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Health Assessment > Test 4 Review > Flashcards

Test 4 Review Flashcards

1
Q

Organs in the RUQ

A 
Liver
Gallbladder
Head of Pancreas
Right Kidney
Hepatic flexure of Colon
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2
Q

Organs in RLQ

A 
Cecum
Appendix
Ascending Colon
Small Intestine 
Right Ovary and tube
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3
Q

Organs in LUQ

A 
Left Lobe of LIVER
Spleen
Stomach
Left Kidney
Splenic flexure of colon
Pancreas (body and tail)
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4
Q

Organs in LLQ

A

Sigmoid Colon
Descending Colon
Small Intestine
Left Ovary and tube

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5
Q

Bright Red Vomitus

A

Fresh Blood

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6
Q

Coffee Grounds Vomitus

A

Old Blood that has had time to mix with digestive juices

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7
Q

Vomitus and Bile

-Color

A

Dark brown or black

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8
Q

Order for Assessment of the Abdomen

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
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9
Q

Abdominal Inspection Contour

A

Normal:
-Straight horizontal line from costal margin to symphysis pubis

Abnormal:

  • Rounded
  • Scaphoid - inverted
  • Protuberant - pregnant
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10
Q

Caput Medusae

A

Engorged dilated vein at umbilicus

Vena cava obstruction

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11
Q

Cullen’s Sign

A

Light blue tint at umbilicus
-free blood in peritoneal cavity

This can occur either following rupture of a Fallopian tube secondary to an ectopic pregnancy or w/ ACUTE HEMORRHAGIC PANCREATITIS

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12
Q

Von Recklinghausen’s Disease

A

Cafe au lait spots may be attributed to Von Recklinghousen’s disease

-formation of neurofibromas

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13
Q

Normal Bowel Sounds

A

Intermittent high pitched gurgling sounds
-5-30 times per minute

Normal hyperactive bowel sounds (borborgymi)

Absent bowel sounds are abnormal

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14
Q

Borborygmi

A

Normal Hyperactive bowel sounds. Loud, audible stomach growling sounds )

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15
Q

Murphy’s Sign

A

Assessing for Cholecystitis

  1. With Pt Supine, stand at Pt’s right side
  2. Palpate below the liver margin at the lateral border of the rectus muscle
  3. Have Pt take a deep breath
  4. NORMAL RESPONSE IS ‘NO PAIN IS ELICITED’

Murphy’s sign is positive in inflammatory processes of the gallbladder, such as cholecystitis

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16
Q

Rovsing’s Sign

A

Differential technique to elicit referred pain, reflective of peritoneal inflammation secondary to appendicitis

  1. Press deeply and evenly in the LLQ for 5 seconds
  2. No pain should be elicited
  3. Abdominal pain felt in the RLQ is abnormal and is a positive Rovsing’s sign
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17
Q

Rebound Tenderness

A
  1. Several seconds of firm pressure to abdomen
  2. Hand 90 Degree angle perpendicular
  3. QUickly release pressure
  4. SHOULD NOT HAVE PAIN

-Peritoneal irritation
-Pain in RLQ = Appendicitis
Area in the RLQ is known as MCBURNEY’S POINT

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18
Q

Obturator Muscle Test

A

Test for appendicitis:

  1. Flex knee to hip
  2. Rotate leg inward
  3. Observe for pain
  4. SHOULD NOT HAVE PAIN

Pain indicates irritation of obturator muscle and can be caused by a ruptured appendix or pelvic abscess.

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19
Q

Iliopsoas Muscle Test

A

An inflamed or perforated APPENDIX may be distinguished by irritation of the lateral ilipsoas muscle:

  1. Hand on Rt thigh. Push down as pt raises leg
  2. Observe for pain in RLQ as described by pt
  3. SHOULD NOT BE PAIN

Inflammation of ilipsoas muscle in groin caused by inflamed appendix

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20
Q

Prostate Gland

A

Prostate lies just below the bladder and encircles the urethra like a doughnut
-Size and shape of a chestnut

Prostatic secretions are thin, milky, and alkaline

  • Provide transport medium for spermatozoa
  • fluid composes 15-20% of ejaculate

Primarily for reproduction, also provides protection against UTI

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21
Q

Prostate Structure and Exam

A

Prostate has 5 Lobes:
-Anterior, Posterior, Median, and 2 lateral

The right and left lateral lobes are accessible to examination

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22
Q

Rectal Prolapse

A

Associated with:

