Comprehensive Health Assessment: Respiratory, Cardiovascular, Abdominal, and Functional Health

Comprehensive practice flashcard set covering physical assessment techniques, anatomy, clinical indicators, and diagnostic parameters across the respiratory, cardiovascular, abdominal, and urogenital systems, alongside Gordon's Functional Health Patterns Framework.

Which major anatomical organs are located within the right upper quadrant (RUQ) of the abdomen?

The liver, gallbladder, duodenum, head of the pancreas, and right kidney.

Which major anatomical organs are located within the left upper quadrant (LUQ) of the abdomen?

The stomach, spleen, body of the pancreas, and left kidney.

Which anatomical structures are located within the right lower quadrant (RLQ) of the abdomen?

The cecum, appendix, right ureter, right ovary, and right spermatic cord.

Which anatomical structures are located within the left lower quadrant (LLQ) of the abdomen?

The sigmoid colon, left ureter, left ovary, and left spermatic cord.

What is the correct sequence of examination techniques for the abdominal assessment, and why is this order followed?

Inspection, auscultation, percussion, and palpation. Auscultation is performed before percussion and palpation because manipulation of the abdominal wall can alter bowel motility and distort bowel sounds.

How should a patient be prepared and positioned for an abdominal examination?

The patient should void first, lie supine with knees flexed, be draped from xiphoid to symphysis pubis, and be examined in a warm, quiet, and well-lit room while the nurse uses a soothing voice.

What are the "7 Fs" associated with abdominal distention?

Fat, feces, fetus, fluid (ascites), flatus, fibroid tumor, and fatal growths.

What are the four recognized abdominal profile contours observed during inspection?

Flat, rounded, scaphoid, and protuberant.

What is the expected normal rate and acoustic characteristic of bowel sounds?

A rate of $5\text{--}30/\text{min}$, characterized as soft gurgles and clicks heard using the diaphragm of the stethoscope.

Under what condition are bowel sounds documented as absent, and what clinical conditions do they suggest?

When no bowel sounds are heard for $>5\,\text{minutes}$; this is uncommon and suggests an ileus or bowel obstruction.

What do hyperactive, high-pitched tinkling bowel sounds and borborygmi represent?

Borborygmi represents loud stomach growling, while hyperactive high-pitched tinkling sounds suggest partial bowel obstruction or gastroenteritis.

Over which major vascular landmarks should the bell of the stethoscope be placed to auscultate for abdominal bruits?

The abdominal aorta, renal arteries, iliac arteries, and femoral arteries.

What percussion notes are normally expected over the abdomen when evaluating hollow organs versus solid organs?

Tympany is expected over gas-filled intestines, while dullness is mapped over solid organs (liver, spleen), a distended bladder, or masses.

How is shifting dullness performed to detect ascites during abdominal percussion?

The patient lies supine while the examiner percusses outward to mark the borders between tympany and dullness; the patient then turns onto one side and the borders are percussed again to identify if dullness shifts toward the dependent side.

What is the purpose and technique of fist percussion over the costovertebral angle (CVA)?

It is used to detect renal tenderness or inflammation by placing one hand flat over the CVA on the patient's back and striking it firmly with the ulnar fist of the other hand.

What are the specific technique parameters for light palpation versus deep palpation of the abdomen?

Light palpation begins first using the first four fingers held close together to depress the skin approximately $1\,\text{cm}$ in a gentle rotary motion; deep palpation depresses the skin approximately $5\text{--}8\,\text{cm}$ ($2\text{--}3\,\text{inches}$) to assess organ size, consistency, and deep masses.

What is the typical adult bladder capacity, and what causes of transient urinary incontinence are captured by the DIAPPERS mnemonic?

Normal capacity is $200\text{--}400\,\text{mL}$. The DIAPPERS mnemonic stands for Delirium, Infection, Atrophic urethritis, Pharmaceuticals, Psychological, Excess urine, Restricted mobility, and Stool impaction.

What is the normal liver span at the right midclavicular line, and what causes hepatomegaly?

Normal span is $6\text{--}12\,\text{cm}$; enlargement is commonly associated with hepatitis and cirrhosis.

How is Murphy's sign assessed, and what does a positive test indicate?

The examiner palpates the right upper quadrant beneath the liver border while the patient takes a deep inspiration; a sharp arrest in inspiration due to tenderness indicates acute cholecystitis.

