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H & P Practical No.1 > General Inspection, Vital Signs & Skin through Cardiac > Flashcards

General Inspection, Vital Signs & Skin through Cardiac Flashcards

1
Q

GENERAL START: Introduce self to patient

A
  • Wash hands before touching patient.
  • Ask how he/she would like to be addressed.
  • Inquire about why patient is being seen, in patient’s own words.
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2
Q

General Inspection
Observe patient - noting general state of health, facial expression, stature, build posture, level of distress, hygiene, speech, mobility, mental alertness, etc.

A

• “I am inspecting the patient for general state of health, stature, signs of distress, hygiene, and mental alertness.”

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3
Q

Vital Signs: Height, weight, & temperature

A

• “I have noted your ht, wt, and temperature.”

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4
Q

Radial pulse (apical pulse if radial pulse is questionable)

A
  • Palpate the patient’s radial pulse, using the pads of the distal 1st and 2nd fingers.
  • Count for 15 seconds and multiple by 4 (if any irregularity noted, count for 60 seconds).
  • “I am noting the patient’s pulse by counting for 15 seconds and multiplying by 4.”
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5
Q

Radial pulse statement

A

• “I am noting the patient’s pulse by counting for 15 seconds and multiplying by 4.”

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6
Q

Respirations

A
  • While continuing to palpate the radial pulse, count the patient’s respirations for 15 seconds and multiple by 4.
  • “The patient’s respirations are ___ and unlabored.”
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7
Q

Respiration statement

A

• “The patient’s respirations are ___ and unlabored.”

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8
Q

Blood Pressure

A
  • 1st use the BP cuff to estimate BP or ask the patient what his/her usual BP reading is. Inflate cuff to 30 mmHg above this # before determining BP.
  • “The patient’s blood pressure is ___.”
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9
Q

BP Statement

A

• “The patient’s blood pressure is ___.”

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10
Q

SKIN START: Inspect skin - noting color, rashes, any lesions including color, type, location, and distribution. (and statement)

A
  • Expose legs and torso if necessary.

* “I am inspecting the skin noting the color and looking for any rashes or lesions.”

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11
Q

Skin statement- general

A

• “I am inspecting the skin noting the color and looking for any rashes or lesions.”

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12
Q

Palpate skin – noting temperature, texture, and turgor

A
  • Palpate the skin of the upper and lower extremities using the dorsum of the hands.
  • Check skin turgor on the dorsum of the forearm.
  • “The skin is warm and dry and turgor is normal.”
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13
Q

Skin palpation statement

A

• “The skin is warm and dry and turgor is normal.”

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14
Q

HEAD START: Inspect the facial features (and statement)

A

• “I am inspecting the facial features noting that they are symmetric.”

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15
Q

Test function of facial muscles (CN VII)

A
  • Ask patient to squeeze eyes shut, wrinkle forehead, smile, puff out cheeks.
  • “CN 7 is intact.”
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16
Q

Facial muscles statement

A

• “CN 7 is intact.”

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17
Q

Test light touch on the face (CN V sensory)

A
  • Ask patient to close eyes. Using a Q-tip, lightly touch the patient’s forehead, cheeks, and chin.
  • Ask patient to say “now” each time he/she feels the light touch.
  • “CN 5 sensory is intact.”
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18
Q

Light touch on face statement

A

• “CN 5 sensory is intact.”

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19
Q

Palpate the facial bones and sinuses

A

• Ask the patient if he/she experiences any tenderness.

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20
Q

Palpate the TMJ and test ROM

A

• While palpating the TMJ, ask the patient to move his/her jaw from side to side.

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21
Q

Palpate the masseter muscles (CN V, motor)

A

• Ask patient to clench his/her teeth.

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22
Q

Inspect and palpate the hair, scalp, and skull

and statement

A

• “The head is normocephalic. The hair is course and straight with symmetric hair distribution.”

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23
Q

EYES START: Inspect external eyes

A
  • Inspect the lids, conjunctivae, sclera, cornea, and iris.

