Term
| Skin, Hair, and Nails (2 pts) |
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Definition
-Look at skin and say : Tone is even, smooth and firm ..........
-touch skin on hand and say: warm dry and intact.............
-pinch just under clavicle to check turgor which shows elasticity and hydration......
-look at mucus membranes and say: pink, moist, and intact......
Say: I will continue to examine skin throughout the examination....
Inspect and palpate scalp and hair and note texture and distribution.....
Look at nails and say: nails have no signs of clubbing. they are smooth and regular. (not brittle or splitting) |
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Term
| Nose and paranasal sinuses (3 pts) |
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Definition
-Say: nose is symmetrical and midline, has no lesions.....
-hold one nare then the other tell pt to sniff: say both nares are patent.....
-Using an otoscope lift tip of nose and insert scope: note that the mucosa is red, smooth and moist.....sau that the septum is straight (not deviated)
-palpate frontal sinus (below eyebrow).....
-papate maxillary sinus (below cheekbones) the person shouldn't feel pain...... |
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Term
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Definition
-inspect lips outter and inner (use depressor)....
-inspect mucosa moist pink smooth. point to stensen's duct at opening of paratid salavary gland (dipple opp the upper second molar)............
-look at tongue (use depressor): say color is pink and even. (say lift your tongue and inspect the underside) should be smooth with saliva.....
-Teeth and gums: say gums are pink ask them to bite down........
-Pharynx, use depressor look at tonsils report them as 0 (not present) to 4+. (I'm 1+!)
-testing the gag reflex gets in IX and X.
-you can ask them to stick out there toungue ( XII) it should be straight.
ask the person to say ahh watch the uvula rise this does IX and X ( book only says X). |
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Term
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Definition
-note shape of chest wall, spinus process is straight and thorax is symmetrical in an elliptical shape, with downward sloping ribs. anteroposterior diameter is about a 1:2 ration with the transverse diameter.
-Symmetrical expansion: tell person take a breath in, put hands on back and push in skin on both sides with thumb and have them breath out,
-tactile fremitus: repeat 99 as I place my hand on your back, move side to side each time, down 4 times then the 5th time do the sides of the chest. should feel strong vibrations.
-palpate entire chest wall for any tenderness or lumps.
-percuss the posterior (back) lung fields, again move side to side starting up midway between neck and shoulder then moving down 5 times then out slightly to the slide for 6 and 6, then at the sides for 8 and 9. should be dull over scapula, resonant over lungs, resonance ends at end of lung bases. note where lung field ends. with breath in and out. diaphragmatic excursion should be 3-5 cm.
-ascultate over same areas of the back that you palpated noting lung sounds, bronchial only right over trachea, then bronchovesicular right only right under neck, then vesiclular everywhere else. then do the same with the front of the chest. |
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Term
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Definition
inspection:
-person can move around the room and avoid obstacles and respond to directions. relaxed facial expession.
-eyebrows bilateral, symmetrical and move with facial expression
-eyelids and lashes upperlid overlaps upper part of iris. lids approximate when closed
-eyeballs alighed normally in socket no protrusion or sunken appearance.
-ask person to look up, use your thumbs to lower their lids. say eyeball moist and glossy, conjunctiva clear and show the normal structure (pink over lower lids and white over sclera.
-shine light in eye: say no cloudiness.
-iris flat roung regular shape even coloration.
-pupillary reflex shine light in one eye (you can hold hand on the bridge of the nose to keep light on one side. pupil should constrict on same side AND other side.
-accommodation: hold finger far(dilated pupils) then near by nose (constricted and eyes converge)
-use scope (keep both of your eyes open). tell person to stare at something in the room. look in their eye through pupil from 10 inches away then get closer and closer advance lens up as you go.. say red reflex is intact...once close note optic disc as yellow/orange, round/oval, distinct,
-acuity (cn II) snellen eye chart. have pt 20 ft away. hand then card to put over one eye. (keep glasses or contacts for distance on) have the person read the smallest they can on the chart, then ask then ask them to try the next smallest. top number is number of feet from chart bottom # is the distance a normal eye could have read that line.
