Chapter 5 -- Fundamentals of Physical Examination Flashcards


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Clinical Assessment in Respiratory Care, Wilkins.
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College: Second year
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1

four basic components of a physical examination

1. inspection
2. palpation
3. percussion
4. auscultation

2

initial examination

most often performed by the attending physician to assist in making the diagnosis

3

subsequent examination

performed by other members of the health care team to monitor the patient's progress and assess the patient's response to treatment

4

facial expressions

may provide clues to the mental status of the patient

5

nasal flaring

a sign of labored breathing

6

cyanosis

bluish color of the lips and tongue that indicates inadequate oxygenation of the blood

7

diaphoresis

sweating which is a sign of stress and common in patients having a myocardial infarction

8

examination of the eyes

- pupillary reflexes tested by shining a light into the patient's eyes
- pupils should be equal, round, reactive to light, and accommodation
- dilated pupils that respond poorly to light are often a sign of neurological damage
- ptosis (drooping eyelid) is a sign of neuromuscular disease (myasthenia gravis)

9

examination of the neck

- assess for jugular venous distention
- JVD is a sign of right heart failure
- assess for tracheal position; the trachea may shift left or right of center when one lung collapses or when a tumor is present in the neck or upper mediastinum
- palpate for lymphadenopathy; could occur with infection or malignancy

10

barrel chest

an abnormal increase in A-P diameter (COPD)

11

kyphosis

an abnormal A-P curvature of the spine

12

scolliosis

an abnormal lateral curvature of the spine

13

kyphoscoliosis

an abnormal A-P and lateral curvature of the spine

14

restrictive lung disease

rapid and shallow breathing

15

intrathoracic airway obstruction

prolonged expiratory time

16

upper airway obstruction

prolonged inspiratory time

17

use of accessory muscles

indicates an increase in the work of breathing

18

abdominal paradox

occurs when the abdomen sinks inward with each inspiratory effort

19

respiratory alternans

occurs with diaphragm fatigue and is seen as alternating between breathing only with the chest muscles and only breathing with the diaphragm

20

vocal fremitus

palpating the chest while the patient repeats the words "ninety-nine"

21

chest palpation

- increased with pneumonia and atelectasis
- decreased with emphysema and pneumothorax
- thoracic expansion
- normally both sides of the chest expand evenly with normal or deep breathing
- one side may under expand when atelectasis, pneumonia, or a lung tumor is present
- both sides may expand poorly with emphysema

22

chest percussion

- done during examination to access resonance of the underlying tissue
- normal air-filled lungs normally resonate
- hyper-inflated lung and pneumothorax will demonstrate increased resonance to percussion
- decreased resonance with pneumonia, atelectasis, and pleural effusion

23

chest auscultations

performed with a stethescope:
- bell (most often used to auscultate heart sounds)
- diaphragm (most often used to auscultate lungs sounds)
- tubing
- ear pieces

24

auscultation technique

- ask the patient to breath a little deeper than normal
- start at the apices and move toward the base
- compare sounds from one side to the other
- listen for breath sounds and adventitious lung sounds

25

precordium examination

- inspected and palpated for normal and abnormal pulsations
- normal point of maximal impulse is created by a healthy left ventricular systole
- usually felt in the 5th intercostal space on the left at the midclavicular line
- abnormal pulsation on precordium can occur with right/left ventricular hyperophy

26

cardiac murmurs

caused by rapid blood flow through a narrowed valve or backflow through an incompetent valve

27

systolic murmur

occurs when the blood passes trough narrowed semilunar valves or backflows through incompetent AV valves

28

diastolic murmur

occurs when stenotic AV valves or incompetent semilunar valves

29

abdomen examination

- performed to inspect and palpate for distention or tenderness
- an enlarged or tender abdomen can negatively influence breathing

30

hepatomegaly

a large liver

31

ascites

an abnormal collection of fluid in the peritoneal cavity

32

digital clubbing

can be a serious sign of chronic cardiopulmonary disease

33

peripheral cyanosis

consistent with poor circulation

34

pedal edema

may be a sign of heart failure (COPD)

35

physical examination

provides reliable and important evidence regarding the patient's clinical condition

36

respiratory therapists

must be skilled at PE to assess the patient's condition and evaluate the effects of treatments

37

best evaluation

comes from looking at multiple parameters from the PE