Lecture 1- Intro to PD Flashcards by Patrick Carbary

What are the four aspects to a basic exam?

) inspection
) palpation
) auscultation
) percussion

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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

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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

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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

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higher pitched sound of air-filled stomach or bowel

tympany

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normal lungs are resonant, but hyperesonance occurs when ________, or ___________ is present

COPD, PTX

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when air in lungs is replaced by fluid/solid tissue in the lungs or pleural space

dullness

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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

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What are some of the main vital signs?

) general appearance
) height
) weight
) blood pressure
) pulse
) respirations
) temperature
) pulse oximetry
) pain

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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

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height and weight should be __________ to each other

proportionate

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Why are height and weight measured?

) growth and development of a child
) nutritional status
) fluid status

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1 inch = ______ cm

2.54

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2.2 lbs = _______ kg

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girls experience their peak growth spurt at age ____, boys experience their peak growth spurt at age ____.

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What influences height?

) genetics
) endocrine system
) nutrition
) age

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the _____ chart is a more accurate measure of body fat than weight alone

BMI

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occurs before the epiphyses close, results in an enlarged skeleton that is perfectly proportioned

gigantism

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occurs after the epiphyses close, hands, feet, face, head, and soft tissues are enlarged

acromeagly

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usually affects men and women aged 30-50 equally, symptoms include headaches, deepening of voice, sweating, muscle weakness, sleep apnea

acromeagly

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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

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rapid excessive growth, weakness, body proportions relatively normal, increased intracranial pressure, hyperplasia of all organs

gigantism

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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

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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

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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?

1. ) dietary intake (exceeds metabolic usage, generally increase in body fat slowly over time) 2. ) 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?

1. ) oral 2. ) rectal (generally higher than oral by 1 degree) 3. ) axillary (generally lower than oral by 1 degree) 4. ) 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?

1. ) lumen size 2. ) compliance 3. ) 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?

1. ) Take BP when supine, wait 2-3 mins. 2. ) Take BP when sitting up, wait 2-3 mins 3. ) 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.....

1. ) fingerpads of index and middle figers 2. ) never use thumb! 3. ) count beats for 15 secs. and multiply by 4 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