NR 224 HA 2 FINAL EXAM REVIEW

***HA 2 FINAL EXAM REVIEW*** (Review Study Exam 1 & 2) Chapter 18- Breasts & Regional Lymphatics ● Risk Factors: - Psychological: stress, depression, and fatigue can cause a decrease in sexual desire for both men and women. - Abuse: There are many type of abuse, including sexual assault, that can influence a patients reproductive health. - Body image: Both men’s and women’s sexuality is driven in part by their views of their body. - Social interactions: Engaging in sexual activities with multiple partners and having unprotected sex can be significant risk factors for sexual dysfunction and disease. - Environmental: Living in overcrowded conditions can affect a person’s self-expression and sexuality. - Sexual orientation: People who have a different sexual orientation from their family and friends may receive negative messages from them. ● Developmental Competence - During embryonic life, ventral epidermal ridges, or “milk lines,” are present and curve down from axilla to groin bilaterally. ○ Develops along a ridge over thorax, and the rest of the ridge usually atrophies. ○ Supernumerary nipple occasionally persists and is visible along a tract of mammary ridge. ○ At birth, the only breast structures present are lactiferous ducts within the nipple. ● Developmental Competence: Adolescent - At puberty, estrogen stimulates breast changes - Temporary asymmetry: occasionally one breast may grow faster than the other. - Tanner staging: five stages of breast development are included as levels of sexual maturity. - Thelarche precedes menarche by about 2 years. ● Developmental Competence: Pregnant Women - Breast changes start during the second month of pregnancy and are an early sign for most women. - Colostrum may be expressed after the fourth month. ○ Thick yellow fluid is a precursor for milk, containing the same amount of protein and lactose, but practically no fat. ○ Breasts produce colostrum for the first few days after delivery. ○ Rich in antibiotics that protect newborn against infection, so breastfeeding is important. - Lactation: Milk production ○ Begins 1 to 3 days postpartum. ○ Whitish color is from emulsified fat and calcium caseinate. Pregnancy/ Obesity- Lordosis ● Developmental Competence: Aging Women - After menopause, ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy. ○ Decreased breast size makes inner structures more prominent. ○ A breast lump may have been present for years but is suddenly palpable. - Around nipplem the kactiferous ducts are more palpable and feel firm and stringy because of fibrosis and calcification. - Axillary hair decreases. ● Developmental Competence: Male Breast - Rudimentary structure consists of a thin disk of undeveloped tissue underlying the nipple. - Gynecomastia: during adolescence, it is common for breast tissue to temporarily enlarge. ○ Condition is usually unilateral and temporary ○ Reassurance is necessary for adolescent male, whose attention is riveted on their body image. ○ May reappear in aging male and may be due to testosterone deficiency. ● Culture & Genetics: Breast Cancer - Review statistics of breast cancer morbidity, mortality, and prognosis. ○ BRCA 1 and BRACA2 mutation ○ Cumulative risk. ○ Survival varies by stage when diagnosed. - Consider family history, ethnicity, and other environmental variables. ○ Racial disparities in survival ○ Socioeconomic conditions affecting access to health care. - Screening mammography recommendations - Review lifestyle risk factors ○ Alcohol dose-dependent effect ○ Postmenopausal weight gain ○ Decreased physical activity. ● Subjective Data - Breast ○ Pain, lump, discharge ○ Rash, swelling, trauma ○ History of breast disease ○ Surgery of radiation ○ Medications ○ Patient-centered care ○ Perform breast self-examinations / last mammogram - Axilla ○ Tenderness, lump, or swelling ○ Rash ● Breast Cancer: Culture & Women - In many cultures, female breasts signify more than their primary purpose of lactation ○ Affects body image ○ Influenced by society and media response ○ Integrated with women’s self-concept - A woman who has found a breast lump may come to you with fear, anxiety, and panic. ○ Although many breast lumps are benign, women initially assume the worst possible outcome, including cancer, disfigurement, and death. ○ Be sensitive to an individual's perception of female body image. ● Subjective Data Questions: Pain - Any pain or tenderness in breasts? ○ Onset - Pain location ○ Localized or diffused. - Is the painful spot sore to touch? Do you feel a burning or pulling sensation - Appearance of pain cyclic? ○ Any relation to menstrual cycle? - Precipitating factors ○ Brought on by strenuous activity? ○ Change in activity? ○ Sexual manipulation? ● Subjective Data Questions: Lump & discharge - Lump ○ Location: Ever noticed lump or thickening in breast? Where? ○ Onset: When did you first notice it? Changed at all since then? ○ Appearance: Does lump have any relation to your menstrual period? ○ Noticed any change in overlying skin: Redness, warmth, dimpling, swelling? - Discharge ○ Onset: Any discharge from nipple? When did you first notice this? ○ Characteristics? ○ What color is discharge? ○ Is consistency thick or runny? ● Subjective Data Questions: Rash & Swelling Rash - Appearance: Any rash on breast? - Onset: When did you first notice this? - Location: Where did it start? On the nipple, areola, or surrounding skin? Swelling - Location: Any swelling in breasts? In one spot or all over? - Appearance: r/t your menstrual period, pregnancy, or breastfeeding? - Any change in bra size? ● Subjective Data Questions: Trauma & History of Breast Disease - Trauma - Any trauma or injury to the breasts? - Presentation: Did it result in any swelling, lump, or break in skin? History of breast disease - Any history of breast disease yourself? - Diagnosis: What type? How was this diagnosed? - Medical management: When did this occur? How is it being treated? - Family history: Any breast cancer in your family? Who? Sister, mother, maternal grandmother, maternal aunts, daughter? ○ At what age did this relative have breast cancer? ● Subjective Data Questions: Treatment and Medications - Surgery or radiation - Surgical intervention: Biopsy with results ○ Mastectomy? Mammoplasty, augmentation, or reduction? - Radiation as part of therapy? - Imaging studies: Mammography, a screening x-ray examination of breasts? When was the last x-ray? Medications - Have you taken oral contraceptives? How long? - Have you been on HRT? How long? - Types of medications: Rx and OTC ● Subjective data Questions: Patient-centered Care - Ask about self-breast exam (SBE) - Teaching moment to review basics of examination Review screening guidelines recommendations based on age and patient history - American Cancer Society ○ Begin at ages 40 to 44, screening mammography ○ Annual mammography from ages 45 to 54 ○ Biennial mammography over age 55 or continuation of annual ● Subjective Data Questions: - Axilla ○ Tenderness, lump, or swelling Appearance: Any tenderness or lump in the underarm area? Location: Where? When did you first notice this? - Rash Appearance: Any axillary rash? Please describe it. Precipitating factor: Does it seem to be a reaction to deodorant? ● Additional History Questions - Preadolescent girl ○ Appearance: Have you noticed