Exam 2 Study Guide PDF

Module 6 Abdomen Abdominal Quadrants and Regions Four Quadrants: 1. Right Upper Quadrant (RUQ) 2. Left Upper Quadrant (LUQ) 3. Right Lower Quadrant (RLQ) 4. Left Lower Quadrant (LLQ) Nine Regions: 1. Right Hypochondriac 2. Epigastric...

Module 6 Abdomen Abdominal Quadrants and Regions Four Quadrants: 1. Right Upper Quadrant (RUQ) 2. Left Upper Quadrant (LUQ) 3. Right Lower Quadrant (RLQ) 4. Left Lower Quadrant (LLQ) Nine Regions: 1. Right Hypochondriac 2. Epigastric 3. Left Hypochondriac 4. Right Lumbar 5. Umbilical 6. Left Lumbar 7. Right Iliac (Inguinal) 8. Hypogastric (Pubic) 9. Left Iliac (Inguinal) Main Abdominal Structures by Quadrant RUQ: Liver, gallbladder, duodenum, right kidney, ascending colon. LUQ: Stomach, spleen, pancreas, left kidney, transverse colon. RLQ: Appendix, cecum, right ovary and fallopian tube (in females). LLQ: Left ovary and fallopian tube (in females), sigmoid colon. Internal Anatomy Peritoneum Definition: A serous membrane that lines the abdominal cavity and covers abdominal organs. Parietal Peritoneum: Lines the abdominal wall. Visceral Peritoneum: Covers the organs. Abdominal Viscera  Solid Viscera: Organs that maintain a shape (e.g., liver, pancreas, spleen). Hollow Viscera: Organs that change shape (e.g., stomach, intestines, bladder). Location and Function Liver: Detoxification, metabolism, protein synthesis. Stomach: Digestion of food. Intestines: Nutrient absorption and waste elimination. Kidneys: Filtration of blood, urine formation. Assessment of Abdominal Viscera CVA Tenderness: Assess for kidney tenderness by gently tapping the costovertebral angle. Main Vascular Structures Abdominal Aorta: Supplies blood to organs. Iliac Arteries: Supply the lower abdomen and legs. Visualizing, Palpating, and Auscultating Arteries Right and Left Iliac Arteries: Palpated in RLQ and LLQ. Collecting Subjective Data: Nursing Health History Questions for Abdominal Health History Describe any abdominal pain (location, quality, duration). Changes in appetite or weight. Bowel habits and recent changes. Abdominal Pain Possible Reasons for Abdominal Pain Gastrointestinal disorders, infections, inflammation, organ rupture. Origin Based on Pain Quality  Burning/Gnawing: GERD, Peptic Ulcer Disease (PUD). Dull/Aching: Appendicitis, diverticulitis. Sharp: Gallstones, pancreatitis. Older Adult Considerations Sensitivity to pain may diminish; assess pain carefully. Mechanisms and Sources of Pain 1. Visceral Pain: From internal organs, often dull and poorly localized. 2. Parietal Pain: From irritation of the peritoneum, sharp and localized. 3. Referred Pain: Felt in areas distant from the source. Indigestion Definitions Indigestion: Discomfort in the upper abdomen. Heartburn: Burning sensation from acid reflux. Acid Reflux: Backward flow of stomach acid into the esophagus. GERD: Chronic acid reflux leading to esophageal irritation. Factors Increasing Gastric Secretion Stress, spicy foods, large meals, caffeine, alcohol. Nausea and Vomiting (N/V) Triggers Smells, medications, infections, motion sickness. Medical Terms Emesis: Vomiting. Hematemeis: Vomiting blood. Esophageal Varices: Enlarged veins in the esophagus, often due to liver disease.  Peristalsis: Muscle contractions that move food through the digestive tract. Appetite Assessing Appetite Changes Ask about recent changes in eating habits, preferences, and any weight loss or gain. Older Adult Considerations Decreased appetite may result from diminished taste sensation, dental issues, or medications. Bowel Elimination Assessing Bowel Habits Normal frequency varies but is typically between 1-3 times daily to 3 times weekly. Definitions Constipation: Infrequent bowel movements; hard stools. Diarrhea: Frequent, watery stools. Older Adult Considerations Increased risk for constipation due to decreased mobility and medication side effects. Personal Health History Viral Hepatitis Definition: Inflammation of the liver due to viral infection.  