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1
Q

skin basics

A

integumentary system
largest organ of the body

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2
Q

skin is composed of

A

water, protein, fats, and minerals

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3
Q

layers of the skin

A

epidermis
dermis
hypodermis

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4
Q

functions of the skin

A
  • protection
  • absorption
  • excretion
  • secretion
  • regulation
  • sensation
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5
Q

hair functions

A

appending of the skin
protects the body
enables sensory stimulation

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6
Q

genetic changes alter the

A

amount and distribution of body hair

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7
Q

where are hair follicles located

A

in the dermis
present in all areas of the body except the palms and soles

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8
Q

sebaceous glands support

A

each hair follicle
secretes sebum

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9
Q

sebum maintains

A

hair moisture and condition

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10
Q

sebaceous glands

A

decline with age

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11
Q

nails

A

epidermal appendages

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12
Q

nails arise from

A

a nail matrix in the epidermal layer and are composed of a nail plate and bed

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13
Q

systemic diseases or infectious processes can alter

A

the growth rate and thickness of nails

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14
Q

glands

A
  • sudoriferous glands
  • eccrine glands
  • procaine glands
  • sebaceous glands
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15
Q

sudoriferous glands

A

maintain normal body temperature

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16
Q

eccrine glands

A

cover most of the body with the exception of nail beds, lib margins, glans penis, and labia minora
secret a weak saline solution (sweat)

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17
Q

apocrine glands

A

axillae and genital areas
open into hair follicles

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18
Q

sebaceous glands

A

all over body except palms and soles of hands and feet
secretes sebum - oil like substances
inflammation = acne

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19
Q

older adult changes of skin

A
  • loss of elastin, collagen, and sub fat = thinner skin
  • decreased skin turgor
  • decreased rate of epidermal repair
  • decreased efficiency of glands
  • increased risk of skin breakdown
  • decreased melanin
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20
Q

cultural differences in skin

A
  • differences in hair color and texture (hair coverings)
  • ashy dermatosis
  • traction alopecia
  • keloids
  • congenital dermal melanocytosis - “Mongolian spots”
  • tattoos and body piercings
  • therapeutic burning
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21
Q

priority urgent assessment of skin

A
  • acute lacerations, burns, tissue injuries
  • rash of unknown cause
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22
Q

interventions for acute lacerations, burns, and tissue injuries

A

fluids, oxygen, and skin protection

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23
Q

most skin findings are non emergent but…

A

must be reported for further evaluation and may be associated with other causes

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24
Q

ABCDE of melanoma detection

A

a- asymmetry
b- border
c- color
d- diameter
e- evolving

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25
Q

subjective data for skin

A
  • abcde’s
  • sunburn frequency and sun related skin-care
  • lifestyle factors and personal habits
  • meds and/or allergies
  • family hx
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26
Q

teaching and health promotion for skin

A
  • excess UV radiation and sun exposure
  • promote SPF 30+ and broad spectrum
  • self skin exams
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27
Q

pruritis

A
  • itching
  • preceded atopic lesions
  • follows inflammatory lesions
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28
Q

rash

A
  • can be from contact or allergic dermatitis
  • localized or generalized
  • macular, papular, pustular, vesicular, plaque
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29
Q

single lesion or wound

A

determine if acute or chronic
consider cause

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30
Q

normal findings upon inspection of skin

A

consistent pigmentation throughout the body, skin has pink tones and is normal for ethnic background, skin is clean dry and intact

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31
Q

abnormal findings for inspecting skin

A

vitiligo, flushing, erythema, cyanosis, pailon rubor, brawny, jaundice, uremic frost, wounds or skin lesions

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32
Q

normal findings of palpation

A
  • consistent temp throughout body
  • moisture and warm
  • skin turgor elastic
  • no lesions present
  • nails smooth and nontender
  • hair smooth
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33
Q

abnormal findings upon palpation

A
  • hot temperature
  • diaphoresis
  • dry or flaky skin
  • tenting
  • delayed cap refill
  • swelling or heat at specific site
  • thin or brittle hair
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34
Q

acute wounds

A

heal in less than 6 weeks

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35
Q

chronic wound

A

takes greater than 6 weeks to heal

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36
Q

wound healing phases

A
  • inflammatory phase
  • proliferative phase
  • remodeling phase
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37
Q

inflammatory phase

A
  • begins within 30 minutes of injury and lasts 2-3 days
  • vasoconstriction, platelet aggregation, aid release of thromboplastin promote hemostasis
  • inflammatory reaction follows, polymorphonuclear cells to cleanse the wound of debris and kill bacteria
  • mononuclear cells became macrophages to cleanse wound of debris, dead bacteria, and spent neutrophils
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38
Q

proliferative phase

A
  • may last up to 4 weeks
  • fibroblasts migrate into the wound bed to deposit collagen and secrete growth factors
  • macrophages produce enzymes to stimulate new growth and generate blood vessels
  • wound has the appearance of granulation
  • wound bed is regenerating so wound edges begin to contract an move centrally to close the wound and epithelial regrowth closes it
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39
Q

