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95 Cards in this Set
- Front
- Back
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technique for palpation of lymph nodes
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lightly press with 2nd, 3rd, 4th finger; head titled or to the side
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significance of enlarged supraclavicular nodes
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always a cause for concern- especially if non-tender, may indicate cancer metastasis from breast or thorax
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major bones in skull
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parietal
spenoid temporal occipital mastoid process malar or zygomatic frontal supercillary arch orbital cavity nasal bone nasal fossa maxilla mandible |
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sinsuses that can be examined during physical assessment
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frontal, thumbs pressed under the bony brow on each side of the nose
maxillary, press under the zygomatic processes, using either your thumbs or index & middle fingers |
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function of nasal turbinates
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warm the air breathed in
help fights infection direct air flow |
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how to assess for vegas nerve impairment
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failure of the soft palate to rise bilaterally with vocalization may result from paralysis of the vegas.
check gag reflex by touching posteior wall of the pharynex |
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Mouth assessment techniques
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palpate lips
inspect teeth inspect & palpate the gngivae inspect tongue & buccal mucosa palpate the tongue inspect the palate & uvula inspect oropharyngeal (tonsils & posterior wall of pharynx) elicit gag reflex |
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anatomy of external ear
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auricle/pinna
external auditory canal |
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anatomy of middle ear
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ossicle (malleus, incus, stapes)
it transmits sound from tympanic membran to the oval window of inner ear |
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anatomy of inner ear
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vestiblue
semicircular canals cochlea (contains corti) |
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abnormalities of the ears
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low set ears - down's, trisomy, turner syndrome
tophi - deposits of uric crystals (gout) darwins tubercle preauricular pits |
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auditory canal abnormalities
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dischare purlent, foul smelling - otitis; blood/serous discharge - skull fx
cerumen scaling redness & swelling lesions foreign bodies |
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ear abnormalities
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perforated eardrum
otitis myringotomy tubes bulging cerumen |
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normal eardrum
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no perforations
pearly gray color |
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weber test
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no lateralization is normal
conductive loss if lateralization to deaf ear sensrineural loss if lateralization to better ear |
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Rinne test
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conductive loss - bone conduction greater than air
sensorineural loss - air conduction greater than bone but leass than 2:1 |
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pull the pinna in what direction when inserting speculum
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pull up and back
tilt pt head away insert 1/2 inch |
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normal rinne test
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air conduction should be 2:1
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asymmetry of corneal light reflex may indicate
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weak extraocular muscle
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normal response to the pupil of the eye is to
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constrict in response to a bright light
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PERRLA
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pupils are equal, round and react to light and accomodation
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consensual papillary response
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light is shown in one but both react equally
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absence or diminshment of the red reflex in the eye may indicate
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opacity of the cornea; cornea is normally transparent
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mental status exam
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what is
where are 3 objects, pt renames count backwards again name the 3 objects ask pt to name two simple object they were shown repeat phrase, no ifs, ands, or buts "tells pt. to ___ with paper "please read do what it says "write sentence about anything "copy the picture |
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components of mental status exam
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orientation
registration attention & calculation recall language |
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dermatomes
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the area of body surface innervated by particular spinal nerves
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level of consciousness
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normal
drowsiness or obtundation stupor coma |
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normal consciousness
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persons are alert, awake, & aware of both self & the environment, & respond to external stimuli
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drowsiness or obtundation
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drowsy(obtundation) persons are not fully alert to their environment. clouded & attentiveness is impaired. think more slowly & less clearly. spontaneous movement diminshed
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stupor
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reduction in mental & physical activity. vigurous stimuli needed to elicit response
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coma
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completely unconscious
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glasgow coma scale
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hour-to-hour eval; helps to id improvment, stable, or deteriorating
opening of eyes verbal responses motor responses |
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positive romberg sign
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loss of balance; indicating cerebellar ataxia, vestibular dysfuntion, or sensory loss
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deep tendon reflexes
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0 no response
.5 only elicited w/ reinforcement 1 low normal, diminished 2 normal 3 brisk or more reflexive than normally 4 very brisk, hyperflexive, w/ clonus 5 sustained clonus |
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neurovascular assessment (establish baseline) pt musculoskeletal trauma
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check for compartment syndrome
check for CMS |
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CMS
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circulation
movement sensation |
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compartment syndrome occurs
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when excessive pressure constricts the sturctures within a compartment within the limbs, and reduces circulation to muscles and nerves
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compartment syndrome 5 p's
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pain
pallor pulselessness paresthesia paralysis eventual renal failure |
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pulmonary emboli
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blood closts broke off traveled to lungs blocked an artery supplying blood to lungs
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fat emboli
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fat gobules released from marrow of broken bone into blood stream. traveled to lungs lodged into capillaries, broke down to fatty acid causing pulmonary hypertension
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CMS checks
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circulation/color pink (not white or blue) warm to touch, capillary refill instant, peripheral pulses
motion - can move fingers or toes spontaneously without pain sensitivity - no numbness; can feel touch |
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a compartment is
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a space enclosed by fibrous membrane of fascia
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volkmans contracture
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complications of fracture of elbow joint or forearm
begins as compartment syndrome muscle atrophy, fingers & forearm permanently flexed in claw |
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fractures
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torsion - sudden twisting motion
pathologic - collapse of the bone due to a tumor or disease process compression - crushing force or direct blow fatigue or stress - prolonged stress; as in track avulsion - liagment or tendon pulls a fragment of bone away (grade 4 strains) |
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contusion
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injury to soft tissue w/ no damage to musculoskeletal structures
by blunt force or blow s/s - swelling, tenderness, localized hemorrhage, loss of ROM due to pain |
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strain
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tear in muscle that results in bleeding into the tissues
muscle is stretched beyond it's capacity s/s sharp or dull pain that increases with movement of muscle, swelling, tenderness |
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sprain
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liagment injury with bleeding in soft tissue
twisting motion - forces going in opposite direction s/s joint instability, edema, swelling, |
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RICE (minor sprains & strains)
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rest
ice compression elevation |
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types of fractures
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open/compound
closed/simple complete incomplete stable/non-displaced unstable/displaced |
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closed/simple fracture
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skin intact
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open/compound
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skin integrity is interupted
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complete fracture
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involve entire width of bone
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incomplete fracture
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doesn't involve entire width of bone
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stable/non-displaced
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bones maintain their anatomical alignment
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Direct force
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kinetic energy applied at or near the site of the fx. The bone cannot withstand the force.
