Download Arkansas State University | NURS 6023 NURS6023 study guide for Exam 3 2025/2026 and more Quizzes Nursing in PDF only on Docsity!
Study Guide 3
- Onset pain after lifting---Straight leg raises for herniated disc
- Key in hand with eyes closed, assessing for-stereognosis
- Raise eyebrows, frown, smile and open eyes, assessing –CNS V and VII
- 52 f with acute rapidly progressive headache, -R/O Subarachnoid hemorrhage
- Teenage girl admitted with facial trauma secondary to MVA—stroke cornea of each eye with cotton wisp to check for reflex blinking-what name is this reflex and what CN---Corneal reflex, CN 5 and 7
- Complaint of breathlessness with activity,---orthopnea
- 67 f with c/o CP am palpitation, After EKG dx of A-Fib-complications- Peripheral embolization
- Physical examination of pt with peripheral vascular disease-asses for Size, symmetry and skin color
- Painful ulcerative lesion near medial malleolus with hyperpigmentation---Venous insufficiency
- Blood glucose over 360 with extreme thrist, frequent urination and fruity breath---Hyperglycemia
- State of absolute insulin deficiency, aggravated by hyperglycemia, dehydration and acidosis with positive ketones---Diabetic ketoacidosis (DKA)
- Pelvic exam on 23 y/o female, thin, watery frothy, malodorous discharge---Trichomoniasis
- 27 y.o female, tender warm cystic mass on lower edge of left labia---Bartholin’s gland cyst
- Right lower quadrant abd pain—examine tender area last
- 55 y/o male with pain in epigatrum lasting longer than 30 min---All answers are correct
- Amenorrhea and vaginal spotting, left adnexa tender ---Urine pregnancy test
- 33 male with 1 week history of fever and pain over left scrotom—Epididymis
- 26 y/o coach right side pain---acute appendicitis
- 17 y/o left scrotum, soft movable blood vessels that feel like bag of worms, -- Vericocele
- 10y/o boy, sudden onset pain -Testicular torsion
- 72 y/o female sp CABG and POD #3, Tachy at 150, what is the EKG---Atrial Fibrillation
- 75 y.o male, presents with chest pain, --Cornary Artery disease resulting in STEMI
- 65 yo female check up, BP in both arms----Subclavin Stenosis
- Deterioration of frontal lobe of cerebrum,,, it is Boluntary skeletal movement
- Turn patients forearm so that palm is up---supination
- Cause of Acute UTI---E.coli
- 26 yo DM type 1, caused by pancreatic beta cell destruction predominatly by an autoimmune process
- Unilateral pain during chewing, ------Tempormanidbular joint syndrome
- Assessing patient with suspected cholecystitis—Murphy’s sign
- Cushing’s disease—Glococorticoid excess
- Back pain associated with constipation and urinary retention---Idopathic low back pain
- Bronze skin color and darkened gums----Addison’s disease
- Sudden onset, painful swollen red finger and toe joints----Gout
- Bluish cervix---Chadwicks sign of cervice and order pregnancy test
- 44 yo male, right lower extremity edema and discomfort---DVT
- What type of EKG changes would you expect to find in setting of acute pericarditis---Widespread ST elevation
- Auscultation of heart tones, harsh systolic murmur heard best at 2nd^ intercostal space right midclavicular line---Aortic stenosis
- 70 yo male painful left lower extremity---cyanosis of toes---Ischemic foot related to peripherl artery stenosis
- Snellen chart evaluating for visual acuity---CN II
- QRS complex on EKG--- ventricular depolar
- Pacemaker of heart---SA node
d. QRS – ventricular depolarization e. ST – entire ventricle is depolarized f. T wave – return of ventricle to resting potential
- History a. Chief complaint – OLDCARTS b. Onset c. Duration d. Quality i. What does the chest pain feel like? What makes it better or worse? e. Severity f. Aggravating/alleviating factors g. Associated symptoms h. Past medical/surgical history i. HX of CAD, PVD, atherosclerosis, peripheral artery disease, obesity, hyperlipidemia, DM i. Family hx i. Death, sudden death, MI, coronary artery disease j. Social hx i. Tobacco use, ETOH use, hobbies, sedentary lifestyle, active ii. Was there a sudden change in ability to do physical activity? k. Medications l. Allergies m. ROS
