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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
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
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
For palpation of the abdomen how is it examined?
Auscultation first then palpation
When are tender areas palpated?
What is considered light palpation?
Depressing about 1cm or 1/2 inch
What is bimanual palpation?
- Using two hands
- upper hand applies pressure down and the lower hand feels for findings
What part of the hand should be used to determine internal findings? Why?
The palm and fingers because they are most sensitive to vibrations
Why should a vital artery never be palpated?
Because it could cause blood obstruction
What is the purpose of percussion?
- Sound determines density of underlying tissues
- Depends on the location and size of organ
- Helps verify abnormalities
What is the bell primarily used for?
- low pitched sounds
- vascular or cardiac
What is the diaphragm used for?
- high pitched sounds
- lung or bowel sounds
What 4 types of sounds can be heard?
pitch, intensity, quality, and duration
What is pitch?
- how freq sounds waves are generated per second
- high freq=high pitch
- amplitude of sounds wave
- soft or loud (when describing)
Quality when auscultating
blowing or gurgling
Duration when auscultating
- short, medium, or long
- layers of soft tissue dampen duration of sounds from deep internal organs
Which scale need to be calibrated regularly?
What length/weight should an infant be recorded?
to the nearest 0.5 cm or 1/4 in
In older adults how does pigmentation change?
What is disphoresis?
What causes increase of vascularity in face?
What drug usage causes red, dry skin
How can a stage I ulcer be IDed?
noting warmth and erythema on skin
What can petechiae indicate
liver disease, allergic reaction to meds, clotting problems
What is alopecia
How is a normal nail?
What is a clubbing nail? Cause?
- 180 degree
- chronic lack of oxygen = heart/lung disease
What are Beau's lines?
- depressions indicating temp disturbance
- severe infection or nail injury
What is Koilonychia (spoon nail)?
- concave nail
- iron deficiency, syphilis, strong soap
What are splinter hemorrhages?
- red/brown nail streaks
- bacterial endocarditis, trichinosis
What are paronychia nails?
- inflammation of the base of the nail
- infection, trauma
What does head tilting indicate?
hearing or vision loss
What is exophthalmos and what does it indicate?
- bulging eyes
What is strabismus and what does it indicate
- crossed eyes
- neuromuscular injury/inherited abnormalities
What is ptosis
- eyelid drooping over the eye
- caused by edema or the III CN
What is an arcus senilis?
- a thin white ring along the margin of iris
- common in aging over 40
What is the normal pupil size range?
Continuous pupil dilation indicates what?
neuro abnormalities, opiate withdraw, glaucoma, trauma, eye meds
Pinpoint pupils indicates what?
What else can alter pupil reaction?
- intracranial pressure
- locally applied ophthalmic meds
- lesions along nerves
What is PERRLA
pupils equal, round, reactive to light and accommodation
How far should the speculum be inserted into the ear?
What does a normal ear drum look like?
shiny, gray, translucent, taught
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
What are the adventitious breath sounds
crackles, rhonchi, wheezing, and pleural friction rub
Where are crackles heard?
- dependent lobes
- right and left lung bases
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)
What are the causes of crackles?
random/sudden reinflation of alveoli
Where are rhonchi heard?
What are characteristics of rhonchi (sonorous wheeze)?
- loud, low pitched rumbling (during inhal/exhal)
- cleared by coughing
What are the causes of rhonchi?
muscular spasms or fluid in larger airways
Where are wheezes heard?
all over lung fields
What are the characteristics of wheezing?
- high pitched, continuous, musical
- during both but louder during exhalation
Where are pleural friction rubs heard?
over anterior lateral lung fields
What are the causes of pleural friction rubs?
- inflamed pleura
- parietal pleura rubbing against visceral pleura
What are the characteristics of pleural friction rubs?
- dry, grating during inhalation
- not cleared with coughing
What is the best position for abdomen assessment?