assesment exam 2-HW

synovial joints

freely movable, allowing sliding of opposing

non-synovial joint

little to no movement, connected by fibrous tissue or cartilage

4 signs suggesting acute inflammation in a joint

redness, joint swelling, pain, stiffness

dislocation

complete separation of 2 bones where they meet at a joint

subluxation

a partial dislocation of one of the bones in a joint

contracture

shortening and hardening of muscles, tendons, or other tissue, leading to deformed and rigidity of joints

ankyloses

abnormal stiffening and immobility of a joint due to fusion of the boxes

6 things to inspect on a joint

size, swelling, color, contour, masses, deformity

what signals joint irritation?

swelling

what should be specifically noted about palpation of joints and overlying skin?

heat, tenderness, swelling, or masses

how to test active ROM

ask patient to model your own movements with you as the control

how to test passive ROM

tested when a limitation or injury is noticed in active ROM

what is the MOST sensitive sign of joint disease

limitation in ROM

scoliosis

lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of the involved vertebral bodies.

functional scoliosis findings

flexible, appears with standing and disappears with forward bending, may compensate for other abnormalities like leg length discrepancy

structural scoliosis findings

fixed, curve shows when standing and bending forward. Rib hump with forward flexion, unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level

2 techniques for examining carpal tunnel

phalen test and tinel sign

phalen test

hold both hands back to back while flexing the wrists 90 degrees

tinel sign

direct percussion of the location of the median nerve at the wrist

rheumatoid arthritis

chronic inflammatory pain condition started by an autoimmune response, inflammaroty events, or infection. Inflammation of synovial joints, hyperplasia, and swelling lead to fibrosis, cartilage and bone destruction limiting motion and show deformity

swan neck

flexion contracture curving like a swans neck-often associated w/ chronic rheumatoid arthritis

boutonniere deformities

knuckle appears as if pushed through a buttonhole- associated w/ chronic rheumatoid arthritis

osteoarthritis

noninflammatory, localized, progressive disorder involving deterioration of articular cartilages, subchondral bone remodeling, synovial inflammation and formation of new bone at joint surfaces

bouchard's nodes

bony overgrowths of the PIP joints (less common) often associated with osteoarthritis

herberden's nodes

bony overgrowths (osteophytes) of the DIP joints. commonly associated with osteoarthritis

pallor

red pink tones from oxygenated hemoglobin in blood are lost skin takes on color of connective tissues- commonly pale/white

erythema

intense redness of skin from excess blood in the dilated superficial capillaries

cyanosis

bluish mottled color from decreased perfusion; tissues having high levesl of deoxygenated blood

jaundice

yellowish skin color due to increased bilirubin in blood

causes of pallor

acute high stress states (anxiety/fear), cold exposure, edema, cigarette smoking

causes of erythema

fever, local inflammation, emotional reactions (blush)

cause of cyanosis

decreased oxygenation, changes in LOC, signs of respiratory distress

causes of jaundice

hepatitis, cirrhosis, sickle cell disease, transfusion reaction, hemolytic disease of newborn

ABCDE rule

Asymmetry: not regularly round or oval, 2 halves of lesion don't look the same
Border Irregularity: notching, scalloping, ragged edges, poorly defined margins
Color variation: areas of brown, tan, black, blue, red, white or combo
Diameter: greater than 6mm (size of pencil eraser)
Elevation/Evolution: changes to the lesion (size)

Pressure Ulcer stage 1

non-blanchable erythema; intact skin, red but unbroken. Localized redness, doesn't blanch. Changes in temp or firmness

Pressure Ulcer stage 2

partial thickness, skin loss, loss of epidermis, and exposed dermis. Superficial ulcer looks shallow like an abrasion or blister. Red pink wound bed, no visible fat/deeper tissue

Pressure Ulcer Stage 3

full thickness skin loss; injury extends to sub-q tissue, resembles crater. Visible sub-q fat, granulation tissues, rolled edges. No visible muscle, bone, tendon

