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184 Cards in this Set
- Front
- Back
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What are the four skills requisites for the physical exam?
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Inspection, Palpation, Percussion and Auscultation
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When does inspection begin?
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The moment you first meet the person and develop a "general survey."
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What begins the moment you first meet the person and develop a general survey.
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Inspection
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This step of the physical examination always comes first.
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Inspection
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This step of the physical examination follows Inspection.
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Palpation
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This step of the physical examination is "feeling."
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Palpation
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During the palpation step in the physical exam, these are best used for fine tactile discrimination, as of skin texture, swelling, pulsation and determining presence of lumps.
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Fingertips
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In palpating our patient, when is it most acceptable to use the fingertips?
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Skin texture, swelling, pulsation and determining the presence of lumps.
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During the palpation step in the physical exam, which is best used to detect the position, shape and consistency of an organ or mass?
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Grasping action of the fingers and thumb
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In palpating the patient, when is it most acceptable to use a grasping action of the fingers and thumb.
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When detecting the position, shape and consistency of an organ or mass.
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During the palpation part of the physical exam, what is best used for determining temperature?
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The dorsa (backs) of hands and fingers, because the skin here is thinner than on the palms.
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In palpating a patient, when is it best to use the dorsa of the hands and fingers.
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When determing temperature, because the skin is thinner on the backs of the hands than on the palms.
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During the palpation part of the physical exam, what is best used for vibrations.
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Base of the fingers (metacarpophalangeal joints)/ ulnar surface of hands.
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In palpating a patient, when is it best to use the base of the fingers/ulnar surface of hands?
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Best for vibrations
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This portion of the physical exam is tapping on the person's skin with short, sharp strokes to assess underlying structures.
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Percussion
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What are we doing when we perform percussions on a patients?
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tapping on the person's skin with short sharp strokes to assess underlying structures
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What are four things that we can use percussions for?
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Mapping out a location and size of an organ, signaling the density, detecting an abnormal mass and eliciting a deep tendon reflex using the percussion hammer.
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Which step of the physical examination will map out the location and size of an organ,, signal the density of a structure, detect an abnormal mass and elicit a deep tendon reflex?
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Percussion
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In the percussion stage of the physical examination, how are we able to map out the location and size of an organ?
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By exploring where the percussion note changes between the borders of an organ and it's neighbors.
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During the percussion phase of the physical exam, what can we identify by exploring where the percussion note changes between the borders of an organ and it's neighbors?
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We are able to map out the size and location of an organ.
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During the percussion part of the physical exam, what can we signal by a characteristic note?
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We can signal the density *air, fluid or solid* of a structure
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During the percussion part of the physical exam, we can signal the density (air, fluid or solid) by a.... _______ _______.
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Characteristic note
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During the percussion part of the physical exam, what might we detect?
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An abnormal mass if it's fairly superficial. The percussion vibrations penetrate about 5cm deep.
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During the percussion part of the physical exam, what would we use to elicite a deep tendon reflex?
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The percussion hammer
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Why does percussing over a bone yield no data?
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Because it always sounds "dull."
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What is the stationary hand during percussions?
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The nondominent hand/ The resting hand.
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What is the striking hand during percussions?
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The dominent hand/ The bouncing hand.
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The striking hand during percussions aims for the distal interphalangeal joint. What is our goal by doing this?
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To hit the portion of the finger that is pushing the hardest into the skin surface.
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How many times do we percuss in each location with the striking hand?
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two times
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What do all sounds result from?
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vibrations of some structure
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This sound is another word for intensity.
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Amplitude
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A loud of soft sound where loudness depends on the force of the blow and the structure's ability to vibrate.
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Amplitude
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This sound is another word for frequency.
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Pitch
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The number of vibrations per second.
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Pitch
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More rapid vibrations produce a ____-pitched tone.
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high
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Slower vibrations produce a ____-pitched tone.
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low
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This sound is another word for timbre.
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Quality
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A subjective difference due to a sound's distinctive overtones. Variations within a sound wave produce overtones. Overtones allow you to distinguish a C on a piano from a C on a violin.
