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223 Cards in this Set
- Front
- Back
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• Name the functions of the nose
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The nose, the first segment of the respiratory system, warms, moistens, and filters inhaled air. It is also the sensory organ of smell, and it is innervated by cranial nerve I.
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• List the anatomic landmarks of the external nose.
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The external nose, shaped like a triangle, consists of the bridge or superior part; the free corner or the tip; the nares, which are the openings at the base of the triangle; and (inside the nares) a vestibule, the columella that divides the two nares and is continuous inside with the nasal septum; and the ala, the lateral outside wing of the nose on each side.
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• Describe the nasal cavity.
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The nasal cavity extends back over the roof of the mouth. The anterior edge is lined with coarse nasal hairs that filter the coarsest matter from inhaled air. The remainder of the cavity is lined with ciliated mucous membrane that filters out dust and bacteria. Because of its rich blood supply, the nasal mucosa appears redder than the oral mucosa. The increased blood supply warms inhaled air. Kiesselbach’s plexus is located in the anterior part of the septum, which divides the nasal cavity into two air passages. Kiesselbach’s plexus is the most common site of nosebleeds. The superior, middle, and inferior turbinates increase the surface area of the nose so that more blood vessels and mucous membrane are available to warm, humidify, and filter the inhaled air. Under each turbinate is a cleft, the meatus, named for the turbinate above. The sinuses drain into the middle meatus and tears from the nasolacrimal duct drain into the inferior meatus.
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• Name the paranasal sinuses and their functions.
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There are four pairs of sinuses, two of which are accessible to examination—the frontal and maxillary sinuses. The ethmoid and sphenoid sinuses are not accessible to examination. The sinuses lighten the weight of the skull bones, serve as resonators for sound production, and provide mucus.
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• Identify the structures of the oral cavity.
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The lips, the insides of both cheeks, the roof of the mouth or palate, the mandible, and the maxilla form the oral cavity. The teeth, both sets, begin development in utero. Children have 20 deciduous, or temporary, teeth. All 20 should appear by 2½ years of age. An adult mouth has 32 teeth, the tongue, gums, and openings for three pairs of salivary glands, (parotid, submandibular, and sublingual) and the uvula. The oropharynx is separated from the mouth by a fold of tissue on each side, the anterior tonsillar pillar. Behind the folds are the tonsils, each a mass of lymphoid tissue. Tonsillar tissue enlarges during childhood and puberty then involutes. The nasopharynx is continuous with the oropharynx, although it is above the oropharynx and behind the nasal cavity. The pharyngeal tonsils (adenoids) and the eustachian tube openings are located here.
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• List the functions of the mouth.
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The mouth is the first segment of the digestive system and an airway for the respiratory system. In addition, the mouth contains taste buds and aids in speech production.
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• Identify the effects of some of the age-related changes that take place in the mouth.
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Nasal stuffiness and epistaxis may occur during pregnancy. Also, the gums may be hyperemic and softened. Loss of subcutaneous fats makes the nose appear more prominent in some people. A decrease in smell may occur after age 60 years because of a decrease in the number of olfactory nerve fibers. Tooth loss causes a series of difficulties, including temporomandibular joint pain and osteoarthritis. A decrease in the sensation of smell and taste can affect appetite and contribute to malnutrition. The problems created by tooth loss can also cause the older person to eat soft foods that are high in carbohydrates and to decrease meat and fresh vegetable intake, adding to the risk of nutritional deficit for protein, vitamins, and minerals.
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• Incorporate health promotion concepts when performing an assessment of the nose, mouth, and throat.
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The health risks of smokeless tobacco (SLT) are discussed. The two types of SLT most commonly used in the United States are chewing tobacco and snuff. These products contain cancer-producing chemicals, such as nitrosamines, that cause an increased risk for oral cancers (pharynx, larynx, and esophagus). Early signs of oral cancer are discussed, as well as other effects of SLT use such as gum recession, tooth discoloration, bad breath, nicotine dependence, and unhealthy eating habits. The largest group of SLT users is American Indian/Alaskan Native children, but SLT use is also high among young white males. SLT is not a healthy alternative to smoking.
