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159 Cards in this Set
- Front
- Back
Fat cells act as _________ __________ for the body and ___________ shock and ___________ against mechanical injury by padding internal structures
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Heat insulators
Absorb Protect |
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Above the subcutaneous fat lies the dermis, a layer of connective tissue that contains _____ cells
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no
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What is the main component of dermal tissue?
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Collagen
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Collagen is a protein formed by dermal cells called _____________?
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Fibroblasts
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The elasticity of the skin depends on both the quantity and quality of the elastic fibers, which are scattered among the collagen fibers
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+
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The major component of the elastic fiber is ?
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Elastin
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__________ cells continuously divide to form new cells
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Basal
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The outermost layer of skin
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Stratum corneum
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What is a keratinocyte?
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A basal cell capable of cell division and located closest to the basement membrane
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A keratinocyte takes about 28 to 45 days to move from the basement membrane to the skin surface
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+
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Hair follicles are located in the ___ layer of the skin but are actually extensions of the epidermal layer
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Dermal
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Sebaceous glands continuously produce sebum
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A mildly bacteriostatic, fat-containing substance
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Eccrine sweat glands
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Originate from the epithelial cells
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Apocrine sweat glands
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Are in direct contact with the hair follicle
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Poor nutrition, especially protein deficiencies, vitamin deficiencies, and obesity, can predispose a client to skin lesions and delay wound healing
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+
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Skin disease is clinically described in terms of _________ and __________ lesions
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Primary, secondary
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Secondary lesions are changes in the appearance of the ?
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Primary lesion
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What does lichenified mean?
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Thickened
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What is ABCD r/t skin cancer?
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A = Asymmetry of shape
B = Border irregularity C = Color variation within one lesion D = diameter greater than 5 mm |
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In describing the location of lesions note whether they are ___________ or ____________
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Generalized, localized
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Annular
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Ringlike with raised borders around flat, clear centers of normal skin
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Circinate
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Circular
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Circumscribed
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Well defined with sharp borders
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Clustered
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Several lesions grouped together
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Coalesced
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Lesions that merge with one another and appear confluent
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Diffuse
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Widespread, involving most of the body with intervening areas of normal skin; generalized
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Linear
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Occurring in a straight line
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Serpiginous
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With wavy borders, resembling a snake
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Universal
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All areas of the body involved, with no areas of normal-appearing skin
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Vascular changes are classifies as normal or abnormal depending on the cause
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+
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Petechiae
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Small vascular lesions (<.5mm in diameter)
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Ecchymoses
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Bruises
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Turgor indicates
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The amount of skin elasticity
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Common alterations in nail color White
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Chronic hepatic or renal diseases (hypoalbuminemia)
Shock Anemia Early arteriosclerotic changes (toenails) Myocardial infarction |
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Common alterations in nail color Yellow-brown
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Jaundice
Peripheral lymphedema Bacterial or fungal infections of the nail Psoriasis Diabetes Cardiac failure Staining from tobacco, nail polish, or dyes Longterm tetracycline therapy Normal aging Normal finding in black people Nevus or melanoma of nail matrix in white people |
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Common alterations in nail color Red
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Bacterial endocarditis
Trichinosis Trauma to the nail bed Normal finding in some patients Cardiac insufficiency Polycythemia vera |
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Common alterations in nail color Blue
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Respiratory failure
Methemoglobinuria Venous stasis disease (toenails) |
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Common variations in nail shape
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Early clubbing
Hypoxia Lung cancer |
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Common variations in nail shape Late clubbing
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Prolonged hypoxia
Advanced lung cancer |
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Common variations in nail shape Spoon nails
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Iron deficiency
Poorly controlled diabetes > 15 years in duration Local injury Psoriasis |
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Common variations in nail shape Beaus grooves
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Acute severe illness
Prolonged febrile state Isolated periods of severe malnutrition |
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Common variations in nail shape Pitting
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Psoriasis
Alopecia areata |
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Dark-Skinned Clients
If impaired gas exchange is suspected, examine |
The lips, tongue, nail beds, conjunctivae, and palms and soles at regular intervals for subtle color changes
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Use the back of the hand to palpate for increased warmth
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+
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Dark-Skinned Clients
Areas of the body where inflammation has recently resolved appear |
Darker
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Dark-Skinned Clients
Jaundice assessed where... |
Oral mucosa, especially the hard palate for yellow discoloration
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The most basic skin biopsy techniques is known as
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The Punch Biopsy
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Dry skin is a flaking of which skin layer?
