Health Assessment Final Exam Review
Evidenced-Based Assessment/Cultural Competence/The Interview (Chapters 1-3)

Understand the difference between a medical diagnosis and nursing diagnosis.
o Evaluates the cause of disease; focuses on the function or malfunction of a
specific organ system.
o Nursing diagnoses are developed based on data obtained during the nursing
assessment.

Understand determinants of health as well as what information follows under each
category of determinants of health
o An individual’s health status is influenced by personal, social, economic, and
environmental factors called determinants of health.
o These determinants of health comprise:
 Policy and legislation
 Health care services
 Social factors such as poverty
 Occupational status
 Quality of the neighborhood
 Environments
 Lifestyle factors
 Individual behaviors
 Biology and genetics
o Evidence-based research has consistently shown that poverty has the greatest
influence on health status.

Know the definitions for culture-related concepts
o Culture: A pattern of shared attitudes, beliefs, norms, roles and values that can
occur among those who speak a particular language or live in a defined
geographic location.
o Ethnicity: A social group that may possess shared traits such as a common
geographic origin, migratory status, religion, language, values, traditions, and
food preferences.
o Acculturation: Process of social and psychological exchanges that take place
when there are ongoing encounters between individuals of different cultures
with subsequent changes in both groups.
o Acculturative Stress: Losses and changes that occur when adjusting to a new
system of beliefs, routines, and social roles.
o Biculturalism and Integration: Bidirectional and bi-dimensional: Rather than
solely relying on assimilation, new immigrants developed new means of forging
identities between the country of origin and the host country.
o Spirituality is born out of each person’s unique life experience in his personal
effort to find purpose and meaning in life.
o Religion refers to an organized system of beliefs about the cause, nature, and
purpose of the universe or a belief in a divine and higher power.

Know what internal and external factors are involved in the interview process
o Internal factors:
 Liking others: An optimistic view of people—an assumption of their
strengths and a tolerance of their weaknesses.
 Empathy: The ability to understand with the person and recognize how
he or she perceived his/her world.
 The ability to listen: Listening requires complete and focused attention.
 Self-awareness: To effectively communicate with others, you must know
yourself.
o External Factors:
 Ensuring Privacy: Aim for geographic privacy: a private room in the
hospital, an exam room in a clinic.
 This may also involve asking an ambulatory roommate to step out
or using curtained partitions.
 Refusing Interruptions: Inform support staff of your interview and
ask that they not interrupt you during this time.
 Physical Environment: Room temperature at comfortable level, sufficient
lighting, Place distance between you and the client at 4 feet, arrange
equal status seating.
 Dress: The nurse’s appearance should be appropriate to the setting and
meet conventional professional standards.
 Note-taking: Keep note taking to a minimum. Excessive note taking
during an interview has disadvantages: it breaks eye contact, it interferes
with your observation of the client’s nonverbal communication, and it
may be threatening to the client discussion of sensitive issues.

Understand what types of questions are appropriate to ask during an interview
o Open-ended questions
o Close-ended questions

Know barriers to the interview process
o False reassurance: “Everything will turn out okay”
o Giving advice; “If I were you, I would…”
o Using authority: “Your doctor knows best…”
o Using avoidance language: He has “passed on” …” He has gone to a better
place…”
o Distancing: “There’s a lump in the left breast.”
o Using professional jargon:
o Using Biased Questions: “You don’t smoke, do you?”
o Talking Too Much: Doing all the talking and not giving the client a chance to
speak.
o Interrupting: Cutting a person off or finished the statement for them before they
speak.
o Using “Why” Questions: “Why would you do something like that?”
o Let the client tell his story.

Know what a nurse can do to aid with health literacy barriers
o Provide oral teaching, written materials at the 5th grade reading level, and use
the teach-back approach.
o Tools to assess health literacy: Test of Functional Health literacy (TOFHLA), Rapid
estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS).

Know what is included in a health history assessment versus functional assessment
o Health History
 Reasons for seeking health care
 Health perception/Health management
 History of present illness
 Childhood illnesses
 Adult illnesses
 Accidents/Injuries
 Hospitalizations
 Surgeries
 Obstetric history
 Immunizations
 Physical examinations/Dental visits
 Allergies/Reactions
 Current medications
 Health maintenance
 Knowledge of current and past health and illness
 Communicable disease
 Social history
 Family history/Genogram
o Functional Assessment
 Activities of Daily Living
 Self-esteem/Self-concept
 Activity/Exercise
 Sleep/Rest
 Interpersonal Relationships/Resources
 Spiritual Resources
 Coping and Stress Management
 Personal Habits



Environment/Hazards
Intimate Partner Violence
Occupational Health

Know what is considered objective data and subjective data
o Subjective data is what the client tells you.
o Objective data is what you as a nurse, obtain physical examination.

Know the definitions for different types of beliefs about causes of illness
o Biomedical: All events have a cause and effect
o Naturalistic: The forces of nature must be kept in harmony
o Magic Religious: The world is an arena in which supernatural forces dominate.
o Traditional Treatments and Folk Healers: The variety of healing beliefs and
practices in the United States is diverse.
 For example, in the Hispanic culture: “Curandero (spiritualist healer),
jerboa (herbalist), partera (lay midwife), sabedor (healer who
manipulates bones).”

Be familiar with common beliefs in each region regarding health and illness
o Asia: Health is a balance of yin and yang. Illness: Imbalance of yin and yang.
o Africa: Health is harmony with nature. Illness is disharmony with nature.
o Europe: Health is physical and emotional well-being, feeling okay. Illness is the
absence of well-being, feeling bad.
o Native American: Health is living in harmony with nature. Illness is disharmony
with nature.
o Central and South American: Health is reward for good behavior and the
balance of “hot and cold” humors. Illness is punishment for wrongdoing and an
imbalance of hot and cold.

