N174 Physical Assessment Objectives

Bruits

narrowing of the artery due to hyper-coagulation that block arteries

Abnormal Breathing Patterns

- Dyspnea- Shortness of Breath - Tachypnea (rapid, shallow breathing) - Bradypnea (slow, regular respirations) - Hyperventilation (rapid, deep respirations) - Hypoventilation (irregular, shallow respirations) - Cheyne-Stokes (periods of deep breathing alternating with periods of apnea)

Assessment of Emesis (vomit)

- Green bile stained: intestinal obstruction - Blood in vomit- hematemsis or coffee ground emesis: peptic ulcer, GI bleeding, coagulopathy - Projectile: infection GI, CNS, pyloric stenosis (A condition in which the opening between the stomach and small intestine thickens) - vomiting after paroxysmal coughing: pertussis (whooping cough)

Describe common techniques used to assess the mental status.

- History Interview: any headaches, head injury, syncope (faint), dizziness, vertigo (rotational spinning), seizures, tremors, paresthesia (burning/numbness/tingling), dysphagia (difficulty swallowing), dysphasia (difficulty speaking), environmental/ occupational hazards. - Nuchal rigidity: chin to chest, tight system of the neuro, the have too much pressure because of inflammation of the meninges and CSF - Kernigs: moving the leg towards the stomach - Brudzinski: fanning of the toes **Techniques - Inspection - Palpation

Diastolic and Systolic

A diastolic (di"as-TOL'ik) murmur occurs when the heart muscle relaxes between beats. A systolic (sis-TOL'ik) murmur occurs when the heart muscle contracts. Systolic murmurs are graded by intensity (loudness) from one to six. A grade 1/6 is very faint, heard only with a special effort. A grade 6/6 is extremely loud. It's heard with a stethoscope slightly removed from the chest. EXTRA SOUNDS: S3 and/or S4 Extra heart sounds: snaps, clicks, friction rubs or murmurs (grade 1=very faint, grade 6=very loud); murmurs are only problems when you have symptoms of a cardiac problem.

Discuss normal findings and the significance of abnormal findings

- normal is abdomen flat, - rounded can be normal for babies and pregnant women, - scaphoid is concaved abd which is common for those with muscle and orbital wasting and anorexia - protuberant is just stomach rounded even greater than normal which is common for the people with diabetes, and edema in the organs. - A disease related to those with protuberant is Ascites (which can be accompanied by asymmetry, yellow skin, umbilical cord pushing out) - when thinking of bloating in the stomach you say "abdomen distended" -EX. Hepatomegaly: enlarged abdomen with extremities cachectic due to enlarged liver and maybe other organs. - ASYMMETRY: related to tumors, cysts, bowel obstruction, enlargement of organ, scoliosis, masses, lesions, hernias - Inguinal Hernia: when the abdominal muscle layer is weakened and some organ (intestines usually) poke a hole through the peritoneal cavity and cuts off blood circulation by strangling the arteries/veins.

*What is the first acute sign of a changing neuro status?

*CHANGE IN LEVEL OF CONSCIOUSNESS!!! Acting differently, inability to concentrate, can't make out words, personality changes, it's an emergency situation. One of the most important assessments to make.

Describe anatomy and physiology of muscles, joints, bones

*Fibrous Joints: Bones joined by fibrous tissue (bones of the skull) *Cartilaginous Joints: Bones joined cartilage such as vertebrae *Synovial Joints: Joints that have a lot of movement and are filled with fluid. (knees, elbows, shoulders etc.

Describe the functions of the brainstem, the cerebellum, and 12 pair of cranial nerves.

- *Cerebellum- Keeps person oriented in space, balance. Does not initiate movement but coordinates it, helps you keep space, and not damage yourselves in other objects Assessment: finger to nose test -* Brain stem: - Midbrain- contains many neurons and tracts - Pons - Controls rhythmicity of respiration, contains motor and sensory pathways. - Medulla - Cardiac, respiratory, vasomotor control. Swallow, gag and cough reflex. Motor and sensory fibers cross here. - Spinal Cord - continues with the brain stem **You don't want any infarctions here, or any types of traumas - PERRLA: pupils, equal, round, reactive to light and accommodation - C1, Olfactory: smell - C2, Occipital: vision, PERRLA - C3, Occulomotor: EOM, PERRLA - C4, Trochlear: EOM up and down - C5, Trigeminal: chewing, facial and mouth sensation, corneal reflex - C6, Abducens: EOM laterally - C7, Facial: facial expression, taste, corneal reflex, eyelid and lip closure - C8, Acoustic: hearing, equilibrium - C9, Glossopharyngeal: gag reflex, swallowing, taste - C10, Vagus: gag reflex and swallowing, speech - C11, Accessory: shoulder movement, head rotation - C12, Hypoglossal: tongue movement, speech

