Lecture 1- Intro to PD Flashcards
What are the four aspects to a basic exam?
- ) inspection
- ) palpation
- ) auscultation
- ) percussion
least mechanical but hardest technique to learn, constantly collecting information, see how much you can learn without asking a question, need direct lighting, full exposure to examining area
inspection
laying hands on the patient, touch is informative, tips of fingers for fine discrimination, dorsum of hand for temperature sense, can be light or deep
palpation
technique by which body is struck to produce sounds that vary in quality according to density of the underlying tissue, common method is left middle finger on body, right middle finger used to strike
percussion
higher pitched sound of air-filled stomach or bowel
tympany
normal lungs are resonant, but hyperesonance occurs when ________, or ___________ is present
COPD, PTX
when air in lungs is replaced by fluid/solid tissue in the lungs or pleural space
dullness
not done through clothing or gown, listen for characteristics of sound, not just presence (intensity, pitch, duration, quality), usually performed last except for abdomen, need a quiet room, used for breath, heart and bowel sounds
auscultation
What are some of the main vital signs?
- ) general appearance
- ) height
- ) weight
- ) blood pressure
- ) pulse
- ) respirations
- ) temperature
- ) pulse oximetry
- ) pain
What is included in general appearance?
- ) apparent state of health
- ) apparent vs. stated age
- ) dress, grooming, hygiene
- ) facial expression
- ) other odors
- ) arm/leg movements (rigors)
- ) posture
- ) verbal cues
height and weight should be __________ to each other
proportionate
Why are height and weight measured?
- ) growth and development of a child
- ) nutritional status
- ) fluid status
1 inch = ______ cm
2.54
2.2 lbs = _______ kg
1
girls experience their peak growth spurt at age ____, boys experience their peak growth spurt at age ____.
12
14
What influences height?
- ) genetics
- ) endocrine system
- ) nutrition
- ) age
the _____ chart is a more accurate measure of body fat than weight alone
BMI
occurs before the epiphyses close, results in an enlarged skeleton that is perfectly proportioned
gigantism
occurs after the epiphyses close, hands, feet, face, head, and soft tissues are enlarged
acromeagly
usually affects men and women aged 30-50 equally, symptoms include headaches, deepening of voice, sweating, muscle weakness, sleep apnea
acromeagly
What are some signs of acromeagly?
prominent brow, soft tissues of nose/lips/ears enlarged, prominent jaw, enlargement of hands and feet, elongated head and exaggerated supraorbital ridges
rapid excessive growth, weakness, body proportions relatively normal, increased intracranial pressure, hyperplasia of all organs
gigantism
autosomal dominant disease, most die in 4th or 5th decade of life, death often due to arterial dissections and MVP, people have tall, extremely slender build, armspan greater, joint laxity and spontaneous pneumothorax
Marfan Syndrome
hereditary dominant disease of cartilage and endochondral bone growth, little people, normal sized head and trunk with a slightly distended abdomen, short muscular limbs with stubby hands and thick fingers
achondroplasia
GH deficiency results in child with short stature appearing younger than chronologic age, body and extremities in proportion, growth is normal for 1-2 years then slows and leads to dwarfism if not detected early and treated
hypopituitary dwarfism
genetic mucopolysaccharidosis disorder, characterized by pigeon chest, appears normal at birth, but defects become apparent by age 2
morquio syndrome
What causes weight gain?
- ) dietary intake (exceeds metabolic usage, generally increase in body fat slowly over time)
- ) water retention (renal dysfunction, increased salt intake, malnutrition, cardiac/vascular disorders, medications, can develop very quickly)
What causes weight loss?
malignancy, depression, alcoholism, poor nutrition, chronic infection, high metabolic demand, sleep disorders, etc.
balance between heat production and heat loss, 85% of heat is lost through the skin, regulatory center in hypothalamus, 98.6F and 37C, most consider fever to be greater than 101
temperature
lowest temperature in early morning hours, highest in late afternoon/early evening
diural variation
What methods exist for obtaining a temperature?
- ) oral
- ) rectal (generally higher than oral by 1 degree)
- ) axillary (generally lower than oral by 1 degree)
- ) tympanic (used frequently, same as oral)
equal to cardiac output X peripheral vascular resistance, heart, arteries and blood all influence pressure within the system
blood pressure
What 3 things affect PVR?
- ) lumen size
- ) compliance
- ) viscosity
relative to the state of vasoconstriction and smooth muscle contraction
lumen size
related to the cyclical relaxation and retraction of the arterial walls during systole and diastole, respectively
compliance
replacement of elastic and muscular tissue with that of fibrous tissue
arteriosclerosis
deposition of fatty plaques within arteries leading to narrowed lumen and loss of compliance
atherosclerosis
physical property of fluid related to friction
viscosity
How much blood enters the heart during diastole?
approximately 120 mL of blood
How much blood leaves the heart in the ejection fraction?
