What does physical examination help to gather?
What is the preferred position for musculoskeletal examination?
What is the preferred position to assess vital signs?
What is the preferred position for abdominal assessment?
What is essential for a comfortable examination environment?
What is the Fowler's position?
Head elevated 60°
What is the Semi-Fowler's position?
Head elevated 30°-45°
What is the purpose of Fowler's and Semi-Fowler's positions?
To assess the abdomen, breasts, extremities, and pulses.
What should you do if your client is SOB?
Raise the head of the bed.
What is the Dorsal Recumbent position?
Supine with knees flexed.
When is the Dorsal Recumbent position used?
For abdominal assessment if the client has abdominal or pelvic pain.
What is the Sims position?
Flexion of the hip and knees in a side-lying position.
What is the Prone position?
Lying on stomach.
What is the Lateral Recumbent position?
Lying on the side in a straight line.
When is the Lateral Recumbent position used?
To evaluate heart murmur during a cardiovascular assessment.
What does the general survey assess?
Overall impression of the patient
What demographic information is collected?
Name, address, birth date, gender, race, occupation
What past health history is relevant?
Previous hospitalizations, surgeries, diet, bowel patterns
What should family history include?
Health info of family members, age, disorders
What psychosocial history should be considered?
Relationships, living situation, psychological state
What is the focus of a general survey?
Overall impression of the patient and abnormalities that need further exploration.
What is a focused assessment?
It focuses on symptoms and only assesses involved body systems, especially in acutely ill patients.
What should be assessed in a focused general health assessment?
Special attention to the patient’s acute problem(s).
What is the difference between primary and secondary sources?
Primary source is the patient; secondary sources include family and doctors.
What should be assessed regarding skin during palpation?
What does percussion help determine?
Locations, size, and density of structures.
What does a 1 kg (2.2 lbs) weight gain/loss indicate?
It indicates a 1 liter fluid gain/loss.
What is important for patients with heart failure or dehydration?
Monitoring weight changes over a 24-hour period.
What causes pallor?
Anemia and shock; assessed in oral mucous membranes and conjunctiva.
What is peripheral arterial insufficiency?
Causes smooth, thin, shiny skin with little or no hair
What does venous insufficiency lead to?
Thick, rough skin, hyperpigmented
What causes dry skin?
Dehydration, chronic renal failure, hypothyroidism
What conditions commonly cause edema?
CHF, kidney disease, PVD, low albumin levels
What is clubbing in nails?
Angle > 180 degrees, indicating chronic lack of oxygen
What does myopia refer to?
Diminished distance vision
What is ptosis?
Drooping of the eyelid
What does pain in the outer ear indicate?
Possible otitis externa
What does tenderness behind the ear indicate?
Possible otitis media
What should be observed in the palate?
Color, shape, texture, defects
What indicates infection in the pharyngeal tissue?
Yellow or green exudate
What should be inspected in the neck?
Area where lymph nodes are distributed
What position should the patient be in for neck inspection?
Chin raised, head tilted slightly
What indicates possible enlarged lymph nodes?
Edema, erythema, red streaks
What are normal lymph nodes characteristics?
Less than 1cm, mobile, soft, nontender, not palpable
Where are occipital nodes located?
Base of skull
Where are postauricular nodes found?
Over the mastoid
Where are preauricular nodes located?
In front of the ear
Where are tonsillar nodes located?
Angle of the mandible
Where are submandibular nodes found?
Along the base of the mandible
Where are submental nodes located?
Midline under the chin
Where are anterior cervical nodes found?
Along the sternocleidomastoid muscle
Where are posterior cervical nodes located?
Posterior to the sternocleidomastoid muscle
Where are supraclavicular nodes found?
Above the clavicle
What should be observed in the neck for comparison?
Inspect and palpate both sides
What does tenderness in the neck indicate?
Inflammation
How should carotid arteries be assessed?
One side at a time
What technique is used to assess the thyroid gland?
Palpate with pads of fingers while patient swallows
What is a normal thyroid gland appearance?
Smooth, firm, nontender, often not palpable
How to assess neck muscles?
Have patient turn head side to side, flex, and hyperextend neck
What should be assessed in the thorax and lungs?
Anterior, posterior, and lateral aspects
What methods are used for lung assessment?
Inspection, percussion, auscultation
What anatomical landmark is through the center of the sternum?
Midsternal line
What anatomical landmark goes through the midpoint of the clavicle?
Midclavicular line
What is the anterior axillary line?
Through the anterior axillary folds
What is the midaxillary line?
Through the apex of the axillae
What is the posterior axillary line?
Through the posterior axillary fold
What lines run through the inferior angle of the scapula?
Right and left scapular lines
What line runs along the center of the spine?
Vertebral line
What is important for lung assessment?
