APA T4

to determine the client's ability to perform ADL's and to screen for specific abnormalities (mass)

What are the extremities and the musculoskeletal system in general assessed for, to determine?

• Bones - for shape and form

• Muscles - strength, tone and symmetry

• Joints - tenderness, swelling (edema, pitting or not pitting), thickening, crepitation and ROM

bones, muscles, and joint’s what specifically are you assessing for?

**-Location**: found in movable joints of the body. Transparent thick fluid that resembles the white of an egg yolk.

**-Function**: It acts as a joint lubricant that reduces friction and acts as a shock absorber. Secreted by the synovial membrane.

Synovial Fluid (synovia) Function/ location

\-**Location**: found in moveable joints of the body.

\-**Function:** fibrous fluid filled sac like structure Cushions between bones, tendons, joints and muscles 160 in the human body - bursae

Bursae function/ location

Flexion, Extension, Abduction, Adduction, Pronation, Supination, Rotation, Hyperextension, Internal Rotation, External Rotation, Plantarflexion, and Dorsiflexion

common terms related to Joint Range of Motion.

Ask the patient to stand still with arms resting at sides, ask them to close their eyes. The client should be able to stand still.

What does a Romberg's Sign test for?

Swaying, Inability to stay still, and Inability to keep feet still or loss of balance (potential sign of ataxia - lack of muscle coordination)

What to take note of associated w/ rombergs sign test?

Biceps, Triceps, Patellar, and Achilles reflex

When using a reflex hammer what are the four most commonly tested sites for reflexes?

* 4+ : very brisk, hyperactive.
* 3+ : brisker than average.
* 2+ : average, normal.
* 1+ : diminished.
* 0 : no response.

Reflexes can be graded on four-point scale: what does each number mean?

sign of ataxia - lack of muscle coordination

In gross motor and balance functions what can clumsy, slow, and unsteady movements indicate?

Carpel Tunnel Syndrome (CTS)

\-painful disorder of the hand and wrist

\-Caused by compression of the median nerve running through the carpel ligament.

Pain, Weakness, Burning and tingling, Radiates up the forearm and shoulder joint.

Symptoms of Carpel Tunnel Syndrome (CTS)

Test used to assess Carpel tunnel syndrome (CTS)

Phalens test.

Crepitus

the sound of crackling, rattling or of rough surfaces rubbing together. May be heard with the movements of joints.

Winging of the Scapulae

an outward protrusion of the medial (side closest to the spine) border of the should blade.

Bogginess of joints

an abnormal sponginess felt on palpation, which may be caused by an over accumulation of fluid.

"thorax"

The chest is also called the...?

7 pairs of ribs are called "true" ribs and directly articulate with the sternum

What are the Seven pairs of the ribs called?

3 pairs are called "false" ribs, articulated with each other by costal cartilage

The next three pairs of ribs are called what?

2 pairs (last) are "floating"- they are much shorter and do not articulate with any other structure

The final two pairs of ribs are "floating", why?

The diaphragm makes

What makes up the floor of the chest cavity?

rate, rhythm, depth, retraction of supraclavicular, and inpiratory contraction of the sternomastoid.

When assessing respiratory movements, you should note which things?

shape, symmetry & abnormal areas of retraction or expansion.

What should a patient's chest be assessed for?

-barrel chest

-funnel chest shape

-pigeon chest shape

3 abnormal findings of the supporting structures of the chests ?

Barrel Chest

rounding of the chest cavity, both anterior and posterior side, taking on the shape of a barrel.

Funnel Chest Shape

depression of the sternum, narrowing the diameter of the chest & also known as cobbler chest, sunken chest, pectus excavatum.

when several ribs grow abnormally, leaving the chest to cave in. most people will see this as cosmetic issue.

Causes: Funnel chest shape

Pigeon Chest Shape

a narrow chest width, which causes the sternum to protrude (deformity)

Adventitious sounds

abnormal lung sounds heard when listening to the chest as the person breaths. These may be wheezes, crackles (rales) or strider.

Wheezes:

High pitched sound with a musical quality produced by a high velocity flow of air through a narrowed airway, heard on both inspiration and expiration

asthma, bronchospasm, COPD & inflammation or obstruction of the airway (a foreign object or tumor)

Wheeze are associated with :

Crackles (rales)

Irregular bubbling noise heard during chest inspiration. have a crackling or popping sound produced by air entering distal bronchioles or alveoli that contain serous secretions. (CHF)

Rubs

Superficial grating or creaking sounds heard during inspiration and expiration that is not relieved by coughing.

