NURS 264 Exam 2 Flashcards
Obesogenic Environment
Encourages large portions of high-fat, energy-dense
foods & fails to encourage healthy behaviors such as
physical activity
What is important about nutrition for Infants and children?
- Birth to 4 months of age is most rapid period of growth in life
cycle, double their birth weight.
➢ Breast feeding recommended.
2 Facts about obesity
- 1 in 5 adults worldwide to have
obesity by the year 2025
-Genetics contribution 40 to 70% to obesity
What are 5 ways to make a nutrition screening
➢ 24-hour recall
➢ Food frequency questionnaire
➢ Food diaries or records—3 days typically used
➢ Direct observation of feeding with documentation
➢ Mobile apps
Additional subjective data considerations for Adolescents (5 Things)
➢ present weight.
➢ use of anabolic steroids or other agents to increase muscle
size and physical performance.
➢ overweight and obesity risk factors.
➢ age first started menstruating.
Additional subjective data considerations for pregnant women (2 Things)
➢ number of pregnancies and pregnancy history.
➢ food preferences when pregnant.
Additional subjective data considerations for aging adults (3 Things)
➢ prior dietary history in ages 40’s and 50’s.
➢ factors affecting present dietary intake.
➢ vitamin D and calcium intake.
Derived weight measure (What is it and how is it classified?
Percent usual body weight—formula calculation
* Current weight/usual weight X 100
* 85-95% mild malnutrition
* 75-84% moderate malnutrition
* Less than 75% severe nutrition
Marasmus what is it?
Marasmus (protein-calorie malnutrition)
➢ starved appearance
Kwashiorkor (What is it)
Kwashiorkor (protein malnutrition)
➢ well nourished appearance, edematous
Metabolic syndrome (What 5 things are used to diagnose it?
Diagnosed in the presence of 3 out of 5 biomarkers
➢ Waist circumference
* Gender-based measurements
➢ Glucose level
* Above 100 mg/dL or being treated for hyperglycemia
➢ High-density lipoprotein (HDL-C)
* Gender-based measurements or being treated for
hyperlipidemia
➢ Triglyceride (TG) level
* Above 150 mg/dL or being treated for elevated TG
➢ Hypertension (HTN)
* Systolic and diastolic parameters or being treated for HTN
Pellagra What is it?
Pellagra
➢ Niacin deficiency
Scorbutic gums What is it?
Scorbutic gums
➢ Vitamin C deficiency
Follicular hyperkeratosis What is it?
Follicular hyperkeratosis
➢ Vitamin A and/or linoleic acid deficiency
Bitot’s spots (What are they caused by)
Bitot’s spots
➢ Vitamin A deficiency
Rickets What is it caused by?
Rickets
➢ Vitamin D and calcium deficiency
How much area does the skin cover on the body?
Body’s largest organ system.
➢ Covers 20 square feet of surface area in adults
What 3 things are skin colour derived from?
➢ Melanin—brown pigment
➢ Carotene—yellow-orange pigment
➢ Red purple tones in the underlying vascular bed
Sebaceous glands (What are they)
Sebaceous glands
➢ Sebum—secreted lipid substance through hair follicles
➢ Lubricate skin and form emulsion
Sweat glands (What glands make them up)
Sweat glands
➢ Eccrine produce sweat.
➢ Apocrine produce milky secretion and open into hair follicles.
What 3 things occur in pregnant women in terms of the skin?
Increase in metabolism leads to increase secretion of
sweat and sebaceous glands to dissipate heat.
Expected skin color changes due to increased
hormone levels.
Fat deposits are laid down as maternal reserves for
nursing baby.
What sin colour is most at risk for skin cancers?
Increased likelihood of skin cancer in whites than in black and
Hispanic populations
What equipment is needed for a skin assessment?
Strong direct lighting, gloves, penlight, and small
centimeter ruler
What features should be assessed during a skin assessment? 8 things
- color
- temperature
- moisture
- texture
- thickness
- Edema
- mobility and turgor
- Vascularity or bruising
What should be noted about lesions 6 things?
➢ Color
➢ Elevation → flat or raised
➢ Pattern or shape
➢ Size (cm)
➢ Location and distribution on body
➢ Any exudate: note color and odor
What degree should nail beds be?
Profile sign: view index finger at its profile and note angle of
nail base; it should be about 160 degrees
What is the ABCDEF skin assessment?