Know when to report abuse
o Immediately
Assessment Techniques

Know the functions of a stethoscope and appropriate qualities of a stethoscope
o The stethoscope does not magnify sounds, but it does block out room sounds.
o Diaphragm: Best for high-pitched sounds
 Breath, bowel, and normal heart sounds
o Bell: best for soft, low-pitched sounds
 Extra heart sounds or murmurs

Know what measurements are considered vital signs
o Temperature
o
o
o
o
Pulse (rate, rhythm, and force)
Respirations
Oxygen saturation
Pain

Know which order to perform a physical assessment
o Inspection
o Palpation
o Percussion
o Auscultate

Know what can cause a BP to be falsely high or falsely low
o Taking BP when person is anxious, angry, or active
 False High
o Faulty arm position
 Above heart = False Low
 Below heart = False High
o Cross-legged position
 False High
o Wrong cuff size
 Too narrow = False High
 Too wide = False Low
o Cuff too loose
 False High

Be familiar with pain assessment findings and types
o Nociceptive Pain:
 Develops when nerve fibers in the periphery and the Central Nervous
System (CNS) are stimulated
 It is triggered by tissue damage
o Neuropathic Pain:
 Pain that does not have the principles of nociceptive pain.
 It is pain caused by a lesion or disease of the nervous system.
 It is the abnormal processing of the pain message from the injury to the
nerve fibers. It evolves into a chronic condition.
 Neuropathic pain is difficult to assess and treat.
 Conditions that may cause neuropathic pain are: diabetes, herpes zoster
(“shingles”), sciatica, HIV/AIDS, trigeminal neuralgia, phantom limb pain,
and chemotherapy, multiple sclerosis, tumors, stroke.
o Peripheral Neuropathy:
 Weakness, numbness, and pain from nerve damage, usually in the hands
and feet.
o Sources of Pain:
 Visceral pain: Comes from the larger organs




Somatic pain: Comes from musculoskeletal tissues.
Deep somatic pain: Comes from joints, tendons, and bone.
Cutaneous pain: Comes from skin surfaces and subcutaneous tissues.
Referred pain: Originates from another location
 Referred pain may come from either visceral or somatic
structures.

Be familiar with developmental differences in nutritional status for an infant, pregnant
woman, and aging adult
o Infants, Children Adolescents:
 Determine skinfold thickness, and/or BMI.
o The Pregnant Woman:
 Measure weight monthly up to 30 weeks’ gestation, and then every 2
weeks until the last month of pregnancy, then measure weight weekly.
o The Aging Adult: Height:
 With age, height declines very slowly from the early 30s on.

Know subjective and objective findings for malnutrition

How to calculate BMI and the ranges for underweight, normal, overweight, and obese
o
o
o
o
o
o
o
o
Underweight < 18.5 kg/m2
Normal weight 18.5 to 24.9 kg/m2
Overweight 25 to 29.9 kg/m2
Obesity (class 1) 30 to 34.9 kg/m2
Obesity (class 2) 35 to 39.9 kg/m2
Extreme obesity (class 3) ≥40 kg/m2

Be familiar with how to perform auscultation, inspect, palpation, and percussion

Know types of PPE
o Gloves: contact with body fluids or contaminated items
o Gown: contact with body fluids or contaminated patient and items
o Mask: contacts with sprays or splashes (suction, catheter changes, C-sections)
o Eye protection: contacts with sprays or splashes (suction, catheter changes, Csections)

Know normal vital signs for an adult
o Temperature: 97.6 – 99.6 F
o Respirations: 12 – 20 breaths/min
o Pulse: 60 – 100 beats/min
o Blood Pressure: Less than 120/80 mmHg
o Oxygen Saturation: 95% or higher
Skin, Hair, and Nails/Head, Face, and Neck (Ch 13-14)

Know skin developmental competencies for infants with their description
o Erythema Toxicum Neonatorum
 Occurs in most healthy full-term newborns, usually on 2nd – 3rd day.
 Multiple papules that rapidly evolve into pustules with an erythematous
base.
o Acrocyanosis
 A persistent cyanosis with coldness and hyperhidrosis of hands and feet.
 Occurs chiefly in young women.
o Milia
 Tiny white bumps that commonly appear on a baby’s face.
o Stork Bite
 Salmon-colored patches caused by collections of capillaries.
o Diaper Dermatitis
 Red, moist, maculopapular patch with poorly defined borders.

Know what is included in a skin assessment and expected findings
o Inspect the Skin
 Color, general pigmentation, areas of hypopigmentation, abnormal color
changes
o Palpate the Skin
 Temperature, moisture, texture, thickness, edema, mobility/turgor,
hygiene, vascularity/bruising
o Note any Lesions
 Color, shape/configuration, size, location, and distribution
o Inspect and Palpate the Hair
 Texture, distribution, any scalp lesions
o Inspect and Palpate the Nails
 Shape, contour, consistency, and color
o Teach Skin Self-Examination

Know skin changes in pregnant women
o Striae: Reddened streaks that usually appear on the skin from rapid weight gain
or from weight changes.
o Linea Negra: “Pregnancy line “appears in about three quarters of pregnancies.
o Chloasma: Brown patches that appear on the face. Also called “the mask of
pregnancy.”
o Vascular spiders: May occur when you have increased estrogen in the body
system, during pregnancy.

Know how to stage pressure ulcers
o Stage I: Intact skin appears red but unbroken.
o Stage II: Partial-thickness skin erosion with loss of epidermis or also the dermis.
Superficial ulcer looks shallow like an abrasion or open blister.
o Stage III: Full-thickness pressure ulcer extending into the subcutaneous tissue
and resembling a crater.
o Stage IV: Full-thickness ulcer involves all skin layers and extends into supporting
tissue exposing bone, muscle, tendon, and may show slough (stringy matter
attached to the wound bed).

Know how to document abnormal skin findings
o Color, shape/configuration, size, location, and distribution

Know how abnormal skin findings present themselves

Know abnormal hair findings

Know pediatric abnormal findings for the head
o Hydrocephalus
 Obstruction of drainage of cerebral spinal fluid results in excessive
accumulation, increasing intracranial pressure.
 The face looks small in comparison to the enlargement of the head.
o Down Syndrome:
 Trisomy 21(Chromosomal aberration).
 Head and face characteristics: up slanting eyes, flat nasal bridge, broad
flat nose, thickened tongue, short, broad neck.
o Plagiocephaly:
 Asymmetry of the cranium when seen from the top, caused by positional
preference.
o Craniosynostosis:
 Premature closing of multiple cranial sutures resulting in a malformed
head and cosmetic deformity.
 Mechanism involve genetic mutation, coding structural proteins, growth
factor receptors.
o Atopic (Allergic) Facies:
 Children with chronic allergies may develop characteristic facial features:
 Exhausted face, shadows under the eyes, double or single crease on the
lower eyelids, open mouth breathing.
o Fetal Alcohol Syndrome (FAS):

