Test 2 Review Flashcards
KiloCalorie (also known as calorie)
- Energy Measured in Units
- Amount of heat required to raise 1 gram of water 1 degree centigrade
Carbohydrates
- Major source of energy
- Each gram contains 4 calories
-Should be 50% to 60% of daily caloric intake to prevent ketosis and protein breakdown
- Help form ATP
- Supply fiber and assist in utilization of fat
Carbohydrate Deficiency
-Electrolyte imbalance, fatigue and depression
Carbohydrate Excess
Obesity, tooth decay, affects diabetic
Sources of Carbohydrates
Bread, Potatoes, pasta, corn, rice, beans, and fruits
LDL
- Low-density lipoproteins – carries cholesterol toward cells and tissues and deposit it there
- Strong association between high levels of LDL and CORONARY ARTERY DISEASE
HDL
High-density lipoproteins – carries cholesterol TOWARD LIVER
-High HDL protects against Coronary Artery disease
High Fiber Diet
- Beneficial in disease prevention
- Decreased weight
-Decreased risk of colon cancer, rectal cancer, heart disease, dental caries, constipation, and diverticulosis
Monounsaturated Fats
Olive & canola oil
Lowers LDL doesn’t lower HDL
Saturated Fats
- Animal (butter) & vegetable (nuts, oils)
- Raises cholesterol
PICA
-Craving non-food substances (dirt, clay, starch, ice, etc) increased risk for ANEMIA
Signs and Symptoms of Poor Nutritional Status
-SUBJECTIVE DATA
Subjective data:
- Fatigue
- Delayed wound healing
- Brittle hair, nails
- Mouth sores
- Changes in appetite
- Mood changes
Signs and Symptoms of Poor Nutritional Status
-Objective data
Objective data
- Weight changes
- Dry, rough, scaly skin
- Edema
- Dry, cracked lips
- Swollen, bleeding gums
- Decreased muscle tone
Folic Acid
Function: Synthesis of RBCs
Animal sources
-Liver
Plants:
-Green, leafy veggies, spinach, asparagus, broccoli, kidney beans
Folic Acid Deficiency
Neural tube deficits of fetus in pregnant females
Glossitis
Infant Feeding Guidelines
- Introduce foods one at a time
- Begin w/ foods that are least allergenic
- Avoid egg whites and citrus fruits until 12 months old
- Avoid honey in infants under 12 months (botulism)
Respiratory Rate
Position self and observe
-Count for one full minute
Adult rate 12-20 per minute
Respiration (one cycle)
One Cycle
- 1 inspiration – breathing air into lungs
- 1 expiration – exhaling
Tachypnea
> 20 respirations
Bradypnea
<12 respirations a minute
Apnea
absence of spontaneous breathing for 10 or more seconds
Newborn respirations
30 - 50
3 yr old child respirations
20-30
Pulse
Normal range for adults is 60 - 100 bpm
> 100 is Tachycardia
<60 is bradycardia
Factors affecting Heart Rate
Age -- decreased w/ age Gender -- female is higher Activity -- increased, athletes lower Emotional status -- increased w/ anxiety Pain - increased
Common errors in Blood Pressure measurements
Incorrect Cuff Size
- Too small increases BP reading
- Too large decreases BP reading
Unrecognized auscultatory gap
Incorrect cuff placement
Hypertension
Consistently 120/80 on two consecutive visits after initial screening
Pulse deficit
Apical pulse is greater than radial pulse
-listen and feel at the same time
Orthostatic Hypotension
The drop in blood pressure when you transition from a lying to a standing position
Pulse Pressure
The difference between the diastolic and systolic blood pressures
Taking a temperature
Ask if the client has had anything hot or cold in the past 15 minutes
- Place thermometer at the base of the tongue, left of frenulum
- Don’t bite
Layers of the Skin
Epidermis - superficial layer
Dermis - middle layer
Hypodermis - (subcutaneous tissue)
Epidermis
4 layers
-Hands and feet = 5 layers
Basal layer
- Columnar shaped cells
- Continuous mitosis for new cells
- Skin tone, melanocytes
