Ch. 2: The Physical Examination: Its Basis in Physiology

Question 1

Vital Signs

Answer 1

Body Temperature

Pulse

Respiration

Blood Pressure

Oxygen Saturation

Question 2

Systemic Examinaton of the Chest and Lung

Answer 2

Lung and chest topography

Inspection

Palpation

Percussion

Auscultation

Question 3

Body Temperature

Key Terms:

• vasodilation & vasoconstriction
• metabolism and fever
• afebrile
• pyrexia, hyperthermia, febrile
• hyperexia

Answer 3

Vasodilation vs. vasoconstriction:

Vasodialtion is an increase in body temperature causes the blood vessels near the skin surface to dilate, allowing warmed blood to flow near the skin surface, enhancing heat loss.

In contrast, a decrease in body temperature causes vasoconstriction , which works to keep warmed blood closer to the center of the body—thus working to maintain the core temperature.

Metabolism and Fever:

During a fever (pyrexia, hyperthermia) the metabolic rate increases. This action leads to an increase in oxygen consumption and an increase in carbon dioxide production at the cellular level.

According to estimates, for every 1° C increase in body temperature, the patient’s oxygen consumption increases about 10%.

Fever:

An exceptionally high temperature, such as 41° C (105.8° F), is called hyperpyrexia

Question 4

4 common type of fever

Answer 4

intermittent fever: when the patient’s body temperature alternates at regular intervals between periods of fever and periods of normal or below-normal temperatures.

remittent fever: the patient has marked peaks and valleys (more than 2° C or 3.6° F) over a 24-hour period, all of which are above normal—that is, the body temperature does not return to normal between the spikes.

relapsing fever: when short febrile periods of a few days are interspersed with 1 or 2 days of normal temperature.

constant fever: when the patient’s body temperature remains above normal with minimal or no fluctuation.

Question 5

Hypothermia

Answer 5

Hypothermia may occur as a result of:

1. excessive heat loss
2. inadequate heat production to counteract heat loss
3. impaired hypothalamic thermoregulation.

Clinical signs of hypothermia:

• Below normal body temperature • Decreased pulse and respiratory rate • Severe shivering (initially) • Patient indicating coldness or presence of chills • Pale or bluish cool, waxy skin • Hypotension • Decreased urinary output • Lack of muscle coordination • Disorientation • Drowsiness or unresponsiveness • Coma

Question 6

Common therapeutic interventions fo hypothermia

Question 7

Pulsus Paradoxus

Answer 7

an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus

Causes:

• Decreased blood pressure during inspiration.

> During inspiration the asthmatic patient relies on use of the accessory muscles of inspiration

> accessory muscles help produce an extremely negative intrapleural pressure

> negative pressre enhances intrapulmonary gas flow

> vessels to dilate, creating pooled blood.

• Increased blood pressure during expiration

> patient often activates the accessory muscles of expiration in an effort to overcome the increased airway resistance (R aw ).

> increased power produced by these muscles generates a greater positive intrapleural pressure.

> narrows the vessels of the lungs

> increased pressure on the pulmonary blood vessels enhances left ventricular filling and results in increased cardiac output and arterial blood pressure during expiration. .

Question 8

Blood pressure

Answer 8

1. the blood flow generated by ventricular contraction and
2. the resistance to blood flow caused by the vascular system. Thus, blood pressure (BP) equals flow (V ) multiplied by resistance (R): BP = V × R.