2. Ask client to urinate, and to put on the gown. Provide a container and wipes, enter the room with a chaperone and assist patient into the lithotomy position. P. 623
3. Hormone levels fluctuate resulting in menstrual irregularities. Will experience: hot flashes, night sweats, mood swings, decreased appetite, vaginal dryness, irregular vaginal bleeding, and lowered calcium levels due to lack of estrogen. P. 616
4. Stool specimens p. 631
a. Black stool- indicate upper gastrointestinal bleeding
b. Gray/tan stool- lack of bile pigment
c. Blood- may indicate cancer of rectum or colon
5. hernias p. 504
a. Umbilical- bowel protruding through weakness in umbilical ring
b. Diastasis recti- when bowel protrudes through a separation between the two rectus abdominas muscles. Appears as a midline ridge
c. epigastric hernia- bowel protrudes through a weakness in the linea alba. Small bulge appears midline between xiphoid process and umbilicus
d. incisional hernia- bowel protrudes through a defect or weakness resulting from a surgical incision
6. positions of leatus p. 595 and slide 17
a. hypospadias- displacement of urinary meatus to the ventral surface of penis (on bottom)
b. epispadius- displacement of the urinary meatus to the dorsal surface of the penis (on top)
7. Normally the scrotum should not transilluminate. If fluid scrotum will show red glow, solid masses or blood does not transilluminate. Slide13
8. Palpate above the symphysis pubis, if you can palpate anything bladder will be smooth, round, and firm and is distended. P. 497
9. Tests of appendicitis p.499
a. Rovsing’s sign- palpate deeply in LLQ and quickly release pressure, pain during this test indicates pancreatitis
b. Psoas sign- ask client to lie on left side, hyperextend the right leg of the pt. Pain in RLQ is associated with irritation to iliopoas muscles due to appendicitis
c. Obturator’s sign- Support client right knee and ankle, flex hip and knee, and rotate the leg internally and externally. Pain in RLQ indicates irritation of obturator muscle due to appendicitis.
d. Hypersensitivity test- stroke abdomen with a sharp object lie a tongue depressor or even your thumb and grasp a fold of skin and quickly let go. Pain or exaggerated sensation felt in the RLQ is a positive test and may indicate pancreatitis.
10. To assess for kidney inflammation palpate the right kidney, support the right posterior flank with your left hand, and place you right hand in the right upper quadrant just below the costal margin at the MCL. Enlarge kidneys are due to hydronephrosis.
Percussion against the lower right anterior rib cage. (costovertible angles) If the patient is in pain the kidneys are possibly inflamed. p. 492,496
11. Bowel sounds (abdominal slide) p.487
a. Normoactive: sound heard every 3-30 seconds
b. Hypoactive: a dynamic ileus; paralytic ileus
c. Hyperactive- diarrhea or obstruction
d. Borborygmi: hyperactive “stomach growling”
e. Absent: must listen for at least 1 minute in each quadrant.
i. Must listen for five minutes to conclude that no bowel sounds are present.
12. Joint Movements P. 508 and in power points
a. Abduction: away from midline
b. Adduction: toward midline
c. Circumduction: circular motion
d. Inversion: moving inward
e. Eversion: moving outward
f. Extension: straightening the extremity at the joint
g. Flexion: bending the extremity at the joint
h. Pronation: turning or face down
i. Supination: turning or face up
j. Protraction: moving forward
k. Retraction: moving backwards
l. Rotation_ turning a bone on its own axis-internal and external
13. Special musculoskeletal tests.
a. Phalen’s test: rest both elbows on the table and place the back of both hands against each other while flexing the wrists 90 degrees with fingers pointing downwards and wrists