Week 8 2nd assess Flashcards
(149 cards)
1
Q
2nd assessment=
Consists of:
A
=more through examination→ objective & measurable (quantifiable) info is taken→ vitals, SAMPLE,
= head-toe exam & completing vitals signs
Not every PT has everything in 2nd assess/
2
Q
Assessment 4 techniques:
A
1st visual, 2nd palpation, 3rd percussion, 4th auscultation
3
Q
Frail:
Feeble:
Robust:
Vigorous:
A
= Sick
= lack of strength
= energetic
= VERY energetic
4
Q
Identifying Odors:
A
Ammonia, fruity breath, bitter almond breath, BO, fishy vagina, fecal breath,
5
Q
Ventilations Qs?:
A
Rate, Quality, Pattern, IE 1:2, Positioning/ Accessory M. use?
6
Q
systemic vascular resistance SVR:
A
how much of vessels constriction dilation
7
Q
BP=
Top #=
bottom#=
A
SVR x (SV x HR)
= Systolic pressure = squeeze
=Diastolic = diastolic relax
8
Q
BP sounds= Korotkoff 5 sounds= 1st sound
2nd sound=
3rd sound=
4th sound=
5th sound=
A
= snapping
= swooshing
= tapping
= thumping (muffling)
= silence
9
Q
BGL treatment range:
A
<70 hypo treat w/ sugar & >300 hyper treating w/ fluid
10
Q
GCS:
A
E4, M5 (orient, confused, words, sounds, none), S6 (obey, local/withdraw, normal flex, abnorm flex decorb, exten/ decer, none)
11
Q
Skin function:
A
transmit info, reg/s temp, protect (Burns cant control temp)
12
Q
Pupils sizing range:
A
= 2-4mm bright & 4-8 dim (dilated side w/ anisoria side w/ trauma)
13
Q
Anisocoria:
heterochromia:
A
=unequal pupils greater than 1mm
=dif/ pupil colors
14
Q
Pupils: Direct response:
Indirect response:
Accommodation:
Ocular motor movement:
A
= same pupil in light responds
= pupil opposite of light responds
= eyes cross when finger to nose
= eye movement in “H”
15
Q
Ear (middle) bones:
A
=stapes, incus, malleolus
16
Q
Neck examine:
A
=Kussmaul sign from pericardial sac filled w/ pus
Auscultate for bruits= swoosh = build up= atherosclerosis
Art/ harding& constricting of vessels & arth=build up of vessels
ROM range of motion
17
Q
Chest 3 phases: phase 1:
phase 2:
phase 3:
A
=Chest wall:
=Pulmonic: bronchial, tracheal, bronchovesicular (rhonci), vesicular
=Cardiac: S3: CHF maybe, S4: in CHF (Aortic, Pulmonic, Erb’s point (3rd ICS), Tricuspid)
18
Q
Hamman’s Crunch:
A
=dive injury crunch in heart sounds (air in media stynium ) (pneumo air to heart) can happing from blowing balloons (boyle law)
19
Q
ABDMN examine:
A
Scaphoid abdomen, hemoptysis, hematochezia, Murphy’s sing, McBurny’s point, Aaron’s signs, Rovsing’s sign, Psoas sign
20
Q
!!! Murphy’s signs:
A
= Suspected gall bladder infection→ cupping under rib w/ pressure with breath causing pain
21
Q
!!! McBurny’s point:
A
= RLQ pain w/ rebound tenderness ⅔ of way from umbilicus to illicac
22
Q
Aaroon’s sign:
A
= Epigastric pain during palpation to McBurney’s point
23
Q
Rovsing’s sign:
A
= RLQ pain w/ palpation to LLQ
24
Q
Psoas sing:
A
=Pain to RLQ when patient tries to reaise R leg against resistance
25
Back: Lordosis:
Scoliosis:
Kyphosis:
=swayback
=Lateral curve
=humpback
26
Sniffing position:
=pillow under head ear aligned with sternum (called sniffing bc/ way head recoils when you shift)
27
Ramped position:
for obese PTs, prepare a proper ramp (head and shoulder support) before transferring them to the ambulance.
