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HEALTH ASSESSMENT > FINAL > Flashcards

FINAL Flashcards

1
Q

Describe the flow of blood through the heart.

A
  • Vena cava
    • Right atrium
      • Tricuspid valve
    • Right ventricle
    • Pulmonary arteries
    • Lungs
    • Pulmonary veins
    • Left atrium
    • Mitral valve
    • Left ventricle
    • Aorta
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2
Q

____________: the ventricles relax and fill with blood. Relaxation.

A

diastole

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3
Q

____________: blood is pumped from the ventricles and fills the pulmonary and systemic arteries. Contraction

A

systole

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4
Q

5 Areas where heart valve closures can be heard

A
  1. precordium
  2. Aortic Valve Area
  3. Pulmonic Valve Area
  4. Tricuspid Valve Area
  5. mitral valve area
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5
Q

WHICH HEART SOUND? Closure of the AV valves. Can be heard all over the precordium, loudest at the apex. “LUB” is the sound heard.

A

FIRST

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6
Q

WHICH HEART SOUND? Closure of the semilunar valves. Can be heard all over the precordium, loudest at the base. “DUP” is the sound heard.

A

SECOND

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7
Q

2 components of assessment of the carotid arteries in older patients:

A
  1. PALPATE each carotid artery medial to the sternomastoid muscle in the neck.
  2. AUSCULTATE each carotid artery for the presence of a bruit (blowing, swishing sound)
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8
Q

3 areas to AUSCULTATE on the carotid artery when checking for bruits

A
  1. angle of the jaw
  2. midcervical area
  3. base of the neck
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9
Q

TRUE OR FALSE? excessive pressure on the sinus area higher in the neck & excessive vagal stimulation here could slow down the heart rate.

A

TRUE

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10
Q

TRUE OR FALSE? Palpate firmly and both carotid arteries at the same time to avoid compromising blood to the brain.

A

FALSE - one at a time

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11
Q

WHAT PART OF THE STETHOSCOPE DO YOU USE AUSCULATE THE HEART?

A

DIAPHRAGM

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12
Q

WHAT PATTERN DO YOU USE TO AUSCULTATE THE HEART?

A

Z PATTERN STARTING AT THE BASE AND GOING TO THE APEX

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13
Q

Area of palpation of apical impulse

A

the fourth or fifth and be at the medial to the midclavicular line.

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14
Q

TRUE OR FALSE? APICAL IMPULSE IS PALPABLE IN EVERYBODY.

A

FALSE. Apical pulse is palpable in about half of adults, not palpable in obese persons or in persons with thick chest walls.

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15
Q

How do you estimate the Jugular venous pressure.

A
  • Use the angle of Louis (sternal angle) as an arbitrary reference point and compare it with the highest level of venous pulsation.
    • Hold a vertical ruler on the sternal angle
    • Align a straight edge on the ruler like a T-Square
    • Adjust the level of the horizontal straight edge to the level of pulsation
    • Read the level of intersection not he vertical ruler
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16
Q

What is normal jugular venous pressure

A

2cm or less above the sternal angle

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17
Q

This is a palpable vibration, it feels like the throat of a purring cat.

A

thrill

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18
Q

What does a thrill signify?

A

signifies turbulent blood flow and accompanies loud murmurs.

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19
Q

TRUE OR FALSE? Absence of a thrill rules out the presence of a murmur.

A

FALSE

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20
Q

________________ is the area on the anterior chest overlying the heart and great vessels.

A

Precordium

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21
Q

9 areas are palpable for pulse?

A
  1. Dosalis Pedis
  2. Radial
  3. Ulner
  4. Temporal
  5. Carotid
  6. Femoral
  7. Bracial
  8. Popliteal
  9. Posterior Tibial
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22
Q

TRUE OR FALSE? It is normal to find palpable nodes that are small (1cm or less), movable, and nontender.

A

False.

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23
Q

Enlargement of these nodes could signal a possible infection as this area drains most of the lymph of the lower extremity and genitalia and the anterior abdominal wall.