Dermis
Corium - 2nd layer of skin
- 20X thicker than epidermis
- Connective tissue, elastic fibers, CAPILLARIES
- Structural support of skin
- Hair follicles
- Sweat glands
- Sebaceous glands
- Adipose tissue
Hypodermis - subcutaneous layer
The subcutaneous layer also known as the HYPODERMIS, performing transition and storage functions (WATER AND FAT)
- AKA superficial fascia
- Loose connective tissue and adipose
- Attaches skin to bone
- Temperature insulator/ regulates heat
- Mast cells which release histamine & trigger body’s reaction to allergen
Skin Cancer Risk Factors
- UV LIGHT exposure
- Second-degree burns before age 18
- Acute sunburns
-Outdoor employment
Albinism
A defect of melanin production that results in little or no color (pigment) in the skin, hair, and eyes
- Absence of color in hair, skin, or iris
- Lighter than normal skin and hair
- Patchy, missing skin color
Jaundice
Yellow-green to orange cast or color in skin, sclera, mucous membranes, fingernails, and palmar or plantar surfaces in the light skinned
Increase in serum bilirubin
> 2mg/dL
Associate with
- Liver disease
- Hemolytic disease
Petechiae
Pinpoint, round sports that appear on the skin as a result of bleeding under the skin
- violaceous (red-purple) discolorations of less than 0.5 cm in diameter
- Do not blanch
- Causes include intravascular defects or infections
Purpura
Purple-colored spots and patches that occur on the skin, organs, and in mucus membranes
-Purpura occurs when small blood vessels join together and leak blood under the skin.
- Very small spots called PETECHIAE
- Large purpura are called ECCYMOSES
Ecchymoses
Large purpura
- Bruise/Trauma
- Extravation of blood into the skin
-Can occur with Heparin, Coumadin, and liver dysfunction
Excoriation
Loss of epidermal layers exposing the dermis
-Ex. Abrasion
Lichenification
Layers of skin become thickened and rough as a result of rubbing over a prolonged period of time
Ex. Chronic contact dermatitis
Contact Dermatitis
Affects surfaces in contact w/ irritating agents
-Poison oak, metals, nickel, detergents, cosmetics, rubber, food, shampoo, clothing
Decubitis Ulcer Stages
Stage 1:
-In light skinned pt’s, the area is reddened, but skin is not broken
-In dark skinned pt’s, the picmentation is enhanced
Stage 2:
-Epidermal and dermal layers have sustained injury
Stage 3:
-Subcutaneous tissues have sustained injury
Stage 4:
-Muscle tissue and perhaps bone have sustained injury
Pitting Edema
4 Point Scale:
0+ - No pitting edema
1+ - Mild pitting edema. 2mm depression that disappears rapidly
2+ - Moderate pitting edema. 4 mm depression that disappears in 10-15 seconds
3+ - Moderately severe pitting edema. 6 mm depression that may last more than 1 minute
4+ - Severe pitting edema. 8 mm depression that can last more than 2 minutes
Capillary refill
Pressure is applied to nail bed until it turns white then blood is returned to tissue when pressure is released
- Indicator of peripheral circulation
- Should return to normal in 2-3 seconds
Clubbing of the nails
Clubbing of the nails can result from long-standing HYPOXIA and LUNG CANCER
Central Cyanosis
- Lack of Oxygen in the blood
- > 5g/dL of deoxygenated hemoglobin in the blood
- pulmonary embolism
- Bronchiolitis
- COPD, Asthma
- High Altitudes
- Pneumonia
- Choking
- Croup, epiglottitis
- Heart defects that are present at birth (congenital)
- Heart failure (cardiac arrest)
Tinea Capitis
(RINGWORM)
- Fungal infection of the scalp
- Easily spread – contagious
- Combs, hats, or clothing that have been used by someone w/ ringworm
-Spread by pets particularly CATS
Cheilosis
Cracks around the lips usually attributed to deficiency of RIBOFLAVIN, VITAMIN B-2 OR B-6.
