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Four basic components of the physical examination
- GENERAL APPEARANCE
- Pulse rate
- respiratory rate
- blood pressure
- PALPATION FINDINGS
lungs: inspection, palpation, percussion, auscultation findings
heart: inspection, palpation, and auscultation findings
inspection, palpation, percussion, and auscultation findings
inspection and auscultation findings
- most often seen in neonates and young children with respiratory distress
- indicates that an increase in the work of breathing is present
- may be seen in conditions such as upper airway obstruction, bronchiolitis, pneumonia, rds
- strong evidence that tissue oxygenation may be less than optimal; ABG may be needed
- absence does not indicate that tissue oxygenation is adequate because a sufficent hemoglobin concentration must exist before cyanosis can take place
- pts may used pursed lipped breathing during exhalation
- this provides a slight backpressure in the airways during exhalation
- prevents premature collapse
- common in pts under acute stress or who are having severe pain
- exercise, eating spicy foods, fever, menopause
- common in pts experiencing myocardial infarction
- take serious esp in pts prone to heart disease
- pupils equal
- reactive to light and accomodation
brain death, catecholamines, and atropine can cause the pupils to become dialated and fixed
common medication used during cariopulmonary resuscitation, and its administration minimizes the use of assessing pupillary reflexes as a measure of the pts neurological status.
parasympathetic stimulants and opiates can cause pinpoint pupils
- drooping of the upper lid
- may be an early sign of disease involving the third cranial nerve
- congenital defects, cranial tumors, and neuromuscular diseases, such as myasthenia may cause ptosis.
- may be an early sign of respiratory failure
- trachea may be shifted from midline with unilateral upper lobe collapse (atelectasis), pneumothorax, pleural effusion, or lung tumor.
- trachea shifts toward the collapsed lung but away from the pneumothorax, pleural effusion or lung tumor.
- most common cause of JVPD is right-sided heart failure.
- may occur secondary to left-sided heart failure or chronic hypoxemia
- hypoxemia initiates pulmonary vasoconstriction and increases the resistance to blood flow through the pulmonary vasculature, increasing hte workload of the right ventricle
- contraction of the sternomastoid muscle in the neck is an indication that the patient's work of breathing is increased
- common finding in pts with airway obstruction
- enlarged lymph nodes
- common finding in patients with respiratory infections, and the lymph nodes usually are tender to palpation in this situation
- non tender lymphadenopathy may be caused by malignancy or HIV
- palpated to evaluate the strength of the left ventricular contraction and the condition of the Ao valve
- heart disease causes the carotid pulse to become weark
- stenosis of the Ao valve also causes a weak carotid pulse along with a systolic murmer
WATER HAMMER PULSE
- An in compentent Ao valve that causes regurg of blood back into the LV
- results in a pulse that rises sharply and has a narrow summit and then a
- sudden descent.