- A: asymmetry
- B: border irregularity
- C: color variations
- D: diameter greater than 6 mm
- E: elevation or evolution
- F: funny looking—“ugly duckling” —different from others
Annular or circular and confluent lesions (What do they look like?)
Annular or circular
➢ Begins in center and spreads to periphery
Confluent
➢ Lesions run together
Discrete and grouped lesions (What are they?)
Discrete
➢ Distinct and separate
Grouped
➢ Cluster of lesions
Gyrate (What are they?)
Gyrate
➢ Twisted, coiled, or snakelike
Target or iris and linear lesions (What are they?)
Target or iris
➢ Resembles iris of eyes, concentric rings
Linear
➢ Scratch, streak, line, or stripe
Zosteriform and Polycyclic lesions (What are they?)
Polycyclic
➢ Annular lesions grow together.
Zosteriform
➢ Linear arrangement following a unilateral nerve
route
Macules and Papules (What are they?)
Macules
➢ Solely a color change, flat and circumscribed, less than 1 cm
Papules
➢ Felt and caused by superficial thickening of the epidermis
Patches and plaques (What are they?)
Patches
➢ Macules that are larger than 1 cm
Plaques
➢ Papules coalescing to form surface elevation wider than 1 cm
Nodules and wheals (What are they?)
Nodules
➢ Solid, elevated, hard or soft, greater than 1 cm that may extend deeper
into dermis than papule
Wheals
➢ Superficial, raised, transient and erythematous, irregular in shape due to
edema
Tumors and Hives (What are they?)
Tumors
➢ Larger in diameter, firm or soft, deeper into dermis, may be benign or
malignant,
Urticaria (hives)
➢ Wheals coalesce to form extensive pruritic reaction.
Vesicles and cysts (What are they?)
Vesicles
➢ Elevated cavity containing fluid up to 1 cm (blister)
Cysts
➢ Encapsulated fluid filled cavity
Bullas and Pustules (What are they?)
Bullas
➢ Larger than 1 cm diameter, usually single chamber, superficial in dermis
and ruptures easily
Pustules
➢ Pus in cavity that is circumscribed and elevated.
Excoriations and scars (What are they?)
➢ Excoriations—Self-inflicted abrasion that is superficial
➢ Scars—Permanent fibrotic change after healing
Atrophic scars and Keloids (What are they?)
➢ Atrophic scars—Resulting skin level is depressed with
loss of tissue and thinning
➢ Keloids—Benign excess of scar tissue beyond
original injury
Lichenifications (What is it?)
Lichenifications—Prolonged intense scratching leads
to thickened skin producing tightly packed set of
papules
Stages of pressure injuries (What are they?)
➢ Stage I: Non-blanchable erythema
➢ Stage II: Partial-thickness skin loss
➢ Stage III: Full-thickness skin loss
➢ Stage IV: Full-thickness skin/tissue loss
Basal cell carcinoma (What is it?)
Basal cell carcinoma
➢ Most common skin cancer
➢ Occurs on sun-exposed areas
Squamous cell carcinoma (What is it?)
Squamous cell carcinoma
➢ Less common than basal cell but grows rapidly
➢ Occurs mostly on hands or head
Koilonychia (What is it?)
Koilonychia (spoon nails)
What 4 things should be noted about the older adult population in the US
➢ By 2040, older adults will compose over 20% of the
population
➢ Adults 65+, account for more hospital stays & clinic
visits
➢ Older adults are heterogeneous, and differences exist
among biologic, physical, and emotional rates of
aging
➢ Economic costs of aging associated with personal
care continue to increase
What is the goal of a geriatric assessment?
Goal: Identify strengths and limitations so appropriate interventions can
prevent functional decline
Functional ability definition?)
Functional ability
➢ Refers to one’s ability to perform activities necessary to live in modern
society
What does a functional assessment include?)
- Physical Exam
- Activities of daily living (ADLs) / Instrumental activities of daily living (IADLs)
- Physical Mobility
What are the 6 ADL’s?
➢ Eating/feeding
➢ Bathing
➢ Grooming (washing, combing hair, shaving, cleaning teeth,
dressing)
➢ Toileting
➢ Walking, including propelling a wheelchair, using stairs
➢ Transferring, such as bed to chair
Instrumental activities of daily living (What are they?)
Instrumental activities of daily living
➢ Refer to functional abilities for independent community living
➢ Shopping, telephone use, meal prep, housekeeping, laundry,
managing finances, taking medications, using transportation.
What 2 tools can be used to assess cognition in the aging adult?