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Quality
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The length of time the note lingers.
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Duration
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What are the four components that differentiate the production of sound?
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amplitude, pitch, quality and duration
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Amplitude, Pitch, Quality and Duration are the four components that differentiate the production of ______.
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Sound
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Why will a structure with relatively more air(lungs) produce a louder, deeper and longer sound?
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Because it vibrates more freely.
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A structure with relatively more air (lungs) will produce a ______, ______ and ______ sound because it vibrates more freely.
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Louder, Deeper and Longer
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A structure with relatively more _____ will produce a louder, deeper and longer sound because it vibrates more freely.
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Air
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Why will a denser and more solid structure(liver) give a softer, higher, shorter sound?
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Because it does not vibrate as easily.
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A denser and more solid structure (liver) gives off a ______, ______ and _______ sound because it does not vibrate as easily.
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Softer, Higher and Shorter
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A ________ and more _______ structure gives off a softer, higher and shorter sound because it does not vibrate as easily.
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Dense and more solid structure
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This percussion note has a medium-loud amplitude, a low pitch, a clear and hollow quality and a moderate duration. A sample location of this note would be over normal lung tissue.
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Resonant
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This percussion note has a louder amplitude, a lower pitch, a booming quality and a longer duration. A sample location would be normal over child's lung but abnormal in the adult.
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Hyperresonant
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This percussion sound is normal in a childs lung but in an adult lung means increased amount of air, such as emphysema.
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Hyperressonant
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This percussion note has a loud amplitude, a high pitch, a musical and drumlike quality and is sustained the longest. A sample location is over air-filled viscus like the stomach or intestine.
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Tympany
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This percussion note has a soft amplitude, a high pitch, a muffled thud and a short duration. A sample location would be a relatively dense organ, as liver or spleen.
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Dull
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This percussion note has a very soft amplitude, a high pitch, a dead stop of sound, absolute dullness and a very short duration. A sample location would be when no air is present, over thigh muscles, bone or over tumor.
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Flat
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What is the third step in the physical assessment?
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Percussion
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This step of the physical exam is listening to sounds produced by the body, such as the heart and blood vessels and the lungs and abdomen.
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Auscaltation
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Most body sounds are very soft and must be channeled through a _________ for you to evaluate them.
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Stethoscope
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True/False: A stethoscope magnifies sound.
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False
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This does not magnify sound, but does block out extraneous room sounds.
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Stethoscope
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The tubing of the stethoscope should be of (thick/thin) material.
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Thick
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On the stethoscope, The internal diameter of the tubing should be ___mm thick and about ___-___cm long.
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4mm thick and 36-46cm long
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What are the two end pieces of a stethoscope?
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A diaphragm and a bell
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This stethoscope end piece has a flat edge and is best for listening to high-pitched sounds, such as breath, bowel, and normal heart sounds.
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Diaphragm
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This stethoscope end piece has a deep,hollow, cuplike shape and is best for listening for soft,low-pitched sounds such as extra heart sounds or murmurs.
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Bell
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Hold the diaphragm firm enough against the person's skin so that it leaves a....
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Slight ring afterwards
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Hold the bell lightly against the person's skin just enough that it forms a....
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Perfect seal
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The diaphragm is meant to be held (firmly/lightly) against a person's skin.
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Firmly
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The bell is meant to be held (firmly/lightly) against a person's skin.
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Lightly
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Why is it important not to hold the bell too firmly against a person's skin?
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Because it would cause the person's skin to act as a diaphragm, obliterating the low-pitched sounds.
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Some new stethoscopes have one endpiece with a "________ ________", this enables you to listen to both low and high-frequency sounds without rotation of the endpiece.
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"Tunable diaphragm"
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Before evaluating body sounds, why is it important that the room is quiet.
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To prevent a "roaring" sound in the stethoscope.
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Before evaluating body sounds, why is it important to keep the examination room warm?
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Because if the person starts shivering, the involuntary muscle contractions could drown out other sounds.
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Before evaluating body sounds, why is it important to clean the stethoscope endpiece with an alcohol wipe and then warm it by rubbing it in your palm?
