Midterm Review Flashcards
4 basic techniques of assessment
inspection
auscultation
percussion
palpation
doppler
used to asses pulses when pulses cannot be palpated
stadiometer
used to measure height
wood lamp
used to assess fungal infections on the skin
goniometer
used to measure degree of joint flexion and extension
transilluminator
use to detect air, blood, fluid, or mass in body cavity
epidermis
top layer of skin
dermis
contains nerves, blood, and lymphatic vessels
- embedded with hair follicules, sweat glands, oil glands, and sensory nerves
subcutaneous tissue
third layer of skin
stage 1 pressure injury
1 layer of skin is affected
- intact, but red and non-blanchable
stage 2 pressure injury
2 layers affected (epidermis and dermis)
- bleeding
stage 3 pressure injury
3 layers affected (epidermis, dermis, and subcutaneous)
- see subcutaneous tissue
- skin is completely compromised
stage 4 pressure injury
can see muscles and bones
grading of skin edema
press around bony prominences w/ 3 finger pads
- 0: no edema
- 1+: 2mm
- 2+: 4mm
- 3+: 6mm
- 4+: 8mm
annular vs target lesion
configuration/shape
both circular lesions
- annular: only 1 circle
- target: circle with concentric circles inside w/ dot at center (bullseye lesion)
wheal
primary lesion
reddened, irregular borders, elevated
- cause by insect bite or hives
macule
primary lesion
flat, circumcised border, change in skin color, <1cm
ie/ freckles, petichiae
patch
primary lesion
irregular, >1cm
ie/ mangolian spots, port wine stain, vitiligo
type of macule
vesicle vs bulla
primary lesion
fluid filled round, oval w/ translucent wall
- vesicle: <0.5cm
*ie/ chicken pox, poison ivy, small burn blister
- bulla: >0.5cm
ie/ large burn blisters
port wine stain
vascular lesion
on face that is flat, deep purple/red, irregular shaped
- deepens when person cries or is highly emotional or high temperature
- typically does not fade
spider angioma
vascular lesion
flat, bright red dot w/ tiny radiating blood vessels ranging from pinpoint to 2cm
venous lake
vascular lesion
on the face, neck, ear, and lips; usually common in ages 50+
- soft, compressible, slightly elevated dark blue to purple
- may be due to sun exposure
senile lentigines (liver spots)
usually on hands like hyperpigmented freckles
- common in elderly
cutaneous tags
usually on the neck and upper chest
- common in elderly
- may increase in numbers
manifestations of cirrhosis of the liver
- skin variation: yellowish (jaundice) due to not getting rid of billirubin
tinea pedis
also known as athletes foot
keloid
secondary lesion
elevated, irregular, darkened; excess scar tissue
- the primary lesion: scar
ABCDE criteria
used to rule out malignant lesions
- A: asymmetry
- B: border irregularity
- C: color (varied)
- D: diameter >6mm
- E: evolving change
malignant melanoma
most serious type of skin cancer b/c it spreads rapidly to lymph and blood vessels
- varied colors, irregular borders, >6mm
kaposi’s sarcoma
malignant lesion
painless; blue to purple; resembles keloid; common in HIV patients
black hairy tongue
consistent w/ fungal infection of the tongue
leukoplakia
whitish thickening of the mouth of HIV positive patients
- cannot be scraped off
risk factors of skin cancer
predisposition
- overexposure to UV light
- genetic predisposition
order of occurence of herpes zoster
1) parasthesia (burning/tingling sensation)
2) redness and swelling
3) development of vesicles/blisters
4) weaping blisters
5) crusted lesions
6) posthepaticneuralgia (pain/burning sensation long after blisters disappear
cause of shingles (herpes zoster)
chicken pox virus
lanugo
normal variation
fine, downy hair in newborns
- prominent in the upper chest, shoulder, and back
mongolian spots
normal variation
harmless purplish/blue spots on the sacral area
- common in dark skin
- disappears at age 3
vernix caseosa
normal variation
harmless white, cheese-like mixture of sebum and epidermal cells on skin of newborn
- disappears after several bathings
milia
normal variation
pimple like whiteheads on the nose or cheeks of the newborn
- disappears after 2-3 weeks
vitiligo
harmless white, patchy depigmented areas over the face, neck, hands, and skinfolds of newborn
- does not disappear
hydrocephalus
enlarged head w/ prominent, visible scalp veins
- due to accumulation of cerebral spinal fluid in the head of the baby
craniosynostosis
premature closure of the coronal and saggital sutures of the head
- elongated head and altered orbital and face of baby
vellus hair
short, fine, pale all over the body except lips, nipples, palms, and soles of feet
terminal hair
longer and coarser hair
