Health Assessment

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Health Assessment
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2015-07-06 22:59:10
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Health assessment - midterm
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  1. Types of Data:
    What is subjective?
    What the patient says/tells you
  2. Types of Data:
    What is objective?
    What you OBSERVE (inspect, palpate, auscultate) on the patient
  3. Which of the following is an example of objective data?
    Alert and oriented
    Dizziness 
    An earache 
    A sore throat
    Alert & Oriented
  4. An example of objective data is:

    1) A complaint of left knee pain. 
    2) Crepitation in the left knee joint.
    3) Left knee has been swollen and hot for the past 3 days.
    4) A report of impaired mobility from left knee pain as evidenced by an inability to walk, swelling, and pain on passive range of motion.
    #2  Crepitation is assessed by palpation.
  5. A successful interview allows you to....
    (5 statements)
    • 1. Gather COMPLETE & ACCURATE DATA
    • 2. Establish trust
    • 3. Teach the person
    • 4. Build rapport (encourages continued healthcare)
    • 5. Discuss health promotion & prevention
  6. What are the internal factors that might interfere an interviewer to have successful communication?
    liking others, empathy, ability to listen (active), self awareness
  7. What are the external factors that might interfere an interviewer to have successful communication?
    • ensure privacy
    • refuse interruptions
    • physical environment *arrange equal status seating
    • professional dress
    • Note-taking / Electronic health record form
  8. Techniques of Communication
    what are the steps / process?
    • Introduce the interview- introduce yourself, & your role
    • Working phase- gather data.
    • Verbal responses- assisting the narrative
  9. What type of questions would you use during the working phase (data-gathering phase) of an interview?
    • Open-ended questions: general terms
    • Closed or direct questions: looks for specific information, Y/N responses
  10. What are the 10 traps of interviewing
    • 1. providing false assurance
    • 2. giving unwanted advice (if asked, what would YOU do? Redirect "what are your concerns regarding the surgery?")
    • 3. using authority 
    • 4. using avoid language (pass on instead of dead)
    • 5. distancing (use lump in "your" arm, instead of lump in "the" arm)
    • 6. Using professional jargon
    • 7. Using leading/biased questions
    • 8. Talking too much
    • 9. Interrupting
  11. From the client's perspective, what does Facilitation, General Leads, Minimal cues allow (in the interview)?
    encourages client to say more, shows you're interested
  12. From the client's perspective, what does silence allow (in the interview)?
    allows them time to think, gives interviewer chance to observe client & note non-verbal cues *don't figet*
  13. From the client's perspective, what does Reflection allow (in the interview)?
    echos client's words by repeating part of what person as said, can help express feelings behind words, Mirroring can help them elaborate on a problem
  14. From the client's perspective, what does Empathy allow (in the interview)?
    Names a feeling & allows expression.  Allows client to feel accepted & strengthens support
  15. From the client's perspective, what does Clarification allow (in the interview)?
    useful if client is ambiguous or confusing, summarizes pts words, ensures your understanding is accurate.
  16. As the interviewer, when would you use Explanation in an interview?
    when informing client, sharing objective & factual info.  "do not eat or drink for 12 hrs prior to exam"
  17. As the interviewer, when would you use Interpretation in an interview?
    to link events, make associations, OK to be wrong-this helps foster discussion

    "it seems when you have stomach pain like this, you also have stress in your life"
  18. As the interviewer, when would you use Confrontation in the interview?
    to clarifying inconsistent information that client has said.  Or focusing their attention to an observed behavior

