DAY 1 PM

Question 1

Screening Recommendations

Answer 1

-Physical exam preformed
2 years for adolescent (12-19) and adults >60
4-6 years for adults (20-59)

Question 2

Sequence & and exam technique

Answer 2

• Head to toe
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation

Question 3

Inspection

Answer 3

Visual evaluation

• Use senses to form an opinion that will aid in decision making
• Watch everything they do, and the way they talk/behave
• ID presence of bruises, lumps, lesions/changes in skin and nail color.

Question 4

Palpation

Answer 4

• Touching or feeling with your hands
• Allows you to assess position, size and SHAPE, mobility and consistency of a body region
• May detect fluid in a space
• Uncovers organs that are enlarged or abnormal.

Question 5

Discrimination of findings

Answer 5

• Use fingertips for tactile discrimination
• Use back of hand (dorsum) to measure T
• Use palmar aspects of MCP’s or ulnar surface to detect vibration.

Question 6

Depth of palpation

Answer 6

• Light palpation: assess surface and muscle lesions
• Medium palpations: asses lesions, masses, tenderness, pulsations and pain ( press 1-2cm into the region)
• Deep palpations: assess organ (use one hand on top of the other to press 2-4cm into the region in a circular pattern)

Question 7

Percussion

Answer 7

• Striking the body surface lightly but sharply

- Determines size, position and DENSITY of the underlying structure as well as fluid or air in a cavity.

Question 8

Five percussion sounds

Answer 8

• Flat (Sternum and thigh)
• Dull (liver)
• Resonance (healthy lung)
• Hyper resonance (emphysema lung)
• Tympani (gastric air bubble)

Question 9

Auscultation

Answer 9

-Use a stethoscope to detect the body sounds created by the heart lungs, blood vessels and abdominal viscera.

Question 10

Bell of stethoscope

Answer 10

• Amplifies low pitch sounds

- Heart murmurs, arterial/venous turbulence, bruits.

Question 11

Diaphragm of stethoscope

Answer 11

• Amplify high pitch sounds

- Breath, bowel, voice and regular heart sounds. BP also*

Question 12

Hand hygiene

Answer 12

• WASH HANDS before and after
• Hand wash with plain soap and h20 or antibacterial soap
• Can use EtOH based products if hands aren’t dirty
• Change gloves in btwn procedures and tasks
• NO long nails

Question 13

General assessment

Answer 13

Quick assessment of pt appearance, behavior and mobility

Question 14

Physical parameters

Answer 14

Height: pt to stand erect without shoes against flat vertical surface 1in=2.54cm
Weight: measure weight 1lbs=2.2kg and find BMI = kg (weight) /m2 (height)

Question 15

Weight class for adults

Answer 15

40 obese 3 (morbid)

Question 16

Waist circumference

Answer 16

-Correlated with abdm fat content, risk factor for cardiac fail. place tape just above hipbone and measure just after you breathe out.
Men > 40in
Women > 35 in

Question 17

Vital signs

Answer 17

• Pulse (HR)
• BP
• RR
• Temp
• Pain*

Question 18

Temperature

Answer 18

-Regulated by the HPA
-Normal adult range is 97.5-99.0F average of 98.6F
C=5/9 x (F-32)
-Hyperpyrexia >106F
-Hypothermia <95 F

Question 19

Fever

Answer 19

• Elevation of body temp that exceeds normal daily variations
• Clinically >100.4 F
• Chills and shaking suggest bacteremia as body tries to raise the temp
• Sweating is the body’s response to lower the temp
• Ask about traveling, contacts with sick people, medications like NSAIDs and APAP (they reduce fever)

Question 20

Pulse/HR

Answer 20

• Peripheral pulses assess HR, rhythm and function
• Radial pulse most common to assess
• Adults normal HR is 60-100 bpm
• bradycardia less than 60 bpm
• tachycardia greater than 100 bpm

Question 21

Pulse rhythm

Answer 21

-Normal is steady and even
-Irregular pulses are arrhythmia
if irregular pulse is found listen to the apex of the heart for a more accurate reading with the stethoscope.

Question 22

Force or pulse

Answer 22

• Normal pulse is easily palpated and does not fade in or our
• Based on 4 point scale
  0: absent
  1: weak
  2: normal
  3: increased
  4: bounding/abnormal

Question 23

Respiratory Rate (RR)

Answer 23

• Reported as rpm (respiration per min) count number of inhalation
• Normal range 12-20 rpm
• Bradypnea < 12
• tachypnea >20

Question 24

Blood pressure

Answer 24

• Force of blood as it push against the arterial walls
• Systolic BP: max pressure felt on arteries during left ventricle contraction
• Diastolic BP: resting pressure that the blood exerts between each ventricular contraction

Question 25

Selecting the BP cuff

Answer 25

Length of inflatable bladder of cuff should be about 80% of upper arm circumference.

Question 26

Measuring BP

Answer 26

-Ask pt. and document the use of caffeine and tobacco -Pt. to sit in chair, back supported, arm bared and at heart level -Begin after 5 min of rest -Release air in cuff 2-3 mmHg per sec -First heart beat is Systolic -Point at which beat disappears is diastolic listen until 20mmHG below diastole -Record BP along with which arm used, position and size of cuff

Question 27

Korotkoff sounds

Answer 27

The five phases of BP 1. faint clear tapping (systole) 2. swooshing 3. crisp more intense tap 4. muffling 5. cessation of sounds (diastole)

Question 28

Common Errors

Answer 28

- Incorrect cuff size (small= false high, big= false low) - Arm not at heart level (below= high, above =low) - Deflation speed ( too fast= low Sys or high Dia, too slow = false high Sys)

Question 29

BP classifications

Answer 29

- Pre hypertension 120-139 / 80-89 mmHg - Stage 1 hypertension 140-159 / 90-99 - Stage 2 hypertension >160 / >100

Question 30

Orthostatic or postural blood pressure

Answer 30

- Measure BP and HR in two different positions - BP at supine position after 10 min resting then again within 3 min of standing. - Normally: Sys drops slightly or remain the same upon standing and the Dias rise slightly - Ortho. hypotension is a drop in Sys >= 20mmHg or in distole > 10mmhg