Unclothed chest for accurate sound
What position is best for lung assessment?
Sitting position
What should be observed in chest wall symmetry?
Barrel-shaped, postural influences
What indicates hypoxia or respiratory distress?
Use of accessory muscles or retractions
What is assessed by palpating thumbs toward spine?
Symmetrical movement of thumbs
What should be checked for during palpation?
Tenderness, masses, crepitus
What is fremitus?
Vibration felt during speech or breathing
What can cause crepitus?
How to check for fremitus?
What indicates increased fremitus?
Gross changes in lung condition
What indicates decreased fremitus?
Lung problems like pneumothorax
How to auscultate lung sounds?
What position should the patient be in for lung auscultation?
Supine position, elevate HOB if needed
What is bronchophony?
Assess by having client say '1,2,3' while listening over lung sounds
What is egophony?
Patient says 'eee' and it's heard as 'ay' over lung sounds
What is whispered pectoriloquy?
Patient whispers '1,2,3' and it's heard clearly over lung fields
What are the normal breath sounds?
Where are vesicular sounds heard?
Over the lung periphery
Describe vesicular sounds.
Soft, breezy, low pitched; inspiratory 3X longer than expiratory
Where are bronchovesicular sounds heard?
1st and 2nd ICS anteriorly; over scapula posteriorly
Describe bronchial sounds.
Heard over trachea; loud, high pitched; expiratory longer than inspiratory
What are crackles?
Air bubbling through moisture in alveoli; soft, high pitched, brief
What do crackles indicate?
Pneumonia, heart failure, chronic lung disease
What are rhonchi?
Coarse, snoring, low-pitched sounds due to mucous in large airways
What do wheezes indicate?
Narrowing of small airways; common in asthma and bronchitis
What is the PMI?
Point of maximal impulse; apex of heart touches anterior chest wall
Where is the PMI located?
4th to 5th ICS at the left MCL
What to do if PMI is not located in supine position?
Have patient roll on left side
How does age affect heart position?
Older adults have deeper front to back; infants are more horizontal
What position should the patient be in for assessment?
Supine position or roll on left side
How does age affect anatomical positions?
Older adults: deeper front to back Infants: heart more horizontal, by age 7 PMI same as adults Muscular/overweight: heart lies left and horizontally
What are the phases of the cardiac cycle?
Systole: ventricles contract, eject blood Diastole: ventricles relax, atria contract
What occurs during systole?
Ventricles contract and eject blood into: - Aorta (left ventricle) - Pulmonary artery (right ventricle)
What heart sound is associated with systole?
S1/Lub: occurs when mitral and tricuspid valves close
What occurs during diastole?
Ventricles relax, atria contract, fill ventricles and coronary arteries
What heart sound is associated with diastole?
S2/Dub: occurs when mitral and pulmonic valves close
What is S3 heart sound?
Occurs when heart fills an already distended ventricle, abnormal in adults >31, normal in children and pregnant women
What is S4 heart sound?
Occurs when atria contract to enhance ventricular filling, can be normal in healthy older adults, children, and athletes
What is the starting position for inspection and palpation?
Patient in supine position or elevated at 45 degrees
What should be assessed during inspection and palpation?
Look for visible pulsations, exaggerated lifts, palpate for apical pulse, assess for thrills
What is the systematic approach for auscultation?
Listen for a complete cycle at each location: - Aortic valve: 2nd ICS right sternal border - Pulmonic valve: 2nd ICS left sternal border - Tricuspid valve: 4th ICS left sternal border - Mitral valve: 5th ICS MCL - ERB's point: 3rd ICS left sternal border
What is dysrhythmia?
Failure of the heart to beat at regular successive intervals
What is a ventricular gallop?
Occurs after S2 due to a rush of blood into a stiff or dilated ventricle
What is a heart murmur?
Sustained swishing or blowing sounds, can be asymptomatic or indicate heart disease
What is a thrill in cardiac assessment?
Continuous palpable sensation, sounds like a purring cat
Where is the radial pulse located?
Thumb side of the wrist
Where is the ulnar pulse located?
Little finger side of the wrist
Where is the brachial pulse located?
Inside of elbow
Where is the femoral artery assessed?
Requires deep palpation in the groin area
Where is the popliteal artery located?
Behind the knee
Where is the posterior tibial artery located?
Inner side of each ankle
Where is the dorsalis pedis artery located?
Top of foot between great toe and first toe
What should be assessed during blood pressure measurement?
Measure blood pressure, assess peripheral vascular system, check skin for signs of arterial and venous insufficiency
What is a bruit?
Blowing sound due to narrowing in a vessel, assessed using the bell of the stethoscope over carotid artery
What precautions should be taken with carotid arteries?
