Week 8 2nd assess Flashcards
2nd assessment=
Consists of:
=more through examination→ objective & measurable (quantifiable) info is taken→ vitals, SAMPLE,
= head-toe exam & completing vitals signs
Not every PT has everything in 2nd assess/
Assessment 4 techniques:
1st visual, 2nd palpation, 3rd percussion, 4th auscultation
Frail:
Feeble:
Robust:
Vigorous:
= Sick
= lack of strength
= energetic
= VERY energetic
Identifying Odors:
Ammonia, fruity breath, bitter almond breath, BO, fishy vagina, fecal breath,
Ventilations Qs?:
Rate, Quality, Pattern, IE 1:2, Positioning/ Accessory M. use?
systemic vascular resistance SVR:
how much of vessels constriction dilation
BP=
Top #=
bottom#=
SVR x (SV x HR)
= Systolic pressure = squeeze
=Diastolic = diastolic relax
BP sounds= Korotkoff 5 sounds= 1st sound
2nd sound=
3rd sound=
4th sound=
5th sound=
= snapping
= swooshing
= tapping
= thumping (muffling)
= silence
BGL treatment range:
<70 hypo treat w/ sugar & >300 hyper treating w/ fluid
GCS:
E4, M5 (orient, confused, words, sounds, none), S6 (obey, local/withdraw, normal flex, abnorm flex decorb, exten/ decer, none)
Skin function:
transmit info, reg/s temp, protect (Burns cant control temp)
Pupils sizing range:
= 2-4mm bright & 4-8 dim (dilated side w/ anisoria side w/ trauma)
Anisocoria:
heterochromia:
=unequal pupils greater than 1mm
=dif/ pupil colors
Pupils: Direct response:
Indirect response:
Accommodation:
Ocular motor movement:
= same pupil in light responds
= pupil opposite of light responds
= eyes cross when finger to nose
= eye movement in “H”
Ear (middle) bones:
=stapes, incus, malleolus
Neck examine:
=Kussmaul sign from pericardial sac filled w/ pus
Auscultate for bruits= swoosh = build up= atherosclerosis
Art/ harding& constricting of vessels & arth=build up of vessels
ROM range of motion
Chest 3 phases: phase 1:
phase 2:
phase 3:
=Chest wall:
=Pulmonic: bronchial, tracheal, bronchovesicular (rhonci), vesicular
=Cardiac: S3: CHF maybe, S4: in CHF (Aortic, Pulmonic, Erb’s point (3rd ICS), Tricuspid)
Hamman’s Crunch:
=dive injury crunch in heart sounds (air in media stynium ) (pneumo air to heart) can happing from blowing balloons (boyle law)
ABDMN examine:
Scaphoid abdomen, hemoptysis, hematochezia, Murphy’s sing, McBurny’s point, Aaron’s signs, Rovsing’s sign, Psoas sign
!!! Murphy’s signs:
= Suspected gall bladder infection→ cupping under rib w/ pressure with breath causing pain
!!! McBurny’s point:
= RLQ pain w/ rebound tenderness ⅔ of way from umbilicus to illicac
Aaroon’s sign:
= Epigastric pain during palpation to McBurney’s point
Rovsing’s sign:
= RLQ pain w/ palpation to LLQ
Psoas sing:
=Pain to RLQ when patient tries to reaise R leg against resistance
Back: Lordosis:
Scoliosis:
Kyphosis:
=swayback
=Lateral curve
=humpback
Sniffing position:
=pillow under head ear aligned with sternum (called sniffing bc/ way head recoils when you shift)
Ramped position:
for obese PTs, <LOTS>prepare a proper ramp (head and shoulder support) before transferring them to the ambulance.</LOTS>
BP width:
= 40-50% of mid-arm circumference
BP length:
= Should cover between 80-100% of arm circumference
BP Overall cuff size:
= cover 2/3s of distance of the upper arm (measured from acromion to olecranon)
Neck emamine:
