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235 Cards in this Set
- Front
- Back
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Peripheral arterial disease |
Found in approximately 30% of Adult pop
Stenotic, occlusive aneurysmal disease of the aorta, its visceral arterial branches, and the arteries of the lower extremities, but not coronary arteries |
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Venous thrombosis (Thrombophlebitis) |
presence of a thrombus or clot in a vein that is accompanied by an inflammatory response in the vein wall.
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Embolus
pulmonary emboloism |
dislodgment of the thrombus produces _____ that can travel to the lungs, causing _____ and possible death |
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superficial thombi
Deep Vein thrombosis (DVT) |
thrombi that are usually a response to vessel injury and rarely cause injury
grave danger to pt. 2 million cases per year in US |
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Chronic venous insufficiency (may lead to varicose veins and skin changes) |
incompetent vein valaves secondary to deep being thrombosis or prolonged increased venous pressure as seen in standing or pregnancy
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1) Intima
2) media
3) adventitia (externa): |
Layers of the arteries (3)
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Intima |
artery layer
single continuous lining of endothelial cells, synthesize regulators of clotting, modulate blood flow through synthesis of vasoconstrictors and vasodilators, regulate vein and inflammatory response |
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atheroma |
fatty thickening in the walls of arteries |
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complex atheromas |
thickened asymmetric plaques that narrow the lumen, reducing blood flow, and weaken the underlying media |
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media |
artery layer
composed of smooth muscle cells that dilate and constrict to accommodate blood flow |
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branches from aorta |
large: highly elastic arteries (iliac, carotid, pulm) medium: muscular arteries (coronary, renal) Small: less than 2 mm diameter arterioles: resistance to blood flow occurs here |
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brachial radial ulnar femoral popliteal dorsalis pedis posterior tibial |
Palpable arteries (7) |
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veins |
thin walled and highly distensble. capacity for up to two thirds of circulating blood |
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valve |
protrude into the lumen of veins promote unidirectional venous return to the heart |
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varicosities |
irregular dilatation of veins |
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great saphenous (anterior leg) small saphenous (posterior calf) |
two veins that are superficial with poor tissue support. |
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communicating veins |
connect the superficial venous system with the deep system |
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lymphatic system |
extensive vascular network that drains lymph fluid from body tissues and returns it to the venous circulation
places a large role in in body's immune system |
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lymph nodes |
round, oval (bean shaped) structures that engulf cellular debris and bacteria and produce antibodies |
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epitrochlear nodes |
lymphatics from the ulnar surface of the forearm and hand drain here _____, then onto the axillary nodes. (where the radial surface drains immediately) |
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superficial |
only ____ nodes are palpable |
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horizontal group: lies in a chain high in the anterior thigh below the inguinal ligament
vertical group: clusters near the upper part of the saphenous vein |
superficial inguinal nodes (2) |
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adventitia |
artery layer connective tissue containing nerve fiber |
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edema |
lymphatic dysfunction or disturbances in capillary bed fluid exchange common result in the presence of excess fluid in the interstitial spaces |
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1) increased capillary blood pressure (hydrostatic pressure) 2)increased capillary membrane permeability (capillary leak syndrome) 3)low plasma protein levels (creating low colloid osmotic pressure) 4)blockage or removal of lymphatic drainage 5)DVT 6) venous insufficiency |
6 Edema causing factors |
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hydrostatic pressure |
blood pressure, forcing fluid out of arteriolar end of capillary bed |
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colloid oncotic pressure of palm proteins |
pulls fluid back into blood stream toward the venous end of the capillary beds |
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1+ 2mm 2+ 4mm 3+ 6mm 4+ 8mm
depression lasts 5-30 seconds |
pitting edema depression measuring scale |
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edema, varicose veins, aching in the legs |
3 symptoms of venous stasis |
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raynaud disease |
small arteries spasm in response to cold and change color of fingers and toes (pallor) |
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estrogen use and pregnancy |
increase risk for blood clots |
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lymphedema of the arm and hand |
may follow axillary node dissection and radiation therapy |
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aneurysmal |
an artery that is widely dilated |
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3+ Bounding 2+ Brisk, expected (normal) 1+ diminished, weaker than expected 0 absent, unable to palpate |
