizziness
  • Syncope
  • Tremors develop
  • Strength (grip) less
    strong
    High risk for falls
78
Q

Mental status continued: Memory and Intellectual

A

Memory:
- cerebral function
- recent vs remote memory
- immediate memory test (repeating 3 words back that were just given)

Intellectual:
- learning
- computation
- ability to read
- insight
- judgment

79
Q

Abnormal findings: Muscle tone and reflexes

A

Flaccidity
Spasticity
Rigidity
Cogwheel rigidity: gradual halting in movement like a ticking clock

80
Q

Function of temporal lobe

A

(Auditory, hearing, taste, smell, Wernicke’s area)

81
Q

What is the stepping reflex in infants?

A

Hold infant on flat surface - note regular alternating steps

Reflex disappears before voluntary walking

82
Q

What is the tonic neck reflex in infants?

A

With baby supine, turn head to one side with chin over shoulder; note ipsilateral extension of arm and leg, and flexion of opposite arm and leg

“the fencing position”

Appears by 2-3 months; decreases 3-4 months; disappears by 4-6 months

83
Q

Abnormal findings in male GU

A

enlarged, hard, matted, fixed nodes
firm, painless lump
hard area
enlarged testicle

84
Q

Different layers of bone structure

A

Epiphysis: Muscle to bone
Diaphysis: Shaft
Metaphysis: Between epiphysis and diaphysis
Epiphysial plate (Growth plate)
Periosteum: Thin membrane

85
Q

Palpation in musculoskeletal assessment

A

Temperature
Swelling
Masses
Only an abnormal synovial membrane is palpable (inflamed or warm)

86
Q

Assessing for the 6Ps with injury

A

Pulses
Pallor
Pain
Paresthesia
Paralysis
Poikilothermia (the inability to maintain a constant core temperature independent of ambient temperature_

87
Q

Structure and function of breasts

A

-Breasts lie anterior to pectoralis major and serratus anterior muscles.
-Between 2nd and 6th rib- from side of sternum to midaxillary.
-Superior lateral corner or breast called TAIL OF SPENCE
-Areola surrounds nipples with sebaceous glands called MONTGOMERYS GLANDS

88
Q

Bursae

A

fluid filled sacs that act as cushions to reduce friction

89
Q

Elbow

A

Three bony articulations
Hinge action
Landmarks
Medial epicondyle (humerus)
Lateral epicondyle (humerus)
Olecrenon process (ulna)

90
Q

Structure/function of testes

A

have a solid oval shape, suspended vertically by spermatic cord
left testis is lower because left spermatic cord is longer

91
Q

Abnormal findings in breasts

A
  • Pain
    – pain, tenderness, when noticed, where, cyclic, brought on by activity?
  • Lump, mass, swelling
    – when noticed, changes, relation to period, changes in overlying skin?
  • Discharge from nipples
    – when noticed, color, consistency, odor?
  • Rash
    – when noticed, when did it start, where?
  • Trauma
    – any trauma or injury, result in swelling, lump or break in skin?
  • Swelling
    – one spot, all over, related to period, pregnancy, or breastfeeding, any change in bra size?
  • History of breast disease
    – any in family? yourself? age?
  • Surgery
92
Q

What is the plantar grasp in infants?

A

Touch your thumb at ball of baby’s foot; note that toes curl down tightly

Reflex present at birth; disappears at 8-10 months

93
Q

Cranial Nerve 1: What is it, function and assessment

A

Olfactory
* Smell
* Non-noxious smells
* Sensory

94
Q

What is the rooting reflex in infants?

when does it disapear

A

Appears at birth; disappears at 3-4 months

Brush the infant’s cheek near mouth; note whether infant turns head toward that side and opens mouth

95
Q

Cranial Nerve 7: What is it, function and assessment

A

Facial
Motor
* Facial muscles for expression
* Have client “smile, frown, close eyes tight, lift brows, show teeth, puff cheeks
Sensory
* Taste on anterior tongue
* Tested only if injury occurs or is suspected
* Salt, lemon juice, sugar

96
Q

Types of hip movement

A

Flexion
Extension
Abdution
Adduction
External/Internal Rotation

97
Q

Cerebellar function

A

Complex motor coordination for movement, equilibrium, posture

98
Q

Assessment of the male genitalia: inspect and palpate scrotum

A
  • inspect as male holds penis out of way; you could also do so with back of hand
  • size varies with ambient room temp; asymmetry is normal (left scrotal half lower)
  • spread rugae out between fingers, lift sac to inspect posterior surface
    – normally: no scrotal lesions present
    – common: sebaceous cysts - yellowish 1cm nodules: firm, nontender, multiple
  • palpate gently each scrotal half between thumb and first two fingers
  • palpate each spermatic cord between thumb and forefinger, along length from epididymis up to external inguinal ring
99
Q

Types of bones

A

Classified as long, short, flat, or irregular.

