Health Assessment-Exam 2

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Inspection:

Careful scrutiny of individual as a whole, then each body system.

Palpation:

Using touch to asses factors of texture, temperature, moisture, organ location/size/swelling, vibration/pulsation, rigidity/spasticity, crepitation, lumps/masses, and tenderness or pain.

Percussion:

Tapping of person's skin w/short, sharp strokes to assess underlying structures.

Light palpation:

Detects surface characteristics

Deep palpation:

Used to identify abdominal contents.

Indirect percussion:

Two handed percussion, when fixed hand is stationed on person's skin.

Direct percussion:

Striking hand directly contacts body wall.

Resonant Percussion Notes:

Quality-Clear; hollow w/low pitch

Hyperresonant Percussion Notes:

Quality-Booming; lower pitch

Tympany Percussion Notes:

Quality-musical and drumlike; high pitch

Dull Percussion Notes:

Quality-muffled thud; high pitch

Flat Percussion Notes:

Quality-a dead stop of sound, absolute dullness; high pitch

Diaphragm:

Part of stethoscope best used on high pitch sounds

Bell:

Part of stethoscope best used for low pitched sounds

Otoscope:

Funnels light into ear canal

Ophthalmoscope:

Illuminates internal eye structures

General approach:

Being aware of patient's and examiner's emotional state.

Infant & toddler assessment:

Heart & Lungs first; bowel, ENT, then reflexes

Preschooler assessment:

On parents lap; warm-up games; thorax, abdomen, extremities first; head area last.

Sick patient assessment:

Episodic mini-data base; not full assessment

Areas of the General Survey:

Physical appearance
Body structure
Mobility
Behavior

Physical appearance includes:

Age
Sex
Level of consciousness (LOC)
Skin Color
Facial features

Body Structure includes:

Stature
Nutrition
Symmetry
Posture
Position
Body build, countour

Mobility includes:

Gait
Range of motion

Behavior includes:

Facial expression
Mood and affect
Speech
Dress
Personal hygiene

BMI (Body Mass Index):

Practical marker of optimal weight for height

Waist-to-hip ratio:

Assesses body fat distribution

Influences on temperature:

Diurnal cycle (daily temperature cycle)
Menstrual cycle
Exercise
Age

Sinus Arrhythmia:

Heart rate irregularity that varies w/the respiratory cycle.

Pulse Pressure:

Difference between systolic & diastolic pressure

Physiologic factors controlling BP:

Cardiac output
Peripheral vascular resistance
Volume of circulating blood
Viscosity
Elasticity of vessel walls

False high blood pressure:

Cuff to narrow
Cuff too loose
Deflating cuff too slowly
Failure to wait before repeating
Halting during descent and reinflating

False low blood pressure:

Failure to palpate radial artery while inflating
Inflating not high enough
Diaphram too hard on brachial artery

Orthostatic hypotension:

Systolic pressure drop of more than 20 mm Hg
or
Orthostatic pulse increases 20 bpm

Coarctation (kō-ärk-ˈtā-shən) of the aorta:

A congential form of narrowing

Nociceptors (nō-si-ˈsep-tər):

Specialized nerve endings designed to detect painful sensations from the periphery.

Interneurons:

A neuron of the CNS that transmits impulses from sensory to motor neurons or to other interneurons.

Anterolateral spinothalamic tract:

Pain signals ascend to the brain by this tract

Nociception:

Noxious stimuli are perceived as pain

Visceral pain:

Pain originates from larger interior organs

Deep somatic pain:

Pain originates from blood vessels, joints, tendons, muscles and bones

Cutaneous Pain:

Pain originates from skin and subcutaneous tissue

Referred pain:

Pain felt at one site, but originating from another

Acute pain:

Short term and self limiting

Chronic Pain:

Lasts 6 months or longer

Transduction:

Noxious stimulus takes place in the periphery

Transmission:

Pain impulse moves from the level of the spinal cord to the brain

Perception:

Indicates the conscious awareness of a painful sensation

Modulation:

Pain message is inhibited

Neuropathic Pain:

Abnormal processing of pain message
Most difficult type of pain to assess and treat
Neurochemical level

Objective pain behavior:

Nonverbal cues
Acute: guarding, grimacing, moaning, agitation, restlessness, stillness
Chronic: bracing, rubbing, diminished activity, sighing, appetite change

Dermis layer:

Consists mostly of collagen (a connective tissue); nerves, sensory receptors, blood vessels and lymphatics found here.