- on eyebrows, scalp, axillary, leg, pubic, and face/chest of men
stages of hair growth
- anagen: growth phase; 2-6 yrs
- catagen: transitional phase; 2 weeks
- telogen: shedding phase; 1-4 months
eccrine gland
sweat gland
made of water and salt
- located all over the body
apocrine gland
sweat gland
made of water, salt, protein, fatty acids
- in groin and axillary region
- when mixed with bacteria = musty
sebaceous glands
predominant in scalp area
palpating lymph nodes
gentle, circular motion
assessing for hearing loss
important to ask if there is family history of hearing loss
normal tympanic membrane
pearly gray
white patches on tympanic membrane
indicates previous ear infection
otitis externa
ear infection
fever, drainage, redness, itchiness in ear
- as long as tympanic membrane is pearly gray
otitis media
ear infection
infection of the middle ear
- affects the ossicles (hammer, anvil, stirrup)
otitis interna and S/S
labyrinthitis
ear infection
infections of the semicircular canal, vestibule, and cochlea
- S/S: severe vertigo, hearing loss, ringing of ears
tenderness of mastoid process
indicates infection that can lead to brain infection
unable to visualize tympanic membrane
1) remove otoscope
2) position auricle (pull up and back)
3) reinsert otoscope
classic migraine
type of headache
preceded by aura
- floaters/flashing lights can be seen by patient
- cannot tolerate bright light
cluster headache
type of headache
several headaches over period of days or months
- lasts mins to hrs
- pain usually lasts a few mins/hrs
- onset: sudden
tension headache
type of headache
headache starts @ cervical area and radiates to top of the head; unilateral or bilateral
- onset: gradual
sinus headache
type of headache
patient with sinus headache
normal rinne test
air conduction 2x greater than bone conduction
weber test
1) activate the time
2) put base of fork at midline of skull
- normal: equal lateralization of vibration to right and left ear
ear impacted with cerumen
weber test
lateralization will go to the impacted ear
romberg test
test for balance
- done for 20 secs
- pt stand erect, feet together, hands to sides, with eyes closed
- support pt front and back with both hands
- normal: no swaying; swaying <2in
confrontation
assessing for peripheral vision
how to asses eyes for accomodation
move object closer to the eyes and observe for pupil constriction and convergence
preferred test for stabismus for children
cover/uncover test
normal finding for 6 cardinal fields of gaze
no nystagmus (jerking of the eyes)
normal consensual response
on transillumination, the pupil with direct light will constrict faster than other eye
snellen test grading
example: 20/30
- pt can see at 20 feet what a normal person can see at 30 feet
myopia vs hyperopia
- myopia: nearsighted (difficulty w/ far vison)
- hyperopia: farsighted (difficulty w/ near vision)
presbyopia
farsightedness for ages 45+
- difficulty w/ near vision
dry eyes
redness, grainy, burning
- occurs w/ aging
- advise to instill OTC eye drops (follow direction on bottle)
macular degeneration
central vision loss
- peripheral vison intact
ectropion
lower eyelids everted
- exposing conjuctiva
intropion
upper eyelid is inverted
- causing redness and irritation
midriasis
prolonged dilation of pupils w/o any change to light
- pupils ~ 7mm
causes of midriasis
migraine headache, marijuana, anticholinergic, adrenaline, cocaine, amphetamine, hallucinogen
who usually has blown pupils?
(extensive midriasis)
clients with brain injury
anisocoria
unequal pupil size by 1mm
- both pupils react to light but differ in size
- harmless
causes of anisocoria
injury/lesions in brain
myosis
pinpoint pupils; unilateral or bilateral
opposite of midriasis
causes of myosis
head injury, tobacco use, HTN drug, antipsychotics, galucoma drugs
true ribs
1-7 ribs
false ribs
8-10 ribs
floating ribs
11 & 12 ribs
angle of louis
articulation between manubrium and body of sternum
- inline w/ second rib
skin turgor in elderly
pinch bilaterally below clavicle and below wrist
inspecting yellowing of skin in dark skin patients
inspect lips, oral mucosa, conjuctiva, and palm of hand
clubbing of fingers
> 160 degrees
phalen’s test
conducted for 60 secs to asses for carpal tunnel syndrome;
- dorsal aspect of wrist brought together below the breast
- normal: no pain on wrist, forearm, upper arm, neck, and chest
tinel’s sign
ask pt to put forearms on lap/table and feel for medial nerve
- use 3 fingertips and percuss
- ask if there is any pain
indirect percussion
lung techniques
used to percuss the lung in the intercostal spaces
- normal: resonant sound
auscultation is used to assess for?
