Introduction to Patient Evaluation part 2 Flashcards
Cardinal Techniques of Examination
inspection
auscultation (listening)
palpation (touching)
percussion (tapping)
Inspection
process of observation - use your eyes and nose
learn as much as you can about a patient this way
-weight, skin color, mobility, demeanor, etc.
can be done throughout entire H&P
use appropriate lighting
Palpation
using the hands and fingers to gather info through our sense of touch
palmar surfaces of fingers and hands are more sensitive than tips
-determine position, texture, size, consistency, masses, fluid, and crepitus
ulnar surfaces for vibration and dorsal surfaces for temp. estimation
can be light (1 cm) or deep (4 cm)
-always start with light to not cause tenderness
always wear gloves!
Crepitus
grinding sound (like broken bones) sounds like velcro
Fluctuant
like a balloon, touch one end and the other end moves
masses that are fluctuant usually need to be drained
“laying of the hands”
therapeutic touch where we begin our physical invasion of the patient’s body
Percussion
involves striking on object against another, thus producing vibration and sound
use finger as hammer
sounds waves are heard as percussion tones (called RESONANCE) arising 4-6 cm deep
Sound Classifications
tympany hyperresonance resonance - usually considered normal (depends on part of the body) dullness flatness - sound dies with the tap
Auscultation
involves listening for sounds produced by the body
utilizes stethoscope
keep environment quiet and undistracting; close eyes if needed
listen for sound characteristics: intensity, pitch, duration, quality
reserve this technique for last
-gives patient time to relax
General Appearance
apparent state of health (ill, frail, etc.)
level of consciousness
sign of distress (cardiac or respiratory, pain, anxiety/depression)
skin color and obvious lesions
dress, grooming, and personal hygiene (weather appropriate, clean)
facial expression (eye contact)
odors of body and breath
posture, gait, motor activity
height and weight (if obese, how is fat distributed? BMI?)
Health Promotion and Counseling
clinicians educate patients
early detections of suspicious moles
protective measures for skin
hazards of excessive sun exposure
skin cancers are most common cancers in US
-most prevalent on hands, neck, and head
Basal Cell Carcinoma
comprises 80% of skin cancers
seen frequently just below the eyes (where bags show)
shiny and translucent
grow slowly and rarely metastasize
Squamous Cell Carcinoma
comprises 16% of skin cancers
Lips!
crusted, scaly, and ulcerated
can metastasize
Melanoma
comprises 4% of skin cancers
rapidly increasing in frequency
spread rapidly
HARMM
risk factors for melanoma... History of previous melanoma Age over 50 Regular dermatologist absent Mole changing Male gender
Additional Risk Factors for Melanoma
50 or more common (noncancerous) moles
1-4 or more of atypical or unusual moles
-especially if dysplastic (precancerous)
red or light hair
actinic lentigines: macular brown or tan spots (usually on sun exposed areas)
heavy sun exposure (especially severe childhood sunburns)
light eye or skin color (especially freckles/burns easily)
family history of melanoma
ABCDE Screening Moles for Possible Melanoma
A for asymmetry
B for irregular borders (especially ragged, notched, or blurred)
C for variation or change in color, especially blue or black
D for diameter 6 mm or greater or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement
Intraoral Examination
dental examination
oral mucosal examination
Extraoral Examination
facial inspection examination
head and neck evaluation
-lymph node examination
-salivary gland examination
-thyroid examination
temporomandibular examination
cranial nerve examination
-often associated with unknown pain (source is not a tooth)
