RTH 120 Patient Assessment - Chapter 5 (unit 2)

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The core physical examination techniques are:
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Terms in this set (102)
The core physical examination techniques are:
inspection, palpation, percussion, and auscultation
Physical assessment should include review of the patient's:
- general appearance
- level of consciousness
- and assessment of oxygenation and perfusion.
Chest inspection should include:
- ventilatory pattern
- use of accessory muscles
- chest excursion
- and observation of the right to left chest wall motion and chest-abdominal synchrony
__________ should include noting aeration and any adventitious (i.e., abnormal) breath sounds.
Assessment of breath sounds
Bedside measurement ____________ should be assessed.
of pulse and respirations should be performed and blood pressure
Temperature should be taken to assess for the presence of _________.
hyperthermia or hypothermia
Building a _________ with the patient is important.
trust and rapport
A _________ approach that reduces multiple movement changes is preferred.
systematic
______________ should be taken into consideration when completing a physical exam.
Clinician ergonomics
Before leaving the room, the clinician should ask _____________ .
if the patient has any questions or needs any assistance
Order of the Physical Examination (Head)- Eyes: Examine the conjunctiva, sclera, cornea, and iris of each eye. Test pupils for irregularity, accommodation, and reaction. Evaluate visual fields and visual acuity (cranial nerve II). Assess extraocular movements (cranial nerves III, IV, VI). Test the corneal reflex (cranial nerve V). - Ears: Examine the pinnae and periauricular tissues, Test auditory acuity, - Nose: Connect the nasal speculum to the otoscope and examine the nares, noting the condition of the mucosa, septum and turbinates. - Mouth: Examine the vermilion border, the oral mucosa, the tongue. Identify the salivary duct papillae. Assess the dentition for decay, repair, condition of bite. View the pharynx. Evaluate the function of cranial nerves IX, X, and XII. If appropriate, evaluate sensory divisions of cranial nerves V, VII. - Face: Evaluation of symmetry, smile, frown, and jaw movement will provide information about motor divisions of cranial nerves V and VII.Order of the Physical Examination (Neck) Palpate the neck with emphasis on the salivary glands, lymph nodes, and thyroid. Look for ___________. Identify the carotid arteries and auscultate for bruits. Note _________________. Certain parts of evaluation of this area, jugular venous filling, may warrant review with the patient reclining. Test shoulder strength of the sternocleidomastoid and trapezius muscles (cranial nerves XI and XII).tracheal deviation; jugular venous distentionOrder of the Physical Examination (With the patient supine)Thorax: Reexamine the heart, turning the patient to the left lateral decubitus position if appropriate. Auscultate: Examine the anterior lung structures. Abdomen: After inspection, auscultate, listening for bowel sounds and bruits. Next inspect, percuss, and palpate the abdomen, taking special notice of hepatic or splenic enlargements.The vital signs are ____________ .pulse, respirations, blood pressure, and temperatureVital Signs Monitoring trends in vital signs can indicate if the patient is getting better or worse.Observing changes over time, especially as compared to "baseline" values when the patient is in his or her normal state of health, can be particularly important.A normal adult resting heart rate (HR) is between:60 and 100 beats per minute (bpm)Heart rate tends to ________ with age in adults.increaseIn infants and young children, heart rate __________ with age.declinesTachycardiaA rapid heart rate, more than 100 beats/min.Bradycardiaslow heart rate (less than 60 bpm)If the pulse is irregular, the heart rate should be counted for __________.a full minuteWith exercise, the predicted maximum HR in adults can be estimated as:HR max = 220 - Age in yearsFactors that elevate or increase heart rate:- Anxiety and fear - Body temperatureTachycardia is associated with many:pathological conditionsCertain _______ may elevate HR to the point of tachycardiadrugsAsymptomatic bradycardia requiresprompt evaluationSymptomatic bradycardia may requireemergent interventionA healthy full-term newborn may have a respiratory rate of40 breaths per minuteIn adults, a respiratory rate of > 20 breaths per minute is described astachypneaTachypnea is a normal physiologic response tohypoxemiaIt is important to distinguish between tachynpnea, hyperventilation, and _________.hypoventilation__________ is a level of alveolar ventilation that results in a Paco2 < 35 mm Hg.Hyperventilation___________ is a level of ventilation that results in a Paco2 > 45 mm Hg.Hypoventilation________ and ________ are two different conditions that may or may not occur together.Tachypnea; hyperventilationMany patients with _______ exhibit tachypnea and alveolar hypoventilation at the same time.ventilatory failureMany patients with acute respiratory failure experience a decline in ____________ due to pulmonary disease.lung complianceLungs become more difficult to inflate and the work of breathing is increased. This often results in a:reduction in inspired tidal volumeA normal minute volume ( V E) is respiratory rate (f) multiplied by tidal volume (VT):V E = f X VT_________ is the volume of gas in the conducting airways plus any alveoli that are ventilated but not perfused.Deadspace_______ is defined as a low respiratory rate of < 12 breaths per minute in adults.BradypneaThere are several arterial pressure measurements of interest:- Systolic arterial pressure - Diastolic pressure - Pulse pressure - Mean arterial pressure (MAP)Systolic arterial pressureThe peak pressure within the artery during left ventricular contraction (systole).Diastolic pressureThe lowest pressure within the artery during left ventricular filling (diastole).Pulse pressureSystolic pressure minus diastolic pressure.Mean arterial pressure (MAP)The mean pressure within the artery.At the bedside, blood pressure can be measured with _____________ of an artery.cannulationIn most patients, a __________ is