NUR-230 EXAM 4 WITH COMPLETE EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (2026) A!!

NUR-230 EXAM 4 WITH COMPLETE EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (2026) A!! Breast cancer risk factors - ANSWER Female gender, age (increases after 55), family history, genetic mutations, Ashkenazi Jewish ancestry, smoking, alcohol use, radiation exposure, high fat intake, obesity Abnormal breast findings - ANSWER Marked breast asymmetry, significant/rapid changes in size of one breast, dimpling/retraction/bulging, recent nipple inversion or retraction, or nipples that point in different directions, thickening of nipple tissue, loss of elasticity, nipple discharge Normal breast palpation findings - ANSWER Breasts should feel firm, smooth, and elastic, nontender on palpation Fibrocystic breast tissue - ANSWER Multiple benign masses caused by ductal enlargement and fluid-filled cysts, common in middle-aged women. Fibroadenoma - ANSWER A tumor formed of mixed fibrous and glandular tissue, typically occurring as a benign growth in the breast. Breast cancer - ANSWER Solitary, unilateral nontender mass with irregular, poorly delineated borders. Invasive breast cancer - ANSWER Cancer that has spread beyond the original site into surrounding breast tissue. Noninvasive breast cancer - ANSWER Early-stage cancer remains confined to where it started. Ductal Carcinoma In Situ (DCIS) - ANSWER A type of noninvasive breast cancer. Lobular Carcinoma In Situ (LCIS) - ANSWER A type of noninvasive breast cancer. Mastitis - ANSWER Inflammatory condition of the breast caused by bacterial infection, most common in lactating women (early postpartum) and nonlactating women. Signs of mastitis - ANSWER Red, warm, tender, hard. Gynecomastia - ANSWER Enlargement of one or both breasts in males, most common in puberty, older adult men, men who are overweight. Risk factors for cervical cancer - ANSWER High-risk Human Papillomavirus (HPV) infection, being sexually active, multiple partners, having many children, smoking. Risk factors for testicular cancer - ANSWER Cryptorchidism (undescended testes), family history, history of testicular cancer, HIV infections, Orchitis. Total hysterectomy - ANSWER Entire uterus and cervix are removed, ovaries and fallopian tubes remain. Partial hysterectomy - ANSWER Uterus (upper portion) is removed, cervix, ovaries and fallopian tubes remain. Risk factors for ovarian cancer - ANSWER Family history, self-history, family history of lynch syndrome, genetic predisposition, infertility, endometriosis, obesity. Risk factors for prostate cancer - ANSWER Older man, black men, family history, over age of 70. Causes of abnormal bleeding in menstrual cycles - ANSWER Pregnancy, stress, eating disorders, endocrine disorders, thyroid disease, excessive exercise. Risk factors for STIs (STDs) - ANSWER Unprotected intercourse, multiple sexual partners, early reproductive maturity, alcohol and substance use. Candida infections - ANSWER Scaling red rash with sharply demarcated borders, generally a large patch with loose scales, affects superficial layers of skin and mucous membranes only. Bulging of anterior vaginal wall - ANSWER Sign of pelvic organ prolapse. Cystocele - ANSWER Bulging of anterior vaginal wall. Rectocele - ANSWER Bulging of posterior vaginal wall. Uterine prolapse - ANSWER Descent of the cervix or entire uterus into the vaginal canal; pelvic pressure or bulging; difficulty with urination and defecation; decreased sexual function. Stress incontinence - ANSWER Coughing, sneezing, laughing, heavy lifting, exercise, any movement that increases intra-abdominal pressure. Sims position - ANSWER Best position for rectal examination. Knee-chest position - ANSWER Best position for rectal examination. Anorectal abscess - ANSWER Extreme pain with anal palpation. Positive guaiac test - ANSWER Indicates blood has been found in the stool. False-positive guaiac test - ANSWER Certain foods (red meat, poultry, fish, vitamin C-enriched foods and beverages) cause a false-positive. False-negative guaiac test - ANSWER Vitamin C interfering with the reaction, as well as certain foods like red meat and some raw vegetables; medications like aspirin and NSAIDs. Tinea cruris - ANSWER A fungal infection that affects the groin area, caused by dermatophyte fungi. Phimosis - ANSWER A condition where the foreskin (prepuce) cannot be retracted back over the glans (head). Paraphimosis - ANSWER A urologic emergency where the foreskin becomes trapped behind the corona of the glans penis and cannot be moved forward (reduced) to cover the glans. Balanitis - ANSWER An inflammation of the glans penis (head of penis) that occurs due to accumulation of smegma beneath the foreskin, tight foreskin, poor hygiene, bacterial and fungal overgrowth. Hypospadias - ANSWER A congenital condition where the urethral opening is abnormally positioned on the ventral surface of the penis instead of the tip. How should the environment feel for interviewing children? - ANSWER Reassuring, so that they feel comfortable to share What should you do to ensure the child understands the questions? - ANSWER Establish the child's understanding through simple questions What does general routine screening include? - ANSWER Being alert to signs of domestic violence through the entire interview and examination in all clients, when screening using the appropriate tools, and when interviewing clients What does a focused specialty assessment include? - ANSWER If sexual assault is identified, further assessment and a gynecologic examination and more advanced PTSD screening What is the external structure of the male genitalia? - ANSWER Penis and scrotum What is the penis's function known as? - ANSWER Male reproduction organ and plays a role in reproduction and urination What is the scrotum and its function? - ANSWER A thin-walled sac, suspended below the pubic bone; maintains temperature control What is the internal structure of the male genitalia? - ANSWER Testis, epididymis, and vas deferens What exactly is the testis? - ANSWER Solid oval shape, suspended vertically by the spermatic cord; left is lower than the right What is the epididymis function? - ANSWER Coiled duct system and storage site of sperm What is the Vas Deferens function? - ANSWER Duct which conveys sperm from the testicle to the urethra Where is the anal canal? - ANSWER Final segment of the digestive system Where is the rectum? - ANSWER Lowest part of the large intestine Where is the prostate gland? - ANSWER Surrounding the neck of the bladder What does the prostate gland secrete? - ANSWER Thin, milky substance that promotes sperm motility and neutralizes vaginal secretions What happens to a 40-year-old male with their sperm production? - ANSWER It starts to decline, tho it still works at 80 to 90 What exactly happens to an aging male adult? - ANSWER 1. decreased muscle tone 2. decreased subcutaneous fat 3. decreased cellular metabolism What happens to the genital area in regard to pubic hair and the penis as a male ages? - ANSWER Their pubic hair decreases, and rest turns grey Penis size decreases How is HIV/AIDS transmitted? - ANSWER Through exchange of body fluids How many people worldwide have HIV/AIDS? - ANSWER 35 million; 19 million not aware What are the risk factors of HIV/AIDS? - ANSWER Unprotected sex, IV drug use, uncircumcised, born to HIV+ mother, exchange of body fluids in other ways How common is Prostate cancer? - ANSWER The second most common and one of the leading causes of death in men What is prostate cancer like? - ANSWER Slow growing but treatable How many men in the U.S. get prostate cancer and how many die from it - ANSWER About 23 of every 100 men and 2 to 3 die from it What are the risk factors for prostate cancer? - ANSWER 1. age 2. race 3. family history 4. genetic