  • Poor tone of the pelvic musculature
  • Chronic straining at stool
  • fecal incontinence
  • neurological disease or traumatic damage to the pelvis

Complete rectal prolapse involves entire bowel wall

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23
Q

Rectal Prolapse Assessment

A

A small, symmetrical projection of 2 to 4 cm long indicates a rectal prolapse

The rectal prolapse is best assessed w/ the Pt in a SQUATTING POSITION

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24
Q

Kyphosis

A

Excessive Convexity of the thoracic spine

Pt w/ kyphosis presents w/ chin tilted downward onto the chest and abdominal protrusion.
Forward downward hunching of the head, neck, shoulders, and upper back

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25
Q

Lordosis

A

Excessive concavity of the lumbar spine

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26
Q

Scoliosis

A

Lateral curvature of the spine (the thoracic or lumbar vertebrae). The curvature becomes accentuated on forward flexion of the waist

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27
Q

List

A

A leaning of the spine. If an imaginary line is drawn straight down from T1, the gluteal cleft is lateral to it..

** Look up slide 36 or pg 674

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28
Q

Scissors Gait

A

The gait of a Pt w/ multiple Sclerosis MS:

  • Adduction at the knee level produces short, slow steps
  • Gain is uncoordinated, stiff, and jerky;
  • Foot is dragged across the floor in a semicircle
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29
Q

Spastic Hemiplegia Gait

A

Gait of Cerebral Palsy:

  • extension of one lower extremity w/ plantar flexion and foot inversion
  • arm is flexed at elbow, wrist, and fingers
  • arm does not swing w/ gait

Pt walk by swinging affected leg in a semicircle
Foot is not lifted off the floor

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30
Q

Festinating Gait

A

Gait of Parkinson’s disease:

  • Pt has decreased step height and length
  • Increased step speed, resulting in shuffling
  • posture is stooped
  • hesitation to begin walking and to terminate walking
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31
Q

Antalgic Gait

A

Degenerative joint disease of the hip:

-Limited weight bearing on affected leg in an attempt to limit discomfort

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32
Q

Normal Gait

A

Walking is initiated in one smooth, rhythmic fashion
-foot is lifted 2.5 to 5 cm (1 to 2 inches) off the floor and propelled 12 to 18 inches forward in a straight path

Read pg 633

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33
Q

Tinel’s Sign

A

A tingling or pricking sensation that occurs in the hand, thumb, index, and middle fingers when the median nerve is tapped is indicative of median nerve compression (carpal tunnel syndrome)

Tingling in hand, thumb, index or middle finger abnormal = POSITIVE TINEL’S

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34
Q

Phalen’s Sign

A
  1. Ask the Pt to maintain the wrist flexion of 90 degrees for at least one minute
  2. Ask the Pt to describe the sensations that occur in the hands and fingers

Normal:
-There will be no change in the sensation of the hands and fingers

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35
Q

Trendelenburg Test

A
  1. Ask Pt to stand on one foot, w/ the knee of the non-weight bearing leg flexed to raise the foot off the floor.
  2. Assess the symmetry of the iliac crests while the Pt is standing on one leg

Normal:
-The iliac crest on the side opposite the weight-bearing leg elevates slightly

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36
Q

Limb Measurement

A
  1. Place Pt. in a supine position on the exam table w/ the legs extended
  2. Measure the leg from the anterior superior iliac spine to the medial malleolus

Normal:
-Limb length measurements should be w/in 1 to 3 cm of each other.

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37
Q

Cervical Spine ROM

A
  • Chin to chest (flexion) 45 degrees
  • Look up at ceiling (hyperextension) 55 degrees
  • Move ear to shoulder w/out elevating shoulder (lateral bending) 40 degrees
  • Turn head to each side to look at shoulder - 70 degrees
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38
Q

Shoulders ROM

A
  • Forward Flexion – 180 degrees
  • Hyperextension – 50 degrees

Abduction – 180 degrees
Adduction – 50 degrees

Internal Rotation – 90 degrees
External Rotation – 90 degrees

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39
Q

Elbow ROM

A

Flexion – 160 degrees
Extension – 0 degrees

Supination – 90 degrees
Pronation – 90 degrees

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40
Q

Wrist ROM

A

Flexion – 90 degrees

Hyperextension – 70 degrees

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41
Q

Fingers ROM

A

Flexion – 90 degrees

Hyperextension – 30 degrees

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42
Q

Wrist Deviation

A

Radial deviation – 20 degrees

Ulnar deviation – 55 degrees

43
Q

Assessing Distal Limbs and Digits

A

Ask the Pt to perform specific movements of the distal limb on command:

Assessing Median Nerve:

  • Ask pt to perform opposition of the thumb to the little finger
  • Normal = complete motor function of the distal limb and digits, and the pt will not experience any numbness or tingling.

