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NSG 316 > Topic 12 > Flashcards

Topic 12 Flashcards

1
Q

Mouth and Throat-Preparation

A

o Position person sitting up straight with his or her head at your eye level.
o If person wears dentures, offer a paper towel and ask person to remove them.

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2
Q

lips: african americans

A

o African Americans normally may have bluish lips and a dark line on gingival margin

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3
Q

normal gum appearance

A

o Pink or coral with a stippled (dotted) surface
o Tight and well-defined

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4
Q

gums: african american

A

o African Americans normally have a dark melanotic line along gingival margin

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5
Q

Stensen’s duct

A

opening of parotid salivary gland

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6
Q

Leukoedema

A

benign grayish opaque area - normal finding in African Americans & East Indians

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7
Q

Fordyce’s granules

A

o small white or yellow papules on mucosa, tongue and lips (not significant)

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8
Q

anterior hard palate appearance

A

white with irregular transverse rugae

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9
Q

posterior soft palate appearance

A

pinker, smooth, and upwardly movable

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10
Q

Torus palatinus

A

normal; nodular bony ridge down middle of hard palate

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11
Q

Tonsils graded in size as follows:

A
  • 1+ Visible
  • 2+ Halfway between tonsillar pillars and uvula
  • 3+ Touching uvula
  • 4+ Touching each other
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12
Q

normal healthy tonsil grade

A

1+ or 2+

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13
Q

Touching posterior wall with tongue blade elicits what? testing…

A

gag reflex; this tests cranial nerves IX and X, the glossopharyngeal and vagus.

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14
Q

Test cranial nerve XII, hypoglossal nerve, by

A

asking person to stick out tongue;
§ should protrude in midline; note any tremor, loss of movement, or deviation to side.

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15
Q

Edentulous person appearance

A

mouth and lips fold in, giving a “purse-string” appearance

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16
Q

aging adult: GI function

A

-Salivation decreases (dry mouth and decreased sense of taste)
-Esophageal emptying and gastric acid secretion are delayed
-Incidence of gallstones increases
-Decreased liver size, most liver functions remain normal; (however, drug metabolism is impaired)
-frequent constipation

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17
Q

aging adult: common causes of constipation

A

o Decreased physical activity
o Inadequate intake of water
o Low-fiber diet
o Side effects of medications
o Irritable bowel syndrome
o Bowel obstruction
o Hypothyroidism
o Inadequate toilet facilities, difficulty ambulating to toilet

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18
Q

recommendations for obesity

A

o healthy food patterns,
o decreased consumption of sweetened/processed foods,
o increased physical activity

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19
Q

when doing the physcal exam of teh abdomen, you always want to…

A

Auscultate prior to palpation and percussion

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20
Q

inspection of the abdomen: contour

A

Determine profile from rib margin to pubic bone; contour describes nutritional state and normally ranges from flat to rounded
-FLAT, ROUNDED, SCAPHOID, PROTUBERANT

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21
Q

normally the umbilicus is

A

midline and inverted, with no sign of discoloration, inflammation, or hernia

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22
Q

good skin turgor on the abdomen reflects…

A

healthy nutriton

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23
Q

how do you assess skin turgor

A

gently pinch up a fold of skin; then release to note skin’s immediate return to original position

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24
Q

striae

A

striae, silvery white, linear, jagged marks about 1 to 6 cm long
Occur when elastic fibers in reticular layer of skin are broken after rapid or prolonged stretching, as in pregnancy or excessive weight gain

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25
Q

recent striae are what color

A

pink or blue

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26
Q

older striae are what color

A

silvery white

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27
Q

Pigmented nevi (moles)

A

circumscribed brown macular or papular areas, common on abdomen

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28
Q

abdomen: pulsation or movement

A

Normally you may see pulsations from aorta beneath skin in epigastric area, particularly in thin persons with good muscle wall relaxation

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29
Q

ascites

A

free fluis in the peritoneal cavity

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30
Q

what are signs of ascites

A

distented abdomen, bulging flanks, umbilicus that is protruding and displaced forward

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31
Q

Surgical scar alerts you to

A

possible presence of underlying adhesions and excess fibrous tissue.

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32
Q

Percussion and palpation can increase peristalsis, which…

A

would give a false interpretation of bowel sounds.

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33
Q

what side of the stethoscope do you use for bowel sounds and how do you hold it?

A

diaphragm; hold it lightly,

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34
Q

where do you begin when auscultating the abdomen

A

Begin in RLQ at ileocecal valve area because bowel sounds are normally always present here.

