Foundational Physical Assessment Exam. 2

What do you do if a patient says they wish to be dead?

Ask: "Do you have a plan?", "What is your plan?"

What is pruritis?

itchy skin

How do you best assess pain?

0-10 scale and ask pt how it feels

Chalazion?

A bump on your eyelid {inflamed bump in oil gland/swells}- don't confuse it with sty!

What is a bulla?

A fluid-filled blister more than 5 mm (about 3/16 inch) in diameter with thin walls. A bulla on the skin is a blister.

What is a wheal?

A raised, itchy (pruritic) area of skin that is sometimes an overt sign of allergy.

What are the different types of pain?

Acute Pain. Acute pain can be cured in minutes or months. , Chronic Pain. Chronic pain lasts more than six months and ranges from mild to severe on a daily basis. , Neuropathic Pain. Neuropathic pain is due to nerve damage. , Nociceptive Pain. Nociceptive pain is a result of tissue damage.

Acute vs chronic pain?

Acute pain happens quickly and goes away when there is no cause, but chronic pain lasts longer than six months and can continue when the injury or illness has been treated.

What is level of consciousness(LOC)? What are the different stages and how would patient present? Example: alert- spontaneous eye opening, looking at you, responsive, following commands.

Alert: the patient opens their eyes spontaneously, looks at you when spoken to in a normal voice, responds appropriately to stimuli, and movements are purposeful. Lethargic: the patient appears drowsy but opens their eyes to loud verbal stimuli and looks at you, responds to questions, and then falls back asleep. Obtundation: the patient opens their eyes with tactile stimuli and looks at you but responds to you slowly and may be confused. Stupor: the patient awakens only after painful stimuli is applied (i.e., applying pressure to the nailbed). The patient's verbal responses are slow or absent. The patient will fall into an unresponsive state when the stimuli stops. Coma: patient is unarouseable and their eyes remain closed. There are no purposeful responses to internal or external stimuli. However, nonpurposeful responses to painful stimuli and brain stem reflexes may still be present.

What are the functions of: Cerebellum?

Also known as "little brain", it is responsible for coordinating movement and balance

What is the Glasgow Coma Scale? What do the numbers mean?

Below 8: intubate

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN I. Olfactory nerve: sense of smell- instruct the pt to sniff repetitively and tell you when an odor is detected

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN II. Optic nerve: ability to see- shine a light into the pts eye to examine the structure at the back of the eye

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN III. Oculomotor nerve: ability to move and blink your eyes- The oculomotor, trochlear, and abducens nerves are tested by holding a pen or finger 30 to 40 cm (about 1.31 ft) in front of the patient and moving in an H-shaped pattern pausing during vertical and lateral gaze.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN IV. Trochlear nerve: ability to move your eyes up and down or back and forth- refer to CN III description

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN IX. Glossopharyngeal nerve: ability to taste and swallow- It can be tested with the gag reflex by touching the pharynx with a tongue depressor or by touching the arches of the pharynx.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN V. Trigeminal nerve: sensations in your face and cheeks, taste and jaw movements- Ask the patient to clench his or her jaws. Palpate the masseter and temporal muscles for asymmetry of volume and for tone.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN VI. Abducens nerve: ability to move your eyes- refer to CN III

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN VII. Facial nerve: facial expressions and sense of taste- tested by asking the patient to crease up their forehead by raising their eyebrows, close their eyes, and keep them closed against resistance, puff out their cheeks, and reveal their teeth.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN VIII. Vestibulocochlear: sense of hearing and balance- Hearing can be assessed by whispering a number into each ear separately, making a distracting noise with your fingers in the contralateral ear, and asking the patient to repeat.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN X. Vagus nerve: digestion and heart rate- use a soft cotton swab to tickle the back of the throat on both sides. This should cause the person to gag.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN XI. Accessory nerve: shoulder and neck muscle movement- assessing two muscles: the trapezius and sternocleidomastoid. When assessing the trapezius, ask the patient to shrug their shoulders, then apply resistance. Accessory nerve weakness will present with weak or no resistance to your downward force.

List the 12 cranial nerves (name and number & cranial nerve) how to assess them and what you would expect to find on a normal adult? Abnormal response?

CN XII. Hypoglossal nerve: ability to move your tongue- have the patient protrude her tongue. Assess for deviation of the tongue, atrophy, and fasciculations.

What is clubbing? What causes this?

Clubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails may also show changes. Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases.

What are the different headaches? Signs and symptoms of each? Cluster headaches

Cluster headaches- may occur with severe burning and piercing pain. They occur around or behind one eye or on one side of the face at a time. Symptoms may include: swelling, redness, flushing, and sweating on the side that's affected by the headache nasal congestion and eye tearing on the same side as the headache

Delirium vs dementia?

Delirium- short term memory loss/confusion -is reversible vs. Dementia: long term memory loss -is not reversible, dementia has a long-term onset and gradually gets worse

Dizziness vs. vertigo?

Dizziness can be a range of sensations including feeling light-headed, faint, woozy, giddy, unsteady, off-balance or weak. Vertigo is a type of dizziness that feels as though you or your surroundings are spinning.

