How many pounds of skin does each person shed each year on average
One
What is the only organ that can be viewed directly?
Skin
The three layers of the skin from outside to in
Epidermis (inner basal cell layer and horny cell layer)
Dermis (connective tissue, collagen)
Subcutaneous (adipose tissue)
Thin, tough, cells bound tightly together for protection. Tougher on palms and soles. Completely replaced every 4 weeks. Avascular (nourished by blood vessels in the dermis)
Epidermis
Inner layer of the epidermis that forms new skin cells and contains keratin and melanocytes
Basal cell layer
Outer epidermis layer that consits of dead keratinized cells that are interwoven and closely packed
Horny cell layer
Consists mostly of connective tissue or collagen: tough, fibrous tissue that allows skin to stretch with movements. Nerves, sensory receptors, blood vessels, lymphatics , appendages from the epidermis (hair follicles, sebaceous glands and sweat glands lie
Dermis
Layer of lobules of fat cells, stores fat for energy, provides insulation for temperature and aids in protection, increases mobility
Subcutaneous layer
Located in the basal cell layer, gives brown tones to skin and hair
Melanin
T/F: All people have the same amount of melanocytes, but the amount varies with genetic, hormonal and evironmental influences
True
Tough, fibrous protein located in hair, skin and nails
Keratin
Where does the brown pigment of our skin come from?
Melanin
Where does the yellow-orange tones of our skin come from?
Carotene
Where does the red-purple tones in our skin come from?
Underlying vascular beds
Threads of keratin, that are vestigial for humans and play a cosmetic/psychological meaning in most people
Hair
The visible projecting part of the hair is called the:
Hair shaft
The part of the hair that is below the surface embedded into the follicle
Root
Expanded area of the hair where new cells are produced at a high rate
Bulb matrix
T/F: Hair growth is cyclic (periods of acting and resting phases)
True
Surrounds the hair follicles which contract and elevate the hair so it resembles goosebumps when the skin is exposed to cold or emotional states
Arrector Pilli
What are the two types of hair?
1. Vellus
2. Terminal
Fine, faint hair that covers most of the body except the dorsa of the distal parts of the fingers, umbilicus, glans penis and inside the labia palms and soles
Vellus hair
Darker, thicker hair that grows on the scalp and eyebrows and after puberty: the pubic area and the face and chest in the male
Terminal hair
Produce sebum, located in mostly in the scalp, forehead, face and chin
Sebaceous glands
A protective lipid substance secreted through hair follicles that lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin. Secreted from sebaceous glands
Sebum
What are the two types of sweat glands?
Eccrine and apocrine
Type of sweat gland that are coiled tubules that open directly onto the skin surface and produce sweat. Widely distributed throughout the body and are mature in the two month old infant
Eccrine glands
Type of sweat gland that produces a thick, milky secretion and open into hair follicles. Located mainly in the axillae, anogential area, nipples and naval. Vestigial in humans. Becomes active in puberty and secretion occurs with sexual stimulation.
Apocrine glands
When bacterial flora reacts with _____ sweat it =body odor
Apocrine
T/F: Body odor increases in the older adult
False. Body odor decreases with the older adult
Hard palates of keratin on dorsal edges of fingers and toes
Nails
The normal color of the nail plate
Clear
Where do nails get their pink color?
From the underlying nail bed that is vascular epithelial cells
White, opaque, semilunar area at the proximal end of the nail that lies over the nail matrix
Lunula
Where new karatinized cells are formed in the nails
Nail matrix
A pt comes in showing "spoon nails" with a concave shape. What would you expect?
Chronic iron deficiency anemia
T/F: The cuticle works like a gasket to cover and protect nail matrix
True
T/F: The skin is waterproof and almost indestructible and has protective and adaptive properties
True
How does the skin protect us?
Minimizes injury from physical, chemical, thermal and light-wave sources
How does the skin prevent penetration?
It stops invasion of microorganisms and loss of water and electrolytes from the body
How does the skin give us perception?
By providing us with sensory-surgace holding the neurosensory end-organs for touch, pain, temp and pressure
How does the skin provide us with temp regulation
Allows heat to escape through sweat glands and stores heat in subcutaneous insulation
How does the skin make us identifiable?
