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307 Health Assessment > TEST 4 > Flashcards

TEST 4 Flashcards

ANUS, RECTUM, PROSTATE, BREAST, FEMALE GU, MALE GU, MS, NEUROLOGIC

1
Q

Anal canal

A

(3.8 cm long in adult): outlet of GI tract

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2
Q

rectum

A

: (12 cm long in adult) : distal portion of GI tract

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3
Q

prostate

A
  1. located 2 cm behind symphysis pubis & anterior to rectum
  2. surrounds the bladder neck and urethra
  3. secretes a thin, milky, alkaline fluid
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4
Q

meconium stool

A

infant’s first stool ( within 24-48 hrsafter birth), is dark green, sign of anal patency

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5
Q

frequency of infant stool

A

normally one after each feeding (from gastrocolic reflex)

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6
Q

when does a child gain voluntary control of stool

A
  1. 1.5-2 yrs
  2. voluntary control occurs with mylination of nerves supplying the anal sphincters
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7
Q

the prostate gradually enlarges in middle age/aging males with what

A

increased incidence of benign prostatic hypertrophy (BPH)

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8
Q

Prostate cancer screening

A

Discuss PSA and DRE annually
Beginning at age 50 for average risk
Beginning at age 45 for high risk (African Americans and those with 1st degree relative

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9
Q

Colon cancer screening:

A

Colonoscopy every 10 years beginning at age 50 (sooner if risk factors present)

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10
Q

rectal bleeding

subjective assessment

A

blood in the stool (melena), any odor

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11
Q

black tarry stools indicate

subjective assessment

A

gi bleed

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12
Q

non tarry black stools indicate

subjective assessment

A

iron med ingestion

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13
Q

red blood in the stool indicates

subjective assessment

A

gi bleed, localized bleed in anus, cancer

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14
Q

abnormal stool

subjective assessment

A

clay-colored (absent bile pigment), frothy stool (steatorrhea-excessive fat in stool), flatulence

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15
Q

medications affecting stool

subjective assessment

A

laxatives, stool softens, enemas, iron pills

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16
Q

rectal conditions

subjective assessment

A

hemorrhoids, pruritis, fistula, fissures

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17
Q

family history of anus/rectum/prostate

subjective assessment

A

polyps; colon, rectal, or prostatic cancer

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18
Q

self care behaviors

anus/rectume/prostate- subjective assessment

A

amount of high-fiber foods in diet, water intake (glasses per day); date of last digital rectal exam, colonoscopy, prostate-specific antigen test (for men)

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19
Q

Examine the stool

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

normally soft with brown color)

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20
Q

rectal bleeding

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

bright red blood on surface of the stool

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21
Q

colonic bleeding

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

bright red blood is mixed with stool

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22
Q

black tarry stool with distinct odor

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

upper gi bleed

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23
Q

black stool

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

ingestion of iron or bismuth substance

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24
Q

gary/tan stool

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

lacks bile

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25
Q

pale/yellow/greasy stool

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

steatorrhea

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26
Q

occult blood

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

colon cancer

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27
Q

test stool for occult blood

OBJECTIVE ASSESSMENT: anus/rectum/prostate

A

alse positive can occur with intake of red meat or if taking Fe supplements within the last three days

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28
Q

fissure

A

tear

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29
Q

hemorrhoids

A

enlarged blood vessel

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30
Q

rectal prolapse

A

rectal wall protrusion through anua

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31
Q

pruritis ani

A

intense itching around anus

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32
Q

fecal impaction

A

collection of hard, desiccated feces in the rectum

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33
Q

rectal polyp

A

requires biopsy

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34
Q

carcinoma

A

rectal cancer

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35
Q

breasts

A

mammary glands
Need to assess both male & female
Are accessory reproductive organs in females

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36
Q

location of breasts

A

Located anterior to pectoralis major & serratus anterior muscles between 2nd & 6th ribs

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37
Q

surface anatomy

breast

A

Tail of Spence
Nipple
Areola
Montgomery’s glands

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38
Q

4 quadrants

breast

A

upper outer quadrant, lower outer, lower inner quadrant, upper inner quadrant
* Upper outer quadrant: location for most breast tumors

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39
Q

glandular tissue

breast- internal anatomy

A
  • Lobes
  • Lobules
  • Alveoli
  • Lactifereous duct
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40
Q

breast tissues

A

glandular
fibrous
adipose

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41
Q

fibrous tissue

breast

A
  • Suspensory ligaments
  • -Cooper’s ligaments
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42
Q

Lymphatics (Anterior Lymphatic Drainage)

breast

A
  • > 75% of lymph drains into the ipsilateral axillary nodes.
  • Drainage flows from central axillary nodes up to the infraclavicular and supraclavicular nodes.
  • Small amount of lymph drains directly up to infraclavicular group, deep into chest, or into abdomen, or crosses over to the opposite breast.
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43
Q