remodeling phase

A
  • begins at end of proliferative
  • can last up to 2 years
  • once deposition of new collagen is maximized (at 3 weeks), macrophages stimulate a gradual replacement and new replaced collagen with mature collagen which greatly increases the strength of the wound
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40
Q

measuring of the wound

A

L x W x D
length - head to toe
width - side to side
depth - straight down into wound bed

measure of tunneling and undermining

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41
Q

braden scale pressure ulcers

A
  • moisture
  • activity
  • mobility
  • nutrition
  • shear
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42
Q

if pt is incontinent

A

keep skin clean, dry, and intact

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43
Q

skin and wound assessment

A
  • throughout full body skin assessment on hospital admission for ALL pts (head to toe with 2 nurses)
  • looking for pressure injuries, moisture associated skin damage, intrigo, diabetic foot ulcer,venous ulcer, arterial ulcer, traumatic wound, lesions, surgical incisions/puncture sites
  • burns
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44
Q

pressure injury

A

injury to skin and underlying tissue resulting from prolonged pressure over bony prominences

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45
Q

INJURY

A

I- incontinence care
N- nutrition and hydration
J- just move
U- use pressure relief
R- reassess at least 1x/shift
Y- you seek help early

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46
Q

stage I

A

nonblanchable erythema w/ closed skin

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47
Q

stage II

A

top layer of skin comes off

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48
Q

stage III

A

fat tissue

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49
Q

stage IV

A

fat into bone and tendons

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50
Q

unstageable

A

dead skin cells and eschar

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51
Q

SDTI

A

severe deep tissue injury that hasn’t opened

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52
Q

burn assessment

A
  • classified on depth of tissue destruction and percentage of total body surface area affected
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53
Q

depth of burn

A

assess vascular and sensory status as well as appearance and blancing of burn

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54
Q

percentage of burn

A

calculated using wallace rule of 9s

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55
Q

superficial burns

A

epidermis layer

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56
Q

superficial dermal burns

A

epidermis and part of dermis

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57
Q

deep dermal burns

A

epidermis and all of dermis

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58
Q

total thickness

A

all layers of skin (may extend to supportive fascia

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59
Q

wound healing complications

A
  • infection
  • osteomyelitis
  • necrosis/gangrene
  • peri-wound dermatitis
  • edema
  • hematoma
  • dehiscence
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60
Q

infection

A

most common
redness, swelling, pain
catch early, discharge teaching

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61
Q

osteomyelitis

A

infection into bone
requires surgery and IV antibiotics and even possible amputation

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62
Q

necrosis/gangrene

A

no circulation
amputation

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63
Q

peri-wound dermatitis

A

boggy soft tissue around wound bed which can indicate wrong treatment

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64
Q

hematoma

A

bleeding under skin

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65
Q

dehiscence

A

reopening of wound

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66
Q

analyze labs and diagnostics

A
  • integumentary findings often reflect the status of other symtpoms
  • constantly observe skin while assessing other symptoms
  • culture and sensitivity
  • wood light test
  • allergen testing
  • biopsy
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67
Q

diagnosis: wound

A

description: alteration in or damage to one or more layers of skin

assessment: wound, surgical incision, break in skin integrity

interventions: document wound assessment, and exudate, collab w/ provider on debridement and/or surgical intervention

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68
Q

diagnosis: impaired skin integrity, tissue integrity, or DTI

A

description: damage to tissues of subq layer of skin, mucous membrane, cornea, or all of these

assessment: damaged or destroyed subq, muscle, bone, mucous membranes, or corneal tissues

interventions: size and depth, periwound skin, continence status, tube/incision placement, apply dressing, assess risk of skin breakdown, evaluate special matresses, avoid bony prominences, collab w physician on surgery or debridement

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69
Q

diagnosis: risk for infection

A

description: pathogenic organisms from break in skin tissue, body’s primary defense

assessment: break in skin integrity, tubes and procedures, exposure to pathogens, malnutrition, inadequate immunity, chronic disease

interventions: frequent handwashing, universal precautions, protect wound, monitor fever, WBC elevation, drainage, or erythema, discontinue as soon as possible, nutrition

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70
Q

breast and axillae landmarks

A
  • anterior chest way 2nd intercostal space superiorly, 6th or 7th ICS inferiorly, sternal margin to midaxillary line
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71
Q

breast and axillae are supported by

A

pectoral muscle and superficial fascia

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72
Q

breast structures

A
  • lie anterior to serratus anterior and pectoralis major muscles
  • comprised of: nipple, areola, montogomery gland, fibrous tissue, glandular tissue, lymph nodes
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73
Q

blood supply to breasts

A
  • deep breast tissue and nipple: internal mammary and lateral thoracic arteries
  • superficial tissues: intercostal, subscapular, and thoracodorsal arteries
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74
Q

axillae and lymph nodes

A
  • each breast has lymphatic network
  • lateral axillary - brachial
  • central axillary - midaxillary
  • posterior axillary - subscapular
  • anterior axillary - pectoral
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75
Q

pregnancy

A

changes occur around 2 months
begin to express colostrum during 4th month (high protein, carbs, and antibodies, low in fat)

