NR304 Exam 3 Study Guide / NR 304 Exam 3 Study Guide (Latest-2022/2023): Chamberlain Colle, Study Guides, Projects, Research of Nursing

Download NR304 Exam 3 Study Guide / NR 304 Exam 3 Study Guide (Latest-2022/2023): Chamberlain Colle and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Exam 3 Study Guide Breast and Axillae Structure and Function -Purpose: production of milk and sexual pleasure -Cooper’s Ligaments: “coopers droppers” breast stretch as you age (ligaments lengthen and stretch) -Four quadrants of the breast (face of clock) -Tail of spence: up by the axillary, check for lumps -Where breast cancer is usually found -Palpate all the lymph nodes -Central (axillary) -Pectoral (anterior) -Subscapular (posterior) -Lateral (brachial) Breast History -Is it cyclic? Does it occur around the same time? Example: every time a woman gets her period she gets breast pain. -Caffeine contribute to pain -Skin Rash: where did it start? From the nipple out? Or the skin towards the nipple? Paget’s Disease: nipple is red, scaly, and itchy, spreading off of nipple Galactorrhea: discharge -Yellow discharge: clostridium (normal for pregnant) -Bloody nipple discharge: cancer -Grayish discharge: clogged duct from milk Development: Childhood -Newborns: breasts may be enlarged at birth due to mom’s hormones (witch’s milk) -Adolescence: tanner 2-5 about 3 years -Stage 1) preadolescent stage: before age 10, nipple small, slightly raised -Stage 2) Breast bud stages: after age 10, nipple and breast form small mound -Stage 3) Menarche begins (first period), breast bud will enlarge -Stage 4) Late adolescent stage (14-17 years) Pregnancy Non-pregnant breast -3-4 days before period: full, tight, heavy, sore -4-7 days after period: least full, least nodular Pregnant breast -Ductal system expansion, secretory alveoli -Nipples/areola large and dark, venous pattern -Colostrum (4th month) thick yellow protein rich Cultural Considerations -African-American girls begin puberty 1-1.5 years earlier than Caucasian -Menses: African-American girls 8.87 years compared to 10 years for Caucasian -Puberty began before 8 years highest in Hispanics Breast Exam: Inspection -Skin: color, texture, temperature, appearance, dimpling, nipple retraction -One breast usually bigger than the other -Supernumerary Nipples: normal variant Supernumerary Nipples -Normal variant along tract of mammary ridge -3rd Nipple Abnormalities Peau cl’orange: porous, orange looking, big sign of breast cancer Gynecomastia: enlargement of breasts (male) usually due to testosterone decrease from cirrhosis, testicular tumor, DM, pituitary tumor, alcoholism, obesity Risk Factors for Breast CA -50 years or older -BRCA 1 and 2 genes -First degree relative -Menstruation less than 12 yr Cultural and Environmental Considerations Cultural -Infibulation-circumcision of the clitoris “SOCIAL CUSTOM”, not religious -Menstrual Prohibition- “Red Tent” no touching food or men. PERIODS Dysmenorrhea: painful periods, very bad cramps Amenorrhea: No period Primary Amenorrhea: never had period -15 to 16 years old may be due to hormones LH and FSH or chromosomal abnormalities Secondary Amenorrhea: had period in past, but not now -Due to birth control pills, pregnancy, menopause, thyroid dysfunctions, athletics or antidepressants Exposure to Diethylstilbestrol DES -Given in the 1940s or 1950s, was supposed to prevent miscarriages -Offspring had weird uterine tumors and testicular cancers Infertility Concerns: Under 35 has to be a full 12 months -Over 35 talk to you a lot quicker Lithotomy: position in which you place female for examination -Draping or feet at sides -Pillow, tuck sheet between legs Chandelier’s Sign -Cervical motion tenderness -While poking cervix patient will jump up if sign is positive Speculum of Cervix -Nulliparous: perfect donut, never had sex or a baby -Parous: after childbirth -Cervical Eversion: cells are growing on the outside Rectovaginal Examination -One