Central axillary nodes

breast

A

: high up in middle of axilla, receives lymph from the other 3 groups

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44
Q

Pectoral nodes

breast

A

(anterior): just inside anterior axillary fold

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45
Q

subscapular nodes

breast

A

(posterior): deep in the posterior axillary fold

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46
Q

lateral nodes

breast

A

along the humerus inside the upper arm

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47
Q

Milk lines or ventral epidermal ridges:

breast

A

present during embryonic life; curve down from axilla to groin bilaterally
* Breast develop along thoracic milk line ridge

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48
Q

supernumerary nipple

breast- developmental considerations

A

an extra nipple which develops along the mammary ridge

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49
Q

breasts at birth

A

contain just lactiferous ducts; areola is not present

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50
Q

asolescent females

A

effects of estrogen on the breasts results in:
- Increased fat disposition
- - Development of duct system
- - Earlier onset of puberty
- * African Americans: mean age is 8 & 9
- * Whites: mean age is 10
- - Asymmetry (one breast may develop quicker)
- - Breast tenderness is common

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51
Q

Tanner’s Sexual Maturity Rating (1969) or Sexual Maturity Rating

A
  • Five stages (full development from stage 2-5 takes an average of 3 yrs; can range from 1.5 – 6 yrs)
  • Development of pubic hair
  • Axillary hair (onset 2yrs after pubic hair)
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52
Q

monthly changes of breast

A
  • Midcycle to onset of menstruation: increased nodularity
  • 3 to 4 days before menstruation: fullness with heaviness & tenderness
  • Days 4 to 7 of menses: smallest size
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53
Q

pregnancy

breast

A

-Noted changes at second month
- Increased ductal system & supporting adipose tissue
- - True secretory alveoli develop
- - Nipples become larger, darker, more erectile
- - Enlarged, darker areolae

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54
Q

colostrum

breast

A

may be expressed after the 4th month; precursor to milk (contains some amount of protein & lactose as milk but almost no fat)

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55
Q

milk production

breast

A

(lactation) occurs at 1-3 days postpartum

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56
Q

post menopause: decreased estrogen & progesteroneresulting in:- Decreased glandular tissue with formation offibrous tissue- Atrophy of adipose tissue- Major decrease in breast size in the 80’s;decreased elasticity  sagging, flabby,flattened breasts- Axillary hair decreases

aged female- breast

A
  • Decreased glandular tissue with formation of fibrous tissue
    • Atrophy of adipose tissue
    • Major decrease in breast size in the 80’s; decreased elasticity
  • sagging, flabby, flattened breasts
    • Axillary hair decreases
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57
Q

Male breast:

Male breast:

A
  • Underdeveloped tissue behind the nipple
    • Well developed areola but nipple is small
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58
Q

Gynecomastia:

A

enlargement of the male breast, temporary enlargment is common during adolescence; can occur in the aging male (from decreased testosterone levels)

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59
Q

Breast development

A

African American: mean age of 8.87
Whites: mean age 9.96

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60
Q

Menses:

A

African Americans: average age 12.16
Whites: average age12.88

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61
Q

Breast cancer

A
  • Increased incidence in whites
  • Lower risk in Asian, Hispanic & Native Americans, but poorer outcomes
  • Alcohol use can increase likelihood of developing breast cancer
  • Effect of fat in diet is questionable
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62
Q

Influence of breasts on self-image, sexual attractiveness and beauty

A

strong influence in western culture

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63
Q

Risk factors that cannot be changed:

Female gender, age > 65

A

Personal history of breast CA
Mutation of BRCA1 & BRCA 2 genes
Previous biopsy with breast atypical hyperplasia or breast disease
Previous breast irradiation
Menstruation before age 12 or menopause after age 50
First degree relative with breast cancer

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64
Q

Risk factors that cannot be changed:

Lifestyle-related risk factors: breast cancer

A

Nulliparity or first child after age 30
Current oral contraceptive use
Long-term use of HRT (combinedtype)
Not breast feeding
Alcohol intake of 2-5 drinks daily
Obesity (especially after menopause & high-fat diet

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65
Q

pain

Assessment: Subjective Data

A

pain or tenderness in the breast (mastalgia), history of trauma, infection, benign breast disease, relationship to menstrual cycle, precipitating & associating factors

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66
Q

lump

Assessment: Subjective Data

A

: lump or thickening, when noticed, any changes

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67
Q

discharge

Assessment: Subjective Data

A

Galactorrhea, clear, bloody or blood tinged, note any medications

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68
Q

rash

Assessment: Subjective Data

A

note when it was noticed, location, appearance

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69
Q

swelling

Assessment: Subjective Data

A

one location or generalized, relationship to menses, lactation, pregnancy

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70
Q

trauma

Assessment: Subjective Data

A

: swelling, lump, or break in skin

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71
Q

History of breast disease

Assessment: Subjective Data

A

type, method of diagnosis, date, treatment, family history of breast cancer, fibrocystic diseases

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72
Q

surgery

Assessment: Subjective Data

A

biopsy, mastectomy, mammoplasty (augmentation or reduction)

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73
Q

surgery

Assessment: Subjective Data

A

biopsy, mastectomy, mammoplasty (augmentation or reduction)

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73
Q
A
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74
Q

Self-care behaviors for women

Assessment: Subjective Data

A

monthly breast self -examinations, routine clinical breast examination, mammograms
* Ages 40-44: Have opportunity for annual screening mammography
* Ages 45-54: annual screening mammography
* Ages 55+: annual or biennial mammography