    "you look sad"  Or "earlier you said you didn't drink, but just now you mentioned going out after work for beer"
  19. What is the purpose of the Summary portion of the interview?
    Condenses facts & validates what has been said.  Signals interview is almost over.  Allows opportunity for client to correct anything
  20. What is the process of analyzing health data and drawing conclusions?
    Diagnostic Reasoning
  21. What are the 6 steps to the nursing process?
    • ADOPIE
    • Assessment
    • Diagnosis
    • Outcome identification
    • Planning
    • Implementation
    • Evaluate
  22. What is assessment in the nursing process?
    Collecting data eg history, PE, functional assessment, evidence based practice,
  23. What is diagnosis in the nursing process?
    compare clinical findings with normal & abnormal, Interpret data, validate data
  24. What is outcome ID in the nursing process?
    Outcome Identification, identify expected outcomes, individualize to the person, culture, realistic & measurable
  25. What is planning in the nursing process?
    establish priorities, develop outcomes, set timelines, id interventions, integrate E-B trends & research
  26. What is implementation in the nursing process?
    implement in safe & timely manner, use EBP, collaborate w/colleagues.  use community resources, coordinate care delivery
  27. What is evaluation in the nursing process?
    progress toward outcomes, conduct systematic/ongoing criterion based evals, include pt & significant others, ongoing assessment, disseminate results
  28. 1st level priority probs
    • emergent, life threatening & immediate
    • eg airway, supporting breathing
  29. 2nd level priority probs
    • next in urgency- needs prompt intervention
    • eg Mental status change, acute pain, acute urinary probs, untreated med probs, abnormal lab values, risks of infection, or risk to safety/security
  30. 3rd level priority probs
    • important to health, but can address later
    • eg more long term, response to tx takes longer
  31. A patient admitted to the hospital with asthma has the following problems identified based on an admission health history and physical assessment. Which problem is a first-level priority? 
    1) Ineffective self–health management 
    2) Risk for infection 
    3) Impaired gas exchange
    4) Readiness for enhanced spiritual well-being
    3) Impaired gas exchange 

    • Remember the ABCs plus V
    • Airway
    • Breathing
    • Cardiac/Circulation
    • Vital sign concerns
  32. What is Evidence Based Practice?
    systematic approach to practice that emphasizes the use of evidence in combination with the clinicians experience, as well as pts preferences & values, to make decisions about care and treatment
  33. What is OLDCARTS
    • Onset
    • Location (any radiation?)
    • Duration
    • Characteristics
    • Aggravating factors
    • Relieving factors
    • Treatments tried
    • Scale / severity
  34. What are the 4 types of collection data?
    • Complete (total health) 
    • Focused or Problem-Centered 
    • Follow-up
    • Emergency
  35. What situations would Complete (total health) databases used for?  What's included in complete database?
    Primary care setting or on admission to hospital

    get a complete health history & full PE, gathers past and current health state & forms a baseline
  36. What situations would Focused/Episodic or Problem-centered database be used for?  What's included in Focused/Episodic database?
    Can be used in all situations- hospital/PCP/long-term.  Outpt clinic- pt has a rash

    For limited / short-term problem.  Collect mini databases.  Smaller in scope & more targeted.   Concerns mainly 1 problem
  37. What situations would Follow up database be used for?  What's included in Follow up?
    Can be used in all settings,  It's the status of any problems aht should be evaluated at regular intervals
  38. What situations would Emergency database be used for?  What's included in emergency collection?
    Substance OD, Trauma/Accidents

    Urgent, rapid- crucial information collected alongside lifesaving measures
  39. What is holistic health?
    Consideration of the whole person.  Views mind, body, body, spirit as interdependent & functioning as a whole within the environment.
  40. According to the holistic model, a narrow definition of holistic health includes:
    the absence of disease
  41. What type of database is most appropriate when rapid collection of data is required and often compiled concurrently with lifesaving measures?
    Emergency
  42. What is a nursing diagnosis?
    Clinical judgments about a person’s response to an actual or potential health state. 

    Nursing diagnoses-used to evaluate response of the whole person to actual or potential health problems. 