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Stratum corneum
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Dehydration of the stratum corneum is also known as
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Xerosis
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What is the cause of pruritus?
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Stimulation of itch-specific nerve fibers at the dermal-epidermal junction
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The anti-inflammatory properties of topical steroid preparations may be maximized if the ointment or cream is applied to
a) dry skin b) damp skin c) open skin d) cool skin |
b) damp skin
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What are the thee phases of wound healing?
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- inflammatory or lag
- fibroblastic or connective tissue repair phase - maturation or remodeling phase |
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For a full-thickness wound to heal the nonviable tissue must be removed to allow gradual filling in of the defect with granulation tissue
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+
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A pressure ulcer is any lesion caused by
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Unrelieved pressure
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Describe the pathophysiology of a pressure ulcer
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- Mechanical forces exerted to or on the skin lead to the formation of pressure ulcers
- These forces pressure, friction, and shear lead to direct and ischemic tissue damage - Injury occurs more often to skin over bony prominences - May occur anywhere - Excessive skin moisture increases the susceptibility of the skin to damage when mechanical forces are exerted |
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Excessive or prolonged pressure can compress blood vessels at the point of contact, leading to ischemia, inflammation, and tissue necrosis
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+
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Pressure occurs when the pt. is positioned on a hard, unyielding surface that does not diffuse the weight
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+
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Friction occurs when
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Surfaces rub the skin and irritate or directly pull off epithelial tissue
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Hydrophobic material
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Is beneficial when the wound is relatively free of drainage and the objective is to protect the ulcer from external contamination, such as urine or feces
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Hydrophilic (absorbent) material
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Draws excessive drainage away from ulcer surface
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Folliculitis
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Superficial infection involving only the upper portion of the follicle
Caused by Staph |
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Furuncles (boils)
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Caused by Staph
|
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Cellulitis
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Generalized nonfollicular infection with either Staph or Strep involving deeper connective tissue
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Herpes zoster (shingles) is caused by
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Reactivation of the latent chickenpox virus
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Herpes zoster is essentially a disease of ?
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Immunosuppression
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Antibacterial drugs for skin disorders (ointments)
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- Neomycin sulfate
- Gentamicin - Chloramphenicaol - Povidone iodine - Bactroban |
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Creams for skin disorders
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Silvadene
|
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Antifungal drugs (ointments and creams) for skin disorders
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- Clotrimazole
- Nystatin - Ciclopirox olamine - Miconazole nitrate - Econazole - Tolnaftate - Haloprogin - Undecylenic acid - Ketoconazole |
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Antifungal powders for skin disorders
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- Nystatin
- Tolnaftate |
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Antifungal oral drugs for skin disorders
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- Nystatin
- Clotrimazole |
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Scabies is a contagious skin disease caused by
|
Mite infestation
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Psoriasis is characterized by what colored scales
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Silvery white scales
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Common sites of psoriasis
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- scalp
- elbows - trunk - knees - sacrum - extensor surfaces of the limbs |
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What is a keloid?
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An overgrowth of a scar resulting from an excessive accumulation of collagen and ground substance after skin trauma
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What is a nevi?
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A mole; benign neoplasm of the pigment forming cells
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What is a wart?
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Small tumor, or verrucae, caused by papillomavirus infection of the skin
|
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What is a hemangioma?
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A blood vessel tumor one of the most common types of benign tumors
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What is actinic keratoses?
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Premalignant lesions involving the cells of the epidermis
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What are factors that increase risk of frostbite?
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- age
- immobility - alcohol use - vascular disease - psychiatric disorders |
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Define accommodation
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The process of maintaining a clear visual image when the gaze is sifted from a distant to a near object
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What does 20/50 mean?
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A person is able to see at 20 feet what a healthy eye sees at 50 feet
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What is the confrontation test used to evaluate?
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Used to examine a patients visual fields, or peripheral vision
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What is keratoconjunctivitis sicca also called and what is its cause?
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- Dry eye syndrome
- Results from changes in the composition of tears, lacrimal gland malfunction, or altered tear distribution |
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What is bacterial conjunctivitis?
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- Pink eye
|
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What are recognized causes of bacterial conjunctivitis?
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- Staph aureus
- Haemophilus influenzae - Pseudomonas aeruginosa |
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What is trachoma?
