Head to Toe Assessment Questions Flashcards
Adduction
Movement toward the midline
Abduction
Movement away from the body
Supination
Palms upward
Pronation
palms downward
Flexion
Decreasing the angle of a joint
Extension
increasing the angle of a joint
Inversion
Feet turned inward
Eversion
Feet turned outward
Lordosis
“Swayback”: Increased lumbar curvature above buttocks most often found in young children. neuromuscular problem with hip or posture
Scoliosis
Lateral curvature of the spine. Begin screening for this from 11-14 and treatment at 40 degree curvature.
Kyphosis
Exaggeration of the posterior thoracic spine curvature which can be due to osteoporosis (hunched Back)
Romberg Test
Has a patient stand still with eyes open, then with eyes closed. Tests their balance
Wheeze
Continuous musical sounds
Caused by high velocity airflow through significantly narrowed airways
Stridor
Harsh honking wheeze with severe bronchospasm
Air passing through a very constricted airway. Secondary to croup or a swallowed object caught in the airway
Crackles
Fluid in the lungs. Bubbling sounds. Not cleared with coughing
Common in the lower lung lobes
Rhonchi
Loud, Low pitched, Rumbling course sounds heard throughout lungs.
Typically secondary to mucus/fluid in larger airways. May be cleared with coughing
Chest Excursion
Holding hands on the back while the person breathes and seeing what happens to your hands. They should expand equally
Vocal Fremitus
External vibration while a pt talks. (the 99 test)
Lack of vibration may be due to: Accumulation of mucus, Lung Collapse, Lung lesion
Cheyne-Stokes
Alternating periods of deep rapid breathing followed by periods of apnea.
Associated with end-of-life
Biots Respirations
Irregular breathing pattern characterized by varying shallow respirations followed by periods of apnea
Associated with intracranial pressure and respiratory compromise.
Kussmal Respirations
A type of hyperventilation marked by exaggerated deep, regular, rapid breathing.
Normal with exercise
May be present with: aspirin (asa) overdose, pain, fever, hysteria, cardiac and or respiratory disease, Diabetic Ketoacidosis
ABCDE
Test for abnormal mole: Asymmetrical, Border, Color (black? dark brown? changing?), Diameter (no more than 6mm), Evolution