28
BP width:
= 40-50% of mid-arm circumference
29
BP length:
= Should cover between 80-100% of arm circumference
30
BP Overall cuff size:
= cover 2/3s of distance of the upper arm (measured from acromion to olecranon)
31
Neck emamine:
= Kussmaul's sing, JVD, Trachea deviation, Bruits, ROM
32
Bristol stool chart:
= type 4 healthy type, 1 hard deer pebbles, type 8 liquid
33
3 types of abdomen pain:
= Visceral: (dull) distension, ischemia, inflammation
Referred: kehrs should pain w/ abdomen b/c phriadam nerve
= Somatic> (sharp pinpoint) appendinixsitis
34
Extrems: edema:
Poor perfusion: pitting edema +1 ¼ inch, +2 ½ inch, 3 ½ -1inch, 4
35
CN 1:
Olefactory = smell
36
CN 2
Optic= Vision (senses light)
37
CN 3
Oculomotor = pupil m-vt (controls size of pupil)
38
CN 4
Trochlear = eye motor function (look up & down)
39
CN 5
=trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin)
40
CN 6
abducens= Lateral Eye m-vt
41
CN 7
facial= sense tongue & motor eyebrows expression
42
CN 8
vestibulocochlear= sense hearing, balance, equilibrium
43
CN 9
glossopharyngeal= sense post/ pharynx, taste,
44
CN 10
vagus= “wondering” sense taste post tongue, Motor speck and swallow
45
CN 11
Accessory = traps Muscles motor
46
CN 12
Hypoglossal = motor tongue out
47
Scaphoid abdomen
A severely sunken in & flat abdomen
48
Persistent abdominal pain lasting how long is classified as a surgical emergency.
6 Hours
49
"Hammer" of ear:
"Stirrup" of ear:
"Anvil" of ear:
= Malleus bone
= Stapes bone
= Incus bone
50
Where to auscultate for a Tricuspid valve murmur?
Where to auscultate for a Pulmonic valve murmur?
Where to auscultate for a Mitral valve murmur?
Where to auscultate for a Aortic valve murmur?
= 4th ICS, just to the Left of the sternum
= 2nd ICS, just to the Left of the sternum
=5th ICS, Left of the sternum
= 2nd ICS, just to the Right of the sternum
51
Hematemesis:
Hypotyposis:
Hematochezia:
Melana:
= vomiting blood
= coughing blood
= Pooping bright red stool
= Pooping dark black stool
52
Crunch/rasping sound auscultated over left side of chest that is synchronous with the heart beat is?
Hamman's Crunch
53
Percussion 5 sounds:
Tympany, Hyperresonance, Resonance, Dull, Flat
"Thunderous Hammers Rattle Doors Flatly"
54
Tympany percussion sound:
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach
55
Hyperresonance percussion sound:
= “Booming” , loud intensity, Low pitched, long duration, located in Hyperinflated-Lung
56
Resonance percussion sound:
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung
57
Dull percussion sound:
= “thud” , Medium intensity, medium pitched, medium duration, located in solid organs
58
Flat percussion sound:
= “Extremely dull” , Soft intensity , High pitched, short duration, located in muscle & atelectasis
59
Direct Percussion:
Technique:
Commonly used for:
= tapping directly on PTt's skin w/ your fingertip.
= tap sharply & release immediately.
= used w/ percussing PT’s frontal & maxillary sinuses
60
Indirect percussion:
Technique:
Commonly used for:
=indirectly percussing PT;
= Place 1 hand on area you wish to percuss. Use finger of that hand (usually middle finger) as striking surface. Sharply tap (simply from snapping wrist) distal knuckle of finger w/ tip of other middle finger. Snap the finger back quickly to avoid dampening sound.
= Percussing chest (make sure finger lies in ICS)
61
Blunt percussion:
technique:
Commonly used for:
= “Blunt weapon” best used for detecting pain/ inflammation.
= Simply strike PT’s skin w/ ulnar side of your fist w/ just enough force to elicit tenderness but not cause undue pain.