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76
Q

newborns and infants

A

breast tissue is not sex specific
enlarged breast tissue with some white discharge is common
supernumerary nipple

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77
Q

children and adolescents

A
  • prior to puberty, no change in breast tissue
  • adolescence (females at birth develop related increased hormones
  • adipose tissue and lactiferous ducts grow from increased estrogen
  • progesterone stimulation = lobular growth and alveolar budding
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78
Q

full breast development occurs over

A

3 year period of time

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79
Q

tanner stage 1

A

girls: elevation of papilla only, villus hair only, 2.2-2.4 inches/year, adrenarche and ovarian growth

boys: testes <2.5 cm, villus hair only, 2.0-2.4 in/year, adenarche

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80
Q

tanner stage 2

A

girls: breast bud under areola, aerola enlargement, sparse hair along labia, 2.8-3.2 inches/year, clitoral enlargement, labia pigmentation, uterus growth

boys: testes 2.5-3.2cm thinning and reddening of scrotum, sparse hair at penis base, 2.0-2.4 in/yr, decrease in BF

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81
Q

tanner stage 3

A

girls: breast tissue grows but no contour or seperation, coarser hair curled pigments cover pubes, 3.2 inches/year, axillary hair, acne

boys: testes 3.3-4.0 cm, increase of penis length, thicker curly hair spreads to pubis, 2.8-3.2 inches/year, gynecomastia, voice rbeak, increased muscle mass

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82
Q

tanner stage 4

A

girls: projection of areola, and papilla, secondary mound formation, adult hair, does not spread to thigh, 2.8 in/yr, mearche and development of menses

boys: testes 4.1-4.5 cm, penis growth darkening of scrotum, adult hair doesn’t spread to thighs, 4in/yr, axillary hair, voice change, acne

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83
Q

tanner stage 5

A

girls: adult type contour, projection of papilla only, adult hair spreads to thighs, cessation of liner growth, adult genitalia

boys: testes >4.5cm, adult genitalia, adult hair spread to medial thighs, deceleration, cessation, facial hair, muscle mass increase

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83
Q

older adults

A
  • glandular, alveolar, and lobular tissue decrease
  • post-menopause (fat deposits replace glandular tissue, decreased ovarian hormone levels)
  • suspensary ligaments relax
  • decreased size and elasticity
  • axillary hair growth stops
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84
Q

breasts in males

A
  • immature structures w/ well developed areole and small nipples
  • mid-puberty - hormone levels change causing gyneocmastia, palpable, discrete mass of firm subareolar tissue greater than 2cm in diameter
  • pubescent
  • adolescent
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85
Q

priority urgent assessment

A
  • trauma
  • infection
  • pain
  • masses
  • nipple dischargec
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86
Q

conditions requiring further evaluation to rule out cancer

A
  • new breast lump or mass
  • swelling or all or part of breast
  • skin irriation
  • breast/nipple pain
  • nipple retraction
  • redness, scaliness, or thickening of nipple, nipple discharge
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87
Q

subjective data collection

A
  • sensitive topic
  • focus on health hx (discomoft, masses, lumps, breast surgeries, mestrual cycle, pregnancy, lactation history, hormone replacement therapy, hormonal contraceptive use, hx of breast tauma and self care behaviors, family hx of breast cancer
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88
Q

symptoms of breast cancer

A

breast pain
rash
lumps
swelling
nipple discharge
trauma

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89
Q

gail model

A

uses 7 risk factors for breast cancer risk such as age, age of first period, age at first birth, family hx, number of breast biopsis, number showing atypical hyperplasia, race/ethnicity

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90
Q

teaching and health promotion for breasts

A
  • genetic testing for early diagnosis
  • mammograms (yearly age 45-54) every other year age 50-74
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91
Q

normal breast findings

A
  • skin tone matching ethnicity
  • potential striae
  • varierty of normal shape and size
  • breasts symmetric
  • contour smooth.uninterupted
  • areola round to oval, pink to dark brown
  • nipples everted
  • potential supernumeracy nipple
  • no s/s of infection
  • no rashes
  • smooth countour on palpation
  • one or more small ,soft, nontenderous nodules
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92
Q

abnormal breast findings

A
  • eryhtema
  • hyperpigmentation
  • unilateral vascular appearance
    -rashes
  • peau d/orange
  • nipple retraction
  • change in color or size
  • assymetric breasts
  • firm hard enlarged lymph nodes
  • tender warm enlarged lymph nodes
  • tenderness on palpation
  • nipple discharge
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93
Q

how many lactiferous duct empty to nipple

A

15-20

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94
Q

ducts lead from alveoli (lobules) where

A

milk is synthesized

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95
Q

fibrous connective tissue

A

structural support: cooper bands

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96
Q

glandular tissue is formed by ducts and lobules

A

15-20 glandular lobes in each breast from nipple outwards

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97
Q

nipple and areola

A
  • surrounded by smooth muscle which contract to express milk during lactation
  • sensory innervation stimulated by infant sucking “milk let down”
  • tactile stimulation can stimulate normal reflexes that cause a smaller firmer breast and puckering of areola
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98
Q

