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Physical Examination Techniques
- Inspection
- Palpation
- Percussion
- Auscultation
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Inspection
The process of informed observation
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Palpation
Using your sense of touch to assess for injuries or abnormalities
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Percussion
The production of sound waves by striking one object against another
- Tympany-Drumlike, Stomach
- Hyperresonance- Booming, Hyperinflated lung
- Resonance- Hollow, Normal lung
- Dull- Thud, Solid organs
- Flat- Extremely dull, Muscle or atelectasis
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Auscultation
Listening with a stethoscope for sounds produced by the body
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Physical Examination Equipment
- Stethoscope- used to auscultate
- Sphygmomanometer- blood pressure cuff
- Opthalmoscope- used to see into the eye
- Otoscope- used to see into the ear and nose
- Scale- weight
- Tongue blades
- Penlight
- Visual acuity chart/card
- Reflex hammer
- Thermometer
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Manometer
Pressure gauge on BP cuff. Used to measure pressure in mmHg
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General Survey
- Appearance
- Vital signs
- Additional assessments
- -PulseOx
- -Capnography
- -Cardiac monitoring
- -Blood glucose
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Appearance
- Level of conciousness
- Signs of distress
- Apparent state of health
- Vital statistics- height, weight
- Sexual development
- Skin color and obvious lesions
- Posture, gait and motor
- Dress, grooming, hygiene
- Odors
- Facial expressions
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Vital Signs
- Pulse
- Respiration
- Blood pressure
- Body temp
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Pulse Rate
Number of pulses in one minute
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Pulse Rhythm
Pattern and equality of intervals between beats
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Pulse Quality
Strength, which can be weak, thready, strong or bounding
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Tachycardia
Higher than 100 bpm
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Normal Adult Vital Signs
- Pulse: 60-100
- Respirations: 12-20
- Systolic BP: Men: 100-135 Women: 90-135
- Body Temp: 98.6
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Respiration
Exchange of oxygen and carbon dioxide in the lungs and at the cellular level
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Repiratory Rate
Number of breaths in one minute
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Tachypnea
Rapid breathing
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Respiratory Effort
How hard the patient works to breath
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Quality of Respiration
Depth and pattern of breathing
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Breathing Patterns
- Eupnea- normal rate and pattern
- Tachypnea- fast breathing
- Bradypnea- slow breathing
- Apnea- no breathing
- Hyperpnea- deep breaths
- Cheyne-stokes- Gradual increases and decreases in respirations with periods of apnea
- Biot's- Rapid, deep gasps with short pauses between sets
- Kussmaul's- Tachypnea and hyperpnea
- Apneustic- Prolonged inspiratory phase with shortened expiratory phase
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Tidal Volume
Amounth of air one breath moves in and out of lungs
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Blood Pressure
Force of blood against artery walls as the heart contracts and relaxes
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Systolic BP
Force of blood against arteries when ventricles contract
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Diastolic BP
Force of blood on the arteries when ventricles relax
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Kortokoff Sounds
Sounds of blood hitting arterial walls
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Perfusion
Passage of blood through an organ or tissue
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Pulse Pressure
Difference between systolic and diastolic BPs
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Hypertension
BP higher than normal
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Hypotension
BP lower than normal
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Hyperthermia
Increase in body's core temperature
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Hypothermia
Decrease in body's core temperature
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Pulse Oximeter
Noninvasive device that measures the oxygen saturation of blood
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Capnography
Real-time measurement of exhaled carbon dioxide concentrations
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End-Tidal Carbon Dioxide (ETCO2) Detector
A device used in capnography to measure exhaled carbon dioxide concentrations
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Cardiac Monitor
Machine that displays and records electrical activity of the heart
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Glucometer
Tool used to measure blood glucose
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Anatomical Regions
- Skin
- Hair, eyes, ears, nose, mouth
- Neck
- Chest and lungs
- Abdomen
- Extremities
- Posterior body
- Peripheral vascular
- Neurologic
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Skin Characteristics to Assess
- Color
- Moisture
- Temperature
- Texture
- Mobility and turgor
- Lesions
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Turgor
Normal tension in the skin
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Lesion
Any disruption in normal tissue
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Vascular Skin Lesions
- Purpura- reddish purple blotches larger than 0.5 cm
- Petechiae- reddish purple spots less than 0.5 cm
- Ecchymoses- reddish purple blotch varying in size
- Spider Angioma- reddish legs radiate from red spot
- Venous Star- bluish legs radiate from blue center
- Capillary Hemangioma- Irregular red spots
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Primary Skin Lesions
- Macule- flat spot. color varies, white, brown, red, purple. less than 1 cm
- Patch- irregular flat macule. greater than 1 cm
- Papule- elevated firm spot. color varies. less than 1 cm
- Plaque- superficial papule. more than 1 cm. rough texture
- Wheal- pink irregular spot varying in shape and size
- Nodule- elevated firm spot. 1-2 cm
- Tumor- elevated solid. more than 2 cm. same color as skin
- Vesicle- elevated area less than 1 cm. contains serous fluid
- Bulla- vesicle with diameter more than 1 cm.
