FSCJ HA exam Flashcards

Terms Definitions
Bradypnea
slow
Tympany
Intensity-loudPitch-highquality-drumlikelocation-stomach intestine
Dull
Intensity-softPitch-hihgQuality-muffled thudLocation-liver,spleen
Visceral
organ
Respiratory Patterns7
TachypneaBradypneaHyperventilationHypoventilationCheyne-stokes respirationBiot's respirationChronic obstructive pulmonary breathing(COPB)
Hyper resonant
Intensity-louderPitch-lowerQuality-boomingLocation-adult lungs increased air (COPD)
endocrine
(up)adrenergic activity
Hypoventilation
irregular shallow pattern
renal
oliguria, urinary retention
Internal anatomy
Outer layerMiddle layerRetina
Vertebrae
C1-7, T1-12, L1-5, S5(fused)
pulmonary
hypoventilation, hypoxia, (down)cough, atelectasis
Costochondral junction
where ribs join cartilage
Adventitious (abnormal) lung sounds
Wheezecracklesrhonchifriction rubstridor
Subjective Data
-cough-SOB-chest pain with breathing-past history of resp infections-smoking history-environmental exposure-self care behaviors-additional ?s for aging adult(fatigue with normal ADLs, sob)
Conjuctiva
thin mucous membrane; transparent protective covering of eyeball and mucous membrane
Equipment
Platform scale with height attachmentSphygmomanometerStethoscope ThermometerFlashlight/PenlightTuning fork/reflex hammerTongue depressorVision screener (index card)Flexible tape measure and rulerSharp object (for pain sensation)Cotton balls (for light touch)
immune
impaired cellular function, impaired cellular healing
central nervous system
fear, anxiety, fatigue
acute pain
-short term-self-timing-follows a predictable trajectory-dissipates after injury heals
Pleurae
Visceral pleura line outside of lungParietal pleura lines outside of chest wall and diaphragm
Outer layer
sclera: fibrous protective white coveringcornea: covers iris and pupil
Normal Breath Sounds
Bronchial (tracheal) breath soundsBronchovesicular breath sounds(mixed sounds)Vesicular breath sounds
4 characteristics of sound
Pitch,quality, loudness, duration
Veslcular breath sounds
-rustling(wind) sound-low pitch,soft amplitude, inspir > expir-best heard (posteriorrly) over perpheral lung field
Inferior angle of scapula(lower tip)
7-8th rib
Resonance
predominant note over healthy adult lung fields;low pitch, clear hollow sound
External ear-fxn
funnels sound waves-External auditory canal: opening into exrernal earCerumen: yellow waxy material; lubes and protects T.M.Tympanic Membrane(eardrum): pearly gray color, seperates external ear from middle
Q
quality/ quantityhow does it feel, look, or sound, and how much of it is there?
abdomen-inspect adn palpate
-contour, symmetry-guarding, organ size
cardiac
tachycardia, (up)BP, (up) cardiac O2 demand, (up)cardiac output
Bronchoveslcular breath sounds
-mixed sounds-mod pitch, mod amplitude, inspir -best heard anteriorly over major bronchi, near sternum in 1st & 2nd ICS-heard pasteriorly: between scapula especially on right
How to Auscultate
Position person sitting, leaning forward slightly, and instruct to breath through mouthConsider background noises vs lung sounds1. stand behind person and start2. Auscultate posterior start from apices (~C7) to bases (T10)3. Auscultate lateral from axilla down to 7-8th rib4. Use zigzag sequence 5. Listen for one full respiration at each site6. Always compare RIGHT side to LEFT
Deep Palpation
best use for abdominal contents(1-2 inches)
Manubriosternal angle
"Angle of Louis"articulation of the manubrium and body of sternumthis is where you start counting ribs-Also, it is the site of tracheal bifurction into R&L bronchi and upper border of atria of heart
EARS-structure 3
1. external ear(auricle or pinna)2. Middle ear (air filled cavity inside temporal bone)3. Inner ear (sensory organs for equilibrium and hearing)
Posterior Thoracic Landmarks
Vertebra prominces-spinous process of C7Spinous processes are knots of vertebrae
Obj data-physical exam of ear
Prep:-positioncleaning ear canalInspect external ear-for position and alignment-for skin condition-patency of external auditory meatusPalpate external ear-for tenderness-palpate auricles and push tragus,palpate mastoid process
Aging Adult changes #1
-costal cartilages calcify-less mobility to thorax-respiratory muscle strength decrease starting-50-decrease in elastic properties within lungs-harder for the lungs to inflate with each respiration-results in small airway closure-so have a decrease vital capacity and increase residual volume
Canthus
corner of eye; angle where lids meet
The Aging Process: Parameters of mental statusGeneral knowledge and vocab?