4 gradings of pulses |
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aortic insufficiency
brachial artery |
bounding carotid, radial, and femoral pulses may illicit ____ , then you should palpate the ____ |
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not its size, consistency, and tenderness |
if a node is present, ___(3)___ |
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lying down, draped (genitalia), legs fully exposed |
to inspect the legs, the pt should be ___(3)___ |
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chronic venous insufficiency |
brownish discoloration or ulcers just above the malleolus suggest |
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arterial insufficiency from inadequate circulation |
coldness, especially when unilateral, suggests ___ |
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Venous distension |
occurs when the veins swell because there is a greater volume of blood moving through them than there should be |
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lymphedema and advanced venous insufficiency |
thickened brawny skin suggests |
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aneurysm |
pathological dilatation of the artery |
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pain and numbness or tingling cold pale and pulseless |
sudden arterial occlusion from embolism or thrombosis causes __(3)___. The limb distal to the occlusion becomes __(3)__ |
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lymphadenopathy |
enlargement of the nodes, with or without tenderness |
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varicose veins |
veins that are dilated and tortuous. Their walls may feel somewhat thickened. seen often in legs |
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allen test |
compressing ulnar and radial veins in hands while pt makes fist. release one at a time and look for skin flushing (3-5 seconds) or pallor (artery occlusion) |
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Ankle-brachial index (ABI) |
if pt has risk factors of peripheral artery disease, ___ should be performed. it is a noninvasive method to assess lower extremity arterial blood flow by comparing systolic blood pressure in ankle and arms |
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rubor |
dusky redness in skin |
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pulsus alterans |
the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of strong/ weak ventricular contractions
usually indicates L sided heart failure |
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sets the stage for development of DVT
venous stasis, hypercoagulability, vessel wall damage |
virchow triad |
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smoking cessation weight control exercise program hypertension control hyperlipidemia control diabetes management limiting alcohol intake foot care |
health promotion for arterial disease (8) |
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avoidance of prolonged sitting and standing " of constrictive clothing exercise program weight control foot care dehydration prevention |
health promo for venous disease (6) |
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right upper quadrant (RUQ) r lower quadrant (RLQ) Left U quadrant (LUQ) L L quadrant (LLQ) |
quadrants of the abdomen |
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ascending colon duodenum gallbladder right kidney liver pancreas (head) transverse colon ureter (right) |
RUQ (8) |
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descending colon left kidney pancreas (body and tail) spleen stomach transverse colon ureter (left) |
LUQ (7) |
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appendix ascending colon bladder cecum rectum ovary, uterus and fallopian tube prostate and spermatic cord small intestine ureter (right) |
RLQ (9) |
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bladder descending colon ovary, uterus, fallopian tube prostate and spermatic cord small intestine sigmoid colon ureter (left) |
LLQ (7) |
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visceral pain parietal pain referred pain |
3 types of abdominal pain |
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visceral pain |
occurs when hollow abdominal organs (intestine) contract unusually forcefully or are distended/ stretch.
pain of actual organ |
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parietal pain |
originates from inflammation in the parietal peritoneum
pain of a cavity |
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referred pain
pain in shoulder from ruptured spleen |
pain in different part of the body from the infected area
ie=____ |
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constipation |
most common GI complaint |
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dyspepsia |
chronic or recurrent discomfort or pain centered in the upper abdomen |
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discomfort |
a subjective negative feeling that is nonpainful
ie: bloating, nausea, fullness, heartburn |
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heartburn |
rising retrosternal burning pain or discomfort occurring weekly or more often |
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gastroesophageal reflux disease symptoms include heartburn, acid reflux, regurgitation more than once a week |
GERD |
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dysphagia |
difficulty swallowing |
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odynophagia |
pain in swallowing |
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appendicitis |
RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall rigidity on palpation may cause pt to double over |
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diverticulitis
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small, bulging sacs or pouches of the inner lining of the intestine that become inflamed or infected. Most often, these pouches are in the large intestine (colon).
