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N190 - Physical Assessment > Final Review > Flashcards

Final Review Flashcards

1
Q

what technique to elicit crepitus on chest injury?

A

palpation

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2
Q

what technique for diaphragmatic excursion?

A

percussion

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3
Q

what technique for full/distended bladder?

A

indirect percussion

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4
Q

what technique for the sinuses?

A

direct percussion

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5
Q

what technique for the lungs?

A

indirect percussion

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6
Q

transilluminator

A

detect blood, fluid, or masses in body cavity

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7
Q

wheal

A

reddend, irreg border
- ie/ insect bite, hives

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8
Q

lichenification

A

rough, thick, hardened epidermis due to constant scratching/rubbing

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9
Q

venous lake

vascular lesion

A

elevated, dark blue, compressible soft lesion on the lip or neck
- common in elderly

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10
Q

port wine stain

vascular lesion

A

falt, irreg, pale-deep purple red;
color deepens in response to emotion or high temp

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11
Q

hemengioma

vascular lesion

A

bright red, raised, nonblanch
- present @ birth - few months after
- disappears at age 10

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12
Q

spider angioma

vascular lesion

A

flat red dot w/ tiny radiating vessels; pinpoint - 2 cm; blanchable

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13
Q

light palpation

A

fingerpads of 1 hand
- 0.5-1 cm

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14
Q

moderate palpation

A

fingerpads
- 2-3 cm

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15
Q

deep palpation

A

palmar surface; bimanual
- 4-5 cm
- liver, spleen, kidneys

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16
Q

indication:

open sore on hand; not healed for several months

A

malignancy/skin cancer

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17
Q

nystagmus

A

jerky eye movement during 6 cardinal field of gaze

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18
Q

weber test

A

normal: equal lateralization to right and left ears
- abnormal: impacted cerumen; lateralization towards the ear w/ cerumen

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19
Q

rhine test

A

normal: air conduction 2x greater than bone conduction

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20
Q

craniosynostosis

A

infant w/ elongated head; altered face and orbit of eyes

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21
Q

presbyopia

A

difficulty with near vision
- common in ages 45+

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22
Q

hyperopia

A

difficulty w/ near vision

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23
Q

myopia

A

difficulty w/ far vision

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24
Q

acute glaucoma

A

increase pressure in the eyes
- S/Sx: sudden pain; ↓ vision; halos around light; dilated, oval pupil; cloudy cornea w/ curcumcorneal redness
- Outcome: may lose vision in 1-2 hours
- Tx: surgery
- EMERGENCY; IMMEDIATE ATTENTION

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25
Q

otitis externa

A

infection of outer ear; tympanic normal, pearly grey

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26
Q

otitis media

A

infection external & ossicles

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27
Q

otitis interna

(labyrinthitis)

A

infection in the semicircular canal, cochlea, & vestibule
- S/Sx: severe vertigo, dizziness

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28
Q

otoscope

A

funnels light into ear canal

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29
Q

retinal detachment

A
  • S/Sx: diminished vision; floaters; sudden flash; shadow in vision
  • Outcome: lose vision withing days of diagnosis
  • Tx: laser surgery (photocoagulation); freezing (cryopexy)
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30
Q

how to assess EOM

A

6 cardinal fields of gaze
- H or wheel wagon method

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31
Q

leading cause of blindness in US?

A

diabetic retinopathy

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32
Q

how to test integrity of cranial nerve III?

A

look up and down without moving head

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33
Q

indication:

white patches of tympanic membrane

A

scarring from previous infection

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34
Q

nursing care:

positive rombergs test

A

provide bedside comode

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35
Q

sinus headache

A

from sinus infection

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36
Q

classic migraine

A

preceded by aura; spots and flashes; numbness/tingling of face and extremities

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37
Q

cluster headache

A

numerous headaches over days-months; no aura; sudden onset
- associated w/ alcohol, stress, or emotional distress
- may last for a few minutes-hours

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38
Q

tension headache

(muscle contraction headache)

A

gradual onset; steady pain; starts from cervical to top of head; unilateral or bilateral
- associated with stress, overwork, dental problem