- Common Chief Complaints a. Chest Pain i. One of the most important symptoms of cardiac disease ii. Pain could be secondary to cardiac etiology or stem from pulmonary, GI, or musculoskeletal origins iii. Patients may have a “chest pain equivalent”
- Fatigue, weakness, SOB, referred pain
- Atypical symptoms more common in women and elderly iv. Cardiac origin should be ruled out in all patients with c/o chest pain v. OLDCARTS vi. Differentials:
- Angina/ACS a. True symptom of coronary artery disease b. Caused by hypoxia to the myocardium which leads to anaerobic metabolism and the production of lactic acid – the acid irritates the heart muscles and causes pain c. Imbalance of oxygen delivery and oxygen demand d. Levine’s Sign (clutching chest) e. Classically substernal f. May be relieved by rest and/or medications g. May have associated s/s (n/v, diaphoresis, SOB)
h. Stable: occurs in repetitive pattern, precipitated by exertional demands, duration is greater than 30 seconds to a few minutes, resolves with rest or typical medication regimens i. Unstable: occurs in escalating and crescendo pattern, may occur at rest, duration is greater than stable but usually < minutes, resolution takes longer – may require IV nitrates – these patients have already tried their sublingual nitroglycerin without improvement
- Demand Ischemia a. Mismatch between myocardial oxygen demand and supply
- example is severe anemia b. Evidence of ischemia, but no CAD c. May cause elevation in cardiac biomarkers d. Aortic valve disease, uncontrolled HTN, severe anemia, tachy or bradyarrhythmias, heart block, inflammatory disease, severe pulmonary hypertension, CHF, critical illness
- Non-ischemic CV origins of Chest Pain a. Pericarditis i. Inflammation of the pericardial sac ii. May occur following MI or procedure, such as a CABG iii. May be infectious, r/t malignancy, or autoimmune iv. Chest pain – sharp and pleuritic, may improve with sitting or leaning forward, worsen with cough or inspiration v. EKG – wide spread ST elevation vi. Pericardial friction rub vii. Relief – analgesics and anti-inflammatory meds viii. Ultimate treatment depends on cause b. Thoracic Aortic Aneurysms i. Ascending, descending, or aortic arch ii. Most are asymptomatic – found incidentally iii. Chest pain may be associated with rapid growth, dissection, or rupture iv. May rarely c/o dysphagia or dyspnea, typically r/t compression of adjacent organs v. Need imaging vi. Surveillance vs Repair – refer to vascular surgery vii. SMOKING CESSATION c. Abdominal Aortic Aneurysms i. Most asymptomatic
- neurologic – epilepsy, cerebrovascular disease
- psychogenic e. Fatigue f. Edema i. Palpable swelling produced by expansion of interstitial fluid volume ii. Typically apparent after institial fluid volume has increased by 2.5- liters iii. Causes: cirrhosis, CHF, nephrotic syndrome, venous disease, lymphatic disease iv. Pitting VS Non-Pitting
- Press fingers into the dependent areas for 2-3 seconds g. Leg Pain/ Claudication
- Acute Coronary Artery Syndrome a. Unstable Angina, NSTEMI, STEMI b. New ischemic changed in a 12 lead EKG i. Inferior MI: changes in Lead 2, Lead 3, ADF ii. Lateral MI: changes in Lead 1, AVL, V5, V iii. Septal: changes in Lead V1, V iv. Anterior: changes in Lead V3, V v. ST Elevation - seen in patients who are infracting vi. ST Depression – already infarcted c. Possible elevation in cardiac markers d. Rest angina lasting longer than 20 minutes, new onset angina that markedly limits physical activity, or increasing angina that is more frequent, longer duration or occurs with less exertion e. Relieved with medication and/or successful coronary interventions
- Tachyarrhythmias a. Sinus Tachycardia – most common, treat the underlying cause i. May be due to dehydration – will resolve with rehydration b. SVT, A. Flutter, A. Fib, V. Tach know rhythm strip c. Abnormal heart rhythm with ventricular rate >100BPM d. S/S: hypotension, CHF, chest pain, acute MI, palpitations, decreased Loc e. Stable VS Unstable i. Is your patient experiencing S/S?
