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knowledge assessment II Flashcards

1
Q

thoracic cage is composed of

A

sternum, clavicle, scapulae, 12 vertebrae, and 12 pairs of ribs

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2
Q

three main compartments of thoracic cage

A

airways
blood vessels
interstitinum

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3
Q

mediastinum

A

heart, great vessels, lymph nodes, nerves, fat

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4
Q

additional structures within the thorax

A

thymus, distal part of trachea, and most of the esophagous

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5
Q

thoracic muscles

A
  • intercostals
  • transverse thoracic
  • subcostal
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6
Q

blood supply within thorax

A

arterial: thoracic aorta, subclavian, brachial, axillary
venous: various veins
pulmonary arteries, pulmonary veins

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7
Q

pulmonary arteries

A

carry deoxygenated blood from the right side of the heart to each lung

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8
Q

pulmonary veins

A

return oxygenated blood from lungs to the left side of the heart

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9
Q

anterior thoracic landmarks

A

begin at suprasternal (jugular notch)

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10
Q

costal angle

A

angle between ribs at the costal margins located at bottom of sternum at the xiphoid process

typically 90 degrees or less

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11
Q

why wouldn’t you palpate ribs posteriorly?

A

harder to do as a result of overlying musculature so easiest to assess at vertebrae

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12
Q

midsternal line

A

anterior in center of sternum

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13
Q

midclavicular line

A

in middle of clavicle or collar bone

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14
Q

anterior axiallary line

A

aligns where arms closed

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15
Q

vertebral line

A

middle of vertebrae posteriorly

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16
Q

scapular line

A

starts closest to vertebral line right where scapula starts

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17
Q

midscapular line

A

starts in middle of scapula

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18
Q

posterior axillary line

A

runs vertically along posterior edge from top of axilla between anterior and posterior axiallary lines

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19
Q

the right lung has how many lobes?

A

3

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20
Q

the left lung has how many lobes?

A

2

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21
Q

RML is ausculatated using an

A

anterior approach, although a small portion can be ausculatated laterally
- may be difficult with women due to breast tissue

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22
Q

horixontal fissue

A

divides RUL and RML of lung

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23
Q

RML extends from

A

4th rib at sternal border to the 5th rib at midaxillary line

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24
Q

the lower border of right lung is

A

higher than the left because the liver displaces the lung tissue upward

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25
Q

the left lung is

A

narrower than right because the heart and pericardium bulge to the left displacing the lung tissue

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26
Q

the base of the lungs refers to

A

very bottom of lung fieldsd

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27
Q

apex of lungs refers to

A

very top of lungs

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28
Q

components of respiratory tracts

A

nasal cavity
eipglottis
nasopharynx
oropharynx
laryngeal pharynx
larynx and vocal cords
esophagous
trachea
right and left lung
right and left bronchus
terminal bronchiole
diaphargm

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29
Q

the trachea bifurcates at the

A

caring into right and left mainstem bronchi which turn into smaller bronchi and continue to separate until becoming terminal bronchioles which give rise to alveolar sacs lined by alveoli

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30
Q

the right mainstem broncus is

A

shorter, wider, and more vertical than left

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31
Q

the upper respiratory tract is responsible for

A

moisturizing inhaled air and filtering noxious particles

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32
Q

what triggers respiration

A

automatic process initiated by pons and medulla

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33
Q

main trigger in respiration

A

increased CO2 levels in blood

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34
Q

other triggers of respiration

A

decreased oxygen levels, increased acidity, certain medication (drug overdoses, opiates, sedatives) causing hypoventilation or apnea, brain injury (hyperventilation)

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35
Q

inspiration

A
  • diaphragm contract and flattens pulling lungs downward
  • thorax and lungs elongate increasing in length
  • external intercostal muscles open ribs and lift sternum
  • increase in anteroposterior diamter fo thorax causing 500-800 mL of air to enter lungs of adults
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36
Q

with increased thoracic size

A

pressure within the thorax is less than pressure in the atmosphere causing influx of atmospheric air to enter the lungs

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37
Q

expiration

A
  • diaphragm, internal intercostal muscles, abdominal muscles relax
  • pressure in lungs is greater than atmosphere
  • air is pushed out and chest and abdomen return to relaxed position
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38
Q

effective breathing depends on sufficient

A

nerve innervation, muscle excursion, strength

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39
Q

pts with conditions effecting the spinal cord (especially c3-5) may need

A

ventilator support

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40
Q

extreme obesity can limit

A

chest wall expansion therefore compromising breathing

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41
Q

progressive loss of muscle function can

A

limit ability to ventilate and cough
(muscular dystrophy)

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42
Q

respiratory issues in older adults

A
  • decline in respiratory strength
  • lungs lose elasticity
  • decreased flexibility in rib cartilage
  • bone density decreases
  • decreased AP ratio (barrel chest)
  • diminished respiratory volume
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43
Q

immobility in older adults creates risk for

A
  • atelectasis (airway collapse)
  • reduced air exchange
  • hypoxia
  • hypercapnia
  • acidosis
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44
Q

older people having a reduced cough and gag reflex puts them at higher risk for

A

aspiration of secretions
aspiration pneumonia

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45
Q

risk of postoperative respiratory complications in older adults due to

A

impaired cough reflex, weaker muscles, and decreased respiratory capacity

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46
Q

stress increases what in older adults

A

respiratory complications

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47
Q

genetic patterns of inheritance increase risk for respiratory disorders such as

A

cystic fibrosis
alpha-1 antitrypsin deficiency (associated w/ early onset emphysema)
asthma

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48
Q

cultural and ethnic variability of respiratory illnesses

A

TB
smoking

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49
Q

risk factors of TB

A

HIV +
immigrants
homeless
drug and alc abuse

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50
Q

ABC

A

airway breathing circulation

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51
Q

acute shortness of breath priorty assessment

A

assess airway, RR, PR, BP, and O2 sat
auscultate lungs for possible abnormalities
administer O2 as orderd
administer bronchodilators as ordered
elevate head of bed

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52
Q

important factors for those with acute SOB

A

keep patient calm as anxiety increases respiratory decline

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53
Q

as O2 level in blood and tissues decrease,

A

pts become more dyspneic and cyanotic causing insufficient blood supply to brain resulting in confusion and decreasing level of consciousness

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54
Q

priority urgent assessment #3 for acute SOB

A
  • may be unable to cooperate fully
  • ausculatate when turning client
  • prioritize subjective data
  • ask only pertinent Qs related to situation
  • cluster interventions
  • assess when client is more relaxed
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55
Q

assessment of risk factors for respiratory conditions

A

past medical history
lifestyle and personal habits
occupational history
environmental exposures
medications
family hx

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56
Q

teaching and health promotion for respiratory conditions

A

smoking cessation
prevention of occupation exposure
prevention of asthma
immunizations

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57
Q

all smokers should be

A

asked at every appointment about readiness to stop as smoking has been linked to lung cancer, emphysema, chronic bronchitis, CV disease, and oropharyngeal cancer

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58
Q

asthma triggers

A

tobacco smoke
dust
molds
furred and feathered animals
cockroaches
pests

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59
Q

have you ever been diagnosed with a respiratory disease or condition such as asthma, bronchitis, emphysema, pneumonia or lung cancer?

