NCMA121 - Health Assessment Summary Notes

NCMA121 Coverage

  • Assessment of Heart and Vessels
  • Assessment of Neurologic System
  • Assessment of Abdominal
  • Assessment of Musculoskeletal System
  • Assessment of Female Genitalia
  • Assessment of Male Genitalia
  • Assessment of Peripheral Vascular System
  • Relevant Ethico-Legal Considerations in Conducting Health Assessment
  • GUIDELINES OF AN EFFECTIVE INTERVIEW AND HEALTH HISTORY / HEALTH CARE TEAM IN HEALTH ASSESSMENT

Cardiovascular System

  • Cardiovascular System: Delivers oxygenated blood and removes waste products.
  • Autonomic Nervous System: Controls heart pumping.
  • Vascular Network: Arteries, veins, capillaries maintain blood flow and pressure.
  • Capillaries: Exchange materials between blood and tissue cells.
  • Heart: Four-chambered muscle, pumps blood throughout the circulatory system.
  • Closure of tricuspid and mitral valves: S1 (lub) sound.
  • Closure of pulmonary and aortic valves: S2 (dub) sound.

Heart Chambers

  • Right Atrium: Receives deoxygenated blood from the body.
  • Right Ventricle: Pumps blood to the lungs.
  • Left Atrium: Receives oxygenated blood from the lungs.
  • Left Ventricle: Pumps blood into systemic circulation.

Heart Valves

  • Atrioventricular Valves:
  • Tricuspid: Prevents backflow from right ventricle to right atrium
  • Mitral: Prevents backflow from left ventricle to left atrium
  • Semilunar Valves:
  • Pulmonic: Prevents backflow from pulmonary artery to right ventricle.
  • Aortic: Prevents backflow from aorta to left ventricle.

Heart Sounds

  • Produced by valve closure.
  • S1: "lub", closure of AV valves (tricuspid and mitral), beginning of systole.
  • S2: "dub", closure of semilunar valves (aortic and pulmonic), beginning of diastole.

Extra Heart Sounds

  • S3 & S4: Diastolic filling sounds from ventricular vibration.
  • S3: Ventricular gallop, early diastole after S2.
  • S4: Atrial gallop, late diastole before S1.

Murmurs

  • Turbulent blood flow, swooshing sound (increased velocity, valve defects, malfunction, abnormal chamber opening).

Auscultating Heart Sounds

  • Aortic Area: 2nd ICS at right sternal border.
  • Pulmonic Area: 2nd or 3rd ICS at left sternal border.
  • Erb’s Point: 3rd to 5th ICS at left sternal border.
  • Mitral (Apical): 5th ICS near left MCL; apex of the heart.
  • Tricuspid Area: 4th or 5th ICS at left lower sternal border.

Auscultation Areas Notes

  • Sounds travel in direction of blood flow.
  • Aortic Area: right 2nd ICS to apex of heart.
  • Pulmonic Area: 2nd and 3rd left ICS close to sternum.
  • Assessment Positions: Sitting, supine, and left lateral.

Inspection (Neck & Precordium)

  • Neck:
  • Carotids: Visible, palpable pulsations.
  • Jugulars: Undulated wave, obliterated by pressure, affected by respirations/position.
  • Precordium:
  • Positive pulsation at apex

Palpation (Carotid & Jugular & Precordium)

  • Carotid Artery: Palpate each carotid separately.
  • Jugular Veins: Occluding under the jaw, the jugular should flatten, but the wave form will become more prominent.
  • Cardiac Rate >100 bpm : Sinus tachycardia, Supraventricular tachycardia (SVT), Paroxysmal tachycardia (PAT), Uncontrolled atrial fibrillation, Ventricular tachycardia, etc.
  • Cardiac Rate <60 bpm: Sinus bradycardia heart block, etc.
  • Irregular Rhythm: Arrhythmia.
  • Precordium: Normal apex (left ventricular area) PMI is 1-2 cm, Apical pulsation may not always be palpable, Left lateral displacement of PMI may occur during the last trimester of pregnancy

Auscultation

  • Neck:
  • Auscultate the carotid with the bell portion of the stethoscope for bruits, Auscultate the jugulars with the bell portion of the stethoscope for venous hums.
  • Positive carotid bruit may be normal in children and is associated with high-output states
  • Precordium: At apex Note rate, rhythm, extra sounds, or murmurs, Auscultate at each site (apex, LLSB, Erb's point, base left and base right).

