Chapter 12
Addiction: an unhealthy, continued involvement with a mood altering object or activity in spite of harmful consequences. Addictive behavior has 3 components
1. withdrawal a series of temporary physical and biological symptoms that occurs when the addict abruptly abstains form an addictive behavior.
2. a pattern of pathological behavior (deterioration in performance at work, school, family and social interaction)
3. relapse the tendency to return to the addictive behavior after a period of abstinence.
Signs of addiction these four components are present in all forms of addiction, whether chemical or physical.
1 compulsion (often characterized by) obsession excessive preoccupation with the behavior and an overwhelming need to perform it
2 loss of control the inability to predict whether an isolated occurrence of the behavior will be damaging.
3 negative consequences physical damage,
financial trouble, legal trouble... that do not occur with normal behavior
4 denial or the inability to perceive that behavior is self destructive.
the Addictive Process
nurturing through avoidance begins when a person repeatedly seeks the illusion of relief to avoid unpleasant feelings or situations.
as the person becomes increasingly dependent on the addictive behavior, there is a corresponding deterioration in relationships.
eventually the addicts do not find the addictive behavior pleasurable but consider it preferable to the unhappy realities they are trying to escape
Phases of Addiction
Phase I Learns Mood swing-- first drink is pleasant and no emotional cost. the drinker learns that the degree of mood swing is controlled by the dosage.
Phase II Seeks Mood Swing---occasional excessive use but no real emotional cost.
Phase III Harmful Dependency- plays a progressive emotional cost that results in lower self worth, ebbing ego strength. Low self image becomes chronic.
Phase IV Drinks to Feel Normal-- Starts at a point of chronic depression and drinks to feel good.
Phase V free floating mass of negative feelings about self. Rational defenses lock in negative feelings about the self, resulting in mental mismanagement.
The Physiology of Addiction:
neurotransmitters, biological messengers, exert their influence at specific receptor sites on nerve cells. Drug use and chronic stress can alter these receptor sites and cause the production and breakdown of neurotransmitters.
Mood altering chemicals, foe example, fill up receptor sites for the body’s natural “feel good” neurotransmitters (endorphins) so that nerve cells are fooled into believing they have enough neurotransmitters and shut down production of these substances temporarily. When the drug use is stopped, those receptor sites become emptied, resulting in uncomfortable feelings that continue until the body resumes neurotransmitter production or the person consumes more of the drug.
Tolerance: the phenomenon in which progressively larger doses of a drug or more intense involvement in a behavior is needed to produce the desired effects.
the Biopsychological model of Addiction: (know the difference between the 3 influences and the life events)
theory of the relationship among an addict’s biological (genetic nature) and psychological and sociocultral influences.
BIOLOGICAL OR DISEASE INFLUENCES,
people addicted to mood altering drug metabolize them differently, and the children of alcoholics have been shown to have abnormal concentrations of neurotransmitters-this causes them to be more prone for drug dependency. alcoholism runs in families
SOCIOCULTRAL INFLUENCES
cultural expectations help to determine in what manner in which we will engage in certain behaviors. in Europe where children are gradually introduced to alcohol in a responsible family setting, there is a much lower incidence of alcoholism.
the Social learning theory states that people learn behaviors by watching role models--parents care givers, and significant others.
LIFE EVENTS
major stressful life events such as marriage, divorce, and death are common triggers for addictive behaviors. death of a spouse is the most common trigger for excessive drinking in the elderly, and divorce is the most common stimulus of alcoholism in women.
FAMILY INFLUENCES
family members whose needs are not met fully, neglected, abused, children or children of divorce are more likely to suffer negative consequences from stress and struggle with addiction.
biological, psychological, sociocultral, and environmental factors all contribute to the development of addiction. one factor may play a larger role than the others, but a single factor is rarely the cause.
Enables are people who knowingly or unknowingly protect addicts from the natural consequences of their behavior.
