Physical Assessment Flashcards
Head + Neck Assessment (9)
- Inspect head position and facial features to look for symmetry.
- Assess eyes (position, color, conjunctiva condition), movement
- Pupils for size, shape, and equality (normal are round, equal in size/shape, consensual response to light)
- Test pupillary reflexes - dim light, penlight from side of patient face and direct light on pupil, observe response noting briskness and quality of reflex
- Assess ears
- Assess nose
- Assess mouth
- Assess/palpate the neck
- Assess lymph nodes
Thorax and Lung Assessment - Crackles
Most common in dependent lobes, right and left lung bases; caused by random, sudden reinflation of alveoli groups; also related to increase in fluid in small airways. Sound like fine, short, interrupted crackling sounds heard during end of inspiration, expiration, or both. May or may not change with coughing. Medium crackles = lower, wet sounds heard during middle of inspiration, not cleared with coughing; coarse crackles, loud bubbly sounds heard during inspiration, not cleared with coughing
Lung Assessment - Rhonchi (sonorous wheeze)
Heard primarily over trachea and bronchi; if loud enough. can be heard over most lung fields
Caused by fluid or mucus in larger airways, causing muscular spasm/turbulence
Loud, low pitched, continuous; heard more during expiration, sometimes cleared by coughing; sounds like blowing air through fluid with a straw
Lung Assessment - Wheeze (sibilant wheeze)
Heard all over lung fields but more distinct over posterior lung fields
High velocity airflow through severely narrowed or obstructed bronchus (asthma)
High pitched, musical sounds like a squeak, heard continuously during inspiration or expiration, usually louder on expiration, not cleared during coughing
Lung Assessment.- Pleural Friction Rub
Heard over anterior lateral lung field (if patient is sitting upright)
Caused by inflamed pleura, parietal Plura rubbing against visceral pleura
Grating quality heard best during inspiration, doesn’t clear during coughing, heard loudest over lower lateral anterior surface
Thorax Assessment
Stand behind patient and inspect for size/symmetry. Note deformities, position of spine, slope of ribs, retraction of intercostal spaces during inspiration and bulging during expiration. Symmetrical expansion during inspiration.
Palpate to find any masses, unusual movement, tenderness
Auscultation of Breath Sounds - Normal Bronchial Breath Sounds
Loud and high pitched; hollow quality, expiration lasts longer than inspiration. Best heard over trachea
Auscultation of Breath Sounds - Normal Bronchovesicular Breath Sounds
Medium pitched and blowing sounds of medium intensity; inspiratory phase equal to expiratory phase. Best heard posteriorly between scapulae and anteriorly over bronchioles lateral to sternum at first and second intercostal spaces
Auscultation of Breath Sounds - Normal Vesicular Lung Sounds
Soft, breezy, low pitched; inspiratory phase 3 times longer than expiratory phase. Best heard over periphery of lung (except over scapula)
Cardio Assessment - Auscultate Heart Sounds
Patient sits up and leans slightly forward, then lie supine, then end exam with patient in left lateral recumbent position. Patient doesn’t speak, breathes comfortably. Begin with diagram of stethoscope, alternate with bell
Begin at apex or PMI, move systematically to aortic area, pulmonic area, Erb point, tricuspid area, mitral area.
Listen for S2 at each site, loudest at aortic area
If heart rate is irregular, compare apical and radial pulses; difference in pulse rates is the pulse deficit
Cardio Abnormality - AFib (atrial fibrillation)
Rapid, random contractions of atria cause irregular ventricular beats over 100 BPM and atrial beats at 200-350 BPM
Sinus Artythmia
Pulse rate changes during respiration, increasing at peak of inspiration and decreasing during expiration
Sinus Bradycardia
Pulse rhythm is regular, but rate is under 60 BPM
Sinus Tachycardia
Pulse rythmicités is regular, but rate is over 100 BPM
Premature Ventricular Contraction
Premature beat occurs before regulatory expected heart contraction; underlying rhythm can be any rate
Signs of venous insufficiency
Venous
Pain (aching, increases in evening and with dependent position)
No paresthesia
Temp is normal to touch
Color is normal or cyanotic
Pulses present
Brown pigmentation around ankles
Shallow ulcers around ankles, edema apparent
Signs of atrial insufficiency
Pain - burning, throbbing, cramping, increases with exercise
Numbness, tingling, decreases sensation (most common in foot and toes)
Temp is cool to touch
Color pis pale
Capillary refill over 2 seconds
Pulses decreased or absent
Skin is thin and shiny, decreased hair growth, thickened nails
Deep ulcerations, well defined at site of trauma or tips of toes
What is the edema scale?
2 mm = 1+
4 mm = 2+
6 mm = 3+
8 mm = 4+
Strength of pulse rating scale
0 - absent, not palpable
1+ - diminished, pulse barely palpable, weak and thready, easy to obliterate
2+ - normal, easy to palpate
3+ - full, easy to palpate, increases
4+ - strong, bounding, cannot be obliterated
What causes distended abdomen?
9Fs - fat, flatus, feces, fluids, fibroid, full bladder, false pregnancy, fatal tumor, fetus. If gas, flanks don’t bulge. They urge with fluid. Tumor may cause more unilateral bulging or distention, pregnancy causes symmetrical bulge in lower abdomen.
Listening to bowel sounds with NG or NI tube
Make sure to turn off suction temporarily if it’s connected to suction to check bowel sounds
Listening to abdomen
Listen to each quadrant until you can hear the normal gurgling/bubbling. Describe as normal, hyperactive, hypoactive, absent. Listen 5 minutes over each quadrant before deciding they’re absent.
Components of musculoskeletal system assessment
Generally observe
Hand grasp strength
Strength of lower arms and legs - patient resists as you apply force, maintain pressure until told to stop. Note symmetrical muscle groups and compare left and right weakness
Observe body alignments for sitting, supine, prone, or standing
Inspect gait
Neuro Assessment - Patient Orientation Questions
Name, location, day of week and year, note behavior and appearance
Cranial Nerves I (olfactory), II (optic) and VII (auditory) are assessed during head and neck exam
CN III (oculomotor), IV (trochlear) and VI (abducens) assessment
Assess extra ocular muscles (EOMs). Ask patient to log straight ahead without moving head and follow movement of finger through six cardinal positions of gaze; measure pupil reaction to light reflex and accommodation using penlight
CN V (trigeminal)
Apply light sensation with cotton ball to symmetrical areas of face
CN VII (facial)
Note facial symmetry, have patient frown, smile, puff out cheeks, raise eyebrows
CNs IX (glossopharyngeal) and X (vagus)
Have patient speak and swallow. Ask them to say AH while you use tongue blade and penlight, check for midline uvula and symmetrical rise of uvula and soft palate. Use tongue blade and place on posterior tongue to elicit gag reflex
CN XII (hypoglossal)
Inspect tongue for symmetry, tremors, and movement towards nose and chin
CNs XI (spinal accessory)
Patient shrugs shoulders against resistance, then have patient turn head towards each side against resistance
Assessing extremities for sensation
Patient’s eyes are closed. Patient discerns between sharp or dull
Light touch to diff points on extremities
Position - grasp finger or toe, holding it by sides with thumb and index finger. Alternate moving finger or toe up and down. Ask patient to state when finger is up or down, repeat with toes
Assess motor or cerebellar function
Gait: patient walks, turns, comes back
Romberg test
Patient stands with feet together, arms at sides, both eyes open and eyes closed for 20-30 seconds; observe for swaying. Should be negative.
