NURS 210 test 2

where are the parotid glands

in the cheeks over the mandible and are not normally palpable

where are the carotid artery and internal jugular vein

beneath the sternomastoid muscle

where is the external jugular vein

diagonally across the sternomastoid muscle

what cranial nerve controls the neck muscles

XI

where are the preauricular nodes

in front of the ear

where are the post auricular nodes

behind the ear

where are the occipital nodes

at the base of the skull 

where are the submental nodes

behind the tip of the chin

where are the submandibular nodes

halfway between the chin and the angle of the jaw on the jaw line

where are the jugulodiagastric (tonsillar) nodes

under the angle of the mandible

where are the superficial cervical nodes

overlay the sternomastoid muscle 

where are the deep cervical nodes

deep under the sternomastoid muscle

where are the posterior cervical nodes

posterior triangle along the traps

where are the supraclavicular nodes

above and behind the clavicle at the sternomastoid muscle

hyperplasia

an increase of the normal number of cells in an organ

subjective data about head, neck, and face assessment

Headache, Head injury, Dizziness, Neck pain or limited range of motion, numbness, or tingling, Lumps or swelling, difficulty swallowing, or a history of smoking, History of head or neck surgery

objective data about head assessment

skull: shape and size, palpate temporal artery and temporomandibular joint

objective data about face assessment

facial expression, symmetry of movement

objective data about neck assessment

symmetry of head position, active ROM, shrug test

bruits

an abnormal sound, a murmur

additional assessment for infants

head size, palpate the fontanels, and note the tonic neck reflex.

additional assessment for pregnant woman

assess for chloasma (a blotchy, hyperpigmented area over the cheeks and forehead) and thyroid gland enlargement

additional assessment for aging adult

observe for prominent temporal arteries, kyphosis of the spine, and senile tremors.

what is nociceptive pain

when functioning and intact nerve fibers in the PNS and CNS are stimulated. starts from outside the nervous system from actual or potential tissue damage

what are the 4 phases of nociceptive pain

transduction, transmission, perception, and modulation

what is neuropathic pain

pain due to lesion or disease in somatosensory system and is abnormal processing of the pain message. sustained on a neurochemical level. (chronic pain)

what are the physical pain sources

visceral, somatic, deep somatic, cutaneous, referred

what is visceral pain

pain that originates from the larger internal organs

what is somatic pain

pain that orignites from the musculoskeletal tissue or body surface

what is deep somatic pain

pain from blood vessels, joints, tendons, muscles, and bone

what is cutaneous pain

derived from the kin and subcutaneous tissue

what is referred pain

felt at a particular site but is felt at another location

what are the three types of pain

acute, chronic, breakthrough 

what is acute pain

short-term and self-limiting, predictable and disputes after the injury heals

what is chronic pain

paint that continues for 6 months or longer. results from abnormal processing by pain fibers

what is malignant pain

cancer-related pain

what is breakthrough pain

a spike in pain level in otherwise controlled pain

what are the most common side effects of opioids

respiratory depression and constipation

what questions should be asked on the initial pain assessment 

ask questions about pain and discomfort, location of pain, if pain limits function or activities, and how the patient usually reacts when in pain.

overall pain assessment tools

Initial Pain Assessment or the Brief Pain Inventory

pain rating scale

assesses severity of pain. numeric for adults and older children, face scales are for young children, verbal descriptor scale can be used with older adults

objective data for pain

assessment, nonverbal behaviors

behavior associated with chronic pain

bracing, rubbing, sighing, diminished activity, and change in appetite

assessment tools that measure physiologic and behavioral indicators of pain

CRIES score and FLACC scale

external structures of eye

eyelids, eyelashes, acanthus, caruncle, tarsal plate, conjunctiva, lacrimal apparatus, punch

function of eyelids?

protect eye from injury strong light, and dust

function of eyelashes?

filters out dust and dirt

what is the canthus?

corner of the eye where the eyelids meet

what is the caruncle?

a small fleshy mass containing sebaceous glands located in the inner canthus

what is the tarsal plate?

a stripe of connective tissue that gives shape to the upper lid. contains meibonian glands

function of meibomian glad?

secretes an oily lubricant onto the lids

what is the conjunctiva

a thin mucous membrane that covers the exposed part of the eye

what is the function of the lacrimal apparatus?

provides constant irrigation by creating tears

what is the puncta

where the tears drain into on the upper and lower lids in the inner canthus 

how many muscles are attached to the eyeball

six

what muscles are attached to the eyeball

superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles.