    The holistic model of health care is used in nursing, and culture is an important factor to consider in a nursing assessment.
  43. A nursing diagnosis is best described as:
    1) a determination of the etiology of disease. 
    2) a pattern of coping. 
    3) an individual’s perception of health. 
    4) a concise statement of actual or potential health concerns or level of wellness.
    4) a concise statement of actual or potential health concerns or level of wellness.
  44. Causes of disease can be viewed in 3 different ways: biomedical/scientific, naturalistic/holistic, or magiocoreligeous perspective

    What is biomedical/scientific belief?
    • Biomedical/Scientific theory assumes all events in life have a cause & effect
    • -that human body functions more or less mechanically
    • -that life can be reduced/divided into smaller parts
    • -all of reality can be measured/observed
    • -germ theory! bacteria/viruses cause specific disease
  45. Causes of disease can be viewed in 3 different ways: biomedical/scientific, naturalistic/holistic, or magiocoreligeous perspective

    What is naturalistic/holistic perspective?
    List the 2 theories that fall under this category
    • -human life is only one aspect of nature & part of the general order of cosmos 
    • -more common in American Indians, Asians
    • -believe forces of nature must be kept in balance or harmony

    • *yin-yang theory: health exists when all aspects of the person are in perfect balance. Yin=empty/darkness/cold/female
    • Yang=full/lightness/hot or warm/male
    • (cold foods are eaten with Fever, etc)  Embraced by asians/america asians

    *hot/cold theory: Hispanic/Arab/Black/Asian groups.  4 humors of the body regulates & are described in terms of temp,dryness,moisture
  46. Causes of disease can be viewed in 3 different ways: biomedical/scientific, naturalistic/holistic, or magiocoreligeous perspective

    What is magiocoreligious perspective?
    the world is an arena in which supernatural forces dominate.  Examples are voodoo, witchcraft, faith healing

    May be seen in blacks/caribbean areas, christian groups (roman catholic/mormons)
  47. Read the type of Folk healers:  Then name the demographic & associated religion/theory.
    Herbalists
    Root worker/Spiritualist
    Brauchers
    Medicine Man (shaman)
    Folk Healer
    Herbalists......................... Asian, yin & yang

    Root worker/Spiritualist...... African, natural

    • Braucher/Homeopathic....... England/Russia, physical & emotional well-being; feeling OK
    • *braucher is common among amish*

    Medicine Man................... Amer. Indian /Alaska, living in harmony with nature

    Folk/Espirtualista............. Spanish/Mexican, Hot & Cold humors
  48. What are the steps to cultural competency?
    Attitudes, Knowledge, & skills to provide quality care in diverse populations.  It is a Complex, evolving process.  It involves your own soul searching.

    Need to ID the meaning of "health" to the patient.  Understanding how health care system works
  49. What is another name for # of pregnancies?
    what does the following mean?
    Grav 3
    Term 2
    Preterm 1
    Ab 0
    Living 3
    gravidity

    • 3 grav= # of pregnancies
    • 2 term = 2 babies to full term
    • 1 preterm = 1 baby that's preterm
    • 0 Ab = 0 abortions
    • 3 living = 3 children living
  50. What is important for allergies when documenting in a patients chart?
    Always ask about reaction!! eg rash, itching, difficulty breathing
  51. What is medication reconciliation?
    a comparison list of current meds with a previous list.  Be sure to ask about OTC drugs. & beware of generic & name brand, don't want to have overdosing
  52. What is a pedigree or genogram?  What is especially important to specifically ask about?
    a graphic family tree that uses symbols to depict gender, relationship, and age of immediate blood relatives.