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35
Q

Bowel sounds originate from…

A

movement of air and fluid through small intestine

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36
Q

character of bowel sounds

A

Bowel sounds are high pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute; do not bother to count them

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37
Q

bowel sounds can either be…

A

normal, hypoactive, or hyperactive

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38
Q

borborygmus

A

sound of hyper peristalsis

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39
Q

when listening to vascular sounds in the abdomen, what are we listening for

A

no sound usually, abnormal is bruits and thrills

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40
Q

To assess kidney, place one hand over…

A

12th rib at costovertebral angle on back

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41
Q

durinf costovertebral angle tenderness the person normally feels…

A

thud but no pain

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42
Q

when doing palpation in the abdomen, tender areas are examined…

A

last

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43
Q

mcburney’s point

A

appendix tenderness

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44
Q

Murphy’s sign

A

gall bladder tenderness

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45
Q

when should you AVOID palpation

A

when Trauma, injury, distention, or infection can make organs enlarged and friable-prone to rupture with palpation

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46
Q

aging adult: abdomen

A

-increased deposits of subcutaneous fat on abdomen and hips because it is redistributed away from extremities
-Abdominal musculature is thinner and has less tone than that of younger adult, so in absence of obesity you may note peristalsis
-Because of thinner, softer abdominal wall, organs may be easier to palpate, in the absence of obesity
-With distended lungs and depressed diaphragm, liver can be palpated lower, descending 1 to 2 cm below costal margin with inhalation

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47
Q

obesity: inspection

A

uniformly rounded. Umbilicus sunken

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48
Q

obesity: ausultation

A

normal bowel sounds

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49
Q

obesity: palpation

A

Normal. may be hard to feel through thick abdominal wall.

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50
Q

air or gas: inspection

A

single round curve

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51
Q

air or gas: auscultation

A

Depends on cause of gas (decreased or absent bowel sounds w ileus); hyperactive bowel sounds with early intestinal blockage

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52
Q

air or gas: palpation

A

May have muscle spasm of abdominal wall

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53
Q

ascites: inspection

A

Single curve. Everted umbilicus. Bulging flanks when supine. Taut, glistening skin; recent weight gain; increase in abdominal girth

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54
Q

ascites: auscultation

A

Normal bowel sounds over intestines. Diminished over ascitic fluid

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55
Q

ascites: palpation

A

taut skin and increased intra-abdominal pressure limit palpation

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56
Q

ovarian cyst: inspection

A

Curve at lower half of abdomen, midline, everted umbilicus

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57
Q

ovarian cyst: auscultation

A

Normal bowel sounds over upper abdomen where intestines pushed superiorly

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58
Q

ovarian cyst: palpation

A

Transmits aortic pulsation, whereas ascites does not

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59
Q

pregnancy: inspection

A

Single curve. Umbilicus protruding. Breasts engorged.

60
Q

pregnancy: auscultation

A

Fetal heart tones. Bowel sounds diminished.

61
Q

pregnancy: palpation

A

uterine fungus. Fetal parts. Fetal movements

62
Q

feces: inspection

A

localized distention

63
Q

feces: auscultation

A

normal bowel sounds

64
Q

feces: palpation

A

Plastic-like or rope-like mass with feces in intestines

65
Q

tumor: inspection

A

localized distention

66
Q

tumor: ausculation

A

normal bowel sounds

67
Q

tumor: palpation

A

Define borders. Distinguish from enlarged organ or normally palpable structure

68
Q

bowel obstruction characteristics

A

-Would hear decrease/absent bowel sounds past/near obstruction
-Absence of stool or gas passage
-Change in VS (decrease BP, increase pulse, and cool skin)
-Tenderness to palpation
-Fever, vomiting, colicky pain from peristalsis above obstruction

69
Q

umbilical hernia

A

A soft, skin covered mass, the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring.

70
Q

hiatal hernia

A

protrusion of a part of the stomach upward through the opening in the diaphragm

71
Q

epigastric hernia

A

Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.

72
Q

incisional hernia

A

A bulge near an old operative scar that may not show when person is supine but it’s apparent when the person increases intraabdominal pressure buy a sit-up, by standing or by the Valsalva maneuver

73
Q

Valsalva maneuver

A

forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart

74
Q

diastasis recti

A

midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles

75
Q

succussion splash

A

Unrelated to peristalsis, this is a very loud splash auscultated over the upper abdomen when the infant is rocked side to side. It indicates increased air and fluid in the stomach, as seen with pyloric obstruction or large hiatus hernia.

76
Q

hypoactive bowel sounds

A

diminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis; from paralytic ileus as following abdominal surgery; or from late bowel obstruction. Also occurs with pneumonia.

77
Q

bruit

A

systolic pulsatile blowing

78
Q

anorexia

A

A loss of appetite from GI disease as a side effect to some medications, with pregnancy, or mental health disorders.