supernumerary nipple

A
  • located along milk line
  • only small nipple and areola usually present
  • mistaken for common mole
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99
Q

anterior axillary

A
  • pectroal nodes
  • along lower border of pectoralis major inside anterior axillary fold, they drain the anterior chest wall and much of breast
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100
Q

posterior

A
  • subscapular nodes
  • along lateral border of scapula
  • palpated deep in posterior axillary fold
  • drain posterior chest wall and portion of arm
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101
Q

lateral nodes

A
  • brachial nodes
  • found along upper humerus
  • drain most of arm
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102
Q

central axillary nodes

A
  • midaxillary
  • most frequently palpable
  • lymph drains from central axillary nodes to the infraclavicular and supraclavicular nodes
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103
Q

male breasts

A
  • chiefly small nipple and areola
  • overlie thin disc of undeveloped breast tissue
  • may be dificult to distinguish male breast tissue from surrounding muscle of chest wall
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104
Q

pregnancy

A
  • estrogen, progesterone, prolactin influence breast chanegs
  • colostrum: first 3-5 days, protein, carbs, antibodies, low in fat, easier to digest
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105
Q

puberty

A

secondary characteristics develop under hormonal influence of estrogen and progesterone
mearche glandular tissue of breasts change
tanner staging used to describe breast development

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106
Q

older adults

A

glandular, alveolar, and lobular tissue decrease
due to decrease in hormones

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107
Q

black or african american females are almost 40% more likely to die from

A

breast cancer compared to white females

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108
Q

inspection of breasts

A

arms at side to note any redness, size and symmetry of breasts, countour of breasts and characteristics of nipples and their direction
dimpling or retraction may suggest underlying cancer
leaning forward to assess for any retraction of nipple and areola

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109
Q

palpation of breasts

A
  • lateral
  • medial
  • consistency of tissues
  • tenderness
  • nodules
  • using pads of 3 fingers, palpate in small circles systematically
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110
Q

increase in amount of breast flandular tissue in boys or men caused by imablance of

A

hormones estrogen and testosterone, gynecomastia can affect one or both breasts sometimes unevenly

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111
Q

male breast exam

A
  • rash, infection, usual pigmentation
  • pectoral nodes
  • lateral nodes
  • subscapular nodes
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112
Q

visible signs of breast cancer

A
  • nipple retraction and deviation
  • skin dimpling
  • peau d’orange
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113
Q

overiew of pediatrics

A
  • vary sequence according to child’s age and comfort level, more distressing interventions towards end of visit
114
Q

four principles of child development

A
  • child development proceeds along a predictable pathway
  • the range of normal development is wide
  • various physical, social, and environmental factors, as well as diseases, can affect child’s development and health
  • the childs developmental level affect how you conduct history and physical exam
115
Q

health promotion and counseling for children

A
  • age appropriate developmental achievement for a child
  • health supervision visits
  • integration of physical exam findings with healthy lifestyle recommendations
  • immunizations
  • screening procedures
  • anticipatory guidance
  • partnership among HCP and child and family
116
Q

physical development is faster

A

during infancy than any other time

117
Q

birth to 1 months

A

physical: fixes/follows, head control
cognitive/language: responds to sounds
social/emotional: smiles, regards faces

118
Q

1mo - 2mo

A

physical:
cognitive/language: squeals
social/emotional:

119
Q

2mo-3mo

A

physical: rolls over, grasps rattle
cognitive/language:
social/emotional:

120
Q

3mo-4mo

A

physical:
cognitive/language: immitates speech sounds
social/emotional: works for toy

121
Q

4mo-5mo

A

feeds self

122
Q

5mo-6mo

A

physical: sits, thumb finger grasp
cognitive/language:
social/emotional:

123
Q

6mo-7mo

A

physical:
cognitive/language: dada/mama specific
social/emotional:

124
Q

7mo-8mo

A

physical: pulls to stand
cognitive/language:
social/emotional: indicates wants

125
Q

8mo-9mo

126
Q

9mo-10mo

A

physical: crawls
cognitive/language:
social/emotional: imitates activities

127
Q

10mo-11mo

A

physical: stands
cognitive/language: 2 words
social/emotional:

128
Q

11mo-12mo

A

physical: walks
cognitive/language: 3 words
social/emotional: uses spoon

129
Q

infant health hx

A
  • problems during pregnancy
  • how close was birth to due date
  • any problems during labor or birth
  • vaginal or c section
  • allergies
  • medications, supplements, vitamins
  • illnesses
  • family hx
  • health maintenance (immunizations, safety)
  • health patterns (diet, sleep, elimination)
130
Q

physical exam of infants

A
  • approach infant gradually using toy or object for distraction
  • perform most of exam in parents lap
  • speak softly or mimic infant’s sound to attract attention
  • if cranky, make sure infant is well fed
  • ask about infants strengths to find out developmental and parenting information
  • do no expect head to toe in specific order
  • save mouth and ear exams for last
131
Q

somatic growth

A
  • height
  • weight (dry diaper or naked)
  • head circumfrence (1st 2 years of life)
  • length (<2 years old, supine)
132
Q