At-Risk Populations: Intravenous drug users, unvaccinated individuals, those with high-risk sexual behaviors. Previous Abdominal Surgeries May lead to adhesions or complications like bowel obstruction. Medications Affecting the GI Tract Aspirin, Ibuprofen, Steroids: Can cause gastric irritation or bleeding. Family History Relevant Family History Conditions like gastrointestinal cancers, inflammatory bowel disease, or liver diseases. Lifestyle and Health Practices Patient Education Alcohol: Risk for liver disease; moderation is key. Exercise: Promotes bowel regularity and overall health. Stress: Can exacerbate gastrointestinal issues; consider stress management techniques. Collecting Objective Data: Physical Examination Order of Abdominal Examination 1. Inspection 2. Auscultation 3. Percussion 4. Palpation Abnormal Findings  Skin Coloration: ○ Purple discoloration (Cullen’s sign): Suggests bleeding in the abdominal cavity. ○ Turner’s sign: Bruising around the flanks. Striae Stretch marks caused by rapid weight gain or loss, pregnancy, or hormonal changes. Scars Document by quadrant; Keloids are raised scars from excess collagen formation. Umbilicus Assessment Inspect for discoloration (Cullen’s sign), location, and contour. Abdominal Contours Flat, Rounded, Scaphoid, Distended: Can indicate various conditions. Causes of Abdominal Distention (6 F's) 1. Fat 2. Feces 3. Fetus 4. Fibroids 5. Flatulence 6. Fluid Bowel Sounds Auscultate using the diaphragm; normal sounds are high-pitched and irregular. Postoperative Bowel Sounds It may take 24-48 hours to recover propulsive activity. Absent Bowel Sounds  Listen for at least 5 minutes before confirming absence. Borborygmus A term for stomach growling. Vascular Sounds Use the bell for detecting bruits (abnormal blood flow sounds) over arteries. Friction Rub Indicative of inflammation of peritoneal surfaces; typically heard over the liver or spleen. Percussion Techniques Tympany: Air-filled structures (e.g., stomach). Dullness: Solid organs or fluid (e.g., liver). Hyperresonance: Indicates excess air (e.g., emphysema). Liver Span Normal span is about 6-12 cm at the mid-clavicular line (MCL) and 4-8 cm at the midsternal line (MSL). Hepatomegaly and Splenomegaly Hepatomegaly: Enlarged liver, often due to disease or overload. Splenomegaly: Enlarged spleen, may result from infections or blood disorders. Kidney Percussion Blunt Percussion: Tap over the CVA; tenderness may suggest pyelonephritis. Light and Deep Palpation Light palpation first to assess surface characteristics, then deep for organ size and tenderness. Aorta Palpation  Palpate gently in the epigastric area; avoid if aneurysm is suspected. Tests for Ascites Ascites: Accumulation of fluid in the peritoneal cavity. Fluid Wave Test: Used to detect fluid presence. Tests for Appendicitis/Peritoneal Irritation Appendicitis: Inflammation of the appendix. Rebound Tenderness (Blumberg Sign): Pain upon releasing pressure. Rovsing Sign: Pain in the RLQ when pressure is applied to the LLQ. Psoas Sign: Pain when flexing the hip against resistance. Test for Cholecystitis Cholecystitis: Inflammation of the gallbladder. Murphy's Sign: Pain and interruption of breath when palpating the gallbladder during inhalation. Abnormal Findings Abdominal Distention Usually abnormal (excluding pregnancy); percussion can help determine the cause. Abdominal Bulges Hernias: Umbilical, epigastric, incisional, diastasis recti. Module 7 Musculoskeletal System Bones Functions of Bones 1. Support: Provides structural support for the body. 2. Protection: Shields vital organs (e.g., skull protects the brain). 3. Movement: Serves as levers for muscles to facilitate movement. 4. Mineral Storage: Stores minerals, particularly calcium and phosphorus. 