(Future) Exam 3 Flashcards
1
Q
Eyelids
A
protect eyes from dust, light, injury
2
Q
Palpebral fissure
A
- open space between eyelids
3
Q
Limbus
A
border between cornea and sclera
4
Q
canthus
A
angle where lids meet (inner, outer)
5
Q
Caruncle
A
fleshy mass at inner cants contains sebaceous glands
6
Q
Tarsal plates
A
Connective tissue in upper lid- contain meibomian glands - lubricate lids
7
Q
Conjuctiva
A
transparent protective covering
8
Q
Cornea
A
covers/protects iris and pupil
9
Q
lacrimal gland
A
outer corner of eye - secretes tears
10
Q
Puncta
A
where tears drain
11
Q
Outer layer-sclera
A
continuous anteriorly with a smooth, transparent cornea that covers iris and pupil
12
Q
Cornea
A
cornea: smooth and transparent
- part of refracting media of eye, bending incoming light rays so that they will be focused on inner retina
- very sensitive to touch;
13
Q
contact with a wisp of cotton stimulates a blink in both eyes, this is called
A
Corneal reflex
14
Q
middle layer-choroid
A
- dark pigmentation to prevent light from reflecting internally and is highly vascular to deiver blood to retina
- anteriorly is coninous with ciliary body and iris
15
Q
Muscles of _______ body control _________ of lens
A
ciliary; thickness
16
Q
Pupil size during sympathetic vs parasympathetic
A
sympathetic - dilates
Parasympathetic - constricts
17
Q
Lens
What are they?
what determines the amount of fluid produced?
A
Refracting medium/ keeps a viewed object in focus on the retina
- Intraocular pressure is determined by the amount of fluid produced balanced by resistance to outflow
18
Q
through the ophthalmoscope, we can see
A
- optic disc
- Macula
- retina
-retina vessels
19
Q
CN VI: abducens
A
lateral movement
20
Q
CN IV: trochlear
A
superior oblique, down and in
21
Q
CN III: Oculomotor
A
All rectus, inferior oblique
22
Q
what is a normal reaction for the pupils to light?
A
constriction
23
Q
reflexes: Accommodation
A
eye adaptation for near vision
- converge and constrict
24
Q
pupillary light reflex
A
dark room, look in the distance, bring light from the side
(note pupil size as well)
25
pupillary light reflex: Direct light reflex
- constriction of same-sided pupil
26
pupillary light reflex:
Consensual light reflex
Simultaneous constriction of other pupil
27
what test do you do for Accommodation?
What is a normal response to it?
- focus on distant object, then shift gaze to near
- Normal response: pupillary constriction and convergence of eyes
28
Doccumentation: PERRLA
pupils equal, round, react to light and accommodate
29
a confrontation test is a..
visual field
30
Extraocular muscle function: Corneal light reflex
What CN tested?
What do we assess?
How do we assess?
CN V and VII
- assess parallel alignment of eyes
- Shine light and note symmetrical reflection on cornea
31
Extraocular muscle function: Cover test
What does it detect?
What is a normal response?
- detects deviated alignment
- Note covered and uncovered eye
- Normal response - steady fixed gaze
32
Extraocular muscle function: Diagnostic positions test (cardinal positions of gaze)
What do we say for a normal response?
- parallel tracking with both eyes
- if not, nerve or muscle dysfunction possible
33
Anisocoria
one eye dilated and other is constricted
34
Isocoria/miosis
both eyes extremely constricted
35
Mydriasis
Both eyes extremely dilated
36
developmental considerations for eye assessment
- Vaginal infections in pregnant person at delivery (herpes, gonorrhea)
- Developmental milestones of vision noted by parents
- Routine testing at school
- Awareness of safety measures to protect eyes
37
eye function is ________ at the beginning of life but gets _____ as on gets older
not good; better
38
Newborn eye problems: Excessive tearing
What can this indicate?