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To avoid the "chandelier sign" elicited when placing a cold endpiece on a warm chest.
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Before evaluating body sounds on a man with a hairy chest, what should be done to avoid a crackling sound?
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Wet the hair before ausculating the area
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True/False: It is sometimes okay to evaluate body sounds through a gown.
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False
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In evaluating body sounds, why is it important never to listen through a gown?
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Because listening through clothing creates artifactual sound and muffles any diagnostically valuable sound from the heart or lungs.
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When evaluating body sounds it is important to avoid your own "_______", such as breathing on the tubing or the "______" from bumping the tubing together.
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"artifact" and "thump"
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Before being able to identify abnormal body sounds, it first important to know what?
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What normal body sounds are suppose to sound like.
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A wallmounted or gooseneck stand lamp is needed for ______-_______ lighting.
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high-intensity
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This type of lamp is needed for high-intensity lighting. This provides tangential lighting (directed at an angle), which will highlight pulsations and body contours better than perpendicular lighting.
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Wall mounted or gooseneck lighting
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A wall mounted or gooseneck stand lamp is needed for high-intensity lighting. This provides "_______" lighting (directed at an angle), which will highlight pulsations and body contours better than perpendicular lighting.
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Tansgential
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This type of lighting will highlight pulsations and body contours better than perpendicular lighting.
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Tasgential
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This type of lamp is needed for high-intensity lighting.
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A wall-mounted or gooseneck stand lamp.
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The examination table should be equipped to raise the person's head up to ___ degrees.
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45* degrees
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The following items are usually needed for a screening physical examination:
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Platform scale with height attachment
Sphygmomanometer Stethoscope with bell and diaphragm endpieces Thermometer Pulse oximeter Paper and pencil or pen Flashlight or penlight Otoscope/opthalmoscope Tuning fork Nasal speculum Tongue depressor Pocket vision screener Skin-marking pen Flexible tape measure and ruler marked in centimeters Reflex hammer Sharp object(split tongue blade) Cotton balls Bivalve vaginal speculum Clean gloves Materials for cytologic study Lubricant Fecal occult blood test materials |
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This piece of examination equipment funnels light into the ear canal and onto the tympanic membrane.
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Otoscope
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On the otoscope there are five specula, each a different size. Choose the ____ one that will fit comfortably into the person's ear canal.
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Largest
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This piece of examination equipment illuminates the internal eye structures.
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Opthalmoscope
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The opthalmoscope uses a system of lenses and mirrors that enables you to look through the pupil at the _______(background) of the eye. Much like looking through a keyhole at a room beyond.
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Fundus
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This tool uses a system of lenses and mirrors that enables you to look through the pupil at the fundus (background) of the eye, much like looking through a keyhole at a room beyond.
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Opthalmoscope
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What are the five parts of the head on an opthalmoscope?
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1) Viewing aperture, with five different apertures 2) Aperture selector dial on front 3) Mirror window on the front 4) Lens selector dial 5) Lens indicator
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On the lens indicator of the opthalmoscope it shows a number- also known as the _______- that indicates the value of the lens in position
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diopter
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The black numbers on the opthalmoscope indicate a positive/negative lens.
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Positive
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The black numbers on the opthalmoscope indicate a positive lens from ___-____.
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0-40+
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The red numbers on the opthalmoscope indicate a positive/negative lens.
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Negative
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The red numbres on the opthalmoscope indicate a negative lens of ____ to ____.
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0-20-
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Nearsightedness
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Myopia
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When dealing with an opthalmoscope, what is MYOPIA?
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Nearsightedness
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Farsightedness
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Hyperopia
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When dealing with an opthalmoscope, what is HYPEROPIA?
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Farsightedness
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Will an opthalmoscope correct an astigmatism?
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NO
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Will an opthalmoscope correct nearsightedness(myopia)?
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YES
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Will an opthalmoscope correct myopia?
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YES
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Will an opthalmoscope correct farsightedness (hyperopia)?
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YES
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Will an opthalmoscope correct hyperopia?
