Laboratory - Final exam review.docx
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Laboratory - Final exam review Week 5-13 Week 5: Turning the sole of the foot outward = eversion The movement of bone away from the midline of the body = abduction The palm of the hand faces upwards = supination The increasing angle of the joint = extension Movement of an extremity in a full circle...
Laboratory - Final exam review Week 5-13 Week 5: Turning the sole of the foot outward = eversion The movement of bone away from the midline of the body = abduction The palm of the hand faces upwards = supination The increasing angle of the joint = extension Movement of an extremity in a full circle = circumduction Further straightening of a joint = hyperextension Moves leg towards midline = adduction Movement of a bone on its axis = rotation Decreasing the angle of a joint = flexion The palm of the hand faces downwards = pronation Turning the sole of the foot inward = inversion Active range of motion (AROM): the space in which you move a part of your body using your muscles. You make an effort without outside help (ex, lifting your arms above your head to stretch the muscles) *done by client* Passive range of motion (PROM): the space in which you move part of your body when someone or something is creating the movement. You are not the one engaging the muscles you would normally use to start the movement and do the work. *nurse does it* Active ROM is more beneficial because it strengthens the muscles, while passive only keeps the joints healthy Isotonic (dynamic) exercises: Causes muscle contraction and changes in muscle length (isotonic contraction) Enhances circulatory and respiratory functioning, increases muscle mass, tone, and strength, promotes osteoblastic activity Improves cardiovascular fitness Ex, walking, swimming, jogging Isometric (static) exercise: Involves tightening or tensing muscles without moving body parts Flex or contract muscles while being static Ex, clenching butt, flex quads Isokinetic (resistive) exercises: Pushing against something stationary strengthens muscles Ex, push-ups Number of steps per minute = pace Exercise in which another provides energy to move body parts = passive exercises A device that measures the angle of joint movement = goniometer The way a person walks = gait The exercise carried on by the client that moves the body parts = active exercises Activities of daily living = ADL Degree of movement possible for each joint = range of motion The normal condition of tension of a muscle at rest = muscle tone T/F: F - the spine of a newborn has the shape of an “S” - “C” shape F - It is normal for an infant to have an extra gluteal fold - bones are not fully developed until later years T - at 5 months of age a baby rolls from prone to supine and back to prone T - at 8 months a baby sits alone without support T - at 12 months of age a baby will hold a cup and spoon and can feed themselves T - at 14 months a baby walks alone T - it is normal for toddlers to have lumbar lordosis (tummy sticks out when standing and walking) F - at age 60, decrease in muscle mass, tone, and strength exceeds 20% - 5% T - in older adults, thinning of the intervertebral discs is a normal musculoskeletal change T - the appearance of an older adult stance, posture is one of the general flexion The patient is the first person you should talk to about making decisions on aspects of care Air cast: is designed to be removable, better for hygiene, and skincare, and to perform physical therapy exercises or to clean the injured area. This makes it easier to maintain skin health and comfort during the healing process Traditional cast: not removable, can cause itchy and odor skin, provides proper immobilization, beneficial for injuries that require longer times to heal What will the skin look like once a cast is removed? Skin changes: the skin under the cast may appear pale, dry, and flaky. It can be sensitive and may itch due to a lack of exposure to air and moisture. Bruising or discoloration: depending on the nature of the fracture and the presence of any surgical interventions, there may be bruising or skin discoloration. Hair growth: in areas where the cast was in contact with the skin, there might be temporary hair loss or changes in hair texture Atrophy: muscles haven't been moved in a while Week 6: Temperature: Temp most accurate going to be higher than the surface (ex, rectal) - Core temp Temp not as accurate, lower than core (ex, forehead) - surface temp The preferred site of body temp assessment of children is ear or axillary The average range of adult oral temperature is 36-38 degrees Celsius, anything over is a fever Someone's temperature will be slightly higher at 1800 during the 24-hour cycle The appropriate term for a fever is febrile or pyrexia The appropriate site to take the temperature of an unconscious client is the ear area Pain: The most reliable indicator of a person's pain is the person's self-report. Pain is a highly subjective experience for each person. Physical examination for pain: facial expressions, body movements, vitals signs, muscle tension, verbal and nonverbal cues, restlessness or agitation, pallor or flushing, sweating, appetite and sleep changes OPQRSTUV O - Onset/origin: when and where did it start P - Palliation/provocation: what makes the pain better Q - Quality: what does the pain feel like R - Region/Radition: where is your pain, and does it radiate S - Severity: score pain using a validated pain tool T - Timing/Treatment: when did the pain begin or end and how long did it last U - Understanding: what do you believe is causing this symptom V - Value: any other views or feelings about this symptom Respiratory: Bronchial