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Uvula
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- free projection hanging down from the middle of the soft palate
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Candidiasis
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- white, cheesy, curdlike patch on buccal mucosa due to superficial fungal infection
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Cheilitis
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- red, scaling, shallow, painful fissures at corners of mouth
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Caries
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- decay in the teeth
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Epistaxis
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- Nosebleed, usually from anterior septum
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Gingivitis
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- red swollen gum margins that bleed easily
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Leukoplakia
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- chalky white, thick, raised patch on the sides of the tongue; precancerous
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Malocclusion
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- upper or lower dental arches out of alignment
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Rhinitis
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- red, swollen inflammation of nasal mucosa
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Xerostomia
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- Dry mouth
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Dysphagia
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- Difficulty swallowing
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Bruit
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- Blowing, swooshing sound heard through the stethiscope over an area of abnormal blood flow
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Goiter
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- increase in size of thyroid gland that occurs with hyperthyroidism
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Lymphadenopathy
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- emlargement of the lymph nodes due to infection, allergy, or neoplasm
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Macrocephalic
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- abnormally large head
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Microcephalic
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- abnormally small head
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Normocephalic
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- round symmetric skull that is appropriately related to body size
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Torticollis
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- head tilt due to shortening or spasm of one sternomastoid muscle
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Vertigo
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- illusory sensation of either the room or one's own body spinning; it is not the same as dizziness
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Bruxism
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- teeth grinding
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bifid uvula
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is a uvula, a structure in the rear middle of the mouth, that is split down the middle
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Halitosis
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- Bad breath
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leukoedema
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- A benign abnormality of the buccal mucosa characterized by a filmy , opalescent-to-whitish gray, wrinkle.
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Alopecia
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- Hair loss
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Annular
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- circular shape to skin lesion
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Bulla
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elevated cavity containing free fluid larger than 1 cm in diameter
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Confluent
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skin lesions that run together
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Crust
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thick, dried out exudate left on skin when vesicles/pustules burst or dry up
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Cyanosis
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- dusky blue color to skin or mucous membranes due to increased amount of unoxygenated hemoglobin
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Erosion
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- intense redness of the skin due to excess blood in dilated superficial capilaries, as in fever or inflammation
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Excoriation
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self inflicted abrasion on skin due to scratching
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Fissure
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- linear crack in skin extending into dermis
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Furuncle
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- (boil) supportive inflammatory skin lesion due to infected hair follicle
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Hemangioma
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- skin lesion due to benign proliferation of blood vessels in the dermis
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Iris
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- target shape of skin lesion
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Jaundice
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- yellow color to skin, palate, and sclera due to excess billirubin in the blood
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Keloid
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hypertrophic scar, elevated beyond site of original injury
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Lichenification
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- tightly packed set of papules that thickens skin, from prolonged intense scratching
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Lipoma
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- benign fatty tumor
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Maceration
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- softening of the tissue by soaking
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Macule
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- flat skin lesion with only color change
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Nevus
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- (mole) circumscribed skin lesion due to excess melanocytes
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Nodule
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- elevated skin lesion, greater than 1 cm diameter
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Pallor
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Excessively pale, whitish pink color to lightly pgmented skin
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Papule
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- palpable skin lesion, less than 1 cm in diameter
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Plaque
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- skin lesion in which papules coalesce or come together
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Pruritus
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- itching
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Purpura
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- red-purple skin lesion due to blood in tissues from breaks in blood vessels
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Pustules
