Exam 2 Study Guide Flashcards
(133 cards)
1
Q
What are the 4 quadrants (4Qs) (demonstrate where to find them)?
A
RLQ, RUQ, LUQ, LLQ
2
Q
RUQ structures (7) ?
A
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Right kidney and adrenal gland
- Hepatic flexure of colon
- Part of ascending and transverse colon
3
Q
LUQ structures (7) ?
A
- Stomach
- Spleen
- Left lobe of liver
- Body of pancreas
- Left kidney and adrenal gland
- Splenic flexure of colon
- Part of transverse and descending colon
4
Q
RLQ structures (5) ?
A
- Cecum
- Appendix
- Right ovary and tube
- Right ureter
- Right spermatic cord
5
Q
LLQ structures (5) ?
A
- Part of descending colon
- Sigmoid colon
- Left ovary and tube
- Left ureter
- Left spermatic cord
6
Q
How do we assess in the subjective assessment of the abdomen?
A
ID CC, then PQRSTU.
7
Q
What does PQRSTU stand for again?
A
P = Provocation/Palliation
Q = Quality/Quantity
R = Region/Radiation
S = Severity Scale
T – Timing
U = understanding
8
Q
Under which category do the following questions fall in the PQRSU pain assessment?:
What where you doing when the pain started? What caused it? What makes it better? Worse? What seems to trigger it? Stress? Position? Certain activities?
What relieves it? Medications, massage, heat/cold, changing position, being active, resting?
What aggravates it? Movement, bending, lying down, walking, standing?
A
P = Provocation/Palliation
9
Q
Under which category do the following questions fall in the PQRSU pain assessment?:
What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching.
A
Q = Quality/Quantity
10
Q
Under which category do the following questions fall in the PQRSU pain assessment?:
Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around? Did it start elsewhere and is now localized to one spot?
A
R = Region/Radiation
11
Q
Under which category do the following questions fall in the PQRSU pain assessment?:
How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?
A
S = Severity Scale
12
Q
Under which category do the following questions fall in the PQRSU pain assessment?:
When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you first experienced it? When do you usually experience it: daytime? night? early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?
A
T – Timing
13
Q
When are these questions asked?
Appetite?
Dysphagia?
Solids? Liquids?
Food intolerance?
Sx?
Abdominal pain?
Bowel habits?
PQRSTU if so…
A
In the subj. assessment of the abdomen
14
Q
What does N/V stand for and what are follow-up questions?
A
Nausea/vomiting.
Follow-up questions:
- Freq
- Hematemesis
- Timing
- Associated symptoms?
15
Q
Associated symptoms of N/V?
A
diarrhea, pain, fever, chills, foods in the past 24hrs
16
Q
Define reflux
A
aka GERD occurs with stomach content reflux up the esophagus
17
Q
pyrosis
A
heart burn
18
Q
In the subj. assessment of the abdomen, what ?’s do we specifically ask about bowel habits (6)?
A
- Frequency
- Color
- Consistency
- Changes
- Laxative use
- Bleeding: Melena or tarry (occult) upper GI
19
Q
melena/tarry?
A
dark stool, with or without blood
20
Q
What history is needed in the subj. assessment of the abdomen (3) ?
A
- Past Hx? (Surgeries? Other GI problems? Gall bladder disease? Ulcer? Appendicitis?)
- Family Hx? (CA, polyps, IBD, IBS)
- Medications? (Antacids (Pepto?, NSAIDS, Fe+)
21
Q
All medications have…
A
GI side effects (N/V/D)
22
Q
What are NSAIDs associated with?
A
GI bleed
23
Q
What is ETOH associated with?
A
peptic ulcer disease
24
Q
Polyps in colon can sometimes be a precursor to…
A
cancer
25
What does Fe do to stools?
turn it green, black, or hard
26
Looser stools after surgeries where part of colon is removed d/t...
reduced reabsorption time
27
What assessments may we completed during the subj. assessment of the abdomen (think intake) ?