= Kussmaul’s sing, JVD, Trachea deviation, Bruits, ROM
Bristol stool chart:
= type 4 healthy type, 1 hard deer pebbles, type 8 liquid
3 types of abdomen pain:
= Visceral: (dull) distension, ischemia, inflammation
Referred: kehrs should pain w/ abdomen b/c phriadam nerve
= Somatic> (sharp pinpoint) appendinixsitis
Extrems: edema:
Poor perfusion: pitting edema +1 ¼ inch, +2 ½ inch, 3 ½ -1inch, 4
CN 1:
Olefactory = smell
CN 2
Optic= Vision (senses light)
CN 3
Oculomotor = pupil m-vt (controls size of pupil)
CN 4
Trochlear = eye motor function (look up & down)
CN 5
=trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin)
CN 6
abducens= Lateral Eye m-vt
CN 7
facial= sense tongue & motor eyebrows expression
CN 8
vestibulocochlear= sense hearing, balance, equilibrium
CN 9
glossopharyngeal= sense post/ pharynx, taste,
CN 10
vagus= “wondering” sense taste post tongue, Motor speck and swallow
CN 11
Accessory = traps Muscles motor
CN 12
Hypoglossal = motor tongue out
Scaphoid abdomen
A severely sunken in & flat abdomen
Persistent abdominal pain lasting how long is classified as a surgical emergency.
6 Hours
“Hammer” of ear:
“Stirrup” of ear:
“Anvil” of ear:
= Malleus bone
= Stapes bone
= Incus bone
Where to auscultate for a Tricuspid valve murmur?
Where to auscultate for a Pulmonic valve murmur?
Where to auscultate for a Mitral valve murmur?
Where to auscultate for a Aortic valve murmur?
= 4th ICS, just to the Left of the sternum
= 2nd ICS, just to the Left of the sternum
=5th ICS, Left of the sternum
= 2nd ICS, just to the Right of the sternum
Hematemesis:
Hypotyposis:
Hematochezia:
Melana:
= vomiting blood
= coughing blood
= Pooping bright red stool
= Pooping dark black stool
Crunch/rasping sound auscultated over left side of chest that is synchronous with the heart beat is?
Hamman’s Crunch
Percussion 5 sounds:
Tympany, Hyperresonance, Resonance, Dull, Flat
“Thunderous Hammers Rattle Doors Flatly”
Tympany percussion sound:
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach
Hyperresonance percussion sound:
= “Booming” , loud intensity, Low pitched, long duration, located in Hyperinflated-Lung
Resonance percussion sound:
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung
Dull percussion sound:
= “thud” , Medium intensity, medium pitched, medium duration, located in solid organs
Flat percussion sound:
= “Extremely dull” , Soft intensity , High pitched, short duration, located in muscle & atelectasis
Direct Percussion:
Technique:
Commonly used for:
= tapping directly on PTt’s skin w/ your fingertip.
= tap sharply & release immediately.
= used w/ percussing PT’s frontal & maxillary sinuses
Indirect percussion:
Technique:
Commonly used for:
=indirectly percussing PT;
= Place 1 hand on area you wish to percuss. Use finger of that hand (usually middle finger) as striking surface. Sharply tap (simply from snapping wrist) distal knuckle of finger w/ tip of other middle finger. Snap the finger back quickly to avoid dampening sound.
= Percussing chest (make sure finger lies in ICS)
Blunt percussion:
technique:
Commonly used for:
= “Blunt weapon” best used for detecting pain/ inflammation.
= Simply strike PT’s skin w/ ulnar side of your fist w/ just enough force to elicit tenderness but not cause undue pain.
