DAY 1 PM Flashcards
Screening Recommendations
-Physical exam preformed
2 years for adolescent (12-19) and adults >60
4-6 years for adults (20-59)
Sequence & and exam technique
- Head to toe
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
Inspection
Visual evaluation
- Use senses to form an opinion that will aid in decision making
- Watch everything they do, and the way they talk/behave
- ID presence of bruises, lumps, lesions/changes in skin and nail color.
Palpation
- Touching or feeling with your hands
- Allows you to assess position, size and SHAPE, mobility and consistency of a body region
- May detect fluid in a space
- Uncovers organs that are enlarged or abnormal.
Discrimination of findings
- Use fingertips for tactile discrimination
- Use back of hand (dorsum) to measure T
- Use palmar aspects of MCP’s or ulnar surface to detect vibration.
Depth of palpation
- Light palpation: assess surface and muscle lesions
- Medium palpations: asses lesions, masses, tenderness, pulsations and pain ( press 1-2cm into the region)
- Deep palpations: assess organ (use one hand on top of the other to press 2-4cm into the region in a circular pattern)
Percussion
- Striking the body surface lightly but sharply
- Determines size, position and DENSITY of the underlying structure as well as fluid or air in a cavity.
Five percussion sounds
- Flat (Sternum and thigh)
- Dull (liver)
- Resonance (healthy lung)
- Hyper resonance (emphysema lung)
- Tympani (gastric air bubble)
Auscultation
-Use a stethoscope to detect the body sounds created by the heart lungs, blood vessels and abdominal viscera.
Bell of stethoscope
- Amplifies low pitch sounds
- Heart murmurs, arterial/venous turbulence, bruits.
Diaphragm of stethoscope
- Amplify high pitch sounds
- Breath, bowel, voice and regular heart sounds. BP also*
Hand hygiene
- WASH HANDS before and after
- Hand wash with plain soap and h20 or antibacterial soap
- Can use EtOH based products if hands aren’t dirty
- Change gloves in btwn procedures and tasks
- NO long nails
General assessment
Quick assessment of pt appearance, behavior and mobility
Physical parameters
Height: pt to stand erect without shoes against flat vertical surface 1in=2.54cm
Weight: measure weight 1lbs=2.2kg and find BMI = kg (weight) /m2 (height)
Weight class for adults
40 obese 3 (morbid)
Waist circumference
-Correlated with abdm fat content, risk factor for cardiac fail. place tape just above hipbone and measure just after you breathe out.
Men > 40in
Women > 35 in
Vital signs
- Pulse (HR)
- BP
- RR
- Temp
- Pain*
Temperature
-Regulated by the HPA
-Normal adult range is 97.5-99.0F average of 98.6F
C=5/9 x (F-32)
-Hyperpyrexia >106F
-Hypothermia <95 F
Fever
- Elevation of body temp that exceeds normal daily variations
- Clinically >100.4 F
- Chills and shaking suggest bacteremia as body tries to raise the temp
- Sweating is the body’s response to lower the temp
- Ask about traveling, contacts with sick people, medications like NSAIDs and APAP (they reduce fever)
Pulse/HR
- Peripheral pulses assess HR, rhythm and function
- Radial pulse most common to assess
- Adults normal HR is 60-100 bpm
- bradycardia less than 60 bpm
- tachycardia greater than 100 bpm
Pulse rhythm
-Normal is steady and even
-Irregular pulses are arrhythmia
if irregular pulse is found listen to the apex of the heart for a more accurate reading with the stethoscope.
Force or pulse
- Normal pulse is easily palpated and does not fade in or our
- Based on 4 point scale
0: absent
1: weak
2: normal
3: increased
4: bounding/abnormal
Respiratory Rate (RR)
- Reported as rpm (respiration per min) count number of inhalation
- Normal range 12-20 rpm
- Bradypnea < 12
- tachypnea >20
Blood pressure
- Force of blood as it push against the arterial walls
- Systolic BP: max pressure felt on arteries during left ventricle contraction
- Diastolic BP: resting pressure that the blood exerts between each ventricular contraction
Selecting the BP cuff
Length of inflatable bladder of cuff should be about 80% of upper arm circumference.
Measuring BP
-Ask pt. and document the use of caffeine and tobacco
-Pt. to sit in chair, back supported, arm bared and at heart level
-Begin after 5 min of rest
-Release air in cuff 2-3 mmHg per sec
-First heart beat is Systolic
-Point at which beat disappears is diastolic
listen until 20mmHG below diastole
-Record BP along with which arm used, position and size of cuff
Korotkoff sounds
The five phases of BP
- faint clear tapping (systole)
- swooshing
- crisp more intense tap
- muffling
- cessation of sounds (diastole)
Common Errors
- Incorrect cuff size (small= false high, big= false low)
- Arm not at heart level (below= high, above =low)
- Deflation speed ( too fast= low Sys or high Dia, too slow = false high Sys)
BP classifications
- Pre hypertension 120-139 / 80-89 mmHg
- Stage 1 hypertension 140-159 / 90-99
- Stage 2 hypertension >160 / >100
Orthostatic or postural blood pressure
- Measure BP and HR in two different positions
- BP at supine position after 10 min resting then again within 3 min of standing.
- Normally: Sys drops slightly or remain the same upon standing and the Dias rise slightly
- Ortho. hypotension is a drop in Sys >= 20mmHg or in distole > 10mmhg