your breasts changing? ○ Onset: How long has this been happening? ○ Description: What have you noticed? ○ Feelings: What do you think about all this? - Pregnant woman ○ Appearance: Have you noticed any enlargement or fullness in the breasts? ○ Presentation: Is there any tenderness or tingling? ○ Medical history: Do you have inverted nipples? ○ Anticipatory planning: Are you planning to breastfeed your baby? - Menopausal woman ○ Have you noticed any change in breast contour, size, or firmness? ● Risk profile for Breast Cancer - Breast cancer is the second major cause of death from cancer in women. - However, early detection and improved treatment have increased survival rates. - Review factors associated with “relative risk” RR above 1 indicates a higher likelihood of occurrence among exposed than unexposed persons. ● Objective Data - Preparation ○ Woman sitting up facing examiner An alternative draping method is to use a short gown, open at back, and lift it up to woman’s shoulders during inspection. ○ During palpation when woman is supine, cover one breast with gown while examining other. Be aware that many women are embarrassed to have their breasts examined; use a sensitive but matter-of-fact approach. ○ After examination, be prepared to teach woman breast self-examination. - Equipment ○ Small pillow ○ Ruler marked in centimeters ○ Pamphlet or teaching aid for breast self-examination (BSE) ● Inspection of the Breast ○ General appearance - Note symmetry of size and shape - Common to have a slight asymmetry in size. ○ Skin - Normally smooth and even color - Note any localized areas of redness, bulging, or dumping; also any skin lesions or focal vascular pattern - Fine blue vascular network visible during pregnancy; pale linear striae, or stretch marks, follow pregnancy. - Normally no edema is present. ○ Lymphatic drainage areas - Observe axillary and supraclavicular regions; note any bulging, discoloration, or edema ○ Nipple - Should be symmetric on same plane on both breasts - Nipples usually protrude, although some are flat and some are inverted. - Normal nipple inversion may be unilateral or bilateral and usually can be pulled out. - Note any dry scaling, any fissure or ulceration, and bleeding or other discharge. - Supernumerary nipple is normal variation. ○ Check the breast for skin retraction - Perform sequence of maneuvers to assess for this abnormality. ● Inspection and palpation of the axillae. ○ Examine axillae while woman is sitting. - Inspect skin, noting any rash or infection; lift woman’s arm and support it so that her muscles are loose and relaxed; use right hand to palpate left axilla. - Reach fingers high into axilla; move them firmly down in four directions. - Move woman’s arm through range-of-motion to increase surface area you can reach. - Usually nodes are not palpable, although you may feel a small, soft, nontender node in central group. - Note any enlarged and tender lymph nodes. ● Palpation of the breasts ○ Vertical strip pattern is recommended to detect breast masses. - Two other patterns are in common use: From the nipple palpating out to periphery as if following spokes on a wheel Palpating in concentric circles out to periphery ○ In nulliparous women, normal breast tissue feels firm, smooth, and elastic. - After pregnancy, tissue feels softer and looser. ○ Premenstrual engorgement is normal from increasing progesterone. ● Palpation of the breasts - After palpating over four breast quadrants, palpate nipple; note any induration or subareolar mass. With your thumb and forefinger, gently depress nipple tissue into well behind areola; tissue should move inward easily. - If woman reports spontaneous nipple discharge press areola inward with your index finger. repeat from a few different directions; note color and consistency of any discharge. - If a woman mentions a breast lump that she has discovered herself, examine the unaffected breast first to learn a baseline of normal consistency for this woman. ● Characteristics of a Lump or mass - Location ○ As with clock face, describe distance in centimeters from nipple; or diagram breast in woman’s record and mark in location of lump. - Size ○ Judge in centimeters in three dimensions: width, length, and thickness - Shape ○ State whether lump is oval, round, lobulated, or indistinct. - Consistency ○ State whether the lump is soft, firm, or hard. - Movable ○ Is the lump freely movable or fixed when you try to slide it over the chest wall? - Distinctness ○ Is lump solitary or multiple? - Nipple ○ Is it displaced or retracted? - Note skin over lump ○ Is it erythematous, dimpled, or retracted? - Tenderness ○ Is lump tender to palpation? - Lymphadenopathy ○ Are any regional lymph nodes palpable? Teach Breast Self-examinations (BSE) ● BSE: Keep Teaching Simple - The simpler the plan, the more likely the person is to comply. - Describe correct technique and rationale and expected findings to note as woman inspects her own breasts. - Teach woman to do this in front of a mirror while she is disrobed to waist. - At home, she can start palpation in shower, where soap and water assist palpation. - Then palpation should be performed while lying supine. - Encourage woman to palpate her own breasts while you monitor her technique. - Use of model for return demonstration as well as pamphlets may be helpful. ● Male Breast - Examination of male breast can be abbreviated, but do not omit it. - Normal male breast has flat disk of undeveloped breast tissue beneath nipple. Gynecomastia ○ Benign growth of this breast tissue, making it distinguishable from other tissues in chest wall. ○ Feels like a smooth, firm, movable disk ○ Occurs normally during puberty and is temporary The adolescent is acutely aware of his body image. Reassure him that this change is normal, common, and temporary. ● Developmental Competence - Infants and children ○ In neonate, breasts may be enlarged and visible due to maternal estrogen crossing placenta. May secrete “witch’s milk”—not significant will resolve ○ Note position of nipples on prepubertal child. Symmetric, just lateral to midclavicular line, between fourth and fifth ribs Nipple is flat, and areola is darker pigmented. - Adolescent girl ○ Breast development usually begins on an average between 8 and 10 years. ○ Tanner staging ○ Teach BSE - Pregnant woman ○ Breasts increase in size, as do nipples. Vascular changes occur as a result of hormones of pregnancy. Nipples become darker, areola darken and widen. - Lactating woman ○ Colostrum changes to milk production around the third postpartum day. Breast engorgement occurs. Nipple soreness can occur. - Aging woman ○ On inspection, breasts look pendulous, flat, and sagging. Changes noted on breast tissue with aging Reinforce value of BSE. Women over 50 years old have increased risk for breast cancer. ● Abnormal Findings: Signs of retracting and inflammation - Dimpling ○ Nipple retracting - Edeme (peau d’orange) - Fixation - Deviation in nipple pointing. ● Abnormal Findings: Breast Lumps - Benign (fibrocystic) breasts disease - Cancer - Fibroadenoma - Differentiating breast lumps: Age Shape, consistency, and demarcation Number, mobility, and tenderness Skin retraction, pattern of growth, and risk to health. ● Abnormal Findings: Abnormal Nipple Discharge - Mammary duct ectasia - Intraductal