= in costovertebral angle when examining a PT for a kidney infection
AVPU:
Alert, responds to Verbal stimuli, Only Painful stimuli, & Unresponsive
Dysarthria:
Dysphonia:
Aphasia:
= defective speech caused by motor deficits
= voice changes caused by vocal cord problems
= defective language caused by neurologic damage to the brain
Expressive aphasia:
Receptive aphasia:
= words will be garbled &/or expressed
= words will be clear but unrelated to your questions
(PT w/ receptive aphasia can have such difficulty talking that you could mistakenly suspect a psych disorder)
Assessing PT’s ability to concentrate w/ 3 exercises:
= 1st: digit span
= 2nd: serial sevens
= 3rd: spelling backwards
1st exercise for assessing PT’s concentration:
2nd exercise for assessing PT’s concentration:
3rd exercise for assessing PT’s concentration:
= Digital Span PT repeat a series of numbers back to you. (Norm/= repeat at least 5 numbers forward & backward)
= Serial Sevens= PT start @ 100 & subtract 7 each time(Norm/= complete once in 90 Secs w/ <4 errors.)
= Spelling Backwards: PT spell a common five-letter word backward
Tachypnea possible causes:
Bradypnea possible causes:
= hypoxia, shock, head injury, DKA, or anxiety.
= drug OD, severe hypoxia, or CNS insult
Exhalation process:
Inhalation process:
= Passive use→ of respiratory muscles’ elastic recoil.
= Active use requiring ATP→ of respiratory muscles (diaphragm & intercostals) to increase the chest’s inner diameter.
Eupnea:
Hyperpnea:
Cheyene-Stokes:
= Normal breathing
= Deep breathing
= Gradual increases & decreases in respirations w/ periods of apnea; caused by increasing ICP & brainstem injury
Normal BP:
SBP 100-135 mmHg & DBP 60-80 mmHg
Orthostatic Vital sign Test:
Healthy PTs vitals w/ test:
Positive test:
= Take PT’s pulse & BP while they’re supine & have PT sit up, dangle feet, & then stand. In 30- 60 secs retake vital signs.
=Healthy PT vitals should not change;
= HR increases 10- 20 BPM or if SBP drops 10- 20 mmHg indicating possible hypovolemia
Hyperthermia is a temp of:
Temp of up to 102°F (38.9°C):
Temp rises above 103°F (39.4°C):
Temps above 105°F (40.6°C):
= =100.4°F (38°C) or higher
= increases metabolism markedly.
= Neurons of the brain can denature.
= brain cells die & seizures can occur
Body maintains temp ~of:
Celsius# to Fahrenheit:
Fahrenheit# to Celsius:
= 98.6°F (37°C)
= (C# -32) / 1.8
= (1.8 x F) + 32
Hypothermia treatment:
Body temp of 93°F (33.9°C):
Temp drops below 90°F (32.2°C):
Temp drops much below 70°F (21.1°C):
= b/c low fibrillation threshold always handle PTs gently when assessing/moving them.
= normal body warming mechanisms begin to fail.
= Shivering stops, heart sounds diminish, & cardiac irritability +
= PT has deathlike appearance & possibly irreversible asystole (absence of heartbeat)
Skin % of weight to body:
Skin reg/s body temp through:
Epidermis is avascular (has no blood vessels) so:
Eccrine glands aka merocrine glands:
Apocrine glands found exclusively:
= 15%
= radiation, conduction, convection, and evaporation
= blood vessels from underlying dermis must supply its nutrition
= open onto skin surface & help control body temp w/ water excretion
=armpits & genital region & open into hair follicles giving off a scent & respond to emotional stress “Apple smells”
Skin tugor test:
Norm/ skin test results: immediately returns to its original state.
Poor turgor results:
Decreased mobility suggests:
= pulling skin fold of over a bony prominence & then releasing it
= immediately returns to its original state
= Tenting & from dehydration.
= edema or scleroderma, a progressive skin disease.
