NR 509 Final Exam Latest Update with Verified Solutions

NR 509 Final Exam Latest Update with Verified Solutions Assessing from Head to Toe Think about which order you will be assessing your patient from head to toe Start by inspecting- you will inspect you patient head/face Then palpating lymph nodes Ascultating lung sounds and heart soun Percussing abdomen Assess patient's gait OLD CART Onset Location Duration Characteristic Aggravating factors Relieving factors Treatment Subarachnoid Hemorrhage Severe and Sudden "worst headache of my life" Nausea and Vomiting can be present Cranial Nerve X Vagus nerve Used to assess when you touch the soft palate and view uvula Signs of Otitis Externa (swimmers Ear) Painful movement of the auricle and tragus (page 245) Review fig 7-43 Physical Signs of Meningitis (pg 765) Neck stiffness with resistance of flexion. Won't be able to touch chin to chest Red flags for Headaches Progressively frequent or severe over 3 month period New onset after 50 Aggravated or relieved by change in position Recent head trauma Labs to check with Vitiligo Thyroid panel: TSH, free T3 and Free T4, СВС Preservation Patient uses words repeatedly. Using words or phrases repeatedly often seen in schizophrenia Erectile Dysfunction Older men in their late 40s that experience ED is usually psychological rather than testosterone. Tanner Staging of breasts in females Stage I: preadolescents-elevation of nipple Tanner Staging of breasts in females Stage 2: Breast bud stage- elevation of breast and nipple as a small mound. Tanner Staging of breasts in females Stage 3: further enlargement of elevation of breast and areola Tanner Staging of breasts in females Stage 4: projection of areola and nipple for a secondary mound above the level of the breast Tanner Staging of breasts in females Stage 5: mature stage- projection of nipple only HPV vaccine Prevents infection from subtypes 16 and 18. Measuring tape when measuring uterus in a pregnant woman Place tape measure on pubic symphysis and place zero end of tape, when you can firm feel the bone. Extend the tape measure to the very top of the uterine fundus and note the number of cm measured. The number should equal the number of weeks of gestation Bounding pulse Bounding meaning 2+ On scale 0-3 Bacterial Vaginosis- Discharge: Gray or white, thin, homogeneous, scant, malodorous Symptoms: Fishy genital odor Vulva: Usually normal Vagina: Usually normal Laboratory Assessment: Saline wet mount for "clue cells," "whiff test" with KOH for fishy odor Candida vaginitis Discharge White, curdy, often thick, not malodorous Symptoms: Itching, vaginal soreness, external dysuria, dyspareunia Vulva: Often red and swollen Vagina: Often red with white patches discharge Laboratory Assessment: KOH preparation for branching hyphae Erectile Dysfunction May be a from psychogenic causes, especially if early morning erection is also reflect decreased preserved; it may testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, and diabetes. Rovsing sign: pain in the RLQ during left sided pressure Diverticulitis- Inflammation of the diverticula. Left lower quadrant pain, especially with a palpable mass. Deep palpation is usually required to delineate the liver edge, the kidneys, and abdominal masses. The pain may be cramping at first, then steady. absence seizures sudden brief lapse of consciousness, with momentary blinking, staring, or movements the lips and hands but no falling. Two subtypes are typical absence (lasts less than 10 sec and stops abruptly) atypical absence (may last more than 10 sec). Post ictal state: no aura recalled. In typical absence, there is a prompt return to normal and in atypical there might be some postictal confusion. signs of increased intracranial pressure Papilledema of the optic disc elevated ICP causes intraaxonal edema along the optic nerve leading to engorgement and swelling on the optic disc pink, hyperemic, loss of venous pulsations, disc more visible, disc swollen with blurred margins, physiologic cup not visible) Headache, blurred vision, feeling less alert than usual, vomiting, changes in behavior, weakness or problems with moving or talking, lack of energy or sleepiness signs of respiratory distress Tachypnea: greater than or equal to 25 breaths/min pneumonia and cardiac disease Cyanosis or pallor (signals hypoxia) Audible sounds of breathing: audible whistling during inspiration over the neck or lungs stridor signals upper airway obstruction in the larynx or trachea Contraction of the accessory muscles of the neck or supraclavicular retraction, contraction of the intercostal or abdominal oblique muscles - Is the trachea midline? what is objective information What you detect during the examination, laboratory information, & test