Respiratory
How many auscultation spots are on anterior and posterior chest?
10 and 18
What is the abnormal cracking or popping sometimes heard in MSK joints?
Crepitus
Where is S1 and S2 loudest?
S1 is loudest at Tricuspid and Mitral
S2 is loudest at Aortic and Pulmonic
What is the ranges for bowel sounds (all three types)?
Hypoactive <5
Normoactive 5-30
Hyperactive 30+
How long do you keep a tempadot in for?
A minute.
When listening to breath sounds, how should you instruct your patient to complete the assessment?
Deep breaths through mouth
List three abnormal colours that can be present when assessing skin?
Cyanosis - blue
Pallor - Grey
Jaundice - yellow
What are the names of the two pedal pulses?
Dorsalis Pedis
Posterior Tibialis
Ensure we are assessing that quadrant last.
Descriptors for respiratory
Clear, Even, Unlaboured, Deep, Shallow
Where do you assess chest expansion anteriorly?
xiphoid process
What is S3?
Third heart sound known as a "gallop". Third sound after "lub dub".
What is a pulse deficit? What does it indicate?
A difference between the sound of the apical pulse at the apex with the pulse at another site (in HEAS we do Radial). It indicates the hearts contractions are too weak to produce a peripheral pulse.
Whats the order of assesesment
Inspection for contour, Auscultation for bowel sounds, Palpation for masses and tenderness
Descriptors for pulse
Strength (strong, moderate, weak, thready, absent), Regular/ irregular
Where are you assessing when completing a tactile fremitus assessment?
You are assessing for vibrations when the patient is saying "99". Hands should be positioned with only the outer aspect of the hand on the chest. Increased vibrations means tissue is more solid which may indicate pneumonia. Decreased vibrations could be air or fluid blockage.
Stridor
Wheezing
Crackles (rales)
Pleural friction rub
What is JVD? How do we assess this?
Jugular Vein Distension.
Bulging of jugular vein. This can be a sign of HF or fluid overload.
Have patient in 30-40 degree angle and have patient look opposite from nurse. This allows for better visualization. You are looking for pulsations.
What would absence of bowel sounds indicate?
Potential blockage. This is an emergency!!!
How do you position the pinna for tympanic temperature? Why is it important we do this?
Adults - Pull up and out
To straighten the ear canal to get an accurate temperature
What types of chest sounds are heard anteriorly?
Vesicular, Bronchial vesicular, Bronchial
What is abnormal flexion and abnormal extension?
Also known as decorticate posturing (flexion) this is a sign of brain injury.
Also known as decerebrate posturing (extension) this is a sign of brain stem damage.
If a patient has a below knee amputation, what pulses would you evaluate?
Femoral and popliteal
What is rebound tenderness? What diagnosis would this indicate?
Upon pressure to the site, pain/ tenderness is alleviated. When pressure is taken off the site, pain resumes. Indicative of appendicitis.
Why do we add 30mmHg to our calculated baseline?
To assist us in verifying where we lose the pulse. Additionally, so that when we re-inflate we are able to accurately hear when we hear the first sound (Systolic).