papilloma - Carcinoma - Paget disease (intraductal carcinoma). ● Abnormal Findings - Disorders occurring during lactation Mastitis Breast abscess Plugged duct - Male breast abnormalities Gynecomastia Male breast cancer Chapter 25- Male Genitourinary System ● Developmental Competence: Infants - Prenatally, testes develop in the abdominal cavity near the kidneys. - At birth, testis measure 1.5 to 2 cm long and 1 cm wide. - Only a slight increase in size occurs during prepubertal years. ● Developmental Competence: Adolescents - Signs of puberty are appearing earlier in boys according to research studies both in the United States and other countries. First sign is enlargement of testes. Next, pubic hair appears, then penis size increases. Stages of development are documented in Tanner’s sexual maturity ratings. ● Developmental Competence: Gender Identity - Do not assume sexual orientation by appearance. - Be aware of the definition of “sexual minority.” Self-identify as gay, lesbian, bisexual, and transgender - Provide an accepting attitude while providing factual information that is confidential in nature. - Identify and provide supportive resources ● Developmental Competence: Adults and Aging Adults - Male does not experience a definite end to fertility as a female does. - Around age 40 years, production of sperm begins to decrease, although it continues into the 80s and 90s. - Testosterone production declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life. Pubic hair decreases and penis size decreases. Due to decreased tone of dartos muscle, scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous. Testes decrease in size and are less firm to palpation. Increased connective tissue is present in tubules, so these become thickened and produce less sperm. ● Sexual Expression in Later Life - Chronologic age by itself should not mean a halt in sexual activity; physical changes need not interfere with libido and sexual pleasure. - Older male is capable of sexual function as long as they are in reasonably good health and have an interested, willing partner. - Danger is in male misinterpreting normal age changes as a sexual failure; once this idea occurs, it may demoralize men and place undue emphasis on performance rather than on pleasure. - In the absence of disease, withdrawal from sexual activity may be due to (any combination of) : loss of spouse, depression, preoccupation with work. marital or family conflicts. side effects of medication, heavy alcohol use. lack of privacy, living with children or in a nursing home. economic or emotional stress. poor nutrition or fatigue. ● Culture and Genetics: Circumcision During pregnancy or immediate neonatal period, parents may ask whether or not to circumcise male infant. Religious and cultural as well as medical indications American Academy of Pediatrics (AAP) health benefits outweigh risks Circumcision: Lowers risk for certain STIs such as HPV, herpes simplex virus, genital ulcer disease in men and decreased risk for bacterial vaginosis and trichomoniasis in females Reduced risk for contracting HIV infection through heterosexual contact ● Culture and Genetics: Kidney Disease and Bladder Cancer - Kidney disease Two main causes of ESRD: hypertension and diabetes Prevalence of diabetes and hypertension is higher in some racial groups: African Americans, American Indians and Hispanics are more likely to be affected Contributing factors: low socioeconomic status with higher proportion of at risk behaviors, presence of comorbidities, and limited access to care/ - Bladder cancer 4th most common cancer in men with ethnic differences Smoking is the most common risk factor along with occupational exposure to chemicals Assess for painless hematuria. ● Subjective Data Questions (1 of 4) 1. Frequency, urgency, and nocturia: Ask about a. whether the person urinates more often than usual. b. whether the person feels as if he or she cannot wait to urinate. c. whether the person is awakened during the night because he or she needs to urinate, and if so how often and whether this is a recent change. 2. Dysuria: Ask about: a. any pain or burning with urinating. 3. Hesitancy and straining: Ask about: a. Any trouble starting a urine stream? b. Need to strain to start or maintain the stream? c. Has there been any change in force of stream? d. Dribbling, so that you must stand closer to the toilet? e. Afterward, do you still feel you need to urinate? f. Ever had any urinary tract infections? ● Subjective Data Questions (2 of 4) 1. Urine color: Ask about: a. whether the usual urine clear or discolored, cloudy, foul-smelling, or bloody. 2. Genitourinary history: Ask about: a. any difficulty in controlling urine. ⇒ Urgency incontinence: sudden loss, as in acute cystitis ⇒ Stress incontinence: involuntary urine loss with physical strain, sneezing or coughing due to weakness of pelvic floor b. Do you accidentally urinate when you sneeze, laugh, cough, or bear down? c. Any history of kidney disease, kidney stones, flank pain, urinary tract infections, or prostate trouble? ● Subjective Data Questions (3 of 4) 1. Penis: Ask about: a. Have you had any problem with your penis, such as pain or lesions? b. Any discharge? How much? Increased or decreased since start? Color? Odor? Discharge associated with pain or urination? 2. Scrotum, self-care behaviors: Ask about: a. Any problems with scrotum or testicles? b. Any lumps or swelling on testes? Change in size of scrotum? History of undescended testicles as infants? Any bulge or swelling in scrotum? c. Have you ever been told you have a hernia? Have you had any dragging, heavy feeling in scrotum? ● Subjective Data Questions (4 of 4) 1. Sexual activity and contraceptive use 2. Use gender-neutral terms Are you in a relationship involving sexual intercourse? a. Are aspects of sex satisfactory to you and your partner? b. Are you satisfied with the way you and your partner communicate about sex? c. Occasionally a man notices a change in ability to have an erection when aroused. Have you noticed any changes? d. Do you and your partner use a contraceptive? Which method? Is this satisfactory? Do you have any questions about this method? e. How many sexual partners have you had in the last 6 months? f. What is your sexual preference? Do you prefer a relationship with a woman, a man, or both? ● STI Contact Questions 1. Any sexual contact with a partner having an STI, such as gonorrhea, herpes, AIDS, chlamydia, venereal warts, or syphilis? a. When was this contact? Did you get the disease? b. How was it treated? Were there any complications? c. Do you use condoms to help prevent STIs? d. Do you have any questions or concerns about any of these diseases? ● Additional History: Infants and Children 1. Does your child have any problem urinating? Does his urine stream look straight? a. Any pain with urinating, crying, or holding the genitals? b. Any urinary tract infections? 2. Age appropriate questions: a. Has toilet training started? How is it progressing? b. If a child is 5 years old or older, does he wet the bed at night? Is this a problem for children or for parents? What have you done? How does the child feel about it? 3. Problems with structure and appearance: a. Any problems with the child's penis or scrotum, such as sores, swelling, or discoloration? 