what cranial nerves stimulate the eye muscles

III, IV, and VI

what are the internal layers of the eye (outer → inner)

sclera, choroid, retina

what is the sclera

a tough, fibrous protective layer that attaches to the cornea

what is the cornea

a transparent layer that covers and protects the iris and pupil

what is the choroid

the dark middle layer that is highly vascularized to deliver blood to the retina. it is continuous with he ciliary body and the iris

what is the ciliary body

controls the thickness of the lens

what is the iris

the iris serves as a diaphragm which helps dilate and contract the pupil

what is the retina

the innermost layer which is the most visually receptive

what is the function of the retina

changes light waves into nerve impulses 

what is the fovea centralis

the sharpest and keenest vision, located in the retina

what is the macula

a slightly darker pigmented region of the retina which traduces light

what are the visual reflexes

pupillary light reflex, fixation, and accommodation

what is the pupillary light reflex

the normal contraction of the pupils when bright light shines on the retina

what is the fixaiton reflex

reflex direction of the eye toward an object attracting a persons attention

what is the accommodation reflex

the adjustment of the eye for near vision, accomplished by the ciliary muscle movement

what does vision look like at birth 

eye function is limited but peripheral vision is intact in newborns. macula matures by 8 months. eye movement matures by 3-4 months. eyeball reaches adult size by age 8

what eye changes happen with aging

decreased tear production, decreased pupil size and lens uses loses elasticity (presbyopia), lens begins to thicken and yellow (cataract), decreased visual acuity

what to ask about to obtain subjective data

Vision difficulty, Eye pain, Strabismus or diplopia, Redness or swelling, Watering or discharge, A history of ocular problems, Glaucoma, Use of glasses or contact lenses, Patient-centered care, Medications, History of smoking, Vision loss

additional history to take for infants and children

vaginal infections in mother at time of delivery, developmental milestones, vision testing, safety measures

additional history to take for older adults

vision difficulty with driving or night vision, glaucoma testing, cataracts, dry or burning eyes, and decrease in usual activity

how to obtain objective data about vision

Snellen eye chart for central vision, confrontation test for peripheral vision, Hirschberg test for corneal light reflex, general inspection

what does the malleus do

pulls at the center of the ear and causes it to appear oval and slightly concave

what is the pars flaccida

a small, slack, superior section of the membrane

what is the pars tensa

the remainder of the membrane, it is thicker and more taut

what is the annulus 

the outer fibrous rim of the ear drum

what are the three bones of the middle ear

malleus, incus, and stapes

what are the functions of the middle ear

conducts sound, protects inner ear, equalization of air pressure

what is the vestibular apparatus made of

vestibule and semicircular canals 

what parts of the auditory system are involved in hearing

peripheral, brainstem, and cerebral cortex levels

what is conductive/partial hearing loss

mechanical dysfunction of the external or middle ear

what is sensorineural or perceptive hearing loss

a pathological condition of the inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex

what is mixed hearing loss

from conductive and sensorineural causes

anatomical differences in hearing in infants

the eustachian tube is relatively short and wide and is more horizontal than it is in an adult. This allows for easier migration of pathogens to the middle ear from the nasopharynx. Also, the lumen is easily occluded.

anatomical differences in hearing in adults <40

otosclerosis causing conductive hearing loss.

anatomical differences in hearing in aging adults

hearing acuity may be decreased because of the coarse and stiff cilia lining the ear, impacted cerumen, and nerve degeneration in the inner ear.

subjective questions to ask about hearing

earaches and ear infections; discharge from the ears; hearing loss and environmental noise; tinnitus and vertigo, and cleaning of the ears.

subjective questions to ask about hearing for infants and children

ear infections, hearing ability, and if the child places objects in the ears. When assessing older children and adolescents, ask about involvement in contact sports.

objective questions to ask about hearing

inspect and palpate, size and shape, skin condition, tenderness, otoscope examination

what is the Romberg test

assesses the vestibular apparatus and the ability to maintain standing balance

what are the paranasal sinuses

air-filled pockets in the cranium that lighten the weight of the skull, serve as sound resonators, and provide mucus

subjective questions to ask about the nose

ask about discharge and frequency of colds; sinus pain; trauma and nose bleeds; allergies; and an altered sense of smell.

subjective questions to ask about the mouth and throat

sores or lesions; bleeding gums; toothaches; sore throat; hoarseness; dysphagia; altered taste; smoking and/or alcohol consumption; and dental care

subjective questions to ask about the mouth and throat in children

mouth sores, tonsillitis, and when the first teeth became apparent.

subjective questions to ask about the mouth and throat in older adults

mouth dryness related to medications, tooth loss, altered sense of taste and smell, and self-care activities.