NURS 612 AHA Exam 2 Study Guide from Chen Walta Review (complete A+ solution guide) / AHA Exam 2 Study Guide from Chen Walta Review

AHA Exam 2 Study Guide from Chen Walta Review Abnormalities in nail beds (pt. complains of problem with nail beds) Fungal infection (onychomycosis) Thick and yellow or white discoloration of nail bed May separate fro ...

AHA Exam 2 Study Guide from Chen Walta Review Abnormalities in nail beds (pt. complains of problem with nail beds) Fungal infection (onychomycosis) Thick and yellow or white discoloration of nail bed May separate from the nail bed May report associated discomfort, paresthesia, loss of manual dexterity May lose ability to walk, exercise, wear shoes Cellulitis Swollen, red, and painful to touch Bacterial infection A.K.A. Paronychia Paronychia Hx of nail trauma or manipulation Chronic- repeated exposure to moisture with tenderness and mild swelling. Redness, swelling, and tenderness at the lateral and proximal nail folds. Purulent drainage under cuticle. Soft tissue infection around fingernail. Chronic can produce rippling of the nail Leukonychia White spots on nail plate (caused by heavy metal poisoning such as lead, cirrhosis of the liver or chemotherapy. Different types of skin lesions Nodule Elevated, firm, circumscribed lesion Deeper in dermis than a papule. 1 to 2 cm in diameter Erythema nodosum, lipoma Cyst Elevated, circumscribed encapsulated lesion In the dermis or subcutaneous layer filled with liquid or semisolid material. Sebaceous cyst, cystic acne Papule Elevated, firm, circumscribed area Less than 1 cm in diameter Wart (verruca), elevated mole, lichen planus (Shiny like plaque psoriasis) Pustule Elevated, superficial lesion Similar to a vesicle but filled with purulent fluid Impetigo, acne Different types of headaches Classic Migraine Childhood onset-more common in women Unilateral or generalized Lasts hours to days Onset is morning or evening Pulsating or throbbing pain. Causes- Menstrual cycle, not eating, birth control pills, let down after stress. Can cause nausea/vomiting Temporal arteritis Older adults Unilateral or bilateral Lasts hours to days Occurs anytime Throbbing Causes-stress, anger, bruxism Hypertensive Adulthood Bilateral or occiput Lasts for hours Occurs in morning Throbbing Remits as the day progresses Cluster Adulthood Unilateral ½-2 hours duration Onset at night Intense burning, boring, searing, knifelike Can cause personality changes, sleep disturbances Caused by alcohol consumption Occurs more in men Thyroid problems based on patient history Hypothyroidism Weight gain Constipation Fatigue Cold intolerance Normal size thyroid Goiter Nodules Hyperthyroidism Weight loss Tachycardia Diarrhea Heat sensitivity Normal size thyroid Goiter Nodules Fine hair Brittle nails Proptosis Papules and pustules developed as result of hygienic activity. Folliculitis Inflammation and infection of hair follicle and surrounding dermis. Patho: inflammatory cells w/I the wall of the hair follicle create follicular based pustule inflammation can be superficial or deep Subjective data: Acute onset of papules and pustules associated with pruritus or mild discomfort May have pain with deep folliculitis Risk factors- frequent shaving, hot tubs, occlusive dressing, obesity Objective data: Small pustules May be surrounded by inflammation or nodular lesions May have suppurative drainage with crusting. Furuncle (Boil) Deep seated infection of pilosebaceous unit Patho: Staph aureus most common Starts as small perifollicular abscess May occur singly or in multiples Subjective data: Acute onset of tender red nodule that becomes pustular Objective data: Skin is red, hot, and tender Common in face, neck, arms, axillae, breasts, thighs, and buttocks Tinea (Dermatophytosis)-Group of noncandidal fungal infections that involve the stratum corneum, nails, or hair Patho: Infection of dermatophytes acquired by direct contact Lesions classified according to the anatomic location on hairy or non-hairy parts. Subjective May report pruritus Objective date: May be popular, pustular, vesicular, erythematous, or scaling Secondary bacterial infection Nodules that occur in the supraclavicular area-causes and likely differential diagnosis The supraclavicular node that warns of malignancy lies anterior to the sternocleidomastoid muscle. Non-Hodgkin lymphoma- malignant neoplasm of the lymphatic system and the reticuloendothelial tissues. Could also be abdominal/thoracic neoplasms, thyroid/laryngeal disease, or mycobacterial/fungal infections. What is differential diagnosis? Based on chief complaint, signs and symptoms What all can be wrong? What do we suspect? A