NUR 3065 Exam 4 fully solved & updated

optimal nutritional status - answer-sufficient nutrients are consumed to support needs malnutrition - answer-over, under, and nutrient deficiencies What groups of people are vulnerable to malnutrition (7)? - answer-infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults People who have impaired nutrition are at risk of developing (5)... - answer-•Impaired growth and development •Lowered resistance to infection and disease •Delayed wound healing •Longer hospital stays •Higher health care costs What causes undernutrition? What are the clinical signs of undernutrition (5)? - answer-•reserves are depleted &/or nutrient intake is inadequate for needs •Clinical signs - Stunting, wasting - emaciated - cachectic - dry skin - hair changes, lips, tongue, gums, eyes, mucous membranes, etc. What is overnutrition and what is it caused by? - answer-- Overnutrition: consumption in excess of needs - Caused by consumption of nutrients, especially calories, sodium, and fat, in excess of body needs Overnutrition is a major nutritional problem today; it can lead to obesity and is risk factor for (8)... - answer-•Heart disease and hypertension •Type II diabetes •Stroke •Gallbladder disease •Sleep apnea •Certain cancers •Osteoarthritis When do growth and nutrient needs stabilize? - answer-During adulthood What lifestyle factors affect nutrition (6)? - answer-- cigarette smoking - stress - lack of exercise - excessive alcohol intake - diets high in saturated fat, cholesterol, salt, sugar - diets low in fiber What are major risk factors of malnutrition in the older adult (7)? - answer-•poor physical or mental health •social isolation •alcoholism •limited functional ability •poverty •polypharmacy •Decline of extended families and increased mobility of families reduce available support systems What can interfere with access to a balanced diet in older adults? - answer-Facilities for meal preparation, transportation to grocery stores, physical limitations, income, and social isolation interfere with acquisition of balanced diet Normal physiologic changes in aging adults that directly affect nutritional status include (8)... - answer-•Poor dentition •Decreased visual acuity •Decreased saliva production •Decreased gastric acid secretion •Slowed (GI) gastrointestinal motility •Decreased gastrointestinal absorption •Diminished olfactory and taste sensitivity •Decrease in energy requirements due to loss of lean body mass and increase in fat mass What interventions can we take to ensure balanced nutrition in an older adult (4)? - answer-•Encourage calcium and vitamin D (osteoporosis prevention) •May need to increase protein •May not need to increase calories with decreased metabolism •Assess dentition, swallowing, etc. What nutritional history do we take from our patients (11)? - answer-- Eating patterns - Usual weight - Changes in appetite, taste, smell, chewing, swallowing - Recent surgery, trauma, burns, infection - Chronic illnesses (DM, Crohn's Disease) - Vomiting, diarrhea, constipation - Food allergies or intolerances (lactose/milk, gluten, etc.) - Medications or nutritional supplements•Self-care behaviors - Alcohol or illegal drug use - Exercise and activity patterns - Cultural and/or religious dietary practices (cold drinks, vegetarian, meats, kosher, keto, etc.) What are the various methods for collecting current dietary intake information (4)? - answer-•24-hour recall •Food frequency questionnaire •Food diary •During hospitalization, documentation of nutritional intake can best be achieved through calorie counts of nutrients consumed or infused What are the common guides used to determine adequacy or insufficiency of diet (3)? - answer-ChooseMyPlate, Dietary Guidelines, and Daily Reference Intakes (DRIs) What are we looking for in an "observation of general appearance" in a nutritional assessment (4)? - answer-•Skin, hair, mouth, lips, and eyes show deficiencies more readily •Obese? •Cachectic (fat and muscle wasting)? •Edematous? What measurements do we take in a nutritional assessment (6)? - answer-•Height and weight, BMI •triceps skinfold thickness •elbow breadth •arm and head circumferences Underweight BMI range - answer-18.5 Normal BMI range - answer-18.5-24.9 Overweight BMI range - answer-25- 29.9 Obese BMI range - answer-30-39.9 Morbid obesity BMI range - answer-greater than 40 What labs do we take in a nutritional assessment (6)? - answer-•Hemoglobin •Hematocrit •Cholesterol •Triglycerides •Total lymphocyte count •Serum albumin What is a desirable total serum cholesterol level? What is your total serum cholesterol made up of? - answer-- desirable total serum cholesterol: Less than 200 mg/dL - HDL + LDL + 20 percent of your triglyceride level. What is the purpose of HDL (High Density Lipoprotein)? What are healthy levels in men and women? What are bad levels? - answer--higher levels are better, Low HDL cholesterol puts you at higher risk for heart disease - Less than 40 mg/dL (men), less than 50 mg/dL (women): increased risk of heart disease - above 60 mg/dL = protective What is a desirable LDL (low-density lipids) level? - answer-- lower is good - Less than 100 mg/dL: optimal What is a desirable triglyceride level? - answer-- Less than 150 mg/dL: normal Metabolic syndrome increases the risk for (3).... - answer-CAD, DM, mortality To be diagnosed with metabolic syndrome, a patient needs at least 3 of the 5 following biomarkers... - answer-•HTN •increased fasting blood sugar •elevated triglycerides •↑ waist circumference •low HDL What are we assessing in a ROS of the abdomen - answer-•Changes in appetite- anorexia, weight loss or gain •Food intolerance •Dysphagia •Pyrosis/ Heartburn •Indigestion pain (associated with eating) •Other abdominal pain •Nausea and/or vomiting •Hematemesis/ Vomiting blood •Stomach/Intestinal ulcers •Liver disease •Gallbladder disease •Jaundice •Appendicitis •Colitis •Flatulence •Changes in bowel habits •Changes in stool characteristics •Constipation •Diarrhea •Black stools •Rectal bleeding •Rectal conditions •Hemorrhoids •Fistula What organs are located in the RUQ (7)? - answer-- right lobe of liver - gallbladder - duodenum - head of pancreas - right kidney And right adrenal gland - superior part of ascending colon - right of transverse colon What organs are located in the RLQ (8)? - answer-- cecum - appendix - most of ileum - inferior part of right uterine tube - right ovary - ascending colon - right ureter - right spermatic cord What organs are located in the LUQ (8)? - answer-- left lobe of liver - spleen - most of the stomach - jejunum and proximal ileum - body and tail of pancreas - left adrenal gland and left kidney - superior part of descending colon - left half of transverse colon What organs are in the LLQ (6)? - answer-- sigmoid colon - inferior part of descending colon - left ovary - left uterine tube - left ureter - left spermatic cord What actions can we take to enhance an abdominal assessment (6)? - answer-- Empty bladder - Patient comfort (pillows and draping) - Arms at side or crossed over chest - Ask the patient to point to any painful areas; examine last - Warm hands and stethoscope - Ticklish or nervous patients: slow movements, distraction, use their hands What is the abdomen exam order? - answer-1. Inspection 2. Auscultation 3. Percussion 4. Palpation What is the medical term for "stomach growling"? - answer-Borborygmus What do we inspect when assessing the abdomen (5)? - answer-- The skin: scar, striae, dilated vein, rashes and lesions - The umbilicus: contour, inflammation, bulges - The contour of the abdomen - Peristalsis - Pulsations What are the different ways the contour of the abdomen can be presented (5)? - answer--flat -rounded -scaphoid -protuberant -Abnormal- hernia flat abdomen - answer-abdomen is straight with no distention or indention rounded abdomen - answer-abdomen protrudes due to subq fat scaphoid abdomen - answer-abdomen caves in protuberant abdomen - answer-abdomen is distended What kind of pulsations are normal to see in an abdominal assessment? - answer-- abdominal aorta in the epigastric region - Normal = slight or no pulsations visible What can dilated veins on the abdomen indicate? - answer-hepatic cirrhosis In an abdominal assessment, why is auscultation performed before palpation and percussion? - answer-percussion and palpation maneuvers can alter the bowel sound What is the normal frequency and sound of bowel movements - answer-- high-pitched, gurgling, cascading sound - Occurs every 5-30/min Hyperactive bowel sounds - answer-- loud, high-pitched, rushing - hyperperistalsis, ↑motility (diarrhea, early mechanical intestinal obstruction) hypoactive bowel sounds - answer-- diminished or absent↓ motility, inflammation - paralytic ileus, peritonitis, late bowel obstruction Should we hear bruits in an abdominal assessment? Where do we listen for bruits (4)? - answer-- Normal = usually no sound is present - assess over the aorta, renal arteries, iliac arteries, femoral arteries(renal artery stenosis) What sounds should we hear when percussing the abdomen - answer-Distribution of tympany (over stomach and intestines) and dullness (over liver) Why do we distend the abdomen in an abdominal assessment? - answer-To determine if the cause is fluid vs. air What organs do we outline in an abdominal assessment (3)? - answer-Liver, spleen, and gastric bubble How do we determine if hepatomegaly is present? - answer-if liver is more than 2-3 cm below costal margin may be sign of enlargement How do we determine if the spleen is enlarged? - answer-An enlarged spleen expands anteriorly, downward, and medially, often replacing the tympany of the stomach and colon with the dullness of a solid organ → then moves below the costal margin Tympanic sounds - answer--musical and drum-like note of higher pitch than resonance - air filled space stomach, intestines - Predominant due to gas in GI tract What are resonance sounds? What about hyperresonance sounds? - answer-- clear, hollow, moderate pitch lung tissue or over abdomen - hyperesonance: lies between tympany and resonance; caused by gas distention, normal child lung, emphysema adult Dull sounds - answer--short high itch note with little resonance , muffled - solid: dense organs (liver, spleen), fluid, feces, mass Flat sounds - answer-very soft, over bone or tumor What are we feeling for when we perform a light palpation of the abdomen (4)? - answer-tenderness, muscular resistance, superficial organs and masses. What are we feeling for when we perform a deep palpation on the abdomen? - answer-delineate abdominal masses How do we assess for peritoneal inflammation (3)? - answer-- Cough - Palpation (guarding, rigidity) - rebound tenderness What does voluntary guarding look like and what is it caused by? - answer-•Tightening of the abd. muscles occurs when a person is cold, tense, or ticklish •It is bilateral. •It may decrease with exhalation. What does involuntary guarding look like and what causes it? - answer-•Rigidity is constant, a board-like hardness •May be unilateral •Protective mechanism with acute inflammation of the peritoneum. How do we percuss the liver? What is the normal liver size? - answer-- Right midclavicular line (MCL), begins with lung resonance, percuss down the interspaces until changes to dull at the liver; about 5th intercostal space. - Then percuss low, from abdominal tympany up the MCL to dull. - Normal measures 6-12 cms - Liver more than 2-3 cm below costal margin may be sign of enlargement How do we palpate the liver? What are normal findings in a liver palpation? - answer-- One hand behind back, 11th to 12th ribs, right costal margin, breath slowly, move fingers upward with exhalations - Normal- feel the edge of the liver bump as the diaphragm pushes it down during inhalation - Hook fingers over costal margin - Abnormal- hepatomegaly- Hepatitis, etc. What are the 2 techniques we use to percuss the liver? - answer-- Percuss the left lower anterior chest wall - Check splenic percussion sign What does a normal palpation of the spleen look like - answer-•Normal- not palpable -Must be enlarged 3 times it's normal size to be felt-Splenomegaly What can cause splenomegaly? What do we do if we detect splenomegaly? - answer--Splenomegaly- with mono, trauma, leukemia, etc. -Friable, can rupture, refer now How do we assess costovertebral angle (CVA) tenderness? What are normal findings during this percussion? - answer-•Assess kidneys 12th rib at the CVA on the back •Normal- no pain •Abnormal- inflammation, UTI How do we palpate the abdominal aorta? What are normal findings? - answer-- Abdominal Aorta: Upper abd, slightly left of midline - Normal: 2.5-4 cms pulsations Where are the inguinal lymph nodes? - answer-Groin What are common presenting symptoms with gastrointestinal disorders (5)? - answer-•Abdominal pain, acute or chronic •Indigestion, nausea, vomiting including blood, loss of appetite, early satiety •Dysphagia / odynophagia •Diarrhea, constipation •Jaundice What is the typical pain experienced with acute appendicitis (OLDCARTS)? - answer-Onset: vague Location: poorly localized, periumbilical pain followed usually by RLQ pain Characteristics: dull periumbilical pain, may be cramping•Radiation: periumbilical RLQ Associated factors: anorexia, nausea/vomiting, low fever Relieving factors: if subsides temporarily, suspect perforation of the appendix, movement/cough Timing: Periumbilical (4-6h), RLQ (depends on intervention) Severity: periumbilical (mild but increasing), RUQ (steady/more severe) How do we test for acute appendicitis in an abdominal assessment? - answer-- rebound tenderness (Blumberg sign) - Push down slowly and deeply, lift up quickly - Normal: negative, no pain on release of pressure - Abnormal: pain on release = peritoneal inflammation How do we use the Alvarado Score (MANTRELS score) to test of appendicitis? - answer-- Symptoms- Migration, Anorexia, N&V - Signs- Tenderness RLQ, Rebound tenderness, Elevated temp. - Labs- Leukocytosis (WBC ↑), Shift of labs - Abnormal = score more than 7 - prob. appendicitis Iliopsoas muscle test - answer-- test for acute appendicitis - person supine, lift right leg straight up, flex at hip - then push down right thigh as person resists - Normal- negative- no pain - Abnormal- pain in the RLQ, with inflammation Acute cholecystitis - answer-- occurs when bile becomes trapped gallstone blocks the cystic duct - causes irritation and pressure in the gallbladder; can lead to swelling and infection What are S/S of acute cholecystitis? - answer-•Symptoms- -abd. pain episodic RUQ-Worse after eating spicy or fatty foods-N & V-Not indigestion, GERD, not better with antacids •Signs- Murphy sign-Abnormal to feel pain when palpating liver, as the liver descends and pushes into the gallbladder. What organs can cause abdominal distention - answer-- Uterus- pregnancy, etc. - Bowel: small and large-- constipation, IBS, hernia - Bladder - Liver - Stomach - Ovarian cyst/cancer How can air/gas build up and cause abdominal distention? What are S/S of abdominal distention caused by gas (bowel sounds? percussion?)