The Physical Examination Ch. 2 Flashcards
The four major vital signs are
body temperature, pulse, RR, BP
What is the fifth vital sign
Pulse Ox (sp02)
Body temperature is routinely measured to assess for signs of…
inflammation or infection
Core temperature remains relatively constant at about…
37C or 98.6F
An increased in body temperature causes the blood vessels near the skin to dilate is a process called
vasodilation
Decrease in body temperature causes
vasoconstriction
What are the four common types of fevers?
Intermittent, Remittent, Relapsing and Constant
Intermittent fever is described as what kind of fever?
alternates at regular intervals periods of fevers and periods of normal or below normal temperatures (on and off)
Remittent fever, the pt has
peaks and valleys (more than 2C or 3.5F) over a 24 hour period
Relapsing fever is said to last
1 to 2 days, goes away and comes back
Constant or continuous fever is when pt’s body temp remains
above average without change
Hypothermia is the term to describe
core temperature below the normal range
Hypothermia may occur as a result of (3)
- excessive heat loss
- not able to create enough heat
- impaired thermal regulation
Signs of Hypothermia may include (5)
- decreased pulse and rr
- severe shivering
- coldness and chills
- skin pale or bluish
- Hypotension
Signs of severe Hypothermia may include
- loss of conciseness
- altered mental status
- coma
Interventions for Hypothermia (5)
- remove wet clothing
- provide dry clothing
- place pt in warm environment
- cover pt head w/ cap or towel
- supply warm oral or IV fluids
What are some factors that affect body temperature? (5)
Age, environment, time of day, exercise, stress, hormones
The four most commonly used sites for temperature are
- mouth
- rectum
- ear (tympanic)
- axilla
Rectum and tympanic are considered
core temperatures
What is generated through the vascular system w/ each ventricular contraction of the heart (systole)
pulse
a pulse is measured by
rate, rhythm, and strength
Normal pulse range in adults?
60 to 100
A HR lower than 60 bpm is called
bradycardia
A pulse rate greater than 100 is called
tachycardia
The diaphragm is the primary
muscle of respiration
What does the diaphragm do at the end of inspiration?
And causes the pressure in the lungs to__________
it relaxes and the natural elasticity (recoil) causes the pressure in the lung to increase
Normal RR is
12- 20 breaths per minute
Eupnea
Normal. RR 12-20
Bradypnea
Below 12 breaths
Tachypnea
More than 20 breaths
Apnea
No breathing
Hypoventilation
Decreased rate and depth
Hyperventilation
Increased rate and depth
Cheyenne-Stokes
Faster and deeper, then slower and shallower, ending with apnea
Kussmaul’s
Increased rate and depth; associated w. diabetic ketoacidosis
Biot’s
Fast and deep w. abrupt apnea
What is the force exerted by the circulating volume of blood on the walls of the arteries?
Arterial blood pressure
What is the term when the heart is contracting (top)?
Systolic blood pressure
What is the term when the heart is relaxed ( bottom)?
Diastolic blood pressure
Blood flow is equal to
cardiac output
What is the average cardio output
5L
What is the equation for CO
CO=SV x HR
When an individual’s blood pressure is chronically above normal range, this is called?
Hypertension
An elevated BP of UNKOWN cause is called
primary hypertension
An elevated BP of a KNOWN cause is called
secondary hypertension
Hypertension is BP constantly over
140/90
An abnormal condition in which the BP is not adequate for normal perfusion and oxygenation of vital organs is called what?
Hypotension
Hypotension is BP
90/60 or below
Occurs when BP quickly drops as the individual rises to an upright position or stands.
Orthostatic hypotension also called postural hypotension
Systolic BP that is more than 10mm Hg lower on inspiration than expiration is called…
Pulsus paradoxus
Noninvasive reading of o2 saturation is called
pulse ox
Normal Sp02 in adults range from
95% to 99%
Mild hypoxemia (sp02) ranges from
91% to 94%
Moderate (sp02) hypoxemia ranges from
86% to 90%
Severe (sp02) hypoxemia is
85% or below
Most common sequence for examination is
- Inspection
- Palpation
- Percussion
- Auscultation
An ongoing observational process that begins w/ the history and continues throughout the pt interview is called
Inspection
The process of touching the pt’s chest to evaluate the symmetry of the chest expansion, the position of the trachea, skin temp, muscle tone, areas of tenderness, lumps, depressions and tactile and vocal fremitus is called
Palpation
This is evaluated by lightly placing each hand over the pt’s chest so that the thumbs can meet at the midline which evaluates the symmetry of
Chest expansion
Vibration that can be perceived by palpation over the chest is
tactile fremitus
Tactile and vocal fremitus is decreased when anything obstructs the transmission of vibrations such as (air)
COPD, tumors or thickening of the plural cavity, plural effusion, pneumothorax, and muscular or obesity chest wall
Vibration that can be perceived by palpation or auscultation over the chest during phonation is
vocal fremitus
Tactile and vocal fremitus increases in pt with (fluid)
alveolar consolidation, atelectasis, pulmonary edema, lung tumors, pulmonary fibrosis, and thin chest walls
Percussion is performed over the chest wall to determine the
size, borders, and consistency of air, liquid or solid material in the underlying lung
This note Is heard when the chest is percussed over areas of pleural thickening, pleural effusion, atelectasis, and consolidation
Dull percussion note
When chest is percussed over areas of trapped gas what note is heard?