A

you want to ask this as certain diseases like COPD have long term effects that result in slow progressive decline in function, asthma symptoms may occur at any age and improve or worsen over time, pneumonia usually has acute onset and resolves itself after meds

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60
Q

common chest symptoms

A
  • chest pain
  • dyspnea
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • cough
  • sputum
  • wheezing
  • functional abilities
  • older adults
  • cultural factors
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61
Q

general appearance of respiratory examination

A

observe pt posture and positioning
posture is upright and ANOx3/4, facial expression relaxed

abnormal: pts in tripod position (common in COPD or those w respiratory distress)

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62
Q

inspection of posterior chest

A

moving around to inspect posterior chest, inspect and compare AP to assess overall shape of thoracic cage, observe spontaneous chest expansion

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63
Q

palpation of posterior chest

A

palpate chest for tender areas
use fingertips starting above scapula over the lung apex and progress from sid eto side compare findings bilaterally, palpate for crepitus

abnormal: lesions, lumps, massess, crepitus (air filled massess underneath skin)

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64
Q

tactile fremitus posterior chest

A

evaluates density of lung tissue
- place palmar base or ulnar surface of hand on patients chest above scapula and ask patient to say 99, vibrations of air in bronchial tree are transmitted allowing assessment of intensity and symmetry of fremitus from L + R lungs

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65
Q

percussion in posterior chest

A

can help discover if tissue is air filled, fluid filled, or solid, usually interpreted in combination with otehr examination techniques
percuss anteriorly, posteriorly, and laterally

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66
Q

ausculatation posterior chest

A

ask pt to breathe deeply through mouth
ID breath sounds by listening for intensity, quality, pitch, and duration of inspriation compared with expiration

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67
Q

vesicular breath sounds

A

soft, low pitched and found over fine airways near site of air exchange (lung periphery)

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68
Q

bronchovesicular sounds

A

found more centrally, over major bronchi that have fever alveoli

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69
Q

bronchial breath sounds are

A

loud high pitched and found over trachea and larynx
common to hear crackles on inspiration with first deep breath (if heard ask patient to cough)

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70
Q

inspection of anterior chest

A

use same techniques
inspect chest wall for deformities or asymmetry between right and left sides, assess size of costal angle, observe for use of accessory muscles to breathe, no barrel chest, inspect ICSs for retractions or bulging

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71
Q

palpation of anterior chest

A

Palpate the anterior chest for tenderness, masses, or lesions. Begin at the lung apices and move from side to side, ending below the costal angle and moving laterally to the midaxillary line-No tenderness, masses, or lesions should be observed

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72
Q

percussion anterior chest

A

precuss anterior and lateral chest in the ICSs
avoid percussion over bone and/or breast tissue

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73
Q

percussion in anterior chest should sound

A

resonant in lungs

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74
Q

auscultation of anterior chest

A

auscultate the trachea and anaterior and lateral lung fields
listen to lung apices
listen down to the 6th ICS bilaterally or when breath sounds become absent signalling end of lung fields

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75
Q

bronchial breath sounds are audible over

A

the trachea

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76
Q

bronchovesicular sounds are heard over the

A

2nd-3rd ICSs to the right and left of sternum over the bronchi

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77
Q

vesicular sounds are heard in

A

other areas of lung fields

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78
Q

making clinical decisions regarding respiratory conditions

A
  • analyze lab and diagnostic testing
  • prioritize hypotheses and take action
  • analyzing changing findings
  • interprofessional collaboration w respiratory therapy
  • plan the care
  • evaluate outcomes
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79
Q

RR: elevated WBC count may indicate

A

infection like pneumonia

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80
Q

analysis of sputum sample may help ID

A

causative microorganism

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81
Q

arterial blood gas is a direct measure of

A

blood O2 , CO2, and acid balance

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82
Q

radiographic studies can provide

A

objective evidence of disease process within thorax and lungs

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83
Q

PET scans

A

measure the metabolic rate of various body tissues, providing info about presence and stage of a malignancy
if PET scans revealed adrenal metasisis the potentially lethal surgery would not benefit pt

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84
Q

Acute shortness of breath is a medical emergency. Immediate assessments are necessary. What is the priority assessment the nurse would make with a client who has acute shortness of breath?
A. Administer inhalers
B. Administer oxygen
C. Raise the head of the bed
D. Auscultate lungs

A

D. auscultate

acute SOB; immediate auscultation then o2 is administered and inhalers may be given then head of bed elevated

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85
Q

nurses measure nutritional status by

A
  • taking height and weight measurements
  • monitoring I&Os
  • measuring lab values
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86
Q

body function is affected by intake of

A

primary nutrients

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87
Q

nutrients

A
  • carbohydrates
  • proteins and amino acids
  • lipids and fatty acids
  • vitamins and minerals
  • supplements
  • fluid and electrolytes
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88
Q

carbohydrates

A

main source of bodily energy
simple and complex
should comprise 45-65% of caloric intake

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89
Q

proteins and amino acids

A

proteins function in cell structure and tissue maintenance
amino acids are building blocks of protein
total amount needed per day increases when ill

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90
Q

lipids and fatty acids

A
  • triglycerides, sterols, and phospholipids
  • maintain total body function (promote absorption of fat soluble vitamins A, D, E, K
  • saturated, unsaturated, and monosaturated
  • HDLs and LDLs
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91
Q

clinical significance of lipids and fatty acids

A

excess leads to atherosclerosis, stroke, and MI
increase in obesity

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92
Q

USDA and AHA recommend how much fat intake

A

20-35% of caloric intake

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93
Q

vitamins and minerals

A
  • foundation of cellular structures
  • key role in nutrient metabolism
  • vitamin B and D are commonly lacking
  • minerals of importance: iron, zinc, calcium
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94
Q

water

A

body loses 1500-2800mL/day
requires minimum intake of 1500 mL/day to maintain excretion of metabolic waste

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95
Q

sodium and potassium

A

essential
limited to 2300 mg/day

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96
Q

medications commonly prescribed for individuals w/ chronic illness can lead to

A

alteration in K+ levels
abnormal K+ levels can lead to lethal cardiac dysrhythmias

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97
Q

utilize MyPlate guidelines mad eby USDA and HHS

A
  • consider food choices that meet personal, cultural, and budget preferences
  • recognize that eating is part of lifestyle, social system, and way of living
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98
Q

goals for nutritional guidelines

A

encourage individuals to meet nutritional needs
choose variety of options
pay attention to portions

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99
Q

pregnancy and lactation

A

additional 300-500 calories per day
emphasis on protein
vitamin and mineral supplement may be required

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100
Q

vitamin b

A

neccessary for those trying to get preganant at least 1 month before conception and 2-3 months after

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101
Q

infants, children, and adolescents

A

protein is ciritcal
milk:
- under 2: whole milk
- 2-5: low fat milk

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102
Q

older adults have decreased

A

taste and third drive
poor dentition
BMR decline
high risk of malnutrition and dehydration