growth charts

A
  1. birth to 36 mo
  2. 2-18 years old
133
Q

vital signs of babies

A
  • temperature (fever common)
  • respiratory rate (high than adults): ranges between 30-60 bpm, sleeping respiratory rate most reliable
  • pulse: higher than adults, more sensitive to illness, exercise, emotion
  • BP: not routinely done under age 3
134
Q

birth - 2mo heart rate

A

140
range: 90-190

135
Q

0-6mo heart rate

A

130
range: 80-180

136
Q

6-12 months

A

115
range: 75-155

137
Q

skin exam of infant

A
  • inspect color, skin markings, birthmarks, dark or bluish pigmentation, vascular marking
  • palpate turgor, abdominal wall, tenting
138
Q

angels kiss

A

vascular marking on babies eye

139
Q

stork’s bite

A

vascular marking on back of babies neck

140
Q

cafe au lait

A

spont of babies back

141
Q

mongolian spot

A

more common in darker skin babies, may be mistaken for abuse or bruising

142
Q

erythema toxicum

A

occurs first couple of days after birth, will go away

143
Q

newborn acne

A

no treatment goes away on own

144
Q

cradle cap

A

sebhorrehac dermatitis
on top of babies head

145
Q

atopic dermatitis

146
Q

candida monillia

A

yeat reash within folds of skin

147
Q

diaper rash

A

not within folds of skin

148
Q

impetigo

A

crusty hard rash on body

149
Q

central cyanosis

A

bluish hue to central parts of body such as head torso and mouth
NOT NORMAL

150
Q

acrocyanosis

A

hands and feet with bluish hue, normal findings

151
Q

newborns head

A

1/4 body length
1/3 of body wieght

152
Q

skull symmetry and head circumfrence

A
  • assymetric head swelling
  • plagiocephaly
  • measure circumfrence
  • palpate carefully
153
Q

macrocephaly

A

big head
>98%

154
Q

microcephaly

A

small head

155
Q

facial symmetry

A

inspect
compare face with parents
abnormal appearance can lead to diagnosis of down syndrome, noonan syndrome, or fetal alchol effects

156
Q

upslanting face

A

down syndrome

156
Q

down slanting face

A

noonan syndrome

157
Q

short face

A

fetal alcohol syndrome

158
Q

micrognathia

A

when lower jaw is smaller than normal

159
Q

congential hypothyroidism

A

can lead to neuro deficits

160
Q

congenital syphillis

A

leads to complications for baby

161
Q

facial nerve palsy

A

inability to move and assymetry of face

162
Q

battered child syndrome

A

collection of injuries due to beating of child or mistreatment

163
Q

perennial allergic rhinits

A

inflammation of nose

164
Q

examining eyes of infant

A
  • use subdued lighting
  • use tricks and small toys
  • eye movement (esotropia, exotropia)
  • pupillary reaction
  • irises
  • conjunctiva (swelling or redness)
  • visual acuity (cannot be measured)
  • opthalmoscopic exam (red retinal reflex)
165
Q

esotropia

A

when one or both eyes move inward

166
Q

exotropia

A

when one or both eyes move outward

167
Q

visual milestones

A

birth: blinks
1 month: fixes on object
1 1/2 - 2months: coordinated eye movements
3 months: eyes converge, baby reaches
12 months: acuity around 20/50

168
Q

ear exam

A
  • major goal is to examine position, shape, features, and detect abnormalities
  • ear canal in children is directed downards
169
Q

ear milestones

A

0-2mo: startle response and blink to sudden noise
2-3mo: change in body movements in response to sound, change in facial exprsesion to familiar sounds
3-4mo: tunring eyes and head to sound
6-7mo: turning to listen to voices and conversation

170
Q

otitis media

A

ear infection

171
Q

patency of nasal passage

A
  • gently occlude nostril while holding mouth closed
  • obligate nasal breathers
  • do not occlude both nares
172
Q

infant mouth exam

A
  • endentulous
  • mucousa smooth
  • epstein pearls (NORMAL)
  • amount of saliva
  • crying (normal: lusty, strong)
  • teeth eruption: one tooth for each month of age between 6-26months
173
Q

oral candidasis

A

oral yeast infection

174
Q

herpetic stomatitis

A

viral infection causing sores and ulcers in mouth

175
Q

neck of infant

A
  • examine while supine
  • palpate lymph nodes
  • congenital cysts
  • inspect position of thyroid cartilage and trachea
  • palpate clavicle
176
Q

infant chest

A
  • assess respirations and breathing - assess obstruction due to displacement of left lung due to heart location
  • nasal flaring?
  • grunting? - not normal
  • audible wheezing?
  • lack of breath sounds?
177
Q

palpation of infant chest

A

tactile fremitus
feel for symmetry in vibrations
NO PERCUSSION

178
Q

auscultation

A

breath sounds louder than adult
usually inspiratory, coarse sounds

179
Q

breath sounds of infants

A
  • more difficult to distinguish
  • wheezes, crackles, rhonchi?
180
Q

observing respiration of child

A
  • general appearance: inability to feed or smile, lack of consolability
  • respiratory rate: tachypnea, apnea
  • color: pallor or cyanosis
  • nasal component of breathing: nasal flaring
  • audible breath sounds: grunting, wheezing, stridor (upper airway), obstruction
  • work of breathing: nasal flaring, grunting, retractions, pradoxical breathing
181
Q