It is unique to every person by skin color, facial characteristics, hair and fingerprints
How does the skin provide us with communication methods?
Emotions, vascular mechanisms such as blushing or branding
UV light converts ________ into vit. D
Cholesterol
Functions of the skin
Protection
Prevents penetration
Perception
Temp regulation
Identification
Communication
Wound repair
Absorption/secretion
Production of vit D
By age 70-80 the skin looks:
thin, lax, dry, wrinkled
Factors that put the aging person at risk for skin disease and breakdown
Thinning of skin
Decrease in vascularity and nutrients
Loss of protective cushioing in subcutaneous layer
Lifetime of env. trauma to skin
Social changes of aging (less nutrition, limited financial resources)
Increased sedentary lifestyle
Chance of immobil
Why does wrinkling occur in the aging person?
Because the underlying dermis thins and flattens and there's a loss of elastin, collagen and subcutaneous fat and a reduction in muscle tone
What does loss of collagen increase risk for in the aging person?
Shearing, tearing injuries
In the aging adult, vascularity of skin decreases while vascular fragility ____
Increases
In the aging adult, a minor trauma may produce dark, red, discolored areas aka
senile purpura
T/F: More pigment changes and a yellowed leathery texture occur with smoking and sun exposure
True
T/F: Chronic sun exposure is more prominent in light skinned persons
True
What hapens to the sebaceous glands in the aging person?
Decrease in number and function leaving dry skin.
Decreased response of the sweat glands to thermoregulatory demand puts the aging person at risk for:
Heat stroke
In the aging adult, what major things happen to the hair?
1. Number of functioning melanocytes decrease (hair looks white or gray and feels thin/fine)
T/F: Genetic script determiness the onset of graying and number of gray hairs
True
What happens to the aging male in regards to hair?
Get a symmetric W-shape balding in the frontal areas
Testosterone present- decreases axillary and pubic hair growth
What happens in the aging female in regards to hair?
Testosterone present- decrease in axillary and pubic hair growth
Estrogen in females cause facial hair growth
What happens in the aging adult in regards to nails
Grow more slowly
Lusterless
Longitudinal ridges resulting from local trauma at the nail matrix
What happens in the agiing adult in regards to self-esteem
Changes in skin/hair can be viewed directly so has a psychological impact.
Self-esteem linked to a youthful appearance by the media
Blacks and american indians have a _______ incident of skin cancer
Lower
What race has the highest incidence of skin cancer against blacks and hispanics
Whites
What two cultures have mild body odor if none at all
Asians and american indians
_____ have lower salt concentrations in their sweat than whites
Blacks
How have arctic inuits environmentally adapted?
They sweat less than whites on their trunks and extremeties but more on their faces to prevent perspiration and wet clothes in a cold climate
What are some skin conditions mostly found in blacks?
1. Keloids
2. Pseudofolliculitis
3. Melasma
4. Areas of inflammatory hypopigmentation or hyperpigmentation that appears as dark or light spots
Scars that form at the site of a wound and grow beyond the normal boundaries of the wound, mostly seen in blacks
Keloids
Razor bumps or ingrown hairs caused by shaving too closely with an electric or straight razor
Pseudofolliculitis
Mask of pregnancy", patchy tan to dark brown discoloration of the face
Melasma
Describe the hair and scalp of blacks
hair: very fragile, ranging from long and straight to short, spiraled, thick and kinky
Hair and scalp tends to be dry
Requires daily brushing, combing and application of oil
What kind of hair do asians normally have?
Straight, silky hair
What happens to the hair with someone who has inadequate nutrition
Becomes dry, brittle and lusterless
When the hair of black children change in texture and color and becomes less kinky with a copper-red color
Marasmus
ABCDE
Asymmetry (not regularly round or oval, or both sides dont look the same)
Border (irregular border, notching
Color (areas of brown, tan, black, blue, red, white or combination)
Diameter
Elevation
A mole greater than ____ mm is worrisome
6mm
Seborrhea
Oily
Xerosis
Dry
Most common skin symptom of itching. occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice,uremia, lice
Puritis
Shaggy or excessive hair
Hirsutism
When you see a generalized rash what is the first thing you should think?