Common Abnormalities

  • Angina Pectoris: Chest pain from myocardial ischemia.
  • Congestive Heart Failure: Heart fails to pump sufficiently.
  • Right-Sided Failure: Fatigue, weight gain, neck vein distension, edema.
  • Left-Sided Failure: Fatigue, left ventricular heaves, dyspnea.
  • Coronary Artery Disease: Narrowing of coronary arteries, often atherosclerosis.
  • Pericarditis: Inflammation of pericardium, chest pain aggravated by inspiration.

Musculoskeletal System

  • Made of bones, muscles, and joints. Controlled and innervated by the nervous system.

Bones

  • Provide structure, protection, store calcium, produce blood cells. 206 bones: axial and appendicular skeleton - Composed of osseous tissue Compact Bone: hard and dense, outer layer Spongy Bone: contains numerous spaces, inner layer Osteoblasts: bone formers Osteoclasts: bone destroyers Red marrow: produces blood cells Yellow marrow: composed mostly of fats

Skeletal Muscles

  • Types: skeletal, smooth muscle, cardiac 650 skeletal (voluntary) muscle, which are under conscious control Assist with posture, produces body heat and allow body to move.

Skeletal Muscle Movements:

  • Abduction — moving away from midline of the body Adduction — moving toward midline of the body Circumduction — circular motion Inversion — moving inward Eversion — moving outward Extension — straightening the extremity at the joint and increasing the angle of the joint Flexion — bending the extremity at the joint and decreasing the angle of the joint Pronation — turning or facing downward Supination — turning or facing upward Protraction — moving toward Retraction — moving backward Rotation — turning head to the right shoulder then back to the midline, next turning the head to left shoulder then back to midline JOINTS (ARTICULATION) Provide a variety of range of motion (ROM ) for the body parts.

Joints (Articulation)

  • Provide a variety of range of motion (ROM ) for the body parts. Fibrous — are joined by fibrous connective tissue and are immovable (sutures bet. Skull bones) Cartilaginous — are joined by cartilage joints bet. Vertebrae Synovial — contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones Temporomandibular Joint — open and closes the mouth — projects and retracts the jaw — moves jaw from side to side Sternoclavicular Joints — has no obvious movements — junction between the manubrium of the sternum and the clavicle.

Assessment Proper Inspect Muscles

  • Compare each muscle on one side of the body to the same muscle on the other side For any apparent discrepancies, measure the muscles with a tape Normal: equal size on both sides of body Deviations from normal: ATROPHY (a decrease in size) or HYPERTROPHY (an increased in size) Inspect Muscles and Tendons for Contractures Normal: no contractures Deviations from normal: Malposition of body part (foot drop or foot flexed forward) Inspect Muscles for Tremors Inspect any tremors of the hands and arms by having the client hold arms out in front of body Normal: no fasciculation or tremors Deviations from normal: presence of fasciculation or tremors

Palpate muscles

  • Normal: normally firm Deviations from normal: atonic (lacking tone) Palpate muscles while the client is active and passive for flaccidity, spasticity, and smoothness of movement Normal: smooth coordinated movements Deviations from normal: flaccidity (weakness or laxness) or spasticity (sudden involuntary muscle contraction) Test muscle strength. Compare the right side with the left side. Normal: equal strength on each body side Deviations from normal 25% or less muscle strength GRADING MUSCLE STRENGTH

PALPATION AND INSPECTION

  • Bones Inspect the skeleton for normal structure and deformities. Normal: no deformities Deviation from normal: bones misaligned Palpate the bones to locate any areas of edema or tenderness. Normal: no tenderness of swelling Deviation from normal: presence of tenderness of swelling Joints Inspect the joint for swelling. Normal: no swelling Deviation from normal: one or more swollen joints Palpate each joint for tenderness, smoothness of movement, swelling, crepitation, and presence of nodules. Normal: No tenderness, swelling, crepitation, or nodules Deviation from normal Presence of tenderness, swelling, crepitation, or nodules