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indegestion |
general term for distress associated with eating that can have many meanings |
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nausea |
feeling sick to my stomach |
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retching |
involuntary spasm of the stomach, diaphragm, and esophagus that culminates in vomiting |
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vomiting emesis |
forceful expulsion of gastric contend out of the mouth |
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hematemesis |
coffee grounds emesis or red blood |
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norexiaa |
loss or lack of appetite |
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flatus |
passing excessive gas |
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acute diarrhea
chronic diarrhea |
diarrhea that last 2 weeks or fewer
diarrhea that last 4 weeks or longer |
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tenesmus |
a constant urge to defacate accompanied by pain, cramping, and involuntary straining |
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present for atlas 12 weeks of prior 6 months with 2 or more symptoms fewer than 3 bowel movements/ week 25% or more defamation with either straining or incomplete evacuation lumpy or hard stools manual facilitation |
constipation prerequisites |
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obstipation |
severe constipation with no gas passing signifies intestinal obstruction |
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melena |
black tarry stools |
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hematochezia |
stools are red or maroon colored |
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jaundice |
yellowish discoloration of the skin and sclerae from increased levels of bilirubin (bile pigment) |
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acholic stools |
stools may become gray or light colored without bile |
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hepatitis a |
hepatitis from travel or meals in areas of of poor sanitation (food and water) |
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hepatitis b |
from sexual contact or sharing needles hepatitis |
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hep c |
hep from sharing needles |
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cognitive or neurosensory deficits |
involuntary voiding or lack of awareness suggests |
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bladder infection |
pain in the lower abdomen is typically dull and pressure like |
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urinary urgency |
an unusually intense and immediate desire to void. suggests bladder infection/ irritation |
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polyuria |
a significant increase in the 24 hour urine volume. exceeding 3 liters |
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nocturia |
urinary frequency at night. usually waking more than once |
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urinary incontinence |
an involuntary loss of urine that may become socially embarrassing or cause problems with hygiene |
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stress incontinence- increased pressure/ urethral sphincter weakened urge incontinence: unable to hold urine overflow incontinence : bladder cannot be emptied till bladder press>urethral press functional incontinence:impaired cognition/ physical |
4 kinds of urinary incontinence |
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hematuria |
blood in urine |
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gross hematuria
microscopic hematuria |
blood in urine visible to naked eye: ___
opposite is: ___ |
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flank pain |
pain on one side of body between abdomen and back |
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inspection, auscultation, percussion, and palpation |
order or abdomen exam |
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bruits |
vascular sounds resembling heart murmurs over the aorta and other arteries in the abdomen
may suggest vascular occlusive disease |
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5 to 34 clicks and gurgles per minute
borborygmi |
normal bowel sounds
prolonged gurgles of hyper peristalsis "stomach growling" |
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tympany
dullness |
predominates percussion of abdomen because of gas in GI tract
Scattered areas of ____ from fluid and feces |
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situs inversus (rare) |
organs are reversed |
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abdominal masses |
deep palpation of the abdomen is usually to find ____ |
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Inflammation (hep)
Congestion (Heart failure) |
tenderness over the liver suggests |
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splenomegaly (enlarged spleen) |
suspect___if a notch is palpated on the medial border, the edge extends beyond midline, percussion is dull
abnormal (hypertension, hiv, infarct) |
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abdominal aortic aneurysm (AAA) |
palpating pulsations in the upper abdomen suggests |
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traube space |
percussion for spleen occurs here - between lung resonance above and the costal margin |
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ascites |
the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)
due to cirrosis/ liver disease/ malnutrition |
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appendicitis |
pain begins near the umbilicus, then shifts to right lower quadrant where coughing increases it |
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rebound tenderness |
It refers to pain upon removal of pressure rather than application of pressure to the abdomen. |
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Murphy sign of acute cholecystitis |
a sharp increase in tenderness with a sudden stop in inspiratory effort |
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Cholecystitis |
is inflammation of the gallbladder, which occurs most commonly due to obstruction of the cystic duct with gallstones |
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ask pt to raise head and shoulders off table |
to better see the bulge of a hernia |
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vaccinations |
best way to protect adults from hep A and B |
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colorectal |
3rd most common cancer 90% of cases after age 50 |
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nipple at the center of areola |
tip of breast contains ____ |
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lobules (alveoli)
ducts |
milk is produced in ___ and travels down ___ to the nipple |
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small nipple and areola |
male nipple consists of |
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central nodes (in arm pit)
Subscapular, pectoral |
lymphatics from the breast drain toward the axilla and into
below them are ___, then ____ |
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lateral nodes |
along the upper humerus, nodes that drain most of the arm |
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OLDCART |
if patient confirms a lump/ mass in breast - |
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galactorrhea |
inappropriate discharge of milk containing fluid is abnormal 6 months after cessation of breastfeeding |
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nipple retraction |
nipple pulled inward. Not a prob if its been there since birth, but if it is new, it could indicated breast cancer |
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clinical breast examination (CBE) |