Types of Addiction:
Money Addictions: compulsive gambling, spending, and borrowing
addicts of this kind tend to describe it in terms similar to those used by drug addicts.
equally common for all genders, races and religions but
men are twice as likely to become compulsive gamblers
women are twice as likely as men to become “shopaholics”
men tend more towards compulsive borrowing
Compulsive Gambling:
compulsive gamblers are persons addicted to gambling.
unable to see the necessity to stop, and unable to control urges
cardiovascular problems occur in 38% compulsive gamblers and
their suicide rate is 20 time higher than that of the general pop.
Compulsive shopping and borrowing:
the obvious “shopaholics" are the people who go on mad spending sprees, but those people who buy things they need or want but can’t afford may also be shop alcoholics. the critical issue is whether it is done to fulfill a psychological need--power, love or control.
Workaholism:
workaholic: who gradually becomes emotionally crippled and addicted to control and power in a compulsive drive to gain approval and success.
the only addiction that wins the admiration of others
pursuit of the “work persona”
in a survey 64% of the grandchildren of alcoholics identified their parents as workaholics. more men suffer from this disorder than women but the rate is becoming more equal is as equality for women in the workplace is being established.
men between 40 and 50 are most likely to become workaholics
Exercise Addiction:
addictive exercisers: people who exercise compulsively in order to meet the needs of nurturance, intimacy, self-esteem, and self competency.
we do not have any exact figures on this addiction
Sexual Addictions:
sex addicts confuse sexual arousal with intimacy.
sex addict may not seek partners to fulfill needs, they may use masturbation
tend to have a history of sexual abuse
affects men and women of all ages
do not feel nurtured by the person, but by the activity.
suicide is high among people who have problems with sex control
Codependency: a self defeating relationship in which a person is addicted to an addict.
four core symptoms are involved in codependency, codependents have difficulty:
1. experiencing appropriate levels of self esteem
2. setting healthy boundaries
3. owning and expressing their own reality
4. taking care of their adult needs and desires
codependency is based on a pattern of behavior, for example, codependents tend to basis their self esteem on factors external to their self, like the ability to control the feelings and behaviors of others. codependents are more likely healthy people with unclear, invasive, or rigid boundaries. unclear boundaries creates a double image that can lead to confusion tension and conflict
rigid boundaries remain immovable even when flexibility would be more appropriate
invasive boundaries are aggressive giving rise to behavior towards others that is invasive or abusive.
Codependents have difficulty owning all or pert of their reality in the following ways:
1. they do not accurately perceive their appearance or the way their body is functioning
2. they find it hard to identify their thoughts and express them openly/honestly
3. they have difficulty labeling their feelings or feel overwhelmed by them
4. they have difficulty perceiving how their behavior affects others, or accepting that their behavior may be hurtful to others.
Intervention: a planned process of confrontation by significant others.
it is not enough to get an addict to admit addiction, they must also realize that their behavior is destructive and needs treatment.
individual confrontation is difficult and often futile. However, an addict’s defenses often crumble when confronted by a group of loved ones. it is critical that those involved in the intervention communicate how they plan to end their enabling. these consequences must be actions that the loved ones are willing to follow through with if the addict odes not stop. the confrontation should be well planned and rehearsed because the addict will likely not want to be confronted. once recognition has been achieved, recovery can begin.
Treatment:
treatment and recovery from any addiction begins with abstinence, refraining from the addictive behavior. people addicted to sex food or work face a special problem in that they can not merely quit the activity, they must learn to engage in the behavior in way that are non compulsive.
detoxification refers to the early abstinence period when an addict adjusts physically and cognitively to being free from the influence of the addiction. this period can be physically dangerous, especially for those addicted to chemicals. The addict may need the care of health professionals. abstinence does little to exchange a person’s traits that cause the behavior in the first place. Only through recovery that involves learning new ways to look at the world, ones self and others. this may involve learning new ways of being happy. It involves learning interdependence with significant others and new ways of taking care of ones self physically and emotionally.
Brief intervention:
brief intervention therapy, therapy based on the assumption that even very brief treatment, if designed properly, can be highly successful in treating addicts.
in this approach therapists use “motivational interviewing” with patients. Six key components (FRAMES) in the brief intervention therapy help patients to gain confidence in their ability to quit:
Feedback: specific feedback is tailored to the individual
Responsibility: patients are told that recovery is up to them, they are not seen as helpless victims of a disease.
