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asessment normal findings

asessment normal findings

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assessment normal findings
assessment normal findings

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Published by: Amy on Apr 19, 2009
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Physical Examination
Marfori, Francis Anthony V, MD, BSN
Definition of Terms
\ue000Symptoms
\ue001Reasons why patient/s see/s the
physician
\ue001Unpleasant
unusual

subjective sensation which affects the patient\u2019s comfort and productivity

\ue001E.g. \u2013 pain
Definition of Terms
\ue001The seven attributes of a symptom
\u2022Location
\ue001Where is it? Does it radiate?
\u2022Quality
\ue001What is it like?
\u2022Quantity or Severity
\ue001How bad is it?
\u2022Timing
\ue001When did / does it start? How long
does it start? How often does it come?
Definition of Terms
\ue001The seven attributes of a symptoms
\u2022TheSetting in which it occurs,
including
environmental
factors,
personal
activities,

emotional reactions, or other circumstances that may have contributed to the illness

\u2022Factors that make it better or worse
\u2022Associated manifestations
Definition of Terms
\ue000Signs
\ue001Alteration in function / structure
which can be detected by a physical
examination
\ue001Objective evidence of a disease as
detected by a physical examination
\ue001E.g. \u2013 high temperature, flushing,
marked weight loss
Definition of Terms
\ue000Syndrome
\ue001A group of symptoms and/or signs
that, occurring together, constitute a
particular disorder
\ue001E.g. \u2013 irritable bowel syndrome
\u2022Intermittent pain in the lower
abdomen

\u2022Abdominal swelling
\u2022Irregular bowel movements
\u2022Mucus in the feces
\u2022Excessive gas
\u2022Worsening of symptoms after eating

Introduction
\ue000Most
patients
view
physical
examination with at least some anxiety
\ue000A thorough examination does more
than prevent sickness and prolong the
lives of healthy men and women
\ue000A privilege \u2013 show some respect
Introduction
\ue0004 fundamentals

\ue001Inspection
\ue001Palpation
\ue001Auscultation
\ue001Percussion

Introduction
\ue000Inspection
\ue001Examination of patient by way of
observing the patient
\ue001Needs: good pair of eyes, good
lighting
\ue001E.g. \u2013 color, lesions, pigmentation
Introduction
\ue000Palpation
\ue001Examination of the body by the sense
of touch
\ue001Supplement inspection
\ue001E.g. \u2013 fremitus, crepitations, chest
expansion
Introduction
\ue000Auscultation
1
\ue001Act of listening to a sound produced
by the body
\ue001Direct \u2013 ear; indirect \u2013 stethoscope
\ue001E.g. \u2013 heart sounds, breath sounds,
vascular sounds, peristaltic sounds,
fetal heart sounds
Introduction
\ue000Percussion
\ue001Technique by striking the chest wall

and perceiving the character of the sensation as they are perceived by the ear and palpating fingers

\ue001To detect amount of air, presence of
fluid, presence of organomegaly
\ue001E.g.
\u2022Resonance \u2013 percussion of lung
containing a normal amount of air
(normal lung)

\u2022Hyperresonance
\u2022Flatness \u2013 less than normal air (thigh)
\u2022Dullness \u2013 air has been completely

removed (liver)
\u2022Tympany \u2013 air in an enclosed chamber
(gastric air bubble)
Introduction
\ue000Setting the stage
\ue001Reflect on your approach to the
patient
\ue001Decide on the scope of the
examination
\ue001Choose the examination sequence
\ue001Adjust
the
lighting
and
the
environment
\ue001Make the patient comfortable
Introduction
\ue000Approaching the patient
\ue001Let the patient know you are a
student
\ue001May need to spend more time
\ue001Avoid interpreting your findings
Introduction
\ue000Scope of the examination: how
complete should it be?