sounds are heard over the trachea and major bronchi Bronchovesicular sounds are heard over the first and second intercostal space Vesicular breath sounds are heard over the lung fields Resonance = hollow sound heard over normal lungs Tympany = drum like sound heard over an air-filled stomach or intestines T/F: F - the right lung comprises two lobes, and the left lung comprises three lobes - the right lobe has 3 lobes, the left has 2 lobes due to the fact it needs to make room for the heart T - During inspiration the diaphragm descends and flattens T - the trachea bifrucates about at the level of the sternal angle F - Tactile fremitus will be decreased with consolidation of the lung - greater intensity in areas of increased lung density T - Percussion sounds over aerated lung tissue are resonant F - The bell of the stethoscope is used to ausculate the lungs - The diaphragm is used T - The anteroposterior ot transverse diameters of the adult T - Expiration is normally twice as long as inspiration When examining for tactile fremitus, it is important to: Palpate the chest symmetrically The pulse oximeter measures: Arterial oxygen saturation Normal range of respirations/minutes for: Adult: 12-20 Newborn: 30-60 4 characteristics included in an assessment of respirations: Respiratory rate Rhythm Depth Effort Difficult respirations = Dyspnea Abnormally slow respirations = bradypnea Respiratory rate more than 24 b/m = Tachypnea Very shallow respirations = Hypoventilation Absence of respirations = Apnea Normal, quiet breathing = eupnea Week 7: The normal angle between fingernail and nailbed is 160 degrees This angle is important because it can indicate heart disease or problems in the heart Pulse: Pulse rate is measured in beats per minute (bpm) with a normal rate ranging from 60 to 100 in the male adult In infants and children 100-160 bpm From birth to adulthood the pulse decreases 4 things to asses when taking a clients pulse: Pulse rate Pulse rhythm Pulse strength/volume Pulse bilateral equality A very slow pulse rate = Bradycardia The chest cavity = Thorax Pulse rate over 100 beats/m = tachycardia A pulse with an abnormal rhythm = arrhythmia The difference between apical and radial pulse = pulse deficit Wave of blood produced when left ventricle of heart contract = pulse Blood pressure is measured in mmHg using as instrument called a sphygmomanometer Diastolic pressure is less significant than systolic pressure In the average adult, the arterial blood exterts a pressure stong enough to raise a column of mercury to a height of 120 mmHg during systole and 80 mmHg during diastole Blood pressure increases throughout the day peaking at late afternoon/early evening Pulsations of the blood are auscultated above the brachial artery when assessing a high BP Abnormally high blood pressure = hypertension the difference between systolic and diastolic pressure = Pulse pressure ( pulse pressure is important in infants can detect an issue in the heart) The pressure of the blood against the arterial walls when ventricle of the heart contract = systolic pressure Abnormally low blood pressure = hypotension The pressure of the blood against the arterial walls when ventricles of the heart are at rest = diastolic pressure An instrument used to measure the pressure of blood within the veins = sphygmomanometer Korotkoff phases indicated in the B/P reading 130/84/80: 130 - phase 1 - a sharp thump 81 - phase 4 - a softer blowing sound that fades 80 - phase 5 - silence Week 9: Peristalsis = intestinal movement of content like food moving through When asuculating bowel sounds, the diaphragm of the stethoscope is used Before concluding that bowel sounds are absent, the nurse must ausculate the abdomen for at least 5 minutes, you should hear 5-30 sounds per minute The characteristic percussion sound elicired over the abdomen is tympany The normal range of liver span in the midclavicular line is 6-12cm The normal percussion sound elicited over the liver is a dull sound The second assessment method used to examine the abdomen is ausculation To determine the position of the lower liver border, the nurse starts percussing the right upper quadrant T/F: F - When inspecting the abdomen normally peristalsis should be visible - only on thin patients, not normal T - Silver white striae in the lower abdominal area are normal ‘ F - On light palpation, you should be able to feel the liver, spleen, and kidneys - deep palpation on these organs T - to assess abdominal contour, the nurse should have her head only slightly higher than the clients abdomen T - Elderly clients often manifest a more lax abdominal tone T/F - marked pulsation is observable in the abdominal aorta in elderly clients F - to assess the young infants abdomen, the best approach is to have him/her on the parents lap, true for toddlers, false for young infants - young infants are also for this approach F - the sequence for a pediatric abdominal assessment should be 1) auscultation, 2) percussion, 3) inspection, 4) palpation - inspection, ausculation, palpation, percussion T - Crying tenses the abdominal muscles and interferes with accurate assessment Organ in quadrant of stomach: Stomach = upper left quadrant Sigmoid colon = lower left quadrant Appendix = lower left quadrant Gallbladder = upper right quadrant Liver = upper right quadrant Duodenum = upper right quadrant Body of the pancreas = upper left quadrant Cecum = lower right quadrant Head of the pancreas = upper left quadrant Genitourinary assessment: Voiding at frequent intervals = frequency Decreased urine output (less than 400ml/24 hrs) = oliguria Accumulation of urine in the bladder = urinary retention Feeling the need to void immediately = urgency Painful or