Newborn skin:

Thin, smooth,elastic, more permeable than adults; more at risk for fluid loss; subcutaneous layer is thin and inefficient

Pregnancy:

This condition causes incresed pigmentation

Pruritus (pru-rite-tus):

Itch is an unpleasant sensation that causes the desire or reflex to scratch

Lesion:

Refers to any abnormality of tissue in the body

Pallor:

Skin looks pale

Erythema (er-ə-ˈthē-mə):

Skin looks flushed (red)

Cyanosis:

Skin looks mottled or bluish

Jaundice:

Skin looks yellow

Diaphoresis:

Profuse perspiration

Dehydration:

Mucous membranes look dry; lips dry & cracked

Primary Lesion:

A lesion that develops on previously unaltered skin

Secondary Lesion:

When a lesion changes over time

ABCDE Rule:

Asymmetry, Border, Color, Diameter, Elevation

Annular:

Circular lesion-begins in center and spreads to periphery

Confluent:

Lesions that run together.

Discrete:

Lesions that are distinct and remain separate

Gyrate:

Twisted, coiled spiral,snakelike lesions.

Polycyclic:

Annular lesions grow together

Zosteriform:

Linear arrangement along nerve route

Hematoma:

A bruise you can feel

Salivary glands that may be examined:

Parotid Glands:
In cheeks, over mandible, anterior to and below the ear
Submandibular Glands:
Beneath the mandible at the angle of the jaw

Sublingual glands:

The third pair of salivary glands, that lie in the floor of the mouth.

Two major neck muscles:

Sternomastoid muscle and the trapezius muscle

Thyroid gland:

Endocrine gland w/rich blood supply that synthesizes and secretes (produces & discharges) T3 & T4 hormones that stimulate cellular metabolism

Lymph Nodes :

Filter lymph and engulf foreign substances and may become swollen with infection.

Fontanels:

The spaces where sutures intersect on infants
aka-soft spots

Areas Lymph nodes can be examined:

Head/neck, arms, axillae and inguinal region
Greatest amount in head/neck region

Hyperplasia:

A general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen

Head of infants/children:

Measure head w/each vist up to 2 years; yearly up to 6

Hydrocephalus:

Accumulation of excessive amounts of CSF within the ventricles of the brain

Paget's disease of bone:

Disease that softens, thickens and deforms bone

Crainosynostosis:

Premature closure of the skull sutures

Acromegaly (ak-rō-ˈmeg-ə-lē):

Excessive secretion of growth hormone from the pituitary; after puerty creates an enlarged skull and thickend crainal bones

Transillumination:

Inspection of infant skull for suspected intracranial lisions or abnormal sized head.

Torticollis (wryneck):

Hematoma in one sternomastoid muscle, resulting in head tilt to one side.

Pilar cyst (Wen):

Smooth, firm, fluctuant (moveable & compressible) swelling on the scalp; benign growth.

Facial features associated with Fetal alcohol syndrome:

Short palpebral fissures
Low nasal bridge
Indistinct philtrum
Thin upper lip

Trisomy 21:

Down Syndrome-upslanting eyes, flat nasal bridge, small broad flat nose, protruding thick tounge, short broad neck, etc.

Parkinson's syndrome:

Caused by a deficiency of the neurotransmitter dopamine, causing degeneration of the basal ganglia in the brain.
Face is flat and expressionless; mask-like

Cushing's Syndrome:

Caused by excessive secretion of ACTH hormone & chronic steroid use; person develops rounded, moon-like face, prominent jowls, red cheeks, etc.

Goiter:

An increased size of the thyroid gland
Occurs w/hyperthyroidism, Hashimoto's Thyroiditis & hypothyroidism

Exophthalmos:

Bulging eyeballs

Bell's Palsy:

Unilateral facial paralysis caused by paralysis of cranial nerve 7; rapid onset caused by a virus.

Scleroderma:

Connective tissue disease characterized by hardening and shrinking changes in skin, blood vessels, muscles.

Sclera layer:

Outer layer of eye; tough, protective white covering; covers iris and pupil

Three concentric coats of eye:

Sclera, Choroid and Retina

Choroid layer:

Has dark pigmentation to prevent light from reflecting internally and is heavily vascularized to deliver blood to retina.

Retina layer:

The visual receptive layer where light is changed into nerve impulses.