Nutritional assessment? Tobacco? ETOH? Caffeine?
28
List factors we consider in the developmental portion of the abdomen assessment for INFANTS/CHILDREN (7)
1. Breast or formula?
2. Whole milk 1yr
3. Intro of solids
4. Constipation?
5. # stools/day (amount of liquid in diet?)
6. Overweight?
7. Pain?
29
List factors we consider in the developmental portion of the abdomen assessment for TEENS (4)
Eating patterns
Exercise pattern
Weight loss/gain
Body image
30
List factors we consider in the developmental portion of the abdomen assessment for AGING ADULT (5)
1. How do they get their food?
2. Who grocery shops?
3. Eat alone?
4. Wt changes
5. Bowel preoccupation
31
How do we prepare a patient for objective assessment of abdomen (3) ?
Lighting
Empty bladder (? Specimen)
Warm room, stethoscope & hands
32
How do we position pt for abdomen assessment?
Supine/knees bent, head on a pillow, arms at the side or on their chest. Not over their head, causes the abdominal muscles to tense
33
Why keep the knees bent during abdominal exam????
It will relax the abdomen
34
Sequence of assessment for ABD (4) ?
1. Inspect
2. *Auscultate
Then…
3. Percuss
4. Palpate
35
Why do we want to auscultate first before percussion or palpation???
Percussion and palpation will increase peristalsis which may give a false impression of bowel sounds.
36
Demeanor can be 1)_____ or 2)_____ in ABD inspection
1. relaxed
2. agitated
37
Findings after inspection of ABD contour can be either of these (5)
1. Scaphoid: concave (sunken)
2. Flat
3. Rounded
4. Protuberant: convex (bulging/stretched)
5. Distended
38
Abdominal distention can be from (7)...
obesity, air or gas, ascites (fluid in abdomen), an ovarian cyst, pregnancy, stool in the colon, or a tumor.
39
What do we inspect in the abdomen (6)
1. Symmetry
2. Pulsations
3. Bulges
4. Visible mass
5. Umbilicus
6. Skin
- lesions/rashes
- Scars
- Striae
40
Abdominal pulsations from the abdominal aorta are normal and are found between
the xiphoid and umbilicus.
41
The umbilicus should be (5)...
midline, inverted, no discoloration, inflammation, or hernia.
42
Occurs when part of the intestine protrudes through an opening or weak spot in the abdominal muscles.
umbilical hernia
43
Is a common and typically harmless condition.
umbilical hernia
44
Umbilical hernias are most common in...
... infants, but they can affect adults as well.
45
In an infant, an umbilical hernia may be especially evident when...
... the infant cries, causing the baby's belly button to protrude.
This is a classic sign of an umbilical hernia.
46
Occur when elastic fibers in the skin are broken after rapid or prolonged stretching, as in pregnancy or excessive weight gain
Straie
47
We auscultate all 4 quad and begin w/ _______ (ileocecal valve area), BS normally always here
RLQ
48
_____ sounds are air and fluid moving through the small intestine
Bowel
49
In BS we note these two
character and freq.
50
BS are classified as
normal, hypoactive, or hyperactive. Can also be borborygmus (hyperactive) or absent (hypoactive).
51
Borborygmus
stomach growling – HUNGRY
52
Causes of absent or hypoactive bowel sounds?
Peritonitis, or infection/inflammation of the peritoneum, Surgery/manipulation of the bowel/medications used during surgery and late bowel obstruction
53
Causes of hyperactive bowel sounds?
Diarrhea, laxative use, early bowel obstruction, gastroenteritis (page 561)
54
When auscultating for w=vascular sounds we use _____ of steth to listen to these (4)....
Bell.
1. aorta
2. renal
3. iliac
4. femoral
55
What is considered normal when auscultating ABD for vascular sounds?
It’s normal NOT to hear any vascular sounds.
56
What quads do we percuss in abdomen?
ALL 4 quads
57
Tympany predominates, during percussion of ABD, because...
air rises to the surface when the patient lays down.