Advise: firm an clear recommendations are given
Menu: there are different ways to work out the addiction
Empathy: the best therapists have this and are neither too pushy nor too confrontational
Self-efficacy: patients are told “you can do it and empowered to change”
researchers report that their success lies in helping addicts to believe in their ability to quit or moderate and retain their motivation to do so once they do.
Chapter 14
Alcohol and College Students:
Alcohol is the most widely used (and abused) recreational drug in our society
It is the most popular drug on college campuses, where 85% of students consume alcoholic beverages.
the number of female drinkers is now close to equaling the number of male drinkers
Binge drinking: drinking for the express purpose of being intoxicated; five drinks in a single sitting for men and four drinks for women
in a recent study, 44% of college students were found to be binge drinkers
How to Drink Responsibly in Social Situations:
if you are the guest,
the first rule is to honor anyone’s decision not to consume alcohol
know your limits and stay within them; if you feel pressured to drink you could pretend
stick to the limit of one ounce of alcohol per hour, will reduce chance of drunkenness and may leave you able to drive
stick to drinks other than strait liquor because they are easier to “nurse”
never drink on an empty stomach, eating and drinking at the same time will slow the rate at which alcohol enters your body
alternate alcoholic beverages with nonalcoholic
if you are drunk don’t drive home.
when with friends have a designated driver
understand that being drunk does not excuse your behavior
remember that it is easy to enjoy yourself with out becoming drunk. try being silly w/ out alcohol
if you are the host,
be sure that food is available to guests
serve beverages with a lighter alcoholic content
limit the availability of alcohol to your guests
when preparing a mixed drink, measure the alcohol carefully
limit the time of drinking
plan the party to focus on something other than alcohol
have nonalcoholic beverages available to guests
if a guest is to drunk to drive home make arrangements for him
never take the word of a person you feel is drunk that he is “ok” to drive
they may have developed learned behavioral tolerance: the ability of heavy drinkers to modify their behavior so that they appear sober even though they have high BAC levels
IMPORTANT: if a friend passes out after having too much to drink be sure to watch him and put him on his side with his legs bent so that if he vomits he will not suffocate. face up or face down positions are dangerous.
Blood Alcohol Concentration (BAC): is the ratio of alcohol to total blood volume; the factor is used to measure the psychological and behavioral effects of alcohol.
# of drinks BAC Psychological and Physical Effects
1 .02-.03% no overt effects, slight mood elevation
2 .05-.06% feeling of relaxation, warmth; slight decrease in reaction time and fine muscle coordination
3 .08-.09% Balance, speech, vision, and hearing slightly impaired; feelings of euphoria, increased confidence; loss of motor coordination
4 .10% Legal intoxication in most states; some have lower limits
5 .14-.15% Major impairment of physical and mental control; slurred speech, blurred vision, lack of motor skills
7 .20-% Loss of motor controll--must have assistance in moving about; mental confusion
10 .30% Severe intoxication; minimum conscious control of mind and body
14 .40% unconsciousness, threshold of coma
17 .50% Deep come
20 .60% Death from respiratory failure.
Absorption and Metabolism:
Unlike the molecules in most other intestable foods and drugs, alcohol molecules are sufficiently small enough to be absorbed throughout the entire length of the digestive system. The upper part of the intestinal tract, the small intestine, just below the stomach, absorbs 80% of the alcohol because it absorbs it at a faster rate.