What clinical conditions are indicated by rebound tenderness and Rovsing's sign?

Peritoneal inflammation and appendicitis.

What clinical tool is depicted here for standardizing the description and consistency of stool output?

The Bristol Stool Form Scale, which classifies stool into seven types ranging from separate hard lumps (Type 1, severe constipation) to liquid with no solid pieces (Type 7, severe diarrhea).

What physical assessment finding is shown around the umbilicus, and what is its clinical significance?

Cullen's sign (bluish periumbilical discoloration), which indicates retroperitoneal hemorrhage or intra-abdominal bleeding.

What vascular assessment finding is depicted on this abdomen, and what pathology causes it?

Caput medusae, which represents distended, engorged superficial abdominal veins radiating from the umbilicus due to severe portal hypertension.

What female pelvic support defect is depicted in this anatomical diagram?

A rectocele, which is a herniation or prolapse of the anterior rectal wall bulging forward into the posterior vaginal wall.

What physiological properties and anatomical relationships characterize the prostate gland?

It is approximately the size of a testis, encircles the urethra at the bladder neck, produces $15\%\text{--}30\%$ of seminal fluid volume, and secretes fibrinolysin to liquefy coagulated semen and promote sperm motility.

What are the tactile findings during digital rectal examination (DRE) of a normal prostate versus benign prostatic hyperplasia, malignancy, and acute prostatitis?

A normal prostate is small, smooth, mobile, nontender with a palpable median sulcus; benign prostatic hyperplasia (BPH) is enlarged and smooth/soft; malignancy presents with firm, irregular nodules; acute prostatitis presents as warm, swollen, and exquisitely tender (where vigorous DRE must be avoided to prevent bacteremia).

What are the normal reference ranges for resting heart rate and cardiac output in a healthy adult?

Resting heart rate is $60\text{--}100\,\text{bpm}$ and cardiac output is $4\text{--}8\,\text{L/min}$.

What is the anatomical position of the heart, and what factors can cause positional variations?

The heart lies left of the midline, above the diaphragm, behind the sternum, between the medial borders of the lungs, extending from the 3rd to 6th intercostal cartilage. Variations occur due to body build, chest configuration, diaphragm level, and dextrocardia.

What are the four anatomical layers of the heart wall and coverings?

The pericardium (outer fibrous protective sac), epicardium (visceral layer of pericardium and outermost muscle layer), myocardium (middle muscular pumping layer), and endocardium (innermost layer lining chambers and valves).

During which phase of the cardiac cycle does the myocardium receive most of its blood supply, and where do coronary veins primarily drain?

The myocardium receives blood primarily during diastole when the heart muscle relaxes; venous blood drains predominantly into the right atrium through the coronary sinus.

Into which two major arteries does the left main coronary artery divide, and what clinical risk is associated with occlusion of the right coronary artery?

The left main artery divides into the left anterior descending (LAD) and left circumflex (LCX); occlusion of the right coronary artery (RCA) typically causes an inferior-wall myocardial infarction.

What physiological event produces the S1 heart sound ("lub"), and where is it heard loudest?

Closure of the mitral and tricuspid valves at the beginning of ventricular systole; it is heard loudest at the apex.

What physiological event produces the S2 heart sound ("dub"), and what is physiologic splitting?

Closure of the aortic and pulmonic valves at the beginning of diastole; it is heard loudest at the base. Physiologic splitting of S2 into aortic and pulmonic components may be heard during inspiration at the pulmonic area.

What is the timing, cadence, and clinical implication of an S3 heart sound?

It occurs in early diastole during rapid ventricular filling, follows the "Kentucky" cadence ($S_1\text{--}S_2\text{--}S_3$), and may indicate volume overload or heart failure.

What is the timing, cadence, and clinical association of an S4 heart sound?

It occurs in late diastole when atria contract against a noncompliant, stiff ventricle, follows the "Tennessee" cadence ($S_4\text{--}S_1\text{--}S_2$), and is associated with CAD, hypertension, MI, or cardiomyopathy.

What specific palpatory sensations on the chest wall correspond to the distinct parts of the hand indicated in this diagram?

The palmar aspects of the four fingers detect localized pulsations; the palmar surface over the metacarpophalangeal joints detects thrills (fine vascular vibrations); and the heel/base of the palm detects heaves or lifts (lifting of the precordium from increased workload).