Pressure Ulcer Stage 4

Full thickness skin/tissue loss; injury to all skin layers, extends to supporting tissue, exposes muscle, bone, tendon and may show slough and eschar, rolled edges, and tunneling

tinea capitus

rounded, patchy hair loss, broken-off hairs, pustules, scales on skin

pediculosis capitus (head lice)

intense itching in occiput. Nits seen in occipital area and around ears 2-3 mm oval translucent bodies adherent to hair shafts

loss of skin turgor

less elasticity due to loss of collagen as aging increases

clubbing of nails

clubbing can occur due to chronic lung inflammation, lung cancers, heart defects with right-to-left causing release of growth factors and promotion of growth of vessels

vesicle

elevated cavity w/ free fluid; up to 1 cm a "blister: clear serum flows if wall ruptured ex. herpes simplex

wheal

superficial, raised, transient and erythematous; slightly irregular shape from edema ex. mosquito bite

annular

begins in center and spreads to periphery ex. ringworm

discrete

distinct individual lesion that remain separate ex. skin tags

grouped

clusters of lesions ex. contact dermatitis

macule

solely a color change, flat and circumscribed of less than 1 cm ex. freckles

cerebral cortex

center for governing thought, memory, reasoning, sensation and voluntary movement

frontal lobe

personality, behavior emotions, and intellectual function. Precentral gyrus initiates voluntary movement

parietal lobe

postcentral gyrus in the parietal lobe is the primary center for sensation

temporal lobe

primary auditory reception center. Functions of hearing, taste, and smell

occipital lobe

primary visual receptor center

wernicke's area

in temporal lobe- language comprehension. If damaged the person hears speaking/sound but has attached (receptive aphasia)

broca's area

located in frontal lobe- mediates motor speech. When injured, the person can't speak. They understand want to say but only garbled speech results

cerebellum

motor coordination of voluntary movements, equilibrium (body balance), and muscle tone. Not in charge of movement itself, but the coordination and smoothness of it. Operates below the conscious level

12 cranial nerves

Olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal

3 major motor pathways in CNS

corticospinal crossed/uncrossed, cerebellar, extrapyramidal

cerebellar system

coordinates movement, maintains posture and equilibrium

corticospinal crossed/uncrossed

mediates voluntary movement, purposeful movements

extrapyramidal tracts

all motor nerve fibers originating in motor cortex, basal ganglia, brain stem, and spinal cord outside the pyramidal tract. maintains muscle tone, and body movements (gross automatic movements)

upper motor neurons

descending motor fibers, can influence or modify lower motor neurons. Located in CNS. Convey impulses from motor areas of cerebral cortex to lower motor neurons in anterior horn cells of spinal cord

lower motor neurons

located mainly in PNS. Final common pathway, funnels neural signals and provides final direct contact with muscles. Any movement is translated to action by lower motor neuron (LMN) fibers

upper motor neuron disease examples

stroke, cerebral palsy, multiple sclerosis

lower motor neuron disease example

bell palsy in face, spinal cord lesions, polio myelitis

Cerebellar function tests that assess coordination

rapid alternating movements (RAM), heel-to-shin test, finger-nose-finger test

Rapid alternating movements (RAM)

ask person to pat knees with both hands, lift up, turn hands over, and pat knees with the backs of hangs. Then ask client to repeat faster. OR ask patient to touch thumb to each finger and then reverse the motion

Heel-to-Shin test

test lower-extremity coordination by asking the person, who is in a supine position, place heel to the opposite knee and run it down shin from knee to ankle. Normally heel moves in a straight line down skin

Finger-Nose-Finger test

ask patient to touch index finger to touch finger to nose. After a few times move finger to a different spot. Movement should be smooth and accurate

3 cerebellar function tests that assess balance

- gait: observe as the person walks 10-20 feet, turns and returns to starting point. The patient can also be asked to walk in a straight line heel-to-toe
- the Romberg test: ask person to stand with feet together and arms at sides. Then ask to close their eyes and hold the position for 20 seconds
- Ask person to perform shallow knee bend on one leg and then the other. May use one hand supported on table

Method of testing for pain

tested by ability to feel a pinprick. Apply a broken tongue blade lightly to skin alternating "sharp" and "dull" and ask the patient to identify the sensation

method for testing touch

apply a wisp of cotton to skin and brush over skin in random order of sites and at irregular intervals. Have the patient identify when the cotton contracts the skin

method for testing vibration

place a tuning fork over bony prominences. Use a low pitch fork due to the vibrations slower decay. Ask patient to identify when vibration starts and stops

method for testing position

test ability to perceive passive movements by moving a finger or big toe up and down and have patient identify which way it moved. The test is performed with patient's eyes closed. Vary the movement of up/down. Digit should be held by the sides

stereognosis

place a familiar object (key, cotton ball) in patients hand and ask them to identify it

graphesthesia

have the patient "read" a number when it is traced on skin. Trace a single digit on palm of hand with blunt instrument have them identify it

extinction

simultaneously touch both sides of the body at the same point, ask person to identify how many sensation are felt and where

point location

touch skin and withdraw stimulus promptly. Ask patient to put finger where you touched