= in costovertebral angle when examining a PT for a kidney infection
62
AVPU:
Alert, responds to Verbal stimuli, Only Painful stimuli, & Unresponsive
63
Dysarthria:
Dysphonia:
Aphasia:
= defective speech caused by motor deficits
= voice changes caused by vocal cord problems
= defective language caused by neurologic damage to the brain
64
Expressive aphasia:
Receptive aphasia:
= words will be garbled &/or expressed
= words will be clear but unrelated to your questions
(PT w/ receptive aphasia can have such difficulty talking that you could mistakenly suspect a psych disorder)
65
Assessing PT’s ability to concentrate w/ 3 exercises:
= 1st: digit span
= 2nd: serial sevens
= 3rd: spelling backwards
66
1st exercise for assessing PT's concentration:
2nd exercise for assessing PT's concentration:
3rd exercise for assessing PT's concentration:
= Digital Span PT repeat a series of numbers back to you. (Norm/= repeat at least 5 numbers forward & backward)
= Serial Sevens= PT start @ 100 & subtract 7 each time(Norm/= complete once in 90 Secs w/ <4 errors.)
= Spelling Backwards: PT spell a common five-letter word backward
67
Tachypnea possible causes:
Bradypnea possible causes:
= hypoxia, shock, head injury, DKA, or anxiety.
= drug OD, severe hypoxia, or CNS insult
68
Exhalation process:
Inhalation process:
= Passive use→ of respiratory muscles’ elastic recoil.
= Active use requiring ATP→ of respiratory muscles (diaphragm & intercostals) to increase the chest’s inner diameter.
69
Eupnea:
Hyperpnea:
Cheyene-Stokes:
= Normal breathing
= Deep breathing
= Gradual increases & decreases in respirations w/ periods of apnea; caused by increasing ICP & brainstem injury
70
Normal BP:
SBP 100-135 mmHg & DBP 60-80 mmHg
71
Orthostatic Vital sign Test:
Healthy PTs vitals w/ test:
Positive test:
= Take PT’s pulse & BP while they’re supine & have PT sit up, dangle feet, & then stand. In 30- 60 secs retake vital signs.
=Healthy PT vitals should not change;
= HR increases 10- 20 BPM or if SBP drops 10- 20 mmHg indicating possible hypovolemia
72
Hyperthermia is a temp of:
Temp of up to 102°F (38.9°C):
Temp rises above 103°F (39.4°C):
Temps above 105°F (40.6°C):
= =100.4°F (38°C) or higher
= increases metabolism markedly.
= Neurons of the brain can denature.
= brain cells die & seizures can occur
73
Body maintains temp ~of:
Celsius# to Fahrenheit:
Fahrenheit# to Celsius:
= 98.6°F (37°C)
= (C# -32) / 1.8
= (1.8 x F) + 32
74
Hypothermia treatment:
Body temp of 93°F (33.9°C):
Temp drops below 90°F (32.2°C):
Temp drops much below 70°F (21.1°C):
= b/c low fibrillation threshold always handle PTs gently when assessing/moving them.
= normal body warming mechanisms begin to fail.
= Shivering stops, heart sounds diminish, & cardiac irritability +
= PT has deathlike appearance & possibly irreversible asystole (absence of heartbeat)
75
Skin % of weight to body:
Skin reg/s body temp through:
Epidermis is avascular (has no blood vessels) so:
Eccrine glands aka merocrine glands:
Apocrine glands found exclusively:
= 15%
= radiation, conduction, convection, and evaporation
= blood vessels from underlying dermis must supply its nutrition
= open onto skin surface & help control body temp w/ water excretion
=armpits & genital region & open into hair follicles giving off a scent & respond to emotional stress “Apple smells”
76
Skin tugor test:
Norm/ skin test results: immediately returns to its original state.
Poor turgor results:
Decreased mobility suggests:
= pulling skin fold of over a bony prominence & then releasing it
= immediately returns to its original state
= Tenting & from dehydration.
= edema or scleroderma, a progressive skin disease.