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103
Q

factors influencing nutrition

A

culture
religion
geographic location
food and fluid preferences
eating patterns, digestions, allergies
shopping resources and skills
kitchen facilities and ability to prepare food
meaning behind food and feeding
social patterns at means
GI structures and dentititon

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104
Q

subjective cues in nutritional assessment

A
  • deficits develop over time
  • during stress or trauma caloric need increases
  • ask pt nutritional preferences
  • if pt in unable to make decisions, consider consult
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105
Q

nurses role in nutritional assessment

A
  • look at developmental, social, economic, and cultural facotrs
  • complete nutrition screening (risk factor assessment, comp. nutritional history, physical exam, calculated measurements, serial lab values)
  • pt teaching
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106
Q

main causes of malnutrition

A

poverty, alcoholism, hospitalization, aging, and eating disorders

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107
Q

alcohol recommeded intake

A

1 drink/day - females
2 drink/day - males

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108
Q

if pt is at risk for altered nutrition this should be done

A
  • food records
  • food frequency questionnaires
  • direct observation
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109
Q

comprehensive physcial assessment for nutrition

A

body time - small, average, large
general appearance
swallowing
BMI (18.5-24.9)

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110
Q

CBC

A

can exclude anemias from nutritional deficiencies like iron, folate, and b12

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111
Q

serum albumin

A

longer half life protein than prealbumin
inflammation will decrease serum albumin making it an unreliable serum marker for malnutrition

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112
Q

prealbumin

A

half life is much shorter (2 days) and its total body pool is smaller and is a more reliable indicator of pt nutritional status

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113
Q

prealbumin is degraded by

A

kidneys so any renal dysfunction causes increase in its serum levels

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114
Q

transferrin

A

iron deficiency states (chronic blood loss anemia) levels of transferrin are elevated because of increase amount of iron absorption
levels increase w renal failure
oral contraceptives or estrogen formulas also alter levels

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115
Q

rentinol binding protein

A

vitamin a and zinc are vital in proper functioning of RBP and hence any abnormalities in levels of these micronutrients affect levels of RBP in serum

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116
Q

creatinine and blood urea nitrogen

A
  • nitrogen balance means more loss than intake
    nitrogen balance is measured w concentration of urea in urine
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117
Q

diagnosis or hypothesis: UNDERWEIGHT

A

description
nutrient intake that fails to meet energy and metabolic needs

assessment
body weight 20% of more below ideal, BMI <18.5, lack of interest in food, nausea, vomiting, diarrhea

interventions
weight pt daily, monitor intake, nutritional supplements, offer food frequently

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118
Q

OVERWEIGHT

A

description
adult BMI over >30kg/m2

assessment
body weight more than 20% above ideal, BMI > 24.9 eating in response to cues other than hunger, triceps skin fold >25 mm in females or 15 mm in males

interventions
have pt keep food diary and record every intake
teach reading of food labels, weight 2x/week, iteach increased intake of fruits and vegetables

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119
Q

fluid imablance

A

description
increased fluid usually due to impaired heart and circulation or low excretion by kidneys

assessment
altered electrolytes, elevated creatinine, decreased hematocrit, and hemoglobin, weight gain

interventions
monitior I&Os, wieght daily at same time of day, evaluate serum sodium ,creatinine, and hematocrit

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120
Q

dehydration

A

description
decreased intravascular, interstitial, or intracellular fluid; dehydration

assessment
decreased BP, increased HR, orthostatic BP changes, thirst, dry skin, sunken eyes

interventions
monitor intake and output, weigh daily, provide fluids every 2 hrs, treat causes of nausea, vomitting, or diarrhea

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121
Q

reference locations of abdomen

A

R hypochondriac region
epigastric region
L hypocondriac region

R lumbar region
umbilical region
L lumbar region

R iliac region
hypogastric region
L illiac region

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122
Q

what organs are within right hypochondriac region

A

liver and gallbladder, right kidney, small intestine

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123
Q

organs within epigastrium region

A

stomach, liver, pancreas, duodenum, adrenal glands, spleen

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124
Q

organs within left hypochondriac region

A

spleen, colon, left kidney, pancreas

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125
Q

organs within right lumbar

A

gallbladder, liver, right colon

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126
Q

organs within umbilical region

A

umbilicus, parts of small intestine, duodenum

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127
Q

organs within left lumbar

A

descending colon, left kidney

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128
Q

organs within right iliac

A

appendix, colon

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129
Q

organs within hypogastric

A

urinary bladder, sigmoid colon, female reproductive organs

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130
Q

organs within left iliac

A

descending colon, sigmoid colon

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131
Q

GI organs

A

stomach
small intestine
colon

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132
Q

GI accessory organs

A

liver
pancreas
gallbladder

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133
Q

GU organs

A

urinary system: KUB
genital system: spermatic cord for males and ovaries and uterus for females

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134
Q

blood vessels, peritoneum, and muscles abdominal organs

A

abdominal aorta
muscles
spleen

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135
Q

funciton of GI tract

A

ingestion and digestion
absorption of nutrients
elimination

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136
Q

steps of kidney filtration

A
  1. glomerulus
    filters small solutes from blood
  2. proximal convoluted tubules
    reabsorbs ions, water, and nutrients; removes toxins and adjusts filtrate pH
  3. descending loop of henle
    aquaporins allow water to pass from filtrate into interstitial fluid
  4. ascending loop of henle
    reabsorb na+ and cl- from filtrate into the interstitial fluid
  5. distal tubule
    selectively secretes and absorbs different ions to maintain blood pH and electrolyte imbalance
  6. collecting duct
    reabsorbs solutes and water from filtrate
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137
Q

GI considerations for older adults

A
  • decreased saliva and stomach acid produciton
  • difficulty swallowing, absobing, and digesting
  • motility and peristalsis decrease
  • dentition changes
  • financial constraints
  • less likely to feel abdominal pain
  • fat accumulates in lower abdomen making assessment more difficult
  • liver decreases in size and function
  • renal function declines
  • diminished thirst sensation
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138
Q

GI issues among AA

A

sickle cell anemia
glucose-6-phosphate dehydrogenase deficiency
lactose intolerance

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139
Q

GI issues among Americans of Greek and Italian Decesent

A

lactose intolerance
thalassemia
anemia

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140
Q

AA have highest incidence of

A

hep B

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141
Q

AA and hispancis have higher mortality rates from

A

hep B and C

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142
Q

AA hispanics native hawaiians/islanders, native americans have higher

A

diabetes, obesity, and related complications

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143
Q

risk factors for focused abdominal assessment

A
  • past medical/surgical hx
  • general GI questions
  • lifestyle and personal habits (weight gain, GU issues, female vs male, neurologic complaints, metabolism, skin, lymph, alc/substance abuse)
  • occupation
  • foreign travel
  • high-risk behaviors
  • meds
  • family hx
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144
Q

abdominal complications

A

colorectal cancer
foodborne illness and allergy
hepatitis

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145
Q

symptoms of abdominal complications

A
  • indigestion
  • anorexia
  • n/v, hematemesis
  • dysphagia, odynophagia
  • change in bowel habits/function (constipation, diarrhea)
  • jaundice/icterus
  • urinary/renal symptoms (incontinence, kidney pain, ureteral colic)
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146
Q

oder of operations for abdominal assessment

A

inspection
auscultation
percussion
palpation

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147
Q

contour of GI

A

flat, rounded, distended, scaphoid, or protuberant

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148
Q

symmetry of GI

A

shine a light across the abdomen to view for symmetry

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149
Q

umbillicus

A

midline and inverted with no discoloration

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150
Q

skin of GI

A

smooth, even, all one color, good place to assess skin pigmentation because it is typically protected from sunlight

