2024-2025 NURS190 Physical Assessment Final Exam (30 Solved Assessments)

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NURS 190PhysicalAssessment Finallatest2024/2025EXAMInspectiontechnique(3):●FIRSTtechniquewithgeneralsurvey●Generalsurvey:○Observingmobility/gait,physicalappearance,generalwellness/health,mood&behavior (facial expressions, interactions), mental status(observing patient’sbodylanguageandresponsewhenaskingquestions)●Doit theSAMEWAYeverytime→lesslikelytoforgetsomething●Donotrushit,especiallywithanxiouspatients○Makesurethepatientiscomfortable○Temperatureintheroomissuitableforthepatient●Makesurethatyouhaveeverythingthatyouneed→sothatthepatienthasconfidenceinyou●Knownormalvsabnormal whensurveyingappearance&symmetry○CompareANYTHINGthathasapair○Eyes-level,equal,isthereeyeliddrooping?○Smile-isthereadroop?○Alwayscomparethetwosidestoensurethatthereisnoabnormalitybetweenthe two sides●Listenfornaturalsounds○Abnormalsounds:wheezing,laboredbreathing,crepitusduringROM●Detectabnormalodors:○CDIFF,alcoholonapatient,acetone/sugarybreath●Trynottoassumeanything!→usecriticalthinking!○Ex:someonewithlowbloodsugarorissueswithhypoxiacanappearintoxicated●Knowyournormalvalues:○Bloodpressure,HR,RR,O2sats,temperature○Foreachagelevels■Infants:mustfasterRRthanelderlyPercussiontechnique(3)●Types:○Directpercussion-tappingbodywithfingertipsofdominanthand

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■Forasmallinfant→directpercussiononthechest■Adult→onthesinusesonthe face○Bluntpercussion-placepalmofnondominanthandflatagainstthesurfaceandstrikeitwithclosed-fistdominanthand■Usedtoassessthekidneys→assessingforpain/tenderness

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(UTI)○Indirectpercussion-mostcommonlyused■Plexor=hammerortappingfinger■Pleximeter=deviceorsurfacethatacceptsthetap●Sounds:○Intensityofamplitude:softnessorloudness○Pitchorfrequency:highorlow(vibrationspersecond)○Duration:lengthoftime○Quality:recognizableovertonesordrumlike sounds●Tympany-soundheardoverstomachorintestines○Loud,high-pitched,drum-liketone●Resonance-normalsoundheardoverlungs○Loud,low-pitched,hollowtone●Hyperresonance-airtrappedinlungs○Abnormallyloud,lowtoneoflongerdurationthanresonance■COPD,traumaorlungcollapse●Dullness-oversolidbodyorgans(liver)○High-pitchedtone,softandshort●Flatness-oversolidtissue,muscle,orbone○High-pitchedtone,verysoft&shorterthandullness■Ex:ribsSkinassessment(5)●Lifespanconsiderations:○Infantsandchildren■Newbornskin→coveredwithvernixcaseosa■Infantshavethin,soft,skinandfreeofhair■Miliaandstorkbites-common,harmlessmarkingsinnewborns■Mongolian spots-gray,blueorpurplespotsinsacralandbuttocksarea●Fadebyage3●Trynottoconfuseitwithpossibilityofabuse→asktheparent“isthissomethingthathasbeenheresincebirth?”■Poortemperatureregulation→donotsecretefromglands○Pregnantfemale■Skinpigmentationincreases→inareolae,nipples,vulva,perianalarea●Developmentofmelasmaandlineanigradowntheabdomen●Resolveitselfafter pregnancy■Hormonalchanges→causeoilandsweatglandstobecomehyperactive●Acneworsensin1sttrimester■Hairmayfalloutduringmonths1-5○Olderadult■Skinelasticitydecreaseswithaging