Components of the neurologic recheck exam performed routinely on hospitalized persons monitored for neurologic deficit

level of consciousness, motor functions, pupillary response, vital signs

3 areas of assessment on the Glasgow Coma Scale

eye opening response, motor response, verbal response

spastic hemiparesis

arm immobile against body, flexion of the shoulder, elbow, wrist, and fingers and adduction does not swing freely. Leg stiff and extended and circumducts with each step. Causes: UMN lesion of corticospinal tract. ex. stroke, trauma

cerebellar ataxia

staggering, wide-based gait; difficult w/ turns; uncoordinated movement w/ and Romberg sign. Causes: alcohol or barbiturate effect on cerebellum; cerebellar tumor; multiple sclerosis

parkinsonian (festinating)

stooped posture: trunk is pitched forward; elbows, hips, and knees flexed. steps short and shuffling. Hesitation to begin walking and difficult and stop suddenly. Person holds body rigid. Walks and turns body as one fixed unit. Difficult w/ any change in direction. Causes: parkinsonism

steppage

slapping quality-looks like walking up stairs and finding no stair there. Lifts knee and foot high and slaps down hard and flat to compensate for foot drop. Causes: weakness of peroneal and anterior tibial muscles; caused LMN lesion at spinal cord. ex. poliomyelitis

Direct light reflex with a consensual light reflex

when one eye is exposed to bright light, a direct light reflex (constriction of that pupil) consensual light reflex (simultaneous constrictions of other pupil) occurs

why do you advance a light in from the side when testing the pupillary light relex

if you advance from front, the pupils constrict to accommodate for near vision, thus you don't know what the pure response to the light would have been

cataracts

clouding of the crystalline lens partly due to ultraviolet radiation

age related macular degeneration

loss of central vision caused by yellow deposits (drusen) and neovascularity in the macula

glaucoma

optic nerve neuropathy characterized by loss of peripheral vision caused by increased intraocular pressure

visual impairment

not being able to see letters on the eye chart at the line 20/50 or below.

what kind of impact does VI and blindness have on physical and mental health

increases the risk for lost productivity, chronic health conditions, accidents and injuries, social isolation, depression, and mortality

how could VI be improved or corrected

improved through glasses, contact lenses, and refractive surgery

how to test for accommodation

ask person to focus on a distant object, to allow pupils to dilate. Have person shift gaze to a near object (finger) 7-8 cm from patient's nose. Normal response will show pupillary constriction and convergence of axes of the eyes

how do you perform the cover test on children, Normal response? Abnormal response?

have child stare straight ahead at your nose or at familiar puppet. Cover one eye w/ opaque card. Look at uncovered eye: normal response should be a steady, fixed gaze. If muscle weakness exists, the covered eye drifts into a relaxed position. Then uncover other eye and observe. Should stare straight ahead. If it jumps to re-establish fixation, eye msucle weakness exists. Repeat w/ other eye

Phoria

mild weakness noted only when fusion is blocker

Tropia

more severe than phoria. constant malalignment of the eyes

conjunctivitis

"pink eye" red, beefy-looking vessels at periphery but usually clearer around iris, commonly from viral/bacterial infection, allergy, or chemical irritation. Purulent discharge accompanies bacterial infection. Symptoms include itching, burning, foreign body sensation and eyelids stuck together on awakening

subconjunctival hemorrhage

red patch on sclera, subconjunctival hemorrhage- usually not serious. Red patch sharp edges, occurs from increased intraocular pressure from coughing, vomiting, weight lifting, labor during childbirth, straining at stool/trauma

hyphema

blood in the anterior chamber is a serious result of herpes zoster infection. Also occurs w/ blunt trauma or spontaneous hemorrhage. Suspect school rupture or major intraocular trauma. Gravity settles blood in front of iris.

blepharitis (inflammation of the eyelids)

red, scaly, greasy flakes and thickened, crusted lid margin occur with staphylococcal infection or seborrheic dermatitis of the lid edge. Sx: burning, itching, tearing, foreign body sensation and some pain