A

Inguinal lymph nodes

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24
Q

Describe the lymphatic system of a healthy 3 year old child

A
  1. Well developed
  2. lymph nodes are relatively large and the superficial ones often are palpable even when the child is healthy.
  3. Lymph nodes are firm, mobile and nontender.
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25
Q

Typical capillary refill time

A

Normally the vessels refill within a fraction of a second up to 2 seconds.

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26
Q

What does capillary refill lasting more than 1 or 2 seconds indicate

A

vasoconstriction or decreased cardiac output.

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27
Q

This occurs in 20% of cases of deep vein thrombosis.

A

Positive Homan’s sign

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28
Q

thrombophlebitis (possible complications)

A

inflammation
blocked venous return
cyanosis
edema

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29
Q

This is also present in a variety of other conditions such as muscle injury, achilles tendonitis and plantar muscle injury.

A

positive Homan’s sign

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30
Q

What are the SUBJECTIVE signs of venous stasis?

A

aching pain in calf or lower leg, worse at end of the day, worse with prolonged standing or sitting.

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31
Q

What are the OBJECTIVE signs of venous stasis?

A 
Firm brawny edema
coarse, thickened skin
pulses normal
brown pigment discolouration
petechiae
dermatitis
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32
Q

This will show discoloured feet (dark colour)

A

venous stasis

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33
Q

This causes increased venous pressure, which then causes RBCs to leak out of veins and into the skin. As these RBCs break down, they leave hemosiderin (iron deposits) behind, which are the brown pigment deposits.

A

venous stasis

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34
Q

This can occur after acute deep vein thrombosis

A

venous stasis

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35
Q

Documentation for edema

A
  • 0+=no pitting edema
    • 1+: Mild pitting, slight indentation, no perceptible swelling of the leg
    • 2+: Moderate pitting, indentation subsides rapidly
    • 3+: Deep pitting, indentation remains for a short time, leg looks swollen
    • 4+: Very deep pitting, indentation lasts a long time, leg is very swollen.
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36
Q

Grading of pulses (amplitude) on three point scale (0-3+)

A
  • 0: Absent
    • 1+: Weak
    • 2+: Normal
    • 3+: increased, full, bounding
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37
Q

Distended bladder assessment

A
  • Percuss lightly in all four quadrants to determine the prevailing amount of tympani and dullness.
  • tympany occurs over intestines
  • dullness occurs over full bladder
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38
Q

A dull note forward of the midaxillary line indicates enlargement of the ___________, as occurs with mononucleosis, trauma, and infection.

A

spleen

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39
Q

The splenic dullness normally is not wider than _____ cm in the adult and should not encroach on the normal tympani over the gastric air bubble.

A

7

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40
Q

Reason for auscultation preceding percussion and palpation

A
  • This is done because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.
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41
Q

what are Borborygmi

A
  • hyper active bowel sounds
  • occur with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
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42
Q

Possible percussion notes of abdomen

A

TYMPANY should predominate because air in the intestines rises to the surface when the person is supine

DULLNESS over the liver and spleen

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43
Q

DESCRIBE THE DEPTHS OF Light and deep palpation

A

light: 1 cm
deep: 5-8 cm

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44
Q

Objective of light palpation

A

Objective is not to search for organs but to form an overall impression of the skin surface and musculature

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45
Q

Objective of deep palpation

A

Palate for specific organs

  • liver
  • spleen
  • kidneys
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46
Q

Assessment for abdominal aortic aneurysm

A

AUSCULTATE: murmur is harsh, systolic, or continuous and accentuated with systole.
If a bruit is heard, do not palpate the area for fear of rupturing!

