HA Final Exam

Final Exam Study Guide Notes

Connective Tissues

  • Cartilage

    • Function:

    • Allows bones to slide over one another.

    • Reduces friction, prevents damage, and absorbs shock.

    • Types:

    • Articular Cartilage: Found on the ends of bones.

  • Tendons

    • Function: Connect muscles to bones.

    • Example:

    • Biceps Brachii Tendon: Connecting the biceps muscle over the head of the humerus to the glenoid fossa.

  • Ligaments

    • Function: Connect bone to bone to stabilize joints and limit movement.

    • Example:

    • Anterior Cruciate Ligament: In the knee, which prevents lateral movement of the knee.

  • Bursae

    • Function: Fluid-filled sacs in areas of friction to cushion bones or ligaments that might rub against each other.

    • Example:

    • Subacromial Bursa: Located in the shoulder to reduce friction during adduction.

  • Meniscus

    • Function: A cartilage disk between bones to absorb shock and cushion joints.

    • Examples:

    • Medial and Lateral Menisci: In the knee, which cushion the tibia and femur.

  • Fascia

    • Function: Flat sheets that line and protect muscle fibers, attach muscle to bone, and provide structure for nerves, blood vessels, and lymphatics.

    • Description:

    • The outer layer of fascia, which tapers at each end to form tendons.

Passive Range of Motion (ROM)

  • Guidelines:

    • When performing passive ROM, do not force the joint.

    • Stop if resistance or discomfort is reported.

Cranial Nerves (Table 22.1)

  1. Olfactory (CN I)

    • Type: Sensory

    • Anatomy: Originates in the nasal mucosa; ends in the temporal lobe.

    • Physiology: Responsible for smell and its interpretation, influencing peristalsis, salivation, and sexual stimulation.

  2. Optic (CN II)

    • Type: Sensory

    • Anatomy: Originates in the retinal cells; travels via the optic nerve to end in the occipital lobe.

    • Physiology: Responsible for vision, including visual acuity and peripheral vision.

  3. Oculomotor (CN III)

    • Type: Motor

    • Anatomy: Originates in the midbrain; supplies motor fibers to the eye, eyelid, ciliary muscles, and iris.

    • Extraocular Movements (EOMs): Upward, medial, downward, up and in, eyelid raising, pupil constriction.

  4. Trochlear (CN IV)

    • Type: Motor

    • Anatomy: Originates in the midbrain; motor fibers to the superior oblique muscles of the eye.

    • EOMs: Down and in.

  5. Trigeminal (CN V)

    • Type: Sensory and Motor

    • Anatomy: Originates in the pons; has three branches: ophthalmic (sensory), maxillary (sensory), and mandibular (sensory and motor).

    • Branches:

      • Ophthalmic: Sensation to cornea, conjunctiva, nasal mucosa, forehead, and nose.

      • Maxillary: Sensation to skin of cheek and nose, lower eyelid, upper jaw, teeth, oral mucosa.

      • Mandibular: Sensation to lower jaw and motor function for muscles of mastication.

  6. Abducens (CN VI)

    • Type: Motor

    • Anatomy: Originates in the pons; supplies motor fibers to the lateral rectus muscle.

    • EOMs: Lateral.

  7. Facial (CN VII)

    • Type: Sensory and Motor

    • Anatomy: Originates in the pons; sensory fibers to the anterior two-thirds of the tongue and soft palate; motor fibers to muscles of the face.

    • Function: Taste and sensation for anterior tongue; primary motor nerve for facial expression.

  8. Acoustic (CN VIII)

    • Type: Sensory

    • Anatomy:

      • Cochlear Sensory Fibers: Originate in cochlea, transmit auditory sensation to ear, pons, and temporal lobe.

      • Vestibular Sensory Fibers: Originate in semicircular canals and vestibular ganglion, end in pons.

    • Physiology: Responsible for hearing (Cochlear) and equilibrium (Vestibular).