* “I am inspecting the eyes for symmetry, exophthalmos, ptosis, injection (hyperemia), and icterus.”

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24
Q

Inspect external eyes statement

A

• “I am inspecting the eyes for symmetry, exophthalmos, ptosis, injection (hyperemia), and icterus.”

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25
Q

Test visual acuity (CN II)

A
  • Hold hand-held eye chart 14” from patient’s eyes. Ask him/her to cover 1 eye and read the lowest line that he/she can, then cover the other eye and read the lowest line that he/she can.
  • “The patient’s vision is ___.”
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26
Q

Visual acuity statement

A

• “The patient’s vision is ___.”

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27
Q

Assess depth of the anterior chambers

A
  • Shine light toward side of patient’s eye (bilaterally) and look for a shadow on the medial aspect of iris.
  • “No crescent shadows noted.”
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28
Q

Depth of ant. chambers statement

A

• “No crescent shadows noted.”

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29
Q

Corneal light reflection (and statement)

A

• “Corneal light reflections are symmetric.”

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30
Q

Direct and consensual pupillary light reflexes (and statement)

A

• “Pupils are equal round and reactive to light.”

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31
Q

EOMs (CNs III, IV, VI) and accommodation

A
  • Using H pattern, evaluate EOMS in 6 cardinal positions.
  • “EOMs are intact bilaterally, without nystagmus.”
  • “Eyes converge and accommodate to near vision.”
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32
Q

EOMs (CNs III, IV, VI) and accommodation statements

A
  • “EOMs are intact bilaterally, without nystagmus.”

* “Eyes converge and accommodate to near vision.”

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33
Q

Ophthalmoscopic examination bilaterally

A
  • Use correct technique.
  • “Red reflex is present. Disc margins are sharp, cup to disc ratio is 1:2, AV ratio is 2:3 and there are no hemorrhages or exudates.”
34
Q

Ophthalmoscopic examination bilaterally statement

A

• “Red reflex is present. Disc margins are sharp, cup to disc ratio is 1:2, AV ratio is 2:3 and there are no hemorrhages or exudates.”

35
Q

EARS START: Check hearing (CN VIII)

A

• Ask patient to repeat whispered words or to indicate when they hear you rub your fingers.

36
Q

Inspect external ears

A
  • Inspect the auricle and surrounding tissue.

* “I am inspecting the ear for masses or lesions.”

37
Q

Inspect external ears statement

A

• “I am inspecting the ear for masses or lesions.”

38
Q

Palpate ears

A
  • Palpate the auricle, tragus, and mastoid.

* “There is no ecchymosis or discoloration of the mastoid.” (“Battle sign” suggests basilar skull fracture)

39
Q

Palpate ears statement

A

• “There is no ecchymosis or discoloration of the mastoid.” (“Battle sign” suggests basilar skull fracture)

40
Q

Otoscopic examination bilaterally

A
  • Use correct technique.

* “Canal is patent. Light reflex and landmarks are noted, and the TM is pearly gray and translucent.”

41
Q

Otoscopic examination bilaterally statement

A

• “Canal is patent. Light reflex and landmarks are noted, and the TM is pearly gray and translucent.”

42
Q

NOSE START: Inspect external nose (and statement)

A

• “Nose is midline and without deformities.”

43
Q

Test nasal patency

A

• Ask patient to occlude 1 nostril and sniff, then occlude the other nostril and sniff.

44
Q

Palpate external nose

A

No instructions on script

45
Q

Nasal speculum exam bilaterally

A
  • Inspect the nasal mucosa, septum, and turbinates.

* “The nasal mucosa is pink with scant clear rhinorrhea present.”

46
Q

Nasal speculum exam bilaterally statement

A

• “The nasal mucosa is pink with scant clear rhinorrhea present.”

