mobility and perception

proproicieption

position of the body

presbyopia

age related loss of focus on close objects (far sighted

myopia

loss of function on distant objects related to eyeshade (nearsighted)

cataracts

opacity of the lens, blocking light to the retina due to age related protein clumping

glaucoma

increased intraocular pressure causing compression of the optic nerve and reduction of peripheral vision

macular degeneration

loss of central vision from deteritioaton of retina, usually correlated with age

Ophthalmoscopy

direct visualization of back of eye

conducive

Alteration of middle ear that prevents sound waves from entering

sensorineural

•Alteration of inner ear, nerves, or brain processing

snellen test

measures visual acuity at a distance

Rosenbaum test

– measures close visual acuity

Tonometry

– measures intraocular pressure

conducive - •Cerumen impaction

build-up of earwax preventing sound conduction

conducive - otitis media

Otitis media – infection of the middle ear structures that causes build-up of fluids, preventing sound conduction

sensorineural - presbycusis

age-related deterioration of ear hair cells and auditory nerves causing loss of high-pitched hearing

•Ototoxicity - sensorinerual

loss of hearing related to medication side effects

Tinnitus – sensorineural

“ringing” in the ears; is a symptom of disease or medication side effects

sensorineural - Meniere’s disease

Meniere’s disease – chronic disease in which there is fluid accumulation in the inner ear causing balance issues, dizziness, and hearing loss

rinne test

⚬Rinne test - tuning fork used to create air conduction (AC) sound and bone conduction (BC) sound (air should seem louder than bone = normal)

weber test

⚬Weber test - tuning fork placed on top of head (sound should be equal in both ears

audiometry

•Audiometry - headphones used to discriminate between different frequencies and volumes

Otoscopy

Otoscopy - direct visualization of the external canal and tympanic membrane

•Paresthesia

•numbness and tingling

neuropathy

•Neuropathy – nerve damage, typically from diabetes, vitamin deficiencies, medications, autoimmune disease

paraplegia

Paraplegia – loss of sensation in lower body

hemiplegia

•Hemiplegia – loss of sensation in half of body (left or right)

quadriplegia

Quadriplegia – loss of sensation from the torso down

primary lesions

atrophy

Wasting away or weakening of a muscle or tissue, usually from lack of use or illness.

contractures

Contractures: Permanent tightening or shortening of a muscle, tendon, or joint that limits movement.

osteoporosis

Osteoporosis: A condition where bones become weak, thin, and more likely to break because bone density decreases.

atelectasis

Atelectasis: Partial or complete collapse of part of a lung, causing the tiny air sacs (alveoli) to not fill properly with air.

secretion congestion

secretion congestion: Build-up of mucus or other secretions in the airways, making it harder to breathe and sometimes causing coughing or abnormal lung sounds.

seborrheic keratosis

(age spots)

⚬Acrochordon

skin tags

lipoma

(adipose “fat” deposit)

nevi

⚬Nevi (freckles/moles)

skin abnormalities

Macule = flat
Papule = small bump
Nodule = deeper lump
Vesicle = small fluid blister
Bulla = big fluid blister
Pustule = pus
Tumor = large solid mass
Wheal = temporary swelling/hive
Plaque = raised, flat area

macule

• Macule: A flat, discolored spot on the skin that you can see but cannot feel.
  Example: Freckle.

papule

• Papule: A small, raised, solid bump on the skin.
  Example: Small pimple.

• 
  

nodule

• Nodule: A firm, solid, raised lump that is usually deeper and larger than a papule.
  Example: A small lump under the skin.

• 
  

vesicle

• Vesicle: A small, raised blister filled with clear fluid.
  Example: Small blister from poison ivy.

bulla

• Bulla: A larger, fluid-filled blister.
  Think: big vesicle.

• 
  

pustule

• Pustule: A raised skin lesion filled with pus.
  Example: Pus-filled pimple.

tumor

• 
  

• Tumor: A solid, raised mass or lump that is larger than a nodule. It may be benign or malignant.
  Think: large solid mass.

wheal

• Wheal: A raised, swollen area of skin that is usually temporary and often itchy.
  Example: Hives or a mosquito bite.

plaque

• Plaque: A raised, flat-topped area that is usually wider than it is tall.
  Example: Psoriasis patches.

•Primary vs. secondary intention

⚬primary - edges approximated with minimal exposed tissue (i.e. sutures)

⚬secondary - edges left open, more regeneration necessary (i.e. large chronic wound)

undermining

Undermining - a hollow between the skin surface and the wound bed, resulting from death of the underlying tissue

tunneling

Tunneling - a passageway or channel underneath the base of the woundbed that has the potential for infection

pi staging

The ONLY skin wounds that are staged are pressure injuries!!!

No reverse staging as the wound heals

There are SIX total stages according to NPIAP (National Pressure Injury Advisory Panel):

•Stage 1

•Stage 2

•Stage 3

•Stage 4

•Unstageable

Deep tissue injury

blanchable

•Blanchable skin turns pale or lighter when pressure is applied, indicating temporary vessel compression.

non blanch able

•Non-blanchable skin remains red/discolored, signaling blood leakage or deep tissue damage

If there is redness over a bony prominence or under a medical device, it is only a stage 1 if it is non-blanching. If it blanches, we document this as “blanchable redness”

stage 1 pressure injury

•Skin is intact (closed wound)

•Non-blanchable area of dark pink or redness over a bony prominence

stage 2 pressure wound

•Partial-thickness with exposed dermis

•Wound bed is viable granulation tissue (pink, red)

•Blisters are considered stage 2, even if intact

stage 3 pressure wound

•Full-thickness with exposed adipose/subcutaneous tissue

•Wound bed is granulation tissue, potentially with slough or eschar

•Depth varies depending on location

•Tunneling or undermining may be present

stage 4

•Deep full-thickness with exposed muscle, bone, tendon, etc.

•Wound bed is granulation tissue, potentially with slough or eschar

•Depth varies depending on location

•Tunneling or undermining may be present

unstagable pressure wound

•Deep full-thickness but extent cannot be determined due to slough or eschar obscuring wound bed

•If slough or eschar are removed, will reveal stage 3 or stage 4

deep tissue injuries

•Non-blanchable maroon or purple discoloration

•Epidermal/dermal separation from blood-filled blister

•Does NOT have slough, eschar, subcutaneous tissue, granulation tissue, muscle, bone or tendon present

phases of wound healing

1.Hemostasis - platelets cause bleeding to stop, temporary clot forms

2.Inflammatory - white blood cells brought to the area, exudate present

3.Proliferative - fibroblasts start to create new granulation tissue

4.Maturation & remodeling - scar tissue forms to create strong, more uniform tissue

homeostasis

Hemostasis - platelets cause bleeding to stop, temporary clot forms

inflammatory

2.Inflammatory - white blood cells brought to the area, exudate present

proliferative

.Proliferative - fibroblasts start to create new granulation tissue

maturation and remodeling

.Maturation & remodeling - scar tissue forms to create strong, more uniform tissue