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.
