State of health, level of consciousness, and signs of distress.

The general height, weight, and build. Skin color, dress, grooming, and personal hygiene. 

Facial expression, odors, posture, gait, and motor activity.

• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene

Characteristics of Percussion Tones

Tympany

Quality, Pitch, Intensity, Location

• Quality: Musical, drumlike
• Pitch: High
• Intensity: Loud
• Location: Air-filled stomach

Characteristics of Percussion Tones

Hyperresonance

Quality, Pitch, Intensity, Location

• Quality: Booming
• Pitch: Very low
• Intensity: very loud
• Location: Emphysematous lung

Characteristics of Percussion Tones

Resonance

Quality, Pitch, Intensity, Location

• Quality: Hollow
• Pitch: low
• Intensity: loud
• Location: normal lung

Characteristics of Percussion Tones

Dullness

Quality, Pitch, Intensity, Location 

Quality: thudlike

Pitch: medium

Intensity: medium

Location: liver, diaphragm

Characteristics of Percussion Tones

Flatness

Quality, Pitch, Intensity, Location

Quality: Extreme dullness

Pitch: High

Intensity: soft

Location: sternum, thigh

Decribe the process of deep palpation

What is the purpose of deep palpation?

One or both hands may be used

When both are used: place fingers of one hand over fingers of other hand

The top hand presses and guides the bottom

Purpose: to locate organs, determind their size, and detect abnormal masses

Percussion of the abdomen is:

Choose: tympanic, resonant, hyperresonant, dull, or flat

Percussion of a hyperinflated lung tissue is:

Choose:  flat, hyperresonant, resonant, dull, or tympanic

Percussion of normal lung tissue is:

Choose: hyperresonant, resonant, dull, tympanic, flat

Percussion of the liver is:

choose:  dull, flat, hyperresonant, tympanic, or resonant

Percussion of bone is:

tympanic, dull, resonant, flat, hyperresonant

1. The more ______ the medium, the _______ the percusison sound.
2. ________ tones are the loudest, and _______ are the quietest.

choices: hollow, dense, louder, quieter, tympanic, flat, resonant, hyperresonant, dull

dense, quiter

Tympanic, flat

• Frequency (heard as pitch, expressed in cycles per second is the measure of vibration)
• Intensity (describes the loudness of the sound)
• Duration (the length of the sound or timing)
• Quality (the musical characteristic of a sound)

How is a person's orientation evaluated?

Orientation X 1 indicates:

Orientation X 2 indicates:

Orientation X 3 indicates:

By asking simple, direct questions about person, place, and time

X 1, person

X 2 person, and place

X 3 person, place, and time

1. Level of consciousness
2. Orientation
3. Mood
4. Language and memory

With a normal supply of oxygen, the lips, nail beds, and tongue appear what color?

Hypoxia changes this color.  What color would it appear and what is this called?

pinkish-red : normal

gray, blue, or purple  called cyanosis

Skin color appearing pale as a result of hypoxia or anemia, is known as:

A yellow tone to the skin as observed in liver disease is known as:

Redness, usually form irritation or inflammation is known as:

pallor

jaundice

erythema

WOUNDS

1. What would yellow or green color of a wound indicate?
2. What would black, brown, or gray color indicate?
3. What color and consistance of drainage would indicate infection?
4. What color of drainange would indicate blood?
5. What is a watery, clear drainage?

1. infection
2. necrotic (dead) tissue
3. creamy, colored drainage
4. bright red
5. serum

Place fingers on either side of the trachea below the cricoid cartilage

Using the fingers on the left, push the trachea to the right and ask patient to swallow as you palpate the gland.

Do the opposite to palpate the left side of the thyroid.

black and round

constrict briskly

PERRLA

pupils equal, round, reactive to light and accomodation

Cranial nerve I is important in the sense of smell

Cranial nerves II, III, IV, and VI are important for Vision

Cranial nerve VIII is important for hearing

Cranial nerves V, VII, IX, and XII are important in the coordination of facial movement or reflex activity

instrument used to asses internal eye structures

This permits visualization of the...

opthalmoscope

retina, optic nerve disc, macula, fovea centralis, and retinal vessels

laterilzation

on patient's head or midforehead

conduction = unaffected

sensorineural = affected

To conduct the Rinne test, where do you place the tuning fork?