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39
Q

intropion

A

inverted upper lid
- irritation of eyes

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40
Q

ectropian

A

lower lid everted
- exposes conjunctiva

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41
Q

most common hyperthyroidism

A

graves’ disease

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42
Q

gingivitis

A
  • S/Sx: red, bleeding, receeding gums
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43
Q

expected finding:

bell’s palsy

A
  • muscle distortion
  • pain behind ears
  • impaired taste
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44
Q

expected finding:

1) no fluid in sinus
2) fluid in sinus

A

1) red glow
2) no red glow

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45
Q

SBE for elderly client

A

the same day every month

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46
Q

SBE for mensturating client

A

3-5 days after cycle
- hormones are more stable

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47
Q

common cause of benign nipple discharge

A

intraductal papilloma
- postmenopausal client
- serous/bloody discharge

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48
Q

benign breast

(fibrocystic disease)

A
  • S/Sx: lumps, pain/tenderness, and nipple discharge due to thickening of breast tissure
  • common in womens 20’s
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49
Q

fibroadenoma

A

defined breast tumor w/ NO tenderness/discharge
- common in ages 15-35

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50
Q

Peau D’ Orange

A

orange peel appearance
- indicates malignancy

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51
Q

most reliable indicator of central cyanosis in asthma client

A

oral mucosa

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52
Q

early signs of hypoxia

A
  • altered LOC
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53
Q

abnormal findings:

whispered pectriloguy w/ bilateral PNA

(both lungs filled w/ fluid)

A

loud, clear bilaterally

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54
Q

expected findings:

whispered pectriloguy

auscultate technique

A

soft, indistinguishable

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55
Q

technique to assess respiratory system

A

assessing from side to side

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56
Q

tracheal

normal lung sounds

A

harsh, high-pitch
- I < E
- over trachea

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57
Q

bronchial

normal lung sounds

A

loud, high-pitch
- E > I
- next to trachea, above each clavical, 1st ICS

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58
Q

broncho-vesicular

normal lung sounds

A

medium, medium-pitch
- I = E
- over major bronchi in 2nd & 3rd ICS; between scapulae

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59
Q

vesicular

normal lung sounds

A

soft, low-pitch
- I > E
- remainder of the lungs

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60
Q

bradypnea vs hypoventilation

abnormal breathing patterns

A

< 10 breaths/min; slow
- bradypnea: regular
- hypoventilation: irregular

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61
Q

tachypnea vs hyperventilation

abnormal breathing patterns

A

> 20 breaths/min; rapid
- tachypnea: shallow
- hyperventilation: deep

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62
Q

cheyne-stokes vs biot’s (ataxic)

abnormal breathing patterns

A

periods of apnea
- cheyne-stokes: regular; in dying patients
- biot’s (ataxic): irregular; brain damage

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63
Q

crackles

adventitious sounds

A

low-pitched, bubbling, loud
- due to collapsed, fluid filled lungs
- *ie/ lobar pnuemonia

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64
Q

rhonchi

(sibilant)

adventitious sounds

A

high-pitched, continuous
- due to blocked airflow
- ie/ asthma

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65
Q

rhonchi

(sonorous)

adventitious sounds

A

low-pitched, continuous, snoring, rattling
- ie/ COPD

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66
Q

stridor

adventitious sounds

A

loud, high-pitched, crowing heard W/O stethoscope
- common in obstructive upper airway

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67
Q

friction rub

adventitious sounds

A

low-pitched, grating, rubbing
- *ie/ pleural inflammation

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68
Q

expected findings:

normal chest

chest configuration

A

elliptical with lateral diameter 2:1 with anteroposterior diameter
- usually by age 6

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69
Q

expected findings:

infant chest

chest configuration

A

rounded; equilateral in anteroposterior diameter; barrel chest
- COPD = barrel chest

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70
Q

abnormal findings:

pectus carinatum

(pigeon chest)

congenital chest deformities

A

forward displacement of sternum w/ depression of adjacent cartilage
- no tx required

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71
Q

abnormal findings:

pectus excavatum

(funnel chest)

congenital chest deformities

A

depression of sternum & adjacent cartilage
- cradiac murmur
- surgery required in severe cases

