Midterm Flashcards
the parts of a health history
biological data reason for seeking care history of present illness or present health past medical history family history/cultural assessment review of symptoms functional assessment of ADL's
the components in performing a physical assessment
inspection- use of vision and smell
palpation- use of touch; always palpate tender areas last
- light palpation- assesses surface area for temperature, texture, moisture, swelling, vibration, tenderness, crepitus, rigidity
–fingertips are best used for fine tactile discrimination, as of skin texture, swelling pulsation, and determining the presence of lumps
–the dorsa of hands are best used determining temperature because the skin here is thinner than on the palms
–base of finger or ulnar surface of the hand is best used for vibrations
-deep palpation- assesses internal organs or masses
percussion- involves tapping of fingers to body part and listening to sounds; identifies density, organ shape, and organ position
- characteristic of percussion notes:resonant (ie. normal lung), hyperresonant (pneumothorax), tympany (ie. abdomen), dull (ie. bones), and flat
- direct percussion- tapping finger or hand directly on the body
- indirect percussion- involves a stationary finger and a striking hand
auscultation- use of sound; listening to heart, lung, bowel, and carotid sounds
- diaphragm- use to listen to high-itched sounds (ie. breath and bowel)
- bell- use to listen to low-pitched sounds (ie. vascular sounds, extra heart sounds)
subjective symptoms
"symptoms" what the patient complains of health history chief complaint review of symptoms PQRSTU - provocative vs palliative - quality and quantity - region and radiation - severity and scale - timing and type of onset - understanding
objective symptoms
“signs”
what is observed of the patient
- includes physical examination, diagnostic testing, lab results, etc.
primarily factual and descriptive
secondary lesions
crust- a drying of blood or sebum from healing
scale- a collection of dry or greasy dead skin cells
fissure- a crack in the skin
erosion- skin breakage at the epidermis level; no bleeding; may appear moist; may occur after a bulla has burst
ulcer- skin breakage may occur at the epidermis, dermis, and subcutaneous level
excoriation- skin breakage of the epidermis and the dermis; blood may be present
scar- replacement of lost normal tissue; often caused by injury or laceration
atrophic scar
lichenification- a thickening and roughening of the skin; may occur after extreme scratching has taken place
keloid- occurrence where scar tissue has over-grown itself
lesion configuration
annular or circular
confluent- when a rash meshes all over the place with no particular pattern
discrete- singular and randomly spread on one part or on different parts of the body
grouped- singular and bunched together
linear
zosteriform or dermatomal- lesions occur on one side of the body usually following a nerve dermatone
anatomy of the ear
auricle or pinna (external ear) - funnels sound into the external auditory ear canal which ends at the tympanic membrane middle ear - directly after the tympanic membrane - conducts sound to the inner ear via three ossicles: -- malleus -- incus --stapes - the eustachian tube connects the middle ear and the nasopharynx inner ear - made of: -- semicircular canals --cochlea -- acoustic nerve (cranial nerve VIII)
external ear examination
inspection
- size and shape: equal size bilaterally without swelling or thickening
- skin condition: intact, with no lumps or lesions
palpation
- mastoid process, pinna and tragus: no tenderness
- lymph nodes: no lymphadenopathy
otoscopic examination
canal: no discharge, lesions, redness, or swelling
- cerumen: presence without blockage; gray-yellow to light brown and black; moist and waxy to dry
tympanic membrane
- color and characteristics
- intact, not bulging or retracted
- position of cone of light
- integrity of membrane
- visualize the umbo, manubrium, and short process of the malleus
aging process with the ears
adults > 50 years old
- decreased hearing
- high-pitched sound diminishes first
- decreased speech discrimination
- there may be social-safety implications
aging process with the eyes
aging adult
- visual acuity decreases
- perform same examination as adult
- central acuity may decrease, particularly after 70 years of age; peripheral vision may be diminished
- ocular structures
- pupils small in old age; pupillary light reflex may be slowed
- eyebrows may show loos of hair
- arcus senilis- a deposition of fat around the cornea. it looks yellow-white and is considered normal after age 45 to 50. it has no effect on vision
eye examination
visual acuity
- snellen eye chart
– patient should have at least 20/20 vision
visual fields
- confrontation test
– assuming the tester has intact peripheral vision, the pt. should see object coming into their peripheral vision when the tester does
PERRLA- pupils equal round reactive to light and accommodation
- pupil size
- pupillary light reflex
– pupils should constrict directly and consensually
- accommodation
– pupils should constrict or dilate when presented with a close object or far-away object, respectively
extraocular muscle function
- corneal light reflex (hirschberg test)
– light should shine in the same spot on both eyes
- six cardinal positions of gaze
– eyes should parallel track
- cover-uncover test
ophthalmic examination
ask the patient to stare at a fixed, distant object
- dilates pupils and steadies retinal structures
ten inches away from the pt. come in at a 15 degree angle towards the front
red reflex should fill the pupil
at a closer view, the optic disc, vessels, fundus, and the macula may be present
macular degeneration
a disease that destroys your sharp, central vision; affects ability to see fine detail
glacoma
group of diseases that can damage the eye’s optic nerve; straight-ahead vision may decrease until no vision remains; may develop as a result of metabolic disorders, trauma, or heredity
cataract
a clouding of the lens in your eye
cranial nerves
1S olfactory- sense of smell
2S optic- visual acuity and visual fields
3M oculomotor- pupil constriction and accommodation; extraocular motor function
4M trochlear- corneal light reflex; extraocular motor function
5 trigeminal
- S cornea, nasal and oral mucosa, facial skin
- M muscles of mastication
6M abducens- corneal light reflect; extraocular motor function
7 facial
- S taste (anterior 2/3 tongue)
- M facial muscle symmetry
8S acoustic- sense of hearing
9 glossopharyngela
- S taste (posterior 1/3 tongue)
- M swallowing, salivation, and specch
10 vagus
- S palate and uvula upward movement upon phonation
- M swallowing and voice quality
11M spinal accessory
- sternomastoid and trapezius muscle strength
12M hypoglossal- tongue movements; tongue at midline
deep tendon reflexes (DTR) grading
4+ very brisk, hyperactive with possible clonus
3+ brisker than average may indicate disease
2+ average, normal
1+ diminished, low normal
0 no response
clonus
rapid contraction of the plantar muscle upon flexion
indicative of disease
reinforcement
regarding DTR’s
done to enhance a reflex
person performs an isometric exercise in a muscle group somewhat away from the one being tested
used as a distraction technique
mini mental examination
tests cognitive functioning standard set of 11 questions scoring: - optimal 30 - no cognitive impairment 24-30 - cognitive impairment <24
mental status
ABC-T
- alertness/appearance
- alert
- lethargy
- obtundation
- stupor
- coma
- grooming and personal appearance
- level of consciousness (note the ease of arousal)
- behavior
- affect
- mood
- speech (aphonia, dysarthia, aphasia)
- cognitive function
- orientation (place, place, and time)
- thought processes
- processes- how a person thinks
- content- what a person thinks about