-near vision. only teste if over 40 or report difficulty.....
Visual fields: (cn II)
-periferal vision. cover one of their eyes and one of yours on the same side.. come from the top of them, from behinbd the side of the covered eye, from behind the uncovered eye, and from below. tell them to say now when they see it.
-positions test: out to 6 positions (3 each side) out back , out back, out back on each side. up middle, lower. moverment is parallell no weakness of extraocular muscles. (CN 3,4, 6) |
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Term
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Definition
-feel for coratids (one at a time) say reg rhythmn and rate, then listen for bruites over carotid arteries with the bell on both sides of the neck.
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-inspect jugular by having person lie down (remove pillow) and then sit up the veins should disappear. this assess central venous pressure and heart efficiency as a pump and fluid overload.
-inspect anterior chest. look for apical, you might not see it at 4yh or 5th intercostal. note no heaves or lifts.
-feel for apical pulse note the fingerbreadths (1 or 2) it takes to feel it.
-put palm on chest moving down symmetrically you shouldn't feel any other impulses like thrills other than PMI.
Asculaltate over APE to MAN valves, first with bell noting murmers. then with diaphram. S! is louder in MAN and S2 is lounder in AP. Erbs pt should have an equal loudness for s1 nd s2. |
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Term
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Definition
-inspect both sides of the hands noting color and nailbeds. check capillary refill should be 1-2 secs. shows perfusion and cardiac output.
-view fingers to the side to check for clubbing. nailbed should be 160 deg.
-palpate both radial pulses note rate rhythmn and elasticity and grade amp 0-4+. do the same with brachial pulses.
- (mod allen test)occlude ulnar and radial pulses while pt pumps fist until hand blanches. then have them release grip and you let go of their wrist and blood should return in 2-5 secs
-inspect and palpate legs. should be summetric without swelling or atrophy. feel for temp comparing symmetric spots. check homans signs for DVT's dorsiflex foot.
-palpate pulses: femororal, popliteal (behind knee), dorsalis pedis (top of foot), and posterior tibial.rate 0-4+
Note any edema present. |
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Term
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Definition
-CN 1 olfactory smell close eyes identify smell...
-CN 5 trigeminal clench teeth palpate masseter muscle which should be equal. note symmetry. also touch various parts of face while pts eyes closed tell them to identify when they feel the touch.
-CN 7 facial nerve: smile and puff out cheeks.
-cranial accessory nerve: (CN 11). shrug shoulders against resistance.
-test strength against resistance simultaneously. in upper and lower extremity.
Cerebellar function: gait watch them walk, have them walk heal toe, rhomberg test have person stand , arms at side, close eyes, they should only sway minimally.-open eyes do a shallow knee bend one leg than another.
-rapid alternating movement. pat knees switching palms to backs of hand quickly.
there finger to their nosealternating hands and increasing speed. then heel down shin down to ankle to show coordination.
- then test pain vs soft touch on upper foot vs pin prick, also test vibration sense with tuning fork vibration. to test two dermatones do some on the hand and some on the foot.
-position sense, move pts finger up or down and have them tell you if its up or down.
-put object in hand and have them identify and name it.
-draw a letter or number in the pt hand with your finger have them identify it.
-use hammer to test deep tendon reflex's 0-4 /knee jerk (L2-L4), tricept reflex-just above elbow (C7-C8). Bicept-hold bicept tendon and strike on your thumb (C5-6)/brachioradialis reflex-hold thumb strike behind bony process of wrist, / ankle -hold toes up and dorsiflex foot and tap the tendon./plantar reflex-touch middle of foot and move upward with handle of hammer (should plantar flex, no babinski).
check for clonus- push foot to dorsiflex should feel no movement |
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