Pertinent History for Respiratory tract

- Any chronic conditions Asthma, COPD, CHF, DM - Exposure to new medication ACE-Inhibitor- cough, if have a cough change to an "arb". - Recent change in diet Peanuts, Strawberries - Substance abuse/Overdose hx Opioid abuse-decrease RR, drops below 12 breaths/min ASA toxicity-increased RR, too much acid so the RR increase to blow away the acid. - **Prior Deep vein thrombosis (DVT): clot forms where blood can pool and stagnate, or pulmonary embolism(PE): clot stops circulation - Recent trauma to chest: commonly happens in car accidents like hitting the steering wheel or airbag deployment. MORE AT RISK Shortness of breath= dismya, short of breath laying flat (fluid in the lungs= pulmonary edema), orthopnea (when the fluid in the lungs are pushed down when the patient sits up the gravity pushes fluid down and patient won't have trouble breathing again). ACE inhibitor medications end in "ils"= lisinopril, etc Cough= ask for how long and if it is wet or dry (productive or not productive), if wet (productive) you'd ask what color is the sputum, At risks with TB: prison systems, military, schools, medical residents, etc.

Respiratory Tract Healthy People 2020 Focused Areas

- Asthma - Chronic obstructive pulmonary disease - Chronic sleep apnea - Tobacco use

distinguish landmarks to guide assessment of the respiratory tract

- Bony structures - Horizontal and vertical lines - Division of the thorax -Lungs start above the clavicle (pleural apices) - The inter costal spaces are where you would listen to the breath sounds - use the clavicle midline to know where you'd check for the apical location. use the jugular notch at the top of the sternum to count down how many ribs down for the location where you want to hear the breath sounds on anterior view, for posterior you use the spinous process and the scapula.

To learn how some common abdominal conditions are diagnosed using physical examination.

- Hypoactive, hyperactive, and absent bowel sounds are all abnormal: that means things aren't passing through your GI tract properly (too fast, too slow, or not at all) - HYPOACTIVE: inflammation, non-mechanical (just happened, no external cause) obstruction, operative manipulation of bowel, peritonitis, can be considered a normal finding when discovered after surgery and the anesthesia is still active. -HYPERACTIVE:gastroenteritis, diarrhea, hunger, powerful peristaltic action -ABSENT: after 5 minutes, common in post op patients, paralytic ileus (paralysis from the nerves), obstructions - Patients with scarring on abdomen are more likely for injuries to the abdomen because that area is already replaced with scar tissue, so will not be functioning or protecting the body as best it could be. - Rebound tenderness: pain when palpation pressure is released quickly, suggests peritoneal irritation makes us think appendicitis - Pain during this maneuver indicates irritation of psoas muscle->appendicitis - Sharp abdominal pain while palpating the liver during inspiration- halts the examination think of cholecystitis (inflammation of the gallbladder, a small, digestive organ beneath the liver.) - Enlarged liver could be: CHF (congestive heart failure), Hepatitis (inflammation of the liver), Cirrhosis (Chronic liver damage from a variety of causes leading to scarring and liver failure), Cyst (noncancerous and have a sac-like structure that can contain fluid, pus, or gas), CA (carotid artery, leading to lack of oxygen, blood, fluids/ nutrients to the brain) -Feeling a mass in the epigastric area suggests gastric outlet obstruction or abdominal aortic aneurysm -aneurysm: blood pooling in between arteries lining - Positive CVA (costoveterbral angle) tenderness: concerned about pyelonephritis, inflammation of the kidneys

