Exam 2 Flashcards
Preauricular lymph node location
In front of the ear
Posterior auricular lymph node location
Behind the ear
Occipital lymph node location
Base of the back part of skull
Submental lymph node location
Underneath chin
Submandibular lymph node location
Halfway between the angle and the tip of the mandible
Juggulodigastric lymph node location
Under the angle of the mandible
Superficial cervical lymph node location
Overlying the external mastoid muscle
Deep cervical lymph node location
Deep under the external mastoid muscle
Posterior cervical lymph node location
And the posterior triangle along the edge of the trapezius muscle
Supraclavicle lymph node location
Just above and behind the clavicle at the external mastoid muscle
How do you assess the trachea
through palpation normally the trachea is midline and slightly movable inspect and palpate for any shift note and deviation from midline
Hyperventilation
Increase in rate and depth of breath
Techypnea
Faster breathing
Bradypnea
Decreased respiration less than 10 breasts per minute
Orthopnea
Trouble breathing while in a lying down position
Dyspnea
Difficulty breathing
Hypercapnia
Excessive amount of CO2
Hypoxemia
Lack of oxygen
Cheyne-stokes
Increase in breathing then decrease in breathing followed by a period of apnea. Usually happens at the end of life.
how to assess thorax and lungs
Inspect palpation percussion ausculation
Thorax and lungs inspection
Shape and symmetry of chest
Posture/position used to breath
Respiratory rate
Rhythm
Skin color and condition
Lung expansion
Use of accessory muscles
Clubbing
Posture/position used to breath thorax and lung assessment
Which includes a relaxed posture and the ability to support one’s own weight. (Tripod Position - which is seen a lot in COPD patients which is where they lean forward to breathe) Neck Muscles are also hypertrophied due to the aid of forced respiration across the obstructed airway.
Respiratory rate thorax and long assessment
Norm al is 12 to 20 breaths per minute braided is less than 10 breast per minute and tachypnea is less than 24 breast per minute
Shape and symmetry of chest thorax and lung assessment
anterior-posterior (AP) to transverse diameter; which should be less than transverse, 3/4 in adults. barrel chest is when the AP is equal to transverse diameter which is caused by hyperinflation of lung (Barrel chest common in COPD constant lack of inspiration scoliosis and kyphosis)
Rhythm thorax and lung assessment
Bradypnea, tachypnea, hyperventilation, normal
Skin color and condition thorax and long assessment
Color could be consistent with the person’s background with allowance for sun exposure areas on the chest and back lips nails and mucous membrane. This is the best place to do a skin and pigment assessment due to its usual lack of exposure from the sun.
Cyanosis
The turning of blue due to the lack of O2 in the body
Use of accessory muscles thorax and lung inspection
No reaction or bulging of the interspace should occur on inspiration normally accessory muscle is not used during a augment respiratory
Clubbing thorax and lung inspection
Increased size and fanning of fingers and fingernails due to a chronic respiratory disease
Palpation thorax and lung inspection
Tenderness or crepitus
Symmetry of lung expansion
Assess tactile fremitus
Tenderness or crepitus lung and thorax palpation
Looking for tenderness and crepitus air bubbles or crackling under the skin
Symmetry of lung thorax and lung palpation
By placing your warmed hand sideways on the posterior lateral chest wall with thumb pointed together at the T9-T10. Slide your hand immediately to pinch up a small fold of skin between your thumbs ask the person to take a deep breath and as your patient inhales deeply your thumbs should move apart symmetrically
Assess tactile fremitus
Move hands across and down either the chest or the back have the patients say either 99 or blue moon these words produce strong vibrations. Each side should have the same vibrations.
Percussion thorax and lung
Resonance
Dull
Flat
Hyper resonance
Resonance percussion sound meaning
Low-pitched clear hollow sound. Normally found in lungs.
Dull percussion sound
Fluid sound normally found in liver, heart, spleen abnormal in lung
Flat percussion sound
Should be heard over muscles and bones
Hyper resonance percussion sound
Low-pitched booming sound found when too much air is present such as emphysema and or pneumothorax
Ausculation lung and thorax
Three types of normal breathing sounds found in older children and adults.
Bronchial
Bronchialvesicular
Vesicular
Ausculation Lung and thorax bronchial
Also known as tracheal. Loudest inspiration harsh hollow tubular
Ausculation Lung and thorax broncovesicular
Moderate, inspiration equals expiration, mix sound, major bronchi very few alveoli
Ausculation Lung and thorax vesicular
Softest, expiration, rustling sound small bronchioles and alveoli
Stridor lung sound
High pitched whistling sound heard when taking a breath. Caused by blockage in trachea
Wheezing lung sound
Whistling sound due to narrowing of airways caused by edema and asthma
Rhonchi lung sound
Rattling sound in larger airways of lung caused by excessive mucus
Rales long sound
Bubbling sound heard in small airways alveoli typically when they fill with fluid
Assessment finding for asthma
Inspection - increased respiratory rate shortness of breath audible wheeze cyanosis
Palpation-tactical fremitus decrease, tachycardia.
Percussion - resonant or hyper resonant if it’s chronic asthma.