changes 5. exposure to agent orange 6. toxic chemicals 7. diet 8. low melatonin levels What is the education for prostate cancer? - ANSWER Behaviors to reduce risk and the symptoms How is the prostate with benign prostatic hypertrophy? - ANSWER Enlarged, smooth, firm and slightly elastic Which age group is benign prostatic hypertrophy common in? - ANSWER Men older than 50 What diseases/conditions have rectal bleeding? - ANSWER Hemorrhoids, colorectal cancer and anal cancer What are the external genitalia for females? - ANSWER Labia Majora and Labia Minora (vestibule) What are the openings of the vestibule? - ANSWER Urethral meatus, skene glands, vaginal orifice, and one to Bartholin glands What are the internal genitalia for females? - ANSWER Vagina, cervix, uterus, ovaries What are the three layers of the uterus? - ANSWER Endometrium, myometrium, and peritoneum With an aging female adult, what generally happens with genitalia? - ANSWER Atrophy of vaginal mucosa, estrogen production decreases, decline in ovary function, vagina shortens and narrows, pubic hair thins and becomes sparse What are the causes of hemorrhoids for women? - ANSWER Straining, pregnancy, sitting for long periods of time, constipation, diarrhea, obesity, anal intercourse, and low fiber diet (8) What are the symptoms of hemorrhoids? - ANSWER 1. bleeding 2. itching 3. irritation 4. pain 5. discomfort 6. swelling What are the treatments for hemorrhoids? - ANSWER Creams, suppositories, stool softeners, hemorrhoid destruction or surgery Where does cervical cancer originate? - ANSWER Uterine cervix What is cervical cancer preceded by? - ANSWER Precancerous stage of Dysplasia, 100% treatable What is the first stage of Cervical Cancer? - ANSWER Carcinoma in situ Virtually all cases of Cervical Cancer are caused by what? - ANSWER HPV, type 16 and 18 responsible for 70% How do we screen for cervical cancer? - ANSWER Pap smears every 3 years for women 21 to 65; pap and HPV testing every 5 years for 30 to 65 What are the risk factors for cervical cancer? - ANSWER 1. HPV 2. smoking 3. chlamydia infection 4. diet 5. overweight 6. IUD use 7. multiple full-term pregnancies 8. poverty 9. family history What education is needed for cervical cancer prevention? - ANSWER Recognition and risk reduction How common is colorectal cancer? - ANSWER 3rd most common What is the lifetime risk numbers for men and women? - ANSWER 1 in 21 for men 1 in 23 for women What is the screening age for colorectal cancer? - ANSWER 50 to 75 years old What are the risk factors for colorectal cancer? - ANSWER Older (50+), African American/Eastern European, other cancers, IBP, polyps, family history, type 2 diabetes, obesity, sedentary lifestyle, diet, smoking, alcohol use, HPV What is the education for colorectal cancer? - ANSWER Recognition and risk reduction What are normal findings for LOC? - ANSWER awake, alert, and oriented to person, place and time What are the normal findings for speech? - ANSWER Speech is clear, makes and maintains conversation appropriately What are the normal findings for comfort level? - ANSWER Patient denies any pain or discomfort What to do if a client does report pain or discomfort? - ANSWER Have them rate it on a scale of 0 to 10, try to make them comfortable What are normal findings for skin? - ANSWER Skin is pink, warm and dry; immediate recoil on clavicle What are normal findings for the pupils? - ANSWER PERRLA What are normal findings for breath sounds? - ANSWER Lungs clear to auscultation anterior and posterior bilaterally, respiratory rate under 18, no reports of dyspnea What are normal findings for heart sounds? - ANSWER Heart S1 and S2 present, regular rate and rhythm, no S3 or S4 appreciated. no murmur, rub or gallop What are normal findings for bowel sounds? - ANSWER Active bowel sounds present in all 4 quadrants, 5 to 35/min What are normal findings for motility and strength of extremities and peripheral pulses? - ANSWER Able to actively move all extremities, equal strength, 5/5. Radial, dorsalis pedis and posterior tibial pulses 2+, no edema How does height and weight work for toddlers? - ANSWER A step-like fashion What is bow leggedness of a toddler due to? - ANSWER Typically persists throughout toddler hood due to the leg muscles having to bear the weight of the upper body What is the height at age 2 equal to? - ANSWER One half of the child's adult height What is the major gross motor skill for toddlers? - ANSWER Locomotion What motor skills do toddlers learn? - ANSWER 15 months = walk without help 18 = walk upstairs with one hand held 24 = walk up and down stairs one step at a time 30 = jump with both feet What two steps are in the sensorimotor phase of a toddler? - ANSWER Tertiary circular reactions and preconceptual What does tertiary circular reactions involve for toddlers? - ANSWER Trial and error experimentation, and relentless exploration and mental combinations What does the preconceptual phase include for toddlers? - ANSWER Representation thought to recall the past, represent the present and anticipate the future Where is the toddler at for moral stages? - ANSWER First substage of the preconventional stage What stage of psychosocial development is toddlers? - ANSWER Autonomy vs. shame and doubt What are preschoolers like compared to toddlers? - ANSWER Generally slender, graceful and agile What motor skills do preschoolers learn at age 3? - ANSWER Ride a tricycle, go upstairs using alternate feet, stand on one foot for a few seconds, and broad jump What motor skills do preschoolers learn at age 4? - ANSWER Skip, hop on 1 foot, catch a ball, and go downstair using alternate feet What motor skills do preschoolers learn at age 5? - ANSWER Can skip on alternate feet, throw and catch a ball, jump rope, and balance on alternate feet with eyes closed What cognitive stage are preschoolers in and what are the two stages that they go through? - ANSWER Preoperational thought; preconceptual and intuitive phase What ages are the preconceptual phase for and what does it include? - ANSWER 2 to 4; forms concepts aren't as complete at adults, makes simple classifications, associates one event with a simultaneous one What does the intuitive phase include for preschoolers? - ANSWER 4 to 7; child becomes capable of classifying, quantifying and relating objects but remains unaware of the principles behind these operations How much can a 3-year-old say? - ANSWER 900 words, three to four sentences, and can talk incessantly How much can a 4-year-old say? - ANSWER 1,500 words, tell exaggerated stories, and sing simple songs How much can a 5-year-old say? - ANSWER 2,100 words, know 4 or more colors, the names of the week and the months Where is the preschooler for moral stages? - ANSWER Preconventional stage, lasts for 10 years What happens during the preconventional stage of moral development? - ANSWER Conscience emerges, emphasis is on external control What psychosocial stage are preschoolers in? - ANSWER Initiative versus guilt How do school age children's gender affect their growing? - ANSWER Girls grow faster than boys During preadolescence, 10 to 13, what occurs? - ANSWER Children experience rapid and uneven growth compared to age mates What motor skills do they learn as a school age child? - ANSWER Bicycling, roller skating and skateboarding What do school age children gain in regard to their hands? - ANSWER Greater dexterity and competence for crafts, video games, and computers What cognitive stage are school age children (7 to 11) in? - ANSWER concrete operations marked by inductive reasoning, logical operations, and reversible concrete thought What do children develop by age 7 to 9? - ANSWER Adult articulation patterns What is the moral development for school age children? - ANSWER Conventional level of the role conformity stage and has a