4. Inappropriate behavior: a. Has anyone ever touched your penis or in between your legs and you did not want them to? ● Additional History: Preadolescents and Adolescents 1. Ask questions that are appropriate for age. 2. Start with a permission statement: “Often boys your age experience . . . ” This conveys that it is normal and all right to think or feel a certain way. Try the ubiquity approach, “When did you . . . ” rather than “Do you . . . ” This method is less threatening because it implies that the topic is normal and unexceptional. Do not be concerned if a boy will not discuss sexuality with you or respond to offers for information. You do well to “open the door;” adolescents may come back at a future time. 3. Around age 12 to 13, but sometimes earlier, boys start to change and grow around penis and scrotum; what changes have you noticed? Have you ever seen charts and pictures of normal growth patterns for boys? Let’s go over these now. Who can you talk to about your body changes and about sex information? How do these talks go? What about sex education classes at school? How about your parents? Is there a favorite teacher, nurse, doctor, minister, or counselor to whom you can talk? 4. Boys around age 12 to 13 have normal experience of fluid coming out of penis at night, called nocturnal emissions, or “wet dreams.” Teenage boys wonder if they are only ones who ever had them, like having an erection at embarrassing times, having sexual fantasies, or masturbating. Boys might have thoughts about touching another boy’s genitals and wonder if he might be homosexual. Would you like to talk about any of these things? 5. Often boys your age have questions about sexual activity.Have you had this? What questions do you have? How about things like birth control, or STIs such as gonorrhea or herpes? Do you have any questions about these? Are you dating? Someone steady? Have you had intercourse? Are you using birth control? What kind of birth control do you use? Has a nurse or doctor ever taught you how to examine your own testicles to make sure they are healthy? Have you had the vaccine Gardasil? 6. Has anyone ever touched your genitals and you did not want them to? ● Additional History: Aging Adult 1. Any difficulty urinating? a. Have you experienced any hesitancy or straining, a weakened force of stream, dribbling, or incomplete emptying? 2. Do you ever leak water or urine when you don’t want to? a. Do you use pads/tissue to catch urine in your underwear? 3. Do you need to get up at night to urinate? a. What medications are you taking? What fluids do you drink in the evening? ● Objective Data: Preparation and Equipment Preparation Position male standing with underwear down and appropriate draping. Concerns are similar to those experienced by female during examination of genitalia. Take time to consider these feelings, as well as to explore your own. Your demeanor should be confident and relaxed. Use a firm deliberate touch, not soft, stroking one. Equipment Gloves: wear gloves during every male genitalia examination Occasionally may require glass slide for urethral specimen Materials for cytology Flashlight ● Inspection and Palpation: Penis - Skin normally looks wrinkled, hairless, and without lesions; dorsal veins may be apparent. - Glans look smooth and without lesions; ask uncircumcised male to retract foreskin, or you retract it; it should move easily. Some cheesy smegma may have collected under foreskin; after inspection, slide foreskin back to original position. - Urethral meatus positioned just about centrally - Compress glans anteroposteriorly between your thumb and forefinger; meatus edge should appear pink, smooth, and without discharge. ● Inspection and Palpation: Scrotum - Inspect scrotum as male holds penis out of the way; alternatively, you hold penis out of the way with the back of your hand. - Palpate gently each scrotal half between your thumb and first two fingers. - Palpate each spermatic cord between your thumb and forefinger, along its length from epididymis up to external inguinal ring. - If you find a mass, then provide additional specific information relative to location, size, shape, and ability to reduce. - Perform transillumination if mass or swelling is detected. ● Inspection and Palpation: Hernia - Inspect inguinal region for bulge as a person stands and strains down; normally none is present. - Palpate inguinal canal. For the right side, ask male to shift his weight onto his left leg. Use technique: NAVEL (Nerve, Artery, Vein, Empty space, Lymphatics) - Palpate femoral area for a bulge. Normally you feel none. ● Palpation of Inguinal Lymph Nodes - Palpate horizontal chain along groin inferior to inguinal ligament and vertical chain along upper inner thigh. - Normal to palpate an isolated node on occasion; it then feels small, 1 cm, soft, discrete, and movable Enlarged, hard, matted, fixed nodes are abnormal findings. ● Self-Care: Testicular Self-Examination (TSE) Encourage self-care by teaching every male from 13 to 14 years old through adulthood how to examine his own testicles. Early detection of cancer is enhanced if male is familiar with his normal consistency. Points to include during health teaching are: T—timing, once a month S—shower, warm water relaxes scrotal sac E—examine, check for, and report changes immediately ● Assessment of Urinary Function - Observe urine color. - Note pH and specific gravity. - Serum analysis of kidney function correlates with creatinine level which is relatively stable (end product of muscle metabolism). - BUN measures urea which can vary based on several factors (end product of protein metabolism). ● Developmental Competence: Infants and Children - Perform this procedure right after abdominal examination. - Preschool-age to young school-age child, 3 to 8 years of age, leave underpants on until just before examination - Older school-age child or adolescent, offer an extra drape, as with adult; reassure child and parents of normal findings - Inspect penis and scrotum. - Palpate scrotum and testes. - Inspect and palpate inguinal area for a bulge. ● Developmental Competence: Adolescent - Adolescents show wide variation in normal development of genitals. - Using SMR charts, note enlargement of testes and scrotum. pubic hair growth. darkening of scrotal color. roughening of scrotal skin. increase in penis length and width. axillary hair growth. ● Developmental Competence: Aging Adult - May note thinner, graying pubic hair and decreased size of penis - Size of testes may be decreased and may feel less firm. - Scrotal sac pendulous with less rugae - Scrotal skin may become excoriated if man continually sits on it. ● Abnormal Findings: Urine Color and Discoloration 1. Range of colors associated with specific conditions 2. Can also be associated with medications and/or foods or vitamin supplements 3. Can also be due to use of contrast dyes during surgery and/or diagnostic procedures ● Abnormal Findings: Urinary Problems and Male Genital Lesions Urinary problems ● Urethritis (urethral discharge and dysuria) ● Renal calculi ● Acute urinary retention and urinary tract infection ● Urethral stricture Male genital lesion ● Tinea cruris ● Genital herpes—HSV-2 infection ● Genital warts ● Syphilitic chancre ● Carcinoma ● Abnormal Findings: Penis Abnormalities Hypospadias Priapism Phimosis