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Yes
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This is occasionally used, depending on the individual's needs, to measure joint range of motion.
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Goniometer
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What is a goniometer used for?
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Joint range of motion
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This is occasionally used, depending on the individuals needs, to augment pulse or blood pressure measurement.
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Doppler sonometer
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What is a Doppler sonometer used for?
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Augmenting pulse or blood pressure
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This is occasionally used for ausculating fetal heart tones.
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Fetoscope
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What is a Fetoscope used for?
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Ausculating fetal heart tones
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This is occasioinally used to measure pelvic width.
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Pelvimeter
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What is a Pelvimeter used for?
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Measuring pelvic width
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An infection acquired during hospitalization
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Nosocomial infection
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What is a nosocomial infection?
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An infection acquired during hospitalization.
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What are a few microorganisms that are resistant to antibiotics?
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staphylococcus aureus, enterococcus, HIV
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What is the single most important step to decrease risk of microorganism transmission?
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Wash your hands!
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When should you wash your hands?
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1) before and after every physical patient encounter 2)after contact with blood, body fluids, secretions and excretions 3) after contact with any equipment contaminated with body fluids 4) after removing gloves
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This sanitation technique takes less time than soap and water and it also kills more organisms more quickly and is less damaging to the skin.
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Alchohol-based rub
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These are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents.
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Standard Precaustions
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T/F: Wearing gloves is a protective substitute for washing hands.
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False
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This test is used to measure visual acuity.
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Snellen eye chart
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What is the Snellen eye chart used for?
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To measure visual acuity
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T/F: Wearing gloves is a protective substitute for washing hands.
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False
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This test is used to measure visual acuity.
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Snellen eye chart
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What is the Snellen eye chart used for?
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To measure visual acuity
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During the physical examination, how does sharing information with you patient benefit you as a nurse.
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It helps build rapport and increases the person's confidence in you as an examiner.
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The _____ of the development is more meaningful than the exact chronological age.
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Order
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Erikson defines the major task of infancy as establishing ______.
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trust
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Why should the parent always be present during a physical exam of an infant?
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To understand normal growth and development and for the child's feeling of security.
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During the physical exam of the infant, where should the neotate be placed?
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On a padded examination table or held against a parent's chest for some steps
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Once the baby can sit without support (around 6 mos) where should most of the examination be performed?
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While the infant is sitting on the parent's lap.
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By ___-___ months, the infant is acutely aware of the surroundings. Anything outside the infant's range of vision is "lost", so the parent must be in full view.
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9-12months
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By 9-12 months, the infant is acutely aware of the surrounds. Anything outside the infant's range of vision is "______" , so the parent must be in full view.
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LOST
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When preparing for a physical exam of an infant, timing should be __-__ hours after feeding, when the baby is not too drowsy of too hungry.
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1-2hrs
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When is the proper time to perform the physical exam on the infant?
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Should be one to two hours after feeding, when the baby is not too drowsy or too hungry.
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When preparing for the physical exam of an infant, what should the temperature in the room be like? What may the infant require?
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Room should be warm. Infant may require an overhead radiant heater.
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An infant will not object to being nude. Have the parent remove outer clothing, but leave a _______ on a boy.
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Diaper
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An infant does not mind being touched, but make sure your hands and stethoscope endpiece are _____.
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Warm
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During a physical exam with an infant, we should use a soft, crooning voice because the baby responds more to the teeling in the ____ of the voice than to what was actually said.
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Tone
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T/F: We should lock eyes with an infant from time to time during the physical exam.
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TRUE, an infant likes eye contact
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T/F: We should frown during the physical exam of the infant.
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FALSE, Smile and take the time to play. Don't look so serious.
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T/F: We should keep movements jerky during the time of infant.
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FALSE, Movements should be kept smooth and deliberate
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T/F: It is okay to use a pacifier for crying or during invasive steps while doing a physical exam of an infant.
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TRUE
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During the physical exam of an infant, offer these for a distraction when the infant is fussy.
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Bright colored toys
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T/F: It is okay to let an older baby touch the stethoscope or tongue blade.