77
Primary skin marks:
"Many= Macule
Purple = Plaque
Wizards = Wheal
Paint = Patch
Pretty = Papule
New = Nodule
Tattoos = Tumor
Placing = Pustule
Various = Vesicle
Colors = Cyst
Beneath = Bulla
Their = Telangiectasia
Skin" = Skin
78
Macule:
Plaque:
Wheal:
Patch:
Papule:
Nodule:
Tumor:
Pustule:
Vesicle:
Cyst:
Bulla:
Telangiectasia:
= flat spot; color varying w/ white-brown or red-purple less than 1cm
= Superficial papule w/ diameter > than 1cm & rough texture
= Pink friction "burn"
= irregular flat spot w/ diameter > 1cm
= Elevated firm spot color white-brown /blue-purple w/ diameter <1cm
= elevated firm spot 1-2cm
= elevated solid >2cm
= elevated spot <1cm purulent liquid
=elevated area <1cm w/ serous fluid
= elevated palpable area w/ liquid or viscous matter
= vesicle w/ diameter >1cm
= Red threads
79
Secondary skin lesions:
= Fissure "Frightening
= Scar Scars
= Erosion Etch
= Keloid Killer
= Ulcer Ulcers
= Excoriation Exposing
= Scale Scaly
= Lichenification Layers
= Crust: Crumbling
= Atrophy: Atrophy"
80
Abnormal Nail Findings:
Clubbing, Paronychia, Onycholysis,Terry’s nails, Transverse lines, Psoriasis, Beau's Lines,
81
Beau’s lines in finger nails:
Estimating the timing or length of an illness by:
Why lines form:
= Transverse depressions in nails & associated w/ severe illness.
Like transverse lines, they form under nail fold & grow out w/ nail.
= Location of the line. (lines on >1 nail often indicates PT had serious systemic illness during past 2-3Mns)
During severe illness, the nails grow slowly, thus forming the lines.
82
Psoriasis in finger nails:
= small pits in the nails and can be an early sign of psoriasis
83
Traverse Lines in finger nails:
Can appear w/ or with:
= White lines parallel w/ lunula vs cuticle &
= Severe illness; shows under proximal nail folds & grow out w/ nail
84
Terry's nails:
Seen in:
= mostly whitish nail w/ band of reddish-brown at distal nail tip
= Aging, liver cirrhosis/failure, CHF, & diabetes
85
Onycholysis in finger nails:
= nail bed separates from the nail plate. It begins distally & enlarges the free edge of the nail. There are many causes including hyperthyroidism
86
Paronychia in finger nails:
=inflammation of proximal & lateral nail folds & can be acute or chronic. The folds appear red, swollen, & tender. The cuticle cannot be visible. People who frequently immerse their hands in water are susceptible
87
Clubbing fingernails:
= “finger clubs” distal phalanx of each finger is rounded and bulbous. The proximal nail feels spongy. This is caused by the chronic hypoxia found in cardiopulmonary diseases and lung cancer.
88
A boggy (soft & pliable) nail suggests:
= the clubbing seen in systemic cardiorespiratory diseases.
89
Psoriasis skin condition:
Skin look:
= chronic skin condition causing cells build up rapidly on skin's surface
= Thick, red, scaly patches that can be itchy & sometimes painful
90
Hair Dandruff:
Hair psoriasis:
Hair seborrheic dermatitis:
= Mild flaking
= Heavy flaking
= Greasy scaling
91
External eye consists:
Mnemonic:
= Eyelid, Conjunctiva, Lacrimal gland, Ocular muscles, & Bony skull orbit = "Every Cat Loves Outside Birds"
92
lacrimal glands in temporal region of superior eyelid F:
= Produce tears to moisten the eye
93
Eyelids function:
= Spread tears over eyes, reg/ light entering, & protect from foreign bodies
94
Conjunctiva:
= thin membrane covering anterior surface of eye & inside of the eyelid
95
Ocular Muscles:
Innervated by 3 cranial nerves:
= control eye movement
= Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
96
Cranium consists of:
saying:
= Frontal, Parietal, Temporal, Occipital, Ethmoid, & Sphenoid bones
"Parents on top" "S above E in alphabet"
97
Face includes nasal bones:
Maxillary, Lacrimal, Zygomatic, Palate, Inferior nasal Concha,& Vomer
98
internal eye consists of:
Mnemonic:
= sclera, cornea, iris, lens, & retina
= "Some Cool Individuals Like Reading"
99
sclera:
Cornea:
Retina:
= white of the eye; Dense avascular structure gives eye shape
= Separates anterior chamber fluid from external environment & permits light to enter the lens & reach the retina.