The rate of absorption is affected by:
1 the concentration of alcohol in your drink,
2 the amount of alcohol you consume,
3 the amount of food in your stomach
4 pylorospasm (spasms in the pyloric valve)
5 your mood
the concentration of your drink and the amount of food in your stomach are the two major factors affecting how quickly your system will absorb alcohol.
the higher the concentration of alcohol, the faster it is absorbed by your digestive tract. As a general rule, beer and wine rare absorbed more slowly than distilled beverages.
carbonated alcoholic beverages are absorbed more rapidly than those with out carbonation because the carbonation relaxes the pyloric valve and allows more of the alcohol to pass on to the small intestine where it is more rapidly absorbed.
if the stomach is full with food it is less likely to empty into the intestines, and the alcohol has less surface exposure to the walls of the stomach because of the presence of food
the more alcohol you consume the longer absorption takes
if alcohol builds up in the stomach it may become irritated and completely close the pyloric valve. if this irritation continues vomiting may result.
powerful moods such as stress and tension can cause the stomach to empty its contents into the small intestine, increasing the rate of absorption.
women appear to metabolize alcohol at a rate 30% slower that men because they have less of the enzyme, hydrogenaze, and consequently a woman drinking the same amount as a man will on average have a BAC that is 30% higher.
Immediate Effects:
alcohol is a dietetic, causing increased urinary output. Although this effect might be expected to lead to automatic dehydration (loss of water), the body actually retains water, most of it in the muscles or cerebral tissues. This is because water is usually pulled out of the cerebrospinal fluid (fluid within the brain and spinal cord) leading to what is known as mitochondria dehydration at he cellular level within the nervous system. Mitochondria are the miniature organs in cells that rely heavily upon fluid balance. when dehydration occurs from drinking, the mitochondria cannot carry out their normal functions, resolution in the “morning after” headaches suffered by some drinkers.
Hangover: the physiological reaction to excessive drinking, including headache, nausea, depression, anxiety, depression, diehard , and thirst.
the causes of hangovers are not well known. they can be partially be attributed to dehydration, but that does not completely explain the reactions with in the body. the effects of cogners, forms of alcohol that are metabolized more slowly than ethanol and produce toxic by products, are suspected. muscle aches and nausea are caused by increased hydrochloric acid production in the stomach, and overdoing physically it during a drinking spree.
it usually takes 12 hours to recover from a hangover. bed rest, solid food, and aspirin may help relieve the discomforts of a hangover, but nothing really relieves a hangover but time.
Long Term Effects:
men who had 2-4 drinks a week had the lowest of all death rates for all causes
men who had 2 or more a day had a death rate 63% higher than non drinkers
researchers found that the reduced risk of dying from heart disease was offset by the risk of cancer in those who had more than 1 drink a day
the nervous system is especially sensitive to alcohol, even people who only drink moderately experience shrinking in brain size, and loss of a degree of intellectual ability
it is better to have one drink every day than to have 7 drinks one day a week
alcohol related brain damage can be partially reversed by good nutrition and staying sober.
cardiovascular effects:
evidence suggests that the effects of alcohol are not all bad, but it is not recommended to prevent heart disease because there are many more related cardiovascular problems than benefits. alcohol contributes to high blood pressure and a slightly increased heart rate.
Holiday heart syndrome: irregular heart rhythms or total loss of rhythm caused by occurrences of binge drinking, that usually occur around holidays like Christmas and New Years.
Cardiomyopathy: deterioration of the heart muscle caused by prolonged heavy drinking.
Liver Disease:
Cirrhosis: the last stage of liver disease associated with chronic heavy use of alcohol during which liver cells die and damage is permanent.
Alcoholic hepatitis: condition resulting from prolonged use of alcohol in which the liver is inflamed. It can result in death.
Cancer: consumption of alcohol has been found to increase the risk of cancer
Alcohol and Pregnancy:
Fetal Alcohol Syndrome (FAS): a disorder that may affect the fetus when the mother consumes alcohol during pregnancy. Among its effects are mental retardation, small head, tremors, and abnormalities of the face limbs heart and brain.
Fetal Alcohol Effects (FAE): a syndrome describing children with a history of parental alcohol abuse, but with all the physical or behavioral symptoms of FAS. among its symptoms are low birth weight, irritability, and possible mental impairment.
Chapter 15
Tobacco:
Particulate matter: condenses in the lungs to form a thick, brownish sludge called tar.
tar contains various carcinogenic (cancer causing) agents such as benzopyrene and chemical irritants such as phenol. Phenol has the potential to combine with other chemicals to contribute to the development of lung cancer.