- this may indicate blocked tear ducts
39
Newborn eye problems: Red or encrusted eye lids
This could be a sign of an eye infection
40
Newborn eye problems: constant eye turning
What may this signal?
This may signal a problem with eye muscle control
41
Newborn eye problems: Extreme sensitivity to light
this can indicate what?
this may indicate an elevated pressure in the eye
42
Newborn eye problems: Appearance of a white pupil
This may indicate the presence of an eye cancer
43
Strabismus
eyes point in two different directions
44
developmental considerations: Aging adult
- Visual difficulty with driving, climbing stairs
- Last glaucoma test - loss of peripheral vision, aching pain
- History of cataracts - blurring vision
- Eyes feel dry, burning
- Decrease in visual activities - sewing, reading
45
aging adults: Decreased tear production
dry eyes
46
Arcus Senilis
Lipid material infiltrates around limbus
47
aging adult: pupil size will...
decrease
48
Presbyopia
what becomes physically hard?
decreased accommodation for near vision, lens hard, cannot change shape
49
3 main reasons for decreased visual functioning
cataract formation - opacity of lens
- glaucoma
- Macular degeneration
50
glaucoma
Increased what?
Gradual loss of what?
increased ocular pressure, gradual loss of peripheral vision
51
Macular degeneration
- loss of central vision common cause of blindness
52
Heal promotion for an adult (eye assessment)
early screenings for glaucoma - preventable
53
Risk factors for Cataracts (6 things)
- > 50 age
- prolong UV-B light
- Diabetes mellitus
- Cigarette, Heavy alcohol use
- High BP
- Diet low in Vit E and B
54
Risk factors for Glaucoma (5 things)
> 40 age
- Family history
- Race ethnicity - African ancestry, Caucasian, E. European
- Arteriosclerosis
- Myopia, Hyperopia
55
Risk factors for Macular Degeneration (6 things)
> 65 age
- Prolong UV-B light
- Female, Early Menopause Caucasians
- Cigarette, heavy alcohol use
- High BP
- High Fat diet
56
unexpected findings for eye assessment:
type of difficulty?
What is a RED FLAG
What can be a sudden onset?
- vision difficulty
- Pain (RED FLAG)
- Sudden onset = floaters, blind spot, loss of peripheral vision
57
unexpected findings for eye assessment: Strabismus/diplopia
crossed eyes, double vision
58
unexpected findings for eye assessment: Redness/sweling
infection
59
unexpected findings for eye assessment:
Watering/discharge
color. when present
60
common place for nosebleeds are in the
Kessel box plexus
61
Subjective data for the nose
- discharge
- frequent cold, upper respiratory infections
- sinus pain
- trauma
- epistaxis, nosebleeds
- allergies
- altered smell
62
Objective data for the nose
What is it called to look and touch?
What are we looking for when we look at the nose?
- inspect and palpate
- Symmetry, latency
- Nasal cavity
63
Subjective data: Mouth
- Sores or lesions
- Sore throat
- Bleeding gums
- Toothache
- Hoarseness
- Dysphagia
- Altered taste
- Health promotion
64
Risk factors for cancer of the Oral cavity
- use of tobacco products
- Alcohol use
- HPV
- UV radiation
- Born male
- >55 of age
-poor oral hygiene
- Poor diet
- Weak immune system
- Use of mouthwash with high alcohol content
- Irritation from dentures
65
objective data: Mouth
What do we inspect for?
What is the name of the palate and their description?
inspect for
- color
- moisture
- cracking
- lesions
Buccal mucosa
- palate - hard and soft
66
objective data: Teeth and gums
what condition are we looking for?
- condition - decay/color
- Number of teeth (any absent)
- occlusion - uppers rest on Lower - malocclusion
67
Objective data: Tongue
- color
- moist
- lesions
68
Objective data: palate
Description
What test do we do for what CN?
What is in the back of the throat and it’s description?
