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55 Cards in this Set

  • Front
  • Back
appendicitis sx/s
rovsings sign-test rebound tenderness when RN releases pressure from abd RLQ pain, sharp, stabbing pain
Psoas sign
pt raises R leg apply pressure down while pt pushes leg elevated pain in RLQ
Murphys Sign
finger under liver boarder pt inhale deeply RUQ sharp pain causes pt to hold breath-insipitory arrest-acute cholecystitis-positive Murphys Sign
palpate bladder
ABNORMAL-distended dull percusion tones
normally bladder not palpable, only do if pt has health hx, dull percusion-start at symphysis pubis and move upward and outward to estimate bladder boarders
prostate and rectal exam
prostate-anterior surface of rectum feeling sulcus between 2 lateral lobes-Rectum-finger in far and turn-soft, smooth, nontender
Colorectal Cancer
S/S change in bowel habits, pencil stools>3-5 days, rectal bleeding, Abd cramping, decreased appitite, jaundice, weakness, fatigue-R/F-90%>50 yrs, IBD, Family hx, high fat/animal fat diet, alcohol, obesity. Reduce Risk-annual fecal test>50 yrs, colonoscopy q 10 yrs-hx colonoscopy q 5 yrs, raisins, grapesASA, NSAIDS< incidence
Prostate Cancer
2nd leading cause of death R/F-age, family hx, testosterone levels, multi sex partners, fats, race>Af. Am. whites, <asians/hispanics.
Reduce Risk-50 yrs annual prostate exam, increase fiber, omega 3's, decrease etoh 2/day max, green tea daily>antioxidants, soy/legumes for phyto estrogen effects
Normal Prostate
nontender, rubbery-2 lateral lobes divided by median sulcus-lobes smooth, 2.5 cm long, chestnut or heart shaped
Rotator Cuff Tear
painful and limited abduction accompanied by muscle weakness and atrophy while testing ROM
Functions of Bones
provide structure, give protection, serve as levers, store calcium, produce blood cells-206 bones-axial skeleton(head and trunk)-appendicular skeleton(extremities shoulders hips)
bone resorption increases, calcium absorption decreases, production of osteoblasts decreases. decrease bone density, more fx. pt's immobile, reduced intake of Ca and Vit D. 80% women, low estrogen levels smoking, steroid use
a disease occurring mainly in women that results from a lack of vitamin D or calcium, causing softening of the bones and resulting pain and weakness
a metabolic disorder mainly affecting men in which excess uric acid is produced and deposited in the joints, causing painful swelling, especially in the toes and feet
A diet high in Purine-liver, sardines-can trigger gouty arthritis
Cerebellum Fx
located behind brain stem and under cerebrum-has 2 hemispheres, does not initiate movement FX is coordination and smoothing of voluntary movements, equilibrium, and maint of muscle tone
Cerebellum assessment
condition and mvmt of muscles, strength and tone, note involuntary mvmt, Evaluate balance, gait, Romberg test, coordination-finger to nose, finger to thumb, palms up and down, heel to shin
Frontal Lobe FX
Directs voluntary, skeletal actions-left side of lobe controls right side of body-influences communication-talking, writing-emotions, intellect, reasoning ability, judgement, behavior, contains broca's area responsible for speech
Cranial nerve fx
Olfactory I
Sensory-smell impulses from nasal mucous membranes to brain
Cranial Nerve Fx
Optic II
Sensory-Visual impulses from eye to brain
Cranial Nerve fx
Oculomotor III
Motor-Contracts eye muscle to control eye movement, constricts pupils, elevates eyelid
Cranial Nerve Fx
Trochlear IV
Motor-contracts one eye muscle to control inferomedial eye movement
Cranial Nerve Fx
Trigeminal V
Sensory-Carries sensory impulses of pain, touch, and temp from face to brain, influence clenching and lateral jaw mvmt-biting and chewing
Cranial Nerve Fx
Abducens VI
Motor-Control lateral eye movement
Cranial Nerve Fx
Facial VII
Sensory fibers for taste Anterior 2/3rds of tongue and stimulates secretions from salivary glands and tears from lacrimal glands
Cranial Nerve Fx
Acoustic VIII
Sensory-Sensory fibers for hearing and balance
Cranial Nerve Fx
Glossopharyngeal IX
Sensory-Posterior 1/3rd of tongue and sensory fibers of the pharynx-Gag reflex
Cranial Nerve Fx
Vagus X
Sensory-sensations from throat, larynx, heart, lungs, bronchi, gi tract, abd viscera
Motor-swallowing, talking, production of digestive juices