Nicotine impairs the cleansing function of the cilia by paralyzing them for up to one hour following the smoking of a cigarette. Tars and other solids in tobacco smoke are thus allowed to accumulate and irritate sensitive lung tissue.
cigarette smoke is made up of dangerous gases, the most dangerous of which is carbon monoxide. In tobacco smoke, the concentration of carbon monoxide is 800 times higher then the level considered safe by the US Environmental Protection Agency (EPA). In the human, carbon monoxide reduces the oxygen carrying capacity of the red blood cells by binding with the receptor sites for oxygen. Smoking thus diminishes the capacity of the circulatory system to carry oxygen, causing oxygen deprivation in many body tissues.
Physiological Hunger reducing Effects of Nicotine
1 nicotine decreases the stomach contractions that signal hunger
2 it also decreases blood sugar levels
3 decreased sensation in the taste buds
Nicotine Poisoning: symptoms often experienced by beginning smokers. they include dizziness; diarrhea; lightheadedness; erratic pulse and vomiting.
tobacco smoking is responsible for 30% of all deaths from cancer
Lung cancer is the leading cause of death in the US
cigarette smoking increases the risk of pancreatic cancer by 70%
smokers can reduce those odds by 30% or more if they quit for 11 years
cancers of the lip, tongue, salivary glands and esophagus are 5 times as likely to occur in smokers
smokers are also more likely to develop kidney, bladder, and larynx cancers
Caffeine Addiction:
caffeinism, or caffeine intoxication is an addiction to caffeine. symptoms include chronic insomnia, jitters, irritability, nervousness, anxiety, and involuntary muscle twitches. Withdrawing from caffeine may compound the effects and produce severe headaches.
you would have to drink between 67 and 100 cups in a day to produce a fatal overdose of caffeine, but it is possible to experience sensory overload from caffeine
moderate use of caffeine (less than 500 milligrams a day, five cups) produces few side effects in healthy, non pregnant people. however, people who suffer from irregular heart beats are cautioned against the use of caffeine because the resultant increase in heart rate can be life threatening.
Coffee is still considered a gastric irritant that can contribute to ulcers. Decaffeinated coffee still causes irritation.
Pregnant women are still advised not to consume any caffeine it may be hazardous to growing fetus.
Chapter 22
Death:
the concept of brain death, defined as irreversible cessation of all functions of the entire brain stem, has gained increasing credence.
the Ad Hoc Committee of Harvard defined it in 1968:
1. unrecpetivity and unresponsiveness--that is, no response even to painful stimuli
2. No movement for a continuous hour after observation by a physician and no breathing after three minuets off a respirator.
3. No reflexes; including brain stem reflexes, pupils are fixed and dilated
4. A flat EEG for at least 10 min.
5. All of these test repeated 24 hours later with no change
6. Certainty that hypothermia (extreme loss of body heat) and the depression of the central nervous system caused by the use of drugs such as barbiturates are not responsible for the conditions.
Thanatology: the study of death and dying.
the five psychological stages that patients often experience as they approach death:
1. denial: (not me this must be a mistake) usually the first stage. accepts it intellectually but rejects it emotionally
2. anger: (why me?) may become hostile to friends family even the world
3. bargaining: (if I'm allowed to live, I promise...) usually in the middle
4. depression: (it’s really going to happen to me and I can’t do anything about it
5. acceptance: (I'm ready) often the final stage. the patient stops battling with emotions. often dies peacefully while asleep.
Bereavement: is generally as the loss or deprivation experienced by a survivor when a loved one dies.
disenfranchised grief: grief for a loss experienced by a person can not be openly acknowledged
ex. gay relationship partner dies, miscarriage, the retarded, those that were close but not family
Grief: is a state of mental distress that occurs in reaction to a significant loss, including one’s own impending death, the death of a loved one or a quasi-death experience.
know ex.
Quasi-death experiences losses or experiences that resemble death in that they involve separation, termination, significant loss, a change of personal identity, and grief.
Mourning: refers to the culturally prescribed and accepted time periods and behavior patterns for the expression of grief. In Judisim, for example, “sitting shivah” is a designated mourning period of seven days that involves prescribed rituals and prayers.