Paraphimosis Epispadias Peyronie’s disease ● Scrotum Abnormalities Absent testis, cryptorchidism Small testis Testicular torsion Epididymitis Varicocele Spermatocele Early testicular tumor Diffuse tumor Hydrocele Scrotal hernia Orchitis Scrotal edema ● Abnormal Findings: Inguinal and Femoral Hernias Review Course, clinical signs and symptoms, frequency and cause Types Indirect inguinal hernia Direct inguinal hernia Femoral hernia ● Summary Checklist: Male Genitourinary System Inspect and palpate the penis. Inspect and palpate the scrotum. If a mass exists, try to transilluminate it. Palpate for an inguinal hernia. Palpate the inguinal lymph nodes. Chapter 26- Anus, Rectum, and Prostate ● Developmental Competence infant - Meconium: First stool passed by newborn is dark green; occurs within 24 to 48 hours of birth, indicates anal patency - Gastrocolic reflex: wave of peristalsis in response to eating - Infant passes stools by reflex. ● Developmental Competence child & adults - At male puberty, the prostate gland undergoes a very rapid increase to more than twice its prepubertal size; during young adulthood size remains fairly constant. - Prostate gland commonly starts to enlarge during middle adult years; increases with age. → Benign prostatic hypertrophy (BPH) present in 80% of men over 60 years of age ● Subjective Data: 1. Usual bowel routine 2. Change in bowel habits 3. Rectal bleeding, blood in stool 4. Medications: laxatives, stool softeners, iron 5. Rectal conditions: pruritus, hemorrhoids, fissure, fistula 6. Family history 7. Patient-centered care: diet of high-fiber foods, most recent examinations ● Subjective Data Questions (1 of 2): 1. Usual bowel routine: ask about a. frequency, characteristics of stool, straining or pain with movement. b. change in bowel habits, constipation versus diarrhea, onset and duration. c. associated clinical symptoms—pain/nausea/vomiting. d. r/t foods ingested and/or occurrence in other family/group members. 2. Rectal bleeding: ask about a. presence of blood in stool—quantity/color/odor, onset, duration and frequency. (upper GI bleed = dark blood) b. spotting or out right passing of blood with stool. c. characteristics: clay-colored, pus or mucus, frothy. d. accompanied by flatus. ● Subjective Data Questions (2 of 2): 1. Medication: ask about a. Rx or OTC, laxatives or stool softeners, iron pills. (laxatives can cause electrolyte imbalances, esp. POTASSIUM. Overuse can also cause metabolic alkalosis and dependence!) (iron pills can cause constipation and cause stool to look greyish black & tarry or greenish color) b. use of enemas to move bowels. 2. Rectal conditions: ask about a. rectal area problems—itching, pain, or burning. b. hemorrhoids—presence and treatment. c. fistula—presence and treatment. 3. Family history: ask about a. polyps, or cancer in the colon or rectum. b. inflammatory bowel disease or prostate cancer. 4. Patient-centered care: ask about a. usual amount of high-fiber foods in diet. b. number of glasses of water taken daily. c. fate of last diagnostic testing as well as PSA for males. ● Additional History: Infants and Children 1. Have you ever noticed any irritation in your child’s anal area, such as redness, raised skin, or frequent itching? 2. How are your child’s bowel movements? How frequent are they? Are there any problems or pain or straining with bowel movement? ● Objective Data: Preparation and Equipment Preparation Perform rectal examination on all adults and particularly for those in middle and late years. Place the patient in the best position relative to gender. ● Males: Left lateral decubitus, standing, or lithotomy ● Females: Lithotomy for examining genitalia or left lateral decubitus for exam of rectum alone ● Rectal suppositories: best position is left lateral! Equipment ● Penlight ● Lubricating jelly ● Glove ● Guaiac test container ● Inspect Perianal Area: - Spread buttocks wide apart and inspect the perianal region. Anus normally looks moist and hairless, with coarse folded skin more pigmented than perianal skin. Anal opening tightly closed; no lesions present - Inspect sacrococcygeal area; normally appears smooth and even. Instruct a person to hold breath and bear down by performing a Valsalva maneuver. ● No break in skin integrity or protrusion through anal opening should be present. Describe any abnormality in clock-face terms, with 12:00 as the anterior point toward symphysis pubis and 6:00 toward coccyx. ● Palpate Anus and Rectum Instruct the person that palpation is not painful but may feel like needing to move bowels. Drop lubricating jelly onto gloved index finger; place pad of index finger gently against anal verge. Rotate examination finger to palpate entire muscular ring. Above anal canal, rectum turns posteriorly, following curve of coccyx and sacrum. Promptly report any mass you discover for further examination. ● Prostate Gland: - On the anterior wall in male, note the elastic, bulging prostate gland. Palpate the entire prostate in a systematic manner; note that only superior and part of lateral surfaces is accessible to examination. - Note the following characteristics: 1. Size 2. Shape 3. Surface 4. Consistency 5. Mobility 6. Sensitivity ● Cervical Examination: Palpate cervix in female through anterior rectal wall. Withdraw examination finger; normally no bright red blood or mucus is on the glove. To complete the examination, offer the person tissues to rem ove lubricant and help the person to a comfortable position. ● Examination of Stool: Inspect any feces remaining on the glove. Normally color is brown and consistency is soft. Test any stool on the glove for occult blood using a specimen container that your agency directs. If stool Hematest is positive, it indicates occult blood. Note that false-positive finding may occur if the person has ingested red meat within 3 days of the test. Enhance self-care by providing the average risk patient an at-home collection kit to screen for asymptomatic colorectal cancer and precancerous lesions. ● Developmental Competence: Infants and Children Newborn and infant - Confirm a patent rectum and anus by noting passage of the first meconium stool within 24 to 48 hours of birth. - Check anal reflex to assess sphincter tone; gently stroke anal area and note quick contraction of sphincter. - Mongolian spot is a common variation of hyperpigmentation in African American, American Indian, Mediterranean, and Asian newborns. Children - Inspect perennial area of school-age child and adolescent during genitalia exam. ● Developmental Competence: Aging Adult As an aging person performs Valsalva maneuver, you may note relaxation of peri-anal musculature and decreased sphincter control. Otherwise, full examination proceeds as that described for younger adults. ● Health Promotion Teaching - Prostate cancer, colorectal cancer (CRC) and HPV PSA—effective earl screening test Screening for CRC starts at age 50 with recommended colonoscopy FIT—Fecal Immunochemical test—start at age 40 HPV vaccine—Men under 26 years of age - Increase fluids, fiber, and exercise - Avoid sitting or standing for long periods of time. - Teach patients abnormal and normal stool colors, lesions, and proper use of laxatives/stool softeners. ● Anal Region Abnormalities 1. Pilonidal cyst or sinus: a small hole or tunnel in the skin. It may fill with fluid or pus, causing the formation of a cyst or abscess. 