Name signs/symptoms and test for the different disease processes?Meningitis?

Fever with cold hands and feet, vomiting, drowsy or difficult to wake, confusion and irritability, severe muscle pain, pale blotchy skin, spot or rash, severe headaches and stiff neck. A spinal tap diagnosis this disease.

Mental health disorder signs and symptoms? Schizophrenia

Hallucinations. ,Delusions. ,Disorganised thinking. ,Lack of motivation. ,Slow movement. ,Change in sleep patterns. ,Poor grooming or hygiene. ,Changes in body language and emotions.

How can you assess the balance of a patient?

Have pt close eyes and hold hands to side and stand on one leg

Name signs/symptoms and test for the different disease processes? Alzheimer's?

Memory loss that disrupts daily life. ,Challenges in planning or solving problems. ,Difficulty completing familiar tasks. ,Confusion with time or place. ,Trouble understanding visual images and spatial relationships. ,New problems with words in speaking or writing.- Perform brains scans such as CT, MRI,and PET

What are the different headaches? Signs and symptoms of each? Migraine headaches

Migraine headaches- is a headache disorder that causes intense pulsing pain deep within your head. Migraine episodes may last between 4 and 72 hours untreated, significantly limiting your ability to carry out your daily routine. During one, you may experience: throbbing pain, usually on one side of the head light sensitivity sound sensitivity nausea and vomiting

Nasal drainage colors and meanings?

Multiple colors in the mucus could be because of its concentration. Thick and sticky mucus is mostly green in color. If the mucus has a tinge of brownish or red blood, it may be the result of a dried or irritated nose because of excessive picking, rubbing and blowing. When you blow your nose and see yellow boogers, that usually means your body is fighting an infection.

What are the different headaches? Signs and symptoms of each? New daily persistent headaches (NDPH)

New daily persistent headaches (NDPH)- is a rare condition where a person develops a new headache that's moderately painful or worse and doesn't get better over time

Name signs/symptoms and test for the different disease processes? Stroke?

Numbness or weakness in the face, arm, or leg; Confusion or trouble speaking or understanding speech; Trouble seeing in one or both eyes; Trouble walking, dizziness, or problems with balance; severe headache with no known cause.-A MRI test can detect the signs of stroke

What is nystagmus? Strabismus? Exotropia? Exophthalmos? How do we assess these?

Nystagmus: involuntary eye movement {need penlight to test), Strabismus: Lazy eyes/ crossed eyes, Exotropia: Eyes point outward, Exophthalmos: bulging eyes {think the vending machines at stores with the little dogs that you squeeze, and the eyes pop out Graves' Disease/Thyroid Disease}

What is pain tolerance vs threshold?

Pain threshold is defined as the amount of time elapsed before the participant reports the stimulus to be painful, while pain tolerance is the duration of time before the individual cannot tolerate the stimulus any longer and wishes to terminate it

Where is the Temporomandibular joint? How do we assess it? What is a normal vs abnormal response?

Palpate directly over the joint while the patient opens and closes the mandible, and the extent of mandibular condylar movement can be assessed. Normally, condylar movement is easily felt. Have the patient close slowly, and you will feel the condyle move posteriorly against your finger.

What is petechiae? Purpura? Ecchymosis?

Petechiae: is red/purple little dots from bleeding on the skin, Purpura: a purple rash of purple dots due to bleeding (blood thinners older pts), Ecchymosis: this is just a bruise

Signs of abuse?

Physical Abuse., Domestic Abuse., Sexual Abuse., Psychological Abuse., Financial or Material Abuse., Modern Slavery., Discriminatory Abuse., Organisational Abuse.

Conjunctivitis?

Pink eye (irritated conjunctiva)

What is the skin turgor test for?

Skin turgor refers to the elasticity of your skin. When you pinch the skin on your arm, for example, it should spring back into place with a second or two. Having poor skin turgor means it takes longer for your skin to return to its usual position. It's often used as a way to check for dehydration.

What is a good way to communicate with someone who has expressive aphasia after a stroke?

Speak in short, simple sentences. Be patient - Allow plenty of time for a response. Talk with the person who has aphasia, not for him or her. Remove distractions - Turn off radios and TVs and focus on the person with aphasia.

Pressure Ulcers and staging?

Stage 1: just erythema of the skin. Stage 2: erythema with the loss of partial thickness of the skin including epidermis and part of the superficial dermis. Stage 3: full thickness ulcer that might involve the subcutaneous fat. Stage 4: full thickness ulcer with the involvement of the muscle or bone.

Hordeolum?

Sty on eye

What are the different headaches? Signs and symptoms of each? Tension Headache

Tension-type headaches (most common type of headache)- you may feel a dull, aching sensation all over your head. Tenderness or sensitivity around your neck, forehead, scalp, or shoulder muscles also might occur.

Scale for depression? Scales for alcohol abuse?

The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. Alcohol Use Disorders Identification Test (AUDIT).

What is the Rinne test? Webber test?