in vaginal canal and on in rectum Adnexa: Ovaries Abnormal Findings: External Pediculosis Pubis: lice in pubic hair -Will itch when lice takes a bite Herpes Simplex Virus-2 -Pubic region -Once you have herpes you have it for life -Burning, tingling, itching -Painful, especially during urination -Cannot have a vaginal birth Syphilitic Lesion -Nontender papule which converts to draining ulcer Abscess of Bartholin’s Gland -Labial edema, erythema with palpable mass -Purulent drainage Human Papilloma Virus -Cauliflower warts in clusters -More than 40 HPV types -Seen on vulva, inner vagina, cervix, and anal area Atrophic Vaginitis -Estrogen deficiency -Dryness, itching, dyspareunia -Postmenopausal women Candidiasis (Yeast infection) -Alteration in vaginal pH (douches) predispose to this condition -Vulva and vagina are erythematous -Cheesy, white discharge Bacterial Vaginosus -Smelly vaginal discharge -May look grayish white or yellow -“Fishy” smell, which may be worse after sex -Multiple sex partners, alcohol, and douching -Protects from bacteria Corpus Cavernosum: pair of sponge-like regions of erectile tissue which contain most of the blood in the penis during penile erection Corpus Spongiosum: surround urethra Prostate -Similar to skene’s gland in females -Size of chestnut -Consistency of hardboiled egg without shell -Secretes milky, alkaline solution (aids sperm motility) Scrotum -Loosely hanging pear-shaped pouch -Below surface lie two muscles: Dartos and cremasteric (contract the testes) Testes: left hangs lower than right, both will hang lower than body to maintain a good body temperature to keep sperm healthy Epididymis: comma shaped organ Inguinal Area: groin area -Lots of lymph nodes -Can get inflamed -Testicular cancer can affect groin lymph nodes -Femoral ring Perianal Area: anus -Anus is terminal end of the GI system -Valves of Houston: keep stool supported -Internal Muscles Involuntary: S1, S2, and S3 Male Genitals -Should be evident at birth -Any ambiguity, get genetic counseling Hypospadias: urethral opening on ventral side of the penis Epispadias: urethral opening on the dorsum of the penis Phimosis: cannot retract foreskin (normal occurrence up to 3-years old) Cryptorchidism: one or both testes absent from scrotum -Descend by 2-3 years of age, if not take it out (surgery) -can increase testicular cancer Puberty onset in Males: 10-15 years old -Increase in testosterone -Testes and scrotum enlarge -Testes produce mature -Nocturnal emissions Precocious Puberty -Endocrine disorder, idiopathic, genetic causes, adult male characteristics appear before 10 years old Maturation Stages in the Male Stage 2: pencil penis Stage 3: larger in size Stage 4: pubic hair will grow out on medial aspect of thighs Penis (Smegma) -Exfoliated cells under foreskin Hernia -patient will bend down and cough, a little lump will poke out at you False Positive Occult Blood -Iron Supplement -Blood from other than GI tract (nose bleed, swallow blood from respiratory tract) -High amounts of red meat -Vegetables: cabbage, radishes, broccoli, cantaloupe, and parsnips Benign Prostatic Hyperplasia -happens to men as they age -Symptoms: urinary frequency, urgency, nocturia Prostatitis -Swelling and inflammation of the prostate gland -Result in dysuria, pain in the groin, pelvic area or genitals, and sometimes, flu-like symptoms -FLOWMAX: antibiotics Prostate Cancer -Increases with age -Highest incidence in African-American -Signs and symptoms (nonspecific): urinary retention, dribbling, cystitis Testicular Cancer -most common cancer in ages 20-35 years old -No warning signs -greatest incidence in Caucasians Syphilitic Chancre -Nontender lesions -Round or oval shaped Genital Herpes -Small vesicles -Occur in clusters -Painful Genital Warts -Caused by HPV -Papular Lesions Epididymitis -Associated with UTI and chlamydia -Painful and tender Orchititis -Inflammation of one or both testicles -Associated with the virus that