NURSE-UN 239 Final: HAP - Final Study Guide
28 Oct 2018
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Professor
1
HAP Final Exam Study Guide (use in addition to Exam 1 Study Guide)
WEEK 5
HEENOT
Subjective data
Health history
• Head – hx injury or surgery
• Neck – thyroid disease, neck surgery, thyroid meds
• Eyes – injury or surgery, glasses or contacts (@ risk of delirium when these aren’t avail in hospital), last exam, meds
o People with diabetes need 1x yearly check up
• Ears – environment noise (loud job), hx surgery
• Nose/sinus – hx nasal trauma/surgery
• Mouth/throat – hx oral surgery, throat cancer (HPV related), last dental exam (dentures esp. for elderly)
Review of systems - HEENOT
• Head – dizzy, headache (tension, migraine, clutter), vertigo
• Neck – pain, limited ROM, lumps/swelling (lymph assessment), enlarged/tender, goiter (iodine)
• Eyes – decrease acuity, diplopia (2x vision), blind spots, glaucoma & cataracts esp for elderly
• Ears – aches, infections, discharge, tinnitus (ringing, from meds), vertigo (room is spinning, has to do with vestibular
apparatus), hearing loss (more in men), presbycusis (hearing loss w/ age)
• Nose/sinus – frequent colds, allergies, nosebleeds, change sense of smell (elderly eat spoiled food)
• Mouth/throat – hoarseness or voice change (cancer), oral health linked to systemic health (for ex: can worsen symptoms of
diabetes)
Older adults –
• Less ROM head/neck – trouble driving
• Hearing aids, glasses, etc. → don’t have can lead to delirium
• Dentition – never use toothpaste on dentures, makes pits for bacteria to grow
#1 reason for seeking care…. #2 History of Present Illness (HPI)
Objective data
• Head – inspect size and shape, palpate for lumps/tenderness
o Micro/macrocephaly – small/larger than normal
o Hydrocephaly – baby w/ swollen head
o Acromegaly – related to GH, overgrowth
o Paget’s disease – boney overgrowth
o Anencephaly – no brain
o Senile tremors in elderly are benign
o Tongue protrusion – seen in Parkinson’s or drug side effect
o Facial expression appropriate for circumstance
o Normal color – cyanosis & pallor w/ O2 issue
▪ Red butterfly rash – SLE
o Mole changes ABCDE
o Symmetrical movements – droopy face w/ stroke hx
o Periorbital edema = severe
o Bags under eyes evident w/ allergies
o Hyperthyroidism → puffy face
o Temporomandibular joint (TMJ) – abnormal with crepitation/popping, limited ROM
• Neck –
o Symmetry: head tilt, rigidity, muscle weakness
o ROM: pain during movement/limited
o Strength of cervical muscles seen by shrugging shoulders
o Trachea should be positioned midline – shift indicates extra air
o Lymph nodes: shouldn’t be able to feel, tenderness may indicate infection
o Thyroid – may be palpable in older adults, have patient swallow after displacing it to the side
▪ Listen for bruit – whooshing sound indicates turbulent blood flow when thyroid’s enlarged
• Eyes-
o Ptosis: drooping lids
o Ectropion: lashes/lids turn out
2
o Entropion: lashes turn in and irritate eyes
o Cyanosis can be seen in lower lids, indicates O2 problem
o Jaundice/yellow can indicate liver problems
o Cloudiness = cataracts
o Snellen chart – 20/20 means at 20 feet, they can read what a normal person at 20 ft. can read
▪ As denominator increases, vision is worse (20/40= at 20 feet they can read what a normal person can read
at 40 feet)
o Presbyopia: change in accommodation w/ age
o Myopia/hyperopia: nearsightedness/farsightedness
o PERRLA – pupils equal, round, reactive to light and accommodation
o Shine light and look at opposite eye for consensual constriction (can be brisk or sluggish)
o Accommodation: constriction when eyes focus on something close
o Drugs can change size of pupils
o 6 cardinal fields of gaze: cranial nerves 3, 4, 6
• Ears-
o Microtia (small ears) seen with genetic diseases (downs syndrome)
o Should not be cerumen impaction, eczema
o Palpation of pinna and tragus should not show tenderness
o Mastoid might be tender w/ mastoiditis
o Whisper test shows loss of high frequency hearing (presbycussis) more common in men
▪ Don’t let pt read lips
o Weber’s test – shows if hearing is equal bilaterally, doesn’t show you cause of problem
▪ In conductive hearing loss, lateralizes to defective ear
• Uses stapes, incus, and malleus
▪ In sensorineural loss, lateralizes to unaffected ear
• Nerve-related hearing loss
o Rinne test –
▪ For bone conduction (BC), hold up to mastoid
▪ For air conduction (AC), hold up to ear
▪ AC should be 2x long as BC!
