Physical Assessment: Adomen And Extremeties

Front 1

Why does auscultation preceed percussion and palpation in the abdominal exam?

Back 1

Because these 2 techniques can alter motility of the bowek and heighten bowel sounds

Front 2

What causes assymetry in the shape/contour of the abdomen?

Back 2

pregnancy, masses, obstruction, and increased fluid.

Front 3

Scaphoid

Back 3

sunken (dehydration) shape/contour of the abdomen

Front 4

Protuberant

Back 4

Protruding shape/contour of the abdomen- from pregnancy, rapid weight gain, or large weight loss

Front 5

Striae

Back 5

stretch marks. May be silvery, or red after weight loss. Due to pregnancy, rapid weight gain, or large weight loss.

Front 6

Inspect Umbilicas

Back 6

note contour, location, and signs of inflammation or hernia (umbilical hernia protrudes through the umbilicus)

Front 7

Inspect shape/contour of abdomen

Back 7

Is it:
Flat
Scaphoid
Rounded
Protuberant

Front 8

Inspect skin (abdomen) for:

Back 8

Scars
Striae
Umbilicus
Peristalsis
Pulsations

Front 9

Auscultate abdomen techniques:

Back 9

Listen in all 4 quadrants
Note frequency and character of bowel sounds
Listen for bruits
Liver and spleen for friction rubs

Front 10

What do bowel sounds sound like and how often do they occur?

Back 10

High pitched gurgling sounds
Occur every 5 to 15 seconds and range from 5-30 per minute

Front 11

Normal bowel sounds

Back 11

5-30 per minute

Front 12

Hypoactive bowel sounds

Back 12

less than 5

Front 13

Hyperactive bowel sounds

Back 13

greater than 30

Front 14

Borborygmus

Back 14

hyperactive bowel sounds
stomach growling

Front 15

What causes absence of bowel sounds?

Back 15

decreased intestinal motility, paralytic ileus, late bowel obstruction, peritonitis, and appendicitis. also in patients who have had surgery in the past 24 hours.

Front 16

Friction rubs

Back 16

abnormal rough grating sound (like 2 pieces of leather rubbing together)
usually heard over the liver and spleen and can possibly indicate infection, inflammation, and malignancy

Front 17

Bruits

Back 17

abnormal "purring" sound; likely to be heard over the abdominal aorta or renal arteries with the bell of the stethoscope. auscultate renal arteries, iliac arteries, and aorta for bruits

Front 18

Venous hum

Back 18

a continuous medium pitched sound auscultated in the epigastric and umbilical area. may indicate hepatic cirrhosis

Front 19

What 3 things do you percuss in the abdomen?

Back 19

Liver
Spleen
Stomach-Gastric air bubble (for tympany)

Front 20

Where do you percuss the stomach?

Back 20

located at the left 6th-7th rib

Front 21

The liver width is greater in ____ and ____

Back 21

1. men
2. tall individuals

Front 22

What should percussing the spleen sound like? What would dullness indicate?

Back 22

1. tympanic
2. the spleen is enlarged

Front 23

What 3 things do you lightly palpate for?

Back 23

Muscular resistance
Abdominal tenderness
Superficial organs and masses

Front 24

What 6 things do you deeply palpate for?

Back 24

masses
tender areas
liver
spleen
kidneys
aorta

Front 25

If mass is discovered, note these 6 characteristics:

Back 25

size
location
mobility
contour
consistency (soft, firm, hard)
tenderness

Front 26

Spleen must be ___ times its normal size to be palpated

Back 26

3

Front 27

When palpating the aorta, a prominent pulsation with lateral expansion suggests ____

Back 27

aortic aneurysm

Front 28

Superficial reflexes in abdomen

Back 28

upper abdominal reflexes
lower abdominal reflexes
cremastic reflex

Front 29

Inspect upper extremeties for:

Back 29

size and symmetry
color and texture of skin and nailbeds
venous pattern
edema

Front 30

normal nail bed angle

Back 30

160 degree angle between fingernail and nail base

Front 31

Shamroth technique

Back 31

place first phalanges of each finger together and assess for diamond-shaped space between

Front 32

normal capillary refill

Back 32

2 seconds or less

Front 33

sluggish capillary refill

Back 33

3-4 seconds

Front 34

abnormal capillary refill

Back 34

>4 seconds

Front 35

prominence in venous pattern and edema may suggest ____ ____

Back 35

venous obstruction

Front 36

Impaired circulation to extremety may be judged by:

Back 36

skin color
skin temperature
peripheral pulse
blanching nail beds
peripheral edema

Front 37

edema in interstitial fluid causes area to appear:

Back 37

swollen, shiny, and taut

Front 38

dependent edema

Back 38

found in areas of dependence such as feet in erect individual and sacrum in bedfast client