Allergic reation to new food
Significant loss of hair
Alopecia
Drugs that can cause allergic skin reuption
Asprin
Antibiotics
Barbituates
some tonics
Drugs that may increase sunlight sensitivity and give burn response
Sulfonamides
Thiazide diuretics
Oral hypoglycemic agents
Tetracycline
Drugs that can cause hyperpigmentation
Antimararials
Antineoplastic agents
Hormones
Metals
Tetracycline
Most important self-care behavior for aging adult
Daily bland lotion
Small, flat macules of brown melanin pigment that occur on sun exposed skin
Freckles
(nevus) a proliferation of melanocytes
Moles
Macular only and occurs in children and adolescence
Junctional nevus
Progression of the junctional nevus that occurs in young adults
Compound nevi
Mainly in older ages, nevus cells only in dermis
Intradermal nevus
Small, smooth slightly raised red dots. Common on trunk in older adults over age 30. Normally increase in size and number with aging. Not significant
Cherry (senile) angiomas
A ringworm infection mostly found in school age children
Tinea capitis
Intense redness of skin from excess blood (hyperemia) in the dilated superficiail capillaries. Expected with fever, local inflammation, emotional reactions (blushing) can cause increased skin temp. Occurs with polycythemia (increase in RBC, venous stasis
Erythema
Bluish color that signifies decreased perfusion; tissues dont have enough o2 in blood. Can be a nonspecific sign. Difficult to see in dark skinned people.
Cyanosis
What diseases/disorders does cyanosis indicate
Hypoxemia
Shock
Heart failure
Chronic bronchitis
Congenital heart disease
Yellowish skin color indicates rising amounts of bilirubin in the blood. Except for physiological jaundice in a newborn, it doesnt occur normally. First noted in junction of the hard and soft palate in the mouth and in the sclera.
Jaundice
A pt comes in with light or clay colored stools and dark golden urine, what would you expect
Jaundice
Profuse perspiration that occurs with increased metabolic rate such as heavy activity or fever
Diaphoresis
T/F: When looking for signs of dehydration, a dark skinned person may have dry and flaky mucous membranes and that is normal for them. And indicates no dehydration
True
When the skin feels smoother and softer like velvet this may indicate:
Hyperthyroidism
When the skin feels dry, rough and flaky this may indicate
Hypothyroidism
A pt comes in with very thin, shiny skin, what may this indicate
Arterial insufficiency
Literally "hard skin". Chronic connective tissue disorder associated with decreased mobility
Scleroderma
When a lesion develops of previously unaltered skin it is:
primary lesion
When a lesion changes over time or changes because of self indicated behaviors this is called a
secondary lesion
What is a normal nail profile
160 degrees
Early clubbing starts at ____ degrees
180
Occurs with congenital cyanotic heart disease and neoplastic and pulmonary diseases. Nails may be spongy with a early nail profile at 180degrees
Clubbing
Brown linear streaks in nails are ______ in light skinned people and may indicate melanoma
ABNORMAL
Abnormal capillary refill
If it takes longer than 1-2 seconds.
If you see a cyanotic nail bed or a capillary refill that is sluggish to return, what should you consider?
Cardiovascular or resp. dysfunction
Commonly called "liver spots", small, flat brown macules. Clusters of melanocytes that occur after extensive sun exposure. Common in aging aduly
Senile Lentigines
Raised lesions, thickened areas of pigmentation that look crusted, scaly and warty. Two types: seborrheic and actinic. Common in aging adult
Keratoses
looks dark, greasy and stuck on. Develop mostly on the trunk but also on face and hands. Do not become cancerous
Sebborrheic keratosis
red-tan scaly plaques that increase over the years to become raised and roughed. May have a silvery-white scale adherent to the plaque. Occur on sun exposed surfaces. Are premalignant and may develop into squamous cell carcinoma.
