Physical Assessment

• Physical Assessment

-Is an organized systematic process of collecting _______________ data based up healthy history ?

-Is health history objective or subjective ?

-Objective

-subjective

• What does Health History consist of ?

>__________ & _________

>History of ___________ illness

>____________ History

>___________ compliant

>__________ History

>Review of systems ?

-What is the difference between history of present illness & chief complaint ?

-name & DOB

-present

-Family

-Chief

-Past

-History of present illness is what leads up to the present problem ← aka chief complaint

• Typical Order of a Physical Assessment

a.) _______________ ?

b.) ________________ , Ex: you have a respiratory pt and your looking at the chest area, what are you feeling for in doing this step ?

c.) _________________ ; this is done so by tapping body w/fingers and what are you listening for during this step ?

d.) ___________________ ; there is direct and indirect , what’s the difference ?

-Inspection

-Palpating , lumps/pain/tenderness

-Percussion , hollowness/air filled/solid mass

-Auscultation , direct: listening / indirect: stethoscope

• Types of Assessment

-Comprehensive : ______________ + __________________ examination ?

-Focused : focus on the _________ problem and its used for ___________ problems ?

-Systems specific : limited to one ______________________________ ?

-Ongoing : performed as needed to asses ___________ and evaluates pt _______________ ?

-interview , head -to-toe

-main , urgent

-body system (Ex: GI , cardiac , lungs, neuro)

-status , outcomes

-A general survey assessment is an assessment of the pt and their _________________ as a whole ? >Examples : do they have _____________ or _______ running , _______________ ?

-What’s a normal oxygen saturation ?

-surrounding

-IV lines , O2 , catheter etc.

-95-100

• Vital Signs / Pain Score / IV Site

-IV needle sizes :

>The bigger the # = ______________ needle ?

>The smaller the # = _____________ the gauge ?

-smaller

-bigger

• Skin - Integumentary

-What is mottled skin ?

-If I have skin that is tenting , then that means that their is lack of ______________ or they are __________ ?

-We measure skin/lesions via ?

-When pt has clubbing nails, then that indicates they have _____________ , meaning they have low ______ ? What type of conditions could pts have that also portrays this ?

-purple/blotchy skin

-hydration , elderly

-cm (peace sign = 5-6 cm)

-hypoxia , O2 , COPD, Emphysema

• Head & Neck (HHENT)

-What does PERRLA stand for ?

-What can you determine looking at a pts ear symmetry ?

-Which way should you pull the helix of an adults ear to use the Otoscope ?

-Which way should you pull the helix of a child ?

-Pupils , Equal , Round , Reactive (to) , Light , & Accommodation (near & distant objects)

-if they have any neurological conditions (Ex: down syndrome children have low set ears)

-Pull helix up & back

-down & back

• Upper Extremities

-How do you test for hand grip ?

-When feeling for pulse strength, we have to document what ?

—Pulse on Scale

>0= no pulse

>1+ = ______________

>2+ = _______________

>3+ = ___________

>4+= ________________ ?

-crossing fingers & have pt pull on fingers

-amplitude

-diminished

-normal

-full

-bounding

-How do you test for capillary refill ?

-Where is a good place to check for edema ?

-press down on your finger nail & release and see how many sec it takes for it to return (normal = <2 secs)

-shin bone

• Respiratory

-When listening to respiratory system, we are listening _______________ & __________________ and on direct _________ ?

>Crackles : small ______________ , ______________ , or ______________ sounds in the lungs and are heard during __________________ ?

>Ronchi : resembles ______________ , occurs when airway is ______________ or airflow becomes ___________ ?

>Stridor : ___________ like sound due to blockage of airflow in ______________ or back of ____________ ?

>Wheezing : _________ pitched sounds due to _______________ airways ?

-anteriorly & posteriorly , skin

-clicking , bubbling , rattling , inspiration

-snoring , blocked , rough

-wheeze , trachea , throat (barely air = emergency)

-high , narrowed (still moving air)

• Chest Expansion

-Elliptical chest : is the ____________ chest shape , meaning my AP dm should be __________ the distance of my transverse ?

-Barrel chest : AP dm is __________ to transverse dm, usually in pts w/ ___________ ?

-Funnel chest : is chest ___________ in ? What is a potential prob ?

-normal , half

-equal , COPD

-caved , displaced heart

-Laborious breathing is when pt has to utilize ____________________________ ?

• Lung Sound Locations

>Over the neck (tracheal ) , you’ll hear _______________ sounds , which are ________________ or _____________ sounds ?