patient with cough, wheezing, and fever DDx could be bronchitis, PNA, asthma, etc. How do you palpate lymph nodes on the body depending on which lymph node it is? Head and neck: Lightly palpate the entire neck for nodes Bending the patient’s head forward or to the side will ease taut tissues and allow better accessibility to palpation Feel for nodes on the head in the following six step sequence: The occipital nodes at the base of the skull The postauricular nodes located superficially over the mastoid process. The preauricular nodes just in front of the ear The parotid and retropharyngeal (tonsillar) nodes at the angle of the mandible. The submandibular nodes halfway between the angle and the tip of the mandible. The submental nodes in the midline behind the tip of the mandible Then move down to the neck, palpating in the following four step sequence The superficial cervical nodes at the sternocleidomastoid muscle. The posterior cervical nodes along the anterior border of the trapezius muscle. The cervical nodes deep to the sternocleidomastoid (the deep cervical nodes may be difficult to feel if you press too vigorously; probe gently with your thumb and fingers around the muscle.) The supraclavicular areas, probing deeply in the angle formed by the clavicle and the sternocleidomastoid muscle, the area of Virchow nodes. Axillae: Imagine a pentagonal structure: the pectoral muscle anteriorly, the back muscles (i.e. latissimus dorsi and subscapularis) posteriorly, the rib cage medially, the upper arm laterally, and the axilla at the apex. Let the soft tissue roll between your fingers, the chest wall, and the muscles as you palpate. A firm, deliberate, yet gentle touch may feel less ticklish to the patient. Support the patient’s forearm with your contralateral arm and bring the palm of your examining hand flat into the axilla; let the patient’s forearm rest on that of your examining hand. Rotate your fingertips and palm, feeling the nodes; if they are palpable attempt to glide your fingers beneath the nodes. Epitrochlear: Support the arm in one hand as you explore the elbow with the other. Grasp the patient’s right wrist, palm facing up, with your left hand. The elbow should be in the relaxed position at approximately 90 degrees. Place your right hand under the patient’s right elbow and cup your fingers around the elbow to find the area that is proximal and slightly anterior to the medial epicondyle of the humerus. There is a groove between the triceps and biceps muscles Palpate that groove with your fingers using a circular motion. Repeat using your left hand for the patient’s left elbow Inguinal and popliteal: Use a systemic approach when palpating sites of lymph node clusters Move the hand in a circular fashion, probing gently without pressing hard. Relieve tension by flexion of the extremity. To palpate have the patient lie supine with the knee slightly flexed. The superior superficial inguinal (femoral) nodes are close to the surface over the inguinal canals. The inferior superficial inguinal nodes lie deeper in the groin. To examine the popliteal nodes, relax the posterior popliteal fossa by flexing the knee. Wrap your hand around the knee and palpate the fossa with your fingers. Patient complains of pain between shoulder blades, it is more intense with deep breathing and coughing. Pleurisy- inflammatory process of the visceral and parietal pleura. Patho: Result of infective process Tumor Subjective data: Sudden onset with chest pain when taking a deep breath or cough Pain may be referred to ipsilateral shoulder Objective data: Pleural friction rub heard on auscultation Fever Tachypnea that is shallow *** Pleural effusion vs PNA vs Asthma vs P.E. Pleural effusion: Inspection: Diminished and delayed respiratory movement on affected side. Palpation: Trachea shifted Diminished fremitus Tachycardia Percussion: Dullness and flatness Hyperresonance above the affected area. Auscultation: Diminished to absent breath sounds Crackles Bronchophony, whispered pectoriloquy, egophony Occasional friction rub Pneumonia: Inspection: Tachypnea Shallow breathing Nasal flaring Palpation: Increased fremitus with consolidation Decreased fremitus with empyema or pleural effusion Tachypnea Percussion: Dullness Auscultation: Crackles, rhonchi, bronchial breath sounds, whispered pectoriloquy Asthma: Inspection: Tachypnea Nasal flaring Retractions Percussion: Hyperresonance Limited diaphragmatic expansion Auscultation: Prolonged expirations Wheezing Pulmonary embolism (P.E.): Pleuritic chest pain with or without dyspnea Tachycardia Tachypnea Low grade fever Hypoxia >>>>>>>>>>>>>>>>>>>>>CONTINUES.......(20 pages)