= Sensory network of eye transforms light rays into electrical impulses that the optic nerve transmits to the brain.
100
Lens & Function:
Iris:
Iris function
= Cellular structure behind iris; Convex & transparent allows images to focus onto the retina
=Circular contractile muscle; Its pigment produces color of eye
=Controls amount of light reaching the retina by controlling pupil size & initiated by Optic N. CN-II (senses light), & Oculomotor N. CNIII (controls size of pupil)
101
visual acuity test=
Recording PT's grade:
1st # grade:
2nd #:
Normal results:
= PT 20 ft from Visual Acuity wall/Snell Chart/PT hold visual acuity card 14 In from their face. Ask PT to cover 1 eye & begin reading the lines
= Grade next to smallest line which PT can read at least ½ letters
= Distance PT is away from chart
= Distance from which a normal eye could read the line
= 20/20. EX 20/70= normal eye could read line 70 ft away but PT could read it only from 20 ft.
102
Bitemporal hemianopsia:
Left/Right Homonymous Hemianopsia:
Homonymous Quadrantic Defect:
= loss of vision in the outside half of each eye
= loss of vision in the right half of both eyes or left half of both eyes
= loss of vision in the same quadrant of both eyes EX LQ & LQ loss
103
Sluggish pupil suggests=
Bilateral eye sluggishness can indicate= Global Hypoxia to the brain tissue or an adverse drug reaction.
Constricted pupils= Opiate OD
Fixed & dilated pupils usually= brain death.
Nystagmus= fine jerking of the eyes
When shining light laterally of eye look for:
Shadow could suggest=
= pressure on Oculomotor Nerve CN-III) from increased ICP.
=Global Hypoxia to the brain tissue or an adverse drug reaction.
= Opiate OD
= Brain death
= fine jerking of eyes
= Crescent-shaped shadow on medial side of iris B/c iris is flat & cast no shadow.
= Glaucoma→ caused by blockage that restricts aqueous humor fluid from leaving anterior chamber thus increasing intraocular pressure & threatens PT’s eyesight.
104
Ear has 3 parts:
Outer ear, Middle ear, & Inner ear
105
Outer ear consists:
Mnemonic:
= Auricle, External Acoustic Meatus “Ear canal”, & Tympanic membrane “eardrum”
"All Ears Auscultate Mighty Tubas"
106
Auricle:
Auricle comprises:
= visible skin-covered cartilage that extends outward from the skull
= Helix (outer rim), Antihelix (Inner rim), Lobe, Concha (Opening-canal), & Tragus (protuberance lying in front of concha)
107
Mastoid process of Temporal bone=
Mastoid bone=
= behind ear & works as attachment for sternocleidomastoid muscle (palpable behind earlobe)
= contains air-filled cells to middle ear & why ear infections(otitis) often presents w/ tenderness in the mastoid area
108
Translucent tympanic membrane=
= @ end of ear canal, separates ear canal from middle ear "ear drum"
109
External Acoustic Meatus “ear canal”:
= opens behind tragus & is ~2-3 Cms long in adults.
110
Hair & sebaceous ear glands:
= produce wax (cerumen) line distal third of canal.
111
Middle ear contains 3 small bones/ossicles:
Middle ear bones Function:
Middle ear anatomy :
= malleus, incus, stapes
= transmit & amplify sound from tympanic membrane to inner ear.
= air-filled cavity in temporal bone, begins w/ medial surface of tympanic membrane.