PALPATE the aortic pulsation in the upper abdomen slightly to the left of midline - normally it is 2.5 cm to 4cm wide

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47
Q

Murphy’s sign (Inspiratory Arrest)

A

A normal response is to complete the deep breath without pain

Pain occurs with inflammation of the gallbladder. The descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway

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48
Q

Range of liver span

A

Normal liver span ranges from 6 to 12 cm

Average is 10.5 for males and 7cm for females

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49
Q

7 organs in Right Upper Quadrant (RUQ)

A
  1. Liver
  2. Gallbladder
  3. Duodenum
  4. Pancreas (head)
  5. Kidney & adrenal (right)
  6. Colon (hepatic flexure)
  7. Colon (part of ascending and transverse)
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50
Q

7 organs in Left Upper Quadrant (LUQ)

A
  1. Stomach
  2. Spleen
  3. Liver (left lobe)
  4. pancreas (body)
  5. kidney & adrenal (left)
  6. Colon (Splenic flexure)
  7. Colon (part of transverse and descending)
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51
Q

5 organs in Right Lower Quadrant (RLQ)

A
  1. Cecum
    1. Appendix
    2. ovary and tube (right)
    3. ureter (right)
    4. spermatic cord (right)
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52
Q

5 organs in Left Lower Quadrant (LLQ)

A
  1. Colon (Part of descending)
  2. Sigmoid colon
  3. ovary and tube (left)
  4. ureter (left)
  5. spermatic cord (left
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53
Q

3 organs found midline

A
  1. Aorta
  2. Uterus (if enlarged)
  3. Bladder (if distended)
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54
Q

Positive obturator test

A

With patient in supine, lift the right leg, flexing at the hip and 90 degrees at the knee. Hold the ankle and rotate the leg internally and externally

  • Negative or normal response is no pain
  • Positive response is pain.
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55
Q

When is the obturator test performed?

A

when appendicitis is suspected.

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56
Q

What does fecal occult blood indicate?

A

Occult bleeding usually indicates cancer of colon

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57
Q

TRUE OR FALSE? Fecal occult test may have a false positive response if the person has ingested significant amounts of red meat within 3 days of the test

A

True.

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58
Q

2 common conditions of intense itching and irritated skin in children

A
  • Diaper rash

* Pin Worms

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59
Q

What causes hemmorhoids

A

increased portal venous pressure from:

  • straining to poo
  • chronic constipation
  • pregnancy
  • obesity
  • chronic liver disease
  • low fibre diet
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60
Q

SUBJECTIVE Symptoms of Benign prostatic hypertrophy

A

urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia

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61
Q

OBJECTIVE Symptoms of Benign prostatic hypertrophy

A

a symmetrical nontender enlargement, commonly occurs in males beginning in the middle years

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62
Q

NAME THE Skeletal muscle movement: bending a limb at a joint

63
Q

NAME THE Skeletal muscle movement: straightening a limb at a joint

64
Q

NAME THE Skeletal muscle movement: moving a limb away from the midline of the body

65
Q

NAME THE Skeletal muscle movement: moving a limb toward the midline of the body

66
Q

NAME THE Skeletal muscle movement: turning the forearm so that the palm is down

67
Q

NAME THE Skeletal muscle movement: turning the forearm so that the palm is up

A

Supination

68
Q

NAME THE Skeletal muscle movement: moving the arm in a circle around the shoulder

A

Circumduction

69
Q

NAME THE Skeletal muscle movement: moving the sole of the foot inward at the ankle

70
Q

NAME THE Skeletal muscle movement: moving the sole of the foot outward at the ankle

71
Q

NAME THE Skeletal muscle movement: moving the head around a central axis

72
Q

NAME THE Skeletal muscle movement: moving a body part forward and parallel to the ground

A

Protraction

73
Q

NAME THE Skeletal muscle movement: moving a body part backward and parallel to the ground

A

Retraction

74
Q

NAME THE Skeletal muscle movement: raising a body part

75
Q

NAME THE Skeletal muscle movement: lowering a body part

A

Depression

76
Q

Temporomandibular joint assessment

A

Ask the person to open mouth maximally, partially open mouth, move jaw side to side and stick out lower jaw

Should be easily performed

77
Q

Number of cervical vertebrae

78
Q

Number of thoracic vertebrae

79
Q

Number of Lumbar vertebrae

80
Q

Number of Sacral vertebrae

81
Q

Number of coccygeal vertebrae

82
Q

Assessment of glenohumoral

A

INSPECT and compare both shoulders posteriorly and anteriorly ~ check for abnormal swelling

PALPATE both shoulders anteriorly and posteriorly, noticing any muscular spasm or atrophy, swelling, heat or tenderness

