Exam 3 Content Material Flashcards
What organs would you expect to find in the Right upper quadrant?
- Gall Bladder
- Liver
- R kidney
- Duodenum
What organs would you expect to find in the Right lower quadrant?
- appendix
- Ascending colon
- R ureter
- spermatic cord
- ovary
- ectopic pregnancy
What organs would you expect to find in the Left upper quadrant?
- Stomach
- spleen
- pancreas
- L kidney
- splenic flexure
What organs would you expect to find in the Left lower quadrant?
- segment of transverse colon
- descending colon
- L ureter
- spermatic cord
- ovary
What are some common characteristics of the abdomen with older persons?
- Fat migrates to the abdomen & hips – both genders
- More fat; less water content = Older persons “drier” than younger persons
- Delayed esophageal emptying
- Decreased gastric secretionIncreased incidence of gall stones
- Decreased liver size
- Common complaint – constipation
What are some areas of abdominal visceral pain?
- Epigastric
- Periumbilical
- Suprapubic
What are some characteristics of abdominal visceral pain?
- It occurs in Solid or hollow organs
- Ranges from steady ache or vague to colicky pain - dilation or spasm
- Midline – bilateral innervation
- Poorly localized
Epigastric pain will involve what structures?
Stomach, duodenum, biliary tract
Preumbilical (umbilical) pain will involve what structures?
small bowel, appendix, cecum
Suprapubic (hypogastric) pain will involve what structures?
colon, sigmoid, GU tract
What are some characteristics of parietal pain?
- Involves parietal peritoneum
- Sharp; localized pain
- Causes tenderness & guarding which progresses to rigidity
What is refered pain?
An aching pain that is localized in same cutaneous (close to the surface) dermatone sharing same spinal cord levels as visceral inputs
What are some examples of refered pain?
- Myocardial infarction – Can cause pain in the epigastric, neck, jaw or upper extremity regoins
- gall bladder disorders - Can cause pain the right shoulder early on in the disease
- Ureteral obstruction – can cause testicular pain
If a pt. states they have Loose, gray-tan, clay-colored stools, this can be an indication of what?
- blocked bile duct - due to absence of bile pigment
- Can also be related to hepatitis
It a pt. states they have black tarry stools this could indicate what?
upper GI bleeding is occuring
What is Hematemesis?
- Vommiting up blood (a significant amount of blood)
- This can be attributed to an upper GI bleed
What is Steatorrhea?
- Yellow, pale stool with high fat content
- Indicates malabsorption
When conducting a health history with Women of child bearing age, what should you ask?
- Last menses
- Sexual activity
- If using Contraception
- STDs
- # of Pregnancies
When conducting a health history you would want to know if the pt is taking what medications?
- NSAIDs - can cause ulcers
- H2 blockers - blocks stomach acid
- PPI - decreases stomach acid production
- Coumadin - causes vitamin K deficiency
What are some symptoms of Gastroesophageal reflux disease (GERD)?
Burning, mid-epigastric pain usually 30-60 minutes after eating
What is Cholecystitis?
Inflammation of the gallbladder
What are some symptoms of Cholecystitis?
- Nausea & diarrhea 2-4 hrs. after eating fatty food, alcohol, caffeine
- Pain may radiate to R or L scapula (referred pain)
What is a Pancreatitis?
Inflammation of the pancreas
What are some symptoms of a Pancreatitis?
- Acute, boring, mid-epigastric pain that may radiate to L or R or into back
- N/V
What do you look out for when inspecting the abdomen?
- Generalized skin color changes
- Ecchymosis
- Striae
- Lesions & nodules
- Scars
- Abnormal movements
- Contour, symmetry, and surface motion
In what order are you going to conduct your physical assessment of the abdomen?
Inspect → auscultate → percuss → palpate
What areas are you going to auscultate in the abdomen?
- Diaphragm 4 quadrants
- Start at RLQ (ileocecal valve)
- Bowel sounds – 5-30/m normal
When auscultating the abdomen what are some abnormal spunds you could hear?
- Bruits in the aorta, renal, iliac & femorals arteries
- Venous hum
- Peritoneal rub
- Document & report abnormal findings
What is the purpose of
Light & deep palpation?
You are feeling for Tenderness which may be caused by:
local inflammation, peritoneal or underlying organ inflammation, stretching of organ capsule
How would you Percuss the abdomen?
Percuss all four quadrants in supine position; Detects fluid, air, fluid-filled or solid masses
What is Borborygmus?
