Patient Care

inspection, palpation, percussion, auscultation

What are the 4 main parts of the physical exam?

pulse pressure

the difference b/t systolic and diastolic pressures

Korotkoff sounds

sounds made by the blood flow through the arteries which may change depending on how open/closed the artery is

Auscultatory gap

Phenomenon where korotkoff sounds disappear for 20-25 mmHg after systolic then reappear

Subjective, Objective, Assessment, Plan

What does “SOAP” stand for in regards to clinical documentation?

chyle

lymph fluid

bone marrow, thymus

primary lymph organs

lymph nodes, spleen, mucosal associated lymphoid tissues (MALT)

secondary lymph organs

glymphatic system

waste disposal system which filters specifically the cerebral interstitial fluid by mingling with the CSF

Interstitial fluid

Plasma which leaks out of capillaries as blood circulates, some of which ultimately gets reabsorbed while some is cleared away into the lymphatic system

lymphocytes

immune cells which travel within the chyle

hydrostatic

Pressure exerted by fluid within the capillaries

Greatest at arterial end of the capillary bed which leads to filtration of fluid out of the capillaries

Oncotic

Pressure exerted by proteins within fluid of capillaries

It is greatest at the venous end of the capillary bed, leading to reabsorption of fluid into the capillaries

thymus

gland within chest that allows T-lymphocytes to grow and multiply

Most active in children, but activity decreases throughout aging

spleen

secondary lymphatic organ which filters blood by allowing lymphocytes to interact with circulating blood, removing waste products and cellular debris

mucosal associated lymphoid tissues

Secondary lymphatic organ which lines the respiratory, digestive, and urogenital tracts for extra immune protection

Lymphadenopathy

enlargement in one or more lymph nodes

may occur in the setting of inflammation of malignancy

lymphadenitis

infection of one/more lymph nodes

lymphedema

abnormal accumulation of lymph fluid (usually the extremities) causing swelling

lipolymphedema

chronic condition caused by the abnormal accumulation of lymph and fat

lymphoma

cancer originating in the lymph system

lymphangitis

inflammatory reaction that follows the lymph channels

appearing like a streaky erythema up an extremity towards more central lymph nodes

typically appearing w/ lymphadenopathy

Faith, Importance/Influence, Community, Action/Address

Spiritual assessment model FICA

Sources of hope, organized religion or group, personal spirituality, effects on medical care

Spirituality assessment HOPE

Identifying data, CC, HPI, Medications, Allergies, PMH, Shx, Fhx, ROS

Components of medical history

Setting the stage, CC, Patient story, Transition to physical exam

What are the 4 parts of the medical interview

Name, preferred name, DOB, age, DOE

What are the 5 pieces of identifying information needed in every history?

Character, Location, Onset, Radiation, Intensity, Duration, Exacerbation, Palliative factors, Associated factors/sx, Concerns, similar prior events

What are the aspects of ChLORIDE PACS?

attributes of a symptom

What is ChLORIDE PAC used to describe

Name, Dose, Route, Frequency, Indication, Adherence

What are the 6 things you need to know about a patient’s medications?

>5% of total body weight loss over 6 months

What is a “significant” amount of weight loss?

Fatigue

Lack of energy, easily tired out, lacking stamina

Malaise

Overall feeling of being “unwell” or run down, general discomfort

Anhedonia

Little interest or pleasure in doing things that used to bring happiness

Polyphagia

Excessive hunger

Polydipsia

Excessive thirst

Polyuria

frequent daytime urination

Nocturia

Frequent nighttime urination

diaphragm

What part of the stethoscope is able to auscultate high pitched sounds?

bell

What part of the stethoscope is able to auscultate low pitched sounds?

rales

Abnormal lung sound which sounds like crackes, is discontinuous, intermittent, non-musical, and only heard in areas where fluid is being pulled through

Normally heard at the bases of the lungs

Indicative of CHF or pneumonia

rhonchi

Low-pitched lung sound which sounds like snoring or gurgling and is indicative of mucus buildup in the larger airways

wheezing

a high-pitched, whistling sound produced when you breathe, caused by narrowed or inflamed airways

Rub

an abnormal, scratchy sound heard through a stethoscope, indicating active inflammation of the pericardium

Gallop

an extra, abnormal heart sound that creates a triplet or quadruplet rhythm

bruit

turbulent blood flow in a vessel

pulse pressure

The difference b/t SBP and DBP

40-60

Normal pulse pressure

½ inch above antecubital fossa

Where should you place the blood pressure cuff?

left common carotid, brachial artery, posterior tibial artery, dorsalis pedis artery

where to feel pulses?