- Atrial Fibrillation a. Most common cardiac arrhythmia b. Irregularly irregular c. No distinct P waves d. Risk Factors: HTN, CAD, valvular heart disease, CHF, OSA, obesity, DM, CKD, post- operative state, hyperthyroid e. Most serious complication: arterial embolization – thrombotic CVA most common f. Every pt with Atrial Fib should be evaluated for the need for antithrombotic therapy
i. CHA-DS-VASc Score ii. Look at the patients history as well – 85 year old with multiple falls is not a good candidate for anticoagulation
- Ventricular Tachycardia a. NSVT – 3 or more consecutive ventricular beats, rate > 100 BPM, duration < 30 seconds i. Clinical S/S: usually asymptomatic; may have palpitations, chest pain, SOB, syncope, presyncope ii. Usually found incidentally on EKG iii. Goal is to treat the underlying cause if possible
- Electrolyte imbalances, MI, hypoxia, adverse drug reaction, hypotension iv. May require further diagnostics
- Event monitor, stress testing, AICD, ablation b. Wide Complex Sustained VTACH i. Monomorphic VS Polymorphic ii. Causes: acute MI, CAD, cardiomyopathy, prolonged QT interval iii. Clinical S/S; may briefly experience same as above prior to abrupt LOC iv. May cause cardiac arrest v. May progress to V Fib
- Bradyarrhythmias a. Ventricular rate < 60BPM b. Dysfunction of cardiac conduction system at level of SA node, atria, or AV node c. Risk Factors: advanced age, inflammatory states, infection, ischemia, MI, cardiomyopathy, medications, electrolyte imbalances, trauma, hypoxia, hypothyroid d. S/S: dizziness, presyncope, syncope, SOB, fatigue e. Normal aging process includes a decrease in HR
- Heart Failure a. Causes: uncontrolled HTN, Ischemic heart disease, PE, valvular heart disease, arrythmias, sleep apnea, lack of compliances, systemic infection, anemia b. Right Sided i. Congestion of peripheral tissues ii. Liver congestion, GI tract congestion, dependent edema and ascites c. Left Sided i. Decreased cardiac output 1. Activity intolerance, pulmonary congestion, hypoxia, orthopnea, paroxysmal nocturnal dyspnea, cough with frothy sputum d. NYHA Functional Classification i. Class I: heart disease without resulting limitation of physical activity ii. Class II: slight limitation, symptoms develop with ordinary activity, but no symptoms at rest iii. Class III: marked limitation of physical activity, symptoms develop with less than ordinary physical activity, but no symptoms at rest
a. Inspection i. General appearance – height, weight, facial skin, eyes, skin/nail beds, presence of edema, hair distribution, temperature changes on extremities, chest wall, PMI, JVP
- Cyanosis – indicative of decreased oxygen saturation and circulating hemoglobin, may indicate impaired pulmonary function, may indicate L to R cardiac shunting
- Petechiae on Palate, Splinter hemorrhages – may indicate infective endocarditis
- Exophthalmos – severe periorbital edema in patients with CHF
- Retinal Changes - clues to other vascular changes
- Hair Loss – PVD
- Marfan Syndrome – connective tissue disorder – really tall and really long arm span, stretch marks, aortic root dilation – need referral to vascular specialist
- Endocarditis – fever, chills, weight loss, Janeway Lesions (non- tender erythematous macule usually on palms of hands and soles of feet), Osler nodes (tender, subcutaneous nodules mostly on pads of fingers, sometimes on the toes), Roth Spots (exudative hemorrhagic lesions of the retina with a pale center) ii. PMI – inspect the L anterior chest for visible PMI; using finger pads, palpate at the apex for the PMI – 5th^ ICS, L MCL
- May be tapping (normal), sustained, diffuse
- If you can’t feel with the patient sitting – have them turn to the left side lying down
- PMI > 3cm in diameter indicated L ventricular hypertrophy iii. JVP – have the patient lay supine and raise HOB 45 degrees, turn the patients head to the L, use a centimeter ruler to measure the vertical distance between the angle of Louis and the highest level of JVP – add 5 cm to this measurement
- More than 4cm above sternal angle is elevated
- Normal < 8
- Tachycardia can cause inaccurate measurement
- Jugular Vein Vs Carotid Artery a. Venous i. Usually not palpable ii. Soft, biphasic – 2 beats per heartbeat iii. Pulsations are eliminated by light pressure iv. Height of pulsation changes with positioning v. Height of pulsation usually falls with inspiration b. Arterial i. Palpable ii. Single outward pulse iii. Pulsations not eliminated by pressure