data. All physical exam findings, or signs. what can cause epistaxis Trauma (especially nose picking), inflammation, drying and crusting of the nasal mucosa, tumors, and foreign bodies signs of pneumonia Dullness replaces resonance, crackles can arise from abnormalities of the lung parenchyma, pleural rubs, localized bronchophony and egophony (in patients with fever and cough the presence of bronchial breath sounds and egophony more than triples the likelihood of pneumonia. Pleuritic pain: sharp, knifelike, aggravated by deep inspiration, coughing, movements of the trunk. Often persistent and severe. When performing a breast exam, identify what abnormal masses should do when the arm moves Fibroadenoma: very mobile Cysts: mobile Cancer: may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted over head or hands are pressed against hips) hepatitis A Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water and foods leading to infection of household and sexual contacts Stress incontinence: the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise the bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery, postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men. Overflow incontinence detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention. The bladder is typically flaccid and large, even after an effort to void. Mechanisms: obstruction of the bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc diabetic neuropathy. Functional incontinence: the patient is functionally able to reach the toilet in time because of impaired health or environmental conditions Mechanism: problems in mobility resulting from weakness, arthritis, poor vision, or other conditions. Also environmental factors such as an unfamiliar setting, distant bathroom facilities, bedrails, or physical retraints. Where do you palpate the lymph nodes when assessing for strep? Strep throat streptococcal pharyngitis, bacterial infection that may cause a sore, scratchy throat Common childhood infection has a classic presentation of erythema of the posterior pharynx and palatal petechiae Enlarged swollen cervical lymph nodes superficial cervical lymph nodes Superficial cervical- superficial to the sternocleidomastoid causes of increased jugular venous pressure Elevated JVP is highly correlated with both acute and chronic heart failure. It is also seen in tricuspid stenosis, chronic pulmonary hypertension, SVC obstruction, cardia tamponade, and constrictive pericarditis what to do if you feel an abdominal mass Occasionally there are masses in the abdominal wall rather than inside the abdominal cavity. Ask the patient either raise the head and shoulders or to strain down, thus tightening the abdominal muscles. Feel for the mass again. what should be listed under adult illnesses in health history Medical Surgical OBGYN Psychiatric what is listed under present illness Problems prompting the patients visit, including onset the problem, the setting it developed, its manifestations, and any treatments to date how to prioritize patient complaints List most active & serious problems first and their date of onset. Problems can be symptoms, signs, past health events such as a hospital admission or surgery or diagnoses what is included in constitutional symptoms Fatigue, weakness, fever/chills, night sweats, weight changes or pain -BMI interpretation The BMI incorporates estimated but more accurate measures of body fat than weight alone how retinal detachment presents Sudden, painless, unilateral vision loss cranial nerve you're assessing when checking lateral gaze Cranial nerve VI (6) Abducens what conditions do not have red reflexes Cataracts, detached retina, the vitreous, artificial eye or retinoblastoma in children optic neuritis presents Sudden vision loss, unilateral, painful; associated with multiple sclerosis Weber Test Tuning fork at vertex Sound lateralizes to impaired ear - room noise not well heard, so detection of vibrations improves. Rinne Test Tuning fork at external auditory meatus; then on mastoid bone While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea. Chalazion A sub acute nontender usually painless nodule caused by a blocked meibomian gland. Usually points inside the lid rather than on the lid margin. what a retracted tympanic membrane with effusion looks like (p.288) what an ulcer due to venous insufficiency looks like (p.525 538) why venous insufficiency causes edema, swelling and ulceration Chronic obstruction and incompetent valves in the deep venous system. deep Buerger test is for chronic arterial insufficiency patient's LE Buerger color changes with first raising the LE while supine, then having patient sit up. Normal= return of pinkness in<10 sec, filling of veins in <15 sec