Primary skin marks:
“Many= Macule
Purple = Plaque
Wizards = Wheal
Paint = Patch
Pretty = Papule
New = Nodule
Tattoos = Tumor
Placing = Pustule
Various = Vesicle
Colors = Cyst
Beneath = Bulla
Their = Telangiectasia
Skin” = Skin
Macule:
Plaque:
Wheal:
Patch:
Papule:
Nodule:
Tumor:
Pustule:
Vesicle:
Cyst:
Bulla:
Telangiectasia:
= flat spot; color varying w/ white-brown or red-purple less than 1cm
= Superficial papule w/ diameter > than 1cm & rough texture
= Pink friction “burn”
= irregular flat spot w/ diameter > 1cm
= Elevated firm spot color white-brown /blue-purple w/ diameter <1cm
= elevated firm spot 1-2cm
= elevated solid >2cm
= elevated spot <1cm purulent liquid
=elevated area <1cm w/ serous fluid
= elevated palpable area w/ liquid or viscous matter
= vesicle w/ diameter >1cm
= Red threads
Secondary skin lesions:
= Fissure “Frightening
= Scar Scars
= Erosion Etch
= Keloid Killer
= Ulcer Ulcers
= Excoriation Exposing
= Scale Scaly
= Lichenification Layers
= Crust: Crumbling
= Atrophy: Atrophy”
Abnormal Nail Findings:
Clubbing, Paronychia, Onycholysis,Terry’s nails, Transverse lines, Psoriasis, Beau’s Lines,
Beau’s lines in finger nails:
Estimating the timing or length of an illness by:
Why lines form:
= Transverse depressions in nails & associated w/ severe illness.
Like transverse lines, they form under nail fold & grow out w/ nail.
= Location of the line. (lines on >1 nail often indicates PT had serious systemic illness during past 2-3Mns)
During severe illness, the nails grow slowly, thus forming the lines.
Psoriasis in finger nails:
= small pits in the nails and can be an early sign of psoriasis
Traverse Lines in finger nails:
Can appear w/ or with:
= White lines parallel w/ lunula vs cuticle &
= Severe illness; shows under proximal nail folds & grow out w/ nail
Terry’s nails:
Seen in:
= mostly whitish nail w/ band of reddish-brown at distal nail tip
= Aging, liver cirrhosis/failure, CHF, & diabetes
Onycholysis in finger nails:
= nail bed separates from the nail plate. It begins distally & enlarges the free edge of the nail. There are many causes including hyperthyroidism
Paronychia in finger nails:
=inflammation of proximal & lateral nail folds & can be acute or chronic. The folds appear red, swollen, & tender. The cuticle cannot be visible. People who frequently immerse their hands in water are susceptible
Clubbing fingernails:
= “finger clubs” distal phalanx of each finger is rounded and bulbous. The proximal nail feels spongy. This is caused by the chronic hypoxia found in cardiopulmonary diseases and lung cancer.
A boggy (soft & pliable) nail suggests:
= the clubbing seen in systemic cardiorespiratory diseases.
Psoriasis skin condition:
Skin look:
= chronic skin condition causing cells build up rapidly on skin’s surface
= Thick, red, scaly patches that can be itchy & sometimes painful
Hair Dandruff:
Hair psoriasis:
Hair seborrheic dermatitis:
= Mild flaking
= Heavy flaking
= Greasy scaling
External eye consists:
Mnemonic:
= Eyelid, Conjunctiva, Lacrimal gland, Ocular muscles, & Bony skull orbit = “Every Cat Loves Outside Birds”
lacrimal glands in temporal region of superior eyelid F:
= Produce tears to moisten the eye
Eyelids function:
= Spread tears over eyes, reg/ light entering, & protect from foreign bodies
Conjunctiva:
= thin membrane covering anterior surface of eye & inside of the eyelid
Ocular Muscles:
Innervated by 3 cranial nerves:
= control eye movement
= Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
Cranium consists of:
saying:
= Frontal, Parietal, Temporal, Occipital, Ethmoid, & Sphenoid bones
“Parents on top” “S above E in alphabet”
Face includes nasal bones:
Maxillary, Lacrimal, Zygomatic, Palate, Inferior nasal Concha,& Vomer
internal eye consists of:
Mnemonic:
= sclera, cornea, iris, lens, & retina
= “Some Cool Individuals Like Reading”
sclera:
Cornea:
Retina:
= white of the eye; Dense avascular structure gives eye shape
= Separates anterior chamber fluid from external environment & permits light to enter the lens & reach the retina.
