Exam 1 Physical Assessment Flashcards
What are the two components of a health assessment?
Health History (can be subject)
Physical Assessment (more objective)
Caucasians have a 20% higher chance of _________ cancer than African Americans.
_______ cancer is higher in African Americans than Caucasians.
Skin Cancer
Prostate Cancer
What is the classical difficult breathing pose?
Tripod
A large amount of weight loss (30-40 lbs) over a short period of time for a young person can indicate __________.
Diabetes (Type 1)
Why is it important to note hygiene during the physical assessment?
Can indicate socioeconomic status, funding, and educational status. (consider alternatives)
An unpleasant odor may be __________
Cultural
Patient may not consider their odors unpleasant
From an anesthesia standpoint, what two illicit substances are we concerned with?
Cocaine
Meth
Hard time treating BP with these two drugs in the system
What is the most important thing to do before the anesthesia time out?
Patient Identification (Name/DOB/MRN)
Involve the patient.
In critically ill patients, peripheral temperatures are often _________.
Inaccurate
Be sure to accurately document body temp
What is the most common measurement of height and weight?
BMI
Thank you insurance company
The scientific study of the measurements and proportions of the human body.
Anthropometry
Extremes of weight may have issues with ___________.
Large patients may be __________.
Emaciated patients may be ___________.
Extremes of weight may have issues with wound healing.
Large patients may be diabetic
Emaciated patients may be malnourished
This patient population may be prone to positioning injuries.
What is the normal range of adult breaths per/min?
10-18 breaths per minute
How do you prevent kids from rolling the temp probe around their mouth when obtaining a reading?
Ask the child to make the kiss face or duck lips.
When do you avoid rectal temp probes?
Uncooperative patients
Immuno-suppressed patients
Patient on blood thinners
What is important to ask patients when they state they have medication allergies.
Ask what the medication does during the “allergic” reactions sometimes it is a common side effect rather than a true allergic reaction.
How many cigarettes are in a pack?
A patient has smoked half a pack for 50 years. Calculate the pack year.
20 cigarettes in a pack
25 pack years
0.5 packs x 50 years = 25 pack years
Legionnaires’ disease is a lung infection you can get from inhaling droplets of water from things like _______ or ________.
Air conditioning and Hot Tubes
Environmental factors associated with health history
What is important to note during the health history when inquiring about a patient’s medication.
When they last took them
What is the leading cause of beta-blocker overdose?
Accidental excess intake
What medication do you want to avoid if someone is wheelchair-bound?
Succinylcholine
What can cause corneal abrasion if these are left on the patient?
Contact lens
Ensure all dentures are removed pre-op to reduce _______.
Risk of injury and aspiration
___________ fractures are notoriously known for a rough emergence.
Mandibular
How did you think they broke their jaw? Fights. Crazy patients are still crazy after anesthetics. Consider adjuncts.
Palms and fingers are used to palpate for:
Texture
Mass
Fluid
Assess skin temperature
Ask for consent before you touch them, tell them what you are doing. Surprises are not a good thing
What are the three types of palpations?
Light - slow gentle pressure (1-2 cm)
Deep - used to detect abdominal masses, abdominal cavity (4-5 cm)
Bimanual - using both hands to trap something (neck masses)
What organ is important to percuss?
Lungs
Important to figure out whether there is fluid or air (hemothorax or pneumothorax)
What are the 3 methods of percussion?
Mediate or indirect percussion- striking finger, used on abdomen and thorax
Immediate Percussion- directly striking surface with fingers, used on sinus or an infant thorax
Fist Percussion- one hand flat on the surface and striking the back of the hand with a fist, used to evaluate back and kidney tenderness.
What is a cool way to assess your sinus cavity?
Stick a flashlight in your mouth
Percussion on air-filled spaces will have ________.
Percussion on fluid-filled spaces will have a ______ sound.
Resonance (drumlike noises)
Dull sound
What is circumoral cyanosis?
