exam 4 Flashcards
Subjective data gathering of breast history
pain, lump, and discharge, rash, swelling, trauma, history of breast disease, surgery or radiation, medications, patient-centered care, perform breast self-examination/last mammogram, tenderness, lump, or swelling, rash, make sure to ask questions about any pain or swelling, tenderness, sore, burning sensation?
Patient teaching about self-breast exam—what information would you teach the patient?
lie down, press the 3 middle fingers, in a circular motion and use 3 levels of pressure, follow and up and down motion, sit up and examine underarm with arm slightly raised, note any surface changes or lumps and if there are any discharge coming from the nipple
Abnormal findings during inspection of breast during exam
dimpling, nipple retraction, edema (Peau d’Orange), fixation, deviation in nipple pointing, benign (“Fibrocystic”) Breast Disease, cancer, fibroadenoma, differentiating breast lumps, age, shape, consistency, and demarcation, number, mobility, and tenderness, skin retraction, pattern of growth, and risk to health
Internal structures of the breast
glandular tissue, fibrous tissue, adipose tissue
Factors that increase relative risk for invasive breast cancer in women
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-BRCA 1 and BRCA 2 genes
-Breast cancer survival rates have increased greatly in recent years
-Ethnic and racial considerations:
-Mortality rate is 40% higher for Black women
-Worse prognosis with later stage diagnosis
-Lifestyle risk factors
Procedure to perform the Phalen’s test
having the patient hold both wrists in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30-60 seconds, help diagnose carpel tunnel
Procedure to perform plantar flexion
the downward movement of the foot away from the body, which occurs when the ankle is bent
Crepitation
dry crackling sound or sensation due to grating of the ends of the damaged bone
Positions/movements for normal range of motion of the ankle
limited to flexion (dorsiflexion) and
extension (plantar flexion) in one plane, eversion and inversion
Lordosis
Kyphosis
Osteoporosis
lordosis: inward or concave curvature of the lumbar spine
kyphosis: an abnormal rounding of the upper back that causes a person to appear hunched over or to slouch
osteoporosis:a bone disease that weakens bones, making them more likely to break, degenerative
Abduction/adduction
abduction: moving a body part away from an axis or the median line
adduction: moving body part toward the center or toward the median line
ligaments
fibrous bands from one bone to another bone that strengthen the joint and prevent unwanted movement
supination
turning forearm so that palm is up
Passive range of motion
having to help them do the range of motion, external force
Common exam findings along with symptoms of patients with rheumatoid arthritis
inflammatory, joint pain, stiffness, swelling
Common symptoms of osteoarthritis
degenerative, pain when using the joint, limit joint movement, pain, swelling
Swan-neck and boutonniere deformity
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swan-neck: knuckle is bent back
boutonniere: ulnar deformity, wrist is outward
Know all 12 cranial nerves by name, roman numeral and functions
I: olfactory: sensory
II: optic: sensory
III: oculomotor: motor
IV: trochlear: motor
V: trigeminal: sensory and motor
VI: abducens: motor
VII: facial: sensory and motor
VIII: acoustic: sensory
IX: glossopharyngeal: sensory and motor
X: vagus: sensory and motor
XI: spinal: motor
XII: hypoglossal: motor
“some say marry money but my boyfriend says beautiful babies matter more.”
Documentation of findings of normal and abnormal patellar reflexes
A normal patellar reflex is documented as a brisk, quick extension of the knee with a single, moderate movement when the patellar tendon is tapped, typically graded as a “2+” on a reflex scale; an abnormal patellar reflex could be absent (0), diminished (1+), exaggerated or hyperactive (3+, 4+), or accompanied by clonus (rhythmic oscillations) which indicates a neurological issue, and should be noted with the specific findings on each side of the body.