Describe techniques of assessment included on the Lab Check List

- INSPECT- swelling/deformity/shortening of limb - PALPATE/FEEL for tenderness and crepitus with movement and temperature. Range of Motion- Passive (someone else is doing the movement) and Active (the patient is actually doing it) Muscle-Strength Testing, 0-5 scale Neurovascular exam Color, temp, CRT (cap refill time), pulses, edema, sensation, motor function, nerve involvement - Assess for stiffness, instability, pain, crepitus, unusual joint movement, bogginess (the feeling of swollen, filled with fluid), warmth - Assess ROM- PASSIVE AND ACTIVE ROM - Muscle strength - Assess symmetry *Parathesia: tingling, numbness *Pain *Pallor- capillary refill time < 3 seconds *Paralysis *Pulses- distal to injured extremity

Understand the components of health history and documentation

- Identifying data/ biographic data - Chief Complaint (CC):complaint, symptom, length of duration - History of Present Illness (HPI): OLDCART & ICE, & PQRST - Past Medical History (PMHx) - Social History (SHx) - Family History (FMx): CA, CVA, DM, HTN, CAD - Psychosocial History - Review of Body Systems: General, Derm/Hair/Nails, HEENT, Respiratory, Cardiovascular/ Peripheral Vascular, GI, Reproductive/OB, Musculoskeletal, Neurological, Psychiatric Onset, Location, Duration, Characteristics, Aggravation, Relieving, Treatment... Impact of ADLs, Coping strategies, Emotional response... Provokes, Quality/Quantity, Radiation/ Region, Severity, Timing, Understanding

Identify the parameters necessary to obtain a Glasgow Coma Scale and be able to interpret the results.

- Level of Consciousness (LOC): alert, somnolent, stuporous, comatose. - Orientation: person, place, time = A&O x 3. - Glasgow Coma Scale: level of consciousness and predictive of future comatose status: eye response, verbal response, motor response.

Medical Dx that require Neuro Assessment

- Meningitits - CVA - Epilepsy/Seizures - Traumatic Brain Injury - Medications/ETOH - Spinal Cord Injuries - Guillaine-Barre - Parkinsons - Multiple Sclerosis - Myasthenia Gravis - Malignancies - Hemorrhage/ SAH, epidural, - Any change in LOC

Define key terms related to neurologic assessment.

- Mental Status: AAO, AO, disoriented, general inspection - Cranial Nerves: 1-12 - Motor- cover more in musculoskeletal - Coordination: cerebellum controlled - Sensation: sharp vs dull, hot vs cold- important for safety reasons - Reflexes - Gait: way you walk, ataxia= abnormal gait

Describe variations in techniques and findings

- Normocephalic, head midline, skull and facial structures intact and symmetric, skin intact, facial movements symmetric and smooth, no tenderness with palpation to scalp and neck, palpable temporal arteries, TMJ full ROM with no palpable tenderness or crepitus, neck full ROM, trachea midline, no facial or neck lymphadenopathy - Hair - medium brown, curly, fine texture, with receding frontal hairline. Skull and facial features symmetric. Smiles, frowns, shows teeth, puffs cheeks, wrinkles forehead and closes eyelids tightly (CN VII intact). Full ROM of TMJ, no palpable crepitus. No sinus tenderness with palpation/percussion. Two bilateral submandibular 1 cm lymph nodes, firm, mobile, non-tender. No other noted lymphadenopathy. Trachea midline. Full ROM of neck.

Significance of Sputum Assessment

- Purulent Thick, yellow/green: Bacteria -Thin, mucous: Viral - Pink-tinged:Lung CA, TB - Pink tinged, profuse, frothy: Pulmonary edema - Malodorous: Lung abscess

Discuss related Healthy People 2020 objectives

- Reduce sports and recreational injuries. - Reduce deaths caused by motor vehicle crashes. - Increase the use of safety belts. - Increase the use of helmets by cyclists. - Reduce deaths by falls.

*Acute Compartment Syndrome

- Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area - Can be from external source like a cast, - Prevention of pressure buildup of blood or fluid accumulation - Pathophysiologic changes sometimes referred to as ischemia-edema cycle - Within 4 to 6 hr after the onset of acute compartment syndrome, neuromuscular damage is irreversible; the limb can become useless within 24 to 48 hr. - Onset, of some section that has 6+ s/s

Basic Nursing management of Resp. Distress

- Sit people upright when in respiratory distress - High Fowlers: 60-90 degree - Apply oxygen - NPO until stable - Encourage bed rest and energy conservation until stable

Common types of Medications involving Cardiac Diseases

-Beta Blockers (-olol) -ACE Inhibitors (-ils) -Calcium Channel Blockers -Diuretics -Platelet Aggregation Inhibitors -Anticoagulants -Antidysrthymics -Cardiac Glycosides -Potassium Supplements -Nitrates -Antilipids

Describe the functional anatomy of the nervous system. .

