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155 terms

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
Malocclusion:
Drifting teeth that occurs wtih tooth loss
Xerostomia (zir-ə-ˈstō-mē-ə):
Dry mouth
Rinne Test:
Tuning fork is placed on mastoid process, then is quickly inverted and placed by ear canal; patient signals when sound goes away. Positive Rinne test (is normal)when sound is heard twice as long by air conduction as by bone conduction.
AC>BC.
Weber Test:
Tests hearing when patient reports hearing better w/one ear over the other; fork is placed midline skull-should hear sound equally
Torus Palatinus:
A bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate.
Otisis Media:
Inflammation of the middle ear, or middle ear infection.