5. Blood Cell Production: Produces red blood cells, white blood cells, and platelets in the bone marrow. Osteoporosis Definition: A condition characterized by weakened bones and increased fracture risk. At-Risk Populations: ○ Postmenopausal women ○ Older adults ○ Individuals with a family history of osteoporosis Modifiable Risk Factors: ○ Sedentary lifestyle ○ Smoking ○ Excessive alcohol consumption ○ Low calcium and vitamin D intake Patient Education to Prevent Bone Loss Nutrition: Encourage a balanced diet rich in calcium (dairy, leafy greens) and vitamin D (sun exposure, supplements). Exercise: Promote weight-bearing and resistance exercises to strengthen bones. Lifestyle Changes: Advocate for smoking cessation and moderation of alcohol intake. Skeletal Muscles: Movements 1. Abduction: Moving away from the midline. 2. Adduction: Moving toward the midline. 3. Circumduction: Circular motion of a limb.  4. Extension: Straightening a joint, increasing the angle. 5. Flexion: Bending a joint, decreasing the angle. 6. Dorsiflexion: Toes drawn upward toward the ankle. 7. Plantar Flexion: Toes pointed away from the ankle. 8. Pronation: Turning or facing downward. 9. Supination: Turning or facing upward. 10. Rotation: Turning a bone on its own axis. Joints Joint (Articulation): A point where two bones meet, allowing for movement. Bursa: A fluid-filled sac that reduces friction between tissues, such as tendons and bones. Normal Movements by Joint Elbow: Flexion and extension. Shoulder: Flexion, extension, abduction, adduction, rotation. Hip: Flexion, extension, abduction, adduction, rotation. Knee: Flexion and extension. Collecting Subjective Data: Nursing Health History (HPI) Effects of Weight Gain on the MSK System Increased load on joints can lead to pain, osteoarthritis, and decreased mobility. Assessing Joint, Muscle, and Bone Pain Character or Quality: Ask patients to describe pain (sharp, dull, aching). Questions to Ask: ○ Onset and duration of pain. ○ Location and intensity. ○ Aggravating and relieving factors. Personal Health History Common Questions: ○ History of fractures or injuries. ○ Menopausal status (related to estrogen levels and osteoporosis risk). Older Adult Considerations Increased risk of osteoporosis and joint stiffness; assess mobility and fall risk. Family History Relevant conditions include rheumatoid arthritis (RA) and osteoporosis. Lifestyle and Health Practices Questions to Ask: ○ Activity level and exercise frequency. ○ Medication usage and any known side effects. ○ Dietary habits and intake of calcium and vitamin D. ○ Use of tobacco, caffeine, and alcohol. ○ Impact of stress on health. Medication Effects on MSK Function Steroids: Can lead to bone loss. Statins: May have muscle-related side effects. Lifestyle Factors and Osteoporosis Risk Smoking, Caffeine, and Alcohol: Increase osteoporosis risk by affecting calcium absorption and bone density. Nutrients for MSK Health Calcium and Vitamin D: Essential for bone health; deficiencies can increase osteoporosis risk. Importance of Routine Exercise Regular physical activity helps maintain bone density, muscle strength, and overall mobility. Collecting Objective Data: Physical Examination Assessment of Joints and Muscles Inspection: Look for swelling, redness, and deformities. Limitations in ROM: Measured with a goniometer. Muscle Strength Rating Scale (0-5) 0: No muscle contraction. 1: Flicker of contraction. 2: Full range of motion with gravity eliminated. 3: Full range of motion against gravity. 4: Full range of motion against gravity with some resistance. 