Usually fixed with a balanced nutritional diet
Sclera
Outer layer of the Internal structure of the eye
-white opaque (the white of the eye)
Iris
Part of the middle layer of the internal structure of the eye.
-colorful part of the eye
Pupil
Part of the middle layer of the internal structure of the eye.
-Opening in the center of the iris, regulates the amount of light entering the eye
Retina
Part of the INNER LAYER of the internal structure of the eye
- Innermost layer of the eyeball
- Extension of the optic nerve
Glaucoma
Occurs when aqueous fluid pressure increases in the anterior chamber due to inadequate drainage of fluid.
Risk factors for Glaucoma
- Older adults
- Family history of glaucoma
- Ethnicity (especially African Americans, asians, and hispanics)
- Elevated intraocular pressure
- hypertension
- Diabetes mellitus
- Myopia
- Prolonged steroid use
Hordeolum
Acute localized inflammation, tenderness, and redness, w/ the pt complaining of pain in the infected area
- Bumps
- Stye
- Inflammation
- Infection of sebaceous gland
STAPH infection usually
Exotropia
Outward turning of eye
Esotropia
Inward turning of eyes
6 fields of gaze assessment
MIDLINE
- left lateral
- left lateral inferior
- right lateral inferior
- right lateral
- right lateral superior
- left lateral superior
Retina Assessment (NORMAL FINDINGS)
- Red reflex is present
- Optic disc is pinkish-orange in color, w/ a yellow-white excavated center known as the physiologic cup
- Ratio of cup diameter to that of the entire disk is 1:3
4 main vascular branches emanating from the disc, each consisting of an arteriole and a venule
- Light often produces a “light reflex” glistening from the arteriolar vessel.
- Normal arterial-to-venous width is a ration of 2:3 or 4:5
Corneal Ulceration
A grayish, well-circumscribed ulcerated area on the cornea is most commonly caused by a bacterial invasion.
- A TREELIKE configuration on the corneal surface is identified.
- This type of ulceration is caused by HERPES SIMPLEX VIRUS
Assessing for “accommodation”
Instruct Pt to shift gaze to distant object for 30 seconds
Instruct Pt to then look at your finger or an object held 10 cm from pt.
Note the reaction and size of the pupils.
ACCOMMODATION occurs when pupils constrict and converge to focus on objects at close range
Lacrimal Sac Assessment
Inspect for:
- Swelling, enlargement, tearing, exudate
- Compare to other eye
- Pain?
- Gently palpate
- Note discharge
- Tears overflowing
Lacrimal Sac Abnormal findings
Dacryoadenitis
-Trauma, measles, mumps, mononucleosis, painful swelling beside nose, near inner canthus
Dacryocystitis
-Inflammatory obstruction of lacrimal duct
Ptosis
Drooping of the eye lid
-Can either be congenital or acquired
Congenital Ptosis
- Failure of the levator muscle to develop.