Identify the five cardiac auscultation landmarks and their precise intercostal locations shown on this scrub top.

Aortic area ($2\text{nd}$ right intercostal space at sternal border), Pulmonic area ($2\text{nd}$ left intercostal space at sternal border), Erb's point ($3\text{rd}$ left intercostal space at sternal border), Tricuspid area ($5\text{th}$ left intercostal space at sternal border), and Mitral/Apical area ($5\text{th}$ left intercostal space at the midclavicular line).

What criteria define the intensity grading scale for cardiac murmurs from Grade I to Grade VI?

Grade I is barely audible in a quiet room; Grade II is quiet but clearly audible; Grade III is moderately loud; Grade IV is loud with an associated palpable thrill; Grade V is very loud with a thrill, audible with the stethoscope partly off the chest; Grade VI is extremely loud with a thrill, audible with the stethoscope completely off the chest wall.

Which common valvular disorders produce systolic murmurs versus diastolic murmurs?

Systolic murmurs are caused by aortic stenosis and mitral regurgitation; diastolic murmurs are caused by aortic regurgitation and mitral stenosis.

How can an examiner auscultate to distinguish a pericardial friction rub from a pleural friction rub?

A pericardial friction rub is continuous, high-pitched or scratchy, and does not vary when the patient holds their breath, whereas a pleural friction rub disappears during breath-holding.

What are the location and normal physical characteristics of the point of maximal impulse (PMI)?

Located at the 5th intercostal space at the left midclavicular line; it feels like a light, localized tap measuring $1\text{--}2\,\text{cm}$, lasts for about half of systole, and is palpable in approximately $50\%$ of healthy adults.

What assessment findings distinguish left-sided heart failure from right-sided heart failure?

Left-sided heart failure produces pulmonary congestion (crackles, cough, dyspnea, paroxysmal nocturnal dyspnea, and $S_3$); right-sided heart failure produces systemic venous congestion (jugular venous distention, dependent peripheral edema, hepatomegaly, and weight gain).

What is the expected normal capillary refill time, and what does delayed return indicate?

Normal is $<3\,\text{seconds}$; delayed capillary refill indicates reduced cardiac output, hypovolemia, or impaired peripheral arterial perfusion.

How should the patient be positioned when inspecting for jugular venous distention (JVD)?

The patient should be in a supine position with the head of the bed (HOB) elevated between $30^\circ$ and $45^\circ$.

What standard numerical scale is used to grade the amplitude of peripheral pulses?

$0$ = absent; $1+$ = weak/diminished; $2+$ = normal; $3+$ = increased/full; $4+$ = bounding.

What skin, pain, pulse, and ulcer characteristics differentiate arterial insufficiency from venous insufficiency?

Arterial insufficiency presents with severe pain exacerbated by walking, cool/pale/shiny skin, diminished or absent pulses, minimal/no edema, and deep, well-defined ulcers on toes or pressure points. Venous insufficiency presents with aching relieved by elevation, warm brown/brawny skin, normal pulses, pronounced edema, and shallow irregular ulcers around the ankles.

What indentation depths and rebound recovery times define the four-point pitting edema scale shown in this image?

$1+$ = $2\,\text{mm}$ depression, rebounds immediately; $2+$ = $4\,\text{mm}$ depression, rebounds in $<15\,\text{seconds}$; $3+$ = $6\,\text{mm}$ depression, rebounds in $30\text{--}60\,\text{seconds}$; $4+$ = $8\,\text{mm}$ depression, rebound takes $>2\,\text{minutes}$.

What are the "5 Ps" of acute peripheral arterial occlusion requiring urgent escalation?

Pain, pallor, pulselessness, paresthesia, and paralysis.

How is the elevation pallor test performed, and what result suggests significant arterial disease?

The patient's legs are elevated above the heart level; normal perfusion maintains pink color with no pallor within $60\,\text{seconds}$, whereas rapid onset of pallor indicates severe peripheral arterial disease.

What is the primary clinical objective of utilizing Gordon's Functional Health Patterns Framework?

To organize patient assessment data systematically, provide a comprehensive holistic view of the whole person, identify health problems and deviations early, and support clinical judgment.

Into which three broad categories are Gordon's 11 Functional Health Patterns divided?

01: Physical Function, 02: Cognitive & Psychosocial, and 03: Personal & Meaning.

