Exam 2 Blueprint-1 (1) PDF

Exam 2 Guide and Blueprint Module 6 – Chapter 23: Assessing Abdomen Abdominal quadrants/regions o Know the four quadrants and the 3 center areas of the nine regions. o Be able to locate main abdominal structures by quadrants (see Assessment Guide 23-1) Int...

Exam 2 Guide and Blueprint Module 6 – Chapter 23: Assessing Abdomen Abdominal quadrants/regions o Know the four quadrants and the 3 center areas of the nine regions. o Be able to locate main abdominal structures by quadrants (see Assessment Guide 23-1) Internal anatomy o What is the peritoneum? Be able to differenEate between parietal vs visceral peritoneum. o What are the abdominal viscera? Be able to differenEate between solid vs hollow viscera (Fig 23-4). o Know the locaEon and general funcEon of the abdominal viscera o Know how to assess the abdominal viscera (e.g., CVA tenderness for kidney tenderness) o What are the main vascular structures that supply the abdominal organs? o Know where to visualize, palpate, and auscultate the arteries (e.g., right and leN iliac arteries are in the RLQ and LLQ) Collec7ng Subjec7ve Data: The nursing health history o Know how to ask quesEons for the nursing abdominal health history. Abdominal pain o What are some possible reasons why abdominal pain occurs? o Be able to idenEfy the possible origin of the pain based on the quality or character (see Box 23-1), such as “burning/gnawing” pain may be due to GERD or PUD. o You do not need to know all of the disease processes per pain quality but know about 2-3 per category. o Know older adult consideraEons (e.g., sensiEvity to pain may diminish with aging) o For locaEon, know the three mechanisms and sources of abdominal pain (see Box 23-1) o Be able to differenEate between visceral, parietal, and referred pain. Indiges0on o What is indigesEon, heartburn, acid reflux, and GERD? o Review textbook for abnormal findings based on the COLDSPA mnemonic. o What factors are known to increase gastric secreEon and acidity and cause or aggravate indigesEon? Nausea and vomi0ng (N/V) o Review the textbook for abnormal findings for N/V. o Know what N/V can be triggered by (e.g., smells). o Other medical terms to know: emesis, hematemesis, esophageal varices, ulcers, peristalsis Appe0te o Review textbook for abnormal findings for appeEte changes. o What quesEons would you ask to assess appeEte? o Describe older adult consideraEons (e.g., decreased appeEte may be due to decreased taste sensaEon) Bowel Elimina0on o How would you assess a client for bowel eliminaEon? What is considered a normal frequency? o What is consEpaEon? Diarrhea? o What are some older adult consideraEons regarding bowel eliminaEon? Personal Health History o What is viral hepaEEs? Who is at an increased risk for exposure to hepaEEs viruses? o Prior abdominal surgeries or trauma may cause what issues for the paEent? o Which medicaEons may produce side effects that adversely affect the GI tract? (e.g., aspirin, ibuprofen, and steroids may cause gastric bleeding). Family History o What family history is relevant when collecEng an abdominal assessment? Lifestyle and Health Prac5ces o Be able to provide paEent educaEon as it affects the GI tract for the following: o Alcohol and alcohol-related disorders, exercise, and stress Collec7ng Objec7ve Data: Physical Examina7on Physical Assessment o What is the order to perform the abdominal examinaEon?  o Describe abnormal findings as it relates to the coloraEon of the skin (e.g., purple discoloraEon) and what it may signify (e.g., bleeding within the abdominal wall). Turner’s sign and Cullen’s sign o What are striae and what are they caused by? o Know what a scar is and how to assess it (e.g., document by quadrant). What are keloids and how do they occur? o What are you assessing when inspecEng the umbilicus? (e.g., Cullen’s sign, locaEon, contour) o What are the different types of abdominal contours and possible reasons why they may occur? o Know the “6 F’s” that are the major causes of abdominal distenEon: fat, feces, fetus, fibroids, flatulence, and fluid. o When auscultaEng for bowel sounds use the diaphragm of the stethoscope o Describe bowel sound consideraEons postoperaEvely. How long does it take to recover propulsive acEvity? o Describe bowels sounds that may indicate early or late obstrucEon. o How long would you listen to confirm absent bowel sounds? o What is borborygmus? o When auscultaEng for vascular sounds use the bell of stethoscope. o What is a bruit and where may you hear it? o What is a venous hum and