sinus tachycardia Regular rhythm but HR >100 bpm STOP. Don't palpate Abd Bruit Look listen feel proper abd assessment sequence bowel sounds should listen for these in each quadrant for 5 mind prior to documenting absent. Grips/ Resistance Should be equal and strong Neg. Babinski toes curl inward sinus bradycardia Regular rhythm but HR <60 bpm Cyanosis Bluish discoloration (from decreased O2 levels) dysrhthmia irregular heart beat Aortic Listen to right 2nd intercostal space Pulses rated 0-3+. Use doppler if you can't find one focused assessment One body system Tenting A sign of dehydrstion Petechiae Purple/red spots on skin caused by small hemorrhages Ecchymosis Bruising crackles Sounds like cellophane or dry hair tender areas Palpate this last mitral where to listen for the apical pulse rebound tenderness pain is greater when you release pressure pleural friction rub Metal on metal, grating Rhonchi Sounds like blowing air through milk with a straw 1/2 inch Light palpation wheezes musical sounds melanomas asymmetrical, irregular borders, blue/black in color, greater 6 mm diameter Jaundice Yellowing of the skin due to increased bilirubin Cap refill Helps to assess adequate circulation JVD Can be a sign of Fluid overload PERRLA pupils equal round reactive to light and accommodation Hypoxemia Decreased O2 in arterial blood sinus tachycardia Regular rhythm but HR >100 bpm STOP. Don't palpate Abd Bruit Look listen feel proper abd assessment sequence bowel sounds should listen for these in each quadrant for 5 mind prior to documenting absent. Grips/ Resistance Should be equal and strong Neg. Babinski toes curl inward sinus bradycardia Regular rhythm but HR <60 bpm Cyanosis Bluish discoloration (from decreased O2 levels) dysrhthmia irregular heart beat Aortic Listen to right 2nd intercostal space Pulses rated 0-3+. Use doppler if you can't find one focused assessment One body system Tenting A sign of dehydrstion Petechiae Purple/red spots on skin caused by small hemorrhages Ecchymosis Bruising crackles Sounds like cellophane or dry hair tender areas Palpate this last mitral where to listen for the apical pulse rebound tenderness pain is greater when you release pressure pleural friction rub Metal on metal, grating Rhonchi Sounds like blowing air through milk with a straw 1/2 inch Light palpation wheezes musical sounds melanomas asymmetrical, irregular borders, blue/black in color, greater 6 mm diameter Jaundice Yellowing of the skin due to increased bilirubin Cap refill Helps to assess adequate circulation JVD Can be a sign of Fluid overload PERRLA pupils equal round reactive to light and accommodation Hypoxemia Decreased O2 in arterial blood
(Print)
Regular rhythm but HR >100 bpm
Abd Bruit
proper abd assessment sequence
should listen for these in each quadrant for 5 mind prior to documenting absent.
Should be equal and strong
toes curl inward
Regular rhythm but HR <60 bpm
Bluish discoloration (from decreased O2 levels)
irregular heart beat
Listen to right 2nd intercostal space
rated 0-3+. Use doppler if you can't find one
One body system
A sign of dehydrstion
Purple/red spots on skin caused by small hemorrhages
Bruising
Sounds like cellophane or dry hair
Palpate this last
where to listen for the apical pulse
pain is greater when you release pressure
Metal on metal, grating
Sounds like blowing air through milk with a straw
Light palpation
musical sounds
asymmetrical, irregular borders, blue/black in color, greater 6 mm diameter
Yellowing of the skin due to increased bilirubin
Helps to assess adequate circulation
Can be a sign of Fluid overload
pupils equal round reactive to light and accommodation
Decreased O2 in arterial blood