  9. Glossopharyngeal (CN IX)

    • Type: Sensory and Motor

    • Function:

      • Sensory Divisions: Form from external ear, tympanic membrane, upper pharynx, posterior one-third of tongue, ending in medulla.

      • Motor Divisions: Supply pharyngeal muscle and parotid gland.

    • Functions: Elevation of pharyngeal muscle for swallowing and speech; parotid gland secretion; general sensory functions.

  10. Vagus (CN X)

    • Type: Sensory and Motor

    • Anatomy: Originates in medulla; sensory from larynx, esophagus, trachea, carotid bodies, thoracic, and abdominal viscera; motor fibers supply pharynx, larynx, thoracic, and abdominal viscera.

    • Function: Provides parasympathetic innervation, effects include digestion, defecation, slowed heart rate, and reduced cardiac contraction strength.

  11. Spinal Accessory (CN XI)

    • Type: Motor

    • Anatomy: Originates in the medulla with two branches; cranial root innervates laryngeal and pharyngeal muscles; spinal root innervates trapezius and sternocleidomastoid muscles.

    • Function: Swallowing and speaking; turning of head and shoulder elevation.

  12. Hypoglossal (CN XII)

    • Type: Motor

    • Anatomy: Originates in medulla; ends at the tongue.

    • Function: Tongue movement.

Glasgow Coma Scale (Box 22.2)

  • Purpose: A tool for assessing a patient’s response to stimuli; scores range from 3 (deep coma) to 15 (normal). Used to assess level of consciousness following trauma or neurological events.

  • Components:

    1. Eye Opening (E):

    • Score: 1-4

    • Responses:

      • 4: Opens eyes spontaneously.

      • 3: Opens eyes to voice (verbal stimuli).

      • 2: Opens eyes to pain.

      • 1: No eye opening.

    1. Verbal Response (V):

    • Score: 1-5

    • Responses:

      • 5: Oriented (normal conversation, knows person/place/time).

      • 4: Confused conversation (disoriented but able to speak).

      • 3: Inappropriate words (random words, no conversation).

      • 2: Incomprehensible sounds (moaning).

      • 1: No verbal response.

    1. Motor Response (M):

    • Score: 1-6

    • Responses:

      • 6: Obeys commands.

      • 5: Localizes pain (purposeful movement toward stimulus).

      • 4: Withdraws from pain.

      • 3: Flexion to pain (decorticate posturing).

      • 2: Extension to pain (decerebrate posturing).

      • 1: No motor response.

  • Interpreting Total Score:

    • Total GCS Meaning:

    • 13–15: Mild injury / near-normal.

    • 9–12: Moderate injury.

    • 3–8: Severe injury (coma; ≤8 often needs intubation).

Cultural Variation and Health Disparities (Chapter 22)

  • Racial Disparities:

    • Stroke Risk: African Americans are twice as likely to die from stroke compared to White Americans due to higher rates of hypertension, obesity, diabetes mellitus, and smoking.

    • Other at-risk populations include Hispanics and Native Americans, who often delay care, discontinue treatment once feeling better, and avoid primary care visits.

    • Lower Risk Group: Asian Americans are generally less affected by stroke (American Heart Association, 2021).

  • Functional Limitations:

    • Post-Stroke: African Americans and Hispanics exhibit higher rates of functional limitations from strokes.

    • Caregiving Support: Important for recovery of motor function; stroke survivors who receive more therapy recover faster but have limited access to such resources.

    • Functional Status Assessment (U.S. Department of Health and Human Services Office of Minority Health, 2021):

    • Ability to walk up to 10 steps without resting.

    • Ability to sit for about 2 hours.

    • Ability to reach overhead, grasp small objects, lift/carry 4 kg (10 lb), go out for activities, and participate in social activities.

Older Adults and CNS Changes

  • CNS Changes with Aging:

    • Continuous structural changes from birth throughout life; aging without dementia still induces changes in the brain, notably in frontal and temporal cortexes and subcortical areas.

    • Effects on Cognitive Abilities:

    • Processing speed, executive function, episodic memory, response to stimuli, reflexes, multi-tasking skills decline with aging.

