Study Guides Test2 Flashcards
Describe the appearance of Pallor
Light pale skin
Erythema in light and dark skin
Light skinned: red or pink
Dark skin: purple tinge
Cyanosis
Light skin- blue dusky
Dark skin- dark but dull
Jaundice
Yellowing of skin, palms , eyes
One color, flat such as freckle
Macule
Something you can feel that is solid and elevated such as:
Mole
Papule
Plateau like such as Psoriasis
Plaque
Nodule:
Solid, elevated such as fibroma
Mass in deeper dermis such as lipoma
Tumor
Superficial, raised, transient such as mosquito bite
Wheal
Elevated cavity with free fluid
Such as a blister
Vesicle
Turbid(cloudy) fluid and cavity
Such as acne or impetigo
Pustule
Primary skin lesions include?
Macule, Papule, plaque, nodule, tumor, wheel, vesicle, pustule
Secondary skin lesions include?
Crust, scale, vision, erosion, ulcer
Thick dried out exudate left when vesicles burst or dry up such as impetigo or weeping
Crust
Compact desiccated flakes of skin dry or greasy from Shedding of dead excess keratin cells such as eczema
Scale
Linear cracks with abrupt edges extend into dermis such as athletes foot
Fissure
Scraped out but shallow depression with no scar
Erosion
Deep depression into dermis such as pressure sore on body
Ulcer
Where to assess for jaundice ?
Sclera of eyes and hard palate
Why do we assess skin turgor?
To assess for dehydration
How to assess a lesion on a skin assessment?
Color, size, location, depth, drainage?
What capillary refill is considered normal?
Less than 1 second
What does ABCDE stand for when assessing skin
Asymmetry
(Half of mole doesn’t match the other)
Border
Color
Diameter
(Bigger than 6mm)
Evolving
(Changing in shape,color, size)
Characteristics of herpes zoster infection/shingles
Lesion on one side of body that does not cross the midline
How are lesions of ringworm described?
Annular lesion
Meaning shape of ring
Intense redness of the skin due to excess blood in dilated superficial capillaries
Erythema
Blue mottled color
Cyanosis
Absence of red pink tones from the oxygenated hemoglobin in blood
Pallor
Increase and Bilirubin in the blood causing a yellow color in the skin
Jaundice
Name borders of two regions in the neck :
Stemomastoid muscle and midline of body
Behind sternomastoid and trapezius muscles and clavicle
Anterior triangle
Posterior triangle
List facial structures that should appear symmetric when inspecting the head
Eyebrows , nasofolds, sides of mouth, ears , nose, eyes, palpebral fissures
Describe the characteristics of lymph nodes with associated with acute infection
Acute onset and less than 14 days of duration
Characteristics of lymph nodes were associated with chronic inflammation?
Nodes are tender and firm, warm, and large
Characteristics of lymph nodes when associated with cancer
Hard, Bigger than 3 mm, unilateral , non-tender
Identify the blood vessel that runs diagonally across the sternomastoid muscle
External jugular vein
Characteristics of lymph nodes in neck of healthy people
Mobile, soft, non tender
What are the characteristics of Bell’s palsy
Unilateral paralysis of half of the face
Cranial nerves
Oculomotor
Abduces
Trochlear
What does 20/40 vision mean?
Number on top is number of feet away from chart
Bottom number is the distance (40ft) that one can see normally where a normal person could see normally at 20 ft
Common age related changes in the eye
Loss of skin elasticity which causes wrinkles and drooping
Fat tissues and muscle atrophy
Decrease in acuity, tears, yellow nodules, cloudy cornea
What does it indicate when the examiner records positive consensual light reflex??
Construction of other pupil when one eye is exposed to bright light
How is visual acuity assessed
Snellen eye chart
What is conjunctivitis associated with?
Reddened conjunctiva / pink eye
Cause of red reflex?
Light reflecting from retina
Successful PERRLA exam?
Pupils are able to follow moving object close up and far away
They respond well to light, equal in size, round, and react to light
One cause of visual impairment?
Glaucoma
Whispered voice test of hearing acuity?
Test one ear at a time
Stand 2 ft behind
Mask hearing in other ear
Cover lips
Whisper 3 random letters and numbers
Have them repeat it
Passing is 3/6
Tympanic membrane in the ear is what color?
