9 - Health Management & Physical Examination
9 - Health Management & Physical Examination
9 - Health Management & Physical Examination
6
Lesson 4: Health Management & Physical Examination . 2
Pulse Sites ................................................................... 6
Health Assessment vs Physical Examination .............. 2
Assessment of the Pulse .............................................. 6
Health Assessment ...................................................... 2
Rate ......................................................................... 6
Physical Examination ................................................... 2
Rhythm ..................................................................... 6
Modes of Examination .............................................. 2
Volume (Amplitude) .................................................. 6
Positions in Physical Examination ............................. 2
Arterial Wall Elasticity ............................................... 6
Assessing the General Appearance and Behavior of an
Presence/Absence of Bilateral Equality ..................... 6
Individual.................................................................. 2
Respiration..................................................................... 7
Laboratory and Diagnosis Examinations ................... 2
Three Processes .......................................................... 7
Framework for Health Assessment .............................. 3
Two Types of Breathing................................................ 7
Functional Health Framework....................................... 3
Costal ....................................................................... 7
Data Collection in terms of Gordon ........................... 3
Diaphragmatic .......................................................... 7
11 Functional Patterns .......................................... 3
Respiratory Centers ..................................................... 7
Head-to-Toe Framework .............................................. 3
Medulla oblongata .................................................... 7
Body System Framework ............................................. 3
Pons ......................................................................... 7
Assessing Vital Signs ................................................... 3
Pneumotaxic Center .............................................. 7
Body Temperature......................................................... 4
Apneustic Center................................................... 7
Types of Body Temperature ......................................... 4
Carotid and Aortic Bodies ......................................... 7
Core Temperature .................................................... 4
Assessing Respiration .................................................. 7
Surface Temperature................................................ 4
Rate ......................................................................... 7
Factors Affecting the Body’s Heat Production ............... 4
Depth ....................................................................... 7
Basal Metabolic Rate (BMR)..................................... 4
Rhythm ..................................................................... 7
Muscle Activity ......................................................... 4
Quality or Character .................................................. 7
Thyroxin Output ........................................................ 4
Major Factors Affecting Respiratory Rate...................... 7
Epinephrine, Norepinephrine, and Sympathetic
Stimulation ............................................................... 4 Must Know (Terms) ...................................................... 7
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LESSON 4: HEALTH MANAGEMENT & PHYSICAL Positions in Physical Examination
EXAMINATION
➢ Dorsal Recumbent
→ back lying position with knees flexed and hips
Health Assessment vs Physical Examination
externally rotated
Health Assessment
➢ Dorsal/Supine
→ is a collection of data about an individual’s health → back lying position with or without a pillow
Physical Examination
➢ Genupectoral/Knee-Chest Kneeling position
→ is a head-to-toe review of each body system that offers → with torso at 90 degrees angle to hips
objective information about the client
▪ and allows the healthcare provider to make clinical ➢ Lateral/Side-lying Position
judgments
➢ Sim’s Position/Semi-Prone Position
→ Purpose of Physical Examination
▪ for routine screening to determine the client’s ➢ Prone/Face-lying position
eligibility for health insurance → with the head turned to the side; aka abdominal-
lying position
▪ for acquiring a new job
▪ for the client’s admission to the hospital Assessing the General Appearance and Behavior of an
Individual
→ specimen used:
▪ urine
▪ stool
▪ blood
▪ other body secretions
2
Framework for Health Assessment Body System Framework
→ Head
▪ hair
▪ scalp
▪ eyes
▪ ears
▪ oral cavity
▪ cranial nerves
→ Neck
→ Chest
→ Abdomen
→ Extremities
→ Genitals
→ Rectum
3
Body Temperature Processes Involved in Heat Loss
Surface Temperature
Conduction
→ the temperature of the:
▪ skin → the transfer of heat from one surface to another
▪ subcutaneous tissue
▪ and fat → it requires a temperature difference between the two
surfaces
→ measured by taking axillary temperature
→ ex. application of moist wash-cloth over the skin
→ body heat is primarily produced by metabolisms
→ Diurnal Variations
Epinephrine, Norepinephrine, and Sympathetic Stimulation
▪ the highest temperature is usually reached
→ increase the cellular metabolisms between 8:00 a.m. to 12:00 noon
→ these in turn increase body temperature
▪ and the lowest temperature is reached between
4:00-6:00 a.m.
Increase Temperature of the Body Cells
→ fever → Exercise
▪ increases the rate of cellular metabolisms
→ Hormones
▪ Ex.
progesterone
thyroxine
norepinephrine
and epinephrine
increase body temperature
→ Stress
4
Alterations in Body Temperature Clinical Signs of Fever
→ body temperature above the normal range → cold or chill stage of fever
▪ Hyperthermia, or fever → increased heart rate
→ increased respiratory rate and depth
→ shivering
Hyperpyrexia
→ pale, cold skin
→ very high fever, 41°C (105.8 F) and above → cyanotic nail bed
→ complaints of feeling cold
→ “Goose flesh” appearance of the skin
Hypothermia
→ cessation of sweating
→ subnormal core body temperature → rise in body temperature
Remittent Fever
→ drowsiness, restlessness, delirium, and convulsions
→ the temperature fluctuates within a wide range over the 24-
hour period → herpetic lesions of the mouth
▪ but remains above the normal range ▪ fever blisters
→ loss of appetite
Relapsing Fever
→ the temperature is elevated for a few days, alternated with → malaise, weakness, and aching muscles
a 1- or 2-days normal temperature
Defervescence
Constant Fever
→ fever abatement
→ body temperature is consistently high → skin that appears flushed and feels warm
→ very high fever temperatures (41-42°C) → sweating
→ decreased shivering
→ possible dehydration
Decline of Fever
Lysis
5
Pulse Assessment of the Pulse
→ Position Changes
▪ in sitting or standing position there is a decreased Arterial Wall Elasticity
venous return to the heart → the artery feels straight, smooth, soft, and pliable
decreases BP
increases in the heart rate
Presence/Absence of Bilateral Equality
6
Respiration Assessing Respiration
→ Ventilation
Depth
▪ the movement of gases in and out of the lungs
▪ Inhalation (Inspiration) → observe the movement of the chest
▪ Exhalation (Expiration) → it may be normal, deep, and shallow
→ Diffusion
▪ the exchange of gases from an area of higher Rhythm
pressure to an area of lower pressure → observe for regularity of exhalations and inhalations
→ Stress
Two Types of Breathing
→ Environment
Costal ▪ high temp = decrease RR
▪ low temp = increase RR
→ thoracic
→ involves movement of the chest → Medications
▪ e,g narcotics decrease RR
Diaphragmatic
→ Bradypnea
Pons
▪ slow breathing
→ contains the following:
▪ less than 12 breaths/minute in an adult
→ Orthopnea
Apneustic Center ▪ ability to breathe only in the upright position
→ responsible for the deep, prolonged inspiration
→ Apnea
▪ absence of respirations
Carotid and Aortic Bodies
→ Platypnea
→ contain peripheral chemoreceptors
▪ the difficulty of breathing in an upright position
7
Blood Pressure Determinants of Blood Pressure
→ Race → after puberty and before age 65 years, males have higher
BP
→ Obesity
→ after the age of 65 years, females have higher BP due to
hormonal variations in menopause
Medications
Diurnal Variations
Diseases Process
→ Diabetes Mellitus
→ Renal Failure
→ Hyperthyroidism
→ Cushing’s Diseases
▪ cause increase BP