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■Sebumproductiondecreases→causesdryness●Morepronetoskinbreakdown■Perspiration/sweatingdecreases■Decreaseinmelaninproduction→resultingrayhair■Nailsbecomethickerandmorebrittleduetodecreasedamountofcirculation■Hairthinsbecauseof decrease ofhairfollicles■Liverspots,hyperpigmentedfreckles,increasedamountofskintags●Psychosocialconsiderations:○Stressedinducedillness:■Trichotillomania-hairtwisting&pulling■Nailbiting■Visibleskindisordersinrelationtoself-esteem/bodyimage●Culturalandenvironmentalconsiderations:○Socioeconomicstatus■Notabletogotothedoctorbecauseoffinances○Homeenvironment■Aretheyhomeless?→ifso,couldbemorelikelytodevelopskincancer dueto outsideexposure○Means ofemployment■Iftheyworkoutside→importanttoknow■Donotassumebadhygiene!!→couldbefromwork○Changesinskincolor→maybemoredifficulttodetectinpatientswithdarkskin○Dryskindoesnotnecessarilyindicatedehydration○Skinresponsetostressorsdifferfrompersontoperson■Autoimmunedisorders○Differencesinhaircolorandtexturevaryfromdifferentculturalgroups○Prolongedimmersionofhandsinwatercan causeparonychia-reddenedcuticlescausinginfection○Table13.2(variations)31:28●Focusedinterview-questionsrelatedto:○Noticeanysmells/foulodors○Changesincolor→oxygenationissuesorperfusion○Sweating→fever,beinginthesuntoolong,excessivesweating○Skin:■Ingeneral■Illnessorinfection■Symptoms,pain,behaviors■Age■Externalenvironment○Hair:■Ingeneral■Infantsandchildren

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○Nails:■Ingeneral■Infantsandchildren■Pregnantfemales■Olderadult●Colorvariationsinlightanddarkskin○Pallor-lossofcolorinskinduetoabsence of oxygenatedhemoglobin■Lightskin:●Whiteskinlosesrosy tones●Yellowtoneappearsmoreyellow■Darkskin:●Blackskinlosesitsredundertonesandappearsash-gray●Brownskinbecomes yellow-tinged○Absenceofcolor-loss of pigment■Albinism-white/paleblondhairandpinkirises■Vitiligo-verynoticeableaspatchymilk-whiteareas■Tinea-appearspatchyareaspalerthansurroundingskin○Cyanosis-bluecolorinskin due toinadequate tissue perfusion■Lightskin:●Skin,lips,mucousmembraneslookblue-tinged;nailbedsareblue■Darkskin:●Mayappearashadedarker●Maybeundetectableexceptforlips,tongue,oralmucousmembranes,nailbeds,andconjunctivae○Reddishbluetone-ruddytoneduetoincreasedhemoglobinandstasisofblood■Lightskin:reddishpurplehue■Darkskin:difficulttodetect;normalskinmayappeardarkerinsomepatients○Erythema-rednessoftheskinduetoincreasedvisibilityofnormaloxyhemoglobin■Lightskin:localinflammationandredness■Darkskin:hardtodetect;inflammationappearpurpleordarkerthansurroundingskin○Jaundice-yellowundertoneduetoincreasedbilirubin■Generalized;visible insclera,oralmucosa,hardpalate,fingernails, palmsofhands,andsolesofthefeetSkin lesions(5)●Primarylesions:○Maculeandpatch-flat,nonpalpablechangeintheskincolor■Macule:Smallerthan1cm■Patch:largerthan1cm○Papule andplaque-elevated,solidpalpablemasseswithacircumscribed