an important component of women's health care to detect breast cancers |
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breast cancer |
thickening and prominent pores of breasts |
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supine |
pt position for breast palpation |
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divide breast into clock |
to document location of breast mass |
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use 3 different levels of pressure, move in an up and down pattern |
breast examination technique |
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breast cancer |
most commonly diagnosed cancer among african american women |
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BRCA1 and BRCA2 |
inherited genetic mutations of breast cancer in about 5-10% of population |
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mammography |
the process of using low-energy X-rays to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer
very effective in reducing cancer mortality |
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behavior problems are suspicious indicators of mental health disorders |
when to perform a mental status exam |
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psychological |
problems related to mood or anxiety |
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somatoform symptom |
symptom that lacks an adequate medical or physical explanation (30% of symptoms) |
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irritable bowel syndrome fibromyalgia chronic fatigue TMJ disorder |
4 examples of functional syndromes (medically unexplained) |
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anhedonia |
little interest or pleasure in doing things |
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generalized anxiety disorder social phobia panic disorder ptsd acute stress disorder |
5 anxiety disorders |
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level of consciousness |
alertness or state of awareness of the environment |
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attention |
the ability to focus or concentrate over time on one task or activity |
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memory |
the process of registering and recording info |
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memory refers to intervals of years |
remote or long term memory |
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covers minutes, hours, days |
recent or short term memory |
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orientation |
awareness of personal identity, place, and time; requires both memory and attnetion |
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perceptions |
sensory awareness of objects in the environment and their interrelationships |
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thought processes |
the logic, coherence, and relevance of the pt's thought as it leads to selected goals |
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thought content |
what the pt thinks about, |
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insight |
awareness that symptoms or disturbed behavior are normal or abnormal |
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judgement |
process of comparing and evaluating alternatives when deciding on a course of action |
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affect |
an observable, usually episodic, feeling or tone expressed |
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mood |
a more sustained emotion that may color a person's view of the world |
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language |
a complex symbolic system for expressing, receiving, and comprehending words |
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higher cognitive functions |
assessed by vocal, amount of info, abstract thinking, calculations, and construction of objects that have 2 or 3 dimensions |
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appearance and behavior speech and language mood thoughts and perceptions cognitive processes |
5 aspects of mental status exam |
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lethargic |
patients are drowsy but open their eyes and look at you, respond to questions, then fall asleep |
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obtunded |
patients open their eyes and look at you, but respond slowly and are somewhat confused |
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stuporous |
patients are unaware of surrounding and are totally or almost totally immobile and unresponsive, even to painful stimuli |
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comatose |
patients are unconscious and do not respond to painful stimuli or voice and do not open their eyes |
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manic episode |
pt who is singing, dancing and has expansive movements may be experiencing a ___ |
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OCD |
excessive fastidiousness may be seen in |
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dysarthria |
defective articulation |
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aphasia |
a disorder of language |
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Person, place and time |
discovers a pt's orientation |
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Mini mental state examination (MMSE) |
brief test is useful for screen for cognitive dysfunction or dementia |
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intermittent claudication |
episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium sized arteries |
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superficial thrombophlebitis |
clot formation and acute inflammation in a superficial vein. |
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deep venous thrombosis (DVT) |
clot formation in a deep vein pain is none or tight, or bursting, usually in calf |
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chronic venous insufficiency (deep) |
chronic venous engorgement secondary to venous occlusion or incompetency of venous valves aching in legs may result in ulcer/ edema |
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burger disease (thromboangiitis obliterans) |
inflammatory and thrombotic occlusions of small arteries and veins in smokers may result in gangrene or ulceration |
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compartment syndrome |
pressure builds from trauma or bleeding into one of four major areas between knee and ankle. each area is enclosed by fascia can be chronic or acute
tight, bursting pain in calf |
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acute lymphangitis |
acute bacterial infections (usually streptococcal) spreading up the lymphatic channels from a portal of entry
may result in red streaks on skin/ tender lymph nodes |
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mimics acute cellulitis |
acute bacterial infection of the skin and subcut tissues |
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chronic arterial insufficiency |
intermittent claudication - pain at rest tissue ischemia decreased/absent pulse pale/rubor ulceration on toes/ points of trauma on feet may develop gangrene cool temp |
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chronic venous insufficiency |
ulceration sides of ankles/ aching leg pain hypertension in veins edema cyanotic/ brown pigmentation
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weak pulse |
decreased stroke volume (i.e.: heart failure) and increased peripheral resistance may lead to |
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pulsus alternans |
pulse alternates in amplitude from beat to beat |
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little hair, skin may be brown/ blue, poor/ slow healing |
poor perfusion may lead to __3__ |
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aspirin |
