Assessment Exam 3 Review

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Assessment Exam 3 Review
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  1. Where would you find each type of lymph node?
    • Head and Neck(10):
    • Occipital - posterior base of the skull
    • Postauricular - behing auricle or in front of mastoid process
    • Preauricular - in front of targus of ear
    • Submandibular - along medial border of mandible, halfway between the angle of the jaw and the chin
    • Submental- behind the tip of the mandible in the midnline, under the chin
    • Tonsillar - aling the mandible, anterior to the sternocleidomastoid muscle
    • Superficial anterior cervical - superficial to the sternomastoid muscle
    • Posterior cervical - aling anterior aspect of the trapezius muscle
    • Deep cervical -Under the sternocleidomastoid muscle
    • Supraclavicular - above the clavicle, in the angle between the clavicle and the sternocleidomastoid muscle

    • Auxillary -
    • - - Central nodes - midaxillary
    • - - Posterior nodes - posterior axillary line along the latissimus dorsi muscle
    • - - Anterior nodes - anterior axullary line anlong greater pectoral muscle

    • Epitrochlear nodes - approx 3 cm above the elbow on the inner part of the arm - drain lover arm & hand

    • Superficial inguinal nodes -two groups
    • - - horizontal chain (superior) - anterior thigh just under inguinal ligament
    • - - vertical chain (inferior) - close to the great saphenous vein
  2. What are normal findings of lymph nodes?
    • circular or oval
    • not palpable or they may feel like very small beads no larger than 1 cm in diameter

    Abnormal: enlraged, tender to touch

    • Size & shape(< 1 cm & pea shaped)
    • Delimitation (discrete boundaries v. confluent/merge)
    • Mobility (mobile in infection v. fixed in CA)
    • Consistency (soft v. CA is hard & firm esp. unilateral)
    • Tenderness (tender with infection v. nontender/painless with CA)
  3. Normal findings when inspecting head and neck
    • Inspect, palpate skull (firm & nontender) - Normocephalic- appropriately proportioned Microcephalic - small head
    • Macrocephalic - large head

    • Inspect facial features, symmetry, & appropriateness of facial expression - Facial features calm plus alert & oriented
    • Cranial nerve VII (facial - both) -tongue (salt, sugar, lemon) raise eyebrows, purse lips, stick out tongue, close eyes tightly, show teeth, puff cheeks
    • Facial drooping - CVA or Bell’s palsy

    Inspect, palpate, & auscultate temporal arteries - temporal artery is elastic and not tender

    • Inspect, palpate bony structures of face
    • Tenderness = Sinus infection
    • Acromegaly -enlarged bony structure due to increased growth hormonesPalpate temporomandibular joint for movement or tenderness/pain
    • - no swelling, tenderness, or crepitation with movement - mouth opens fully (3 to 6 cm) & moves laterally 1-2 cm each direction

    • Inspect neck for positioning and range of motion (midline trachea, sternocleidomastoid & trapezius)
    • Torticollis = “wry” neck due to muscle spasm/ contraction
    • ROM: flex, extend, lateral & rotate

    • Palpate neck/trachea:
    • midline position not deviated; check neck against resistance - Neck resistance 0-5+ (musculoskeletal) & shrug shoulders against resistance (CN XI, spinal accessory- motor)

    Inspect anterior neck for thyroid enlargement below cricoid cartilage -thyroid usually not visible unless goiter, hyperthyroid, or tumor (tell pt. to raise chin & swallow to see slight thickening/fullness in neck)

    • Palpate thyroid gland - Thyroid below cricoid cartilage (have pt shallow)
    • Posterior approach -with pt’s head slightly to right & chin to chest then push trachea to right with left fingers & feel thyroid with right fingers
    • Anterior approach -with head flexed forward to right use thumb to stabilize trachea & feel with fingers

    Thyroid = size of thumb pad, right lobe larger than left; May not be felt - If felt, should be smooth, firm & nontender (nodules = malignant)

    Ausculate thyroid only if enlarged (bruit/bell)

    • Inspect/palpate regional lymph nodes - normally lymph nodes soft, mobile & nontender < 1 cm if palpable
    • Enlarged, tender, and firm but movable suggests infection
    • Unilateral, hard, asymmetric, fixed, nontender suggests
    • malignancy

    • Lymphadenopathy > 1 cm enlarged
    • Regional lymphadenopathy -2 lymph groups enlarged
    • Generalized lymphadenopathy - 3 or more enlarged lymph nodes x 3 or more months (ex. HIV/AIDS if enlarged longer than 3 months)