112
Umbo=
Eustachian tubes=
= pulls eardrum inward/concave(“cone of light” visible w/ otoscopy)
= help move mucus from ear- nasopharynx & help =pressure w/ outside air & middle ear during swallowing, sneezing, & yawning
113
Malleus (Hammer):
Incus (Anvil):
Stapes (Stirrup):
= 1st bone in middle ear that picks up sound vibrations from eardrum
= 2nd bone connects Malleus to stapes & helps pass sound vibrations
= 3rd bone transfers sound vibrations to inner ear thru oval window
114
Vestibule:
Semicircular Canals:
Cochlea:
= Central part of inner ear helps w/ balance & detecting head position
= 3 loops in inner ear help w/ balance w/ detecting head rotation
= “Cochlear hears” coil transmits sound to Acoustic N. (CN-VIII) "sound vibrations to electric impulses"
114
inner ear cavity contains:
Cochlea transmits to:
Hearing=
Labyrinth=
= Vestibule, Semicircular canals, Cochlea, Labyrinth
=acoustic nerve (CN-VIII).
= vibrations from environment to the tympanic membrane (trans/ed through eardrum to ossicles & cochlea to translate for brain)
= helps us maintain balance by sensing position & m-nt of our head & innervated by the acoustic nerve.
115
Otorrhea:
= discharge from ear
116
Hearing loss testing use=
Pneumatic Otoscope:
= a tuning fork (typically 512 Hz) to perform the Rinne & Weber tests
= can Push air through speculum allowing to test tympanic membrane mobility
117
Rinne Test:
Doing Rinne Test:
Rinne Test normal:
= hear sounds better through air or bone
=Tuning fork placed on mastoid bone (bone conduction) & then next to your ear (air conduction).
= hear sound longer w/ air conduction= normal
118
Weber Test:
Weber Test Conductive Hearing Loss:
Weber Test Sensorineural Hearing Loss:
=hear sound equally in both ears; Tuning fork @ center of forehead
= Sound louder w/ tuning fork in Affected ear (can be infection/wax)
= Louder w/ tuning fork in UNaffected ear (damaged cochlea/nerve)
119
External nose comprises:
= nasal bones, septum, nares, & turbinates,
120
Nares:
Nasal Septum:
Turbinate/ conchae=
Turbinates help:
= anterior openings in the nose.
= divides nasal cavities.
=Bony ridges on medial surface of nose to create turbulence
= Clean, warm, & humidify inspired air w/ mucous membranes (very vascular & resp/s system’s 1st filtration system)
121
Paranasal sinuses:
Nasal bones:
Sinus bones saying:
= Air pockets in nasal cavity bones & line w/ mucus membranes & cilia
= frontal, maxillary, ethmoid, & sphenoid bones
=“FESM front front, E before S, M muncher”
122
Cilia in sinuses:
Sinuses function:
nasal flaring indications:
Rhinitis:
Lips:
= fine hair like “nipples” move secretions into oral & nasal cavities
= Help insulate brain & give vocal resonance (absent w/ head cold)
= Respiratory distress
= runny nose commonly from allergies
= mark mouth entrance & play a role in articulation of speech
123
Mouth houses:
Roof of mouth formed by:
Major salivary glands:
Parotid Gland:
Submandibular Gland:
Sublingual Gland:
Amylase:
Teeth:
Tongue:
Tongue Function:
Gingiva:
= : tongue, gingiva(gums), teeth, salivary glands,
= hard & soft palate
= parotid, submandibular, & sublingual.
= Post/ jaw & Ant/ ears; make amylase breaks carbs/starches to sugars
= Under & along lower jaw; Makes saliva for digestion & moisture
=makes amylase for digestion & secrets mucus for lubricate mouth
= enzyme to help break down food chemically
= Anchored in bony sockets & norm/=32 permanent teeth
= mobile muscle covered w/ mucous membranes & taste buds
= helps chewing, forming words, swallowing (moving food for teeth)
= "gums" very vascular mucosa linings & protect teeth
124
pharynx consists of 3 distinct areas:
=Nasopharynx, Oropharynx, Laryngopharynx
125
Nasopharynx:
Oropharynx:
Laryngopharynx:
= "filter" (behind nasal)
="Food processor" (back throat)
= "air & food pathway" (above epiglottis)
126
Tonsil:
Uvula:
= help separate oropharynx food process/ from nasopharynx.