-Cerebrum: largest part of the brain, contains 2 hemispheres, 4 lobes, - Frontal Lobe- Conceptualization, motor ability and judgment, thought process, emotions. - Parietal Lobe- Interpretation of sensory information, ability to recognize body parts. - Temporal Lobe- memory storage, integration of auditory stimuli. - Occipital Lobe - Visual Center.

Familiarize oneself with the basic techniques when performing the physical exam

-Inspection: color, size, shape, symmetry, contour, movement, drainage -Palpation: touch, too-painful, too-little pressure, size, shape, mobility, location, position - Percussion: audible sound, determine size, shape of vibration, temperature, texture, organs filled with excess air or fluids, moisture, edema - Auscultation: listen to sounds produced by the body, the body/ intensity/ pitch/ duration/ quality Documentation: flow sheets, narrative sheets/ nursing notes, electronic health records

Best areas to assess facial symmetry

-nasolabial fold (mouth area) - palpebral fissure (eyes area from lid to bottom lashes - lateral canthus to pinna are equal

Aspiration Pneumonia

Abscess is a pocket of liquid on the skin, the tissue in the abscess is actually atypical, decreases blood flow causing tissue necrosis, increase the fluids. Aspiration precautions are interventions to reduce the risk of aspiration of food, liquids, and/or secretions during the swallowing process - feed small amounts of food, seat patient fully upright, do not force feed, do oral hygiene before and after meals, crush pills and put in soft foods.

Explain common physical assessment procedures used to evaluate tissue integrity of patients across the lifespan.

As the skin ages, the epidermis thins and stretches, and collagen and elastin fibers decrease, causing decreased skin elasticity and increased skin wrinkling. A variety of lesions are common and some are normal changes of aging.

Identify and list the 5 steps of the Nursing Process

Assessment: gathering data, subjective and objective, first interview. Diagnosis: identify problem, nursing diagnosis. Planning/Outcomes: create goals, objective. goals, general goals. Implementation: carry out the plan. Evaluation: gather data to see if goals are achieved, make sure the implementation os pt care is working, if not repeat steps.

Explain the process for assessment of tissue integrity.

Inspect and palpate • Shape and contour • Profile sign-note the angle of the nail base; it should be about 160 degrees • Consistency- The surface is smooth and regular not brittle or splitting. • Color- the translucent nail plate is a window to the even pink nail bed underneath

What questions would I ask the patient when completing the focused interview?

CC (cardiac related): chest pain, dyspnea, ankle swelling, palpitations, syncope, dizziness, fatigue, claudications, arm pain/back pain/ upper abdominal pain HIP/ROS: take note of Aggravating Factors, if pain only happens with breathing think about a pulmonary or musculoskeletal problem, if hurt with physical exertion think angina, true cardia chest pain hurts regardless of position or breathing. - Do you experience dyspnea? (ask With exertion? At rest? With anxiety? HOW MANY PILLOWS DO YOU SLEEP ON?- ORTHOPNEA*** Where do you sleep? Pain?) - Do you have ankle swelling? (ask Both ankles? one ankle = probably DVT; both = heart failure Worse in the evening? (congestive heart failure) Pitting or non-pitting? (depression, sign of edema) non pitting = lymphedema , immune response, happens unilaterally, when you remove a lymph system (lymphsectomy), means you cannot check vitals with that side Does the swelling go away with elevation or not?) - Do you have Palpitations? (ask Exactly what do you feel? (heart racing, thumping etc) When occur? After coffee/stress? Duration- how long for? Regular beat? Skipped beats? (irregular = Atrial Fib) Followed by fainting attack? -ventricular tachycardia Relieved by cough or cold water? -Supraventricular tachycardia) - Have you experienced Syncope (fainting) or dizziness? (ask Activity at time of onset? Emotional distress? Micturition (peeing), Postural (position) -WITH or WITHOUT WARNING? - If still dizzy when lying down and aggravated by head movements the dizziness is NEUROLOGICAL) - Do you experience Claudication (poor arterial blood flow)? (ask about Exertional pain @ ANKLE, CALF, BUTTOCK SMOKER? How far can you walk? Lets take a walk Numbness, Tingling, Pain) - Do you feel fatigue? (How long have you been fatigued /easily fatigued? How far can you walk? Worse in the morning/afternoon/night time? Sleeping patterns) - Have you had a fever? (think Bacterial infections: Infective endocarditis!!, valve carditis, Risk factors: IV drug users)

