Exam 3

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servinggod247
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271513
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Exam 3
Updated:
2014-04-24 13:39:36
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health assessment
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health assessment
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  1. What strategies are used to examine the breasts?
    • Inspection
    • Palpation
  2. Examination of the breasts usually include examining the ________ and ________
    • axillae
    • relevant lymph node chains
  3. The major focus of adult breast examinations in adults is identification of
    • breast masses
    • skin or vascular changes that could indicate malignancy
  4. 5 Ds relatd to nipples
    • Discharge
    • Depression or inversion
    • Discoloration
    • Dermatologic changes
    • Deviation: compare opposite side
  5. What would be an expected post-menopausal breast change?
    • Fine, granular texture of breast tissue
    • Flattened, elongated and suspended more loosely from the chest wall 
    • Nipples smaller and flatter
  6. Breast History of Present Illness
    • Breast discomfort:
    • Duration
    • Onset
    • Relation to menses
    • Character
    • Associated symptoms
    • Contributory factors
    • Medications

    • Breast mass or lump:
    • Duration
    • ONset
    • Symptoms
    • Changes in lump
    • Associated symptoms
    • Medications

    • Nipple discharge:
    • Character
    • Associated symptoms 
    • Associated factors
    • Medications

    • Breast enlargement in men:
    • History of hyperthyroidism, testicular tumor, Kleinfelter syndrome
    • Medications: 
    • Treatment for prostate cancer
    • Illicit and or recreational drugs.
  7. Breast Past Medical History
    • Previous breast disease
    • Genetic mutations
    • Previous cancers: ovarian, colorectal, endometrial
    • Surgeries
    • Changes in breast characteristics
    • Changes in breast that occur with menses
    • Risk factors for breast cancer
    • Mammogram
    • Menstrual history
    • Pregnancy
    • Lactation
    • Use of hormonal meds
    • Other meds
  8. Breast Family History
    • Breast cancer
    • Other cancers
    • Other breast disease in female and male relatives
  9. Breast Personal and Social history
    • Age
    • Breast support used in exercise
    • Caffine intake
    • self exams
    • Alcohol
    • Anabolic steroids or weed

  10. 1.     When completing history and physical exam for women’s health, what would be some history data or physical findings that would suggest risks for breast cancer?
    • Age: increases with age
    • Gender: female
    • Genetic risk: BRCA1 or BRCA2 mutation increases risk 35%-85%
    • Person history of breast cancer
    • Family history of breast cancer
    • Previous breast biopsies
    • Race: white women 
    • Previous breast radiation
    • Menstrual onset: before age 12 or menopause after age 55 
    • Breast density: dense or fatty
    • Childbirth: after 30
    • Hormone therapy
    • Alcohol 
    • Obesity and high-fat diets
    • Lack of physical activity
  11. What would be the procedure/s for completing a breast exam on a woman? 
    • Inspect size, symmetry, countour, skin color, texture, venous patterns, and lesions
    • Lift breasts with your fingertips
    • Inspect nipples- round or oval, everted
    • Inspect breasts with arms over head, hands pressed against hips with shoulders roled forward, seated and leaning forward from the waist

    • Palpation:
    • Chest wall sweep
    • Bimanual digital palpation (lay hand flat underneath and palpate with fingers across top)
    • Lymph node palpation

    • Patient in supine position with pillow or towel under side inspected. Arm raised above head.
    • Palpate either Vertical strip, circular, wedge
  12. What would be the procedure/s for completing a breast exam on a man?
    • Inspect size, symmetry, countour, skin color, texture, venous patterns, and lesions
    • Inspect nipples- round or oval, everted

    • Palpation: Can be brief 
    • Chest wall sweepBimanual digital palpation (lay hand flat underneath and palpate with fingers across top)Lymph node palpation
  13. Male chest should be symmetrical but may be convex
    symmetrical and generally even with the chest wall but may be convex

  14. 1.     What positioning is best when completing a breast exam on a woman? On a man?
    • Woman- Inspect breasts with arms over head, hands pressed against hips with shoulders rolled forward, seated and leaning forward from the waist
    • Palpate while sitting and while laying supine with arm above head and towel under side 

    Man- sitting arms at side

  15. 1.     What would be some physical findings when completing a woman’s breast exam that might be different but not especially concerning?
    • inverted nipples- if lifetime history 
    • one breast larger than the other
    • Supernumerary nipples- common in black women. Infrequently associated with congenital renal or cardiac anomalies
    • Lobular feel of glandular tissue 
    • Fine, granular feel of breast tissue in older women
    • Firm transverse ridge of compressed tissue along lower edge of breast

    Typical for breasts to swell, increase in nodularity, and tenderness during menses
  16. What are you examining when doing a prostate exam
    you are palpating the posterior surface of the prostate gland
  17. rectum filling causes
    reflexive stimulation that relaxes the internal sphincter
  18. Prostatic sulcus
    • felt during a prostate exam between the two lateral lobes
  19. Equipment needed to exam prostate, anus, rectum
    gloves, lube, drapes, penlight, fecal occult blood testing material
  20. How to do a rectal exam
    rotate the index finger to palpate the anterior rectal wall as above. Ask the patient to bare down so that you can reach further into the rectum
  21. Types of hemorrhoids
    External: Varicose veins that originate below the anorectal line and are covered by anal skin

