Physical Assessment Part 2

Vocabulary practice flashcards covering cardiovascular, vascular, abdominal, lymphatic, breast, musculoskeletal, and neurological physical assessment concepts based on lecture notes.

Pulmonary Circulation

The circulation pathway where oxygen-depleted blood circulates from the heart to the lungs and then back to the heart.

Systemic Circulation

The circulation pathway where the left ventricle pumps oxygenated blood into the arterial system to deliver oxygen to body tissues through arteries

Capillaries

Microscopic blood vessels into which arteries subdivide, serving as the site where oxygen is delivered to body tissues.

Venous System

A low-pressure system of veins that collects oxygen-depleted blood from tissues and returns it to the right atrium of the heart.

Cardiac Systole

The phase of the cardiac cycle during which the ventricles contract and pump/eject blood out of the heart; S1

Cardiac Diastole

The phase of the cardiac cycle during which the ventricles relax and fill with blood; S2

Point of Maximal Impulse (PMI)

The specific chest location where apical heart pulsation is best felt or heard, situated at the left $5\text{th}$ intercostal space at the midclavicular line.

1. inspection

2. palpation

3. auscultation

What are the steps of heart assessment? 3

• look at chest, skin, pulsations

• PMI location left 5th ICS

• check for heaves/lifts

What is included in the inspection step of heart assessment? 3

Cardiac Heaves / Lifts

Visible chest wall pulsations that typically indicate ventricular enlargement.

Cardiac Thrill

An abnormal palpable vibration felt anywhere on the chest wall (except the PMI) caused by turbulent blood flow.

1. aortic

2. pulmonic

3. Erb’s

4. tricuspid

5. mitral

Where are you listening to heart sounds and what are the names? 5

S1 Heart Sound (Lub)

heart sound caused by the closure of the tricuspid and mitral valves at the beginning of ventricular systole.

S2 Heart Sound (dub)

heart sound caused by the closure of the aortic and pulmonic valves at the end of systole and beginning of diastole.

S3 Heart Sound

A low-pitched ventricular gallop sound with a 'KenTUCKy' cadence, expected in children and young adults, listened for with the stethoscope bell.

S4 Heart Sound

An extra heart sound occurring before S1 with a 'FLOrida' rhythm, expected in older adults, athletic adults, and children, heard best with the stethoscope bell.

Heart Murmur

A blowing or swishing sound caused by turbulent blood flow due to increased blood volume or obstructed/altered flow through the heart.

Aortic Auscultatory Area

The cardiac listening site located to the right of the sternum at the $2\text{nd}$ intercostal space.

Pulmonic Auscultatory Area

The cardiac listening site located to the left of the sternum at the $2\text{nd}$ intercostal space.

Erb's Point

The cardiac listening site located to the left of the sternum at the $3\text{rd}$ intercostal space where both S1 and S2 sounds are heard.

Tricuspid Auscultatory Area

The cardiac listening site located at the lower left sternal border at the $4\text{th}$ intercostal space.

Apical / Mitral Area

The cardiac listening site located at the left $5\text{th}$ intercostal space at the midclavicular line, used for assessing apical heart rate.

5th intercostal space to left of midclavicular line; loacation of assesing APICAL heart rate; AKA mitral area

Where is PMI located

Bruits

Blowing or swishing vascular sounds that indicate obstructed peripheral blood flow

Left Lateral Recumbent Position

A patient position facilitating the auscultation of extra heart sounds and murmurs.

arteries

• carry blood away from heart

• high-pressure system (pulse)

pulmonary arteries

only arteries in body carrying deoxygenated blood

systemic arteries

carry oxygenated blood to tissues/organs

veins

• carry blood to heart

• low-pressure system

pulmonary veins

only veins in body carrying oxygenated blood

systemic veins

veins that carry deoxygenated blood back to the heart

• reflect heart function better than peripheral arteries

• auscultate for bruit

• use bell

• never palpate both carotid at same time

• palpated in emergency

What are important traits of the carotid artery? 5

Jugular Venous Distention (JVD)

Visible swelling of the jugular veins when the patient is in semi-Fowler's position, signaling right-sided heart congestion or fluid overload.

Grade 0 Pulse

An absent peripheral pulse that is not palpable.

Grade 1+ Pulse

A pulse that is palpable, but thready and weak, and easily obliterated with pressure.

Grade 2+ Pulse

An expected normal pulse finding that is easily identified and not easily obliterated.

Grade 3+ Pulse

An increased pulse strength that requires moderate pressure for obliteration.

Grade 4+ Pulse

A full, bounding pulse quality that cannot be obliterated.

• carotid

• radial pulse

• ulnar pulse (little finger side of wrist)

• brachial pulse

What are the upper extremity peripheral arteries for vascular assessment? 4

• femoral pulse

• popliteal pulse

• dorsalis pedis pulse

• posterior tibial pulse

What are the lowerextremity peripheral arteries for vascular assessment? 4

Femoral Pulse Location

A peripheral pulse point located in the groin area.

Popliteal Pulse Location

A peripheral pulse point located behind the knee.

Dorsalis Pedis Pulse Location

A peripheral pulse point located on the top dorsum of the foot.

Posterior Tibial Pulse Location

A peripheral pulse point located behind the inner ankle malleolus.