removes stickyness of blood, thinning blood and preventing clots |
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peptic ulcer |
ulcer in the duodenum or stomach may be helicobacter pylori |
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acute pancreatitis |
inflammation of pancreas. pt should lean forward to relieve |
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biliary colic |
sudden obstruction of the cystic duct or common bile duct by a gallstone (may radiate to scap) usually last few hours |
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cholecystitis |
inflammation of the gallbladder by obstruction of duct |
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irritable bowel syndrome |
change in frequency or form of bowl movement without structural or chemical |
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cancer |
____ may block the bowel lumen |
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ulcerative colitis |
inflammation of the mucosa and submucosa of the rectum and colon with ulceration stool may be bloody/ diarrhea
IBD |
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crohns disease |
is a form of inflammatory bowel disease (IBD). It usually affects the intestines diarhea |
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malabsorption syndrome |
defective absorption of fat, including fat soluble vitamins, with steatorrhea (excessive excretion of fat) |
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melena |
passage of black, tarry, stool results from blood loss in GI tract, or swallowing blood (infants) |
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beets |
can cause pink urine, and reddish stool |
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umbilical hernia |
protrusion of a defective umbilical ring (most common in infants) and in women during child birth |
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diastasis recti |
separation of the two rectus abdomens muscles, through which abdominal contents for a midline ridge |
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incisional hernia |
protrusion through an operative scar |
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epigastric hernia |
a small midline protrusion through a defect in the line alba occurs between xiphoid and umbilicus |
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lipoma |
common, benign, fatty tumors in submit tissue almost anywhere on body |
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pannus |
apron of fatty tissue that may extend below the inguinal ligaments |
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peritoneal inflammation |
tenderness is more secure with this than visceral tenderness |
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cirrohosis or malignancy (with tumors) |
liver is firm and hard |
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colostomy |
opening -- called a stoma -- that connects the colon to the surface of the abdomen. This provides a new path for waste material and gas to leave the body. |
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rectal vault |
large intestine empties in the ___ |
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dissecting aneurysm |
blood vessel is bulbous and has potential to burst |
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directly over kidney |
where is kidney pain |
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spleen, appendix, part of liver |
one can live without ___3___
in abdomen |
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hematuria |
blood in urine could be from UTI / kidney stone |
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check hematocrit |
when there is black, sticky stool, ____ |
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fibroadenoma |
benign tumor on breast |
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cysts |
masses in breast that regress after menopause |
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paget disease of nipple |
uncommon form of breast cancer that usually starts as a scaly, eczema like lesion |
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pt posture |
may elude to certain mental issues |
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rest pain |
ischemia at rest pain distally (fingers/toes) |
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claudication |
pain from lack of blood flow "limping" |
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gangrene |
death of tissue seen in CAI |
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neuropathy |
nerve damage may lead to ulcers, especially in diabetic patients may not be painful |
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arterial insufficiency ulcer: |
ulceration of toes/ feet/ areas of trauma severe pain, gangrene, nails thickened, loss of hair atrophic skin |
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striae |
stretch marks (high cortisol levels in cushing syndrome) |
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scaphoid |
abdomen is concave / hollowed |
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abdominal peristaltic waves |
abdominal obstruction will lead to |
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peritoneum inflammation |
ab pain/ tenderness/ rebound tenderness/ muscle spasms signifies |
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adenocarcinoma |
cancers of stomach and pancreas are |
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antiacids |
stomach cancer is not relieved by |
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lean forward |
to relieve pain in pancreatic cancer |
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arterial occlusions from embolism/ atheroma |
asymmetric diminished pulses signifies may be evaluated by allen test |
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epigastric pain |
referred pain in pleurisy and MI |
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periumbilical pain |
appendicitis starts as ____ before right lower quadrant pain (if this subsides, appendix may be perforated) |
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sigmoid colon |
acute diverticulitis most often involves the ___ |
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black
red |
blood in stool from SI (small intestine)/ stomach/ esophagus
blood in stool from LI |
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fluid |
Ascities - the lowest point of abdomen fills with ___
if pt lies on side, ^ will shift and sound will become tympanic on upward side |
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vertical strip |
best pattern/ technique for breast exam |
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mammary duct ectasia |
tender cords a benign but sometimes painful condition of dilated ducts with surrounding inflammation breasts |
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nonpuerperal galactorrhea |
milky discharge from breasts unrelated to prior pregnancy and lactation |
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papilloma |
spontaneous unilateral bloody discharge from one or two ducts warrants further evaluation for |
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>4
2.1-4 |
breast cancer risk:
2 or more 1st degree relatives with breast cancer
1 first degree relative with BC |
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3 years in women 20-40 annually in 40+
should be in conjunction with mammography |
CBE - how often and with what |
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not considered necessary but women interested should do it 5-7 days after onset of menses |
breast self examination (BSE) is |
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palpate the areola and breast tissue |
male breasts (palpation) |
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gynecomastia |
if the male breast is enlarged and it is not due to obesity, it is _____, which arises from hormone imbalances |