what does it mean? o Where may you hear a fricEon rub in the abdomen and what is a fricEon rub associated with? o Know how to percuss for tone in all abdominal quadrants (see Figure 23-12). o When would you hear tympany vs dullness vs hyperresonance? o Know where to measure the span of the liver via percussion (Fig 23-14). o What is a normal liver span at the MCL (mid-clavicular line) versus MSL (midsternal line)? o What is hepatomegaly and why may it occur? o What is splenomegaly and what may it result from? o Describe how to perform blunt percussion of the kidneys. o What may tenderness indicate? (e.g., CVA tenderness may suggest pyelonephriEs) o Describe how to perform light and deep palpaEon. Provide consideraEons for palpaEon (see Box 23-4). o Do you palpate at the tender locaEon or away from the tender locaEon first? o Describe how to palpate the aorta? (see Fig 23-22). When would you not palpate an aorta and why? Tests for Ascites o What is ascites and what may it be caused by? What test could you perform? Fluid wave test Tests for Appendici5s/Peritoneal Irrita5on o What is appendiciEs? What is peritoneal irritaEon? o Know rebound tenderness (Blumberg sign). Describe a posiEve result. o Know referred rebound tenderness (Rovsing sign). Describe a posiEve result. o Know how to assess for the psoas sign. Describe a posiEve result. o Safety =p: Avoid con=nued palpa=on when test findings are posi=ve for appendici=s due to danger of rupturing the appendix. Test for Cholecys55s o What is cholecysEEs? o Know how to assess for the Murphy’s sign. Describe a posiEve result. Review Assessment Guide 23-3: Abdominal Signs Abnormal Findings Abdominal disten5on o With the excepEon of pregnancy, abdominal distenEon is usually considered an abnormal finding. Percussion may help determine the cause. Abdominal bulges o Umbilical hernia, Epigastric hernia, Diastasis recE, Incisional hernia Module 7 – Chapter 24: Assessing Musculoskeletal System Bones What are the funcEons of bones? What is osteoporosis? Who is at an increased risk for osteoporosis and what are some modifiable risk factors? o What paEent educaEon would you provide to prevent bone loss? Skeletal Muscles: Understand the skeletal muscle movements (see Box 24-1): o AbducEon: Moving away from midline of the body o AdducEon: Moving toward midline of the body o CircumducEon: Circular moEon o Extension: Straightening the extremity at the joint and increasing the angle of the joint o Flexion: Bending the extremity at the joint and decreasing the angle of the joint o Dorsiflexion: Toes draw upward to ankle o Plantar flexion: Toes point away from ankle o PronaEon: Turning or facing downward o SupinaEon: Turning or facing upward o RotaEon: Turning of a bone on its own long axis Joints What is a joint (or arEculaEon)? What is a bursa? For each of the following joints, know the normal movements: Elbow, Shoulder, Hip, Knee Collec7ng Subjec7ve Data: The Nursing Health History HPI Describe the effect of weight gain on the MSK system. Describe joint, muscle, and bone pain and quesEons you would ask to assess. o How would a paEent describe these types of pain (e.g., character or quality)? Personal health history List common quesEons to ask when collecEng personal health history, specific to the MSK system. o Past problems or injuries o Menopause § decreased estrogen levels lead to greater risk for the development of osteoporosis? Know older adult consideraEons (e.g., osteoporosis, or joint-sEffening condiEons) Family history Describe the relevant family history related to the MSK system (e.g., RA) Lifestyle and health prac7ces List common quesEons to ask when collecEng lifestyle and health pracEces, specific to the MSK system. o AcEvity level/exercise, MedicaEons, Tobacco, caffeine, and alcohol use, Typical 24-hour diet, ADLs, Social health and sexual acEvity, Body image, Stress Describe examples of how medicaEons can affect MSK funcEon (e.g., steroids or staEns). How does smoking, caffeine, and alcohol affect the risk of osteoporosis? Describe the nutrients needed to promote muscle tone, bone growth, and Essue healing. o Does calcium deficiency increases the risk of osteoporosis o vitamin D is required to absorb calcium via sun exposure, diet, or supplement Know the factors that increase the risk of osteoporosis (e.g., diet, estrogen levels, acEvity level). Describe the significance of rouEne exercise to prevent disease in the MSK system. Collec7ng Objec7ve Data: Physical Examina7on Describe the assessment of the joints and muscles. o What are you inspecEng and noEng? o If you idenEfy a limitaEon in ROM, you measure the ROM with what device? GONIOMETER Describe the assessment of the muscles. o What is the muscle strength raEng scale (0-5)? Be able to describe each raEng. o DifferenEate between passive and acEve range of moEon.  