N201 CheckList

Question 1

Step 1: When you walk into the patient’s room

Answer 1

“Hello, how are you?”
“I will just check your armband and proceed to wash my hands”
“I will provide you with some privacy before we begin as well as gather my equipment”

Question 2

Step 2: Reason for seeking care.

Answer 2

"So what brings you here today?"
"I am coming in with a sore throat"
-Ears hurt
-Back of neck
-Tongue hurts

Question 3

Step 3: Ask detailed questions about RSC

Answer 3

P: Provocation (What were you doing at the time the pain happened?)
Q: Quality (How intense or severe is it)
R: Radiation (Does it spread anywhere?)
S: Severity Scale (On scale…; Is it the pain getting better, worse, or stayed the same?)
T: Timing (When did it first occur? How long did it last?)
U: Understand Patient’s Perception (What do you think is the meaning of the problem?)

Question 4

Step 4: History questions related to head, neck, and integument

Answer 4

General health
-Is your overall health okay? Do you exercise?
Skin
-Have you noticed any skin discoloration? Do you have a history of skin disease (eczema)
Hair
-Have you seen any hair thinness? Or bald spots?
Head:
-You experienced any dizziness? Headaches?
Eyes:
-Do you wear glasses? Redness around your eyes?
Nose and Sinuses
-Have you experienced any sinus pain? Any nosebleeds?
Mouth and throat
-Swelling in your throat? Changes in taste?
Neck
-Is your neck stiff? Limitation of motion?

Question 5

Step 5: Inspect head

Answer 5

“I will go ahead and inspect your head. I will be feeling for for any bumps, change in shape, or tenderness”

Question 6

Step 6: Inspect scalp

Answer 6

“I will next chair your hair for any lesions, hair distribution, change in hair texture.”

Question 7

Step 7: Inspect face

Answer 7

“I will check your face for symmetry, change in color”

Question 8

Step 8: TMJ

Answer 8

“While I am checking your face. I will place my hands near your jaw and ask you to open and close your mouth.”

Question 9

Step 9: Inspect neck

Answer 9

“I will look at your neck for proper movement and color”

Question 10

Step 10: Thyroid and trachea

Answer 10

“I will feel on your trachea. I will come on the back of your neck and feel your trachea. May I have you swallow?”

Question 11

Step 11: Carotid

Answer 11

“I will check the pulses in your neck, one at a time”

Question 12

Step 12: Lymph nodes (pre auricular, post auricular, occipital, tonsillar, submandibular, submittal, anterior cervical, posterior cervical, supraclavicular, and infraclavicular

Answer 12

“Next I will feel for your lymph nodes”

Question 13

Step 13: Snellen eye chart

Answer 13

Direct her to eye chart

Question 14

Step 14: Confrontation Test

Answer 14

move fingers from periphery

Question 15

Step 15: Diagnostic Positions Test

Answer 15

“H”

Question 16

Step 16: Inspect eyes

Answer 16

“Now I am going to check your eyes, lids, and brows”

Question 17

Step 17: Lid lag

Answer 17

Pull the eye down

Question 18

Step 18: Color and appearance of eye

Answer 18

Pull down lower lid and have person look up

Question 19

PICK UP PEN LIGHT OR OTHER LIGHT SOURCE

Answer 19

PICK UP PEN LIGHT OR OTHER LIGHT SOURCE

Question 20

Step 19: Check clarity of cornea

Answer 20

“I will check your eyes for clarity”

Question 21

Step 20: Hirschberg test : shine light far so light can shine in both pupils

Answer 21

“I will be shining a light in your eyes to check for corneal clarity” “Just look straight ahead”

Question 22

Step 21: Pupil size

Answer 22

PERRLA

Question 23

Step 22: Observe pupillary light reflex

Answer 23

Light from direct: at angle of same sided pupil

Consensual :

Question 24

Step 23: Observe for convergence/accommodation

Answer 24

Bring object close to nose

SAY PERRLA: “Pupils are equal, round, and reactive to light and accommodation”

Question 25

PUT LIGHT SOURCE BACK

Answer 25

PUT LIGHT SOURCE BACK

Question 26

Step 24: Observe alignment of ears and eyes, check external ears, palpate ears

Answer 26

“I will check your ears and eyes. I will also be inspecting and checking the outer part of your ear.”

Question 27

PICK UP OTOSCOPE

Answer 27

PICK UP OTOSCOPE

Question 28

Step 25: Straighten ear canal and inspect ear for redness, ear drum (normal is gray), lesions

Step 26: Inspect external ears for skin condition and presence

Step 27: Palpate external ear, move auricle, push on triages, and palpate mastoid; assess for any tenderness or masses

Step 28: Check gross auditory acuity test (test hearing) with whispered voice test

Answer 28

“I am going to use this light to check your ears. Looks like your eardrum is gray and normal”

“I will be looking at your external ear for presence and color”

“I will then feel on your external ear, (palpate)

“Next, I will whisper a two-syllable word and I want you to say it right back to me.” (CATDOG)

Question 29

PUT OTOSCOPE BACK

Answer 29

PUT OTOSCOPE BACK

Question 30

Step 29: inspect external nose for symmetry and lesions’ check patency of each name

Answer 30

“I will be checking your nose. Hold one side of your nostril and breath normally”

Question 31

Step 30: inspect lips and membranes for hydration and color

Answer 31

“I will next check your lip for color and hydration”

Question 32

Step 31: Using head tilt technique, inspect nares and septum

Answer 32

“Can you tilt your head back all the way so I may look at the inside of your nose?”

Question 33

Step 32: Using penlight OR otoscope and gauze and tongue depressor:

• Inspect tongue, mucous membranes, gums, teeth, floor of mouth, hard and soft palate.
• Assess soft palate/uvula for rise with phonation
• inspect oropharynx
  
  • note tonsillar grade
  • discuss gag reflex assessment and expected findings

Answer 33

“I will use my penlight to examine your mouth, checking for any swelling, discoloration, or infection. Stick your tongue out wide for me. I am checking for your tonsils. Lift your tongue up for me, then down.”

Question 34

Step 33: Finished with exam; wash hands; describe findings as appropriate

Answer 34

“We are all finished. I will wash my hands and then we will discuss the findings”