Volume 2 Chapter 2A

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amerelman
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Volume 2 Chapter 2A
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2010-05-09 16:01:18
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Volume 2 Chapter 2A
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  1. Physical Examination Techniques
    • Inspection
    • Palpation
    • Percussion
    • Auscultation
  2. Inspection
    The process of informed observation
  3. Palpation
    Using your sense of touch to assess for injuries or abnormalities
  4. 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
  5. Auscultation
    Listening with a stethoscope for sounds produced by the body
  6. 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
  7. Manometer
    Pressure gauge on BP cuff. Used to measure pressure in mmHg
  8. General Survey
    • Appearance
    • Vital signs
    • Additional assessments
    • -PulseOx
    • -Capnography
    • -Cardiac monitoring
    • -Blood glucose
  9. 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
  10. Vital Signs
    • Pulse
    • Respiration
    • Blood pressure
    • Body temp
  11. Pulse Rate
    Number of pulses in one minute
  12. Pulse Rhythm
    Pattern and equality of intervals between beats
  13. Pulse Quality
    Strength, which can be weak, thready, strong or bounding
  14. Bradycardia
    Below 60 bpm
  15. Tachycardia
    Higher than 100 bpm
  16. Normal Adult Vital Signs
    • Pulse: 60-100
    • Respirations: 12-20
    • Systolic BP: Men: 100-135 Women: 90-135
    • Body Temp: 98.6
  17. Respiration
    Exchange of oxygen and carbon dioxide in the lungs and at the cellular level
  18. Repiratory Rate
    Number of breaths in one minute
  19. Tachypnea
    Rapid breathing
  20. Bradypnea
    Slow breathing
  21. Respiratory Effort
    How hard the patient works to breath
  22. Quality of Respiration
    Depth and pattern of breathing
  23. 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
  24. Tidal Volume
    Amounth of air one breath moves in and out of lungs
  25. Blood Pressure
    Force of blood against artery walls as the heart contracts and relaxes
  26. Systolic BP
    Force of blood against arteries when ventricles contract
  27. Diastolic BP
    Force of blood on the arteries when ventricles relax
  28. Kortokoff Sounds
    Sounds of blood hitting arterial walls
  29. Perfusion
    Passage of blood through an organ or tissue
  30. Pulse Pressure
    Difference between systolic and diastolic BPs
  31. Hypertension
    BP higher than normal
  32. Hypotension
    BP lower than normal
  33. Hyperthermia
    Increase in body's core temperature
  34. Hypothermia
    Decrease in body's core temperature
  35. Pulse Oximeter
    Noninvasive device that measures the oxygen saturation of blood
  36. Capnography
    Real-time measurement of exhaled carbon dioxide concentrations
  37. End-Tidal Carbon Dioxide (ETCO2) Detector
    A device used in capnography to measure exhaled carbon dioxide concentrations
  38. Cardiac Monitor
    Machine that displays and records electrical activity of the heart
  39. Glucometer
    Tool used to measure blood glucose
  40. Anatomical Regions
    • Skin
    • Hair, eyes, ears, nose, mouth
    • Neck
    • Chest and lungs
    • Abdomen
    • Extremities
    • Posterior body
    • Peripheral vascular
    • Neurologic
  41. Skin Characteristics to Assess
    • Color
    • Moisture
    • Temperature
    • Texture
    • Mobility and turgor
    • Lesions
  42. Turgor
    Normal tension in the skin
  43. Lesion
    Any disruption in normal tissue
  44. 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
  45. 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
  46. 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
  47. 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.
  48. Layers of the Scalp
    SCALP

    • Skin
    • Connective tissue
    • Aponeurosis
    • Loose tissue
    • Periosteum
  49. Temporomandibular Joint (TMJ)
    Joint where the mandible connects to the skull
  50. 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
  51. Vital Structures of the Neck
    • Spinal cord
    • Carotid arteries
    • Jugular veins
    • Larynx/trachea
    • Esophagus
  52. Crackles (Rales)
    light, crackling, popping, nonmusical sounds heard usually during inspiration. associated with fluid
  53. Wheezes
    Continuous, high pitched musical sounds. Asthma, bronchospasm, small foreign bodies in the lower airway
  54. 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
  55. Stridor
    Predominatly inspiratory wheeze/high pitched squeal. Laryngeal obstruction
  56. Pleural Friction Rub
    Squeaking or grating sound
  57. Bronchophony
    Abnormal clarity of patient's transmitted voice sounds while auscultating the chest. Can happen with fluid in the lungs.
  58. Whispered Pectoriloquy
    Abnormal clarity of patient's transmitted whispers while auscultating
  59. Egophony
    Abnormal change in patient's tone while auscultating

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