NR 509 MIDTERM STUDY GUIDE FINAL

NR 509 MIDTERM STUDY GUIDE FINAL Preauricular nodes - CORRECT ANSWER-in front of the ear Posterior auricular node - CORRECT ANSWER-superficial to the mastoid process (behind the ear) Occipital node - CORRECT ANSWER-at the base of the skull posteriorly Tonsillar node - CORRECT ANSWER-at the angle of the mandible Submandibular node - CORRECT ANSWER-midway between the angle and the tip of the mandible. These nodes are usually smaller and smoother than the lobulated subman-dibular gland against which they lie Submental nodes - CORRECT ANSWER-in the midline a few centi-meters behind the tip of the mandible Superficial cervical nodes - CORRECT ANSWER-superficial to the sternocleidomastoid. Posterior cervical nodes - CORRECT ANSWER-along the anterior edge of the trapezius. Deep cervical chain lymph nodes - CORRECT ANSWER-deep to the sternocleidomastoid and often inaccessible to examination. Hook your thumb and fingers around either side of the sterno-cleidomastoid muscle to find them. Supraclavicular nodes - CORRECT ANSWER-deep in the angle formed by the clavicle and the sterno-cleidomastoid. shotty - CORRECT ANSWER-Small, mobile, discrete, nontender nodes, are frequently found in normal people physical assessment techniques - CORRECT ANSWER-Inspection - visual examination; Palpation - tactile examination; Percussion - tactile and auditory examination; Auscultation - auditory examination head and neck - CORRECT ANSWER-Begin the physical assessment by inspecting general appearance of head/neck - CORRECT ANSWER-facial expression, contours, asymmetry comprehensive assessment - CORRECT ANSWER-Seeing patient for first time; Includes all the elements of the health history and the complete physical examination; fundamental and personalized knowledge about the patient that strengthens the clinician-patient relationship; provides a complete basis for assessing these concerns and answering patient questions focused assessment - CORRECT ANSWER-chief complaint such as cough, abdominal pain, sore throat, etc. or a follow-up for a chronic illness; Your history and physical will be much more focused on the chief complaint as you begin diagnosis and management basic - CORRECT ANSWER-maximize patient's comfort, avoid unnecessary changes in position, enhance clinical efficiency, move head to toe, examine the patient from their right side active listening - CORRECT ANSWER-closely attending to what the patient is communicating, connecting to the patient's emotional state, and using verbal and nonverbal skills to encourage the patient to expand on his or her feelings and concerns Empathic responses - CORRECT ANSWER-the capacity to identify with the patient and feel the patient's pain as your own, then respond in a supportive manner Guided questioning - CORRECT ANSWER-show your sustained interest in the patient's feelings and deepest disclosures and allows the interviewer to facilitate full communication, in the patient's own words, without interruption. Nonverbal communication - CORRECT ANSWER-eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs—crossed, neutral, or open validation - CORRECT ANSWER-helps to affirm the legitimacy of the patient's emotional experience. Partnering - CORRECT ANSWER-When building rapport with patients, express your commitment to an ongoing relationship Summarization - CORRECT ANSWER-Giving a capsule summary of the patient's story during the course of the interview to communicate that you have been listening carefully. Transitions - CORRECT ANSWER-Inform your patient when you are changing directions during the interview empowering the patient - CORRECT ANSWER-encourage patients to ask questions, express their concerns, and probe your recommendations in order to encourage them to adopt your advice, make lifestyle changes, or take medications as prescribed. subjective - CORRECT ANSWER-apparent only to the person affected' perceptions, feelings, thoughts, expectations. Cannot be observed and can be discovered only by asking questions objective - CORRECT ANSWER-detectable by an observer or can be tested against an acceptable standard; tangible, observable facts; includes observation of the clients behavior, medical records, lab and diagnostic tests, data collected by physical exam chief complaint - CORRECT ANSWER-Make every