? - answer-- Causes: surgery, ileus, etc. - Signs: single, round curveileus- decreased bowel sounds - hyperactive bowel sounds with early obstruction - percussion: tympany palpation- discomfort, tight What is ascites? What causes it? - answer-- Free fluid in the abdominal cavity -- disention - Causes: cancer, cirrhosis, hepatitis, heart failure, portal HTN, pancreatitis What are S/S of ascites? - answer-- Signs: abd. Distention, increasing abd. girth, Bulging flanks, Umbilicus protruding and downward - Dull percussion over fluid What tests can we do to determine if ascites is present (palpation and percussion)? - answer-- Fluid wave upon palpation - Shifting dullness: abnormal is positive on percussion of fluid What are the S/S of bowel obstruction? - answer-- vomiting - absence of gas or stool passage - distended abdomen - hyperactive bowel sounds in early obstruction; hypoactive or no bowel sounds in late obstruction - dehydration, loss of electrolytes - fever - pain from strong peristalsis - accumulation of fluid and gas - leaking fluid into peritoneum - hypovolemic shock Where are the common sites of referred pain (3)? - answer-Liver, appendicitis, gallbladder, and others What are the colorectal screening tests (3)? - answer-- Colonoscopy - Sigmoidoscopy - Fecal Occult Blood Testing (FOBT) (Guaiac, Immunochemical) What is a huge risk factor for colorectal cancer? How do we prevent this type of cancer? - answer-- Risk Factor: Polyps, etc. - Cancer Prevention: Removal of pre-cancerous polyps - Long-term survival: Improved by early detection What do we ask in a musculoskeletal ROS? - answer-•Arthritis •Gout •Joint pain •Joint stiffness •Joint swelling •Deformity •Limited range of motion in joint •Noise with joint motion •Muscle cramps •Muscle pain •Muscle weakness •Gait or problems with coordination •Back pain •Back stiffness •Limited ROM in back •Disk disease •Walker/Cane or other mobility aid used •Daily activities limited by ROM Besides a ROS, what additional history should we ask for when assessing the musculoskeletal system - answer-•Surgery or other treatments--past hospitalizations from musculoskeletal problems •Functional health patterns What functional health patterns do we ask for when assessing the musculoskeletal system (7)? - answer--Nutritional: metabolic pattern, dietary supplements -Elimination -Activity/exercise/mobility -Sleep/rest -Cognitive/perceptual: musculoskeletal pain -Safety -Quality of Life What is the musculoskeletal system made up of (5)? - answer-- 206 bones - joints - muscles - ligaments - tendons What are muscles? List the different types of muscles in the body and their mechanism of action. - answer-- Muscles = more than 600 voluntary or striated muscles - Three types of muscle: 1. visceral (smooth, involuntary) 2. cardiac 3. skeletal (striated, voluntary) What are the different types of joints (6)? - answer-•hinge(elbow) •pivot(proximal radioulnar joint) •condyloid (wrist) •saddle(thumb joints) •ball and socket (hip & shoulder) •plane (kneecap) hinge joint - answer-Joint between bones (as at the elbow or knee) that permits motion in only one plane pivot joint - answer-rotating bone turns around an axis; i.e. connection between radius/ulna and humerus condyloid joint - answer-- synovial joint that does everything except rotating - wrist joint saddle joint - answer-type of joint found at the base of each thumb; allows grasping and rotation ball and socket joint - answer-hip and shoulder joints plane joint - answer-short slipping or gliding movements; i.e. kneecap What are the 6 basic types of joint movements? - answer-•flexion & extension •dorsiflexion & plantar flexion •adduction & abduction •Inversion & eversion •Internal & external rotation •Pronation & supination What are we looking for when we inspect and palpate joints (2)? - answer--Observe general body build, muscle configuration & symmetry of joint movement -Note for swelling, deformity, nodules or masses & discrepancies in limb length or muscle size Active ROM vs Passive ROM - answer-- Active ROM: voluntary, demonstrate, and have pt. repeat -Passive ROM: another gently moves the pt. How do we assess muscle strength on a scale from 0-5? - answer-0- no detection of muscular contraction 1- slight contraction, trace strength 2- full ROM, passive motion, poor 3- full ROM with gravity, fair 4- full ROM against gravity, some resistance, good 5- full ROM against gravity, full resistance, normal Nonsynovial joints - answer-immovable, with cartilage closures Synovial joint - answer-freely movable, with separate bones enclosed in joint cavity Ankylosis - answer-stiffness or fixation of a joint Cartilage - answer-avascular, cushions the bones and covers the surface of the opposing bones Ligaments - answer-fibrous bands running directly from one bone to another Tendon - answer-a fibrous structure that connects skeletal muscles to bones Bursa - answer-- an enclosed sac filled with viscous synovial fluid located in areas of potential friction - help muscles and tendons glide smoothly over bone Flexion - answer-Decreases the angle of a joint Extension - answer-Straightening of a joint Dorsiflexion - answer-bending of the foot or the toes upward Plantar flexion - answer-bending of the sole of the foot by curling the toes toward the ground Adduction - answer-Movement toward the midline of the body Abduction - answer-Movement away from the midline of the body Elevation - answer-raising a body part Depression - answer-lowering a body part Inversion - answer-turning inward Eversion - answer-turning outward, i.e., of a foot Internal rotation - answer-turning the joint inward External rotation - answer-turning the joint outward Pronation - answer-palm down Supination - answer-Palm up Protraction - answer-Moving a part forward Retraction - answer-moving a part backward Circumduction - answer-circular movement of a limb at the far end How do we perform an upper extremity assessment for TMJ (inspection and palpation, tests)? - answer-- Inspect and palpate: assess size, firmness, crepitus, and strength bilat - Tests for CN V- Trigeminal What is the normal ROM of the jaw? - answer-•Vertical motion- open mouth •Lateral- side to side •Protrude out with jaw •retract back in to body What is the normal ROM for the shoulder joint (10)? - answer-•Extension •Forward flexion •Hyperextension •Internal rotation •External rotation •Abduction •Adduction •Elevation •Depression •Circumduction How do we assess muscle strength of the shoulders - answer-•shoulder shrug against resistance (CN XI) •deltoids (pt. holding arms straight out, push arms down) What are abnormal findings in a shoulder assessment usually caused by? - answer-rotator cuff injury What is the normal ROM of the elbow joint (5)? - answer-•Flexion •Extension •Possible hyperextension •Pronation •Supination How do we assess muscle strength in the elbow joint? - answer-Flex and extend against resistance What can cause abnormal findings in an elbow joint assessment? - answer-tennis elbow, soft, boggy, thickening, inflammation and tenderness What is the normal ROM in the wrist (5) and hand (3)? - answer-- Wrist: 1. Flexion 2. Extension 3. Hyperextension 4. Ulnar deviation 5. Radial deviation - Fingers: 1. Flexion 2. Abduction 3. Adduction How do we assess muscle strength in the wrist/hand? - answer-Hand grips What can cause abnormal findings in a wrist/hand assessment? How can we confirm this is the cause of the abnormalities observed? - answer-- Carpal Tunnel Syndrome - Assess with Phalen test, Tinel sign What is Phalen's test? How does a patient perform it? - answer-- Test for carpal tunnel syndrome - Ask the person to hold both hands back to back while flexing the wrists 90 degrees. - Acute flexion of the wrist for 60 seconds produces numbness and burning in a person with carpal tunnel syndrome What is Tinel's sign and how does a patient perform it? - answer-- In carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a positive Tinel's sign - No pain: negative, normal What is the normal ROM for the hip joint (6)? - answer-•Hip flexion with knee straight •Hip flexion with knee flexed •Internal & External rotation •Abduction •Adduction How do we test muscle strength at the hip joint (2)? - answer-•quadriceps (pt. to push up against resistance) •hamstrings (push down) What is the normal ROM for the knee joint (2)? - answer-•Flexion-extension •Hyperextension How do we test muscle strength (2)? - answer-- bulge sign - ballottement What are abnormal findings in knee ROM (3)? - answer-Swelling , pain, ↓ROM What is the normal ROM for the ankle (4)? - answer-•Dorsiflexion •Plantar Flexion •Inversion of hind foot •Eversion of hind foot How do we test muscle strength of the ankle? - answer-maintain flexion ↓ ↑(push up and down) What is the normal ROM of the neck (5)? - answer-•Flexion, extension •Hyperextension •Lateral bending •Rotation How do we test muscle strength of the cervical spine? - answer-against resistance What are abnormal findings in the cervical spine assessment (3)? - answer-•Limited ROM •Pain with movement •Asymmetry of the muscles Describe the normal symmetry of the spine (3)? - answer-•Symmetry: shoulders, iliac crests, gluteal folds, knees, feet •Convex thoracic curve •Concave lumbar curve What is the normal ROM of the spine (5)? - answer-•Extension •Flexion •Hyperextension •Lateral bending •Rotation Is there any muscle strength of the spine? - answer-no What causes abnormal findings in a spinal assessment? - answer-Herniated Disc Kyphosis - answer-pronounced thoracic curve Lordosis - answer-pronounced lumbar curve Scoliosis - answer-Lateral curvature of thoracic and lumbar spine Functional vs structural scoliosis - answer-- Functional scoliosis is flexible. It is apparent with standing and disappears with forward standing - Structural scoliosis is fixed. The curvature shows both on standing and on bending forward Gena varum - answer-- "bowlegged" stance is normal through the first two years of life - Resolves with growth and ambulation Gena valgum - answer-knock-kneed stance occurs normally between 2 and 3½ years of age Where is muscle atrophy most common? - answer-most common in the distal extremities sarcopenia - answer-- Age-related loss in skeletal muscle - a direct cause of the age-related decrease in muscle strength joint stiffness - answer-Thinning of cartilage and synovial thickening also work to causing joint stiffness and joint pain Decreased intervertebral disc space leads to... - answer-loss in height Degenerative changes lead to (3)... - answer-loss of elastic tissue in joints, ligaments, and tendons. Degenerative changes such as loss of elastic tissue in joints, ligaments, and tendons may result in.... - answer-bone, cysts and erosions, making the bones prone to fracture. osteoarthritis - answer-- degenerative joint disease - Non-inflammatory, localized, progressive - Deterioration of cartilages that cushions How does aging affect the incidence of osteoarthritis? - answer-Aging increases incidence What are signs and symptoms of osteoarthritis (4)? - answer-- Asymmetric joint involvement - Commonly affects hands, knees, hips, spine - Affected joints are stiff, swell with bony protuburances - Pain and limited motion What is rhuematoid arthritis (RA)? What does it cause? - answer-- chronic, autoimmune disease - Inflammation at synovial tissues, Any joint, not localized - Leads to cartilage and bone loss S/S of rheumatoid arthritis (8)? - answer-•Pain and ↓motion of affected joints •Heat •Redness •Swelling •Fatigue •Lymphadenopathy •Ulnar deviation or drift •Swan-neck and Boutonnière deformity What does osteoporosis do to the bone? - answer-Loss of bone density- spongy, weak, brittle, at risk for fractures What are the risk factors for osteoporosis (8)? - answer-aging, postmenopausal, white, female, small frame & low body weight, lack of exercise, smoking, and some medications (steroids) How do we diagnose someone with osteoporosis? - answer-DEXA scan Prevention strategies/ patient education for osteoporosis (3) - answer--Calcium 1000 to 1200 mg/ day -Vitamin D3 (needs to absorb Ca++), 400 to 1000 IU/day, or more -Exercise (weight bearing) What is acute gout? What is it caused by and what does it cause? - answer-•a type of arthritis •caused by excess uric acid in the blood •produces urate crystals in the joint space What are the risk factors for acute gout (5)? - answer-- obesity - alcohol consumption - dehydration - rich foods: chocolate, seafood, meat or red wine high in purines - Some medicines: especially diuretics S/S of gout (5) - answer--episodic redness - swelling - heat - extreme pain - attacks can last a few days or many weeks Chronic gout - answer-Tophi- collection of sodium urate crystals in and around the joint What do we ask about in a ROS of the bladder, kidneys, and urinary system? - answer-• Frequency • Urgency • Nocturia • Recent urinary changes • Dysuria • Polyuria • Oliguria (not peeing enough) • Hesitancy or straining • Narrowed stream • Cloudy urine • Hematuria • Incontinence • Kidney disease • Kidney stones • Urinary tract infections • Pain in flank, groin, suprapubic region, or low back • How many times awaken at night to void • Describe measures used to avoid UTI and use of Kegel exercises What questions do we ask in a ROS in a male GU assessment (8)? - answer-•Any problems? •Enlarged prostate •Penile or testicular pain •Penile or testicular lesions or sores •Penile discharge •Testicular lumps •Inguinal hernia •Describe testicular self-exam routine and last completed What ROS questions do we ask in a gynecological assessment (8)? - answer-•Age at onset of menarche •Last menstrual period •Menstrual cycle timing: regular/monthly, irregular, rare, none •Type of contraceptive used (if applicable): Include the regularity of use •Post-menopausal age (if applicable) •Date of last gynecological exam/ Pap test •Results of last Pap test •History of surgery: including hysterectomy, oophorectomy, salpingectomy, Bilat. Tubal Ligation, LEEP cone biopsy total hysterectomy vs total hysterectomy with bilateral salpingoopherectomy - answer-- total hysterectomy = removal of uterus - total hysterectomy with bilateral salpingoopherectomy = removal of uterus and both fallopian tubes and ovaries What are common gynecological problems (10)? - answer-•Amenorrhea •Menorrhagia (heavy periods) •Dysmenorrhea •Pelvic pain •Premenstrual pain •Intermenstrual spotting •Vaginal itching •Vaginal discharge •Menopausal symptoms •Post-menopausal bleeding How do we ask our patients about their sexual orientation (4)? - answer-- Presently in a sexually active relationship? - When was your last sexual encounter? - How many previous partners? Total? Recent - Intercourse- oral, vaginal, rectal? How do we ask our patients about sexual problems they may be experiencing (4)? - answer-- Any sexual problems? - Dyspareunia or pain with intercourse? - Female- desire, arousal, orgasm, and satisfaction - Male- desire, arousal, erectile changes, ejaculation changes, and satisfaction How do we ask our patients about contraceptives / STI protection (2)? - answer-- Contraception- satisfied with your method? - STI protection- types used, used consistently? How do we get a patient's history of STIs? - answer-- History of STI's: chronic vaginal infections- BV, yeast - Gonorrhea - Chlamydia - Syphilis - Herpes - Human papilloma virus - HIV/AIDS gender vs sex - answer-- sex is biologically determined(genetically determined) - gender is socially constructed. gender identity vs gender expression - answer-- Gender expression is all of the external characteristics and behaviors that are socially defined as either masculine or feminine, such as dress, grooming, mannerisms, speech patterns and social interactions. - Gender identity is how we think of ourselves; psychological , internal perception sexual orientation - answer-a person's sexual identity in relation to