Medical Terminology and Anatomy, Exams of Nursing

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NR 509 Final 2022 Know that in a 47-year-old man ED is usually ___________ rather than testosterone - psychologic Erectile dysfunction may be from psychogenic causes, especially if - early morning erection is preserved. it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, and diabetes When performing a breast exam, know what abnormal masses should do when the arm - may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted over head or hands are pressed against hips) Fibroadenoma and cysts mobility - very mobile/mobile Know that a high proportion of breast masses are noted during ________ - BSE Breast stage 1 - preadolescent- elevation of nipple only Breast stage 2 - breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar diameter breast stage 3 - further enlargement of elevation of breast and areola, with no separation of their contours breast stage 4 - projection of areola and nipple to form a secondary mound above the level of breast breast stage 5 - mature stage- projection of nipple only; areola has receded to general contour of the breast (although in some individuals the areola continues to form a secondary mound) Know where pain is located with pancreatitis: acute - epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe sequelae of organ failure Know where pain is located with pancreatitis: chronic - epigastric, radiating to back Know how hepatitis A is transmitted - Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water and foods leading to infection of household and sexual contacts Stress incontinence - the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise the bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery, postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men. urge incontinence - detrusor contractions are stronger than normal and overcome the normal urethral resistance. The bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes ie: frequent voluntary voiding at low bladder volumes. overflow incontinence - detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention. The bladder is typically flaccid and large, even after an effort to void. Mechanisms: obstruction of the bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic neuropathy. functional incontinence - the patient is functionally able to reach the toilet in time because of impaired health or environmental conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor vision, or other conditions. Also environmental factors such as an unfamiliar setting, distant bathroom facilities, bed rails, or physical restraints. Incontinence secondary to medications - drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic blockers, and potent diuretics Know where lymph nodes should be with strep - · Strep throat àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy throat Know how a bartholin's gland infection presents - Acutely, the gland appears as a tense, hot, very tender abscess. Possible labial swelling. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small. Know where pain is with appendicitis - RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall rigidity on palpation is suspicious for appendicitis Know how syphilis presents genitally - Female: syphilitic chancre- firm, painless ulcer from primary syphilis, forms approx. 21 days after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals regardless of treatment in 3-6 weeks. Secondary syphilis (Condyloma lantum)- large raised, round or oval, flat-topped gray or white lesions point to condylomata lata. These are contagious and, along with rash and mucus membrane sores in the mouth, vagina, or anus are manifestations of secondary syphilis. Male: Primary syphilis: small red papule that becomes a chancre, a painless erosion up to 2 cm in diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated. Chancre heals within 3-8 weeks. Know the signs of proctitis - Anorectal pain, itching, tenesmus, or discharge or bleeding from infection or rectal abscess suggest proctitis. Know what causes dark, bloody emesis - Hematemesis may accompany esophageal or gastric varices, Mallory-Weiss tears, or peptic ulcer disease. Know what causes an S3 heart sound - In children and young adults, a third heart sound (S3) may arise from rapid deceleration of the column of blood against the ventricular wall. In an older adult, an S3 usually indicates a pathologic change in ventricular compliance. Know the signs of thrombophlebitis - Local swelling, redness, warmth, and a subcutaneous cord signal superficial thrombophlebitis (an emerging risk factor for DVT). Know what chalazion is - A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May become acutely inflamed, but unlike a stye, usually points inside the lid rather than on the lid margin. Know what the lungs do with age - Chest wall becomes stiffer and harder to move (decrease in chest wall compliance), respiratory muscles may weaken, and the lungs lose some of their elastic recoil. Lung mass and the surface area for gas exchange decline, and residual volume increases as the alveoli enlarge. An increase in closing volumes of small airways predisposes to atelectasis and risk of pneumonia. Diaphragmatic strength declines. Know what diastasis recti is - As tension on the abdominal wall increases with advancing pregnancy, the rectus abdominus muscles may separate at the midline, called diastasis recti. If diastasis is severe, especially in multiparous women, only a layer of skin, fascia, and peritoneum may cover the anterior uterine wall, and fetal parts may be palpable through this muscular gap. Identify the macula in the eye - Know the sequence of the abdomen - Inspect, auscultate, percuss, palpate (first palpate lightly, then deeply). Assess the liver and spleen by percussion then palpation. Try to palpate the kidneys. Palpate the aorta and its pulsations. If you suspect kidney infection, percuss posteriorly over the costovertebral angles. Senile (Actinic) Pupura - Know the signs of epididymitis - Acute epididymitis: an acutely inflamed epididymis is indurated, swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Know what to do if you cannot feel a testicle in the scrotum of a newborn - If you feel a testis up in the inguinal canal, gently milk it downward into the scrotum. Need to differentiate between undescended testes (in the inguinal canals) and highly retractile testes. Know the sign factors of prostate cancer: age - rare in ages below 40 but incidence rates begin increasing rapidly after age 50. Median age at diagnosis is 66. Know the sign factors of prostate cancer: ethnicity - African American men have the highest incidence and mortality rates. Compared to white men, a higher percentage of African American men are diagnosed with prostate cancer before age 50. They are also more likely to present with advanced-stage cancer. Know the sign factors of prostate cancer: family hx - Genetics appear to play an important role in prostate cancer risk. For men with one affected first degree relative (father, brother) risk of developing prostate cancer increases