Physical Examination PDF

Physical Examination/Assessment Usually conducted from the patient’s right General Survey side Vital Signs Follows a generally accepted sequence to Head and Neck minimize changes in position, respect patient Chest and Lungs privacy,...

Physical Examination/Assessment Usually conducted from the patient’s right General Survey side Vital Signs Follows a generally accepted sequence to Head and Neck minimize changes in position, respect patient Chest and Lungs privacy, and minimize discomfort Cardiovascular System Breasts and Axillae Scope varies depending on illness and Abdomen severity – comprehensive versus focused Genitourinary System Systematic process of using observational Musculoskeletal System skills (sight, hearing, and touch) to detect Skin and Extremities health problems and assess response to drug Neurologic System therapy Four Fundamental Techniques Inspection – visual surveillance Percussion – tapping with finger (directly or indirectly) to assess the density of underlying structures (by listening to the resultant sound [i.e., percussion note: resonant, dull, tympanic, flat]) Palpation – using hands to feel areas of the body that cannot be seen; performed with fingertips, palm, or back of hand that varies in depth (superficial vs. deep) Auscultation – listening (directly with ear or indirectly with the aid of a device) to sounds that arise from the body spontaneously  Inspection of Appearance and Behavior Observe the patient’s posture, gait, clothing, personal grooming, body habitus (physical characteristics), body position (e.g., sitting comfortably, shifting uncomfortably in pain, leaning forward with chin propped up on hands), affect (mood), and appropriateness of the patient’s affect to the situation. Examples Apparent state of health Ill appearing, muscular build, appears older than stated age, and appearance disheveled Normal: WDWN (well-developed, well-nourished), NAD (no active disease) Apparent state of Resting comfortably, in moderate distress discomfort or distress Behavior/Affect Follows commands and responds appropriately, appears anxious, withdrawn, combative, lethargic Posture and gait Hunched over, ambulates with cane Vital Signs (VS) Set of clinical measurements that reflects the patient’s overall health status Comprised of blood pressure (BP), heart rate (HR), respiratory rate (RR), temperature (T/Temp) ↓ * auscultation palpation inspection inspection  ☆ Palpation of Arterial Pulse Radial artery is used most often, but any accessible large artery can be used Assess the rate (or beats per minute), strength (normal, weak or bounding), and regularity (regular is evenly spaced vs. irregular is unequally spaced beats which can be regularly irregular or irregularly irregular) Normal: 60-100 beats/minute with normal strength and regular beats Palpation of Arterial Pulse Abnormal findings Causes Bradycardia (100 Medications (e.g., beta-agonists, stimulants, beats/min) epinephrine) Infection, anxiety, volume depletion, fever, exercise low volume Weak pulse Heart failure, hypovolemia Bounding pulse Anxiety, pain, hyperthyroidism Irregular hear rate Cardiac arrhythmias (e.g., atrial fibrillation) Inspection of Respiration Unobtrusively observe the patient breathe for complete respiratory cycles Assess the breaths per minute, pattern of breathing, and use of accessory muscles such as sternocleidomastoid and/or abdominals (transverse, oblique) Normal: normal depth with evenly spaced inspirations and expirations with a rate of 12-20 breaths/min Inspection of Respiration Abnormal findings Causes Deep breaths Metabolic acidosis Shallow breaths Obstructive airway disease Use of accessory muscles Asthma exacerbation Apnea: absence of Obstructive sleep apnea respiration Bradypnea: 20 Pain, anxiety, exercise, asthma exacerbation, breaths/minute COPD, pneumonia cholon obsuitive pulmonary disease Auscultation of Blood Pressure Palpate brachial artery and auscultate Korotkoff sounds with stethoscope and sphygmomanometer Appropriate blood pressure measurement requires specific technique and process that is often incorrectly executed in clinical practice Normal: systolic BP (SBP)