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151
Q

pulsation or movement of GI

A

no pulses or abnormal movements

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152
Q

output of GI

A

emesis or stool

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153
Q

focus on urine output

A

make note of urine characteristics
- pale/straw, yellow, clear, little to no odor

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154
Q

clear urine indicates

A

over hydration

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155
Q

dark yellow urine indicates

A

mild dehydration

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156
Q

amber urine indicates

A

moderate dehydration

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157
Q

orange urine indicates

A

severe dehydration, excess bilirubin or some meds

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158
Q

red (hematuria) urine indicates

A

blood in urine
pyelonephritis, cystitis, bladder or prostate CA

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159
Q

tea colored urine

A

liver disease

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160
Q

auscultate vascular sounds on GI

A

listen with the bell of the stethescope
listen for bruits, venous hums, friction rubs

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161
Q

percussion of GI

A

determine organ size and tenderness
detects fluid air or masses in abdominal cavity
percuss all 4 quadrants
blunt percussion over kidney at CVA

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162
Q

what sounds should be heard in abdomen

A

tympany

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163
Q

palpation of GI

A

check for areas of pain
check blumberg sign

164
Q

never palpate abdomen of patients who have had

A

organ transplants or of a child with a suspected Wilms tumor

165
Q

lab tests for GI

A

CBC and BMP can evaluate some functions
gastroccult tests for blood in emesis
hemoccult tests for blood in stool

166
Q

diagnostic tests for GI

A

esophagogastroduodenoscopy (EGD)
barium enema
colonoscopy
endoscopic retrograde cholangiopancreatography (ERCP)
computed tomography (CT) scan
magnetic resonance imaging (MRI)

167
Q

deficient food intake

A
  • dietary intake that is inadequate in quantity, quality, or both for metabolic needs
  • body weight decreased, BMI less than normal
  • rovide nutritional supplements (e.g., milk shakes) administer antiemetics as ordered
168
Q

diarrhea

A
  • at least 3 liquid stools per day
  • passage of loose unformed stools
  • obtain stool specimen to determine infection (e.g., C. diff)
169
Q

constipation

A
  • decrease in normal frequency of defecation with hard dry stool
  • abdominal distention, pain, tenderness, firm abdomen, no stool for days
  • obtain order for stool softener if pt is on opioids, increase intake of fiber, assist with ambulation, ensure adequate intake of fluids
170
Q

impaired urinartion

A
  • differentiate functional overflow, reflex, stress, and urge continence, impaired elimination, and urinary retention
  • voiding more than every 2 hrs while awake, awakening at night to urinate, voiding more than 8x in 24 hrs
  • review meds that may contribute to incontinence, perform bladder scan to evaluate if residual is present, teach principles of bladder training
171
Q

urinary retention

A
  • inability to empty bladder completely
  • absence of urine output, bladder distension, dribbling, frequent voiding
  • void every 2 hrs double void, teach kegel exercises, avoid fluids before bed
172
Q

4 heart valves

A

tricuspid
mitral
pulmonic
aortic

173
Q

carotid arteries carry blood from

A

heart to head

174
Q

jugular veins

A

internal and external

175
Q

steps of conduction system

A
  1. SA node
  2. AV node
  3. Bundle of His
  4. R/L bundle branches
  5. purkinje fibers
176
Q

flow of blood

A
  1. SVC receives blood from limbs neck and head while IVC receives blood from trunk viscera and lower limbs. both IVC and SVC bring this deoxygenated blood into the right atria
  2. the right atrium contracts and the tricuspid valve opens causing blood flow into the ventricles
  3. the ventricles then contract causing the pulmonary artery / semilunar valve to open and send deoxygenated blood to the lungs to become oxygenated
  4. gas exchange occurs in lungs and oxygenated blood then enters back into heart through left atria
  5. left atria contracts causing bicuspid valve to open and have blood enter left ventricle
  6. left ventricle contracts causing aortic semilunar valve to open to spread blood throughout the entire body
177
Q

right atrium

A

deoxygenated blood via vena cavae

178
Q

left atrium

A

oxygenated blood via pulmonary veins

179
Q

right ventricle

A

deoxygenated blood via pulmonary arteries

180
Q

left ventricle

A

oxygenated blood via aorta

181
Q

systole

A

refers to phase of heartbeat where the heart contracts and pumps blood from chambers into artery

182
Q

diastole

A

phase of heartbeat where heart relaxes and allows blood to fill within heart chambers

183
Q

S1 heart sounds

A

s1 is consistent with the closing of mitral and tricuspid valves

184
Q

s2 heart sounds

A

consistent with closure of aortic and pulmonic valves

185
Q

stroke volume

A

the volume of blood pumped by the ventricles with each heartbeat

186
Q

cardiac output

A

amount of blood pumped by the heart in a minute

187
Q

preload

A

volume in the right atrium at the end of diastole

188
Q

preload is an indicator of

A

how much blood will be forwarded to and ejected from the ventricles

189
Q

formula of cardiac output

A

HR x stroke volume

190
Q

cardiac cycle

A
  1. atria fill passively
  2. atria contract
    - all valves close, isovolumentric phase of contraction
  3. pressure builds in ventricular chambers
  4. semilunar valves open, ventricles eject blood
  5. ventricles relax; all valves close
191
Q

p wave

A

arises from contraction of atria

192
Q

qrs complex

A

ventricular contraction

193
Q

t wave

A

repolarization of heart

194
Q

older adults (heart)

A
  • increased risk of hypertension and heart disease
  • changees in heart and BP due to age related siffening of vasculature and decreased responsiveness to stress hormones
  • changes in BMI, late diastolic filling, cardiac reserves, left ventricualr wall, left atrial size, mitral valve, responses to stress hormones lead to poor responses
195
Q

in the older population you would assess for (heart)

A

heart failure, atrial fibrillation, chest pain, fatigue, dyspnea associated with symptoms