    Coronary heart disease, high blood pressure, stroke, diabetes, obesity, blood disorders, cancer, sickle-cell anemia, arthriti, allergies, addiction, mental illness, suicide, seizures, kidney disease, & TB.
  53. What is ROS
    review of systems.  Roughly goes from Head- to - Toe.  It's listed as presence or absence- don't use negative.  This section is limited to patient's statements or subjective data (DO NOT LIST Objective findings e.g. skin is warm & dry.
  54. Starting with general overall health state, list systems to review
    • General overall health- weight loss, fatigue, etc
    • Skin- pigment, change in mole, rash, lesions
    • Hair- any loss, nails
    • Head- freq./severe headache, injury, dizziness,
    • Eyes- vision, pain, diplopia, glaucoma
    • Ear- aches, infections, tinnitus
    • Nose & sinus-nosebleeds, allergies
    • Mouth/Throat- tonsils, dysphagia
    • Neck- pain, lumps, swelling
    • Breast- pain, lump, discharge, rash
    • Axilla- tenderness, lump
    • Resp.- lung disease, chest pain with breath, cough, sputum, tb skin test?
    • Cardio- chest pain, pressure, tightness ,cyanosis nocturia, edema, heart disease
    • Peripheral Vascular- coldness, numbness, swelling of legs, varicose veins
    • GI- appetite, dysphagia, heartburn, indigestion, constipation, diarrhea
    • Urinary System- frequency, urgency, nocturia, 
    • Genital systems - male & female
    • Sexual Health
    • Musculoskeletal- arthritis, gout, stiffness, 
    • Neurological- seizures, stroke, fainting, 
    • Hematologic- excessive bruising, lymph node swelling
    • Endocrine- diabetes, thyroid, excessive sweating
  55. What is a Functional Assessment?
    What are ADLs?
    measure of a person's self-care ability in areas of general physical health or absence of illness.

    Activities of Daily Living
  56. What are some examples of ADLs?
    • self-esteem/Self-concept
    • activity/exercise
    • sleep/rest
    • nutrition/elimination
    • interpersonal relationships
    • spiritual resources
    • coping/stress management
    • personal habits
    • alcohol- CAGE (Cut down your drinking? anyone Annoyed by your drinking, felt Guilty, drink in morning? = an Eye opener?)
    • illicit drugs
    • environment/hazards
    • intimate partner violence
    • occupational health
  57. What is a general survey?
    study of whole person- consider 4 parts of physical appearance, body structure, mobility, behavior
  58. What are the 6 characteristics to examine when looking at PHYSICAL APPEARANCE
    • Age- appears stated age?
    • Sex- sex dev., transgender
    • LOC- alert/awake?
    • Skin Color- even pigment., pallor, jaundice
    • Facial Features- symmetric, any drooping?
    • Overall Appearance- acute distress
  59. What are 7 characteristics to examine when looking at BODY STRUCTURE
    • Stature- height
    • Nutrition- cachectic, emancitated
    • Symmetry
    • Posture- stiff, tense
    • Position- person stis comfortable? tripod
    • Body Build/Contour- arm span (fingertip to fingertip equals height), body length from crown to pubis roughly equal to length from pubis to sol
    • Obvious physical deformities
  60. What are 2 characteristics to examine when looking at Mobility
    • gait- walk smooth & even
    • Range of Motion- jerky uncoordinated movement
  61. What are 5 characteristics to examine when looking at Behaviour
    • Facial expression- maintains eye contact, expression appropriate to situation
    • MOod & Affect- comfy & co-op 
    • Speech- articulation, clear & understandable?
    • Speech Pattern- even pace, word choice
    • Dress- appropriate for age & culture
  62. What are the types of measurement in a General Survey?
    Weight: unexplained weight loss can indicate short-term or long-term illness

    Height

    • BMI: Healthy=19 or greater & less than 25
    • *overweight/obesity affects more hispanics & blacks compared to white.  Asians have lower than other ethnic groups

    Waist Circumference- ≥35 in: Females, & ≥40 in: Males  INCREASES RISK  for type 2 diabetes, dyslipidemia, hypertension & CVD
  63. What can influence normal temperature?
    • diurnal cycle of 1 - 1.5, trough occurs early a.m
    • menstruation cycle- increase
    • exercise- increases
    • age- infant/young has wide normal variations due b/c of less effective heat control mechanisms.  Older adult is usually lower (mean 97.2)