2. Fissure: a small tear in the thin,moist tissue that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. 3. Hemorrhoids: swollen veins in your lower rectum.Internal hemorrhoids are usually painless, but tend to bleed.External hemorrhoids may cause pain 4. Pruritus ani: the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.The intensity of anal itching increases from moisture, pressure, and rubbing caused by clothing or sitting. 5. Fecal impaction (FI): a common gastrointestinal disorder and source of significant patient discomfort with potential for major morbidity especially in elderly population. FI is defined as the inability to evacuate large hard inspissated concreted stool or bezoar lodged in the lower GI tract. 6. Anorectal fistula: a small tunnel that connects an abscess,an infected cavity in the anus to an opening on the skin around the anus. ● Abnormalities: Rectum and Prostate - Rectum 1. Abscess: a swollen area within body tissue,continuing an accumulation of pus 2. Rectal polyp: abnormal growths that start in the inner lining of the colon or rectum.Some polyps are flat while others have a stalk. Colorectal polyps can grow in any part of the colon.Most often, they grow in the left side of the colon and in the rectum. 3. Anorectal fistula: an opening in the skin near the anus that leads into a blind pouch or may connect through a tunnel with the rectal canal.Also, it can be defined as the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract 4. Carcinoma: a type of cancer that starts in the cells that make up the skin or the tissue lining organs, such as the liver or kidneys.Like other types of cancer,carcinomas are abnormal cells that divide without control. They are able to spread to other parts of the body,but don't always. - Prostate 1. Benign prostatic hypertrophy (BPH): prostate gland enlargement-it is a common condition as men get older.An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.It can also cause bladder,urinary track or kidney problems. 2. Prostatitis: a swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid that nourishes and transports sperm. Prostatitis often cause painful or difficult urination. 3. Carcinoma: a cancer that occur in the prostate.It is one of the common types of cancer in men Chapter 27- Female Genitourinary System adnexa uteri - Accessory parts of the uterus; fallopian tubes and ovaries. amenorrhea - absence of menstrual flow, usually due to a disturbance in hormonal concentrations atrophic vaginitis - thinning of the vagina and loss of moisture because of depletion of estrogen, which causes inflammation of tissue Chlamydia - A sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated. contraceptive - device, method or agent that prevents conception cystocele - hernia of the urinary bladder dysmenorrhea - pain caused by uterine cramps during a menstrual period dyspareunia - painful sexual intercourse due to medical or psychological causes dysuria - painful or difficult urination, commonly described as a "burning sensation" while urinating -gravida - number of times a woman has been pregnant hematuria - presence of blood in the urine herpes simplex virus type 2 - sexually transmitted, ulcer-like lesions of the genital and anorectal skin and mucosa; after initial infection, the virus lies dormant in the nerve cell root and may recur at times of stress Human Papillomavirus (HPV) - viral sexually transmitted disease that causes genital warts and other symptoms last menstrual period (LMP) - the date indicating the first day of a patient's last menstrual period menarche - the first menstrual period menopause - the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines Menorrhagia (hypermenorrhea) - excessive bleeding during menstruation menses, menstruation - monthly uterine bleeding Nabothian cysts - benign growths that commonly appear on the cervix after childbirth nocturia - excessive urination at night Papanicolaou (Pap) test - microscopic analysis of cells taken from the cervix and vagina to detect the presence of carcinoma Para - Gravida (gravidity): # of Pregnancies *Para (parady): # of live births* WOMAN HAS TWO KIDS, ONE ABORTION, AND IS CURRENTLY PREGNANT: Gravida = 4; Para = 2 perimenopausal phase - the stage of menopause during which estrogen and progesterone levels are erratic, menstrual cycles may be very irregular, and women begin to experience symptoms such as hot flashes rectocele - hernia of the rectum through the vaginal floor sexually transmitted infections (STIs) - disease that spreads from one person to another through intimate sexual contact Speculum (Graves', Pederson) - medical tool for investigating body cavities; in the case of Graves' and Pederson - this is used for examination of the vaginal cavity uterine prolapse - the condition in which the uterus slides from its normal position in the pelvic cavity and sags into the vagina Subjective data - -Menstrual hx -Obstetric hx -Menopause -Self-care behaviors -Urinary symptoms -Vaginal discharge -Hx -Sexual activity -Contraceptive use -STI contact -STI risk reduction (education) Position for female exam - *Dorsal lithotomy* external genitalia of female - *Inspection* -Skin color is even; labia minora are darker pink -Hair distribution in usual female pattern of inverted triangle, although it normally may trail up abdomen -Labia majora normally are symmetric, plump, and well formed; in nulliparous woman, labia are gaping and slightly shriveled -No lesions should be present, except for occasional sebaceous cyst HPV vaccine - Gardasil or Cervarix -- 11-12yo-- x3 over 6months available to all women *9-26yo* -it is recommended for girls and women before they become sexually active because it is not effective if individual is already infected with HPV- UTI - urinary tract infection -E.coli -Lower UTI can travel upward -Get C/S to see which antibiotics to use birth control pill - raises potential for blood clots -if patient smokes and takes B/C that can be a very dangerous mix, and causes a high risk for blood clots A deep recess formed by the peritoneum between the rectum and the cervix is called - a rectouterine pouch A caruncle is a(n) - small, red mass protruding from the urethral meatus Vaginal lubrication during intercourse is produced by - The vestibular (Bartholin) glands secrete clear lubricating mucus during intercourse Chapter 28- The Complete Health Assessment: Adult Which action would the nurse take while examining the genitalia of a male patient? 1 Inspect for aortic pulsations. 2 Check for inguinal hernia. 3 Palpate epitrochlear nodes. 4 Percuss costovertebral angle. Which action would the nurse take when assessing the neck area of a patient? 1Grade the size of tonsils, if present. 2Test muscle strength against resistance. 3Assess functioning of cranial nerve X. 4Palpate carotid pulse on both sides at once. Which parameter would the nurse assess as a part of the musculoskeletal assessment of an adult patient's lower extremities? 