Do not palpate or massage vigorously or simultaneously, can cause syncope or circulatory arrest
What is the normal variation in blood pressure readings?
Readings may vary by 10 mm Hg, tend to be higher in right arm
What should be done if systolic readings differ by 15 mm Hg?
Repeat the measurement
What do the jugular veins do?
Return blood from the brain to the superior vena cava
Which jugular vein is best to examine?
Right internal jugular vein
What does elevated JVP indicate?
CHF or constricted flow into the right side of the heart
What does low JVP indicate?
Hypovolemia
What indicates an absent pulse wave?
Arterial occlusion or stenosis
How to assess peripheral arteries?
Using the distal pads of second and third fingers
How to assess the radial pulse?
Count for 30 seconds or a full minute if irregular
What are the grades for pulses?
0 = absent 1 = diminished 2 = expected 3 = full 4 = bounding
What does tissue perfusion assess?
Skin, mucosa, and nail beds
What are the 5 Ps to assess?
What indicates venous insufficiency?
Dependent edema
What should be inspected in peripheral veins?
Varicosities, peripheral edema, and phlebitis
What is the normal range for bowel sounds?
5-35 times per minute
What does hyperactive bowel sound indicate?
Borborygmi, or loud 'growling' sounds
What is the first step in abdominal assessment?
Inspection of the abdomen
What should be noted during abdominal inspection?
Symmetry, masses, or pulsations
What does a shiny and taut abdomen indicate?
Ascites
What is assessed during abdominal auscultation?
Peristalsis and vascular bruits
What should be done before palpation?
Perform inspection and auscultation first
What should you listen for during auscultation?
What should be done with suction devices during assessment?
Always turn off any suction devices (from NG tubes or drains)
What is the sequence of abdominal assessment?
What does palpation detect?
When should painful areas be palpated?
Palpate painful areas last
What questions should be asked regarding bowel movements?
What should be assessed in urination?
What should be assessed in the musculoskeletal system?
What does osteoporosis include?
What are the types of spinal curvature?
What are signs of muscle tone issues?
What does the Romberg test assess?
Balance
What does 'Alert & oriented X3' mean?
Patient is oriented to person, place, and time
What scale is used to evaluate neurological status?
Glasgow Coma Scale (GCS)
What is assessed in language function?
What is aphasia?
Omission or addition of words due to cerebral cortex injury
What is assessed in intellectual function?
What does stereognosis assess?
Identifying a familiar object in the hand with eyes closed
What should be noted during musculoskeletal palpation?
What is normal muscle tone?
Muscles should be firm
What should be assessed for range of motion?
Any limited range of motion should be noted
What is stereognosis?
Identifying a familiar object in the hand with eyes closed.
What are the 12 cranial nerves used for?
Assessing sensory and motor functions.
Where is the cranial nerve assessment used?
In the recovery room area after a spinal block.
What does sensory function assessment include?
Responses to pain, temperature, light touch, vibration, position, and two-point discrimination.
What is assessed in motor function?
Dysfunction, use of aids like cane or walker.
What is the Romberg Test?
Test for balance; feet together, arms at side, eyes closed.
What indicates a positive Romberg Test?
Client falls to the side.
How are reflexes graded?
From 1+ to 4+.
What does the assessment of female genitalia include?
Internal and external organs, cultural sensitivity, and changes across lifespan.
What should be discussed during a female examination?
Menarche onset, period problems, STDs, PAP exams, birth control, and STD protection.
What is important to ensure during the examination?
Proper positioning, environmental control, and good lighting.
What should be communicated to the patient before examination?
Tell the patient what you are about to do.
What is assessed in male genitalia?
Integrity of external genitalia, inguinal ring, and canal.
What should be discussed during a male examination?
STDs, condom use, sexual history, and self-testicular exam.
What is emphasized for colon health?
Need for self-screening habits and colonoscopy after age 50.
What should be done after the assessment?
Record findings, give time to dress, consult if serious findings.
What should be communicated after the assessment?
Significant findings should be communicated.
What is the first step in patient examination?
Forming the patient.
What should be done with the examination area?
Delegate cleaning of examination area.
What should be recorded during the assessment?
Complete assessment; review for accuracy and thoroughness.
What technique is used for chest percussion?
Indirect chest percussion.
What is the nail plate?
The hard part of the nail.
What does the term 'Eponychium' refer to?
The cuticle area at the base of the nail.
What is the role of Paronychium?
The skin around the nail.
What are the types of lymph nodes mentioned?
What are the cervical chain nodes?
What are the regions of the abdomen?
What organs are found in the upper right quadrant?
What is located in the upper left quadrant?
What does the term 'Sigmoid colon' refer to?
The part of the colon closest to the rectum.
What is the significance of the term 'pulmonic'?
Related to the lungs.