58
Dull sounds over...
more solid organ
59
Normal Adult Liver Span: __ cm
Mean Males: __ cm
Mean Females: __cm
6-12cm
Mean Males: 10.5 cm
Mean Females: 7 cm
60
Demonstrate CVAT (2 steps). Describe findings.
To assess for costovertebral angle tenderness,
1. place one hand over the 12th rib at the costovertebral angle on the back.
2. Thump that hand with the ulnar edge of your other fist.
The person normally feels a thud, but no pain. The presence of sharp pain indicates inflammation of the kidney or the area around the kidney.
61
kidney stone
aka renal calculi, is a solid concentration or crystal aggregation formed in kidneys from dietary minerals in urine.
62
Describe Fluid wave steps (4)
1. Stand on person’s right side
2. Place ulnar edge of someone else’s hand on the abdomen in the middle
3. Place your hands on either side of the pt in the flank area
4. Press on the left flank and wait to feel it in the right hand
63
When is fluid wave test done and how can we differentiate between similar conditions?
When you suspect a patient has ascites. Because of a distended abdomen you can differentiate ascites from distention from gas or adipose tissue. You won’t feel a change if it is gas or adipose tissue, but with ascites you will feel a tap on your other hand.
64
Why might someone have ascites?
Heart failure is one reason. Some types of cancers – and pancreatitis
65
When may liver span palpation technique used?
In chronic lung disease the liver can be displaced downward by hyperinflated lungs, but the overall span will be within normal limits
66
We palpate _____ then ____ cm then ___ cm
Use ____ fingers making a gently ____ motion
Lift fingers (do not drag) ____wise around the abdomen
Use _____ surface fingers
Light then Deep 1cm then 5-8cm
Use first 4 fingers making a gently rotary motion
Lift fingers (do not drag) clockwise around the abdomen
Use palmar surface fingers
67
When do we use the duck bill palpation (and what is it) ?
AKA ballottement method is a bimanual method used to palpate kidneys, a retroperitoneal organ.
68
What technique is used to to palpate the lower margin of liver and involves:
1. Face the patient’s feet. 2. Hook your fingers over the costal margin from above.
3. Ask the person to take deep breath.
4. Feel bump against fingertips --- or NOT.
Alternative Hooking Technique
69
Which test is being described here:
“take a deep breath” Inspiration depresses liver/GB for palpation under costal margin
(+) inspiratory arrest
Murphy's sign
70
Normally, palpation of liver causes _____
However, in pt. with inflamed ______ (cholecystitis), pain occurs.
Hold fingers under _____ Ask pt. to _____
When test is _____ the descending liver pushes the inflamed gallbladder onto the examination hand, and the person feels sharp pain, and abruptly stops inspiration midway --- + inspiratory arrest
1. no pain.
2. gallbladder
3. liver border
4. take deep breath
5. positive
71
"AAA" stands for
Abdominal Aortic Aneurysm
72
Which technique is being described:
WIth index finger and thumb
If the pt has an aortic aneurism, a bruit will be auscultated,
The femoral pulses might be slightly decreased,
It will likely be below the umbilicus and it will be pulsating, and if the pt is thin enough you will be able to see it.
Pincer grasp
73
This special procedure is looking for which sign?
Should be assessed when a person reports abdominal pain and you suspect appendicitis, or when you elicit tenderness during palpation.
Rebound tenderness, also known as Blumberg’s sign.
74
This special procedure is assessing for which sign?
Choose a site away from the painful area, and hold your hand 90 degrees, or perpendicular, to the abdomen.
Push down slowly and deeply, then lift up quickly. This makes structures that are indented by palpation rebound suddenly.
A normal, or negative, response is no pain or release of pressure. This procedure should be performed at the end of the examination because it can cause severe pain or muscle rigidity.
The presence of rebound tenderness is a reliable sign of peritoneal inflammation, which accompanies appendicitis
Rebound tenderness, also known as Blumberg’s sign
75
Which sign is this special procedure assessing for?