    Internal: Varicose veins that originate above the anorectal junction and are covered by rectal mucosa
  22. Texture of prostate
    The gland should feel like a pencil eraser- firm, smooth, and slightly moveable
  23. Best position for a rectal exam
    • standing with the hips flexed and the upper body supported by the examining table
    • OR
    • left lateral with hips and knees flexed
  24. Size of a healthy prostate felt in the rectal wall
    has a diameter of about 4cm, with less than 1cm protrusion into the rectum
  25. Glands of the vagina
    • skene
    • bartholin
  26. Skene glands
    glands that are beside the meatus and urethra, insert one finger as far as the second joint of finger into vagina and press forward with your palm facing up, milk glands and there shoulod be no discharge or tenderness
  27. Bartholin glands
    located at the posterolateral portion of the labia majora, palpate the lateral tissue around the entrance of the vagina
  28. How would the cervix appear in a nonpregnant woman
    firm like the tip of the nose

    pregnant= softer
  29. cervix should move ________ in each direction with minimal or no discomfort
    1-2 cm
  30. the anterior posterior position of the cervix correlates with the
    position of the uterus
  31. a cervix that is pointing anteriorly indicates a
    retroverted uterus
  32. a cervix that is pointing posteriorly indicates an
    anteverted uterus
  33. Cervix should be located __________
    midline
  34. the cervix may protrude ______ into the vagina
    1-3 cm
  35. The cervix of a woman of childbearing age has a diameter of
    2-3 cm
  36. Surface of cervix should be
    smooth, shiny, pink
  37. Discharge should be
    • odorless
    • creamy or clear
    • think, thin or stringy
    • heavier during midcycle or immediately before period
  38. Size and shape of of cervix
    small, round or oval
  39. A woman who has not has children has a __________________ cervical os, after a woman has a child it ____________
    small, round


    smiles at you
  40. Lithotomy position
    • butt hanging of end of table but with upper part of her crack still on the table
    • depress the drape down between knees so you can see the patient if she is having discomfort
    • never spread her legs for her when beginning exam- as her to do it
  41. when should a woman begin getting pelvic exams
    when she becomes sexually active
  42. Best thing to lubricate speculum with
    water or water-soluble lubricant. Most clinicians use water because you can warm the speculum with warm, not hot, water. Don’t use gel because could interfere with vaginal specimen.
  43. Proper technique for use of speculum
    insert finger just inside the vagina and apply pressure downward, ask patient to relax, use fingers of that hand to separate the labia minora so that the vaginal opening becomes clearly visible, then slowly insert the speculum along the path of least resistance often slightly downwards, don’t touch clitoris or catch pubic hair or pinch labia skin, insert the speculum the length of the vaginal canal and gently open the speculum by pressing the thumb piece, slowly sweep speculum upwards until cervix comes to view, adjust light source, once cervix is visualized between the anterior and posterior blades, lock the speculum blades to stabilize blades.
  44. Why do recto-vaginal exam
    it allows you to reach almost 1 inch higher into the pelvis, which enables you to better evaluate the pelvic organs and structures. Only do rectovaginal examination if uterus is flipped backwards.
  45. How to check muscle tone during pelvic exam
    ask the patient to squeeze the vaginal opening around your finger, then ask patient to bear down as you watch for urinary incontinence and uterine prolapse which is marked by protrusion of cervix or uterus into the vagina upon straining. Anal Sphincter – place index finger into vagina and press middle finger against the anus and ask the patient to bear down, as she bears down slip index finger into the rectum just past the sphincter, ask woman to tighten and relax her sphincter and observe sphincter tone.
  46. uterus positions
    – Page 565 Figure 18-27, Chris also said to memorize Figure 18-1 on page 537
  47. 8.    How would you document when finding a breast mass?
    • *transillumination can be used to confirm the presence of fluid in certain masses
    • Location: clock positions and distance from the nipple
    • Size: in centimeters: length, width, and thickness
    • Shape: round, discoid, lobular, stellate, regular, or irregular
    • Consistency: firm, soft, hard
    • Tenderness
    • Mobility: movable (in what directions) or fixed to overlying skin or sub adjacent fascia
    • Borders: discrete or poorly defined
    • Retraction: presence or absence of dimpling; altered contour
    • All new solitary or dominant masses must be investigated with further diagnostic testing
  48. indicators of carcinoma in breast
    sentinel nodes
  49. 10.    Which patient position would be the position of choice when beginning the history and physical exam.
    sitting comfortably
  50. How does the health care provider respond to the client who is not being compliant?
    • Always ask that instructions be repeated so that you can be sure of clarity and understanding
    • Know your biases and constrain them
    • Find out why family members are concerned
  51. When a client presents with the chief complaint, what is the process of documenting that chief complaint?
    • May be stated verbatim in quotes
    • Always include duration of the problem
  52. Be familiar with what information is included in the history and what information is included in the physical exam.
    • History of Present Illness- onset, location, duration, character, associated factors
    • Past Medical History-injuries or surgeries
    • Family History- heart disease, genetic disorders
    • Personal and Social History- smoking, alcohol

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