the gender to which they are attracted What are the ways in which our sex is presented externally (2)? - answer-- anatomy: genitalia and/or reproductive organs - biology: chromosomes and/or hormones How much urine can the bladder hold? - answer-500cc What color is normal urine? What is the consistency of normal urine? - answer-- color = yellow, pale, amber - consistency = clear, transparent, cloudy What is a normal urine output per hour? What about over 24 hours? - answer-- normal urinary output = 30 cc/hour - 24 hour urine production = 1,000 to 2,000 cc What questions do we ask when we are trying to see if our patient has had any problems urinating (6)? - answer-Have you experienced any: • Hesitancy or straining • Weakened force of stream • Incontinence- dribbling, leaking, loss of bladder control • Do you ever leak water or urine when you don't want to? • Do you use pads/tissue to catch urine in your underwear? • Urgency- strong and sudden need to void, feel as if you cannot wait to urinate Urge incontinence - answer-involuntary urine loss from overactive muscles in the bladder, bladder spasms or unknown cause Stress incontinence - answer-involuntary urine loss with physical strain, sneezing, coughing, laughing, running, etc. Overflow incontinence - answer-constant dribbling of urine - possible causes: DM neuropathy, prostatic hyperplasia, prolapse What is usually the first manifestation of DM? - answer-nocturia urinary retention - answer-incomplete emptying urinary frequency - answer-urinating more often than usual nocturia - answer-need to get up at night to urinate What questions do we ask when assessing a patient's nocturia (2)? What usually causes nocturia (4)? - answer-•What medications are you taking? •What fluids do you drink in the evening? •Occurs with frequency and urgency in urinary tract disorders; •other causes include cardiovascular, DM, habitual, diuretic medication What is dysuria and what usually causes it (3)? - answer-- pain or burning with urinating - Burning common with acute cystitis, prostatitis, and urethritis How do we inspect and palpate the bladder? What types of things are we looking for? - answer-- Inspect the bladder area: look for flatness, distension any devises (catheters- foley, condom; irrigation) - Palpate for: fullness- non-palpable, non-distended, filling, full, distended - pain: non-tender, tender, rate on a 1-10/10 scale How do we percuss the urinary system? What are normal and abnormal findings? - answer-- Percuss for CVA tenderness- none, negative or - which kidney is involved- if positive or tender What do we assess and calculate in a urine/kidney function exam (3)? - answer-•Assess for urine color and amount •Calculate- Intake and Output (I&O should be equal) •Assess for equipment/devices - catheter, urometer, etc. What kind of diagnostic tests can we perform in a urine/kidney function exam? - answer-•Diagnostics: UA, culture, urine dipstick, 24 hour urine, etc. • bladder scan- assesses bladder volume- scan before and following voiding (checking for retention) What kind of procedures/surgeries can we perform in a urine/kidney function exam? - answer-Procedures and/or surgeries: ultrasound, xray, MRI, cystoscope, bladder tack, etc. A UTI (bacterial infection) may involve (4)... - answer-all of the tract- bladder, kidney, ureter or urethra A UTI is also known as (3)... - answer-cystitis; bladder infection; urethritis pyelonephritis - answer-- UTI that reaches the kidneys - is a worse infection What are the s/s of a UTI (9)? - answer-• Frequent urination • Urgency • Fullness-feeling like you have to urinate • small amounts of when you urinate • Dysuria- pain on urination, burns to void • Urine- Cloudy, strong, possible hematuria- blood in your urine • CVA tenderness on palpation (Kidneys, flank area)- for pyelonephritis • Fever and chills- for pyelonephritis • Lab work- UA positive for blood, leukocytes, ↑ WBCs, bacteria on culture, etc. What is the treatment for a UTI (4)? - answer-• seek heath care • may get a dipstick or a urine culture • antibiotics are needed, may use Cipro, maybe Macrobid or Septra/Bactrim • Azo-standard or something like it over-the-counter (yellow-orange stain, not before a test is done, be careful with your clothes) How can we prevent UTIs (6)? - answer-•Drinking plenty of water every day •Regularly drinking cranberry juice •Don't hold your urine when you need to void •Taking showers rather than baths (especially bubble baths with fragrances, allergic-like reactions) • Cleansing the vaginal area, and urinate, before and after sexual intercourse • Wiping from front to back after bowel movements to help prevent bacteria from the anus from entering the vagina or urethra • Avoiding the use of feminine hygiene sprays, powders, and douches What s/s are often confused with mental incapacity in the elderly instead of a UTI (3)? - answer-Increased mental confusion, unexplained falls, and deterioration of health of an elderly person may be related to a UTI, not a mental incapacity- very common What do we assess in an elderly patient if we suspect that they have a UTI (4)? - answer-hydration, appetite, dysuria, nocturia Urolithiasis - answer-urinary stones Renal lithiasis/Nephrolithiasis - answer-kidney stones What are possible causes of urinary tract calculi (stones) (3)? - answer-• Dehydration • Urinary stasis/ obstruction • Increased minerals and salts (ex. calcium, oxalates, phosphates, uric acid) What are s/s of urinary tract calculi (4)? - answer-• Pain- depends on the location of the stone, may radiate • CVA tenderness - depends on the location of the stone • Urine-Hematuria (inflammation, irritation, infection) • temperature increase, diaphoresis, WBCs and bacteria (if UTI) What do we monitor when a patient has a urinary calculi (2)? - answer-• Monitor I&O • Strain the urine How do we treat urinary calculi (4)? - answer-• Pain management • Increase fluids (po, IV) if able • Modify diet if needed for prevention/to decrease occurrence of future stones- low calcium oxalate, low sodium, low purine- depends on the type of stones • Possibly prepare patient for Lithotripsy procedure or surgery For a breast exam, how do we assess the lymph nodes? What lymph nodes do we assess (4)? - answer-- Assess the lymph nodes: inspect and palpate the most common locations - Head, neck, inguinal area, and axillae What do we ask about in a ROS of the breast (10)? - answer-• Cyclical changes • Pain • Lump • Discharge • Rash • Swelling • Trauma • History of Breast disease • Self-care- mammogram, self- breast awareness • Family history of breast cancer What do we ask in an axilla ROS (4)? - answer-tenderness, lymph nodes, lump, rash The breast area is though to contain (4)... - answer-milk ducts, fat, and muscles and ligaments What does normal breast tissue feel like? What is normal for breasts to feel like after pregnancy? - answer-- Normal: tissue feels firm, smooth, elastic - Normal after pregnancy: may be looser, hollow after breastfeeding What are normal cyclical/monthly changes that occur in the breasts? - answer-varies with women premenstrual- slightly enlarged, tender, nodular What are the effects of aging on the breasts (4)? - answer-- decreased breast size and elasticity - glandular tissue and fat atrophies - breasts flatten, drop, sag, - loose fatty fullness What are normal findings in a breast assessment when we inspect the general appearance, skin, and nipples? - answer-• General appearance- symmetry, size, slight asymmetry is normal • Skin- smooth, even, no edema, no orange-peel • Nipples- symmetric, both everted, flat, or inverted - only 1 nipple retracted is suspicious Why do we tell the patient to lift their arms up when assessing the breasts? - answer-to assess for