NURS 308- Exam 3

what do you inspect on the female external genitalia?

-skin color

-hair distribution

-lesions

-perineum

-anus

speculum exam

internal exam to observe for female internal organ normalcy; obtain specimens

pap smear

Test for early detection of cervical cancer; scraping of cells removed from cervix for examination under microscope.

cytobrush

use this to collect endocervical cell samples; goes into os

STI screening

done if patient has complaints or abnormal discharge (GC or chlamydia culture is done with a sterile cotton applicator)

bimanual examination done with...

cervix, uterus, adnexa (ovaries)

HPV vaccination

requires a series of 3 shots; give at ages from 9-26 to prevent cervical cancer; recommended at 11 & 12

urinary incontinence

inability to control urination

Urgency Urinary Incontinence

loss of urine with sudden compelling desire to urinate that is difficult to defer

stress urinary incontinence

involuntary discharge of urine during coughing, straining, or sudden movements

cystocele

bulge of the bladder into the vagina

rectocele

bulge of the rectum into the vagina

uterine prolapse

downward displacement of the uterus into the vagina

menopause

when estrogen and progesterone decrease and stop producing

vagina becomes shorter and narrower, decreases secretions; typically lasts 1-2 years

pediculosis pubis

also known as crab lice; an infestation with lice in the pubic hair and pubic region; transmission through sexual contact, bedding, towels, etc; causes severe itching and erythematous

genital herpes

pain, fever, dysuria, or asymptomatic

shallow vesicles with erythema on inner thighs and genital area

no cure, just suppression

syphilis

papule that is red, round, oval, yellowish serous discharge

treat with antibiotics, damage can't be undone

human papillomavirus

has a high correlation with cervical cancer

chlamydia

minimal or no symptoms, urinary frequency, dysuria, vaginal discharge

can lead to pelvic inflammatory disease

can be cured with meds

gonorrhea

women have NO symptoms and can eventually cause infertility

contagious until cured, need antibiotics

bacterial vaginosis

constant discharge of thin creamy white

foul fishy odor

trichomoniasis

an infection caused by the protozoan parasite Trichomonas vaginalis; also known as trich

pruritis, urinary frequency, red raised papules and petechiae, yellow-green discharge

living organism

candidiasis

yeast infection

itching, thick white discharge in the vulva and vagina

predisposing causes of vulvovaginal inflammation

oral contraceptives, antibiotics

puberty for boys

9-10 years old

enlargement of testes, pubic hair appears, penis size increases

40 years

when does sperm production decrease?

older male adult genitalia changes

hair decreases

penis size decreases

scrotum hangs lower

testes size decrease

urinary frequency

the need to urinate often

urinary urgency

sudden, compelling urge to urinate

nocturia

excessive urination during the night

dysuria

painful or difficult urination

urination hesitancy

inability to start and/or maintain urination

phimosis

stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis

hypospadius

a congenital condition in males in which the opening of the urethra is on the underside of the penis

epispadius

congenital abnormality where urethral opening is located on upper surface of penis

cryptorchidism

undescended testicles

hydrocele

scrotal swelling caused by a collection of fluid

hernia

bulge at the inguinal ring or femoral canal

testicular cancer risk factors

Cryptochordism, prior testicular cancer or family hx; race (Caucasian 5X greater risk than African American)

TSE

testicular self-examination

T: timing (once a month)

S: shower (warm water relaxes scrotal sac)

E: examine (check for and report changes immediately)

Inspection for the vascular system

arms: skin, profile sign, capillary refill, symmetry, pulses

legs: skin & hair, symmetry, temperature, calf muscle, inguinal lymph node, pulses, pretibial edema, and leg veins

normal pulse grade

2+

doppler

used when unable to palpate a pedal pulse

pretibial edema

depress skin over tibia or medial malleolus for 5 sec; +1 slight

1+ edema

mild pitting, slight indentation, no perceptible swelling of the leg

2+ edema

moderate pitting, indentation subsides rapidly

3+ edema

deep pitting, indentation remains for a short time, leg looks swollen

4+ edema

very deep pitting, indentation lasts a long time, leg is very swollen

Raynaud's syndrome

diminished blood supply to extremities resulting in discoloration (due to extreme temperatures or stress)

lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

arterial ulcer

An open wound on the lower legs and feet caused by poor arterial blood flow

venous ulcer

wound that results from inadequate return of blood from an extremity

superficial varicose veins

normal leg veins have dilated as a result of chronic increased venous pressure and incompetent valves that permit reflux of blood back toward leg instead of forward toward heart

