Head to Lungs Exam Flashcards
Physical exam from head to lungs
Setting & Preparation
Assemble equipment
Wash hands
Introduce yourself as student NP and that you will be doing an exam
State that the patient is in a private room
Explain what exams you will be doing (HEENT and lungs)
Vital signs and measurements
Verbalize height, weight, vitals, and snellan chart results.
General Survey
State of health- healthy
Stature- Within normal height range
Weight- Overweight
Posture- upright posture
Hygiene- hygienic appearance
Affect- appropriate for situation
Speech- spontaneous
Awareness- aware of situation
Behavior, facial expression, and mannerisms- appropriate for situation
Integumentary (skin, hair, nails)
Skin: Medium skin ton with scattered nevi (macules) that appear symmetrical, clear borders, uniform in color, and less than 6 mm.
Appropriate hair distribution for age and sex
Nails on hands and feet: nailbed color consistent with skin color, less than 3 second cap refill, no evidence of clubbing, infection, or deformities
Head and Face
Inspect and palpate head, hair, scalp, ears, nose, sinuses, lymph nodes (posterior cervical, anterior cervical, submandibular, and supraclavicular),and face for lumps/tenderness
Palpate TMJ and open and close mouth
Eyes +peds
Inspect conjectiva, sclera, iris, and upper and lower eyelids
Assess pupils with pen light: equal, round, reactive to light and accommodation.
Fundoscopic exam: clear, well defined optic disc with sharp margins, no visible hemorrhages, exudates, or other abnormalities in the retina or macula
Peds tests: cover/uncover test for strabismus/phorias, red reflex for cataracts and retinal abnormalities, and corneal light reflex for strabismus
Ears + vertigo
Already inspected and palpated ears
Otoscopic exam- ( ear canals have skin flaking due to psoriasis and tympanic membrane is pearly grey and intact.
The Dix Hallpike Maneuver would be performed if the patient reports dizziness that is suspected to be vertigo. This test can diagnose BPPV.
Nose and Sinuses
Already palpated nose and sinuses
Assess septum/turbinates, nasal mucosa, and patency
transilluminate sinuses (septum is midline, mucose is pink, no congestion or drainage)
Oropharynx
Inspect lips, buccal mucosa, gums, teeth, hard & soft palate, tongue, floor of mouth, uvula, and grade tonsils ( 1+).
Note mobility of uvula (uvula is midline)
Note tongue symmetry and movement (tongue is mobile and movement is symmetrical)
Neck
Already inspected/palpated the lymph nodes
Inspect for JVD
Palpate carotid pulse (2+)
Auscultate carotid pulse
Inspect + palpate for tracheal position (midline)
Palpate thyroid gland from behind and has patient swallow
Back and posterior chest
Verbalize inspecting skin
Palpate scapula, spine, and back muscles
Palpate spinous process for tenderness
Palpate for lumps and tenderness across back
Percuss for CVA for tenderness
Lungs Posterior
Inspect respiratory effort: respirations are effortless with expected rate, depth, rhythm, and pattern.
Palpate for tactile fremitus while patient says 99 (6 posterior and 2 lateral)
Palpate thoracic expansion by hands around back with thumbs facing up)
Percuss lung fields (6 posterior and 2 lateral)
verbalize percussing for diaphragmatic excursions for patients with COPD, asthma, and after surgery. The expected finding is 3-5mm of movement of the diaphragm.
Auscultate breath sounds: 6 posterior and 2 lateral
Verbalize that bronchophony, egophony, and whispered pectoriloquy can be used to detect consolidation. If the patient’s voice becomes clearer as you descend, it indicates consolidation.
Lungs Anterior
Inspect respiratory effort and skin
Verbalize that the TD:AP is normal with the transverse diameter being larger than the anteroposterior diameter
Palpate for tenderness/lumps
Tactile fremitus in 4 areas
Percuss lung fields in 4 areas
Auscultate breath sounds in apices and four other locations