196
Q

leading cause of death worldwide

A

heart disease

197
Q

coronary heart disease is most present amongst

A

65+, men, and native americans/alaska natives

198
Q

leading cause of death in hispanic americans

A

heart disease and stroke

199
Q

african americans are at increased risk for what heart problem

A

CV disease and stroke

200
Q

in asian americans and pacific islanders heart disease causes

A

1/3 of deaths

201
Q

diabetics are at increased risk for

A

a-fib and heart disease

202
Q

priority urgent assessment and interventions for cardiac issues

A
  • cardiac emergencies: rapid assessemnt + intervention
  • focused physical exam; cardiac, respiratory
  • additional priority assessments: arrythmias, fluid volume overload; decompensated heart failure
  • data clustering
203
Q

symptoms of heart issues

A
  • chest pain
  • sob
  • abnormal BP
  • inadequate tissue perfusion
  • orthopnea / paroxysmal nocturnal dyspnea (PND)
  • dyspnea
  • cough; diaphoressis
  • fatigue
  • edema
  • noctuira
  • palpitations
204
Q

assessment of risk factor for cardiac complications

A
  • biographical information
  • past medical history
  • lifestyle and personal habits
  • medications
  • family history
  • teaching and health promotion
  • smoking cessation
  • control of BP and cholesterol level
205
Q

older adults tend to have what issues regarding cardiac problems

A

decreased activity tolerance
syncope
arrythmias; heart failure

206
Q

techniques for assessing heart

A
  • inspect jugular veins
  • palpate carotid arteries
  • ausculate carotid
  • inspect precordium
  • palpate PMI, precordium
  • ausculatate the pulse, extra heart sounds (s3 and 4), systolic and diastolic murmors
207
Q

variations in heart sounds

A
  • split heart sounds
  • systolic ejection click
  • snap
  • pericardial friction rib
208
Q

diagnostic testing and labs for cardiac

A
  • lipid profile; cardiac enzymes and proteins
  • ECG, chest xray, echocardiogram, hemodynamic monitoring, stress test, cardiac catheterization and coronary angiography, cardiac electrophysiology
209
Q

s1 sounds are louder at

A

apex of heart (bottom)

210
Q

s2 sounds are louder at

A

base of heart (top)

211
Q

s1 sound is

A

result from closure of mitral and tricuspid valves

212
Q

s2 sound is

A

result from closure of aortic and pulmonic valves

213
Q

risk factors for cvd

A
  • old age
  • family hx
  • male
  • high BP
  • high cholesterol
  • smoking
  • diabetes mellitus
  • obesity
  • decreased acitvity
  • high fat diet
  • excessive alcohol intake
  • elevated C-reactive proteion
  • elevated BNP
214
Q

capillaries

A

connection between arteries and veins that exchange nutrients, agses, and metabolites between blood vessel and tissues

215
Q

arterioles

A

delivers oxygen and nutrients

216
Q

venules

A

collect metabolites

217
Q

lymphatic system is composed of

A

lymph nodes
lymphatic vessels
spleen
tonsils
thymus
tonsils/adenoids
appendix
bone marrow
small intestine

218
Q

thymus

A

maintains fluid and protein balance
works w immune system
carries lymphatic fluid in tissues to blood stream

219
Q

lymphedema

A

lymph in tissues is greater than capacity

220
Q

primary lymphedema

A

congenital

221
Q

secondary lymphedema

A

injury

222
Q

older adults with vessel and lymph issues

A
  • systolic hypertension
  • arterial disease (atherrosclerosis; PAD; chronic venous insufficiency (CVI)
  • deep vein thrombosis (DVT)
  • venous thromboembolism (VTE)
  • venous insufficiency and chronic lymphedema
  • primary varicose veins
223
Q

peripheral arterial disease mainly impacts

A

african americans (male and female)
mexican american females

224
Q

CV disease is most prominent in

A

african americans and hispanics

225
Q

hypertension is most common in

A

african americans

226
Q

genetics impact what vascular issues

A

atherosclerosis
hypertension
diabetes
hyperlipidemia

227
Q

PAD continues to increase in

A

low, middle, and high income countries

228
Q

CVI (chronic venous insufficiency)

A

more prevalent in females in industrialized countries

229
Q

pad is greater in what gender in US

A

females

230
Q

priority urgent assessment for vascular issues

A
  • prioritize based on acute rather than chronic
  • complete arterial occlusion: limb threatening situations
  • deep vein thrombosis (DVT): immediate anticoagulant therpay necessary
  • pulmonary embolism: life threatening
231
Q

symptoms of complete arterial occlusion

A

pain
numbness
coolness
extremity color change

232
Q

deep vein thrombosis symptoms

A

pain
edema
extremity warmth

233
Q

pulmonary embolism symptoms

A

acute dyspnea
chest pain
tachycardia
diaphoresis
anxiety

234
Q

seven Ps for vascular issues

A
  1. pain
  2. pallor: pale skin color
  3. poikilothermia: inability to regulate core body temo
  4. paresthesias: numbness, tingling
  5. pulselessness: lack of pulse via palpation, auscultation
  6. paralysis: complete loss of muscle function
  7. perfusion: capillary refill
235
Q

assessment of risk factors for vascular complications

A

past medical hx
lifestyle and personal habits
medications
family hx

236
Q

teaching for patients with PAD

A

risk factor mod:
smoking
high fat diet
limited activity

hypertension and diabetes

daily assessment of feet
other risk factorsL hypertension, diabetes, chronic kidney disease, hereditary

237
Q

teaching and health promotion: venous disease

A

education: methods of decreasing venous pressure
avoid standing and sitting long periods of time, elevate legs periodically
compression stockings
educate on signs of DVT and PE

238
Q

risk reduction and health promotion for lymphatic disorders: extremity edema

A

avoid sitting, standing long periods of time
address chronic lymphedema early

239
Q

common symptoms of lymphatic disorders

A

pain
numbness and tingling
cramping
skin changes
edema
decreased functional ability
older adults

240
Q

basic techniques of vascular/lymphatic assessment

A
  • inspect arms and legs
  • palpate arms and legs
  • palpate peripheral pulses
  • auscultate BP; doppler
  • assess for edema
  • perform allen test: ABI assessment
  • assess for color change
241
Q

skin changes in arterial issues

A

cool to touch
thin, dry, scaly skin
hairless
thick toe nails
“DR. EP” - dangle legs = rubor, elevate legs = pale

242
Q

skin changes in venous issues

A

warm to tocuh
thick tough skin
brownish color

243
Q

assessment of arms in vascular assessment

A

inspection of size, symmetry, color, edema, lesions
palpation- temperature, texture, and turgor, capfill
auscultation of BP

244
Q

assessment of legs in vascular assessment

A

Inspection- size, symmetry, atrophy, color, cap refill, edema
Palpation- temperature, texture & turgor, pulses
Auscultation- doppler

245
Q

lab and diagnostic testing for vascular issues

A

wells score system; arterial versus venous; seven Ps; cholesterol and triglyceride levels; glucose levels, HbAIC; serum D-dimer; ultrasound; doppler; lymphoscintigraphy

246
Q

normal capillary refill

A

less than 2 seconds

247
Q

pain

A

one of the most common reasons for seeking health care

248
Q

pain affects

A

quality of life
social interactions
sense of well being, self-esteem
financial resources

249
Q

peripheral nervous systems (PNS)

A

contains two main types of nerve fibers
- A-delta (sharp stabbing pain)
- C fibers (achy, ongoing)
A and C fibers are commonly referred to as nociceptors

250
Q

nociceptors carry

A

pain to central nervous system

251
Q

central nervous system is composed of

A

brain and spinal cord

252
Q

neuroanatomy of pain

A
  1. nerve endings in finger sense pain
  2. signals of pain get sent to dorsal horn
  3. signals then travel to thalamus
  4. then to cerebral cortex
  5. then the spinal cord sends it back to dorsal horn
  6. endorphins in spinal cord release blocking pain
253
Q

gate control theory

A

states body responds to pain by:
- opening a neural gate to allow pain to be prodced
- creating a blocking effect at the synaptic junction to stop the pain