Actinic keratosis
skin tags" which are overgrowths of normal skin that form a stalk and are polyp-like. Occur on eyelids, cheeks and neck, axillae and trunk
Acrochordons
What would pallor look like in a light skinned and dark skinned person
Light: generalized pale
Dark: skin appears yellow or ashen gray, skin loses healthy glow. Check areas with least pigmentation such as conjunctivae, mucous membranes
What would cyanosis look like in a light and dark skinned person
Light: dusky blue
Dark: Dull, lifeless skin, apparent on skin and check conjunctivae, oral mucosa and nail beds
What would erythema look like in a light and dark skinned person
Light: red, bright pink
Dark: purpleish tinge, difficult to see. Palpate for warmth
What would jaundice look like in a light and dark skinned person?
Light: yellow in sclera, hard palate, mucous me branes and skin
Dark: best noted yellow in hard and soft palate and palms
Lesion that is circular, begins in center and spreads to periphery. (Common in ringworm)
Annular
Lesions that run together (uriticaria)
Confluent
Distinct, individual lesions that remain spate (skin tags or acne)
Discrete
Twisted lesion that looks like coiled spiral
Gyrate
A lesion that looks like a scratch, streak, line or stripe
Linear
Clusters of lesions (poison ivy)
Grouped
Iris looking lesion (tick bite)
Target
Linear arrangement of lesions along a unilateral nerve route (herpes zoster)
Zosteriform
Annular lesions taht grow together
Polycylic
Soley a color change, flat and circumscribed of less than 1cm (freckles, flat nevi, hypopigmentation, measles, scarlet fever)
Macules
Macules larger than 1cm
Patch
Solid, elevated, hard or soft larger than 1cm. May extend to deeper dermis
Nodule
Larger than a few cm in diameter, firm or soft, deeper into dermis, may be beign or malignant
Tumor
Friction blisters, burns or contact dermatitis
Bulla
Encapsulated fluid-filled cavity in dermis or subcutaneous layer that elevates skin
Cyst
Health promotion tips the nurse should review with the client for the skin hair and nails
Wear sunscreen
Dont smoke
Use sports protection
Dangers of indoor tanning
Skin-self assessment using ABCDE
Tattoing and piercing
Exercise
Rigid bony box that protects the brain and the special sense organs. Includes the bones of the cranium, face, and jaw. Joined together by sutures
Skull
What are the 4 cranial bones
Parietal
Frontal
Occipital
Temporal
Function of the head
Protect the brain and nerves inside
How many facial bones do we have
14
All 14 facial bones also articulate at sutures except for the:
Mandible
Serves as the conduit for the passage of many structures which are lying in close proximity: blood vessels, muscles, nerves, lymphatics, viscera of the resp and digestive systems
The neck
Job is to detect and eliminate foreign substances from the body. Major part of immune system
Lymphatics
What are the major muscles of the neck?
Sternomastoid- involved in head rotation and head flexion
Trapezius- muscles move the shoulders and extend and turn the head
When checking for abnormal lymph nodes, where should you explore?
The area proximal (upstream) to the location of the abnormal node
Term that denotes a round, symmetric skull that is appropriately related to body size
Normocephalic
What can a swollen lymph node indicate
Acute infection
Chronic inflammation
Cancerous
HIV infection
Neoplasm
Hodgkins lymphoma
Headache that occurs on both sides of the head, forehead and back of head. Feels like a band-like tightness
Tension
How long does a tension headache usually last
30 minutes to days
Not as severe type of headache, mild to moderate pain that occurs from stress, anxiety, depression, poor posture. Can cause fatigue, anxiety, stress, photophobia. Relieved by rest, massaging muscles in area or nsaids
Tension headahces
Headaches that normally occur only on 1 side of the head but may occur on both. Characterized by throbbing, pulsating pain that is moderate/sever
Migraine
How long does a migraine usually last
Rapid onset, peaks 1-2 hours later and lasts 4-72 hours
What can cause a migrain?