100
Q

Warning signs of Alzheimer’s

A

memory loss
losing track
forgetting words
getting lost
poor judgment
abstract failing
losing things
mood swings
personality change
growing passive

101
Q

Developmental considerations in Breast assessment (Older Woman)

A

 After menopause
 Ovarian secretion of estrogen and progesterone
decreases, causing breast glandular tissue to
atrophy
 Decreased breast size makes inner structures
more prominent
 A breast lump may have been present for years
but is suddenly palpable
https://www.cmsschicago.org/news-blog/moderate-walking-
can-reduce-the-risk-of-breast-cancer-in-older-women/

102
Q

Function of occipital lobe

A

(vision)

103
Q

Cranial Nerve 8: What is it, function and assessment

A

Acoustic / Vestibulocochlear
Sensory
* Sensory for hearing and equilibrium
- requires special equipment to full assess
- bedside assessment with conversation
* Balance

104
Q

Shoulder Joint anatomy

A

Clavicle
scapula
acromiclavicular joint
acromion
Glenohumeral joint
Head of humerous
Humerous

105
Q

Cranial Nerve 11: What is it, function and assessment

A

Spinal accessory
Motor
* Trapezius and sternomastoid movement
- have patient turn head and apply resistance
- assess shoulder shrug

106
Q

Qualifying sensation: what is hyperesthesia?

A

increased sensitivity

107
Q

What is the placing reflex in infants?

A

hold infant up next to table - able to place foot on table

Reflex appears at 4 days after birth

108
Q

Spinal abnormalities

A

Kyphosis- (hump) top curvature
Lordosis (lower back curvature)
scoliosis (spinal curvature)

109
Q

Motor pathways of the CNS

A

Corticospinal (pyramidal) tract
Motor fibers travel from motor cortex to brainstem, where they cross and go down the opposite (contralateral) side

110
Q

Testing cerebellar function

A

Assessing balance and gait/coordination

Romberg test- make sure they dont fall (Stand still for 30 seconds and not lose balance)
Finger-to-nose test
Heel to shin- to test for neurological vs weakness
Rapid alternating movements - flip hands back and forth (how fast pt can do it)

111
Q

Teaching testicular self-examination (TSE)

A
  • encourage self care: teach every male 13-14
  • testicular cancer most common in young men 20-35
    – males with undesended testicles at greatest risk; white males 4x more likely to contract cancer
  • early detection of cancer enhanced if male is familiar with normal consistency
  • points to include during teaching (TSE):
    – T: timing, once a month
    – S: shower, warm water relaxes scrotal sac
    – E: examine, check for and report changes immediately
  • shower or bath
  • hold scrotum in palm of hand
  • feel each testicle with thumn and first two fingers
    – testicle: egg-shaped and movable, feels rubbery with smooth surface
  • report abnormal findings
112
Q

Developmental considerations: Musculoskeletal assessment (pregnancy)

A

 Hormones increase joint mobility
 Lordosis (low back curvature and pain)

113
Q

Abnormal Findings: neuro (movement and muscle tone)

A

Muscle Tone
* Flaccidity
* Spasticity
* Rigidity
* Cogwheel rigidity (watch-hand arm ticking)
Movement
* Paresis
* Paralysis
* Myoclonus
* Fasciculation/Tic/Tremor
* Resting
* Intention
* Chorea
* Athetoid (cerebral palsy)

114
Q

Cartilage

A

made up of connective tissue. Provides structure and support. Allows bones to glide over eachother.

115
Q

Developmental considerations in neurological assessment: Infants

A

Rooting reflex: (brush cheek, infant should turn head toward side)
Palmar Grasp (tight grasp around finger/toe)
Tonic neck reflex (baby supine, “fencing position”
Moro reflex- scare baby
Placing Reflex- place foot on table
Stepping Reflex- should alternate steps

116
Q

Function of frontal lobe

A

(Personality, emotions, intellect, Broca’s area)

117
Q

Cranial Nerve 10: What is it, function and assessment

A

Vagus
Both sensory and motor

Sensory: viscera of thorax and abdomen
motor: pharyngeal muscles (swallowing)
- consider the patient with stroke
- assess gag

Vagus is also important during the Valsalva maneuver - bearing down and the HR drops

