PA MIDTERM SG
Apex: point of maximal impulse ; apical pulse
• LMCL 5th ICS (heart sits here at 5th ICS)
• Hold stethoscope for 1 full min (60 sec) on apical pulse
• You should hear a soft vibration, tapping sensation
Dark Skin
Pallor: skin is ash-gray, yellow-tinged, looks dull
Jaundice: Yellow undertone in oral mucosa, palm of hand and feet
Erythema: purple or darker than surrounding skin, accompanied by higher
temp, hardness & swelling
Light Skin
Pallor: loss of rosy tones, pt appears with yellow tones
Jaundice: Yellow undertone
Erythema: redness accompanied by higher temperature at site
Shamroth Technique
— assessing for clubbing
— Ask pt to bring dorsal aspect o corresponding fingers together creating a
mirror image
AFIB:
• No P-wave, irregular (Dysrhythmic atrial contraction with no regularity or
pattern)
• Atria is fluttering and pumping ineffectively, stasis (pooling) in the atria &
ventricles
• Pt can develop clot, pt’s with AFIB will be on blood thinners
Atrial Flutter: No P-wave, sawtooth looking
Dehydration: capillary refill, skin turgor
HEART LANDMARKS:
Aortic: RSB 2nd ICS Pulmonic: LSB 2nd ICS
Erb’s: LSB 3rd ICS
Tricuspid: LSB 4th ICS
*Mitral: LMCL 5th ICS*
Otoscope: pull ear up and back
Arterial Insufficiency:
Objective data:
• Diminished pulses, cool shiny skin
, • absence of hair on toes, pallor lower extremities on elevation
• Red color lower extremities
Subjective data:
• Pain, aching burning, discomfort in feet, calve, thighs
• Numbness when at rest in legs/feet
• Appearance of symptoms when walking uphill (claudication)
⁃ medial and outer canthus location for eye assessment
Vision Defects:
Emmetropia: normal vision 20/20
Myopia: nearsightedness, light rays focus in front of retina
Hyperopia: farsightedness, light rays focus behind the retina
Presbyopia: older pt, light ray focuses past the retina, hyperopia, farsighted
Presbecusis: gradual hearing loss in older pt
Xanthelasma: yellow plaques on lids at inner canthus
Pingueculae: yellow nodules on conjuctiva, does NOT affect vision, caused
by too much sun expose or wind/dust
Pterygium: pink nodules on conjuctiva, can affect vision and grow over the
cornea
Weber Test: testing bone conduction, place tuning fork on midline of
anterior frontal lobe of skull, normal is documented no lateralization
[abnormal loss in right? document it is lateralized to the left]
Rhine Test: Bone conduction & Air conduction. Bone conduction: place
tuning fork on mastoid process, Air
Conduction: place tuning fork 1 1/2 inch away from ear. AC should be twice
the # than BC [BC: 15, AC: 30]
Convergence (accommodation): eyes should turn inward, and constrict when
focus on penlight
6 Field Cardinal Gaze (H & Wheal) which muscles: eye level, only eyes move,
test CN 3,4,6 and extraoccular muscles
Acute Glaucoma: immediate intervention must be done, medical emergency,
sudden increase in intraoccular pressure
Confrontation (Peripheral): pt covers one eye while you cover the opposite
Apex: point of maximal impulse ; apical pulse
• LMCL 5th ICS (heart sits here at 5th ICS)
• Hold stethoscope for 1 full min (60 sec) on apical pulse
• You should hear a soft vibration, tapping sensation
Dark Skin
Pallor: skin is ash-gray, yellow-tinged, looks dull
Jaundice: Yellow undertone in oral mucosa, palm of hand and feet
Erythema: purple or darker than surrounding skin, accompanied by higher
temp, hardness & swelling
Light Skin
Pallor: loss of rosy tones, pt appears with yellow tones
Jaundice: Yellow undertone
Erythema: redness accompanied by higher temperature at site
Shamroth Technique
— assessing for clubbing
— Ask pt to bring dorsal aspect o corresponding fingers together creating a
mirror image
AFIB:
• No P-wave, irregular (Dysrhythmic atrial contraction with no regularity or
pattern)
• Atria is fluttering and pumping ineffectively, stasis (pooling) in the atria &
ventricles
• Pt can develop clot, pt’s with AFIB will be on blood thinners
Atrial Flutter: No P-wave, sawtooth looking
Dehydration: capillary refill, skin turgor
HEART LANDMARKS:
Aortic: RSB 2nd ICS Pulmonic: LSB 2nd ICS
Erb’s: LSB 3rd ICS
Tricuspid: LSB 4th ICS
*Mitral: LMCL 5th ICS*
Otoscope: pull ear up and back
Arterial Insufficiency:
Objective data:
• Diminished pulses, cool shiny skin
, • absence of hair on toes, pallor lower extremities on elevation
• Red color lower extremities
Subjective data:
• Pain, aching burning, discomfort in feet, calve, thighs
• Numbness when at rest in legs/feet
• Appearance of symptoms when walking uphill (claudication)
⁃ medial and outer canthus location for eye assessment
Vision Defects:
Emmetropia: normal vision 20/20
Myopia: nearsightedness, light rays focus in front of retina
Hyperopia: farsightedness, light rays focus behind the retina
Presbyopia: older pt, light ray focuses past the retina, hyperopia, farsighted
Presbecusis: gradual hearing loss in older pt
Xanthelasma: yellow plaques on lids at inner canthus
Pingueculae: yellow nodules on conjuctiva, does NOT affect vision, caused
by too much sun expose or wind/dust
Pterygium: pink nodules on conjuctiva, can affect vision and grow over the
cornea
Weber Test: testing bone conduction, place tuning fork on midline of
anterior frontal lobe of skull, normal is documented no lateralization
[abnormal loss in right? document it is lateralized to the left]
Rhine Test: Bone conduction & Air conduction. Bone conduction: place
tuning fork on mastoid process, Air
Conduction: place tuning fork 1 1/2 inch away from ear. AC should be twice
the # than BC [BC: 15, AC: 30]
Convergence (accommodation): eyes should turn inward, and constrict when
focus on penlight
6 Field Cardinal Gaze (H & Wheal) which muscles: eye level, only eyes move,
test CN 3,4,6 and extraoccular muscles
Acute Glaucoma: immediate intervention must be done, medical emergency,
sudden increase in intraoccular pressure
Confrontation (Peripheral): pt covers one eye while you cover the opposite