causes mumps and STIs -Spermatic cord twists -Sport injuries Testicular Torsion -Testicle rotates, twisting the spermatic cord -Sudden and severe pain and swelling -Common between ages 12 and 16 Pilonidal Cyst -pocket that usually contains hair and skin debris -occurs frequently in people who sit for long periods of time Hemorrhoids -Varicosities of the hemorrhoidal veins Prolapsed rectum -Occurs when rectal mucosa protrude through the anus Perirectal Abscess -infection of anal gland -opening between internal and external Inguinal Hernias Direct Hernia -Characteristics: extrusion of abdominal contents into inguinal ring -Signs/Symptoms: most often painless, appears as swelling Indirect Hernia -Characteristics: Abdominal intestine may remain within the inguinal canal -Most common type of hernia -Signs/Symptoms: Swelling present -During coughing, you will feel pressure against your fingertip Femoral Hernia -Characteristics: Bulge occurs over the femoral artery -Lowest incidence of all inguinal hernias -Signs/Symptoms: May not be painful -Risk of strangulation Urinary System Subjective Data -Nocturia: getting up during the night to urinate -Dysurina: burning when you pee -Hematuria: blood in urine -Amber: concentrated urine and blood can be present due to filtration -Foamy urine: protein spill, bad kidney damage (beer color urine) Infants and Children -Renal blood flow and glomerular filtration rate, increase at birth compared to fetal filtration -Enuresis: bedwetting -Concerning after 5 years of age, may be social and family issues, infection, and diabetes Pregnancy: -1st trimester: pressure on bladder from uterus -2nd trimester: frequency decreases -3rd trimester: frequency returns -Urine production increase -May retain urine (UTI) -Edema in ankles, legs Older Adult -Decrease in renal blood flow and perfusion -Decrease ability to concentrate and dilute urine -Prostate enlargement -Kidneys are not functioning as well as they use to Important Labs Blood Urea Nitrogen (BUN)-excreted by kidney after metabolism Creatinine: cleared by kidney as normal product of muscle contraction Serum Potassium: monitored closely since if K+ not cleared by kidney, then it builds up in body causing cardiac arrhythmias Percussion/Palpation -Do not percuss or palpate if there is a tumor, polycystic kidney disease, or discomfort in pelvis region -Palpate over costovertebral angel, right and left Bladder Palpation -Palpate the bladder 2-2.5 inches below the umbilicus -Percuss bladder -Dull indicated full bladder Changes in Urinary Elimination -Dysreflexia: neurological dysfunction of bladder-may retain or be incontinent (Parkinson, MS, DM) Incontinence -Functional: continent but cannot get to the bathroom, disabled, line waiting -Reflex: incontinent with full bladder or at predictable intervals -Stress: with laugh, cry, sneeze -Urge: sudden need and urgency-often bladder spasms -Total: no control of bladder/urine often due to neurologic injury Urinary Retention: not able to fully empty bladder-leads to urinary stasis and infection Renal Calculi: stones -Form accumulation of magnesium, ammonium, phosphate, and uric acid -Urinary frequency, urgency, hematuria -Obese and weight gain increase risk for kidney stones -Not drinking enough fluids increase risk Abnormal Findings Pyelonephritis (inflammation of renal pelvis of kidney) -Usually due to reflux of bacteria from bladder up to infect kidneys fever, N/V, CVA tenderness, hematuria Glomerulonephritis (inflammation of glomerulus) -Usually due to antibody/antigen reaction to a bacterial infection (strep) -Tea color, frothy urine -Glomerulus becomes leaky -Often hypertensive Tumors Renal Tumors: benign or malignant -Malignant more common -Hematuria, flank pain, weight loss, palpable mass Bladder Cancer -Related to smoking, multiple sex -Aging -Painless hematuria, flank pain, frequent urination UTI -Inflammation of bladder-cystitis -Usually sudden onset (may have blood in urine)