Pearly gray
What might the sensation of vertigo mean?
Pathology in the semicircular canals
Common cause of conductive hearing loss
Impacted cerumen
Functions of nose
Smell, respiration, filtration of air, warms and moistens air , sneezing out unwanted particles
Appearance of deviated nasal septum ?
Perforated septum?
Deviated? hump
Or shelf in one nasal cavity
Perforated: spot or light from a penlight that is shinning in the other nails
4 point grading scale for the size of tonsils ?
1+
2+
3+
4+
1-visible
2-halfway between tonsillar pillars and uvula
3-touching the uvula
4- touching one another
What is the most common reason for dry mouth in the elderly?
Medications
What to do if You notice a coin have a deviated septum
Document the deviation in the medical record in case the person needs to be suctioned
Where are oral malignancies most likely to develop
In the mucosal gutter under the tongue
What sense in the elderly is greatly decreased
Ability to identify orders
What abnormal conditions could affect the location of the apical impulse
Cardiac enlargement
Left ventricle dilation a.k.a. volume overload
Barrel chest, left ventricular hypertrophy and no dilation or pressure overload
Pulmonary emphysema
Which heart sounds is loudest?
1st Lub -at the mitral area at the apex
And softer at the base
Characteristics of the second heart sound and intensity of Apex in the base of the heart
Dub - loudest at the base
Closure of semilunar valve and signals end of dyalstole
Major risk factors for heart disease and stroke
Hypertension, smoking, high cholesterol, obesity, diabetes, physical inactivity, family history of heart disease, age, gender
Which heart sounds coincides with the carotid artery pulse and R wave if connected to an ECG monitor
S1
What are the characteristics of an innocent and functional murmur
An innocent murmur has no pathologic cause
A functional murmur Is caused by increased blood flow in the heart
Where to escalate the Pulmonic valve
Second left interspace
What is the cause of the second heart sound?
Closing of the aortic and pulmonic valves
When auscultating the heart, what is your first step?
Identify S1 and S2
Why should the stethoscope bell depressed lightly against the skin?
Because the build of the act of a diaphragm
Tough, Fibrous, double walled Sac that surrounds and protects the heart
Pericardium
Thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
Endocardium
Reservoir for holding blood
Atrium
Ensures smooth, friction free movement of the heart muscle
Pericardial fluid
Muscular pumping chamber
Ventricle
Muscular wall of the heart
Myocardium
Three ways that help return blood to the heart
Contracting skeletal muscles which milk blood back toward the heart
The pressure gradient cause breathing
Intraluminal valves and sure flow
What are the risk factors for venous status
Elderly diabetes, obesity, peripheral vascular disease, pregnancy, smoking, verocrose veins, activity
Function of the lymphatic system
Transports fluids back to blood
Acts as the body’s defense and resistance to disease
What is the function of the lymph nodes
Removes toxins from lymph that do not belong there
Acts as a filter
Organs of the lymphatic system
, tonsils, Thymus , spleen
Symptom areas to address during peripheral vascular system history
Leg pain or cramps, skin changes and arms or legs, lymph node enlargement, medication
Grading scale for assessing force of a pulse, zero, one, two, three, 4+
Zero means no pulse
One plus means weak
2+ means normal
3+ means increased
4+ plus means full bounding
Skin characteristics with arterial insufficiency in legs
Malnutrition, pallor and coolness occur
And characteristics with venous insufficiency in the lower legs?
Malnutrition, thin, shiny atrophic skin, thick nails, with hair loss,Ulcers, gangrene
Raynaud phenomenon associated tricolor changes of the skin tone ???
Blue to white to tored
What is the function of the venous system
It forms a major part of the immune system that defends the body against diseases
If it clients Rt hand was red and swollen where would you asses for further infection?