➢ Mini mental status exam (MMSE)
➢ Montreal Cognitive Assessment (MoCA)—more sensitive
Informal supports vs formal supports (What is the difference between the two?)
- informal supports are family and close friends who help with things like shopping, bathing and feeding
- formal supports are government plans and caregivers who are paid to be there
What are the 6 Environmental assessments for the aging adult?
Physical environment
➢ Observations to determine safety and modify potential hazards,
safety and access to services
Falls
➢ 20% result in serious injury
Older adult drivers
➢ Account for 18% of all traffic fatalities
Sleep
➢ Screening tools to measure changes in sleep pattern
Spiritual assessment
➢ Individualized inquiry
Special considerations
➢ May require more time to examine
Musculoskeletal systems 6 functions.
➢ Needed for support and to stand erect
➢ Needed for movement
➢ To encase and protect inner vital organs
➢ To produce RBCs in the bone marrow
➢ Serve as a reservoir for storage of essential minerals
How many of each type of vertebra are there and how many are there in total?
➢ 7 cervical
➢ 12 thoracic
➢ 5 lumbar
➢ 5 sacral
➢ 3 to 4 coccygeal
33 IN TOTAL
What portions of the spine are concave and what are convex?
➢ Cervical and lumbar curves are concave (inward or anterior).
➢ Thoracic and sacrococcygeal curves are convex.
What are the motions of vertebral column
Motions of vertebral column:
➢ Flexion, extension, abduction, and rotation
What 2 things are special about the knee joint?
Synovial membrane is largest in body.
Largest joint in body
By what age has a fetus formed the “Scale model”
By 3 months, fetus has formed “scale model” of the skeleton of
cartilage.
➢ Ossification to true bone continues in utero.
At what age does the last episyphesis closure occur?
Epiphyses: specialized growth plates at end of long bones
➢ Longitudinal growth continues until closure of epiphyses; last closure
occurs about age 20.
At what age does bone decomposition begin to occur?
After age 40, resorption occurs more rapidly than deposition.
What demographic is at the highest risk for fractures?
- Caucasian women
What is the purpose of a musculoskeletal assessment?
Purpose of musculoskeletal examination is to assess function for
ADLs and to screen for abnormalities.
What are the steps to a musculoskeletal assessment (like palpation and auscultation)
Inspection, Palpation, Range of Motion, Muscle Strength,
and Crepitus
What three things should be assessed for when assessing circulation in the body (CMS)
C = circulation
Assess color, temperature, cap. refill, pulses
M = motor (movement)
Assess for movement (wiggle toes, move fingers, etc.)
S = Sensory (sensation)
Assess for sense of touch
What are each of the 5 levels of muscle strength?
5 = Full ROM against gravity with full resistance
4 = Full ROM against gravity, some resistance (weak)
3 = Full ROM with gravity (no opposing force)
2 = Full ROM with gravity eliminated (Passive movt.)
1 = Slight Contraction, no movement (visible or palpable)
0 = No Contraction or involuntary movements (paralysis)
What is the phalen and tinel sign test
➢ Phalen test
—acute flexion of wrist produces numbness and burning if +
➢ Tinel sign test
—percussion of median nerve produces burning and
tingling if +
Where should you measure for leg length ?
- anterior iliac spine to medial malleolus (crossing over the leg)
What back posture is common for adolescence?
- kyphosis and screening for scoliosis should be done as well.
Get up and go test (What is it used for?)
- Used in older adults to assess risk for falls
Ankylosing spondylitis (What is it?)
➢ Ankylosing spondylitis – chronic inflamed vertebrae
➢ Back pain in lower back and buttocks, improves with movement
Osteoporosis (What is it?)
➢ Osteoporosis
➢ Decrease in skeletal bone mass, low BMD
➢ Increased risk for fractures
Epicondylitis (What is it?)
Epicondylitis
—tennis elbow
What conditions can be caused by rheumatoid arthritis?
Conditions caused by chronic rheumatoid arthritis:
➢ Swan-neck and boutonniere deformities
➢ Ulnar deviation or drift
➢ Acute rheumatoid arthritis
What is fibromyalgia and what is needed to diagnose it?
Widespread musculoskeletal pain greater than 3
months
➢ Additional body symptoms → fatigue, sleep
disturbance, psychological stress & functional
symptoms
➢ More prevalent in women than men
➢ Issue with sensory processing → allodynia and/or
hyperalgesia
➢ Revision of diagnostic criteria proposed