Front 39

peripheral edema

Back 39

feet, hands

Front 40

pitting edema

Back 40

press your finger into edematous area for 2-3 seconds and note the depth of indentation

Front 41

Grades of pitting edema: 1+

Back 41

slight pit, normal contour

Front 42

Grades of pitting edema: 2+

Back 42

deeper pit, fairly normal contour

Front 43

Grades of pitting edema: 3+

Back 43

puffy, appearance of deeper pit

Front 44

Grades of pitting edema: 4+

Back 44

extremely deep pit, definately swollen

Front 45

Anasarca

Back 45

generalized edema- massive edema.
Example is in renal disease where fluid retention continues over an extended period of time

Front 46

pulmonary edema

Back 46

fluid accumulation in lungs due to imbalanced capillary dynamics

Front 47

cerebral edema

Back 47

fluid within the brain

Front 48

pulmonary edema

Back 48

fluid accumulation in lungs due to imbalanced capillary dynamics

Front 49

cerebral edema

Back 49

fluid within the brain

Front 50

What do you auscultate the upper extremeties for?

Back 50

bruits on the brachial, radial, and ulnar arteries

Front 51

what does enlargement of the epitrochlear lymph nodes mean?

Back 51

infection of the hand and forearm

Front 52

What do you do if you can palpate the epitrochlear lymph node?

Back 52

note size, consistency, & tenderness. Should be very difficult to palpate, shouldn't be enlarged.

Front 53

What do you palpate the upper extremeties for?

Back 53

rate, rhythm, and quality of the brachial, radial, and ulnar pulses

Front 54

Deep tendon reflexes

Back 54

elicited by tapping a tendon

Front 55

superficial/cutaneous reflexes

Back 55

obtained by stimulating the skin

Front 56

pathological reflexes

Back 56

usually present only in disease

Front 57

reflexes grading scale:

Back 57

4+ brisk, hyperactive, clonus

3+ more brisk than norma, not necessarily indicitave of disease

2+ normal

1+ no response

Front 58

normal response of the triceps reflex

Back 58

palpable extension of the elbow

Front 59

normal response of the supinator or brachioradialis

Back 59

flexion of the elbow and supination of the forearm

Front 60

loss of hair on the lower extremeties indicates early signs of:

Back 60

peripheral arterial disease or arterial insufficiency

Front 61

to assess for arterial insufficiency in the lower extremeties, use:

Back 61

the 3 P's:
Pain (intermittent

Pallor

Pulselessness

*A client will have pain, decreased/absent peripheral pulses, pale skin color, cool skin temperature, mild edema, thin, shiny skin, loss of hair over the feet and toes, thickened nails. Ulcers may or may not be present

Front 62

intermittent quadication

Back 62

pain in legs

Front 63

Homan's sign indicates

Back 63

deep vein phlebitis/thrombosis

Front 64

normal response of the knee reflex

Back 64

leg extends, quadriceps contract

Front 65

normal response of the ankle reflex

Back 65

plantar flexion

Front 66

Normal response of the babinski reflex

Back 66

toes flex or remain still.

*Toes should not fan out, except on an infant

Front 67

Tandem walking

Back 67

heel-to-toe walking

Front 68

Romberg test

Back 68

-test for sensory equilibrium
-normal- slight swaying
-abnormal- loss of balance

Front 69

A positive Romberg test indicates

Back 69

cerebellar ataxia or vestibular dysfunction

Front 70

Muscle strength scale

Back 70

0 no movement at all
1 muscle contracts but extremety cannot move (you wil see muscle twitch)
2 extremety can move, but not against gravity
3 full range of motion against gravity only, not against resistamce
4 full range of motion against moderate resistance and gravity
5 normal movement against gravity and resistance

Front 71

abnormal response to finger to finger or finger to nose test

Back 71

cerebellar disease

Front 72

Loss of sensation and an abnormal position test response indicates

Back 72

peripheral neuropathy, alcoholism, and vitamin B12 deficiency

Front 73

tactile agnosia

Back 73

abnormal response to stereognosis test- inability to recognize objects by touch, may indicate a parietal lobe lesion

Front 74

graphesthesia

Back 74

number identification

Front 75

tongue minimal distance for two-point discrimination

Back 75

1mm

Front 76

fingertips minimal distance for two-point discrimination

Back 76

2-8mm

Front 77

toes minimal distance for two-point discrimination

Back 77

3-8mm

Front 78

palms of hands minimal distance for two-point discrimination

Back 78

8-12mm

Front 79

chest and forearms minimal distance for two-point discrimination

Back 79

40mm

Front 80

back minimal distance for two-point discrimination

Back 80

40-70mm

Front 81

upper arm and thighs minimal distance for two-point discrimination

Back 81

75mm

Front 82

Meningeal signs

Back 82

brudzinki's sign
kernig's sign

Front 83

a __ bruzinski's sign and a __ kernig's sign indicates disc disease

Back 83

negative
positive