Assessing Ulnar nerve:
-ask pt to perform abduction of the fingers

Assessing Radial Nerve:
-ask Pt to perform hyperextension of the thumb or wrist

44
Q

Assessing the Median Nerve

A

Ask Pt to perform opposition of the thumb to the little finger of the same hand.

Normal finding is that there will be complete motor function of the distal limb and digits, and the Pt will not experience any numbness or tingling

45
Q

Assessing the Ulnar Nerve

A

Ask Pt to perform abduction of the fingers

46
Q

Assessing the Radial Nerve

A

Ask Pt to perform hyperextension of the thumb or wrist

47
Q

Herniated Intervertebral Disc

A
  1. Pt is placed in a supine position w/ both legs fully extended
  2. Ask Pt to raise both legs at least 2 inches off table while maintaining the legs in extension for at least 30 seconds

Inability to do this is suggestive of pressure on the spinal nerves and is indicative of a herniated intervertebral disc

48
Q

Ovarian Cycle

A

Consists of 2 phases:

  1. Follicular phase
  2. Luteal phase

During Follicular phase:
-Actions of FSH and LH from anterior pituitary gland stimulate ripening of 1 ovarian follicle called graffian follicle. Remaining follicles are suppressed by LH

Ovulation occurs when high levels of LH cause the release of the ovum from the Graafian follicle

DUring Luteal phase, LH stimulates development of the corpus luteum

49
Q

Follicular Phase

A

During the follicular phase, actions of FSH and LH from the anterior pituitary gland stimulate the ripening of one ovarian follicle called the Graafian follicle. The remaining follicles are suppressed by LH

50
Q

FSH

A

Follicle stimulating Hormone
-FSH and LH from pituitary gland stimulate one ovarian follicle called Graafian follicle

FSH is engaged in ripening of one ovarian follicle

51
Q

LH

A

Luteinizing Hormone

  • stimulates development of corpus luteum
  • suppresses all other follicles
52
Q

HCG

A

Human Chorionic Gonadotropin

  • secreted by the implanting blastocyst
  • maintains Corpus Luteum
  • HCG is tested in pregnancy tests
53
Q

Ovulation

A

Ovulation occurs when high levels of luteinizing hormone LH cause the release of the ovum from the Graafian follicle

  • Endometrial lining begins to regenerate under the influence of estrogen
  • Cervical mucus becomes clearer, thinner, and threadlike
  • Basal body temp rises
54
Q

Allergies (Vagina)

A
  • Numerous feminine hygiene products can cause allergic reactions or increase the incidence of CANDIDA VAGINOSIS
  • Be aware of any latex allergies; condom and diaphragms are usually made of latex.
  • Spermicide nonoxynol 9 can also cause allergic reactions
55
Q

Menarche

A

The onset of menstruation, which occurs between 9 and 16 years of age, and ends at menopause, which occurs between 45 and 55 years of age

56
Q

Menopause

A

Cessation of menstruation

Associated Symptoms Include:
-hot flashes, palpitations, numbness, tingling, drenching sweats, mood swings, vaginal dryness, itching

Treatment of symptoms includes
-Estrogen replacement therapy

57
Q

Pap Smear (Preparation)

A

Instruct the Pt not to use vaginal sprays, douche, or have coitus 24 to 48 hours before the scheduled physical assessment and a Pap smear

58
Q

Pap Smear (procedure)

A

Collection of specimens from the ENDOCERVIX and the CERVIX
-In Pt w/ hysterectomy, specimen is obtained from vaginal cuff.

Purpose of Pap smear is to evaluate cervicovaginal cells for pathology that may indicate carcinoma

59
Q

HSV

A

Herpes Simplex Virus

Small, swollen, red vesicles that fuse together to form a large, burning ulcer that can be painful and itch are indicative of herpes simplex virus HSV

60
Q

HPV

A

Human Papillomavirus

White, dry, cauliflower-like growths that have narrow bases are suggestive of condyloma acuminatum (HPV

61
Q

Sexual abuse Signs

A
  1. Bruising of the mons pubis, labia, or perineum, and vaginal or rectal tears
  2. Emotional signs such as lack of eye contact, extreme anxiety or guarding. Refusal to assume certain positions can indicate abuse
  3. Presence of STD in the Very Young or Very Old PT is strongest evidence of sexual abuse
62
Q

Strongest Evidence of Sexual Abuse

A

Presence of an STD in the VERY YOUNG or the VERY OLD Pt is the strongest evidence of sexual abuse.