Range of Motion (ROM)

  • Ask the client to move selected body parts. If available, use a goniometer to measure the angle of the joint in degrees Normal: Varies to some degree in accordance with. person’s genetic makeup and degree of physical activity Deviations from normal Presence of tenderness, swelling, crepitation, or nodules

Abnormalities Affecting The Wrist, Hands And Fingers

  • Acute Rheumatoid Arthritis — tender, painful, swollen, stiff joints Chronic Rheumatoid Arthritis — chronic swelling and thickening of the metacarpophalangeal and proximal interphalangeal joints, limited ROM, and finger deviation toward the ulnar side Boutonniere and Swan-neck Deformities — flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint — hyperextension of the proximal interphalangeal joint with flexion of the distal interphalangeal joint Thenar Atrophy — atrophy of the thenar prominence due to pressure on the median nerve is seen in carpal tunnel syndrome Ganglion — non-tender, round, enlarged, swollen, fluid filled cyst and commonly seen at the dorsum of the wrist Osteoarthritis — hard, painless, nodule over the distal interphalangeal joints ( Heberden’s nodes) and over the proximal interphalangeal joints (Bouchard’s nodes) Tenosynovitis — painful flexion of a finger (infection of the flexor tendon sheaths) ABNORMALITIES OF FEET AND TOES Acute – Gouty Arthritis — metatarsophalangeal joint of the great toe is tender, painful, reddened, hot and swollen Callus — are non-painful, thickened skin that occur at pressure Corn — are painful thickening of the skin that occur over the bony prominences and at pressure points Plantar Wart — are painful warts ( verruca vulgaris ) that often occur under a callus, appearing as tiny dark spots Hallux Valgus — the great toe is deviated laterally and may overlap the second toe

NEUROLOGIC SYSTEM - 12 Cranial Nerves

  • I - Olfactory
  • II - Optic
  • III - Oculomotor
  • IV - Trochlear
  • V - Trigeminal
  • VI - Abducens
  • VII - Facial
  • VIII - Acoustic
  • IX - Glossopharyngeal
  • X - Vagus
  • XI - Spinal Accessory
  • XII - Hypoglossal

Assessment Proper - CN I – OLFACTORY NERVE Have client sit in a comfortable position at your eye level Ask the client to clear the nose to remove any mucus Close eyes, occlude one nostril, and identify a scented object that you are holding such as soap, coffee, or vanilla Repeat procedure for the other nostril Normal: Client correctly identifies scent presented to each nostril Some older clients’ sense of smell may be decreased Deviations from normal: Neurogenic Anosmia - inability to smell or identify the correct scent - may indicate: olfactory tract lesion, frontal lobe tumor, congenital, nasal or sinus problems, nerve tissue injury - smoking and use of cocaine

CN II – OPTIC Use snellen chart to assess vision in each eye Ask the client to read a newspaper or magazine paragraph to assess near vision Assess visual fields of each eye by confrontation Use an ophthalmoscope to view the retina and optic disc of each eye ##Visual Acuity Use a Snellen chart to assess vision in each eye Normal: Client has 20/20 vision OD (right eye) and OS (left eye) – (distance vision) Deviations from normal difficulty reading Snellen chart missing letters squinting ##Extraocular Movements - CN III, IV, VI Assess pupillary response to light (direct and indirect) and accommodation in both eyes Normal: Eyelid covers about 2 mm of the iris Eyes move in a smooth, coordinated motion in all directions (the six cardinal fields) Bilateral illuminated pupils constrict simultaneously Pupil opposite the one illuminated constricts simultaneously Deviations from normal: Ptosis (drooping of the eyelid) is seen with weak eye muscles myasthenia gravis Possible causes of abnormal eye movements cerebellar disorders increased ICP (indication: limited eye movement) paralytic strabismus Possible causes of pupil abnormalities oculomotor nerve paralysis Argyll Robertson pupils narcotics abuse CN III damage lesions of the sympathetic nervous system PNS or CNS dysfunction CN V lesion