= Sensory network of eye transforms light rays into electrical impulses that the optic nerve transmits to the brain.
Lens & Function:
Iris:
Iris function
= Cellular structure behind iris; Convex & transparent allows images to focus onto the retina
=Circular contractile muscle; Its pigment produces color of eye
=Controls amount of light reaching the retina by controlling pupil size & initiated by Optic N. CN-II (senses light), & Oculomotor N. CNIII (controls size of pupil)
visual acuity test=
Recording PT’s grade:
1st # grade:
2nd #:
Normal results:
= PT 20 ft from Visual Acuity wall/Snell Chart/PT hold visual acuity card 14 In from their face. Ask PT to cover 1 eye & begin reading the lines
= Grade next to smallest line which PT can read at least ½ letters
= Distance PT is away from chart
= Distance from which a normal eye could read the line
= 20/20. EX 20/70= normal eye could read line 70 ft away but PT could read it only from 20 ft.
Bitemporal hemianopsia:
Left/Right Homonymous Hemianopsia:
Homonymous Quadrantic Defect:
= loss of vision in the outside half of each eye
= loss of vision in the right half of both eyes or left half of both eyes
= loss of vision in the same quadrant of both eyes EX LQ & LQ loss
Sluggish pupil suggests=
Bilateral eye sluggishness can indicate= Global Hypoxia to the brain tissue or an adverse drug reaction.
Constricted pupils= Opiate OD
Fixed & dilated pupils usually= brain death.
Nystagmus= fine jerking of the eyes
When shining light laterally of eye look for:
Shadow could suggest=
= pressure on Oculomotor Nerve CN-III) from increased ICP.
=Global Hypoxia to the brain tissue or an adverse drug reaction.
= Opiate OD
= Brain death
= fine jerking of eyes
= Crescent-shaped shadow on medial side of iris B/c iris is flat & cast no shadow.
= Glaucoma→ caused by blockage that restricts aqueous humor fluid from leaving anterior chamber thus increasing intraocular pressure & threatens PT’s eyesight.
Ear has 3 parts:
Outer ear, Middle ear, & Inner ear
Outer ear consists:
Mnemonic:
= Auricle, External Acoustic Meatus “Ear canal”, & Tympanic membrane “eardrum”
“All Ears Auscultate Mighty Tubas”
Auricle:
Auricle comprises:
= visible skin-covered cartilage that extends outward from the skull
= Helix (outer rim), Antihelix (Inner rim), Lobe, Concha (Opening-canal), & Tragus (protuberance lying in front of concha)
Mastoid process of Temporal bone=
Mastoid bone=
= behind ear & works as attachment for sternocleidomastoid muscle (palpable behind earlobe)
= contains air-filled cells to middle ear & why ear infections(otitis) often presents w/ tenderness in the mastoid area
Translucent tympanic membrane=
= @ end of ear canal, separates ear canal from middle ear “ear drum”
External Acoustic Meatus “ear canal”:
= opens behind tragus & is ~2-3 Cms long in adults.
Hair & sebaceous ear glands:
= produce wax (cerumen) line distal third of canal.
Middle ear contains 3 small bones/ossicles:
Middle ear bones Function:
Middle ear anatomy :
= malleus, incus, stapes
= transmit & amplify sound from tympanic membrane to inner ear.
= air-filled cavity in temporal bone, begins w/ medial surface of tympanic membrane.