79
Q

dysphagia

A

difficulty swallowing
-Occurs with disorders of the throat or esophagus, such as thrush, neurological changes or obstruction

80
Q

pyrosis

A

heartburn; burning sensation in upper abdomen due to reflux of gastric acid

81
Q

visceral abdominal pain

A

from an internal organ (dull, general, poorly localized)

82
Q

parietal abdominal pain

A

from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement)

83
Q

hepatitis

A

inflammation of the liver

84
Q

melana

A

black, tarry stools; blood is stool

85
Q

Male rectal exam position

A

left lateral decubitus or standing position; instruct standing male to point his toes together; this relaxes regional muscles, making it easier to spread buttocks

86
Q

female rectal exam position

A

o lithotomy position if examining genitalia as well
-Use left lateral decubitus position for rectal area alone

87
Q

what is the best position for rectal exams in male and female patients

A

left lateral

88
Q

when inspecting the perianal region, instruct the client to

A

spread buttocks wide apart

89
Q

when inspecting the sacrococcygeal area, describe any abnormality in…

A

clock-face terms, with 12:00 as the anterior point toward symphysis pubis and 6:00 toward coccyx

90
Q

normal stool

A

color is brown and consistency is soft

91
Q

abnormal stool

A

Black, gray, tan, pale yellow, greasy, occult blood

92
Q

occult blood test

A

est used to detect hidden blood in the feces
-negative response is normal

93
Q

what can cause a false positive in an occult blood test

A

if person has ingested red meat within 3 days of test

94
Q

colorectal cancer (CRC) screening

A

Screening identifies precancerous polyps so they can be removed before they become cancer

CRC is most often found in people age 50 and older

95
Q

CRC screening tests include: older adult tests

A

o Fecal occult blood test (FOBT)
o Flexible sigmoidoscopy
o Combination of FOBT and flexible sigmoidoscopy
o Colonoscopy
o Double-contrast barium enema

96
Q

abscess

A

o A localized cavity of pus from an infective anorectal gland. Characterized by persistent throbbing rectal pain, and appears red, hot, swollen, indurated, and tender.

97
Q

rectal polyp

A

protruding growth from the rectal mucous membrane that is fairly common;
The polyp maybe pendunculated (on a stock) or sessile (on the surface close to the mucosa wall)

98
Q

fecal impation

A

o A complete colon blockage by hard, desiccated immovable stool, which presents as constipation or overflow incontinence.

99
Q

carcinoma: subjective data

A

frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination; Continuous pain in lower back, pelvis, thighs

100
Q

carcinoma: objective data

A

a malignant neoplasm often starts as a single hard nodule on the posterior surface, producing a symmetry and a changing consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone hard and fixed. The median sulcus is obliterated

101
Q

pilonidal cyst or sinus

A

hair-containing cyst or sinus located in the midline over the coccyx or lower sacrum

102
Q

anorectal fistula

A

Anorectal Abscess starts from an effective anorectal gland; The infection channels through the perianal tissues to form a fistula, a connection between the infected gland and the outside perineum

103
Q

fissure

A

An exquisitely painful longitudinal tear in the superficial mucosa at the anal margin

104
Q

hemorrhoids

A

varicose veins in rectum
-Swollen, painful rectal veins; often a result of constipation

105
Q

rectal prolapse

A

The complete rectal mucous membrane protrudes crew the anus, appearing as a moist red donut with radiating lines

106
Q

Pruritus ani

A

o intense itching and burning in the perineum has myriad causes: soaps, restrictive clothing , fecal soiling or hemorrhoids, eczema or psoriasis, sexually transmitted infections , candida infection from moist or sweaty folds of skin and obese or aging persons, systemic causes such as diabetes and liver disease, and pinworm infestation in children.
o Persistent scratching makes an inflammatory response and shows as red raised thickened excoriated skin may be swollen moist.

107
Q

Dyschezia

A

painful or difficult bowel movement; Pain due to local condition (hemorrhoid, fissure) or Constipation

108
Q

steatorrhea

A

Excessive fat in stool: malabsorption as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn’s disease.

109
Q

Male does not experience a definite end to fertility as female does, around age ___ years, production of sperm begins to decrease, although it continues into _____

A

40; 80s and 90s

110
Q

testosterone production

A

o declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life
o Pubic hair decreases and penis size decreases
o Testes decrease in size and are less firm to palpation

111
Q

Circumcision

A

surgical removal of the foreskin; religious and cultural indications

112
Q

prostate cancer is more common in…

A

North America and northwestern Europe

113
Q

Two main causes of ESRD (End Stage Renal Disease):

A

Hypertension & Diabetes

114
Q

Prevalence of diabetes & hypertension is higher in some racial groups:

A

African Americans, Native Americans & Hispanics are more likely to be affected

115
Q

contributing factors to prevalence of diabetes and hypertension

A

low socioeconomic status lead to poor health outcomes by limiting access to care and/or diagnosis/treatment being delayed

116
Q

It is normal for a male to feel apprehensive about having his genitalia examined, especially by a female examiner, so…

