IPA Exam 3 Flashcards
Absent Bowel sounds
If none are heard after 2 minutes, the absence of bowel sounds suggest paralytic ileus from peritioneal irritation/peritonitis.
Borborygmi
Low pitched ruming sounds associated with hyperperistalsis. Can also be common in early intestional obstruction.
Infrequent bowel sound
can be caused by inflammatory processes of the serosa, like pertionitis
Hyperactive bowel sounds
Can be caused by inflamattion of intestional mucusa - some that could cause diarrhea.
Intestional obstruction
Initialy cause frequent bowel sounds, or “rushes” as the intestines try to force their contents through a tight opening, followed by decreased sounds or tinkles, then silence.
Normal Bowel sound
Normal sounds occur approximately every 5-10 seconds and have a high pitched sound.
Bulging flanks
Large amounts of acities, the flanks can buldge. Percussion over the flanks should generate a dull tone if there is fluid. In the absense of dullness, bulging flanks suggests that a large volume is not present.
Fluid wave
Patient/assistant press the edges of both their hands firmly down the middle of the midline of the abdomen. this pressure helps stop the transmission of a wave through fat. Tap one flank sharply with your fingertips while feeling the other flank for a pulse.
Identifying peritoneal signs
Shake tenderness: If you put your hands on either side and shake pts hips, gently rock them side to side, the patient will report increased pain in the affected area.
Cough Tenderness: similar localization of pain when the patient coughs.
Palpation of area: Palpaing over the effected area ( right lower quadrant in the setting of acute appendititis reproduces the pain.
Guarding: The abdominal muscles contract due to severe underlying inflammation, protecting the area when it is examined. With advanded peritonitis the entire adbominal wall may become rigid.
Heel Tap
Firmly tap on the plantar surface of one of the patient’s heels to elicit potential abdominal pain. This is done unilaterally, to check for appendicitis and cholecystitis.
Mcburney’s point
Deep palpation 1/3 of the way between the ASIS and the umbilicus. Rebound tenderness is highly suggestive of appendititis.
Murphy’s Sign
Place the fingers of your right hand under the liver edge and ask pt to take deep breath in, palpating the gallbladder while the patient exhales, continue palpating, you ask them to take another deep breath . A positive Murphy’s sign occurs of the patient winces of abruptly halts inspiration during palpation of the gallbladder - indiciting possible choleycystitis.
Renal artery stenosis
when a pt has some combination of impaired renal function, difficult to control HTN, and known vascular disease or risk factors. The prescence of bruit lends supporting evidence for the existience of renal artery stenosis.
Mesenteric atherosclerosis
Symptoms with chronic mesenteric ischemia include postprandial abdom pain, food avoidance, and weight loss. Occurs in patient’s with risk factors for atherosclerosis.
Vasculitis
Often accumpanied by additional symptoms (weight lose, joint pain, fever, abdom. pain)
Peritoneal fiction rub:
A rough layer, grating sound that indicates peritoneal inflammation as the two layers of the peritoneum (parietal and visceral) rub against each other.
Structures of lung
visceral pleura (lung side) and parietal pleura (chest wall side), which normally contains a small amount of lubricating pleural fluid. The upper lobes are best heard anteriorly. The lower lobes occupy the majority of the posterior fields.
What consists of the bony structure of the thorax? (AKA ribs)
12 ribs, that articulate with posterierly with the thoracic vertebrae. (first 7 attach directly to the sternum = true ribs). 8th, 9th, 10th, attach to the costal cartilages of the pairs of superior to them. 11th and 12th pairs are free and termed floating ribs.
Muscles for Respiration
Diaphgragm contracts and pushes downward into the belly during inspiration, making space in the thoracic cavity.
Lung exam (not ascultation)
Inspection of the overall shap of the thorax, asymmetry and abnormalities.
Pectus excavatum
“sunken” check, the rubs grow inward
Pectus carinatum
Concave outward curve of the chest
Barrel Chest
Increased size in overall chest caivty - often linked to COPD/Empheysima
Other skinds of thoax quality
Assessing skin color, cap refill, clubbing of fingers.
Thoracic expansion
Place both hands on the posterior aspect of the chest, at the 12th ribs with thumbs are the midline. Create a midline skin fold, have patient take cycles of respirations, obverse for symmetry.
Tactile Fremitus
Place the ulnar side of your hands resting on the posterior chest wall, have the pt say “99”. Feel the transmitted vibrations and check for symmetry as you move down the chest wall with pt saying 99 at each level.