o
o
o
o
o
o

Alcohol is teratogenic to the developing fetus, resulting in
cognitive/psychosocial impairment, and changes in facial and brain
structure.
Allergic Salute and Crease:
 The transverse line on the nose is also a feature of chronic allergies.
Torticollis (Wryneck):
 A hematoma in one sternomastoid muscle, probably injured by
intrauterine malposition, results in a head tilt to one side and limited
neck ROM to the opposite side.
Simple Diffuse Goiter (SDG):
 Goiter, chronic enlargement of the thyroid gland is common in regions of
the world where soil is low in iodine. Iodine is an essential element in the
formation of thyroid hormones.
Multinodular Goiter (MNG):
 Multiple nodules usually indicate inflammation or a multinodular goiter
rather than a neoplasm.
Pilar Cyst:
 This is a smooth, firm, shiny, swelling on the scalp that contains sebum
and keratin.
Parotid gland enlargement:
 Rapid painful inflammation of the parotid glands occurs with mumps.
 Parotid swelling also occurs with blockage of a duct, access, or tumor.
Know abnormal facies with chronic illnesses
o Acromegaly:
 Excessive secretion of growth hormone from the pituitary gland after
puberty causes an enlarged skull and thickened cranial bones.
o Cushing Syndrome:
 With the excessive secretion of adrenocorticotrophic hormone (ACTH),
and chronic steroid use, the person develops a rounded “moonlike “face,
prominent cheeks, hirsutism on the upper lip area, and acneiform rash on
the chest.
o Bell Palsy:
 A lower motor neuron lesion produces a rapid onset of cranial nerve VII
paralysis of facial muscles; almost always unilateral.
 This may be a reactivation of the herpes simplex virus that has been
latent since childhood.
 The condition is greatly improved with corticosteroids given within 72
hours of onset.
o Stroke:
 A stroke is an acute neurological deficit caused by blood clot of a cerebral
vessel, as in atherosclerosis (ischemic stroke), or a ruptured cerebral
vessel (hemorrhagic stroke).
 If you suspect a stroke, ask the person to smile.
o Parkinson Syndrome:
 A deficiency in the neurotransmitter dopamine and degeneration of the
basal ganglia of the brain.
 The immobility of the face produces a face that is flat, expression-less,
and “masklike”.
o Cachetic Appearance:
 Accompanies chronic wasting diseases such as cancer, dehydration, and
starvation.
 Features include sunken eyes, hollow cheeks, and exhausted expression.

Know thyroid disorders
o Graves’ Disease (Hyperthyroidism):
 Increased production of thyroid hormones causes an increased metabolic
rate.
 This is manifested by goiter and exophthalmos (bulging eyeballs),
nervousness, fatigue, weight loss, muscle cramps, and heat intolerance.
o Myxedema (Hypothyroidism):
 A deficiency of thyroid hormones reduces the metabolic rate causing
non-pitting edema, cold intolerance, puffy face, dry skin, dry brittle hair
and eyebrows.
Eyes, Ears, Nose/Mouth/Throat (Ch 15-17)

Know examination of the eye and how to document findings

Know presentation of cataracts, glaucoma, macular degeneration, near-sightedness, and
far-sightedness.
o Cataracts
 A clouding of the crystalline lens from a clumping of proteins.
o Glaucoma
 A condition of increased pressure within the eyeball, causing gradual loss
of vision
o Macular Degeneration
 A degenerative condition affecting the central part of the retina (the
macula) and resulting in distortion of or loss of central vision. It occurs
especially in older adults.
o Near-sightedness
 A common vision condition in which near objects appear clear, but
objects farther away look blurry. It occurs when the shape of the eye —
or the shape of certain parts of the eye — causes light rays to bend
(refract) inaccurately.
o Far-sightedness

A common vision condition in which you can see distant objects clearly,
but objects nearby may be blurry

Know how to document abnormal findings in the eye

Know infant reflexes and primarily what causes them
o Newborn: Startle (Moro) reflex, acoustic blink reflex.
 The Moro reflex is an infantile reflex that develops between 25–30 weeks
of gestation and disappears between 3–6 months of age. It is a response
to a sudden loss of support and involves three distinct components:
spreading out the arms (abduction) pulling the arms in (adduction)
o 3 to 4 months: Acoustic blink reflex, infant stops movement and appears to
listen.
 Involuntary closure of the eyelids after exposure to a sharp, sudden
noise. This is a normal startle response that may be exaggerated in
patients with anxiety disorders or hyperacusis. It may be blunted in
infants or adults with a hearing disorder or facial nerve paralysis.
o 6 to 8 months: Infant turns head to localize sound, responds to own name.

Know abnormal findings for the ear
o Frostbite
 Frostbite is an injury caused by freezing of the skin and underlying
tissues. First your skin becomes very cold and red, then numb, hard and
pale. Frostbite is most common on the fingers, toes, nose, ears, cheeks
and chin. Exposed skin in cold, windy weather is most vulnerable
to frostbite.
o Otitis Externa
 Otitis externa is a condition that causes inflammation (redness and
swelling) of the external ear canal, which is the tube between the outer
ear and eardrum. Otitis externa is often referred to as "swimmer's ear"
because repeated exposure to water can make the ear canal more
vulnerable to inflammation.
o Sebaceous Cyst
 Cysts are abnormalities in the body that may contain liquid or semiliquid
material.
o Tophi
 A deposit of crystalline uric acid and other substances at the surface of
joints or in skin or cartilage, typically as a feature of gout.
o Battle’s Sign
 Battle's sign is a bruise that indicates a fracture at the bottom of the skull.

Know sinuses exam
o Two pairs of sinuses are accessible to examination:

The frontal and maxillary sinuses and the ethmoid and sphenoid sinuses.