PMS, food, alcohol, caffeine, letdown after stress, sensory, changes in sleep pattern, physical activity
Pain that develops when nerve fibers in the periphery and in the central nervous system are functioning and intact. Occurs with tissue damage
Nociceptive pain
What are the 4 types of noceoceptive pain
1. Transduction (injured tissue releases chemicals that propagate pain message, action potential moves along an afferent fiber to spinal cord)
2. Transmission (pain impulse moves from spinal cord to brain)
3. Perception (conscious awareness of a pain sens
Pain that travels up the spinal cord, is fast, sharp and immediate (paper cut)
A delta pain-mylenated
Pain that is dull and achy, slower response (ankle sprain)
C-fiber pain- nonmylentated
Pain that is chronic pain that is unpredictable and difficult to treat
Neuropathic
Short term pain that has a beginning, middle and end, lasts <6months, protective (ex: hand on stove, move hand) and is nociceptive. Usually visible in pain, moaning, groaning protecting injury and objectively seen with high VS
Acute pain
Long term pain of 6 months or longer, can be divided into malignant or nonmalignant, often associated with musculoskeletal conditions, does not stop when injury heals. Originates from abnormal processing of pain fibers from peripheral or central sites, di
Chronic pain
T/F: Infants have the same pain capacity as adults
True
T/F: Pain is a normal process of aging and should be considered tolerable in the older adult
False! Pain is never normal and should never be considered tolerable
T/F: People with dementia don't feel pain
false
Men vs. women regarding pain
Men-more stoic about pain
Women- More likely to develop migraines during childbearing years, more sensitive to pain during pms and more likely to have fibromyalgia
Hormonal changes have a strong influence
Women have more emotional displays of pain
What races are often prescribed and administered less analgesic therapy than whites
Blacks and hispanics
OLD CARD- used to assess problems such as pain
Onset
Location
Duration
Characteristics
Aggravating factors
Revealing factors or radiation
Treatment tried
What are some indications the pt is feeling pain
Swelling/inflammation
Injury
Decreased ROM
Bruising, lesions, open wounds, tissue damage
Facial expressions ex: guarding, moaning, stillness, diaphoresis
Increase in VS
What places an adult at risk for under nutrition or overnutrition
Lifestyle factors (stress, smoking, lack of exercise, excessive alcohol, high fat diets)
Occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands. Adults are more vulnerable
Under nutrition
What does under nutrition cause
Risk for impaired growth
lowered resistance to infection, disease, wound healing
longer hospital stays
higher health care costs
Caused by consumption of nutrients-especially calories, sodium and fat in excess of body needs. Can lead to obesisty and risk factor for type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, and certain cancers
Overnutrition
A BMI in adults ___or higher is considered overweight while a BMI of ___ or higher is considered obese
25 or higher- overweight
30 or higher- obese
What puts the older adult at risk for under and over nutrition
Poor physical or mental health
Normal physiologic changs (poor dentition, slowed gi)
Decrease in energy
Medications
Why are newly arriving immigrants at risk for overnutrition
Because they have to adapt to us diet of high fats
Black women have _____ hemoglobin levels than white women independent of iron intake and that their risk for osteoporosis is less despite overall ca intake
Black
Underweight BMI
<18.5
Normal BMI
18.5-24.9
Obese BMI
30-39.9
Extreme obesity BMI
>40
The elliptical open space between the eyelids
Palpebral fissure
The corner of the eye, the angle where the lids meet
Canthus
The exposed part of the eye, it is a transparent protective covering. Thin mucous membrane folded like an envelope between the eyelids and the eyeball
Conjunctiva
Outer fibrous coating of the eye
Sclera
Very sensitive to touch, contact with a wisp of cotton stimulates a blink in both eyes call the corneal reflex
Cornea
Round and regular, size depends on balance between pns and sns constriction. Reacts to amount of ambient light and to accomodation or focusing an object on the retina
Pupil
A biconvex disc located just posterior to the pupid. Serves as a refracting medium, keeping a viewed object in the continual focus on the retina. Bulges for focusing on near objects and flattens for far away objects
Lens
The lens _____ for focusing on near and the lens _____ for far away objects
Bulges- near
Flattens- far
The visual receptive layer of the eye in which light waves are changed into nerve impulses. Surrounds the soft, gelatinous vitreous humour
Retina
The area in which fibers from the retina converge to form optic nerves. Located towards the nasal side of the retina.