Describe inspecEon of the posture and gait o What are some possible abnormal curvatures you may observe? o How would you note normal findings for gait? What are some abnormal findings for gait? § Note any older adult consideraEons. TMJ Describe TMJ dysfuncEon (e.g., clinical manifestaEons). What is crepitus? Cervical, thoracic, and lumbar spine Describe how to inspect and palpate the cervical, thoracic, and lumbar spine (including the spinous processes and the paravertebral muscles). Note normal findings compared to abnormal findings. o Herniated disc, ankylosing spondyliEs, pregnancy, obesity o Compression fractures o Lumbosacral muscle strains DifferenEate between thoracic kyphosis, lordosis, and scoliosis Describe flajening of the lumbar curvature (which condiEons can it be seen with?) Note any older adult consideraEons. Describe how to test for back and leg pain. o What is the straight leg (Lasegue) test? What does it check for? Shoulders, arms, and elbows Describe how to inspect and palpate the shoulders, arms, and elbows Note normal findings compared to abnormal findings. o DislocaEon, tenderness, rotator cuff tear, o What is bursiEs? Describe how to test for ROM (which movements). Wrists Describe how to palpate the anatomic snukox and what type of fracture may be indicated with snukox tenderness. Describe the tests for Carpal Tunnel Syndrome (CTS) o Know how to perform the Phalen Test or Tinel Sign. What would a posiEve result look like? o Which nerve is entrapped in CTS? Hands and Fingers o What findings are seen in acute rheumatoid arthriEs vs osteoarthriEs? o DifferenEate between Heberden nodes and Bouchard nodes. Where are they located? Hips Describe how to inspect and palpate the hips Note normal findings compared to abnormal findings. o Impaired ROM may be signs of which condiEons? Knees Describe how to inspect and palpate the knees Note normal findings compared to abnormal findings. o OsteoarthriEs o Torn meniscus Describe how to test for ROM (which movements). DifferenEate genu valgum (knock knee) vs genu varum (bow legged) Describe older adult consideraEons Know the bulge test and ballojement test. What would a posiEve result indicate? Know the McMurray Test. Torn Meniscus Ankles and Feet Note normal findings compared to abnormal findings. o What is the most common site of sprains? Ankle o Know symptoms of Gouty arthriEs o What is the most common cause of heel pain? Plantar FasciiEs (inflammaEon) Describe how to test for ROM (which movements). o What is seen with hammer toe (Hallux Valgus)? What is a bunion?  Module 8 - Chapter 25: Assessing Neurologic system Central Nervous System What are the four major divisions (or lobes) of the brain? Describe their funcEon. o Where is Broca and Wernicke’s area? What are these two areas responsible for? Be able to describe the structure and funcEons of the cerebrum, brain stem, and cerebellum. o The brain stem controls and regulates respiratory funcEon, heart rate, and blood pressure.) Describe the spinal cord and its funcEons. Describe the neural pathways (sensory and motor) and their funcEons (e.g., sensaEons of pain, temperature, voluntary movement, muscle tone, body control) o Sensory impulses travel to the brain by way of two ascending neural pathways o Motor impulses are conducted to the muscles by two descending neural pathways: Peripheral Nervous System Describe the 12 pairs of cranial nerves and know the funcEons of each cranial nerve (see Table 25-2). Be able to describe the clinical manifestaEons that may occur with dysfuncEons to each of the cranial nerves (e.g., a decrease in smell may be related to a dysfuncEon of cranial nerve I; ringing in the ears and decreased ability to hear may occur with dysfuncEon of cranial nerve VIII, etc.) Collec7ng Subjec7ve Data: The Nursing Health History HPI Describe the common concerns (e.g., headache, seizures) and quesEons to ask when collecEng subjecEve data for the neurologic system (e.g., COLDSPA). What is a seizure? List some condiEons that may have seizures (e.g., epilepsy). What quesEons to ask Describe common condiEons that may be related to dizziness. (e.g., Ménière disease). Terms to know: paresthesia, Ennitus, dysarthria, dysphasia, aphasia, dysphagia, fasciculaEons, tremors, Ecs, myoclonus, amnesia, delirium, demenEa