Physical Examination of the Patient Flashcards
Describe Peripheral Edema and what it entails
- Presence of excessive fluid in the tissue known as pitting edema
- Occurs primarily in arms and ankles
- Caused by CHF and renal failure
- Rated +1, +2, +3, etc. The higher the number, the greater the swelling.
- Recommend diuretic therapy.
Ascites
accumulation of fluid in the abdomen generally caused by liver failure
Capillary Refill
Indication of peripheral circulation.
a. Blanching the hand and watch for color to return.
b. Color should return within 3 seconds
Skin Color
a. Decrease in color (ashen, pallor) due to anemia or acute blood loss (Vasoconstriction will cause this change in color by reducing blood flow)
b. Jaundice - increased bilirubin level in blood and tissue. Appears mostly in the face and trunk.
c. Erythema - redness of the skin. May be caused by capillary congestion, inflammation, or infection
d. Cyanosis - blue or blue-gray (dusky) discoloration of skin and/or mucous membranes. Caused by hypoxia.
Restrictive Chest Configurations (3)
- Pectus Carinatum - anterior protrusion of the sternum
- Pectus Excavatum - depression of part of or the entire sternum
- Kyphosis - convex curvature of the spine (lean forward)
Eupnea
Normal respiratory rate, depth, and rhythm.
NORMAL RR for adults is 12 - 20 breaths/min
Hyperpnea
Increased RR, increased depth, normal rhythm
Cause: Metabolic disorder/CNS disorders
Cheyne-Stokes
Gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 seconds, with periods of apnea lasting up to 60 seconds
Cause: increased ICP, brainstem injury, drug overdose
Biot’s
Increased RR and depth with irregular periods of apnea. Each breath has the same depth.
Cause: CNS problem
Kussmaul’s
Increased RR, increased depth, irregular rhythm, breathing sounds labored
Cause: hypoxemia, metabolic acidosis, renal failure, diabetic ketoacidosis
Apneustic
Prolonged gasping inspiration followed by extremely short, insufficient expiration.
Cause: problem with respiratory center, trauma, or tumor
Hypopnea
Shallow or slow breathing
Retractions
Intercostal and/or sternal retractions occur when the chest moves inward during inspiratory efforts instead of outward.
Adult: airway obstruction
Newborn: respiratory distress (nasal flaring most common sign)
Mallampati Classification (four classes)
Class I: Soft palate, uvula, fauces, pillars visible
Class II: Soft palate, uvula, fauces visible
Class III: Soft palate and base of uvula visible
Class IV: Only hard palate visible.
(Class III and IV are considered difficult airways)
NORMAL pulse rate (adult)
60 - 100/minute
Recommended treatment for Tachycardia?
oxygen therapy
Recommended treatment for Bradycardia?
Atropine (bradycardia suggests heart failure, shock, code/emergency)
A change in heart rate of __________ is an adverse reaction.
20 beats/min. Stop therapy, notify nurse or doctor, and record event.
Paradoxical pulse/pulsus paradoxus
Pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthmaticus, tension pneumothorax, cardiac tamponade).
Tracheal deviation toward normal side (away from pathology) indicates
Problem is outside of the lung in the pleural space.
- Massive pleural effusion
- Tension pneumothorax
- Neck or thyroid tumors
- Large mediastinal mass
Diagnostic Chest Percussion
Resonant
Tympanic
- Normal, air-filled lung
- Normally heard over air-filled stomach
Vesicular
Normal breath sounds
Bronchial Breath Sounds
Normal sounds heard over the trachea or bronchi. These breath sounds over the lung periphery would indicate lung consolidation.
Egophany
The patient is instructed to say “E” and it sounds like “A”. Indicates consolidation.
Adventitious
Abnormal breath sounds
Crackles/rales
Secretion/fluid.
- Coarse: instruct patient to cough or suction patient
- Medium: recommend bronchial hygiene (CPT)
- Fine: associated with CHF/pulmonary edema. Recommend oxygen, PPT, positive inotropic agents (heart strengthening agents), diuretics
Unilateral wheeze indicates
Foreign body obstruction. Recommend RIGID bronchoscopy.
Stridor
High-pitched or crowing inspiratory sound caused by upper airway obstruction.
a. Supraglottic swelling (epiglottitis)
b. Subglottic swelling (croup, post extubation)
Treat with topical decongestant (racemic epinephrine)
If “marked” stridor - intubate!
Stertor
Noisy breathing that occurs during inhalation. Snoring.
Pleural friction rub
Coarse, grating raspy or crunching sound caused by inflamed surface of the visceral and parietal pleura rubbing together.
May be associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.
Recommend steroids and antibiotics.
Normal Heart Sounds
- Sounds created by the closure of heart valves
- First sound (S1) created by normal closure of the mitral and tricuspid valves at the beginning of ventricular contraction.
- Second sound (S2) is normal and occurs when systole ends. The ventricles relax and the pulmonic and aortic valves close.
Abnormal heart sounds and what they suggest
S3: In an adult, the presence of S3 may suggest heart failure.
S4: The presence of a fourth sound is indicative of a cardiac abnormality such as uncontrolled hypertension or aortic stenosis.
Recommend echocardiogram.
NORMAL blood pressure value (ADULT) and acceptable range
120/80 mm Hg
Systolic: 90 - 140 mm Hg
Diastolic: 60 - 90 mm Hg