CN V – TRIGEMINAL Test motor function Ask the client to clench the teeth while you palpate the temporal and masseter muscles for contraction Normal Temporal and masseter muscles contract bilaterally Deviations from normalDecreased contraction in one of both sides Asymmetric strength in moving the jaw may be seen with lesion or injury of the 5th cranial nerve Pain occurs with clenching of the teeth. Test sensory function - touch forehead, cheeks, chin with sharp/dull object, Test corneal reflex to elicit blink bilaterally Normal: Properly identify sensation to light touch, sharp/dull. Blink reflex in tact

CN VII – FACIAL - test Motor and Sensory function Smile Frown and wrinkle forehead Show teeth Puff out cheeks Purse lips Raise eyebrows Close eyes tightly against resistance Normal: smiles, frowns, wrinkles forehead, shows teeth, puffs out cheeks, purses lips, raises eyebrows, and closes eyes against resistance movements are symmetric Deviations from normal: Inability to close eyes, wrinkle forehead, or raise forehead along with paralysis of the lower part of the face on the affected side Bell's Palsy: Paralysis of the lower part of the face on the opposite side affected may be seen with a central lesion that affects the upper motor neurons Stroke. Not routinely tested, if testing is indicated, however, touch the anterior two thirds of the tongue with a moistened applicator dipped in salt, sugar, or lemon juice Normal: Properly identify flavor

- CN VIII – ACOUSTIC / VESTIBULOCOCHLEAR Normal: Client hears whispered words from 1–2 feet Weber test: Vibration heard equally well in both ears Rinne test: AC > BC Deviations from normal vibratory sound lateralizes to good ear in sensorineural loss Air conduction is longer than bone conduction

- CN IX, X – GLOSSOPHARYNGEAL, VAGUS To test motor function and gag reflex Normal: Soft palate does not rise, bilater Soft palate and uvual will rise equally; Positive gag reflex; Swallow equally with positive voice

- CN XI – SPINAL ACCESSORY Ask the client to shrug the shoulders against resistance to assess the trapezius muscle Ask the client to turn the head against resistance, first to the right then to the left, to assess the sternocleidomastoid muscle Normal and symmetric; Strong contraction of trapezius muscles; Normal - strong contraction of sternocleidomastoid muscle on the side opposite the turned face. ###- CN XII – HYPOGLOSSAL Assess strength and mobility of tongue Normal and symmetric
- level of consciousness to identify terms

Level of Consciousness Alert — Follows commands in a timely fashion Lethargic — Appears drowsy, may drift off to sleep during examination Stuporous — Requires vigorous stimulation (shaking, shouting) for a response Comatose — Does not respond appropriately to either verbal or painful stimuli glasgow coma scale

-reflexes and findings 4+, 3+, 2+, 1+, and 0+ is the grading standard Brachioradialis Reflex Biceps Reflex Triceps Reflex Patellar Reflex Achilles Reflex Plantar Reflex Abdominal Reflex Cremasteric Reflex

MENINGEAL IRRITATION Test for MENINGEAL IRRITATION Supine Place hands behind the patient’s head and flex the neck forward until the chin touches the chest Normal: Neck is supple; client can easily bend head and neck forward Deviations from normal Pain in the neck and resistance to flexion can arise from meningeal inflammation, arthritis, or neck injury SigNS OF MENINGEAL IRRITATION 1. Brudzinski’s Sign As you flex the neck watch the clients hips and knees in reaction to your maneuver Normal: Hips and knees remain relaxed and motionless Deviations from normalPain and flexion of the hips and knees are positive Brudzinski’s signs, suggesting meningeal inflammation 2. Kernig’s Sign Flex the client’s leg at both hip and the knee, then straighten the knee Normal No pain is felt Deviations from normal Pain and increased resistance to extending the knee are (+) Kernig’s sign When bilateral = suspect meningeal irritation