= "Epiglottis" of nose & mouth @ soft palate hanging in back of mouth
127
“Coffee grounds” in mouth:
Pink-tinged sputum indicates:
Green/Yellow phlegm suggests: a respiratory infection.
= suggests an upper gastrointestinal (GI) bleed
= acute pulmonary edema
= a respiratory infection.
128
Midline neck structures:
Neck houses many life-sustaining structures:
= thyroid, trachea, esophagus, & S-column
= SC,Carotid Art/s & Jugular V.s delivering from/to brain, Air passage (lar/x/trac/), food passage (esoph/) into stomach (Major disruption to structures can= rapid deterioration/ death)
129
Chest bone cage comprises:
Chest’s 3 cavities:
Lungs' Lobe #s:
Mediastinum contains:
= 3 bones of sternum, 12 pairs of ribs & cartilage, & S-column
= mediastinum, right & left pleural cavity
= 3 R lobes & 2 L lobes to make room for heart
= heart, great vessels (vena cava, aorta, & pulmonic vessels), Trachea, & Esophagus
130
pectus excavatum:
Pectus carinatum:
=condition where sternum is depressed
= condition where sternum curves outward
131
Consolidated lung tissue:
Egophony:
Bronchophony:
Whispered pectoriloquy:
= pus/ tumor replaces air-filled lung
= change in voice sound through stethoscope; PT's "ee" sound is heard as "ay," suggesting lung consolidation/ pleural effusion.
= PT's spoken voice sounds louder & clearer than normal when auscultated w/ stethoscope, often indicating lung consolidation
= sign where PT's whispered voice heard clearly through stethoscope, often indicating lung consolidation.
132
Newborn vitals :
Infant vitals:
Toddler vitals:
Preschool vitals:
School age vitals:
Adolescent vitals:
= RR 30-60, HR 100-180, SBP 60-90
= RR 30-60, HR 100-180, SBP 87-105
= RR 24-40, HR 80-110, SBP 95-105
= RR 24-34 , HR 80-110 , SBP 95-110
= RR 18-30 , HR 65-100, SBP 97-112
= RR 12-26 , HR 60-90 , SBP 112-128
133
Tricuspid Valve auscultation site:
Pulmonic Valve auscultation site:
Mitral Valve (Apex) auscultation site:
Aortic Valve auscultation site:
= 4th intercostal space, Left Sternal border.
=2nd intercostal space, Left Sternal border.
= 5th intercostal space, Left Midclavicular line
=2nd intercostal space, Right Sternal border.
134
Tactile fremitus:
= When the PT speaks, you can feel vibrations on their chest wall.
135
hyperresonant percussion sound in right chest can indicate:
Dull percussion sound in right chest can indicate:
= Pneumothorax
= Hemothorax
136
"Lub" (S1) Sound:
"Dub" (S2) Sound:
“Dee” (S3) Sound:
“Dee” (S4) sound:
= Mitral & Tricuspid valve closing (high pitch)
= Aortic & Pulmonic valve closing (high pitch)
= AKA “ventricular gallop”:“dee” of “lub-dub-dee”. Listen @ apex w/ PT lying on their left side
= AKA “arterial gallop” is low-pitched “dee” of “dee-lub-dub” heard in early-mid diastole. Listen @ apex w/ PT lying on their left side
137
S1 Sounds auscultated @:
S2 Sounds (aortic) auscultated @:
S2 Sounds (Pulmonic) auscultated @:
= 5th ICS at Left Sternal border
= 2nd ICS at Right Sternal border
= 2nd ICS at Left Sternal border
138
Splitting heart sounds:
= mitral & aortic valves close slightly before the tricuspid & pulmonic valves thus hear two sets of sounds instead of one
139
Ejection Click heart sound:
Opening Snap heart sound:
Pericardial Friction Rub heart sound:
Murmur heart sound: Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.
= Sound from a stiff or stuck valve.