What does 'tricuspid' refer to?
A heart valve located between the right atrium and ventricle.
What is the function of the mitral valve?
Regulates blood flow from the left atrium to the left ventricle.
What does physical examination help to gather?
What is the preferred position for musculoskeletal examination?
What is the purpose of Fowler's and Semi-Fowler's positions?
To assess the abdomen, breasts, extremities, and pulses.
When is the Dorsal Recumbent position used?
For abdominal assessment if the client has abdominal or pelvic pain.
When is the Lateral Recumbent position used?
To evaluate heart murmur during a cardiovascular assessment.
What psychosocial history should be considered?
Relationships, living situation, psychological state
What is the focus of a general survey?
Overall impression of the patient and abnormalities that need further exploration.
What is a focused assessment?
It focuses on symptoms and only assesses involved body systems, especially in acutely ill patients.
What should be assessed in a focused general health assessment?
Special attention to the patient’s acute problem(s).
What is the difference between primary and secondary sources?
Primary source is the patient; secondary sources include family and doctors.
What should be assessed regarding skin during palpation?
What is important for patients with heart failure or dehydration?
Monitoring weight changes over a 24-hour period.
What technique is used to assess the thyroid gland?
Palpate with pads of fingers while patient swallows
How to check for fremitus?
How to auscultate lung sounds?
What position should the patient be in for lung auscultation?
Supine position, elevate HOB if needed
Describe bronchial sounds.
Heard over trachea; loud, high pitched; expiratory longer than inspiratory
How does age affect heart position?
Older adults have deeper front to back; infants are more horizontal
How does age affect anatomical positions?
Older adults: deeper front to back Infants: heart more horizontal, by age 7 PMI same as adults Muscular/overweight: heart lies left and horizontally
What are the phases of the cardiac cycle?
Systole: ventricles contract, eject blood Diastole: ventricles relax, atria contract
What occurs during systole?
Ventricles contract and eject blood into: - Aorta (left ventricle) - Pulmonary artery (right ventricle)
What occurs during diastole?
Ventricles relax, atria contract, fill ventricles and coronary arteries
What is S3 heart sound?
Occurs when heart fills an already distended ventricle, abnormal in adults >31, normal in children and pregnant women
What is S4 heart sound?
Occurs when atria contract to enhance ventricular filling, can be normal in healthy older adults, children, and athletes
What is the starting position for inspection and palpation?
Patient in supine position or elevated at 45 degrees
What should be assessed during inspection and palpation?
Look for visible pulsations, exaggerated lifts, palpate for apical pulse, assess for thrills
What is the systematic approach for auscultation?
Listen for a complete cycle at each location: - Aortic valve: 2nd ICS right sternal border - Pulmonic valve: 2nd ICS left sternal border - Tricuspid valve: 4th ICS left sternal border - Mitral valve: 5th ICS MCL - ERB's point: 3rd ICS left sternal border
What is a ventricular gallop?
Occurs after S2 due to a rush of blood into a stiff or dilated ventricle
What is a heart murmur?
Sustained swishing or blowing sounds, can be asymptomatic or indicate heart disease
What should be assessed during blood pressure measurement?
Measure blood pressure, assess peripheral vascular system, check skin for signs of arterial and venous insufficiency
What is a bruit?
Blowing sound due to narrowing in a vessel, assessed using the bell of the stethoscope over carotid artery
What precautions should be taken with carotid arteries?
Do not palpate or massage vigorously or simultaneously, can cause syncope or circulatory arrest
What is the normal variation in blood pressure readings?
Readings may vary by 10 mm Hg, tend to be higher in right arm
What should be done with suction devices during assessment?
Always turn off any suction devices (from NG tubes or drains)
What questions should be asked regarding bowel movements?
What should be assessed in the musculoskeletal system?
What are the types of spinal curvature?
What are signs of muscle tone issues?
What does sensory function assessment include?
Responses to pain, temperature, light touch, vibration, position, and two-point discrimination.
What does the assessment of female genitalia include?
Internal and external organs, cultural sensitivity, and changes across lifespan.
What should be discussed during a female examination?
Menarche onset, period problems, STDs, PAP exams, birth control, and STD protection.
What is important to ensure during the examination?
Proper positioning, environmental control, and good lighting.
What should be communicated to the patient before examination?
Tell the patient what you are about to do.
What should be discussed during a male examination?
STDs, condom use, sexual history, and self-testicular exam.
What should be done after the assessment?
Record findings, give time to dress, consult if serious findings.
What should be recorded during the assessment?
Complete assessment; review for accuracy and thoroughness.
What are the types of lymph nodes mentioned?
What are the regions of the abdomen?
What is the function of the mitral valve?
Regulates blood flow from the left atrium to the left ventricle.
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