1



1. Abdomen(perform typical exam and investigate LUQ complaint)

❖ Ask if and where it hurts

❖ Instruments: Stethoscope, skin marker

❖ Pt supine with knees flexed

❖ Inspect: contour, site and shape of umbilicus; skin, dilated veins, visible peristalsis, visible pulsations, movement of 4 quadrants with respiration

❖ Auscultation of the abdomen, assessment of intestinal motility(bowel sounds) do with diaphragm in all 4 quadrants

❖ Normal 5-34 BS/min

❖ Bell over abdominal aorta, renal arteries, common iliac arteries listening for bruits(caused by turbulent blood flow due to atherosclerosis or vascular obstruction)

❖ Palpation of the abdomen(superficial to detect muscle guarding=involuntary muscle spasm often due to peritonitis, superficial masses and find ventral wall hernias; deep palpation-discover organ enlargement or masses

❖ Palpate area of C/C (pain) last

❖ Review the examination sequence for the following conditions:

• each abdominal organ

liver

- percuss, size assessment of liver(6-12 cm)

- palpate: support posterior inferior ribcage, describe lower border, hepatomegaly

spleen

- splenic percussion-sign test, detection of splenomegaly

- palpation, support posterior inferior ribcage, assessment of splenomegaly

kidneys

- palpation, detect enlarged/displaced kidney

- murphy’s punch: kidney swelling or infection

abdominal aorta

- palpation: detection of AAA, normal is 5mm; small BC)

▪ In conductive hearing loss, sound is heard through bone as long as or longer than it is through air(BC=AC or BC>AC)

▪ In sensorineural hearing loss, sound is heard longer through air(AC>BC)

[pic]

13. arterial(arterial insufficiency- 3 tests; allen’s, b/l BP, b/l pulses, capillary refill)

❖ Review the names and correct examination technique for the exams below

❖ Review tests to assess arterial insufficiency (upper and lower extremities) and venous insufficiency (lower extremities):

• 1. Arterial insufficiency in the upper extremity:

• Pale skin, peripheral cyanosis, capillary refill, Allen's test, palpate arterial pulses

• 2. Arterial insufficiency in the lower extremity:

Pale skin, peripheral loss of hair, thin skin, peripheral cyanosis, peripheral ulcers, capillary refill, “the painful red foot, inflammation or ischemia?”; Buerger's test

• 3. Venous insufficiency in the lower extremity:

• Thickened and pigmented skin, peripheral dependent edema, pitting edema, ankle ulcers, varicose veins, Trendelenburg's test

• 4. Assessment of edema:

• B/L; U/L, lymphedema, non-lymphedema, pitting edema, dependent edema

- carotid

- brachial

- radial

- ulnar

- aortic

- femoral

- popliteal

- posterior tibialis

- dorsalis pedis

14. cardio(what kind of sounds does the bell hear? Diaphragm? Which hears murmurs? Location of tricuspid valve? Describe blood flow through heart)

❖ Instruments: stethoscope, penlight, ruler

❖ Review correct location of the arteries and veins of the neck

❖ Assessment of increased central venous pressure = increased jugular venous pressure= abnormal hepatojugular reflux (caused by CHF etc.)

❖ Review the causes of increased central venous pressure = increased jugular venous pressure= abnormal hepatojugular reflux: right-sided heart failure (CHF), tricuspid stenosis, cardiac tamponade, constrictive pericarditis, superior vena cava obstruction, hypervolemia etc.

❖ Review how to measure JVP (perform only if requested) ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download