Know how to grade tonsils
o 1+ = Visible
o 2+ = Halfway between tonsillar pillars and uvula
o 3+ = Touching the uvula
o 4+ = Touching one another

Know abnormal findings and causes of gingivitis, rhinitis, epistaxis, black hairy tongue,
and candidiasis
o Gingivitis
 Gum margins are red and swollen and bleed easily. This case is severe;
gingival tissue has desquamated, exposing roots of teeth. Inflammation is
usually caused by poor dental hygiene or vitamin C deficiency. The
condition may occur in pregnancy and puberty because of changing
hormonal balance.
o Rhinitis
 Acute Rhinitis
 The first sign is a clear, watery discharge, rhinorrhea, which later
becomes purulent, with sneezing, nasal itching, stimulation of
cough reflex, and inflamed mucosa, which causes nasal
obstruction. Turbinates are dark red and swollen.
 Seasonal Allergic Rhinitis
 AR is an abnormal immune response from repeated exposure to
antigens, with rhinorrhea, itching of nose and eyes, lacrimation,
nasal congestion, and sneezing. Note serous edema and swelling
of turbinates to fill the air space. Turbinates are usually pale
(although they may appear violet), and their surface looks smooth
and glistening. Common allergens are dust mite, animal dander,
mold, pollen. AR produces disordered sleep, obstructive sleep
apnea, sinusitis, avoidance of outdoor activities, and poor work
performance.
o Epistaxis
 The most common site of a nosebleed is Kiesselbach plexus in the
anterior septum. Peak incidence is bimodal, <18 years and >50 years.
Causes include nose picking, forceful coughing or sneezing, fracture,
foreign body, illicit drug use (cocaine), topical nasal drugs, warfarin
(Coumadin), aspirin, or a coagulation disorder. Bleeding from the anterior
septum is easily controlled and rarely severe. A posterior hemorrhage is
less common (<10%) but more profuse, harder to manage, and more
serious.
o Black Hairy Tongue
 This is not really hair but rather the elongation of filiform papillae and
painless overgrowth of mycelial threads of fungus infection on the
tongue. Color varies from black-brown to yellow. It occurs after use of
antibiotics, which inhibit normal bacteria and allow proliferation of
fungus, and with heavy smoking.
o Candidiasis
 A white, cheesy, curdlike patch on the buccal mucosa and tongue. It
scrapes off, leaving a raw, red surface that bleeds easily. Termed thrush
in the newborn. It is an opportunistic infection that occurs after the use
of antibiotics and corticosteroids and in immunosuppressed people.
 The Candida species as normal oral flora is present in 60% of healthy
adults. Overgrowth of Candida occurs with steroid inhaler use, HIV
infection, use of broad-spectrum antibiotics or corticosteroids, leukemia,
malnutrition, or reduced immunity.
Neurological System (Ch 24)

Know which portion of the brain is responsible for which bodily functions
o Frontal Lobe
 Personality, emotions, intellectual function
o Parietal Lobe
 Process sensation
o Occipital Lobe
 Primary visual receptor center
o Temporal Lobe
 Auditory reception center
o Wernicke’s Area
 Located in the temporal lobe.
 Associated with language comprehension.
o Broca’s Area
 Located in the frontal lobe.
 Mediates motor speech.
o Basal Ganglia
 Large bands of gray mater buried deep within the two cerebral
hemispheres.
 Forms the subcortical-associated motor system.
 Initiates and controls movement.
o Thalamus
 The main relay station where sensory pathways of the spinal cord,
cerebellum, basal ganglia, and brainstem form “synapses”.
 Connections are crucial to human emotion and creativity.
o Hypothalamus

The major respiratory center with basic vital functions of temperature,
appetite, sex drive, heart rate, blood pressure, sleep, autonomic nervous
system activity, and stress response.
o Cerebellum
 A coiled structure under the occipital lobe.
 Controls motor coordination of voluntary movements, equilibrium, and
muscle tone.
o Brainstem
 The central core of the brain.
 CN 3 – 12 originate from the nuclei in the brainstem.
 Three areas: Midbrain, Pons, and Medulla
o Spinal Cord
 Long, cylindrical structure of nervous tissue.
 Occupies the upper 2/3 of vertebral canal from medulla to lumbar
vertebrae.

Know stereogensis, graphesthesia, whisper test, weber test, and Rinne test with
associated findings.
o Stereognosis: Finely localized touch. Without looking you can identify familiar
objects by touch.
o Graphesthesia: is the ability to “read” a number by having it traced on the skin.
With the person's eyes closed, use a blunt instrument to trace a single digit
number or a letter on the palm.
o Whisper test: 1) Stand 1-2 feet behind client so they cannot read your lips. 2)
Instruct client to place one finger on tragus of left ear to obscure sound. 3)
Whisper word with 2 distinct syllables towards client's right ear. 4) Ask client to
repeat word back. 5) Repeat test for left ear.
o Weber test: Place the base of a struck tuning fork on the bridge of the forehead
or nose. In a normal test, there is no lateralization of sound. With unilateral
conductive loss, sound lateralizes toward affected ear. With unilateral
sensorineural loss, sound lateralizes to the normal or better-hearing side
o Rinne test: Place the base of a struck tuning fork on the mastoid bone behind
the ear. Have the patient indicate when sound is no longer heard. Move fork
(held at base) beside ear and ask if now audible. In a normal test, AC > BC;
patient can hear fork at ear.

Be familiar with babinski’s reflex vs. plantar reflex and when they happen
o Babinski’s reflex: Stroke your finger up the lateral edge and across the ball of the
infant's foot. Note fanning of toes (positive Babinski reflex). The reflex is present
at birth and disappears (changes to the adult response) by 24 months of age
(variable)
o Plantar reflex: Touch your thumb at the ball of the baby's foot. Note that the
toes curl down tightly. The reflex is present at birth and disappears at 8 to 10
months.

Know cranial nerves by name, number, sensory/motor, and function
o CN I – Olfactory, sensory, smell
o CN II – Optic, sensory, vision
o CN III - Oculomotor, motor, movement of eyeball
o CN IV- Trochlear, motor, movement of eyeball
o CN V - Trigeminal, sensory and motor, facial sensation/chewing
o CN VI – Abducens, motor, eye movement
o CN VII – Facial, sensory and motor, facial movement/taste
o CN VIII – Vestibulocochlear (acoustic), sensory, hearing and balance
o CN IX – Glossopharyngeal, sensory and motor, voice/tasting/swallow
o CN X – Vagus, sensory and motor, voice/tasting/swallow
o CN XI – Spinal accessory, motor, head/shoulder movement
o CN XII – Hypoglossal, motor, tongue movement

Be familiar with terms tone, strength, plegia, paresis, and involuntary
o Tone: the continuous and passive partial contraction of muscles, or the muscle's
resistance to passive stretch during resting state. It helps to maintain posture
o Strength: how much force you can exert or how much weight you can lift
o Plegia: A plegia is caused by damage to one or more nerves that travel from the
brain to the muscle and initiate movements.
o Paresis: An incomplete paralysis is called a paresis.
o Involuntary: With or without control. Involuntary muscles are the ones that do
not move or contract under the conscious control of a person.