No change
T
timingwhen did it begin? how often does it occur? is it sudden or gradual? how lond does an episode of the symptom last?
Anterior chest-palpateTactile fremitus
-palpate over lungs apices in supraclavicular area-compare vibrations from one side to other when pt says "99"-avoid palpating over female breast
6-Minute Distance Walk
-Simple measure of functional status in aging adults; mirrors real life conditionsHOW:Locate a flat walk surface; low traffic; comfortable shoes; pulse ox on-Instruct to walk at own pace; cover as much ground as possible in 6 minutes; sit or rest periods okNormal: walking > 300 meters in 6 mins= persons more likely to angage in ADLs
Mechanisms of Respiration4 functions of respiratory system
Supply O2Remove CO2Establish homeostasis/acid-base balancemaintain heat exchange
Thorax and Lungs: surface landmarks
Thoracic Cage-bony, conical shapecontains sternum, 12 pair ribs, 12 thoracic vertebrae, diaphragm
Anterior
apex is 3-4 cm above inner 1/3 clavicles; base rests on diaphragm at 6th rib, midclavicular line
Hearing Loss(obstruction of sound transmission)3 types
1. Conductive:mechanical dysfunction of ex-or mid ear. can hear sound if amplitude is increased. obstruction from foreign body, perforated T.M., impacted cerumen2. Sensorineural-pathology of inner ear,CN VIII. increased amplitude doesnt help;cause presbycuss: cause gradual nerve degeneration(aging)-and or ototoxic Rx which destroy hair cells in cochlea3. Equilibrium: inner ear labyrinth signals brain about bodys position. inflammation sends wrong info=vertigo: staggering gait and a strong,spinning, whirling sensation
Palpate entire chest wall
for tenderness, temp,moisture, lumps, masses
Posterior Chest-InspectAnteroposterior
transverse diameter: 1:2 to 5:7If A-P diameter=transverse diameter > barrel chest
pain assessment tools
-initial pain assessment -brief pain inventory-short-form mcgill pain questionnaire-pain rating scales-descriptor scales
Standard Precautions: use with all
-Wash Hands:after touching body fluids, whether or not wearing gloves-Wash Hands: after removing gloves-Wash Hands: between each patient-Wear Gloves: when touching body fluids-Changes gloves between tasks-Remove gloves promptly after each use and before touching non contaminated objects-Wear mask and eye protection if expecting "splashes"
Tactile (or vocal) fremitus
-a palpable vibrationUse palmer base of fingers or ulnar side of handStart over lung apices and palpate from one side to otherHave person say 99 or blue moonAssess for bilateral symmetry of vibrations felt
Middle layer(choroid layer)
Iris varies opening by adjusting pupil size; contract in bright light and accomodate for near vision; dilate pupil when light is dim and for far visionPupil i sround and regular
Broncial(tracheal) breath sounds
-harsh hollow sound -high pitch, low amplitude, inspir =expir,-best heard(anteriorly):over trachea and larynx
Vital capacity
the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum
Cheyne stokes respiration
cycle of wax(increased rate and depth) and wane
Residual volume
the amount of air remaining in the lungs even after the most forceful respiration
What controls respiration
the normal stimulus to breath is an increase of carbon dioxide in the blood
How to Percuss
the art of striking one object against another to create soundNon-dominant hand-middle finger placed firmly on area to be percussed,fingers seperated Striker hand: makes a striking force;sharp downward wrist motion; tip of middle finger strikes joint of middle finger on non dominant hand
Fit and quality of stethoscope
earpiece slope points forward toward your nose
Response time decreases?