    37 C = 98.6 F
  64. What is stroke volume?
    with every beat, heart pumps about 70 ml of blood into the aorta (in adults)
  65. What is bradycardia?  What is tachycardia? (name # range)
    • Bradycardia = <50
    • Tachycardia= >95 or greater than 100

    tachycardia occurs with fever & or maybe sepsis, pneumonia, myocardial infarction, pancreatitis
  66. How is pulse force described?  (amplitude)
    • 3+ full, bounding
    • 2+ normal
    • 1+ weak, thready
    • 0 absent
  67. What is systole and diastole?
    systolic- max pressure felt on artery, occurs during LEFT VENTRICULAR Contraction

    diastolic- min pressure felt on artery, it is the elastic recoil/resting pressure

    PULSE PRESSURE is the difference between systolic & diastolic pressures & reflects the stroke volume
  68. what is MAP?
    mean arterial pressure- the pressure forcing blood into the tissues averaged over cardiac cycle.  (this is not an avg of systolic/diastolic, b/c diastolic lasts longer).  It's value is closer to diastolic pressure, plus 1/3 of the pulse pressure.
  69. What are the 5 factors that influence BP
    • Cardiac output
    • Peripheral Vascular Resistance
    • Vol. of circulating blood
    • Viscosity
    • Elasticity of vessel walls
  70. PQRSTU is a mnemonic that helps the clinician to remember to address characteristics specific to.....
    Pain presentation. 

    • P = provocative or palliative
    • Q = quality or quantity
    • R = region or radiation
    • S = severity scale
    • T = timing
    • U = understand patient’s perception.
  71. A flat macular hemorrhage is called a
    purpura
  72. Newborn infants’ eccrine glands do not secrete sweat in response to heat until the first few months of life; newborn temperature regulation is ineffective. The evaporation of sweat reduces body temperature.There are two types of sweat glands: Eccrine glands and Apocrine glands. The apocrine glands produce a thick, milky secretion and open into the hair follicles; they are located mainly in the axillae, anogenital area, nipples, and navel.
    Newborn infants’ eccrine glands do not secrete sweat in response to heat until the first few months of life; newborn temperature regulation is ineffective. The evaporation of sweat reduces body temperature.

    There are two types of sweat glands: Eccrine glands and Apocrine glands. 

    The apocrine glands produce a thick, milky secretion and open into the hair follicles; they are located mainly in the axillae, anogenital area, nipples, and navel.
  73. Accumulating factors that place an aging person at risk for skin disease and breakdown include...?
    Thinning, decrease in vascularity and nutrients, loss of protective cushioning of the subcutaneous layer, a lifetime of environmental trauma to skin, social changes of aging, an increasingly sedentary lifestyle, and the chance of immobility. 

    Aging results in the loss of protective cushioning of the subcutaneous layer of the skin. Aging results in decreased vascularity of the skin. Aging results in thinning of the skin.
  74. What term refers to a linear skin lesion that runs along a nerve route?
    Zosteriform
  75. What is an annular lesion
    Annular describes a lesion that is circular and begins in the center and spreads to the periphery.
  76. What is a dermatome
    A dermatome is an area of skin that is mainly supplied by a single spinal nerve.
  77. What is mobility?  What is turgor?  (in the skin)
    • Mobility= ease of skin to rise
    • Turgor= ability of skin to return when released
  78. What are primary lesions?  And secondary lesions?
    • Primary= develops on previously unaltered skin
    • Secondary= lesion has changed over time, or changes because of scratching or infection
  79. What could cause clubbed nails?  What is early clubbing?
    • Lung disease, COPD
    • congenital cyanotic heart disease

    Early Clubbing= angle of nail base straightens out to 180 degrees & base is spongy to palpate
  80. What is the difference between a macule & papule?
    • Macule is flat & solely a color change eg freckle
    • Papule is elevated eg mole, wart
  81. What is the larger version of a macule?
    Larger version of papule?
    Large macules (>1cm) is PATCH eg vitiligo

    Large papules (>1cm) is PLAQUE eg psoriasis
  82. What is a nodule?

