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Techniques for Testing Vision, Hearing, and Physical Exams in Health Assessment, Exams of Medicine

Instructions for conducting various health assessments, including testing for visual acuity using a snellen eye chart, assessing hearing with the rinne test, and performing physical exams to identify conditions such as bradypnea, orthopnea, and tachypnea. It also covers techniques for auscultating the lungs and abdomen, identifying different types of breath sounds, and assessing for edema.

Typology: Exams

2023/2024

Available from 04/04/2024

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Rasmussen Health Assessment
final exam updated 2024
How to test for visual acuity - ANS>> Snellin eye chart
(Stand 20 feet away from the chart)
how to test for hearing - ANS>> Use the Rinne test
Do a physical exam
Bruit - ANS>> abnormal blowing or swishing sound heard during auscultation of an
artery or organ
How to auscultate lungs - ANS>> side to side (zig-zag movement, have pt. take a full
breath while you are listening - start C7 to T10 COMPARING )
How to auscultate abdomen - ANS>> perform auscultation prior to palpation or
percussion. Listen in a clockwise manner starting in the lower right quadrant, listen for 5
minutes in each quadrent
normal bowel sounds - ANS>> 5-30 per minute, high pitched
hypoactive bowel sounds - ANS>> follow abdominal surgery or with inflammation of
the peritoneum, 5-15 per minute, could be bowel obstruction
hyperactive bowel sounds - ANS>> loud, high-pitched, rushing, tinkling sounds that
signal increased motility (diarrhea, laxative use, gurgling)
ABCDEs of melanoma - ANS>> asymmetry, border, color, diameter, evolution
Skin assessment on dark skinned patient - ANS>> Pallor: yellowish brown, ashen gray
Erythema: purplish tinge difficult to see
Cyanosis: dull and lifeless
Jaundice: check for yellowness of palms of hands
bronchial breath sounds - ANS>> higher pitch, louder, inspiration and expiration are
equal and there is a pause between inspiration and expiration. (heard in the front)
bronchovescicular breath sounds - ANS>> moderate, high pitched,
( inspiration = to expiration)
vesicular breath sounds - ANS>> low pitched, soft, expiration, alveoli
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Rasmussen Health Assessment

final exam updated 2024

How to test for visual acuity - ANS>> Snellin eye chart (Stand 20 feet away from the chart) how to test for hearing - ANS>> Use the Rinne test Do a physical exam Bruit - ANS>> abnormal blowing or swishing sound heard during auscultation of an artery or organ How to auscultate lungs - ANS>> side to side (zig-zag movement, have pt. take a full breath while you are listening - start C7 to T10 COMPARING ) How to auscultate abdomen - ANS>> perform auscultation prior to palpation or percussion. Listen in a clockwise manner starting in the lower right quadrant, listen for 5 minutes in each quadrent normal bowel sounds - ANS>> 5-30 per minute, high pitched hypoactive bowel sounds - ANS>> follow abdominal surgery or with inflammation of the peritoneum, 5-15 per minute, could be bowel obstruction hyperactive bowel sounds - ANS>> loud, high-pitched, rushing, tinkling sounds that signal increased motility (diarrhea, laxative use, gurgling) ABCDEs of melanoma - ANS>> asymmetry, border, color, diameter, evolution Skin assessment on dark skinned patient - ANS>> Pallor: yellowish brown, ashen gray Erythema: purplish tinge difficult to see Cyanosis: dull and lifeless Jaundice: check for yellowness of palms of hands bronchial breath sounds - ANS>> higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration. (heard in the front) bronchovescicular breath sounds - ANS>> moderate, high pitched, ( inspiration = to expiration) vesicular breath sounds - ANS>> low pitched, soft, expiration, alveoli