63
Q

Vaginal Speculum

A

Insert the Speculum at an OBLIQUE angle on a plane parallel to the exam table.

Gently rotate the speculum blades to a horizontal angle and advance the speculum at a 45 degree downward angle against posterior vaginal wall until it reaches end of vagina

Encourage the Pt to BEAR DOWN. This will help to relax the perineal muscles.

64
Q

Cervix

A

Normal Cervix is a glistening pink

  • It may be pale after menopause
  • Blue (chadwick’s sign) during pregnancy
65
Q

Carcinoma of the Cervix

A

Can manifest as a cauliflower-like overgrowth

66
Q

Cervical Polyp

A

Observed as a bright red, soft protrusion through the cervical os.

67
Q

Seminal Vesicles

A

Secrete fluid that helps provide a source of energy for sperm metabolism

Produce prostaglandins, which contribute to sperm motility and viability

68
Q

Urethral Discharge

A

Associated w/

  1. dysuria
  2. painful ejaculation
  3. fever
  4. change in frequency of urination
  5. pruritus, conjunctivitis, arthritis, dermatological rash
  6. STD
69
Q

Urethral Discharge

-further assessment

A
  1. a new sexual partner in the last 6 months
  2. multiple partners
  3. partner known to have other partners
  4. Unprotected intercourse
70
Q

Hydrocele

A

Accumulation of fluid between the two layers of tunica vaginalis.

71
Q

Spermatocele

A

Sperm-filled cysts at the top of the testis or in the epididymis

Blockage of the efferent ductules of the rete testis causes formation of sperm-filled cysts called spermatocele

72
Q

Variocele

A

Dilated veins in the pampiniform lexus of the spermatic cord

Decreased sperm count

73
Q

Inguinal Hernia

A

Ask Pt to turn head and cough

Note any masses felt

Pg 808

74
Q

Epispadias

A

When the urethral meatus opens dorsally on the glans penis

Epispadias is a rare defect that is present at birth (congenital)

In this condition, the urethra does not develop into a full tube. The urine exits the body from the wrong place

75
Q

Hypospadias

A

Condition in which the urethral meatus opens ventrally on the glans penis

76
Q

Testicular Torsion

A

Surgical Emergency

Twisting or torsion of testis causes venous obstruction, secondary edema, eventual arterial obstruction

77
Q

Cryptorchidism

A

Describes one or both testes that are undescended

Absent testes

78
Q

Orchitis

A

Presents as an acute, painful onset of swelling to the testicle along w/ warm scotal skin, described as “heaviness in the scrotum.”

It is an infectious process, w/out sudden onset

79
Q

Epididymitis

A

Palpation reveals induration swollen, tender epididymis

Pathogenic organisms from urethra to epididymis
Bacterial pathogens:
-Chlamydia trachomatis
-Neisseria gonorrhoeae

80
Q

Epididymitis Symptoms

A
  • Blood in semen
  • Discharge from urethra
  • Discomfort in lower abdomen or pelvis
  • Fever
  • Groin Pain
  • Lump in testicle
  • Pain during ejaculation or urination
  • Painful scrotal swelling and testicle pain during bowel movement
81
Q

Scrotal Edema

A

-Scrotal edema accompanies edema associated w/ the lower half of the body, such as CONGESTIVE HEART FAILURE, RENAL FAILURE, AND PORTAL VEIN OBSTRUCTION

Trauma is a major cause of acute scrotal swelling

Scrotal or testicular hematoma formation, as well as testicular rupture, may be present

82
Q

Transillumination of the Scrotum

A
  • Used to determine the etiology of a scrotal mass
  • Normal = no red glow
  • Normal testicle does not transilluminate

Transmission of a red glow indicates serous fluid w/in the scrotal sac (indicating either hydrocele or Spermatocele)

83
Q

Breast Masses

A

Breast masses can occur anywhere in the breast or axilla

Usually found in the upper outer quadrant because it is the location of most of the glandular tissue

Masses can be unilateral or bilateral

84
Q

Breast Masses

-characteristics

A

Masses that are soft, well defined, and tender indicate cysts

These are most common in women ages 30 to 50 yrs and will diminish after menopause.

