Health Assessment

Front 1

general survey:
age

Back 1

appears his or her stated age
abn* - older, b/c of chronic illness, chronic alcoholism

Front 2

general survey:
sex

Back 2

sexaul development appropriate.
abn*- delayed or precocious puberty

Front 3

general survey:
level of consciousness

Back 3

alert, oriented, attends to questions -- person, place, time.
abn*- confused, drowsy, lethargic

Front 4

general survey:
skin color

Back 4

color tone is even, pigmentation varying w/ genetic background, intact
abn*pallor,cyanosis,jaundice,erythema, lesions

Front 5

general survey:
facial features

Back 5

facial features symmetric --
abn*- immobile, masklike, asymmetric, drooping

Front 6

gernal survey -
normal: no signs of acute distress are present

Back 6

abn* respiratory signs, SOB/wheezing. pain, indicated by grimace - holding body part

Front 7

body structure:
stature

Back 7

height appears normal w/ age, genetic heritage
abn* excessively tall/short

Front 8

body structure:
nutrition

Back 8

weight appears normal range for height/body - body fat distribution is even
abn*- cachectic, emaciated

Front 9

nutrition abn*

Back 9

centripetal obesity- concentrated in face, neck, trunk, thin extremities
(Cushing's Syndrome)
hyperadrenalism

Front 10

body structure
symmetry

Back 10

body parts equal bilaterally
*abn - unilateral atrophy or hypertrophy
assymetric location of body part

Front 11

body structure:
posture

Back 11

stands comfortable,erect.
*abn - rigid spine & neck, stiff, tense, slumped

Front 12

body structure:
posture
normal for age

Back 12

older person -- kyphosis
tolddler - toddler lordosis

Front 13

body structure:
position

Back 13

sits comfortable in chair
abn* tripod, COPD
resists lying down - CHF
fetal position - abd. pain

Front 14

Mobility:
gait

Back 14

base is as wide as shoulders, smooth, well balanced.
*abn - wide base, staggered, stumbling, shuffling, dragging, limping

Front 15

Mobility:
range of motion

Back 15

full mobility for each joint, accurate, smooth, coordinated
abn*- limited, paralysis, jerky, titics, tremors, seizures

Front 16

Behavior:
facial expression

Back 16

eye contact - unless culture
(asians)
-abn* flat, depressed, angry, sad, anxious

Front 17

Behavior:
Mood & Affect:

Back 17

comfortable/cooperative
*abn - hositle, distrustful, suspicious, crying

Front 18

Behavior:
speech

Back 18

clear, understandable
abn* - dysarthria - speech, dysphagia - swallow

Front 19

Behavior:
dress

Back 19

appropriate to climate, clean, fits.
*abn - too large, held by belt - wt. loss, ascites -
long sleeves - drug abuse

Front 20

Behavior:
personal hygiene

Back 20

clean and groomed for age, occupation, socioeconomic group. -
abn* - unkept - illness

Front 21

weight - kg & lbs

Back 21

balance, recommended range for height
same time a day (lasix)

Front 22

height -

Back 22

headpiece on top of head, shoeless, stand straight

Front 23

Temperature

Back 23

hypothalamus as thermostat

Front 24

influences temperature

Back 24

diurnal cycle - 1 degree to 1.5 degree from early morning to later in evening

Front 25

factors affecting body temperature

Back 25

menstrual cycle, exercise, age (elders, lower)

Front 26

routes

Back 26

oral, electronic thermometer, axillary, rectal, tympanic membrane thermometer

Front 27

pulse

Back 27

with every beat, the heart pumps an amt. of blood - called Stroke Volume

Front 28

rhythm "sinus arrythmias"

Back 28

irregularity - children/young adults

Front 29

force of pulse

Back 29

strength of heart's SV
3 + full, bounding
2 + normal
1 + weak, thready
0 - absent

Front 30

elasticity

Back 30

artery feels springy, straight, resilient.