NEUROLOGICAL PROBLEMS AND TERMS WITH THEM AGNOSIA — Agnosia means the brain has trouble recognizing things, even though the eyes, ears, and other senses work fine Visual Agnosia Tactile Agnosia Auditory Agnosia ASTEREOGNOSIS — Inability to correctly identify objects AKINESIA — Complete or partial loss of voluntary muscle movement APHASIA — Absence or impairment of ability to communicate through speech, writing, or signs APRAXIA — Inability to carry out learned sequential movements or commands CIRCUMLOCUTION — Inability to name object verbally, so patient talks around object or uses gesture to define it DYSARTHRIA — Defective speech; inability to articulate words; impairment of tongue and other muscles needed for speech DYSPHASIA — Impaired or difficult speech DYSPHONIA — Difficulty with quality of voice; hoarseness NEOLOGISMS — Made-up, nonsense, meaningless words PARAPHRASIA — Loss of ability to use words correctly and coherently; words are jumbled or misused TREMORS — Involuntary movement of part of body INTENSION TREMOR — Involuntary movement when attempting coordinated movements FASCICULATION — Involuntary contraction or twitching of muscle fiber
Abdominal System - Abdominal Quadrants The abdomen is divided into four quadrants: Right Upper Quadrant (RUQ), Right Lower Quadrant (RLQ), Left Upper Quadrant (LUQ), and Left Lower Quadrant (LLQ). These quadrants are used as reference points to describe the location of abdominal organs and any associated pain, tenderness, or abnormalities. - Abdominal Regions Another method of dividing the abdomen is by using nine regions: epigastric, umbilical, hypogastric (or suprapubic), right hypochondriac, left hypochondriac, right lumbar, left lumbar, right iliac (or inguinal), and left iliac (or inguinal). These regions provide a more detailed anatomical map for locating specific organs and characterizing abdominal findings. - Abdominal Wall Muscles The abdominal wall is composed of several layers of muscles that support and protect the internal organs: External Abdominal Oblique Internal Abdominal Oblique Transverse Abdominis Rectus Abdominis Internal Anatomy of the Abdominal Cavity The internal anatomy of the abdominal cavity includes various organs and structures held in place by the peritoneum and mesentery. - Peritoneum Is a thin, shiny, serous membrane that lines the abdominal cavity and protects the internal organs. It includes the spleen, bile duct, gallbladder, small intestine, stomach, large intestine, and liver. The abdominal viscera are the internal organs located within the abdominal cavity. These organs can be divided into two main categories: solid viscera and hollow viscera. Solid Viscera - Liver, - Pancreas - Spleen, - Adrenal glands - Kidneys - Ovaries, and uterus. Hollow Viscera - Stomach - Gall bladder - Small intestine - Colon, and bladder Retroperitoneal Organs Kidneys - Bean-shaped organs that lie tucked against the posterior abdominal wall - Get rid of the body waste products - for acid base balance, fluid and electrolyte balance, arterial blood pressure. Ureters the passageway of urine from the kidneys.
THE ABDOMINAL VISCERA (ORGANS) - Stomach A J-shaped pouch-like organ located in the left upper quadrant of the abdomen beneath the diaphragm - Lies to the right of the spleen and is partially covered by the liver Serves as a reservoir where the complex mechanical and chemical processes of digestion occur Breaks down food particles into the molecular form of digestion - Small Intestine A tubular-shaped organ extending from the pyloric sphincter to the ileocecal valve at the opening of the large intestine - Measure from 10 feet to 30 feet Segments: duodenum, jejunum, ileum - Large Intestine A tubular-shaped organ extending from the ileocecal valve to the anus - Greater diameter than the small intestine Segments: ascending colon, transverse colon, descending colon - Vermiform Appendix A finger-like shape that extends off the lower cecum in the right lower quadrant PROCEDURE AND EQUIPMENTS Assessment Equipments- drapes, tape measure w centimeter markings - Marking pen - Stethoscope. Order of Assessment- Inspection- AuscultationPercussion- Palpation
* INSPECTION Procedure Normal contour- flat /rounded symetry- bilaterally pigment- skin is paler than general skin - scars - pale smooth minimially raised - striae-linear and white or silvery Masses Normal- no mass Umbilicus- Midline Normal Pulsation Normal- intermittent gurgling sound in all four quadrants Abdominal Percussion All four abdominal quadrants - Tympany- predominance in stomach area and intestines(Normal) - Bulges and masses should not be apparent Abnormal InspectionFindings contour- protruberant or distended- below umbilicus-full bladder, pregnancy above could be gastric dilitation (tumor or mass) symetry- not symmetrical pigment- Cullen’s sign and Grey-Truner sign should not be present Masses masses should not be presented- hernia or diasisect Rect- should not be present Umbilicus- umbilical -deverated sign - sign should not be presented - pulsating should not be heard/ palpated in thin women is normal Auscultations- Bowel Sounds- Active bowel sounds- Normal- 30-5 high pitched loud sound- Diarrrea- increase Hypactive bowel- paraletic- peritonitus Vascular- arterial- sounds not normally present - bell technique - hepatic - sounds present Percussions - Abdomen Percussions- Tympany- predominance in stomach area and intestines(Normal) = Dullness- Normally heard on the organs on the liver,bladder-Normal - liver should only measure/span between 6 and 12 cm normal height - percussion should not produce - pain
Palpation Palpation - to assess liver Palpation - is used to describe surface areas and - - - consistency liver is palpability (Abnormal findings) - hard, nodularity - masses- nodularity cancer tenderness palpation- is used to assess Spleen should be non palpable palpable would be considered splenomegaly enlarged kidney urinary bladder empty normally not palpable a full bladder is - palpability inguenal Palpations- normal - less than 1 cm- masses Abnormal Findings that may be present during Abdominal Assessment. Abdominal - findings may also include - severe abnormal may be tumor, infection, or - organ palpatiod abdominal sounds and organs. Female Genitalia. The female reproductive system consists of external and internal organs that play crucial roles in reproduction, hormone production, and overall health. The external genitalia (vulva) and internal genitalia Each have their distinct structures and functions. Mons Pubis - Fatty area above the female genitals, usually has - hair Labia Majora - Outer lips of the vulva, thick and has hair. Labia Minora - nner lips, thinner and no hair. Clitoris - Small, sensitive part that gives sexual pleasure. Vestibule - Area between the labia minora where the vaginal and Urethral Openings are. Urethral Meatus - Opening where urine comes out. Skene’s Glands - Small glands near the urethra, produce uid. Vaginal Orifice - Opening of the vagina, where blood, babies, and Intercourse happen. It’s acidic (pH 3.8–4.2) to help protect Against bacteria