Takes longer for brain to process info and react to it
physical exam of earTest hearing acuity
Whisper voice whisper test-CN VIIIHow: one finger on tragus1-2 ft from persons occluded earexhale and whisper a 2 syllabus word(tuesday, armchair, baseball, fourteen)Normal: person should repeat word correctly
Additional subjective data (eye) for aging adult
-? vision difficulty climbing stairs or night driving-? last vision test for glaucoma, pain around eyes, loss of peripheral vision-? history of cataracts; loss or progressive blurring-? Do eyes feel dry or burning; decreased tear production, decreased elasticity-? Decrease`in usual activitiesex. reading, sewingcentral vision acuity lost w/ macular degeneration
chronic pain behaviors( higher risk for undetection)
more variability since person cannot live in constant state of grimacing, diaphoresis, guardingBehaviors: bracing, rubbing, diminished activity, sighing, appetite changes, sleeping to self-ditract
Note: position of person needed when breathing
Tripod position if COPD give leverage to aid in expirationNote skin color and conditionFor example: blue=cyanotic
the aging adult and pain
- a common experience among 65 yrs and older-but not normal process of aging-pain=pathology or injury; never something to tolerate or accept just because "aged"
Pleura
lung
Resonant
Intensity-med-loudPitch-lowQuality-hollowLocation-normal lung
orthopnea
hemoptysis
Tachypnea
shallow>24/min
Flat
Intensity-very softPitch-highQuality-dead stopLocation-thigh,bones,tumor
Structure-Thoracic cavity
Mediastinum
Thoracic configurations:
barrel chestkyphosislordosis
subj data-ears
-earache-infections-discharge-hearing loss-environmental noise-tinnitus(ringing,crackling,buzzing)-vertigo-self care behaviors
muscle/skin-inspect
-color, swelling-masses, deformity-sensation changes
Anterior thoracic landmarks
Suprasternal notchSternumManubriosternal angle
Posterior
C7=apex of lung tissue-and-T10=base
Hyperventilation
rate and depth increased
Hypercapnia=?
increase CO2 in blood
Light Palpation
detect surface characteristics;accustom patient to being touched (~1/2 inch deep)
Setting
Eliminate confusing artifactsex-noisy room,hairy chest>carackles; your breathing on tubingNever listen thru a gown/clothingExam Room-warm, comfortable, quiet, private, well lit, no distractions/noisesExam table-Position so both sides of patient are easily accessible
Respiratory starts in your?
nose
Palpation
Purpose-use of touchDetermines texture, size, consistency, and location of body parts
Crackles(rales)
crackling sound;at end of Inspiration;resulting from collapsed or waterlogged alveoli
Biot's respiration
Cheyne stokes but irregular
Wheeze
musical whistling soundExpira > Inspirafrom narrowed airways(resulting from bronchoconstriction or secretion)
Hypoxemia
decrease of oxygen in blood
Kyphosis
outward curvature of thoracic spine
Objective Data
Prep:-Position and draping-timing during a complete exam-start in back-cleaning stethoscope end pieceEquipment needed:-stethoscope-small ruler marked in cm-alcohol wipe(clean stethoscope)
Crepitus
coarse crackling sensation palpable over skin surface(when air escapes from lung and enters SQ tissue)
Lung borders
Anterior, lateral, and posterior
COPB
normal inspiration and prolonged expiration
Ausculation
Purpose-listening to sounds produced by the body using a stethoscope
Middle ear fxn
-contains auditory ossicles:malleus,incus, and shape-Eustachian tube-connects mid ear to nasopharnyx:allows air passage during swallowing and yawning
Types of Palpation
Light and Deep
socio-psychological responses
depression, confusion, isolation, family distress, diminished QOL
musculoskeletal
spasm, joint stiffness, limited function and limited mobility
joints-inspect
size, contour, circumferenceAROM AND PROM
Pleural cavity
a vaccumm; negative pressure(hold lungs tight against chest wall); filled with few ml of lube fluid (so during respiration, lungs slide up and down noiselessly)
Posterior Chest-Auscultate
breath sounds:characteric noises heard through chest wall as air passes through tracheo-bronchial tree
Objective date continued...eye
7. Test for PERRLAPupils,Equal,Round,Reactto Light,Accomodate
acute pain behaviors
guarding, grimacing, moaning, agitation, restlessness, stillness, diaphoresis or change in vital signs
cutaneous
superficial, sharp, burning skin and subcutaneous tissue
S
severity scaledoes it interfere with ADLs? how does it rate on severity scal of 1 to 10?