    What is a tumor?
    • Nodule= solid, elevated (hard or soft), >1cm
    • eg xanthoma, fibroma

    Tumor= Larger than a few centimeters (firm or soft)
  83. What is a wheal?  What can they turn into if coalesce?
    wheal= superficial, raised, transient & erythematous  eg. mosquito bite

    wheals merged together= Urticaria (hives)
  84. What is the difference between a vesicle & bulla?
    • vesicle= elevated cavity w. free fluid "blister"
    • eg herpes simplex, chickenpox

    Bulla= larger, >1cm.  single chamber of fluid, ruptures easily eg friction blister, burns
  85. What's the difference between a cyst & pustule?
    Cyst= encapsulated, fluid filled eg sebaceous cyst

    Pustule- tubid fluid, eg impetigo, acne
  86. Shapes & configuration of lesions:

    What's the diff between confluent & discrete?  what about annular?
    • confluent=runs together eg hives
    • discrete= distinct individual eg acne

    annular= circular (starts in center & spreads to periphery)  eg ringworm
  87. Shapes & configuration of lesions:
    What's linear, target, zosteriform, polycyclic?
    • Linear= stratch, streak, line, stripe
    • Target= iris, concentric rings of color
    • Zosteriform= linear mark along a unilateral Nerve Route
    • Polycyclic= annular (circles) grown together
  88. What are secondary lesions? (list specific types)
    • Crust=thick,dried out exudate e.g impetigo
    • Scale=compact flakes of skin,silvery/white e.g scarlet fever, psoriasis, eczema
    • Fissure=crack, dry or moist e.g cheilosis
    • Erosion= scooped out/shallow depression, heals w/o scar b/c doesn't extend to dermis
    • Ulcer=deep depression into dermis, leaves scar eg sore, chancre
    • Excoriation=self-inflicted eg scratch, bites
    • Scar=skin lesion repaired, tissue lost & replaced with collagen
    • Atrophic Scar=loss of tissue & thinning of epidermis
    • Lichenification=chronic intense scratching leads to thickened skin
    • Keloid=excess tissue in place of scar, higher incidence in blacks, hispanics, asians
  89. What are the steps in physical assessment of Head & Neck?
    • Head- palpate skull, inspect face
    • Neck- symmetry, ROM, lymph nodes (pre/post auricular, occipital, submental, submandilular, anterior, posterior, deep cervical, supra/sub clavicular, thyroid
  90. What direction will trachea go in aortic aneurysm, tumor, unilateral thyroid lobe enlargement, or pneumothorax?
    PUSHED TO UNAFFECTED SIDE (healthy side)
  91. What direction will trachea go in large atelectasis, pleural adhesions or fibrosis?
    PULLED TO AFFECTED SIDE (disease side)
  92. What are facial characteristics of Fetal Alcohol Syndrome?
    narrow palpebral fissures, epicanthal folds, midfacial hypoplasia
  93. What are facial characteristics of Down syndrome?
    upslanting eyes, inner epicanthal folds, flat nasal bridge, small broad flat nose, thick tongue, ear dysplasia
  94. What are aggravating symptoms of the following headaches?
    Tension
    Migraine
    Cluster
    Tension= stress, anxiety, depression, poor posture

    Migraine= menstruation, foods  eg EtOH, caffeine, Hunger, letdown after stress, sleep deprived, sensory stimuli, changes in weather, physical activity