Cranial Nerve Fx
Spinal Accessory XI
Motor-Innervates neck muscles-mvmt of shoulders and head rotation
Cranial Nerve Fx
Hypoglossal XII
Motor-innervates tongue muscle that promote mvmt of food and talking
Bells Palsy
dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell's palsy
Neuro Assessment of older adult
observe for tremors and involuntary mvmt-cerebellar
meningeal irritation
Brudzinski's sign-flex neck, watch hips and knees-pain and flexion of hips and knees=positive Brudzinskis, meningeal irritation. Kernig's sign-flex leg at hip and knee and then straighten knee-pain and increased resistance to extending knee=positive Kernigs sign, if Kernig's sign is bilateral=meningeal irritation
Older adulthood: risk doubles each decade after age 55
Male sex (slightly higher risk)
African American
History of stroke or transient ischemic attack (TIA)
Chronic alcohol intake (more than two drinks per day)
History of cardiovascular disease such as coronary artery disease, heart failure, rhythm abnormalities (especially atrial fibrillation), mitral valve prolapse
Sleep apnea
High serum levels of fibrinogen, beta-lipoproteins, cholesterol, hematocrit
Diabetes mellitus
Drug abuse (especially cocaine and methamphetamines)
High-dose oral contraceptives (especially with coexisting hypertension, smoking)
High estrogen levels
Postmenopausal woman
Sedentary lifestyle
Newly industrializing environment
Sickle cell anemia
Family history of stroke
Teach Risk Reduction Tips
Monitor blood pressure regularly; exercise regularly.
Stop smoking, especially if taking oral contraceptives. (Quitting smoking reduces risk to non-smoker level in 5 years.)
Limit intake of alcohol to less than three drinks per day.
Schedule regular health care checkups.
Adhere to a diet low in fat and cholesterol; follow cardiovascular disease risk factor modifications.
Have regular blood tests to measure cholesterol and hematocrit levels.
If diabetic, follow diabetes treatment plan.
Monitor blood sugar regularly, if diabetic.
Avoid use of drugs such as cocaine and methamphetamines.
Warning Signs of Stroke
Sudden numbness (face, arm, leg), especially if on only one side of body
Sudden confusion, trouble speaking or understanding speech
Sudden vision problems in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
Brain Stem Components
between cerebral cortex and spinal cord, consists mostly of nerve fibers. 3 parts-midbrain, pons, medulla oblongata.
Brain Stem Fx
Midbrain, Pons, Medulla Oblongata
midbrain-relay center for eye and ear reflexes, relays impulses between higher cerebral centers and lower pons, medulla, cerebellum, and spinal cord.
Pons-links cerebellum and midbrain to medulla-responsible for various reflex actions.
Medulla oblongata-contains nuclei for cranial nerves and has centers that control/regulate respiratory fx, HR, and BP
Spinal Nerve Sets
Spinal Nerves Comprising 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal nerves, the 31 pairs of spinal nerves are named after the vertebrae below each one's exit point along the spinal cord Each nerve is attached to the spinal cord by two nerve roots. The sensory (afferent) fiber enters through the dorsal (posterior) roots of the cord, whereas the motor (efferent) fiber exits through the ventral (anterior) roots of the cord. The sensory root of each spinal nerve innervates an area of the skin called a dermatome
documentation of objective/subjective data
Neurologic system
better to describe pt's response than to label the behavior
documentation of S/O data of musculoskeletal system
Sample Documentation of Subjective Data-
No history of past problems with joints or muscles. “Broke right arm as child, had cast for 6 weeks.” No problems with that arm since that time. Walks 1 mile four times a week; plays golf twice a week; likes being outside when not at work. Polio immunization as child; last tetanus immunization 3 years ago after cutting foot with garden tiller. Recalls grandmother as having rheumatoid arthritis. Does not smoke or drink alcohol. Drinks two caffeinated colas per day. Consumes food from all food groups; drinks milk daily. Client reports no recent weight gain or loss. Occupation requires long hours sitting working at a computer. Has good supportive chair. Has not had any back problems.