Know how to document reflexes
o 4+ Very brisk, hyperactive response (indicative of disease)
o 3+ Brisker than average (may indicate disease but probably normal)
o 2+ Average, normal
o 1+Diminished, low normal
o 0 No response

Know cranial nerve functions for birth to twelve months
o Cranial Nerves II, III, IV, VI: Optical blink reflex- shine into eyes
o Cranial Nerve V: Rooting reflex, sucking reflex
o Cranial Nerve VII: Facial movements (crying, smiling)
o Cranial Nerve VIII: Loud noise causes the Moro reflex until 4 months
o Cranial Nerve IX, X: Swallowing, gag reflex, sucking and swallowing
o Cranial Nerve XII: Pinch nose and infant’s mouth opens and tongue rises in
midline

Know GCS scores
Breasts, Regional Lymphatics, Thorax, and Lungs (Ch 18-19)

Know most concerning findings of breasts
o Dimpling: Shadow dimple(skin tether) is a sign of skin retraction. Cancer causes
fibrosis, which contracts the suspensory ligaments. The dimple may be seen at
rest, with compression, or with lifting of the arms. There could be a distortion of
the areola as the fibrosis pulls the nipple toward it. Dimpling is A/W
inflammatory breast cancer
o Nipple retraction: The retracted nipple appears flatter and broader, like an
underlying crater Skin retraction is manifested by as dimple which is apparent at
rest and compression. Retraction occurs when a tumor is attacking the duct,
which causes the nipple to be pulled in.
o Peau d’orange: Orange peel appearance. Suggestive of breast cancer, requires
further investigation.
o Edema (Peau d’Orange): widespread peau d’ orange results from skin infiltration
of cancer and skin edema. Lymphatic obstruction produces edema. This thickens
the skin giving it a “pigskin” or orange-peel appearance. This condition suggests
cancer.
o Benign “Fibro\cystic” Breast Disease: Multiple tender masses that occur with
numerous symptoms and physical findings: swelling/ tenderness, severe pain,
significant lumpiness, cysts, nipple discharge, infection/inflammation.
o Breast Cancer: Solitary, unilateral non-tender mass. Solid, hard, dense, fixed to
underlying tissues. Borders are irregular and poorly delineated. Most common in
the upper outer quadrant. Found in women aged 18-30 years; increased age risk
across all ages until age 80.
o Fibroadenoma: Benign tumors, most comply present as self-detected in late
adolescence. Solitary, non-tender mass that is solid, firm, rubbery, and elastic;
round, 1-5 cm, freely moveable and slippery. Usually, no associated axillary
lymphadenopathy.
o Mastitis: An inflammatory mass before abscess formation. Hot, tender, hard.
May occur during the first 4 months of lactation from an infection and begins as
a blocked duct. Treated with rest, local heat, and antibiotics. Frequent nursing to
keep the breast as empty as possible helps.
o Mammary duct Ectasia: Paste like matter in subareolar ducts produce sticky,
purulent discharge that may be cream colored, green, or bloody. Caused by
stagnation of cellular debris and secretions in the ducts leading to obstruction,
inflammation, and infection. Itching, burning, or drawing pain occurs around
nipple. May have subareolar redness and swelling. Ducts are palpable as
rubbery, twisted tubules under areola. May have palpable mass, soft or firm,
poorly delineated. Not malignant but needs biopsy.
o Intraductal Papilloma: These are discrete benign tumors that arise in a single or
multiple papillary ducts. May have serous or serosanguineous discharge. Often
there is palpable nodule and underlying duct. Most common in women ages 40
to 60. Most are benign, although multiple papillomas have a higher risk of
subsequent cancer than do solitary ones. Requires core needle biopsy and
possible excision.
o Carcinoma: Bloody nipple discharge that is unilateral and from a single duct
requires further investigation.
o Paget Disease (Intraductal Carcinoma): Early lesions has unilateral, clear yellow
discharge and dry, scaling crusts, friable at nipple apex. Spreads outward toward
areola with erythematous halo on areola and crusted, eczematous, retracted
nipple. Later lesions shows nipples reddened, ulcerated with bloody discharge,
and erythematous plaque surrounding the nipple. Symptoms include tingling,
burning, itching. Except for the expected redness and occasional cracking from
initial breastfeeding, any other dermatitis of the nipple area must be explored
carefully and referred immediately.
o Breast Abscess: A rare complication of generalized infection if untreated. A
pocket of pus that feels hard, looks red, and is quite tender accumulates in one
local area. May breastfeed depending on location of abscess, associated pain,
and type of medicine. Continue to nurse on unaffected side. Treat with
antibiotics, surgical incision, and drainage.
o Plugged Duct: This is common with milk is not removed completely because of
poor latching, ineffective suckling, infrequent nursing, or switching to a second
breast too soon. There is a tender lump that may be reddened and warm to
touch. No infection. It is important to keep breast as empty as possible and milk
flowing. The woman should nurse her baby frequently on affected side first to
ensure complete emptying and manually expressed any remaining milk. A
plugged duct usually resolves in less than one day.

Know normal changes in breasts of pregnant woman
o A delicate blue vascular pattern is visible over the breasts
o The breasts and nipples increase in size.
o The areola gets darker.

Know breast self-examination education
o Best time is 3-5 days after the start of your period cause the breasts are likely to
be less tender; encourage to do BSE at the same time every month for
consistency.
o For post-menopausal women: do BSE on the same day every month for
consistency.

Know what triggers breathing
o The normal stimulus to breathe for most of us is an increase of carbon dioxide in
the blood, or hypercapnia.

Know findings with bronchophony and egophony
o Bronchophony: Normal findings: normal voice transmission is soft, muffled, and
indistinct; You can hear sound through the stethoscope but cannot distinguish
exactly what is being said. Abnormal finding: Pathology that increases lung
density enhances transmission of voice sounds; You auscultate a clear “ninetynine.” The words are more distinct than normal and sound close to your ear.
o Egophony: Normally you should hear “eeeeeeee” through your stethoscope.
Abnormal finding: over area of consolidation or compression the spoking “eeee”
sound changes to a bleating long “aaaa” sound.

Know risk factors and common findings with COPD
o Risk factors: Smoking, exposure to secondhand smoke, air pollution, genetics,
age.
o Common Findings: barrel chest this occurs from hyperinflation of the lungs. Neck
muscles are hypertrophied from aiding in forced respirations across the
obstructed airways. Sitting in a tripod position (leaning forward with arms braced
against their knees, chair, or bed) it gives them leverage so the abdominal,
intercostal, and neck muscles all can aid in expiration. Cyanosis, Tense, strained,
tired facies and purse-lipped breathing. Clubbing of distal fingers. Rectus
abdominis and internal intercostal muscles are used.