iv. Height is unchanged by position or inspiration
- Hepatojugular Reflux a. Useful test for assessing high JVP b. By applying pressure over the liver, you can grossly assess RV function c. Have pt lie in bed, mouth open, and breathe normally to prevent Valsalva d. Place right hand over RUQ and apply firm pressure for 10 seconds e. Normally there will be a short increase in venous dilation followed by a fall to baseline f. If there is RV failure, neck veins will stay elevated during entire compression
- Palpation a. PMI, chest wall, carotid pulse, peripheral pulses (brachial, radial, ulnar, popliteal, dorsalis pedis, posterior tibial), cap refill, edema, thrombophlebitis b. Any condition that increases the rate of ventricular fillings can produces a palpable impulse c. Pulses grades on scale of 0- d. Palpate chest wall for heaves or lifts from abnormal ventricular movements
- Auscultation a. 5 traditional auscultatory areas i. Aortic, pulmonic, Erb’s, tricuspid, mitral b. Avoid listening through clothing c. Listen with diaphragm and bell i. Diaphragm – high pitched sounds ii. Bell – low pitched sounds d. If possible, listen in sitting and leaning slightly forward, supine, left lateral recumbent positions e. Note intensity, pitch, location, radiation, duration, and timing f. S1 – onset of systole, closure of mitral and tricuspid valves, loudest over mitral or apex, best heard with diaphragm i. Increased: fat deposits, pericardial effusion, systemic HTN, pulmonary HTN, calcification of mitral valve ii. Split S1: possible – occurring with asynchronous L and R ventricles g. S2 – beginning of diastole, closure of aortic and pulmonic valve, loudest at base of heart at aortic area, best heart with diaphragm i. Increased: systemic HTN, pulmonary HTN, exercise, mitral stenosis ii. Decreased: shock, hypotension, fat deposits overlying the heart h. S3 – early diastolic sound resulting from passive flow of blood from atria, low pitched, best heard with bell in L lateral recumbent position, loudest at apex, normal in children and young adults, >40 = indicator of systolic dysfunction, unaffected by respiratory cycle i. “Ken-tuc-ky” i. S4 – late diastolic sound immediately preceding S1, best heard with bell, loudest at apex or mitral area in L lateral recumbent position i. “tenn-es-see” ii. Associated with HTN, CAD, high output state, recent MI, AS
ii. Loudest in mitral area iii. Usually does not radiate iv. CX: rheumatic heart disease, congenital (rare), mitral annular calcium calcification b. Aortic Regurgitation i. 1 st^ third of diastole ii. Loudest at aortic area of the base of the heart – R midclavicular iii. Unchanged by respiration iv. CX: rheumatic heart disease, aortic root dilation, congenital bicuspid AV, calcific valve disease
- MR.AS-S and MS. ARD a. Mitral regurgitation and aortic stenosis are systolic, Mitral stenosis and aortic regurgitation are diastolic
- Diagnostic Studies a. EKG, echocardiogram, ABD US, CXray, hematologic studies, coronary and peripheral angiogram i. Angiogram = only true definitive way to detect stenosis or blockage
- Blood Pressure a. Take in an unassisted upright position b. BP = CO X SVR c. Primary HTN i. Pathogenesis poorly understood ii. Risks: age, obesity, family hx, race, high Na diet, excessive ETOH, physical inactivity d. Secondary HTN i. Causes typically coexist with risk factors for primary HTN ii. Prescription or OTC medications, renal disease, pheochromocytoma e. Complications: i. LV hypertrophy, heart failure, ischemic stroke, CKD/ESRD, ischemic heart disease, intracerebral hemorrhage f. HTN Diagnosis i. Age <60 = BP >140/ ii. Age >60 = BP >150/ g. A difference > 15 points in one arm compared to the other may indicated subclavian stenosis h. Hypertensive emergency = diastolic BP 120 or greater or systolic BP 180 or greater
- Orthostatic Hypotension a. Have the patient lay down for 5 min and measure BP and HR, have the patient stand and repeat reading immediately. Allow 90 seconds for maximal changes. b. A drop in SBP of 20 or more is orthostatic c. Usually an increase in HR d. Should check in pts: >65, having dizziness or weakness when standing, those with DM