lung techniques
bronchophony, egophony, and whispered pectoriloquy
palpation
lung techniques
used to asses for tactile fremitus
what causes tactile fremitus?
fluid in lungs, fibrosis, tumor, and infection
percussion
lung techniques
used to asses for diaphragmatic excursion
diaphragmatic excursion
- normal: 3-5cm; up to 7-8cm in well-fit/athletes
- <3-5cm: should be ruled out for pneumonia or pneumothorax (chest xray)
transillumation of sinuses
- normal: red glow around
- no red glow = congestion of sinuses
complaint of sinus headache
transillumination or direct percussion of sinuses
sounds of bronchophony
ausculation techniques of lungs
- normal: muffled sound
- abnormal: loud and clear
hyperresonance
percussion techniques of lungs
air is trapped in lungs
crackles
ausculation techniques of lungs
- expected in lobar pneumonia
rhonchi (sibulant)
wheezing
ausculation techniques of lungs
continuous, high-pitched
- expected in asthmatic pt
rhonchi (sonorous)
wheezing
ausculation techniques of lungs
low-pitched, continuous, snoring, rattling
- common in COPD, pneumonia, chronic bronchitis, and cystic fibrosis
whispered petriloguy
ausculation techniques of lungs
- normal: faint, muffled, indistinguishable
causes of atelectasis
decrease breath sounds on lower lobes of lungs
- causes: prolonged bedrest of postop pts, ineffective coughing, or HYPOventilation
normal chest configuration in adults
eliptical
- lateral diameter 2:1 with posterior diameter of chest
normal chest configuration of infants
barrel chest
- common in COPD patietns
scoliosis
lateral deviation of the spinal process
kyphosis
exaggerated curve of thoracic vertebrae
- common in elderly and osteoporosis
lordosis
exaggerated curve of the lumbar vertebra
- common in pregnant women
pectus excavatum
(funnel chest)
congenital; depression of sternum and adjacent cartilage
- compresses the heart and lungs
- hear cardiac murmurs
- surgery is indicated
tachypnea vs hyperventilation
breathing
greater than 20 breaths/min
- tachypnea: shallow
- hyperventilation: deep
bradypnea vs hypoventilation
breathing
less than 12 breaths/min
- bradypnea: regular
- hypoventilation: irregular, shallow
cheyne’s stokes vs biot’s ataxia
breathing
periods of apnea
- cheyne’s stokes: regular (in elderly, dying pts)
- biot’s ataxia: irregular (due to brain damage)
pt w/ rhinitis
most important question to ask: Hx of allergies
most common area of breast tumor
upper, outer quadrant of breast
- close to axillary region
SBE
(self breast exam)
- elderly/men: same day and time every month
- mensturating female: 3-5 days after cycle (hormones are more stable)
fibroadenoma
well-defined breast tumor w/ no tenderness or discharge
- most common in adolescent girls (15-35 y/o)
intraductal papilloma
most common cause of benign nipple discharge (bloody or liquidy)
- common in postmenopausal females
peau d’orange
orang peel appearance on skin of breast
- sign of breast malignancy
S/S of hypoxia
tachycardia, tachypnea, low O2 sat
monitor/action of hypoxia
- monitor: O2 sat, ABG
- actions: O2 therapy, IS, elevate HOB, breathing exercises
S/S and actions of retinal detachment
- S/S: floaters, sudden flashes of light, shadow in vision, diminished vision
- actions: prepare for Sx (laser sx, laser beam freezing sx)
EMERGENCY; may lose vision withing days of diagnosis
10 lymph nodes
- preauricular
- postauricular
- occipital
- submental
- submandibular
- retropharyngeal
- anterior cervical cahin
- deep cervical chain
- post cervical chain
- supraclavicular
infected pressure injury
- elevated temp
- elevated WBC
- purulent discharge
- redness
S/S of COPD
- barrel chest
- decreased O2 sat
- clubbing of fingers (hypoxia)
- rhonchi (sonorous)
tracheal
breath sounds
- harsh, high-pitched
- over trachea
- I < E
bronchial
breath sounds
- loud, high-pitched
- next to trachea
- E > I
bronchiovesicular
breath sounds
- medium-pitched
- next to sternal border; between scapulae
- I = E
Vesicular
breath sounds
- soft, low-pitched
- over remainder of lungs
- I > E