Umbo=
Eustachian tubes=
= pulls eardrum inward/concave(“cone of light” visible w/ otoscopy)
= help move mucus from ear- nasopharynx & help =pressure w/ outside air & middle ear during swallowing, sneezing, & yawning
Malleus (Hammer):
Incus (Anvil):
Stapes (Stirrup):
= 1st bone in middle ear that picks up sound vibrations from eardrum
= 2nd bone connects Malleus to stapes & helps pass sound vibrations
= 3rd bone transfers sound vibrations to inner ear thru oval window
Vestibule:
Semicircular Canals:
Cochlea:
= Central part of inner ear helps w/ balance & detecting head position
= 3 loops in inner ear help w/ balance w/ detecting head rotation
= “Cochlear hears” coil transmits sound to Acoustic N. (CN-VIII) “sound vibrations to electric impulses”
inner ear cavity contains:
Cochlea transmits to:
Hearing=
Labyrinth=
= Vestibule, Semicircular canals, Cochlea, Labyrinth
=acoustic nerve (CN-VIII).
= vibrations from environment to the tympanic membrane (trans/ed through eardrum to ossicles & cochlea to translate for brain)
= helps us maintain balance by sensing position & m-nt of our head & innervated by the acoustic nerve.
Otorrhea:
= discharge from ear
Hearing loss testing use=
Pneumatic Otoscope:
= a tuning fork (typically 512 Hz) to perform the Rinne & Weber tests
= can Push air through speculum allowing to test tympanic membrane mobility
Rinne Test:
Doing Rinne Test:
Rinne Test normal:
= hear sounds better through air or bone
=Tuning fork placed on mastoid bone (bone conduction) & then next to your ear (air conduction).
= hear sound longer w/ air conduction= normal
Weber Test:
Weber Test Conductive Hearing Loss:
Weber Test Sensorineural Hearing Loss:
=hear sound equally in both ears; Tuning fork @ center of forehead
= Sound louder w/ tuning fork in Affected ear (can be infection/wax)
= Louder w/ tuning fork in UNaffected ear (damaged cochlea/nerve)
External nose comprises:
= nasal bones, septum, nares, & turbinates,
Nares:
Nasal Septum:
Turbinate/ conchae=
Turbinates help:
= anterior openings in the nose.
= divides nasal cavities.
=Bony ridges on medial surface of nose to create turbulence
= Clean, warm, & humidify inspired air w/ mucous membranes (very vascular & resp/s system’s 1st filtration system)
Paranasal sinuses:
Nasal bones:
Sinus bones saying:
= Air pockets in nasal cavity bones & line w/ mucus membranes & cilia
= frontal, maxillary, ethmoid, & sphenoid bones
=“FESM front front, E before S, M muncher”
Cilia in sinuses:
Sinuses function:
nasal flaring indications:
Rhinitis:
Lips:
= fine hair like “nipples” move secretions into oral & nasal cavities
= Help insulate brain & give vocal resonance (absent w/ head cold)
= Respiratory distress
= runny nose commonly from allergies
= mark mouth entrance & play a role in articulation of speech
Mouth houses:
Roof of mouth formed by:
Major salivary glands:
Parotid Gland:
Submandibular Gland:
Sublingual Gland:
Amylase:
Teeth:
Tongue:
Tongue Function:
Gingiva:
= : tongue, gingiva(gums), teeth, salivary glands,
= hard & soft palate
= parotid, submandibular, & sublingual.
= Post/ jaw & Ant/ ears; make amylase breaks carbs/starches to sugars
= Under & along lower jaw; Makes saliva for digestion & moisture
=makes amylase for digestion & secrets mucus for lubricate mouth
= enzyme to help break down food chemically
= Anchored in bony sockets & norm/=32 permanent teeth
= mobile muscle covered w/ mucous membranes & taste buds
= helps chewing, forming words, swallowing (moving food for teeth)
= “gums” very vascular mucosa linings & protect teeth
pharynx consists of 3 distinct areas:
=Nasopharynx, Oropharynx, Laryngopharynx
Nasopharynx:
Oropharynx:
Laryngopharynx:
= “filter” (behind nasal)
=”Food processor” (back throat)
= “air & food pathway” (above epiglottis)
Tonsil:
Uvula:
= help separate oropharynx food process/ from nasopharynx.
