Examination Techniques and Equipment Flashcards
What contains transmissable infections agents?
Blood Body fluids Secretions Excretions (except sweat) NONintact skin Mucus membranes
What procedures require masks to prevent the spreading of transmissable infectious agents
insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture
Transmission-based precautions
Applies to pathogens spread by Air Droplet Dry Skin Contaminated Surfaces
Latex Allergy
Occurs from direct or mucus membrane contact
Healthcare and pts with multiple surgeries or procedures are at risk
Four examination techniquest
Inspection
Palpation
Percussion
Auscultation
Guidelines for Inspection
Adequate lighting
Unhurried and careful inspection
Expose what you want to inspect
Validation of findings with patient
Palpation guidelines
Keep fingernails short Have warm hands Be gentle in approach Use correct palpation depth Use appropriate hand surface
Palmar surface of the fingers and finger pads allow for?
Position, texture, size,consistency, fluid, creptitus (joint popping) form of a mass or structure
Ulnar surface of the han
Side of little finger allows for inspection of vibration
Dorsal surface of the hand
Checks temperature
Percussion guidelines
One object striking against another produces vibrations and sound waves
Tapping fingers produces vibrations on underlying tissues
Sound waves from vibrations produce percussion tones (resonance)
Tone is related to density of underlying tissues
Tympany
loud, high, drumlike gastric bubble (stomach)
Hyperresonance
very loud, low, booming
normal lungs in children, emphysematous lungs in adults
Resonance
loud, low, hollow
healthy lung tissues
Dullness
soft, moderate, thudlike
Over liver
Flatness
soft, high, dull
Over muscle
Immediate (direct) percussion
finger strikes directly against body (reflexes)
Mediate (indirect)
Middle finger of dominant hand is hammer, middle finger finger of nondominant hand is placed on body and struck
Fist percussion
Nondominant hand is placed on body and struck with fist of dominant hand (CVA tenderness)
Auscultation guidelines
Sounds produced by body
Performed last in examination (2nd in abdominal)
Stethoscope placed on naked skin
Listen for sound, and one sound at a time
Take time to identify
Do not anticipate next sound
What are the 6 vital signs?
Pulse, respirations, BP, temp, pain, and O2
Normal arterial O2
97-99
Pediatric VS
high HR, higher temp
Geriatric VS
low HR, lower temp
Measurement of height and weight
Adult - Standing platform scale with height attachment
Infant - Weight on platform scale lying or sitting
Child (when able to stand) - stadiometer
infants and children up to 2-3 y/o need their head circumference taken
Special Concerns for Patients with Disabilities
Bowel and bladder concerns
Autonomic hyperreflexia (overreaction to external or bodily stimuli)
Hypersensitivity
Spasticity
Stethoscope
Amplifies auscultations
Bell - low pitched sounds
Diaphragm - high pitched sounds
Pulse Oximeter
Measures percentage of hemoglobin saturated with oxygen
Measures how much oxygen the blood is carrying as a percentage of the maximum it could carry
Taken via the finger, toe or pinna of the ear
Snellen Alphabet (visual acuity chart)
Smallest complete line patient can see is recorded
Recorded as a fraction (20/20)
Larger denominator = poorer vision
20/40 a normal person can see at 20 is what a poorer person sees at 40
Rosenbaum and Jaeger charts (Near Vision)
Series of numbers, E, X and O in graduated sizes
Acuity recorded at distance (20/20) or Jaeger equivalents (J-2)
Otoscope
Contains illumination piece for external auditory canal and tympanic membrane
Speculum directs beam of light down ear canal
Pneumatic attachment evaluates fluctuating capacity of tympanic membrane
Hold otoscope like a pencil and use other hand to hold pt head
Nasal Speculum
Used with penlight to see lower and middle turbinates of nose (ridges)
Open blade by squeezing handles of instrument
Stabilize speculum with index finger to avoid contact of blades to nasal septum
Tilt pts head
Tuning Fork
Cranial nerve eight
test auditory fxn and vibratory sensation
measures in cycles per second or Hz
Auditory used to estimate hearing loss by noting which vibrating tuning forks can be hears (500-1000Hz)
Vibratory sense is measured by holding vibrating fork against bony prominence (100-400Hz)
Percussion Hammer
Tests deep tendon reflexes (DTRs)
Hammer held loosely between thumb and index finger and a tendon is tapped to elicit reaction
Finger may also be used as percussion hammer in peds
Neurologic Hammer
Variant of percussion hammer (can test DTRs)
Base of handle unscrews, revealing soft brush
Knob on head unscrews, revealing sharp needle (no longer used due to cross contamination)
Monofilament
Test sensation on plantar surface of foot
Bends at 10g of linear pressure-patient has lost sensation if not felt when bent (used in diabetics)
Guidelines include:
Test various foot points while patients eyes are closed
Press and bend filament
Have patient indicate if filament if felt