47
Q

MOUTH START: Inspect the mouth and pharynx

A
  • Inspect the lips, teeth, gums, mucosa, and tonsils.
  • Note breath odor and tap teeth with tongue blade if indicated.
  • “The lips are red without lesions and the teeth are in good repair.”
  • “I am inspecting the buccal mucosa, Stenson’s (parotid) duct, the posterior pharynx, and tonsils.”
  • “The floor of the mouth and Wharton’s duct are normal.”
48
Q

Inspect the mouth and pharynx statements

A
  • “The lips are red without lesions and the teeth are in good repair.”
  • “I am inspecting the buccal mucosa, Stenson’s (parotid) duct, the posterior pharynx, and tonsils.”
  • “The floor of the mouth and Wharton’s duct are normal.”
49
Q

Examine soft palate and uvula (CN IX, X) and statement

A
  • Ask the patient to stick out his/her tongue and move it from side-to-side.
  • “CN 12 is intact.”
50
Q

Palpate the oral cavity

A
  • Use a clean glove (individual glove should not be placed on countertop).
  • Palpate the floor of the mouth and buccal mucosa, between gloved fingers inside mouth and other fingers outside mouth (bimanual technique).
51
Q

NECK START: Inspect neck

A
  • Observe for neck symmetry, fullness, masses, thyromegaly, JVD, tracheal alignment.
  • “I am inspecting the neck for symmetry, fullness, masses, and JVD.”
52
Q

Inspect neck statement

A

• “I am inspecting the neck for symmetry, fullness, masses, and JVD.”

53
Q

Assess neck ROM

A
  • Assess flexion, extension, lateral rotation, and lateral flexion.
  • Ask patient to: touch his/her chin to chest, look up at ceiling, look to the R and L, and tilt head to shoulder on both sides.
54
Q 
Test lateral rotation against 
resistance bilaterally (CN XI)
A

• Ask patient to turn his/her head into your hand as you provide resistance.

55
Q

Test shoulder shrug against resistance (CN XI)

A

No instructions given in script

56
Q

Palpate lymph nodes

A
  • Palpate each group of lymph nodes.
  • Palpate occipital, post-auricular, and pre-auricular nodes.
  • Palpate tonsillar (retropharyngeal), submaxillary (submandibular), and submental nodes.
  • Palpate anterior cervical (superficial and deep), posterior cervical (superficial and deep), and supraclavicular nodes.
  • Verbalize each group being palpated.
  • “I am palpating the lymph nodes, occipital (as they are palpated), post-auricular (as they are palpated), pre-auricular (as they are palpated), etc.”
57
Q

Palpate lymph nodes statements

A

“I am palpating the lymph nodes, occipital, post-auricular, and pre-auricular nodes, tonsillar (retropharyngeal), submaxillary (submandibular), and submental nodes, anterior cervical (superficial and deep), posterior cervical (superficial and deep), and supraclavicular nodes

58
Q

Palpate carotid arteries (and statement)

A

• “Carotid pulses are 2+ bilaterally.”

59
Q

Auscultate carotid arteries (and statement)

A
  • Use the diaphragm and bell of the stethoscope.

* “No carotid bruits appreciated.”

60
Q

Palpate tracheal position (and statement)

A
  • Examine while facing patient.

* “Trachea is midline.”

61
Q

Palpate thyroid (and statement)

A
  • Use posterior approach and ask patient to swallow during palpation.
  • “The thyroid is not enlarged and no nodules are appreciated.”
62
Q

PULMONARY/CHEST START: Inspect the patient’s chest, body habitus, and skin (and statement)

A

• “I am observing the patient noting chest symmetry, AP diameter, and any deformities or lesions.”

63
Q

Observe the patient’s breathing pattern and effort (and statement)

A

• “Respirations are regular and unlabored without intercostal retractions or use of accessory muscles.”