Sample Documentation of Objective Data-
Client is 5 feet, 6 inches, weighs 140 lbs. Gait smooth, with equal stride and good base of support. Full ROM of TMJ with no pain, tenderness, clicking, or crepitus. Sternoclavicular joint midline without swelling or redness. Normal curves of cervical, thoracic, and lumbar spine. Paravertebral area nontender. Full, smooth ROM of cervical and lumbar spine. Upper and lower extremities symmetric without lesions, nodules, deformities, tenderness, or swelling. Full, smooth ROM against gravity and resistance
TMJ Disorders
pt's with temporomandibular joint (TMJ) dysfunction may have difficulty chewing and may describe their jaws as “getting locked or stuck.” Jaw tenderness, pain, or a clicking sound may also be present with ROM.
Lymph Node Assessment
Hold the pt's elbow with one hand, and use the three fingerpads of your other hand to palpate firmly the axillary lymph nodes
No palpable nodes or one to two small (less than 1 cm), discrete, nontender, movable nodes in the central area.
Enlarged (greater than 1 cm) lymph nodes may indicate infection of the hand or arm. Large nodes that are hard and fixed to the skin may indicate an underlying malignancy.
breast exam
have pt lie down and to place overhead the arm on the same side as the breast being palpated. Place a small pillow or rolled towel under the breast being palpated.
Use the flat pads of three fingers to palpate the client's breasts Palpate the breasts using one of three different patterns-circular or clockwise, wedged, or verticle strip. Choose one that is most comfortable for you, but be consistent and thorough with the method chosen.
Be sure to palpate every square inch of the breast, from the nipple and areola to the periphery of the breast tissue and up into the tail of Spence. Vary the levels of pressure as you palpate.
Medium—mid-level tissue
Firm—to the ribs
Breast Cancer
Breast cancer is the most common cancer among women, and the incidence is rising. Breast cancer is the second leading cause of cancer death among white American women. Breast cancer deaths are highest among African-American women. However, early detection and treatment have resulted in increased survival rates. A 4% yearly increase during the 1980s has now leveled off at about 101 diagnosed cases per 100,000 women
Risk Factors
Gender (100 times more common in women)
Age (Risk increases with increasing age, especially after age 50 years.)
Genetics (In 10% of breast cancers, mutations of BRCA1 and BRCA2 genes are identified. In addition, a p53 tumor suppressor gene has been identified in some breast cancers.
Family history of breast cancer or ovarian cancer
Personal history of breast cancer or certain precursor conditions
Early menarche and late menopause
No natural children
First child born to a mother older than age 30
Oral contraceptive use (slight risk)
Regular alcohol intake, especially with two to five drinks daily
Higher education or socioeconomic status
Previous breast irradiation
Hormone replacement therapy with progesterone
Wet ear wax
Chest exposed to radiation therapy as child
Possible Risk Factors for Breast Cancer
Taller height
High waist-to-hip ratio; obesity beginning as adult or after menopause
High-fat diet
Low number of births
No breast-feeding
Low level of physical activity
Exposure to pesticides
Long-term antibiotic use
Possible Risk Factors for Mortality
No (or poor) breast self-examination
Poor screening (physical examination or mammography) Teach Risk Reduction Tips
Do not delay pregnancy until after 30 years of age.
Perform monthly breast self-examination (BSE).
Follow the American Cancer Society Guidelines for clinical evaluation and mammography.
Avoid weight gain in adulthood, especially around menopause.
Strenuous exercise, especially in youth, but also in adulthood; stay active.