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75
Q

axilla

breast- subjective

A

Tenderness, lump, or swelling, Rash

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76
Q

General appearance

Objective Data- breast

A

size & shape
* Sudden increase in size of one breast indicates inflammation of new growth

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77
Q

skin

objective data-breast

A

smooth & even color normally, striae after pregnancy
* Abnormal findings: edema, redness, hyperpigmentation, unilateral dilated veins in nonpregnant women; orange-peel appearance (Peau d’orange

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78
Q

Lymphatic drainage areas

objective data- breast

A

observe axillary and supraclavicular regions for bulging, discoloration, or edema

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79
Q

nipple

objective data- breast

A

normally symmetrical and on the same plane, generally protrude, may be flat or inverted
* Normal variation: supernumerary nipple
* Abnormal finding: deviation in pointing, recent nipple retraction, discharge (unless pregnant or breast feeding)

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80
Q

nipple (pt 2)

objective data- breast

A

Use maneuvers to screen for retraction
* Abnormal finding: retraction or fixation (indicates fibrosis generally from neoplasms)

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81
Q

objective assessment of the breast

A

Inspect and palpate the axillae
Palpate the breasts:
- Vertical strip pattern (best choice)
- Spokes of a wheel
- Concentric circles

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82
Q

Note characteristics of any lump/mass:

breast

A
  1. Location
  2. Distinctness
  3. Size
  4. Nipple
  5. Shape
  6. Skin over the lump
  7. Consistency
  8. Tenderness
  9. Movable
  10. Lymphadenopathy
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83
Q

palpating the breast

A

May need to use bimanual palpation with pendulous breasts
* Abnormal findings: lumps, signs of inflammation (heat, redness, and swelling) Gently apply pressure or stripping motion to the nipples to assess for any nipple discharge.

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84
Q

breast self exam

A

Teach the breast self-examination to be performed monthly; stress that the best time to perform BSE is:
- Female with menstrual periods: right after the menses or on the 4-7th day of the menstrual cycle
- Pregnant or postmenopausal females: use a familiar date or the first day of each month

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85
Q

Assess the male breast

A

inspect and palpate the chest wall and the nipple for any lumps or swelling

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86
Q

Gynecomastia

A

enlarged breast tissue (smooth, firm, movable); normal during puberty, can result form steroid usage or certain medications

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87
Q

Assessment of Abnormalities: Signs of Retraction and Inflammation in the Breast

A

Dimpling
Edema (Peau d’Orange)
Fixation
Nipple retraction/Deviation in nipple pointing
* All of the above findings indicate cancer

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88
Q

Benign breast disease

Assessment of Abnormalities: Breast Lump

A

(formally called fibrocystic breast disease): multiple tender masses, consists of six diagnostic categories:
1) Swelling & tenderness
2) Mastalgia
3) nodularity
4) Dominant lumps
5) Nipple discharge with intraductal papilloma & duct ectasia
6) Infections &inflammation

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89
Q

cancer

Assessment of Abnormalities: Breast Lump

A

solitary unilateral nontender mass which is dense, hard, and fixed to underlying tissue; has irregular borders; may be painful but generally painless
* Most common site: the upper outer quadrant
* * Increased risk in women > age 50, starts diminishing by 80

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90
Q

Fibroadenoma

A

a solitary nontender mass, type of benign breast disease; feels solid, firm, rubbery, and elastic; move freely
* Increased risk: ages 15-30 yrs, can occur up to age 55
* Requires biopsy for diagnosis

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91
Q

Differentiating breast lumps

A

refer to Table in text
* What are the differentiating characteristics for fibroadenoma, benign breast disease, and cancer?

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92
Q

FEMALE GENITOURINARY SYSTEM

A

Engorged external genitalia (from maternal estrogen), become small in a few weeks

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93
Q
A
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94
Q

puberty

FEMALE GENITOURINARY SYSTEM

A

Effects of estrogen  development of the secondary sex characteristics & cell growth in reproductive tract
– First sign: breast development & pubic hair, starts between ages 8.5 – 13 and takes about 3 yrs for full maturation

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95
Q

Menarche

A

onset of menses
- Irregular menses common
- - Sexual Maturity Rating in Girls

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96
Q
  • Goodell’s sign:

female gu- Pregnant female:

A

cervix softens at 4-6 weeks

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97
Q

chadwicks sign

female gu- Pregnant female:

A

cervix and vaginal mucosa has cyanotic appearance at 8-12 weeks

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98
Q

hegars sign

pregnancy- female gu

A

isthmus of the uterus softens at 6-8 weeks

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99
Q

pregnancy

female gu

A

Urinary frequency occurs from early growth of the uterus
- Cervical & vaginal secretions more acidic
- - Increased incidence of candidiasis

