PHYSICAL EXAMINATION Flashcards
(a) Patients with pain should be assessed for onset, duration, characteristics,
location, severity, associated symptoms, and treatment of pain.
(b) Specific data include factors that influence the pain, the type of discomfort
(e.g., radiation of pain or position related relief), symptoms (e.g., dizziness
or cyanosis), and use of nitroglycerin.
(c) Other considerations include cough, difficulty breathing, and loss of
consciousness.
History of Present Illness: Chest Px
Relevant data include associated symptoms (e.g., dyspnea or anorexia), as
well as any interruption in usual activities or bedtime changes.
History of Present Illness: Fatigue
Patients with a cough should be assessed for the onset and duration of the
cough, as well as the character of the cough (dry, wet, night-time, aggravated
by lying down).
History of Present Illness: Cough
History of Present Illness: Difficulty breathing (dyspnea, orthopnea)
Relevant data include aggravating factors (e.g., with exertion, lying down, or
climbing stairs) and paroxysmal nocturnal dyspnea.
History of Present Illness: Loss of consciousness
(transient syncope)
History of Present Illness: Leg pain or cramps
(a) Patients having leg discomfort should be assessed for onset and duration of pain and whether leg elevation or immobilization changes pain.
(b) The character of discomfort should be described, and questions should be directed toward any burning in toes, changes in skin color or temperature,
dizziness, limping, or discomfort during the night.
History of Present Illness: Severe headaches
Patients having severe headaches should be assessed for onset and duration, location, character, and known history of hypertension.
History of Present Illness: Swollen ankles
(a) Patients having swollen ankles should be assessed for onset and duration, related circumstances, and associated symptoms.
(b) Treatment includes rest, massage, heat, elevation, and medication.
History of Present Illness: Family History:
Pertinent data includes family members with diabetes, heart disease,
hyperlipidemia, hypertension, obesity, congenital heart defects, sudden death, and risk
factors related to the cardiovascular system.
History of Present Illness:
Associated symptoms/complaints with respect to the initial CC of Chest Pain:
(a) Anxiety
(b) Dyspnea
(c) Diaphoresis
(d) Dizziness
(e) Nausea
(f) Vomiting
Personal and Social History
Relevant data include employment risks, tobacco habits, nutritional status, alcohol
consumption, personality assessment, usual exercise activities, relaxation patterns, and
drug use.
Age and Condition- Related Variations:
(1) Pregnant women
(a) History of cardiac disease or surgery; dizziness or faintness on standing; indications of heart disease during pregnancy; progressive or severe dyspnea,
progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, and chest pain related to effort or emotion.
(2) Elderly
(a) Lower extremity swelling, reproducible lower extremity pain with exertion resolving with rest (claudication), venous-stasis ulcers.
Stethoscope with bell and diaphragm use
1) The bell is used for low frequency sounds.
2) The diaphragm is used for high frequency sounds.
There are four (4) components to a heart examination and must be completed in this
order:
(a) Inspection
(b) Palpation
(c) Percussion (Omitted for the heart examination)
(d) Auscultation
Apical impulse location
(a) 5th L intercostal space
(b) Midclavicular line
*checks for enlarge left ventricle
Preparation and Positioning PCL
leaning forward, supine,
left lateral recumbent positions.
S1
closure of mitral/tricuspid valves.
S2
closure of aortic/pulmonic valves (sometimes split).
S3
early diastole (passive filling) vibration of ventricular walls.
hr scar
S4
ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to high output.
small squeeze
Wide apical pulsation may indicate
left ventricular hypertrophy. Loss of palpable
apical pulsation may indicate fluid, air, or displacement.
Thrills are associated with
failure of semilunar valve to close, aortic or
pulmonary stenosis, or atrial septal defect.
Normal findings heart
1) Resting heart rate is 60 to 90 min and regular.
2) No bruits or murmurs are present.
Loud S1 suggests
increased blood velocity, mitral stenosis, heart block,
hypertension, or calcification of mitral valve.
Potential bruits
(turbulent blood flow)
First Korotkoff sound indicated
systolic B/P.
The last Korotkoff sound heard before it disappears is
the diastolic B/P.
The amplitude of the pulse is described on a scale of 0 to 4:
1) 4 Bounding, aneurysmal
2) 3 Full, increased
3) 2 Expected
4) 1 Diminished, barely palpable
5) 0 Absent, not palpable
Pitting Edema scale
1) 1+ Slight pit, disappears rapidly (2-3 mm in depth).
2) 2+ Somewhat deep pit, disappears in 10 to 15 seconds (4-5 mm in depth).
3) 3+ Noticeable deep pit that lasts more than a minute (6-7 mm in depth).
4) 4+ Very deep pit that lasts 2 to 5 minutes (8-9 mm in depth).
(a) Redness, thickness of the vein, tenderness along superficial vein, and warmth.
(b) Can be indicated through taking a good history and exam.
(c) Use Doppler for confirmation of diagnosis.
(d) Clinical test for thrombosis, use Homan’s sign.
Palpate and assess for thrombosis
A value of less than 9 cm
suggests ventricular failure.
Normal Adult Exam
(1) Patient exhibits no visible pulsations or heaving chest.
(2) Pulses are symmetric.
(3) Bilaterally, pulse amplitude is 2+.
(4) Bilateral extremities are warm and pink with hair present.
The difference between the systolic and diastolic pressures is the pulse pressure.
The pulse pressure should range from 30 to 40 mm Hg, even to as much as 50 mm Hg.
Positive Homan’s sign indicates
venous thrombosis
Older Adults
(1) Normal findings
(a) Blood pressure <140/90
(b) The systolic blood pressure increases with age, while the diastolic blood pressure decreases
