located in the temporal lobe and is associated w/ language comprehension. When damaged in the person’s dominant hemisphere, receptive aphasia results. The person hears sound but it has no meaning. It’s like hearing a foreign language.

located in the frontal lobe, mediates motor speech. When injured in the dominate hemisphere, expressive aphasia results. The person cannot talk. The person can understand language and knows what they want to say but can only produce a garbled sound.

a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium. (Balance of the body) and muscle tone. It DOES NOT initiate movement but coordinates and smoothes it. It’s like the “automatic pilot” of an airplane it adjusts and corrects voluntary movement.

Pain (the 5th vital sign)

how to assess it

(interview)

1) Do you have pain?

2) Where is your pain?

3) When did the pain start?

4) What does your pain feel like? (burning,stabbing, aching, cramping, sharp, shooting)

5)How much pain do you have now?

6) What makes your pain better or worse?

7) how does pain limit your function or activities?

8) How do you usually act when you are in pain?

9) what does this pain mean to you? 

cramping or pain in leg muscles brought on by a predictable amount of walking (or other excercise) and it's relieved by rest.

*It's a marker of PVD of the aorticiliac, femoral, popiteal arteries.

*the limbs will be shiny & thin

*cont or intermittent

the inability to maintain body balance when the eyes are shut and the feet are close together (or standing on one foot)

+sign = the pt sways & falls when the eyes are closed.

*seen in sensory ataxia and following traumatic brain injury

pain in the calf when foot is passively dorsiflexed.

*this finding suggests a venoud thrombus of the deep veins in the legs

a gradual progressive process, causing decreased cognitive functions even though the person is fully conscious and awake.

*not reversible.

Apex = bottom

Base = top

Aortic: 2^nd IC right sternal border S2>S1 (end of systole and start of diastole).

 Pulmonic 2^nd IC left sternal border S2>S1.

Erbs  is the 3^rd IC left sternal border S1=S2

Tricuspid 5th IC left lower sternal border S1>S2

Mitral 5^th IC mid-clavicular line S1>S2 (End of diastole and the start of systole).

* Use diaphragm for auscultation switch to bell side to listen for murmurs/bruits.

Bronchial Sounds

 -location: trachea

                            -quality: harsh or hollow

                  -pitch: high

                                    -amplitude: loud

                                              -duration: insp<exp

Broncho-Vesicular

-location: over major bronchi (anterior is 1^st and 2^nd, and                                                posterior is scapula)

                                    -quality: mixed

                                    -pitch: medium

                                  -amplitude:  moderate

                              -duration: insp = exp

-peripheral lung field (2, 3, 4)

                                    -quality: soft, blowing

                                    -pitch: low

                                    -amplitude: soft

                                    -duration: insp > exp

Thorax and Lungs

-12 ribs

-intercostal spaces

-2 ribs:

            -apex of ribs 2-3 cms above ribs (inner 3^rd of clavicle)

            -base of ribs at 6^th rib

            -right lung: shorter and with 3 lobes

            -left lung: narrower, 2 lobes

Inspection of lungs

-RR, depth and effort

            -use of accessory organ, nasal flaring, facial expression,

            -shape and symmetry of chest expansion

            -AP:T ratio

                        -normal = 2:1

                        -abnormal: 1:1 (which is barrel chest)and associated with emphysema, aging and asthma

            -skin color

            -abnormal chest shapes

            -clubbing of nails

            -tripod position

Palpitation of lungs

            -Position of trachea ~ moves away from collection of fluid and towards collapsed lung or consolidation

            -Chest bones and muscles

            -Crepitus: air in subcutaneous tissue

            -Palpate for thoracic expansion

            -Tactile Fremitus: palmar surfaces of fingers or ulnar surface of hands onthe 2^nd intercostal space, feeling for same vibrations when pt says,”99”

                        -Vibrations increased with fluid in the lung (pneumonia)

                        -Vibrations decreased with COPD, fluid outside lung (pleural effusion), and air outside the lung (pnumothorax)

Percussion of lungs

-Percuss for resonance, hyperresonance or dullness to determine if     structure is filled with air, fluid or solid

                        -Flat/dull: pleural effusion or lobar pneumonia,

                        -Normal (resonance): healthy lung or bronchitis

                        -Hyperresonant: emphysema or emphysema or pneumothorax

            -Symmetrical or generalized?

            -Diaphragmatic excursion

Auscultation of lungs         

 -Listen anteriorly and poseriorly

            -right middle lob best heard in axillary position

            -when listening posteriorly, pt. head should be bent slightly forward with       arms crossed in front

            -have pt. breath deeper through mouth

Central Nerves

I: patency-nostrils tested by close one nostril, have them out the other

II: Vision tested Snellen Test

III : superior rectus, inferior rectus, lateral rectus, medial rectus (eye); tested by Diagnostic Positions Test

IV : superior oblique, inferior oblique; tested by Diagnostic Positions Test

VII: Facial Expressions

VIII: Hearing tested by Voice Test/Whisper, Weber Test, Rinne Test & Audiogram

XI: neck muscles tested by ROM – should shrug, resistance to turn head, muscle strength

XII: Tongue movement

IPPA

For abdomen:

(Inspect, Auscultation, Percussion, Palpation)

Head & Neck Assessment

         Inspection

            -Skull and scalp mobility, normocephalic, lesions, symmetry, hair, face- expressions, symmetry, nose flaring, nasolobial folds

 Lymph Nodes

-Pre-auricular

                        -Posterior auricular

                        -Occipital

                        -Submental

                        -Submandibular

                        -Jugulodiagastric

                        -Superficial Cervical

                        -Deep Cervical Chain (tilt head to side to palpatate)

                        -Posterior Cervical

                        -Supraclavical

when you shine the light into one eye you should have bilateral constriction

No? = Neurological problems!

Tests CN II

 should be standing about 20 feet from the chart with corrective lenses on.  Do one eye at a time then both eyes. OD = right eye, OS = left eye, and OU = both eyes.  The top number is the distance and the bottom number is the normalcy

Diagnostic Positions test:

 tests functions of CN III, IV, and VI by doing the six cardinal positions to test coordination of movement and parallel

Cover/Uncover Test:

Ears Test

Weber: place vibrating tuning fork midline person’s skull, forehead, or top of head

                        -Normal = sound heard equally both ears

                        -Abnormal = sound heard only one side

Rinne: compare air conduction to bone conduction; place a tuning fork on mastoid process, when pt. hears it turn around and let them hear

            -AC:BC usually 2:1