Epitrochlear node
Would you screan for deep vein thrombosis
Measure the widest point with a tape measure
What should you do if you are an able to palpate the popilteal pulse
Proceed with the examination because it is often impossible to palpate this pulse
What is a known risk for venous ulcer development
Obesity
What is a cause if arteriosclerosis
Loss of elasticity of walls of blood vessels
What is intermittent claudication
Muscular pain relieved by exercise
Describe the most important point about the health history for the respiratory system
Cough, shortness of breath, chest pain with breathing history or respiratory infection, smoking history, environmental exposure, self-care behaviors
With the elements included in the inspection of the respiratory system
Posterior and lateral thorax, anterior chest
What is barrel chest and what might it signify
What is win the ribs or horizontal instead of normally down word
It may be due to normal aging or emphysema or asthma
Marked sunken sternum and adjacent cartilages
Pectus excavatrum
Three types of normal breath sounds, location, name, description of sound
Bronchial : trachea/larynx, high pitched/loud
Bronchovesicular: scapulae Rt side , moderate pitch and amplitude
Vesicular sounds : bronchioles and alveoli, low pitch sound, soft
How many degrees is the normal costal angle
90
What is the expected ratio when comparing the anterioposterior diameter of the chest with the transverse diameter
The ratio should be 1:2 to 5:7
Ap is lower than transverse
What is the tripod position
Position where is the patient leans forward with hands on their knees, on chair, or bed helps COPD patient with expiration
Description of the left lung
Narrower than the right with two lobes
Characteristic timing of the cough of chronic bronchitis
Productive cough for at least three months of the year for two consecutive years
Symmetric chest expansion with assessment
Please handsome postorolateral chest wall with thumbs at the level of T9 or T10 And then slide my hands up to pinch a small fold of the skin between the thumbs
A client has increased respiratory rate Chest expansion decrease on the left side, for percussion over the left lower lobe, breath sounds louder with fine crackles over the left lower lobe. What might the symptoms resemble?
Lobar pneumonia
Base of nails angel are greater than 160 degrees and feels spongy when palpating . What does this indicate?
COPD
What is the best Method to listen to breath sounds on a client
Did the diaphragm of the stuff in the chest wall, listen to one for respiration in each location, ensure to do a side to side comparison
What do you ask the client to do in order to perform the technique of egophony
Say e-e-e each time stethoscope is moved
What does pulse oximetry measure
Arterial oxygen saturation of hemoglobin
What is it important to do when examining for tactile fremitus
Palpate the chest symmetrically
Exaggerated posterior curvature of the thoracic spine
Kyphosis
LS shaped curvature of the thoracic and lumbar spine
Scoliosis
Sunken sternum and adjacent cartilage
Pectus excavatum
Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
Normal chest
Forward protruding of the sternum with ribs sloping back at either side
Pectus carinatum
Inspection of the abdomen findings that should be noted
Contour, symmetry, umbilicus skin, pull station, Hair distribution, demeanor
Rationale for performing auscultation of the abdomEn Before health palpation or percussion
Palpation can increase Movementin the stomach and give a false interpretation of bowel sounds
HowTo listen to bowel sounds
Use the diaphragm of the stethoscope and press lately on the skin, listen to all four quadrants starting with the right lower and go clockwise, listen for five minutes at a time, note characteristics and frequency of bowel sounds
What does a normal abdominal sound like
Perched, gurgling, cascading sounds 5 to 30 times per minute
How do hyperactive sound in the stomach sound
Loud, high-pitched rushing, tingling sounds that signal mobility
Hypo active stomach sounds, when would one to have?
After surgery or with inflammation of the periitoneum
deep Palpation
Abnormalties detected by palpation
5 to 8 cm noting location, size, consistency, mobility of organs in the presence of any tenderness
enlarge liver, enlarge spleen, tenderness
Light palpation
Abnormalties that may be detected by palpation?