▪ Conductive hearing loss BC > AC
▪ Sensorineural hearing loss AC > BC
• Mouth/throat
o Beefy/red tongue = anemia
o Enlarged tongue = downs syndrome
o Buccal mucosa for color, moisture, nodules, lesions
o Tonsil grading:
▪ +1 visible
▪ +2 halfway to uvula
▪ +3 touching uvula
▪ +4 touching each other
o Red tonsils might be acute infection
o White patches might mean mono, leukemia, diphtheria
o Normal to have cavities, crips, and pits in tonsils
o Tongue deviation – cranial nerve 12 damage, cerebral palsy
o Halitosis – poor oral hygiene, alcohol consumption, smoking, DKA (fruity)
CRANIAL NERVES
“Oh Oh Oh, Tiny Tits Are Fun And Give Virgins Awkward Hips”
“Oh Oh Oh, To Touch And Feel A Girls Vagina, Ah, Heaven”
“Some say marry money but my brother says big brains matter more”
Olfactory sensory
Optic sensory
Oculomotor motor
Trochlear motor
Trigeminal both
Abducens motor
Facial both
3
Acoustic (vestibulococchlear) sensory
Glossopharyngeal both
Vagus both
Accessory motor
Hypoglossal motor
CN1 = Olfactory
• Not routinely checked but if it is you need to check patency first
• Checks sense of smell
CN 2 = Optic
• Eye exam
• Visual acuity and peripheral vision
CN 3 = Oculomotor
• Eye movement
CN 4 = Trochlear
• Eye movement
CN 5 = Trigeminal
• Jaw movement
• Also sensory so can be tested by swabbing face
CN 6 = Abducens
• Eye movement
CN 7 = Facial
• Smile/frown, eyebrow movements, lips, mouth, puff cheeks
CN 8 = Acoustic/vestibulocochlear
• Whisper voice test
• Hearing
CN 9 = Glossopharyngeal
• Uvula should rise when you say AH
• Normal voice sounds
• Gag reflex
CN 10 = Vagus
• Uvula should rise when you say AH
• Normal voice sounds
• Gag reflex
CN 11 = Spinal/Accessory
• Head movement
• Shoulder shrug
CN 12 = Hypoglossal
• Stick tongue out
• Say light tight dynamite
Pediatric variations
• Head and neck – same as adult
• Eyes – visual acuity of 20/40 is acceptable
o Vision problems = school related issues
• Ears – hearing problems indicate developmental delay, behavioral issues due to hearing
• Nose – allergic salute = line across nose
• Mouth/throat – larger tonsils are OK
Older adult variations
• Eyes –
o Pseudoptosis – droopy
o Orbital fat decreased so eyes look sunken
o Lacrimal apparatus fxn poorly → dry eyes
o Acrus senilis – gray line around eye
o Decrease vision after age 70
o Impaired color perception
o Presbyopia – near vision decreased after age 40
• Ears –
Document Summary
Hap final exam study guide (use in addition to exam 1 study guide) Older adults : less rom head/neck trouble driving, hearing aids, glasses, etc. Don"t have can lead to delirium: dentition never use toothpaste on dentures, makes pits for bacteria to grow. In conductive hearing loss, lateralizes to defective ear: uses stapes, incus, and malleus. Oh oh oh, tiny tits are fun and give virgins awkward hips . Oh oh oh, to touch and feel a girls vagina, ah, heaven . Some say marry money but my brother says big brains matter more . Cn1 = olfactory: not routinely checked but if it is you need to check patency first, checks sense of smell. Cn 2 = optic: eye exam, visual acuity and peripheral vision. Jaw movement: also sensory so can be tested by swabbing face. Cn 7 = facial: smile/frown, eyebrow movements, lips, mouth, puff cheeks. Cn 8 = acoustic/vestibulocochlear: whisper voice test, hearing.