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border■Papule:smallerthan0.5cm■Plaques:groupsofpapulesthatformlesionslarger0.5cm○Noduleandtumor-elevated,solid,hardorsoftpalpablemassextendingdeeperintothedermis■Nodules:smallerthan2cm■Tumors:mayhaveirregularbordersandarelargerthan2cm○Vesicle and bulla: elevated,fluid-filled, round or oval-shaped, palpable masseswiththin,translucentwallsandcircumscribedborders■Vesicles:smallerthan0.5cm■Bullae:largerthan0.5cm○Pustule-elevated,pus-filledvesicleorbullawithacircumscribedborder■Sizevaries○Wheal-anelevated,oftenreddishareawithanirregularbordercausedbydiffusefluidintissues■Sizevaries○Cyst-elevated, encapsulated, fluid-filled or semisolid mass originating insubcutaneoustissueordermis■Usually1cmorlarger●Vascularlesions:○Ecchymosis-flat,irregularshapedlesionofvaryingsizewithnopulsation;doesnotblanchwithpressure→BRUISE■Inlightskin:bluish,purplemarkthatchangesyellow■Brownskin:variesfrombluetodeeppurple■Black:darkenedarea○Hemangioma-bright,redraisedlesionabout2-10cmindiameterthatdoesnotblanchwithpressure;presentatbirthorwithinfewmonthsofbirthandtypicallydisappearsbyage10■Clusterofimmaturecapillaries○Cullensign-periumbilical;couldindicateinternalbleedinginabdomen○Greyturnersign-flankarea;couldindicatebleedingintoperitoneum,pancreatitis,etc.○Hematoma-raised, irregularly shaped lesion similar to ecchymosis except that itiselevatedandlookslikeswelling■Causedby leakageofbloodinto theskinandsubcutaneoustissue○Petechiae-flat,redorpurplerounded“freckles”;approximately1-3mmindiameter;pinpointlesions■Difficulttodetectindarkskinanddonotblanch○Purpura-flat,reddish-blue,irregularlyshapedextensivepatchesofvaryingsize○Port-winestain-flat,irregularshapedlesionrangingfrompaleredtodeeppurple-red■Color deepens with exertion, emotional response, or exposure to extremetemperatures■Presentatbirthandtypicallydoesnotfade

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○Spiderangioma-flat,brightreddotwithtinyradiatingbloodvesselsranginginsizefromapinpointto2cm;blancheswithpressure○Venous lake-soft, compressible, slightly elevated vascular lesion; color typicallyrangesfromdarkbluetopurple●Infectiouslesions:○Tinea-fungalinfectionaffectingthebody,scalp,orfeet■Body=tineacorporis■Scalp=tineacapitis■Feet=tineapedis(athlete’sfoot)○Measles (Rubeola)-highly contagious viral disease that causes a rash of red topurple macules or papulesthat begins on face, then progresses over the neck,trunk,arms,andlegs■Lesionsdonotblanch■Oralmucosamaydemonstratetiny,whitespotsthatlooklikegrainsofsalt○Varicella (chicken pox)-mild infections disease caused by primary infection withthevaricellazostervirus;small,red,fluid-filledvesiclesusuallyonthetrunkfromwhichtherashprogressestotheface,arms,andlegs■Eruptoverseveraldaysformingpustules,thencrusts■Causeintenseitching○Rubella-highly contagious diseasecaused by rubella virus; typically begins aspink,papularrashthatissimilartomeaslesbutpaler■Skinlesionsbeginonthefaceandthenspreadoverthebody○Herpessimplex→coldsores○Herpeszoster→shingles■Clustersofsmallvesiclesthatformontheskinalongtherouteofsensorynerves○Impetigo-contagious,bacterialskininfectionthatusuallyappearsontheskinaroundthenoseandmouth■Lesions may begin as barely perceptible patch of blisters that break,exposingred,weepingareabeneath■Tancrustformsoverthearea■Common in childrenNailabnormalities(2)●Causedby:geneticfactors,infectiousdiseaseprocesses,traumaticinjuries●Mayalsoprovidecluestopresenceofunderlyingdiseaseprocessinvolvingotherbodysystems●Spoonnails/ koilonychia-can be a sign ofanemia,especiallyiron-deficiencyanemia●Paronychia-softtissueinfectionaroundafingernailatthecuticlecausinginflammation●Beaulines-occurafterillness,injurytothenail,eczemaaroundthenail,duringchemotherapyforcancer