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- elevated cavity containing thick, turbid fluid
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Scale
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- Compact desiccated flakes of skin from shedding of dead skin cells
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Telangiectasia
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- skin lesion due to permantly enlarged and dilated blood vessels that are visible
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Ulcer
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- Sloughing of necritc inflammatory tissue that causes a deep depression in skin, extending into dermis
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Vesicle
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- elevated cavity containing free fluid up to 1 cm diameter
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Wheal
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- raised red skin lesion due to interstial fluid
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Zosteriform
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- linear shape of skin lesion along a nerve route
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3 Layers of Skin
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- Epidermis
- Dermis - Subcutaneous Tissue |
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Dermis
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- inner supportive layer consisting mainly of connective tissue or collagen
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Functions of Skin
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- Protection
- Prevents penetrations - Perception (Sensory) - Temperature regulation - Identifaction - Communication - Wound repair - absorption and excretion - Production of Vitamin D |
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Subcutaneous Layer
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- addipose tissue, made up of lobules of fat cells
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2 types of human hair
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- Vellus
- Terminal |
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sebaceous glands
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- produce protective lipid substance called sebum. Secreted through hair follicles
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Eccrine glands
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- coiled glands that open directly to the skin surface and produce sweat
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apocrine glands
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- produce thick milky secretion and open into the hair follicles Located primarily in axillae, anogenital area, nipples and navel
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Vellus hair
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- faint fine hair that covers most of the body
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Terminal hair
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- Darker thicker hair that grows on the scalp and eyebrows and, after puberty, on the axillae, the pubic area, and the face and chest in the males
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xerosis
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- dry skin
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Vitiligo
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- Complete absence of melenin pigment in patchy areas of white or light skin on the face, neck, hands, feet, bodyfolds and around orifices
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ABCDE
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- Asymmetry
- Border - Color - Diameter - Elevation or Enlargement |
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4 Point Grading Scale for Pitting Edema
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1+
2+ 3+ 4+ |
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1+ on the scale for pitting Edema
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Mild Pitting,slight indentation, no perceptible swelling of the leg
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2+ onthe pitting edema scale
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- Moderate pitting, indentation subsides rapidly
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3+ on the pitting edema scale
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- Deep pitting, indentation remains for a short time, leg looks swollen
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4+ on the Pitting edema scale
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- Very Deep pitting, indentation lasts a long time, leg is very swollen
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Primary Lesions
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- A lesion that develops on previously unaltered skin
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Secondary Lesions
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- When a lesion changes over time due to scratching or infection
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erythema toxicum
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- tiny punctate red macules and papules on the chest, trunk, cheeks, back, and buttocks
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Harlequin
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- lower half of body turns red, and upper half blanches
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Cutis marmorata
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- transient mottling on trunk and extremities
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acrocyanosis
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- bluish color around the lips, hands, fingernails, feet and toenails
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cafe au lait
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large round or oval patch of light brown usually present at birth
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physiologic jaundice
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- yellowing of skin, sclera, and mucous membranes due to increased numbers of red blood cells hemolyzed following birth
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carotenemia
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- yellow-orange color in light skinned persons from large amounts of foods containing carotene
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Anterior Triangle
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- lies in front, between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its own apex down at the suprsternal notch
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Posterior Triangle
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- Lies behind the sternomastoid muscle, with the trapezius muscle on the other side and with its base along the clavicle below.
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Facial features that should appear symmetrical are
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- Eyebrows
- palpebral fissures - nasolabial folds - Sides of the mouth |
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caput succedaneum
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- the edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma
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Cephalhematoma
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- subperiosteal hemmorrhage, which is a result of birth trauma ( soft, fluctuant, and well defined over one cranial bone because of periosteum holds bleeding in place
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Accomodation
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- adaptation of the eye for near vision by increasing the curvature of the lens
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Anisocoria
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- unequal pupil size
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Arcus senilis
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- gray white arc or circle around the limbus of the iris that is common with aging