increased desire to please others What psychosocial stage are school age children in? - ANSWER Industry versus inferiority Around what percentage of adult height is achieved in adolescence? - ANSWER 20 to 25% How much do girls gain in height during adolescence and until when? - ANSWER 5 to 20 cm until 16 or 17 How much do boys gain in height during adolescence and until when? - ANSWER 10 to 30 cm until 18 or 20 Around what percentage of adult weight is achieved during adolescence? - ANSWER 20 to 50% When do girls start puberty? - ANSWER between 8 and 14 When do boys start puberty? - ANSWER Between 9 to 16 What happens during boys' puberty? - ANSWER Increase in height, weight, muscle mass, penis and testicle size, facial and body hair, and voice deepens How are motor skills in adolescence? - ANSWER They have reached adult levels What is the cognitive period that adolescents go through? - ANSWER Formal operations What are the 3 substages of the cognitive period? - ANSWER 1. sees relationships involving the reverse of the reciprocal; 2: develops the ability to order triads of propositions or relationships; 3: develops the capacity for true formal thought What is the moral development for an adolescent? - ANSWER Postconvention level of morality -- age 13 What happens during the postconventional level of morality? - ANSWER Can acknowledge a conflict between socially accepted standards and try to decide between them What psychosocial stage are adolescents? - ANSWER Identity versus role diffusion What are ways to approach a toddler for interviews? - ANSWER Encourage parental presence, provide careful and simple explanations just before the procedure, use play, tell child it is okay, encourage expression What are ways to approach a preschooler for interviews? - ANSWER Explain why things are the way that they are, validate child's perceptions, avoid threatening words, involve child in teaching, use toys What are ways to approach a school age child for an interview? - ANSWER Remember to remain concrete, use group discussion, provide healthy teaching, give more responsibility, use school-age explanations What are ways to approach an adolescent for interviews? - ANSWER Give them control whenever possible, explore expected parental involvement, involve adolescent in planning, explain how the body will be, use peers with common situations, encourage open and honest discussion, be nonjudgmental What is the developmental approach to a physical assessment for a toddler? - ANSWER Allow a toddler to sit on a parent's lap, enlist parent's aide, use play and praise cooperation What is the developmental approach to a physical assessment for a preschooler? - ANSWER Use storytelling, use doll and puppet play, give choices when possible What is the developmental approach to a physical assessment for a school age child? - ANSWER Maintain privacy, use gown, explain procedures and equipment, teach about their bodies What is the developmental approach to physical assessment for an adolescent? - ANSWER Ensure privacy and confidentiality, provide option of having parent present or not, emphasize normality, provide health teaching What is the age range for a neonate? - ANSWER First 28 days of life What is the age range for an infant? - ANSWER From day 29 to year 1 What is the age range for a toddler? - ANSWER 1 to 3 years What is the age range for a preschooler? - ANSWER 3 to 6 years What is the age range for a school age child? - ANSWER 6 to 12 years What is the age range for an adolescent? - ANSWER 12 to 18 years How are the adverse events/effects in the oldest-old populations? - ANSWER Includes falls, confusion, incontinence, generalized weakness, and lethargy What are the most common geriatric syndromes? - ANSWER Urinary incontinence, cognitive impairment, pressure injuries, falls, polypharmacy, delirium, and weight loss What are the other issues related to syndromes? - ANSWER Malnutrition, eating and feeding problems, sleeping problems, dizziness and syncope, and self-neglect What helps to compare new assessment data? - ANSWER Knowing the older individual's functioning baseline What is a functional assessment for an older individual? - ANSWER An evaluation of the person's ability to carry out the basic self-care activities of daily living What is the commonly used tool for assessing functional status in older adults? - ANSWER Katz Activities of Daily Living What are Instrumental Activities of Daily Living? - ANSWER Activities more focused on household chores and cognitive abilities How is functional ability determined? - ANSWER By the dynamic interplay of the frail elder's physiologic status, emotional and cognitive statuses, and the physical, interpersonal and social environments What is a major purpose of assessing the frail older adult? - ANSWER To correctly identify and describe the patient's ability to perform ADLs How does the Katz ADL assessment tool work? - ANSWER 1 point for every activity that they are independent in What happens to the aging adult's ability to smell and taste? - ANSWER Decreases with age, can diminish appetite What can medications do to the older adult? - ANSWER Can decrease their smell and taste What are indicators of malnutrition? - ANSWER Poor wound healing, bruising, dental deterioration, poor appetite and fluid intake, and weight loss What is the scoring like for the SLUMS test for someone with more than a high school education? - ANSWER the higher the score, the better the cognition. 27-30 -- normal cognition 21-26 -- mild impairment 1-20 - dementia What is the scoring like for the SLUMS test for someone with only high school education? - ANSWER 25-30: Normal cognition 20-24: Mild neurocognitive disorder 1-19: Dementia What is the scoring like for SAD PERSONNA test? - ANSWER 0-2 Low risk 3-4 Moderate risk 5-6 High risk 7-10 Very high risk What do the scores for the Glasgow Coma scale mean? - ANSWER 13-15: Mild head injury (patient may be responsive) 9-12: Moderate head injury (requires further observation) 3-8: Severe head injury (requires immediate intervention and intensive care) Urge incontinence - ANSWER A sudden, strong urge to void followed by rapid bladder contraction, often not enough time to reach the toilet. Fistula - ANSWER Inflamed tract forming an abnormal passage from within the anus or rectum to the outside skin surface; characterized by red, raised granulation tissue, and drainage that is serosanguineous or purulent Gross Motor - ANSWER Involves the use of large muscle groups and the whole-body movement. Fine-Motor - ANSWER Involves precise movement using smaller muscle groups, particularly hands and fingers. Social Adaptive Behavior - ANSWER Child's ability to interact with others, respond to social situations, and adapt to their environment appropriately for their developmental stage. Erikson's Theory - ANSWER The EGO is the seat of personality functioning; society and culture influence behavior. Basic Trust vs. Basic Mistrust - ANSWER Stage for infants (0-1 year) in Erikson's theory. Autonomy vs. Shame and Doubt - ANSWER Stage for toddlers (2-3 years) in Erikson's theory. Initiative vs. Guilt - ANSWER Stage for preschoolers (3-6 years) in Erikson's theory. Industry vs. Inferiority - ANSWER Stage for middle childhood (school age 7-12) in Erikson's theory. Identity vs. Role Confusion - ANSWER Stage for adolescence (12-19 years) in Erikson's theory. Intimacy vs. Isolation - ANSWER Stage for young adults (20s) in Erikson's theory. Generativity vs. Stagnation - ANSWER Stage for middle adults (late 20s-50s) in Erikson's theory. Ego Integrity vs. Despair - ANSWER Stage for older adults (50s and beyond) in Erikson's theory. Cognition - ANSWER Defined as how a person perceives and processes information. Sensorimotor Stage - ANSWER 0-2 years: Thought is dominated by physical manipulation