Physical Assessment

Question 1

General Appearance

Answer 1

1. Assess:
   > General Build and Appearance
   > Skin Color
   > Distress Level
   > LOC
   > SOB
   > Position
   > Verbal Responses
2. As a result, poor cardiac output and decreased cerebral perfusion can cause:
   > Confusion
   > Memory Loss
   > Slowed verbal responses
3. Late signs of severe right-sided heart failure are:
   > Ascites
   > Jaundice
   > Anasarca (generalized edema)

Question 2

Skin

Answer 2

1. Includes color and temperature
2. The best areas to assess circulation are:
   > nail beds
   > mucous membranes
   > conjunctival mucosa
3. Central Cyanosis: decreased oxygenation of the arterial blood in the lungs and appears as a bluish tinge of the conjunctivae and the mucosa membranes of the mouth and tongue
4. Peripheral Cyanosis: occurs when blood flow to the peripheral vessels is decreased by peripheral vasoconstriction.
   > Rubor (dusky redness) replaces pallor in a dependent foot suggest arterial insufficiency.
5. Skin temperature is assessed symmetry by touching different areas of the body with the back of the hand or finger