Head, Face,Neck, Thorax & Abdomen Flashcards
When assessing someone’s thyroid gland, what’s the first assessment technique you should use?
Inspection
What is meant by the term tangential lighting?
shinning parallel to the surface
When palpating lymph nodes, use ______ pressure.
gental
Normal lymph nodes, when they are palpable, should feel ______, _______, ______, and _________.
movable
discrete
soft
non-tender
The conjunctiva should be ____ and the sclera should be _______.
clear
white
What are three normal variations you can sometimes see when inspecting the eyes of African American individuals?
gray-blue or “muddy” color
yellowish fatty deposits
small brown macule
What is the term for a yellowing of the sclera that indicates jaundice?
scleral icterus
What is the term for “pink eye”?
conjunctivitis
PERRL
Pupils, Equal, Round, React to Light
Most adults’ resting pupil size is ___ to ___mm.
3 to 5
Anisocoria
pupils of two different sizes
nystagmus
a fine oscillating movement best seen around the iris
When would nystagmus be normal?
at an extreme lateral gaze
If the reflection is not in the same spot, what does that mean?
asymmetry of the light reflex indicates deviation in alignment from eye muscle weakness or paralysis
What instrument do you need to check for a red reflex?
opthalmascope
If a person has difficulty hearing whispered words, what type of hearing loss are they likely suffering from?
high frequency
At what stage in the assessment should a child’s tympanic membranes be examined?
at the end
Before inserting the speculum in the ear of an infant or child less than three years, pull the pinna _________.
straight down
For an adult, pull the pinna _____.
up & back
Describe a normal TM.
pearly gray, shinny, translucent
When palpating the sinuses, what should the patient feel?
firm pressure but no pain
What are two reasons a person’s sinuses might be tender to palpitation?
chronic allergies
acute infection
What are some conditions which might cause unequal chest expansion?
marked atelectasis, lobar pneumonia, pleural effusion, thoracic trauma (fractured ribs or pneumothorax)
What does the word remits mean?
palpable vibration (generated by the larynx)
Which part of your hands should you use when assessing for vibration?
palmar base (the ball) of the fingers the ulnar edge of the hand
Why should you avoid assessing for vibration?
bone damps out sound transmission
If someone has lobar pneumonia, would you expect increased or decreased fremitus over that area?
increased
If someone has a pneumothorax, would you expect increased or decreased fremitus over that area?
decrease
What is the predominate percussion sound should expect to hear over the lungs field?
resonance
What might an area of hyperresonance indicate?
too much air
What might an area of dullness indicate
abnormal density in the lungs tumor lung cancer pneumonia pleural effusion atelectasis
Should you use the bell or the diaphragm of you stethoscope when auscultating lung sounds?
diaphragm
How hard should your patent breathe during lung auscultation?
a little deeper than normal
What should you do if your client has a particularly hairy chest?
press harder or wet hair with a damp cloth
What is the name of the sound you should normally hear when auscultating peripheral lung fields?
vesicular
When you lower auscultating
lower
Where is S1 heard?
apex
Where is S2 heard?
base
What condition can displace the PMI down and/or to the left?
cardiac enlargement
What are the two normal heart sounds you are supposed to hear?
S1 S2
Why is it important to not press too firmly on the carotid arteries?
it will slow down the heart rate
Why is it important to assess only one carotid artery at a time?
to avoid compromising arterial blood to the brain
Which end piece of your stethoscope should you use when auscultating bowel sounds?
diaphragm
Why is it important to auscultate the abdomen before percussing or palpating it?
can increase peristalsis / create sounds that weren’t there
What might rebound tenderness indicate?
apendicitis
After abdominal surgery, the best way to determine GI motility is to measure……
return of flatus & first postoperative bowel movement
When auscultating the lungs, the examiner should remember to…
Auscultate lung sounds directly on the client’s skin w/ the diaphragm
Have the patient to breath through their mouth
Listen to one full inspiration & expiration before moving to the next site
Auscultate in a side-to-side pattern to compare
Listen to the front & backside of the patient
Two main challenges w/ lung auscultation
1.Lung sounds can be difficult to hear.
Best heard 1,000 - 5,000 Hz
Normal lung sounds < 500 Hz
2. The sounds we are trying to hear are often very short.
bronchial breath sounds
the sound air makes when flowing through a tube.
Relatively high pitch, which makes them easier to hear
The expiratory phase is long (at least as long as inspiration).
There’s a tiny gap b/w inspiration and expiration.
Alveolar sacs
air filled sacs in the lungs
vesicular breath sounds
Lower frequency, which makes them harder to hear
The expiratory phase is short
There is no silent pause
Bronchial breath sounds are only ______ if heard over the neck.
normal
*They’re not supposed to be heard anywhere else.
The normal chest is supposed to contain ______ _____ that transforms the sound into ______ breath sounds.
alveolar air, vesicular
If you hear bronchial breath sounds over the lung fields, the _____ have either _______ or _______ w/ fluid (blood, puss, or pulmonary edema).
alveoli, collapsed, filled
Crackles
Very important findings
discontinuous (very short) sounds
Taken together, crackers can have a long duration
Normally heard on inspiration
Early inspiratory
Air flowing through large central bronchus covered in secretions
Bubbling noise
Possible: Bronchitis
Mid Inspiratory
Inflamed, partially dilated medium sized bronchi
Possible: Bronchiectasis
Late Inspiratory
Small, distal airways that are partially collapsed
Possible: Fluid, pulmonary fibrosis, pulmonary hemorrhage, pneumonia, pulmonary edema, heart failure (left side)
Wheezes
high-pitche, typically expiratory, and longer
Air flows through narrow airway a suckling effect is created on the airway wall (airway flutter)
Inspiratory & expiratory or just expiratory
Does narrowing of the airway necessarily mean that causes wheezing?
No. Its the speed of the air.
Beware of the silent asthmatic
Asthmatics on the brink of respiratory failure might not wheeze
Not wheezing anymore may be a sign of the condition worsening
Exhaling w/ too much force during lung auscultation may cause ______.
wheezing
If you hear a wheezing type noise that is only on inspiration, you’re probably hearing _______.
stridor
Stridor
the result of closing (adduction) of the vocal cords.
Rhonchi
Similar to wheezes They are longer Snoring quality to them Often caused by thick secretions that narrow the airway Can diffuse but often localized
A persistent ________ localized to a specific area can be a sign of neoplasm.
rhoncus