Optic disc
Characteristics of the optic disk
Color varies from creamy yellow-orange to pink, has a round oval shape, margins that are distinct and sharp, and a physiological cip. The smaller circular area inside the disc is where blood vessels exit and enter
Located on the temporal side of the fundus. Slightly darker pigmented region surrounding the fovea centralis
Macula
6 Muscles that attach to the eyeball to it's orbit and serve to direct the eye to the points of the persons interest. Gives the eye both straight and rotary movement. Stimulated by cranial nerve III, IV and VI.
Extraocular muscles
What happens in the older adult regarding the eye
Decreased tear producting
feeling of dryness and burning
Degeneration of lipid material around the limbus
Pupil size decreases
Lens loses elasticity, becomes hard (glass)
Presbyopia (cant see near)
Floaters appear
Need more light to see
Cataracts
Glaucoma
What race has the presence of narrowed palpebral fissures?
Asians
How do we get the color of the iris ?
Genetically
Glaucoma is more common in ______
Blacks
Whites older than 40:
Macular degeneration causes blindness
Blacks older than 40:
Cataracts and open-angle glaucoma causes blindness
Hispanics older than 40:
Open angle glaucoma is the leading cause of blindess
T/F: Poverty can cause visual limitations
True
Cross eyed
Strabismus
Seeing double
Diplopia
What responses from the client regarding changes in vision of the eye may be worrisome
Acute onset of floaters occurs with retinal detachment
Halos around light occuring with acute narrow-angled glaucoma
Scotoma, a blind spot surrounded by an area of normal or decreased vision, occurs with glaucoma and with optic nerve disorders
Night blind
What reponse from the client may be worrisome about eye pain?
Sudden onset of eye symptons (pain, floaters, blind spots, loss of peripheral vision) is an emergency. Refer immediately
T/F: Strabismus is a deviation in the axis of the eye
True
What response from the client may be worrisome regarding watering/discharge of the eye
Tearing and epiphora due to irritants or obstruction in drainage is thick and yellow
Glaucoma increases what:
Intraocular pressure
Tests to see how good your vision is from 20 ft away. Normal vision is 20/20 meaning you see 20 ft what a person with normal vision sees from 20 ft away.
Snellen Eye chart
What would it mean if you had 20/15 vision
Youworst than normal vision and can see from 20 ft away what a person with normal vision sees from 15 ft away.
Test that is a gross measure of peripheral vision. Compares the person's peripheral vision with your own, assuming yours is normal
Confrontation test
Test that leads the eyes through the six cardinal positions of gaze, will elicit any muscle weakness during movement. A normal response is parallel tracking of the object with both eyes
Diagnostic positions test
What is an ophthalmoscope used for
To enlarge your view of the eye so you can inspect the media and the ocular fundus
How can you best visualize the optic disk
By looking towards the nose, it will look creamy yellow-orange color to pink and will be round or oval
What is the significance of the red light reflex?
To look for cataracts against the red reflex
When inspecting the eyes without instrument, what would you expect to find in an adult
Eyebrows may show loss of the outer 1/3-1/2 of hair because of decreased hair follicles
Remaining eyebrows are course
Skin around eyes may be wrinkled
Eyes may appear sunken in due to atrophy of orbital fat
Decreased tear production may cause eyes to loo
When would you use a penlight
When testing for light reaction and reflexes
Test that assesses the parallel alignment of the eye axes by shining a light towad the persons eye. Asymmetry of the light reflex indicates deviation in alignment from eye muscle weakness or paralysis. If seen, perform cover test
Corneal light reflex
Test that when light is directed into blind eye, no response occurs in either eye. When light is directed in normal eye both pupils constrict. As long as oculomotor nerve is intact
Monocular blindess
When the light is directed across the eye from the temporal side it illuminates the entire iris evenly because the normal iris is flat and creates no shadow
Normal anterior chamber
When the iris is pushed anteriorly because of increased intraocular pressure. Because direct light is recieved from the temporal side, only the temporal part of the iris is illumiated; the nasal side is shadowed. May be a sign of glaucoma
Shallow anterior chamber
Decrease in power of accomodation with aging, suggested when the person moves the card farther away
Presbyopia
In the older adult, what test screens for glaucoma
Confrontation test
The lower lid is loose and rolling out, does not approximate to eyeball. Causes excess tearing. The eyes feel dry and itchy because tears do not drain correctly. Exposed palpebral conjunctiva increases risk for inflammation. Occurs in aging as a result of
Ectropion
The lower lid rolls in because of spasm of lids or scar tissue contracting. Constant rubbing of lashes may irritate cornea. The person's feels a "foreign body" sensation.