Atelectasis
partial or total collapse of lung usually from a bronchus obstruction of bronchus ventilating a segment of lung tissue
Anterior Chest-Percuss
Begin in apices of supraclavicular areaPercuss in intercostal spaces, comparing side to sideExpected Percussion notes:-resonance in supraclavicular areas and RUL,RML,LUL-Flat, over muscle or bone-Dull over heart(L) and liver(R) and female breast-Tympany-over stomach
How to Palpate
Fingertips-use for fine tactile discriminationFinger-Thumb Opposition-use for position,shape, consistency of an organ/massDorsa of hands/fingers-use for tempMetacarpophalangeal joints or ulnar side of hand-use for vibration
Lacrimal apparatus
constant irrigation to conjuctiva and cornea
Aging adult changes #2
-Vital capacity-Residual volume-#of alveoli decrease so less surface area for gas exchnge-lung bases becomes less ventilated since closing a number of airways so therefore an increase risk of dyspnea with exertion beyond person's usual workloadAlso older persons risk of postoperative complications increase especially atelectasis and infection from decreased ability to cough, loss of protective airway secretions, and increased secretions
Aging Adult
1. Chest configuration change from increased A-P diameter (round barrel shape) Kyphosis(outward curvature of thoracic spine)2. Bony prominence of thoracic cage from decreased SQ fat3. Chest expansion decreased (but should be symmetrical)4. Fatigues easily with deep mouth breathing (during auscultation) avoid hyperventilation
Lateral
from apex of axilla to 7-8th rib
Hearing Loss-aging adult
ear canal-course and thickcerumen drier-appocrine gland atrophyimpacted cerumen-common but reversible hearing losshistory of frequent infections >eardrum scarringex. people that listen to incredibly loud music/sounds, rock bands
Physical Assessment, continued....
-Examination sequencemay write out exam sequence and refer to it as you proceed-Brief health teachingdo this as you proceed through the exam-When findings are complicatedmay want to linger longer to concentrate on some finding"Just because i'm lingering a long time doesnt mean that anything is wrong with u"-Summarize findings for person
R
region/ radiationwhere is it? does it spread?
deep somatic
from pressure, trauma, ischemia to blood vessel, joints, tendons, muscles, bone
Friction Rub
creaking leathery sound; end of Inspir and begin of Expir;resulting from rubbing of inflamed pleural surfaces
Anterior Chest-palpate for tenderness, lumps, masses
-Symmetric chest expansionHow:Place hands on anterolateral wall with thuimbs along costal margin and pointint toward xiphoid processHave pt. take deep breathWatch thumbs move apart symmetrically and note smooth expansion of chest with your fingers
Inner ear fxn
-Contains bony labyrinth: inside is vestibule and semicircular canals, and cochlea(central hearing apparatus)looks like snail
Objective data(eye)Physical exam
1. Test central vision acuity(snellen eye chart) and near vision (handheld vision screener)Note: hesitancy, squinting, leaning forward, misleading letters2. Test visual fields-Confrontation test-gross measure of peripheral vision-CNII-compare pt.'s peripheral vision to examiner(assuring its normal)HOW: Cover pt.'s eye and opposite eye of examiner2 ft away using pencil or fingerslowly advance it in from peripheryask person to say "now" when sees it
objective data continued eye
5. Inspect external ocular structureseyebrows, eyelids, lashes, eyeballs,(moist and glossy6. Inspect anterior eyeball structuresConjuctiva-normal: clean and pink over lower lid and white over the scleraSclera-normal: china white; gray blue or muddy in dark skinnedCornea-normal: smooth,clear, and no irregulationIris-normal: flat w/ round regular shapePupils-normal: round,regular, equal sizeAbnormal: anisocoria: unequal size pupils, 5% people
Posterior structure of lobes
contains almost all lower lobe
Refernce Lines
used to pinpoint a finding vertically on chestFor example: on anterior chest
