Health Assessment Exam 1 Chunk 2

Front 1

Skull and Face

-epistaxis
-dysphasia

Back 1

-epistaxis: nose bleed
-dysphasia: trouble swallowing

Front 2

Eyes

Back 2

-decreased acuity, visual loss, blurred vision, decreased peripheral vision, blind spots-->scotoma: blind spot in visual field surrounded by normal vision

Front 3

Ears
-tinnitus
-vertigo
-otalgia

Back 3

-tinnitus: buzzing, ringing
-vertigo: objective-feels like the room is spinning, subjective-feels like you're spinning
-otalgia: ear pain

Front 4

Nose and sinuses

What cranial nerve?

Back 4

Cranial never 1: olfactory nerve (sense of smell. Decreases with smoking and age)

Front 5

Lymph nodes

Four areas where lymph nodes are accessible

Back 5

-head and neck: cervical nodes drain head and neck
-arms/breast: axillary nodes drain upper arms/breast
-inguninal area
-axillae

Front 6

Preparation for exam.

Back 6

-warm room with privacy
-sitting position with patient's head at your eye level, dark room for eye parts of the exam, remove dental appliances, hearing aids

Front 7

What equipment do you need for the exam?

Back 7

-snellen eye chart
-penlight
-ophthalmoscope
-eye cover/card
-tuning fork
-otoscope
-batteris
-gauze
-gloves
-tongue blades
-ruler

Front 8

Inspect and palpate the skull
-normocephalic
-microcephaly
-macrocephaly

Back 8

-normocephalic: head is appropriate for body size
-microcephaly: head is small for body size
-macrocephaly: head is big for body size

Front 9

Inspect the face
-symmetry
-exophthalmoses

Back 9

-symmetry: palpebral fissures, nosolabial folds, sides of mouth
-exophthalmoses: bug eyes (eyes popping out)

Front 10

Inspect/palpate the neck
-tracheal position

Back 10

-tracheal position: should be midline. shift will shift to healthy side. Tug could indicate severe respiratory distress syndrome or tumor

Front 11

Inspect the eyes
-snellen chart
-visual fields of confrontation
-corneal light reflex
-cover test
-extraocular movements (EOMS)

Back 11

-snellen chart: used in the visual acuity test
-visual fields of confrontation: examines peripheral vision between examiner and patient
-corneal light reflex: shine pen light on eye while they look ahead. stand 12 inches from patient. Light should be reflected in same spot on both eyes
-cover test: uncover eye, eye will deviate (abnormal finding)
-EOMS (extraocular movements): 6 cardinal fields of gaze. looking for parallel movement of the eyes-->should stay aligned

Front 12

External ocular structures
-ptosis
-lid lag
-exophthalmos
-endophthalmos
-lacrimal apparatus

Back 12

-ptosis: drooping of the upper eye lid
-lid lag: upper lid is open above sclera
-exophthalmos: bud eyes (eyes popping out)
-endophthalmos: eyes displaced in the orbit
-lacrimal apparatus: tear ducts

Front 13

Anterior eyeball structures
-PERRLA
-direct light reflex
-consensual light reflex
-accommodation

Back 13

-PERRLA: P-pupil, E-equal, R-round, R-reactive to, L-light, A-accommodation
-direct light reflex: shine light on eye and look at constriction of that same eye
-consensual light reflex: shine light on eye and look at OTHER EYE constriction
-accommodation: eyes will converge or constrict

Front 14

Inspect the ears
-external ear
-internal ear
-ear alignment

Back 14

-external ear: auricle, position and alignment, skin condition, external auditory meatus (opening of ear)
-internal ear: canal, tympanic membrane (pearly grey=eardrum, Cone of light=left ear 7 o'clock, right ear 5 o'clock
-ear alignment: position and alignment. low set ears=angle is > 10' (draw a line directly from eyes and a vertical line in front of the ear)

Front 15

Palpate the ears
-hearing tests

Back 15

-Whisper/voice test: high tone test. qualitative test. abnormalities=further eval. Test one ear at a time (unilateral). Have them cover tragus and examiner covers his mouth and whispers two words on patient's side of head with closed ear
-Weber: hear better out of one ear than the other. Should hear equal bilaterally. Lateralization=hear better with one ear than the other. Put tuning fork on top of head-->should be heard equally in both ears
-Rinne: longer with air conduction than bone conduction (AC>BC) put tuning fork behind ear against skull then move it in front of the ear (in the air)
-AC > BC

Front 16

Inspect the nose
-transluminate sinuses

Back 16

-normal to see light

Front 17

Palpate nose and sinuses
-frontal sinuses
-maxillary sinuses

Back 17

-frontal sinuses: should transluminate. should feel pressure when palpated, but no pain
-maxillary sinuses: should see reflection of light on roof of mouth. should feel pressure, but no pain

Front 18

Grading tonsils

0
+1
+2
+3
+4

Back 18

0: tonsils are absent
+1: normal, visible
+2: 1/2 way between uvula
+3: so enlarged they touch uvula
+4: so enlarged they touch each other. aka kissing tonsils

Front 19

Palpate the TMF
-vertical
-lateral
-protrude
-clench teeth

Back 19

-vertical: open mouth 3-6cm WNL (3 fingers)
-lateral: partially open mouth and protrude jaw and to side to side 1-2cm
-protrude: stick jaw far out (check for no deviation)
-clench teeth (CN #5): check muscle size firmness and strength. Check against resistance