Nonsteroidal anti-inflammatory drug (NSAID) therapy (may have protective effect).
Research: natural or synthetic vitamin A.
Well-rounded diet low in fat and including flaxseed.
Limit alcohol intake.
Reduce antibiotic use except when absolutely necessary.
Avoid use of birth control pills and hormone replacement unless necessary; discuss with your physician.
Avoid exposure to pesticides.
Maintain regular sleep schedule; 9 hours/night in a dark room.
Avoid exposure to bright light at night. Avoid night shift if possible
Signs of Breast cancer
prominant or asymmetric venous pattern, recent retracted nipple, dimpling retraction, lumps, painful mvmt
male breast exam
Inspect and palpate the breasts, areolas, nipples, and axillae. Note any swelling, nodules, or ulceration. Palpate the flat disc of undeveloped breast tissue under the nipple.
No swelling, nodules, or ulceration should be detected.
Soft, fatty enlargement of breast tissue is seen in obesity. Gynecomastia, a smooth, firm, movable disc of glandular tissue, may be seen in one breast in males during puberty for a temporary time. However, it may also be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and thyrotoxicosis. Irregularly shaped, hard nodules occur in breast cancer.
Fx's of the breast
The female breast is an accessory reproductive organ with two functions: to produce and store milk that provides nourishment for newborns and to aid in sexual stimulation. The male breasts have no functional capability
Axillary Lymph Node Assessment
Redness and inflammation may be seen with infection of the sweat gland. Dark, velvety pigmentation of the axillae (acanthosis nigricans) may indicate an underlying malignancy.
Inspect and Palpate
Hold the client's elbow with one hand, and use the three fingerpads of your other hand to palpate firmly the axillary lymph nodes
No palpable nodes or one to two small (less than 1 cm), discrete, nontender, movable nodes in the central area.
Enlarged (greater than 1 cm) lymph nodes may indicate infection of the hand or arm. Large nodes that are hard and fixed to the skin may indicate an underlying malignancy.
First palpate high into the axillae, moving downward against the ribs to feel for the central nodes. Continue to move down the posterior axillae to feel for the posterior nodes. Use bimanual palpation to feel for the anterior axillary nodes. Finally palpate down the inner aspect of the upper arm.
Prehn Sign
has epididymitis, passive elevation of the testes may relieve the scrotal pain (Prehn's sign)
Scrotal Abnormalities
Collection of serous fluid in the scrotum, outside the testes within the tunica vaginalis.
Appears as swelling in the scrotum and is usually painless.
Usually the examiner can get fingers above this mass during palpation.
Will transilluminate (if there is blood in the scrotum, it will not transilluminate and is called a “hematocele”).
Scrotal Hernia
A loop of bowel protrudes into the scrotum to create what is known as an indirect inguinal hernia.
Hernia appears as swelling in the scrotum.
Palpable as a soft mass and fingers cannot get above the mass.
Testicular Tumor
Initially a small, firm, nontender nodule on the testis.
As the tumor grows, the scrotum appears enlarged and the client complains of a heavy feeling.
When palpated, the testis feels enlarged and smooth—tumor replaces testis.
Will not transilluminate.
Failure of one or both testicles to descend into scrotum.
Scrotum appears undeveloped and testis cannot be palpated.
Causes increased risk of testicular cancer.
Inflammation of the testes, associated frequently with mumps.
Client complains of pain, heaviness, and fever.
Scrotum appears enlarged and reddened.
Swollen, tender testis is palpated. The examiner may have difficulty differentiating between testis and epididymis
Infection of the epididymis.
Client usually complains of sudden pain.
Scrotum appears enlarged, reddened, and swollen; tender epididymis is palpated.
Usually associated with prostatitis or bacterial infection.
Small Testes
Small (less than 3.5 cm long), soft testes indicate atrophy. Atrophy may result from cirrhosis, hypopituitarism, estrogen administration, extended illness, or the disorder may occur after orchitis.
Small (less than 2 cm long), firm testes may indicate Klinefelter's syndrome.
Torsion of Spermatic Cord
Very painful condition caused by twisting of spermatic cord.
