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 ...
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
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
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