Health Assessment 4 Flashcards

Health Care
Terms Definitions
ecchymosis
bruising
CULTURAL CONSIDERATIONS
cn 8
acousticwhisperweberrinne
PEDICULOSIS CAPITIS
head lice/nits
miosis
constricted pupils (587)
ONYCHOGRYPHOSIS
overgrowth of the nail
CONFLUENT
lesions that run togetherurticaria
CYST
elevated, encapsulated, fluid-filled or semisolid mass originating in the subcutaneous tissue or dermis;1 cm or largersebaceous cysts/epidermoid cysts
tinnitus
ringing in the ear
PLAQUE
elevated, solid, palpable mass, circumscribed border, larger than 0.5cm,psoriasis, actinic keratosis, lichen palms
causes of hypertension
-smoking-dyslipidemia-disruption is amount of lipids in blood.-diabetes mellitus-age >60-sex (men and postmenapause women)-family historyHeart diseases:-left ventricular hypertrophy-angina or prior myocardial infarction-prior coronary revascularization-heart failurestroke or transient ischemic attacknephropathyperipheral arterial diseaseretinopathy
PERRLA
pupils:equalroundreact to light and accomodation
nails
well trimmedattached to nail platetransparent with white tipscapillary refill under 2 seconds
Maxillary hypoplasia, Micrognathia, and auricular deformity is seen in:
Treacher-Collins Syndrome
CUSHING'S SYNDROME
increased adrenal hormone production leading to a rounded "moon" face, ruddy cheeks, prominent jowls, and excess facial hair
JUGULODIAGASTRIC
digastric/having 2 bellies; said of certain muscles
ERYTHEMA
redness due to increasesd bisibility of nml oxyhemoglobin; face and upper chest
THYROID GLAND
largest gland, butterfly shaped; located at the anterior portion of the neck; lies over the trachea and the sternocleidomastoid muscles covering the lateral aspects of the lobes
TARGET
lesions with concentric circles of color
junctional nevus
macular only. not raised mole
auscultatory gap
period when Korotkoff's sounds disappear during auscultation.occurs in about 5% of people, most often in HPT due to noncompliant arterial system
assessment techniques: ORDER
1. inspection2. Palpation3. Percussion4. Auscultation
temperature
warm to toucheven on both sides
Severe maxillary and midfacial hypoplasia with low set ears is seen in:
Crouzon Syndrome
The ____, a coiled structure containing the organ of Corti, transmits sound impulses to the eith cranial nerve.
cochlea
COMMON NAIL ABNORMALITIES
clubbing-lack of oxygen; grooves, ridges, pitting-chemo patients; brittle thickening, swelling;
PORT WINE STAIN
flat, irregularly shaped lesion ranging in color from pale red to deep purple red; color deepens with exertion, emotional response, or extreme temps;present at birth and does not fade; large flat mass of bld vessels;commonly appears on the face/head but may occur at other sites
rinne test
comparing AC and BCnormal is AC>BC
diastolic pressure
the elastic recoil, or resting, pressure that ht eblood exerts constantly between each contraction
neuropathic pain
abnormal processing of the pain message. difficult oassess and treat. -pain is often perceived long after the site of injury heals.-sustained on neurochemical level, cannot be identified by xray, cat scan
macule
solely a color change, flat and circumscribed of less than 1cm. ex. freckes, flat nevi, hypopigmentation, petechiae, measles, scarlet fever.
urticaria (hives)
wheals coalesce to form extensive reaction, intensely pruritic
3) thoracic expansions
chest expands symmetrically and bilaterally
Palpation
examination of the body using the sense of touch (568)
Dialated scalp veins and bossing of the skull, as well as sclera visible above the iris are seen with:
Hydrocephalus
The ___ is the dense, avascular structure that appears anteriorly as the white part of the eye. It physically supports the internal structure of the eye.
Sclera
____ are small, whitish uric acid crystals along the peripheral margins of the auricles and may indicate gout.
Tophi
circumoral pallor is associated with:
scarlet fever
 