    • Preauricular = in front ear high
    • Postauricular = behind ear high
    • Occipital = base skull / back neck
    • Parotid = anterior ear lobe
    • Tonsillar = below ear/jaw level behind
    • Submandibular = under jaw
    • Sublingual=between jaw & chin
    • Submental = under chin
    • Cervical = along sternocleidomastoid (anterior & posterior cervical chains in neck)
    • Supraclavicular = below clavicle (bad if enlarged as drains from abd. & thorax, esp. left side)

    • Check on lymph nodes:
    • Size & shape(< 1 cm & pea shaped)
    • Delimitation (discrete boundaries v. confluent/merge)
    • Mobility (mobile in infection v. fixed in CA)
    • Consistency (soft v. CA is hard & firm esp. unilateral)
    • Tenderness (tender with infection v. nontender/painless with CA)
  4. Age related changes to mouth, nose, and throat
    • Larger nose due to unabated cartilage formation
    • Coarser nasal hair with less filtering= more colds
    • Decrease smell due to less sensory cells in nose
    • Decrease taste buds/perception
    • Dysphagia= Problems swallowing
    • Teeth darken/stain with enamel
    • Decrease gingival tissue as less elastic so more bleeding gums
    • Xerostomia (dry mouth)
    • Varicose veins on ventral surface of tongue
  5. Age Variations: Elderly Eyes
    Graying of eyebrows & lashes with coarser hair

    • Decrease elasticity of eyelis muscles with crow's feet & pseudoptosis (droopy eyelid)
    • *Ectropion - lower lid droops away from globe
    • *Entropion - innter lid turns inward (infections)

    Decrease corneal sensitivity/ reflex

    Decrease tearing so dry eyes

    Presbyopia - loss of lens elasticity- loss of near vision

    Decrease color perception esp. blue, violet & green

    Decrease depth perception leading to falls

    Decrease pupil size & ability to dilate in dark
  6. Elderly Considerations: Hearing
    Auricle cartilage enlarges (elongated ear)

    Decrease sebaceous glands so drier cerumen (obstructs easier)

    Tympanic membrane thickens & more opaque causing hearing loss (50% > 85 years with hearing loss)

    Increase wiry hair in auditory canal

    Presbycusis = progressive sensory hearing loss due to aging esp. high pitched tomes & later low pitched tones

    Difficulty filtering background noise
  7. Vision Tests
    • 1. Snellen chart - 20 feets 20/30 means client can read at 30 feet what a person with normal vision can read at 20 feet
    • Near vision tested at 14 inches - recorded as 14/14

    • Myopia - impaired far vision
    • Presbyopia - imparied near vision

    • PERRLA= Pupils Equal, Round, React to Light, Accomodation
    • Inspect eyes for size and shape
    • React to Light - darken room, ask client to focus on distant object, shine light into eye & pupillary reaction

    • Accomodation - Hold object at 12 inches, instruct client to focus on object, as you move closer to face pupils should constirict & eyes converge to focus on hear object
    • pupils constrict when focusing on near object
    • pupils dilate when focus on distant object

    • Concensual light reflex -
    • 1. shine light on L eye & check L pupil reflex
    • 2. shine light on R eye & check L pupil reflex
    • Normal findings - eye constrict in direct light and consensualy

    Confrontation - tests periperal vision - cover one eye & hold up random number of fingers is 4 periperal quadrants CONTROLLED BY CN 2 - OPTIC

    • Extraocular muscles - movement through 6 cardinal fields
    • Controlled by CN III - oculomotor (motor),
    • IV- trochlear (motor), VI- abducens (motor)

    Hirschberg's Test - assess for location of light reflection by shining a penlight on pupils - light should fall symetrically on both pupils - if light falls off center in one eye then misalignment
  8. Rosenbaum and Jaeger Tests
    reading cards used to measure near (reading) distance
  9. How would you know if one eye muscles were weaker than the other?
    Extraocular muscle test - 6 cardinal fields - have client follow hand/ object with eyes - movements should be coordinated, move in unison, with parpllel allignment
  10. What should the tympanic membranes look like?
    Rhinne Test
    Weber Test
    Whispered voice test
    Tympanic membrane should be pearly, grey, shiny, and translucent with no bulging or retratction. Slightly concave, smooth intact. A cone-shaped reflection of otoscope light is normally seen at 5 oclock in the R ear and 7 oclock in the L

    • Rhinne Test - compare air conduction with bone conduction - tuning fork on mastiod process
    • air conduction should be twice as long as bone conduction

    • Weber Test - tuning fork centered on head - ask client which ear he hears sound better in
    • -should hear equally in both ears
    • lateralization - hears better in one ear than the other
    • conductive hearing loss - client will hear better in poor ear becuase the ear cant sence conductive sound as well
    • sensorineural hearing loss - client will hear better in good ear - nerve damage to bad ear

    whispered voice test - block one ear & whipser about 12 inches away
  11. Bone conduction vs. air conduction - which is longer?
    Air conduction is twice as long as bone conduction
  12. Otoscope - what size of speculums to use?
    Otoscope is a flashlight-type viewier used to visualize the eardrum and external ear canal