Entropion
Occurs from neuromuscular weakness, oculomotor cranial nerve III damage, or congenital. It is a positional defect that gives the person a sleepy appearance and impairs vision
Ptosis
How can the nurse prevent eye health
Wearing eye protection is the work place that requires them
Recommend and perform screenings for eye problems like glaucoma
Promote wearing glasses when they are needed
Serves to funnel sound waves into it's opening, the external auditory canal
External ear
What is the external auditory canal lined with?
Glands that secrete cerumen; ear wax
What is the purpose of serumin
To keep foreign bodies out
The outer 1/3 of the ear is _______
Cartilage
Inner 2/3 of the eye consists of:
Bone covered by thin, sensitive skin
What seperates the external ear from the middle ear and is tilted slighly obliquely to the ear canal, facing downward and somewhat forward. Is a translucent pearly gray
Tympanic membrane
Tiny air filled cavity inside the temporal bone, contains tiny ear bones or auditory ossicles, the malleus, incus and stapes. The eustachian tube which connects the middle ear with the nasopharynx and allows passage of air
Middle ear
The three functions of the middle ear
Conducts sound
Protects inner ear by reducing sounds
Eustachian tube allows equalization of air pressure on each side of tympanic membrane so it doesn't rupture
Part of the ear that is embedded in bone, holds the sensory organs for equillibrium and hearing. Not accessible to direct examination, but can assess its functions
Inner ear
Which cranial nerve is responsible for hearing
Auditory, cn VIII
The most efficient pathway of hearing is
Air conduction
What are the two pathways of hearing
Air conduction
Bone conduction
Hearing loss that involves a mechanical dysfunction of the external or middle ear. It is a partial loss because the person is able to hear if the sound amplitude is increased enough. May be caused by impacted cerumen, foregn bodies, a perferated tympanic
Conductive hearing loss
Gradual nerve degeneration that occurs with aging
Presbycusis
Hearing loss that signifies pathology of the inner ear, cranial nerve VIII or the auditory areas of the cerebral cortex. May be caused by presbycusis and by ototoxic drugs which affect the hair cells in the cochlea
Sensorineural
What do ototoxic drugs affect?
The hair cells in the cochlea
What type of hearing loss is most common in the older adult
Sensorineural, presbycusis
is a common cause of conductive hearing loss in young adults. It is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound causing progressive deafness.
Otosclerosis
a type of sensorineural hearing loss common in adults over the age of 65. It is a gradual loss caused by nerve degeneration in the inner ear that solely progresses after the fifth decade.
Presbycusis
Changes in the ear of the older adult may include
Cilia becomes coarse and stiff. This may cause cerumen to accumulate and oxidize which can reduce hearing.
The cerumen is drier
Presbycusis
What kind of cerumin do caucasions and african americans have
Wet cerumin, which is honey brown to dark brown and moist
What kind of cerumin do american indians and asians have
Dry cerumin- gray and flaky and forms a thin mass in ear canal
What can cause a rupture of tympanic membrane
Ear infections may cause a ruptured eardrum, more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open (rupture).