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TRUE
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During the physical exam of a sleeping infant, what steps should we do first?
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Listen to heart, lung and abdominal sounds
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T/F: During the physical exam on the infant, the invasive procedures such as the examination of the eye, ear, nose and throat should be done first.
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FALSE
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This test should be completed last when doing a physical exam of an infant, because it may cause the baby to cry.
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The Moro or "startle" reflex
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Erickson describes the Toddler stage as developing ________.
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Autonomy
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Which stage does Erickson describe as the development of autonomy.
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The Toddler
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What may a toddler experience some frustration or negativism in relation to autonomy.
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Because their will to explore the world conflicts with their dependency on their parents.
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Where should the toddler be positioned during the whole physial exam?
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On the parents lap
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Where should the toddler be positioned when it is required that the child be in a supine position, such as in the abdominal examination.
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On the parent's lap. Bring your chair up to the parent's chair and sit knee to knee with the parent. Have the child lay his or her head in the parents lap and his or her legs in your lap.
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T/F: Enlist the aid of a cooperative parent to help position the toddler during invasive procedures.
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TRUE
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Because children one to two years of age can understand symbols, what may be a good idea to supply as a security object?
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A blanky or teddy bear
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T/F: During the physical exam on the toddler you should pay more attention to the toddler than the parent.
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FALSE- Focus more on the parent. By essentially "ignoring" the child at first, you allow the child to adjust gradually and to size you up from a safe distance.
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T/F: You should always ask permission from a child for each exam step.
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FALSE- Children like to say "NO" and if they say no and you do it anyways-that child will lose trust in you. Instead use clear instructions of what you are going to do.
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Because one or two year old child likes to make choices, it is good to enhance autonomy by using a limited option. What would be an example of this?
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"Shall I listen to your heart next, or your tummy?"
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T/F: When assessing a toddler, it is a good idea to demonstrate procedures on the parent first.
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TRUE
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When should we note the child's gross motor and fine motor skills and gait?
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While attention is still focused on the parent
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While attention is still focused on the parent, what should we observe about the child?
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gross motor and fine motor skills and gait
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How should the physical assessment of the toddler begin?
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With games, such as the Denver II test or cranial nerve testing.
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T/F: When assessing a toddler, you should save the distressing procedures for last.
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TRUE
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The Preschool child is at the stage that displays developing ______.
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Initiative
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What stage in life does the child begin to develop "initiative?"
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The preschool phase
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Although a preschool age child can talk, it's important to remember that the child's understanding is limited. Use, ____, ____ explanations.
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Short, simple
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T/F: The preschooler is usually willing to undress.
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TRUE
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T/F: The toddler is usually willing to undress.
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FALSE
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T/F: During the physical exam of the preschooler, Talk to the parent and explain the steps in the examination exactly
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FALSE, talk directly to the child
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T/F: When assessing a preschooler, allow a choice whenever possible.
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FALSE, do not allow a choice when there is not
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T/F: During the physical exam of the preschooler, it is okay to allow the child to play with equipment.
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TRUE
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T/F: It is okay to allow the preschool age child to hold the stethoscope for you.
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TRUE
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T/F: Rush through the physical exam on a preschooler.
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FALSE
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What is an example of feedback you would provide to a preschooler during the physical exam?
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"Your tummy feels just fine"
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What should be examined first when assessing a preschool aged child?
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The thorax, abdomen, extremeties and genitalia
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What should be examined last durring the assessment of the preschooler?
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Head, eye, ear and nose
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During the school-age period, the major task of the child is developing ______.
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Industry
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What stage does the child develop industry?
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School aged child
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The major task of adolescense is developing a _______-________.
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Self identity
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During later years, the tasks are developing the _____ of ____.
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Meaning of life
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The aging adult tasks are about developing the ____ of ___.
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Meaning of life
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This person has tasks that are developed around the meaning of life.
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The aging adult
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Examining body areas appropriate to the problem helps develop a ____ _____.
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Minidatabase
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Mini database
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Examining the body areas appropriate to the problem.
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