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●Splinterhemorrhage-canbeamanifestationofconnectivetissueconditionsuchaslupusorscleroderma;appearasreddish-brownspotsinthenail●Onycholysis-painlessseparationofthenailfromthenailbed;fungalinfectioncausingthenailstothickenandliftoffnailbed●Clubbing-nailsappearconvexandwide;angleisgreaterthan160degrees○PooroxygenationSubjectivedata(3)Equipment(2)●Variousinstrumentsthathelpinvisualizing,hearing,andmeasuringdata○Stethoscope, otoscope, penlight, doppler ultrasound, ophthalmoscope, reflexhammer,BPmachine(table9.1)○Beforephysicalassessment:■Gatherallequipment!■Organizeit■Placewithineasyreachforavailability○Stethoscope-auscultatesbodysoundssuchasBP,heartsounds,respirations,bowelsounds■Usedonexposedskin!!■Components:●Binaurals-pointedtowardface●Flexibletubing●Endpiece○Bell-low-pitchedsounds(murmurs)○Diaphragm-bestforhigh-pitchedsounds(lungsounds,bowelsounds,normalheartsounds)■Doesnot“amplify”sound!!→justisolatesthem○Dopplerultrasonicstethoscope-detectsoundsthataredifficulttohearwithregularstethoscope■Fetalheartsounds,peripheralpulses■Usegel→isolatessoundwavesbetter○Ophthalmoscope-inspectsinternal eyestructures■Components:●Handle&head●Usedtoseeanteriorstructureoftheeye:○Largeaperture:dilatedpupils○Smallaperture:constrictedpupils○Red-freefilter:helptoseeopticdisc○Grid:ifthereisanylesions→helptolocatesizeoflesions○Slit

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○Otoscope-examinesexternalearstructures■Needtomakesureyou’reusingtherightsize!●Toolargeortoosmallcanpreventyoufromseeinganything■Components:●Handle,light,lens,speculaofvarioussizes■Normalappearanceoftympanicmembrane:clear,pearlcolored;nopurulentfluid○Woodlamp→used for fungalinfectionGeneralsurvey(2)●Observingmobility/gait,physicalappearance●Generalwellness/health●Mood&behavior(facialexpressions,interactions)●Mentalstatus (observingpatient’sbodylanguageandresponsewhenaskingquestions)●Open-ended-intentionallygeneralandencouragethepatienttoprovideadditionalinformation○Canbeduringactualassessment○H&P○Whatkindofchangeshaveyounoticedthathaveoccurredwithyourskin?○“Tellmemoreaboutthat…”●Close-ended-quickandsimple,yesornoquestion○Doyouhaveallergies?Areyoutakinganymedication?Neckassessment(1)●Inspectionofskin●Testingrangeofmotion●Observationofcarotidarteriesandjugularveins●Palpationoftrachea●Inspection,palpation,andauscultationofthyroidglandEyeassessment(5)○General:“Describeyourvisiontoday…”○Considerexpectationsbasedon:■Age■Race■Environment■Healthpractices■Past&currentproblems/therapies○Askaboutanyinfections,surgeries,orinjuries○Considerpatient’sabilitytoparticipate→basedonanyproblemsstatedthataresignificant○Symptoms,painandbehaviors○“Whenwasyourlasteyeexam?”→especiallyinanolderclient,diabetic

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patients●Lifespanconsiderations:○Infantsandchildren:■Didthemotherhaveavaginalinfection?■Wasthechildfulltermorpremature?Ifpremature,howearly?●CouldhavebeenoveroxygenatedinNICUcausingvisualproblems○Pregnantfemale:■Anychangesinvision?■Reassuremotherthatitistemporary→willreturnby6months○Olderadult:■Doyouhaveanydryness?●If the individual OVER USES eye drops → the lacrimalglandsarelesslikelytocontinuetoproducetears■Anyproblemswithnightvision?→mayaffecttheirdailyliving○Internalenvironment:■Askwhetherornotthepatientistakinganymedicationsthatcouldaffectvision■Isthereafamilyhistoryofeyeproblems?●GlaucomaISinherited●Cataractsarenot genetic○Externalenvironment:■Havetheybeenexposedtoanyeyeirritants?■Dotheyworkinanenvironmentthatcancauseeyeirritants?■Aretheyusingsafetyequipmenttoprotecteye?●Eyeassessment(5)○Inspection:■Whatdoesthescleralooklike?●Isitanormalwhitecolor?●Istherejaundice?→canindicateliverproblems■Lookingforredness,drainage○Tests:■SnellenTests(distance)-testsforvisualacuity●TestsforcranialnerveII●Stand20feetawayandcoveroneeye○Readthesmallestlinetheycanpossiblyread○Ifpatientreadshalformoreofthelinewrong→moveuptothenexthighestlevel●Firstnumber→20feetawayfromSnellen○NEVERCHANGES●Secondnumber→howfarawaysomeonewithnormalvisionwillseewhatyousee●Ex:20/40:you’restandingat20feetandseeingwhataperson