Crackles (fine) - ANS>> discontinuous, high-pitched, short crackling, (popping sounds heard during inspiration that are not cleared by coughing) Crackles (coarse) - ANS>> Loud, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration. (May decrease somewhat by suctioning or coughing but will reappear shortly. Sounds like opening a velcro fastener) Stridor - ANS>> strained high-pitched sound (heard on inspiration caused by obstruction in the pharynx or larynx) How to assess edema - ANS>> 1+ Barely detectable impression when finger is presssed into skin. 2+ Slight indentation. 15 seconds to rebound 3+ Deeper indentation. 30 seconds to rebound. 4+ > 30 seconds to rebound. S1 heart sound - ANS>> Start of systolic (the first heart sound heard)

  • heard louder at mitral and tricuspid S2 heart sound - ANS>> second heart sound (start of diastolic)
  • heart louder at aortic & pulmonic phases of cardiac cycle - ANS>> atrial systole, atrial diastole, ventricular systole, ventricular diastole What heart area is at the right second intercostal place? (APETM) - ANS>> Aortic (1) What heart area is at the left second intercostal place? - ANS>> Pulmonic (2) What heart area is at the left third intercostal place? - ANS>> Erbs (3) What heart area is at the left fourth intercostal place? - ANS>> Tricuspid (sternal border 4) What heart area is at the left fifth intercostal place? - ANS>> mitral (5) barrel chest - ANS>> A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema. Scoliosis - ANS>> abnormal lateral curvature of the spine Funnel Chest (Pectus Excavatum) - ANS>> a chest that is hollowed out
  • Polyposis syndromes
  • Family History
  • History of Breast/Genitalia cancer
  • History of polyps cystitis - ANS>> inflammation of the bladder How to assess for gross hearing - ANS>> Rinne and Webber test tactile fremitus - ANS>> palpable vibration CN II - ANS>> Optic - vision CN III - ANS>> oculomotor (motor eye movement) CHF - ANS>> left side distention Naturalistic - ANS>> term refers to observations made of individual's behavior in an everyday life setting (yin and yang, hot and cold, holistic) Dyspnea - ANS>> shortness of breath Tachycardia - ANS>> Fast heart rate (greater than 100 bpm) Clubbing of fingers - ANS>> Caused by chronic hypoxia. Presence of this is suggestive of pulmonary disease or any type of abnormal Respiratory issue Pulse locations - ANS>> brachial, ulnar, radial, dorsal pedis, popliteal how to take adult temperature? - ANS>> lift ear up and then back (97-99) bilateral bronchi - ANS>> large mucus plug in airway what is a function of the venous system? - ANS>> holding more blood when blood volume increases Grading scale for assessing the force of an arterial pulse - ANS>> 0 = absent 1+ weak 2+ normal 3+ Increased, 4+ full, bounding Osteoporosis - ANS>> loss of bone density >75-90%

Osteoporosis s/s - ANS>> early shows no s/s age 30-40, over 55 F>M (Lupus, RA, inflammatory bowel, celiac disease Heberden's nodes - ANS>> Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis How might you elicit the Babinski response? - ANS>> Stroke the lateral aspect of the sole of the foot from heel to across the ball TMJ (temporal mandibular joint) - ANS>> chewing, popping, and grinding of teeth, jaw popping, should open and close, slide up and down, and side to side Function Assestments - ANS>> Test to be able to tell if elderly patients can perform regular tasks Passive Range of Motion (PROM) - ANS>> therapist putting a patient's joints through available range of motion without assistance from the patient (anything your physically doing for the patient yourself) Romberg test - ANS>> - ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed (expected finding: client should be able to stand with minimal swaying for at least 20 seconds other could be multiple sclerosis, alcohol intoxication, shows loss of proprioception and vestiubular function) Olfactory 1 - ANS>> smell optic 2 - ANS>> vision facial 7 - ANS>> eye brows, puff face, smile,(CNS lesions, stroke) CN 8 (Acoustic) - ANS>> equilibrium and hearing Range of Motion (ROM) - ANS>> - active, passive, voluntary

  • knee
  • elbow ROM limitations - ANS>> when the patient has a ROM limitation or injury, use passive motion; anchor joint with one hand while the other moves it to it's limit, Positive Romberg test - ANS>> loss of balance that occurs when closing the eyes multiple sclerosis alcohol intoxication loss of proprioception loss of vestibular function.