5: Full range of motion against gravity with full resistance. Active vs. Passive Range of Motion Active: Patient moves the joint. Passive: Examiner moves the joint. Inspection of Posture and Gait Normal Findings: Upright posture, balanced gait. Abnormal Findings: ○ Curvatures: Scoliosis, kyphosis, lordosis. ○ Gait Abnormalities: Shuffling, limping. TMJ TMJ Dysfunction: Characterized by jaw pain, clicking, or locking. Crepitus: A crackling or grinding sound in a joint. Spine Assessment Inspection and Palpation: Check spinal alignment and tenderness along the spinous processes and paravertebral muscles. Normal vs. Abnormal Findings: ○ Herniated Disc: Pain radiating down the leg. ○ Ankylosing Spondylitis: Reduced spinal mobility. Curvatures: ○ Kyphosis: Exaggerated thoracic curvature. ○ Lordosis: Exaggerated lumbar curvature. ○ Scoliosis: Lateral curvature of the spine. Flattening of Lumbar Curvature: Seen in conditions like obesity or pregnancy. Testing for Back and Leg Pain Straight Leg (Lasegue) Test: Checks for nerve root irritation, typically indicating a herniated disc. Upper Extremities Assessment Shoulders, Arms, and Elbows Inspection and Palpation: Assess for tenderness, dislocation, and range of motion. Bursitis: Inflammation of the bursa, causing pain and swelling. Testing for ROM Movements: Flexion, extension, abduction, adduction, rotation. Wrist Assessment Palpation of Anatomic Snuffbox: Tenderness may indicate a scaphoid fracture. Carpal Tunnel Syndrome (CTS) Tests: ○ Phalen Test: Wrist flexion for 60 seconds; positive if symptoms occur. ○ Tinel Sign: Tapping over the median nerve; positive if tingling occurs. Hands and Fingers Rheumatoid Arthritis vs. Osteoarthritis: ○ RA: Symmetrical joint swelling, deformities. ○ OA: Joint stiffness and pain, often in weight-bearing joints. Heberden Nodes: Located at distal interphalangeal joints (DIP). Bouchard Nodes: Located at proximal interphalangeal joints (PIP). Hips Assessment Inspection and Palpation: Assess for range of motion and tenderness. Impaired ROM: May indicate osteoarthritis or hip impingement. Knee Assessment Inspection and Palpation: Assess for swelling, tenderness, and range of motion. Conditions: ○ Osteoarthritis: Joint pain, stiffness. ○ Torn Meniscus: Locking sensation in the knee. ROM Testing Movements: Flexion and extension. Genu Valgum vs. Genu Varum  Genu Valgum: Knock knees. Genu Varum: Bow-legged. Older Adult Considerations Increased risk of knee issues; assess for stability and strength. Special Tests Bulge Test: Detects small amounts of fluid in the knee. Ballottement Test: Checks for large effusions in the knee. McMurray Test: Assesses for torn meniscus. Ankle and Feet Assessment Normal Findings: Check for symmetry and range of motion. Common Sprains: Most common site is the ankle. Gouty Arthritis Symptoms: Severe pain, redness, swelling, typically in the big toe. Plantar Fasciitis: Common cause of heel pain. Testing for ROM Assess dorsiflexion, plantar flexion, inversion, and eversion. Hammer Toe and Bunions Hammer Toe: Deformity causing the toe to bend downward. Bunion: A bony bump at the base of the big toe. Module 8 Neurological System Central Nervous System (CNS) Major Divisions (Lobes) of the Brain 1. Frontal Lobe ○ Function: Responsible for reasoning, planning, problem-solving, emotional regulation, and voluntary motor functions.  2. Parietal Lobe ○ Function: Processes sensory information related to touch, temperature, pain, and spatial orientation. 3. Temporal Lobe ○ Function: Involved in auditory processing, language comprehension, and memory. 4. Occipital Lobe ○ Function: Responsible for visual processing and interpretation. Broca’s and Wernicke’s Areas Broca’s Area: Located in the left frontal lobe; responsible for speech production. Wernicke’s Area: Located in the left temporal lobe; responsible for language comprehension. Structure and Functions Cerebrum: Largest brain part; responsible for higher cognitive functions, voluntary movement, and sensory processing. Brain Stem: Controls vital functions such as breathing, heart rate, and blood pressure. It includes the midbrain, pons, and medulla oblongata. Cerebellum: Coordinates movement, balance, and fine motor skills; helps with motor learning. Spinal Cord Description: A cylindrical structure extending from the brainstem to the lower back, surrounded by vertebrae. Functions: Transmits signals between the brain and body, processes reflexes, and integrates sensory and motor functions. Neural Pathways Sensory Pathways: Two ascending pathways transmit sensory impulses (e.g., pain, temperature) to the brain. Motor Pathways: Two descending pathways carry motor impulses from the brain to muscles for voluntary movement and body control. Peripheral Nervous System (PNS) Cranial Nerves (12 Pairs) 1. Olfactory (I): Smell; dysfunction can cause anosmia. 