Blue discoloration around the mouth only. It is usually seen in infants, especially above the upper lip. If your child has darker skin, the discoloration might look more gray or white. Discoloration may also appear on hands and feet.
When you see someone with jaundice what do you need to think about?
Impaired liver
Impaired coagulation and bleeding
What is cholestasis?
The interruption of bile flow from the liver. The bile containing conjugated. bilirubin remains in the liver instead of being excreted.
What is the treatment for gallstones and bile duct stones?
Endoscopic retrograde cholangiopancreatography (ERCP)
What is the concern with vitiligo patients?
It is an autoimmune disorder and they will have trouble fighting off infections.
What are you worried about with raccoon eyes?
Basilar skull fx and direct facial trauma
What are Battle signs?
Bruising over the mastoid process, an indication of head trauma, basilar skull fracture.
What can cause petechiae?
Prolonged Straining
Asphyxiation/ Strangulation
Meds - Allergies
Infectious Disease - Septic
Leukemia
Thrombocytopenia
One of the main types of cancer to affect people with HIV.
Kaposis Sarcoma
Important to inspect skin lesions
What does poor skin turgor indicate?
Dehydration or chronic condition
Why is it important to assess symmetry with edema?
Edema can occur as a result of a systemic issue such as cardiac failure or a localized issue such as an inflammatory response to a bee sting, DVT, or compartment syndrome.
The angle between the nail should be ______.
160 degrees
Greater than 180 degrees = clubbing of the nails, cyanosis
What is clubbing of the nails associated with?
Heart and lung disease
COPD
What are two concerns from an anesthesia standpoint for rheumatoid arthritis patients?
- Atlantoaxial instability
- Chronic steroid use will lead to adrenal insufficiency
What do spoon nails indicate?
Anemia
Iron Deficiency
What is a big thing to consider when assessing hair?
Lice
What can Hirsutism be caused by?
Polycystic ovary syndrome (PCOS)
Cushing Syndrome
Congenital adrenal hyperplasia
Tumors
Meds (Minoxidil)
What things can make the skull asymmetric?
Tumors
Bone Flaps (their skull might be placed in their abdomen while the brain swelling goes down. Kangaroo)
If there is a funny-looking kid, what do you do first?
Assess their parents, because they can be funny looking too.
Be polite
What do you need to consider when taping a patient’s eyes for surgery?
Expensive eyelashes and eyebrows.
Cover them with gauze.
What do you do for patients with decreased lacrimal functions?
Make sure to use artificial tears
What can the eyes tell us about disease processes?
Exothalmus (hyperthyroidism)
What is Horner syndrome?
Anesthesia-caused (interscalene block) syndrome resulting in
-miosis (small pupils)
-ptosis (droopy eyelid)
-a notable difference in pupil sizes (anisocoria).
-pupils are slow to respond
-sunken eye
-no sweating (anhidrosis) on the side of the face where anesthesia was used.
What happens to a patient’s eyes after ketamine intake?
Nystagmus
What happens to a patient’s eyes during stage 2 of anesthesia?
Instead of the eyes being midline, the patient will have a disconjugate gaze (eyes rolled to one side or the other).
Remember, stage 2 is the danger zone, they are anesthetized but not adequately
What is Arcus Senilis?
Deposit of phospholipids and cholesterol in the peripheral cornea, usually in elderly patient, and it can affect vision.
How do we cause and fix constricted pupils?
Opioids will constrict pupils
Narcan to fix them
What is the ability for your eyes to see things up close and far away?
Accommodation
If patient’s can’t accommodate their vision, it may be a problem with the optic nerve
What field of vision is lost with retinal artery occlusion, eye strokes?
Peripheral Vision
What is the Rinne’s Test
Hearing test for air and bone conduction.
In healthy individuals, Rinne’s test is positive (indicating air conduction is better than bone conduction)
What is the Weber’s Test
A tuning fork is placed on the head to test hearing.
Normal is that sound of the tuning fork heard midline.
If we have a patient with barotrauma, air trapping, and bleeding what do we want to avoid?