of objects and events. Preoperational Stage - ANSWER 2-7 years: Function is symbolic, using language as a major tool. Concrete Operations Stage - ANSWER 7-11 years: Mental reasoning processes assume logical approaches to solving concrete problems. Formal Operations Stage - ANSWER 11-15 years: True logical thought and manipulation of abstract concepts emerge. Cephalocaudal Development - ANSWER Means 'head to toe'; head control develops first, sitting comes next, and standing develops last. Fluid Intelligence - ANSWER Basic information-processing skills involving cognitive abilities like attention, reasoning, problem-solving, and spatial orientation. Crystallized Intelligence - ANSWER Skills that depend on accumulated knowledge, experience, good judgement, and mastery of social conventions valued in our culture. Generativity - ANSWER Key concept in Erikson's theory of psychosocial development (middle adulthood); reaching out to others in ways that guide and give the next generation. Pediatric Assessment - ANSWER To adequately assess pediatric patients, the nurse must consider differences in anatomy and physiology, growth, developmental milestones, and psychosocial issues specific to each particular pediatric age group. STI's - ANSWER Sexually transmitted infections. Contraception - ANSWER Methods to prevent pregnancy. Pregnancy - ANSWER The condition of carrying a developing fetus within the female body. Mental health issues - ANSWER Conditions that affect a person's thinking, feeling, behavior, or mood. Substance abuse - ANSWER The harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Perinatal history - ANSWER Medical history of the mother during pregnancy and shortly after childbirth. Developmental milestones - ANSWER Key skills or behaviors that most children can do by a certain age. Temperature measurement methods in pediatrics under age 5 - ANSWER Axillary (armpit), tympanic membrane (ear), temporal artery (forehead). Preferred method for rectal temperatures - ANSWER In febrile children, rectal is preferred for accurate core body temperature. Assessing heart rate in infants - ANSWER Wait till the child is quiet, use a pediatric stethoscope, count for a full minute. Assessing respiratory rate in infants - ANSWER Count before assessing heart rate, observe abdominal movement, count for a full minute. Correct cuff size for BP measurement - ANSWER Cuff width should be 40% of the circumference of the limb. Measuring height in newborns/infants - ANSWER Recumbent length is measured in supine position from the top of the head to the heel. Growth charts - ANSWER Tools used to track childhood growth according to national averages. Physical exam for infants 6 months - ANSWER Start with least invasive assessments, assess respiratory status while calm. Physical exam for infants 6 months - ANSWER Proceed with the same sequence as adult examination when cooperative. Physiologic jaundice - ANSWER Appears after the first 24 hours of life, peaks around day 3-5, resolves by 1-2 weeks. Signs of physiologic jaundice - ANSWER Yellow discoloration of skin and sclera, urine change to amber/brown, stool color change. Lanugo - ANSWER Fine, downy hair covering parts of a newborn's body, more prominent in preterm infants. Molding of cranial bones - ANSWER Cranial bones override each other to navigate through the birth canal. Palpating the infant's head - ANSWER Feeling for fontanelles, suture lines, smooth contours, and symmetry. Depressed fontanelle - ANSWER Indicates dehydration. Bulging fontanelle - ANSWER Indicates increased intracranial pressure (ICP). Head control in infants - ANSWER 2 weeks: turns head side to side; 4 months: full head control. Fixing on and following an object - ANSWER An infant should be able to do this by a certain age (exact age not provided). Ear examination procedure for infants - ANSWER Grasp the lower portion of the pinna and apply gentle traction down and slightly backward. Infants' breathing characteristic - ANSWER Infants are obligate nose breathers until 3 months old. Signs of respiratory distress in infants - ANSWER Nasal flaring, retractions, see-saw breathing, stridor, grunting, coughing, rapid labored breathing, irritability or distress, lethargy. Chest circumference changes in infants - ANSWER Infants have a round thorax instead of oval, with equal anteroposterior and lateral measurements. Common cause of systolic murmurs in neonates - ANSWER Transition from fetal to extrauterine circulation. Signs indicating congenital heart defects in newborns - ANSWER Cyanosis shortly after birth. Ballard Assessment - ANSWER A neuromuscular examination to assess a newborn's neuromuscular maturity in comparison with the gestational age. Tests for hip dysplasia in infants - ANSWER Barlow Maneuver, Ortolani Maneuver, Allis Sign, Skinfold Assessment. Indicators of hearing impairment in children - ANSWER Inattentiveness during conversation, asking for statements to be repeated, facial expressions that appear puzzled. Allergic salute - ANSWER The presence of a transverse crease at the bridge of the nose due to frequent nose wiping. Age for 1:2 AP-to-lateral chest dimension development - ANSWER By 5 or 6 years. Age when children stop being abdominal breathers - ANSWER Around 7 years of age. Abnormal findings in musculoskeletal assessment - ANSWER Any deviation from developmental pattern, history of increasing falls, or asymmetry of shoulders, scapula, or iliac crest. Neurologic assessment for children - ANSWER Make it a game for the child. Atopic dermatitis associations - ANSWER Often associated with hay fever, asthma, and dermatitis. Signs/symptoms of atopic dermatitis - ANSWER Occurs most commonly in areas of flexion. Procedure for examining ears in children - ANSWER Review proper procedure for ear exams in children on page 436. Procedure for eye exams in children - ANSWER Review proper procedure for eye exams in children on page 435-436. Common problems in pediatric assessments - ANSWER Atopic dermatitis is often associated with hay fever, asthma, and dermatitis. Signs of respiratory distress - ANSWER Nasal flaring, retractions, see-saw breathing, stridor, grunting, coughing. Expected findings in musculoskeletal assessment - ANSWER Progress in the same order as for adults; examine ears/mouth last. Privacy during adolescent assessments - ANSWER Offer option for privacy, with parent stepping out of the room. Signs/Symptoms of Impetigo - ANSWER red, weeping, crusted lesions, intense itching Impetigo in Infants - ANSWER face, scalp, extremities, diaper area Impetigo in Older Children and Adults - ANSWER arms and hands (inside elbow), legs and feet (behind knee) Impetigo - ANSWER a common bacterial skin infection in children ages 2-5 and is highly contagious Impetigo Progression - ANSWER Enters through minor breaks in the skin can occur as secondary infection of pre-existing skin conditions or infestations. Initial lesions rupture characteristic crust. Signs/Symptoms of Acute Otitis Media - ANSWER pulling or tugging at ear, fever, decreased hearing Signs/Symptoms of Tonsillitis - ANSWER Scratchy throat, pain so severe it hurts to swallow, sore throat, red and edematous pharynx, fever, fatigue, muffled voice Cleft Lip/Cleft Palate - ANSWER Incomplete fusion of structures during fetal development Complication: Sepsis - ANSWER -rapidly sets in -cancer causes immunocomprimised state -low grade fever (less then 99F); is often only symptom before full septic shock starts Complication: DIC - ANSWER -can occur with sepsis -during sepsis---massive clotting and massive bleeding complication: sepsis and DIC tx - ANSWER early intervention with IV antibiotics at the first sign of infection (low grade fever) saves LIVES Complication: spinal chord compression - ANSWER tumor presses on and compresses the spinal chord, or