General Assessment & Intro To Instruments Flashcards
Universal precautions for pt care
Standards set by CDC
Protect the pt and provider from the spread of infectious diseases
Wash hands before and after wearing gloves
When should gloves be worn?
If there is obvious blood, body fluid and pt presenting with diarrhea
What are the CDC standards for pt care?
Perform hand hygiene
Use PPE if possible exposure to infectious material
Follow respiratory hygiene/cough etiquette principles
Ensure appropriate pt placement/isolation
Properly handle, clean and disinfect pt care equipment and instruments
Follow safe injection practices (face shield for LP)
Proper handling of needles and sharps
What are the 4 types of hand hygiene based on CDC guidelines?
Hand washing, antiseptic hand wash, alcohol based hand rub, and surgical hand hygiene/antisepsis
Hand rubbing with an alcohol based hand rub
The gold standard technique to perform hand hygiene on all occasions except for those described for hand washing with soap and water
Recommended for health care works for the routine, day to day decontamination of hands
Hand washing with soap and water
Occupies a central place in hand hygiene and should be employed when hands are visibly dirty or soiled with blood/other body fluids; after using the toilet; and when exposure to potential spore forming pathogens (C. Diff) is strongly suspected or proven including outbreaks of diarrhea
What are the 4 main vital signs?
BP, pulse, respiratory rate and temperature
The bell of the stethoscope is used for
Low pitched sounds (bruits)
The diaphragm of the stethoscope is used for
High pitched sounds (breath sound and heart tones)
What are the three types of sphygmomanometers?
Mercury, aneroid and digital
What is the gold standard for reading BP?
By auscultation
Cuff selection for BP measurement
The length of the cuff’s bladder should be at least equal to 80% of the circumference of the upper arm and the width of the bladder should be at least equal to 40% of the length of the upper arm
Korotkoff sound
The first knocking sound heard when taking BP measurements and it indicates the pt’s systolic pressure
When the sound disappears it marks the diastolic pressure
Which other factors should be noted when taking BP?
Pressure difference in both arms, pt position, which arm was used and the cuff size
What environment is ideal for taking BP?
Pt should avoid smoking, caffeine and exercise >30 min prior to measuring BP
Exam room quiet and warm
Pt should sit quiet for 5 min with feet on the floor (not on exam table)
Arm should be free of clothing, dialysis fistulas, cut down scares and lymphedema
What are the three common errors in BP monitoring?
Falsely high BP, falsely low BP and auscultatory gap
Falsely high BP
Brachial artery below the heart
Cuff too small (narrow)
Cuff too large (wide) on a large arm
Falsely low BP
Brachial artery above heart
Cuff too large (wide) on a small arm
Auscultatory gap
Period of diminished or absent Korotkoff sounds during the manual measurement of BP
Improper interpretation of this gap may lead to BP monitoring errors: namely an underestimation of systolic BP and/or an overestimation of diastolic BP
Checking the pulse rate
Use your index finger not thumb
Report whether pulse is regular or irregular
Pulse rate is by convention reported per minute
Count for 30 seconds and multiply by 2
Can also count for 15 sec and multiply by 4
What are the different locations in which you can check the pt’s pulse?
Radial artery, dorsalis pedis artery, carotid artery, brachial artery, abdominal aorta, femoral artery and popliteal artery
Scale for grading pulses
3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate
Two methods for measuring respiratory rate
Look for chest rise and count
Listen while examine heart or lungs with stethoscope
-count for 30 seconds and multiply by 2
-most adults breathe at about 15-20 breaths per min
-dont call attention to the fact that you are counting
Where can you take a pt’s temperature?
Orally (measures body temp)
Rectally (higher than when taken by mouth)
Axillary (lower than when taken by mouth)
Ear (core temp/internal organs)
Skin (quick)
When is the general assessment of the pt made?
Once you have first looked at the pt and as you are doing your interview and PE
The general assessment of the pt consists of noting their
Apartment state of health (general judgment)
Level of consciousness (alert, awake and responsive)
Signs of distress (cardiac or respiratory, pain, anxiety or depression)
Skin color and obvious lesions (skin color, scars, plaques or nevi)
When observing the general appearance of the pt, which factors should also be noted?