Nitrous
When nitrous diffuses out, it will put pressure in air trap spaces.
Why would use cocaine for the nose in anesthesia?
Anesthetic agent and vasoconstricting effects
downside is elevated BP with coke
What does a bright red tongue indicate?
Deficiency of Iron or B12
What side of the nare is larger?
Right Nare usually
People with chronic hypertension may present symptoms of a bloody _______.
Bloody nose (epistaxis)
What does the color of the following lips indicate?
Cherry Lips:
Pallor Lips:
Cyanotic Lips:
Cherry Lips: Carbon Monoxide Poisoning
Pallor Lips: Anemia
Cyanotic Lips: Hypoxia or hypoperfusion
What is Leukoplakia?
Thick white patches on the gum due to smoking and alcohol
How do you assess the pharynx?
Extend neck slightly, open mouth wide, and say ‘ah’.
Place a tongue depressor on the middle third of the tongue and use a penlight for inspection, look for edema, ulcer, and inflammation.
What assessment do we want to make of the neck?
Anatomical position
Flexion/extension of the neck
Side-to-side movement of the head
The neck should move freely without pain
What is a common sign of COPD?
Barrel Chest
Butterfly Rashes are associated with what autoimmune disorder?
Systemic Lupus Erythematosus
Clubbing of the fingers is associated with what congenital heart defect?
Ventricular Septal Defect
Overriding of Aorta
Pulmonary Stenosis
Right Ventricular Hypertrophy
Pill Rolling Tremors are associated with what neurological disorder?
Parkinsons
What sign accompanies cholecystitis?
Murphy’s sign
RUQ pain on inspiration while palpating is positive for inflamed gallbladder.
The bruising of the flanks appears as a blue discoloration and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity.
Grey Turner’s Sign
Universal sign of ischemic chest pain,
Levine’s Sign
What vision changes are associated with glaucoma?
Tunnel vision
Breast exam considerations during physical assessment.
Symmetry
Lumps
Discharge
Pain
Previous Hx
Long Thoracic Nerve
What is the most common breast surgery for males?
reduction mammoplasty for gynecomastia
What is the concern of a concave chest?
Cardiac output
Respiration ability
Chest pain with breathing is usually associated with
Orthopedic/muscular issue
Infection- Inflammation of the tissues that line the lungs and chest cavity (Pleurisy)
Chest pain with breathing is usually not associated with cardiac issues
What is the concern with massive hemoptysis?
A cancerous tumor has eroded into their pulmonary artery.
How does an ETT form a TE Fistula?
If a patient is intubated for a long period of time, the tube can cause erosion.
Important to check your cuff pressures
How do you locate your apical pulse?
Locate the 5th intercostal space just to the left of the sternum and move fingers laterally, just medial to the left mid-clavicular line.
What is important when assessing radial pulses?
Check for symmetry
What can cause unequal radial pulses?
Aortic Aneurysm
Subclavian Steal Syndrome - may not have the same blood flow from one side to the other
Devices- ports
Clavicular Fractures
What is a quick way to check for perfusion?
Capillary refill on nail bed
Why do you need to investigate syncopal episodes?
Need to find the cause of syncope:
Hypotension: dehydration
Cardiac Issue: Beta-blockers
Cervical Lesion: Raising arms put pressure on the spine causing vasodilation
Valvular Lesion- aortic stenosis
What can you find during the abdomen assessment that will tell you if the surgery is going to be complicated?
Surgical Scars
more surgeries, means more scar tissue, longer surgeries d/t adhesions
What do you worry about with stool assessment?
C-diff poo
GI Bleed (dark tarry stool, frank red blood)
What is important to ask for patients with renal failure?
Do they make urine?
Why will an OB doc ask about urine color during a C-section?
Accidentally severing the ureter will result in hematuria
What is the biggest complaint of patients in the PACU after peripheral nerve blocks or regional anesthesia?
Inability to urinate
What is important to note about voiding?
