Chapter 2 - the medical examination Flashcards
1
Q
Medical History
A
- take it
2
Q
Sign
A
Refers to something that the clinical can see or feel in the pt.
- temperature, respiration, heart beat, and blood pressure
3
Q
Symptom
A
Refers to something the pt. feels but the clinician can’t
- headache, nausea, dizziness, and pain
4
Q
Comprehensive Medical History steps
A
- identify pt. age/gender
- CC = location, quality/quantity, frequency, onset/duration, associated factors (aggravate or alleviate)
- past history
- current health status (diet, drugs, immunizations)
- fam history = diabetes, hypertension etc.
5
Q
Physical Exam
A
- pt. apparent state of health, level of consciousness, signs of distress, height/weight, skin color, hygiene, obvious lesions
- it begins with vital signs and skin and goes from there
6
Q
Vital Signs
A
- height/weight
- blood pressure
- heart and respiratory rate
- body temp
7
Q
Height and Weight
A
- baseline for future reference
- height measured with stadiometer
- weight is usually measured in Kg
8
Q
Blood pressure
A
- stethoscope and sphygmomanometer (correct size)
- pt. has to rest for awhile before it is taken
- lower edge of cuff is 2.5 cm above antecubital crease
- inflate cuff to >200 mmHg
- deflate 2-3 mmHg/second
9
Q
Blood pressure sounds
A
- examiner listens for two consecutive sounds = systolic pressure (ventricles contracting)
- when sound disappears = diastolic pressure (relaxation of ventricles)
- also known as fifth korotkoff sound
10
Q
Pulse rate and rhythm
A
- radial pulse
- number of beats in 15 seconds x 4
- normal 60-72 bmp
- rate, rhythm and force
- normal for athletes to have bradycardia (100 bmp)
11
Q
Respiratory Rate and Rhythm
A
- rate, effort, and depth of inspiration
- counting the number of respirations in 1 minute
- normal = 12-20 breaths/min
12
Q
Temperature
A
- may be as low as 96.4 F in the morning or as high as 99.1 F in the evening
- rectal temperatures are higher by 0.4 - 0.5 C
13
Q
Stethoscope
A
- examiner holds the end piece between the fingers, pressing the diaphragm firmly against the skin, whole contact
- don’t let tubing rub against itself
- listen for presence or absence of sound as well as intensity, pitch, duration and quality
- bell is used to hear low-pitched sounds
- diaphragm (big) is used to hear high-pitched sounds
14
Q
Opthalmoscope
A
- viewing internal structures of the eye
- contains light source which allows us to view the inner eye (near/far focusing)
15
Q
Otoscope
A
- viewing the external auditory canal/tympanic membrane
- has light and disposable speculums for cleanliness
- can also be used for the nose