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100
Q

mucus plug

pregnancy- female gu

A

provides the fetus protection from infection

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101
Q

bloody show

pregnancy- female gu

A

mucus plug dislodges, sign of labor

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102
Q

menopause

A

cessation of menses (generally at ages 48-51

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103
Q
  • Decreased estrogen levels results in:

female gu- aging female

A
  • Decreased size of uterus & ovaries (ovaries not palpable)
  • Weakened pelvic muscles & ligaments uterus drops
  • Cervix shrinks, becomes pale in color- Vaginal atrophy
  • Decreased vaginal secretions and increased pH
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104
Q
  • Dyspareunia:
A

pain with sexual intercourse

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105
Q

CROSS-CULTURAL CARE:

A

Women of Muslim faith, Hispanic, or Africans may have strict beliefs regarding exposure of the genitalia

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106
Q

female circumcision

A

Infibulation or female genitalia mutilation
 Removal of the clitoris for the purpose of removing sexual pleasure -illegal in the US

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107
Q

clotting

FEMALE GENITALIA: SUBJECTIVE DATA

A

signifies heavy menstrual flow or pooling of blood in vagina

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108
Q

Menstrual history

FEMALE GENITALIA: SUBJECTIVE DATA

A

LMP (first day of last menstrual period)
- Menarche (onset normally between ages 12-14; possibly abnormal at ages 16-17 (indicates endocrine problem, underweight, or perhaps very athletic)
- Cycle (normally 18-45 days)

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109
Q

amenorrhea

FEMALE GENITALIA: SUBJECTIVE DATA

A

absent menses

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110
Q

menses duration

FEMALE GENITALIA: SUBJECTIVE DATA

A

average 3-7 days

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111
Q

gravida

subjective data- female gu

A

number of pregnancies

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112
Q

para

subjective data- female gu

A

number of births

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113
Q

abortions

female gu- subjective data

A

interrupted pregnancies (elective or spontaneous

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114
Q

pregnancy subjective data questions

female gu

A

Note specific information for each pregnancy (complications, duration, labor, baby’s condition)
* Are you pregnant now?

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115
Q

menopause

subjective data- female gu

A

cessation of menstruation, perimenopausal symptoms (normally occur at ages 40-55) due to hormonal changes
* Note patient’s feelings about menopausal changes

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116
Q

Self-care behaviors

subjective data- female gu

A

frequency of gynecologic checkups ,last Papanicolaou test & results

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117
Q

Urinary symptoms

subjective data- female gu

A

urinary frequency, urgency, dysuria, nocturia, hematuria, incontinence

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118
Q

true incontinence

subjective data- female gu

A

loss of urine without any warning

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119
Q

urgency incontinence

female gu- subjective data

A

sudden loss right after urge to void

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120
Q

stress incontinence

female gu-subjective data

A

loss of urine with physical strain (results from weak muscles)

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121
Q

vaginal discharge

female gu- subjective data

A

normally small amount, clear or cloudy, non irritating, and without foul odor

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122
Q

additional subjective data- female gu

A

Any dyspareunia (pain with sexual intercourse)
- Medications
- Use of vaginal douches, feminine sprays, nonventilating underwear
- History of any vaginal infections & its treatment

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123
Q

sexual activity

female gu- subjective data

A

start with open-ended question, note:
- Presently in sexual relationship
- Any concerns or problems with sexuality
- More than one sexual partner
- Sexual preference
- * Show acceptance to discuss sexual concerns

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124
Q

Contraceptive use

subjective data- female gu

A

also note if she smokes cigarettes (increased risk of CV problems with BCPs), any plans to have children, previous problems with becoming pregnant

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125
Q

infertility

subjective data- female gu

A

having unprotected sexual intercourse without conceiving after one year

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126
Q

Sexually transmitted infection (STI) contact

female gu

A

any history of STIs, type, treatment, any complications

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127
Q

STD risk reduction

female gu

A

: consistent use of condoms?

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128
Q

For infants & children

female gu

A

inquire about any rashes, vaginal discharge, itching
* Screen for sexual abuse – have child name three adults they trust (often a parent is the abuser)
* Stress to the child that it is not OK for someone to touch or look at their private parts in secret)

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129
Q

For adolescents

female gu

A

assess for sexual growth & development; inquire about sexual behavior
* Initially use permission type statements “Often girls your age experience…”
* Avoid judgmental statements
* Avoid ambiguous terms such as: “sexually active”; better to use specific questions

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130
Q

ANATOMY OF THE MALE GU

A

Penis
Scrotum
- rugae
- cremaster muscle
Testes
Lymphatics

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131
Q

HOW DO THE TESTES DESCEND

A

through inguinal canal into the scrotum, along with the vas deferens, blood vessels and nerves

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132
Q

CRYPTOCHIDISM

A

UNDESCENDED TESTES

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133
Q

RETRACTION OF THE FORESKIN

A

Don’t retract foreskin before age 3 months (can tear the membrane attaching to the shaft)

135
Q

MALE PUBERTY ONSET

A

Ages 91/2 – 131/2
- 1st sign: enlargement of testes, next pubic hair,then penis enlarges

136
Q

DURATION OF MALE PUBERTY

A

anges from 2-5 yrs, average length of time is 3 yr

137
Q

END OF MALE FERTILITY

A

no definite age with men
- Age 40: sperm starts to decline, but production is still present in the 80’s & 90’s

