Exam 3: NR 414 Flashcards
This is a facial bone that articulates a joint instead of a suture
Mandible
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This is a blood vessel that runs diagnonally across the sternomastoid muscle
External jugular Vein
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This isthmus of the thyroid gland lies just below the
cricoid cartilage
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What can be a cause of cluster headaches
alcohol and daytime napping
Shrugging the shoulders is a test of the status of which cranial nerve?
XI
What should the fontanels feel like during examination
firm, slightly concave, and well defined
If the thyroid gland is enlarged bilaterallly what maneuver is appropriate?
listen for a bruit over the thyroid lobes
What are the characteristics of lymph nodes on a normal healthy person?
Mobile, Soft, Nontender
What is cephalhematoma associated with
subperiosteal hemorrhage
What size are normal cervical lymph nodes
smaller than 1 cm
A throbbing, unilateral pain associated with nausea, vomiting and photophobia is a characteristic of:
migrain headache
Lymph node in front of the ear
preauricular
this is superficial to the mastoid process
posterior auricular
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at the base of the skull
occipital
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This is behind the tip of the mandible
Submental
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Halfway between the angle and the tip of the mandible
submandibular
This is under the angle of the mandible
jugulodigastric
This is overlying the sternomastoid muscle
superficial cervical
Deep under the sternomastoid muscle
deep cervical
The is the open space between the eyelids
palpebral fissure
The cornial reflex is mediated by which cranial nerves
V & VII
What retinal structures are viewed through the ophthalmoscope
- optic disc
- retinal vessels
- gen. background
- macula
What is positive consensual light reflex
simultaneous constriction of the other pupil when one eye is exposed to bright light
Aging causes thickening and yellowing of the lens, this is called…
senile cataract
What is considered an eye emergency
SUDDEN onsent of vision change
How is visual acuity assessed?
The Snellen Eye Chart
What is the cover test used for?
to test muscle weakness
How do you use the opthalmoscope
- remove your own glasses and approach the patients left w/ your left eye
The 6 muscles that control eye movement are innervated by which cranial nerves x3
- III
- IV
- VI
A person with normal vision would see your moving finger temporally at
90 degrees
A person is known to be blind in the left eye. What happens to the pupils when the right eye is illuminated by a penlight beam?
both pupils constrict
While using the ophthalmoscope an interruption of the red reflex occurs when?
there is an opacity in the cornea or lens
In documentation of an eye examination what does PERRLA
Pupils
Equal
Round
React
Light
Accomodation
What causes the red reflex
light reflecting from the retina
What is the color of a normal tympanic membrane using an otoscope
pearly gray
What could sensorineural hearing loss related to?
gradual nerve degeneration
Prior to examining the ear, what should be palpated for tenderness
- pinna
- tragus
- mastoid process
For using an otoscope for a younger child, what is the methos
pull the pinna down
During the examination of holding the nose and swallowing what should the eardrum do
flutter
what is darwins tubercle
a congenital painless nodule at the helix
Where are the hearing receptors located
cochlea
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The sensation of vertigo is the result of
pathology in the semicircular canals
What is a common cause of conductive hearing loss
impacted cerumen
What findings indicates infection of acute purulent otitis media?
- absent light reflex
- reddened drum
- bulging drum
A person has a yellow tympanic membrane, what could this indicate?
serum in the middle ear
What is one way to reduce risk for acute otitis media
smoking in the house and car
Examining a child’s hearing (6months), what should the examiner watch for
head turning when saying the child’s name
A patient with a head injury has clear watery drainage from the ear, what should the examiner asess for
presence of glucose in the drainage
What is the neocorte
more than halve in the brain, processing visual info
Eye protection
- palpabral fissure
- eye lids
- limbus
- canthus
- caruncle
Sebacous glands help with
tears, or lubrication
2 Types of Conjuctiva
- palpebral- lines the lids
- bulbar- overlays eyeball
Lacrimal Apparatus
helps control irrigation of the eye
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Extraocular Muscles, how many?