retractions, dimpling, puckering, fixation What are the techniques we use to palpate the breasts (3)? What are we assessing for (5)? - answer-• Use pads of fingers, circular motion over each breast • Assess for- heat, redness, swelling, masses • Depress the nipple- checking for any discharge • Inspect and palpate the axillary lymph nodes How does a patient perform a self breast exam (4)? - answer-• Every month after your menstruation • Look in the mirror for symmetry, dimpling, nipple change • pads of fingers, circular inside to out, up and down • Check for any breast changes that do not resolve What education do we provide to our patients in terms of their breasts? - answer-how to perform a self examination and what abnormalities they should be looking for What are risk factors for breast cancer (11)? - answer-- female - increasing age - personal breast cancer - family history - started menstruation early (before 12) - menstruation ended late (after 55) - never was pregnant or late age for pregnancy - did not breastfeed - took hormone replacement - obesity - alcohol and tobacco use What are s/s of breast cancer (9)? - answer-• A single, immobile, usually painless lump, or thickening inside the breast or underarm area • Swelling, warmth, redness or darkening of the breast • Change in the size or shape of the breast • Dimpling or puckering of the skin • Itchy, scaly sore or rash on the nipple • Retraction or pulling in of your nipple or other parts of the breast • Nipple discharge that starts suddenly- bloody or clear suspicious • New pain in one spot that doesn't go away • Axillary lymph nodes that are palpable, irregular, tender, positive on bx. Is breast cancer usually unilateral or bilateral? - answer-unilateral What are s/s of fibrocystic (non-cancerous) breasts (8)? - answer-• Pain or discomfort in both breasts • The pain commonly comes and goes with the period, but can last through the whole month • Breasts that feel full, swollen, and heavy • Pain or discomfort under the arms • Thick or lumpy breasts, may also feel grainy • A round, movable lump, especially one that is tender to the touch, suggests a cyst. • Cysts may feel like a lump in the same area of the breast that becomes larger before each period and shrinks afterward. • This type of lump moves when it is pushed with your fingers. It does not feel stuck or fixed to the tissue around it. What are the causes of fibrocystic breasts (3)? - answer-- fluctuating hormone levels • - Water retention - eating chocolate or drinking caffeine (there is no clear proof) What are the different treatment options for fibrocystic breasts (7)? - answer-• Take over-the-counter medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) • Apply heat or ice on the breast • Wear a well-fitting or sports bra • eating less caffeine or chocolate • May take a mild diuretic (like the vitamin B6) • If it persists- get a clinical breast exam, R/O cancer • may need an ultrasound or fine needle aspiration (FNA) biopsy to aspirate the fluid and to confirm a benign diagnoses What is fibrosis? - answer-a large amount of fibrous tissue, the same material that ligaments and scar tissues are made of What is the most common benign breast tumor in women under age 30? - answer-fibroadenoma What are the s/s of fibroadenoma (5)? - answer-• Usually single lumps with smooth, well-defined borders • Easily moveable under the skin (you can almost roll them) • Firm / Rubbery • Painless • The lump does not go away with your cycle. What is the treatment for a fibroadenoma? - answer-- Fibrosis usually does not increase your breast cancer risk and does not need any special treatment. -U/S, biopsy if concerned, surgical removal may be needed if quality of life would be better with the tumor is gone. What is mastitis and when does it usually occur? - answer-- breast infection - usually occurs during breastfeeding s/s of mastitis (8)? - answer-•Localized pain •Inflammation, redness, and warmth •Tenderness and swelling •Body aches •Fatigue •Breast engorgement •Fever and chills •Abscess What are common breast surgeries (4)? - answer-- Breast augmentation - Breast biopsy - Breast lumpectomy - Breast mastectomy What is puberty and at what age does it usually begin? - answer-- onset of sexual maturation to the ability to reproduce - 8 to 12 years of age; gonads produce more sex hormones What does puberty begin and end with in females? What about males? - answer-•Females: Begins with thelarche (breast development) and ends with ovulatory menstrual cycles •Males: Begins with voice changes and ends with mature sperm Adrenarche - answer-- increased adrenal androgens - puberty In puberty, there is a positive feedback system between (3)... - answer-LH, FSH, and GnRH What is the male hormone and what are the roles of this hormone (2)? - answer-- Male hormone: testosterone - "Testosterone causes growth of the testes, scrotum, and penis." - "Positive feedback loop: gonadotropins stimulate the gonads (testes) to produce more sex hormones." What are the two functions of the testes? - answer-1) Produce mature sperm that are capable of reproduction consistently, not cyclically 2) Production of the sex hormones- testosterone and androgens What are subjective genital abnormalities in men (5)? - answer-• Genital pain • Lesions • Genital swelling • Penile discharge • Urinary symptoms How do we inspect the penis, inguinal area, scrotum, and rectal area? - answer-• Penis: condition of skin, color, lesions, discharge, size, position of urinary meatus, foreskin • Scrotum: size and position, color, hair distribution, lesions, swelling, pediculosis • Inguinal area: condition of skin, bulges • Rectal area: condition of skin, lesions, hemorrhoids, polyps, fissures, bleeding How do we palpate the penis, scrotum/testes, and epididymis? - answer-• Penis: consistency, tenderness, masses, discharge • Scrotum & testes: size, shape, symmetry, mobility, tenderness, masses • Epididymis: swelling, tenderness, nodules How do we palpate the inguinal area and the anus/rectum? - answer-• Inguinal area: hernias, lymph nodes, tenderness • Anus & rectum: sphincter tone, tenderness, lesions, masses, hemorrhoids, polyps, test any stool for occult blood How do we palpate the prostate? - answer-size, shape, symmetry, mobility, consistency, nodules, tenderness, grade size What are normal findings upon inspection and palpation of the penis-- shaft, foreskin, and urethra? - answer-- Penis: wrinkled, hairless, no lesions - check foreskin - check urethra: midline, pink, smooth, no discharge - shaft: smooth, semi-firm, non-tender What are normal findings when we inspect and palpate the scrotum (3)? - answer-- lift and spread rugae - pubic hair consistent with age - asymmetry is normal, left lower usually What are normal findings when we inspect and palpate the testes (2)? - answer-- oval, egg shaped, firm, rubbery, smooth, freely movable, equal size bilaterally, and slightly tender - move closer to the body in response to cold temps What are normal findings upon inspecting and palpating the inguinal area? - answer-- Palpate: for an inguinal hernia (should be non) - Palpate: Inguinal area for lymph nodes- occas., soft, discrete, movable and non-tender OK How should men perform a testicular self exam using the TSE pneumonic? - answer-- T= timing- exam monthly, whenever in the day - S= shower- hands are warm and soapy, testes are pendulous. The cremaster muscle contracts in response to cold and retracts the scrotal sac, drawing the testicles closer to the body. - E= examine- palpate for consistent findings. Support the testes and roll between the thumb and fore finger. report changes/problems- ex. change in color, shape, a firm painless lump, enlarged testicle, enlarged node, etc. Do males experience a definite