- Condition may be associated w/ pathology of the superior rectus muscle as well
Acquired Ptosis
If Ptosis is acquired it is related to one of three factors
- Mechanical:
- Heavy lids from lesions, adipose tissue, swelling, edema - Myogenic
- Muscular diseases such as myasthenia gravis or multiple sclerosis - Neurogenic
- Paralysis from damage of neural pathways
External Ear Assessment
Inspection
-Note position, size, color, and shape
Palpation
-Auricle
External Ear Assessment (NORMAL FINDINGS)
- Flesh Color
- Positioned centrally and in proportion to the head
- No foreign bodies, redness, drainage, deformities, nodules, or lesions
External Ear Assessment (ABNORMAL FINDINGS)
- Pale, red, cyanotic
- Small-size or large-size ears
- Purulent drainage
- Clear or bloody drainage
- Hematoma behind ear over mastoid
- Pain or tenderness on palpation
Conditions (ABNORMALITIES) of External Ear
Perichondrial Hematoma -Cauliflower ear - blunt trauma Perichondritis -inflammation of fibrous connective tissue over cartilage of ear Carcinoma -Basal and squamous cell carcinoma Battle's sign -Head trauma to temporal bone // bruise behind the ear Tophi -Uric acid nodules -may indicate gout
Perforated Nasal Septum
May be caused by nasal insufflation (snorting) of COCAINE, which can lead to necrosis of the septal cartilage
Frequency Range of Humans
Human ear is capable of hearing w/in a frequency range of: -20 to 20,000 Hz
Hearing a decibel range of:
- 0 to 140
Weber Test
- Strike tuning fork
- place firmly on middle of pt forehead, on top of head at midline, or on the front teeth
- Ask if sound is heard centrally or towards one side
Normal Finding:
-Able to hear sound equally in both ears
Weber Test
-Unilateral Conductive Hearing Loss
Sound Lateralize’s to AFFECTED ear
-Sound is conducted directly through bone to the ear
Occurs when there are external or middle ear disorders such as:
- Impacted Cerumen
- Perforation of Tympanic membrane
- Serum or pus in ear
- Fusion of ossicles
Webber Test
-Sensorineural Loss
- Sound lateralize’s to UNAFFECTED EAR
- Can’t hear sound in damaged ear
- Nerve damage in impaired ear
Disorder in inner ear, auditory nerve, or the brain
- Congenital defects
- Effects of ototoxic drugs
- Prolonged exposure to loud noise
Rinne Test
- Stand behind pt and strike tuning fork
- Place stem of fork against pt mastoid process
- Ask pt to tell you when sound stops
- when sound stops, put fork next to ear
- note length of time pt hears the sound in the air
Rinne Test Results
-Air conduction is heard twice as long as bone conduction
-Air conduction > bone conduction
AC > BC = + RINNE TEST
If pt hears sound longer through bone conduction it is a
(- RINNE TEST)
-could mean disease or damage to outer or middle ear
Transillumination of Sinuses
If sinusitis is suspected:
- Observe red glow over sinuses
- observe symmetry between two sides
-Absence of illumination suggests sinus congestion
Breath smells
The breath should smell fresh
- Breath is FOUL
- Halitosis can be a symptom of tooth decay, poor oral hygiene, or diseases of the gums, tonsils, or sinuses - Breath is ACETONE
- common in pt’s who are malnourished or who have diabetic ketoacidosis. Low carb diet - Breath smells MUSTY
- Pt may have liver failure and caused by breakdown of nitrogen compounds - Breath smells like Ammonia
- Pt in end-stage renal failure due to inability to eliminate urea
Streptococcal pharyngitis
Tonsils, pillars, and uvula are very red and swollen, w/ patches of white or yellow exude on the tonsils. The posterior pharynx is bright red. Pt reports soreness of the throat w/ swallowing
Tonsillitis
Posterior pharynx is red w/ white patches. Tonsils are large and red w/ white patches, and the uvula is red and swollen
Dacryadenitis
Lacrimal sac abnormal finding
-trauma, measles, mumps, mononucleosis, painful swelling beside nose, near inner canthus
Dacryocystitis
Lacrimal sac abnormal finding
-inflammatory obstruction of lacrimal duct
Foul Breath Smell
Halitosis
-can be a symptom of tooth decay, poor oral hygiene, or diseases of the gums, tonsils, or sinuses
Acetone Breath Smell
Common in pt’s who are malnourished or who have diabetic KETOACIDOSIS
-low carb diet
Musty breath Smells
Pt may have liver failure
-caused by breakdown of nitrogen compounds
Ammonia Breath smells
Pt in end-stage renal failure due to inability to eliminate urea
Perichondrial Hematoma
-Cauliflower ear / blunt trauma
Perichondritis
Inflammation of fibrous connective tissue over cartilage of ear
Carcinoma
basal and squamous cell carcinoma
Battle’s Sign
Head trauma to temporal bone
-bruise behind the ear
Tophi
Uric acid nodules
-May indicate gout