Consolidation

fluid, leukocytes, and erythrocytes accumulate in spaces that are normally air filled, producing a consolidated area. The most common cause of this is pneumonia.

Fremitus (tactile)

A vibration of the chest wall during breathing that is palpable on examination. It may indicate inflammation, infection, congestion, or consolidation of a lung or a part of the lung

soft in intensity and lower in pitch. Resembles a gentle sigh created when air moves through the smaller airways of the bronchioles and alveoli. This sound is best heard on inspiration at the base of the lungs

Normal breath sounds: Vesicular

moderate-intensity and has a moderate pitch blowing sound that is created by air moving through the bronchi.

Normal breath sounds: Bronchovesicular

high pitched, loud, harsh sound created by air moving through the trachea

Normal breath sounds: Bronchial

a breathing pattern associated with a lesion to the medullary respiratory centers in the brain, causing the individual to take a series of inspirations, followed by a series of expirations

Ataxic Respirations:

abnormal pattern of breathing characterized by increased followed by decreased depth, alternating long periods of apnea followed by a period of rapid breathing,

Cheyne-Stokes Respirations:

abnormal breathing pattern usually associated with diabetic or metabolic acidosis and with kidney failure.

Kussmaul breathing

-Midsternal line

-midclavicular line

-mid axillary lines

-anterior axillary

-posterior axillary lines

-vertebral line spine

- scapular lines.

Name the Chest Wall Landmarks on all the Surfaces of the Chest?

a vertical line running down the center of the sternum

Midsternal line

extend vertically in the center between the midsternal line and the axillary line

Midclavicular lines

vertical lines extending down from the anterior axillary

Anterior axillary

vertical lines extending down from the axilla along the posterior side

Posterior Axillary lines

vertical lines extending down from the axillary along the posterior side

Midaxillary lines

vertical line extending down the spinous process of the spine

Vertebral line spine

vertical lines extending down from anterior angles of the scapulae

Scapular lines

* RUQ - LUQ - RLQ - LLQ
* horizontal line and vertical line meet at the umbilicus to create the quadrants

What are the four quadrants which the abdomen is divided into? And where do the horizontal and vertical lines intersect at?

bowel sounds first, as palpation can alter bowel sounds

While assessing the abdomen, which is most important to do first? Auscultation of the abdomen or palpation of the abdomen?

Lightly place the diaphragm in the RLQ, slightly below and to the right of the umbilicus. Auscultate in a clockwise fashion all four quadrants (Using the diaphragm)

Which quadrant do we begin our auscultation of the abdomen in? Then auscultate in which direction, all four quadrants?

* RUQ = liver, gall bladder.
* RLQ = small intestine, large intestine.
* LUQ = stomach.
* LLQ = large intestine.

What are the locations by quadrant, of some of the major organs in the abdomen? P.85/86/Slides

Ask patient to void before starting the assessment

What is important to remind your client to do, prior to beginning the examination, for their comfort?

appears as a blunt projection or swelling extending out from the body (bulging)

abnormal findings of the abdomen - **Protuberant**:

a mass extending outward from the abdomen (protrudes from something else)

abnormal findings of the abdomen - **Protuberance**:

client is lying in supine position, the weight of the fluid pushes out to the side and causes the flanks to bulge

abnormal findings of the abdomen - **Bulging Flanks of Ascites:**

bowel sounds, vascular sounds and friction rubs

Auscultation of the abdomen is done to assess for?

hypoactive (often associated with post-surgery, inflammation, or a bowel obstruction)

When assessing the abdomen, absent or very low and sporadic sounds are called what? And they are associated with...

hyperactive (often associated with diarrhea)

When assessing the abdomen, loud, frequent bowel sounds and have a rushing sound are called what? And they are associated with....

skin integrity, color, texture, scars, striae (stretch marks), rashes, lesions, shape and any abnormal movements

What would we be Inspecting the abdomen for?

used to detect tenderness, masses or distension.

What are we attempting to detect upon palpation of the abdomen?

* Light & Deep

What are the two types of palpation?

* Tenderness
* Muscle shifting
* Organ location
* Abnormal mass
* Distension

What is light palpation used to identify? P, 84

an accumulation of fluid in the peritoneal cavity, which is caused by advanced liver disease, heart failure, pancreatitis or cancer, bulging will be observed in the flank area when the client is lying supine

What is the definition of ascites?

* Incidence of colon cancer is higher among older adults than younger adults
* Decreased absorption of oral medication often occur with aging
* Impaired metabolism of drugs in the liver may occur

What are the physical changes that occur to the abdomen caused by aging?