\ue001Comprehensive?
\ue001Focused?
\ue001General

Principle:
new
patient
warrants
a
complete

physical examination, regardless of the chief complaint or setting

Introduction
\ue000On Choosing the exam sequence,
position and handedness
\ue001Head to toe (cephalocaudal)
\u2022Not from feet, genitalia or rectum to
face or mouth
\u2022Not from rectum to vagina
\ue001Examine from the patients right side
\ue001Sitting, supine patient depending on
the area examined
Introduction
\ue000Adjusting lighting and environment

\ue001Adjust the bed
\ue001Ask the patient to move toward you
\ue001Tangential lighting for examination of

JVP, thyroid gland, apical impulse
Introduction
\ue000Promoting the patient\u2019s comfort
\ue001Show concern for privacy and
comfort
\ue001Draping the patient: visualize one
area of the body at a time
Introduction
\ue000Hand washing! ! ! ! !
Introduction
\ue000Overview
of
a
comprehensive
examination

\ue001General survey
\ue001Vital signs
\ue001Skin
\ue001Head
\ue001Eyes
\ue001Ears
\ue001Nose and sinuses
\ue001Mouth and pharynx
\ue001Neck
\ue001Back
\ue001Posterior thorax and lungs
\ue001Breast, axilla and epitrochlear nodes

2

\ue001Musculoskeletal system
\ue001Breasts
\ue001Anterior thorax and lungs
\ue001Cardiovascular system
\ue001Abdomen
\ue001Rectal examination in men
\ue001Genitalia and rectal examination in

women

\ue001Legs
\ue001Neurological examination
\ue001Mental status

General Survey

\ue000Psyche / mental status
\ue000Apparent state of health
\ue000Signs of distress
\ue000Position and posture
\ue000Movement and paralysis / paresis
\ue000Gait

\ue000Speech
\ue000Nutritional status
\ue000Development and stature
\ue000Temperature
\ue000Facies
\ue000Skin

General Survey \u2013 Psyche / Mental State
\ue000Degree
of
consciousness

or awareness of a patient to his environment

\ue001Mood

\u2022Anxious
\u2022Apathetic
\u2022Depressed
\u2022Elation
\u2022Hostility
\u2022Withdrawn

\ue001Intellect \u2013 dull or intelligent
\ue001Orientation \u2013 time, place and person
General Survey \u2013 Psyche / Mental State
\ue000Levels of consciousness
\ue001Coma
\u2022Deepest stage, unarousable
\u2022Semi-coma \u2013 positive response to
pinprick
\ue001Stupor
\u2022Marked reduction in mental and
physical activity
\u2022Sleeping but arousable
\ue001Delirium
\u2022Confused state with agitation and
hallucination
\ue001Confusion
\u2022Mental slowness, inattentiveness
\u2022Incoherence in thinking
General Survey \u2013 Psyche / Mental State
General Survey \u2013 Psyche / Mental State
\ue000Examples
of
disturbances
in
orientation and emotional states
\ue001Korsakoff\u2019s syndrome
\u2022Disorientation
state
in
chronic
alcoholism
\ue001Grave\u2019s disease (hyperthyroidism)
\u2022Mentally quick, unusually alert
\ue001Myxedema (hypothyroidism)
\u2022Alligator look \u2013 dull, apathetic, lack of
intelligence, swollen face, heavy eyes
\ue001Catatonia
\u2022Statue like, in psychiatric patient
General Survey \u2013 Apparent State of
Health
\ue000Judging from the general appearance
of the patient

\ue001In good health
\ue001Acutely ill / Chronically ill
\ue001Frail / robust

General Survey \u2013 Cardiac / Respiratory
Distress
\ue000Types

\ue001Dyspnea
\ue001Orthopnea
\ue001Tachypnea \u2013 increase RR
\ue001Bradypnea
\ue001Hyperpnea \u2013 increase RR and depth

\ue000Severity

\ue001Mild
\ue001Moderate
\ue001Severe

\ue000Pain, anxiety or depression
General Survey \u2013 Position and Posture
\ue000One holds the body while sitting and
standing
\ue000Height and build

\ue001Unusually short or tall
\ue001Slender or muscular
\ue001Body symmetry
\ue001Look for deformities

General Survey \u2013 Position and Posture
3

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