1Clubbing 2Romberg sign 3Brachial index 4Accommodation - The Romberg test is used for assessing the balance and vestibular function during the musculoskeletal assessment of the lower extremities. Assessment for clubbing of the nails is a respiratory finding, not a musculoskeletal assessment. The brachial index is determined as a part of the assessment of the lower extremity circulation. It helps to assess the risk of peripheral artery diseases, but it does not assess musculoskeletal functioning. Accommodation is an assessment of the eye, not an assessment of the musculoskeletal system in the lower extremities. Which area would the nurse assess to determine the presence of pretibial edema in a patient? 1Eyes 2Scalp 3Lower extremities 4Inguinal lymph nodes Under which component of a health history would the nurse document the findings of a genogram? 1Review of Systems 2Past Health 3Biographic Data 4Family History In which position would the nurse place a bedridden male patient to ensure proper assessment of the genitalia? 1Supine 2Fowler's 3Prone with widely extended legs 4Left lateral with right leg drawn up Which action would the nurse ask the patient to take to properly assess for cardiac murmurs? 1Hyperextend the neck. 2Rest in the prone position. 3Shrug the shoulders quickly. 4Lean forward and exhale briefly. Which technique would the nurse use to assess for an abnormal thrill? 1Percussion 2Inspection 3Palpation 4Auscultation For which lymph nodes would the nurse check while assessing the patient's neck? 1Cervical 2Axillary 3Inguinal 4Epitrochlear Which examination would include both size and strength parameters? 1Breast 2Abdominal 3Eyes 4Musculoskeletal Which specimen would the nurse collect for an occult blood test? 1Blood 2Urine 3Stool 4Mucus Which component would the nurse assess first when taking vital signs? 1Blood pressure 2Temperature 3respirations 4Radial pulse - The usual sequence is pulse, respirations, blood pressure, and temperature. A positive Babinski reflex in an adult would alert the nurse to which type of impairment? 1Neurologic 2Cardiovascular 3Musculoskeletal 4Gastrointestinal - If the adult exhibits a positive Babinski reflex, the neurologic system is impaired. Which assessment parameter would the nurse be documenting when using a stick gram? 1Hematest 2Cranial nerves 3Family history 4Deep tendon reflexes Which pulse would the nurse palpate while assessing the inguinal area of a patient? 1Radial 2Femoral 3Dorsalis pedis 4Popliteal Which component of the physical examination would the nurse be examining when using the Snellen chart? 1Vision acuity 2Stereognosis 3Facial symmetry 4Pain level Which patient data would the nurse document under the heading of Past Health? 1Race 2Date of birth 3History of present illness 4Current medications Cranial nerves: I - olfactory- sensory- sense of smell - Test: “Could you please close your eyes and tell me what you smell?” II- optic- sensory- vision - Test: “Do you wear glasses? If so, please put them on.” Use the Snellen Eye Chart to assess vision III- oculomotor- motor- eye movement, pupillary constriction and accommodation, muscles of upper eyelids - Test: PERRLA IV- trochlear- motor- eye movement (intorsion, downward gaze) - Test: I am going to do an eye movement diagnostic positions test. Please watch my pen and follow it without moving your head (side, side, diagonal up, diagonal down). There is no nystagmus noted. V- trigeminal- sensory & motor- somatic sensation from face, mouth, cornea, and mastication muscles - Test: Please clench your teeth. Please close your eyes and tell me if you feel a sharp or dull touch.” (touch the forehead, cheek, chin, upper extremity, and lower extremity) VI- abducens- motor- eye movement (abduction and lateral movement) - Test: I am going to do an eye movement diagnostic positions test. Please watch my pen and follow it without moving your head (side, side, diagonal up, diagonal down). There is no nystagmus noted. VII- facial- sensory and motor- controls the muscles of the facial expressions, translate from anterior tongue, and the lacrimal and salivary glands - Test: Please smile. Frown. Show your teeth. Puff out your cheeks. Purse lips. Raise your eyebrows VIII- vestibulocochlear- sensory- hearing and sense of balance - Test: I am now going to perform the whisper test from 2 feet away.” (whisper apple pie and potato chip) IX- Glossopharyngeal- sensory & motor- sensation from posterior tongue and pharynx, and taste from posterior tongue, carotid baroreceptors and chemoreceptors, salivary gland - Test: Please open your mouth, I am going to use a tongue depressor, please say “Ahhh”; I would assess the rise and fall of the uvula, I would ask the patient to swallow, I would note voice quality, Gag reflex would also be assessed X- Vagus- sensory & motor- autonomic functions of gut, cardiac inhibition, sensation from larynx and pharynx, muscles of vocal chords, swalloung - Test: Please open your mouth, I am going to use a tongue depressor, please say “Ahhh”; I would assess the rise and fall of the uvula, I would ask the patient to swallow, I would note voice quality, Gag reflex would also be assessed XI- Spinal accessory- motor- shoulders and neck muscles - Test: Please shrug up against resistance, which will be my hands. Please turn your head against resistance, which will be my hands XII- Hypoglossal -motor- Movements of tongue - Test: Please stick out your tongue and move it side to side Chapter 29- The Complete Health Assessment: Infant, Child, Adolescent Practice Questions: 1. A 5-year-old child is in the clinic for a checkup. The nurse would expect him to: a.Need to be held on his mother's lap. b.Be able to sit on the examination table. c.Be able to stand on the floor for the examination. d.Be able to remain alone in the examination room. 2. Which statement is true regarding the recording of data from the history and physical examination? a.Use long, descriptive sentences to document findings. b.Record the data as soon as possible after the interview and physical examination. c.If the information is not documented, then it can be assumed that it was done as a standard of care. d.The examiner should avoid taking any notes during the history and examination because of the possibility of decreasing the rapport with the patient. 3. When assessing the neonate, the nurse should test for hip stability with which method? a.Eliciting the Moro reflex b.Performing the Romberg test c.Checking for the Ortolani sign d.Assessing the stepping reflex 4. A female patient tells the nurse that she has four children and has had three pregnancies. How should the nurse document this? a.Gravida 3, para 4 b.Gravida 4, para 3 c.This information cannot be documented using the terms gravida and para. d."The patient seems to be confused about how many times she has been pregnant." 5. The nurse is documenting the assessment of an infant. During the abdominal assessment, the nurse noticed a very loud splash auscultated over the upper abdomen when the nurse rocked her from side to side. This finding would indicate: a.Epigastric hernia. b.Pyloric obstruction. c.Hypoactive bowel sounds. d.Hyperactive bowel sounds. 6. Which of these actions is most appropriate to perform on a 9-month-old infant at a well-child checkup? a.Testing for Ortolani sign b.Assessment for stereognosis c.Blood pressure measurement d.Assessment for the presence of the startle reflex 7. During an assessment, the nurse is unable to palpate pulses in the left lower leg. What should the nurse do next? a.Document that the pulses are nonpalpable. b.Reassess the pulses in 1 hour. c.Ask the patient turn to the side, and then palpate for the pulses again. D. Use a Doppler device to assess the pulses. 