Auscultation- breathing sounds decreased, voice sounds decreased prolonged expiration
Pneumonia assessment findings
Inspection - respiration of 24 per minute or more, guarding, lack of expansion on affected side.
Palpation pulse greater than 100 beats per minute, chest expansion decrease on affected side.
Percussion - Dull over pneumonia area
Auscultation - tachycardia, loud bronchial breathing, voice sounds have increased clarity, fine medium crackle.
Emphysema assessment findings
Inspection - increased AP diameter (barrel chest) tripod position.
Palpation - decreased tactile fremitus and breathing sounds.
Percussion - hyper resonant.
Auscultation- muffled heart sound, decrease breath sound, may have an occasional wheeze.
Abdominal assessment
Inspection, auscultation, percussion, palpation
Abdominal assessment inspection
Shape, symmetry, umbilical, skin, pulsation and movement, hair distribution, demeanor
Auscultation abdominal assessment
Bowel sounds-high pitch gurgling, cascading sounds heard five to 30 times per minute.
vascular sounds- check the aorta, femoral, iliac, renal artery. No sound is normal. However younger patients may have a brew it from the artery medium to low and pitch and hurt between the xiphoid process and belly button.
Abdominal assessment percussion
General tympany, liver span, splenic dullness, costovertebral angle tenderness, fluids, fluid wave, shifting dullness
Abdominal assessment palpation
Liver, spleen, kidney, aorta
Borborygmus
Stomach growling, hyperparastalsis
Dysphagia
Difficulty swallowing
Bruits
Vascular sounds
Ascites
Free fluid in the peritoneal cavity occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer
Striae
Pink / blue to silvery white linear and jagged lines found on the abdomen
Hernia
A loop of bowel or content protruding through a weak spot in the abdominal muscle
Concave contour
Shape of belly curves inward
Protuberance
A sign of distension in the abdomen
Scaphoid
Abdominal caving
Right upper quadrant organs
Liver, gallbladder, duodenum, head of pancreas, write adrenal gland, portion of right kidney, part of ascending and transverse colon
Organs in right lower quadrant
Cecum, appendix, right ovary and fallopian tube, right ureter, lower pole of right kidney, portion of ascending colon, right spermatic cord, bladder if distended
Organs and left upper quadrant
Stomach, spleen, left lobe of liver, body of pancreas, left adrenal gland, portion of left kidney, portion of transverse and descending colon
Organs in the left lower quadrant
Lower pole of left kidney, portion of descending colon, sigmoid colon, bladder, leftovery, left fallopian tube, left spermatic cord
Abdominal assessment
Blumberg’s sign, Murphy sign, ilipsoas muscle test, obturator test
Blumberg sign
When you push down slowly and deeply and pull up quickly pain should be felt when pulling up. This test should be performed last due to cause of pain and muscle rigidity
Murphy’s sign
And spiritually arrest gallbladder infection hold your finger under the liver border ask your patient to take a deep breath, not accurate for patients older than 60
Iliopsoas muscle test
When appendicitis is suspected with the patient patient lies supine lift the right leg straight up and flex at the hip and then press down over the lower part of the right thigh The person is trying to hold their right leg up.
Obturator test
The patient raises right leg flexing 90° at the knee while the examiner holds the ankle and rotates the leg internally and externally there should be no pain
Considerations for all adults
Inspection - increase deposits of subcutaneous fat on abdomen and hips and abdominal masculature is thinner and has less tone
palpate - organs are easier to palpate and absence of obesity liver is easier to palpate or below coastal margin, kidney is easy to palpate.
Developmental consideration for infants
Inspection-contour of abdomen because of immature abdominal musculature.
Peristalsis Visible because of the thin musculature
Three types of joints
Synovial joints, non synovial joints, cartilage joints
Ligament
Our fibereous bands running directly from one bone to another bone that strengthen the joint and help prevent movement in undesirable direction.
Synovial joints versus non-synovial joints versus cartilage joints
Synovial joints contain synovial fluid, bursa fluid sacs and joints that are used to reduce friction.
Non synovial joints are minimal movement joints that provide integrity such as sutures of skull
cartilage joints are separated by fibrocartilage discs that are only slightly movable
skeletal muscle movements range of motion
Flexion or extension. Abduction or adduction. Pronation or supination. Circumduction. Inversion or eversion. Rotation. Protraction or retraction. Elevation or depression.
Muscle strength grading scale
5/5 full ROM against gravity, full resistance
4/5 full r o m against gravity, some resistance
3/5 full r o m against gravity, no resistance
2/5 full r o m without gravity, passive ROM
1/5 slight muscle contraction, no movement
0/5 absence of visible and palpable muscle contraction
Ballottement
When large amounts of fluid are present compression on the Supra patellar pouch if no fluid then that means the patella is snugly against the femur
Phalen
Ask the person to hold both hands back to back while flexing the wrist 90°
Tinel
Direct percussion of the location of the median nerve at the risk producing no symptoms
Muscle testing
Have patient flex and hold while you apply opposing force
Developmental considerations for pregnant women
Increase level of circulating hormones cause increased movement and joints.
Lordosis curving inward lower back compensating for large fetus
Aging adults musculoskeletal considerations
Loss of bone matrix. Postural changes. The vertebral column shortens. More pronounced bony prominences. Absolute loss of muscle mass.