- 6 of them
- attach to the eye ball
- causes eye ball to move
Why babies eyes don’t move as much
muscles not developed
3 Cranial nerves that control eye
- help w/ extra occular movement
- 1) CN 3: Ocular Motor
- 2) CN 4: Trochlear
- 3) CN 6: Abdusins
3 Concentric coating of the eye
- outer fibrous sclera- cornea (reflex)
- middle vascular choroid- iris, pupil, lens, ant/pos chambers
- inner nervous retina- optic disc, retinal vessels, macula, fovea centralis
What is the pupil controlled by?
Parasympathetic and sympathetic nervous systemt
Fight or flight pupil
dilate
Rest & Digest Pupil
constricts
What is the visual receptor of the inner eye
Retina (controller of light)
Pupillary Light Reflex is
- when pupils are exposed to light
- Direct- light directly in the eye
- Consensual- (indirect, other eye constricts too)
What is fixation in eye exam
the ability to follow and direct vision (follow my finger)
What is accomodation in eye exam
- ability to adapt to near vision
- looking far to looking near
- pupils constrict & converge (eyes are following)
What are some problems with accomodation
- squinting
EOM
extra occular muscle
Big problems with infants vision
- poorly coordinated EOM
- symmetry with eye muscles
- 80% are farsighted improves by 8 yrs
Aging adult eye problems
- presbyopia-
- decreased visual acuity
- decreased night vision
- pupil size decreases
- cataracts
Palpebral fissured cultural competency
- asian
- downsyndrome have smaller fissures
Dark vs light color eyes
- lighter the eyes increased sensitivity to light
Subj Data for eyes
- visual difficulty
- blind spots
- pain
- diplopia, strabismus
- redness
- watery discharge
- history of ocular probs
- glaucoma
- use glasses
- self care
What is strabismus?
cross eyed
Infants Subj Data
- Vaginal infection from the mother
- STIs from mother
- milestone deficits w/ vision
- routine eye exam at school?
- parents aware with safety
- sharp objects
Adult Subj Data Eye
- last test for glaucoma
- history of cataracts
- burning dryness
- decrease in usual activities (reading/sewing)
Obj Data Eyes
- position
- snellen eye chart
- handhel visual screener
- opaque card
- pen light
- applicator stick
- opthalmascope
What is the Snellen Chart, (20/20)
- 20 ft away, what typical person can see from 20 ft away
- Test it with their glasses ON
How do you know they met the requirements of the Snellen Chart
can read more than 50% of the row
How do you test near vision?
- Read a magazine/newspaper
- Jaeger card
- handheld vision screener
- norm is 14/14
What is the confrontation test
- compare persons’s peripheral vision with yours
- Gross meausre of peripheral vision
- make sure you put your finger somewhere you can BOTH see
OD (eye)
dominant (right)
OS (eye)
left sinister
OU
unite- both eyes
How do you inspect Extraocular Muscle Function
- Corneal Light Reflex, “Hischberg”- symmetrical light reflects
- Diagnostic positions test- cardinal directions, go clockwise
- Cover Test- cover one eye with paper, no deviation
What is an eye test used when intoxicated?
diagnostic test,
Nystagmus
eye twitching, when they’re drunk
How do you inspect external ocular structures
- external to inward
- eyebrows
- eyelids and eye lashes
- eyeballs
- conjuctiva and sclera
- lacrimal apparatus
What is Arcus Senilis
- gray white arc around cornea, due to lipid deposits.