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Indirect force
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the kinetic energy is transmitted form the point of impact to a site where the bone is weaker. The fracture occurs at the weaker point.
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Fractures
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The bone is unable to absorb the kinetic energy to which it is subjected
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Bone Healing
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Hematoma formation
Cellular proliferat Callus ossificationion Callus formation Consolidation and remodeling |
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Osteomyelitis
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Infection – Occurs as a complication of compound fx or following surgery
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Avascular necrosis
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Bone cells are deprived of 02 and nutrients; they die and their cell walls collapse
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Factors that impede bone healing
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Excessive edema – impedes supply of nutrients
Location, severity, blood and nutrition supply |
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Delayed union
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failure of a fracture to consolidate in the usual time
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Non-union
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failure to form a stable union after 6-9 months
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Malunion
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healing with deformity
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Methods of reduction
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bring the ends into proper alignment
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Open reduction
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usually used in compound and comminuted fx
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Internal fixation
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promotes early mobilization and is often preferred for old adults (brittle bones, increased risk of immobility
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External fixation
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pins attached to external frame. Preferred with extensive soft tissue damage or infection. Provides for early ambulation
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Traction
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The use of a pulling force to treat muscle and skeleton disorders
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Tinel sign
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strike over
median nerve indication of carpal tunnel syndrome |
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Measuring leg length
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Measure from anterior superior iliac spine to medial malleolus of the ankle, crossing the knee on the medial side
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Joints
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Synarthrodial
Amphyarthrodial Diarthrodial (synovial) |
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Diarthrodial joint sub-types
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Ball-and-socket
Hinge Condylar – knee flexes and extends and rotates slightly Biaxial (gliding movement of wrist) Pivot – permit rotations only, as in radio-ulnar area |
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Rotator cuff injuries
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injuries to the capsule of 4 muscles and their tendons surrounding the shoulder joint.
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Assessment of the Musculoskeletal System
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Inspection
Palpation ROM Muscle strength Special tests and procedures Tools – tape measure, goniometer Ask the client to contract the muscle by extending or flexing the joint; then resist as examiner applies force against the muscle contraction Compare strength bilaterally May be graded 1 to 5 with 5 being full resistance |
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Inspection muscle
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Posture/gait
Symmetry Alignment |
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Kyphosis
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An outward curvature of the thoracic spine – hunchback appearance
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Lordosis
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Exaggerated curvature of the lumbar spine (if back is flexible, usually no medical intervention is needed
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Scoliosis
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Lateral curvature of the spine
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Thomas Test
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checking for hip flexion contracture in the extended leg
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Trendelenburg Test
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testing for weak hip abductor muscles on the weight-bearing side –
indicated by drop of iliac crest on side of lifted leg. |
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order of assessment for muscular
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inspection
palpation ROM muscle strength |
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visual acuity
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snellen chart
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confrotation testing visual field is
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the total area where objects can be seen in the peripheral vision while the eye is focused on a central point.
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Abnormal growth of the conjunctiva over the cornea; may be due to
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overexposure to ultraviolet light
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Conjuctivitis
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“pink eye”; purulent drainage; extremely infectious
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Cataracts
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Opacity or clouding of the lens; protein breakdown due to aging; also hypoparathyroidism, steroids, maternal rubella
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Hordeolum
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stye
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Proprioception and Cerebellar Function
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Rapid rhythmic alternating movements
Accuracy of movements Balance Romberg Gait Sensory Function Cortical Sensory Functions Reflexes |
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Accuracy of movements
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finger to finger test
finger to nose test heel to shin test |
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Balance Romberg
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pronator drift
stand on one foot hop on one foot |
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Gait
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barefoot
heel to toe |
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Sensory Function
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Superficial touch
Superficial pain Temperature and deep pressure Vibrations Position |
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Cortical Sensory Functions
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Stereognosis
Two-point discrimination Extinction Phenomenon Graphesthesia |
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Reflexes
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Superficial
Babinski – Plantar – stroke lateral side of foot from heel to ball Babinski sign (not expected in adults) is dorsiflexion of big toe |