138
Q

TESTOSTERONE PRODUCTION DECLINE STARTS IN THE 30S AND CAUSES A DECREASE IN

A
  • Muscle tone
  • SC (fat) tissue
  • Cellular metabolism
  • Pubic hair with graying
  • Size of penis & testes, scrotum hangs lower- Slower & less intense sexual response
  • Libido & sexual pleasure is still present
139
Q

Lack of sexual activity in older adult males may be from:

A
  • Loss of spouse
  • depression
  • Preoccupation with work
  • Marital or family conflict
  • Side effects of meds
  • Heavy use of alcohol
  • Lack of privacy
  • Economic or emotional stress
  • Poor nutrition
  • Fatigue
140
Q

MALE GENITOURINARY:SUBJECTIVE DATA

A

Frequency, urgency, and nocturia

141
Q

POLYURIA

MALE GENITOURINARY:SUBJECTIVE DATA -

A

excessive quantity of urine

142
Q

OLIGURIA

MALE GU- SUBJECTIVE DATA

A

diminished quantity (<400ml/24hrs)

143
Q

NOCTURIA, FREQUENCY, AND URGENCY TOGETHER INDICATES

MALE GU- SUBJECTIVE DATA

144
Q

CAUSES OF NOCTURIA

A

UTI, CARDIOVASCULAR, HABITUAL, OR USE OF DIURETIC MEDS

145
Q

DYSURIA

MALE GU- SUBJECTIVE DATA

A

any pain or burning with urination, indicates acute cystitis, prostatitis, urethritis

146
Q
  • Signs of progressive prostatic obstruction

MALE GU- SUBJECTIVE DATA

A

Hesitancy, straining, any decrease in force of the stream, terminal dribbling, sense of residual urine, recurrent UTIs

147
Q

URINE COLOR

MALE GU- SUBJECTIVE DATA

A

Clear, cloudy, discolored, foul smelling (indicates UTI), hematuria

148
Q

HEMATURIA

MALE GU- SUBJECTIVE DATA

A

DANGER SIGN, POSSIBLY CANCER

149
Q

RED

URINE COLOR

A

blood, cancer, cystitis, nephritis, common following prostate surgery

150
Q

TEA

URINE COLOR

A

Liver disease, may accompany jaundice ,blood

151
Q

CLOUDY

URINE COLOR

A

UTI, KIDNEY STONE

152
Q

CLEAR/PALE YELLOW

URINE COLOR

153
Q

AMBER

URINE COLOR

A

DEHYDRATION

154
Q

Scrotum, self-care behaviors

MALE GU

A

any scrotal problems, performing testicular self-examination monthly, any lumps, lesions, tenderness, change in size, bulge, swelling, dragging heavy feeling in scrotum, hernia

155
Q

Sexual activity and contraceptive use

MALE GU- SUBJECTIVE DATA

A

currently in a sexual relationship, satisfaction in sexual activity, ability to communicate with partner about sex, ability to have an erection, any changes, use of contraception, how many sexual partners over the last 6 months, sexual preference regarding gender

156
Q

TIPS FOR SEXUAL ACTIVITY ASSESSMENT

A
  • Keep the questions about sexual activity in the routine of the review of the body systems
  • Need to communicate your acceptance of discussing sexual activity
  • Screen for possible STI
157
Q

INFANTS AND CHILDREN

MALE GU DEVELOPMENTAL CONSIDERATIONS

A

testes descended? toilet training, wetting bed
* Screen for sexual abuse!

158
Q

ADOLESCENTS

MALE GU DEVELOPMENTAL CONSIDERATIONS

A

use permission statement, ubiquity approach, avoid judgmental comments, noctural emissions or wet dreams, STDs, homosexuality, birth control, self testicular exam
* Avoid ambiguous statements such as “having sex”

159
Q

AGING ADULTS

MALE GU DEVELOPMENTAL CONSIDERATIONS

A

difficulty urinating, hesitancy, straining, dribbling, incomplete emptying of bladder, hematuria, nocturia, medications, sexual function

160
Q

Inspect and palpate for a hernia

MALE GU

A

: note any bulge while patient strains

161
Q

Palpate the inguinal lymph nodes

MALE GU

A

(horizontal chain along the groin & the vertical chain along the upper inner thigh)
* Normal finding: an isolated node <1cm, soft, discrete, nontender & movable
* Abnormal finding: enlarged, hard, matted, fixed nodes

162
Q

Teach testicular self-examination (TSE)

A

to be performed every month
T = timing, once a month
S = shower, warm water relaxes scrotal
E = examine, check for changes, report changes immediately

163
Q

TESTICULAR CANCER

A

rare but increased risk in young men ages 15 to 40; increased incidence in whites (4x more than in nonwhites