DVT (deep vein thrombus)

blood Clot usually deep in veins. Usually legs or pelvis can move

acute swelling

warmth and redness

use a doppler to find a pulse

occlusions

blockages in blood vessels

atherosclerosis with the build up of fat

aneurysms

sac formed by dilation in artery wall

arteriosclerosis

hardening of the arteries, commonly seen with old age

atherosclerosis

fatty deposits (plaque) build up in the arteries

chronic arterial symptoms

deep muscle pain

cool, pale skin

numbness and tingling

onset is gradual after exertion

aggravated by activity and elevation

relieved by rest

chronic venous symptoms

chronic pain increases at the end of the day

aching, tiredness, fullness feeling

aggravated by prolonged standing, sitting

relieved by elevation, lying, walking

edema, weeping ulcers at ankles

arterial ulcer

due to plaque buildup

cool, pale skin

pain, numbness

venous stasis

due to incompetent valves, poor circulation

brownish discoloration

hemosiderin (RBC breakdown, iron deposits)

C1

atlas

C2

axis

thyroid gland

secretes hormones that stimulate cellular metabolism (T3 and T4)

lymphatic

major part of the immune system with a separate vessel system; conserves fluid and plasma protein, major part of the immune system; absorbs lipids from the intestinal tract

preauricular

in front of ear

posterior auricular

mastoid process

occipital

base of the skull

submental

midline behind tip of mandible

submandibular

halfway between the angle and the tip of the mandible

jugulodigastric

under the angle of the mandible

superficial cervical

overlying the sternomastoid muscle

deep cervical

deep under the sternomastoid muscle

posterior cervical

edge of trapezius muscle

supraclavicular

just above and behind the clavicle, at the sternomastoid muscle

lymph nodes

cervical, axillary, epitrochlear, inguinal

spleen

upper left quadrant

destroys old RBC, filters microorganisms, produces antibodies, store RBC

tonsils

entrance to the respiratory tract

protects against local infection

thymus

gland above mediastinum in front of the aorta

no function in adults

atrophies after puberty

migraine

severe, recurring, unilateral, vascular headache

tension headache

pain is like a band squeezing the head

cluster headache

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

how to palpate lymph nodes

Use a gentle circular motion of fingerpads

Palpate bilaterally with both hands to compare the two sides for symmetry

Begin with pre-auricular lymph nodes, palpate the 10 groups of lymph nodes in routine order

Many lymph nodes are close together: be thorough and consistent

acute lymph infection

onset is less than 14 days

enlarged bilaterally, warm, tender, firm, freely moveable

chronic lymph infection

clumped together

lymph malignancy

hard, nontender, matted, fixed, unilateral, greater than 3 cm

goiter

enlargement of the thyroid gland

torticollis

head tilt due to shortening or spasm of one sternomastoid muscle

pilar cyst (wen)

Smooth, firm, fluctuant swelling on scalp; pressure of contents causes overlying skin to be shiny and taut

Benign growth

parotid gland enlargement

Rapid painful inflammation of the parotid occurs with mumps. swelling anterior to lower ear lob

hyperthyroidism

excessive activity of the thyroid gland

results in a goiter and protruded eyes

hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity

bell's palsy

CN VII LMN lesion - both upper and lower facial weakness on same side of lesion

cannot wrinkle forehead or blink

stroke

paralysis only in lower facial region, unilaterally

isolated head tremors (aging adult)

unknown causes

benign, head nodding, tongue protrusions

tooth loss (older adult)

may cause lower jaw to appear smaller

tail of spence

extension of breast tissue into the axilla

MEN

besides women, who can get breast cancer and should also do breast exams?

days 4-7 of your cycle

when is the best time to do a breast self exam