Intro to Physical Exam Things to Know Flashcards
Wash Hands
have to perform for 20 seconds (think cna exam)
Introduce self as PA student
have to perform, basic introduction
General Appearance
assess general health, level of consciousness, affect, signs of distress: state why it’s important to proctor and what you notice in pt
Height and Weight (BMI)
- measure at every visit
- take off shoes, excess clothing
**state the classifications of weight by BMI:
a. <18.5 underweight
b. 18.5-24.9 normal
c. 25-29.9 overweight
d. 30+ obese
**not actually checking weight or height
Blood Pressure (BP)
- state how to accurately do blood pressure and why correct cuff size, pt sitting, no restrictive clothing, uncrossed legs, etc is important
- state that BP should be checked in both arms but only check one in reality
- state that bell part of stethoscope is recommended due to the smaller surface area and typically easier to hear the sounds due to less background noise
- normal BP is 120/80
- state that palpating radial artery is useful and then pumping up the blood pressure cuff while using it helps find the top to go to, go 30 above from when you can’t feel the artery
Orthostatic BP
do not need to perform but state that you would check supine, sitting and standing BP if pt stated any symptoms such as sudden dizziness w/standing, blurry vision, fainting, lightheadedness or muscle tremors
- also mention that orthostatic blood pressure would be noticed by notable decreases in BP from supine to standing in intervals of at least 20 systolic and 10 diastolic w/an increased HR going from one to the other as well
Pulse
check radial pulse for 30 seconds if regular (it will be), 60 if not
- state normal pulse range (60-100 bpm)
- note rate and rhythm (note the rate that you found and if it was strong, faint, bounding, etc.)
- state that if HR was irregular that you would then listen to the heart at its source to determine arrhythmias, murmurs, etc.
Respiratory Rate
count respirations for 1x minute and state the normal range (12-20) and what you got from your count
Pain
have pt rate pain on a scale of 0 to 10
- state a few questions you would ask if pt were in pain (onset, was it associated with anything, what makes it better, what makes it worse, how would they describe the pain)
- state what you would use for children (face chart)
Skin Inspection
state what you would look for on inspection of skin
- jaundice, discoloration, bruising, trauma, lesions, wounds, etc.
Eye Inspection
state what you would look for on inspection
- eye discoloration, check light sensitivity, how dilated the pupils are, are they enlarged, round, etc.
Ear Inspection
assess gross hearing as you talk w/pt
- state what screening tests you would attempt if you thought pt was having trouble hearing: whisper test and finger rub test
Heart Inspection
Auscultation (listen in 4 places):
1. Right side 1 inch below collarbone
2. Left side 1 inch or 2 below collarbone
3. Down another inch or two on left
4. down another 1/2 inches on left for central chest-ish
- state that you are assessing for rate, rhythm, and any abnormal sounds
Lungs Inspection
Auscultation (listen in 4 places on back):
1. upper left quadrant
2. upper right quadrant
3. lower right quadrant
4. lower left quadrant
- state what you would look for on inspection: shallowness of breathing, listen for wheezing, crackling, labored breathing
- state that you are assessing for rate, rhythm, and listening for any abnormal sounds
Abdomen Inspection
Auscultation (listen in 4 places)
- listen for bowel sounds in left/right and upper/lower quadrants
Palpation
- lightly palpate each quadrant
- state you are looking for distension, contour, scars, and lesions on the stomach
- state that you are listening for bowel sounds
- state that you would palpate for any masses, tenderness, organ enlargement or dissension