254
Q

steps for pain transmission

A
  • gate opens due to continued painful stimulus
  • pain passes from pns to cns
  • pain passes from spine to limbic system, cerebral cortex
  • stimulus identified as pain; passes through efferent pathways; reaction created
255
Q

nociception

A

most common clinical interpretation of pain

256
Q

steps in nociception

A
  • transduction
  • transmission
  • perception
  • modulation
257
Q

transduction

A

trauma to peripheral nociceptors

258
Q

transmission

A

sending of signal from peripheral nociceptors to dorsal root ganglion

259
Q

modulation

A

alteration of pain signal towards the brain

260
Q

perception

A

brain percieves pain and decreases modulation

261
Q

neuronal plasticity

A

nervous system modification in pain transmission
may causes increase in pain severity

262
Q

types of pain

A
  • acute
  • chronic
  • visceral
  • somatic
  • cutaneous
  • referred
  • phantom
263
Q

acute pain

A

recent tissue damage
if untreated may lead to chronic pain

264
Q

chronic pain

A

approximately 10% of us adults experience daily
stima sometimes associated
HICP - high impact chronic pain that limits at least one major life activity

265
Q

neuropathic pain

A

more constant stimulus resulting in neuronal plasticity
peripheral sensitization (results of inflammatory process, nonpainful touch/pressure becomes painful)

266
Q

nociplastic pain

A

pain w/ no identifable cause
ex. fibromyalgia, chronic low back pain, irritable bowel syndrome, headaches, restless leg syndrome, TMJ
- neuronal windup
physiological responses to painful stimuli
- windup
- peripheral sensitization
- central sensitization

267
Q

pain in older adults

A
  • chronic pain present in 25-40% of 65+
  • more common along women, adults over 85, lower BMI, more than one pain location, higher severity and longer duration
  • chronic diseases may affect assessment of pain
  • no evidence available to suggest pain sensation diminished
  • cognitive impairment, dementia, and delirium more common in older patients, presesnting challenges for assessing pain
  • use of behavioral observations may be helpful
268
Q

cultural variations and health disparities of pain

A
  • disparity in assessment and treatment of pain in racial and ethnic minorities
  • no evidence of biological or psychosocial factors between races
  • may be unconscious bias
  • more likely to rate pain scores lower, receive less pain meds
  • cultural differences in communicating about pain
  • sex differences between females and males
  • need to be aware of sociocultural varibale that influence pain behavior and expression
269
Q

some pain must be assessed and treated to prevent

A

chest pain = mycardial infarction
worst headache ever = stroke/ cerebral hemmorhage

270
Q

acute pain produces

A
  • high BP
  • tachycardia
  • diaphoresis
  • shallow respirations
  • restlessness
  • facial grimacing
  • guarding behavior
  • pallor
    -pupil dilation
271
Q

assessment or risk factors for pain

A
  • undertreated or untreated acute pain especially after surgery or crush type injury
  • complex regional pain syndrome (CRPS)
  • develop neuropathic pain
272
Q

teaching and health promotion of pain

A
  • report pain and take pain meds
  • continue to refuse pain meds, ask patient why
  • pain is what patient says it is
273
Q

common symptoms of pain

A

pain intensity
pain quality

274
Q

impact of pain on quality of life

A

location
duration
intensity

275
Q

OLDCARTS

A

onset
location
duration
character
aggravating
relieving factors
timing
severity

276
Q

physiological effects of pain

A

neurologic, cardiac, pulmonary, GI, GU, musculoskeletal, skin, metabolic

277
Q

behavioral responses to pain

A

emotional, social, vocalization, verbalization, facial expression, body action

278
Q

patients unable to verbalize pain

A

moaning, facial grimacing, bracing, rubbing painful areas, restlessness, vocal complaints

279
Q

pain assessment tools

A
  • visual analog scale
  • numeric pain intensity scale
  • brief pain inventory (BPI) - pain intensity scale, body diaphragm, functional assessment efficacy of pain meds
  • mggill pain questionairre (MPQ)- set of verbal descriptiors used to capture sensory aspect o fpain, VAS, present pain intensity
  • pain enjoyment and general acitivty tool (PEG)
  • clinically aligned pain assessment tool
280
Q

lifespan considerations of pain

A

newborns, infants, children
- painful for adult = painful for child
- FLACC (2mo-7yo)
- FACES (> 3yo)

281
Q

older adults in pain

A

prevalent (may be seen as natural part of aging)
chronic illness
may be stoic and conceal pain
may fear result of having pain so wont communicate
assess effects of pain on lifestyle
ask about comorbities
review meds, vitamins, and herbs

282
Q

patients unableto report pain

A

attempt self report, try to ID cause
observe behaviors, ask family
attempt analgesic trial
opioid crisis
misuse and abuse of opoids
CDC guidelines for pain managment

283
Q

what organization set standards on pain mangament

A

the joint commision

284
Q

barriers to pain assessment

A

predjudices/bias
- educational values
- family values
- cultural values
- inaccurate or ineffective assessment can result in incorrect dose and/or treatment

285
Q

function of skeletal system

A

support
movement
protection
produce RBCs (bone marrow)
storage of minerals (i.e., calcium)

286
Q

muscle

A

skeletal voluntary control connected by tendon to bone

287
Q

cartilage

A

specialized forms of connective tissue allows bone to slide, reduces

288
Q

fibrous, cartilaginous and synovial joints

A

places of union of two or more bones

289
Q

ligaments

A

fibrous bands from one bone to another that strengthen the joint, prevent unwanted movement

290
Q

bursae

A

enclosed fluid filled sac, serves as a cushion, reduces friction

291
Q

meniscus

A

cartilage disk between bones to cushion joints and absorb shcok

292
Q

fascia

A

flat sheets that line and protect muscle fibers, attach muscle to bone and provide structure for nerves, blood vessels, and lymphatics

293
Q

flexion

A

decreases angle of bones

294
Q

dorsiflexion

A

bending the ankle so that the toes move toward head

295
Q

plantar flexion

A

move foot so that the toes move away from the head

296
Q

extension

A

increases the angle to a straight line or zero degrees

297
Q

hyperextension

A

extension beyond the neutral position

298
Q

abduction

A

movement away from center of body

299
Q

adduction

A

movement toward center of body

300
Q

rotation

A

turing of joint around longitudinal axis

301
Q

internal rotation

A

rotating an extermity medially along its axis

302
Q

external rotation

A

rotating an extremity laterally along its axis

303
Q

pronation

A

turning forearm so palm is down

304
Q

supination

A

turning forearm so palm is up

305
Q

circumduction

A

circular motion that combines flexion, extension, abduction, and adduction

306
Q

inversion

A

turning sole of foot inaward

307
Q

eversion

A

turning sole of foot outward

308
Q

protraction

A

moving body part forward and parallel to ground

309
Q

retraction

A

moving body part backward and parallel to groun

310
Q

elevation

A

moving body part upward

311
Q

depression

A

moving body aprt downward

312
Q

opposition

A

moving thumb to touch little finger

313
Q

temporomandibular joint (TMJ)