vertebrae collapse due to bone loss associated with bone cancer Complication: spinal chord compression hallmark sign - ANSWER back pain* -will progress to neuromuscular weakness -loss of sensation -burning pain -paralysis Complication: spinal chord compression TX - ANSWER high dose corticosteroids, radiation, and spinal stabilization surgery (if caused by bone cancer) Complication: Hypercalcemia - ANSWER certain cancers release PTH stimulating bones to release calcium, elevating serum calcium levels Complication: hypercalcemia Early symptoms - ANSWER -skeletal pain -kidney stones -altered cognition Complication: hypercalcemia late symptoms - ANSWER -ECG changes -Dehydration -severe muscle weakness -loss of deep tendon reflexes Complication: Hypercalcemia Tx - ANSWER -treat with Normal saline IV -then......treat with furosemide to pull off the excess calcium Complication: superior vena cava syndrome - ANSWER tumor or clot compresses SVC and limits blood flow into right atrium; can be acute or slow onset Complication: superior vena cava syndrome--- EARLY SIGN - ANSWER -periorbital edema upon waking -edema/tightness of the collar Complication: superior vena cava syndrome--- LATE SIGN - ANSWER -redness to upper chest, neck, and face -engorged blood vessels above the blockage (EXTREME JVD) -edema in arms and hands****** -dyspnea -narrowing of trachea (stridor; this is an emergency) complication: superior vena cava syndrome Tx - ANSWER -treated with TPA if caused by clot -high dose radiation if caused by tumor -may stent SVC Complication: tumor lysis syndrome--EARLY SIGN - ANSWER -cloudy urine Complication: tumor lysis syndrome - ANSWER many tumor cells causing increased potassium and hyperuricemia --chemo is working way tooo well complication: tumor lysis syndrome--LATE SIGN - ANSWER -AKI -cardiac dysrhythmia Complication: tumor lysis syndrome Tx - ANSWER -adequate hydration 3-5L(ml/day) ***during or after chemo -isotonic fluids (normal saline) -may require hemodialysis -SIT them UP!!****** -allopurinol to decrease uric acid Cardiac tamponade - ANSWER tumor direct pressure in or around pericardial sac resulting in decreased venous return and sudden drop in cardiac output cardiac tamponade: assess - ANSWER -JVD (fluid overload with clear lungs) -decreased HR and CO -dyspnea -hypotension -heart sounds are distant and muffled End of life: decision making - ANSWER the only right decision is the one that the client/family makes. -DNR does not matter in EMS or OR exemption Stroke - ANSWER Emergent* mass causality --emergent chest pain - ANSWER Emergent positive influenza - ANSWER not respiratory distress--non urgent respiratory distress--urgent respiratory failure--emergent urgent/nonurgent and flu postive give mask and have them wait in waiting room meningitis (nuchal rigidity) - ANSWER stick in room DROPLET PRECAUTIONS Knife sticking out of head - ANSWER GO TO OR/SURGERY suspecting violence in death - ANSWER leave lines in place*** call coroner dont let people alone with body hypothermia - ANSWER warm fluids** warm from inside out--starting at trunk*** mild--mental slowness, shivers, slurred speech** moderate--confusion, slower** ABCDE - ANSWER A-airway; jaw thrust maneuver B-breathing; bag valve mask (not worried about artificial airway) C-circulation; cardiac assessment, heart monitor, pulse..looking for bleeding and hanging fluids D- disability--GCS E- exposure--cutting clothes off, preventing hypothermia fungal pneumonia - ANSWER probably have AIDS** transmission? ---NO respiratory--maintain airway HARRT - ANSWER take 90% of the time** take within 24-36 hours after exposure will this prevent from getting opportunistic infection?-----NO nutrition with AIDS - ANSWER high calorie, high protein, low fat no buffet no raw foods anti-bacterial soap clean in bleach or diswasher once per week thrush - ANSWER allowed to have sugary things but need to rinse mouth out with water after white patches** nothing taste good** Acute graft rejection: Kidneys - ANSWER -creatnine is elevated and may or may not be producing urine -notify surgeon if HYPOTENSION occurs or excessive diuresis acute graft rejection - ANSWER fever** pain** organ dysfunction** acute graft rejection: Pancreas - ANSWER -blood sugar is high--late sign -decreased urinary output -graft tenderness -fever -hypertension Acute graft rejection: Lung - ANSWER SOA Acute graft rejection: Liver - ANSWER -elevated liver enzymes -monitor temp frequently -RUQ pain -report increased abdominal pain -distention, and rigidity Acute graft rejection: Heart - ANSWER -SOA, irregular heart rate, -fluid gain -hypotension; new bradycardia hemorrhage - ANSWER kidneys--hematuria; retroperitoneal bruising liver---bruising on outside; firm and painful abdomen vitals--elevated HR, low BP, elevated RR infection--lung transplant - ANSWER bloody sputum elevated HR elevated temp allergic reaction - ANSWER stop the infusion** admin epi--impaired airway** stabbing with epi through clothes on top of thigh; carry 2 epi and call 911** maintain airway--intubate** Lupus - ANSWER inflammatory connective tissue disorder lupus: hallmark sign - ANSWER butterfly rash lupus exacerbation - ANSWER fever and fatigue fibromyalgia - ANSWER chronic pain disorder low impact exercise plenty of rest take antidepressant if prescribed autoimmune flare trigger - ANSWER stress on body causes infection lupus - ANSWER take temp every day wash skin with mild soap avoid sunlight lyme disease - ANSWER long sleeves DEET scleroderma - ANSWER leather-like edamatous skin/hard shiny skin impaired swallow issues lower GI affects--diarrhea emergent - ANSWER life threatening limb threatening ABC's and amputation and STROKE urgent - ANSWER not immediately life threatening new onset respiratory** GI, etc new onset abdominal pain** non urgent - ANSWER they are not going anywhere anytime soon **simple fractures, strains/pains, PCP stuff** Abdominal trauma: kidney - ANSWER -injury to flank monitor for flank pain, bleeding, and hematuria REPORT IMMEDIATELY Abdominal trauma: bladder - ANSWER -monitor urine output -dont remove foley after surgery -ruptured bladder needs surgical repair heat exhaustion: Interventions - ANSWER -rehydrate with electrolytes (NO SALT TABLETS) -cool with cold packs, cool water, fans -keep from passing out complication: heat stroke--hallmark sign - ANSWER temp higher than 104F -confusion complication: heat stroke--interventions - ANSWER IV fluids and urinary catheter insertion (with temp probe) -remove clothes, provide cooling blankets and ice packs to axillae, groin, head, and neck -no oral thermometer** -bladder = central/core temp hypothermia: hallmark sign - ANSWER temp lower than 95F hypothermia: mild - ANSWER shivering, slowed speech, mental slowness hypothermia: moderate - ANSWER confusion, stupor, decreased ability to clot hypothermia: severe - ANSWER bradycardia, hypotension, death hypothermia: assess - ANSWER -core temp -cardiac rythm -mental status Hypothermia: interventions - ANSWER -warm trunk first; cardiopulmonary bypass or hemodialysis -warm blood may be necessary in severe cases -warm IV fluids, heated O2 -administer drugs with caution **no mass vasodilation; warm slowly Frostbite: assess - ANSWER -core temp -pain during rewarming frostbite: interventions - ANSWER -rewarm in water that 104-108F -admin pain meds before rewarming--extremely painful -elevate affected extremity -monitor for compartment syndrome and infection altitude sickness: hallmark sign - ANSWER headache, nausea, vomiting--feeling "hungover" Altitude sickness: assess - ANSWER -respiratory rate--watch for hyperventilation -exertional dyspnea Altitude sickness: interventions - ANSWER -apply O2 -monitor for complications --high altitude cerebral edema and pulmonary edema Drowning: assess - ANSWER immediately ABCDE s/sx of infection