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Argyll Robertson pupil
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- pupil does not react to light; does constrict with accommmodation
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Astigmatism
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- refractive error of vision due to differences in curvature in refractive surfaces of the eye (cornea and lens)
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A-V crossing
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- crossing paths of an artery and vein in the ocular fundus
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Bitemporal hemianopsia
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- loss of both temporal visual fields
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Blepharitis
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- inflammation of the glands and eyelash follicles along the margin of the eyelids
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Cataract
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- opacity of the lens of the eye that develops slowly with aging and gradually obstructs vision
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Chalazion
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- infection or retention cyst of a gland, showing as a beady nodule on the eyelid
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Conjuctivitis
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- infection of the conjunctiva; pinkeye
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Cotton-wool area
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- abnormal soft exudates visible as gray-white areas on the ocular fundus
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Cup-disc ratio
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- ratio of the width of the physiologic cup to the width of the optic disc, normally half or less
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Diopter
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- unit of strength of the lens settings on the opthalmoscope that changes focus on the eye structures
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Diplopia
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- Double vision
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Drusen
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- benign deposits on the ocular fundus that show as round yellow dots and occur commonly with aging
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Ectropion
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- lower eyelid loose and rolling outward
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Entropion
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- Lower eyelid rolling inward
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Exophthalmos
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- protruding eyeballs
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Fovea
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- area of keenest vision at the center of the macula on the ocular fundus
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Glaucoma
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a group of eye diseases characterized by increased intraocular pressure
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Hordeolum
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- (stye) red, painful pustule that is localized infection of hair follicle at eyelid margin
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Lid Lag
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- the abnormal white rim of sclera visible between the the upperlid and iris when a person moves the eyes downward
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Macula
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- round, darker area of the ocular fundus that mediates vision only from the central visual field
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Microaneurysm
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- abnormal finding of round red dots on the ocular fundus that are localized dilations of small vessels
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Miosis
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- constricted pupils
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Mydriasis
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- dilated pupils
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Myopia
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- "nearsighted"; refractive error in which near vision is better than far vision
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Nystagmus
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- involuntary, rapid, rhythmic movement of the eyeball
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OD
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- oculus deter, or right eye
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OS
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- oculus sinister; or left eye
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Optic atrophy
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- pallor of the optic disc due to partial or complete death of optic nerve
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Optic disc
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- area of ocular fundus in which blood vessels exit and enter
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Papilledema
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- stasis of blood flow out of the ocular fundus; sign of increased intracranial pressure
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Presbyopia
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decrease in power of accommodation that occurs with aging
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Pterygium
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- triangular opaque tissue on the nasal side of the conjunctiva that grows toward the center of the cornea
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Ptosis
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- drooping of the upper eyelid over the iris and possibly covering pupil
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Red Reflex
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- red glow that appears to fill the person's pupil when first visualized through the opthalmoscope
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Stabismus
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(suint, crossed eye) disparity of the eye axes
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Xanthelasma
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- soft, raised yellow plaques occuring on the skin at the inner corners of the eyes
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6 sets of extraocular muscles
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1. Superior rectus CN III
2. Lateral Rectus CN VI 3. Inferior Rectus CN III 4. Superior Oblique CN IV 5. Medial Rectus CN III 6. Inferior Oblique CN III |
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3 Concentric Coats of the Eyeball
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1. Sclera
2. Choroid 3. Retina |
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Choroid
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- middle layer of the eye
- dark pigmented to prevent light from reflecting internally - heavily vascularized |
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Sclera
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- Outer layer of the eye.
- White Color |
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Retina
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- Inner layer of the eye
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Annulus
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- Outer fibrous rim encircling the eardrum
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Atresia
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- congenital absence or closure of ear canal
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Cerumen