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines; these sounds signal increased bowel motility
A patient complaining of sharp pain w/ percussion @ the 12th rib at costovertebral angel is often associated with what?
pyelonephritis (inflammation of the kidney) or a renal stone
What is Obturator’s sign used to check for?
An inflammed appendix
What is shifting dullness?
Percussing one side of abdomen causes shifting of fluid (if more than 500 ml fluid)
What is Ascites?
Ascites is the build up of fluid in the space between the lining of the abdomen and abdominal organs
What is a hernia?
Protrusion of abdominal viscera through abnormal opening in muscle wall
What is Pyloric stenosis?
A congenital defect causing a narrowing of the pyloric sphincter
What is Pyrosis?
A burning sensation in the esophagus and stomach from reflux of gastric acid
What is a cholecystitis?
Inflammation of the gallbladder?
What does a positive Blumberg sign indicate?
Peritoneal inflammation
What is Murphy’s sign used for?
To indicate cholecystitis
How would you describe murphy’s sign?
Pain felt when taking a deep breathe when the examiner’s fingers are on the appropriate location of the inflammed gallbladder
What are straie?
A silvery white or pink scar tissue formed by stretching of andominal skin as with pregnancy or obesity?
What is kyphosis?
An excessive outward curvature of the spine, causing hunching of the back.
This has a great occurance with people who are over 70 yrs old.
What is the most common musculoskeletal concern that prompts a person to seek care?
Joint pain
What is Rheumatoid arthritis and what are some nursing considerations of this disease?
- Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues.
- It involves symmetric joints (if one joint is inflammed, the other one will be too). Other musculoskeletal illnesses invovle isolated or unilateral joints.
- RA pain is worse in the morning when arising.
- RA stiffness occurs in the morning and after rest periods
- Movement decreases pain
- S/S: fatiuge, weakness, anorexia, Weight loss, low grade fever, lymphadenopathy.
What is Osteoarthritis and what are some nursing implications for this disease?
- Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint.
- asymetric pain is localized and is worse usually later in the day
-
Movement increases pain
*
What is Tendinitis and what are some nursing implications for this condition?
- Tendinitis is inflammation, irritation, and swelling of a tendon
- Pain is worse in the morning but improves during the day
- Movement increases pain
What is myalgia?
Pain in a muscle or group of muscles that is usually felt as cramping or aching
Fractures have what kind of pain?
Sharp pain that increases w/ movement
Other bone pain usually feels dull and deep and is unreleated to movement
What is Osteoporosis?
A decrease in skeletal bone mass occuring when rate of bone resorption is > than that of bone formation
What are some risk factors w/ osteoarthritis?
- age > 50
- Family history ( eg Rheumatoid Arthritis)
- Obesity
- Joint abnormality
- History of trauma
What are some factors that can cause Osteoporosis?
- age
- Gender - Female
- family history
- estrogen deficiency
- small stature
- race – Northern European descent
- Heavy cigarette and/or ETOH use
- Poor diet with low Ca intake
- Periods of immobilization
- Use of steroids
- Sedentary lifestyle
What are some risks associated w/ osteoporosis?
The weakened bone state increases the risk for stress fractures: especially at the hip, wrist, and verebrae.
What is Costrochondritis and what are some nursing implications of this disease?
- inflammation of the ribs’ junctions to the sternum
- **With movement, the pt. experiences chest pain **
- Swelling, Heat/warmth, Redness
How would temporalmandibular Joint pain manifest?
Pain into the face and clicking noise with jaw movement
In what order would you assess the musculoskeletal system?
- Inspection
- Palpation
- Range of Motion
- Muscle Testing
What is a Ganglion Cyst?
swelling or benign tumor on a joint or tendon sheath
When inspecting the musculoskeletal system, what are you assessing?
- Size
- Contour
- Skeletal changes –> Kyphosis/Scoliosis
- Color
- Swelling
- Atrophy
- Nodules
When palpating the musculoskeletal system, what are you assessing for?
- Sensation: for any Tenderness/Pain
- Temperature: warmth and tenderness signal inflammation
- Swelling / Mass: edema, Infection, inflammation
- **Crepitus = audible and palpable crunching or grating that accompanies movement ( eg RA) **
What is subuxation?
2 bones in a joint stay in contact but their alignment is off
What is contracture?
Shortening of a muscle leading to limited ROM in a joint
What is ankylosis?
stiffness or fixation of a joint
Describe articular disease
Any disease that produces swelling and tenderness around the whole joint, and limts the ROM in both active and passive motion
Ex: arthritis
Describe extra-articular disease
- Injury that occurs to a tendon, ligamnet, or nerve.