Scrotum appears enlarged and reddened.
Palpation reveals thickened cord and swollen, tender testis that may be higher in scrotum than normal.
This condition requires immediate referral for surgery because circulation is obstructed.
Sperm-filled cystic mass located on epididymis.
Palpable as small and nontender, and movable above the testis.
This mass will appear on transillumination.
Abnormal dilation of veins in the spermatic cord.
Client may complain of discomfort and testicular heaviness.
Tortuous veins are palpable and feel like a soft, irregular mass or “a bag of worms,” which collapses when the client is supine.
Infertility may be associated with this condition.
testicular exam
Inspect the size, shape, and position. Ask the client to hold his penis out of the way. Observe for swelling, lumps, or bulges.
The scrotum varies in size (according to temperature) and shape. The scrotal sac hangs below or at the level of the penis. The left side of the scrotal sac usually hangs lower than the right side.
An enlarged scrotal sac may result from fluid (hydrocele), blood (hematocele), bowel (hernia), or tumor (cancer) (Abnormal Findings 24-2).

Inspect the scrotal skin. Observe color, integrity, and lesions or rashes. To perform an accurate inspection, you must spread out the scrotal folds (rugae) of skin (Fig. 24-6). Lift the scrotal sac to inspect the posterior skin.
Scrotal skin is thin and rugated (crinkled) with little hair dispersion. Its color is slightly darker than that of the penis. Lesions and rashes are not normally present. However, sebaceous cysts (small, yellowish, firm, nontender, benign nodules) are a normal finding.
Rashes, lesions, and inflammation are abnormal findings (Fig. 24-7).


Palpate the scrotal contents. Palpate each testis and epididymis between your thumb and first two fingers (Fig. 24-8). Note size, shape, consistency, nodules, and tenderness.

Clinical Tip • Do not apply too much pressure to the testes because this will cause pain.
Testes are ovoid, approximately 3.5 to 5 cm long, 2.5 cm wide, and 2.5 cm deep, and equal bilaterally in size and shape. They are smooth, firm, rubbery, mobile, free of nodules, and rather tender to pressure. The epididymis is nontender, smooth, and softer than the testes.

Testes do not get smaller with normal aging although they may decrease in size with longterm illness.
Absence of a testis suggests cryptorchidism (an undescended testicle). Painless nodules may indicate cancer. Tenderness and swelling may indicate acute orchitis, torsion of the spermatic cord, a strangulated hernia, or epididymitis (see Abnormal Findings 24-2). If the client has epididymitis, passive elevation of the testes may relieve the scrotal pain (Prehn's sign). If the client has a strangulated hernia, the client should be referred immediately to the physician and prepared for surgery.

Palpate each spermatic cord and vas deferens from the epididymis to the inguinal ring. The spermatic cord will lie between your thumb and finger (Fig. 24-9). Note any nodules, swelling, or tenderness.
The spermatic cord and vas deferens should feel uniform on both sides. The cord is smooth, nontender, and ropelike.
Palpable, tortuous veins suggest varicocele. A beaded or thickened cord indicates infection or cysts. If you palpate a scrotal mass, have the client lie down. The mass may return to the abdomen by itself. If it does not, place your fingers above the scrotal mass. If you can get your fingers above the mass, suspect hydrocele (see Abnormal Findings 24-2). Cyst suggests hydrocele of the spermatic cord.
Pap Smear
begin yearly Pap tests about 3 years after becoming sexually active, but at least by age 21. If a woman has had three normal annual Pap test results in a row, the test may be done less often at the judgment of the woman's health care provider. After hysterectomy, more frequent Pap tests may be recommended
Vaginal infx
Trichomonas Vaginitis (Trichomoniasis)
caused by a protozoan organism,usually sexually transmitted.discharge yellow-green, frothy,foul smell, labia swollen,red, vag walls- red, rough,covered with small red spots/petechiae. causes itching, urinary frequency pH of secretion >4.5 (usually 7.0 or more). vag secretions are stirred into a potassium hydroxide solution (KOH prep), a foul odor (typically known as a “+” amine)
Atrophic Vaginitis
after menopause, estrogen production low.discharge blood-tinged, minimal. labia and vag mucosa atrophic, pale, dry, areas of abrasion-bleed easily. causes itching, burning, dryness,painful urination
Candidal Vaginitis (Moniliasis)
overgrowth of yeast,causes a thick, white, cheesy discharge.labia inflamed and swollen. vag mucosa red, contains patches of the discharge.intense itching discomfort.pH of secretions <4.5 amine (in KOH) is negative.