Define health assessment and list the three parts

Definition: systematic method of collecting data, organized in a specific order to follow each time so you don't miss steps: employs objective and subjective data, organize data, analyze data, interpret findings, utilize critical thinking to evaluate the data. Three Parts: - Interview: health history - Physical Assessment: observed and measured - Documentation: if not documented you did no do it according to law/everywhere.

Identify priority tissue integrity assessment findings.

Evolving changes include changes in size, shape, symptoms (itching, tenderness), surface (bleeding), and shades of color. Malignant melanoma- The least common but most serious type of skin cancer, because it spreads rapidly to lymph and blood vessels. Lesion contains areas of varied pigmentation and may be black, brown, blue, or red, often with irregular edges with notched borders

Describe and list factors that affect tissue integrity.

Factors that affect skin: - Protection from microogranisms, protects underlying tissue from physical/chemical - Perception- Senses - Temperature regulation- Sweat glands - Identification- finger prints/ emotions (flushing when nervous) - Absorption- Transdermal medications - Production of vitamin D- with uv light

Abnormal findings in Respiratory tract

INSPECTION -- Chest rise asymmetric barrel chest 1:1 AP:T, Respiratory rate uneven, has signs of respiratory distress, Breathing labored, irregular breathing, Does use accessory muscles, has nasal flaring, there are visible lesions or scarring on thorax Skin integrity is not intact PALPATION - there is pain or tenderness w/ lesions or masses upon palpation, tactile fremetius not present PERCUSSION -Upon percussion of the thorax or lungs hyperresonance (COPD), Hyper-resonance Too much air Emphysema Flatness / dull Fluid or solid/bone Pleural effusion Pneumonia Tumor AUSCULTATION - Crackles (Rhales): Discontinuous, intermittent, nonmusical, brief sounds Classified as fine or coarse Crackles caused by air moving through secretions and collapsed alveoli Associated conditions pulmonary edema, early CHF, PNA **** - Wheeze: Continuous, high pitched, musical sound, hissing quality, longer than crackles Usually heard more on expiration can be heard on inspiration Produced when air flows through narrowed airways, decreased diameter of airway due to mucus or bronchoconstriction, spasms Associated conditions asthma, COPD - Rhonchi: Low pitched, snoring quality, continuous sounds Implies obstruction of larger airways by secretions Associated condition acute bronchitis - Stridor: Inspiratory musical wheeze Loudest over trachea Suggests obstructed trachea or larynx Medical emergency requiring immediate attention******Get HELP! Associated condition inhaled foreign body, croup

Normal findings in Respiratory tract

INSPECTION: - Chest rise symmetrical 2:1 AP:T, Respiratory rate even, No signs of reSpiratory distress, Breathing not labored, regular breathing, do not use accessory muscles, No nasal flaring, No visible lesions or scarring on thorax, Skin integrity is intact PALPATION - Upon palpation of anterior and posterior thorax, no palpable pain, tenderness, or lesions, Thoracic expansion symmetric, smooth and even, tactile fremitus present PERCUSSION -Upon percussion of the thorax or lungs resonance through out. AUSCULTATION - Breath sounds clear bilaterally in anterior posterior and right middle lobe , no audible wheezing, or adventitious sounds

Describe techniques required for assessment of the cardiovascular system.