Palate
- anterior hard, posterior soft
- Uvula: fleshy pendent - midline
- Say "ah" tests cranial nerve X the vagus nerve
69
Objective Data: throat
- note color, exudate, lesions
- Check gag (CN IX, X)
- Breath odor
- Tonsils - free of exudate
- Grade:
1+ visible
2+ halfway between tonsils
3+ touching uvula
4+ touching each other
70
Newborn mouth assessment
No teeth, assess suck reflex, intact lip and palate
71
Macroglossia
enlarged tongue
72
leukoplakia
white spot on tongue
73
kopliks spot
white spots on the bottom lip, measles possibly
74
mucocele
mucus bubble near gums, benign and goes on its own
75
angular cheilitis
cracks on side of lips
- from denture use or too much saliva
76
furuncle
bubble filled with fluid in one of the noses, painful
77
ankyloglossia
a short frenulum (the line under your tongue)
78
malocclusion
top teeth don't rest comfortable on the bottom teeth
79
Perforated septum
hole in septum
80
understand face anatomy bones for exam!
81
Face anatomy muscle movement is CN #?
CN VII
82
C7 tells us what
(Not a cranial nerve)
where neck ends and thoracic begins
83
need to know lymph nodes
84
finding with maxillary/frontal sinuses
no pain but pressure
85
SSMMBMBSBBMM (CN I-XII)
some say marry money buy my big brother says big brains matter more
86
sternomastoid has lymph nodes including
posterior and anterior cervical chain lymph nodes
87
what is an enlarged lymph node called
lymphadenopathy
88
pulse we can palpate on the head
temporal pulse
89
lymphedema
swollen lymph nodes
90
how to assess edema
pitting edema, push on the area
91
fontanels should be what?
Other considerations for the fontaneles?
flat
if not, dehydration is inward and outward is increased CP or fluid excess
92
pregnant ladies have swollen thymus bc of
increase in hormones
93
pregnant people may have chloasma which is
fibrous pigmentation that looks like a mask or mustache looking
94
tremors with age are normal or not
yes, its normal
95
Balance test is called the
rhonberg
96
impacted cerumen is...
common but reversible cause of hearing loss in older people
97
The ear is a common sight for what type of cancer?
Skin cancer
98
anosmia means
altered sense of smell
99
development considerations for infant and children
(Weight and length)
weight
- upright scale is 2-3
Length
- measure supine until age 2
100
lifestyle modifications (the 3 typical)
- weight
- alcohol/smoke use
-diet
101
CNS: cerebral cortex
Center for what?
2 and 4 of what?
center for higher functions
- 2 Hemispheres
- 4 lobes
102
the 6 components of the CNS
TBH-CBS
- Thalamus
- Basal Ganglia
- Hypothalamus
- Cerebellum
- Brain Stem
- Spinal Cord
103
CNS Pathways: Sensory. what are the 2 tracts
Spinothalamic tract
Posterior Tract
104
CNS Pathways: MOTOR, what are the 2 tracts
- Pyramidal (Corticospinal) tract
- Extrapyramidal Tract
105
what are the 2 motor neurons?
upper and lower motor neurons
106
the PNS consists of nerves, what are the 2 nerves and how many pairs for each
Cranial nerve = 12 pairs
Spinal nerves = 31 pairs (dermatomes)
107
Which CN are sensory: contain only Afferent fibers
CN I olfactory
CN II Optic
CN VIII Vestibulocochlear
108
Which CN are motor: contain only Efferent fibers
CN III (Oculomotor)
CN IV (Trochlear)
CN VI (Abducens)
CN XI (Accessory)
CN XII (Hypoglossal)
109
What involuntary muscles are innervated by the PNS autonomic nervous system
also, what is the function of this?