Grief work: the process of accepting the reality of a persons death and coping with the memories of the deceased.
Hospice: a concept of care for terminally ill patients designed to maximize the quality of life.
the primary goals of hospice care are to:
1. relieve a dying person’s pain
2. offer emotional support to the dying person and their loved ones
3. to restore a sense of control to the dying person, family and friends.
Rational Suicide: an alternative to the extended dying process where the patient or care givers take action to shorten and remove the pain from the dying process (not a real definition, I made it up, but that is basically what they meant; they did not give one explicitly)
Self-deliverance: a positive action taken to provide a permanent solution to the long term pain and suffering for an individual and his or her loved ones faced with terminal illness.
suicide or mercy killing.
Dyathanasia: the passive form of mercy killing in which life prolonging treatments or interventions are withheld, thereby allowing the terminally ill person to die naturally.
Euthanasia: the active form of mercy killing in which the a person or organization knowingly acts to hasten the death of a terminally ill person.
Let's Play Doctor book
WHAT’S IN A DOCTOR’S BAG
Ophthalmoscope: an optical instrument used to look inside the eyes, uses a system of lenses and mirrors. has a little light
Otoscope: used to examine the ear canal and ear drum.
Stethoscope: used for listening to the sounds of the body
Reflex Hammer: padded hammer used to check reflexes
Blood pressure cuff: use to measure a patients blood pressure
Thermometer: you better know this one damn it.
Tongue depressor: looks like a popsicle stick
PATIENT’S HISTORY
Chief complaint: reason you came to the doctor
History of present illness: records
Past medical and surgical history
Medications
Allergies
Social history: marital status, job, smoker y/n, drinker...
Review of Body’s Systems: mental checklist kept by doctor
PHYSICAL EXAM
2nd in importance only to history
THE DOCTOR’S METHODS
Looking (inspection)
Listening (Auscultation)
Feeling (Palpitation)
Tapping (Percussion)
THE VITAL SIGNS
1. Heart rate and rhythm
factors that could increase heart rate:
a. body temperature
b. anxiety
c. pain
d. exercise
e. hyperthyroidism (hormone increase)
f. anemia when there are not enough red blood cells to carry oxygen
g. medications
factors that could decrease heart rate:
a. sleep (slower when asleep)
b. organic heart disease (heart may be damaged causing it to not properly receive the signals to beat.)
c. hypothyordism (hormone decrease)
d. medications
the heart rhythm:
3 types of beats
1. regular
2. regularly irregular (beats are not same but there is a pattern)
3. irregularly irregular (no pattern)
Taking the Pulse: the radial artery on the wrist is the most common place. do not use your thumb because it has a pulse of its own that can be felt.
2. The Breathing Rate: most of the time the heart rate and the breathing rate change together
how to take the breathing rate: count the times the chest rises in a minute, or do 15 sec and multiply by 4 . normal rate is 12-20/ min
factors that may increase:
many of the same as for heart.
also some diseases may increase it
factors that may decrease:
same as heart
also body can increase or decrease acid content by slowing or increasing breathing
it is generally normal to breathe at a regular rate
3. The Blood Pressure
normal 120/80
high blood pressure diastolic above 90--- systolic above 160
Low Blood pressure: generally without symptoms of dizziness or weakness it is not a problem.
causes of low blood pressure:
blood loss
dehydration
heart attack/ heart failure
irregular heart rates
drugs medicines
4. Body Temperature
98.6 is normal could be as high as 99.9
body follows 24 hour cycle
lowest at 4AM; highest at 6PM
temp can be measured in: mouth, rectum, under arm, and in ear
above 100.5 is generally said to be fever
in mouth in usually .7 deg lower than in rectum
ear 1 deg lower than rectum
Causes of high temp: exercise, infection
Causes of low temp: cold weather
5. Level of Oxygen in Blood (Pulse Oximetry)
added as 5th vital sign in recent years after development of simple way of measuring oxygen content in blood
light sensing device placed on patient's finger; light shines into finger and detects each heart beat and determines how much xygen is being carried in the blood
especially useful in patients with asthma, emphysema, and pneumonia
normal hemoglobin in blood is 95-99% saturated with oxygen; level may drop to 60-70% if lungs are diseased
EAR, NOSE, AND THROAT
Inflammation: complex set of chemical reactions and changes that tissues undergo in response to bacterial invasion or other diseases; response to injury as an early attempt to prevent further injury and means of beginning the healing process; chemical reactions act as signals which call different blood cells to site of injury; cells come to repair damage or fight the enemy (bacteria, virus, etc.)