end to fertility? What about females? - answer-Male does not experience a definite end to fertility as female does When does sperm production begin to decrease in men? What about testosterone production? - answer-• Around age 40 years, production of sperm begins to decrease, although it continues into 80s and 90s • Testosterone production declines after age 30 but continues very gradually so resulting physical changes are not evident until later in life What are the results of declining testosterone in older men (5)? - answer-• Pubic hair decreases • Penis size decreases • 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 What is a unique aspect of male health assessment? - answer-Discussion of prostate health and examination of prostate gland is a unique aspect of male health assessment. What are normal prostate changes as a male ages? - answer-Gradual enlargement of prostate gland considered to be normal part of aging. How do we test for prostate cancer (2)? Why do we test this way? - answer-• Prostate cancer typically detected by testing blood for prostate-specific antigen (PSA) and/or on digital rectal examination (DRE) • PSA made by normal prostate gland • When prostate cancer develops, PSA levels increase What can cause PSA levels to increase in men (besides prostate cancer) (3)? - answer-benign enlargement of prostate (BPH), age, and prostatitis can cause PSA to increase What is the most commonly diagnosed cancer in men? Is it the deadliest? - answer-Prostate CA-most frequently diagnosed CA, not the deadliest Who should be offered prostate cancer screening early (who is at high risk of developing prostate cancer)? - answer-Men at higher risk for developing prostate cancer: - African Americans - men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65) What is benign prostatic hyperplasia (BPH) and what usually causes it? - answer-- Enlargement of the prostate, resulting in compression on the urethra - Causes: At birth, the prostate is pea sized, it grows until it reaches adult size, and around 40 to 45yo benign hyperplasia begins and continues slowly until death. What are the risk factors for BPH (3)? - answer-• Associated with aging and continued growth of the prostate • About half of all men older than 75 have some symptoms. • ↑ risk also with: obesity, westernized countries, race, family history What are s/s of BPH (9) and why do they occur? - answer-Bladder outflow obstruction with compression on the urethra→ S&S include: • Urinary retention • Urinary frequency • Hesitancy- delay in starting a urine stream • Urgency- feeling of needing to void • Decreased force of the urine stream • Overflow incontinence (dribbling) • A sense of bladder fullness (not completely empty) • Possibly nocturia • Potential for hydronephrosis, bladder and kidney infections, etc. What do we find upon examination in someone with BPH (6)? - answer-symmetric, nontender, enlarged prostate, also smooth, rubbery and firm What are abnormal findings in the penis upon inspection and palpation (5)? - answer-- lesions: ulcers, vesicles, warts - phimosis, hypospadias, epispadias, stricture - inflammation of the shaft, glans or urethra - marked tenderness on exam - discharge: bloody, purulent What are abnormal findings in the scrotum upon inspection and palpation (5)? - answer-- swelling is not normal - Lesions not normal - absent, atrophied, or fixed testes - nodules, swelling or edema (hydrocele), or varicose veins (vericocele) thickened cord - hernia- inguinal, femoral What are abnormal findings in the testes upon inspection and palpation (3)? - answer-- infection: prostatitis, epidisymitis - Torsion: emergency - Inguinal lymph nodes: enlarged, hard, matted, fixed What is urethritis and what usually causes it (5)? - answer-- Inflammation of the urethra usually, but not always, caused by a sexually transmitted disease - Nonsexual origins can be caused by urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma What are the s/s of urethritis (4)? - answer-- Meatus edges are reddened, everted, and swollen - purulent urethral discharge is present - dysuria - urine cloudy with discharge and mucous shreds What are urethral strictures? What causes them? - answer-• Fibrotic narrowing of the urethra caused by scarring • Commonly a result of trauma or untreated or severe urethral infections Phimosis - answer-Inability to retract foreskin from the glans of the penis (distal to proximal) What is paraphimosis? What does it cause and what is paraphimosis caused by? - answer-- Foreskin is retracted and fixed. - Construction ↓circulation - Inability to replace or cover the glans with the foreskin (proximal to distal) - Frequently caused by poor hygiene or chronic infections Hypospadius - answer-congenital disorder where urethra opens on ventral surface of the penis Epispadius - answer-Urethra exits on dorsal surface of the penis What is varicocele and what can it cause? - answer-- Inflammation/dilation of veins in the scrotum - Incompetent venous valves in internal spermatic and renal veins; may cause infertility What are s/s of varicocele? - answer-asymptomatic or feeling of scrotal "fullness" What is hydrocele? What causes it (3) and what are its s/s (2)? - answer-- Scrotal swelling- collection of fluid - Causes: infection, hernia, trauma - Symptoms: painless swelling, bulky Prostatitis - answer-Inflammation of the prostate What is epididymitis and what is it caused by (3)? - answer-inflammation usually caused by GC or chlamydia, or prostatitis What are s/s of epididymitis (2)? - answer-severe pain, swelling What is orchitis and what is it associated with? What is it usually caused by? - answer-- acute inflammation of the testes - Associated with epididymitis - Probably caused by systemic infection, most common- mumps What can cause erectile dysfunction (4)? - answer-•Associated with- age •Medications •Vascular diseases •Alcohol intake What is priapism and what body mechanism causes it? - answer-•Painful, persistent erection 4 hours •Involves impaired venous drainage from corpus caverosa What can cause priapism (6)? - answer-sickle cell disease, anticoagulant therapy, DM, Leukemia, some antidepressants meds, unknown Vaginismus - answer-recurring involuntary muscle spasms in the outer third of the vagina that interfere with sexual intercourse Anorgasmia - answer-orgasmic dysfunction Dyspareunia - answer-painful intercourse What are the 2 functions of the ovaries? - answer-1) Produce mature ovum (eggs, follicles) 2) Produce sex hormones What are the female sex hormones (3)? - answer-- Estrogens - Progesterone - Androgens What are the estrogens (3) ? - answer-produced from the follicles: • Estradiol (E2) (most active, most prevalent) • Estrone • Estriol Where is estrogen produced? What about progesterone? - answer-- Estrogens produced from the follicles) - Progesterone produced from the corpus luteum What are androgens in a female? - answer-Other hormones: FSH, LH, oxytocin, prolactin, relaxin, hCG How do breasts change when breastfeeding/pregnant (4)? - answer-- larger with hormonal stimulation - tender with fluid ↑ - veins make colostrum at 4 months - produce milk How does the heart change during pregnancy (5)? - answer-- Increasing blood volume, almost double - ↑HR - ↑ Stroke volume, ↑ cardia output - no change BP until late - more swelling, varicose veins How do the lungs change during pregnancy (4)? - answer-- ↑ maternal oxygen consumption - ↑ resp. rate late - Diaphragm rises with less space - SOB with ↓lung capacity How does the digestive system change during pregnancy (5)? - answer-- Constipation: shifting bowels - N&V - reflux - indigestion - softening of esophagus sphincter How does the bladder change during pregnancy (4)? - answer-- ↓ capacity - frequency - incontinence - pressure How does the skeletal system change in pregnancy (6)? - answer-- Elastin levels change - gives ability to widen hips and ribs - Ribs expand (ex. larger bra size 32 to 36) with ↑ baby's size - Lordosis, gait changes, balance changes - ↓ ROM, ↑ risk for fractures How do nutrient needs change during pregnancy? What is optimal weight gain and what nutrients does the mother need to intake for fetal development (2)? - answer-- ↑ nutrient needs - weight gain optimal at 20-30 lbs - calcium (assess teeth)- need for baby bones - iron: need for ↑ blood volume perimenopause - answer-menopausal transition, end of a woman's reproductive ability, midlife What is the average age of perimenopause? How long does it last? - answer-- Age: 35-50 - may last several months to several years What hormone fluctuations occur in perimenopause? How do they occur? - answer-- ovarian function declines -- reflex and compensatory surges/spikes - fluctuations: lower than hyperstimulation - LH and FSH increase as estrogen and progesterone decrease - the pituitary increases the release of LH and FSH to stimulate the ovaries to produce estrogen and progesterone, but the feedback to turn off these hormones is absent In perimenopause, the pituitary calls, and what happens? - answer-the ovaries are not there to answer Menopause is marked by what? - answer-no menstruation for 12 months What are normal physiological changes associated with menopause (5)? - answer-•Amenorrhea •Gradual decrease in ovarian function •Low estrogen and progesterone production •Ovulation stops •Increase in FSH and LH with negative feedback Surgical menopause - answer-following an oophorectomy if not already menopausal, abrupt and immediate What are some vasomotor s/s of menopause (4)? - answer-- headache - palpitations - night sweats - insomnia What are some GU s/s of menopause (4)? - answer-- vaginal dryness - dyspareunia - vaginal itching / burning - urinary frequency, dysuria, burning What are menopause effects with decreased estrogen (4)? - answer-• Hot flashes are very common. • Atrophic changes in the vagina, ovaries, and uterus • Decreased calcium absorption, can lead to bone loss and osteoporosis. • Decrease protective benefits, can lead to increased risk of heart disease What are some andropause effects of decreased testosterone (4)? - answer-• Decreased muscle mass and strength • Sexual dysfunction, decreased libido, mood swings "Man-opause"- male menopause? Because menopause is marked by 1 year without menstruating (or one year without ovarian function), it causes (2)... - answer-- irregular menses that gradually become farther apart and produce lighter flow- perimenopause - dramatic physical changes What are normal external changes and changes in the labia with aging? - answer-- Externally, mons pubis looks smaller because fat pad atrophies - Labia and clitoris gradually decrease in size What changes occur in the vagina with aging (5)? - answer-• Vagina becomes shorter, narrower, and less elastic because of increased connective tissue • Without sexual activity, vagina atrophies to one-half its former length and width • Vaginal epithelium atrophies, becoming thinner, drier, and itchy (this results in a fragile mucosal surface that is at risk for bleeding and vaginitis.) • Decreased vaginal secretions leave vagina dry and at risk for irritation and pain with intercourse, dyspareunia • Vaginal pH becomes more alkaline, and a decreased glycogen content occurs from the decreased estrogen What changes occur in the cervix with aging? - answer-• Cervix shrinks, looks paler, thick, glistening epithelium What changes occur in the uterus with aging (3)? - answer-• Uterus shrinks in size because of decreased myometrium • Uterus droops as sacral ligaments relax and pelvic musculature weakens • Sometimes it may protrude, or prolapse, into vagina What changes occur in the ovaries with aging (2)? - answer-• Ovaries atrophy to 1 to 2 cm and are not palpable after menopause • Ovulation still may occur sporadically after menopause What do we ask women in a ROS of their GU system (9)? - answer-• Menstrual- regularity, timing, amount • Sexual activity, contraception, protection used • Obstetric • Medical or psychological problems • Surgeries, medications, allergies • Family history • Tobacco and alcohol consumption, any illicit drug use What do we inspect in a female GU exam (3)? - answer-• Inspection: assess the breasts sitting up • Inspection: assess the external genitalia • Speculum: inspect vagina, cervix, obtain Pap, etc. What do we palpate in a female GU exam (3)? - answer-• Palpation: assess the thyroid and breasts • Palpation- bimanual: assess the vagina, cervix, uterus (5- 8 cms) ovaries (3 cms), and fallopian tubes • Palpation- recto vaginal What are the 3 parts to the pelvic exam? - answer-•Inspection: external genitalia, the speculum exam •Palpation: Bimanual exam •Palpation: Recto-Vaginal Exam How do we take a biopsy of the cervix? - answer-- cervix is viewed through a speculum - cervix is "punched"-- small samples are taken What are common reasons women have abdominal scars (4)? - answer-- Cesarean section - BTL (Bilat. Tubal Ligation) - Hysterectomy- with the cervix or not - BSO (Bilat. Salpingo-Oophorectomy) What are risk factors for STDs (5)? - answer-•Adolescence •New or multiple sex partners •History of STD infection •Presence of another STD •Lack of barrier contraception How common is HPV? Does it go away? How many types of HPV are there? - answer-- Very common, over 50% in lifetime occurrence - HPV may clear or have spontaneous regression- estimated at 10-30% within three months (CDC). - Over 100 HPV types What are the clinical manifestations of HPV (4)? - answer-• Asymptomatic • Low risk/ low cancer rates • Genital warts: usually HPV types 6 & 11 • raised, spiky, flat, or cauliflower-shaped (Condylomata acuminate) Cervical dysplasia - answer-- pre-cancerous lesions - can be associated with HPV Recurrent respiratory papillomatosis associated with HPV types (2)... - answer-6 and 11 Types of HPVs that cause vulvar, cervical or anal cancers (5) - answer-16, 18, 31, 33, 35 HPV types ____ and ____ found in 70% of cervical cancers - answer-16, 18 What is the Bethesda cervical cytology classification system? What are the biopsy results of someone with cervical cancer and how does this cancer progress? - answer-- Pap tests- low-grade SIL, high-grade SIL - Biopsy results- cervical intraepithelial neoplasia (CIN) - CIN1, CIN2, CIN3, cervical cancer progression - Need to do a colposcopy (magnifaction) and biopsy for a diagnoses What is HSV1? How do we treat it? - answer-- Cold sores or "fever blisters" on the lips are a sign of herpes virus infection - There is no cure for herpes infection, but medications can reduce the severity and duration of outbreaks. What is HSV2? - answer-- Genital herpes is a chronic, lifelong viral infection - About 80% of initial and 98% of recurrent infections are type 2 What are other herpes diseases besides HSV1 and HSV2? - answer-chicken pox and herpes zoster How is the herpes virus transmitted and how do we treat it? - answer-- Transmission: through contact with a person who is shedding the virus - Treatment: Antiviral episodic and suppressive therapy dramatically reduces, but does not completely eliminate shedding. What is the viral cycle like in HSV2 (4)? - answer-• The first outbreak tends to be the worst, and the first year tends to be the worst • Can remain in latent stage until reactivated; • Causes of reactivation- unknown but may be related to stress, sun exposure, hormonal fluctuations, or illness • Herpes lies dormant in the nerve root, and moves down the root to the skin- can produce itching, aching, prodromal symptoms What are the s/s of