Periph Vasc System - Ch 20

● Arteries
○ where do you check?
● Veins
○ have valves to force 1-way flow
■ with edema, test for valve competency
● Pulse
○ radial
○ brachial
■ good for newborns and children
○ Femoral
○ popliteal
○ posterior tibial
○ dorsalis pedis
● lymphatics
○ right lymphatic
■ right arm and right side of head
○ left lymphatic
■ everything else
○ Move towards subclavians
● immune organs
○ tonsils
○ thymus
○ spleen
○ marrow
● subjective history
○ leg pain or cramps
■ esp in evenings or aggravated by walking
○ skin changes or discharge
■ hair patterns: men can lose hair during heart problems
○ Swelling
■ one sided can be caused by obstruction
■ can be related to Cong. heart failure
○ medications
■ DVT can be caused by a number of meds
○ bed rest
● Objective data
○ arms
■ cap refil
● <3 sec
■ pulses are equal bilaterally
■ edema
● can be from surgery or heart failure
■ look for scars, tattoos, track marks
 ○ legs
■ skin and hair
● can indicate heart failure
■ symmetry
● size, color, temp
■ Homan’s sign
● dorsiflex foot, if pain in the calf, it is indicative of DVT
■ Manual compression test
● shows if blood is going backwards
■ Edema
● grading scale

Abdomen - Ch 21
● Auscultate FIRST
● Know which organs are in each quadrant
● Subjective data
○ changes in appetite
■ inc or dec
■ change in weight
○ dysphagia
■ difficulty swallowing
○ food intolerances
○ pain
■ can be diffuse or referred
■ have the patient point with one finger where the pain is
■ nausea/vomiting - N/V
● emesis - vomiting
■ BMs
● color
○ black - iron intake, or GI bleed
○ red - rectal blood
● consistency
● frequency
● laxative use
● surgeries, missing organs, etc
● medications
○ alcohol, drugs, supplements
● nutritional assessment
● Objective data
○ inspect
■ contour
■ skin tone
■ symmetry
■ bulges
 ● use cross lighting
■ hernias are often visible
■ umbilicus
● inverted and midline
● piercings are not infected
■ stretch marks
● new are pink
● old are white or silver
■ no veins should be visible
■ pulsations
● can indicate aortic problems
○ Auscultate the abdomen
■ start lower right, move around clockwise
■ sounds might be absent after surgery or blockages
■ Listen for vascular sounds
● bruits
● aortic sounds
○ Palpation
■ fluid wave
● can show free fluid in the abdomen
● can show ascites
■ palpate the parts with pain LAST

Musculoskeletal - Ch 22
● synovial vs nonsynovial joints
● different joint movements
● Structure
○ TMJ
■ jaw moving, no popping
○ spine
■ midline
■ c7 sticks out on back of neck
● Subjective data
○ Joints
■ pain
● anything help?
■ stiffness
● movement limitations
■ swelling, heat, redness
○ Muscles
■ weakness
■ pain/cramps
● atrophy in places of pain
● when? during walking?
 ○ Bones
■ deformities
■ trauma
● pins, rods, etc
○ ADLs
■ patient safety at home
● can PT use stairs, toilet selves, prepare food
■ self care behaviors

Neuro - Ch23
● Structure
○ don’t worry about cranial nerves
○ Dematomes p628
■ important in anesthesia and spinal injury
● subjective data
○ dysphasia vs dysphagia
● Objective data
○ watch gait
■ fine coordination and movement
○ Rhomberg
■ test balance with eyes closed
○ Cerebellar dysfunction looks like drunkenness, many of the sames tests are used
○ sensory
■ sharp vs dull
■ temperature
■ cotton ball
○ reflexes
■ graded 0-+4
● very subjective
● +2 is normal
■ don’t document a 0 until you try reinforcing
■ Clonus
● dorsiflex, then release (keeping hand against foot), if there are
“beats” the nervous system is hypersensitive
○ Glasgow coma scale (GCS) - p663