s/sx of ARDS Drowing: interventions - ANSWER -protect airway -promote oxygenation (may need to vent with high PEEP if surfactant is gone) -monitor for complications mass casualty triage: RED - ANSWER emergent threats to life only but can be saved mass casualty triage: yellow - ANSWER urgent, major injuries will require treatment but are not life threatening mass casualty triage: Green - ANSWER non-urgent, no treatment required for minor injuries mass casualty triage: BLACK - ANSWER expectant; expected to die Cutaneous anthrax: hallmark sign - ANSWER raised vesicle on skin that opens, bleeds, and sinks inward to necrose dermal tissue cutaneous anthrax: assess - ANSWER -skin -exposure history cutaneous anthrax: interventions - ANSWER -culture wound -oral antibiotics if no systemic infection -Iv antibiotics if systemic illness -wound on face or neck -pregnancy inhalation anthrax: assess - ANSWER not transmisable from person to person** -exposure hx -blood culture/chest Xray for Dx Inhalation Anthrax: interventions - ANSWER -likely targets should be vaccinated before exposure -start antibiotics (cipro or doxycycline AND rifampin, clindamycin, or vancomycin)******* IMMEDIATELY** Hemoglobin - ANSWER 12-18 hematocrit - ANSWER 37-52% White blood cell Count (WBC) - ANSWER 5-10 platelet count - ANSWER 150-400 Red blood cell count (RBC) - ANSWER 4.2-6.1 Promthrombin time (PT) - ANSWER 11-12.5 (normal on coumadin = 16.5-31.25) INR - ANSWER 0.9-1.2 (1.8-3.6 therapeutic) PTT - ANSWER 60-70 (heparin normal = 90-175) Na - ANSWER 135-145 K+ (potassium) - ANSWER 3.5-5.0 creatinine - ANSWER 0.5-1.2 BUN - ANSWER 10-20 albumin - ANSWER 3.5-5.0 Mg (magnesium) - ANSWER 1.5-2.5 Ca (calcium) - ANSWER 9-10.5 specific gravity - ANSWER 1.003-1.030 urgent - ANSWER new onset pneumonia altitude illness - ANSWER dexamethasone--reduces cerebral edema HAPE - ANSWER treat with tadalafil and sildenafil RED: EMERGENT - ANSWER -airway obstruction -shock -severed legs -chest pain SOB -hemorrhage YELLOW: can wait a short time - ANSWER -open fracture with distal pulses -large wounds -require hospitalization GREEN: non-urgent - ANSWER -walking wounded -closed fracture -sprains -abrasions -contusions BLACK: EXPECTED TO DIE - ANSWER -lethal injuries -massive bleeding -extensive full thickness burns -massive head trauma -high cervical spine injury sepsis: assess - ANSWER low grade fever and mild hypotension are EARLY -tachypnea and tachycardia -low HCT, HGB, platelets, fibrinogen levels ARDS: assess - ANSWER -rapid onset of severe dyspnea -refractory to O2 therapy -struggling to breath -hypoxemia is EARLY indicator!!! John brown is burned over 90% of his body and is barely breathing. He is intubated and IV fluids were started at the scene *mass casualty example - ANSWER BLACK: EMERGENT Mr. Miller, the van driver has a deep and long bleeding laceration on his forehead, is complaining of severe chest pain radiating down his left arm, SOA, nausea, and a headache *mass casualty example - ANSWER RED: EMERGENT Patty Miller is complaining of severe pain in her right leg (her femur bone is protruding through her skin) and bleeding, and her right arm as well as her neck is hurting *mass casualty example - ANSWER YELLOW: URGENT Sam Miller who did not have a seat belt on is complaining of chest and back pain. He has what appears to be ribs protruding through his right chest wall. He has no breath sounds on that side when assessed. *mass casualty example - ANSWER RED: EMERGENT Tom Smith was back in the third seat and was hanging half way out of the vehicle and unconcious. When he arrived, blood was coming out of his LEFT ear, legs mangled, and a gaping hole in his abdomen with blood everywhere *mass casualty example - ANSWER BLACK: NON-URGENT Mrs. Tipton has no visible injuries. You are able to assess her orientation. She has a blank stare on her face. You ask her questions and give her commands, and no response is given. She is not moaning or making any noise, only staring straight ahead. *mass caualty example - ANSWER YELLOW: URGENT Mr. Gulliver believes his leg is broken. He tells you that he is in a great deal of pain and is unable to stand on his leg. The fire department had to remove him from the bus because he was pinned behind the steering wheel. The airbag inflated but there were no visible injuries caused by the airbag that can be seen. *mass casualty example - ANSWER GREEN: NON-URGENT Non urgent - ANSWER Cleft Lip - ANSWER incomplete fusion of the nanomedical or intermaxillary process Cleft Palate - ANSWER incomplete fusion of the secondary palate: may involve uvula Cystic Fibrosis in Children - ANSWER Barrel chest, digital clubbing, chronic sinusitis, nasal polys Classic Findings Associated with Croup - ANSWER Inspiratory stridor (harsh, vibratory sound), Barking Cough (seal-like, harsh sound), Hoarseness (voice quality changes) Symptoms of Congenital Heart Defects (CHD) - ANSWER Heart murmur, splitting heart sounds, systolic thrill, dyspnea, tachypnea Muscular Dystrophy Progression - ANSWER Begins in pelvic girdle spreads to shoulder girdle, walking on toes, caused by tibial and peroneal muscle weakness Scoliosis Screening Age Group - ANSWER Adolescents = after skeletal age of 10 Cerebral Palsy - ANSWER A permanent disorder of movement and posture caused by nonprogressive damage to the developing brain Signs of Cerebral Palsy - ANSWER Hyperactive deep tendon reflexes, rigidity of extremities, scoliosis and contractures ADHD - ANSWER Attention Deficit/Hyperactivity Disorder = dysregulation of neurotransmitters Manifestations of ADHD in Kids - ANSWER Inattention, hyperactivity, impulsivity Normal Aging Signs - ANSWER Pain, urinary incontinence, and severe memory loss are NOT a normal part of aging Height Loss in Older Adults - ANSWER Height loss: bone density loss, vertebral compression (weakened vertebrae can compress), intervertebral disc changes (lose water content and become thinner), posture changes Weight Loss in Older Adults - ANSWER Weight loss: loss of lean body mass, decreased appetite, social isolation, decreased caloric requirements Bruising or lacerations - ANSWER Fractures inconsistent with functional ability, pressure ulcers, dehydration, and poor hygiene. Skin changes in older adults - ANSWER Skin becomes cooler, has a parchment-like appearance, decreased elasticity, and tears easily. Liver spots and skin tags - ANSWER Common skin changes seen in older adults. Pseudoptosis - ANSWER Relaxed upper eyelid seen in older adults. Hearing changes in older adults - ANSWER Ability to hear high-frequency sounds diminishes. Ectropion - ANSWER An abnormal finding in older adults where the eyelid turns outward. Entropion - ANSWER An abnormal finding in older adults where the eyelid turns inward. Long-time pipe smokers' risk - ANSWER At risk for lip cancer, lung cancer, esophageal cancer, and oral cavity cancers. Teeth changes in older adults - ANSWER Teeth may appear longer, darker, or stained. ROM of neck - ANSWER Generally done one movement at a time for safety reasons to prevent injury and allow for proper assessment. Kyphoscoliosis in elderly - ANSWER Can cause respiratory complications, impaired ventilation, and dyspnea on exertion. Cool feet and weak pedal pulses - ANSWER Associated with Peripheral Artery Disease and arterial insufficiency. Musculoskeletal expected findings - ANSWER Muscle mass decrease and osteoarthritis. Neurologic expected findings - ANSWER Deviation of gait from midline, difficulty with rapidly alternating movements, and some loss of reflexes and sensations. Resting tremor - ANSWER A hand tremor that is reduced with purposeful movement. Common problems in older adults - ANSWER Skin cancer, cataracts, macular degeneration, glaucoma, diabetic retinopathy, conductive and sensorineural hearing