osteoporosis risk factors - ANS>> post-menopause- reduction of estrogen levels; calcium intake; activity level Vertigo - ANS>> spinning caused by inner ear disorder

  • objective vertigo: person feels like the room is spinning subjective vertigo: person feels like he or she is spinning Syncope - ANS>> fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum Disequilibrium - ANS>> shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits plantar flexion - ANS>> bending of the sole of the foot by curling the toes toward the ground dorsal flexion - ANS>> move foot so that toes are pointed upward Heberden's nodes - ANS>> - are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes, ).
  • result of osteoporosis Bouchard's nodes - ANS>> hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes). They are seen in osteoarthritis, , proximal contracture - ANS>> fibrosis of connective tissue in the skin, fascia, muscle, or joint capsule that prevents normal mobility of the related tissue or joint ankylosis - ANS>> the loss, or absence, of mobility in a joint due to disease, injury, or a surgical procedure Dislocation - ANS>> displacement of a bone from its joint tetany - ANS>> condition affecting nerves causing muscle spasms as a result of low amounts of calcium in the blood caused by a deficiency of the parathyroid hormone atrophy - ANS>> (n.) the wasting away of a body organ or tissue; any progressive decline or failure; (v.) to waste away tremors - ANS>> Continuous quivering or shaking. subluxation - ANS>> the partial displacement of a bone from its joint Ballotment - ANS>> Leg extended, compress the suprapatellar pouch and then push the patella sharply against the femur, watching for fluid returning to the pouch

Crepitus - ANS>> a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone.

  • often in knee, popping crunching malaise - ANS>> a vague feeling of physical discomfort or uneasiness, weakness How do you assess intimate Partner Violence - ANS>> - ask every women if she has been abused (tell them you ask everyone!)
  • routine screening for IPV Caregiver burnout - ANS>> - somatic complaints
  • increased stress and anxiety
  • social isolation
  • depression
  • weight loss Babinski reflex - ANS>> Infant reflex where if its foot is stroked, the baby's toes fan out reflex - ANS>> simplest reflex tapping the tendon stretches the muscle spindles in the muscle how to assess cerebellar function - ANS>> Romberg, finger to nose, heel to shin functional ability - ANS>> the physical, psychological, cognitive, and social abilities to carry out the normal activities of life get up and go test - ANS>> Time it takes for a person to rise from an armchair, walk 10 feet, turn, walk back and sit down (Average healthy adult >60 years can do it in 10 seconds) thoracic expansion - ANS>> The expansion of the chest wall palpated when the person takes a deep breath; should be bilateral and symmetric malignant melanoma - ANS>> Most serious form of skin cancer; often characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised. eye accommodation - ANS>> the process by which the eye's lens changes shape to focus near or far objects on the retina abnormal respirations - ANS>> noisy respirations like wheezing (high pitched whistling), changes in vital signs, and changes in the color, odor, and consistency of sputum (report these to the nurse).

general changes in geriatric populations - ANS>> - skin changes

  • lung harder to inflate
  • increae in systomlic BP due to thickening of arteries CNI - ANS>> Olfactory CNII - ANS>> Optic CNIII - ANS>> Oculomotor CNIV - ANS>> Trochlear (movement of eyeball) CNV - ANS>> trigeminal (general sensation of face, cornea etc) CN VI - ANS>> Abducens (lateral eyeball movement) CNVII - ANS>> Facial; movement of facial muscles; facial expression; tear formation; salivation; taste sensation in anterior tongue CNVIII - ANS>> Vestibulocochlear (hearing and balance) CNIX Glossopharyngeal - ANS>> taste ability to swallow and speak CN X - ANS>> - vagus
  • assess mouth for movement of soft palate and the gag reflex
  • assess swallowing and speech CN XI - ANS>> Accessory (motor) CN XII - ANS>> Hypoglossal (tongue movement) myalgia - ANS>> Muscular pain, "muscle aches" pitting edema - ANS>> edema that retains an imprint when touched Knee Joint - ANS>> largest and most complex joint in the body, hinge joint, permits flexión and extension Test Reflexes - ANS>> Short snappy blow to insertion tendon of muscle