Lip pallor-anemia
 
Cyanosis-resp. or CV problems
 
Swelling of lips-Infection or Allergy (angioedema)
 
Round, oval, or irregular bluish grey macules on the lips and buccal mucossa-Peutz-Jeghers syndrome
SCHAMROTH TECHNIQUE
used to assess clubbing; ends of fingers become enlarged, soft, and spongy; the angle b/t the skin and the bail base is >160 degrees
VENOUS LAKE
varicose veins; flat blue lesion with radiating, cascading, or linear beins extending from the center; ranges in soze frp, 3-25cm; a type of talangiectasis (vascular dilation/spider veins) caused by increased intravenous pressure in superficical veins;anterior chest/lower legs near varicose veins
diagnostics positions test
CNIII, IV, VIassesses for muscle weakness during movement. EOM's: extra ocular movements. ask pt to hold head steady and follow movement of yr finger as moves in 6 cardinal positions, holding and returning to center. observe for parallel tracking and presence of nystagmus only in extreme lateral gaze.note placement of upper eyelid which should overlap superior part of eye lid.
cherry (senile) angiomas
small, smooth, slightly raised bright red dots that commonly appear on the trunk in all adults over 30.
senile lentigines
commonly called liver spots and are small, flat brown macules.
systolic pressure
the maximum pressure felt on teh artery during left ventricular contraction or systole.
respirations
30 seconds, multiply by 2 and not rhythm
______ is elicited by gentle grasping the cricoid cartilage and applying upward pressure while the patient stands with his or her chin extended upward. A downward tug of the trachea may be felt if an aneurysm is present.
Oliver's Sign
T or F
The facies of older adults vary wit their nutritional status.
True
Inflammatory process involving both the choroid and the retina with sharply defined lesion, generally whitish yellow that becomes stippled with dark pigment in the later stages ending with a chorioretinal scar:
Chorioretina Inflammation-most common cause is laser therapy for diabetic retinopathy but may also be seen in histoplasmosis, cytomegaloviris, toxoplasmosis, or congenital rubella infections
 