When appy inflammation is suspected, pt has tenderness in the RLQ
Pt. supine.
Lift right leg straight up, flexing at hip.
Push down over the lower part of right thigh as person tries to hold leg up.
Abnormal – when the iliopsoas muscle is inflamed from inflamed/perforated appendix, pain is felt in the RLQ.
Normal would be the patient having no pain with this test.
Iliopsoas sign
76
Developmental consideration: growth needs is for what age group?
children
77
1.
2.
3.
must be plotted serially on a growth chart with every MD visit for chikdreb
1. Ht
2. Wt
3. Head circumference
78
where child will eat only one thing meal after meal, normal, and parents should be reassured that their children will be alright.
food jags
79
Developmental consideration: body image is for what age group?
adolescents
80
Developmental consideration: healthy habits is for what age group?
adults
81
Developmental consideration: extra caloric and nutrient needs is for what group?
pregnancy
82
Developmental consideration: health related needs, isolation, money is for what age group?
aging adult
83
This is an ex. of which type of assessment?
Individuals identified at nutritional risk on screening should undergo a comprehensive nutritional assessment
noninvasive
84
Palpating for symmetric expansion (2-steps, 1 expected result) ?
1. Place hands on posterolateral chest wall with thumbs at T9-10
2. pinch small fold of skin ask person to take deep breath
thumbs should move apart symmetrically
85
Inspection of thoracic cage: AP:transverse diameter ratio?
AP 1:2 transverse diameter
86
When palpating thoracic cage: CostoVertebral Angle (CVA) Tenderness purpose is?
Kidney issues
87
What are the 3 normal breath sounds we hear in auscultation of lungs?
1. Bronchial
- Trachea/larynx
2. Bronchovesicular
- Major bronchi
3. Vesicular
- Peripheral lung fields
(Decreased breath sounds also a possibility)
88
1. Bronchial (location)
- Trachea/larynx sounds like?
heard in the tracheal area and are loud, high-pitched sounds with a slightly longer expiration than inspiration
89
2. Bronchovesicular (location)
- Major bronchi sounds?
medium-pitched sounds and are heard in the bronchi located anteriorly (1st and 2nd intercostal space next to the sternum) and posteriorly (between the shoulder blades) on the chest. The inspiration and expiration are equal.
90
3. Vesicular (location)
- Peripheral lung fields sounds?
heard throughout the peripheral lung fields and are soft, low pitch sounds. The inspiration is slightly longer than the expiration.
91
Which sounds from lungs does this describe: Caused by moving air colliding with secretions in the tracheobronchial passageways or by popping open of previously deflated airways
Adventitious Sounds
92
What are 4 types of adventitious sounds?
1. Crackles
- Course: formerly called course rales
- Fine: formerly called rales
- Atelectatic rales
2. Pleural friction rub
3. Wheezes
4. Stridor
93
ICS
intercostal space
94
Resonance should be heard in which part of the thorax/lungs?
ICS
95
Hyper-resonance in the thorax/lungs indicates... is usual in ...?
over-inflated
usual for infant or small child
96
Hypo-resonance in the thorax/lungs indicates and is found over _____...
(aka dullness) density differences. Dull and flat over bone.
97
As we go down (in percussion) the thorax/lungs, we want to hear _____, not in the intestines though, because then we have an enlarged _____.
dullness, liver
98
In palpation of thorax/lungs, what is this called?