HYMEN -Thin tissue partly covering the vaginal opening. Bartholin’s glands - Glands near the vagina that release fluid For lubrication. - INTERNAL GENITALIA Consisting of the following: A muscular tube where menstruation comes Out, where the baby passes during birth, and where Intercourse happens. It’s acidic (pH 3.8–4.2) to help Protect against bacteria. Cervix The lower part of the uterus that connects to the Vagina.
Uterus - The womb; where the baby grows during Pregnancy. - Anteverted and ante exed Normal position of the uterus, tilted slightly forward The Ovaries that produce egg cells and female HORMONES(like estrogen and progesterone. Fallopian Tubes- Tubes that carries the egg from the ovary - to the uterus Fertilization Usually happens here. Fimbriae fingerlike ends of the fallopian tubes that Help catch the egg from the ovary ASSESSMENT PROCEDURE AND TECHNIQUE INSPECTION (Procedure to follow skin Normal: Pubic hair is distributed in an inverted triangular Pattern. May be some growth on abdomen and upper inner Thighs. No signs of infestation -Skin over mons pubis is - clear. Older clients may have gray, thinning pubic hair Normal: labia mayora and minora symmetrical with smooth to Moderate skin. Slightly pigmented Skin - no edema. - Clitoris: about 2 cm long and 0.5 cm in diameter. No redness Urethral opening slit-like, midline, and free of Discharge, swelling, redness, or lesions

-Palpation The palpation of these three areas consisting that all 3 test normal to feel soft with no swelling, or painful. Labia Palpation URETHRAL MEATUS, SKENE’S & BARTHOLIN’S GLANDS VAGINAL INTROITUS AND PERINEUM - ABNORMAL FINDINGS AND SIGNS - THAT MAY BE IDENTIFIEDPubic lice, nits, or flecks of residual blood on skin - Ecchymosis may be caused by blunt trauma Labile varicosities edema may be obstruction of the lymphatic system or Hematoma Formation Skin Areas -Chancre Condylomata auminatum Herpes simplexHypertrophy of clitoris: - Chancroid -dischared Abnormal -may not be - Clear - Vaginal Necrosis and other tearRectocele