Can help establish causal agents
 
Visual field defect can be detecked with a large lesion.
A hairy tongue with yellow-brown to black elongated papillae on te dorsum of the tongue sometimes follows:
antibiotic therapy
Inflammation of the vestibular nerve following an acute viral upper respiratory infection
Acute Vestibular Neuronitis
POSTERIOR AURICULAR NODE
behind the ear,over the outer surface of the mastoid bone
"20/20" means....
normal visual acuity is 20/20. top 20 indicates the distance the person is standing from the chart. while denominator gives the distance at which a normal eye could have read that particular line.
orthostatic hypotension
a drop in systolic pressure of more than 20mm Hg and/or orthostatic puse increases of 20bpm or more, occurs iwth a quick change to a standing position. Orthostatic changes also occur w/ prolonged bedrest, older age, hypovolemia, and some drugs.
graphethesia
im going to write a number in your hand please tell me what it is
_____ are often tender with redness and swelling to the midline of the neck and often are associated with difficulty swallowing and breating. They move upward with tongue protrusion and swallowing and may have a small opeing in skin with drainage of mucus
Thyroglossal duct Cyst
The ____ is located in the temporal region of hte superior eyelid and produces tears that moisten the eye.
lacrimal gland
The _____ is a convergence of small fragile arteries and veins located on the anterior superior portion of the septum.
Kisselbach Plexus
3 LAYER OF SKIN
1)epidermis - basal cell layer (makes new cells), horny cell layer, origin of skin color2)dermis - CT and elastic tissue3)subcutaneous
elderly: hearing loss
cilia lining the ear canal bcms coarse and stiff; this may cause decreased hearing, since it impedes sound waves. also causes cerumen to accumulate and oxidize, reduces hearing.-life history of frequent ear infections may result in scarring on the drum.
normal factors that vary BP
agesexracediurnal rhythm (BP clims to a high in late afternoon and early evening and then declinesweightexerciseemotionsstress
bell abdomen
now im going to listen for bruit with the bell over the abdominal aortarenal arteriesiliac arteries, and noramlly the femoreal arteries but they are in the groin areai would lsiten for 30 secs in each position for the prsence of bruitif bruit were noted it would not be safe to percuss or palpate
Thickening, hardness, or tenderness over the arteries may be associated with temporal ______.
arteritis. A bruit is highly suggestive of a vascular anomally and can be associated with temporal arteritis.
A third fontanel called the ______, located between the anterior and posterior fontanels, may be an expected variant but is also common in infants with ______.
Mastoid Fontanel, Down's Syndrome
A sign of hyperthyroidism is ____ or ____ of the eyelids.
fasciculations or tremors
An instant hearing loss may indicate:
A hearing loss over a few hours or days may indicate:
vascular disruption or autoimmune process, viral infection
A bifid uvula is a benign condition and normal variant in some native american/american indian populations but it may also be a sign of  a
submucous cleft palate
 A bony proturberance that occurs bilaterally on the lingual surface of the mandible, near the canine and premolar teeth.
mandibular torus-an expected variant that occurs in 7-10% of the population. may also occur form the midline of the hard palate and is an expected variant in 20-35% of the population.
normal range of puse rate
60-100. more rapid in infancy and childhood. rate also varies with gender: after puberty, females ahve slightly faster rate than males. >100=anxiety or increased exercise.
clubbing
- angle b/t the nail & nail bed is 180 degrees or >- may be caused by lack of oxygen (582)
Major facial landmarks are the :
palpebral fissures and the nasolabial folds
A ____ is caused by a staphylococcal infection and involves a suppurative inflammation of the follicle of an eyelash resulting in a erythematious or yellow lump.
A hordeolum or Sty.
A red spot on the buccal mucosa at the opening of the stensen duct jis associated with:
parotitis (mumps)
A bluging fontanel with pulsation may be indicative of:
Increased ICP from a space-occupying mass or meningitis.
White specks scattered in a linear pattern around thye entire circumference of the iris are called:
Brushfield spots and are strongly suggestive of Down Syndrome
The roots of teeth are anchored to the alveolar ridges of the ____ and ____.
maxilla and mandible
 
Adults generally have 32 permanent teeth.
review of systems: young adult and children
1. general; wt loss/gain, colds, ear infections, illnesses, energy level, behavior change.2. skin; birthmarks, skin disease, pigment change, moles, rash 3. head; headache, head injury, dizziness.4. eyes; strabismus, diplopia, pain, redness, discharge5. ears6. nose and sinuses7. mouth and throat8. neck9. breast10. respiratory system11. cardiovascular system; cyanosis, limitation of activity, dyspnea on exertions, palpitations, High BP12. Gastrointestinal system13. Urinary system14. genital system15. sexual health16. musculoskeletal system17. neurological: numbness, tingling18. hematoogica: excessive bruising, lymph node swelling, exposure to toxic agents/radiation.19. endocrine system: history of diabetes or thyroid disease, excessive hunger, thirty or urination, abnormal hair distribution, precocious or delayed puberty.
When examining an infants eyes it is best to:
Examining in a dimly lit room encourages the baby to open its eye. Also holding the infant upright suspended under its arms, or holding the baby at one's shoulder, the infant then looking behind the holder, prompts the eyes to open.
A low set position or unusual angle of the auricle may indicate:
chromosomal aberrations or renal disorders
 
Auricular position can be checked by drawing an imaginary line between the canthus of the eye and th most prominent proturberance of the occiput. The top of the auricle should be above this line.
 
Next Draw a verticle imaginary line perpendicular to the previous line just anterior to the auricle. Position hould be almost verticle with no more than 10 degree lateral posterior angle.
In infants a cystic mass high in the neck may be a _________ or a ________. A mass over the clavicle, changing size with crying or respiration, suggests a _______.
thyroglossal duct cyst, brachial cleft cyst, cystic hygroma.
Near vision can be tested and measured using a:
The handheld card such as a rosenbaum pocket vision screener.
 
