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5 reasons for physical exam?
- gather basline info of pts health status
- supplement, confirm, refute info during H/P
- ID or confirm nursing Dx
- make clinical judgements of pts health status
- evaluate outcome of care
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When meeting a pt for the first time it is important to get a baseline assessment to allow to refer back to what?
pattern of findings ID when the pt was first assessed
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What are the 5 skills of an assessment?
- Inspection-using eyes to view findings
- Palpation-using hands to touch body parts
- Percussion-tapping body w/ fingertips to produce vibrations
- Auscultation-sounds produced by body
- Olfaction -smelling to find abnormalities
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For palpation of the abdomen how is it examined?
Auscultation first then palpation
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When are tender areas palpated?
Last
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What is considered light palpation?
Depressing about 1cm or 1/2 inch
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What is bimanual palpation?
- Using two hands
- upper hand applies pressure down and the lower hand feels for findings
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What part of the hand should be used to determine internal findings? Why?
The palm and fingers because they are most sensitive to vibrations
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Why should a vital artery never be palpated?
Because it could cause blood obstruction
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What is the purpose of percussion?
- Sound determines density of underlying tissues
- Depends on the location and size of organ
- Helps verify abnormalities
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What is the bell primarily used for?
- low pitched sounds
- vascular or cardiac
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What is the diaphragm used for?
- high pitched sounds
- lung or bowel sounds
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What 4 types of sounds can be heard?
pitch, intensity, quality, and duration
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What is pitch?
- how freq sounds waves are generated per second
- high freq=high pitch
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Intensity
- amplitude of sounds wave
- soft or loud (when describing)
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Quality when auscultating
blowing or gurgling
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Duration when auscultating
- short, medium, or long
- layers of soft tissue dampen duration of sounds from deep internal organs
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Which scale need to be calibrated regularly?
mechanical scales
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What length/weight should an infant be recorded?
to the nearest 0.5 cm or 1/4 in
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In older adults how does pigmentation change?
increases unevenly
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What is disphoresis?
sedative-hypontic (alcohol)
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What causes increase of vascularity in face?
alcohol
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What drug usage causes red, dry skin
PCP phencyclidine
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How can a stage I ulcer be IDed?
noting warmth and erythema on skin
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What can petechiae indicate
liver disease, allergic reaction to meds, clotting problems
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What is alopecia
hair loss
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How is a normal nail?
160 degree
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What is a clubbing nail? Cause?
- 180 degree
- chronic lack of oxygen = heart/lung disease
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What are Beau's lines?
- depressions indicating temp disturbance
- severe infection or nail injury
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What is Koilonychia (spoon nail)?
- concave nail
- iron deficiency, syphilis, strong soap
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What are splinter hemorrhages?
- red/brown nail streaks
- bacterial endocarditis, trichinosis
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What are paronychia nails?
- inflammation of the base of the nail
- infection, trauma
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What does head tilting indicate?
hearing or vision loss
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What is exophthalmos and what does it indicate?
- bulging eyes
- hyperthyroidism
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What is strabismus and what does it indicate
- crossed eyes
- neuromuscular injury/inherited abnormalities
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What is ptosis
- eyelid drooping over the eye
- caused by edema or the III CN
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What is an arcus senilis?
- a thin white ring along the margin of iris
- common in aging over 40
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What is the normal pupil size range?
3-7 mm
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Continuous pupil dilation indicates what?
neuro abnormalities, opiate withdraw, glaucoma, trauma, eye meds
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Pinpoint pupils indicates what?
opiate intoxication
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What else can alter pupil reaction?
- intracranial pressure
- locally applied ophthalmic meds
- lesions along nerves
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What is PERRLA
pupils equal, round, reactive to light and accommodation
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How far should the speculum be inserted into the ear?
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What does a normal ear drum look like?
shiny, gray, translucent, taught
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What are the 3 types of hearing loss
- conduction-interrupts sound waves form outer to inner
- sensorineural-inner ear, aud nerve, and hearing center of the brain
- mixed-combo of both
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What are the adventitious breath sounds
crackles, rhonchi, wheezing, and pleural friction rub
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Where are crackles heard?
- dependent lobes
- right and left lung bases
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What are the types and characteristics of crackles?
- fine-high pitched fine,short (end of inspiration)
- moist-lower,moist (middle of inspiration)
- coarse-loud, bubbly (during inspiration)
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What are the causes of crackles?
random/sudden reinflation of alveoli
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Where are rhonchi heard?
over trachea/bronchi
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What are characteristics of rhonchi (sonorous wheeze)?
- loud, low pitched rumbling (during inhal/exhal)
- cleared by coughing
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What are the causes of rhonchi?
muscular spasms or fluid in larger airways
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Where are wheezes heard?
all over lung fields
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What are the characteristics of wheezing?
- high pitched, continuous, musical
- during both but louder during exhalation
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Where are pleural friction rubs heard?
over anterior lateral lung fields
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What are the causes of pleural friction rubs?
- inflamed pleura
- parietal pleura rubbing against visceral pleura
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What are the characteristics of pleural friction rubs?
- dry, grating during inhalation
- not cleared with coughing
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What is the best position for abdomen assessment?
dorsal recumbent
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