= Stenotic Bi/tricuspid valve’s leaflets recoiling abruptly after V diastole
= Inflammation >heart’s visceral/parietal surfaces rub each heartbeat
= "Rumbling/vibrating" > turbulent blood through valves, a large artery, or a septal defect
140
Ascites:
Borborygmi:
Hyperperistalsis:
Normal bowel sounds consist:
More frequent sounds indicate:
Decreased or absent sounds suggest:
= bulges in flanks across abdomen indicating CHF
= loud prolonged "gurgling" (healthy GI) but can= hyperperistalsis
= more bowl sounds> + GI m-nt causing diarrhea/cramps
= Variety high-pitched gurgles & clicks occurring every 5-15 secs
= + GI m-nt possibly indicating diarrhea or early intestinal obstruction
= Paralytic ileus/peritonitis. Listen at least 2mins if abdomen is silent
141
white, curdlike vaginal discharge w/ no odor/yeasty, sweet odor:
Yellow, green, or gray discharge w/ a foul/fishy odor:
Profuse, yellow penis discharge could sign:
Scant, clear/white penis discharge suggest:
= suggest a fungal infection (candidiasis).
= suggest a bacterial infection (gonorrhea or Gardnerella).
= gonorrhea
= nongonococcal urethritis.
142
acute epididymitis/ Testicular torsion:
If surgery isn’t provided within how long? test can be lost:
= twisted spermatic cord (torsed testicle usually swollen/tender & rides higher in scrotum.)
= 6 Hrs (same as ABDMN)
143
Common boner pills:
vardenafil (Levitra), sildenafil (Viagra), and tadalafil (Cialis)
144
Anal canal length & kept closed by:
Internal ring M. type & controlled by what NS system:
When rectum fills w/ feces what happens:
External sphincter muscle type? & under control of what?
lower half of anal canal:
upper half of anal canal:
= ~2.5-4.0 cm long & kept closed by in/external anorectal sphincters
= has smooth muscle that the autonomic nervous system controls.
= Internal sphincter relaxes, resulting in the urge to defecate.
= Striated Smooth Muscle & voluntary control.
= contains sensory fibers
=is somewhat insensitive b/c less sensory fibers
145
Hinge Joints:
Ball-and-Socket Joints:
Saddle Joints:
Condyloid Joints:
Gliding Joints:
Pivot Joints:
common causes of a tender joint :
= Allow only flexion & Extension EX:Finger & elbows.
= Allow rotation & wide range of motion EX Shoulder & hip.
= Permit movement in several planes EX Thumb joints.
= Similar to ball & socket joints but don’t allow rotation. EX Wrist.
= Permit sliding movement of 1 bone across another EX Hands & feet.
= Allow a turning motion EX 1st 2 C-vertebrae.
= arthritis, tendonitis, bursitis, or osteomyelitis.
146
Wrists & Hands:
Radiocarpal Joint:
Carpals & Metacarpals:
MCP Joint (MetaCarpoPhalangeal):
PIP Joint (Proximal InterPhalangeal):
DIP Joint (Distal InterPhalangeal):
M-nts of MCP, PIP,& DIP Joints:
= Phalangies, Metacarpal “Middle”, Carpal
= Radius & Ulna articulate w/ carpal bones @ wrist
= Carpals articulate w/ metacarpals.
= Metacarpals articulate w/ proximal phalanges @ MCP joint.
= Proximal phalanges articulate w/ middle phalanges @ PIP joint.
= Middle phalanges articulate w/ distal phalanges @ DIP joint.
= (Flex/ & extended)MCP joints can abduct (spread)& adduct (together)
147
Elbow Joint Structures:
Ulna nerve:Between olecranon process & medial epicondyle.
Movements: Hinge joint allowing flexion & extension, Supination (turn palm up) & pronation (turn palm down) of the forearm.
Major Muscles: Flexors: Biceps. Extensors: Triceps.
Forearm Muscles: Supinators: Allow forearm to turn the palm up. Pronators: Allow the forearm to turn the palm down.
= lateral & medial epicondyles, olecranon process of proximal ulna, & proximal radius. Bursa: lies between olecranon process & the skin.
148