When the patient last voided. Have the patient go to the bathroom before going to the OR.
What is the birth defect in males in which the opening of the urethra is not located at the tip of the penis?
Hypospadias
What are things to assess for the musculoskeletal system?
ROM
Weakness
Paralysis
Pain, Contracture - don’t move painful extremities while the patient is asleep.
Direction wrist extension and flexion
What is the most common way to stimulate the ulnar nerve?
TOF
Direction of elbow flexion and extension
The direction of shoulder adduction and abduction
What patient population will you want to assess for knee extension and flexion?
The direction of knee extension and flexion?
OB patients, hypermagnesemia will lead to loss of deep tendon reflexes
The direction of dorsiflexion and plantar flexion?
what is a common nerve injury in anesthesia that causes foot drop?
Injury to the Peroneal nerve, they won’t be able to dorsiflex. They will have permanent plantar flexion.
Increase lumbar curvature
Lordosis
hard to get a spinal epidural in, go in from the side instead
Exaggeration of posterior curvature of the thoracic spine.
Kyphosis
Pressure will be placed on their lungs, not ventilating very well
Lateral Spinal curvature
Scoliosis
What are 3 methods to fix scoliosis?
Braces (most conservative measure)
Cotrel Casting (3-quarter body cast)- breathing issues
Harrington Rods
What questions can you ask to test a patient’s orientation?
What city do you live in?
What hospital are you at?
Who is that family member or friend sitting with you?
What year or month are we in?
Don’t ask who the president is. You do not want to get into a debate. Don’t ask what day of the week it is when you don’t even know.
What is the Romberg test used to test for?
Proprioception
Positive Romberg test: the patient becomes unstable on their feet or fall. It signifies poor joint position sense.
Stroke patients often lose their proprioception.
What is the Pronator Drift test?
The pronator drift test helps to assess motor function, muscle strength, coordination, and normal proprioception or position sense.
The Patient will have arms out in front of them with palms up for 10 seconds. If one or both arms drift downwards, the test is positive.
What does VAN stand for in stroke assessment?
What does VAN positive equate to?
What is the quickest way to tell if a patient is VAN negative?
Vision, Aphasia, Neglect
A positive VAN patient has a high risk of a large vessel occlusion (LVO). This means that the patient can have a thrombectomy done.
VAN is negative if their Pronator test is normal, they are able to hold their hands out with palms up for 10 seconds.
Postive Pronator Drift = Positive for LVO
What reflex would you see when you strike a bicep tendon?
Flexion of the arm at the elbow.
What reflex would you see when you strike a tricep tendon?
Extension at the elbow.
What reflex would you see when you strike an Achilles tendon?
Plantar flexion of the foot
When performing this test, make sure to slightly dorsiflex the patient’s ankle by grasping the toes in the palm of your hand and then test the Achilles tendon.
Describe the Babinski reflex in babies and adults.
The Babinski reflex is tested by stroking the underside of the baby’s heel to the great toe. The baby’s toes will fan out and the big toe will move upward.
In an adult, the foot and toes will curl inward.
Babinski is used to test for upper motor neuron lesions.
How do you test for gluteal reflex?
Stimulation of the perineal area with a cotton applicator will result in a contraction of the anal sphincter.
Leonine face is associated with _______.
Leprosy (Hansen’s Disease)
Leprosy is caused by infection with the bacterium Mycobacterium leprae. It mainly affects the skin, eyes, nose and peripheral nerves.
Chipmunk face is associated with what nervous eating disorder?
Bulimia Nervosa
Spider Angioma is commonly associated with what liver disorder?
Cirrhosis
Pyloric stenosis is associated with what shape of mass?
Olive shaped mass
Hyperthyroidism is associated with what ophthalmic change?
Exophthalmos
What physical feature is commonly associated with Cushing’s Syndrome?
Buffalo Hump
Rice water stool is commonly found with what illness?
Severe Cholera
Chlorea is bacterial disease causing severe diarrhea and dehydration, usually spread in water.