72
Q

abnormal findings:

scoliosis

chest configurations

A

lateral curve of spinal process
- common in female

73
Q

abnormal findings:

kyphosis

chest configurations

A

exaggerated posterior curve of thoracic spine
- associated w/ aging

74
Q

abnormal findings:

lordosis

chest configurations

A

exaggerated curve of lumbar spine
- during last term of pregnancy

75
Q

indication:

hyperesonant sound on percussion of lungs

breath sounds

A

air trapped in lungs

76
Q

abnormal findings:

pleural effusion

auscultation of breath sounds

A

absent breath sounds of affected lung

77
Q

indication:

low-pitched, loud, moist, bubbling on auscultation

adventitious lung sounds

A

fluid filled alveoli

78
Q

what part of the chest do you perform cardiac assessment?

A

precordium

79
Q

location of PMI

(point of maximal impact)

A

left midclavicular line; 5th ICS

80
Q

erb’s point

cardiac landmark

A

3rd ICS; LSB

81
Q

angle of louis

cardiac landmark

A

articulation of manubrium & body of sternum in line w/ 2nd rib

82
Q

abnormal findings:

arterial insufficiency

peripheral vascular

A
  • cold, no hair
  • deep muscle pain from activity/elevation of limb
83
Q

abnormal finding:

venous insufficiency

peripheral vascular

A
  • temp is normal, edema
  • pain from prolonged standing/sitting
84
Q

ECG

(electrocardiogram)

A

electrical representation of cardiac cycles, documented by a deflection on a recording paper

85
Q

depolarization

(contraction)

ECG

A

after stimulation by electrical current
- inside cardiac cells: + charge

86
Q

repolarization

(relaxation)

ECG

A

after contraction
- inside cardiac cells: - charge

87
Q

P wave

ECG

A

atrial depolarization
- ~ 0.08 secs

88
Q

PR interval

ECG

A

time needed for electrical current to travel across both atrium & arrive at AV node
- 0.12 - 0.20 secs

89
Q

where is atrial polarization hidden in?

ECG

A

QRS interval

90
Q

QRS interval

ECG

A

ventricular depolarization
- .08 - 0.11 secs

91
Q

T wave

ECG

A

ventricular repolarization

92
Q

QT interval

ECG

A

beginning of ventricular depolarization to moment of repolarization

(ventricular contraction)

93
Q

allen’s test

A

determines the patency of radial and ulnar ateries

94
Q

abnormal findings:

raynaud’s disease

peripheral vascular

A

spasm/tingling of hands & fingertips turn whitish → cyanotic → reddish
- common in young, healthy females 2/2 connective tissue disease, drug intoxication, pulmonary HTN, or trauma

95
Q

deep vein thrombosis

(DVT)

peripheral vascular

A

occulsions of deep veins by blood clot
- sudden swelling on one leg
- dependent edema
- IMMEDIATE REFERRAL; can become VTE → lung = PE

96
Q

subjective findings:

DVT

peripheral vascular

A
  • intense, sharp pain along the iliac, popliteal, or calf muscle
  • intense pain w/ dorsiflexion of foot
97
Q

objective findings:

DVT

peripheral vascular

A
  • unilateral edema
  • low grade fever
  • tachycardia
98
Q

abnormal findings:

infective endocarditis

A

thin red lines or splinter hemorrhages on nail beds

99
Q

pathological cardiac murmurs

A

structural abnormalities of the heart
- mitral regurgitation
- tricuspid stenosis
- aortic regurgitation

100
Q

aortic area

cardiac landmark

A

2nd ICS, RSB

101
Q

S2

(dub)

heart sounds

A

closure of the semilunar valves
- loudest at the base of the heart

102
Q

S1

(lub)

heart sounds

A

closure of the tricuspid and mitral valves
- loudest at the apex of the heart

103
Q

SA node

A

pacemaker of the heart; where the initial electrical impulse occurs
- 60 - 100 joules/min

104
Q

AV node

A

60 joules/min

105
Q

bundle branches

A

40 - 60 joules/min

106
Q

S4

(atrial gallop)

heart sounds

A

before S1

107
Q

S3

(ventricular gallop)

heart sounds

A

after S2

108
Q

what are the major risk factor for diseases?