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- yellow, waxy material that lubricates and protects the ear canal
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Cochlea
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- inner ear structure containing the central hearing apparatus
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Eustachian tube
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- connects the middle ear with the nasopharynx and allows passage of air
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Helix
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- superior posterior free rim of the pinna
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Incus
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- "anvil" middle of the 3 ossicles of the middle ear
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Malleus
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- "hammer" first of the 3 ossicles of the middle ear
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Mastoid
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- bony prominence of the skull located just behind the ear
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Organ of Corti
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- Sensory organ of hearing
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Otalgia
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- pain in the ear
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Otitis externa
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- inflammation of the outer ear and ear canal
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Otitis Media
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- inflammation of the middle ear and tympanic membrane
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Otorrhea
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- discharge from the ear
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Pars flaccida
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- small, slack,superior section of tympanic membrane
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Pars tensa
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- thick, taught, central/inferior section of tympanic membrane
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Pinna
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- auricle, or outer ear
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Stapes
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- "stirrup" inner of the 3 ossicles of the middle ear
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Tinnitus
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- ringing in the ears
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Tympanic Membrane
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- "eardrum" thin, transluscent, oval membrane that stretches across the ear canal and separates the middle ear from the outer ear
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Umbo
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- knob of the malleus that shows through the tympanic membrane
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Vertigo
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- a spinning, twirling sensation
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Function of skin:
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Protection
Prevents penetration. Perception. Temperature regulation. Identification. Communication. Wound repair. Absorption and excretion. Production of Vitamin D. |
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Skin-
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Body’s largest organ system,
Has two layers- |
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Epidermis-
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Outer layer, thin but tough
Cells tightly bound together Avascular |
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Dermis
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Inner supportive layer
Consists of connective tissue and collagen Elastic Nerves, sensory receptors, blood vessels, lymphatics, hair follicles, sebaceous glands, and sweat glands |
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Aging Adult Skin
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Becomes thinner- increase risk for shearing, tearing
Decrease # sweat and sebaceous glands- dry skin, increase risk for heat stroke Hair becomes gray, thin, fine. Changes in distribution Big part of self esteem |
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Cultural Considerations
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Melanin- protects from uv rays
Body odors Mild in Asian and American Indians Strong in Whites and Blacks Skin conditions found in Blacks Keloids Hypo or Hyperpigmentation Pseudofolliculitis Melasma Hair |
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Inspect & Palpate Skin
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General Pigmentation- skin tone
Consistent with genetic background Acyanotic Vitiligo- Freckles Nevus (mole) Birthmarks Color changes Where to check? Pallor Erythema Cyanosis Jaundice Temperature Dorsum of hand Warm, equal bilaterally Hypothermia & Hyperthermia Moisture Slightly moist Diaphoresis & Dehydrated Texture Smooth, firm, even Thickness Uniformly thin Callus Very thin / shiny - arterial insufficiency Edema Fluid accumulating Where? |
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Lesions
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Note
Color Elevation Pattern or shape Size in cm Location and distribution Exudate |
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VASCULAR SKIN LESIONS
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Hemangiomas (port-wine stain, strawberry mark, cavernous hemangioma)
Telangiectasis (telangiectasia, spider or star angioma, venous lake) Pupuric lesions (petechiae, ecchymosis, and purpura |
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WOUND COLOR CODING
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• Necrotic (eschar) = black
• Sloughy = yellow • Granulating = red • Epithelializing = pink • Infected = green |
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Clubbing of the nails occurs with congenital
cyanotic heart disease and neoplastic and pulmonary diseases |
-True
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SECONDARY SKIN LESIONS
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Erosion
Ulcer Atrophic Scar Scar Fissure Scales Crust Keloid Excoriation Lichenification |
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The Head Contains
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Cranium
Face Neck Thyroid gland Lymph nodes |
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Cranium – (skull)
4 bones |
Frontal
Parietal Temporal Occipital |
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Face
14 bones |
Maxilla
Nasal Zygomatic (cheek) Maxilla Lacrimal Mandible (jaw) |
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Neck
Composed of |
Muscles
Ligaments Cervical vertebrae |
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Lymph nodes of the head
& neck |
Size and shape:
< 1cm Round Usually non-palpable Infectious – enlarged, painful Cancer – enlarged, non-painful |
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Lymph nodes Palpate with patient relaxed, neck flexed.
Follow sequence |
1. Preauricular
2. Posterior auricular 3. Occipital 4. Tonsillar 5. Submandibular 6. Submental 8. Superficial cervical 9. Posterior cervical 10. Deep cervical chain** 11. Supraclavicular |
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The nurse is assessing a patient’s face and neck bilaterally for nerve damage. The patient is unable to differentiate between dull and sharp sensation. The nurse suspects damage to which nerve?
Cranial nerve IV: trochlear nerve Cranial nerve V: trigeminal nerve Cranial nerve VII: facial nerve Cranial nerve XI: spinal accessory nerve |
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The nurse suspects that a patient has hyperthyroidism. Which of the following findings would the nurse most likely find on examination?