loss, asthma, COPD, pneumonia, hypertension, angina, MI, HF, anemia, reflux disease, constipation, osteoporosis, fractures, gout, Alzheimer disease, stroke, Parkinson's disease, UTIs, incontinence, benign prostatic hyperplasia. Visual changes with macular degeneration - ANSWER Blurred and darkened vision, blind spots, decreased color perception. Alzheimer's disease - ANSWER An incurable, progressive neurological disorder characterized by a permanent decline in mental function. Clinical findings of Alzheimer's - ANSWER Memory loss, word-finding difficulties, vision issues, personality changes. Risk factors for urinary incontinence - ANSWER Age, gender (women), diabetes, obesity. How is an assessment of mental status accomplished? - ANSWER By interviewing the client and observing their behaviors If depression is suspected in an older adult, what screening tool is used to confirm this diagnosis? - ANSWER Geriatric depression scale What is the Glasgow Coma Scale used for? - ANSWER Rating one's response to stimuli What does the score for the Glasgow Coma Scale tell you? - ANSWER Whoever has a scores 10 or lower needs emergency attention whoever scores a 7 means that they are in a coma How is the Glasgow Coma Scale calculated? - ANSWER Subtracting pupil reactivity score from Glasgow coma scale number What is the depression questionnaire used for? - ANSWER To better assess if a client is depressed What is the SAD PERSONNA assessment tool for? - ANSWER To assess the likelihood of a suicide attempt What is the MMSE assessment tool used for? - ANSWER To assess adults, quickly and easily What is the Saint Louis University Mental Status (SLUMS) assessment tool used for? - ANSWER Similar to MMSE; to assess adults quickly and easily What is the Confusion Assessment Method (CAM) used for? - ANSWER To identify delirium What is the Mini-Cog? - ANSWER A quick screening test What are the steps of Mini-Cog? - ANSWER 1. tell client 3 easy words 2. draw a clock 3. have client repeat the 3 words What is the Denver II test used for? - ANSWER To assess development in children up to age 6 When assessing level of consciousness, always begin the assessment with what? - ANSWER Least noxious stimulus: verbal, tactile, to painful What do you look at during a physical assessment with level of consciousness and mental status? - ANSWER 1. LOC 2. Posture, gait, body movements 3. behavior & affect 4. dress and grooming 5. hygiene 5. facial expressions 6. speech 7. mood, feelings, expressions 8. thought processes and perceptions How long do people have delirium versus Dementia? - ANSWER Hours to weeks versus chronic condition that does not resolve over time How is the onset for delirium versus dementia? - ANSWER Acute onset versus chronic onset How is the attention span for delirium vs. dementia? - ANSWER Impaired/fluctuating attention VS. generally normal How is the memory for delirium vs. dementia? - ANSWER for both, it is recent and immediate memory impaired How is alertness for delirium vs. dementia? - ANSWER Fluctuates between lethargic and hypervigilant VS. generally normal alertness How is thinking and judgment for delirium vs. dementia? - ANSWER Disorganized thinking, slow or accelerated VS. may have word finding difficulty, judgment may be poor What are the different types of family violence? - ANSWER 1. Physical abuse 2. Psychological 3. economic 4. sexual What does physical abuse include? - ANSWER Pushing, shoving, slapping, chocking, punching, burning What does psychological abuse include? - ANSWER use of constant insults or criticism, blaming the victim for things that aren't their fault, threats, isolation, deprivation, humiliation How is psychological abuse defined? - ANSWER Dr. Harriet McMillan states it as "acts such as belittling, denigrating, terrorizing, exploiting, emotional unresponsiveness, or corrupting a child to the point a child's well-being is at risk" What does economic abuse include? - ANSWER Preventing the victim from getting or keeping a job, controlling money and limiting access to funds, spending the victim's money, and controlling knowledge of family finances What does sexual abuse include? - ANSWER Forcing the victim to perform sexual acts against their will, pursuing sexual activity after the victim has said no, etc. What does the Bureau of Justice Statistics state for the statistics of sexual abuse? - ANSWER 6 in 10 rape or sexual assault victims were assaulted by an intimate partner, relative, friend or acquaintance How is Intimate Partner Violence (IPV) defined? - ANSWER Physical, sexual or psychological harm by a current or former partner or spouse What are the forms of harm done in Intimate Partner Violence? - ANSWER 1. Psychological 2. Sexual assault 3. progressive isolation 4. stalking 5. deprivation 6. Intimidation 7. Reproductive coercion How do you begin the screening for IPV? - ANSWER By telling the client that it is important to routinely screen all clients for IPV because it affects so many women and men in our society Where can screening tools for PTSD be found? - ANSWER Department of Veterans Affairs National Center for PTSD Why should we as nurses ensure that an environment is safe and confidential for an interview? - ANSWER It is essential to obtain concise and valid subjective data from any client who has experienced family violence For any child over the age of 3, what should you do when you ask screening questions? - ANSWER Ask them in a secure, private setting with no one else present in the room Epispadias - ANSWER A congenital defect where the dorsal urethral fails to fuse and form a tube, resulting in an abnormally positioned urethral opening on the upper surface of the penis. Scrotal sac position difference - ANSWER The difference in the venous drainage creates slightly different pressures within the spermatic cords on each side. Bacterial vaginosis (BV) - ANSWER Caused by replacement of lactobacilli with anaerobic bacteria, leading to large amounts of thin, white, homogenous vaginal discharge, strong fishy odor, and elevated vaginal pH. Candida vaginitis - ANSWER Common in pregnant women, women with diabetes, immunosuppressed individuals, and women taking broad-spectrum antibiotics, characterized by thick, white, 'cheesy' vaginal discharge, itching, vaginal soreness, external dysuria, and edema of the vulva. Gonorrhea - ANSWER Caused by Neisseria gonorrhoeae bacteria, with incubation of days to 10 days; more than half are initially asymptomatic, with increased vaginal discharge, dysuria, and abnormal menses. Chlamydia - ANSWER Caused by Chlamydia trachomatis bacteria, milder than gonorrhea, with men experiencing urethral discharge and dysuria, and women experiencing vaginal discharge, dysuria, and bleeding after sex. Syphilis - ANSWER Caused by Treponema pallidum bacteria, characterized by a painless ulcer at the infection site, appearing 10-90 days after exposure, with rash, fever, and lymphadenopathy. Cervical strawberry patches - ANSWER Seen with Trichomoniasis, characterized by small punctate red marks visible on the vaginal walls and cervix during examination. HSV - ANSWER Genital herpes with painful blisters, caused by HSV-1 and HSV-2, leading to painful blisters, fever, headache, lifelong infection, and does not cause cancer. HPV - ANSWER Causes genital warts and various cancers, with 150+ types, highly contagious, can lead to cancer, no cure; treatment focuses on treating lesions, vaccines available. Signs/Symptoms of Vaginal Infection - ANSWER Thick, white, 'cheesy' vaginal discharge, itching, vaginal soreness, external dysuria, edema of the vulva Pelvic Inflammatory Disease (PID) - ANSWER Condition caused by Chlamydia and Gonorrhoeae; symptoms include low bilateral abdominal pain, pain worsens with activity, dysuria, vaginal discharge, painful intercourse, abnormal vaginal bleeding Premenstrual