Posterior Chest-Percuss
to assess predominant note over lungs fields
Hyper resonance
when too much air is present;Ex. emphysema or pneumothorax or child: low pitched, booming sounds
Paraoxysmal nocturnal dyspnea
cant breathe when they lay down
chronic pain
-continues for 6 months or longer-does not stop when injury heals-types are malignant(cancer-related) and nonmalignant
gender differences and pain
-influenced by societal expectations, hormones, & genetic make-up-stereotypes: men are most stoic; women are more emotional-genetic differences
Eustachian TubeInstillation of ear drops in Adult and child >3?Instillation of ear drop in child
adult-pull pinna up and outchild
Equipment and a safe environment
-CLEAN GLOVES-clean the equipment -clean vs used area for handling equipment-Nosocomial infections-wash hands-standard precautions-transmission based precautions
Your approach to doing a Phys Assesment
Consider:-Patient's emotional state-Examiner's emotional stateHands on: where to start-Measure Ht/Wt and vital signsfamiliar, non threatening actions-Begin with person's handsskin color, nailbeds, metacarpophalangeal joints-Concentration on one step at a timestepsmay differ with age of patientOrganize your step so patient doesnt have to change positions too often
Symmetric expansion
warm hands with thumbs at T9 or T10slide hand medially to pinchhave person breathOn inhalation, thumbs should move apart ymmetrically
Lobes of the Lungs
paired but not symmetricalRight is shorter than left (liver)Left is narrower than right (heart bulges left)Right has 3 lobesLeft has 2 lobes stacked on the diagonal
Trachae and bronchial tree
Trachea: lies anterior to esophagus; is 10-11cm(adult); extends from cricoid cartilage to Angle of LouisBronchi-transport gases b/w environs and lungs
During respiration, chest size changesInspiration?Expiration
Inspiration- vertical(top to bottom) diameter lenghtens with downward movement of diaphragm: so, anterior-posterior diameter increasesExpiration-vertical diameter shortens with upward movement if diaphragm; so Anterior to posterior diameter decreases
Tip of 12th rib
Midway between spine and persons side
referred
felt at the site but originates at a different location; both are innervated by same spinal nerve
Forced expiratory time
Number of second to exhale from total lung capacity to residual volume. Measures air flow obstructionHOW:Take a deep breath;blow it all out hard with open mouth; Listen over sternum; normal time for full expiration is 4 secs of less
HearingAuditory system has 3 levels
1. Peripheral-ears transmit sounds and convert vibrations into electrical impulsesOrgan of Corti-receptor hair cell fibers2. Brainstem: locates direction of the sound in space3. Cerebral cortex: interprets meaning of the sound ex. stroke pt.s-cant interpret the meaning of the soundThe normal pathway of hearing is: air conductionLess efficient is bone conduction
pain reactions influenced by:
nature of pain( acute or chronic), age, cultural, and gender expectations
Visual Reflexes:1. Pupillary light reflex2. Fixation3. Accomodation
1. normal consriction of pupils when bright light shines on retina: no conscious control of itA. Direct light reflex: when bright light exposed to one eyeB. Consensual light reflex: simultaneous constriction of other pupil2. a reflex directing eye towards an object attracting that persons attention: impaired by drugs,alcohol, fatigue3. Convergence of the axes of the eyeballs with constriction of the pupils; adapts eyes for near vision
Lateral structure of lobes
extends from apex of axilla to 7-8th rib
Anterior structure of lobes
apex of lung is 3-4cm above inner third of clavicle
Most common causes of decreased visual functioning
1. Cataract formation or lens opacity(~46% of 75-85 yr olds)2. Glaucoma-increased intraocular pressure(~7% 75-85;M>F)3. Macular degeneration-or loss of central vision=blindness(28% 75-86yr)
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