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CI1 > Physical Assessment > Flashcards

Physical Assessment Flashcards

1
Q

Why and how do we perform a thorough physical assessment?

A
  • Define patient’s problems accurately
  • History will guide scope of assessment
  • Requires sound theoretical base in order to synthesise info from appropriate sources, i.e. anatomy/physiology, characteristics/limitations of assessment tools
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2
Q

What vital sign is the most accurate predictor of somebody who is deteriorating?

A

Respiratory rate

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3
Q

What are the cardiovascular values?

A 
Normal heart rate: 60-100bpm
Tachycardia: >100bpm
Bradycardia: <60bpm
Hypertension: >145/95mmHg
Hypotension: <90/60mmHg
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4
Q

What are the temperature values?

A

Normal: 36.5-37.5 degrees celsius

Fever/pyrexia: Elevation in body temp above 37.5 (febrile)

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5
Q

What is associated with every 0.6 degree rise in body temperature?

A

A 10% increase in oxygen consumption

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6
Q

What are the respiratory rate values?

A

Normal: 12-20 breaths/min
Tachypnoea: >25 breaths/min
Bradypnoea: <10 breaths/min

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7
Q

What is the only vital sign that can be voluntarily altered?

A

Respiratory rate

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8
Q

What is a trick for measuring respiratory rate accurately?

A

Tell the patient you’re measuring their pulse

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9
Q

What are the 4 main components of physical assessment?

A

Observation (end of bed assessment)
Palpation
Auscultation (what you hear)
Cough

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10
Q

What information can you gain from observation?

A
  • Physical location (ICU vs ward)
  • Monitoring & attachments (oxygen, liners, catheters, drains)
  • General appearance
  • Level of consciousness
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11
Q

What are patients with reduced level of consciousness at risk of?

A

Aspiration (things other than air getting into airways) and retention of pulmonary secretions

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12
Q

What are the 4 levels of consciousness?

A
  • Conscious
  • Unconscious (by still responsive)
  • Semiconscious (drifting in and out)
  • Obtunded (unconscious, not responsive)
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13
Q

What are some of the causes of reduced level of consciousness?

A
  • CO2 narcosis (very high levels of CO2)
  • Medications
  • Brain injury
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14
Q

What are the 3 components of the Glasgow Coma Scale?

A

Eye opening, verbal response, motor response

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15
Q

What is cachexia?

A

When a person is completely skin and bones, opposite of obesity

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16
Q

What general appearance features should you look for?

A
  • Cachexia vs obesity
  • Deformity
  • Scars
  • Barrel shaped chest (hyperinflation)
  • Pectus excavatum/ pectus carinatum
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17
Q

Where does the sternal line run?

A

From jugular notch down to the belly button

18
Q

How does the chest normally expand with each breath?

A

Symmetrical increase in the AP, vertical and transverse diameters

19
Q

What are the accessory muscles of respiration?

A
  • Pectorals
  • Scalenes
  • Sterncleidomastoid
  • Trapezius
  • Abdominals
20
Q

What is paradoxical respiration (diaphragm paralysis)?

A

When the diaphragm isn’t working correctly and the rib cage moves abnormally

21
Q

What is Hoover’s sign?

A

Inward movement of lower rib cage during inspiration

22
Q

What is pursed lip breathing usually a sign of?

A

Someone who is having trouble breathing, e.g. severe COPD

23
Q

What is the normal inspiration to expiration ratio (I:E ratio)?

A

1:1.5 to 1:2

24
Q

What is orthopnoea?

A

Breathlessness when lying flat

25
Q

When is hyperpnoea (increased ventilation) normal?

A

When exercising

26
Q

What is Cheyne-Stokes respiration?

A

A pattern of crescendo-decrescendo breathing interspersing apnoeas (absence of breathing for a period of time)

27
Q

What does cyanosis (blueishness) indicate and where should you look for it?

A

Low oxygen in the blood, fingers, lips and tongue

28
Q

What is clubbing?

A

Loss of the nail bed and flattening of pad on fingers/toes, usually seen in chronic respiratory diseases e.g. CF

29
Q

What can lower limb oedema indicate?

A

Right heart failure or left ventricular failure

30
Q

What are the 3 main reasons for respiratory palpation?

A

1) Chest wall movement
2) Respiratory muscle activity
3) Detecting fremitus (vibration of sputum)

31
Q

When does lateral basal expansion tend to be reduced?

A

In the presence of lung collapse

32
Q

What are normal breath sounds produced by?

A

Turbulence in the airways filtered through the normal lung tissue to the chest wall

33
Q

What may decreased lung sounds indicate?

A
  • Lung collapse
  • Underlying airway damage (e.g. emphysema)
  • Obesity
  • Something in pleural space
34
Q

What may abnormal bronchial breath sounds indicate?

A

Anything that amplifies sound

  • Alveoli filled with fluid
  • Large areas of collapse
  • Lung mass (tumour)
35
Q

What are the 5 types of breath sounds?

A
  • Normal
  • Decreased
  • Absent
  • Abnormal bronchial breath sounds
  • Added sounds
36
Q

What are two types of added sounds?

A
  • Crackles

- Wheezes

37
Q

What are the two types of crackles?

A
  • Coarse: Sputum, changes with cough/movement
  • Fine: Acute pulmonary oedema (widespread fluid throughout alveoli, doesn’t change with cough/movement) OR re-opening of collapsed alveoli (velcro sound)
38
Q

Why do wheezes occur and what are the two kinds?

A

Narrowing of airways; monophonic or polyphonic

39
Q

What are some of the causes of wheezes?

A
  • Bronchoconstriction (e.g. asthma)
  • Sputum
  • Foreign body
  • Tumour
40
Q

What elements of a cough should be assessed?

A
  • Strength (strong/moderate/weak)
  • Moist or dry
  • Productive or non-productive
41
Q

What are the 3 main problems physios can detect through physical assessment?

A
  • Sputum clearance
  • Lung collapse
  • Work of breathing

CI1 (21 decks)

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