    Cluster= exacerbated by alcohol, stress, daytime napping, wind or heat exposure
  95. Eye testing... snellen chart, the larger the denominator =
    the poorer the vision
  96. In peripheral testing, when the patient doesn't see the object, it suggests peripheral field loss.... in aging adults this could be....?
    glaucoma
  97. For EOM test, what if movement is not parallel?  What is nystagmus & what does it indicate?
    failure for eye to move together= weakened EO muscles or dysfunction of cranial nerve innearvating it (III & IV & VI)

    nystagmus=oscillating movt, best seen around iris.  it occurs with disease of semicircular canals in ears, paretic eye muscle, MS or brain lesions
  98. What would lid lag indicate?
    hyperthyroidism

    lid lag=delay in moving the eyelid as the eye moves downwards.
  99. With the pupillary light reflex, what is direct light reflex, & consensual light reflex?
    • direct= constriction of of pupil with light shined on it
    • consensual= the opposite eye also constricts

    when not constricting, consider CNS injury
  100. How to test for accommodation?
    • focus on distant object= pupil dilation
    • have pt. shift gaze to near object (3in) from nose.

    normal response= pupil constriction & convergence of the axes of the eyes

    If all normal, then PERRLA (pupils equal round react to light and accommodation)
  101. What is myopia??

    What is hyperopia??

    What is strabismus?
    myopia= nearsighted.  eye globe is long & light focuses in FRONT of retina  (close objects appear clearly, but far ones don't)

    hyperopia=farsighted.  eye globe is short & light focuses BEHIND retina (far is clear, close is fuzzy)

    strabismus= squint, crossed eye
  102. what is ectropion?
    entropion?

    Pingueculae?
    ectropion= lower lid drops away

    entropion= lower lid turns in

    Pingueculae= yellowish elevated nodules are caused by thickening of bulbar conjunctiva from prolonged exposure to sun, dust, wind
  103. What is the difference between conductive hearing loss & sensorineural?
    • conductive= mechanical error of external or middle ear (inner ear is OK, so it's a partial loss)
    • caused by: cerumen, foreign bodies, perf TM, pus/serum in middle ear

    • sensorineural= inner ear pathology, cranial nerve VIII, or auditory parts of cerebral cortex
    • caused by: prebycusis or ototoxic drugs that affect hair cells in cochlea

    MIXED LOSS IS LIL BIT OF BOTH
  104. What is OM
    otitis media (middle ear infection)= obstruction of the eustachian tube or passage of nasopharyngeal secretions into middle ear
  105. What is prebycusis?
    gradual onset over the yrs, mostly high-frequency loss, worse in noisy environments
  106. What is otorrhea?  

    What are the types of discharge associated with:
    External otitis
    Acute OM
    Cholesteatoma
    otorrhea= infected canal or perf eardrum

    • external otitis= purulent sanguineous or watery
    • acute OM w/perf= purulent (pus)
    • cholesteatoma= dirty yellow/gray, foul odor
  107. If the ear drum appears..... what does it indicate & suggests what dx?

    yellow-amber
    prominent landmarks
    air/fluid level or air bubbles
    absent light reflex
    bright red color
    blue/dark red color
    dark/round or oval areas
    white dense areas
    diminished landmarks
    black/white dots on drum
    yellow-amber=pus -> OME

    prominent landmarks=retracted drum           ->vacuum in middle ear-obstructed e. tube

    air bubbles =serous fluid-> OME

    absent light reflex=bulge eardrum-> acute OM

    bright red color= infect middle ear->acute OM

    blue/dark red color=blood behind eardrum->trauma skull fracture

    dark/round or oval areas=perf ->drum ruptur

    white dense areas=scarring->lotta infections

    diminished landmarks=thickend drum->chronic OM

    black/white dots on drum=colony of growth->fungal infection
  108. Weber test
    What is normal?

    What is abnormal? (for both conductive & sensorineural)
    normal=sound equally loud in both ears (does not lateralize)

    CONDUCTIVE abnormal=hearing loss, lateralizes to "poor" ear "poorer" ear is not distracted by background noise & thus has better chance to hear BC sound (bone conducted).  

    SENSORINEURAL abnormal=sound lateralizes to "better" ear
  109. Rinne Test
    What is normal?