Which specific patterns constitute the Physical Function grouping of Gordon's framework?

Health perception/health management, Nutrition/metabolic, Elimination, Activity/exercise, and Sleep/rest.

Which specific patterns constitute the Cognitive & Psychosocial grouping of Gordon's framework?

Cognitive/perceptual, Self-perception/self-concept, Role/relationships, and Coping/stress tolerance.

Which specific patterns constitute the Personal & Meaning grouping of Gordon's framework?

Sexuality/reproductive and Values/beliefs.

What core principle governs the relationships among the 11 functional health patterns?

Patterns are interconnected and dynamic rather than isolated; a disruption or problem in one pattern directly impacts multiple other patterns.

What are the three core actions nurses employ to collect information across Gordon's patterns?

Ask (interview with open-ended questions), Observe (notice behavior, appearance, and interactions), and Assess (perform physical examination, check vitals and labs, and review medical/family history).

How does Gordon's framework distinguish between subjective and objective data?

Subjective data consists of patient-reported feelings, symptoms, and experiences (e.g., "I haven't been sleeping well"); objective data consists of observable, measurable clinical findings (e.g., heart rate of $108\,\text{bpm}$, consuming $25\%$ of a meal, measured weight loss).

What does the Health Perception / Health Management pattern specifically evaluate?

How the patient perceives their overall health and well-being, their adherence to therapeutic regimens, preventative safety practices, and overall self-management.

What clinical factors are assessed within the Nutrition / Metabolic pattern?

Daily food and fluid intake, appetite, unintended weight changes, metabolic demands, skin integrity, and mucosal hydration.

What parameters are investigated within the Elimination pattern of Gordon's framework?

Bowel, bladder, and skin excretory habits, including regularity, changes in frequency, quality, constipation, diarrhea, and incontinence.

What domains of patient functioning are evaluated within the Cognitive / Perceptual pattern?

Sensory-perceptual acuity (vision, hearing, touch), cognitive adequacy, orientation, memory, decision-making, and pain perception/management.

What clinical indicators signal an abnormal finding within the Coping / Stress Tolerance pattern?

Reports of inability to manage life stressors, disruptive emotional responses, statements such as "I can't handle this anymore," or reliance on maladaptive coping mechanisms.

What are the seven steps that guide the transition from assessment data to clinical judgment?

01: Collect data; 02: Organize with Gordon's patterns; 03: Recognize cues; 04: Identify relationships; 05: Prioritize problems; 06: Plan interventions; 07: Evaluate outcomes.

What rib articulates at the sternal angle (Angle of Louis), and how are intercostal spaces numbered?

The second rib articulates at the Angle of Louis; each intercostal space is named and numbered for the rib directly above it.

How many lobes do the right and left lungs have, and what are the anatomical boundaries of the diaphragm?

The right lung has 3 lobes and the left lung has 2 lobes; the diaphragm lies at ribs 5–6 anteriorly and at T10–T12 posteriorly.

What three vertical reference lines are used to localize thoracic assessment findings?

Midclavicular line, midaxillary line, and scapular line.

What ratio compares the normal adult chest wall to the barrel chest configuration shown in this cross-sectional diagram?

The normal adult anteroposterior (AP) to transverse diameter ratio is $1:2$ (up to $5:7$), creating an elliptical shape, whereas a barrel chest exhibits an AP-to-transverse ratio of $1:1$.

What is the normal costal angle measurement, and what does a costal angle $>90^\circ$ signify?

The normal costal angle is $<90^\circ$; an angle $>90^\circ$ signifies thoracic hyperinflation, typically seen in emphysema and chronic obstructive pulmonary disease (COPD).

What is the clinical significance of intercostal retractions versus intercostal bulging?

Retraction occurs when intercostal spaces pull inward during inspiration due to severe airway obstruction; bulging occurs when intercostal spaces push outward during expiration due to trapped air or massive fluid.

What are the adult threshold rates for eupnea, tachypnea, and bradypnea?

Eupnea is $12\text{--}20\,\text{breaths/min}$, tachypnea is $>20\,\text{breaths/min}$, and bradypnea is $<12\,\text{breaths/min}$.

What clinical breathing patterns are illustrated by these two distinct respiratory waveforms?