- Pustule- elevated area less than 1 cm. contains purulent fluid
- Cyst- elevated palpable area containing liquid or viscous matter
- Telangiectasia- red, threadlike line
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Secondary Skin Lesions
- Fissure- linear red crack ranging into dermis
- Erosion- depression in epidermis caused by tissue loss
- Ulcer- red or purple depression ranging into dermis caused by tissue loss
- Scar- fibrous. variable depth. color ranges from white to red
- Keloid- elevated scar, irregular in shape. larger than original wound
- Excoriation- linear. may be hollow or crusted. caused by loss of epidermis
- Scale- elevated area of excess exfoliation. varies in thickness, shape and dryness. white, silver or tan
- Crust- reddish, brown, black, tan or yellowish dried blood, serum or pus
- Lichenification- thickening and hardening of epidermis with lines
- Atrophy- skin surface thins and markings disappear
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Abnormal Nail Findings
- Clubbing- angle between proximal nail and plate is increased. indicates chronic hypoxia
- Paronychia- folds appear red or swollen. people who get their hands wet frequently
- Onycholysis- nail bed seperates from nail plate. many causes including hyperthyroidism
- Terry's Nails- mostly white nail with a and of reddish brown at the distal tip. liver cirrhosis, CHF, diabetes
- White Spots- trauma to the nails
- Transverse White Lines- may appear after severe illness. parallel to the finger
- Psoriasis- small pits in the nails
- Beau's lines- transverse depressions in the nail. associated with severe illness.
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Layers of the Scalp
SCALP
- Skin
- Connective tissue
- Aponeurosis
- Loose tissue
- Periosteum
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Temporomandibular Joint (TMJ)
Joint where the mandible connects to the skull
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Lip Abnormalities
- Dry, cracked- dehydration, wind damage
- Swlling/edema- infection, allergic reaction, burns
- Lesions, infection, irritation, skin cancer
- Pallor- anemia, shock
- Cyanosis- respiratory or cardiac insufficiency
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Vital Structures of the Neck
- Spinal cord
- Carotid arteries
- Jugular veins
- Larynx/trachea
- Esophagus
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Crackles (Rales)
light, crackling, popping, nonmusical sounds heard usually during inspiration. associated with fluid
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Wheezes
Continuous, high pitched musical sounds. Asthma, bronchospasm, small foreign bodies in the lower airway
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Rhonchi
Continuous sounds heard with a lower pitch and snoring quality. Secretions in larger airways. Bronchitis, penumonia. Usually in early exhalation but also sometimes in inhalation
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Stridor
Predominatly inspiratory wheeze/high pitched squeal. Laryngeal obstruction
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Pleural Friction Rub
Squeaking or grating sound
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Bronchophony
Abnormal clarity of patient's transmitted voice sounds while auscultating the chest. Can happen with fluid in the lungs.
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Whispered Pectoriloquy
Abnormal clarity of patient's transmitted whispers while auscultating
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Egophony
Abnormal change in patient's tone while auscultating
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