Bacterial Vaginosis
cause unknown (poss. anaerobic bacteria), thought to be sexually transmitted. discharge thin/gray-white, positive amine (fishy smell), coats the vaginal walls/ectocervix.labia/vag walls appear normal,pH >4.5 (5.5-6.0).
Cervical Cancer
3rd most common cancer worldwide and second only to breast cancer. yearly 466,000 new cases, 232,000 women die, slow-progressing begins in lining of cervix, gradual changes,then- precancerous state then poss. to cancer. cancer may be squamous cell carcinoma (80% to 90%) or adenocarcinoma (10% to 25%), early cancers can be found by Pap Smear, nearly 100% curable, routine screening is recommended. begin yearly Pap tests 3 yrs after sexually active/or by age 21. If a woman has had three normal annual Pap test results in a row,-not as often After hysterectomy, more frequent Pap tests may be recommended.
Risk Factors
HPV infection, the most important risk factor
Females, especially from late teens to mid-thirties (although rate does not decrease as one ages)
Multiple sexual partners,unprotected sex/beginning at young age/ w/ uncircumcised male
Failure to have regular Pap tests (to detect precancer)
Cigarette smoking
Diet low in fruits and vegetables
Low socioeconomic status associated with low level of preventive care
African American or Hispanic heritage
Multiple pregnancies
Family history
History of chlamydia infection
History of HIV infection
Daughter of a mother who took DES in early pregnancy to prevent miscarriage
Use of oral contraceptives for 5 or more years
Teach Risk Reduction Tips
Avoid exposure to HPV:
Practice sexual monogamy.
Limit number of lifetime sexual partners.
Follow ACS guidelines for annual Pap testing and any recommended follow-up treatment.
Learn and practice good genital hygiene.
Do not smoke cigarettes.
Eat a diet rich in fruits and vegetables, especially in vitamins A, C, and folate.
Use barrier-type contraceptives cautiously. They do not protect well from HPV.
Talk with health care provider about HPV vaccine.
Talk with health care provider about postmenopausal screening for endometrial cancer.
Upper Vs Lower GI Bleeding
Black stool may indicate upper gastrointestinal bleeding,

Ask Sara
Abnormal Breast exam Findings
Lumps-with benign breast disease (fibrocystic breast disease), fibroadenomas, or malignant tumors Premenstrual breast lumpiness and soreness, subside after end of menstrual cycle- benign breast disease (fibrocystic breast disease).
Redness/warmth- inflammation. dimpling/ retraction of nipple or fibrous tissue- breast cancer.
A recent increase in the size of one breast- inflammation or abnormal growth.
The old pt-decrease in size and firmness of breast-decrease in estrogen levels. Glandular tissue decreases whereas fatty tissue increases.

Pain/tenderness of the breasts-benign breast disease and just before and during menstruation. This is especially true for clients taking oral contraceptives. Breast pain-can be late sign of breast cancer.
blood or blood-tinged discharge- referred to MD Sometimes, a clear benign discharge may be manually expressed from a breast that is frequently stimulated. Certain medications (oral contraceptives, phenothiazines, steroids, digitalis, and diuretics) are also associated with a clear discharge.
Skene Glands
female -also known as the lesser vestibular glands, periurethral glands, skene glands, paraurethral gland are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening, surrounded with tissue
Functional Assessment of Older Adult
evaluation of the person's ability to carry out the basic self-care ADLs
Katz Form of ADL's determined by the dynamic interplay of the frail elder's physiologic status, emotional and cognitive statuses, and the physical, interpersonal, & social environments