A

three motions:
- hinge (open and close jaws)
- gliding (protrusion and retraction)
- gliding (side to side movement of lower jaw)

314
Q

shoulder girdle belt of 3 large bones

A

humerus
scapula
clavicle
joints and muscles

315
Q

glenohumeral joint

A

ball and socket action allows mobility of arm on many axes

316
Q

rotator cuff

A

group of muscles and tendons
support and stabilize shoulder

317
Q

subacromial bursa

A

assists with abduction of arm

318
Q

shoulder is what kind of joint

A

ball and socket

319
Q

elbow joint has 3 articulation

A

humerus
radius
ulna

320
Q

palpable landmarks

A

medial and lateral epicondyles of humerus and large olecranon process of ulna

321
Q

radius and ulna articulate with each other at two joints

A

elbow and wrist

322
Q

wrist and hands

A

radiocarpal joint
articulation of radius on thumb side and row of carpal bones

323
Q

condyloid action permits wrist to

A

flex and extend, deviation (side to side)

324
Q

midcarpal joint

A

flexion, extension, and some rotation

325
Q

hips

A

articulation of acetabulum and head of femur

326
Q

hip joints

A

ball and socket
stability for weight bearing function
muscles - stability, bursae - movement

327
Q

palpation of bony landmarks

A

iliac crest
ischial tuberosity
greater trochanter of the femur

328
Q

knee joint

A

three bones - femur, tibia, and patella

329
Q

knees are the

A

largest joint in the body
hinge joint
flexion and extension of lower leg

330
Q

cartilage of knee

A

medial and lateral menisci
cushion tibia and femur

331
Q

stabilization of knee

A

two sets of ligaments
cruciate and collateral

332
Q

ankle (tibotalar) joint

A

fibula tibia and talus
hinge joint
flexion (dorsiflexion) and extension (plantar flexion)

333
Q

landmarks are two bony prominences

A

medial malleolus and lateral malleoulus
help stability of ankle

334
Q

joints distal to ankle give additional mobility to foot

A

subtalar joint - inversion and eversion of foot
foot has longitudional arch with weight bearing distributed between parts that touch ground, the heads of metatarsals and calcaneous heel

335
Q

vertebrae

A

33 connecting bones stacked in vertical columm

336
Q

motions of vertebral column

A

flexion
extension
abduction
rotation

337
Q

lateral view of spine

A

4 curves, double s shape
cervical and lumbar curves concave (inward or anterior)
thoracic and sacrococcygeal curves are convex

338
Q

curves in spine together with intervertebral disks allow spine to

A

absorb shock

339
Q

aging adults in development

A
  • after 40, resportion occurs more rapidly than deposition causing risk for osteoporosis
  • postural and height changes occur (kyphosis with slight flexion of hips and knees to compensate)
  • loss of fat leaves bony prominence more marked
  • loss in muscle mass (decrease in size and atrophy producing weakness, sedentary lifestyle)
  • cartilage degeneration
  • joint stiffness
340
Q

infant/child developmental competence

A

bone grows rapidly during infancy and steadily in childhood, adolescent growth spurt
weight increase - muscles and fat; vary in size and strength due to genetics, nutrition, and exercise

341
Q

epiphyses

A

growth plates at end of long bones

342
Q

longitudonal growth of bones in infants and children continues until

A

closure of epiphyses; last closure about 20

343
Q

pregnancy developmental competence

A

inreased mobility in sacroiliac, sacrococcygeal, and symphysis pubis joints in pelvis contributes to change in posture
lordosis leading to back strain
anterior flexion of neck and slumping of shoulder

344
Q

cultural variation to musculoskeletal system

A
  • bone mineral density
  • curvature of long bones
  • conversion of active metabolites by sunlights
  • biologic sex: exposure to testosterone, estrogen, menopause
  • working conditions, physical activity, frequent repetitive movements, poor ergonomic design, lack of movement
345
Q

common musculoskeletal symptoms

A

pain
discomfort
weakness
limited movement
deformity
lack of balance/coordination

346
Q

skeletal system exam

A

inspect - size and countour of joiny, skin color, and characteristics, symmetry

palpation - of joint area, skin, muscles, bony articulations, and joint capsules

ROM
active or passive

347
Q

subjective assessment of skeletal system

A

joints: pain, stiffness, swelling, heat, redness, limitation of movement

knee joint (if injured)

muscles: pain (cramps) or weakness

bones: pain, deformity, trauma (fractures, sprains, or dislocation)

functional assessment (ADLs)

patient centered care

348
Q

questions for joint pain

A

Pain: any pain or problems w/ joints?
Location: unilateral or bilateral
Characteristics: quality and/or severity
Onset duration and frequency
Aggravating or precipitating factors
Associated clinical presentations
Limitation of motion, stiffness, swelling or erythmea
Impact on ADLs

349
Q

Questions for muscles

A

location of pain or cramping
pain while walking or at rest
associated clinical presentations
muscle characteristics: weakness and size
onset and duration

350
Q

questions for bones

A

pain at rest and/or affect by movement
presence of deformity from injury or trauma and effect on ROM
hx of accidents or trauma with impact on boens
medical and.or surgical treatment - any residual deficits
presence of back pain - provide descriptors
presence of neurological or physical deficits

351
Q

functional assessment of ADLs in skeletal system

A

do joint (muscle, bone) problems create limits in usualy ADLs
screen for safety of independent living, need for home services and QOL
aks specifics about - bathing, toileting, dressing, grooming, eating, mobility, communicating

352
Q

morse fall scale

A
  1. history of falling: immediate or within 3 months( yes = 25 )
  2. secondary diagnoses (yes=15)
  3. ambulatory aid (crutches = 15, furniture = 30) (wheelchair, nurse, none, bed rest = 0)
  4. IV/heparin lock (yes=20)
  5. gait/transferring (weak = 10, impaired- 20)
  6. mental status (forgetful = 15)
353
Q

morse fall scale risk levels

A

no risk (0-24) - no action
low risk (25-50) - fall prevention interventions
high risk (>51) - high risk fall prevention

354
Q

infants and children questions for skeletal system

A

labor and delivery information
achievement of developmental milestones
hx of broken bones/trauma with treatment and/or residual deficits
presence of bone/spinal deformity

355
Q

questions for adolescents regarding skeletal system

A

hx of sports activities
pattern of warm up and exercise
interventions if injury occurs

356
Q

risk factors for musculoskeletal issues

A
  • occupational hazards
  • execise program pattern
  • dietary review: gain or loss in weight
  • medications rx and over counter related to muscle and bone health
  • supplements and vitamins like vit D and calcium
  • smoking history
  • impact on ADLs : acute vs chronic
357
Q

goniometer

A

for measuring angle at which joint can flex or extend

358
Q

parkinsons gait

A

taking small steps with back and neck bent forawrd

359
Q

hemiplegic gait

A

occurs in ppl with history of stroke, which leads to weakness of arm and legs, arms don’t swing and legs are dragged while walking

360
Q

ataxic gait

A

inability to walk in straight line, certain drugs, positional vertigo and cerebral problems can lead to ataxic gait