    • Decreased Proprioception: Increased risk of poor balance, postural hypotension, falls, and injuries associated with aging.

    • Changes in Sensation: Reduced light touch and pain sensation; ischemic paresthesia common in extremities.

    • Ventricular Expansion: May lead to symptoms like headaches, vision problems, personality changes, loss of coordination, mild dementia, or incontinence.

Stages of Consciousness Assessment

  • Classification of Alertness:

    • Alert: Patient is aware of surroundings and responds quickly to stimuli.

    • Confusion: Disorientation in time, place, or person, shortened attention span, memory issues, difficulty following commands.

    • Drowsiness: Slow response to stimuli; lethargy present.

    • Stupor: Brief arousal to vigorous stimuli; otherwise unresponsive.

    • Coma: Unresponsive, cannot be awoken.

Assessment of Unconscious Patients

  • Importance of Assessment:

    • Requires urgent evaluation for cause of unconsciousness; risk for life-threatening complications due to loss of protective reflexes.

    • Assessment components:

    • Use GCS for LOC assessment.

    • Pupillary and brainstem reflexes assessment.

    • Assess motor function, including observation of hemiparesis or spontaneous movements.

    • Stimulus Responses: Use peripheral and central stimuli safely (e.g., pressure methods) to evaluate responses without harm.

Meningeal Sign Assessment

  • Nuchal Rigidity: Assessed by gently flexing neck with the patient supine; pain indicates rigidity.

  • Positive Brudzinski's Sign: Resistance to neck flexion with knee/hip flexion noted.

  • Kernig's Sign: Pain or resistance when extending the leg at the knee during hip flexion indicates possible meningitis.

Tanner Staging: Male Development

  1. Stage 1 (Younger than 10):

    • No pubic hair; small testes and penis (prepubertal).

  2. Stage 2 (Ages 10-13):

    • Sparse, thin hair at the base of the penis; enlargement of testes; coarsening and reddening of scrotal skin.

  3. Stage 3 (Ages 12-14):

    • Continued growth of scrotum/testes; increased penis length and diameter; coarser, darker pubic hair.

  4. Stage 4 (Ages 13-15):

    • Persistent growth of penis/testes; pubic hair extends across pubis, sparing medial thighs.

  5. Stage 5 (Ages 14-17):

    • Full size of penis; adult-type diamond-shaped pubic hair extending to medial thighs.

Testicular Disorders

  • Testicular Torsion:

    • Twisting of the testes causing acute ischemia.

    • Symptoms: severe pain, possible nausea/vomiting (50%), rarely fever, with blue dot sign noting tenderness.

    • Diagnosis: Minor urinalysis abnormalities (0-30%); requires emergency surgery.

  • Epididymitis:

    • Inflammation of the epididymis; characterized by gradual pain and possible nausea/vomiting and fever.

    • Symptoms may include voiding difficulties and urinalysis showing diagnostic yields (20-95%).

    • Treatment: Antibiotics; elevation usually relieves pain.

Prostate Cancer Screening

  • Recommendations:

    • The U.S. Preventive Services Task Force (USPSTF) does not advocate for screening unless patients show preference post-education on risks/benefits.

    • For ages 55-69, screening should involve discussion of benefits/harms.

    • USPSTF advises against PSA screening for those aged 70 and older.

    • Ongoing research into genetic panels' clinical utility for detecting/manage prostate cancer.

Common Symptoms (Chapter 23)

  • Notable Symptoms:

    • Pain (penile, scrotal, or perineal)

    • Urinary issues (urgency, hesitancy, dysuria, hematuria)

    • Erectile dysfunction (ED)

    • Penile lesions or discharge

    • Scrotal enlargement.

Differential Diagnosis for Symptoms**

  • Benign Prostatic Hyperplasia (BPH):

    • Signs/Symptoms: Incomplete bladder emptying, frequent urination, weak stream, nocturia.

    • Diagnostic Tests: DRE, urinalysis, PSA.