- Cardiac muscle
- Smooth muscle
- Glands
Function: to maintain the body's homeostasis
110
The reflex arc is part of the function of which nervous system?
the Peripheral NS
111
Subjective data for neuro assessment
- headache
- Head injury
- Dizziness/vertigo/ syncope
- seizures
- tremors
- weakness
- difficulty with coordination
- numbing or tingling
- difficulty swallowing
- history
- environmental hazards
112
Health promotion for Older adults (Neuro system)
- fall prevention
- understanding cautions wth taking medications
113
Health promotion for patients at risk for impaired intracranial regulation
- wearing a medical alert bracelet
- discussing care plans at school or workplace
- helmets for young children in case of seizure
114
health promotion for patients wth history of stroke, seizure disorder, or brain injury
- understand the side effects of prescription and OTC meds
- avoid alcohol and nicotine
115
3 types of exams for neuro assessment
Screening neurological exam - for well persons with no sig. subjective findings
- Complete neurological exam - for persons with neurologic concerns or findings
- neurologic recheck- person requiring periodic reassessment
116
for the neurologic screening exam, it is screening for a mental status concerning which CN?
What motor function?
What sensory function?
What reflexes?
Mental Status
* CN: II, III, IV, V, VI, VII
* Motor Function: Gait/balance
* Sensory Function: Pain, light touch, vibration
* Reflexes: Biceps, triceps, patellar, achilles
117
for the Complete exam, it is concerning which CN?
What motor function?
What sensory function?
What reflexes?
Mental Status
* CN II-XII
* Motor Function: size, strength, tone, gait, balance, RAM
* Sensory: pain, light touch, vibration, position sense, stereognosis,
graphesthesia
* Reflexes: DTR’s, superficial, plantar
118
For the recheck neuro assessment, it is looking for what generally?
- LOC
- Motor function
- pupillary response
- Vital signs
119
A complete Neuro Exam consists of what 5 things?
- Mental Status
- Cranial Nerves
- Sensory System
- Motor System
- Reflexes
120
For the mental status, at the patient we are looking at what 4 things?
- Appearance
- Behavior
- Cognition: attention span, learning, memory
- Thought process
121
CN I olfactory
sense of smell
122
CN II Optic
Visual acuity and confrontation
123
CN III oculomotor, IV trochlear, VI abducens
EOM's by six cardinal positions, pupil constriction
124
CN V trigeminal (includes motor and sensory)
Motor: strength of temporal and masseter muscles
Sensory: Sensation forehead, cheek, jaw
125
CN VII Facial
motor: mobility and facial symmetry, Sensory: taste
126
VIII Acoustic
normal conversation, whispered words, weber and rinne
127
CN IX Glossopharyngeal and CN X Vagus
uvula and soft palate rise "ahhh",gag reflex, smooth voice sounds
128
CN XI spinal accessory
strength of sternomastoid and trapezius muscle
129
CN XII Hypoglossal
tongue midline
"light, tight, dynamite"
130
what is oxygenation
the process of providing oxygen to all cells of the body
131
Function of the respiratory system
- obtain O2 from atmosphereic air
- Transport air through respiratory tract to alveoli
- Diffuse O2 into blood to be carried to all cells of the body
132
What are the 2 things that the respiratory system function achieves through ventilation?
inspiration and expiration
133
what is respiration?
What is the term commonly used with?
Exchange of O2 and CO2 at the cellular level
- Ventilation
134
What process is breathing typically associated with?
Autonomic process
135
What should be immediately addressed when talking about breathing?
Alterations in breath patterns
136
when doing inspiration, what happens to the torso/lung anatomy?
chest size increases, diaphragm contracts (drops lower) - creates a slightly negative pressure (air flows in)
137
What happens to the torso, lung anatomy during expiration?
the action is passive (easier) so the:
- Diaphragm relaxes (air flows out)
138
eupnea means what
normal breathing
139
disorders/diseases related to dyspnea
- heart issue
- pulmonary issue
- viral/bacterial infection
- chronic condition: Emphysema, lung cancer, COPD, Asthma
- Note orthopnea
- upper/lower respiratory infection
140
COLDSPA related to Chest Pain
- Can be caused by musculoskeletal
- a dull achiness - more respiratory in nature
- middle of the chest can be related to digestive issue
ONSET
- respiratory in nature probably started sooner than later
if pulmonary in nature, thoracic muscles in the rib cage might get inflamed or irritated
- can be a more chronic respiratory disorder
LOCATION
- is it in the center of chest or all over? does it extend to the back of the thorax?