difficult voiding = dysuria Not feeling as if able to empty the blade (volume of 100ml or more of urine remaining in the bladd after voiding) = residual urine Difficult getting the flow of urine started = hesitancy Voiding often during the night = nocturia Involuntary loss of urine = incontinence Polyurea = voiding a lot Week 10: Neurological: T/F: T - a patient is considered alert if they spontaneously open their eyes when you call their name F - Usually loses orientation in order with person being first - time, place, person F - Use open ended questions with the aphasic patient - they are unable to speak properly, will need to use close ended questions T - PERRLA means pupils, equal, round, reacting to light, and accommodating F - A dropper is an instrument used to asses the pupil size - pupilometer To test for sterognosis, you would: Place a coin in the persons hand and ask them to identify the object To elicit a babinksi reflex, the examiner should: Stroke the lateral aspect of the sole of the foot from heel to the ball (babinski normal for kids, not normal for adults) A positive babinski sign is: Dorsiflexion of the big toe and fanning of all toes 8 peripheral vascular checks: Pulses Capillary refills Skin temperature Skin colour Edema Pain level Altered sensation Change in function (movement) What does CSM mean? C: Circulation S: Sensation M: Movement Would perform this assessment after any injury, postoperative, casts, splints, before surgical procedure, stroke Grading scale for assessing the force of an arterial pulse: 0 = Absent/dead pulse 1+ = weak/diminished/thready pulse 2+ = normal/expected pulse 3+ = full/bounding pulse Grading scale for pitting edema: 0 = no pitting edema 1+ = mild pitting edema, 2mm depression, disappears rapidly 2+ = moderate pitting edema, 4mm depression, disappears in 10-15 seconds 3+ = deep pitting edema, 6 mm depression, may last more than 1 min 4+ = very deep pitting edema, 8mm depression, can last more than 2 mins Compartment syndrome: A painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerves and muscles It develops when swelling or bleeding occurs within a compartment because fascia does not move or expand Week 11: Breast examination: When should individuals start doing monthly breast examinations: Women should start doing monthly checks in their 20s Before menopause, when is the best time to tell your client to examine their breasts: Recommend that women perform breast self examination monthly, about 5 days after your period Normal changes in the breast during the life span: Puberty: hormonal changes, especially the increase in estrogen, lead to the development of breast tissue The breasts may feel tender or sore as they grow, asymmetry The areolas (the darker area surrounding the nipples) may darken in colour Menstraul cycle: Hormonal fluctuations during the menstrual cycle can cause changes in breast size and sensitivity Some women may experience breast swelling or tenderness in the premenstrual phase Pregnancy: The breasts undergo significant changes in preparation for breastfeeding Breasts may become larger, more tender, and heavier The areolas may darken, and montogomerys glands (small bumps on the areolas) may become more prominent Veins may be more visible due to increased blood flow Breastfeeding: The breasts continue to change during breastfeeding Milk production causes the breasts to become fuller and sometimes more sensitive The areolas may enlarge, and nipples may become more prominent Postpartum: After weaning, breasts may gradually return to their pre-pregnancy size, but some changes may persist The skin may stretch and breasts may lose some firmness Perimenopause and menopause: Hormonal change during permenoause and menopause can lead to a reduction in breast tissue and changes in breast density Breasts may lose some firmness and fullness The risk of developing breast cancer increases with age, especially after menopause Difference between a cyst and a tumour: Cyst: is a sac-like structure that can be filled with fluid, pus or other substances, it has a distinct boundary or capsule Tumour: is an abnormal mass or lump of tissue that can be either benign or malignant Testicular examination: When should individuals start doing testicular examinations: Men should start doing testicular examinations during puberty, typically around age 15. (puberty and late teens) What should a normal testicular examination include: Size and symmetry Texture: rubbery/smooth No unusual lumps No pain or discomfort What is the most common symptom of testicular cancer: Painless lump or swelling in one of the testicles No chest pain or shortness of breath, no leg cramping or pain, no indigestion or burning, no dizzness or change in cognition = review of body symptoms Breast cancer 20 years ago, hypertension, hypertension controlled by diuretics, cataract surgery 1990 = past health history Older adulthood, ego integrity vs despair = developmental level Decreased appetite and inability to engage in usual activities, complains of fatigue = history of present concern 80 year old widow with four daughters resident of retirement community of 8 years = biographical data Both parents dies of heart disease in their 70s, no known family history of cognitive problems = family health history Doesnt smoke and rarely drinks a glass of wine, performs all personal care independently, walks independently with rolling walker = lifestyle and health practices Complains of fatigue and general malaise = reason for seeking healthcare The five steps in performing a 5-min head to toe assessment: General overview Head and neck assessment Upper extremities assessment Chest and abdomen and back assessment Lower extremities assessment