Inspection of the Precordium: Scars Pectus excavatum/carinatum Kypho/Scoliosis Visualize APEX BEAT (5th intercostal, 1cm left of midclavicular line Below Nipple usually, Visualization to assess ventricular size/thickness Supine position is best!), Palpation of Precordium: THRILL- palpation of a murmur or VSD (feels like when you're gardening and holding the hose that sensation of water flow) LIFT/HEAVE- apical impulse is more vigorous and Palpate the PMI to see if there is displacement due to cardiomegaly=enlarged heart, Auscultation: Carotid arteries and the Heart: -Right middle sternal border/2RICS (aortic) -Left middle sternal border/2LICS (pulmonic) -Left lower sternal border/3LICS (Eerb's point) -Left lower sternal border/4LICS (tricuspid) -Apex- 5th LICS (mitral)

Describe variation in techniques required for abdominal assessment

Inspection: abdomen is: flat? symmetric? hernias? lesions? masses? skin intact? distention? Auscultation: bowel sounds in all four quadrants? no bruits in abdominal aorta or renal arteries? Percussion: tymapany throughout? no pain or tenderness aka negative CVA? Palpation: no palpable masses, lesions, hernias, no distention, tenderness, pain? femoral arteries present +2 bilaterally? no rebound tenderness? edge of liver palpable? negative sign of Murphy's and Psoas?

What are the Abnormal Findings of the physical assessment of the cardiovascular system?

Inspection: motion not present or bounding (like heart jumping out of chest) there is jugular vein distention at 30 degrees from HOB. Palpation: there are lifts/heaves/ thrills, the various pulses checked are thready or bounding, or asymmetrical, capillary refills are longer than 3 seconds Auscultation: there are murmurs, rubs, or gallops, there are bruits in the carotids,

What are the Normal Findings of the physical assessment of the cardiovascular system?

Inspection: motion present upon inspection of the Precordium. HOB at 30 degrees no visible JVD. Palpation: no palpable lifts, heaves, or thrills, PMI palpable in the mid-clavicular 5th intercostal spacing.Upon palpation of ___ pulse, pulse is present +2 bilaterally *Carotid: just medial to and below angle of jaw *Brachial: just medial to biceps tendon Femoral: inferior and medial to inguinal ligament Popliteal: pop fossae (pt should be prone w/knee flexed) *Dorsalis pedis: Lateral to the extensor tendon of the great toe *Posterior tibial: behind and slightly inferior to medial malleolus - "capillary refill time is less than 3 seconds" Auscultation: S1, S2 auscultated, no murmurs, rubs, or gallops. "no audible bruits upon auscultation of carotids"

What are the landmarks that guide assessment of the cardiovascular system?

Jugular notch to know where the 2nd rib begins so i can find the 2nd intercostal spacing, clavicle used to find the PMI/Mitral valve/ Apical pulse in the 5th intercostal mid-clavicular, sternum

Identify the anatomy of the cardiovascular system

Jugular notch, clavicle, sternum (manubrium, angle of Louis, Body, Xiphisternal joint, Xiphoid process), intercostal spacing (specifically 2nd on the right, 3rd, 4th, 5th on the left). Endocardium:The thin inner layer that covers the inside surfaces of your heart's four chambers, valves and muscles. Myocardium: The thick middle layer of the heart muscle. It's the workhorse, responsible for most of the heart's pumping action. *** largest muscle. Epicardium: The thin, glossy membrane that covers the outer surface of the heart. Pericardium: a protective sac encasing the heart. Coronary arteries is the ones that per fusing blood to the heart muscle MI= are from coronary arteries not bringing blood fluid to the heart muscles Ventricular capacity is what we are thinking about when we think of heart failure

Identify normal and abnormal findings with neurological physical assessment

NORMAL: Patient alert and oriented, GCS 15, short term and long term memory intact, facial symmetry noted, CN II-XII grossly intact, +PERRLA, EOM intact, sensation intact to all extremities, sharp vs dull discrimination present, tongue and uvula midline. Uvula and soft palate rise symmetrically with phonation; gag reflex intact, DTR's +2 equal bilaterally, finger to nose test smooth and accurate, heel to shin movement smooth and accurate, no dysmetria, rapid repeating movements intact, tandem gait intact and steady, Romberg absent, no pronator drift ABNORMAL/ dysfunctions: - CN1: unilateral or bilateral anosmia - CN2: optic atrophy, papiledema, amblyopia, field defects - CN3: diplopia, ptosis of lid, dilated pupil, inability to focus on close objects - CN4: convergent strabismus, diplopia - CN5: tic douloureux, loss of facial sensation, decreased ability to chew, loss of corneal reflex, decreased blinking - CN6: diplopia, strabismus - CN7: Bell's palsy, decreased ability to distinguish tastes - CN8: Tinnitus, vertigo, deafness - CN9: loss of "gag" reflex, loss of taste, difficulty swallowing - CN 10: loss of voice, impaired voice, difficulty swallowing - CN 11: difficulty with shrugging of shoulders, inability to turn head to left and right - CN 12: difficulty with speech and swallowing, inability to protrude tongue