Doppler Ultrasound

A diagnostic tool used to detect peripheral blood flow and assess tissue perfusion when pulses are difficult to palpate.

varicose veins (buldging); swollen leg; skin color & texture changes; non-healing wounds

Venous Insufficiency 4

• palpate the epitrochlear nodes, located on the medial aspect of the arms

• assess proximal portion during breast examination

How to assess upper extremities (lymphatic)

assess during examination of vascular system or genital examination

How to assess lower extremities (lymphatic)

male: small amnt of breast is glandular tissue

female: majority of breast is glandular tissue

What is the difference in male and female breast tissue

• any discharge, dimpling, orange peel appearance

• size & symmetry

• contour/shape

• color

• nipple & areola

What to notice during female breast inspection? 5

Systematic approach: vertical, circular, radial/wedge

Breast Palpation Techniques (3)

• nipple & areola for nodules, edema, ulceration

• breast enlargement (from obesity or glandular)

Male Breast inspection includes:

1. inspection

2. auscultation

3. percussion

4. palpation

Abdominal Assessment Order

skin, umbilicus, contour, symmetry, enlarged organs/masses, movements, pulsations

What are you inspecting on abdomen?

bowel sounds (peristaslsis)

bruits (vascular)

What are you auscultating on abdomen? 2

high pitched clicks & gurgles (3-35/min)

What is expected when auscultating abdomen?

increased GI motility

NV

Anxiety

Diarrhea

What can be cause of hyperactive sounds of abdomen? (4)

no sounds after listening a full 5 mins in all quadrants

What has to happen to determine bowel sounds as absent?

• masses, tenderness, distention

• may be light/deep as appropriate

• aortic pulsation

What are you palpating for in abdomen exam?

• softness, no nodules

• no guarding

• bladder is palpable if full

What is expected when palpated abdomen? 3

motility/peristalsis decreases

What abdominal change is expected with aging?

Concave Abdominal Contour

An abdominal shape that has a sunken-in appearance.

Visible Abdominal Peristalsis

Wavelike movements across the abdominal wall that are expected in thin adults but may indicate intestinal obstruction in others.

Midline Abdominal Pulsations

Regular rhythmic movements visible midline above the umbilicus, expected in thin adults, whereas a distinct pulsating mass is unexpected.

Abdominal Tympany

A high-pitched drum-like percussion sound heard over air-filled structures, expected over most of the abdomen.

• usually only assess external genitalia

• voiding habits

• urine color, consistency, amount

What is included in genitourinary assessment? 3

• labia

• clitoris

• urethral opening

• vaginal orifice

• pubic hair

• lymph nodes

What structures are part of female genitalia? 6

penis, urethral opening, scrotum, lymph nodes, pubic hair

What structures are part of male genitalia? 5

• perform after genital examination

• explain all steps to pt

• provide privacy

• use inspection & digital palpation

• assess skin integrity

What is important to remember during rectum/anus assessment? 5

• body shape/symmetry

• balance

• coordination

• joint mobility

• muscle strength

What is included in musculoskeletal assessment (bones, muscles, joints)? 5

Lordosis

An exaggerated inward curvature of the lumbar spine, commonly referred to as swayback.

Kyphosis

An exaggerated outward posterior curvature of the thoracic spine, often creating a humpback shape.

Scoliosis

An abnormal lateral S-shaped curvature or sideways deviation of the spine.

• hand grasps (also neuro)

• dorsiflexion

• plantarflexion

What are the 3 main ROM musculoskeletal assessments performed?

ROM against resistance

What determines muscle strength?

Crepitus (Musculoskeletal)

A crackling or grating sound and sensation produced by friction between bone and cartilage or fractured bone parts during joint movement.

Active ROM occurs when the patient moves joints independently, whereas passive ROM occurs when the examiner moves the patient's joints without patient muscle contraction.

Active vs. Passive Range of Motion

Dorsiflexion

Bending the foot upward at the ankle toward the shin.

Plantar Flexion

Bending the foot downward at the ankle, pointing the toes toward the floor.

• level of consciousness (LOC)

• orientation status

• behavior & appearance

• language

What are the 4 main points of neurological assessment?

• arousal (response to stimuli)

• ranges (alert-deeply comatose)

• based on type of stimuli (auditory, tactile, painful)

What are the parts of LOC? 3

pt’s awareness

oriented to time, place, person, situation (oriented x4)

What does orientation statues refer to?

Lethargic Level of Consciousness

A state of consciousness where the patient is drowsy and drifts back to sleep easily, but can open their eyes and respond when stimulated.

Obtunded Level of Consciousness

A state of consciousness where the client responds to light shaking but remains confused and slow to respond.

Stuporous Level of Consciousness

A state where the client requires painful stimuli (such as a sternal rub) to achieve a brief, minimal response.

Comatose Level of Consciousness

A state characterized by unresponsiveness to painful stimuli, with no voluntary movement and possible abnormal posturing.

Awake

Verbal (pt responds to verbal stimulus)

Pain (pts responds to a pain stimulus)

Unresponsive

How to determine LOC

neurological test to stand with feet tg, arms at both sides, eyes closed. Pt expected to stand w minimal swaying for at least 5 seconds

Romberg’s test

• motor function

• coordination

• balance

• reflexes

What is included in neurological assessment? 4

Glasgow Coma Scale (GCS)

A standardized neurological scoring system assessing eye opening, verbal response, and motor response, where maximum functionality is $15$ and a score of $3$ indicates death.

Reflex Grading Scale (+2 Response)

The standard normal grade assigned to a deep tendon reflex response on a scale ranging from $0$ (no response) to $+4$ (hyperactive response).