= “Epiglottis” of nose & mouth @ soft palate hanging in back of mouth
“Coffee grounds” in mouth:
Pink-tinged sputum indicates:
Green/Yellow phlegm suggests: a respiratory infection.
= suggests an upper gastrointestinal (GI) bleed
= acute pulmonary edema
= a respiratory infection.
Midline neck structures:
Neck houses many life-sustaining structures:
= thyroid, trachea, esophagus, & S-column
= SC,Carotid Art/s & Jugular V.s delivering from/to brain, Air passage (lar/x/trac/), food passage (esoph/) into stomach (Major disruption to structures can= rapid deterioration/ death)
Chest bone cage comprises:
Chest’s 3 cavities:
Lungs’ Lobe #s:
Mediastinum contains:
= 3 bones of sternum, 12 pairs of ribs & cartilage, & S-column
= mediastinum, right & left pleural cavity
= 3 R lobes & 2 L lobes to make room for heart
= heart, great vessels (vena cava, aorta, & pulmonic vessels), Trachea, & Esophagus
pectus excavatum:
Pectus carinatum:
=condition where sternum is depressed
= condition where sternum curves outward
Consolidated lung tissue:
Egophony:
Bronchophony:
Whispered pectoriloquy:
= pus/ tumor replaces air-filled lung
= change in voice sound through stethoscope; PT’s “ee” sound is heard as “ay,” suggesting lung consolidation/ pleural effusion.
= PT’s spoken voice sounds louder & clearer than normal when auscultated w/ stethoscope, often indicating lung consolidation
= sign where PT’s whispered voice heard clearly through stethoscope, often indicating lung consolidation.
Newborn vitals :
Infant vitals:
Toddler vitals:
Preschool vitals:
School age vitals:
Adolescent vitals:
= RR 30-60, HR 100-180, SBP 60-90
= RR 30-60, HR 100-180, SBP 87-105
= RR 24-40, HR 80-110, SBP 95-105
= RR 24-34 , HR 80-110 , SBP 95-110
= RR 18-30 , HR 65-100, SBP 97-112
= RR 12-26 , HR 60-90 , SBP 112-128
Tricuspid Valve auscultation site:
Pulmonic Valve auscultation site:
Mitral Valve (Apex) auscultation site:
Aortic Valve auscultation site:
= 4th intercostal space, Left Sternal border.
=2nd intercostal space, Left Sternal border.
= 5th intercostal space, Left Midclavicular line
=2nd intercostal space, Right Sternal border.
Tactile fremitus:
= When the PT speaks, you can feel vibrations on their chest wall.
hyperresonant percussion sound in right chest can indicate:
Dull percussion sound in right chest can indicate:
= Pneumothorax
= Hemothorax
“Lub” (S1) Sound:
“Dub” (S2) Sound:
“Dee” (S3) Sound:
“Dee” (S4) sound:
= Mitral & Tricuspid valve closing (high pitch)
= Aortic & Pulmonic valve closing (high pitch)
= AKA “ventricular gallop”:“dee” of “lub-dub-dee”. Listen @ apex w/ PT lying on their left side
= AKA “arterial gallop” is low-pitched “dee” of “dee-lub-dub” heard in early-mid diastole. Listen @ apex w/ PT lying on their left side
S1 Sounds auscultated @:
S2 Sounds (aortic) auscultated @:
S2 Sounds (Pulmonic) auscultated @:
= 5th ICS at Left Sternal border
= 2nd ICS at Right Sternal border
= 2nd ICS at Left Sternal border
Splitting heart sounds:
= mitral & aortic valves close slightly before the tricuspid & pulmonic valves thus hear two sets of sounds instead of one
Ejection Click heart sound:
Opening Snap heart sound:
Pericardial Friction Rub heart sound:
Murmur heart sound: Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.
= Sound from a stiff or stuck valve.