Week 6-Abdomen, GI, GU Abdominopelvic A&P Lies between the thoracic diaphragm and the pelvic diaphragm Contains most digestive organs, spleen, and urogenital system Divided by a horizontal and vertical line that crosses the umbilicus (RLQ, RUQ, LLQ, LUQ). Abdominopelvic HPI OLDCARTS If abdominal pain has been present for 3-4 weeks it is not likely acute appendicitis ROS should include o N/V, bowel/bladder habits, pain, weight change, appetite change, bloating, excessive gas, belching, dysphagia, heartburn/indigestion, fever/malaise, rectal pain/itching/bleeding, changes in stool, anal warts/fissures, hx of jaundice/liver disease/hepatitis/gall bladder disease. PMH Jaundice, liver disease, hepatitis, gallbladder disease, infectious disease, PUD, GERD, bleeding/platelet disorders, abdominal trauma, previous abdominal surgeries Family History Liver disease, gallbladder disease, hepatitis, cancer (colon), IBS, polyposis Social History Tobacco use, caffeine use, alcohol use, illicit drug use, medications, usual activities/exercise, sleep habits, usual dietary intake, sexual habits, travel/recent exposures Week 7-Neuro, Musculoskeletal and Lab Interpretation Musculoskeletal System
- Functions of the MS system a. Provides a framework that supports the body b. Allows movement of the body c. Protects internal organs d. Serves as storage site for minerals and production of RBCs e. Generates body heat
- Components of the Bony System a. Axial Skeleton i. Skull, Facial Bones, Ribs, & Vertebral Column b. Appendicular Skeleton i. Pectoral Girdle, upper limbs, pelvic girdle, and lower limbs
- Types of Joints a. Synovial i. Most common ii. Lubricated by synovial fluid to allow the bones to move freely iii. Knees and Shoulders b. Cartilaginous
f. Other Shoulder Problems: i. Myofascial pain:
- asymmetrical trigger points medial to the scapula and over the trapezius; stress and or previous neck injuries ii. Subacromial Bursitis:
- tenderness that can be palpated over the head of the humerus many times on the dominant extremities; pain at night; abrupt onset without known trauma; overuse pattern iii. Acromioclavicular joint separation:
- history of a direct fall or blow to the point of the shoulder iv. Shoulder Dislocations:
- any trauma to the shoulder with a mechanism of injury involving external rotation with abduction; loss of normal contour of the shoulder; marked instability v. Frozen Shoulder:
- total restriction of normal range of motion with an insidious onset of pain; cause though to be an inflammatory process, holding it dependent, or prolonged immobilization; common in women, after age 50, and in diabetics vi. Clavicle Fx:
- direct trauma to the clavicle; obvious deformities to the mid- shaft; pain on palpation to the region
- Elbow, Wrist, & Hand Disorders a. Lateral epicondylitis (Tennis Elbow): i. Inflammation and tenderness of the lateral epicondyle and associated tendons ii. Gradual onset – associated with overuse b. Medial Epicondylitis (Golfer’s Elbow): i. Inflammation and tenderness of the medial epicondyle and associated tendons ii. Gradual onset with overuse c. Olecranon Bursitis: i. Swelling and tenderness at the tip of the elbow d. Ganglion Cysts: i. Most often seen in the wrist as soft, non-tender nodules ii. May be painful e. Carpal Tunnel Syndrome: i. Entrapment of the median nerve causing pain, numbness, and tingling in the hands ii. May be unilateral or bilateral iii. Test with Phalen’s, Tinel’s, or EMG studies f. Colles’ Fx: i. History of a fall on an outstretched hand ii. Pain, edema, and limited ROM with obvious wrist deformities
g. Navicular Fx: i. History of fall on an outstretched hand with impact on fingers or distal palm ii. Tenderness over anatomical snuffbox, possible swelling h. De Quervain’s Tenosynovitis: i. Pain in the radial aspect of the wrist aggravated with ulnar deviation of the hand with the thumb flexed; thickening sheath or nodule in the area of tenderness ii. Positive Finkelstein sign i. Gamekeepers thumb/Skier’s Thumb (Ulnar collateral ligament tear): i. History of sudden, forceful abduction of the thumb; pain on ulnar side of the thumb with swelling of the metacarpal phalanges ii. Stress testing reveals laxity
- Assessment of the Spine a. Inspection: i. Begins when the pt first enters the exam room ii. Observe the pt gait
- Ask to walk heel-toe to test the gastrocnemius iii. Assess the posture iv. Assess from the side and the back b. Palpation i. Palpate the back ii. Palpate for warmth and distal pulses c. Lumbar Spine i. Test foot strength of dorsiflexion ii. Perform the straight leg raise iii. Test the sacroiliac joint
