Lecture 1: Intro to Physical Exam and Instruments Flashcards
What are Universal Precautions?
- standards set by CDC to protect patient/provider from spread of infection
- wear gloves if blood, bodily fluids, or diarrhea present
- wash hands before AND after wearing gloves
What are the 4 types of Hand Hygiene based on CDC guidelines? (HAAS)
- Handwashing - plain soap and water
- Antiseptic Handwashing - contains antiseptic agent
- Alcohol-based handrub - rub hands w/alcohol-containing prep.
- Surgical hand hygiene/antisepsis - handwashing/alcohol-based handrub BEFORE operation by surgical personnel
What are the 5 steps of Hand Washing?
- Wet, Lather, Scrub, Rinse, Dry
- scrub hands for at least 20 seconds
Hand Rubbing vs Handwashing
Rubbing - gold standard technique for day-to-day occasions; recommended day to day decontamination
Handwashing (soap/water) - when hands are visibly dirty or soiled w/blood or other bodily fluids; after using toilet; exposure to spore-forming pathogens
What are Red Bags used for?
for supplies contaminated with bodily fluid or potentially infectious debris
5 steps of the Physical Exam (IAPOP)
- Inspection (look)
- Auscultation (listen)
- Palpation (touch)
- Olfaction (smell)
- Percussion (tap to differentiate air, solid, fluid)
ALWAYS COMPARE BILATERALLY IF POSSIBLE
What is an ophthalmoscope?
- helps visualize inner aspect of eye
- ask patient to look over shoulder (pick a spot)
Ophthalmoscope settings (5 settings)
Half Light - pass through clear portion of eye w/cataract
Red Free - visualize vessels and hemorrhages (black and white retina)
Slit Beam - contour abnormalities of cornea, lens, retina
Blue Light - observe corneal abrasions and ulcers
Grid - rough approx. of relative distance of retinal lesion
How should the ear be held using an otoscope while checking a child < 12 months vs > 12 months?
< 12 months: down and back
> 12 months: up and back
What are the two tests that can be done with a tuning fork and what are their functions?
- Hearing Eval: Air (longer) and Bone Conduction
- Vibratory Sense: place on patella
Purpose: gross hearing of cranial nerves and vibration sense
Reflex Hammer and Deep Tendon Reflexes
- used to elicit tendon reflex
- note speed/intensity and compare bilaterally
Reflex Grading Scale (0-4)
4: very brisk/hyperactive
3: brisker than average, not necessarily disease caused
2: normal
1: low normal, somewhat diminished
0: reflex absent
Stethoscope Bell vs Diaphragm
Bell = low pitched sounds (bruits)
Diaphragm = high pitched sounds
Blood Pressure Cuff Selection
- length should be at least 80% of the circumference of the upper arm
- width should be at least 40% of the length of the upper arm
- wrap around 1 inch above cubital fossa
Taking Blood Pressure
- inflate to 180 mmHg or 30 mmHg higher than estimated systolic BP
- 1st sound = Korotkoff (systolic), when knocking stops = diastolic pressure
- if subjects pressure is elevated, measure two additional times
What level is the heart at?
4th intercostal space
Common Errors in BP monitoring (False High and Low)
False High: brachial A below heart, cuff to narrow, cuff to large on large arm
False Low: brachial A above heart, cuff to large on small arm
- avoid smoking, caffeine, exercise > 30 min prior; patient sits quiet for 5 min with feet on floor
What is the Ausculatory Gap?
period of diminished/absent Korotkoff sounds during manual measurement of blood pressure
- associated with arterial stiffness and atherosclerotic disease
Pulse Locations (7) and scale
- Radial, Dorsalis Pedis, Carotid, Femoral, Politeal, Brachial Arteries and Abdominal Aorta
3: bounding
2: brisk, normal
1: diminished, weaker
0: none
What is the normal temperature of the human body?
97.8-99 degrees Fahrenheit
What is an Osteopathic Structural Exam (OSE) and what are you documenting?
- OSE integrates info about Musculoskeletal system even when dealing w/non-musculoskeletal compaints
- structure and function are reciprocally interrelated and rational therapy is based on the understanding of body unity, self-regulatory mechanisms, and interrelationship of structure and function
- Documentation: Tissue Texture Changes, Asymmetry, Range of Motion, Tenderness
What is normal pulse and respiratory rate?
Pulse = 60-100 beats per minute
Respiratory = 14-20 breaths per minute
