Week 3- Physical Assessment as a Screening Tool Flashcards
PART 1
PART 1
(SQ)
Why is it important to screen the skin and nail beds for abnormal changes?
Changes in skin/nail bed may be the 1st sign of inflammatory, infectious, and immunologic disorders.
New onset of skin lesions (especially in _______) should be medically evaluated.
children
What do we want to assess for during a skin assessment? (6)
Changes in;
- texture
- color
- temp
- clubbing
- circulation
- edema
What are (3) changes in skin color and what may they indicate?
Pallor
-May indicate anemia, arterial insufficiency, fainting, shock.
Jaundice
-May indicate liver condition or hematologic disorder.
Cyanosis
-May indicate advanced lung disease, CHF, or low hemoglobin.
Changes in skin temperature are an indication of vascular supply, what are some other signs of decreased vascularity? (4)
- paresthesia
- muscle fatigue/discomfort
- cyanosis w/ numbness
- pain and loss of hair
(SQ)
Name the ABCDE Criteria utilized for screening suspicious skin lesions.
- Asymmetry
- Border
- Color
- Diameter (>6mm)
- Evolving
Name (3) specific rashes/skin lesions.
- Dermatitis (eczema)
- Herpes Zoster (shingles)
- Rheumatologic Diseases
Dermatitis:
- What are the (3) types of dermatitis? Describe each.
- How does it present?
Contact Dermatitis -Skin reacts to something it has come in contact with. Dyshidrotic Dermatitis -Affects skin that gets wet frequently. Atopic Dermatitis -Often accompanies asthma or hay fever.
-Skin is red, brown, or grey; sore; itchy and sometimes swollen.
Herpes Zoster (shingles):
- Rash may last __-__ days.
- Reports burning, shooting pain and tingling or itching.
- Lesion appears ________ along the path of _________.
- 1-14 days
- unilaterally along path of spinal nerve
Rheumatologic Diseases:
- What is often the first sign of underlying rheumatoid disease?
- What are 3 common rheumatoid diseases?
- Skin lesion/rash
- SLE, Discoid lupus erythematosus, Lyme disease
(SQ)
What characteristics of lymph nodes increase the suspicion of cancer? (3)
- hard
- immovable
- nontender
Capillary refill at nail beds should occur in __ seconds.
3 seconds
(SQ)
Name 3 nail abnormalities and the disease states associated with them.
Beau’s Lines
-acute illness or systemic disease
Splinter Hemorrhages
-may be sign of silent MI or pt may have Hx of MI
Clubbing
-chronic O2 deprivation
Beau’s Lines:
- What is the presentation?
- Usually caused by _____ _______ or _______ _______.
- Name some other associated conditions.
- Transverse grooves across nail plate.
- acute illness or systemic disease
- poor peripheral circulation, eating disorders, cirrhosis, recent MI, other trauma
Splinter Hemorrhages:
- What is the presentation?
- May be a sign of ______ ____ or Hx of ___.
- When is it of more concern?
- Red-brown, linear streaks
- silent MI or Hx of MI
- More of concern when seen on multiple fingers.
Clubbing:
- Usually results from chronic __________ in tissue beds.
- Often observed in patients with COPD, congenital heart defects, and cor pulmonale.
- Can occur within 10 days in patient with acute systemic condition.
- ______ (__-__ days) development of clubbing requires immediate medical evaluation.
- O2 deprivation
- Rapid (10-14 days)
What is Schamroth’s Sign?
Way to tell whether clubbing is occurring. Put distal phalanges up to each other to see if it makes a window.
PART 2: TESTS
PART 2: TESTS
Name the tests utilized. (8)
- Kidney Percussion
- Liver Percussion
- Spleen Percussion
- Murphy’s Sign
- McBurney’s Sign
- Rovsing’s Sign
- AAA Palpation
- AAA Auscultation
What is a + Kidney, Liver, or Spleen Percussion Test?
Tenderness with percussion.
(SQ) Murphy's Sign: -What is the purpose of Murphy's Sign? -How do we perform it? -What is an abnormal finding?
- Purpose: Test for Acute Cholecystitis (gall stones)
- Perform: With pt in hook lying, ask pt to exhale. Perform palpation below costal margin on right side at midclavicular line. Have patient take a deep breath in.
- Abnormal Finding: Patient stops breathing/winces or reports tenderness.
(SQ) McBurney's Sign: -What is the purpose of McBurney's Sign? -How do we perform it? -What is an abnormal finding?
- Purpose: Test for appendicitis.
- Perform: With pt in hook lying, perform a deep palpation 1/2 distance between umbilicus and ASIS on R side. Quickly release and assess for rebounding tenderness.
- Abnormal Finding: Tenderness
(SQ) Rovsing's Sign: -What is the purpose of Rovsing's Sign? -How do we perform it? -What is an abnormal finding?
- Purpose: Test for appendicitis.
- Perform: With pt in hook lying, perform a deep palpation 1/2 distance between umbilicus and ASIS on L side. Quickly release and assess for rebounding tenderness.
- Abnormal Finding: R sided tenderness with remote rebounding testing on L side.
AAA Palpation:
- How do we perform it?
- What is an abnormal finding?
- Perform: With pt in supine, palpate for aortic pulse superior and slightly left of umbilicus. Place palms on abdomen with index fingers on each side of aorta.
- Abnormal Finding: Pulse width >3cm or provocation of symptoms (including tenderness/referred pain to back)
AAA Auscultation:
- How do we perform it?
- What is an abnormal finding?
- Perform: With pt in supine, auscultate just left of the midline. Apply firm pressure but no dent (can occlude vessel) beginning at level of renal arteries and move towards umbilicus.
- Abnormal Finding: Presence of bruit (abnormal blowing/swishing sounds). Palpation and auscultation for AAA improves value of techniques as a screening tool for thin patients with aneurysms >5cm.
When To Perform Abdominal Palpation and Auscultation:
- With a suspicion of abdominal pathology causing ____.
- Who presents with a ___-_______ pattern of LBP unchanging with postures, positions, activities, etc.
- At high risk for _____.
- Who are not responding to therapy interventions.
- LBP
- non-mechanical LBP
- AAA
PART 3: FRACTURE SCREENING
PART 3: FRACTURE SCREENING
List the Fracture Clinical Decision Rules. (5)
- Canadian C-Spine rules
- NEXUS Criteria
- Pittsburg Knee Decision Rule
- Ottowa Knee Decision Rule
- Ottowa Ankle Decision Rule
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(SQ)
What are the indications for use of a tuning fork to screen for a fracture? (3)
- If you cannot get close with palpation, then it is not beneficial to use a tuning fork.
- Sensitivity and specificity not great.
- Positive finding suggests bony involvement (not diagnostic).
(SQ)
What tuning fork frequency should be utilized for fracture screening?
128 or 256Hz
What are (2) tests utilized to screen for fractures?
- Fulcrum Test
- Patellar Pubic Percussion