Describe older adult consideraEons when collecEng subjecEve data for the neurologic system (e.g., hearing, vision, tremors) List the quesEons to ask and describe the condiEons that may affect muscle control (e.g., spinal cord injury) DifferenEate between recent vs remote memory. Past health history List the quesEons to ask for a past health history data for the neurologic system (e.g., head injuries, meningiEs, stroke). Terms to know: meningiEs, encephaliEs, stroke Family history List the quesEons to ask for a family history for the neurologic system (e.g., Alzheimer’s disease). Lifestyle and health prac7ces How does cigareje smoking relate to CVA (cerebrovascular accident or stroke)? Explain how nicoEne affects the brain (e.g., nicoEne constricts the blood vessels which decreases blood flow to the brain). Collec7ng Objec7ve Data: Physical Examina7on A complete neurologic examinaEon consists of evaluaEng the following five areas: o Mental status (discussed in Chapter 6) o Cranial nerves o Motor and cerebellar systems o Sensory system o Reflexes Describe the purpose of the above five areas of a complete neurologic examinaEon. o Understand what is meant by mental status and level of consciousness (see Chapter 6). o What do the motor and cerebellar systems assess (e.g., balance)? o Describe how to document reflexes on a scale from Grade 0 (no response) to Grade 4+ (hyperacEve, very brisk) Cranial nerves IdenEfy the 12 cranial nerves and their sensory and motor funcEons. Know how to assess each of the 12 cranial nerves and note their normal or abnormal findings (important secEon to review). Terms to know: papilledema, ptosis, nystagmus When stroke is suspected, Act FAST. Describe this mnemonic to help remember the clinical manifestaEons of stroke. Motor and cerebellar systems Know how to assess movement, balance, and coordinaEon. Understand the normal vs abnormal findings. o CondiEon and movement of muscles o Strength and tone of muscles o Gait and balance o Tandem walking o Romberg Test o Assessing coordinaEon (finger-to-nose test, rapid alternaEng movements, heel-to-shin test Describe the older adult consideraEons when assessing the motor and cerebellar systems. Terms to know: propriocepEon, dyskinesia, spasEc hemiparesis, footdrop Describe how to safely perform the Romberg test. What is considered a normal vs abnormal finding? Sensory system Know how to assess sensaEon. Understand the normal vs abnormal findings. o Light touch, pain, and temperature o Vibratory sensaEon (list the locaEons to assess using a low-pitched tuning fork) o SensiEvity to posiEon o TacEle discriminaEon (fine touch) o Point localizaEon o Graphesthesia o Two-point discriminaEon o ExEncEon Describe the older adult consideraEons when assessing the sensory system. Reflexes Know how to assess the reflexes. Understand the normal vs abnormal findings. o Deep tendon reflexes. Know scoring scale from Grade 0 (no response) to Grade 4+ (hyperacEve, very brisk)and locaEons to test (e.g., biceps, brachioradialis, triceps, patellar, and Achilles) o Superficial reflexes and common locaEons to test (e.g., plantar reflex-Babinski) § What is a Babinski reflex/sign? When is it considered normal vs abnormal? Describe the older adult consideraEons when assessing the reflexes. Tests for meningeal irrita7on or inflamma7on What is meningiEs? What are associated signs and symptoms of infecEous cause. Describe the tests for meningeal irritaEon or inflammaEon (e.g., neck mobility, Brudzinski sign, Kernig sign). Know how to perform these tests and describe normal compared to abnormal findings Abnormal Findings Cerebrovascular accident (stroke) – see Box 25-1 Describe a cerebrovascular accident (stroke). o DifferenEate between hemorrhagic, ischemic, and transient ischemic ajacks (TIA) Describe the clinical manifestaEons of a stroke (e.g., Be FAST) Describe the major risk factors associated with strokes. Know the evidence-based educaEon to provide a paEent to reduce risks of stroke (e.g., smoking cessaEon). Abnormal muscle movements Describe the following abnormal muscle movements: o Atrophy and fasciculaEons (e.g., seen in ALS or amyotrophic lateral sclerosis) o Tics (e.g., seen in Toureje syndrome or due to medicaEon side effects) o Tremors (e.g., seen in Parkinson’s disease) Abnormal gaits Describe the following common abnormal gaits and their causes: o Cerebellar ataxia o Parkinsonian gait o Scissors gait Abnormal postures in unconscious clients o DecorEcate posturing o Decerebrate posturing