utilized along with a stethoscope or Doppler device.sphygmomanometerSystemic hypertension in adults is a sustained systolic pressure of ≥ ___ mm Hg or a sustained diastolic pressure of ≥ ___ mm Hg.140; 90Significant number of patients are thought to have "____________" hypertension.white coat"white coat" hypertensionBlood pressure is normal at home or work, but is elevated when measured in the clinic setting._____________ and hypertensive encephalopathy are life- threatening conditions associated with very high arterial blood pressures, usually ≥ 180/120 mm Hg.Malignant hypertension___________ is a sustained arterial blood pressure of less than 90 mm Hg over 60 mm Hg (systolic over diastolic).HypotensionTypes of shock include:- Cardiogenic shock - Hypovolemic shockCardiogenic shockcaused by low cardiac outputHypovolemic shockcaused by inadequate intravascular volume due to blood or fluid loss_________ is usually measured orally, rectally, or using an infrared sensor for tympanic (ear) measurement.TemperatureThe average oral temperature in healthy individuals is approximately:37° C or 98.6° FRectal temperatures are about 1.0° F (or 0.6° C) higher than ___________, whereas axillary temperature in adults is about 1.0° F (0.5° C) less than __________.oral temperatures; oral temperature_______ is an abnormally elevated body temperature due to disease that affects hypothalamic set point.FeverA fever typically indicates _________ is present in the body.infectionFUOfever of unknown originFor each ___ degree increase in temperature above 37° C, there is a ___% increase on oxygen consumption, and this may further impair oxygenation in the presence of cardiac or pulmonary disease.1; 13Hyperthermia (as opposed to fever) is:an elevated temperature due to excessive heat production or inadequate heat dissipation.Heat exhaustion (aka heat prostration) may occur:following exertion in a hot humid environment resulting in fluid loss and electrolyte disturbances.Heat exhaustion may lead to:heat strokeBody temperature normally ________ at night.decreasesCachexia:Patients with prolonged illnesses may have severe weight loss and muscle wasting.__________ refers to cyanosis of the oral mucosa or trunk.Central cyanosis__________ is observed in the hands, fingertips, and nail beds of the hands and feet.Peripheral cyanosisThe assessment of a patient's mental status should begin with __________ (the sensory components of the brain and nervous system), level of consciousness (LOC), and orientation.sensoriumTerms that are often used to describe levels of consciousness:- Confused - Delirious - Lethargic - Obtunded - Stuporous - Semi-coma - ComatoseScales and scoring systems to quantify level of consciousness or levels of sedation:Glasgow Coma Scale Ramsay Sedation Scale Richmond Agitation Sedation ScaleMental Status Examination should include:- Appearance - Attitude - Body Language and Eye Contact - Level of Consciousness - Orientation - Motor Behavior - Speech and Language - Mood and Affect - Thought Process and Content - PerceptionOrientation: four aspects to patient orientation include:person, place, time, and situationWhat does HEENT stand for?head, eyes, ears, nose, and throatDuring a HEENT examination, the patients facial expression can revealdistress or pain, alertness, mood, and mental statusDuring a HEENT examination, nasal flaring suggestsan increased work of breathingCyanosis is often most apparent in thelips, gums, and oral mucosaMouth breathing may indicate nasal passage:obstruction or respiratory distressPursed-lip breathing during exhalation is sometimes seen in patients withCOPDDuring an inspection of the chest, the term barrel chest refers tothe dramatic increase in the AP dimension of the chest in some COPD patientsWhat is pulsus paradoxusdecrease in force (not rate) (of a pulse), almost to the point of disappearance during inspiration (only).Why is pulsus paradoxus significant?it is significant if inspiratory blood pressure (systolic) falls more than 20 mmHg on inspirationWhat are some illnesses that have been associated with pulsus paradoxus?hypvolemic shock, heart failure, increase venous return on inspiration, severe emphysema, and asthmaTracheal breath soundsare heard over the trachea and are loud and acoustic high in pitchBronchial breath soundsare loud, coarse sounds normally heard over the large Central airwaysBronchovesicular breath soundsare a combination of bronchial and vesicular sounds and maybe heard between the scapula and around the sternum over the medium sized airwaysVesicular breath soundsare heard over the remaining aspects of the chest and are soft in intensity and low in pitchWhat does adventitious mean?abnormalWhat are adventitious breath sounds?are abnormal and may indicate problems in the long parenchyma and/or the airwayDiminished breath soundsare associated with hypopnea or with an increase in the air-to-tissue ratio in the lungWhat are continuous sounds and are associated with narrowing of the airway?wheezing and stridorWhat is stridor a sign of?upper airway obstruction that is loud and high in pitchWhat are crackles?discontinuous sounds associated with the sudden opening of small airways and alveoli during inspiration. - are described as fine or coarseRhonchilow pitched gurgling sounds associated with secretions in a larger airwayPleural friction rubis thought to be caused by the rubbing together of inflamed pleura as the lung expands and contracts during breathingAbsent breath soundsindicate an absence of air flow that may occur with atelectasis, pneumothorax, or consolidationDiminished breath soundsare often heard over a pleural effusion or with severe COPDWhat is PMI?point of maximum impulse, pulsation that is commonly assessed is the apical impulseClubbingis characterized by a bulbous swelling of the distal phalanges of the fingers and toes caused by proliferation of the connective tissue between the nail matrix and the distal phalanxClubbing may or may not be associated with ________ and _________ alone does not lead to clubbing.cyanosis COPDPutting it all together, the respiratory care clinician must be able to correlate what three things to create a differential list and working diagnosis?- the patient's history - physical examination - diagnostic test results