83
Q

ROM TEST FOR Assessment of glenohumoral

A
  1. With arms at sides and elbows extended, MOVE BOTH ARMS FORWARD AND UP in a wide vertical arcs, then move then back.
  2. ROTATE arms internally behind back, place back of hands as high as possible toward the scapulae.
  3. With arms at sides and elbows extended, RAISE BOTH ARMS in wide arcs in the coronal plane. Touch palms together above head.
  4. Touch both hands behind the head with elbows flexed and rotated posteriorly.
84
Q

Potential Injuries OF glenohumoral

A

rotator cuff lesions

dislocated shoulder

85
Q

WHAT IS OSTEOPOROSIS

A

Decrease in skeletal bone mass occurring when rate of bone resorption is greater than that of bone formation

86
Q

This occurs primarily in postmenopausal White women

A

osteoporosis

87
Q

Risk of developing this is also associated with smaller height and weight, younger age at menopause, lack of physical activity and lack of estrogen replacement therapy.

A

osteoporosis

88
Q

Signs of wrist fracture

A

sharp pain that increases with movement

89
Q
  • an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened as with rheumatoid arthritis
A

Crepitation

90
Q

Chronic disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm

A

Tennis elbow

91
Q

Occurs with activities combining excessive pronation and supination of forearm with an extended wrist

A

Tennis elbow

92
Q

2 Tests for carpal tunnel syndrome

A
  1. phalen’s test

2. tinel’s sign

93
Q

NAME THE TEST FOR CARPEL TUNNEL SYNDROME: Ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand but produces numbness and burning in a person with carpal tunnel syndrome

A

phalen’s test

94
Q

NAME THE TEST FOR CARPEL TUNNEL SYNDROME: Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand. produces burning and tingling in carpal tunnel syndrome

A

tinel’s sign

95
Q

Ortolani sign - positive

A

Hip instability feels like a clunk as the head of the femur pops back into place, positive Ortolani sign

96
Q

Ortolani sign - negative

A

Normally feels smooth and produces no sound

97
Q

Muscle strength testing (0-5+)

A
  • Grade 5: Full ROM against gravity, full resistance
    • Grade 4: Full ROM against gravity, some resistance
    • Grade 3: Full ROM with gravity
    • Grade 2: Full ROM with gravity eliminated
    • Grade 1: Slight contraction
    • Grade 0: No contraction
98
Q

Assessment of patella

A
  • Inspect the skin and lower leg alignment. The lower leg should extend in the same axis as the thigh
    • Inspect the knee’s shape and contour. There are normal concavities or hollows on either side of the patella. Check for swelling
    • Check the quadriceps muscle in the anterior thigh for any atrophy because it is the prime mover of knee extension, important for joint stability
    • Palpate, start on the high anterior thigh, palpate with left thumb and fingers in a grasping fashion
    • Explore the tibiofemoral joint, palpate the infra patellar fat pad and the patella, check for crepitus by holding your hand not he patella as the knee is flexed and extended.
    • Check ROM, bend each knee, extend each knee, ambulate
99
Q

Instrument used to assess angles of joint flexion

A

Goniometer

100
Q

Bones of the knee

A
  • Femur
    • Tibia
    • Patella
101
Q

Osteoarthritis assessment

A

can’t find

102
Q

5 Functions of the musculoskeletal system

A
  1. support
  2. movement
  3. protection
  4. hematopoesis
  5. mineral storage
103
Q

Normal scrotum

A
  • Loose protective sac, which is a continuation of the abdominal wall.
    • After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles.
    • Scrotal wall consists of thin skin lying in folds, or ruggae, and the underlying cremaster muscle.
104
Q

Cremaster muscle function

A

controls the size of the scrotum by responding to ambient temperature, to keep the testes at 3 degrees celsius below abdominal temperature. (best to produce sperm)

hot: scrotum lowers
cold: scrotum rises

105
Q

Hernia

A
  • Swelling, may have pain with straining
    • Inspection–enlarged, may reduce when supine, does not transilluminate
    • Palpation–soft mushy mass, palpating fingers cannot get above mass; mass is distinct from testicle that is normal
106
Q

First sign of male puberty

A

Enlargement of the testes, next public hair, next penis size increases

107
Q

Dysuria

A
  • Burning/pain with urinating

* common with acute cystitis, prostatitis, urethritis

108
Q

Stress incontinence

A

Loss of urine with physical strain due to weakness of sphincters.