- Neck and Back Disorders a. Neck Strain: i. Pain and muscle rigidity extending from upper cervical region and extending into the trapezius ii. Limited ROM & painful movement b. Scoliosis: i. Curvature of the spinal column ii. May present with a uneven shoulder height or uneven iliac crest height c. Herniated Nucleus Pulposus (Herniated Disk): i. Indicated by performing a straight leg test 1. While the pt is laying supine, slowly raise the leg to 30-40 degrees while the knee is fully extended and dorsiflex the foot – if positive – the pt will experience pain in the lumbar region 2. PT NEEDS AN MRI d. Compression Fx/Back Pain: i. Point tenderness to any bony area of geriatric pt after minor trauma ii. Weakness and pain
i. Recent trauma; osteoporosis; pain on palpation ii. Shortening of leg with external rotation, inability to bear weight, bruising iii. DX: xray of the pelvis h. Sciatica i. Recent trauma to the hip or pelvis; sitting for long period of time ii. Tingling or burning down leg; numbness; decreased/abnormal sensations to the thigh or lower extremity; weakness of leg or foot; difficulty walking iii. DX; MRI i. Bursitis i. Hx of trauma or overuse of the area ii. Joint pain and tenderness; warmth over affected area; swelling; crepitus iii. DX: CBC
- Common upper leg and knee problems a. Quadriceps Tear i. Visible tear; pt will not be able to lift leg b. Trochanteric bursitis i. Pain over greater trochanter when lying on affected side c. Patellofemoral syndrome i. Chronic pain along anterior-medial aspect of knee; no welling but puffiness; crepitus and positive inhibition test d. Iliotibial band syndrome i. Hx of running or cycling; pain over lateral femoral condyle; tenderness proximal to lateral joint line; positive Obers test e. ACL Tear i. Pivoting activity with the leg planted; pop or snap will be heard; quick onset of swelling with large effusion; pt cannot straighten leg; positive Lachman’s or draw test ii. Lachman Test: place the knee in 15 degree of flexion and mild external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, forcefully pull the tibia forward and the femur back. f. MCL Tear i. Knee injury with force to lateral knee; knee caves into medial side g. PCL Tear i. Injury with hyperextension; positive posterior draw test h. Hamstring Strain i. Injury with activity requiring burst of speed; reports sudden onset of pain and swelling over the hamstring i. Shin Splints i. Dull intermittent pain over distal third of tibia j. Osgood-Schlatter Dz
i. Onset of pain is gradual; pain over tibial tubercle exacerbated by activities and impact; knee extension causes pain, tenderness, and swelling k. Baker’s Cyst i. Swelling behind medial knee; pain or pressure with full flexion; in ruptured cyst, calf will be enlarged; venous return from lower extremities will be impaired l. Septic Arthritis i. Fever, chills, and malaise; intense joint pain; joint will be hot and erythematous; most common in knee
- Ankle and Foot Disorders a. Sprain i. Most common ankle injury; precipitated by injury followed by acute onset of pain ii. Ottawa guidelines – When to order an x-ray?
- Inability to bear weight for 4 steps
- Bone tenderness at posterior edge or tip of either malleolus b. Plantar Fasciitis i. Inflammation of the plantar facia r/t biomechanical tension on the fascia ii. Heel pain worse after period of rest or early in morning, can have heel spurs c. Morton’s Neuroma i. Fibrous tissue thickening along digital nerves; most commonly between 3 rd^ and 4th^ intermetatarsal ii. Pain decreases with rest d. Stress fx i. Unbearable pain with exercise; obesity; jobs requiring standing for prolonged periods of time on hard surface e. Achilles Tendinitis i. Pain at insertions of tension at posterior aspect of heel; crepitus noted with chronic problems; hx of wearing poor fitting shoes or high heels, long distance running; not stretching prior to activity f. Calcaneal apophysitis i. Active pediatric patients; limp and heel pain worsened by jumping or running; palpation at posterior-plantar junction reveals pain; increased pain with stretching of heel cord g. Jones Fx i. Pain at base of 5th^ metatarsal after inversion injury; possible swelling h. Talar Dome Fx i. Hx of inversion and eversion ankle injury
- Pregnant Considerations a. Falls and tripping are common b. Pregnancy is hypervolemic and hyperdynamic state