DURATION
Is it continuous or intermittent
SEVERITY
if pain is severe, can be cardiovascular musculoskeletal, respiratory, or digestive.
PATTERN
Relieved by rest, meds, activity??
141
COLDSPA for Cough
CHARACTER
- Is it productive or not? if so, does anything cough up?
- white cough-up is an infection with bronchitis
- yellow/green is a bacterial infection
- black is dried blood
- Rust-colored = tuberculosis
- pink-frothy sputum = pulmonary edema
SEVERITY
Need to assess how bad the cough is, not necessarily pain
Does cough happen at certain times of the day? (maybe bronchitis)
If morning = smokers cough
overnight = drainage from upper resp. going down
142
Why is GERD (gastroesophageal reflux disease) included in the respiratory system assessment?
- Can feel burning in the throat in nature and affect the respiratory system
- People who have Asthma have an increased likelihood of getting GERD
143
Personal health history questions for thorax lungs assessment? (6)
- Prior respiratory problems
- Thoracic surgery, biopsy, trauma
- Tested for or diagnosed with allergies?
- Taking any medications?
- Chest X-ray, TB skin test, Influenza immunization? any pulmonary studies?
- Have you traveled outside of the U.S.?
144
Thorax & lungs: Family history questions to ask?
- history of lung disease? Pulmonary disorders in the family?
- Did any family members smoke when you were growing up
145
Thorax and lungs: Lifestyle and health practices questions to ask
- Describe your usual dietary intake
- Do you smoke or use tobacco products?
If yes,
- when start?
- how much?
- When do you smoke?
- Tried quitting?
Environmental exposure?
ADLs?
- experiencing stress? does it affect breathing?
- Taking herbal medicines? Alternative therapies?
146
Thorax and lungs: Health Promotion Opportunities? (3)
- Immunizations?
- Smoking Cessation?
- Weight Maintenance?
Exercise?
147
thorax and lungs: what would you look for during inspection? (4)
facial expression: pursed lips, nasal flaring
LOC: drowsiness, restlessness
Skin color and condition: lips, nail beds, clubbing
Respirations: quality, effort, even
- uses of accessory muscles
148
thorax and lungs: what would you do for inspection? (shape and configuration)
shape and configuration
- spinous process straight
- Downward sloping of ribs
- 90 degrees costal angle
- AP < Transverse
- Note position to breath - tripod? Do they look comfortable?
149
Thorax and lungs: palpation for what feeling
- tenderness
- Sensation, temperature
- Crepitus, Masses
- Chest Expansion
- Tactile Fremitus
150
Thorax and lungs: percussion is hitting for noting what?
What is resonance?
What is hyper resonance?
What woould be a dull sound?
Lung fields: note predominant tone
- Resonance: low-pitched, clear, hollow sound heard over normal lung tissue
- hyper resonance: lower-pitched, booming sound heard when too much air is present, ex: Emphysema
- Dull: soft, muffled thud heard with density in lungs, ex: pneumonia, atelectasis, tumor, pleural effusion
151
Thorax and lungs assesment: Auscultation, what we doing to the patient? (2)
- we are using the diaphragm of the stethoscope
- Look at 6-8 points
152
if during lung sound auscultation, you hear something off? what do u do?
have the patient cough and listen again
153
bronchophony is associated with what?
saying the word 99
154
Egophony is associated with what?
saying ee but sounds like "a"
155
Pediatric patients: what are we inspecting for the thorax? (5)
rounded thorax until age 6
- chest circumference < head until age 2
- first respiratory assessment at birth - Apgar score
- Breathes through nose until 3 months
- Use diaphragm to breath
- Periods of apnea common
156
pediatric patients: what are we palpating?
percussioning?
auscultationing?