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withnormalvisioncouldseeat40feet■Jaeger/Rosenbaum-nearvision●12-14inchesaway■Confrontationtest-peripheralvision●Your eye AND the patient eye are covered on the opposite sides(sameeyewhenfacingeachother)●Somethingiscomingintoview→ifthepatientseesitatthesametimethatyoudo,theyhavenormalvision■Cardinalfieldsofgaze-extraocularmuscles●Cranialnerves 3,4,6●Assessingforanydeviationinvision■Cover/uncover:●Normal=nodeviation●Couldhaveaslightdeviation→butwillnotseeituntilyoucover /uncovertheeye■PERRLA-pupilsareequal,round,andreactivetolightandaccommodation●Pupil size are equal:between3and6●Reactivetolight:constrictionwhenlightisshinedatthem●Accommodation:eyesconvergeandpupilsconstrictwhenlookingatsomethingcloseup■Consensualconstriction-pupilconstrictswhenalightisshoneintheeye○Palpation:■Warmth,tenderness,edema,etc○Ophthalmoscope-lookingattheinternalpartsoftheeye(pupils)■Lookingatthefundus,macula■Wanttoseearedreflex→lightreflectionfromtheretina■Lookingfornormalbloodvessels:●Aretheconstrictedorenlarged?■Arethereanylesions?■Whitespotsonthemacula?■Paleconjunctiva→canindicatetypesofanemia■Parts:●Smallaperture-constrictedpupils●Largeaperture-pupilsthataredilated●Grid aperture-todetectapresenceofanykindoflesionEyeabnormalities(5)●Abnormalitiesoftheeyelids:○Blepharitis-generalinflammation/rednessoftheeyelids■Staphylococcalinfectionleadstored,scaly,and crustedlids

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■Theeyeburns,itches,andtears○Basal cellcarcinoma-usuallyseenon thelowerlid andmedial canthus■Papularappearance○Chalazion-firm,nontendernoduleontheeyelidarisingfrominfectionofthemeibomiangland■Notpainfulunlessinflamed○Hordeolum-alsocalledastye■Resultofstaphylococcalinfectionofhairfolliclesonthemarginofthelids■Affectedeyeisswollen,red,andpainful○Entropion-inversionof theeyelid andlashescaused bymusclespasmof theeyelid■Frictionfromlashescancausecornealirritation○Ectropion-eversionofthelowereyelidcausedby muscleweaknessexposingthepalpebralconjunctiva○Ptosis-droopingoftheeyelid■Occurswithcranialnervedamageorsystemicneuromuscularweakness○Periorbitaledema-swollen,puffyeyelids■Occurswithcrying,infection,trauma,systemicproblems(kidneyfailure,heartfailure,allergies)○Exophthalmos-abnormalprotrusionofoneorbotheyeballs■Usuallyoccurssecondary toGrave’sdisease●Lipidsarebeingdepositedinthebackoftheeyeandpushesitout■Canalsobecausedbyinfectiousdisease,certainformsofcancerandotherdisorders●Abnormalitiesoftheeye:○Conjunctivitis-infectionoftheconjunctivausuallyduetobacteriaorvirus■Pinkeye○Iritis-seriousdisordercharacterizedbyrednessaroundtheirisandcornea■Decreasedvisionanddeep,achingpain■Pupilisoftenirregular○Subconjunctivalhemorrhage-resultsfromrupturedbloodvesselthatleadstobloodaccumulationinthesubconjunctivalspace■Caused by trauma, anticoagulant therapy, hypertension, elevated venouspressure○Pterygium-non-cancerousgrowththatdevelopsfromtheconjunctivaandextendsontothesclera■Mayalsoextendtothecornea■Cancauseproblemswithvision○Hyphema-collectionofbloodintheanteriorchamberoftheeyethatismostoftencausedbyblunttraumatotheeye■Canalsobecausedbyeyesurgery,bloodvesselabnormalities,medicalproblems○Acuteglaucoma-resultofsuddenincreaseinintraocularpressureresultingfrom

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