Infections occur when tissues of the body are invaded by other living organisms; bacteria, viruses, parasites, and fungi may cause infections; infections is almost always accompanied by inflammation
Four signs and symptoms used to determine presence of inflammation = redness, pain, swelling, increased temperature
Ears: outer ear - part of ear visible from outside of body; comprised of pieces of cartilage on each side of the face and tube leading to eardrum
middle ear - cavity directly behind eardrum; three small bones transmit sound from eardrum to inner ear; middle ear is connected to back of throat by eustachian tube which regulates pressure in ear
inner ear - specialized nerve endings sense sound and movement allowing us to hear and keep our balance
examination - swollen lymph nodes in front of or behind the outer ear may indicate infection; bumps called sebaceous cysts can form on ear or in canal because of blocked oil glands; doctor uses otoscope to examine eardrum; wax may form in ear canal - not significant unless wax obstructs hearing or examination; eardrum is round, pinkish-gray, and reflects light from otoscope; doctor can observe movements of eardrum by pumping air into ear canal (process called pneumatic otoscopy); normal eardrum will move in and out as pressure changes
diseases - otitis externa - infection of outer ear, swimmer's ear, for example; otitis media - middle ear infection - eardrum becomes red, light reflected off eardrum makes it appear dull and less transparent, fluid or pus may collect behind eardrum and may cause it to move more slowly or not at all during pneumatic otoscopy; mastoiditis - infection of mastoid bone at back of middle ear - bone is swollen and tender; these can be treated with antibiotics; other viral infections can be detected but not treated
hearing loss - two types: (1) problems with conducting sound through outer and middle ear into inner ear; caused by wax in ear, hardening of bones in middle ear, fluid in middle ear, or hole in eardrum; called conductive loss; common in adults under age of 40 (2) sensory cells and nerves are not transmitting sound effectively to brain or brain has difficulty receiving them; caused by aging deafness, drug-induced nerve damage; excessive exposure to loud noise; called sensorineural loss; common in adults over age of 40
Weber test - hearing test in which doctor strikes tuning fork and places the base of it in the middle of the patient's head at the top; patient should hear sound equally in both ears; sensorineural loss may cause sound to be softer in one ear
Rinne test - doctor strikes tuning fork and places its base against mastoid bone behind the ear; patient informs doctor when sound is no longer heard; then doctor moves vibrating ends of tuning fork to within 2 inches of patient's ear and asked if sound is still audible; conductive loss may result in decreased conduction through air
Nose: upper respiratory infections often start in nose and throat; physician can look in nose with otoscope to see mucous membranes - should be moist, pinkish; if red with yellowish fluid, may be bacterial infection; if red with clear fluid, may be viral infection; if pale with clear fluid, may be allergic reaction rather than infection
Sinuses: doctor taps bones in head which are over sinus cavities; if patient reports pain upon tapping, infection may be present in sinuses; doctor may shine a light through skin into sinus; healthy sinus should allow light to pass through
Throat: doctor inspects tongue, teeth, gums, and roof and floor of mouth, then tonsils and throat; may detect sores in mouth which could indicate herpes, syphilis, cancer or fungal infection
infections: viral infection - redness, prominent bumps on back of the throat (swelling of lymph tissue); mononucleosis (Epstein Bar Virus) - red dots on roof of mouth, enlarged lymph nodes around ears and in neck; strep throat - swollen tonsils, yellow patches on the tonsils, swollen and tender lymph nodes in the neck; diphtheria - dull red color of throat with thick gray layer of fluid
throat culture - swabbing throat with cotton tip and transferring bacteria onto
plate which is put in incubator and allowed to grow; then studied and treated in patient; strep throat can be cured with 10 days of penicillin medication; if not treated completely, strep throat can lead to rheumatic fever which destroys heart valves