Rhythm, rate, amplitude, symmetry

What are you assessing for when taking a pulse?

12-20

What is the normal breaths per min for an adult?

95-100

Normal oxygen saturation?

98.6F or 37C

Normal temperature

18.5-25

Normal BMI?

vellus

Type of hair which is soft, short, often non-pigmented fine hair.

Rooted in the upper dermis

Terminal

Longer, courser, dark hair

Rooted deep in the dermis

keratinocyte

primary cell type of the epidermis

tough, fibrous protein giving the skin structure and resilience

langerhans

Type of cell which is a specialized tissue-resident macrophage found in the epidermis and mucosal tissues

Melanocytes

pigment-producing cells primarily located in the basal layer of the epidermis

merkel cells

sensory cells located in deep layer of epidermis, crucial for sense of touch

paronychium

Name of the lateral fold of the nails

lunula

The moon shaped white pigmented area under the nail

eponychium

name for the cuticle

nail plate

The tough fibrous broad part of the nail

size/shape, color/configuration, associated changes/anatomic arrangement, morphology/margin

SCAM of skin exam

asymmetry, borders, color, diameter, evolving

ABCDE of skin exam

Tenting

when skin is pinched and pulled up and stays up

sign of dehydration

turgor

word for skin elasticity

perfusion

What does capillary refill check for?

fitzpatrick skin phototype scale

What is the scale for describing a person’s skin color?

violaceous

violet/purple skin coloring, often in people of color

depigmentation, localized vasospasm, calcium deposit, scarring, maceration

What would cause a white coloring of the skin

tissue necrosis, excess pigmentation

What would cause black skin color?

melanin deep in dermis, melanocytic lesion in dermis, blood vessels, tattos

What would cause a blue color of the skin?

poor circulation, vasospasm, hypoxia

What are causes of cyanosis

lipid deposition, sebaceous lesions, connective tissue lesions, carotenemia

What causes a yellow pigmentation of the skin?

Hyperbilirubemia, hemolysis

Causes of jaundice?

primary

These lesions are most characteristic lesions associated w/ a disease process or skin condition

secondary

Lesions which change over time caused by the evolution of primary lesions, manipulation, trauma, infection, treatment, or healing process

macule

flat lesions w/ change in skin color and well circumscribed

<1 cm

patch

flat lesion, change in skin color, well circumscribed

>1 cm

Papule

Raised lesion, circumscribed

<1 cm

Plaque

Raised lesion, circumscribed

>1 cm

Vesicle

Elevated, fluid filled, small blisters, circumscribed, <1cm

Bulla

Elevated, fluid filled, blisters, circumscribed

>1 cm

Pustule

elevated, circumscribed

Usually <1 cm

Filled w/ purulent material

Furuncle

Inflammation of hair follicle resulting in a pustule

Carbuncle

Collection of multiple inflamed hair follicles

Comedone

follicular papule filled w/ sebum plug

nodule

elevated firm lesion

circumscribed

variable sizes

centered in dermis or subcutaneous fat, but elevated into the dermis

tumor

soft or firm mass

can be fixed or freely moving

various shapes and sizes

benign or malignant

primary or metastatic

slowly expanding or rapidly growing

cyst

walled off lesion

fluid or semisolid

± firm

± fluctuant

Usually lined w/ epithelium

Wheal

“hives”

pruritic, edematous papules or plaques

central pallor w/ erythematous flare

often confluent or coalescing

excoriation

superficial injury involving disruption of epidermis

usually linear

erosion

shallow loss of epidermis

from traume or natural evolution of skin disease

ulcer

wound deeper than erosions

full thickness loss of epidermis

variable involvement of dermis, subcutaneous layer, or deeper structures

crust

superficial dried serum, blood, or pus

scale

flaking off of the stratum corneum

eschar

crust and tissue necrosis

yellow, brown, or black

component of deeper skin infection, ulcers, or toxins