Nutritional status (normal, slim, cachectic, obese, etc)
State of hydration if obvious
Posture (stooped, erect, flaccid)
Gait (normal, shuffling, antalgic, asymmetrical, unsteady)
Dress (causal, meticulous, disheveled, nude)
Hygiene
Cooperation (personable, conversational, aloof, distracted)
Height/weight (stated with vitals)
Odor
Primary survey (seconds)
Secondary survey (minutes)
What are some signs of distress that can be noted when observing general appearance?
Affect/mood: pleasant, depressed, flat affect
Verbal tones: anger, frustration, obnoxious, impatient
Posture: restless, gait, shifting
PE findings: sweating, flushed
When completing the overall assessment of the skin you should
Scan the skin for variations in skin tone looking for features such as pigment variations, erythema, flushing, jaundice, pallor (pale) or cyanosis
Macule
Flat lesion <1 cm
Patch
Flat lesion >1cm
Papule
Raised lesion, <1cm, not fluid filled
Plaque
Raised lesion, >1cm, not fluid filled
Vesicle
Raised lesion, <1cm and fluid filled
Bulla
Raised lesion, >1cm and fluid filled
Primary lesions
Flat or raised
Examples: macule, patch, papule, plaque, vesicle, bulla, erosion, ulcers, nodules, ecchymoses, petechiae and palpable purpura
When observing the pt’s scalp and hair you should
Evaluate scalp for scars, deformities, bumps, etc
Evaluate hair for any abnormal changes in texture and pattern loss (alopecia)
Assess for presence of excess hair distribution (hrisutism) or virilization (male secondary sx characteristics in female)
Ophthalmoscope
Used to visualize inner aspect of eye including retina, vascular supply, optic nerve, etc
Ask pt to look over shoulder, look through aperture, approach pt, hand on pt forehead, R eye to examine R eye, start 15 degrees from center laterally and move toward the pt to identify red reflex
Large/medium/small light source - ophthalmoscope setting
Small light is used when the pupil is very constricted (ex. In a well lit room)
Large light is best if using mydriatic eye drops to dilate
Medium sized light is used in a dark non dilated pupil
Half light ophthalmoscope setting
If the pupil is partially obstructed by a lens with cataracts, the half circle can be used to pass light through only the clear portion of the pupil to avoid light reflecting back
Red free ophthalmoscope setting
Used to visualize the vessels and hemorrhages in better detail by improving contrast
Will make the retina look black and white
Slit beam ophthalmoscope setting
Used to examine contour abnormalities of the cornea, lens and retina
Blue light ophthalmoscope setting
Can be used to observe corneal abrasions and ulcers after fluorscein staining
Grid ophthalmoscope setting
Used to make rough approximations of relative distance between retinal lesions
When checking the ear of a child >12 months or an adult you should hold the otoscope in one hand and use your free hand to
Pull the other ear gently up and back which straightens the ear canal and improves visualization
When observing the ear canal in a child less than 12 months old you should gently pull the outer ear
Down and back
Using a tuning fork for hearing evaluation
Air conduction - lasts longer than bone conduction; hold the fork in front of external auditory meatus
Bone conduction - hold handle on bones area behind the ear
Evaluating vibratory sense with a tuning fork
Place handle on patella and compare L and R for duration
The tuning fork can be used to perform two
Neurological tests: gross hearing for CN and vibration sense
Upper extremity deep tendon reflexes
Biceps (hammer strikes thumb), triceps (hammer strikes ligament) and brachioradialis (hammer strikes ligament)
Lower extremity deep tendon reflexes (LE DTRs)
Patellar and Achilles reflex
Scale for grading reflexes
4 - very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension)
3 - brisker than average; possible but not necessarily indicative of disease
2 - average; normal
1 - somewhat diminished; low normal
0 - reflex absent
Osteopathic Structural Exam (OSE) integrates information about the
Musculoskeletal system even when dealing with non musculoskeletal complaints
Documenting OSE includes
Tissue texture changes, asymmetry, range of motion and tenderness