Eyes: external conditions - black eye - tissues around eye are damaged, small vessels are broken and bleed, causing brown appearance; membrane surrounding eye can become damaged and can bleed, blood collects between lining and eyeball; if liver fails to function properly and get rid of all bile produced there, whites of eyes may become yellow/green; pink eye occurs when bacteria or viruses invade and infect hair follicles on eyelid, local inflammation, pain, swelling, redness, increased temperature; people with hyperthyroidism often have eyes which protrude or bulge out; tenderness in eye sockets may indicate skull fracture is patient has had an accident
movement - eyes muscles must be carefully controlled to move in synchronization with each other and with the body's movement; doctor also checks that pupils are same size and both react to light
vision test - patient stands 20 feet from wall chart and attempts to read it; eyes are tested separately; doctor checks peripheral vision; loss of peripheral vision may indicate advanced diseases of the eye
inside of eye - room is darkened or pupils dilated with eye drops to enlarge; patient focuses on distant object while doctor examines eye through ophthalmoscope; imperfections like bubbles on lens are sign of early cataract, also inability to see back of retina; veins in back of retina pulsate and are larger than arteries; if veins stop pulsating and optic cup is enlarged, pressure around brain may be dangerously high
Snellen Eye Chart - 2 numbers 20/X; X=the distance at which a person with "normal" vision can read the smallest line you can read at 20 feet
Heart: examined to detect disease or blockage; history - shortness of breath, swelling of ankles, fast heart rate, dizziness or fainting, chest pain are helpful symptoms in diagnosis; blueness of skin may indicate tissues are not receiving enough oxygenated blood; rounded fingernails indicate chronic lack of oxygen; enlarged veins in neck indicate heart is behind in pumping blood to lungs; doctor listens to lungs for fluid buildup indicating heart gets behind in pumping blood to lungs; doctor listens to heart for sounds of valves slapping shut; "lub-dupp" "lub" sound (S1) is closing of tricuspid and mitral valves; "dupp" (S2) is closing of pulmonic and aortic valves;
possible abnormal sounds: S3 - low pitched, indicates fluid overload in heart; S4 - low pitched, indicates ventricles stiff and resistant to incoming blood flow; murmurs - valves are stuck and don't open or close completely;
feeling: pulses, feeling for enlarged liver, feeling chest for point of maximum intensity (PMI) of heartbeat and movement next to breastbone
Lungs: abnormal sounds: rales - sound like rice crispies crackling - pneumonia or fluid overload; rhonchi - coarse sounds heard on expiration - presence of fluid in airways; wheezes - asthma, chronic obstructive pulmonary disease, allergic reactions; rubs - inflamed surfaces of lungs rub together; stridor - high pitched sound on inhalation - swollen throat tissues - respiratory failure; egophony - patient asked to say "ee" but it comes out as "aa" then lung tissue is filled with fluid
Abdomen: visual inspection - obesity, muscle defects, distention; listening for bowel movements; feeling liver, spleen, kidneys, feeling for tumors, and pulsations; tapping to determine size of organs; rectal examination (especially for prostate growths)
abnormal pains: pancreatis pain - located above belly button, often radiates to back; spleen - located in upper left quadrant and may radiate to left shoulder; diverticulitis - lower quadrants; kidneys - located in lower back and may radiate into groin; appendicitis - located around belly button and moves into lower right quadrant as condition worsens; intestines - cramps, can be located almost anywhere
Male genitals: feel testicles for bumps which may indicate testicular cancer; rectal exam to observe prostate gland
Gynecological exam: breast examination - observation and palpation; external pelvic exam - doctor inspects and palpates pelvic region; internal exam - speculum inserted into vagina to separate and hold walls for inspection; bimanual exam - two fingers inserted into vagina while other hand presses on abdomen
Nervous system: reflexes tested with hammer on knee or arm; plantar response - rigid object strokes bottom of foot, toes curl downward to protect sole of foot