64
Q

Palpate the posterior and lateral thorax

A
  • Using finger pads (not tips), palpate across the posterior and lateral thorax.
  • Ask pt to report any tenderness.
65
Q

Percuss the posterior and lateral lung fields for resonance (comparing sides)

A
  • Percuss posterior lung fields in at least 6 locations.
  • Percuss lateral lung fields in at least 4 locations (2 on each side).
  • Note – dullness replaces resonance when fluid or solid tissue replaces normally air-filled lung or occupies the plueral space [e.g. lobar pneumonia (lung filled with fluid); plueral effusion (fluid in the pleural space)].
  • Hyperresonance occurs over hyperinflated lungs (e.g. COPD, pneumothorax).
66
Q

Perform fist percussion of the spine and CVAs

A
  • Use gentle to moderate fist percussion.

* Ask pt to report any tenderness.

67
Q

Auscultate the posterior and lateral lung fields

A
  • Must auscultate on skin.
  • Ask pt to take a moderate-sized breath in and out through his/her mouth each time you move your stethoscope.
  • Listen in at least 6 places posteriorly and 4 places laterally (2 on each side).
  • Listen for a full respiratory cycle with each placement of the stethoscope.
  • “Breath sounds are clear and symmetric.”
68
Q

Auscultate the posterior and lateral lung fields statement

A

• “Breath sounds are clear and symmetric.”

69
Q

Inspect the anterior chest

A
  • Expose pt’s chest and drape appropriately.
  • May need to pull gown down to inspect upper chest of female and pull gown up to inspect lower chest of female.
  • “I am inspecting the anterior chest noting any skin lesions or deformities.”
  • “Breathing remains symmetric and unlabored.”
70
Q

Inspect the anterior chest statements

A
  • “I am inspecting the anterior chest noting any skin lesions or deformities.”
  • “Breathing remains symmetric and unlabored.”
71
Q

Palpate the anterior chest

A

• Using finger pads (not tips), palpate across the anterior chest wall.

72
Q

Percuss the anterior lung fields for resonance (comparing sides)

A

• Percuss the anterior lung fields in at least 6 locations.

73
Q

Auscultate the anterior lung fields

A
  • Must auscultate on skin.
  • Listen in at least 6 locations.
  • “Breath sounds are clear and symmetric.”
74
Q

Auscultate the anterior lung fields statement

A

• “Breath sounds are clear and symmetric.”

75
Q

CARDIAC START:

Auscultate the heart

A

• Auscultate heart in all 4 areas, 1st with the diaphragm, then with the bell.
• Stethoscope on skin.
1. Aortic [2nd R. ICS, RSB (below 2nd rib)]
2a. Pulmonic (2nd L. ICS, LSB)
2b. 2nd pulmonic (3rd L. ICS, LSB)
3. Tricuspid (4th and 5th L. ICS, LSB)
4. Mitral (or apex) (5th L. ICS in MCL)

76
Q

Ask pt to lie down. Expose chest.

Drape appropriately. Examiner on R. side of pt.

A

In-between instruction

77
Q

Inspect chest wall

A
  • Observe for PMI (point of maximum impulse) or precordial heaves.
  • “PMI is noted in the 5th intercostal space (ICS) at the midclavicular (MCL) line. There is no precordial heave.”
78
Q

Inspect chest wall statement

A

• “PMI is noted in the 5th intercostal space (ICS) at the midclavicular (MCL) line. There is no precordial heave.”

79
Q

Palpate the precordium (and statement)

A
  • Note any lifts or thrills.

* “There are no thrills or lifts.”

80
Q

Auscultate the heart

A
  • Auscultate the heart in all 4 areas, 1st with the diaphragm, then with the bell.
  • Stethoscope on skin
81
Q

Palpate the axillary lymph nodes

male pt or female not having a breast exam

A

**For practical, verbalize only (do not perform).****

  • Use 4 sweep technique.
  • Palpate along ant., mid., and post.axillary lines, and medial upper arm
  • “At this point in the exam, I would normally palpate the axillary nodes.”
82
Q

Palpate the axillary lymph nodes

(male pt or female not having a breast exam) statement

A

“At this point in the exam, I would normally palpate the axillary nodes.”

H & P Practical No.1 (1 decks)

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