attempt to quote the patient's own words 7 attributes of a symptom - CORRECT ANSWER-Location, quality, quantity or severity, timing - including onset duration and frequency, setting in which it occurs, alleviating/aggravating factors, associated manifestations Past medical history - CORRECT ANSWER-Medications (prescription, OTC and herbs), allergies to drugs foods seasonal environment (document reaction to each), childhood; illness/hospitalizations, adult illnesses (diabetes, HTN, HIV, hispitalizations, gender of sexual partners, sexual practices), surgical history (dates, indications, types), OBGYN (menstrual hx, methods of contraception, sexual function) , psychiatric (illness and time frame, diagnosis, hospitalizations, treatments), health maintenance (immunizations, wellness exams, pap smears, colonoscopy, etc), family history, personal and social history (intersts, stress, spiritual beliefs, lifestyle habits) review of symptoms - CORRECT ANSWER-(1) to obtain additional information about the patient's chief complaint and history of present illness; and (2) to elicit symptoms of potential problems in uninvolved systems; ask yes or no questions and then follow up when there is a response that indicates an abnormality with open-ended questions; head-to-toe approach - remember that the ROS is subjective data ONLY Problem list - CORRECT ANSWER-defined as a list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient; includes all the medical, social, and psychologic problems the patient has or may have; List the most active and serious problems first and record their date of onset. Helps to individualize the patient's care. On follow-up visits, provides a quick summary of the patient's clinical history and a reminder to review the status of problems the patient may not mention differential diagnosis - CORRECT ANSWER-all the medical diseases that may possibly explain the patient's chief complaint or principal problem; A chief complaint must be identified first. Includes all medical diseases that may possibly explain problem/ CC head - CORRECT ANSWER-Areas are associated with the bone that they are in front of salivary glands - CORRECT ANSWER-glands near mandible parotid - CORRECT ANSWER-glands that lie superficial and behind mandible - visible and palpable when enlarged submandibular gland - CORRECT ANSWER-glands beneath the tongue parotid and submandibular - CORRECT ANSWER-openings of these are visible in oral cavity superficial temporal artery - CORRECT ANSWER-artery that is in front of the ear and runs upward - readily palpable common issues with the head - CORRECT ANSWER-Headache; Change in vision - Hyperopia, Presbyopia, Myopia, Scotomas, Diplopia; Hearing loss, earache, tinnitus; Vertigo Hyperopia - CORRECT ANSWER-farsightedness; This makes close-up objects appear blurry presbyopia - CORRECT ANSWER-gradual loss of your eyes' ability to focus on nearby objects myopia - CORRECT ANSWER-nearsightedness Scotoma - CORRECT ANSWER-A spot in your vision that can be dark, very light, blurred, or flickering · Trouble seeing certain colors Diplopia - CORRECT ANSWER-double vision Examination of the head - CORRECT ANSWER-Note skin on face - color, pigmentation, texture, thickness, hair distribution, lesions; Note skull for contours; Ask if patient has noticed anything wrong with the scalp or hair; Remove hair pieces for exam; Note hair for quality, distribution, texture and any hair loss; Part in separate places to look for scaliness, lumps, redness, scaling, nevi, lesions; Depressions, lumps, tenderness of skull observation of the face - CORRECT ANSWER-Facial expressions, contours, asymmetry, involuntary movements, edema, masses skin - CORRECT ANSWER-note for color, pigmentation, texture, thickness, hair distribution, lesions sclera - CORRECT ANSWER-white coloring of eye upper lid - CORRECT ANSWER-covers portion of iris Conjunctiva - CORRECT ANSWER-clear mucous membrane of the eye Bulbar conjunctiva - CORRECT ANSWER-covers most of anterior eyeball; meets cornea at Limbus Palpebral conjunctiva - CORRECT ANSWER-lines upper and lower eye lids Tarsal plate - CORRECT ANSWER-Connective tissue, firm strips; Each plate parallel row of meibomian glands, which open on lid margin Levator palpebrae - CORRECT ANSWER-muscle that opens upper eyelid Lacrimal gland - CORRECT ANSWER-drains