164
Q

FLEXION

A

bend a limb at joint

165
Q

EXTENSION

A

STRAIGHTEN LIMB AT JOING

166
Q

ABDUCTION

A

MOVE LIMB AWAY FROM MIDLINE

167
Q

ADDUCTION

A

MOVE LIMB TOWARD MIDLINE

168
Q

PRONATION

A

PALM DOWN
THINK PT FACE DOWN IN PRONE

169
Q

SUPINATION

A

PALM UP
THINK PT FACE UP WHEN SUPINE

170
Q

CIRCUMDUCTION

A

MOVE ARM IN CIRCLE AROUND SHOULDER

171
Q

INVERSION

A

TURN ANKLE IN

172
Q

EVERSION

A

TURN ANKLE OUT

173
Q

ROTATION

A

HEAD ROTATES AROUND NECK

174
Q

PROTRACTION

A

moving body part forward & parallel with floor

175
Q

RETRACTION

A

moving body part BACK & parallel with floor

176
Q

ELEVATION

A

RAISING A BODY PART

177
Q

DEPRESSION

A

LOWERING A BODY PART

178
Q

in pregnancy, Increased levels of hormones leads to

A

increased mobility/flexibilty of joints

179
Q

lordosis in pregnancy

A

 Shifts center of balance further back on the lower extremities
 Leads to lower back pain

180
Q

Osteoarthritis

A

Herbeden and Bouchard Nodes

181
Q

loss of muscle mass in aging adults makes bony prominences

A

more pronounced

182
Q

osteoporosis

A

Resorption occurs more rapidly than deposition.
 Loss of height- 1”-4”
 Patient teaching regarding maintaining an active lifestyle is crucial.

183
Q

joints

subjective data

A

any pain; stiffness; swelling, heat or redness; limitation of movement

184
Q

muscles

subjective data

A

any pain, weakness

185
Q

bones

subjective data

A

any pain, deformity, trauma

186
Q

functional assessment

subjective data

A

any limitations in ability to perform ADLs

187
Q

self care behaviors

ms- subjective data

A

aany heavy lifting, repetitive motion or chronic stress to joints, any exercise program, with or without warm-up session), any meds for musculoskeletal problems, weight gain

188
Q

inspection of joints

ms- objective data

A

contour, swelling, color, masses, deformity, or inflammation

189
Q

effusion

A

excess joint fluid

190
Q

subluxation

A

partial dislocation of a joint

191
Q

contracture

A

shortening of a muscle

192
Q

ankylosis

A

stiffness or fixation of a joint

193
Q

Palpation

ms- objective data

A

ote heat, tenderness, swelling, masses

194
Q

rom

ms- objective data

A

have patient do active ROM (stabilize body area proximal to part being moved) and note any limitation
- Note any crepitation (audible & palpable crunching or grating)

195
Q

muscle testing

ms- objective data

A

assess the strength of the muscles
* Grading Muscle Strength system

196
Q

grade 5

muscle testing

A

full rom ag, full resist
100%
normal

197
Q

grade 4

muscle testing

A

full rom ag
some resist
75%
good

198
Q

grade 3

muscle testing

A

full rom with gravity
50%
fair

199
Q

grade 2

muscle testing

A

full rom with gravity eliminated
passive rom
25%
poor

200
Q

grade 1

muscle testing

A

slight contraction
10%
trace

201
Q

grade 0

muscle testing

A

no contraction
0%
zero

202
Q

Assess the temporomandibular joint(TMJ):

A

note any swelling, decreasedmovement or crepitus

203
Q

Assessment for carpal tunnel syndrome

A

phalen’s test
tinel’s sign

204
Q

Inspect & palpate the hands & wrists;

A

note any ulnar deviation, ankylosis, Swan-neck or boutonniere’s deformity, Heberden’s or Bouchard’s nodules

205
Q

Carpal Tunnel Syndrome

A

rritation of the median nerve results in pain, numbness, tingling
* symptoms can affect all digits except pinky*

206
Q

causes of carpal tunnel syndrome

A

Occupation (typing, machinery that vibrates) ,Injury, Pregnancy, Metabolic disorders

207
Q

hips

A

Inspect for symmetry, assess in conjunction with the spine when standing
 Palpate for pain or crepitus
 Assess ROM

208
Q

knee

A

Inspection-skin should be smooth with even coloring and no lesions, no deformities or swelling should be present
 Assess ROM

209
Q

Ankle and Foot

A

 Inspect while sitting, standing and walking
 Assess ROM

210
Q
  • Spine
A

 Inspect while standing
 Assess ROM

211
Q

Major Sensory Pathways

A
  • Spinothalamic Tract
  • Posterior Columns
212
Q

Major Motor Pathways

A
  • Corticospinal or Pyramidal Tract
  • Extra Pyramidal Tract
  • Cerebellar system
213
Q

Upper and Lower Motor Neurons

214
Q

cranial nerves

215
Q

spinal nerves

216
Q

autonomic nervous system

A

parasympathetic nervous system
sympathetic nervous system

217
Q

reflex arc

218
Q

parasympathetic nervous system

A

pns
rest and digest

219
Q

sympathetic nervous system

A

sns
fight or flight

220
Q

Developmental Considerations of infants

nervous system

A

– immature nervous system at birth
- - limited cortical control
- - primitive reflexes
- - myelination occurs cephalocaudally & proximodistally
- - milestones