Press about 1 cm in to get an overall impression of the skin service and superficial musculature
Muscle guarding, rigidity, Large massive and tenderness
Describe a rebound tenderness
Person reports abdominal pain, peritoneal inflammation
Old hand at 90° and push down slowly and deeply. Lift handled quickly and a normal responses no pain in the patient
Describe the procedure and reason for determining CVA tenderness
Please handover the 12th rib at the costoventebral angle on the back
Thump the hand with the owner edge of the other
First pain occurs with inflammation of the kidney or paranephric area
In what sequence do you examine the abdomen
Inspection, escalation, percussion, palpation
What pathalogy might right upper quadrant tenderness indicate
Liver, pancreas, or ascending colon issues
Listening of the abdomen me review roots of what artery’s
Aortic, Renal, iliac, femoral
Why is osculating the abdomen beginning in the RLQ
Because bm sounds are always normally present here
Where is the lower edge of the liver normally located
At the right costal margin
Does the left upper quadrant contain in stomach
Spleen
Describe the significance of the inguinal canal and femoral canal
They are both potential sites for hernias
Teaching points to include when teaching testicular self examination
TSE
Time - once a month
Shower- With warm water because it relaxes scrotal sac
Examine- Check for changes, report changes immediately
Enlarged and reddened scrotum hard to distinguish from testees, wbc and bacteria in urine
Epididymitis
When standing feels soft like bag of worms in testes, varicose veins in spermatic cord
Varicocele
Fluid sac that don’t usually hurt but can if grows too large
Spermatocele
Lump, swelling, or pain in scrotum/abdomen, firmness in testicle /cancer
Testicular tumor
Fluid filled sac around a testicle, often first noticed as swelling of the scrotum
Hydrocele
What is the normal finding on examination of the scrotum
Left testicle hangs lower than the right
Prostatic hypertrophy is common in older men , what s/s May indicate this problem?
Straining , loss of force , and a sense of residual Urine
What would be a normal age-related change in the scrotum
Pendulous scrotum
When teaching about testicular self exam what fact should be shared in regards to age the typical age range for the occurrence of testicular cancer?
15-34 years of age
What is the congenital displacement of the urethral meatus to the inferior surface of the penis called?
Hyposospadias
What is a normal finding on palpation of testes
Firm, rubbery, smooth
Screening measures that are recommended for early detection of colorectal cancer and prostate cancer?
Colonoscopy ages 50-75
Foods to reduce risk of colon cancer
Low in fat
Population with highest BPH
African Americans
How is normal stool described?
Brown and soft in consistency
How to comfort women while doing vagina exam/pap
Empty bladder before exam, Position table so peri area is not exposed to door, elevate head, family or friend present is desired, place stirrups, explain each step before doing it, assure them they can stop at any time , be gentle but firm , communicate
How to prepare vaginal speculum?
Warm and lubricate it with warm water and gel lubricant
Characteristics of vaginal discharge :
White curdy not mal odorous
Candidiasis (yeast infection)
Characteristics of vaginal discharge :
Pruitus, watery, and often malodorous , thick, white , itchy
Trichomoniasis
Characteristics of vaginal discharge :
Thin creamy gray-white malodorous
Bacterial vaginitis
Characteristics of vaginal discharge :
Yellow or green muco purulent discharge
Chlamydia
Characteristics of vaginal discharge :
Purulent /pus
Gonorrhea
Normal presence of genitalia of 70 year old lady
Thin and sparse pubic hair
What is the most common bacterial sexually transmitted STD in the US?
Chlamydia
What problems are associated with smoking and oral contraceptives?
Blood clots and pulmonary clots
Hx questions to ask regarding breast exam
Any hx of breast disease ? Type?
How was it diagnosed ?
Family hx? Ages?
Pain discharge
Rashes , lesions , swelling ?
Components of breast exam
Subjective: pain, lumps, discharge , rash, trauma, hx of disease , surgery, meds , radiation
Objective- inspection, appearance, drainage, nipple, teach self exam
Self Breast exam teachings
Early detection is important
Palpate in shower and lay supine
Perform after period due to decrease congestion
Pathological changes that may occur in the breast:
Bilat nodules pain
Benign breast disease
Pathological changes that may occur in the breast:
Inflammatory mass, red, swollen hard and hot
Acute mastitis
Pathological changes that may occur in the breast:
Solitary, nontender mass, benign
Fibroadenoma
Pathological changes that may occur in the breast:
Solitary non tender growing mass
Cancer
Pathological changes that may occur in the breast:
Early lesion yellow discharge, bloody red nipple
Pager disease
Characteristics to consider when a mass is noted in the breast?
Location, size, shape, moveable , tender, lump
Gynecomastia
Visible breast tissue , enlargement in males
High risk and moderate risk factors for breast cancer
Alcohol, decreased activity, obesity,female, over 50 years old, family history, low income, birth control
Most common site of breast tumors
left Upper outer quadrant
What to know about breasts during development ?
One may grow faster than the other
When should one start getting mammagram and how often?
45 - every year
55 years- Every 2 years
Malignant versus benign lump in the breast
Malignant :fixed, irregular , poorly defined margins
Benign: soft, moveable well defined margins