Increase of fremitus: lung consolidation, air is replaced with something else, like inflammation, blood, pus, etc.
Decrease in fremitus: Excess air in lungs, increase in chest wall thickness.
Percussion of chest
Percuss the left and right sides of the posterior thorax in 5 positions. Moving side to side, zig zag formation comparing sounds on each side. “Resonnace” is hear normally.
Normal lung sounds
Vesicular, bronchovesicular and bronchial sounds through lungs.
crackles
Also known as rales, “scratchy” sounds associated with fluid in the alveoli, pulmonary edema, pneumonia, Fibrosis, atelectasis (collasped lung) and heat failture
Rhonchi
“Gurgling” low pitched sounds caused by fluid in the large and medium sized airways, such as in bronchitis and pneumonia.
Wheezing
Whistling, high pitched noise, loudest on expiration. Caused by forced air moving out of the lungs, like in asthma and COPD and bronchitis.
Stridor
Inspiratory whistling, caused by narrowing of the upper airway, it is best heard over the trachea and can be caused by croup, epiglottitis or a foreign body.
Absent sound
Indicates little air movement and can be caused by chronic severe emphysema, a very severe asthma attack, effusions or pneumothorax. Clinical emergency.
Pleural rub
A grating sound that is produced by motion of the pleura, which is impeded by frictional resistance, sounds like “creaking leather”. It can be caused by pleurisy, pneumonia, or PE.
Egophony
PT says “Eeeee” while auscaltationg. A muffled “eeee” sound is normal whild a nasally “aaaay” sound is abnormal. This change in fluid is completely replaced by fluid, such as pneumonia.
Pleurisy
A pleural rub is heard, which is caused by infection of the pleural cavity.
Pleural effusion
Decreased of absent breath sounds, egophony, and a pleural rub.
Pneumothorax/Hemothorax
Absence of sounds; Decreased, deminished sounds
Pleural tumors
Wheezing, symptoms vary.
Pneumonia
Crackles/rales, and rhonchi
Asthma
Wheezing and absence of sounds with severe cases
Emphysema
Absence of sound
Atelectasis
Decrease of absent breath sounds and fine crackles.
Aortic Heart sound
Best heard at the second intercostal space, sound is S2.
Pulmonic Heart Sound
Second intercostal space on the left of sternum
Tricuspid
Lower on the 4th intercostal space on left side
Mitral heart sound
Heard with bell at te 5th intercostal space
Point of maximal impulse
Felt at the apex of the heart at the 5th intercostal midaxillary line, palating the left ventricle.
Anatomincal contents of breast
Milk producing glands = Lobules
Glands are connected via series of ducts that join to form a common drainage path, terminating at the nipples.
Fibroelastic and fatty tissue - provides support.
Lies over the pec muslce on thoratic cage.
90% drains into the lymph group in the ipsilateral axilla. 1-% frains into the internal thoracaic nodes (below the sternum)
What is the first site of spreading breast cancer?
At the axillary lymph nodes; so they should be included in all breast exams.
What is an epigastric hernia
A protrusion through the linea alba above the umbilicus, most commonly seen in infants.
What is an incisional hernia
A protrusion through a surgical incision site, often seen in obese patients of those with wound healing
Umbilical Hernia
Failure of fasica beneath the umbilicus, often congenital. Can develop in association with obseity and or ascities.
Right Hypochondriac
Liver, Gallbladder, Right kidney, small intestine
Epigastric Region
Stomach, liver, pancreas, duodenum, spleen and adrenal glands
Left hypochondriac
Spleen, colon, left kidney, pancreas
Right lumbar
Gallbladder, liver, right colon
Umbilical region
umbilicus (navel) parts of the small intestine, duodenum
Left Lumbar
Descending colon, left kidney
Right iliac
appendix, cecum
Hypogastric
urinary bladder, sigmoid colon, reproductive organs
Left iliac
Descending colon, sigmoid colon
Grade +1
Up to 2mm of Depression, Rebounding immediately
Grade +2
3-4mm of depression, rebounding in 15 sec or LESS
Grade +3
5-6mm of depression, rebounding in 60sec
Grade +4
8 mm of depression and rebounding in 2-3 minutes
Common risk factors for Edema
Medications, obesity, pregnancy, low protein levels, sitting and standing in same prosition too long.
Conditons: low protein levels, kidney disease, heart failure.
Lymphatic issues, thyroid problems where tissues due to poor circulation result in fluid build up.
Treatment for edema
-foot elevation
- Diuetic prescribed to help elminate excess fluid through urine
- Compression socks for circulation