118
Q

What is the Glasgow Coma Scale

A

a tool used to measure the severity of brain injury and impaired consciousness in patients

15 point scale

119
Q

Developmental considerations in Breast assessment: Older women

A
  • After menopause: ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy
  • Decreased breast size makes inner structures more prominent
  • breast lump may be present for years but is suddenly palpable
120
Q

Mini Mental Status

A

Screening tool
- max score is 30
- 23 or less: cognitive impairment

Used primarily with elderly
- dementia
- delirium

121
Q

Spinal pain

A

Midline: over the spinal processes of the vertebrae
Off the midline: in the paraspinal muscles surrounding the spine

122
Q

how many lobes

Breast structure and function (Internal anatomy) breast composed of 3..

A

Internal Anatomy
 Breast is composed of
* Glandular tissue
* Fibrous tissue including suspensory ligaments
* Adipose tissue
 Glandular tissue contains 15 to 20 lobes radiating
from nipple, and these are composed of lobules

123
Q

Bone function

A

 Provides structure
 Provides protection
 Enables voluntary movement
 Store minerals: calcium
 Produce blood cells: hematopoiesis

124
Q

senile

Neurologic changes related to aging

A

Probable decline in cranial nerve function
Senile tremors
- Benign: intention
- Dyskinesia: no rigidity; can’t really be controlled
Grip remains intact
Rapid alternating movements more difficulty to perform
DTRs less brisk
Generally, stronger stimuli may be needed to elicit response

125
Q

Breasts inspection and palpation: general appearance, skin, lymphatic drainage areas, nipple

A

Note symmetry of size and shape: common to have slight asymmetry in size - often left slightly larger than right
Skin:
- normally smooth and of even color
- note any localized areas of redness, bulging, or dimpling; any lesions or focal vascular pattern
- fine blue vascular network visible during pregnancy; pale linear striae (stretch marks) follow pregnancy
- normally no edema present
Lymphatic drainage areas:
- observe axillary and supraclavicular regions; note bulging, discoloration, edema
Nipple:
- should be symmetrical on same plane
- usually protrude; some inverted or flat
- normal nipple inversion may be unilateral; can be pulled out
- note any dry scaling, fissure, ulceration, bleeding, discharge

3rd nipple is normal variation; along “milk line”

126
Q

Signs and symptoms of breast cancer

A
  • irregular shape
  • firm to stony hard
  • poorly defined (no clear margins)
  • single in number
  • fixed, nonmobile
  • usually nontender, but can be tender
  • positive skin retraction
  • constant growth
127
Q

Tools for neuro assessment

A

flashlight, cotton, object with sharp and dull sides, vibration (tuning) fork, reflex hammer

128
Q

Site of most breast tumors

A

upper outer quadrant (Tail of spence)

129
Q

Structure and function of the scrotum

A
  • Loose protective sac; continuation of abdominal wall
  • after adolescence: scrotal skin deeply pigmented and has large sebaceous follicles
  • scrotal wall consists of thin skin lying in folds (rugae) and underlying cremaster muscle
  • septum inside separates sac into halves; in each is a testis which produces sperm
130
Q

Structure and function of breasts: Internal anatomy

A
  • Breast is composed of:
    – glandular tissue
    – fibrous tissue including suspensory ligaments
    – adipose tissue
  • Glandular tissue contains 15-20 lobes radiating from nipple; composed of lobules

Can be divided into 4 quadrants intersecting at nipple
- upper outer quadrant is site of most breast tumors

131
Q

Musculoskeletal degenerative conditions: Osteoarthritis

A

Most common joint disease
Slowly progressive, non-inflammatory disorder
Cartilage damage
-Secondary synovitis
Aging women
Systemic and local signs and symptoms

132
Q

What are differences between sensory and motor assessment in musculoskeletal

A

sensory checks “feeling” and motor checks “movement.”.

133
Q

Spinal vertebrae

A

Cervical (C1-C7)
Thoracic (T1-T12)
Lumbar (L1-L5)
Sacral (S1-S5)
Coccyx

134
Q

Cranial Nerve 3: What is it, function and assessment

A

Oculomotor (Motor)
* Pupil dilation and constriction
* PERRLA

135
Q

Male Breast Exam

A
  • completed with thorax exam
  • inspect
  • palpate nipple area
  • palpate axillary lymph nodes
  • Gynecomastia: growth of breast tissue, can occur during puberty - normal and temporary
  • breast cancer in men is less than 1% worldwide (most often in older men)

NUR 502 (11 decks)

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