60% of blood, approx 70 mL
How much blood do people circulate per minute?
males 5.5 L of blood
females 5.0 L of blood
What factors affect blood pressure?
age, sex, stress, exercise, race, obesity, medications, disease processes, hydration status
How does age affect blood pressure?
lower in children, both SBP and DBP increase in elderly due to loss of compliance, normal SBP equals (2 x age) + 80
What is SBP?
systolic blood pressure, pressure in the arterial system with the ventricles contract
What is DBP?
diastolic blood pressure, pressure when the ventricles are filling
when using a properly fitting sphygmomanometer, the width of the bladder should be about ____ of the upper arm circumference
40%
when using a properly sphygmomanometer, the length of the bladder should be about ___ of the upper arm circumference
80%
if the bladder is too narrow, the BP will be ___________
falsely elevated
if the bladder is too wide, the BP will be ____________
falsely lowered
What are the phases of the Korotkoff Sounds?
Phase I- first tapping sound, become more intense
Phase II- sounds develop a swishing quality
Phase III- crisp, intense sounds
Phase IV- muffled, soft, blowing sounds
Phase V- sounds disappear
When BP’s vary by more than 10mmHg btwn arms may indicate __________
arterial compression or obstruction
True or False
During the first visit, BP should be obtained in both arms
true
In the popliteal artery, BP is generally __________ higher
10-40mmHg
Normal blood pressure
<80
BP for Prehypertension
120-139/80-89
BP for Stage I Hypertension
140-159/90-99
BP for Stage II Hypertension
greater than 160/greater than 100
When do you need to check orthostatics?
- history of fainting
- dizziness
- syncope
- suspect volume depletion (hypovolemia or dehydration)
How do you check orthostatics?
- ) Take BP when supine, wait 2-3 mins.
- ) Take BP when sitting up, wait 2-3 mins
- ) Take BP when standing
What is orthostatic hypotension?
When SBP drops by 20mmHg or more, or the rise of the pulse by 20 BMP or more
A rise in pulse rate, but no change in BP suggests mild ____________
hypovolemia
What causes orthostatic hypotension?
- dehydration
- blood loss
- drugs
- prolonged bedrest
- anemia
- pregnancy
- vasovagal
normal phenomenon in which there is a drop in systolic blood pressure within inspiration
pulsus paradoxus
A drop in SBP by greater than 10mmHg is significant, and can be due to…
- cardiac tamponade
- pericarditis
- shock
- emphysema
- severe asthma
Where can you easily palpate a pulse?
- temporal arteries
- carotid arteries
- brachial arteries
- radial arteries
- ulnar arteries
- femoral arteries
- popliteal arteries
- posterior tibialis arteries
- dorsalis pedis arteries
When taking a pulse, you should…..
- ) fingerpads of index and middle figers
- ) never use thumb!
- ) count beats for 15 secs. and multiply by 4
- ) if irregular, fast, or slow, count for a full minute
What range of BPM is considered normal?
60bpm-100bpm
Normal pulse rate of a newborn
80-180
Normal pulse rate of an infant
75-160
Normal pulse rate of a toddler
60-110
Normal pulse rate of a child
60-110
Normal pulse rate of an adolescent
50-90
What factors influence pulse?
- volume of blood ejected
- compliance of aorta and arteries
- viscosity of blood
- cardiac output
- peripheral resistance
-evaluate rate, rhythm, and amplitude
What is a pulse rate of regularly irregular?
3 beats, miss 1, 3 beats, miss 1
What is a pulse of irregularly irregular?
atrial fibrillation
normal pulsation followed by a premature contraction (PVC) amplitude of PVC is also less than normal pulse
bigeminal pulse
The force of a pulse is rated out of 4. What do the numbers represent?
4 = bounding 3 = full (increased 2 = normal 1 = diminished (thready) 0 = absent (non-palpable)
smaller amplitude alternating with large and normal rhythm, due to left ventricular failure
pulsus alternans
exaggerated decrease in amplitude during inspiration and increased amplitude during expiration, due to pericardial effusion, constrictive pericarditis, asthma, or emphysema
pulsus paradoxus
an automatic act that is controlled by brainstem, diaphragm is primary muscle of inspiration, evaluated based on rate , rhythm, and quality
respirations
what is a normal respiration rate?
12-20 per minute
deep, regular, sighing respirations (rate can be normal, slow, or fast), occurs in metabolic acidosis, uremia, anxiety, severe hemorrhage, hypoxia
Kussmaul breathing
pattern waxes and wanes clinically so that periods of deep breathing alternate with episodes of apnea, may be normal in children and elderly, occurs in alteration in cerebral circulation, left sided heart failure
Cheyne- Strokes Breathing
ataxic breathing, characterized by breaths that are shallow or deep then stop for short periods, unpredictable, occurs in meningitis (brain damage typically at medullary level)
Biot’s Breathing
seen in obstructive lung diseases, expiration is prolonged due to increased airway resistance, breathing rate may become shallow
obstructive breathing