Lecture 3

Question 1

Describe the specific techniques for
physical examination of the
-abdominal/gastrointestinal (GI):

Answer 1

• abdominal/gastrointestinal (GI):
  
  • stomach, small intestine, large intestine, liver, gallbladder, pancreas, spleen, kidneys, urinary bladder, female reproductive.
  • Health History: history of; pain, nausea, vomiting, diarrhea, food allergies, food/ fluid intake, bowel/bladder elimination, UTI’s, abdominal surgery, alcohol ingestion, menstrual history.
  • Physical assessment: use stethoscope to listen first, ask patient to empty bladder, supine position with head slightly elevated. Abdomen has 4 quadrants. Inspect, auscultate, percuss, palpate.
  • Abnormal Inspection: asymmetry, distention, swelling of abdomen, abdominal masses or unusual pulsations
  • Auscultate bowel sounds: move from right lower to upper then continue. How long should you listen before documenting an absent bowel sound? 2 minutes in each quadrant. When might decreased bowel sounds be heard? Decreased after abdominal surgery or late bowel obstruction. What does a bowel obstruction sound like? High pitched tinkling or rushes of high pitched sounds. What arteries do you auscultate? Abdominal aorta, femoral arteries, iliac arteries, for bruits.
  • Palpation: light gentle dipping motion of 1 cm. Watch for nonverbal cues of pain. Palpate painful areas last. Abnormal findings: involuntary rigidity, spasm, pain.

Question 2

Describe the specific techniques for
physical examination of the
-musculoskeletal:

Answer 2

-musculoskeletal:
-Health History: trauma, arthritis, neurologic disorder, pain/swelling in muscle/joints, frequency of exercise, calcium intake, history of surgery, smoking/ alcohol.
Physical assessment: integrate into other body systems.
Palpation Muscles: bilateral symmetry, tenderness, muscle tone, put each joint and extremity through passive ROM, assess muscle strength. Abnormal findings: atrophy, tremors, flaccidity, loss of strength, decresed ROM uncoordination, swelling pain. Abnormal findings can indicate musculoskeletal disease, trauma, or neurologic disease.
Palpation Bones: feel for normal prominence and symmetry. Abnormal: pain enlargement, caused by trauma, degenerative joint disease, musculoskeletal disease or neurological disease.
Palpating Joints: Put each through full ROM. Joint movement includes: flexion, extension, hyperextension, abduction, adduction, supination, pronation. Abnormal: pain, swelling, nodules, crepitation (grating sound)
Inspecting Spine: patient stands, concave at cervical and lumbar, convex at thoracic and sacrococcygeal. Kyphosis increased thoracic curvature (old people). Lordosis lumbar curve (pregnancy). Scoliosis is lateral curve.

Question 3

Describe the specific techniques for
physical examination of the
-Neurologic:

Answer 3

-Neurologic: cerebral function, cranial nerve function, cerebellar function, motor/sensory/reflexe function.
-Health history: numbness, tingling, tremors, seizures, headaches/dizziness, trauma to head/spine, high BP, stroke, changes to hear/see/taste/smell, control of bladdder/bowel, smoking, alcohol, diabetes, cardiovascular disease, perscription/over the counter meds.
Physical Assessment:
-cerebral function: observe behavior, through entire assessment.
-assess: mental status, memory, emotional status, cognition, behavior.
-cerebellar: motor skills, coordination, and balance
-sensory system: identify sensory stimuli and reflexes.

Question 4

• Neurologic:

- Assessing Mental Status:

Answer 4

• Assessing Mental Status:
  
  • level of consciousness, awareness, behavior, and appearance, memory, and language.
  • Evaluate orientation to person, place, time, cognition, affect. Ability to respond to questions.
  • Abnormal findings: poor hygiene, inappropriate dress, disoriented, absent memory, illogical thought process. These abnormal findings can indicate mental health disorders, developmental delay, brain disease, cerebrovascular disease, alcohol or drug intoxication, or tumor.

Question 5

• Neurologic:
• Assessing Mental Status:
• Level of Consciousness:

Answer 5

-Level of Consciousness:
+awake and alert,
+lethargic (drowsy, asleep most of time, can be aroused by gentle shake or saying name),
+sturporous: unconscious most of time, must be shaken awake, respond to pain with purpose, can make verbal response but usually not appropriate.
+comatose: can’t be aroused even with pain, some reflex, if no reflexes then its deep coma.

Question 6

• Neurologic:
• Assessing Mental Status:
• Level of Awareness:

Answer 6

-Level of Awareness: assess by orientation to time, place, and person.
+Time: date, day of week, season, last holiday
+Place: where are you? Name of city? What state?
+Person: name? Age? Who is your visitor?

Question 7

• Neurologic:
• Assessing Mental Status:
• Memory:

Answer 7

-Memory: Ask questions to find out about immediate recall and past recall. Immediate memory- repeat a series of numbers. Or ask what did you eat for breakfast. Or what is your birthday?

Question 8

• Neurologic:
• Assessing Mental Status:
• Language:

Answer 8

-Language: ask patient to name things in the room, follow simple commands, read short sentence aloud. Injury to cortex can cause aphasia (expressive: understands written or spoken words but cant speak or write correctly) or (receptive: berson cant understand written or spoken words). These can also be combined.

Question 9

• Neurologic:
• Assessing Mental Status:
• Assessing Motor and Sensory Function:

Answer 9

-Assessing Motor and Sensory Function:
+Motor: assess balance, gait, and coordination.
+Sensory function: test sensory discrimination or pain, light touch, and vibrations
+balance and gait: wals on toes, heels, and heel to toe. Observe balance, arm and leg movements.
+motor function and coordination: have patient touch each finger with thumb, rapidly pat hand on thigh, tap foot on floor. Repeat on both sides. Movements should be coordinated. If unable to perform this could be UMN disease or cerebellum disease.
+sensory perception: patient response to pain, light touch, and normalshapes. Have patient close eyes then tough sharp and soft objects to upper/lower extremities and trunk. Go from distal to proximal and patient should be able to distinguish between sharp and soft touch. Hve patient close eyes and identify familiar objects (pen, coin, etc.)
-Age related variations: slow thought process and verbal responses, decreased sensory ability, slower coordination, decreased reflex, confusion in unfamiliar surroundings, slow gait