85
Q

Breast Inspection

A
  1. Arms at Side
  2. Arms over head
  3. Hands on hips
  4. Lean Forward

Reddened areas of the breasts, nipples, or axillae are abnormal findings and may indicate inflammation
-An infection such as mastitis, or inflammatory carcinoma.

Unilateral superficial vascular patterns are abnormal
-They occur as a result of an increased blood supply and may indicate tumor formation, which requires increased vascularization and an increased blood supply.

86
Q

Breast Inspection

-Facing you-Arms at Side

A
  • Areola nipples
  • Color
  • Vascularity
  • Thickening
  • Contour
  • Dimples
  • Lesions/masses
  • Exudates
87
Q

Breast Inspection

-Arms overhead

A

Repeat the inspection w/ the Pt’s arms raised over head. This will accentuate any retraction (tissue drawn back) if present.

88
Q

Breast Inspection

-Hands on Hips

A

Repeat the inspection w/ the Pt pressing her hands into her hips

Will contract the pectoral muscles and accentuate any retractions if present

89
Q

Breast Inspection

-Pt leaning forward

A

Have the Pt lean forward to allow the breasts to hang freely away from the chest wall and repeat the inspection

Look for retractions, dimples, and masses

90
Q

Fibroadenoma

A

The MOST COMMON benign tumor of the breast in women under 30 years old.

Lumps may be:

  • Mobile, easily moveable under the skin
  • single lobular nodule
  • non-tender, Painless
91
Q

Peau d’ orange

A

Characterized as thickening or edema of the breast tissue or nipple and may present itself as enlarged skin pores that give the appearance of an orange rind.

May be indicative of obstructive lymphatic drainage resulting from a tumor, or inflammatory breast cancer

Diagnosed via core biopsy // 1% of cancers

92
Q

Breasts of Pregnant Women

A

Colostrum:
-During pregnancy and up through the first week after birth, there may be a yellow discharge from the nipples known as colostrum

93
Q

Breast Palpation

A

Pt supine includes the following:

  1. Peripheral breast tissue to the nipple, the tail of spence, and the areola
  2. The nipple is compressed to express any discharge
  3. Tail of Spence should be included in exam because this area and the upper outer quadrant are the areas where MOST BREAST MALIGNANCIES DEVELOP
  4. Area around areola should be palpated for masses
94
Q

Palpating Nodes

A
  1. Infraclavicular Nodes
  2. Supraclavicular Nodes
  3. Axillary Nodes
95
Q

Breast Cancer

A

Poorly defined, firm lump that is non-tender, fixed to the skin, and more than 1 cm in diameter should be reported as suspicious of breast cancer.

Risk Factors:

  • females
  • early menarche
  • over age 50
  • Personal or family history
96
Q

Chadwick’s sign

A

Blue Color of the Cervix during Pregnancy

97
Q

Late Menarche

A

Primary amenorrhea is defined as late onset of menarche among females aged 16 (or 14 if secondary sex characteristics are present).

Evaluate client for:

  1. Pregnancy
  2. Inadequate nutrition / eating disorders
  3. chronic diseases/ Crohn’s disease
  4. environmental stess/ intense athletic training
  5. Use of opiates or steroids
  6. autoimmune disease
98
Q

Alcohol and GI

A

Altered nutrition, impaired gastric absorption, at risk for upper and lower GI bleeding, cirrhosis of liver

99
Q

Mastitis

A

Inflammatory condition of the breast that occurs most frequently in lactating women.

Manifests as a local area that is swollen, painful, and erythematous and is usually caused by Staphylococcus aureus (S. aureus).

Fever is usually present

100
Q

Colostrum

A

During pregnancy and up through the first week after birth, there may be a yellow discharge from the nipples known as colostrum.

101
Q

Breast Palpation

A
  1. Wedge method
  2. Concentric circles
  3. Parallel lines
  • Glandular Tissue
  • Areola
  • Compression of nipple
  • Bimanual palpation
102
Q

Indirect Inguinal Hernia

A

Palpated at the inguinal ring. An impulse may be felt on the fingertip when the Pt is asked to cough.

A larger indirect inguinal hernia may feel like a mass at the inguinal canal

103
Q

Direct Inguinal Hernia

A

Oval swelling found at the pubis on inspection. Coughing causes enlargement on palpation of the mass.

Portions of the bowel or omentum protrude directly through the external inguinal ring.

Health Assessment (8 decks)

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