NR 302 Health Assessment Exam 2 Test Blueprint (1) Latest,100% CORRECT

NR 302 Health Assessment Exam 2 Test Blueprint (1) Latest Chapter 12: 6 questions A & P of the layers of the skin Two Layer 1. Epidermis & Dermis Epidermis – Outer layer Completely replaces every 4 weeks ▪ Highly differentiated ▪ Thin but tough ▪ Avascular & nourished by blood vessels in the dermis ▪ Stratified into several zones o Basel cell Layer – Forms new skin cells ▪ major ingredient: fibrous protein Keratin ▪ Melanocytes produce pigment melanin • Gives brown tones to skin & hair • Everyone has melanocytes, however amount of melanin they produce varies with genetic, hormonal, environmental • As new cells migrate up they flatten into the outer horny cell layer o Horny cell layer – dead keratinized cells closely packed & constantly shed or desquamated & replaced w/ new cells Dermis Inner supportive layer Consisting mostly of: Connective tissue, or collage: Tough, fibrous protein that enables the skin to resist tearing o Resilient elastic tissue that allows the skin to stretch w/ body movement o Nerves o Sensory receptors o Blood vessels o Lymphatics o Appendages from the epidermis embedded in the dermis o Hair follicles o Sebaceous glands & sweat glands 2. Subcutaneous Layer Adipose tissue (lobules of fat cells) Stores fat for energy Provides insulation for temperature control Aids in protection Gives skin increased mobility over structures underneath 9 Function of the Skin: Skin is a waterproof, almost indestructible covering that has protective and adaptive properties Protection Minimize injury Wound repair replacement of surface wounds Prevents penetration barrier stops invasion microorganisms & loss of water & electrolytes Communication Blushing/Blanching signal emotion Perception vast sensory surface touch, pain, temperature, and pressure Production of Vitamin D UV light converts cholesterol into Vitamin D. Temperature regulation Heat Insulation/dissipation Absorption and excretion limited excretion of some metabolic wastes, by-products of cellular decomposition Identification unique facial characteristics, hair, skin color, and even fingerprints Hair Threads of keratin Two types of hair: I. Vellus hair: covers most of the body (except palms and soles, dorsa of the distal parts of the fingers, umbilicus, glans penis, inside the labia) II. Terminal hair: darker, thicker hair that grows on the scalp and eyebrows and after puberty on the axillae, pubic area, face and chest in male Sebaceous Glands Produce Sebum(oil): A protective lipid substance secreted through hair follicles Everywhere except palms and soles Most abundant in scalp, forehead, face, & chin Lubricates skin and hair and forms emulsion with water that prevents water loss from skin Dry skin results from loss of water, not directly from loss of oil Sweat Glands Two types of sweat glands: I. Eccrine Glands: widely distributed through the body Mature in the 2-month -old infant Coiled tubules that open directly onto the skin surface & Sweat Sweat evaporation reduces body temperature II. Apocrine Glands: Activated during puberty & Decreases in the aging adult Secretion occurs with emotional & sexual stimulation Bacterial flora reacts w/ apocrine sweat and produce musky body odor Produce a thick, milky secretion & open into the hair follicles Mainly in the Axillae, Anogenital area, nipples, & navel Vestigial in humans Developmental considerations: newborn, older adult Infants & Children ▪ Lanugo Hair follicles: Fine downy hair of the newborn hair. ▪ Develops in the fetus at 3 months’ gestation; by midgestation most of the skin is covered & First few months after birth is replaced by fine Vellus hair ▪ Terminal hair on the scalp May be present at birth ▪ Vernix caseosa present at birth, thick, cheesy substance made up of sebum and shed epithelial cells ▪ Sebum water in skin producing milia (a common variation; white papules on the cheeks & forehead & across the nose & chin; caused by sebum that occludes the opening of the follicles); holds water in the skin; present first few weeks of life; produces cradle cap in some babies ▪ Many Skin functions not fully developed ▪ Skin is thin, smooth, elastic and more permeable than adult ▪ Greater risk for fluid loss ▪ Sebaceous glands decrease in size and production not resume until puberty ▪ Temperature (Heat & Cold) regulation ineffective because subcutaneous layer is inefficient ▪ Eccrine sweat glands do not secrete in response to heat until first few months of life ▪ Pigment system is inefficient at birth The Aging Adult ▪ Skin changes mirror that reflects aging changes that proceed ALL organ systems ▪ Senile Purpura caused by dermal issues atrophy and blood vessels become more fragile causing recurrent bruises of extensor surfaces of forearms caused by minor trauma ▪ Slow atrophy of skin structures ▪ Loss of skin elasticity – folds & sags ▪ Loss of collagen increase risk for shearing ▪ Loss of elastin, collagen, subcutaneous fat ▪ Reduction in muscle tone ▪ Decrease in sweat & sebaceous glands leaving skin dry ▪ Decreased response sweat glands to thermoregulatory increase risk for heat stroke ▪ Wound healing is delayed ▪ Melanocytes decrease (gray fine hair) Abnormal skin findings: Dehydration Dehydration: Normally mucous membrane is smooth and moist-with dehydration mucous membranes are dry, and lips look parched and cracked. Extreme dryness the skin is fissured, resembling cracks in a dry lakebed *Be aware that dark skin may normally look dry & flaky, but this does not necessarily indicate systemic dehydration Chapter 13: 4 questions Lymph nodes: characteristics of healthy lymph nodes Cervical nodes often are palpable in healthy person, but palpability decrease with age Normal nodes feel moveable, discrete, soft, and nontender Developmental Considerations Newborn ▪ Head o Measures 32-38cm (average 34cm) o Skull markedly Asymmetric because of molding of the cranial bones during labor o Involved ridges more prominent o Positional plagiocephaly (Positional Molding) continually sleeps in the recommended position o Caput Succedaneum Edematous swelling & ecchymosis of the presenting part of the head by birth trauma o Cephalhematoma – subperiosteal hemorrhage, birth trauma; greater risk for jaundice o Craniosynostosis – severe deformity caused by premature closure of the sutures; causes a distinctive head shape that correlates with specific close sutures o Head posture and head control – by 2 weeks can turn head side-to-side and shows tonic neck reflex when supine and the head is turned to one side (extension of same arm and leg, flexion of opposite arm and leg; tonic reflex disappears between 3 and 4 month then head maintains midline o Head control is achieved at 4 months o Head Circumference would be chest o Hydrocephalus – face look smaller compared with cranium, which remains larger. Dilated scalp veins ▪ Face o Features symmetry, wrinkling when cries or smiles o No swelling o Parotid glad enlargement is seen best when child sits and looks up at the ceiling the swelling appears below the angle of the jaw ▪ Neck o Short; Lengthens during first 3-4 years o Can see better by supporting the infant’s shoulders and tilting the head back a little o Feel for cartilaginous rings in the midline or slightly right of midline o Infancy cervical lymph nodes are not palpable o Palpable nodes 3mm are normal o Thyroid gland difficult to palpate because neck is short and thick Pregnant ▪ Head ▪ Face o Chloasma may show during 2nd trimester- blotchy, hyperpigmented area over the cheeks, forehead that fades after delivery ▪ Neck o Thyroid gland may be palpable Older Adult ▪ Head o Temporal arteries twisted and prominent o Mild tremor of the head o Senile tremors are benign and include head nodding & tongue protrusion ▪ Face o Teeth lost, lower face looks unusually small, mouth sunken in ▪ Neck o Increased anterior cervical (concave or inward) curve when head and jaw are extended forward to compensate for kyphosis of the spine o Prolapse of the submandibular gland, can be mistaken for tumor o Drooping submandibular glands feel soft and present bilaterally Chapter 14: 15 questions A & P of the Eyes Cranial nerves Responsible for extraocular eye movements (EOMs) Pupillary Light Reflex constriction of pupils when bright light shines on retina Fixation Reflex direction toward object attracting our attention Accommodation Adaptation of the eye for near vision Retina Inner nervous -Visual receptive layer which light waves are changed into nerve impulses inside is the transparent vitreous body Red reflex Normally not present; Red glow filling the person’s pupil; caused by the reflection of ophthalmoscope light off the inner retina Intraocular pressure Determined by a balance between the amount of aqueous produced to its outflow at the angle of the anterior chamber Developmental considerations of Eyes Newborn Function limited Peripheral vision is intact Macula is absent at birth but develop by 4 months; mature by 8 months Binocularity (can fixate on a single image with both eyes) by 3-4 months Lens is spherical at birth & grows flatter throughout life Older adult Eye structure cause distinct facial changes Lacrimal glands involute; causing decreased tear production & feeling of dryness & burning Presbyopia -Pupils decrease in size; lens loos elasticity, becomes hard glasslike decreases ability lens to change shape to accommodate near vision Visual acuity diminishes around 50 -70 Blurred vision & difficulty reading by 40 Cataract formation a clouding of the crystalline lens from a clumping of protein (lens opacity) Curable w/ lens replacement surgery Women 37% high risk than men Glaucoma An optic nerve neuropathy characterized best by loss of peripheral vision, caused by increased intraocular pressure (chronic open-angle is most common type) -women at higher risk Age-Related Macular Degeneration (AMD) loss of central vision caused by yellow deposits (drusen) & neovascularity in the macula (breakdown of cells in macule