8. During a morning assessment, the nurse notices that a patient's urine output is below the expected amount. What should the nurse do next? a.Obtain an order for a Foley catheter. b.Obtain an order for a straight catheter. c.Perform a bladder scan test. d.Refer the patient to an urologist. What should the nurse assess before entering the patient's room on morning rounds? a.Posted conditions, such as isolation precautions b.Patient's input and output chart from the previous shift c.Patient's general appearance d.Presence of any visitors in the room The nurse has administered a pain medication to a patient by an IV infusion. The nurse should reassess the patient's response to the pain medication within _____ minutes. a.5 b.15 c.30 d.60 During an assessment of a hospitalized patient, the nurse pinches a fold of skin under the clavicle or on the forearm to test the: a.Mobility and turgor. b.Patient's response to pain. c.Percentage of the patient's fat-to-muscle ratio. d.Presence of edema. When assessing the neurologic system of a hospitalized patient during morning rounds, the nurse should include which of these during the assessment? a.Blood pressure b.Patient's rating of pain on a scale of 1 to 10 c.Patient's ability to communicate d.Patient's personal hygiene level When assessing a patient's general appearance, the nurse should include which question? a.Is the patient's muscle strength equal in both arms? b.Is ptosis or facial droop present? c.Does the patient appropriately respond to questions? d.Are the pupils equal in reaction and size? When assessing a patient in the hospital setting, the nurse knows which statement to be true? a.The patient will need a brief assessment at least every 4 hours. b.The patient will need a consistent, specialized examination every 8 hours that focuses on certain parameters. c.The patient will need a complete head-to-toe physical examination every 24 hours. d.Most patients require a minimal examination each shift unless they are in critical condition. The nurse is giving report to the next shift and is using the situation, background, assessment, recommendation (SBAR) framework for communication. Which of these statements reflects the Background portion of the report? a."I'm worried that his gastrointestinal bleeding is getting worse." b."We need an order for oxygen." c."My name is Ms. Smith, and I'm giving the report on Mrs. X in room 1104." d."He is 4 days postoperative, and his incision is open to air." The nurse is assessing the IV infusion at the beginning of the shift. Which factors should be included in the assessment of the infusion? Select all that apply. a.Proper IV solution is infusing, according to the physician's orders. b.The IV solution is infusing at the proper rate, according to physician's orders. c.The infusion is proper, according to the nurse's assessment of the patient's needs. d.Capillary refill in the fingers is checked and noted. e.The IV site date is noted. f.Whether the patient is sufficiently voiding is noted. At the beginning of rounds when entering the room, what should the nurse do first? a.Check the intravenous (IV) infusion site for swelling or redness. b.Check the infusion pump settings for accuracy. c.Make eye contact with the patient, and introduce him or herself as the patient's nurse. d.Offer the patient something to drink. During an assessment, the nurse is unable to palpate pulses in the left lower leg. What should the nurse do next? a.Document that the pulses are nonpalpable. b.Reassess the pulses in 1 hour. c.Ask the patient turn to the side, and then palpate for the pulses again. d.Use a Doppler device to assess the pulses The nurse is completing an assessment on a patient who was just admitted from the emergency department. Which assessment findings would require immediate attention? Select all that apply. a.Temperature: 38.6° C b.Systolic blood pressure: 150 mm Hg c.Respiratory rate: 22 breaths per minute d.Heart rate: 130 beats per minute e.Oxygen saturation: 95% f.Sudden restlessness EXTRA (Exam 1) - Cap refill more than 10 sec- peripheral artery disease, shock, dehydration - If you hear an irregular pulse you should listen for a full min - When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard? Swishing whooshing sound - Always auscultate bowel sounds before percussing - Bowel sounds can be heard in the right lower quadrant (RLQ) - Right Upper Quadrant: Liver, stomach, gallbladder, duodenum, right kidney, pancreas, and the right adrenal gland. - Left Upper Quadrant: Liver, stomach, pancreas, left kidney, spleen, and the left adrenal gland. - Right Lower Quadrant: appendix, reproductive organs, right ureter. - Left Lower Quadrant: left ureter, reproductive organs - Aging adults= constipation - Peripheral artery leg pain is reduced by ___ - Venous stasis ulcers have a ruddy (red) colored base - Diverticular disease pain can be found in left lower quadrant (LLQ) - Apical pulse can be felt in the mitral area EXTRA (Exam 2) - Know cranial nerves + tests - Glascow coma scale- - (tests for level of consciousness) - If a pt has a stroke in the right cerebral hemisphere can lead to poor impulse control - obesity/ pregnancy = lordosis - “hunchback” = kyphosis - Pronation - - Eversion - Osteoporosis can cause scoliosis - abduction - Corneal reflex can be tested with a penlight (Hirschberg test) - Romberg test, tests for ataxia aka loss of motor coordination - How many vertebrae are there: 7 cervical, 12 thoracic, and 5 lumbar - Articulation of mandible and temporal is the temporomandibular joint - Knee is capable of flexion and extension (hinge type synovial joint) - Shoulder is capable of circumduction - Babinski’s sign shows the big toe bends up and back to the top of the foot and the other toes fan out. This can mean that you may have an underlying nervous system or brain condition that's causing your reflexes to react abnormally - Cranial nerve 9 or 10 (IX or X) means less frequent spontaneous speech - What do you use to test cranial nerve 5 (V) using a pinprick to test facial sensation and by brushing a wisp of cotton against the lower or lateral cornea to evaluate the corneal reflex. - Test for stereognosis asking the patient to close their eyes and identify the object you place in their hand. Place a coin or pen in their hand. Repeat this with the other hand using a different object. Astereognosis refers to the inability to recognize objects placed in the hand. - How to check for pallor/ cyanosis in dark skin? cyanosis may present as gray or whitish (not bluish) skin around the mouth, and the conjunctivae may appear gray or bluish - where to look for pallor/cyanosis in skin - face, oral mucosa, conjunctiva, nail beds, lips (palms for cyanosis) - assessing pallor in dark skin normal brown skin=looks yellow-brown, normal black skin=looks ashen gray - where to look for cyanosis in dark skin (where pigmentation is the least) conjunctiva, sclera, buccal mucosa, tongue, lips, nails, palms, sole - PVD cold feet- moist heating pad under feet - Chronic arterial insufficiency - dependant rubor, edema, vericosistitis, red, warm, swollen leg - PAD- no leg hair, deformed tonsils, flushed warm legs, chronic pain