Know abnormal breath sounds and most common cause of them
o Crackles (Fine)
 Discontinuous, high-pitched, short crackling, popping sounds heard
during inspiration that are not cleared by coughing; you can simulate this
sound by rolling a strand of hair between your fingers near your ear or by
moistening your thumb and index finger and separating them near your
ear
 Late inspiratory crackles occur with restrictive disease: pneumonia, heart
failure, and interstitial fibrosis
 Early inspiratory crackles occur with obstructive disease: chronic
bronchitis, asthma, and emphysema
o Crackles (Coarse)
 Loud, low-pitched bubbling and gurgling sounds that start in early
inspiration and may be present in expiration; may decrease somewhat by
suctioning or coughing but reappear shortly—sounds like opening a
Velcro fastener
 Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill
who have a depressed cough reflex
o Wheeze (High-pitched)
 High-pitched, musical squeaking sounds that sound polyphonic (multiple
notes as in a musical chord); predominate in expiration but may occur in
both expiration and inspiration
 Diffuse airway obstruction from acute asthma or chronic emphysema
o Wheeze (Low-pitched)
 Low-pitched; monophonic, single note, musical snoring, moaning sounds;
they are heard throughout the cycle, although they are more prominent
on expiration; may clear somewhat by coughing
 Bronchitis, single bronchus obstruction from airway tumor
o Stridor
 High-pitched, monophonic, inspiratory, crowing sound; louder in neck
than over chest wall
 Croup and acute epiglottitis in children and foreign inhalation; obstructed
airway may be life-threatening

Know hypoxia, hypoxemia, hypercapnia, and tachypnea
o Hypoxia: Low levels of oxygen in the blood. Cyanosis (bluish or greyish color of
the skin, nails, lips, or around the eyes) signals hypoxia.
o Hypoxemia: A decrease amount of oxygen in the blood. Lobar Pneumonia can
cause this.
o Hypercapnia: the normal stimulus to breathe for most of us is in an increase of
carbon dioxide in the blood. It is more effective than Hypoxemia.
o Tachypnea: Rapid, shallow breathing. Increased respiratory rate of greater than
24 breaths per minute. This is a normal response to fever, fear, or exercise.
Respiratory rate also increases with respiratory insufficiency, pneumonia,
alkalosis, pleurisy, and lesions in the pons.

Know normal lymph node assessments and findings
o The breasts have extensive lymphatic drainage. Most of the lymph, more than
75% drains into the ipsilateral (same side) axillary nodes.
o Usually lymph nodes are not palpable, although you may feel a small, soft,
nontender node in the central group. Expect some tenderness when palpating
high in the axilla.

Know presentation of pulmonary embolism, pneumothorax, and pneumonia.
o Pulmonary Embolism:
 Subjective: Chest pain, worse on deep inspiration, dyspnea. Objective:
Apprehensive, restless, anxiety, mental changes, cyanosis, tachypnea,
cough, hemoptysis, PaO2 < 80% on pulse oximetry. Atrial blood gases
show respiratory alkalosis. Palpation: Diaphoresis, hypotension.
Auscultation: Tachycardia, accentuated pulmonic component of S2 heart
sound. Adventitious sound: Crackles and wheezes.
o Pneumothorax:
 Inspection: Unequal chest expansion. If large, tachypnea, cyanosis,
apprehension, bulging in interspaces. Palpation: Tactile fremitus
decreased or absent. Tracheal shift to opposite side (unaffected
side).Chest expansion decreased on affected side. Tachycardia and
decreased BP. Percussion: Hyperresonant. Auscultation: Breath sounds
decreased or absent. Voice sounds decreased or absent. Adventitious
sounds: None.
o Pneumonia:
 History: Fever, cough with pleuritic chest pain, blood-tinged sputum,
chills, SOB, fatigue. Inspection: Increased respirations > 24 breaths per
minute. Guarding and lag on expansion on affected side. Childrensternal retraction, nasal flaring. Palpation: Pulse> 100 bpm, chest
expansion on the affected side. Tactile fremitus increased if bronchus
patent, decreased if bronchus obstructed. Percussion: Dull over lobar
pneumonia. Auscultation: Tachycardia. Loud bronchial breathing with
patient bronchus. Voice sounds have increased clarity; bronchophony,
egophony, whispered pectoriloquy. Children – Diminished breath sounds
may occur early. Adventitious Sounds: Crackles, fine to medium.
Cardiovascular (ch 20-21)

Know where to hear each heart sound
o S1: Apex
o S2: Base
o S3: Apex
o S4: Base

Know when extra heart sounds are heard
o S3
 Heard shortly after S2
 Result of vibrations produced during ventricular filling.
 Normally heard only in some children and young adults
 Abnormal in older patients
o S4
 Heard just before S1 at the end of diastole.
 Caused by the recoil of vibrations between the atria and ventricles
following atrial contraction.

Know what the abnormal heart sounds sound like and when they are heard
o Bruit – a blowing, swishing sound indicating blood flow turbulence.
o Heave or Lift – a sustained forceful thrusting of the ventricle during systole. It
occurs with ventricular hypertrophy as a result of increased workload. A right
ventricular heave is seen at the sternal border; a left ventricular heave is seen at
the apex.
o Thrill – a palpable vibration. It feels like the throat of a purring cat. The thrill
signifies turbulent blood flow and directs you to locate the origin of loud
murmurs. However, absence of a thrill does not rule out the presence of a
murmur.
o A pathologic S3 (ventricular gallop) occurs with heart failure and volume
overload; a pathologic S4 (atrial gallop) occurs with coronary artery disease.
o A murmur is a blowing, swooshing sound that occurs with turbulent blood flow
in the heart or great vessels.

Know formula for CO
o CO = Stroke Volume (SV) x Rate (R)
o Measured in L/min

Know signs of heart failure on each side of the heart

Know preload, afterload, cardiac output definitions
o Preload – Volume of blood in the ventricles at the end of diastole.
o Afterload – Resistance left ventricle must overcome to circulate blood.
o Cardiac Output – the volume of blood in each systole (called the stroke volume)
times the number of beats per minute (rate).
 CO = Stroke Volume (SV) x Rate (R)
 Measured in L/min

Know congenital heart defects for infants
o Tetralogy of Fallot:
 Four components: right ventricular outflow stenosis, ventricular septal
defect, right ventricular hypertrophy, overriding aorta.
o Atrial Septal Defect:
 Abnormal opening in the atrial septum resulting in left to right shunt of
blood flow.
o Patent Ductus Arteriosus:
 A channel that joins the left pulmonary artery to the aorta. This is normal
in the fetus and usually closes spontaneously within hours of birth.
o Ventricular Septal Defect:
 Abnormal opening in the septum between the ventricles.
o Coarctation of the Aorta:
 Severe narrowing of the descending aorta that results in increased
workload on the left ventricle.
 Signs & Symptoms: Large murmur, decreases in femoral/pedal pulses, 4point BP would show higher BP in upper extremities because the heart is
working harder to pump blood to those areas R/T to the narrowing of the
aorta.