inspect heart

A
  • central cyanosis
  • tongue, conjunctivae
  • general signs of health (low weight, poor feeding, irritability
182
Q

common noncardiac findings in infants with cardiac disease

A
  • poor feeding
  • failure to thrive
  • irritability
  • tachypnea
  • hepatomegaly
  • clubbing
  • poor overall appearance
  • weakness
183
Q

heart murmurs in infants

A
  • note location
  • timing
  • intensity
  • quality
  • benign murmurs in children have no other abnormal findings
  • most children will have one or more function, or benign, heart murmur before reaching adult hood
184
Q

inspection of abdomen

A
  • protuberant somtach from poor muscle
  • blood vessels and peristalsis easily noted
  • umbilicus
  • inspect for redness and swelling
  • hernia?
  • diastasis recti- belly sticks out
185
Q

inspect male genitalia

A
  • infant supine
  • foreskin
  • urethral meatus
  • shaft of penis
  • scrotum
  • testes
186
Q

hypospadias

A

urethra located on dorsal portion of penia

187
Q

undescended testicle

A

requirement for proper development of sperm

188
Q

inspection of female genitalia

A
  • labias
  • clitoris
  • urethral orriface
  • hymen
  • rashes
  • bruises
  • external lesions
189
Q

MSS of infants

A
  • focus on detection of congenital abnoralities (hands, spine, hips, legs, feet)
  • combine neuro and MS
  • palpate clavicle, spine, and palpate
190
Q

ortoloni and barlow test

A

tests stabilization of femur

191
Q

bowing in legs is normal until

A

toddler age

192
Q

examine legs and feet

A
  • symmetry
  • bowing
  • leg length
  • torsion
  • galeazzi
193
Q

ortolani test

A

moves legs outward

194
Q

barlow test

A

moves legs inward and up

195
Q

foot deformaty

A

club foot
meatasus adductus

196
Q

infant neurological system

A
  • mental status
  • gross and fine motor skills
  • tone
  • cry
  • deep tendon reflexes
197
Q

increased tone in a babies cry indicates

A

cerebral palsy

198
Q

olfactory nerve infant

A

difficult to test

199
Q

CN II optical infants

A

have baby regard your face and look for facial response and tracking

200
Q

CN III and II: ocular and oculomotor infant

A

response to light, darken room, raise baby to sitting position to open eyes and use light to test for optic blink reflex, use otoscope to assess papillary respones

201
Q

CN III, IV, and VI (extraocular movements) infants

A

observe how well baby tracks smiling face

202
Q

V (motor) infants

A

test rooting reflex (when corner of babies mouth is touched head will move in that direction or mouth will open)
test sucking reflex

203
Q

CN VII (facial) infants

A

observe baby crying or smiling, note symmetry of face and forehead

204
Q

CN VIII (acoustic) infants

A

test acoustic blink reflex (blinking in respone to loud noise)
observe tracking to sound

205
Q

IX and X (swallowing) infants

A

observe coordination during swallowing
test gag reflex

206
Q

XI infants (spinal accessory)

A

observe symmetry of shoulders

207
Q

XII infants (hypoglossal)

A

coordination of sucking, swallowing, and tongue thrusting
pinch nostrils; observe reflex opening of mouth with tip of tongue to midline

208
Q

deep tendon reflexes

A

use finger instead of hammer
variable due to underdeveloped corticospinal pathways

209
Q

babinski response

A

toes moving upward when touch receptors on bottom of foot are stimulated

210
Q

ankle clonus

A

indicative of risk for seizures
dorsiflex foot upward and see if leg starts bouncing

211
Q

primitative reflexes

A
  • infantile automations
  • develop during gestation
  • demonstratable at birth
  • disappear at defined ages
212
Q

palmar grasp reflex

A

reflex when given finger
normal from birth to 3-4 months

213
Q

plantar grasp reflex

A

toes curling
normal from birth to 6-8 months

214
Q

trunk incurvation reflex

A

when back of spine is touched infant will turn hips towards that
normal from birth to 2 months

215
Q

placing and stepping reflexes

A

birth (best after 4 days)- varaible age to disappear
stepping when being placed down

216
Q

landau reflex

A

baby lying stomach down in hands where body tenses and head looks up
normal from birth to 6 months

217
Q

parachute reflex

A

extends arms forward to break fall
4-6mo; doesn’t disappear

218
Q

positive support reflex

A

baby will extend legs to support own weight
normal from birth or 2 mo up until 6 months