Normal and abnormal findings for Ears

Normal: Ears are symmetric and intact, color is pink, no redness, nodules, swelling or lesions, external auditory meatus is patent with no drainage, No pain or tenderness on palpation of the external ear and mastoid process Abnormal:

Normal and abnormal findings for Mouth and Throat

Normal: Mucosa of the oral cavity is pink, intact, moist, no visible lesions, gums are pink, intact, moist, no visible lesions, no sensitivity of teeth, no malocclusion; No palpable lymphadenopathy, Trachea midline, no palpable deviation Abnormal:

Risk Factors of a Cardiac Disease

Obesity Ever had heart disease Got high cholesterol? A SMOKER? With DIABETES? Hypertensive? Family history of CAD, CVA, DM, High Cholesterol? Drinking? - IV drugs? - Exercise? - Weight gain/loss? Five Main Risk Factors for Cardiac Disease: *Smoking, hypertension, obesity, diabetes, high cholesterol *****

Differentiate normal from abnormal findings of the musculoskeletal system

Olecranon Bursitis: pain, redness and swelling around the elbow, caused by inflammation of the fluid filled sac of the elbow or knee joint. Rheumatoid Arthritis (RA): thickened synovial membrane, synovial fluid expands, and cartilage erosions occur (thinning of cartilage). Ulnar deviation: slanted look, rheumatoid arthritis (late stage), has swan-neck deformity Bouchard's-hard nodules over the interphalangeal joints: the finger nodes are fluids filled (heberden's node and bouchard's node). Septic arthritis: boggling, swelling, erythema, hot Synovitis: extract fluids from site and send to lab to look for blood, WBC, and bacterial/viral culture. Osteomyelitis: infection of the muscle down to the bone Gout: uric acid crystal built into the toes/feet Bunion: deviation of the bone. A bunion is a bony bump on the joint at the base of the big toe. As the bump gets bigger, it causes the big toe to turn in toward the second toe. The tissues around the joint may be swollen and tender.

Suggested Palpation of the Lymphnodes

Pre auricular, post auricular, occipital, retrophayngeal (tonsillar), submaxillary (submandibular), submental, superficial cervical chain, deep cervical chain, suprclavicular

Right and Left Sided Failure Symptoms

RIGHT SIDED FAILURE - Fatigue, increase peripheral venous pressure, ascites, enlarged liver and spleen, may be secondary to chronic pulmonary problems, distended jugular veins from fluid volume overload, anorexia and complaints of GI distress, weight gain, dependent edema. LEFT SIDED FAILURE - Paroxysmal Nocturnal Dyspnea, elevated pulmonary capillary wedge pressure, Pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea), restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis.

Differentiate normal tissue integrity assessment findings from abnormal findings.

Skin Abnormalities: Senile Lentigines- look like hyper pigmented freckles, most commonly seen on the backs of the hands and the arms Hematoma- A raised, irregularly shaped lesion similar to an ecchymosis, but elevated. Caused by a leakage of blood into the skin and subcutaneous tissue as a result of trauma or surgical incision. Petechiae- Minute hemorrhages resulting from fragile capillaries that are caused by septicemias, liver disease, Vitamins C or K deficiency, or anticoagulant therapy Nail Abnormalities: Onycholysis- Fungal nail infection, causes nails to thicken and appear yellow/white/opaque. Clubbing- the nail appears more convex and wide. Nail angle is greater than 160 degrees. Occurs in chronic conditions where oxygenation is compromised Hair/scalp Alopecia Areata- no known cause for condition, produces loss of hair in a round balding patch on the scalp Hirsutism- Excess body hair in females, typically due to endocrine or metabolic dysfucntion