Pénis - the male external sex organ used for Urination and sexual activity Shaft of penis – The long part of the penis. Glans (corona) – The round tip or “head” of the penis Prepuce – The foreskin that covers the glans (if not Circumcised). Urethra the tube inside the penis where urine and Semen come out. Frenulum – A small, sensitive band of tissue under the Glands that connects to the shaft. Scrotum loose sac of skin behind the penis that Holds and protects the testicles. Rugae wrinkled skin of the scrotum helps with Temperature control Cremaster muscle: muscle that Moves the testicles:

  • Contracts when cold pulls testicles closer to the Body. Relaxes when warm lets testicles hang lower. Internal Genitalia Testes – Make sperm and male hormone (testosterone). Tunica Vaginalis Thin: cover that protects the testes. Spermatic CordHolds the vas deferens, blood Vessels, and nerves.Vas Deferens Tube that carries sperm; longer on The left side. Epididymis Stores and mature sperm. Prostate Gland Produces fluid that helps sperm Move and survive. Seminal Vesicles Produce a sugary fluid that mixes With sprem tomake semen. Cowper’s Glands clear fluid that Lubiricates the urethra before ejaculation. PROPER INSPECTION Pubic Hair Notes hair distribution pattern triangular Sparcely(thinly with unevenly) distributed on scrotum and inner thigh Absent on penis Genital - Normal; No skin intact with or darker skin and around anus

Vascular- artery and vein- descriptionArteries

  • These are blood vessels that carry oxygenated, nutrient rich blood from the heart to the capillaries. * A high-pressure system - Arterial pulse The surge of blood as a result from a heartbeat which forces blood through the arterial vessels under high pressure Major Arteries of the Arm - Major artery that supplies the arm the brachial artery artery, Radial artery and ulnar artery Major Arteries of the Leg- Femoral artery, Popliteal Artery; dorsalis pedis artery Veins - Carry deoxygenated, nutrient depleted, waste-laden blood from the tissues back to the heart - Contain nearly 70% of the body’s blood volume - Walls are much thinner, low-pressure system Types of Veins: Deep Veins, Superficial Veins and Perforator Veins Three Mechanisms of Venous Function Capillaries - Small blood vessels that form the connection between the arterioles and venules - Allow the circulatory system to maintain the vital equilibrium between the vascular and interstitial spacesCollecting objective. Discuss risk factors for PVD with the client. - Accurately inspect arms and legs for edema and venous patterning
  • Observe carefully for signs of arterial and venous insufficiency (skin color, venous pattern, hair distribution, lesions or ulcers) and inadequate lymphatic drainage Recognize characteristic clubbing Palpate pulse points correctly Use the Doppler ultrasound instrument correctly ASSESSMENT PROPER INSPECTION Arms Observe coloration of the hands and arms Normal findings: Color varies depending on the client’s skin tone, although color should be the same bilaterally Abnormal findings: Raynaud disorder : A vascular disorder caused by vasoconstriction or vasospasm of the fingers or toes, characterized by rapid changes of color (pallor, cyanosis, and redness), swelling, pain, numbness, tingling, burning, throbbing, and coldness Normal findings: Skin is warm to the touch bilaterally from fingertips to upper arms Abnormal findings: A cool extremity may be a sign of arterial Insufficiency. Cold fingers and hands, for example, are common findings with Raynaud’s INSPECTION- Cap refill -Compress the nailbed until it blanches release pressure Normal findings: Capillary beds refill (and, therefore, color returns)Normal findings: Radial pulses are bilaterally strong (2Artery walls have a resilient quality (bounce) Abnormal findings Increased radial pulse volume indicates a : - Hyperkinetic state pulse). Reduced (1+) or absent (0) pulse suggests reduced complete artery closure Lack of toughness or inflexibility of the artery wall
Arterial vs Venous Insufficiency