361
Q

scissor gait

A

caused by spasticity of muscles
both knees and thighs cross each other like a scissor, seen among those with cerbral palsy and congenital issues

362
Q

muscle testing

A

test strength of prime mover muscle groups for each joint; repeat motions for active ROM
ask person to flex and hold as you apply force
muscle strength should be equal bilaterally and should fully resist opposing force

363
Q

rating scale for muscle strength

A

5/5 (100%) - normal: complete ROM against gravity and full resistance

4/5 (75%) - good: complete ROM against gravity and moderate resistance

3/5 (50%)- fair: complete ROM against gravity

2/5 (25%)- poor: complete ROM with joint supported, cannot perform ROM against gravity

1/5 (10%)- trace: muscle contraction detectable but no movement of joint

0/5 (0%)- zero: no visible muscle contraction

364
Q

atony

A

lack of normal muscle tone or strength

365
Q

hypotonicity

A

diminished tone of skeletal muscles

366
Q

spasticity

A

hypertonic so muscles are stiff and movements are awkward

367
Q

spasm

A

sudden violent involuntary contraction of a muscle

368
Q

fasciculation

A

involuntary twitching of muscle fibers

369
Q

tremores

A

involuntary contraction of muscles

370
Q

physcial exam for TMJ

A

inspect and palpate
vertical
lateral (side to side)
protrustion (forward and back)
clench of teeth

371
Q

cervical spin physical exam

A

inspect (should be straight and erect
palpate spinous processes and sternomastoid, trapezius, and paravertebral muscles - nontender

372
Q

ROM of cervical spin

A

chin to chest - flexion
look to ceiling - hyperextension
ear to shoulder - lateral flexion
look to right center left - rotation
repeat w resistance

373
Q

thoracic spine physical exam

A

standing draped gown open at back
inspect (from side, note normal convex thoracic curve and concave lumbar curve, kyphosis, lordosis)

palpate spinous processes - not tender

palpate vertebral muscles - firm no tenderness or spasms

chekc ROM - toe touches: look for flexion of 75-90 degress, smoothness and symmetry of movement

374
Q

check ROM of spine

A

bend sideways, backward, twist shoulders to one side then the other; rotation
walk on toes for a ew steps then return walking on heels

375
Q

straight leg (lasegues) test

A

raise affected leg just short of point where it produces pain, then dorsiflex foot
positive if reproduces sciatic pain (confirms presence of herniated disc)

376
Q

testing for carpal tunnel syndrome

A

phalen test - acute flexion of wrist if produces number and burning if +

tinel sign test = percussion of median nerve produces burning and tingling if +

377
Q

amyotrophic lateral sclerosis

A

median age= 55-66 yo
more common in males
most common in whites

378
Q

ankylosing spondylitis

A

females 17-35
males 20-30

3x more common in males
native american at higher risk

379
Q

bursitis

A

older than 40
no sex-related differences, related to chronic stress or acute injury
occurs in all ethnicities

380
Q

carpal tunnel syndrome

A

25-50 yo
3x more likely in people who are pregnant and in menopause; and those with diabetes and thyroid imbalance
more common in whites

381
Q

duputyren contracture

A

older than 40
more common in males
most common in whites

382
Q

gout

A

older than 50
3x more common in males
slightly more common in african americans

383
Q

low back pain

A

30-50yo
males
affects all ethnicities

384
Q

multiple scleorsis

A

18-35 but can occur at any age
2x more common in females
most common in whites but more aggressive form is prevalent in african americans

385
Q

multiple myeloma

A

older than 50
males
2-4x more common in african americans

386
Q

myasthenia gravis

A

women 18-25, males 60+
2x more common in females
all ethnicities

387
Q

osteoarthritis

A

50+ in females, 40-50 in males
more common in females, however hip osteoarthritis is similar
more common in whites

388
Q

osteoporosis types I and II

A

postmenopausal individuals 50-70yo in males
type I more common in females
type I more common in white individuals

389
Q

osteosarcoma

A

younger than 20 , 50-60+
slightly more common in males
slightly more common in african americans

390
Q

paget disease of bone

A

40+
males
whites

391
Q

polymyalgia rheymatics

A

50+
females
white

392
Q

rheumatoid arthritis

A

20-40yo
2-3x more likely in females
native americans

393
Q

scleroderma

A

30-50yo
2-8x more common in females
Choctaw indians, followed by african, hispanic, white, and japanese americans

394
Q

scoliosis

A

10-15yo
8x more common in females assigned at birth
all ethnicities

395
Q

systemic lupus erythematosus

A

20-30yo
10x more common in females
non-white individuals

396
Q

shortleg gait

A

discrepancy in length of one leg, flexion contracture of hip or knee, birth hip dislocation

ex. pt limps while walking unless wearing adaptive shoes

397
Q

footdrop or steppage gait

A

peroneal or anterior tibial nerve injury, paralysis of dorsiflexor muscles, lower motor neuron damage, damage to spinal nerve roots L5 and S1

ex. pt lifts advancing leg high so that toes may clear ground, pt places sole of foot on floor and one time instead of placing heel first (unilateral or bilateral)

398
Q

apraxic gait

A

frontal lobe tumors, alxheimers disease

ex. pt has difficulty initiating walking, after starting gait is slow and shuffling, motor and sensory systems are intact

399
Q

trendelenburg (compensated gluteus medius gait)

A

developmental hip dysplasia, muscular dystrophy

ex. trunk lists toward the affect side when weight bearing is on that side, waddling gait may develop if both hips affected

400
Q

rheymatoid arthritis

A

risk: physical and emotional stress
pain: upper extremities
onset: young adulthood
stiffness: signficant in mornings and after inactivity
generalized complaints: weakness, fatigue, low fever
physical exam: tender, swollen, may be warm
diagnostic tests: serum proteins and synovial fluid - rheumatoid factor

401
Q

osteoarthritis

A

risk: obesity, aging
pain: lower extremities
onset: 50-60s
stiffness: worse later in day and after inactivity
generalized complaints: none
physical exam: may be tender
diagnostics: xray, ct, mri

402
Q

gouty arthritis

A

risk factors: family hx, diet high in urine-rich foods, alcohol, stress
pain: base of big toe, may effect feet, ankles, knees, and elbows
onset: middle aged males
stiffness: none in acute cases, develops w chronic disease
generalized complaints: painful, monoarticular, nocturnal joints, later more joints, great toe most often
physical exam: swollen, warm, tender, shiny, red
diagnostic test: synovial fluid aspiration

403
Q

fibromyalgia

A

risk: family hx, emotional stress
pain: any joints especially neck, back, shoulders, knees, and hands
onset: adult females, 22-55 years of age
stiffness: some stiffness especially in morning
complaints: sleep disturbance, morning fatigue
physical exam: no swellin, tender to touch
diangostic tests: not definitive rule out other diagnosis

404
Q

health promotion and teaching for skeletal isssues

A

diet to protect and maintain healthy bones
smoking cessation
alcohol intake pattern
exercise programs
osteoporosis screening
fall prevention risk

405
Q
A

nur306 (4 decks)

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