219
Q

infant exams should be given at what times

A

1 month
2 months
4 months
6 months
9 months
12 months

220
Q

infant health promotion counseling

A
  • infant exam schedule
  • birth
  • within first week
  • 1,2,4,6,9,12 months
  • assess infants growth and development
  • perform comprehensive physical exam
  • screening tests
  • immunizations
  • anticaptory guidance
221
Q

early childhood

222
Q

middle childhood

A

5-10 years

223
Q

physical and motor milestones early childhood

A

1 year - walks
2 years - throws
3 years - jumps in place, balances on 1 foot
4 years - hops, pedals tricycle
5 years- skips, balances well

224
Q

cognitive milestones in early childhood

A

1 - 2-3 words
2- 2-3 word phrases
3- sentences
4- speech all understandable
5- copies figures and defines words

225
Q

social milestones in early childhood

A

1- plays games (peek abo)
2- imitates activites
3- feeds self
4- imaginative, sgings
5- dresses self and plays games

226
Q

physical milestones during middle childhood

A

enhanced strength and coordination
competence in various tasks and acitivies

needs: creen for strengths, assess problem, involve parents, support for disabilities, anticaptory guidance: safety

227
Q

cognitive milestones during middle childhood

A
  • concrete operation: focus on present, acheivement of knowledge and skills, self efficacy
  • emphasis on short-term consequences, support, screening about skills and school performace
228
Q

social milestones during middle childhood

A
  • achieveing good “fit” with family, friends, school, sustained self-esteem, evolving self-identity
  • assessment, support, advice, about interaction, support emphasis on strengths, understanding, advice
229
Q

health hx of young and school aged child

A
  • observe parent-child interaction
  • abnormalities detected while observing play: behavioral problems, social or environmental problems, neurologic problems
230
Q

tips for examining young child

A
  • examine in parents lap
  • examine teddy bear first
  • let child hold stethescope
  • give child something to hold onto
  • use age appropriate books
231
Q

assessing older children

A
  • provide gown and leave underwear in place
  • parents of younger than 11 should stay w/ child
232
Q

underweight children

A

<5th percetile

233
Q

at risk for overweight

A

> 85th percentile

234
Q

overweight

A

> 95th percentile

235
Q

1-2 year old HR

A

110 average
70-150 range

236
Q

2-6 years old

A

103 average
68-138 range

237
Q

6-10 years

A

95 average
65-125 range

238
Q

skin of children

A
  • after first year of life, techniques same as for an adult
239
Q

common skin issues in children

A

warts (HPV)
ringworm
tinea capitalists - ring worm on skin

240
Q

visual acuity through ages

A

3 months: eyes coverge baby reaches
12 months: 20/100
<4 years: 20/40
4+: 20/30

241
Q

assessing ears

A
  • make it a game
  • allow parents to help hold child
  • tympanic membrane
242
Q

until 3 years old external auditory canal is directed

243
Q

after 3 years of age, external auditory canal is direct

244
Q

common ear problems in children

A
  • otitis media
  • ear tubes
  • swimmers ear
245
Q

nose and sinuses of children

A
  • inspect anterior protion with large speculum
  • inspect nasal mucous membranes
  • look for septal deviation or polyps
246
Q

mouth and pharynx of child

A
  • try to avoid tongue blade
  • demonstrate
  • examine teeth (bottle carries)
246
Q

common problems of throat in children

A
  • strep
  • peritonsillar abscess
  • viral pharyngitis
247
Q

male genitalia

A
  • palpate scrotum to prevent cremasteric reflex of testes (testes moving up)
247
Q

heart murmurs

A

common in young children, usually benign
venous hum
still murmur

248
Q

female genitalia

A
  • inspect for hair, size, shape, color, rashes, bruises, and lesiosn
249
Q

child has increase lumbar _____ and decreased thoracic ______

A

concavity, convexity

250
Q

normal progression of increased

A

bowledgged growth to knock knee pattern, then gradually corrects

251
Q

denver II

A

developmental milestones

252
Q

exam schedules for 1-4 years old

A

12 months
15 months
18 months
24 months
3 years
4 years

253
Q

stages of adolescence

A
  1. early adolescence (10-14)
  2. middle adolescence (15-16)
  3. late adolescence (17-20)
254
Q

physical exam of adolescents

A
  • growth
  • physical maturation
  • screenings for drugs, alcohol, depression, STDs
  • immunizations (dtap, meningitis, HPV)
255
Q

anticipatory guidance for adolescents

A
  • behaviors (illness prevention, nutrition, oral health, physical activity)
  • sexuality
  • substance abuse
  • social achievement
  • community interaction
256
Q

common issues of adolecents

A
  • pulmonary flow murmur
  • sexual maturity
  • scoliosis
  • sports preparticipation
257
Q

skin hair and nails (gereatrics)