of retina)- women at greater risk – unable to read, sew, do fine work, difficulty distinguishing faces (Peripheral vision not affected- can manage self-care and not completely disabled Diabetic Retinopathy leading cause of blindness in working-age adults 25-74 (loss of central vision); may cause great despair (difficulty driving, reading, managing diabetes, and self-care) Eye examination Snellen chart Alphabet chart most commonly used and accurate measure of visual acuity Floaters spots in vison; may look black or gray specks, strings, appear to dart away when look directly at them age-related changes Shadows seen are called floaters Chapter 15: 15 questions A & P of the Ear Auricle External ear also called pinna consist of movable cartilage and skin; serve to funnel sound waves into its opening Cerumen Yellow, waxy material that lubricates and protects the ear; forms a sticky barrier that helps keep foreign bodies from entering and reaching the sensitive tympanic membrane; migrates out to the meatus by the movement of chawing and talking Tympanic membrane (eardrum) Canal lined with glands that secrete cerumen Eustachian tube Connects the middle ear with the nasopharynx & allows passage of air; normally closed but open with swallowing and yawning Middle ear 3 functions: (1) Conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear; (2) protects the inner ear by reducing the amplitude of loud sounds;(3) eustachian tube allows equalization of air pressure of each side of the tympanic membrane so the membrane does not rupture Labyrinth Inner ear embedded in bone; (labyrinth) holds the sensor organs for equilibrium and hearing Hearing loss: Sensorineural vs. Conductive Sensorineural Conductive (or Perceptive) loss signifies pathology of the inner ear, cranial nerve VIII, or the auditory area of the Mechanical dysfunction of the external or middle ear. A partial loss- person able to hear if the sound amplitude is cerebral cortex; may be caused by presbycusis; gradual nerve degeneration by aging or toxic drugs increased enough to reach normal nerve elements in the inner ear; may be caused by impacted cerumen, foreign bodies, perforated tympanic membrane, pus, in the middle ear Developmental considerations Newborn Older Adult Inner ear develops 5th week of gestation Early development posteriorly rotated and low set Eustachian tube shorter and wider; positioned more horizontal; easier for pathogens to migrate to middle ear External ear canal shorter and slope opposite to that of adults Lumen surrounded by lymphoid tissue; easily occluded Higher risk for middle ear infection Cilia lining the ear canal come coarse and stiff; cause cerumen accumulate and oxidize; reduce hearing (impacted cerumen common in aging adults) Cerumen drier because of atrophy of the apocrine glands Scarring on drum Presbycusis- type of hearing loss that occurs with 60% of older adults (person notices high-frequency tone loss; words sound garbled Assessment: Positioning of Ear Adult Child Pull pinna up and back Similar to adult with addition position and alignment of head. Top of the pinna should match an imaginary line extending from the corner of the eye to the occiput Ear sound position with 10 degree vertical Pull the pinna straight down to match the slope of the ear canal Chapter 16: 10 question Developmental considerations: Pregnant Nasal stuffiness & epistaxis result of increased vascularity in the upper respiratory Newborn Milia across the nose Nasal bridge may be flat in black and Asian children No nasal flaring or narrowing with breathing Toddler Older adult Gradual loss of subcutaneous fat make nose appear more prominent Nasal hair grow coarser and stiffer and may not filter air as well Smell sense diminish after 60 because decrease in # of olfactory nerve fibers Abnormal findings Antibiotic therapy Black Hairy tongue; not really hair but rather elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on tongue. Occurs after antibiotic, which inhibit normal bacteria and allow proliferation of fungus, and with heavy smoking (color can be black, brown to yellow) Dehydration Fissured or Scrotal Tongue; Deep furrows divide the papillae into small irregular rows. Chemotherapy Gingival Hyperplasia painless enlargement of the gums, sometimes overreaching the teeth, Newborn Cleft Palate – congenital defect; failure of fusion of the maxillary process. Cleft lip – Maxillofacial clefts are most common congenital deformities associated with phenytoin (Dilantin) maternal smoking and alcohol use, benzodiazepines and corticosteroids; early treatment preserves function of speech and language formation and deglutition(swallowing) Sinusitis Inflamed infection sinus area following URI are most often viral in origin and do not require antibiotics. Considered bacterial infection when signs last greater than 7-10days. Major sign are mucopurulent drainage, nasal obstruction, facial pain/pressure, loss of sense of smell, fever, chills , malaise, dull, throbbing pain in cheek & teeth