- It produces swelling and tenderness to that one spot in the joint and affects only certain panes of ROM, especially during active motion
What is crepitation?
An audiable and palpable crunching or grating that accompanies movement.
What is the phalen test?
A test that reproduces numbness and burning in a person w/ carpal tunnel syndrome
The test: Ask the person to hold both hands back to back while flexing the wrists 90 degress.
What is Tinel’s sign?
Another test used to test carpal tunnel syndrome. Involves direct percussion of the location of the median nerve at the wrise and if positive, produced a burning and tingling along its distribution
What is the most sensitive sign of joint disease?
Limited ROM
What are some characteristics of muscle strength?
Muscle strength should be equal bilaterally and should fully resist opposing force.
- Grade 0 – 5 ( 0 = no contraction, 5 = Full ROM against gravity, full resistance )
What would you educate a person w/ osteoporosis on?
- Diet…milk, soy, limit caffeine
- Exercise…..weight-bearing
- Lifestyle….avoid smoking and alcohol
- Bone density tests, measure height
- Supplements….calcium and Vitamin D
**Assess for diseases eg thyroid. Assess medication SE’s ( eg corticosteroids, anticonvulsants, etc) **
What is a bulge sign?
The bulge sign confrims the presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other.
To conduct this sign, firmly stroke up on the medial aspect of the knee 2-3 times to displace any fluid. Tap the lateral aspect, and watch the medial side in the ahollow for a distinct bulge from a fluid wave. Normaly none is present
What is hallux valgus?
Occurs when the distal part of the great toe is directed away from the body midline
What is scoliosis?
- Lateral curvature of the thoracic and lumbar segments of the spine.
- A difference in shoulder elevation and in level of scapulae and iliac crests occurs w/ scoliosis
- At greatest risk are females 10 years of age through adolescence
- Functional: Scoliosis that iis flexible, aparent when standing, and disapears when bending forward
- Structural: it is fixed
What is the straight leg raising or lasegue test?
If lifting the affected leg reproduces sciatic pain, it confrims the presence of a herniated nucleus pulposus.
What are nucleus pulposus?
the jelly-like substance in the middle of the spinal disc
What is joint effusion?
- Swelling from excess fluid in the joint capsule.
- It is best observed anteriorly
What is frozen shoulder?
Occurs when the shoulder is painful and loses motion because of inflammation.
What is tennis elbow?
Chronic disabling pain at lateral epicondyle of humerus that radiates down extensor surface of forearm. Pain can be located in one finger. Resisting extension of the hand will increase pain.
What is a colles fracture?
- A nonarticular fracture of the distal radius with or without fracture of the unla at the styloid process.
- It usually occurs from a fall on an outstreached hand, and occurs more often in older women
What is lordosis?
Inward or concave curvature of the spine
Common throughout childhood
What are the different movements for each part of the body?
What does wernicke’s area regulate?
Language comprehension
Damage to this area results in receptive aphasia, in which the person can hear language but cannot understand it
What does broca’s area regulate?
Mediates motor speech
When injured in the dominant hemisphere, expressive aphasia occurs in which the person can’t talk but understands language
What does the hypothylamus regulate?
- Major respiratory center
- HR
- BP
- Temp
- Sex drive
- Sleep
What is Anosmia?
A decrease or loss of smell that occurs bilaterally w/ tabacco smoking, allergic rhinitis, and cocaine use.
What is analgesia?
Absent pain sensation
What is Anesthesia?
Absent touch sensation
What is a clonus?
A set of rapid rhythmic contractions of the same muscle
Occurs w/ upper motor neuron disease
What is Parasthesia?
Numbness, tingling Prickly feeling Burning sensation “pins & needles”
Pattern: stocking-glove Ascending from feet upward; hand upward – distal to proximal
What is chorea?
An abnormal involuntary movement disorder
What does the cerebellum control?
The cerebellum controls motor coordination of voluntary movements, equilibrium, and muscle tone. Cerebellar function is tested by balance tests (e.g., gait, Romberg test) and coordination and skilled movements
Impairment: Hypotonia Ataxia Tremor – intention
What is athetosis?
Athetosis is slow, writhing, continuous, and involuntary movements of the extremities
What is End-point nystagmus?
a few beats of horizontal nystagmus at extreme lateral gaze, occurs normally.
where is the extrapyramidal system located?
The basal ganglia are large bands of gray matter buried deep within the two cerebral hemispheres that form the subcortical associated motor system (the extrapyramidal system).
