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153 terms

Health Assessment Test 3

STUDY
PLAY
nonsynovial joints
the bones are united by fibrous tissue or cartilage and are immovable (sutures of the skull) or only slightly movable
cartilage
covers the surface of opposing bones
ligament
fibrous bands running from one bone to another that strengthen the joint and help prevent movement in undesirable directions
bursa
an enclosed sac filled with viscous synovial fluid, much like a joint
synovial joints
are freely movable because they have bones that are separated from each other and are enclosed in a joint cavity
flexion
bending a limb at a joint
extension
straightening a limb at a joint
abduction
moving a limb away from the midline of the body
adduction
moving a limb toward the midline of the body
pronation
turning the forearm so the palm is down
supination
turning the forearm so the palm is up
circumduction
moving the arm in a circle around the shoulder
inversion
moving the sole of the foot inward at the ankle
eversion
moving the sole of the foot outward at the ankle
rotation
moving the head around a central axis
protraction
moving a body part forward and parallel to the ground
retraction
moving a body part backward and parallel to the ground
elevation
raising a body part
depression
lowering a body part
Phalen's test
ask person to hold hands back to back while flexing the wrists 90 degrees; pain means there is carpal tunnel
Tinel's sign
direct percussion of the location of the median nerve at the wrist produces no symptoms
McMurray's test
special test for Meniscal Tears - if you hear or feel a 'click,' McMurray's test is positive for a torn meniscus
Rheumatoid arthritis
inflammatory condition of the joints
Ankylosing spondylitis
chronic progressive inflammation of spine, sacroiliac, and larger joints of the extremities leading to deformity
osteoarthritis
degenerative joint disease
osteoporosis
decrease in skeletal bone mass
Order of Examination for Musculoskeletal
1. Inspection: size and contour of joint; skin and tissues over joint.
2. Palpation: skin temperature; muscles, bony articulations, area of joint capsule.
3. Range of Motion
4. Muscle testing: apply opposing force, grading muscle strength
Menopause and the breast
ovarian secretion of estrogen decreases, which causes breast glandular tissue to atrophy
Breast cancer
incidence varies with cultural groups; although 12% higher in black women than in white women, black women had a 36% higher death rate than white women
Breast changes in the older adult
-glandular tissue atrophy; replaced with fibrous connective tissue
-decreased size and elasticity
-axillary hair decreases
What to note if a lump is present
-location: breast as clock wise face; distance in cm or diagram nipple and record lump
-size: in cm, width x length x height
-shape: oval, round, lobulated, or indistinct
-consistency: soft, hard, or firm
-movable
-distinctness: solidarity or multiple
-nipple retraction: displaced or retracted
-overlying skin: erythematous, dimpled, or retracted
-tenderness
-lymphadenopathy:palpable lymph nodes
Visible signs of breast cancer
-Retraction signs: abnormal contours, skin dimpling, nipple retraction and deviation
-Skin edema
-Paget's Disease of the Nipple
Benign breast disease lump (formerly fibrocystic breast disease)
-shape: round, lobular
-consistency: firm to soft, rubbery
-demarcation: well demarcated
-mobility: fixed
Cancer lump
-shape: irregular, star shaped
-consistency: firm to stony hard
-demarcation: poorly defined
-mobility: fixed
fibroadenoma lump
-shape: round, lobular
-consistency: usually firm, rubbery
-demarcation: well demarcated, clear margins
-mobility: very mobile, slippery
preadolescent female breast
only a small elevated nipple
female breast bud stage
1. a small mound of breast and nipple develops, the areola widens
2. the breast and areola enlarge; the nipple is flush with the breast surface
3. the areola and nipple form a secondary mound over the breast
Mature female breast
only the nipple protrudes; the areola is flush with the breast contour--the areola may continue as a secondary mound in some normal women
gynecomastia
benign enlargement of male breast that occurs when peripheral tissue convert androgen hormones to estrogens; it is a mobile disk of tissue located centrally under the nipple-areola
central axillary nodes
high up in the middle of the axilla, over the ribs and serratus anterior muscle
pectoral (anterior) nodes
along the lateral edge of the pectoralis muscle, just inside the anterior axillary fold
subscapular (posterior) nodes
along the lateral edge of the scapula, deep in the posterior axillary fold
lateral nodes
along the humerus, inside the upper arm
glandular tissue
lobes, lobules, and alveoli; lactiferous ducts and sinuses
fibrous tissue
suspensory ligaments or Cooper's ligaments, extend vertically from the surface to attach on chest wall muscles
adipose tissue
layers of subcutaneous and retromammary fat which provide most of the bulk of the breast
four quadrants of the breast
divide the breast into four part by imaginary horizontal and vertical lines intersecting at the nipple; make convenient map to describe clinical findings.