109
Q

Hesitancy

A
  • Straining
    • Loss of force and decreased calibre
    • Terminal dribbling
    • Sense of residual urine
110
Q

foreskin is advanced and fixed so tight it is impossible to retract over glans.

111
Q

Foreskin is retracted and fixed, once retracted behind glans, a tight or inflamed foreskin cannot return to its original position.

A

Paraphimosis:

112
Q
  • urethral meatus opens on the ventral side of glans, shaft, or at the penoscrotal junction. A groove extends from the meatus to the normal location at the tip.
A

Hypospadias:

113
Q

Meatus opens on the dorsal side of glans or shaft above a broad, spade like penis.

A

Epispadias:

114
Q

Hard, nontender subcutaneous plaques palpated on dorsal or lateral surface of penis, may be single or multiple and asymmetrical

A

Peyronie’s Disease:

115
Q

Pinpoint constricted opening at meatus or inside along urethra

A

Urethral Stricture:

116
Q

Prolonged painful erection of penis without sexual desire

A

Priaspism:

117
Q

Assessment for serous fluid in the scrotum

A
  • Serous fluid does not transilluminate and shows as a red glow.
    • Transillumination (darken the room and shine a strong flashlight from behind the scrotal contents)
    • normal scrotal contents do not transilluminate.
118
Q

Condylomata acuminata (genital warts)

A
  • Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower like patch.
    • Colour may be grey, pale yellow, or pink in White males and black or translucent grey black in black males
    • They occur on shaft of penis, behind corona, or around the anus where they may grow into large grape like clusters
    • Caused by HPV (human papillomavirus)
119
Q

Indirect inguinal hernia

A
  • Sac herniates through internal inguinal ring, can remain in canal or pass into scrotum
    • Pain with straining; soft swelling that increases with increased intra-abdominal pressure, may decrease when lying down
    • Most common
    • Congenital or acquired
120
Q

Vestibule comprises which labile structures

A
  • Urethral meatus
    • Opening of Skene’s gland
    • Hymen
    • Opening of Bartholin’s gland
121
Q

Changes associated with menopause

A
  • Decrease in estrogen production
    • Pubic hair decreases (thin and sparse)
    • Skin is thinner and fat deposits decrease, leaving the mons pubic smaller and the labia flatter
    • Clitoris size decreases
    • Rugae of the vaginal walls decrease
    • Walls look pale pin because of thinned epithelium
    • Cervix shrinks and looks pale and glistening, may retract
122
Q

Goodell’s sign

A

Cervix softens at 4 to 6 weeks of pregnancy

123
Q

Chadwick’s sign

A
  • Vaginal mucosa and cervix look cyanotic at 8 to 12 weeks (increased vascularity and edema of the cervix)
124
Q

number of pregnancies “How many times?”

125
Q

number of births “How many babies have you had?”

126
Q

interrupted pregnancies, including elective abortions and spontaneous miscarriages “Any miscarriage or abortion?”

A

Abortions:

127
Q
  • Loss of urine with physical strain from muscle weakness

* “urinate with a sneeze, laugh, cough, bearing down?”

A

Stress incontinence

128
Q

is considered after 1 year of engaging in unprotected sexual intercourse without conceiving.

129
Q

Lithotomy position during genitalia examination – methods to provide comfort

A
  • Have her empty the bladder before the exam
    • Position the examination table so that her perineum is not exposed to an inadvertent open door
    • Ask if she would like a friend, family member, or chaperone present. Position this person by the woman’s head to maintain privacy.
    • Elevate her head and shoulders to a semisitting position to maintain eye contact.
    • Place the stirrups so that the legs are not abducted too far.
    • Explain each step in the examination before you do it.
    • Assure the woman she can stop the exam at any point should she feel any discomfort.
    • use a gentle, firm touch, and gradual movements.
    • Communicate throughout the exam. Maintain a dialogue to share information.
130
Q