The top waveform depicts Cheyne-Stokes respiration (a crescendo-decrescendo breathing pattern interspersed with periods of apnea); the bottom waveform depicts Kussmaul respiration (rapid, deep breathing characteristic of metabolic acidosis such as diabetic ketoacidosis [DKA]).

What respiratory pattern is depicted in this waveform, and where is the underlying brain damage located?

Biot's respiration, characterized by an irregularly irregular rate and depth with sudden, random periods of apnea; it indicates neurological damage to the medulla or pons.

Which neck and upper shoulder muscles function as accessory muscles during respiratory distress?

Sternocleidomastoid (elevates sternum), scalenes (elevate upper ribs), and trapezius (increases rib cage size); their use at rest is always abnormal.

What is the clinical significance of small clear sputum versus foul-smelling sputum?

Small amounts of clear or light yellow odorless sputum can be normal, whereas foul-smelling sputum is always abnormal and indicates infectious or purulent pulmonary processes.

What is the proper technique and starting landmark for anterior versus posterior thoracic palpation?

Anterior palpation begins standing in front of the patient at the right lung apex above the clavicle, moving systematically downward over ribs and interspaces while palpating tender areas last. Posterior palpation begins standing behind the patient at the right apex near T1, moving down the vertebrae and intercostal spaces.

How is thoracic expansion assessed, and what is the expected normal distance of thumb separation on inspiration?

Place hands with thumbs along the costal margin at T9–T10 pointing medially; on deep inspiration, thumbs should separate symmetrically by $3\text{--}5\,\text{cm}$.

What acoustic phrase does the patient vocalize during tactile fremitus palpation, and what causes vibrations to increase versus decrease?

The patient repeats "99"; tactile fremitus increases with lung consolidation (pneumonia, atelectasis) and decreases when an air or fluid barrier blocks sound transmission (pneumothorax, emphysema, pleural effusion).

Which clinical conditions pull the trachea toward the affected side versus push it away from the affected side?

The trachea deviates toward the affected side in lung collapse or consolidation (atelectasis); it deviates away from the affected side in tension pneumothorax or large pleural effusion.

What pulmonary conditions correlate with resonant, hyperresonant, and dull percussion notes?

Resonance is normal lung tissue; hyperresonance indicates trapped air (pneumothorax, emphysema); dullness indicates fluid or dense solid tissue (lobar pneumonia, pleural effusion).

What are the location, pitch, and inspiratory-to-expiratory (I:E) ratios of the three normal breath sounds?

Bronchial sounds are high-pitched, loud, hollow, with $I < E$, heard over the trachea; bronchovesicular sounds are moderate in pitch and intensity with $I = E$, heard between scapulae and at the 1st–2nd ICS; vesicular sounds are low-pitched, soft, rustling with $I > E$, heard over the peripheral lung fields.

What acoustic characteristics differentiate fine crackles from coarse crackles?

Fine crackles are dry, high-pitched, popping sounds heard during inspiration that do not clear with coughing (e.g., CHF, pneumonia, pulmonary fibrosis); coarse crackles are low-pitched, moist, bubbling/gurgling sounds during inspiration that may clear with coughing (e.g., pulmonary edema, severe pneumonia).

What physical mechanism distinguishes a sibilant wheeze from stridor?

A sibilant wheeze is a high-pitched, musical sound primarily heard on expiration due to acute narrowing of small airways (asthma, bronchitis); stridor is a loud, harsh, high-pitched crowing sound heard predominantly on inspiration due to upper airway obstruction (croup, foreign body).

How are bronchophony, egophony, and whispered pectoriloquy evaluated for consolidation?

In bronchophony, the patient says "99" (normal is muffled; loud/clear confirms consolidation). In egophony, the patient says "ee" (audible transition to nasal "ay" confirms consolidation). In whispered pectoriloquy, the patient whispers "99" (normal is faint; clear/loud whisper confirms consolidation).

What is the expected normal adult pulse oximetry range, and how long should a clinician wait before recording the reading?

The expected $SpO_2$ is $97\text{--}99\%$, and the clinician should wait $15\text{--}30\,\text{seconds}$ after probe placement before recording.

What are the USPSTF lung cancer screening criteria for high-risk individuals?

Annual screening with low-dose computed tomography (LDCT) for adults aged $50\text{--}80\,\text{years}$ who have a $\ge 20\,\text{pack-year}$ smoking history and currently smoke or have quit within the past 15 years.