A

CHAPARONE may be needed during exam-request another staff person to be present

117
Q

when inspecting the inguinal region of a male what is normal

A

normall no bulge is region
-Normal to palpate an isolated node on occasion; it then feels small, 1 cm, soft, discrete, and movable

118
Q

what is abnormal when inspecting the inguinal region of a male

A

Enlarged, hard, matted, fixed nodes are abnormal findings

119
Q

penis: normal findings

A

Skin normally looks wrinkled, hairless, and without lesions; dorsal vein may be apparent
-Glans looks smooth and without lesions;
-Normally, penis feels smooth, semifirm, and nontender

120
Q

scrotal size varies with

A

ambient room temperature; asymmetry is normal, with left scrotal half usually lower than right

121
Q

what age should you encourage TSE

A

every male from 13 to 14 years old through adulthood

122
Q

testicular cancer is most common in

A

young men age 15 to 35

123
Q

Points to include during health teaching of TSE are:

A

o T - timing, once a month
o S - shower, warm water relaxes scrotal sac
o E - examine, check for and report changes immediately

124
Q

TSE Teaching Points

A

Phrase your teaching something like this:
A good time to examine testicles is during shower or bath, when your hands are warm and soapy and scrotum is warm; cold hands retract scrotal contents
Procedure is simple; hold scrotum in palm of your hand and gently feel testicles using thumb and first two fingers

125
Q

normal testivle findings

A

Testicle is egg-shaped and movable; it feels rubbery with a smooth surface

126
Q

abnormal testicle findings

A

lumps are very rare and usually not worrisome, but if you ever notice a firm, painless lump, a hard area, or an overall enlarged testicle, call your physician for further check

127
Q

abnormal findings: male gentialia

A

Urethritis, urethral discharge, and dysuria

128
Q

How is prostate cancer detected?

A

detected by testing blood for prostate-specific antigen (PSA) and/or on digital rectal examination (DRE)

129
Q

assessment of urinary function

A

-Observe urine color
Note pH & specific gravity
-Serum analysis of kidney function correlates with creatinine level which is relatively stable (end product of muscle metabolism)
-BUN measures urea which can vary based on several factors (end product of protein metabolism)

130
Q

renal calculi

A

kidney stones; Renal stones (crystals of calcium oxalate or uric acid) form in kidney tubules and then migrate and become urgent when they pass into ureter, become lodged, and obstruct urine flow, causing hydronephrosis

131
Q

acute urinary retention

A

Inability to pass urine with bladder distention and lower abdominal pain.

132
Q

urethral stricture

A

narrowing of the urethra; Pinpoint, constricted opening at meatus or inside along urethra.

133
Q

external female genitalia

A

vulva or pudendum

134
Q

mons pubis

A

a round, firm pad of adipose tissue covering the symphysis pubis

135
Q

labia majora

A

two rounded folds of adipose tissue extending from mons pubis down and around to perineum

136
Q

labia minora

A

o inside labia majora as two smaller, darker folds of skin

137
Q

Female circumcision, known as infibulation or female genital mutilation

A

Invasive surgical procedure (removal partial or total of the clitoris) usually performed on girls before puberty - social custom

138
Q

what does vaginal bleeding aftera woman has gone through menopause indicate?

A

RED FLAG can indicate cancer

139
Q

menopause

A

cessation of menstruation (1 whole year without a period)

140
Q

positioning for exam on female genitalia

A

o Left lateral
o Lithotomy

141
Q

Hair distribution in usual female pattern of..

A

inverted triangle, although it normally may trail up abdomen

142
Q

With your gloved hand, separate labia majora to inspect:

A

o Clitoris
o Labia minora are dark pink and moist, usually symmetric
o Urethral opening appears stellate or slitlike and is midline
o Vaginal opening, or introitus, may appear as narrow vertical slit or as larger opening
o Perineum is smooth; a well-healed episiotomy scar, midline or mediolateral, may be present after vaginal birth
o Anus has coarse skin of increased pigmentation

143
Q

Sexually Transmitted Virus

A

HPV

144
Q

To screen for STIs, and if you note any abnormal vaginal discharge, what should you do

A

obtain gonorrhea (GC)/chlamydia culture

145
Q

if HPV lingers in a womans cervix, what can it cause

A

cervical cancer

146
Q

why do most people never know that they have HPV

A

because virus usually does not cause any symptoms and body is able to fight it off

147
Q

HPV Teaching Points

A

Remind women that obtaining vaccine does not mean they can forget about routine pelvic examinations and Pap tests

Vaccine will protect against major types of HPV that cause cervical cancer, but not all types

Pap tests detect cell changes in cervix before they turn into cancer, at an early, curable stage

Only other way to prevent HPV is to abstain from all sexual activity

Condoms may not protect against HPV because areas not covered by condom can be exposed to virus

NSG 316 (9 decks)

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