    What is abnormal? (conductive & sesorineural)
    normal= AC>BC

    abnormal conductive=  AC=BC or bone is even longer AC<BC

    abnormal sensorineural= AC>BC intact but reduced overall.  person hears poorly both ways
  110. Enlarged tongue occurs with....
    mental retardation, hypothyroidism, acromegaly

    small tongue=malnutrition
  111. What color should the soft palate be?
    pink, smooth, upwardly movable

    hard palate appears yellow with jaudice
  112. What does "aaaahhhh" test (stick out tongue) test for?

    When sticking out tongue, what's normal & what does it test for?

    (also what does gag reflex test?  although this isn't typically done)
    normal = soft palate & uvula rise midline.  test of cranial nerve X (vagus nerve)

    normal=tongue protrudes midline .  test XII (hypoglossal nerve)

    gag reflex= tests IX (glossopharngeal) & X (vagus)
  113. Tonsils should appear .....?  How are they graded?
    • should appear pink w. NO exudate
    • 1+ =visible
    • 2+ =halfway btwn pillars & uvula
    • 3+ =touching uvula
    • 4+ =touching one another
  114. What are the 4 major functions of respiratory system?
    • First, it supplies oxygen to the body for energy
    • production.
    • • Second, it removes carbon dioxide as a waste product of energy reactions.
    • • Third, it maintains homeostasis (or acid-base balance)
    • in arterial blood.
    • • Fourth, it maintains heat exchange.
  115. What is the normal stimulus to breathe?
    increase CO2 in the blood, aka Hypercapnia

    (decrease in O in the blood, Hypoxemia, also increases respirations but is less effective)
  116. What is indicative when AP = Transverse diameter (lateral)?

    What is normal?
    COPD, from hyperinflation of the lungs.  Neck muscles/accessory muscles are hypertrophied.  Will also tend to sit in tripod position

    AP:Lateral, 1:2
  117. What is indicative for unequal chest expansion?
    • marked atelectasis
    • lobar pneumonia
    • pleural effusion
    • thoracic trauma (eg fractured ribs, pneumonthorax)
  118. What is indicative for Decreased Fremitus? (vibrations)
    • obstructed bronchus
    • pleural effusion/thickening
    • pneumothorax
    • emphysema

    decreased vibrations=obstruction, any barrier that comes btwn sound & yo hand
  119. What is indicative for Increased Fremitus? (vibrations)
    compression/consolidation of lung tissue (e.g. lobar pneumonia)
  120. Percuss Lung Fields
    normal & abnormal?
    normal- resonance (low-pitched clear hollow sound)

    abnormal:  Hyperresonance=lower pitched/booming eg in emphysemia

    Dull=signals abnormal density eg pnuemonia, pleural effusion, atelectasis, tumor
  121. what is adventitious sounds in the lungs?
    sounds NOT normally heard. if heard, describe them as inspiratory vs expiratory, loudness, pitch, & location

    • examples: crackles/rales=popping, inspiration
    • wheeze/rhonchi=continuous musical, expiration
  122. voice sounds should be.....
    muffled & indistinct
  123. What is characteristics of normal adult respiratory patterns
    • rate- 10-20
    • depth- 500-800mL
    • pattern- even

    Ratio of pulse to respiration if fairly constant, about 4:1
  124. What is tachypnea?
    Bradypnea?
    Hyperventilation?
    Hypoventilaion?

    Cheyne-stokes respiration
    Biot
    Chronic Obstructive
    Tachypnea= rate>24, normal response to fever, fear, or exercise

    Bradypnea= rate <10, seen in certain drugs (anesthesia), diabetic coma, increased intracranial press

    Hyperventilation= increase in rate AND depth. extreme fear, diabetic ketoacidosis, salicylate OD.  this pattern blows off CO2=alkalosis

    Hypoventilaion= irregular shallow pattern, eg drug OD

    Cheyne-stokes= gradual wax/wane in regular pattern. breath for 30-45secs with periods of apnea.  eg severe heart failure, renal failure, meningitis, drug OD

    Biot= similar to cheyne-stokes, but it's irregular  eg head trauma, heat stroke, brain abscess

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