  • Urethritis:

    • Signs/Symptoms: Similar to BPH with specific complaints.

    • Diagnostics: Include urinalysis, PSA. Referral if necessary.

  • Prostate Cancer:

    • Symptoms: Newly presented bladder outlet symptoms, nocturia, ED, hematuria.

    • Diagnostics: Positive DRE/PSA requires referral for biopsy and staging.

Tanner Staging: Female Development (Pubic Hair)

  1. Stage 1 (Preadolescent):

    • No pubic hair.

  2. Stage 2:

    • Long, slightly pigmented, straight/downy hair along labia.

  3. Stage 3:

    • Darker, coarser, tightly curled hair sparsely spread over the mons pubis.

  4. Stage 4:

    • Adult-type hair but covers smaller area than average adults, no medial thigh spread.

  5. Stage 5:

    • Adult hair in quantity/type, inverse triangle distribution, medial thigh spread, but not linea alba.

Menopause

  • Definition:

    • 12 consecutive months without menses. Median age for onset is between 50-52 years.

    • Ovaries cease estrogen/progesterone production, leading to various physiological changes:

    • Uterine shrinkage.

    • Flattening of vaginal rugae and atrophy of epithelium, resulting in infections/dyspareunia.

    • Atrophy of labia and clitoris.

Teaching and Health Promotion (Chapter 24)

  • STI Statistics:

    • 26 million new STI cases annually; nearly half occur in ages 15-24.

    • Associated complications: cervical cancer, pelvic infections, infertility.

  • Healthy People 2030 Goals for Female Reproductive Health: Include reducing syphilis rates and increasing screening for chlamydia, targeting young adults/adolescents.

Pregnancy Stages Overview
First Trimester (0 to 13 weeks)

  • Events:

    • Zygote reaches and implants in uterine lining; potential small bleed.

    • hCG production starts, validating pregnancy; essential for maintaining uterine lining.

  • Warning Signs During Early Pregnancy:

    • Bright red bleeding, tissue passage, or significant cramping/dizziness should seek medical evaluation.

Second Trimester (13 to 26 weeks)

  • Growth Milestones:

    • Significant fetal growth; organs develop for potential survival outside uterus.

    • Fetal survey via ultrasound detects organ function; placental conditions assessed proactively.

Third Trimester (26 to 40 weeks)

  • Growth & Development:

    • Fetus gains weight rapidly; overall maturation of organs occurs and fetal skin thickens for protection.

    • Maternal antibody transfer happens; fetal nervous/muscular integration improves.

  • Due Date Determination Methods:

    • Average pregnancy length: 266 days after fertilization; estimated using LMP and Nägele's rule for accuracy adjustments.

Newborn and Infant Development

  • Growth Patterns:

    • Rapid growth continues postnatally; infants should triple their birth weight by one year.

    • Monitoring on growth charts is crucial for assessing health and development in relation to the child’s ethnicity/race.

Safe Sleeping Habits for Infants

  • Recommendations:

    • Position infants on their backs with a firm mattress; no loose bedding to avoid smothering hazards.

    • Crib safety should be prioritized; ensure the sleep environment is free from hazards.

Choking Risks for Infants

  • Prevention Strategies:

    • Identify and remove choking hazards within reach.

    • Proper food preparation (e.g., cutting firm foods) is key; reduce choking risks significantly.

Language Development in Children/Adolescents

  • Assessment:

    • Cultural contexts can impact language assessment; bilingual children may not exhibit delays.

    • Subjective assessments from an RN should focus on underlying health implications for bilingual children.

Pediatric Health Promotion Initiatives (Chapter 27)

  • Bright Futures Program:

    • National initiative addressing children’s health within family/community contexts, emphasizes holistic development considerations.

  • Health Promotion Goals for Children:

    • Screening for development, healthy lifestyle promotion, safety, nutrition, and mental health access.

  • Key Recommendations:

    • Focus on nutrition, obesity reduction, and preventing substance abuse and promoting education in sexual health.