CHARACTERISTICS OF ARTERIAL AND VENOUS INSUFFICIENCY Arterial Insufficiency - Pain: intermittent absent Pulses- Diminshed skin Charactereistics skin cool, shiny, hairless, thick nails Venous insuficency pain - achy edema Skin characteristics- pigmentation varacosities Normal and Abnormal ARTERIAL FINDINGS - toes necroses , Raynaud Disease in hands - Venous - unilateral localized - often Varicose Veins Lymphodemia Peripheral findings- Raynaud Disease in hands

The Philippine Nursing Code of Ethics

SERVING as the ethico-legal practice in the phil. The nurses practice in republic country PREAMBLE Health is a fundamental right of every individual In short the registered nurse need to believe in to protect the fundamental health is the priority REGISTERED NURSE AND PEOPLE Ethical Principles - Values, customs, and spiritual beliefs held by Individuals shall be respected - Individual freedom to make rational and Unconstrained decisions shall be respected Personal information acquired in the process of Giving nursing care shall be held in strict con dence. Registered Nurse Must: - Consider individuality and totality. Respect cultural belief. Take in Consideration the culture and values in Patients. Guidiles that register nurses must follow to practice lawfully. REGISTERED NURSES AND PRACTICE Ethical Principles - Human life - Quality and excellence of health Accurate documentation of action that result the care - REGISTERED NURSES PROFESSION - the ethical professional and Legal dimensions Ethical Dimension Guiddlines - must understand moral conduct - avoid misleading any product gift or commissions - avoid -abusiing - relationships NURSES, SOCIETY AND ENVIRONMENT Ethical principle- preservation life and respect of human rights Guidlines must that registered nurses - be conscious of their obligations as a citien involved in community concerns and be equipped to knowledge of health resource within the community lead principles of right condyct and proper decorun. Data Privacy act The primary privacy bill aims to protect people from unlawful in information for communication system
A document that all patient gets when they get to expect and get taken care of their hospital stay - provide goals and expectations that patient medical treatment should imply Medical treatement - To have access and information and be told when they are right and wrong. - privacy To allow patients their freedom of privacy. Healthcare and To be able to get to give to get any physician or what that - is. Medical research patients of all patients cannot force to be a experiment, unless they consent To have access for communication To complain if the patient has or is mistreat To know all righta to avoid misunderstanding. The Data Privacy- The primary privac bill aims to protect people from unlawful of all infomation communitcationsystem- Section 3 To provide- Breach in confidentiality and to do what is right Patient Rights- It’s every patient right to know the hospital and treatment and expect during their stay in the hospital Legal Responsibilities- to know what to do in a professional matter and know what the patient can offer

Communication during the Interview - Types and What to do##Two types of communication1

  • Non-verbal Communication (body language)Appearance, demeanor- greeting clients( Calm your attitude, expression, silence,listening, laundry list,open and close questions Verbal CommunicationsRe phrasing - encourage client's-verbalizing ability with other means of communicationSpecial considerations to deal with communicationGerontologic variationsCultural variations is communication - some variations: reluctant to relay past trauma. Variations among communication such as past, pressent or future.Emotionall variations in communication - not everyone may want to participate and some people may not listen at times when scared or axious To have a neutral atitude is key. Health cart personnel: * Physician- Dr. Nurse roles are- Promote health and prevent Assistant/ Tech -Help nurses in charge with what need to tend to * Patient Advocate- know the well and wrong and help the patient * Nurse Practitioner- diagnose and maintain * Physical therapist - aid injured with disabilities with their Physical * Occupational Therapist - helps clients with therapy * Respiratory therapist - to improve clients function - * Speech therapist- clients ability to -wallow Nutriotionist: aids client if eating plan has to alter * Conntinuin care nurse *Pharmacist - disponse staff workers - and adminiter care in a timely manner

Guidelines for Effective Interview and Health History

  • Communication is key to the interview process.
  • Non-verbal cues (appearance, demeanor, expression, attitude, silence, listening) are as important as verbal communication.
  • Questioning techniques include laundry lists, open-ended questions, closed-ended questions, rephrasing, inferring, and well-placed phrases to encourage client verbalization.
  • Be aware of and accommodate for gerontologic, cultural, and emotional variations in communication.
  • Understand the roles of different health care team members in assessment and care.