- seen in older adults
Anisocoria
unequal pupil size
How do you inspect ocular fundus
- Internal surface of retina
- Use Ophtalmoscope
- Red reflex
Developmental Competency w/ visoscreening tests
- E Chart
- Picture chart, 3-6 yrs
- Color Vision only affects Boys, red/green most common
- Ischihara plates
- must catch EOM before 6 yrs
Aging Adult Competence
- visual acuity
- color vision
- ocular structure may appear sunken
- tear production decrease
- cornea may look cloudy
- pupils can be smaller
Abnormal Findings in the Eye
- Strabismus
- Esotropia (inward turning of eye)
- Exotropia
- Paralysis
- Periorbital Edema
- Exophtalmos, protruding eye
- Enopthalmus
- Ectroption, rolling out
- Entropion, rolling in
What causes Exophtalmos
- bulging eyes
- people with thyroid problems
What is miosis
constricted and fixed pupils
What is mydriasis
dilated and fixed pupils
What is the sensory organ for hearing
ear
External Ear Structure
- Auricle or Pinna
- External Auditory Canal (kids more narrow, adult s curve)
- Tympanic membrane (ear drum)
- separates middle and external
Eustachian tubes
- allows passage of air
- goes into middle air
- helps with pressure
- tympanic membrane could burst
Structure of Middle Ear
- Malleus, incus, stapes
- eustachian tube
Functions of Middle Ear
- Sounds vibrations from out to in
- helps with air pressure
Inner Ear Structure
- Vestibule and semicircul canals
- cochlea
3 levels of Auditory System
- Peripheral- sound waves become electrical impulses
- Brainstem- locates & identifies sound
- cerebral cortex- interprets meaning
What are the 2 pathways of hearing
- Air conduction, used more often
- Bone conduction, vibration of sound, like being under water, ear infection
Anything obstruction transmission of sound impairs hearing
hearing loss
involves a mechanical dysfunction of external or middle ear
conductive
pathology of inner ear, cranial nerve VII or audiotory areas
sensorineural
This is degeneration of auditory nerve
presbycusis
Mixed hearling loss
combination of conductive and senroineural types in same ear
Equilibrium for hearing
vertigo
What are problems for adults ears
- more likley to have ceremun (more ear wax)
- conductive hearing loss (cerumen gets dry/clogged)
- presbycusis
Otitis Media
Obstruction of eustachian tube or passage of nasopharyngeal secretions middle ear. VERY COMMON
How is cerumen determined
- Genetically
- different from person to person
Subj Data for Ears
- Infections earaches
- discharge, odor?
- hearing loss
- environmental noise (live concerts)
- tinnitus, ringing of the ear
- vertigo
- self-care behavior- qtips
What is vertigo
a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve; giddiness.
Infant Children Subj Data Hearing
- ear infections
- anyone smoke in household
- childcare outside the home
- meeting childhood hearing milestones
Obj Data for Ears
- Inspect Palpate
- Size/Shape
- Skin Condition
- Tenderness
- External Auditory meatus
Normal size of ear
4-10 cm
Microtia
small ears
Otoscope Examination
- Tympanic Membrane
- shiny, translucent, pearly gray
Light Reflex for the Ears
- Anterior/Inferior Quadrant
- 5’oclock for right
- 7’oclock for left
How do you test hearing acuity
- conversational
- whispered voice test (3 random #s & letters, both sides)
-
tuning fork tests
- weber, feel vibration hear sound
- rinne
If they have conductive/sensory hearing loss is it bilateral?
not necessarily
What is vestibular appartus help with?
- balance
Developmental obj data for infants and children EARS
- external alignment is 10 degrees
- otoscopic exam
- hearing acuity, moro or startle reflex, loud noise and blinking
Aging Adult Obj data EARS
- pendulous ear lobe
- ear drum may be wider
- more opaque
- high tone frequency loss
- people are mumbling
4 Cranial Bones
- frontal
- occiptal
- parietal
- temporal
What are the sutures
immovable bones that join the bones
Facial muscles
- expressions
- CN 7
- symmetrical
CN 7
forming of facial expressions
Pain and Sensation nerve
Trigeminal
What are the 3 main sailivary gland
parotid, submandibular, sublingual
Where is the temporal artery
palpable anterior to the ear
what is the function of the neck
a conduit
2 major neck muscles
trapezius, sternomastoid
They is an extensive vessel system, with major part of immune system
lymphatic system
Practice feeling for lymph nodes
Nodes and Glands are not the same
Drainage patterns of lymph nodes
proximal to where node is because lymph node may be swollen. Coming from somewhere else having a problem.