- encircle thorax with both hands
- limited use
- Auscultation - bronchovesicular in peripheral lung fields until age 5-6
157
pregnant patient: thorax assessment considerations (4)
- Thoracic cage may appear wider (inc. AP diameter)
- Deeper respirations
- Thoracic breathing
- Faster resp. rate, SOB in Late pregnancy
158
Clients with history of asthma have an....,........condition.
increased risk of certain condition
159
geriatric patient: thorax assessment considerations
- chest cage shows inc. anteroposterior diameter, giving a round barrel shape and kyphosis or an outward curvature of the thoracic spine
- Chest expansion may be somewhat decreased, although still symmetric
- Tend to tire easily during auscultation when deep mouth breathing is required
160
what is pectus excavatum
chest is inward
161
what is pectus carinatum
Chest is outward (pigeon chest)
162
what is kussmauls respirations
rapid deep breaths then normal, then alternates
163
cheyne-stokes
fast, then slow, then fast, then slow deep breaths
164
tachypnea
fast breathing but even
165
bradypnea
slow breathing
166
word for sensorineural hearing loss resulting from nerve degeneration
presbycusis
167
snellen test and is 20/20 tests for what?
visual acuity
168
hearing loss commonly found in younger adults
Otosclerosis
169
cranial nerve that stimulated lateral movement of eyes?
CN VI Abducens
170
what sinuses are palpable
maxillary and frontal
171
term for drooping of the upper eyelid
ptosis
172
substance that forms a sticky barrier to protect the tympanic membrane
cerumen
173
term for pupils with 2 different sizes
anisocoria
174
when patient feels as though the room is spinning, they feel this type of vertigo
objective vertigo
175
these individuals are subject to nasal congestion and episodes of epistaxis due to normal physiological changes
pregnant people
176
gray-white circle around the limbus due to the deposition of lipid material
arcus senilis
177
site where our upper and lower eyelids meet
Canthus
178
unequal pupil size suspects what?
inc. intracraneal pressure
179
romberg test is for what cranial nerve
CN VIII
180
air-filled pockets in the skull that produce mucous
sinuses
181
salivary gland under tongue
sublingual gland
182
what is the grade for tonsils touching the uvula
3+
183
cessation means what
means to stop
184
leading cause of blindness in hispanic population?
open-angle glaucoma
185
what is the normal pathway of hearing
air conduction
186
normal color of tympanic membrane
pearly gray
187
gray color in mucosa (nose) is a sign of what?
allergies
188
runny nose aka...
rhinorrhea
189
structures in the nasal cavity increase surface area and humidify
- what helps prevent pathogens from getting into the body?
turbinates
- cilia
190
most common site of nosebleeds
kiesselbachs plexus
191
structure that allows for equalization of air pressure on either side of the tympanic membrane to prevent rupture
Eustachian tube
192
way to check kids Eustachian tube
pull ear down and back
193
direct reaction def
when shine light on eye and it reacts
194
consensual def
when you shine a light on the other eye but eye with no light reacts the same way
195
pulmonary edema is associated with what type of failure?
heart failure
196
197
5 areas for auscultation of heart
Aortic valve
Pulmonic
Erb
Tricuspid
Mitral valve
198
Apical pulse is not visible in
Older and pediatric patients
199
What is a thrill
A palpable vibration over the precordium or an artery
200
Faster than 100bpm is considered?
Less than 60bpm is considered?
Tachycardia
Bradycardia
201
What is pulse deficit
When radial pulse falls behind apical rate, indicating weak, ineffective contractions of the left ventricle
202
Sinus arrhythmia can be a normal variant caused by…
Respirations in pediatric patients
203
What are ejection sounds or clicks resulted from?
From an opening of deformed semilunar valves
204
What sounds may accompany murmurs?
Thrills