Order of examination of the internal genitalia

A
  1. Speculum Examination
  2. Inspect the Cervix and Its Os
  3. Obtain Cervical Smears and Cultures
  4. Inspect Vaginal Wall
  5. Bimanual Examination
131
Q

Assessment findings for candidiasis of the vagina

A
  • Intense pruritus, thick whitish discharge
    • Vulva and vagina are erythematous and oedematous. Discharge is usually thick, white, curdy.
    • Diagnose by microscopic examination of discharge on potassium hydroxide wet mount
132
Q

Sexual Maturity Rating Scale 1

A
  • No pubic hair

* Mons and labia covered with fine vellus hair as on abdomen

133
Q

Sexual Maturity Rating Scale 2

A
  • Growth sparse and mostly on labia

* Long, downy hair, slightly pigmented, straight or only slightly curly.

134
Q

Sexual Maturity Rating Scale 3

A
  • Growth sparse and spreading over mons pubis.

* Hair is darker, coarser, curlier

135
Q

Sexual Maturity Rating Scale 4

A
  • Hair is adult in type but over smaller area

* none on medial thigh

136
Q

Sexual Maturity Rating Scale 5

A
  • Adult in type and pattern

* Inverse Triangle

137
Q

Parts of General Appearance documentation

A
  1. Appears stated age
  2. level of consciousness
  3. Skin colour
  4. Nutritional status
  5. Posture and position; comfortably erect
  6. Obvious physical deformities
  7. Mobility/Gait/use of assistive devices/ROM/No involuntary movement;able to rise from a seated position easily
  8. Facial expression
  9. Mood and affect
  10. Speech: articulation, pattern, content appropriate, first language
  11. Hearing
  12. Personal Hygiene
138
Q

Reason for trans-illuminating the sinuses

A

Only if sinuses are tender

139
Q

Cranial nerves for extraocular muscle examination

A

Cranial Nerves III, IV, VI

140
Q

Cranial nerve involved with tongue protrusion

A

Cranial Nerve XII

141
Q

Cerebellar function testing

A
  • Test cerebellar function of the upper extremities using finger-to-nose test or rapid-alternating movements test
    • Test the cerebellar function of the lower extremities by asking the person to run each hell down the opposite shin
142
Q

something you can feel caused by superficial thickening in the epidermis

143
Q

od

144
Q

os

145
Q

Decrease in power of accommodation with aging, is suggested when he person moves the card farther away

A

Presbyopia

146
Q

subjective sensation that the person feels from the disorder

147
Q

Mental Status Examinations

A

Appearance,
Behaviour,
Cognition,
Thought processes

148
Q

General Survey

A
  • overall impression of the patient

* begins when you first encounter him or her

149
Q

Description of abnormal skin lesion

A

Immediate result of a specific causative factor, develop on previously unaltered skin

150
Q

Normal breath sounds

A
  • Bronchial: Trachea and Larynx
    • Bronchovesicular: Over major bronchi
    • Vesicular: Over peripheral lung fields, where air flows through smaller bronchioles and alveoli
151
Q

Heart auscultation areas

A
  • Over the entire precordium (area on the anterior chest overlying the heart and great vessels)
    • Second right interspace: Aortic Valve Area
    • Second Left Interspace: Pulmonic Valve Area
    • Left Lower Sternal Border: Tricuspid Valve Area
    • Fifth Interspace at around left midclavicular line: mitral valve area
152
Q

Arteries that can be palpated

A
  • Dosalis Pedis
    • Radial
    • Ulner
    • Temporal
    • Carotid
    • Femoral
    • Bracial
    • Popliteal
    • Posterior Tibial
153
Q

Movement of joints

A

Joint motion normally causes no tenderness, pain, or crepitation.

154
Q

6 Tests for Cerebellar function

A
  1. Balance Test
  2. Romberg Test (Holding a straight position while eyes are closed)
  3. Rapid Alternating Movements
  4. Finger-to-Finger Test
  5. Finger-to-Nose Test
  6. Heel-to-Shin Test

HEALTH ASSESSMENT (3 decks)

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