NU 650 Final EXAM WITH COMPLETE SOLUTION

NU 650 Final EXAM WITH COMPLETE SOLUTION Order of Assessment Inspection, Palpation, Percussion and Auscultation. EXCEPT with abdomen Comprehensive Health History chief complaint, reason for visit, ROS, past medical and surgical history, social history and family history Pediatric Body measurements length, height, weight, head circumference fro birth to 36 months Normal/Hypertension cut off 130 normal 140+ hypertension Fontanel Closure posterior 1-2 months, anterior 9mo-2years otoscope adult-up and back, peds- down and back, using largest speculum that will fit comforably tympanic membrane Cone of light R-5 l-7 EOM testing CN III, IV, VI AP diameter of chest 1:2 (AP less than transverse) barrel chest COPD Flat or Dull percussion effusion or pneumonia normal resonant percussion healthy lung Hyperressonance (percussion) trapped air crackles/rales high pitched, discontinuous Wheezes high-pitched whistling or squeaking sounds during inspiration or expiration Rhonchi snoring, rumbling sounds heard upon auscultation of the chest during respiration-low pitched tactile fremitus • INCREASED FREMITUS - Means there is liquid or solid inside the lungs (consolidation such as with pneumonia) - Remember Liquid or solid transmits vibrations better than air • DECREASED FREMITUS Means air trapping such as with emphysema or bronchial obstruction. Bronchophony the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue, clearer over disease Egophony abnormal change in tone of voice that is heard when auscultating the lungs EE--AA UE Arteries radial-thumb side, ulnar pinky side Pulse grading 0 absent 1+ weak 2+ normal 3+ increased 4+ bounding palpate bilaterally PMI point of maximal impulse mid-clavicular and 5th ICS S1 normal, closure of AV, Start of systole, loudest at Apex, contraction of ventricles S2 normal, closure of semilunar, end of systole, loudest at base, filling of ventricles S3 third heart sound (normal in pregnant young adults, and children), gallop S4 extra heart sound, end of diastole, indicative of disease-AFIB murmur grading scale I-Barely Audible II-Quiet, Clearly Audible III-moderately Loud IV-loud, thrill V-Very loud, can palpate thrill VI-Very loud, thrill palpable and visible clubbing bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions edema scale 1+ = disappears rapidly. 2+ = last 10-15 seconds. 3+ = lasts more than one minute. 4+ = lasts 2-5 minutes. These are signs used in what scale? normal/abnormal findings spleen normal=tympanic, dullness could be enlargement not normally felt on exam Blumberg Sign: Rebound Test peritoneal inflammation, hurts more when release from palpation shifting dullness a sign of free peritoneal fluid wherein the dullness of percussion shifts, generally from one side to the other, as the patient is turned from side to side. Psoas sign RLQ pain with extension of right thigh indicative of appendicitis Obturator sign RLQ on internal rotation of right thigh indicative of appendicitis assessment of hernia pt may report a lump. observe pt while lying and standing, hernia may disappear while lying. ask pt to strain or perform Valsalva maneuver and observe for bulging. absent bowel sounds may indicate strangulation. cardinal signs of Musculoskeletal disease pain, erythema, swelling, increased warmth, deformity, loss of function Scoliosis abnormal lateral curvature of the spine kyphosis excessive outward curvature of the spine, causing hunching of the back. Knock-knee (genu valgum) Legs curved inward so knees come together as person walks bow-legged knees too far apart anatomic snuffbox landmark depression on the radial aspect of the dorsal wrist; overlays the scaphoid bone Impingement Sign POSITIVE: pain in the shoulder INDICATES: overuse injury to the supraspinatus and possibly biceps tendon Drop Arm Test identifies tear and/or full rupture of rotator cuff Allen test determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery Phalen's sign Tingling, numbness, or pain in the fingers within 60 seconds of performing Phalen's maneuver, a diagnostic test for carpal tunnel syndrome Tinel's sign A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome Drawer Test - knee Patient supine, examiner flexes the hip and the knee of the patient's affected leg until the foot is flat on the table. Examiner sits on the foot of thepatient's afectedleg. Examinergrasps behindthe patient'sflexed knee and exerts a pushing and pulling pressure into the affected knee. +(1) Gapping 6mm (tibia moves posterior) when the leg is pushed. +(2) same when the leg is pulled. INDIC:(1) Torn posterior cruciate ligament. (2) Torn anterior cruciate ligament. Confirmation Test: Lachman'sTest Lachman's Test pivot shift test (ACL tear)