Front 31

respirations

Back 31

ratio of pulse rate to respirations should be 4:1

Front 32

blood pressure
systolic

Back 32

maximum pressure felt on artery during LV contraction

Front 33

blood pressure
diastole

Back 33

resting, between contractions

Front 34

pulse pressure

Back 34

difference between systolic and diastolic, reflects SV

Front 35

mean arterial pressure

Back 35

pressure forcing blood into tissues

Front 36

influences on BP

Back 36

age (rise thru childhood --> adulthood)
gender (after puberty, girls lower, after menopause, higher) race - blacks higher

Front 37

influences on BP

Back 37

diurnal rhythm - BP higher in late afternoon
weight - higher in obese
exercise - increase, after 5 min - normal

Front 38

Physiological Factors controlling BP

Back 38

CO
Peripheral Vascular Resistance
Volume of Circulating Blood
Viscosity
Elasticity of vessel walls

Front 39

Korotkoff Sounds

Back 39

1 tapping - systolic
auscultory gap --
II swooshing
III knocking
IV muffling
V silence (diastolic)

Front 40

precordium

Back 40

area on anterior chest overlying heart and great vessels

Front 41

mediastinum

Back 41

heart and great vessels located here -- between the lungs in the middle third of thoracic cage

Front 42

apex & base of heart

Back 42

apex - bottom
base - top

Front 43

pericardium

Back 43

tough, fibrous, double-walled sac surrounds and protects heart

Front 44

myocardium

Back 44

muscular layer of the heart, does the pumping

Front 45

endocardium

Back 45

thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

Front 46

atrioventricular valves

Back 46

separate atria and ventricles

Front 47

tricuspid

Back 47

right AV

Front 48

bicuspid, or mitral valve

Back 48

left AV

Front 49

semilunar

Back 49

set between the ventricles and arteries
pulmonic - right side
aortic - left side

Front 50

direction of blood flow

Back 50

liver to RA -- inferior vena cava, superior vena cava from head and upper ext. - RA thru tricuspid to RV
RV -- to pulm. valve to pulm. artery -- to lungs -- pulm veins to LA
LA thru mitralvalve, to LV -- to aorta -- body

Front 51

first heart sound

Back 51

S1 - closure of AV valves -- beginning of systole

Front 52

second heart sound

Back 52

S2 -- closure of semilunar valves (end of systole)

Front 53

effect of respiration
(insp. intrathoracic pressure dec.)

Back 53

volume of right and left ventricular systole is equal:
More to the right heart, less to the left

Front 54

extra heart sounds

Back 54

S3 - ventricular filling creates vibration -- resistat to filling

Front 55

fourth heart soudn

Back 55

S3 - end of diastole, resistant to filling

Front 56

murmurs

Back 56

swooshing, turbulent blood flow

Front 57

characteristics of sound

Back 57

frequency (pitch) - heart sounds high or low pitched
intensity (loudness) - loud or soft
duration - very short
timing - systole or diastole

Front 58

pumping

Back 58

Cardiac Output -
CO = SV x R

Front 59

preload

Back 59

venous return that builds during diastole

Front 60

afterload

Back 60

opposing pressure the V must generate to open the aortic vavle against high aortic pressure

Front 61

neck vessels

Back 61

carotid, jugular (int. & ext)

Front 62

subjective data

Back 62

chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis, or pallor

Front 63

health history questions

Back 63

edema, nocturia, cadiac history, family cardiac history, personal habits (cardiac risk factors)

Front 64

preparation

Back 64

position/drape,room prep, order of exam. - marking pen, small centimeter ruler, stehoscope

Front 65

carotid ateries

Back 65

paplate, auscultate for bruit

Front 66

bruit -

Back 66

blowing, swishing ( turbulence due to local vascular cause, atherosclerotic narrowing)

Front 67

jugular veins

Back 67

inspect, estimate, palpate (hepatojugular reflex)

Front 68

precordium

Back 68

inspect anterior chest, palpate apical impulse, & across precordium, percuss to outline cardiac borders

Front 69

heart sounds -

Back 69

note rate/rhythm, sinus arrythmia/pulse deficit
identify S1 & S2 - s1 louder
extra heart sounds/murmur?

Front 70

abn - ejection click

Back 70

short, high pitched sound - click quality

Front 71

aortic prosthetic valve sounds

Back 71

iatrogenically induced heart sound

Front 72

midsystolic click

Back 72

mitral valve prolapse - short, high pitch w/ click quality