- (use) Palms, base fingers, ulnar edge of hands
- (instruct to say) “99” or “Blue Moon”
- Apices to bases compare bilaterally
- Vibration increases w/ compression or consolidation & decreases w/ obstruction, pleural effusion, pneumothorax, emphysema
tactile fremitus
99
(Subj. data of thorax/lungs)Is the sensation of breathlessness in the recumbent position, relieved by sitting or standing
orthopnea
100
(Subj. data of thorax/lungs) Is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
Paroxysmal nocturnal dyspnea (PND)
101
Subj. data of thorax/lungs: SOB can be caused by...
allergens, exercise tol, apnea, orthopnea, PND
102
Thorax/lung auscultation: Broncophany, egophony, and whispered pectoriloquy are examples of....
voice sounds
103
__________ is a voice sound test where you have the pt repeat “99”; normal is soft, muffled, and indistinct; you can hear sound, but not exactly what is being said; diseases that increase density will enhance transmission
broncophony
104
__________ is a voice sound test where you have the pt repeat “ee-ee-ee”; normally you should hear “ee-ee-ee”, if listening over consolidation or compression you will hear “aaaaa” sound
egophony
105
__________ is a voice sound test where you have the pt whisper “1, 2, 3”; normal is faint, muffled, and almost inaudible; with consolidation the whispered voice is transmitted very clearly
Whispered pectoriloquy
106
Subj data on cough includes (3):
description, sputum, and timing
107
Sputum descriptors (5):
1. Clear
2. Rust (TB/Klebsiella)
3. Yellow/green (Bact./pseudomonas)
4. Pink frothy (PE)
5. Hemoptysis
108
Rusty sputum can indicate...
TB/Klebsiella
109
Yellow/green sputum indicates...
Bact./pseudomonas
110
Pink/frothy sputum indicates...
pulmonary embolism (PE)
111
Developmental considerations of thorax/lung belong to which group: Wider thorax, deeper respirations
pregnant women
112
Developmental considerations of thorax/lung belong to which age group:
Barrel chest
Kyphosis
Rigid thorax
Decreased elasticity lungs
Decreased chest expansion
May become dizzy taking deep breaths during auscultation
elderly
113
Chronic obstructive pulmonary disease
is obstruction of airflow
114
In which pulmonary condition would you find the following:
Wheezing, barrel chest, decreased breath sounds, accessory muscle use, clubbing, paradoxical pulse
COPD, where air flow is obstructed
115
Which respiratory condition is this: Collapsed shrunken section of alveoli or an entire lung as a result of (1) airway obstruction (e.g., the bronchus is completely blocked by thick exudate, aspirated foreign body, or tumor); the alveolar air beyond the obstruction is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in); (2) compression on the lung; and (3) lack of surfactant (hyaline membrane disease).
Atelectasis
116
In which pulmonary condition would you find this: Fever, crackles, increased fremitus, bronchophony
Chronic pneumonia
117
Name this respiratory condition, list inspection findings : An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus. These factors greatly increase airway resistance, especially during expiration, and produce the wheezing, dyspnea, and chest tightness.
Asthma
During severe attack: increased respiratory rate, SOB with audible wheeze, use of accessory neck muscles, cyanosis, apprehension, retraction of intercostal spaces. Expiration labored, prolonged. When chronic, may have barrel chest.
118
Name this condition, list inspection findings: Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present; thus lung collapses. Usually unilateral. Pneumothorax can be (1) spontaneous (air enters pleural space through rupture in lung wall, (2) traumatic (air enters through opening or injury in chest wall), or (3) tension (trapped air in pleural space increases, compressing lung and shifting mediastinum to the unaffected side).
Pneumothroax
Inspection: Unequal chest expansion. If large, tachypnea, cyanosis, apprehension, bulging in interspaces.
119
Name this condition, list inspection findings: Inhalation of tubercle bacilli into the alveolar wall starts: (1) Initial complex is acute inflammatory response—macrophages engulf bacilli but do not kill them. Tubercle forms around bacilli. (2) Scar tissue forms; lesion calcifies and shows on xray. (3) Reactivation of previously healed lesion. Dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue (cheeselike). (4) Extensive destruction as lesion erodes into bronchus, forming air-filled cavity. Apex usually has the most damage.
Tuberculosis
Subjective Initially asymptomatic, showing as positive skin test or on x-ray study. Progressive TB involves weight loss, anorexia, easy fatigability, low-grade afternoon fevers, night sweats. May have pleural effusion, recurrent lower respiratory infections.