Fontanels
- where sutures
- intersect,
- soft spots
- 2 of them
What happens to pregnant women to head
thyroid gland enlarges, b/c of hyperplasia of tissue
Aging adult face
skin sags
Subj Data Head
- headache
- head injury, consciousness
- dizziness
- neck pain, limit of motion
- lumps or swelling
- histor of head or neck surgery
What is a follow up question of lumps or swelling in neck
- have you been sick?
- difficulty swallowing
- smoking/drinking?
Cranial Nerve Mneumonic:
Oh Oh Oh To Touch and Feel Very Good Velvet Ah!
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
Cranial Nerve Mnemonic: Sensory, Motor, or Both
1.Some 2.Say 3.Marry 4.Money 5.But 6.My 7.Brother 8.Says 9.Bad 10.Business 11.Marry 12.Money
The pharmacist states that the patient’s biotransformation of a drug was altered.
metabolism has affected the drug.
The nurse recognizes that the administration of a drug influences cell physiology. What is the term for this concept?
Pharmacodynamics
the study of what the body does to the drug
Pharmacokinetics
he nurse realizes that a drug administered by which route will require the most immediate evaluation of therapeutic effect?
intravenous
The nurse administers 650 mg of aspirin at 7 PM. The drug has a half-life of 3 hours. The nurse interprets this information to mean that 325 mg of the medication will have been eliminated from the patient’s system by what time?
10 pm
What is the half-life (t½) of a drug
the time it takes for one-half of the drug concentration to be eliminated
What organ is responsible for the majority of drug excretion
kidneys
If excretion is impaired what risks are there for medication?
toxicity
What type of food decreases the absorption rate of enteric coated medications?
high fat
Which factors will influence the absorption of oral medications?
- presence of food in the stomach
- pH of the stomach
- form of drug preparation
- pain
Schedule I Drug
high abuse, no current medical use
Schedule II Drug
potential for abuse both physiological and psychological. Ritalin
Schedule III Drug
moderate or low physical dependence.
Causes platelet dysfunction and inhibits prostaglandin mediated mucus production of the gastric mucosal
Aspirin
has an antagonistic effect with warfarin and will inhibit its effects.
Vitamin K
has been known to produce a reddish-brown skin tone as one of its side effects.
Pyrazinamide
increases the risk of bleeding and should not be taken before surgery.
Dong quai
reportedly decrease high cholesterol and may help a patient with a cardiac history
Garlic
herbal supplement used to help patients diagnosed with dementia
gingko
herbal supplement that helps decrease the risk of vomiting in nausea.
Ginger
This herbal supplement has been shown to produce anxiety, headache, and gastrointestinal upset. It is not known to produce muscle aches, insomnia, or dry eyes.
Valerian
herbal supplement known to produce hypotension
hawthorn
Herbal supplement known to produce both flatulence and heartburn.
Garlic
The nurse is developing a nursing care plan for a newly diagnosed adult male patient with hypertension. The patient has many questions about his diagnosis and medication. Which nursing diagnosis would be the most appropriate for this patient?
Risk for ineffective therapeutic regimen management related to new diagnosis
The nurse is preparing to teach a patient newly diagnosed with diabetes mellitus how to inject insulin. Which principle(s) will the nurse include when providing patient teaching?
- family or friend in teaching process
- simple written materials individual for patient needs
- Contact information how to reach healthcare provider
The nurse is uncertain regarding directions for preparing a medication. For clarification, who should the nurse contact?
that facility pharmacy
How many agents are available for individual drugs?
30,000
What is the most frequent malpractice claim against hospitals?
- Medication error
- usually a systems error
What are the rules for writing out a medication?
