Medical-Surgical Nursing Discussion
1. Define the following reproductive terms:
Cystocele – a protrusion of the bladder through the vaginal wall resulting from weakened pelvic structures. Rectocele – a protrusion of the rectum through a weakened vaginal wall (rectal prolapse). Phimosis – the prpuce is constricted so that it cannot be retracted over the glans. The prepuce remains down, around the tip of the penis. Hydrocele – usually is a painless cystic mass filled with a straw-colored fluid that forms around the testis. Stress Incontinence – the loss of small amounts of urine during coughing, sneezing, jogging, or lifting. Patients are unable to tighten the urethra sufficiently to overcome the increased detrusor pressure, and leakage of urine results. Urinary Urgency – the involuntary loss of urine associated with a sudden, strong desire to urinate. Patients are unable to suppress the signal for bladder contractions. It is also known as overactive bladder. Urinary Hesitancy - a decrease in the force of the stream of urine, often with difficulty in beginning the flow. Hesitancy is usually the result of an obstruction or stricture between the bladder and the external urethral orifice. In men, it may indicate an enlargement of the prostate gland; in women, it may indicate stenosis of the orifice. Cold, stress, dehydration, and various neurogenic and psychogenic factors are common causes of this condition.
2. Where is sperm produced? In the epididymis of the testicles 3. Why is the scrotum suspended outside the body? It is believed that the testes lie outside the body cavity because they are very sensitive to heat and the higher temperature within the body is unfavorable to the production of sperm. 4. Define the following skeletal muscle movements:
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Abduction – To move away from the midline. The movement of a limb or other part away from the midline of the body, or from another part. Adduction – To move toward the midline. The movement of a limb toward the midline or axis of the body. Pronation – To move the joint down. 1.) Assumption of a prone position, one in which the ventral surface of the body faces downward. 2.) (of the arm) the rotation of the forearm so that the palm of the hand faces downward or backward. 3.) (of the foot) the
Medical-Surgical Nursing Discussion
lowering of the medial edge of the foot by turning it outward and through abduction in the tarsal and metatarsal joints. Supination – To move the joint up. 1. ) One of the kinds of rotation allowed by certain skeletal joints, such as the elbow and the wrist joints, which permit the palm of the hand to turn up. 2.) Assumption of a supine position, one of lying on the back, face up.
5. What does each section of the cerebral cortex control:
Frontal lobe o The primary motor area (also known as the motor “strip” or cortex) o Broca’s speech center on the dominant side o Voluntary eye movement o Access to current sensory data o Access to past information or experience o Affective response to situation o Regulates behavior based on judgement and foresight o Judgment o Ability to develop long-term goals o Reasoning, concentration, abstraction Parietal Lobe o Understand sensation, texture, size, shape, and spatial relationships o Three-dimensional (spatial) perception o Important for singing, playing musical instruments, and processing nonverbal visual experiences o Perception of body parts and body position awareness o Taste impulses for interpretation Occipital Lobe o Primary visual center Temporal lobe o Auditory center for sound interpretation o Complicated memory patterns o Wernicke’s area for speech There is also a Limbic Lobe which is responsible for: o Emotional and visceral patterns connected with survival o Learning and memory
6. Describe Romberg's test. To test equilibrium, ask the patient to stand w/arms at the sides, feet and knees close together, and eyes open. Check for swaying, and then ask him or her to close his or her eyes and maintain position for about 20 seconds. The examiner should be close
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Medical-Surgical Nursing Discussion enough to prevent falling if the patient cannot stay erect. If he or she sways w/the eyes closed but not when the eyes are open (the Romberg sign), the problem is probably proprioceptive (awareness of body position). If the patient sways w/the eyes both open and closed, the neurologic disturbance is probably cerebellar in origin. If the patient cannot perform any of these activities smoothly, the problem is manifested on the same side as the cerebellar lesion. If both lobes of the cerebellum are involved, the incoordination affects both sides of the body. 7. Describe the Babinski 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), but can disappear by as early as 12 months. What is considered a normal response for an adult? What is considered a normal response for a 12 month old? When the Babinski reflex is present in a child older than 2 years or in an adult, it is often a sign of a brain or nervous system disorder. Disorders may include: Amyotrophic lateral sclerosis (Lou Gehrig disease), Brain tumor or injury, Meningitis, Multiple sclerosis, Spinal cord injury, defect, or tumor, Stroke. 8. How would you assess a patient's gait during a neurological exam? Observe as the person walks 10 to 20 feet, turns, and returns to the starting point. Normally, the gait is smooth, rhythmic, and effortless; the opposing arm swing is coordinated; turns are smooth. The step length is about 15 inches from heel to heel. Ask the person to walk a straight line in a heel-t0-toe fashion (tandem walking). This decreases the base of support and accentuates any problem w/coordination. Normally, the person can walk straight and stay balanced. 9. Why is it important that we assess both sides of a patient? (ex. arms, legs, lungs, ears, eyes, etc...) – To check for symmetry of both sides. Does each side look the same, react the same, sound the same, function the same, etc. Documentation of the differences and/or similarities in reference to both sides is important. 10. What is the term for being able to identify a common object (ex. key, coin, etc...) when placed in the hand while the eyes are closed? Stereognosis is the ability to identify objects that are placed in the hand when the eyes are closed. The patient is given common objects and asked to identify them without looking at them. The inability to do this called astereognosis and indicates parietal lobe dysfunction.
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Medical-Surgical Nursing Discussion
References Babinski reflex: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003294.htm Ignatavicius, D., & Workman, L. (2013). Medical-surgical nursing: Patient-centered collaborative care (7th ed.). St. Louis, Mo.: Saunders/Elsevier. Jarvis, C. (2012). Pocket companion for physical examination & health assessment (6th ed.). St. Louis, Mo.: Elsevier/Saunders. Medical Dictionary. (n.d.). Retrieved from http://medical-dictionary.thefreedictionary.com/ NeuroLogic Examination Videos and Descriptions: Sensory Normal. (n.d.). Retrieved from http://library.med.utah.edu/neurologicexam/html/sensory_normal.html Peterson, V., & Potter, P. (2013). Clinical companion for Fundamentals of nursing: Just the facts (8th ed.). St. Louis, Mo.: Elsevier Mosby.
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