Midway Lab Demonstration Flashcards
1
Q
professional approach
A
- demonstrate three phases of assessment (introduction, working, closing)
- prepare work area (lighting, bed position, right side) and gather supplies
- perform handwashwng and universal precautions
- inform patient about what is happening, expected findings, and the meaning of medical terms
- incorporate comfort (including draping) and safety measures
2
Q
measurement of blood pressure
A
- pepre patient (sitting, legs uncrossed, rest 5 mins, arm at heart level) and equipment (bladder width 40% arm circumference; length 80%)
- determine point of pulse obliteration and inflates cuff quickly to pressure at which pulse obliterated +30mmHg
- using bell of stethoscope, deflate cuff rate 2mmHg/sec (or heartbeat)
- record first sound (systolic) and last audible sound (diastolic) in mmHg
- obtain 3 readings and average last 2, wait 15-30 seconds before reinflating cuff
3
Q
assessment of skin and a lesion
A
- inspect: colour, general pigmentation, areas colour changes, brushing, lumps, swelling, masses, tattoos, birthmarks, scars, piercings
- palpate: temperature, texture, thickness, tenderness, moisture, swelling, masses
- skin mobility and turgor: best to test aspect of chest, mobility is ease of rising skin. turgor is prom return of skin when released
- locate and assess skin lesion in terms of 6 defining characteristics
- discuss ABCDE’s danger signs
4
Q
assessment of finger and toe nails
A
- inspect: shape, contour, condition, colour, markings
- inspect: angel of nail base (profile sign) and report expected findings
- palpate: consistency, thickness, adherence to nailbed
- palpate: capillary refill and report expected finding
- discuss situations that could cause changes in angle of nail and capillary refill
5
Q
assessment of regional lymph nodes of head and neck
A
- assess and name 10 lymph chains
- exhibit correct technique: gentle, circular motion with fingertips, assess bilaterally, for deep cervical chain tip head to side, for supraclavicular nodes hunch shoulders and elbows forwards
- indicate if any nodes palpated would note their location, see, shape, elimination, mobility, consistency, and tenderness
- indicate lymph nodes may be palpated in healthy individuals but are movable, discrete, soft, and nontender
- identify potential causes of enlarged lymph nodes (infection, allergy, neoplasm)
6
Q
assessment of central and peripheral visual acuity
A
- demonstrate correct use of Snellen chart and interpretation of results, if patient uses corrective lenses instruct to use during exam if for myopia
- interpret results (what 20/30 means)
- note near vision assessed using Jeagar card if patient over 40 years of age
- conduct confrontation test bilaterally. superior, inferior, temporal, and nasal
- report presence of central and peripheral vision indicated CN II, optic intact
7
Q
assessment of pupillary responses and extra ocular motor function
A
- pupillary responses, note size, shape, symmetry, assess direct and consensual, note speed of reaction, assess for accomodation and convergence
- corneal light reflex (Hirschberg’s test)
- cover-uncover test, steady fixed gaze
- diagnostic positions, no nystagmus or lag
- report presence of pupillary response and extra ocular muscle function indicates CN III, IV, VI (oculomotor, trochlear, and abducens) intact
8
Q
assessment of external and internal ears
A
- inspect and palpate: size, shape, position, skin colour and condition, temperature, texture, tenderness, lumps, nodules
- demonstrate correct procedure for holding otoscope and positioning ear for adult and for child
- inspect meatus and canal: presence of cerement (amount, colour, odour), lesions, foreign bodies, sleeping, or discharge. manic membrane: colour, condition, cone of light position. note bulging, retraction, lesions, scaring, and fluid
- assess hearing acuity: conversation whispered voice test
- report presence of haring indicated CN VIII acoustic intact
9
Q
assessment of mouth and throat
A
- inspect lips, gums, teeth, and buccal mucosa: colour, condition, moisture, swelling, lesions, bleeding, masses, ulcerations
- inspect tongue dorsal and ventral surface: colour, condition, lesions, masses, ulcerations, nodules
- inspect tongue: visible wasting or tremors, position with protrusion, ability lingual speech, report findings indicate CN XII (hypoglossal) intact
- inspect throat and posterior pharyngeal wall: colour, condition, lesions, exudate, visualize tonsils, presence halitosis
- inspect uvula: colour, condition, position, movement with phonation, report finding indicates motor function of CN IX and X (glossopharyngeal and vagus) intact
10
Q
inspection of auscultation of abdomen
A
- prepare patient
- inspect: contour, symmetry, umbilicus, skin colour and condition, pulsations or movements
- observe patient demeanour: signs of voluntary guiding or involuntary rigidity
- bowel sounds: using diaphragm, describes character, frequency, location
- vascular sounds: using bell, presence bruits, identify arteries assessed
11
Q
percussion of abdomen
A
- demonstrate proper technique and assessment all four quadrants
- note predominant tone elicited and situations that might result in change of tone
- measure liver span and report expected findings
- assess for spleen and report expected findings
- assess costovertebral tenderness and expected findings
12
Q
palpation of abdomen
A
- describe difference between light and deep palpation
- demonstrate proper technique light palpation, all 4 quadrants, painful area last
- assess texture, temperature, moisture, rigidity, pulsations, areas tenderness
- indicate difference between voluntary guarding or involuntary rigidity
- describe strategies for dealing with anxious or ticklish patient
13
Q
inspection of thorax
A
- inspect patient demeanour and respiratory effect, describe 3 signs of respiratory distress
- measure oxygen saturation and indicate expected findings
- inspect skin colour and assess for signs o central or peripheral cyanosis
- inspect shape and configuration of posterior surface of thorax (spinous process, scapulae, ribs, anteroposterior to transverse diameter, neck muscles)
- inspect shape and configuration of anterior surface of thorax (sternum, sibs, interspaces, use accessory muscles, costal angle)
14
Q
palpation of thorax
A
- palpate: temperature, texture, turgor, tenderness, lumps, bumps, masses, crepitus
- palpate: chest wall expansion (symmetrical with no lag)
- demonstrate correct procedure for assessing tactile fremitus
- describe expected findings, posterior thorax: fremitus equal bilaterally more pronounced between scapulae, dampened or absent in peripheral lung field
- describe expected findings, anterior thorax: fremitus equal bilaterally more pronounced in 1st or 2nd intercostal spaces near sternum, dampened or absent in peripheral lung field
15
Q
percussion of thorax
A
- demonstrate systematic, side-to-side comparison starting at apices to bases, in intercostal spaces, avoid boy surfaces
- indicate predominant tone over lung field and expected areas at which tone may change (dull over liver, heart, breast tissue; flat over bone; tympani over abdomen; dull in lung mat indicate consolidation)
- instruct patient in order to max expansion of diaphragm and monitors patient status during test
- measure diaphragmatic excursion
- report expected finding: 3-5cm or 7-8cm, measured bilaterally and that right side may be higher due to liver