A

smoking, HTN, DM, obesity, & high cholesterol

109
Q

foramen ovlale

congenital heart diseases

A

passage way for blood between the atriums
- should close shortly after birth

110
Q

ductus arteriosus

congenital heart diseases

A

opening between the pulmonary artery and the descending aorta
- should close 24 - 48 hours after birth

111
Q

tetralogy of fallot

congenital heart diseases

A
  • 4 cardiac defects
  • life threatening; sx right away
112
Q

sympathetic

cardiac nerves

A

stimulates the heart
- ↑HR, ↑ dilation of coronary arteries

113
Q

parasympathetic

cardiac nerves

A

↓ stimulation of the heart
- ↓HR, ↓ contraction of heart, and ↓ dilation of coronary the coronary arteries

114
Q

manifestations:

heart failure

cardiac diseases

A
  • fatigue
  • tachycardia
  • SOB/dyspnea
  • weak paripheral pulses
  • S3
  • ankle edema
115
Q

what technique to assess patency of arterious venous graft?

(AV graft)

A

palpate the side for thrill

116
Q

2 types of abdominal mapping

A
  • 4 quadrants
  • 9 regions
117
Q

costovertebral angle tenderness

(CVAT)

abdominal landmark

A

costovertebral angle using blunt percussion

118
Q

indication:

input > output

A

retaining fluid
- CHF

119
Q

indication:

output > input

A

secreting more fluid that intaking
- DM, kidney failure, excess intake of fluids

120
Q

positive blumberg sign

abdominal abnormal findings

A

sharp, stabbing rebound pain
- positive peritonitis/peritoneal irritation
- EMERGENCY

121
Q

positive rovsing sign

abdominal abnormal findings

A

sharp pain in RLQ when palpating LLQ
- acute appendicitis/peritoneal irritation

122
Q

positive psoas sign

abdominal abnormal findings

A

RLQ pain when R leg is raised up w/ resistance
- appendicitis

123
Q

positive murphy’s sign

abdominal abnormal findings

A

RUQ pain when deep breathing while palpation of lower border of liver
- cholecystitis

124
Q

positive cullen’s sign

abdominal abnormal findings

A

ecchymosis/blueish discoloration of abdomen
- ruptured ectopic pregnancy
- internal bleeding in abd

125
Q

location of mcburney’s point

A

middle 1/3 of the imaginary line from the umbillicus to the right inguinal area

126
Q

normal findings

thin person

abdominal contours

A

flat

127
Q

normal findings:

very thin person

abdominal contours

A

scaphoid

128
Q

normal findings:

obese; toddler; early pregnancy

abdominal contours

A

rounded

129
Q

normal findings:

some toddlers; late stage pregnancy; ascites

abdominal contours

A

protuberant

130
Q

abdominal aortic aneurysm

(AAA)

A

strong abdominal pulsation
- EMERGENCY

131
Q

LUQ organs

A

stomach; spleen

132
Q

RUQ organs

A

liver; gallbladder

133
Q

what quardant to assess for diverticulitis

A

LLQ

134
Q

sequence of assessing the abdomen

A

1) inspect
2) auscultate
3) percuss
4) palpate

135
Q

hepatitis

A

inflam. of liver caused by:
- virus, bacteria, chemicals, drugs, parasite

136
Q

hepatitis B & D

A

transmitted by:
- blood
- sexually
- perinatally
- parenterally

137
Q

hepatitis C

A

transmitted by:
- blood
- parenterally

138
Q

hepatitis A

A

transmitted by:
- fecal/oral
- common in children

139
Q

hepatitis E

A

transmitted by:
- drinking dirty water
- common in travelers

140
Q

anuria

urinary conditions

A

< 100cc in 24 hrs

141
Q

oliguria

urinary conditions

A

100 - 400cc in 24 hrs

142
Q

enuresis

urinary conditions

A

involuntary urination at night
- common in ages 5 and younger
- familial tendency

143
Q

normal bowel sounds in each quadrant

A

irregular, high-pitched, gurgling
- 5 - 30/min

144
Q

borborygmi

A
  • normal: frequent, loud bowel sounds when a person has not eaten in 5-7 hours
  • abnormal: when accompanied by other GI symptoms (bleeding, IBD)
145
Q

indication:

hyperactive

bowel sounds

A

diarrhea; gastritis

146
Q

indication:

hypoactive

bowel sounds

A

post-op; bowel obstruction; constipation

147
Q

indication:

absent

bowel sounds

A

paralytic ileus; complete bowel obstruction

148
Q

collitis

abdominal disorder

A

inflam. of colon
- S/S: abd pain, diarrhea, bloody stool
- may require medical intervs.