Know difference between venous insufficiency, lymphedema, DVT, heart failure edema,
and arterial insufficiency
o Venous Insufficiency
 Lower leg edema that does not resolve with diuretic therapy. Firm,
brawny edema; coarse, thickened skin; pulses normal; brown pigment
discoloration; petechiae; dermatitis. Venous stasis causes increased
venous pressure, which then causes red blood cells (RBCs) to leak out of
veins and into skin. RBCs break down to hemosiderin (iron deposits),
which are brown pigment deposits.
o Lymphedema
 High-protein swelling of the limbs.
 Lymphedema after breast cancer is common but usually mild.
 Obesity increases the risk of lymphedema.
 Signs are: unilateral swelling,
 Treatment: compression wrapping.
 Without treatment, lymphedema is a chronic, progressive disease.
o Deep Vein Thrombophlebitis
 A deep vein is occluded by a thrombus or blood clot.
 Signs are inflammation, redness, swelling, and pain.
 Causes are: prolonged bed rest, immobility, obesity,
 Requires emergency treatment of anticoagulation to prevent a
pulmonary embolism.
o Heart Failure Edema
 Edema is bilateral when the cause is generalized (heart failure)
o Arterial Insufficiency
 Thin, shiny skin; thick-ridged nails; loss of hair on lower legs

Know the flow of blood through the heart
o Right atrium
o Tricuspid valve
o Right ventricle
o Pulmonic valve
o Pulmonary artery
o Lungs
o Pulmonary vein
o Left atrium
o Mitral valve
o Left ventricle
o Aortic valve
o Aorta
o Arteries > Capillaries > Veins
o Inferior/Superior Vena Cava
o Right Atrium
Abdominal/Musculoskeletal (Ch 22-23)

Know causes of changes in stool color
o

Know how to perform an abdominal assessment
o Inspection
 Contour, symmetry
 Flat, scaphoid, rounded, protuberant
o Auscultation
 This is done first because percussion and palpation can increase
peristalsis, which would give a false interpretation of bowel sounds.
 Begin in RLQ at ileocecal valve area because bowel sounds are normally
always present here.
 Note character and frequency of bowel sounds
 Borborygmus is the sound of hyperperistalsis
 A perfectly “silent abdomen” is uncommon; you must listen for 5
minutes by your watch before deciding bowel sounds are completely
absent
o Percussion & Tympany
 Percuss to assess for general tympany, liver, and splenic dullness
 Percuss to assess relative density of abdominal contents, to locate
organs, and to screen for abnormal fluid or masses

First, percuss lightly in all four quadrants to determine prevailing amount
of tympany and dullness
 Move clockwise; tympany should predominate because air in intestines
rises to surface when person is supine
o Palpation
 Judge size, location, and consistency of certain organs and screen for an
abnormal mass or tenderness
 Begin w/ light palpation
 Your objective is not to search for organs but to form an overall
impression of skin surface and superficial musculature
 Save examination of any identified tender areas until last!
 As you circle abdomen, discriminate between voluntary muscle guarding
and involuntary rigidity
 Voluntary guarding occurs when person is cold, tense, or ticklish;
it is bilateral, and you will feel muscles relax slightly during
exhalation; use relaxation measures to try to eliminate this type
of guarding
 If rigidity persists, it is probably involuntary
 Now perform deep palpation using same technique described earlier, but
push down about 5 to 8 cm (2 to 3 inches)
 Moving clockwise, explore entire abdomen
 To overcome resistance of a very large or obese abdomen, use a
bimanual technique
 With either technique, note location, size, consistency, and mobility of
any palpable organs and presence of any abnormal enlargement,
tenderness, or masses
 Mild tenderness normally present when palpating sigmoid colon
 Any other tenderness should be investigated
 If you identify a mass, then note the following:
 Location
 Size
 Shape
 Consistency: soft, firm, hard
 Surface: smooth, nodular
 Mobility, including movement with respirations
 Pulsatility
 Tenderness
 Rebound tenderness (Blumberg’s sign)
 Abdomen wall is compressed slowly and then rapidly released
 Pain upon removal of pressure; indicative peritonitis, occurs in
appendicitis, ulcerative colitis.
 Inspiratory arrest (Murphy’s sign)




Ask patient to breathe out and place hand below costal margin on
the right side of midclavicular line
If patient winces or holds breath, it is considered positive.
Indicative of cholecystitis.
Know purpose of musculoskeletal assessment in the aging adult
o Use functional assessment history questions to elicit any loss of function, selfcare deficit, or safety risk
o Check Activities of Daily Living (ADLs)
o Postural changes are evident with aging, and decreased height is most
noticeable.
o Bone remodeling is cyclic process of resorption and deposition; after age 40,
resorption occurs more rapidly than deposition.
Week 9-10 Powerpoint

Know how to calculate EDD
o Estimated date of delivery
 280 days from the first day of the last menstrual period.

Know delirium vs dementia
o Dementia
 Not a specific disease.
 An overall term that describes a group of symptoms associated with a
decline in memory or other thinking skills severe enough to reduce a
person's ability to perform everyday activities.
 Alzheimer's disease accounts for 60 to 80 percent of cases.
o Delirium
 A serious disturbance in mental abilities that results in confused thinking
and reduced awareness of the environment.
 The start of delirium is usually rapid — within hours or a few days.