Increased heart rate, weight loss Decreased heart rate, weight gain Increased heart rate, weight gain Decreased heart rate, weight loss |
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Prevention is the best policy for treating traumatic brain injuries (TBI). The age group with the highest incidents of hospitalization and death from TBI are:
A. Children, age 0 to 4 B. Adolescents, age 15 to 19 C. Adults, age 65 and older D. Older adults, age 75 and older |
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When recording the findings of the lymph glands, a nurse should note all except:
A. Size B. Shape C. Consistency D. Color |
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OU
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Both eyes
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Distance Vision Tests
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Snellen Eye Chart
- E chart |
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Near Vision Test
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Jaegar card
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Peripheral Vision Test
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Confrontation (wiggle test)
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Color Vision Tests
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Ishihara cards or color bars on Snellen
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Corneal Light Reflex (Hirschberg test)
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- tests for parallel alignment eye
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Cover Test
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- tests for ocular alignment
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Cardinal Fields of Gaze (Diagnostic Positions test)
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- tests for symmetrical movement of the eyes
through the cardinal positions |
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CATARACTS
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Opacity or
clouding of the lens |
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Cranial Nerves IX & X
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(motor function - tongue)
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Test Cranial Nerve XII
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(Does tongue protrude midline?)
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Test Cranial Nerves VII & IX
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(sensory function)
Taste |
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Snellen chart
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is the most commonly used and accurate measure of visual activity. It has lines of letters arranged in decreasing size. Person should be positioned 20ft from the chart
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DISTANCE VISION TESTS
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-Normal vision is 20/20---top # is the distance the patient is from the chart. Have patient read the lowest line possible. Bottom number is number of feet of what the normal eye could have seen from that distance
-E chart- used for people who don’t know the alphabet---typically used for children; is nothing but the letter E and patient is pointing the direction of E. |
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NEAR VISION
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Normal is 14/14
Jaegar card- is held 14inches from the eye |
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PERIPHERAL VISION
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Confrontation test (wiggle test)- botht the patient and the examiner cover the opposite eye and the examiner is flicking or wiggling the finger; the patient notifies the examiner when the movement is able to be seen
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COLOR VISION TEST-
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ishihara cards or color bars on the snellen
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EXTRA OCLULAR MUSCULAR FUNCTION
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(EOM)
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Corneal light reflex (Hirschberg Test)-
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- patient should 12inches away--- the reflection of the light on the corneas is in exactly the same spot on each eye (the bright white dots)
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-Cover test-
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-Cardinal Fields of Gaze (Diagnostic Position Test)- have the patient follow your finger through different movements; the eyes should move smoothly through the different movements. Examiner is 12inches from the patient at eye level. Examiner is going to move finger in six different positions progressing clockwise and patient is to follow the direction of the finger. A normal response is parallel tracking of the object with both eyes
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PERRLA
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P-pupils
E-equal R-round R-reactive to L-light A-accommodation- |
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accommodation-
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two things happen; the eyes converge and constrict; has patient to focus on a distant object (this process dilates the pupils), then have the patient shift the gaze to a near object. A normal response includes pupillary constriction and convergence of the axes of the eyes
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Farsighted
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green numbers
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near sighted-
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red numbers
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Optic disc is located
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on nasal side of the eye
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Macula is on
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temporal side of the eye
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Position
-toddler- |
sit on the parents lap; most comforting for the patient; save it for the last part of the exam
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When using the otoscope on children younger than 3
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pull pinna down
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When using the otoscope on children Older than 3
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pull pinna up and back
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Cone of light will be at____ in the right ear drum
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5 oclock
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Cone of light will be at____ in the left ear drum
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7oclock
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The integrity of the normal tympanic membrane is
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is intact
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Conductive hearing loss-
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cannot convert down the canal; there is something blocking the vibrations
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Sensory loss-
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the problem is in the inner ear; there is not a blockage
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Whisper test
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-press the tragus (occlude one ear); be behind the patient so they cant read the lips; whisper a two syllable word, or random numbers. You would do this for both ears
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WEBER TEST
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Use tuning fork and place vibration on parietal bone and ask patient if they hear vibration in both ears.
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RINNE’S TEST
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Air conduction should be greater or longer than bone conduction
Bone conduction- vibration is place on the mastoid process Air conduction- vibration from tuning fork is not place on surface of skin Abnormal would be if air conduction is equal or less than bone conduction |
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A postivie rinnes test is
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if air conduction is greater than bone conduction
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Romberg Test
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Have patient stand with hands by there side and close eyes. Examiner will have arm in front and arm in back.
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