Hyperresonant note
Hyperresonant notes can be heard in pt’s with (2)
COPD or pneumothorax
When severe alveolar hyperinflation is present (eg. severe emphysema, asthma) the diaphragm is _________ and _____________ and has minimal ___________
low and flat in position and has minimal excursion
Lobar collapse of one lung may pull the diaphragm up on the ______________ side and ______________ ______________
affected side and reduce excursion
________________ of the chest provides information about the heart, blood vessels, and air flowing in and out of the TB tree and alveoli.
Auscultation
3 different normal breath sounds can be auscultated over the normal chest. They are called…
- bronchial breath sounds
- bronchovesicular breath sounds
- vesicular breath sounds
Bronchial breath sounds are normally auscultated directly,
and are caused by
over the trachea and are caused by the turbulent flow of gas through the upper airway.
Bronchovesicular breath sounds are auscultated directly over the
mainstem bronchi
Vesicular breath sounds are the
normal sounds of gas rustling or swishing through the small bronchioles and the alveoli
Abnormal lung sounds (ALS) are
atypical or uncharacteristic, lung sounds that are normally heard over a specific area.
To describe a “pitch” ALS experts recommend the use of such words as
high, moderate, or low
To describe intensity or loudness
faint, soft, mild, moderate, and loud
pathologic conditions increases just vocal fremitus? (2)
- Atelectasis
- PNA
A dull or soft percussion note would likely be heard in which of the following pathologic conditions? (2)
- Pleural thickening
- Atelectasis
Bronchial breath sounds are likely to be heard in (2)
- Alveolar consolidation
- Atelectasis
Wheezing is:
- Produced by bronchospasm
- Cardinal finding of bronchial asthma
- Usually heard as high pitched sounds
In which of the following pathologic conditions is transmission of the whispered voice of a pt through a stethoscope usually clear? (2)
- Alveolar consolidation
- Atelectasis
Which of the following abnormal patterns is commonly associated w/ diabetic acidosis?
Kussmaul’s respirations
A patient who has a temperature within the normal range is called
Afebrile
Another name for hyperthermia
pyrexia
When the body temperature rises above the normal range, the pt is said to have a _______ or to be _______
fever; febrile
An exceptionally high temperature, such as 41c (105.8 F) is called
hyperpyrexia
Intentional lowering of a pt’s body temperature to reduce the oxygen demand of the tissue cells
Induced hypothermia
Nine common pulse sites are
Temporal
Carotid
Apical
Branchial
Radial
Femoral
Popliteal
Dorsal pedal
Posterior tibial
In a clinical setting the pulse is usually assessed by
palpation
Normal pulse rate for newborns
100-180 bpm
Normal pulse rate for toddlers
80-130 bpm
Normal range for a child
65- 100 bpm
Tachycardia may occur as a result of
hypoxemia
anemia
fever
anxiety
emotional stress
fear
hemorrhage
hypotension
dehydration
shock
exercise
Bradycardia may be seen in pts with
hypothermia
physically fit athletes
HR to increase during inspiration and decrease during exhalation is called
sinus arrhythmia
The strength of the pulse to vary every other beat while the rhythm remains regular is called
pulsus alternans
Tachypnea is seen in pts with
fever
metabolic acidosis
hypoxemia
pain
anxiety
Bradypnea may occur in pts w/
hypothermia
head injuries
drug overdose
The numeric difference between the systolic and diastolic bp is the
pulse pressure
Example of pulse pressure: systolic 120 mm hg and a diastolic of 80 mm hg (120- 80)
Equals 40 mm hg
Hyperpnea
Increased depth and rate; similar to hyperventilation
Factors associated w/ hypertension include:
Obesity
high serum sodium level
pregnancy
obstructive sleep apnea
family history of high blood pressure
Another word for tactile fremitus
rhonchial fremitus
Tactile fremitus is commonly caused by
gas flowing through thick secretions that are partially obstructing the large airways
_______ ________ is often noted during inhalation and exhalation and may be clear after a strong cough
Tactile fremitus
Described as flat or soft, HIGH in pitch and SHORT in duration, similar to the sound produced by knocking on a FULL barrel
Dull percussion note
Described as very loud and LOW in pitch and LONG in duration, similar to sound produced by knocking on an EMPTY barrel
hyperresonant note
Under normal conditions, _________ breath sounds are auscultated over most lung fields, both anteriorly and posteriorly
vesicular breath sounds
Recommend terms for Abnormal Lung Sounds are:
fine crackles, medium crackles or coarse crackles, wheezes, bronchial breath sounds, stridor, pleural friction rub, diminished breath sounds, and whispering pectoriloquy