221
Q

developmental considerations of older adults

nervous system

A
  • atrophy with loss of neurons
  • weight & volume of brain decreases
  • pupillary changes
  • increased risk of postural hypotension & falls
222
Q

oldere adults experience decreased

nervous system

A
  • muscle tone & bulk
  • muscle strength & fine motor coordination
  • vibratory sense
  • velocity of nerve conduction –> slower reaction time
  • sense of touch & pain sensation
  • cerebral blood flow & O2 consumption
223
Q

Neurologic Assessment: Subjective data

A
  • Headache* Head injury* Dizziness/vertigo* Seizures* Tremors* Weakness* Incoordination
224
Q

Neurologic Assessment: Subjective Data part 2

A
  • Numbness/tingling* Difficulty swallowing* Difficulty speaking* Past history* Environmental/occupational hazards
225
Q

cranial nerves

review image

A

I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Acoustic
IX. Glossopharyngeal
X. Vagus
XI. Spinal Accessory Nerve
XII. Hypoglossal

226
Q

inspect and palpate motor system (muscles)

A
  • size
  • strength
  • tone
  • involuntary movements
227
Q

Cerebellar function

A

balance tests
coordination and skilled movements

228
Q

balance tests

A

gait
tandem walk
romberg test
hop in place or shallow knee bends

229
Q
  • Coordination & skilled movements
A

rapid alternating movements (RAM)
thumb-to-finger test
finger-to finger test
finger-to-nose test
heel-to-shin test

230
Q

assess the sensory system

A

spinothalamic tract
posterior tract

231
Q

spinothalamic tract

A

pain
temp
light touch

232
Q

posterior tract

A

vibration
position (kinesthesia)
fine tactile touch (stereognosis, graphesthesia)
two point discrimination
extinction

233
Q

Test deep tendon reflexes (DTRs)

A
  • biceps reflex (C5-C6)
  • triceps reflex (C7-C8)
  • brachioradialis (C5-C6)
  • quadriceps reflex “knee jerk” (L2-L4)
  • achilles reflex “ankle jerk” (L5-S2)
  • clonus
234
Q

Test superficial reflexes

A
  • plantar reflex (L4-S2)
  • Babinski sign
235
Q

Developmental Considerations for infants

nervous system

A

assess for milestones, cry, expiratory grunt, lethargy, hyporeactivity, hyperreactivity, change in behavior

236
Q

infant reflexes

nervous system

A
  • Rooting
  • Grasp
  • Tonic neck
  • Moro
  • Sucking
  • Palmar grasp
  • Babinski
  • Stepping
237
Q

glasgow coma scale

A

best eye opening
best motor response
best verbal response

238
Q

glasgow coma scale scores

A

mild 13-15
moderate 9-12
severe 3-8

239
Q

eye opening

glasgow coma scale

A

spontaneous-4
to sound-3
to pressure-2
none-1

240
Q

verbal response

glasgow coma scale

A

oriented-5
confused-4
words-3
sounds-2
none-1

241
Q

motor response

glasgow coma scale

A

obey commands-6
localising-5
normal flexion-4
abnormal flexion-3
extension-2
none-1

242
Q

Postures:

A
  • Decorticate rigidity
  • Decerebrate rigidity
  • Flaccid quadriplegia
243
Q

reflex

A

kernig
brudzinski

244
Q

what does the rectum connect

A

large intestine and anal canal

245
Q

what does the prostate gland do

A

secrtes fluid that promotes sperm production

246
Q

benign prostatic apertrophy

A

prostate gland gets enlarged can cause disruption in urine flow

247
Q

imperforated anus

A

opening is not there and baby isn’t able to pass stool. often not noticed before birth

248
Q

is potty training of urinating or passing stool easier

A

urinating because voluntary control of stool takes longer

249
Q

most prevalent cancer in men

A

prostate cancer

250
Q

is prostate cancer treatable

A

yes, especially if detected early and slow moving

251
Q

psa

A

prostate specific antigen
blood test for prostate cancer screening
*other things can cause psa elevation so just a sign to signify possibility

252
Q

dre

A

digital rectal exam
usually advanced practice

253
Q

common causes of fissure

A

constipation or straining

254
Q

common causes of hemorrhoids

A

constipation or straining

255
Q

s/s of fecal impaction

A

bloating, cramping, distension, very uncomfortable
may use aggressive laxatives, surgical removal, digital removal

256
Q

can men develop breast cancer

A

although not as common, yes they can

257
Q

tail of spence

A

top of upper, outer quadrant that goes up into armpit

258
Q

montgomery’s glands

A

produce oil to keep areola lubricated

259
Q

what is the purpose of glandular tissue in breasts

A

be able to breastfeed

260
Q

approximately how many lobes per breast

261
Q

alveoli in breast

A

produce milk

262
Q

where do breast lobes drain

A

into the lactifereous duct where it is held behind nipple
*all develops during puberty