149
Q

crohn’s

abdominal disorder

A

chronic inflam. of the GI; any part of lower intestines
- S/S: abd pain, diarrhea, weight loss
- no medical interv

150
Q

glomeruli

A

clusters of capillaries in kidneys
- filter 1L/min

151
Q

manifestations:

chronic renal failure

A
  • UREMIA
  • S/S: N/V, anorexia, altered mentation, uremic frost on skin, edema, fatigue, weight loss
152
Q

cause & manifestations:

HYPERnatremia

A
  • Cause: exposure to extreme environmental temp
  • S/S: hypotension, weakness, tachycardia, dry mucosa, oliguria
153
Q

diencephalon

A

thalamus, hypothalamus, epithalamus

154
Q

tremors of parkinson’s

A

rhymic shaking

155
Q

why do you get shorter when you age?

A

shortening of vertebral column

156
Q

osteoarthritis

A

pain aggravated by activities

157
Q

rheumatoid arthritis

A

pain improve with activites

158
Q

risk of osteomyelitis for open metacarpal fracture

A

fever

159
Q

ABduction

A

move outward/away from center of body

160
Q

ADduction

A

move inward/toward center of body

161
Q

risk factors for osteoporosis

A

sedentary lifestyle; no exercise

162
Q

abnormal findings:

positive carpal tunnel syndrome

(phalen’s test)

A

tingling/numbness over media nerve, palmar of thumb, index, middle, ring; pain of upper arm, shoulders, neck, chest

(hold wrist @ 90° flexion for 60 secs)

163
Q

tinel’s sign

A

direct percussion on median nerve
- normal: no pain/tingling on arm along median nerve

164
Q

indication:

rotator cuff injury

A

inability to ABduct arm at shoulder

165
Q

brachioradialis

A

tap flat of DTR hammer 2-3in above wrist when palm in semi-prone w/ elbows aligned w/ waist

166
Q

bicep reflex

A

tap indirectly point of DTR hammer @ antecubital of arm when palm in semi-prone w/ elbows aligned w/ waist

167
Q

ataxia

A

diff. w/ ambu D/T unsteady gait; wide base; swaying
- common in multiple sclerosis, drug/alcohol intox

168
Q

graphesthesia

(two point discrimination)

A

draw letter on clients hand w/ eyes closed
- inability may indicate cortical diseases

169
Q

stereognosis

A

identify familiar object place on hand w/ eyes closed
- inability may indicate cortical diseases

170
Q

how to assess for sensory function

A

sharp or dull touch w/ eyes closed

171
Q

normal achilles tendon reflex

A

plantar flexion of foot and heel jump

172
Q

risk for autonomic dysreflexia in T4 spinal injury patient

A

clients bladder becomes distended

173
Q

bell’s palsy

A

one-sided inflam. of CN VII
- S/S: pain behind ears w/ tinnitus; no headache; impaired taste; diff w/ speech & eating; muscle distortion

174
Q

babinski reflex

A

extend and fan toes & flex foot
- normal up to 24 months
- in >24 months indicates: CNS pathology; upper neuron disease

175
Q

plantar reflex

A

stim sole of foot, from heel across ball of foot to big toe in an inverted ‘J’
- normal adults: plantar felxion, toes curl towards sole of foot

176
Q

expected and unexpected findings:

when assessing CN 12

A
  • Expected: ease and eqaulity of movement
  • Unexpected: tremor, paralysis, diff. w/ speech or swallowing
177
Q

objective findings:

meningitis

A
  • fever, irritability, vomit, seizure, coma

N190 - Physical Assessment (4 decks)

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