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Chapter 2 – The Physical Examination
Chapter 2 – The Physical Examination
Vital Signs Overview
Four primary vital signs:
Body Temperature (T), Pulse (P), Respiration (R), Blood Pressure (BP)
Pulse oximetry (SpO₂) = “fifth” vital sign
Body Temperature
Core set-point ≈ 37^{\circ}\text{C} ( 98.6^{\circ}\text{F} ); normal daily swing ±0.5^{\circ}\text{C}
↑T → vasodilation | ↓T → vasoconstriction
Fever & Hypothermia
Fever patterns: intermittent, remittent, relapsing, constant
Hypothermia = core T below normal; major causes: excessive heat loss, poor heat production, hypothalamic failure
Key hypothermia signs: ↓P & ↓R, shivering, pale/blue cool skin, hypotension, oliguria, ataxia → coma
Immediate care: remove wet clothes, passive/active re-warming, warmed fluids
Factors & Measurement of Temperature
Influencers: age, environment, circadian cycle, exercise, stress, hormones
Common sites: oral, rectal, tympanic, axillary (others: esophageal, pulmonary artery)
Reliability = correct device + site + technique
Pulse
Generated each ventricular contraction
Adult ranges: bradycardia < 60\,\text{bpm} | tachycardia > 100\,\text{bpm}
Assess: rate, rhythm (regular/irregular), strength (strong, weak, thready, bounding)
Respiration Basics
Diaphragm = primary muscle; inspiration active, expiration passive
Normal adult rate 12!–!20\,\text{breaths·min}^{-1}
Common Breathing Patterns
Eupnea: normal ( 12!–!20 )
Bradypnea: <12
Tachypnea: >20
Apnea: absent breathing → arrest
Hypoventilation: ↓rate & depth → ↑PaCO₂
Hyperventilation: ↑rate & depth → ↓PaCO₂
Cheyne–Stokes: crescendo–decrescendo with apnea
Kussmaul: deep, rapid (metabolic acidosis)
Biot: clusters of rapid breaths with pauses
Blood Pressure Fundamentals
Arterial BP = force of blood on arterial walls
• Systolic / Diastolic
• BP = V \times R (flow × resistance)
Blood flow = cardiac output: CO = SV \times HR (≈ 5\,\text{L·min}^{-1})
Abnormalities:
• Hypertension (primary/secondary) • Hypotension
Oxygen Saturation (SpO₂)
Normal 95!–!99\%
Mild 91!–!94\% | Moderate 86!–!90\% | Severe ≤85\%
Remember O₂-Hb dissociation: PaO₂ = 60\,\text{mmHg} \Rightarrow SpO₂ \approx 90\%
Signs of Inadequate Oxygenation
CNS: apprehension → confusion → coma
Respiratory: tachypnea → accessory use, retractions, word-by-word speech
Cardiovascular: tachycardia/HTN → arrhythmias → hypotension, cyanosis, cool clammy skin
Other: diaphoresis, ↓urine output, fatigue
Chest & Lung Examination Sequence
Inspection
Palpation
Percussion
Auscultation
Palpation Highlights
Evaluate chest expansion symmetry (thumbs at T8!–!T10)
Check tracheal position, tenderness, masses, temperature
Fremitus:
• Tactile: vibration from air through secretions
• Vocal: vibration during phonation
Percussion Essentials
Determines underlying air/liquid/solid, size & borders
Dull note: pleural effusion, consolidation, atelectasis
Hyperresonant: COPD, pneumothorax, asthma
Limited diaphragmatic excursion: hyperinflation, lobar collapse, neuromuscular disease
Auscultation & Breath Sounds
Normal: bronchial, bronchovesicular, vesicular
Abnormal (record pitch, loudness, phase, quantity, location):
• Fine/medium/coarse crackles • Wheezes • Stridor • Pleural friction rub • Diminished • Bronchial in wrong area • Whispering pectoriloquy
Avoid obsolete terms: rales, rhonchi, etc.
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Explore Top Notes
AP PSYCH - Module 12- 15
Note
Studied by 63 people
4.5
(2)
AP US History: Period 4
Note
Studied by 261 people
5.0
(1)
Ch 4 - Demand and Supply: The Basics
Note
Studied by 14 people
5.0
(1)
Renin Angiotensin Aldosterone System (RAAS)
Note
Studied by 2 people
5.0
(1)
Chapter 2: Is it Relevant? Adding, Deleting & Revising
Note
Studied by 418 people
5.0
(6)
Organization - Transition Words and Phrases
Note
Studied by 10 people
5.0
(1)