Upper outer quadrant: tail of Spence, and most common site of breast tumors
tail of Spence
the cone shaped breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes; located in the upper outer quadrant of the breast
Inspection of female breast
general appearance, skin, lymphatic drainage areas, nipples should be symmetrical; maneuvers to check for skin retraction
Maneuvers to screen for retraction (female breast)
direct woman to change position while you check the breasts for skin retraction signs; ask her to lift arms slowly over her head; both breasts should move up symmetrically;

next ask her to put hands onto hips and push palms together contracting the pectoralis major--both breast should lift slightly

ask a woman with large pendulous breast to lean forward while you support her forearms and note free-forward movement of both breasts
supernumerary nipple
extra nipple along the the embryonic "milk line" on the thorax or abdomen; a congenital finding
Palpation of axillae
while supporting arm palpate: 1) down the chest wall in a line from the middle of the axilla, 2) along the anterior border of the axilla, 3) along the posterior border, and 4) along the inner aspect of the upper arm
Palpate of female breast
in supine position, arm up over head with pad under side to be palpated to spread breast tissue medially, use patterns to palpate every inch of the breast and examine the tail of Spence high into the axilla
Patterns for palpating female breasts
vertical strip: start high in the axilla and palpate down just lateral to the breast

spokes on a wheel: from the nipple palpate out to the periphery as if following spokes on a wheel

concentric circles: palpate in concentric circles out to the periphery
inframmatory ridge
firm transverse ridge of compressed tissue in the lower quadrants of female breast
bimanual technique of palpation for female breasts
used for women with large pendulous breasts; with woman in sitting position, leaning forward: support the inferior part of the breast with one hand, use your other hand to palpate the breast tissue against your supporting hand
abdomen and the aging adult
fat accumulation in the suprapubic area of females due to the decreased estrogen levels; males also have fat deposits in abdominal level

adipose tissue is redistributed way from the face and extremities and to the abdomen and hips
GI and aging adult
-salivation decreases, causing dry mouth and decreased sense of taste

-esophageal emptying is delayed causing risk of aspiration

-gastric acid secretion is decreased

-greater incidence of gallstones

-liver size decreases; drug metabolism by the liver is impaired

-constipation
solid viscera
those that maintain a characteristic shape: liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus
hollow viscera
stomach, gallbladder, small intestine, colon, and bladder; shape will depend on the contents; usually not palpable unless distended (colon-feces, bladder-urine)
liver
fills most of the right upper quadrant and extends over to the left midclavicular line; lower edge of the liver may be palpable
kidney
bean shaped are retroperitoneal, or posterior to the abdominal contents; left kidney lies at the 11th and 12th ribs, right kidney rests 1-2 cm lower and may be palpable
Abdomen: Right upper quadrant
Liver
Gallbladder
Duodenum
Head of Pancreas
Right kidney and adrenal glands
Hepatic flexure of colon
Part of ascending and transverse colon
Left upper quadrant
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney and adrenal
Splenic flexure of colon
Part of transverse and descending colon
Right Lower Quadrant
Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord
Left lower Quadrant
Part of ascending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
Midline (abdomen)
Aorta
Uterus (if enlarged)
Bladder (if distended)
Contours of the abdomen
describe the nutritional state and normally range from flat to rounded; stand on the person's right side and look down at abdomen, then stoop down to view across the abdomen: flat, scaphoid, rounded protuberant
Inspection of the abdomen
Performed 1st
Contour
Symmetry
Umbilicus
Skin
Pulsation or movement
Hair distribution
Demeanor
Auscultating the abdomen
Performed 2nd
Bowel sounds: character and frequency, normal, hypoactive, or hyperactive; high pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5-30 times per minute, do not count them