The patient will hold the card at a comfortable length and read the smallest line possible.
heart
CN I
smell
reflex
biceptriceppatellaachillesbabinski reflex (no response, negtive for babinski reflex)
CONFIGURATIONS/SHAPES OF LESIONS
alopecia
significant hair loss
PITTING IN THE NAILS
THYROID ENLARGEMENT
common in pregnancy
glaucoma
increased ocular pressure--gradual loss of peripheral vision.incidence increases with age, affecting men and blacks
palpate for tenderness
tactile fremitus
PALLOR
loss of color;face, mouth, conjuctivea, and nails; occurs in fair and dark skin (check the mucous membranes for dark skinned clients)
wheal
superficial, raise, transient, and erythematous; slightly irregular shape due to edema.ex: mosquito bite, allergic reaction, dermographism
strabismus
also known as "heterotropia", "squint", "crossed eye", "cockeyed', "wandering eye", or "wall eyed", is a condition in which the eyes are not properly aligned with each
cn 11
spinal accessoryshrug shoulders against handturn head against hand
Dot hemorrhages represent microaneurysms and are commonly seen in patients with:
diabetic retinopathy
PUSTULE
an elevated, pus-filled vesicle or bulla with circumscribed border; size varies;acne, impetigo, and carbuncles/boils
DISCRETE
lesions that are separate and discretemalluscum
POLYCYCLIC
lesions that are circular but unitedpsoriasis
DOWN SYNDROME
trisomy 21;having 3 homologous chromosomes per cell instead of 2; defect causing varying degrees of mental retardation and characterists facial features...slanted eyes, flat nasal bridge, flat nose, protruding tongue, and a short broad neck
chronic pain
doesn't stop when injury heals.outlasts its protective purpse>6 monthsoriginates from abnormal processing of pain fibers from peripheral or central sites.
hyperresonant percussion notes
AMPLITUDE: louderPITCH: lowerQUALITY: boomingDURATION: longerEX: normal is child's lung, abnormal in adult, over lungs w/ increased amount of air, as in emphysems.
paresthesia
sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect
cn 5
trigeminaltouch with cotton ballclench teeth
Enlarged skull with low forehead,corneal clouding and short neck are seen in: 
Hurler syndrome
Trapped epithelial tissue behind the tympanic membrane that is often the result of untreated or chronic recurrent otitis media:
Cholesteatoma
SUBJECTIVE DATA
Previous history of diagnosischange in pigmentation/molespuritus/itchingexcessive moisture-hot flashesdryness-eczemiabruising/leukemia/clottingrash/lesionmeds/orange-yellow colorhair loss/stresschange in nails/nutrition
pulse pressure
the difference between the systolic and diastolic and reflects the stroke volume
cataracts
yellowing and thickening of lensby age 70
oliguria
Oliguria and anuria are the decreased or absent production of urine, respectively. The decreased production of urine may be a sign of dehydration, renal failure or urinary obstruction/urinary retention.
mental status exam: objective dataCOGNITIVE FUNCTIONS
OrientationAttention spanRecent MemoryRemote memoryNew learning: THE FOUR UNRELATED WORDS TEST.
papule
something you can feel. ie. solid, elevated, circumscribed, ex: elevated nevus, lichen planus, molluscum, wart.
cn 12
hypoglossaltongue up, down, side to side
Moon shaped face with thin erythematous skin and a buffalo hump is characteristic of:
Cushings syndrome
See table 11.2 description of various pupil abnormalities.
See table 12-4 oral manifestatons of HIV infection
Children have ___ deciduous teeth that usually erupt between ___ and ____months. Permanent teeth begin forming in the jaw at ___ months, start coming it around ___ age and process is usually complete by ____ age.
20
6-24
6
6
14-15yrs
FETAL ALCOHOL SYNDROME
a disorder characterized by epicanthal folds, narrow palpebral fissures, a deformed upper lip below the septum of the nose, and some degree of mental retardation
patch
macules that are larger than 1cm. ex: mongolian spot, vitiligo, cafe au lait spot, chloasma, measles rash.
mental status exam
systematic check of emotional adn cognitive functioning: four main headings: appearance, behavior, cognition, thought processes or A,B,C,T
nursing process (6)
1. assessment. 2. diagnosis. 3. outcome identification. 4. planning. 5. implementation. 6. evaluation
mean arterial pressure
pressure focing blood into the tissures, averagesd over the cardiac cycle. diastole lasts longer. it is a value closer to teh diastolic pressure plus one third the pulse pressure.
pulses
normally i would palpate each for 30 seconds and multiply by 2 when palpating i would state that0 is absent1 is weak2 is normal3 is increased4 is boundingtemporal is 2+carotid 2+brachial 2+radial 2+ulnar 2+femoral is in the groin areapoliteal 2+dorsalis pedia 2+posterior tibialis 2+
Encephalocele is a ______ with protrusion of the brain and membranes that cover it through openings in the skull.
neural tube defect
 