Syndrome (PMS) - ANSWER Condition characterized by mood swings, depression, confusion, breast tenderness/discomfort, and headaches Cervical Cancer Signs/Symptoms - ANSWER Abnormal vaginal bleeding; lesions may be visible, usually hard with a granular surface that bleeds easily and has irregular borders Endometrial Cancer Signs/Symptoms - ANSWER Occurs most in postmenopausal women, especially those taking estrogen; symptoms include abnormal uterine bleeding, spotting, and watery vaginal discharge Ovarian Cancer Signs/Symptoms - ANSWER 'Whispering disease'; occurs mostly in women over age 50 in western industrialized nations; symptoms include abdominal distension or fullness Testicular Torsion - ANSWER Twisting of the spermatic cord; hallmark finding includes sudden, severe scrotal pain accompanied by swelling, nausea, and vomiting Transillumination of the Scrotum - ANSWER Helps distinguish between different types of scrotal masses by revealing whether they are fluid-filled or solid Fluid-Filled Mass Examples - ANSWER Hydrocele, Spermatocele Solid Mass Examples - ANSWER Hernia, Testicular tumors/cancer Testicular Cancer Signs - ANSWER Hard and irregular mass felt within the testis Prostate Cancer Signs - ANSWER Usually asymptomatic until causing urinary obstruction; difficulty urinating; on palpation, the prostate feels hard and irregular Benign Prostatic Hyperplasia (BPH) Signs/Symptoms - ANSWER Nocturia, urgency, weak stream, bladder pain Hemorrhoids - ANSWER Dilated veins of the hemorrhoidal plexus resulting from increased portal venous pressure; symptoms include localized itching and bleeding; may appear as blue or purple shiny masses at the anus Anorectal Fissures - ANSWER Tear of the anal mucosa causing intense pain; symptoms include severe rectal pain, itching, and rectal bleeding Abscess - ANSWER Pus-filled cavity in the anal or rectal area; symptoms include rectal pain and fever Lupus: Hallmark sign - ANSWER butterfly rash on face Lupus: Indication of flare - ANSWER Fever and fatigue *also assess BUN function *c reactive protein remains normal Lupus: Interventions - ANSWER -Falls precautions -treat pain with tylenol and NSAIDS (monitor kidney function) -AVOID SUNLIGHT -REPORT FLARE IMMEDIATELY -clean skin with mild soap and pat dry and apply lotion Lupus: medical management - ANSWER -hydroxychloroquine(anti-malarial) decreases absorption of UV light Scleroderma - ANSWER inflammatory, autoimmune connective tissue disease Scleroderma: Hallmark Sign - ANSWER Hard, leather-like edematous skin Late: esophageal dismotility Scleroderma: Assess - ANSWER Swallow safety--esophageal dysmotility (ASPIRATION) O2 circulation skin Scleroderma: Interventions - ANSWER aspiration precautions (keep HOB at 60 degrees during meals and after) skin protection measures small frequent meals--avoid caffeine and alcohol -avoid spices, caffeine and pepper fibromyalgia: S/sx - ANSWER extreme fatigure GI symptoms dysuria blurred vision forgetfulness fibromyalgia: Assess - ANSWER pain level extreme fatigue GI symptoms Fibromyalgia: Interventions - ANSWER NSAIDS Nuerontin (gabapentin) Lyrica (pregabalin) SNRI and tricyclic antidepressants (amitriptyline) promote sleep and low impact exercise (stretching, walking, swimming, rowing, water exercise) Lyme Disease: Hallmark sign - ANSWER stage 1: "bulls eye rash" and flu-like symptoms Stage 2: facial paralysis, carditis, meningitis Lyme Disease: Assess - ANSWER Skin history of tick bites Lyme Disease: Interventions - ANSWER prevention! Insect repellant with DEET early stage--doxycycline antibiotics ORAL late stage--Iv antibiotics (ceftriaxone) avoid tall grass wear light colored clothing have pets wear tick collars Allergic Reaction Priority - ANSWER STOP THE INFUSION/ELIMINATE the trigger, then STOP the immune response Give Epi maintain airway Latex allergy: risks - ANSWER -frequent use of latex condoms -healthcare workers -allergy to avocados, bananas, and some nuts Anaphylactic shock - ANSWER AIRWAY--give epi IV or IM STAT and intubate if needed BREATHING--apply O2; mechanically ventilate CIRCULATION--monitor for distributive shock; give fluids Epinephrine Auto-injector teaching - ANSWER always carry 2 devices inject by "stabbing" into top of thigh with pants on (AVOID pockets) call 911 immediately--patient still needs to be monitored keep epi in cool dark place. Immunocompromised Patient - ANSWER -Do not drink anything that has been sitting out -take temp at least once per day -clean toothbrush once weekly in diswasher or bleach solution -do not eat raw foods; salad, cottage cheese -do not scoop litter boxes -no plants or soil exposure -antibacterial soap -AVOID reptiles HIV: Assess - ANSWER CD4 count ELISA test once per year for at risk patients HIV: Interventions - ANSWER PREVENTION: -condoms -PreP (truvada) must take 4 consecutive days in a row before protected; cant miss more than one dose in a row -needle safety -post exposure prophylaxis-start cART within 24-36 hours of exposure Testicular cancer: Interventions - ANSWER surgical removal chemo radiation cervical cancer: risks - ANSWER -HPV virus -smoking -multiple partners Cervical cancer: hallmark sign - ANSWER painless vaginal bleeding Cervical cancer: screening - ANSWER pap test every 3 years for women of childbearing age**** Cervical cancer: assess - ANSWER -vaginal discharge (painless vaginal bleeding) -sexual hx -vaccine -screening hx cervical cancer: Interventions - ANSWER -vaccinate boys and girls for HPV; 3 vaccines; puberty age -screen for it -removal of cancerous/pre-cancerous cells (cervical scraping, hysterectomy with vaginal resection) -brachytherapy (internal radiation) head and neck cancer: risks - ANSWER -smoking -excessive sun/UV exposure head and neck cancer: screening - ANSWER dental exams head and neck cancer: assess - ANSWER -airway -breathing -self-concept head and neck cancer: interventions - ANSWER -maintain airway -surgical removal of cancer; radical neck disection, facial reconstruction -chemo -external radiation skin cancer: risks - ANSWER -overexposure to UV -genetic -advanced age skin cancer: assess - ANSWER -skin -hx of tanning, outdoor work, SPF use -screening hx -family hx of melanoma skin cancer: Interventions - ANSWER PREVENTION: SPF 30 or higher (fair skin needs higher SPF) -surgical -chemo -external radiation -avoid sun exposure from 11am-3pm Bladder Cancer "urothelial cancer": risks - ANSWER -smoking***** -chemical exposure bladder cancer: screening - ANSWER none; only cystoscopy after symptoms present bladder cancer: assess - ANSWER -urine output -hemturia -pain with urination Bladder cancer: interventions - ANSWER -surgical removal of cancerous tissue -scraping bladder lining to radical cystectomy with urinary diversion (ileal conduit placement) -chemo chemotherapy - ANSWER -can be intrathecal, IV, PO, intrvesical -must be chemo certified; must have 2 RNs double check (high risk meds) chemo side effects - ANSWER -nausea -vomiting -pancytopenia -immunosuppression chemo precautions - ANSWER -double flush toilet -chem-safe PPE -spill clean up per agency protocal External Radiation "teletherapy" - ANSWER -external source (client will not emit radiation) External radiation side effects - ANSWER -radiation dermatitis (mild soap and water with lotion) -bone marrow suppression -xerostomia (excessive thirst) -oral candidiasis/thrush Brachytherapy - ANSWER -internal radiation -specifically to the tumor -client is radioactive -waste products are radioactive -no pregnant women or children allowed -private room and private bathroom -wear lead apron and dosimeter when providing care -visitiors can stay for no longer than 30min per day, and 6 feet from patient HIV: Nutrition - ANSWER high calorie high protein low fat small frequent meals thrush--treat with anitfungal HIV tx: HAART/cART - ANSW