Vascular sounds (bruits): check over the aorta, renal arteries, iliac, and femoral arteries
Percuss the abdomen
Performed 3rd
-General tympany
-Liver span
--Usual technique
--Scratch test
-Splenic dullness
-Costovertebral angle tenderness
-Special procedures
--Fluid wave
--Shifting dullness
borborygmus
stomach growling caused by hyperperastalsis
hyperactive sounds
loud, high pitched, rushing, tinkling sound that signal increased motility
hypoactive or absent sounds
follow abdominal surgery or with inflammation of the peritoneum
Palpate the abdomen
normally palpable structures:
liver, spleen, kidneys, and aorta

light and deep palpation used, for large or obese abdomens use bimanual technique
light palpation
with first 4 fingers close together, depress the skin about 1 cm; make a rotary motion, sliding the fingers and skin together
deep palpation
using the same technique as light palpation, but push down 5-8 cm
bimanual technique for palpating abdomen
place two hands on top of each other; the top hand pushing, the bottom hand is relaxed and can concentrate on the sense of palpation
percussion of costovertebral angle tenderness
indirect fist percussion causes the tissues to vibrate instead of producing a sound, to assess the kidney, place one hand over the 12th rib at the costovertebral angle on the back; thump that hand with the ulnar edge of your other fist; person will feel thud and pain is not normal. Sharp pain occurs with the inflammation of the kidney or paranephric area
PATIENT EDUCATION TO PROVIDE TO MALES PERFORMING A TESTICULAR EXAMINATION
teach testicular self examination to males 13, 14 through adulthood; teach to know the body and not necessarily about cancer since incidence is low, however early detection is key.

TSE
T-Timing, once a month
S-shower, warm water relaxes the scrotal sac
E-examine, check for changes, report changes immediately

palpate in a sweeping side to side motion
cryptorchidism
undescended testes
hydrocele
a cystic collection of serous fluid in the tunica vaginalis, surrounding the testis
Females who are post menopausal
rapid decline of hormones, natural lubrication is decreased; cervical cancer screening should continue into age 70 if cervix is intact and patient is in good health
menopause
cessation of menses, usually occurring between 48-51,
aging and the musculoskeletal system
bone remodeling, osteoporosis; postural changes and decreased height because of shortening of the vertebral column due to loss of water content and thinning of the vertebral discs; contour changes due to loss of fat in the body periphery; bony prominences become more marked
ROM of head and neck
-Chin to chest: flexion
-Lift chin: hyperextension
-Each ear to shoulder: lateral bending
-Turn chin to each shoulder: rotation
ROM of shoulders
-Arms forward and up: forward flexion
-Arms behind back and hands up:
-Arms to sides and up over head: abduction,
-Touch hands behind head: external rotation
ROM of Elbow
-Bend and straighten elbow: flexion, extension
Pronate and supinate hand
ROM of hands and wrist
-Bend hand up, down: extension, flexion
-Bend fingers up, down: hyperextension, flexion
-Turn hands out, in: ulnar deviation, radial deviation
-Spread fingers, make fist: abduction
-Touch thumb to each finger
ROM of hip
-Raise leg: flexion
-Knee to chest: flexion
-Flex knee and hip; swing foot out, in: external rotation, internal rotation
-Swing leg laterally, medially: abduction, adduction
-Stand and swing leg back: hyperextension
ROM of knee
-Bend knee: flexion
-Extend knee: extension, hyperextension
-Check knee during ambulation
ROM of ankle and foot
-Point toes down, up: plantar flexion, dorsiflexion
-Turn soles out, in: eversion, inversion
-Flex and straighten toes
ROM of spine
-Bend sideways, backward: lateral bending, hyperextension
-Twist shoulders to each side: rotation of
kyphosis
enhanced thoracic curve, common in aging people
lordosis
pronounced lumbar curve, common in obese people
scoliosis
a difference in shoulder elevation and in level of scapulae and iliac crests
thought process
the way a person thinks, logical train of thought
language
using the voice to communicate one's thoughts and feelings
attention
the power of concentration
memory
recent: evokes day to day events
remote: brings up years' worth of experiences

the ability to lay down and store experiences and perceptions for later recall
consciousness
aware of one's existence, feelings, and thoughts
thought content
what the person thinks
abstract reasoning
pondering a deeper meaning beyond the concrete and literal
When to perform a full mental status examination
Behavior changes
Brain lesions (trauma, tumor, brain attack)
Aphasia (caused by brain damage)
Symptoms of psychiatric mental illness
Main components of mental status examination: ABCT
A-appearance
B-behavior
C-cognition
T-thought processes
mental status: appearance
posture, body movement, dress, grooming and hygiene
mental status: behavior
level of consciousness, facial expression, speech, mood and affect
mental status: cognition
orientation, attention span, recent and remote memory, new learning, judgement
mental status: thought processes
thought processes, thought content, perceptions, screen for suicidal thoughts
judgment
a person exercises judgment when he or she can compare and evaluate the alternatives to a situation and reach an appropriate course of action
central nervous system
cerebral cortex: frontal lobe, parietal lobe, occipital lobe, Wernicke's area, Broca's area