    Use largest speculum that fits comfortable into the client's ear canal - usually about 5 mm for adults
  13. Muscle pain - description of?
    Muscle pain = crampy with weakness; occurs with walking but relieved by rest- due to peripheral vascular ischemia
  14. Vocabulary that deals with joints
    • Abduct = move away from midline (out)
    • Adduct = move toward midline (in)
    • Circumduction = circular
    • Inversion= inward
    • Eversion = outward

    • Extension = straighten extremity so increase joint angle
    • Flexion = bend extremity so decrease joint angle

    • Rotate = turn midline & back (head & shoulders)
    • Internal rotation - turn toward midline
    • External rotation - turn away from midline
  15. Different types of pain
    Bone pain = deep, dull, boring or intense & not related to movement unless bone fractured then sharp pain

    Muscle pain = crampy with weakness; occurs with walking but relieved by rest= due to peripheral vascular ischemia

    Joint pain = with edema, redness/erythema & inflammation

    Viral illness –myalgia/muscle aches & pain

    Low back pain = most common W.C. injury behind repetitive injuries; 1:5 or 60 –80 mil. with low back pain
  16. Goniometer - what is it used for?
    a device that measures the angle of the joint in degrees

    it is used to measure a limitation in the ROM
  17. Grading system for tonsils
    For a client who has both tonsils and a sore throat

    • 1+ tonsils are visable
    • 2+ tonsils are midway between tonsillar pillars and uvula
    • 3+ tonsils touch the uvula
    • 4+ tonsils touch each other (kissing)
  18. Grading scale for muscles
    • 5 - Normal - active mot against FULLresistance
    • 4 - Slight Weakness - Act mototion against SOME resis
    • 3 - Average Weakness - active motion against gravity
    • 2 - Poor ROM - Passive ROM
    • 1 - Severe Weakness - Slight flicker of contraction
    • 0- Paralysis - No muscular contraction
  19. Grading scale for reflexes
    • 4+ Hyperactive- very brisk - abnormal= disorder
    • 3+ More active than normal but does not indicate disorder
    • 2+ Normal, usual response
    • 1+ Decreased, less active than normal
    • 0 No response
  20. Age related changes to spine
    • –Decrease in bone mass
    • –Intervertebral disks lose water =loss of 1.5 to 3 inches of height
    • –Lordotic or convex curve of back flattens
    • –Flexion/extension of back decrease changing posture to more flexed (kyphosis -hunchback & scoliosis- curving of spine)
    • –Cartilage & ligaments calcify/ less elastic so harder to exercise
    • -Decrease muscle mass & strength
    • -Slower range of motion & unstable gait lead to falls
  21. Tests for cerebellar function
    • Use at least two:
    • Gait
    • Romberg test - - stand upright, hands at sides, then with eyes closed -watch for swaying or imbalance
    • Walk heel to toe
    • hop one one foot, then the other
    • hold one hand out and do several knee bends
    • walk on toes, then on heels

    • touch finger to nose - increase speed
    • thigh taps - rotating palms up & down - increase speed
    • touch each finger against thumb quickly

    supine-heel of one foot to knee of other & slide down
  22. How to assess cerebral function and LOC?
    Recent memory – what ate past 24 hrs. or weather today

    Remote memory – BD or past medical history

    • Memory of learned information – 3 unrelated words
    • then repeat after 5 min., 10 min. & 30 min.

    Abstract reasoning – proverb like rolling stone gathers no moss or how are orange & apple similar?

    • Judgment – driving & police car behind with lights &
    • siren on (what do you do?)

    Visual perception/construction – draw face of clock or copy simple figures

    • Concentration – ability to focus & stay attentive (ex – pick up pencil in L hand then place in R hand &
    • give to me)

    • LOC - 2 parts - Awareness and Arousal
    • Awareness - A & O x 3
    • Time - first to go
    • Place - second to go
    • Person - last to go

    • Arousal - determine Glasgow Coma Scale
    • - Assess for best response to eye opening, motor response, and verbal response
  23. Romberg Test
    graphesthesia
    stereogenosis
    • Romberg Test - stand with arm and sides and feet together
    • - then close eyes for 20 seconds - note any unsteadiness or swaying at either point

    Postive Romberg Test: swaying & moving feet apart to prevent fall

    • Graphesthesia is the ability to recognize writing on the skin purely by the sensation of touch
    • To test - use finger or blunt object to write a number 2, 3, or 5 on the palm os the client's hand - ask client to identify number

    • Stereognosis is the ability to perceive and recognize the form of an object by touch
    • test by having client close eyes - place a familiar object such as a key or a quarter in the palm of their hand and have them identify the object

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