Structures, Triangles, Vessels of Neck

Structures: hyoid bone, thyroid cartilage, thyroid gland, cricoid cartilage, isthmus thyroid, trachea, clavicle, manubrium, sternocleiodmastoid msucle Triangles: anterior triangle- clavicle, trapezius muscle, omohyoid muscle; posterior triangle-sternocleidomastoid muscle, anterior triangle Vessels: Temporal Artery&vein, external carotid artery, internal carotid artery, common carotid artery, sternocleiodomastoid muscle, internal jugular vein, external jugular vein, clavicle

Describe the difference between subjective data and objective data

Subjective: CC, HPI, ROS,PMHx, FHx, SHx Objective: hands-on exam of pt, survey and exam body systems, observe and measure pt, data is seen/felt/ heard (inspection, palpation, percussion, auscultation)

Discuss movements of joints

Synovial joints: allow bones to rotate, laterally, flex and extend. - Flexion decreases the angle between articulating bones - Extension increases the angle between articulating bones - Extension beyond anatomical position is hyperextension - Abduction is movement away from the midline - Adduction is movement toward the midline - Circumduction is movement of the distal end of a body part in a circle - Rotation rotates a bone around its own longitudinal axis - Inversion and Eversion are movements of the soles medially or laterally - Dorsiflexion is standing on your heels - Plantar flexion is standing on your toes - Supination and pronation move the palm anteriorly or posteriorly

describe the physiology of the respiratory tract

THORAX: Part of the body between the neck and abdomen, separated from the abdomen by diaphragm. Walls formed by 12 ribs, attached to the sides of spine curving forward. Principal organs in thoracic cavity are heart, lungs, with major blood vessels. Trachea enters thorax to connect with lungs and the esophagus travels through it to connect with the stomach below diaphragm.

describe techniques required for assessment of the respiratory tract

THORAX:Divided into anterior, posterior, and lateral sections - Anterior Imaginary vertical lines Sternal Midclavicular Anterior axillary lines - Posterior Imaginary vertical lines Vertebral Scapular Posterior axillary - Lateral Imaginary vertical lines Anterior Posterior Midaxillary -SYSTEMATIC APPROACH:****** Superior to inferior (top to bottom) Apices to bases (top to bottom) Right to left- switch sides for comparison -12 points posterior thorax Two points anterior thorax Right Middle Lobe

Identify the physiology of the cardiovascular system (how does this work?)

This is the pumping/plumbing problem JVD shows more pressure in the veinous system Blood enters into the superior vena cava are the right atrium -->goes through the tricuspid valve--> into the right ventricle--> goes through the pulmonary valve--> entering pulmonary atrium--> the lungs--> oxygenated blood from the pulmonary veins --> into the Left atrium --> through the mitral valve --> into left ventricle --> blood moves through the aortic valve--> through the aortic arch into the body.

Identify anatomy of the respiratory tract

Upper Airway: Nasal cavity, Pharynx (nasopharynx, oropharynx, laryngopharynx), Larynx Lower Airway: Trachea, Left and right primary bronchi and bronchioles.

Stomas/ ostomy

a surgical opening created to allow stool or urine to exit the body through the abdomen. 3 MAIN TYPES: colostomy, ileostomy, urostomy -you want the stoma, pink, moist, symmetrical, even prutrution out of skin (cuts ulcerations, redness, irritation, lesions etc)

S2

dub= pulmonic/ aortic valves closing Best heard at LMSB/2LICS Higher pitched than S1--better heard with diaphragm

Describe common techniques used to assess deep, superficial, and brainstem reflexes.

from lab

Describe common techniques used to assess the cranial nerves, the sensory system, the motor system, coordination, and gait.

from lab

S1

lub= mitral/ tricuspid valves closing Best heard at the apex and LLSB Often sounds single unless slow heart rate

Explain client preparation for assessment of the cardiovascular system.

taking a pulse and BP. Position sitting @ 45 degrees on bed, left lateral, supine Expose chest + neck

To know the reason for the sequence of abdominal examination

we auscultate before percussion and palpation so that we do not create false bowel sounds.

To know the four quadrants of the abdomen

you use the peri-umbilical across/laterally and epigastric (abd aorta) to the suprapubic downwards to draw the four quadrants RUQ: right liver lobe, gallbladder, bile duct, transverse colon, ascending colon, some intestines RLQ: cecum, appendix some intestines LUQ: left liver lobe, stomach, spleen, adrenal gland, kidney (upper pole), pancreas, pancreatic duct, descending colon, some intestines LLQ: small intestine, rectum, anus