27.1 | Physical Exam Techniques + The General Survey

inspection

process of informed observation

palpation

using your sense of touch to gather information

percussion

production of sound waves by striking one object against another

auscultation

listening for sounds produced by the body, primarily the lungs, heart, intestines, and major blood vessels

anxiety

a tense posture, restlessness, and fidgeting suggests…

agitation, depression

crying, hand-wringing, and pacing suggest…

depression

hopeless, slumped posture, and slowed movements suggests …

mania

singing, dancing, and expansive movements suggests …

dysphonia

voice changes caused by vocal cord problems

aphasia

defective language caused by neurologic damage to the brain

metabolic or structural issue

disorientation to person suggests …

anxiety, depression, organic brain syndrome

disorientation to time suggests …

psychiatric disorder, organic brain syndrome

disorientation to place suggests …

immediate memory

asking the patient to repeat three or four words that have no correlation tests …

recent memory

asking the pt what they had for lunch or to repeat something you told them earlier tests …

remote memory

asking the pt about facts such as their spouse's name, their child's birthday, or their SSN tests …

amnesia, anxiety, or organic causes

long-term and short-term memory problems can be due to …

vital statistics

weight and height

Broselow tape

can be used to measure an infant patient's length

lips, oral mucosa

central cyanosis is seen in the …

nail beds, hands

peripheral cyanosis is seen in the …

jaundice, high carotene levels

a yellow skin color suggests …

tripod position

sitting straight up and forward, bracing their arms

serious breathing problem

tripod positioning suggests …

stroke

one side of the body dropping and seeming immobile suggests a…

dehydration, incontinence, UTI

a urine or ammonia smell suggests …

diabetic ketoacidosis

fruity breath suggests …

cyanide poisoning

bitter almonds on breath suggests …

throat infection, dental problems, poor hygiene

bad breath suggests …

infection, poor hygiene

body odor suggests …

infection

fishy vaginal odor suggests …

bowel obstruction

fecal breath suggests …

hyperthyroidism

the patient w/ … can stare intently

Parkinson’s syndrome

the face of a … pt can appear immobile

SBP increase, widening pulse pressure, falling pulse rate

signs of increasing ICP

shock

falling blood pressure w/ increasing pulse rate can indicate …

respiration

because O2 and CO2 exchange are essential to sustain life, … must occur continuously and be effective

respiratory rate

number of times a person breathes in 1 minute

tachypnea

rapid breathing

hypoxia, shock, head injury, or anxiety

tachypnea can be the result of …

bradypnea

slow breathing

drug overdose, severe hypoxia, CNS insult

bradypnea can be caused by

rapid intervention

very rapid or very slow breathing require … to ensure that the adequate exchange of gases continues

change in respiratory rate

a … is often the first physical exam finding observed w/ an emergency condition

respiratory effort

how hard the pt is working to breath

using respiratory muscles to increase chest's inner diameter

normal inhalation involves …

active process

inhalation is an …

negative pressure

the increasing space creates … that draws air into the lungs

passive

exhalation is the … process of the respiratory muscles’ elastic recoil

inhalation

an airway obstruction can compromise …

accessory muscle use, retractions, abnormal breath sounds

increased breathing effort is evident in …

asthma, emphysema

diseases in which the smaller airways collapse and trap air in the distal airways

decrease in chest wall expansion

rib fractures cause a … due to pain upon breathing

pneumothorax

a … decreases effective gas exchange because the air enters the pleural space instead of the alveoli

quality of respiration

respiration death and pattern

tidal volume

amount of air the patient moves in and out of the lungs in one breath

500 mL

normal tidal volume for an adult

eupnea

normal breathing rate and pattern

fever, anxiety, exercise, shock

causes of tachypnea

sleep, drugs, metabolic disorder, head injury, stroke

causes of bradypnea

apnea

absence of breathing

death, head injury, stroke

causes of apnea

hyperpnea

deep respirations

stress, DKA

causes of hyperpnea

Cheyne-Stokes

gradual increases and decreases in respirations with periods of apnea

increasing ICP, brainstem injury

causes of Cheyne-Stokes

spinal meningitis, CNS issue, head injury

rapid, deep respirations with short pauses between sets, caused by …

Kussmaul's

tachypnea and hyperpnea

renal failure, metabolic acidosis, DKA

cause of Kussmaul's

pulse wave

results from the heart ejecting blood through the arteries

cardiac contraction

each pulse beat corresponds to a …

ejected blood's impact on the arterial walls

a pulse results from …

hemodynamic status

pulse rate, rhythm, and quality indicate a pt's …

pulse rate

the number of pulsations felt in 1 minute

pulse rhythm

pulse's pattern and equality of intervals between beats

regular, regularly irregular, irregularly irregular, grossly chaotic

a pulse rhythm can be …

extra beats, skipped beats, pacemaker problems

causes of irregular pulse rates

pulse quality

pulse's strength

bounding pulse

strong, brisk pulse

thready pulse

weak, easily obliterated pulse

bradycardia

a HR below 60

tachycardia

a HR above 100

increase in PNS simulation, head injury, hypothermia, severe hypoxia, drug overdose

bradycardia causes

athletes

bradycardia is a common finding in …

it compromises cardiac output and circulatory status

only treat bradycardia if…

SNS stimulation, compensation (for blood loss, fear, pain, fever, drug overdose, or hypoxia)

tachycardia causes

shock

tachycardia is an early indicator of …

ventricular tachycardia

tachycardia can indicate …, a life-threatening cardiac arrhythmia

decreased circulatory status (e.g., shock)

a weak, thready pulse suggests …

hypertension, heat stroke, increasing ICP

strong, bounding pulses can suggest …

60 mmHg

presence of a carotid pulse generally means SBP is at least …

higher

the presence of peripheral pulses indicates a … BP

circulatory collapse

peripheral pulse absence suggests …

radial pulse

most common location for checking pulse of a conscious adult or large child

carotid pulse

location for checking pulse on an unconscious patient

Adam's apple

the thyroid cartilage is also referred to as the …

sternocleidomastoid

the large muscle in the neck

brachial pulse

location for checking pulse in infants and small children

temporal pulse

pulse lateral to eye orbit

carotid pulse

pulse medial to and below angle of jaw