Do not use abbreviations
Nurses rights
- have policies that guide safe drug admin
- identify sys problems
- access to info
Additions rights for med administration
right assessment, ed, evalutation, right to refuse
Factors that modfiy drug response
- Absorption, metabolism, excretion
- age, body weight
- genetics
- route, time
- emotional factors
- pre-existing disease, drug history
- tolerance
Pregnancy Categories
- Category A-Y
- A= no risk
- C= risk for animals, not known for humans
- D= outweigh benefit vs risk
- X=Accutane
Who guides the drug approval process?
- Federal Legislation
- protect the public
- costly process
Stages of Approval for FDA
- Preclinical Investigation- lab research, animal testing
- Clinical- healthy volunteers(I), select groups w/ disease (II)
- Release for general Use (IV), survey harmful effects
What makes pediatric pharmacology difficult
- have not been tests
- not approved by the FDA
- hard to get a good sample size
- smaller profit margin
Limitations of Clinical Trials
- women might be pregnant?
- little drug testing done in women
- failure to detect adverse effects
- effects take a long time to develop
Controlled Substances
- has to have a DEA #
- Act
- Defines categories, Schedule I,II, III
Drug Names
- Chemcial (composition)
- Generic (acetominophine)
- Trade/Brande (Tylenol)
How long does it take to get a patent
- 17 years for generic
- Considered equivalent if serum concentration w/in 80% and 125% of the brand drug
Dietary supplement act requires
clear labeling
3 Phases of Drug Action
- Pharmacoceutic- oral meds, has to dissolve
- Pharmacokinetic- absorption, distribution (blood brain barrier), metabolism, excretion
- Pharmacodynamic- effects on the body. Primary/Secondary
What is the enteric coating for?
less GI upset, absorbs directly in small intestine
3 ways to cross cell membrane
- pass thru channels
- pass with the aid of transport sys
- direct penetration of membrane
lipid soluble drugs can
directly penetrate membranes
What do water soluble drugs need?
a carrier to get across the cell membrane
What is the charge (electrical) of a drug dependent on?
pH
What percent is bioavailable for oral drugs
Always less than 100%. Needs to be 3-5x larger than IV dose
Factors that affect absorption
- good blood flow
- IV arleady there
- subq- less blood flow
- recta, and sublingual fast
- if they’re exercising, decrease absorption
DRugs that can be destroyed by digestive sys
insuline
What is sutained release prep
tablet or capsules filled in tiny sphere that contain the drugs. Coatings that dissovle at variable rates
What happens after absorption
- distribution
what is the first pass effect
- must pass first thru the liver via the portal vein
- warafin, morphine
- liver disease (higher than expected level)
How does abscess and solid tumors affect distribution
no blood supply to inner mass of an abscess. No supply to the core of the tumor
What does a drug need to be distributed
a protein binder
What drug is not bound
free drug
What happens as the free drug is metabolized/excreted?
the protein bound drug is released into the blood stream
What percent of the drugs is active (free)
5%
(95% is binding)
Decreased albumin level is expected with
elderly, newborns, liver disease, malnutrition
Anatomical Barriers for distribution
- blood brain barier
- brain and placenta
- fetal-placental
What is another name for metabolism
biotransformation
Where does biotransformation occur
- liver- cytochrome P450 enzymes
- a group of enzymes responsible for drug metabolism
When drugs are metabolizes the effect are:
- drug inactivation
- accelerated renal excretion of drugs
- increases therapeutic action
- activation of pro drugs
- increased toxicity
How are drugs inactives
liver
can kidneys excrete lipid soluble drugs
no
what happens when drugs are transformed into active metabolites
increased phamacologic response
Steps in Renal Drug Excretion
- Glomerular Filtration
- Passive Tubular Reabsorption
- Active Tubular Secretion
Understand half life
If patient has altered kidney or liver function?
reduce dose
Side Effect Characteristisc
- Predictable= secondary, benadryl drowzy
- Toxic: overdose
- idiosyncratic- unpredictable
- allergic-immune response
Common Allergic Sympzoms
- Urticaria- hives
- Eczema- rash
- Prurits
- Rhinitis
- Wheezing
Onset of Action
how long does it take to kick in
Where do you want your onset to be?