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A chronic, bilateral scarring form of conjunctivitis caused by Chlamydia trachomatis
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For a sharp image to be focused on the retina, the cornea must be _______ and __________
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- Transparent
- Intact |
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With aging, the lens gradually loses water and increases in density
|
+
|
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Define intraocular pressure
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The fluid (aqueous humor) pressure within the eye
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Primary open-angle glaucoma is the most common form of primary glaucoma and is usually bilateral and asymptomatic in the early stages
|
+
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Angle-closure glaucoma (also called closed-angle glaucoma, narrow-angle glaucoma, or acute glaucoma) has a sudden _____ and is treated as an _____
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- Sudden
- Emergency |
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How does HTN possibly lead to retinal damage and decreased vision?
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May cause blood vessel changes in the eyes
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What is the vascular complication of diabetes in the retina?
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Diabetic retinopathy
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In background diabetic retinopathy, the supporting cells of the retinal vessels die, and the capillary walls of the retina allow fluid to leak. As this fluid is absorbed, thick yellow-white deposits, or hard exudates, are formed. The retinal capillaries become diseased and lose their ability to transport needed oxygen and nutrients. Outpouches in the walls of capillaries (microaneurysms) are formed. These fragile capillaries bleed easily and cause intraretinal hemorrhages in the nerve fiber layer of the retina.
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+
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The ability of the eye to focus images on the retina depends on the _____ of the eye from front to back and the _____ power of the lens system
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- length
- refractive |
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Myopia is also known as ?
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Nearsightedness
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In myopia, the refractive ability of the is too _____ for the eye length
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Strong
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Astigmatism occurs when the _____ of the cornea is uneven
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Curve
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Cerumen
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Waxlike secretion of the external ear canal
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Conductive hearing loss
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Hearing loss resulting from a physical disruption in the transmission of sound waves
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Menieres diseases
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An intermittent but progressive deterioration of hearing and balance
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Otitis media
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Inflammation/infection of the middle ear
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Otosclerosiss
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Formation of spongy bone around structures of the middle and inner ear, leading to low-town hearing impairment
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Ototoxic
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Damaging to the structures important for hearing
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External otitis
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Painful condition caused when irritating or infective agents come into contact with the skin of the external ear
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External otitis is also known as
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Swimmers ear
|
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What happens during otitis media?
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An infecting agent introduced into the middle ear causes an inflammation within the mucosa, leading to selling and irritation of the ossicles within the middle ear
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The _____ tube and _____, connected to the middle ear by a continuation of cells, are also affected by otitis media
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- Eustachian
- Mastoid |
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What is a myringotomy?
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A surgical opening of the pars tensa of the tympanic membrane
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What is mastoiditis?
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A secondary disorder resulting from untreated or inadequately treated otitis media
|
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Tympanic membrane perforations usually heal within?
|
24 hours
|
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Define tinnitus
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Continuous ringing or noise perception in the ear
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Define dizziness
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A disturbed sense of a persons proper relationship to space
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Define vertigo
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A sense of whiling or turning in space
|
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What is a cholesteatoma?
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Benign overgrowth of squamous cell epithelium
|
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What are three distinct characteristics of menieres disease?
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- tinnitus
- unilateral sensorineural hearing loss - vertigo |
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When is a hearing loss termed sensorineural?
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If the inner-ear nerve, or sensory, fibers that lead to the cerebral cortex are damaged
|
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What might lead to conductive hearing loss?
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Any inflammatory process or obstruction of the external or mille dear by cerumen or foreign objects
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Spinal cord neurons do not regenerate
|
+
|
|
Cervical involvement usually results from a herniation
|
of the nucleus pulposus in an intervertebral disk
|
|
A herniation results in spinal nerve root compression with
|
Subsequent motor and sensory manifestations, typically in the neck and down the affected arm
|
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Herniated disks occur most often between the _____ and _____ lumbar vertebrae
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- Fourth
- Fifth |
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Smoking has been linked to _____ degeneration
|
Disk
|
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Clients with low back pain report
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- sharp, burning posterior thigh or calf pain that may radiate to the ankle or toes
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Define paresthesia
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Tingling sensation or numbness in the involved limb
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If the sciatic nerve is compressed, the client reports
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Severe pain when raising a straight leg
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Describe the Williams position
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Client lies in the semi-Fowlers position and flexes the knees to relax the muscles of the lower back and relieve pressure on the spinal nerve root
|
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Opioid analgesics are no more effective than nonsteroidal analgesics regarding back pain
|
+
|
|
What is a diskectomy?
