Exam #1 Outline
How to use a stethoscope – bell, diaphragm
-Bell: used for low pitched sounds ex: mummurs
-Diaphragm: used for normal high pitched sounds
Pulses – Location, how do you assess?
Carotid, Axillary, Radial, Brachial, Femoral, Dorsalis pedis, Popliteal, Posterior tibial
Assess: Rhythm, Rate, Force, Equality
Heart Sounds - Location, characteristics, and what do they mean?
S1- Heard at the apex (mitral area), occurs when AV valves close shut, start of systole,
S2- Heard at the base(pulmonary area), occurs when Semilunar valves close shut.
Skin color changes
Pallor: Unhealthy pale appearence
Cyanosis: Skin turns blue due to lack of o2 in blood.
Erythema: Redness caused by injury or inflammation. Can appear as rash, sunburn
Jaundice: Skin turns yellow due to high level of bilirubin.
Brown-tan- Hyperpigmentation, excess of melanin.
Hyper/hypoventilation
Hyperventilation: Rapid deep breathing (tachypnea)
Hypoventilation: Shallow slow breathing. Co2 levels rise, causes sleepiness. (Bradypnea)
Normal breath sounds - identify.
Bronchovesicular sounds are medium-pitched and heard over the major bronchi.
Vesicular breath sounds are heard over the lung surfaces, are lower-pitched, and often described as
soft, rustling sounds.
Abnormal breath sounds - identify.
Adventitious- abnormal, heard during asscultation
Crackles: rales, short, explosive heard in the small or middle of lungs, associated with fluid or
secretions in the lungs
Fine crackles- higher frewquency short duration Coarse crackles- low pitch longer in duration
Wheezes- occurs as air flows throw narrow airway.
Rhonchi- low pitch dull, sounds like snoring.
Stridor- high pitched occurs during obstruction
Diminished- decreased air movement in lunfs
Blood flow through the heart
Blood comes into the right atrium from the body, moves into the right ventricle and is pushed into the
pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the heart through
the pulmonary veins into the left atrium, to the left ventricle and out to the body's tissues through the
aorta.
Risk factors for heart disease
high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and
secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity.
Jugular venous Distension
Bulging of the major veins in your neck. It's a key symptom of heart failure and other heart and
circulatory problems.
Pulse deficit
the difference between the apical and peripheral pulse rates--can signal an arrhythmia
Thoracic expansion
Normal: Chest expansion is symmetrical. Both sides take off at the same time and to the same extent.
Abnormal. Asymmetrical chest expansion is abnormal. The abnormal side expands less and lags
behind the normal side
Bronchovesicular breath sounds
Bronchovesicular sounds are medium-pitched and heard over the major bronchi.
Lung auscultation Technique
Using the diaphragm of the stethoscope, start auscultation anteriorly at the apices, and move
downward till no breath sound is appreciated. Next, listen to the back, starting at the apices and
moving downward. At least one complete respiratory cycle should be heard at each site.
Skin assessment – tools, findings
The Braden Scale is a scale made up of six subscales, which measure elements of risk that
contribute to either higher intensity and duration of pressure, or lower tissue tolerance for
pressure. These are: sensory perception, moisture, activity, mobility, friction,
skin color, moisture, temperature, texture, mobility and turgor, and skin lesions.
Physical examination steps
Guidelines for obtaining a health history.
Skin turgor
Skin turgor is the skin's elasticity. It is the ability of skin to change shape and return to normal.
Heart murmur
whooshing or swishing — made by rapid, choppy (turbulent) blood flow through the heart.
Culture and care
Pain/pain assessment
Patients should be asked to describe their pain in terms of the following characteristics: location,
radiation, mode of onset, character, temporal pattern, exacerbating and relieving factors, and
intensity
Subjective and objective data
Subjective- What patient tells you
Objective- What you can hear, see or touch during assessment.
Assessment Techniques and sequence
Tactile fremitus
the palpable vibration of the chest wall that results from the transmission of sound vibrations
through the lung tissue to the chest wall.
costovertebral angle
CVA- CVA tenderness often indicates kidney pathology.
voice sounds