263
Q

cooper’s ligaments

A

connect breast tissue to chest wall

264
Q

enlargement of central axillary nodes

A

cancer
inflammation
severe ingrown hair

265
Q

where would a supernumerary nipple form

A

along the milk line
*just cosmetic issue

266
Q

what is happening to the onset of puberty over time

A

earlier onset

267
Q

girl height spurt

A

9.5-14.5 years

268
Q

girls menarche onset

A

10-16.5 years

269
Q

breast bud in females

270
Q

pubic hair in females

271
Q

brca1 and brca2 gene mutation

A

can’t fight breast cancer. may elect to have double masectomy

272
Q

penis and scrotum lymphatics drain into

A

inguinal lymph nodes

273
Q

testes lymphatics drain into

A

the abdomen

274
Q

rugae

A

thin skin folded on top of itself on the scrotum

275
Q

cremaster muscle

A

changes size of scrotum based on temp. like 3 degrees celsium cooler than core temp for sperm production

276
Q

phalen’s test

A

carpal tunnel test
hands back to back
note numbness or pain

277
Q

tinel’s sign

A

carpal tunnel
percuss on nerve
note pain/numbness
doesn’t affect pinky

278
Q

central nervous system

A

brain and spinal cord

279
Q

how many cranial nerves

280
Q

how many pairs of spinal nerves

281
Q

autonomic nervous system
ans

A

consists of
parasympathetic nervous system pns
and
sympathetic nervous system sns

282
Q

sensory pathway

A

hot, cold, loud, sharp
your senses

283
Q

motor pathway

A

arm move
leg move
brain coordinating movement

284
Q

parasympathetic nervous system
pns

A

rest and digest

285
Q

sympathetic nervous system
sns

A

fight or flight

286
Q

cerebral cortex

A

gray matter
2 hemispheres
wenicke area
broca area

287
Q

gray matter

A

outter layer of nerve cell bodies
higher functioning happens here

288
Q

cerebral cortex lobes

A

each hemisphere is divided into 4 lobes

289
Q

frontal lobe

A

personality, behavior, emotion, intellect

290
Q

parietal lobe

291
Q

temporal lobe

A

hearing, taste, smell

292
Q

occipital lobe

A

visual reception

293
Q

wrnicke area

A

speech comprehension
understanding
receptive aphasia

294
Q

broca’s area

A

motor speech
articulate speech

295
Q

Basal Ganglia:

A

gray matter, forms extrapyramidal system

`

296
Q

Thalamus:

A

relay station for sensory pathways

297
Q

Hypothalamus:

A

major control center for vital functions

298
Q

Cerebellum:

A

(voluntary) motor coordination, equilirium, muscle tone

299
Q

brain stem

A

midbrain
pons
medulla

300
Q

midbrain

A

motor neurons & tracts connect with thalamus & hypothalamus

301
Q

pons

A

consists of ascending & descending tracts

302
Q
  • Medulla:
A

vital autonomic centers, nuclei for CN VIII- XII, pyramidal decussation

303
Q

spinal cord

A

Long cylindrical structure
Connects brain to spinal nerves
Consists of ascending & descending nerve fiber tracts
Mediates reflexes
Anterior & posterior horns

304
Q

spinothalamic tract

A

anteriolateral
sensations of pain, temp, itching, precise/generalized touch

305
Q

posterior columns

A

position- up down side
vibrations
steriognosis- common object by touch

306
Q

corticospinal or pyramidal tract

A

motor control
fine motor control

307
Q

extra pyramidal tract

A

primitive- like walking motor skills

308
Q

cerebellar system

A

balance and coordination

309
Q

upper motor neurons are located in

310
Q

lower motor neurons are located in

311
Q

right side of brain controls what side of body

312
Q

are spinal nerves sensory or motor

314
Q

reflex arc

A

defense mechanisms
deep tendon reflexes
superficial or cutaneous
visceral response– perrla

315
Q

olfactory
I

cranial nerves

A

nose
sense of smell
common aromas
close eyes
occlude one nostril and smell

316
Q

optic
II

cranial nerves

A

how well eyes work
vision tests
snelling chart
confrontation- peripheral

317
Q

3, 4, and 6

A

make your eyes do tricks

318
Q

oculomotor
III

cranial nerves

A

eye movement
penlight and follow

319
Q

trochlear
IV

cranial nerves

A

eye movement
penlight

320
Q

abducens
VI

cranial nerves

A

eye movement
penlight

321
Q

trigeminal
V

cranial nerves

A

3 branches-forehead, cheek, jaw line
assess by pressing and have them push back or close eyes and use gauze to see if they can tell you where you touch
feel for them to clench teeth

322
Q

facial
VII

cranial nerves

A

smile
raise eye brows
make sure face moves symmetrically

323
Q

acoustic
VIII

cranial nerves

A

hearing
whisper test

324
Q

glassopharyngeal
IX

cranial nerves

A

overlaps with X
gag reflex
stroke back of throat

325
Q

vagus
X

cranial nerves

A

overlaps IX
gag reflex
say ah and palate rises up

326
Q

spinal accessory nerve
XI

cranial nerves

A

shrug shoulders
push against you

327
Q

hypoglossal
XII

cranial nerves

A

tongue movement

328
Q

kernig

reflexes

A

menigeal irritation
leg flexed at hip and knee
push at knee to straighten
will experience pain and can’t straighten

329
Q

brudzinski

reflex

A

lay flat
you raise chin to chest
knees will come up and will experience pain
also meningeal

307 Health Assessment (6 decks)

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