Inspection Cough initially nonproductive, later productive of purulent, yellow-green sputum; may be blood tinged. Dyspnea, orthopnea, fatigue, weakness
120
Name this condition, list inspection findings: Undissolved materials (e.g., thrombus or air bubbles, fat globules) originating in legs or pelvis detach and travel through venous system, returning blood to right heart, and lodge to occlude pulmonary vessels. Over 95% arise from deep vein thrombi in lower legs as a result of stasis of blood, vessel injury, or hypercoagulability. Pulmonary occlusion results in ischemia of downstream lung tissue, increased pulmonary artery pressure, decreased cardiac output, and hypoxia. Rarely, a saddle embolus in bifurcation of pulmonary arteries leads to sudden death from hypoxia. More often small-to-medium pulmonary branches occlude, leading to dyspnea. These may resolve by fibrolytic activity.
Pulmonary Embolism
Subjective Chest pain, worse on deep inspiration, dyspnea.
Inspection Apprehensive, restless, anxiety, mental status changes, cyanosis, tachypnea, cough, hemoptysis, PaO2 <80% on pulse oximetry. Arterial blood gases show respiratory alkalosis
121
Which respiratory condition is this: Infection in lung parenchyma leaves alveolar membrane edematous and porous; thus red blood cells (RBCs) and white blood cells (WBCs) pass from blood to alveoli. Alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris, fluid, and blood cells, which replace alveolar air. This decreases surface area of the respiratory membrane, causing hypoxemia.
Lobar Pneumonia
(Hx; Fever, cough with pleuritic chest pain, bloodtinged sputum, chills, SOB, fatigue.)
122
Name this condition, list inspection findings: Pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs deflated. Pulmonary capillaries engorged. Bronchial mucosa may be swollen.
Heart failure
Increased respiratory rate, SOB on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, pallor in light-skinned people.
123
What do we inspect for in the lower extremities (4; CV-related)?
1. Sores or lesions
2. Edema
- Measure bilat
3. Color
- Pallor
- Rubor
- Cyanosis
- Brawny (V. stasis)
4. Varicosities
124
Which heart sound is this:
Close of AV valves
Begin systole
Loudest apex
S1 (1st heart sound)
125
Which heart sound is this:
Close semilunar valves
End systole
Loudest base
S2 (2nd heart sound)
126
Which heart sound is this: Vibration d/t rapid ventricular filling
- Occurs after S2 d/t vol. overload
- “Kentucky”
- Low pitch
- 1st sx CHF?
S3
127
Which heart sound is this:
- Atria contract & push blood into non-compliant ventricle
- Occurs presystole (before S1)
- “Tennessee”
- Low pitch/apex
- AMI?
S4
128
When is S3 normal and what ages do they affect?
A physiologic S3 is heard frequently in children and young adults, and may occasionally persist after age 40, especially in women. The normal S3 normally disappears when the person sits up.
129
When is S3 considered pathologic (2 conditions)?
A pathologic S3 is also called a ventricular gallop or an S3 gallop, and it persists when sitting up. In adults, it is usually abnormal. The S3 indicates decreased compliance of the ventricles, as in heart failure, and may be the earliest sign of this condition. The S3 also occurs with conditions of volume overload, such as mitral regurgitation, and in conditions of high cardiac output, such as anemia, pregnancy, hyperthyroidism. In these cases, when the primary condition is corrected, the S3 disappears.
130
Lub dub dub extra __ volume overload, may be indicative of a problem, sometimes may fade with time
s3
131
The S4 (fourth heart sound) occurs ...... It is also called ........, and occurs with ......
at the end of diastole, when the ventricle is resistant to filling
an atrial gallop
coronary artery disease (CAD).
132
The atria contract and push blood into a noncompliant ventricle. This creates vibrations that are heard as __ The sound occurs just before __
S4.
S1.
133
To auscultate for the __ sound, listen to all auscultatory areas with both the diaphragm and the bell. If an extra sound is noted, listen carefully to note its timing and characteristics.
S4
