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OMM > OCM Week 1 Lecture > Flashcards

OCM Week 1 Lecture Flashcards

General Assessment and Vitals

1
Q

When do you wash your hands with alcohol-based sanitizer?

A

-Immediately before touching a patient

-Before performing an aseptic task (placing an indwelling device) or handling invasive medical devices

-Before moving from work on a soiled body site to clean a body site on the same patient

-After touching a patient or the patient’s immediate environment

-After contact with blood, body fluids, or contaminated

-Immediately after glove removal

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2
Q

Wash with soap and water

A

-When hands are visibly soiled
-After caring for a person with known or suspected infectious diarrhea
-After known or suspected exposure to spores (Bacillus anthracis, Clostriodioles difficile outbreaks)

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3
Q

Preparing for physical exam

A

-Make sure all of your necessary equipment is available, charged, and in working order
-Proper preparation of the patient (exam gown and/or drape, be mindful of your patient’s modesty)
-In the clinic setting, know your availability of an assistant/chaperone if needed (especially for female breast, pelvic, male genitourinary, rectal exams)
-Proper lighting and room temperature

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4
Q

Inspection

A

information gathered from observation (vision, hearing, smell, overall general impression)

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5
Q

Palpation

A

examination with the hands

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6
Q

Percussion

A

procedure to determine density or size of a tissue/organ/mass/fluid (using the sound produced by tapping the surface with a finger)

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7
Q

Auscultation

A

listening to the sound made by various body structures and functions

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8
Q

Verbalizations

A

You will be asked to verbalize what you are doing as you perform certain parts of the exam

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9
Q

Verbalizations serves two purposes

A
  1. For your own learning purposes (medical terminology and descriptors)
  2. Aids your instructors and evaluators (allows us to hear what you know)

When you begin to examine patients in the clinical setting, you will use different phrases - directed to the patient rather than the faculty

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10
Q

Once you have finished the history portion (subjective portion) of your H&P, let the patient know…

A

you are about to shift to the physical exam portion (objective portion)

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11
Q

Always keep the patient informed

A
  1. Ask permission before examining
  2. Explain what you are going to do before you do it, which lets them know what to expect
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12
Q

Checklist (First three things)

A
  1. Wash your hands (prior to examining/touching the patient, be couscous of touching your hair, face, mask, dropped items/garbage)
  2. Introduce yourself to the patient (full name, title, training institution)
  3. Obtain patient demographics (address the patient with respect, ask for their full name, DOB, how they would like to be referred to
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13
Q

Checklist (Last three things)

A
  1. Ask permission to perform exam
  2. Take vitals (BP, HR, RR)
  3. General assessment of the patient begins once you first walk into the room, and will continue throughout the entire encounter (sight, sound, touch, smell, taste)
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14
Q

Common descriptors

A
  1. Apparent state of health (well appearing, acute or chronically ill, cachetic)
  2. Level of consciousness (awake, alert, appropriate, responsive or lethargic, obtunded, comatose)
  3. Signs of distress (respiratory, pain, anxiety, depression)
  4. Skin color and obvious
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15
Q

Common descriptors continued

A
  1. Dress, grooming, and personal hygiene (Appropriate to weather and temperature, and clean; properly buttoned/zipped; dishelved)
  2. Facial expression (eye contact, appropriate changes in facial expression)
  3. Odors of body and breath (sometimes a smell is worth a thousand words…Strep throat, GI bleed, etc)
  4. Posture, gait, and motor activity
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16
Q

Standard Vital signs

A
  1. Blood pressure
  2. HR and rhythm
  3. Respiratory rate and rhythm
  4. Temperature
  5. Height/weight/BMI
  6. O2 saturation (pulse ox)
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17
Q

Heart rate, usually check what pulse in adult?

A

Radial pulse in an adult. Use the pads of your index and middle fingers. Count 10 seconds x 6, 15 seconds x 4, or 30 seconds x 2, or 60 seconds. If any irregularity, always count full 60 seconds.

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18
Q

Apical pulse

A

-Listening to heart
-Use stethoscope, count 60 seconds
-Use this technique if peripheral pulse is not completely normal/palpable/accessible
-Brachial and carotid pulse may be used

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19
Q

Heart rate: you should note…

A

Rate, rhythm, and quality of pulse
-Common descriptors: regular, irregular, bounding pulse, thready pulse

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20
Q

HR: Normal vs. tachycardic vs bradycardic

A

Normal: 60-100 bpm
Tachy: >100 bpm
Brady: <60 bpm

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21
Q

Respriration

A

-Keep fingers on radial pulse, watch or feel chest rise/fall
-Observe rate, rhythm, depth, and effort of breathing
-Count 15 seconds x 4, 30 seconds x 2, or 60 seconds (in children, usually count for 60 seconds and may be helpful to place hand on abdomen)
-Tell patient you are checking respirations

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22
Q

Descriptors for rhythm

A

regular, irregular

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23
Q

Descriptors for depth

A

shallow, gasping

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24
Q

Descriptors for effort

A

normal, labored

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25
Q

Normal RR

A

12-20 breaths/minute

26
Q

Oral temperature with thermometer

A

Can require 3-5 minutes under tongue

Consider accuracy of temperature (should not use with mouth breathers, wait several minutes after drinking hot or cold beverage or after exposure to extreme environmental conditions)

27
Q

Average normal oral temperature

A

98.6 F

28
Q

Fever (febrile)