two fold. For men with 2 or 3 affected first degree relatives, risk increases 5-11 fold. The BRCA1 and BRCA2 mutations also appear to confer increased risk of prostate cancer. Know the sign factors of prostate cancer: other risk factors - Agent Orange exposure among Vietnam veterans, diets high in animal fat, obesity, and cigarette smoking. BPH is NOT a risk factor. Know what chicken pox looks like (will be a description) - Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters. (CDC) Know the signs of candida vaginitis - (YEAST INFECTION) Discharge that is white and curdy, may be thin but typically thick, not malodorous. Often accompanied by pruritis, vaginal soreness, pain on urination (from skin inflammation) and dyspareunia. Vulva and surrounding skin are often inflamed and sometimes swollen to a variable extent. The vaginal mucosa is often reddened with tenacious patches of white discharge. Know to screen for depression with vague complaints and negative work-up - Know when to order ABI (ankle-brachial index) - Order with findings of diminished or absent pulses (present in peripheral arterial disease (PAD) Know which lymph node group is most commonly involved in breast cancer - central nodes (axillary) Know the Risk Factors for PAD - 1. Age greater than or equal to 50 with a hx of DM or smoking 2. Leg symptoms with exertion Know what atopic dermatitis looks like - Eczema: erythema, scaling, dry skin, and intense itching Know the signs of depression - Early signs: low self-esteem, loss of pleasure in daily activities (anhedonia), sleep disorders and difficulty concentrating or making decisions. Vulnerable populations: young, female, single, divorced, or separated, or chronically ill, bereaved, or have other psychiatric disorders, including substance abuse. Know when to give the tetanus vaccine - All adults age 19 or older who have not received a Tdap should receive a single dose regardless of the time interval since last Td. After receiving Tdap they should receive Td boosters at 10 year intervals. For adults 65 and older this will reduce the likelihood of transmission to infants under 12 months. Know the risk factors for breast cancer - ***Age: (65+ vs <65 years although risk increases across all ages until age 80) Biopsy- confirmed atypical hyperplasia Certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2) Ductal carcinoma in situ Lobular carcinoma in situ Personal hx of early onset breast cancer (<40 years) Two or more 1st degree relatives diagnosed with breast cancer at an early age Age of first full term pregnancy Late menopause Breast tissue density Modifiable risk factors: breastfeeding for less than 1 year, postmenopausal obesity, use of HRT, cigarette smoking, alcohol ingestion, physical inactivity, and type of contraception. Know the signs of BPH - Symptoms arise from both smooth muscle contraction in the prostate and bladder neck and from compression of the urethra. They may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both and are seen in more than 1/3 of men by age 65. The affected gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen. Know the signs of elder abuse - abuse, neglect, exploitation, or abandonment. Prevalence is highest in adults with dementia and depression. Know the signs of rectal prolapse - On straining for a bowel movement, the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of tissue. A prolapse involving only mucosa is relatively small and shows radiating folds. When the entire bowel is involved, the prolapse is larger and covered by concentrically circular folds. Know what a onychomycosis looks like - Know the signs of gestational HTN - Gestational is systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) > 90 mm Hg first documented after 20 weeks, without proteinuria or preeclampsia, that resolves by 12 weeks postpartum. Know what to do if you feel an abdominal mass - Occasionally there are masses in the abdominal wall rather than inside the abdominal cavity. Ask the patient either to raise the head and shoulders or to strain down, thus tightening the abdominal muscles. Feel for the mass again. Know the best way to examine the lateral portion of the breast - Ask the patient to roll onto the opposite hip, placing her hand on her forehead but keeping the shoulders pressed against the bed or examining table. This flattens the lateral breast tissue. Begin palpation in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple, then reposition the patient to flatten the medial portion of the breast. Know what functional syndrome is - has been applied to several related syndromes characterized more by symptoms, suffering, and disability, than by consistently demonstrable tissue abnormality. Examples include IBS, fibromyalgia, chronic fatigue, TMJ disorder, and multiple chemical sensitivity. Have been shown to "frequently co-occur and share key symptoms and selected objective abnormalities." The co-occurrence rates for IBS, fibromyalgia, chronic fatigue, TMJ disorder, and multiple chemical sensitivity reach 30-90%, depending on the disorders compared. The prevalence of symptom overlap is high, name complaints of fatigue, sleep disturbance, musculoskeletal pain, HA, and GI problems. Also overlap in rates of functional impairment, psychiatric comorbidity, and response to cognitive and antidepressant therapy. Internal hemorrhoid - enlargements of the normal vascular cushions located above the pectinate line, usually not palpable. May cause bright red bleeding, especially during defecation. They may also prolapse through the anal canal and appear as reddish, moist, protruding masses. Polyps of the rectum - fairly common and variable in size and number, they can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult or impossible to feel even when in reach of the examining finger. Endoscopy and biopsy are needed for differentiation of benign from malignant lesions. Cancer of the rectum - usually firm, nodular, rolled edge. Know what causes a split S2 - During inspiration the right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the neighboring left ventricle. This delays the closure of the pulmonic valve, P2, splitting S2 into its two audible components. Can be heard at the 2nd and 3rd left intercostal spaces close to the sternum. Know that the Buerger test is for ______________________________ - chronic arterial insufficiency Postural color changes of chronic arterial insufficiency - if pain or diminished pulses suggest arterial insufficiency, consider looking for postural color changes using the Buerger test. Raise both legs to about 90 degrees for up to 2 min until there is maximal pallor of the feet. Then ask the patient to sit up with legs dangling down, compare both feeting noting the time required for: Return of pinkness of the skin, normally about 10 sec or less Filling of the veins of the feet and ankles, normally about 15 Know the causes of increased jugular venous pressure - Elevated JVP is highly correlated with both acute and chronic heart failure. It is also seen in tricuspid stenosis, chronic pulmonary hypertension, SVC obstruction, cardia tamponade, and constrictive pericarditis