General examination Flashcards
Initial assessment
Bed positioning & angle
Immediate intervention
The patient is conscious, does not appear to be distressed, have any pain
Breathing is not laboured, with no obvious evidence of use of accessory muscles
Oxygen mask + tubing Inhalers / nebulisers Bedside medication Sputum pot ± contents Vomit bowl Monitors NEWS2 chart
Inspection of the hands
Nails: Splinter haemorrhages (heart infection+ vessel damage), cyanosis, koilonychias (spooning, anaemia), clubbing (nailbed fluctuation + side view)
Fingers: Capillary refill, shape of joints, make fist & straighten fingers
Palms: Colour of palm crease(anaemia), temperature (CO2 retention vasoconstricts)
Tremors: Fine (outstretch arms), Flapping (cock wrist back for 15s-+ve CO2 retention
Examination of the arms
Pulse: Rate, rhythm, respiratory rate (15s x4)
Inspection: Joint deformity, bruising, scars, venous damage/track marks/medical intervention
Assess: Skin turgor on forearm by pinching up skin- determine hydration status (+ve=mod/severe dehydration)
Examination of head
Face: overall appearance, symmetry (palsy), colour (malar flush, stenosis, CO2 retention, vasodilation), facies (Marfan’s)
Ears: shape, swelling, bruising
Eyes: colour (yellow jaundice sclera), conjunctivae pallor (pink), Xanthelasma + corneal arcus (peripheral corneal opacity) (seen in hypercholesterolemia)
Mouth: buccal (inner cheek) ulceration, tonsils (tonsillitis), gums, tongue (cyanosis (HF, COPD), size (acromegaly), texture (dry-dehydrated, lichen planus)
Examination of neck
Lymph nodes:
Submental Submandibular Deep cervical (URTI/cancer) Supraclavicular (GI malignancy, thyroid disease/thoracic cancer) Posterior cervical Occipital Pre auricular Post auricular (last 4 drain scalp- scalp infection/ cancer)
Examination of chest
Inspect + Palpate:
inspect and palpate lesions e.g. spider naevi (liver disease/pregnancy)
gynecomastia (adrenal/pituitary tumour)
scars (chest surgery)
Examination of legs and feet
Observe and palpate: skin colour hair distribution ulcerations varicose veins temperature between limbs and across joints swelling/pitting oedema (15s compression ankle) skin thickening movement of toes and soles of feet.