Procedure to check for presence of Babinski reflex
firmly stroke the sole of the foot with a blunt object like a tongue depressor, moving from the heel towards the base of the big toe; a positive
Glasgow coma scale—purpose of use in clinical setting
to objectively assess and monitor a patient’s level of consciousness, particularly after a head injury, by evaluating their eye opening, verbal response, and motor response
Symptoms exhibited for a patient with injury to the Broca’s area of the frontal lobe
difficulty forming complete sentences, struggling to articulate words clearly, omitting grammatical elements like “and” or “the,” and generally having trouble expressing themselves verbally despite understanding what they want to say
Testing the function of cranial nerve XI:
Testing the function of cranial nerve XII:
XI(acceessory): shurg shoulders and apply resistence
XII(hypoglossal):place tongue depressor on tongue to intiate gag reflex and watch tonils come to the center and watch uvula rise
physical exam findings associated with deficit of cranial nerve VII
unable to form smile, drooping of face
List the some of the specific mediating function of the frontal, parietal, occipital and temporal lobes of the brain
frontal lobe: decision making,motor control, emotions,personality expression
parietal:touch,taste, spacial awarness
occipital:visual stimuli, recognizing faces and objects
temporal: memory formation,language comprehnesion and emotional recognition
Procedure to perform the graphesthesia test
ask the patient to close their eyes, then use a blunt object like a pen or applicator stick to trace a number or letter on the palm of their hand, and have them identify what you drew
parathesia
numbness, tingling,itching or skin crawling
Functions of the cerebellum
processes motor coordination and
muscle tone of voluntary
movements
sterognosis
ability to recognize objects by feeling their form, size, and weight while the eyes are closed
Positive Babinski test findings in an adult
Babinski reflex is indicated when the big toe flexes upwards and the other toes fan out, which is considered normal in infants but abnormal in adults and older children,
Testing sensory function of cranial nerve V
have patient close their eyes and rub a cotton swab on the face and have patient tell you when they feel it
Functions of the cerebral cortex
governing thought, memory, easoning, sensation, voluntary movement
Exam findings associated with a positive Romberg sign/test
increased body sway, foot movement in the direction of a potential fall, or even falling when eyes are closed while standing with feet together.
2 parts of the nervous system
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central nervous system and peripheral nervous system
Teaching testicular self-exam
do exam after warm bath or shower, roll each testicle between thumb and pointer fingers and feel for any bumbs or lumps or unusual features
Expected normal findings of palpating the testes
should feel oval and firm (not hard) , should feel smooth with no bumbs, should have no pain
Hypospadias
a congenital condition that occurs when the urethra doesn’t develop properly in a male fetus
Signs and symptoms of HSV-2 (herpes) related to STI
Blisters or sores on the genitals, rectum, or mouth
Painful sores that may take a week or more to heal
Flu-like symptoms like fever, body aches, or swollen glands
Unusual or smelly genital discharge
Burning when peeing
Bleeding between periods
Itching, tingling, or burning feeling in the vaginal or anal area
Pain in the legs, buttocks, or vaginal area
A feeling of pressure in the area below the stomach
Patient teaching for prevention of STIs
WEAR CONDOMS
Structures of the male genitalia
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penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles.
Abnormal findings of prostate palpation that be suggestive of cancer
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Bumps or hard areas in the prostate gland
An asymmetrical boggy mass in the prostate gland,Difficulty urinating
Weak or interrupted urine flow
Frequent urination, especially at night
Pain or burning during urination
Blood in the urine or semen
Pain when ejaculating
Erectile dysfunction
Pain or stiffness in the lower back, pelvis, hips, or upper thighs
Common symptoms of benign prostatic hypertrophy
Frequent or urgent need to pee, also called urination.
Peeing more often at night.
Trouble starting to pee.
Weak urine stream, or a stream that stops and starts.
Dribbling at the end of urination.
Not being able to fully empty the bladder.
Positioning patient for rectal exam
The patient lies on the left side with the buttocks near the edge of the examining table or bedside with the right knee and hip in slight flexion.
General recommended guidelines for pap smear screening
start recieving pap smear at age 21 to 29 every 3 years
Physiologic causes of stress incontinence
eakening of the pelvic floor muscles
Signs and symptoms of HSV-2 (herpes) related to STI
Blisters or sores on the genitals, rectum, or mouth
Painful sores that may take a week or more to heal
Flu-like symptoms like fever, body aches, or swollen glands
Unusual or smelly genital discharge
Burning when peeing
Bleeding between periods
Itching, tingling, or burning feeling in the vaginal or anal area
Pain in the legs, buttocks, or vaginal area
Menorrhagia
a menstrual period that is abnormally heavy or prolonged
Common symptoms related to menopause
hot flashes, trouble sleeping, mood changes, night sweats
Use of oral contraceptives—what would you want to include in obtaining information/health history
regarding a woman who wishes to begin use of oral contraceptives
number of partners, practices, any preference, how often, past STI tests