>Where would you hear your bronchial vesicular (BV) sounds , and how do they sound like ?

>Where would you hear your vesicular sounds and how do they sound like ?

-excessive muscles

-bronchial , blowing , hollow

-upper lungs mainstem bronchus & between scapula , and they sound like moderate blowing

-low pitch sound at lung bases & apices (loudest during inspiration)

• Remember Landmarks

>Don’t forget Xiphoid process & Costal margin

https://quizlet.com/514994654/surface-anatomy-thorax-diagram/?i=2mj9r3&x=1jqt

• Cardiovascular

-Where can I find the PMI on chest ?

-What are heaves/lifts in regards to the heart ?

-When palpating the chest and you feel a thrill, what is that ? Do you feel or hear a thrill ?

-Do you see or hear a bruit (turbulent blood flow) ?

-left midclavicular line , 5th intercostal

-abnormal large heart beats

-abnormal turbulent blood flow , feel

-hear

• 5 Areas for listening to the Heart

>Mnemonic :

-Amigos :

-Pon :

-Energia en :

-Tus :

-Metas :

-Universitarias

-Aortic (right 2nd intercostal space)

-Pulmonic (left 2nd intercostal space)

-ERB’S Point : (S1 , S2) & (left 3rd intercostal space)

-Tricuspid (lower left sternal border 4th intercostal)

-Mitral (left 5th intercostal , medial to midclavicular line)

-Umbilical (turbulent blood flow)

• Questions

-Where would you locate the pts apical pulse ?

-How do we describe a difference between the radial & apical pulse ?

-How do we described a pulse that easy to palpate ?

-How do we describe a pulse that is hard to palpate ?

-5th intercostal space, midclavicular line

-by pulse deficit (think cardiac output)

-strong or full

-weak or thready

-What does RRR stand for ?

-What is S1 & S2 ?

-What is pulse amplitude ?

-regular , rate & rhythm

-S1 = closure of atrioventricular (mitral/tricuspid) valves (LUB) / S2 = closure of semilunar (aortic/pulmonary) valves (DUB)

-describe on scale of 0-4 , 2+ (easy/normal)

• Abdomen

>Order

1.) ______________

2.) ____________ (aka ________________)

3.) ___________ ?

-Inspect

-Listen (aka Ausculate)

-Touch

• Bowel Sounds

-Listen w/ ________________ ?

>Normoactive : __________ bowl sounds / min (2q5 secs) ?

>Hypoactive : less than _____ bowel sounds/min ?

>Hyperactive : more than _______ bowel sounds /min ?

>Borborygmi : ______________ noise ?

-diaphragm

-5-30

-5

-30

-growling (think chorro)

• GI & GU Status

-What is thickening ?

-What is BRP ?

-its a consistency added to liquids to make it yogurt like

-bathroom privileges

-How do you assess for paralysis & sensation ?

-pt closes eyes , and we use a cotton ball to touch their face and pt lets us know if they felt it

-What does ADL stand for ?

-Test for balance : _______________ test , has to do w/ ___________________ ?

-Coordination can be tested by ?

-What are you looking for during the Adam’s forward bend test ?

-Activities of daily living

-Romberg’s , proprioception (where your body is in the world )

-finger thumb opposition

-scoliosis or Kyphosis

• 12 Cranial Nerves

l: Olfactory nerve

ll : Optic nerve

lll : Oculomotor nerve

lV : Trochlear nerve

V : Trigeminal nerve

l: smell

ll: vision

lll : eye movement , pupil constriction

lV : eye movement

V : somatosensory info (touch/pain) , from face & head , muscles for chewing

Vl : Abducens nerve

Vll : Facial nerve

Vlll : Vestibulocochlear nerve

lX : Glossopharyngeal nerve

X : Vagus nerve

Xl : Accessory nerve

Xll : Hypoglossal nerve

Vl : eye movement

Vll : taste (anterior 2/3 tongue) , somatosensory from ear , muscles for expressions

Vlll : hearing , balance

lX : taste (1/3 posterior) , somatosensory from tongue , tonsil , pharynx , swallowing muscles

X : sensory , motor , autonomic functions of viscera (glands, digest , heart rate)

Xl :muscles for head movement

Xll : controls tongue muscles

• Spices Assessment for older adults

S : ___________ probs

P : probs w/ ___________ & _____________

I : _____________________

C : __________________

E : Evidence of _________

S : __________ breakdown ?

-sleep

-eating & feeding

-incontinence

-confusion

-falls

-skin