= Stenotic Bi/tricuspid valve’s leaflets recoiling abruptly after V diastole
= Inflammation >heart’s visceral/parietal surfaces rub each heartbeat
= “Rumbling/vibrating” > turbulent blood through valves, a large artery, or a septal defect
Ascites:
Borborygmi:
Hyperperistalsis:
Normal bowel sounds consist:
More frequent sounds indicate:
Decreased or absent sounds suggest:
= bulges in flanks across abdomen indicating CHF
= loud prolonged “gurgling” (healthy GI) but can= hyperperistalsis
= more bowl sounds> + GI m-nt causing diarrhea/cramps
= Variety high-pitched gurgles & clicks occurring every 5-15 secs
= + GI m-nt possibly indicating diarrhea or early intestinal obstruction
= Paralytic ileus/peritonitis. Listen at least 2mins if abdomen is silent
white, curdlike vaginal discharge w/ no odor/yeasty, sweet odor:
Yellow, green, or gray discharge w/ a foul/fishy odor:
Profuse, yellow penis discharge could sign:
Scant, clear/white penis discharge suggest:
= suggest a fungal infection (candidiasis).
= suggest a bacterial infection (gonorrhea or Gardnerella).
= gonorrhea
= nongonococcal urethritis.
acute epididymitis/ Testicular torsion:
If surgery isn’t provided within how long? test can be lost:
= twisted spermatic cord (torsed testicle usually swollen/tender & rides higher in scrotum.)
= 6 Hrs (same as ABDMN)
Common boner pills:
vardenafil (Levitra), sildenafil (Viagra), and tadalafil (Cialis)
Anal canal length & kept closed by:
Internal ring M. type & controlled by what NS system:
When rectum fills w/ feces what happens:
External sphincter muscle type? & under control of what?
lower half of anal canal:
upper half of anal canal:
= ~2.5-4.0 cm long & kept closed by in/external anorectal sphincters
= has smooth muscle that the autonomic nervous system controls.
= Internal sphincter relaxes, resulting in the urge to defecate.
= Striated Smooth Muscle & voluntary control.
= contains sensory fibers
=is somewhat insensitive b/c less sensory fibers
Hinge Joints:
Ball-and-Socket Joints:
Saddle Joints:
Condyloid Joints:
Gliding Joints:
Pivot Joints:
common causes of a tender joint :
= Allow only flexion & Extension EX:Finger & elbows.
= Allow rotation & wide range of motion EX Shoulder & hip.
= Permit movement in several planes EX Thumb joints.
= Similar to ball & socket joints but don’t allow rotation. EX Wrist.
= Permit sliding movement of 1 bone across another EX Hands & feet.
= Allow a turning motion EX 1st 2 C-vertebrae.
= arthritis, tendonitis, bursitis, or osteomyelitis.
Wrists & Hands:
Radiocarpal Joint:
Carpals & Metacarpals:
MCP Joint (MetaCarpoPhalangeal):
PIP Joint (Proximal InterPhalangeal):
DIP Joint (Distal InterPhalangeal):
M-nts of MCP, PIP,& DIP Joints:
= Phalangies, Metacarpal “Middle”, Carpal
= Radius & Ulna articulate w/ carpal bones @ wrist
= Carpals articulate w/ metacarpals.
= Metacarpals articulate w/ proximal phalanges @ MCP joint.
= Proximal phalanges articulate w/ middle phalanges @ PIP joint.
= Middle phalanges articulate w/ distal phalanges @ DIP joint.
= (Flex/ & extended)MCP joints can abduct (spread)& adduct (together)
Elbow Joint Structures:
Ulna nerve:Between olecranon process & medial epicondyle.
Movements: Hinge joint allowing flexion & extension, Supination (turn palm up) & pronation (turn palm down) of the forearm.
Major Muscles: Flexors: Biceps. Extensors: Triceps.
Forearm Muscles: Supinators: Allow forearm to turn the palm up. Pronators: Allow the forearm to turn the palm down.
= lateral & medial epicondyles, olecranon process of proximal ulna, & proximal radius. Bursa: lies between olecranon process & the skin.