Pupillary light reflex:

Normal constriction of pupils when bright light shines on the retina.

Direct light reflex:

When one eye is exposed to bright light, constriction of that pupil occurs.

Consensual light reflex:

When one eye is exposed to bright light, simultaneous constriction of the other pupil occurs.

Fixation:

A reflex of the eye toward the object attracting a person's attention.

Accommodation:

Process where eye changes optical power to maintain a clear image (focus) of an object as its distance changes.

Newborns eyes:

Peripheral vision intact
Macual (area of keenest vision) absent at birth-develops at 4 months-mature by 8 months
4 months binocularity established-can fixate on image w/both eyes simultaneously
Eyeball adult size by 8 yoa

Presbyopia:

Len's ability to change shape decreases, causing decreased near vision

Cataracts:

A clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light.

Glaucoma:

Disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye

Chronic open-angle glaucoma:

Gradual loss of peripheral vision

Macular Degeneration:

Breakdown of cells in the macula of the retina, causing a loss of central vision/clearest vision; most common cause of blindness.

Strabismus:

Eyes do not line up in the same direction when focusing. The condition is more commonly known as "crossed eyes."

Diplopia:

Double vision

Confrontation Test:

Gross measure of peripheral vision

Hirschberg Test:

aka-corneal light reflex
Assesses parallel alignment of eye axes
Asymmetry indicates eye muscle weakness or paralysis

Cover Test:

Detects small degrees of deviated alignment; if covered eye "jumps" to re-establish fixation, eye muscle weakness exists.

Diagnostic positions test:

Tests 6 positions to determine muscle weakness or dysfunction of a cranial nerve

Enophthalmos:

Sunken eyes

Ptosis (to-sis):

Drooping upper eye lid
Could be caused by stroke, Bell's palsy, etc.

Ectropion (ek-trō-pē-ˌän, -pē-ən):
:

Lower eye lid rolls out

Entropion (en-ˈtrō-pē-ˌän, -ən):
:

Lower eye lid rolls in

Blepharitis (blef-a-ˈrīte-tus):

Chronic inflammation of eye lids

Anisocoria (ˌan-ˌī-sō-ˈkōr-ē-ə):

Unequal pupil size

Dacryocystitis (dac·ryo·cys·ti·tis):

Inflammation of lacrimal sac; more common in children

Mydriasis (my·dri·a·sis):

Fixed and dilated pupils

Conjunctivitis:

Infection of the conjunctiva; "pink eye" is caused by bacterial or viral infections, allergies or chemical irritation.

External ear (Auricle or Pinna):

Funnels sound waves into the external auditory canal

Tympanic Membrane (eardurm):

Separates the enternal and middle ear

Middle Ear:

Tiny air-filled cavity inside the temporal bone that conducts sound.

Eustachian Tube:

Found in middle ear, allows for equalization of air pressure on each side of tympanic membrane, preventing rupture.

Inner ear:

Sensory organ for equilibrium and hearing.

Vertigo:

Dizziness that feels as if the room is spinning

Tinnitus (tin·ni·tus):

Ringing of ears

Tuning Fork Tests:

Tests for conductive hearing loss by air or bone conduction.

Romberg's Test:

Balance test

Otosclerosis:

Abnormal bone growth in the middle ear that causes hearing loss; common cause of conductive hearing loss in young adults between 20-40.

Otitis Media:

Middle ear infection caused by obstruction of eustachian tube .

Pathways of Hearing:

Normal pathway is air conduction; alternate route is bone conduction.

Conductive:

Weber test and Rinne test determines this type of hearing loss.

Epistaxis:

Nose bleeds

Number of teeth:

Permenant (adult): 32
Primary (baby teeth): 20

Cranial nerve 12:

Allows us to stick out our tounges.

Tonsil grading:

+1 Visible, +2 Halfway between tonsillar pillars and uvula, +3 Touching uvula, +4 Touching each other

Paranasal sinuses:

Air filled pockets within the cranium

Two sinuses accessible to examine:

Frontal and Maxillary sinuses

Two sinuses present at birth:

Maxillary and ethmoid sinuses

Turbinates:

Three parallel bony projections on the lateral walls of the nasal cavity

Deciduous teeth:

These teeth erupt between 6 & 24 months

Oral moniliasis:

Yeast infection of the mouth and throat caused by a fungus formerly called Monilia, now known as candida albicans

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