hypothalamus

cerebellum

basal ganglia

thalamus

brainstem

spinal cord
frontal lobe
part of cerebral cortex; behavior, emotion, intellectual functions, personality
parietal lobe
sensation
occipital lobe
visual reception
Wernicke's area
speech comprehension
Broca's area
motor speech
hypothalamus
major control center for temperature, heart rate, blood pressure, sleep center, etc.
cerebellum
located under the occipital lobe

concerned with motor coordination of voluntary movements, equilibrium, and muscle tone

does not initiate movement, but coordinates, and smoothes it (swimming, playing piano, juggling)
basal ganglia
control automatic associated movements of the body, i.e. arm swinging alternating with the legs during walking
thalamus
main relay station for the nervous system
brainstem
midbrain

pons

medulla: vital autonomic centers (respiration, heart, GI function); nuclei for Cranial Nerves VIII-XII
peripheral nervous system
composed of the cranial nerves and spinal nerves; these nerve fibers are further divided into two functional parts: somatic and autonomic
somatic fibers
innervate the skeletal (voluntary) muscles
autonomic fibers
innervate smooth (involuntary) muscle, cardiac muscle, and glands
reflex arc
Reflexes are basic defense mechanisms of the nervous system.
They are involuntary.
They permit a quick reaction to potentially painful or damaging situations.
Reflexes also help the body maintain balance and appropriate muscle tone.
Reflexes
Deep Tendon Reflexes: Patella or knee jerk

Superficial Reflexes: Corneal reflex; abdominal reflex

Visceral Reflex; Pupillary response to light and accommodation

Pathologic (abnormal) Reflex: Babinski's or extensor plantar reflex
Cranial nerve I
Olfactory: smell
Cranial nerve II
Optic: visual acuity
Cranial nerve III
Oculomotor: extra-ocular movement - 6 cardinal points--whisker test
Cranial nerve IV
Trochlear: down and inward movement of the eye--whisker test
Cranial nerve V
Trigeminal: motor fucntion, person clenches teeth; sensory function, person's eyes close, test light touch sensation
Cranial nerve VI
Abducens: lateral movement of eye
Cranial nerve VII
Facia: motor function, symmetry-person smiles
Cranial nerve VIII
Acoustic: whisper test
Cranial nerve IX
Glossopharyngeal; tested with absence or asymmetry of the soft palate movement is a dysfunction
Cranial nerve X
Vagus: motor function, gag reflex; tested with absence or asymmetry of the soft palate movement is a dysfunction
Cranial nerve XI
Spinal accessory: ask person to shrug shoulders; or testing the sternomastoid and trapezius muscles against resistance
Cranial nerve XII
Hypoglossal: ask person to stick out tongue - tongue should be midline
Romberg's test
ask person to stand up with feet together and arms at side; once in a stable position ask the person to close their eyes and hold that position.
stereognosis
Ability to recognize objects by feeling forms, sizes and weights. Place a familiar object (paper clip; key, coin, pencil) in the person's hand
graphesthesia
ability to "read" a number by having it traced in the hand
two-point discrimination
person's ability to distinguish separation of two simultaneous points on the skin
extinction
simultaneously touch both sides of the body at the same point; ask the person to state how many sensations are felt and where
point location
touch the skin and withdraw quickly; have person point to where they were touched
tandem walking
ask person to walk in a straight line in a heel-to-toe fashion
cranial nerves
enter and exit the brain rather than the spinal cord
lethargic
not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but thinking seems slow and fuzzy, inattentive, loses train of thought, spontaneous movements are decreased
obtunded
transitional state between lethargy, and stupor; some sources omit this level; sleeps most of time, difficult to arouse--needs loud shout or vigorous shake, acts confused when is aroused, converses in monosyllables, speech may be mumbled and incoherent, requires constant stimulation for even marginal cooperation
stuporous
spontaneously unconscious, responds only to persistent and vigorous shake or pain; has appropriate motor response, withdraws hand to avoid pain; other wise can only groan, mumble, or move restlessly; reflex activity exists
comatose
completely unconscious, no response to pain or to any external or internal stimuli, light coma has some reflex activity but no purposeful movement, deep coma has no motor response
affect
temporary expression of feelings or state of mind
mood
durable, a prolonged display of feelings that color the whole emotional life
perceptions
an awareness of objects through the five senses