where it works but not toxic for as long as possible
What is the lock and key theory
drug attaches to its receptor in a specific manner
What is the thearapeutic index/Range/Window
- margin of safety of a drug
- you want a wide window- when its effective to when its toxic
Peak levels
highest plasma concentration. Blood sample is draw at peak time
Trough level
- lowest plasma concetration
- blood is drawn before the next dose
What happens if peak is too high
patient becomes toxic
If the trough level is too low
the patient is not getting a constant therapeutic level of the drug
What can happen with drug interaction
- additive
- synergistic
- or antagonistic
Drug interaction related to metabolism
- toxicity is likely
MAO inhibitor should not be taken with
tyramine rich foods
What fruit can affect metabolism of certain drugs
grapefruit juice, can last up to 3 days after last glass
more than 90% of all ilness are treated with
Over the counter medications
What is a concern for herbal supplements?
- very little testing
- multi-billion dollar industry
Which adipose fat is worse?
- the kind that covers the organs
- caused by stress
Solid viscera organs
- fud, deeper tone
- pancreas,
- adrenal glands,
- stomach,
- spleen,
- kidneys,
- ovaries,
- uterus
Hollow viscera organs
- tympanic sound
- stomach, gallbladder, small intestine, colon, bladder
Where does kidney sit in reference to each other
left kidneys is higher than right
What are the 4 quadrants
RUQ, RLQ, LUQ, LLQ
RUQ Organs
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LUQ Organs
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RLQ Organs
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LLQ Organs
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What are women more susceptible for Gi wise?
appendicitis
What are gallstones?
- more common as we age
- hard crystalline mass formed abnormally in the gallbladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct.
Subjective Data GI
- appetite
- dsyphagia
- food intolerance
- ab pain
- nausea/vomiting
- bowel habits
- pas ab history
- medication
- nutritional assessment
adolescents subjective data GI
- what do you eat at regular meals?
- Breakfast?
- Wha do you eat for snack
- Excercise Pattern
- Weight management
Subj Data for Older Adults GI
- How do you acquire your groceries
What do you palpate last during phys examination of abdomen?
painful areas last
Inspection of abdomen
- symmetry
- flat vs rounded vs protruded
- umbilicus (inny, outy?)
- scars
- color, striae
- pulsation or movement
- hair distribution
- demeanor
Know bowel sounds
start at RLQ, listen for 5 minutes
Should you hear anything in the abdomen?
no
Percussion of the abdomen
- general tympany
- liver span
- costovertebral angle
- Fluid waves
CVA Tenderness
- tests a UTI
- percussion of lower back
- hurts if you are infection
- kidney inflammation
Ascites Test
- Fluid waves
- dull thud sound
Where is the spleen usually felt
- around 9-11 Intercostal space
Where is a pap smear done
squamocolumnar junction
average age a women will start getting menopause
51.2 yrs
How long is pre-menopausal period
5-7 years
What happens when you no longer have estrogen
- breasts sag
- vaginal vault less moist
- vaginal pH becomes more alkaline
- decreased vaginal secretion
Lithotomy
position for getting a pelvic exam
Aging what to expect w/ vaginal vault
Prostate exam at what age
50-55
Scrotum what do you feal for
How does the Rugae feel
- on scrotal sac
- will have wrinkles
Male are more prone to this because of heavy lifting
hernia
When do testes discend in infants
not until their born. Should by 3-6 months of age.
What would be a concern for infants if testes did not discend
heat
Tanner Stage
What health issue would lead to sexual expression later in life
cardiac
dysuria
pain when peeing
Men getting up in the middle of the night to pee
prostate
Should you retract the foreskin in an infant
NO
Rectal Exam for men DRE
Betwen 50-55
When placing a foley catheter how do you know you’re in
when you see urine
Why would you need a foley in a patient
- Surgery
- Mobility
- Unresolved UTI
How soon should a person be able to void after catheter removal
4 - 6 hours