A
  • epidermis thins
  • decrease in collagen, loss of subq fat, and decrease in dermal support
  • sweat glands decrease
  • nail beds rigid, thicker, and more brittle
  • decreased melanin
258
Q

high sun exposure throughout life

A
  • solar lentigines
  • mottled dyspigmentation
  • acitinic keratoses
259
Q

eyes and vision gereatric

A
  • decrease fat in orbital area
  • relaxed orbital muscles
  • decreased lid elasticity
  • decreased lubrication of eyes
  • ciliary muscle atrophy
  • eye lens is less elastic, larger, and more dense
  • delayed pupillary response
260
Q

ears and hearing

A
  • widening and lengthening of auricle
  • coarse wiry hair growth in external ear
  • narrowing of auditory canal
  • dry cerumen in auditory canal
  • tympanic membrane becomes dull, less flexible and retracted
  • organ of crti atrophies
  • cochlear neurons are loss
261
Q

nose, sinuses, mouth, and throat of gereatrics

A
  • loss of olfactory neurons
  • tooth surfaces dull over time (gum recession, tooth loss)
  • loss of taste detection and sensation
262
Q

thorax and lungs gereatric

A
  • loss of elasticity causing decline in chest expansion
  • decreased accessory muscle strength and decline in cilia causing less effective cough and imapired airway clearance
  • alveoli are thicker and fewer in adult smokers
263
Q

heart and neck vessels of gereatrics

A
  • changes in connective and smooth muscle tissue causing stiffer arterial walls with decreased elasticity which increases afterload
  • coronary artery blood flow decreases by about 1/3
  • decline in atrial pacemaker cells = decreased heart rate
  • cardiac contractility decrease = decreased CO, SV, and cardiac reserves
264
Q

peripheral vascular and lymphatics gereatrics

A
  • calcification of arteries increases rigidity causing high systolic BP
  • aatherosclerotic disease more prominent in arteries supplying brain, heart, and vital organs
  • edema develops from decreased lymphatic drainage
265
Q

breast, chest, and lymphatics gereatrics

A
  • glandular breast tissue atrophies, becomes less dense, and is replaced by fat
  • inframammary ridge thickens so it is easier to palpate
  • suspensory ligaments relax so breast shape changes
  • axillary hair may stop growing
266
Q

abdomen, metabolism, and elmination

A
  • slowed peristalsis
  • decreased absorption of vitamin b12 and d, calcium, and zinc
  • reduced hepatic blood flow causing liver decline
  • size and function of kidney decreases with age
  • decreased peak bladder capacity and weakened bladder muscles
267
Q

ms system gereatrics

A
  • older adults lose height due to gradual copression of spinal column
  • ate 30, bone absorption exceeds bone formation
  • decreased lean muscle mass
  • decline of type 2 (fast-twitch) muscles leading to muscle wasting
268
Q

neuro gereatric

A
  • number of neurons and glial cells decline, neuronal synapses decrease, and accumulation of oxyradiacal in body
  • atrophy related to degenerative neurological processes
  • decreased autonomic function
  • spped of brain processing declines
  • decreased postural control, vibratory sense, and righting reflex
  • senile tremors
269
Q

genitourinary system

A
  • enlargement of prostate gland in males (urinary retention and outlet obstruction)
  • thinning of genital hair
  • estrogen levels decline (thinner vaginal mucosa, declined elasticity, decreased secretions)
  • increased risk of asymptomatic UTI (new onset confusion is first sign)
270
Q

endocrine system

A
  • pituitary gland decreases in size, weight, and vascularity
  • growth hormone secretion declines (significant in addrenal streiods)
  • increased presence of glucose intolerance
  • decreased response to immunizations
271
Q

priority urgent assessment for geriatrics

A
  • hemodynamic instability
  • myocardial infarction
  • infections, including pneumonia, UTIs, and fever
  • dehydration
  • respiratory distress
  • delirium, decreased level of consciousness, and confusion
272
Q

subjective data colelction for older adult

A
  • reduce background noise, increase lighting, and create warm space for good hearing and communication
  • take time with older adult, allow time for them to answer question
  • address questions directly to the client
273
Q

assessment of risks for gereatrics

A
  • past med hx and reasons for current visit
  • lifestyle and personal hbaits
  • mobility and funcitonal capacity (ADLs independence)
  • risk for falls - morse fall scale
  • skin changes or breakdown
  • meds and allergies
  • hx of substance abuse
  • family hx
274
Q

fulmer spices

A

S- sleep disorder
P- problems with eating or feeding
I- incontinence
C- confusion
E- evidence of falls
S- skin breakdown

275
Q

common symptoms of decline

A
  • incontinence (stress, urge, functional): increase age, caffeiene intake, limited mobility, impaired cognition, diabetes, obesity, parkinson’s, stroke, prostate problems in men, diuretic meds
  • sleep depreivation: acute or chonric, female sex, increased age, med or psych illness, shift work
  • pain (acute or chronic)
  • cogntive decline - assess w/ mini-cog or MMSE
  • depression (geriatric depression scale): chronic health problems individuals who have suffered loss of loved one
  • elder abuse- intentional act or failure to act that causes harm to older adult
276
Q

poor hygeine and inappropriate dress indicates

A

decreased functional ability

277
Q

confusion and change in mental status from baseline represents

A

underlying infection, dehydration, or electrolyte imbalances

278
Q

height and weight of older adults

A
  • best to measure on standing scale
  • normal BMI is slightly higher than young adult 25-29 is considered normal
279
Q

respiratory rate of older adults

A

may appear shallower and more rapid
clients with chronic respiratory or cardiac disorders, focus on signs of respiratory distress

nur306 (4 decks)

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