PHAS 7050 Exam 1

history

is used to direct the PE, done in clothes to make the patient more comfortable

wash/sanitize

should be done immediately before examining the patient

draping, bed positioning

completed to ensure privacy and comfort

invasive parts of exam

only completed after obtaining permission (from adult patients)

right side

approach to patient, conserves movement and increases efficiency

JVP, apical impulse

more reliable or comfortable on right side

inspection, palpation, percussion, auscultation

order in which examinations are most often performed and documented

inspection

process of observation, begins when patient is first seen and continues throughout the exam, relies on multiple senses (eyes and nose)

palpation

use of hands or fingers to gather information through sense of touch

palmar surface

used to elicit tenderness or delineate a mass

dorsal surface

used to detect temperature

ulnar surface

detecting vibration

percussion

allows assessment of density of underlying structures (particularly in lungs and abdomen)

dominant hand

used for "hammer" function of percussion

non-dominant hand

used as the "drum" when percussing

tympanitic/hyperresonant

indicates gastric air bubble

resonant

healthy lung sound

dull

solid organ sound (liver)

flat

muscle/bone sound

auscultation

listening for sounds produced by the body (intensity, duration, pitch, quality)

stethoscope

used to auscultate, hear a sound and its characteristics

bell

used to hear low pitched sounds (bruits)

diaphragm

used for high pitched sounds (bowel sounds)

gloves

worn when there is contact with blood or body fluids, mucous membranes, or non-intact skin, or in special circumstances (infectious diseases)

masks, gowns, eyewear, face shields

worn for procedures that are likely to generate droplets and/or splash of blood/body fluids

3 seconds

clean stethoscope or other equipment with CaviWipes for a minimum of?

level of consciousness, apparent state of health, signs of distress, skin color, stature, body habitus, posture, gait, motor activity, hygiene, dress, and grooming, odors, speech, facial expression, pathologic facies

general impression of patient with survey involves

awake, alert, responsive

level of consciousness

acutely/chronically ill, frail, healthy, fit, robust

apparent state of health

pain, anxiety, respiratory distress

signs of distress

pallor, cyanosis, jaundice

skin color

tall, short, disproportional

stature

slim, athletic, overweight; weight generalized or centralized

body habitus

Cushing's Disease

centralized weight

Turner Syndrome

Marfan Syndrome

CHF

may prefer sitting up/lying upright for ease of breathing

COPD

lean forward

thyroid disorders

may lead to hyperactivity/fast movements

depression

may contribute to lack of interest in appearance

DKA

may lead to fruity smelling breath

temperature, pulse (rate/rhythm), RR, height and weight, pulse Ox, BP

vital signs

98.6

normal body temperature

96.4-99.1

normal temperature range; has diurnal variation

oral, rectal, axillary, tympanic

routes for taking temperature

febrile, pyrexia

temperature greater than/equal to 100.4

afebrile

without fever

hyperpyrexia

greater than or equal to 106

hypothermia

less than 95

pulse rate

number of cardiac cycles/minute

60-100

normal adult pulse rate

bradycardia

slow heart rate (less than 60 bpm)

tachycardia

fast heart rate (>100 bpm)

rhythm

is either regular or irregular

apical pulse

pulse taken with a stethoscope and near the apex of the heart; taken with irregular rhythm for a full minute

radial pulse

the pulse felt at the wrist, using index and middle finger (not thumb)

respiratory rate

number of respirations/minute

12-20

normal respiratory rate

tachypnea

rapid breathing (>20)

bradypnea

slow breathing (<12)

no smoking, alcohol, caffeine, or exercise (30 minutes), empty bladder, quiet, warm, no talking, reading, texting (5 minutes), seated comfortably with feet flat on floor and back supported, arm supported at heart level and free of clothing

proper BP preparation

A/V fistula, scar from brachial artery cutdown, lymphedema

if present, avoid arm

80% of arm circumfrence

bladder length proper size

40% of arm circumfrence

bladder width proper size

false increase in BP

small BP cuff

false decrease in BP

large BP cuff

brachial artery

should align with the midline of bladder, bell/diaphragm placed over

2-3 cm

proper distance between the edge of the cuff and the antecubital fossa

systolic BP

estimated by palpating the radial artery and inflating the cuff until the pulse disappears

30 above estimation

the cuff should be inflated to what pressure?

2-3 mmHg/sec

how quickly should you release air from the BP cuff?

systolic pressure

detected when sounds first appear

diastolic pressure

detected when sounds disappear

even

BP should be reported as an (even/odd) number

2 readings, 2 minutes apart

if seeing a patient for the first time, how should you complete a BP reading?

additional readings obtained

taken if there is a difference greater than 5mmHg between arms

higher arm

should be used for future readings

orthostatic hypotension

low blood pressure that occurs upon standing up

3-10 minutes

patient rests supine for how long before taking BP/pulse?

systolic decrease greater than 20, diastolic decrease greater than 10

increase in pulse greater than 30 bpm

symptoms of lightheadedness

positive findings for orthostatic hypotension

BMI

measurement tool that compares height to weight

weight in lb /height in inches squared x 703

BMI calculation

less than 18.5

underweight BMI

18.5-24.9

normal BMI

25-29.9

overweight BMI

greater than 30

obese BMI

greater than 35

obese BMI (class II)

greater than 40

obese BMI (class III)

waist circumference

used to estimate abdominal subcutaneous and visceral fat; increase tied to type 2 DM, high blood cholesterol, high BP, heart disease

>102 cm (40 inches)

high waist circumference in men

>88 cm (35 inches)

high waist circumference in women

color, moisture, temperature, texture, mobility and turgor, lesions

components of skin examination; should be inspected/palpated

diaphoretic

characterized by profuse sweating.

color

indicator of overall health, linked to oxygenation, tissue perfusion, nutritional status, and injury; jaundice, pallor, cyanosis

jaundice

yellowing of the skin; tied to liver function

pallor

paleness; could potentially indicate anemia

cyanosis

bluish discoloration of the skin; tied to CV or pulmonary issues

melanin

contributes to brown coloring of skin

carotene

contributes to yellow color of skin

oxygenated Hb

contributes to red coloring of skin