A

> 100.4 F

29
Q

Hypothermia

A

< 95 F

30
Q

Rectal Temperature

A

0.7-0.9 F > oral temperature

31
Q

Axillary Temperature

A

1F < oral temperature

32
Q

Tympanic Temperature

A

1.4 F > oral temperature

33
Q

Height

A

-Best measured without shoes
-Common descriptors: short or tall, build is slender or lanky, muscular or stocky
-Body symmetry (note general body proportions and any gross deformities)

34
Q

Weight

A

-Obtain weight with as few clothes as possible
-Common descriptors (emaciated/cachectic, slender, obese)
-Calculate BMI
-Scale (special scales for non-ambulatory children, avoid weighing children with a wet and/or dirty diaper, and another special scale to accommodate for heavier weights)

35
Q

Underweight BMI

A

<18.5

36
Q

Normal BMI

A

18.5-24.9

37
Q

Overweight

A

25-29.9

38
Q

Obesity I

A

30-34.9

39
Q

Obesity II

A

35-39.9

40
Q

Extreme obesity III

A

> 40

41
Q

Body Mass Index (BMI) calculation

A

Weight (lbs) x 70 / Height in inches

Weight (kg) / Height (in m^2)

42
Q

Oxygen saturation (pulse ox)

A

-Non-invasive method allowing the monitoring of oxygen saturation in the patient’s hemoglobin
-Place on distal finger for 20-30 seconds (nail polish interference)
-Typical normal pulse ox range from 95-97 to 100

43
Q

Less than 90% is abnormal

A

Hypoxemia
-Consider patient presentation
-Patient with acute lung infection and SOB vs. a long term tobacco user
-Have a pulse ox on all your pulmonary and cardiac patients

44
Q

Pain severity - ask

A

How bad is the pain on a scale from 1-10? 10 should be the worst pain you can imagine

45
Q

Pain scale is

A

Subjective
-Stoic personalities may seem to underestimate
-Most of the general public seem to overestimate

46
Q

Single vs. dual stethoscope head

A

-Bell for low frequency sounds
-Diaphragm for high frequency sounds

47
Q

If you can’t see the holes on your stethoscope it is…

A

the right way around

48
Q

Mercury sphygmomanometers

A

provide the most accurate measurement of BP

(decreasingly found in offices secondary to fear of mercury exposure)

49
Q

Aneroid sphygmomanometers

A

used in most medical offices (epidemiologic data are based on auscultating methods)

50
Q

Automated oscillometric sphygmomanometers are increasingly being used in

A

medical offices and for home monitoring (the readings are not as accurate)

51
Q

Blood pressure optimal conditions

A

-Avoid smoking, exercising, or drinking caffeinated beverages 30-60 minutes prior to measurement
-No exogenous adrenergic stimulants, such as phenylephrine in decongestants or eye drops for pupillary dilatation for example
-Taking the BP in a cool room or while the patient is talking can raise the measured value by as much as 8 to 15 mmHg (ensure the room is quiet and comfortably warm)
-Patient should be seated quietly in a chair with feet on the floor for at least 5 minutes prior to BP measurement
-Patient’s arm should be FREE of clothing

52
Q

Blood pressure - arm positioning

A

Patient position:
-the arm should be supported at the level of the heart
-allowing the arm to hang down when the patient is sitting or standing will result in the brachial artery being below the heart
-rest the arm on a table or a little above the patient’s waist, or support the patient’s arm with your own arm at their chest level

53
Q

BP cuff size

A

-Use of a proper sized cuff is essential
-If too small a cuff is used, the pressure generated by inflating the cuff can lead to overestimation of the systolic pressure by as much as 10 to 50 mmHg in obese patients
-If it is it too big, you can’t secure it tightly enough

54
Q

Cuff and stethoscope placement

A

Palpate the brachial artery

(lower border 2.5 cm above the antecubital crease)

Secure the cuff snuggly, not tightly, and position the patient’s arm so that it is slightly
flexed at the elbow

Should be able to fit 2 fingers under the cuff comfortably

55
Q

Ask the patient what about their BP?

A

Ask patient if they know what their readings normally are to estimate how much you will inflate the cuff (usually 20-30mmHg above that)

56
Q

If the patient doesn’t know previous readings, you can assess a

A

Starting point. With the
fingers of your opposite hand, palpate the radial artery and inflate the cuff until the radial pulse disappears; add 30 mm Hg to this pressure. Deflate the cuff promptly and completely and wait 15-30 seconds

57
Q

Stethoscope placement

A

Place stethoscope diaphragm lightly
over the brachial arter
- Too much pressure on artery can
impede blood flow
-Inflate the cuff to the sum pressure
previously determined and deflate
slowly, 2 to 3 mmHg per heartbeat
-The point at which you hear the
first two consecutive beats is the
systolic pressure

58
Q

Normal BP

A

Systolic: Less than 120 AND
Diastolic: Less than 80

59
Q

Elevated BP

A

Systolic: 120-129 AND
Diastolic: Less than 80

60
Q

High BP (Hypertension Stage 1)

A

Systolic: 130-139 OR
Diastolic: 80-89

61
Q

High BP (Hypertension Stage 2)

A

Systolic: 140 or higher OR
Diastolic: 90 or higher

62
Q

Hypertensive crisis (consult your doctor immediately)

A

Systolic: Higher than 180

AND/or

Diastolic: Higher than 120

OMM (3 decks)

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