The Rinne test is conducted by placing a tuning fork on the mastoid bone and then adjacent to the outer ear. Air conduction uses the apparatus of the ear (pinna, ear canal, tympanic membrane, and ossicles) to amplify and direct the sound. Bone conduction allows the vibration sound to be transmitted to the inner ear. In the Weber test, the base of a gently vibrating tuning fork is placed on the midforehead or the vertex. The patient is asked which ear hears the sound better.

What is the Romberg's test? What is a positive result?

The Romberg test is scored by counting the seconds the patient can stand with eyes closed.- A positive test is an inability to maintain an erect posture over 60 seconds with eyes closed.

What is the CAGE screening tool? AUDIT?

The letters CAGE stand for Cut, Annoyed, Guilty, and Eye(help tell if you have a substance abuse problem). The AUDIT (Alcohol Use Disorders Identification Test) is an effective and reliable screening tool for detecting risky and harmful drinking patterns.

What are the different layers of skin? What is the purpose of the outer layer? Inner layer?

The skin is primarily made up of three layers. The upper layer is the epidermis, the layer below the epidermis is the dermis, and the third and deepest layer is the subcutaneous tissue. The epidermis, the outermost layer of skin, provides a waterproof barrier and contributes to skin tone. Stratum corneum. ,Stratum lucidum. ,Stratum granulosum. ,Stratum spinosum. ,Stratum basale. ,Dermis. ,Hypodermis.

Name signs/symptoms and test for the different disease processes? Myasthenia gravis?

There's no cure for myasthenia gravis. Treatment can help with symptoms. These symptoms can include weakness of arm or leg muscles, double vision, drooping eyelids, and problems with speaking, chewing, swallowing and breathing. - a blood test to look for a type of antibody (produced by the immune system) that stops signals being sent between the nerves and muscles.

Name signs/symptoms and test for the different disease processes? Parkinson's?

Tremors, slowed movements, rigid muscles, loss of automatic movements, speech changes and writing changes. An imaging scan called DaTscan test for this disease

What is referred to as pain?

When you feel pain in a place that is not affected {my leg is injured but my shoulder hurts}

Jaundice? What would you inspect on patient with this?

a diagnostic standpoint, sonography of the liver, biliary tree, and pancreas. a yellow discoloration of the body tissue

What is vitiligo?

a disease that causes loss of skin color in patches. The discolored areas usually get bigger with time.

What is a papule?

a small, raised, solid pimple or swelling, often forming part of a rash on the skin and typically inflamed but not producing pus.

What is a keloid?

a thick raised scar. It can occur wherever you have a skin injury but usually forms on earlobes, shoulders, cheeks or the chest

What is the ABCDE of malignant melanoma?

asymmetry, border, color, diameter and evolving. These are the characteristics of skin damage that doctors look for when diagnosing and classifying melanomas.

How do you assess remote memory?

ask pt about their childhood {security question)

What is cellulitis? What are signs and symptoms of this?

bacterial infection under skin {turns whole limb red & inflamed/burns}

What are the functions of: Brainstem?

breathing, consciousness, blood pressure, heart rate, and sleep. The brainstem contains many critical collections of white and grey matter.

What is pustule?

is a bulging patch of skin that's full of a yellowish fluid called pus. It's basically a big pimple.

What is clubbing?

due to chronic hypoxia

What does the nose do for the body?

filters breathed in debris/foreign material

What is candidiasis? What can cause this?

is a fungal infection caused by a yeast (a type of fungus) called Candida. White patches on the inner cheeks, tongue, roof of the mouth, and throat (photo showing candidiasis in the mouth), Redness or soreness., Cotton-like feeling in the mouth., Loss of taste., Pain while eating or swallowing., Cracking and redness at the corners of the mouth.

Mental health disorder signs and symptoms? Bipolar?

is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).

What are the functions of: Temporal lobe?

managing your emotions, processing information from your senses, storing and retrieving memories, and understanding language.

Obsessive compulsive disorder?

obsessions and compulsions mental disorder {remember she said her neighbor had to lock and unlock the doors at his apartment}

What is normal expectation of nails?

pink, round, no breakage, or clubbing-capillary refill <3secs

What is an Aura?

precursor to a seizure

What are melanocytes? What do they do for us?

produce the protective skin-darkening pigment melanin. melanocyte, specialized skin cell that produces the protective skin-darkening pigment melanin.

What is peripheral vision? How do you test it?

pt holds one arm and the nurse holds one arm, and you go from outward to inward and have the pt match your movements

What are the functions of: Parietal lobe?

receiving and processing sensory input such as touch, pressure, heat, cold, and pain.

How do you assess deep tendon reflexes? What is considered normal?

reflex hammer to knee and elbow {should bounce back}

Mental health disorder signs and symptoms? Depression?

sad, hopeless and lose interest in things you used to enjoy.

Hirsutism?

severe hair growth where it shouldn't be. "Girls with a mustache, hair on inner face"

What is interpersonal violence?

violence between family or partners

What are the functions of: Occipital lobe?

visuospatial processing, distance and depth perception, color determination, object and face recognition, and memory formation.

What are the functions of: Frontal lobe?

voluntary movement, expressive language and for managing higher level executive functions.