Advanced patient assessment

Question 1

data gathering

Answer 1

1. signs(objective information) what can be visualized?( color, pulse, edema)
2. symptoms(subjective information) what the patient feels.(dyspnea, nausea)

Question 2

general malaise

Answer 2

run-down feeling, nausea, weakness, fatigue(suggest possible electrolytes imbalance)

Question 3

dysphasia

Answer 3

difficulty speaking, dysphagia is difficulty swallowing

Question 4

level of consciousness

Answer 4

1. lethargy: drowsy, will answer questions and follow commands but slowly.
2. obtunded: difficult to arouse, needs constant stimuli to follow a simple command

Question 5

diaphoresis(which is profuse sweating)

Answer 5

1. caused by increased metabolism(pregnancy, fever, infection, anxiety)
2. possible cardiac complications(heart failure or mi)
3. hypoglycemia(sweating is an early sign of low blood sugar)

Question 6

pitting edema

Answer 6

1. bilateral= pulmonary hypertension, heart failure, renal insufficiency, septicemia)
2. unilateral= venous extremity obstruction(tight clothing, jewelry

Question 7

clubbing of digits is caused by?

Answer 7

chronic hypoxia, 10-15% CHD, CHF, COPD

Question 8

what can cause jugular venous distention?

Answer 8

1. fluid overload
2. right heart failure
3. airway pressure(peep)
4. cardiac tamponade

Question 9

skin colors

Answer 9

1.cyanosis= > 5 mg\dl of deoxygenated hgb
2. central cyanosis= bluish color of the trunk or oral mucosa(saturation <75%)
3. peripheral cyanosis= bluish or graying color of the fingers\toes.
4. jaundice= yellow coloring suggesting increased bilirubin or liver failure.
5. petechia= tiny round brown-purple spots due to bleeding under the skin(clot disorder)

Question 10

thoracic\chest configuration

Answer 10

1. barrel chest= abnormal increase of ap diameter
2. pectus carinatum=outward sternal protrusion anteriorly.
3. pectus excavatum=depression of all of the sternum
4. kyphosis
5. scoliosis
6. kyphoscoliosis

Question 11

breathing pattern and effort

Answer 11

1. inhalation is active and exhalation is passive.
2. diaphragm= major muscle of ventilation
3. use of accessory muscle (retractions) ventilatory demands increase.
4. paradoxical movement(flail chest)= multiple rib fractures.
5. asymmetrical= one side rises noticeably < than the other(atelectasis, pneumothorax)

Question 12

muscle conditions

Answer 12

1, atrophy- decreased muscle mass due to lack of use\work(neurologic, sedentary lifestyle)
2. hypertrophy(cardiomegaly)- increase in muscle mass due to increased use\work.

Question 13

cough\sputumn type or color?

Answer 13

1. streaked=infection
2. pink\frothy= pulmonary edema
3. bright red= tuberculosis, pleural effusion, cancer.
   4.yellow\green(purulent)= pneumonia, bronchiectasis, chronic bronchitis, cystic fibrosis.
4. dark green to brown with purulence= lung abscess, bronchiectasis.
5. bonchorrhea= >100ml of watery secretions(common cause is chronic bronchitis

Question 14

skin turgor

Answer 14

1. pinch skin between 2 fingers and observe the time of skin to return to normal.
2. decreased skin turgor may indicate dehydration

Question 15

pulsus paradoxus ( pulse\bp varies with respirations)

Answer 15

1. pressure decrease on inspiration and increase on exhalation.
2. due to increased intrathoracic pressure( air trapping, cardiac tamponade)

Question 16

Pulsus alternans( alternating strong\weak pulse)

Answer 16

caused by large pericardial effusion

Question 17

tracheal deviation

Answer 17

1. trachea goes toward the problem= atelectasis, pneumonia
2. trachea goes away from the problem( pneumothorax, pleural effusion, tumor\mass)

Question 18

tactile fremitus(vibrations felt on the chest)

Answer 18

1. increase fremitus= pneumonia, lung tumor or mass, atelectasis
2. decrease fremitus= mucous plug or foreign object, pneumo, pleural effusion, COPD

Question 19

chest expansion

Answer 19

1. upon full inspiration, thumbs should move 3-5cm from center
2. bilateral reduction= neuromuscular diseases, COPD
3. unilateral reduction= pleural effusion, pneumothorax

Question 20

what are the methods of percussion?

Answer 20

1. indirect= finger on finger
2. immediate= finger on the chest

Question 21

percussion types

Answer 21

1. resonance= hollow sound(normal sound).
2. flat\dull= muscle, organs, atelectasis, pleural effusion/
3. tympany or hyper resonance(increased air present)= pneumothorax, emphysema, asthma

Question 22

adventitious breath sounds(abnormal)

Answer 22

1. rales\crackles= secretions or fluids in small airways
2. fine\moist rales= alveolar fluid
3. late inspiratory crackles= atelectasis.
4. rhonchi\coarse crackles= secretions in the large airway.
5. wheeze= high pitched sound caused by narrowing of airways
6. stridor= high pitched sound caused by upper airway obstruction.
7. pleural friction rub= creaky, leather sound.

Question 23

blood clotting testing

Answer 23

1. prothrombin time normal time= 12-15 sec, critical time= >30 sec
2. partial thromboplastin time: normal time 25-39 secs, critical= >50 secs
3. platelet normal count= 150,000-400,000, critical= <25,000