|
The spinal nerve is lifted to remove the offending portion of the disk
|
|
What is a laminectomy?
|
The removal of one or more vertebral laminae plus osteophytes, if present, and the herniated nucleus pulposus
|
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Spinal shock occurs immediately after injury as a result of
|
Disruption in the communication pathways between upper motor neurons and lower motor neurons
|
|
Spinal (or neurogenic) shock is characterized by
|
- Flaccid paralysis
- Loss of reflex activity below the level of the lesion - Bradycardia - Paralytic ileus (occasionally) - Hypotension |
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Autonomic dysreflexia (aka hyperreflexia) is usually seen in injuries _____ the level of the _____ thoracic vertebra
|
- above
- sixth |
|
Autonomic dysreflexia results from uninhibited _____ discharge
|
Sympathetic; the SNS is no longer controlled by higher centers in the cerebral cortex because of the disruption in impulse transmission
|
|
Hyperflexion
|
Occurs when the head is suddenly and forcefully accelerated forward, causing extreme flexion of the neck
Example motor vehicle stopping and head continues forward |
|
Hyperextension
|
Occur most often in automobile accidents in which the pts. Vehicle is struck from behind or during falls when the clients chin is struck.
Example whiplash |
|
Axial loading (vertical compression)
|
Falls on the buttocks or a jump in which a person lands on the feet
Example falling on bottom from a ladder |
|
Excessive rotation
|
Example motor vehicle ejection
|
|
Penetrating injuries
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Classified by the velocity of the vehicle (knife or bullet) causing the injury
|
|
Brown-Sequard syndrome generally results from _____ injuries that cause _____ of the spinal cord or injuries that affect half of the spinal cord
|
- penetrating
- hemisection |
|
Define quadriplegia
|
Paralysis from the neck down involving all four extremities
|
|
Define paraplegia
|
Paralysis involving only the lower extremities
|
|
The number cause of death in SCI patients (replacing renal failure) is/are
|
- Pneumonia
- Pulmonary emboli |
|
During the period of spinal shock, peristalsis _____, leading to a loss of bowel sounds and gastric distension
|
Decreases
|
|
Autonomic dysfunction initially causes an areflexic bladder, which lead to
|
Urinary retention and neurogenic bladder
|
|
The first course of drug treatment for SCI is often
|
Methylprednisolone (Solu-Medrol)
|
|
What is a cause of orthostatic hypotension in SCI individuals?
|
Interrupted autonomic innervation results in the blood vessels being unable to constrict quickly enough to push blood up into the brain, causing dizziness or lightheadedness
|
|
The most important part of promoting self-care in SCI is
|
Setting realistic goals on the basis of the pts. potential functional level
|
|
What are ways to potentially stimulate voiding?
|
- Stroking the inner thigh
- Pulling on pubic hair and hair of the upper thigh - Pouring warm water over the perineum - Tapping the bladder area to stimulate the detrusor muscle |
|
List essentials of a bowel retraining program
|
- Consistent time for bowel elimination
- High fluid intake - High fiber diet - Rectal stimulation with or without suppositories - Stool softeners |
|
Intramedullary tumors account for _____% of spinal cord tumors and are usually _____
|
- 10
- malignant |
|
Extramedullary tumors account for _____% of spinal cord tumors
|
90
|
|
Name two risks of the immobilized SCI pt
|
- Pressure sores
- DVT |
|
How often ought the SCI pt. be turned in bed or adjusted in chair?
|
- at least every 2 hours
- every 30-60 minutes |
|
Six types of MS
|
- Benign
- Relapsing-remitting - Progressive-relapsing - Primary progressive - Secondary progressive - Malignant |
|
Motor assessment of individual with MS may indicate what findings?
|
- Increased or hyperactive deep tendon reflexes
- Clonus - Positive Babinskis reflex - Intention tremor - Dysmetria (inability to direct or limit movement) - Dysdiadochokinesia (inability to stop one motor impulse and substitute another) |
|
Sensory assessment of individual with MS may indicate what findings?
|
- Hypalgesia (diminished sensitivity to pain)
- Paresthesia - Facial pain - Decreased temperature perception |
|
What are the ABCs of drug therapy of MS?
|
- Avonex
- Betaseron - Copaxone |
|
What is BRM?
|
Biologic response modifiers
|