Know findings for for syphilis, herpes, genital warts, and tinea cruris
o Syphilis
 Begins within 2 to 4 weeks of syphilis infection as a small solitary silvery
papule that erodes to a red, ulcer with yellowish discharge.
 1st stage: Open sore (chancre), goes away without treatment.
 2nd stage: Very contagious rash that develops into sores.
 Latent stage: No symptoms but still contagious.
 Late stage: Tumors, damage to brain, heart, and nervous system.
o Herpes



Clusters of small vesicles with surrounding erythema which are painful
and forming superficial ulcers.
The initial infection lasts 7 to 10 days and is treated with oral acyclovir.
The virus remains dormant indefinitely; recurrent flare ups last 3 to 10
days with milder symptoms.
o Genital Warts
 Soft, pointed, moist, fleshy, painless papules may be single or multiple in
a cauliflower like patch.
 Caused by human papillomavirus (HPV) and are one of the most common
sexually transmitted diseases.
 The vaccine Gardasil is indicated for prevention of genital warts and
approved for boys and men ages 9-26 years.
o Tinea Cruris
 A fungal infection that mostly occurs in males but also can be present in
females
 Referred to as ”jock itch” after sweating and wearing layers of clothing.

Know how to do a testicular exam and what the findings can indicate
o Testicular Exam
 Inspect the scrotum as the male holds the penis out of the way. Scrotal
size varies with ambient room temperature. Asymmetry is normal, with
the left scrotal half usually lower than the right.
 Spread rugae out between your fingers. Lift the sac to inspect the
posterior surface. Normally no scrotal lesions are present, except for the
commonly found sebaceous cysts. These are yellowish, 1-cm nodules and
are firm, nontender, and often multiple.
 Palpate gently each scrotal half between your thumb and first two
fingers. The scrotal contents should slide easily. Testes normally feel oval,
firm and rubbery, smooth, and equal bilaterally and are freely movable
and slightly tender to moderate pressure. Each epididymis normally feels
discrete, softer than the testis, smooth, and nontender.
 Palpate each spermatic cord between your thumb and forefinger along
its length from the epididymis up to the external inguinal ring. You should
feel a smooth, nontender cord.
o Findings
 Transillumination
 Perform this maneuver only if you note a swelling or mass. Darken
the room. Shine a strong flashlight from behind the scrotal
contents.
 Serous fluid does transilluminate and shows as a red glow (e.g.,
hydrocele or spermatocele).


Solid tissue and blood do not transilluminate (e.g., hernia,
epididymitis, or tumor).
Abnormalities in the scrotum
 Hernia, tumor, orchitis, epididymitis, hydrocele, spermatocele,
varicocele

Know findings with ectopic pregnancy and endometriosis
o Vaginal bleeding may indicate threatened abortion, cervicitis, or ectopic
pregnancy in 1st trimester and must be investigated.
o Adnexal enlargement or pain with palpitation occur with ectopic pregnancy or
ovarian mass.
o Ectopic pregnancy
 Symptoms: Bleeding, pain
 Diagnosed with transvaginal ultrasound
o Endometriosis
 Symptoms: Pain, commonly involves the ovaries, fallopian tubes, and
tissues lining the pelvis.

Know findings and causes for cervical cancer, atrophic vaginitis, bacterial vaginosis,
candidiasis
o Cervical Cancer
 Causes and risk factors
 HPV infection, having many sexual partners, smoking, engaging in
early sexual contact.
 HPV infection may cause cervical dysplasia or abnormal growth of
cervical cells.
 Early signs and symptoms
 Light bleeding, menstrual bleeding that is longer or heavier,
bleeding after intercourse, increased vaginal discharge, bleeding
after menopause, and unexplained, persistent pelvic and/or back
pain.
o Atrophic Vaginitis
 Chronic and progressive inflammation of the vagina due to thinning and
shrinking of vaginal tissues
 Symptoms are due to a lack of the reproductive hormone estrogen.
 It may occur in peri and post-menopausal women, but most often after
menopause (ages 45-55).
 Symptoms are vaginal dryness and painful sexual intercourse.
o Bacterial Vaginosis
 Overgrowth of bacteria normally present in the vagina.

Symptoms bad odor (fishy), discharge, itching.
o Candidiasis
 A yeast infection of the vagina and the tissues of the vulva.
 Vaginal yeast infections are not considered a sexually transmitted disease
 A healthy vagina contains some bacteria and yeast cells. But when the
balance of bacteria and yeast is disrupted, overgrowth of yeast occurs.
 This causes itching, swelling, and discharge.
 Several factors can cause a yeast infection
 Antibiotics, pregnancy, uncontrolled diabetes, weak immune
system, stress, lack of sleep.

Know symptoms of UTI and BPH
o Urinary Tract Infection
 Presents with dysuria, frequency, urgency, nocturia, suprapubic pain,
occasionally gross hematuria, possibly fever.
 Urine color is cloudy
o Benign Prostate Hyperplasia
 As the prostate enlarges, it presses against the urethra. The bladder wall
becomes thicker. One day, the bladder may weaken and lose the ability
to empty fully, leaving some urine in the bladder. Narrowing of the
urethra and urinary retention – being unable to empty the bladder fully –
cause many of the problems of BPH.
 Obstructive (voiding)
 Hesitancy, intermittency, weak urine stream, straining, sensation
of incomplete emptying.
 Irritative (storage)
 Daytime urinary frequency, nocturia, urgency

Know what fundus height means and what it can determine
o Measured from the superior border of the symphysis to the fundus.
o After 20 weeks, the number of centimeters should approximate the number of
weeks of gestation in a healthy body size and a singleton pregnancy.
 Lagging fundal height of ≥2 cm
 May indicate intrauterine growth restriction, transverse lie, of
oblique presentation of the fetus.
 A fundal height of >4 cm than expected
 Occurs with multiple fetuses, excess amniotic fluid, or uterine
myoma.
 Both conditions warrant an ultrasound.

Know when and how to do APGAR scores
o Completed at 1 and 5 minutes after birth and will provide evidence of
newborn’s immediate adaptation to extrauterine life.
o

Know colonoscopy scheduling
o Colorectal cancer screening (CRC)
 Colonoscopy after age 50 years then every 10 years.

Causes of uterine prolapse
o The uterus protrudes into the vagina.
o Occurs during straining or standing due to weakened pelvic floor muscles.

Know changes in blood pressure during pregnancy
o Early first trimester blood pressures reflect pre-pregnancy values.
o In the 7th gestational week, BP begins to drop until mid-pregnancy as a result of
falling peripheral vascular resistance.
o During the second trimester, the BP lowers. The drop is most pronounced at 20
weeks.
o Blood volume peaks in the middle of the 3rd trimester.

Know symptoms and causes of hemorrhoids
o Swollen veins in your anus and lower rectum
o Typically caused by straining with bowel movements
o Causes painful stooling

Know what Chadwick’s sign is
o Bluish discoloration of the mucosa occurs in pregnancy due to venous
congestion.