Damage to the eardrum can also occur from:
A very loud
What behaviors may indicate hearing loss
Cupping ear to hear
Nodding when inappropriate
Asking "what" a lot
Rining in the ears, originates within the person and accompanies some hearing or ear disorders
Tinnitus
Dizziness, room spinning around you
Vertigo
What can cotton swabs cause
Impacted cerumen causing hearing loss
Test that assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
Romberg test
What would you expect to find in the older adult
Pendulous earlobes with linear wrinkling because of loss of elasticity
Coarse wiry hair
Ear drum may be whiter and more opaque
It may also be thicker
A high-tone frequency hearing loss, Presbycusis
Whisper test is harder for them
How can nurse promote health of the ear
Lowered volume in ear buds
Ear protection in loud environments
The first segment of the respiratory system. It warms, moistens, and filters the inhaled air, and it is the sensory organ for smell.
Nose
The oral cavity is a short passage bordered by lips, palpate, cheeks, and tongue. It contains the teeth, gums, and salivary glands. Teeth chew food to break down for digestion, saliva helps. The tongue helps in mastication, swallowing, cleansing te teeth
Mouth
It goes oropharynx, nasopharynx, and larynx. The throat leads to the stomach. It contains the tonsils and is rich in the lympathics.
Throat
Which CN is responsible for sense of smell
CN I
How does the aging process affect the nost mouth and throat
� Nasal hairs are coarser and stiffer and may not filter air well
� Clipped nasal hairs can cause infection
� Decrease in smell
� In the oral cavity, the soft tissues atrophy and the epithelium thins, especially in the cheeks and tongue
� Loss of taste
�
Condition in which the uvula is split with either completely or partially
Bifid uvula
What races does bifid uvula mostly occur in
American indians and some asians
Cultural group most prone to tooth decay
Whites compared to blacks
What has contributed to a decrease in tooth loss in the US in the past 20-30 years
Fluoride
Rhinorrhea
Nasal discharge
Additional questions for the older adult for nose mouth and throat
� Any dryness in the mouth? Any medications?
� Have you lost any teeth? Can you chew all types of food?
� Are you able to care for your own teeth or dentures?
� Noticed a change in your sense of taste or smell?
Normal assessment in an older adult for nose mouth and throat
� The nose may appear more prominent on the face from a loss of subcutaneous fat
� The mouth and lips fold in
� Teeth may look yellow
� Incisors may have cracks
� Gums may be receded
� Teeth may move with palpation
� Tongue may look smaller
bony structure with a concial shape, which is narrower at the top. Defined by the sternum, 12 pairs of ribs and 12 thoracic vertebrae. Floor is the diaphram. Protects organs inside
Thoracic cage
How many lobes does each lung have
Left- 2 lobes
Right- 3
Main function of the lungs
Exchange co2 and o2
Changes to the thorax and lungs expected with aging
� The costal cartilages become calcified, which produces a less mobile thorax.
� Respiratory strength declines
� Less elastic- Harder to inflate
� Increase in airway closure
� Less surface area for gas exchange
� Dyspnea
Cultural considerations to be aware of with thorax and lungs
Foreign countries more likely to have TB
Asthma common in american kids
African americans, and hispanic children have a higher indication of poorly controlled asthma, including more ER visits, more med and lower use of inhalers
Whites, blacks, asians and
What cultures have the highest chest volume
White
Blacks
Asians
American Indians
Classic s/s of TB, who's most at risk
People in foreign countries most at risk
S/S:
A cough with thick, cloudy, and sometimes bloody mucus from the lungs (sputum) for more than 2 weeks.
� Fever, chills, and night sweats.
� Fatigue and weakness.
� Loss of appetite and unexplained weight loss.
Difficulty breaking when supine
Orthopnea
Awakening from sleep with SOB and needing to be upright to achieve comfort
Paroxsysmal nocturnal dyspnea
What is tactile fremitus
A palpable vibration
added sounds that are not normally heard in the lungs. They are caused by moving air colliding with secretions in the tracheobronchial passageways or by the popping open previously deflated airways.
Adventitious sounds
Using 99 technique while listening with stethoscope over chest wall
Normal: Soft, muffled, indistinct
Abnormal: can hear 99 clearly
Bronchophony
Using the E technique
Normal: Hear E
Abnormal hear A
Egophony
Health promotion tips to give a client on thorax and lungs
� Physical activity
� Don't smoke
� Watch out for second hand smoke