This condition is often caused by a failure of the neural tube to close completely during fetal development and can have a genetic component occuring in families with a history of spina bifida and anencephaly.
Acute glaucoma is accompanied by:
intense ocular pain
blurred vision
halos around lights
red eye
dilated pupil
occasionally c/o stomach pain n&v
Pupillary constriciton to less than 2mm is called:
 
Pupillary dilation of more than 6mm and failure of the pupils to constrict with light characterize:
 
Inequality in pupillary size is called:
Miosis, Mydriasis, Anisocoria
 
Miosis can be caused by ingestion of narcotics or drugs that control glaucoma.
 
Mydriasis can be caused by coma (due to diabetes, alcohol, uremia, epilepsy, or brain trauma), or some eye drops (glaucoma mediations, atropine, amblyopia management in children).
 
Anisocoria-20% of healthy people have but reflexes are normal.Can be caused by local eye meds or unilateral sympathetic or parasympathetic pupillary pathway destruction
 
The sense of smell-cranial nerve ___ is often tested with recognition of different odors.
CN I
CRUST
dry blood, serum, or pus left on the skin surface when vesicles or pustules burst; red,brown,orange,yellow; large crusts that adhere to the skin surface are called scabs;eczema, impetigo, herpes, or scabss following abrasion
orem's self-care model
focus is self-care. focus on the abilities and limitations of the individual for self-care. if you can do ADL's you're still relatively healthy
psychiatric mental illness
no organic etiology has yet been established, anxiety disorder or schizophrenia
light touch
please close your eyes, im going to touch you with a cotton ballplease point to where i am touching you
Brachial Cleft Cysts  are ____, _____  cysts in the lateral neck. They are a  ____-____ cyst with or without a sinus tract to the overlying skin.
 
They are oval, moderately moveable smooth, nontender, fluctuant masses along the ______ boader of the
1. solitary, painless
2. epithelium-lined
3. anteriomedial boader
4. asymptomatic
Coarse, dry, and brittle hair is seen in_____ whereas
Fine, silky hair is seen in_____ or may be  familial in origin.
 
 
hypothyroidism, hyperthyroidism
The ___ is a biconvex, transparent structure immediately behind the iris. It is supported circumferentially by fibers arising from the cilary bodies and is highly elastic. Contraction and Relaxation of the ciliary body changes its ____ permitting images
Lens, thickness, retina
T or F
The tongue is anchored to the back of hte oral cavity at its base and to the floor of the mouth by the frenulum.
True
SUBMENTAL NODE
behind the tip of the mandible at the midline (chin)
testing for accomodation
distant obj then to finger 3'' from face.normal response:1-pupillary constriction2-convergence of the axes of the eyes
pronate and supinate
please flip your hands back and forth like this quickly
The ____ and ____ are membranous spaces formed where 4 cranial bones meet and intersect.
Anterior and Posterior fontanels
Disruption of normal progressing of retina vascular development in preterm infants is called:
Retinopathy of prematurity
 
35% of preterm infants 1250g or less at birth
46% of those 1000g or less
60% of infants less than 750g
 