2. Optic (II): Vision; dysfunction can lead to vision loss.  3. Oculomotor (III): Eye movement, pupil constriction; dysfunction may cause ptosis. 4. Trochlear (IV): Eye movement (downward and inward). 5. Trigeminal (V): Facial sensation, chewing; dysfunction can lead to facial numbness. 6. Abducens (VI): Lateral eye movement. 7. Facial (VII): Facial expressions, taste; dysfunction can cause facial drooping. 8. Vestibulocochlear (VIII): Hearing and balance; dysfunction can cause tinnitus or hearing loss. 9. Glossopharyngeal (IX): Taste, swallowing; dysfunction may affect swallowing. 10. Vagus (X): Autonomic functions, voice; dysfunction can lead to dysphagia. 11. Accessory (XI): Shoulder movement, head turning. 12. Hypoglossal (XII): Tongue movement; dysfunction can affect speech. Collecting Subjective Data: Nursing Health History (HPI) Common Concerns Headaches: Ask about duration, intensity, and triggers. Seizures: A seizure is a sudden electrical disturbance in the brain; conditions like epilepsy may cause them. Questions should address frequency, duration, and triggers. Dizziness: Common causes include Ménière’s disease and vestibular disorders. Terms to Know Paresthesia: Tingling or numbness. Tinnitus: Ringing in the ears. Dysarthria: Difficulty speaking. Dysphasia/Aphasia: Difficulty understanding or producing language. Dysphagia: Difficulty swallowing. Fasciculations: Muscle twitches. Tremors: Involuntary shaking. Tics: Sudden, repetitive movements or sounds. Myoclonus: Sudden muscle jerks. Amnesia: Memory loss. Delirium: Acute confusion; Dementia: Chronic cognitive decline. Older Adult Considerations Assess for changes in hearing, vision, and the presence of tremors that may impact data collection. Objective Data Collection: Physical Examination Complete Neurologic Examination Areas 1. Mental Status: Assesses cognitive function and consciousness. 2. Cranial Nerves: Evaluate sensory and motor functions. 3. Motor and Cerebellar Systems: Assess muscle strength, coordination, and balance. 4. Sensory System: Test for various sensations (touch, pain, temperature). 5. Reflexes: Assess deep tendon and superficial reflexes. Assessment Techniques Mental Status: Evaluate orientation, attention, memory, and language. Motor and Cerebellar Systems: Assess balance (e.g., Romberg test) and coordination (e.g., finger-to-nose test). Reflexes: Document reflexes on a scale from Grade 0 (no response) to Grade 4+ (hyperactive). Cranial Nerve Assessment Assess each cranial nerve for normal vs. abnormal findings. Stroke Assessment: Act FAST Face drooping Arm weakness Speech difficulty Time to call emergency services Abnormal Findings Cerebrovascular Accident (Stroke) Types: ○ Ischemic: Blockage of blood flow. ○ Hemorrhagic: Bleeding in the brain. ○ Transient Ischemic Attack (TIA): Temporary blockage. Clinical Manifestations: Sudden weakness, confusion, trouble speaking, visual disturbances; remember "Be FAST." Abnormal Muscle Movements Atrophy and Fasciculations: Muscle wasting and twitching (e.g., ALS). Tics: Involuntary movements (e.g., Tourette syndrome). Tremors: Involuntary shaking (e.g., Parkinson's disease). Abnormal Gaits Cerebellar Ataxia: Unsteady, wide-based gait. Parkinsonian Gait: Shuffling, reduced arm swing, stooped posture. Scissors Gait: Legs cross while walking, often due to spasticity. Abnormal Postures Decorticate Posturing: Arms flexed, legs extended (indicative of severe brain damage). Decerebrate Posturing: Arms and legs extended (indicates more severe damage).