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29 Cards in this Set

  • Front
  • Back
Know the purpose of percussion. (page 162)
The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ. (more on page 162)
Know the assessment technique always used to begin the physical assessment. (page 162)
"Inspection always comes first." (page 162)
Know situations/conditions/anatomy that tympany or flat sounds would be percussed. (page 164)
Tympany-Over air-filled viscus, e.g., the stomach, the intestine. Flat-When no air is present, over thigh muscles, bone, or over tumor.

**notes say possible fluid**
Explain what sounds would be best heart by the diaghragm and the bell of the stethoscope? (page 165)
You will use the diaghragm most often because its flat edge is best for high-pitched sounds-breath, bowel, and normal heart sounds. The bell endpiece has a deep, hollow cuplike shape. It is best for soft, low-pitched sounds such as extra heart sounds or murmurs.
Describe the assessment technique used to determine presence of crepitus, swelling and pulsations. (page 162???)
Describe the purpose of the otoscope. (page 166)
Funnels light into the ear canal and onto the tympanic membrane.
Describe the purpose of the Doppler US at the site of the pedal and radial artery. (also found on page 198)
(from notes)"Doppler for pedal pulse hand held transducer picks up sound of pulse wave"
"The Dopple technique is used to locate the peripheral pulse sites..."(page198)
Describe considerations in performing an assessment when it comes to patient comfort
"The examination room should be warm and comfortable, quiet, private, and well lit. (page165) "The patient is usually anxious due to the anticipation of being examined by a stranger and the unknown outcome of the examination. If anxiety can be reduced, the person will feel more comfortable and the data gathered will more closely describe the person's natural state." (page169)
The purpose of the CRIES assessment tool. (page 217)
"One tool that has been developed for postoperative pain in preterm and term neonates is the CRIES...Because the sympathetic nervous system is engaged particularly in acute episodes of pain, physiologic changes take place that may indicat the presence of pain. (ONLY CAN BE USED TO MEASURE ACUTE PAIN)
Explain the indications for handwashing, gloves while performing a PE (page 168)
Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not wearing gloves. Wash hands immediately after gloves are removed and between patient contacts. May need to wash hands between procedures on the same patient to prevent cross-contamination of different body sites."
"Wear clean gloves when touching blood, body fluids, secretions, excretions, items contaminated with theses, mucous membranes, and nonintact skin. Change gloves between tasks and procedures on the smae patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching noncontaminated items, and before going to another patient, and wash hands immediately." (page 168)
Describe considerations for performing an exam on an aging adult. (page 173)or possibly other chapters??
"Adjust examination pace to meet possible slowed pace of the aging person. It is better to break the complete examination into a few visits than to rush through the examination and turn off person. Use physical touch..., Do not mistake diminished vision or hearing for confusion. Be aware that agin years contain more of life's stress. Read page 173. Other things include that temp goes down, BP goes up....stuff like that.
Describe the current understanding of pain in pre term and neonates. (chp 11; page 211?)
"Infants have the same capacity for pain as adults. By 20 weeks' gestation, ascending fibers, neurotransmitters, and the cerebral cortex are developed and function to the extent that the fetus is capable of feeling pain. (Anand, 1993)
Describe the difference between a focused and complete assessment. Explain which type of exam you will consider when caring for a patient with SOB.
Personal guess: Focused assessment is conducted on one particular body system, where as complete is well...a complete assessment. And I think clearly you would do a focused exam on someone short of breath.
Describe the appropriate procedure when weighing a client. (page 178)
"Instruct the person to remove his or her shoes and heavy outer clothing before standing on the scale." (page 178)
Describe the appropriate procedure for taking a rectal, oral and tympanic temperature (Copied from Sendil)
Oral (Accurate and Convenient)
- Rectal (Only When Other Routes NOT Practical, High Patient Discomfort/Disruptive)
- Tympanic (Swift and Accurate)
- Axillary (Safe and Accurate when Environment is Reasonable Controlled)
Describe the contraindication for taking a rectal and oral temperature. (page 179
Oral (Accurate and Convenient)
- Rectal (Only When Other Routes NOT Practical, High Patient Discomfort/Disruptive)
- Tympanic (Swift and Accurate)
- Axillary (Safe and Accurate when Environment is Reasonable Controlled)
(Copied from Sandil)

"Take a rectal temperature only when the other routes are not practical-for example, for comatose or confused persons; for persons in shor; or for thos who cannot close the mouth because of breathing or oxygen tubes, wired mandible, or other facial dysfunctionor if no tympanic membrane thermometer equipment is available."
Describe why patients may assume a tripod position during a physical exam. (My own answer)
Generally when someone is SOB or having difficulty breathing they will begin to use their accessory muscles and lean forward with their hands on their knees.
Describe the vital sign changes in elderly clients. (pages 197)
"Temperature. Changes in the body's temperature regulatory mechanism leave the aging person less likely to develop fever but at a greater risk of developing hypothermia. Pulse. The normal range of heart rate is 60 to 100 bpm, but the rhythm may be slightly irregular. Respirations-Aging causes a decrease in vital capacity and a decreased inspiratory reserve volume. Blood pressure-The aorta and major arteries tend to harden with age. With many older people, both the systolic and diastolic perssures increase, making it difficult to distinguish normal aging values from abnormal hypertension. (page 197)
Describe how a normal pulse finding would be documented based on a rating scale. (page 180)
"Assess the pulse, including (1)rate, (2)rhythm, (3)force, and (4)elasticity."
Describe the implications of using an incorrect size BP cuff on a patient
Too small cuff= false high reading. Too big cuff=false low reading.
Describe the “ABCDE” rule. (page 231)
Border irregularity
Color variation
Diameter greater than 6mm
Elevation and Enlargement
Define pulse pressure. If BP reading is 170/100, what is pulse pressure. (taken from Sandil's slide)
Define pulse deficit.
"...check for a pulse deficit by auscultating the apical beat whil simultaneously palpating the radial pulse..."(page 507)
Describe the purpose of postural vital signs. Consider findings that would indicate postural hypotension. (page 187)
"Take serial measurements of puls and blood pressure when: you suspect volume depletion; when the person is known to have hypertension or is taking antihypertensive medications; or when the person reports fainting or syncope...Orthostatic hypotension, a drop in systolic pressure of more than 20mm Hg, and/or orthostatic pulse increases of 20 bpm, or more, occurs with a quick change to a standing position. These changes are due to abrupt peripheral vasodilation without a compensatory increase in cardiac output. Orthostatic changes also occur with prolonged bedrest, older age, hypovolemia, and some drugs.
What is the purpose of the palpating systolic before auscultating? What BP measurement error may occur with out following this procedure. (page 185)
"...Inflate the cuff until the artery pulsation is obliterated and then 20 to 30 mmHg beyond. This will avoid missing an auscultatory gap..."
Define a lesion that is solid, elevated, circumscribed and less than 1 cm in diameter. (page 252)
Define clubbing. (page 236)
"Clubbing of nails occurs with congenital chronic cyanotic heart disease and with emphysema and chronic bronchitis. In early clubbing, the angle straightens out to 180 degrees and the nail base feels spongy to palpation."
Wat would decreased skin turgor indicate. (page 234)
"Poor turgor is evident in severe dehydration or extreme weight loss; the pinched skin recedes slowly or "tents" and stands by itself."
Define the medical term for a mole.(page 231)
Nevus- a proliferation of melanocytes, tan to brown color, flat or raised.