Normally, the patient should hear the sound of the tuning fork when it is placed near the ear, indicating that air conduction of sound is (greater or less) than bone conduction. When the patient does not detect sound until the tuning fork is placed on the mastoid process, bone conduction of sound is (greater or less) than air conduction because of a conductive hearing loss.

on the mastoid process.

greater

greater

An oral fungal infection that appears as cheesy white plaque on the tongue.

Which patients does this frequently occur in?

candidiasis

patients on chemotherapy or antibiotic therapy

1. risk factors for lung disease (e.g. smoking, occupational exposure to pollutants)
2. signs and symptoms of respiratory dysfunction (cough, sputum production, dyspnea)
3. impact of respiratory status on ADL's
4. adaptive measures for any respiratory dysfunction 

1. configuration of the thorax
2. breathing patterns
3. signs of labored breathing
4. observation of the skin and nails

a term used to describe the distance between the sternum and the vertebral column

In a normal adult, the measurement is approximately _____ of the lateral diamater (width) of the chest.

anterior-posterior diameter (AP)

1/2

1. an exaggerated convex curve of the spine

   ---

2. a lateral deviation of the spinal curve

   ---

3. a combination of abnormal lateral and convex curveature of the spine

1. kyphosis

   ---

2. scoliosis

   ---

3. kyphoscoliosis

Conditions to observe for include:

1. breating that is too fast
2. too slow
3. too shallow
4. too deep
5. irregular

1. tachypnea
2. bradypnea
3. hypoventilation
4. hyperventilation
5. cheyne-stokes

evaluate painful or abnormal areas on the chest wall

to test for symmetry of chest expansion

to detect tracheal deviation

 blowing, hollow sounds over the trachea

Expiration is longer and louder than inspiration

loud and high pitched

Intermediate sounds over first and second anterior intercostal spaces and posteriorly bet. scapula

breezy but softer and lower pitched

inspiratory and expiratory times are approx equal

soft and breezy sounds over all lung area except airways

inspiration markedly longer and louder than expiration

Inspiration is higher pitched than expiration

1. Aortic area-second intercostal space, right sternal border
2. Pulmonic area-second intercostal space, left sternal border
3. Tricuspid area-fifth intercostal space, left sternal border
4. Mitral (or apical) area-fifth intercostal space, just medial to the midclavicular line

 A PMI lateral to the normal position (mitral) may indicate an _____ ______.

Pulsations or vibrations over the aortic, pulmonic, or tricuspid areas may indicate what?

enlarged heart

problems with those valves

1. The period from the beginning of S₁ to the beginning of S₂.
2. The period from the beginning of S₂ to the beginning of the next ventricular contraction.

1. systolic
2. diastolic

S₁ coincides with the beginning of systole, when the ____ and ____ valves _____.

S₂ coincides with the beginning of diastole, when the ____ and _____ valves _____.

mitral and tricuspid valves close

aortic and pulmonic valves close

1. Aortic area
2. Pulmonic area
3. Tricuspid area
4. Mitral area
5. Aortic valve
6. Pulmonic valve
7. Tricuspid valve
8. Mitral valave

The third heard sound (S₃) is an extra heart sound that occurs early in ______ as the ventricle rapidly fills. This often signifies _____ _____ in adults.

The fourth heart sound (S₄) is an extra sound that occurs late in _____, just before S₁.  S₄ is frequently associated with _________ and ____ _____ ____.

These sounds are commonly called ______.

diastole; heart failure

diastole; hypertension and coronary artery disease

gallops

tinkling, gurgling sounds

every 5 to 20 seconds.

What is paplation of the abdomen used for?

Where should you paplate and which area should u save for last?

to obtain informaiton about pain or discomfort

all four quadrants, reserving the area of suspected pain or abnormailty until last.