medially, above eye, drains through lacrimal puncta, into the lacrimal sac and into the nose through nasolacrimal duct; Lower lid medially is where the puncta is cornea - CORRECT ANSWER-transparent anterior portion of outer covering of eye iris - CORRECT ANSWER-muscles of this control size of pupils Ciliary body muscles - CORRECT ANSWER-control thickness of lens; Allows the eye to focus on near or distant objects aqueous humor - CORRECT ANSWER-controls pressure inside eye - drains through canal of Schlemm eye fundus - CORRECT ANSWER-Posterior part of eye seen through opthalascope; Optic nerve enters through the eyeball posteriorly; Can be seen at optic disk where retinal arteries and veins converge fovea - CORRECT ANSWER-Lateral and inferior to disk - dark and circular area; Surrounds small depression that marks point of central vision retina - CORRECT ANSWER-light sensitive membrane that covers the fundus vitrous body - CORRECT ANSWER-transparent mass of gelatinous - fills eye ball - not visible through opthalascope Maintains shape of eye visual acuity; snellen eye chart - CORRECT ANSWER-Read smallest line possible while covering one eye 20/20 - distance of patient from; chart/distance from the chart that a normal eye can read the line of letters; top number distance from chart - 200/100 - you must be 20 feet to see what a person with normal vision can see at 100 feet testing of vision fields - CORRECT ANSWER-Good test/technique for early detection of lesions in anterior and posterior visual pathway static finger wiggle test - CORRECT ANSWER-face patient directly - ask patient to look at you in your eyes then place hands 2ft apart, lateral to patient's ears. Slowly move moving fingers of both hands along imaginary surface of bowl, toward central vision line. Ask patient to tell you as soon as finger is seen; While in this position, wiggle your fingers and slowly bring your moving fingers forward into the patient's center of view. Ask the patient to tell you as soon as he or she sees your finger movement. Test each clock hour, or at least each quadrant. Test each eye individually and record the extent of visits in each area. Note any abnormal "field cuts" Kinetic red target test - CORRECT ANSWER-face patient, move 5mm red top pin inward from beyond boundary of each quadrant, along a line bisecting the horizontal and vertical meridians; Ask when he/she can see the pin; Examine eyebrows; Examine eyelids for; Width of palpebral fissures, edema and color, lesions, condition and direction of eyelashes, eyelid closure adequacy; Excessive tearing/dryness; Look at conjunctiva - color, nodules, ducts - look each side and down Inspect cornea and iris - CORRECT ANSWER-Shine pen light from side toward the eye; Light from temporal side...look for crescent shadow on medial side of iris = glaucoma; iris markings are clearly defined Inspect size, shape and symmetry of pupils - CORRECT ANSWER-Darken room, shine bright light with oblique lighting + distant gaze = help to prevent near reaction; Watch for direct reaction consisting of pupillary restriction in eye being illuminated directly - then quickly swing the light to the opposite eye, looking for conceptual reaction (pupillary constriction in opposite eye); If questionable - test near reaction in normal light → hold pencil/finger 10cm from eye, ask patient to alternate focus from pencil to distance behind it → watch for pupillary construction with near effort Ocular alignment from extraocular muscles - CORRECT ANSWER-2 ft directly in front of patient, shine light onto patient's eyes and ask the patient to look at light - inspect reflection in the corneas - they should be visible slightly nasal to the center of the pupil Assess extraocular movement - CORRECT ANSWER-follow finger while sweeping through 6 cardinal directions of gaze - making wide H in the air - lead patients gaze to extreme right, to the right and upward, down on the right then without pausing up to the extreme left then upward; Conjugate movements; Deviation from normal Nystagmus - CORRECT ANSWER-look for jerking movement as patient looks far left then the far right Lid lag - CORRECT ANSWER-as they move up and down slowly midline (hyperthyroidism) - look for white rim of sclera above iris; Normally lid should overlap iris slightly throughout the movement