Can be mild with no visual defect, or refractive error, amblyopia, or progress to retinal detachment and blindness characterized by straight, temporally diverted blood vessels on fundoscopic examination
The ____ is a clear, thin mucouse membrane that coats the inside of the eyelids and covers the outer surface of the eye and protects the anterior surface of the eye with the exception of the cornea and the surface of the eyelid in contact with the globe.
Conjunctiva
 
The Palpebral conjunctiva coats the eyelid, the bulbar or ocular conjunctiva covers the outer surface of the eye and protests the ant. surface of the eye with exception of the cornea and the surface of the eyelid in contact with the globe.
Hair cells in the _____ detect sound vibration and send the information to the auditory division of the eighth cranial nerve.
organ of Corti
If you see an ulcertive lesion (red or white) appearing as piled up edges around a core on teh lateral border of the floor of the mouth you would suspect:
Oral Cancer
pupillary light reflex
darken room and ask pt to gaze into distance.advance light from side toward 1 eye and note response of pupil. normal response is contriction of pupil that eye (direct light reflex) AND simultaneous constriction of pupil in other eye (consensual light reflex)
Teh estimation of thyroid size by lateral inspection is the most sensitive test for determining:
The pressence of a goiter
T or F
You would only inspect the upper tarsal conjunctiva when there is a suggestion that a foreign body is present.
True
 
A erythematous or cobblestone apperance may indicate an allegic or infectious conjunctivitis.
The health of the optic nerve and evaluation for afferent pupillary defect are tested using:
swinging flashlight test
 
Shine light in one eye and then rapidly swing to the other you should see a slight dilation in the second eye while the light is crossing the bridge of the nose but it should constrict equal to the first eye as the light enters the pupil if it continues to dilate  an afferent pupillary defect called Marcus-Gunn pupil is present.
Risk factors for hearing loss in infants and children include:
prenatal factors: maternal infection, irratiation, drug abuse, syphillis
birth wt less than 1500g
severe hyperbilirubinemia
Infection-bacterial meningitis, reccurent episodes of acute otitis media or otitis media with effusion
cleft palat, craniofacial abnormalities
Ototoxic med use
head trauma
hypoxic episode
2 FORMS OF SWEAT GLANDS
eccrine - produces sweat all over the bodyapocrine - produces sweat at the axillae and peineal area
An expression or apperance of the face and features of the head and neck that, when considered together, is characteristic of a clinical condition or syndrome is referred to as a:
Facies-facies develop slowly and should not be considered a subtle diagnostic clue.
Corneal sensitivity, controlled by CN ___ is tested by touching a wisp of cotton to the cornea. 
The expected response is a blink, which requires intact sensory fibers of CN V (trigeminal nerver) and motor fibers of CN VII (facial nerve).
 
Decreased sensation is often associated with herpes simplex infection.
The following my point toward a change in visual acuity in the older adults:

decrease and/or distortion in central vision


use of dim or bright light to increase visual acuity


complaints of glare


difficulty in performing near work without lenses
Symptoms of congenital abnormalities include:

Failure of infant to gaze at mothers face or other objects.


Failure of infant to blink when bright lights or threatening movements are directed at the face.
The oropharynx is separated from the mouth by bilateral anterior and posterior____.
tonsils-they have crypts that collect cell debris and food particles
Macewen Sign via direct percussion of the skull with one finger is useful in determining:
the presence of hydrocephalus or a brain abscess
The major physiologic eye change that occurs with aging is a progressive weakening of accommodation (focusing power) known as _____.
Presbyopia
 
By 45 years of age the lens becomes more rigid and the ciliary muscles weaker. Te lens also continues to form fibers, old fibers compressed centrally form a denser central region and may cause a loss of clarity of the lens and contribute to cataract formation.
when to record three readins in BP
when a variance greater than 10-12 mm Hg exists between phases IV and V. IV: abrupt muffling, sound mutes ot a low-pitched, cushioned murmur.V: silence
You would perform a ____ test if the visual acuity is recorded as a fraction less than 20/20 to see if the acuity was caused by refractive error.
Pinhole Test
 
It should result in an improvement in acuity by at least one line if refractive error is responsible for the diminished acuity.
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Term:
Definition:
Definition:

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