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56 Cards in this Set
- Front
- Back
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What do you assess in general assesment in vitals flow
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Nutritional status - well nourished, malnourished, obese
Level of consciousness - alert, lethargic, obtunded, stuporous Distress - respiratory, cardiac pain, anxiety Development - muscle wasting, extremities Skin coloration - pallor, cyanosis, jaundice Hygiene - unkempt, malodor, well groomed Posture/position of comfort - will change for example in kidney stone |
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This temperature is one degree above oral
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Rectal
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This temperature is one degree below oral
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Axillary
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What do you look for when assesing pulse
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Rate - measure for 15 seconds and multiply by 4
Rhythm- regular, regular/irregular or irregular/irregular Character - how strong pulse is - is it weak and thready or strong and bounding |
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What do you look for when assesing respirations
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Check rate for a full minute
Note rhythm Note character - is it apnea, shallow or deep |
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BLOOD PRESSURE
- Before taking BP have patient sit for _ minutes - What question should you ask before taking BP - Can you take BP over shirt? - Why do you need to pick appropriate size of the cuff? - where do you apply the cuff? - Describe palpatory BP - Describe auscultatory BP |
5 minutes
Question about nicotine/caffeine in past 30 min Bare arm Cuff too large --> BP smaller, cuff to small --> BP larger 2.5 cm proximal to antecubital fossa Inflate while palpating radial artery, note disappearance, deflate and reinflate to 20 mm Hg above disappearance Auscultate brachial artery - deflate cuff 2-3 mm per second - note 1st sound to return - SYSTOLIC BP - note muffling point - note disappearance point - diastolic pressure, REPEAT IN OTHER ARM |
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Normal respiratory rate
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14-20
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What is an auscultatory gap
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Silent interval between true systolic and diastolic pressures
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How should you measure blood pressure if you suspect blood volume loss or syncope
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Take in supine, seated or standing position - if fall is >20 mm Hg = orthostatic hypotension
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ABCD of melanoma
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A - asymmetry
B - border irregularity C - color variation D - diameter greater than 6 mm |
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In inspection of hair what do you look for in :
Scalp Eyebrows Facial hair What else do you look for ? |
Scalp - patterns of loss
Eyebrows - lateral loss = hypothyroidism (myxedema) Facial hair - maturity, hirsutism Infestations |
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In palpation of the hair what are you looking for
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Fine, oily abundant = thyrotoxicosis
Dry, course, thinning with easy fragmentation = myxedema |
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4 steps of inspection of skin
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Appropriate exposure
Generalized scanning - symmetry, exposure, tendency toward lesions Thickness Color |
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2 parts of assessing color of the skin
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Generalized uniformity
Localized discoloration |
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Red (erythema) color of skin can indicate _
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Polycythemia
CO poisoning, Drug reaction Exanthema |
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White (pallor) color of skin can indicate_
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Albinism
Anemia |
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Blue (cyanosis) color of skin can indicate_
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Hypoxia
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Yellow (jaundice) color of skin can idicate
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Hyperbillirubinemia
Hemolysis Liver disease |
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Brown (hyperpigmentation) of the skin can indicate _
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Pituitary, adrenal or liver dysfunction
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Red localized discoloration indicates _
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Inflammation
Hemangioma |
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White (amelanotic) local discoloaration can indicate _
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Vitiligo
Scar |
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Blue local discoloration of the skin can indicate _
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Venous pooling
Nevi |
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Brown local discoloration of the skin can indicate _
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Nevi
Cafe au lait spots Melanoma |
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5 things you looking for in palpation of the skin
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Moisture
Temperature Texture Turgor and mobility Lesions |
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How do you palpate skin for moisture
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Dry, moist, diaphoretic, oily, examine skin folds
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How do you palpate skin for temperature
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Palpation with back of hand comparing symmetrically - check if cool, warm or hot
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What do you check for in texture of the skin
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Soft, rough, smooth, even
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How do you test for turgor and mobility of the skin
Delayed turgor = Decreased mobility = |
Pinch skin of forearm and release - DO NOT pinch dorsum of the hand
Dehydration or edema Connective tissue disease |
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How do you define lesions (6 characteristics)
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Size
Shape/configuration - round, ovoid, annular, linear, clustered, diffused Color Type - macule, papule, patch, plaque, vesical, bulla, ulceration, nodule, cyst Location Border |
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Capillary refill > 2 seconds =
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Hypoperfusion
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What do you check for in nails (6)
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Hygiene = clean, bitten, manicured
Color - pink, cyanosis, yellowing (psoriasis), whitening, green (pseudomonas) Clubbing = hypoxia, cirrhosis, thyroid disorder Lesions -pigmentation ( melanoma),splinter hemorrhages (endocarditis) Nail folds - lesions (warts), inflamation Capillary refill |
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Inspection of the head includes: (4)
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Symmetry and form - normocephalic, micro or macrocephalic
Hair Scalp - lesions, rash Face - symetry and lesions |
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Why do you palpate head?
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For masses and boney deformities
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In checking position of the eye by light reflection you are trying to rule out _
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Strabismus
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By looking at visible sclera above the iris you are trying to rule out _
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Exophthalmos
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Extraocular movements are testing which CN
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III, IV and VI
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When you are looking at cornea what are you looking for
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Clouding
Lesions Injections |
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Why are you shining perpendicular light across the iris
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Rule out shallow anterior chamber
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What are you looking for in pupils (4)
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Size
Shape Symmetry Reaction - consensual and direct |
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What are you looking for in sclera (4)
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Injection
Icterus Lesion Hemorrhage |
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What are you looking for in conjunctiva? (4)
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Injection
Pallor Foreign body (inverting upper lid) Exudate |
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What do you need to identify in ophthalmoscopic exam? (3)
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Cup and Disk - note ratio and papilledema
Identify retinal deformities (detachment, lesions) Identify vascular abnormalities (diabetic retinopathy, HTN changes) |
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How do you check auditory function (acuity)
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By whispered word with contralateral occluded ear
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This test compares air conduction with bone conduction
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Rhinne test
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How do you do Rhinne test
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Strike 512 Hz tuning fork and place handle on mastoid process - ask patient if they can hear that and if so when it stops - when sound stops move in front of ear and ask if patient can hear it again
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Positive Rhinne test - air conduction is better than bone conduction - what does this mean
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Normal or sensorineural hearing loss with impaired air and bone conduction
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Bone conduction beter than air conduction - Negative Rinne test - what does this mean
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Conductive hearing loss
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Compares bone conduction in each air - which test
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Weber test
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How do you do Weber test
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Strike 512 Hz tuning fork, place handle on the center of patients forehead - ask patien which ear sound is heard or felt best - right, left or equally
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In Weber test sound is heard or felt midline - what does this mean
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Normal, no conductive hearing loss
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Sound is heard toward one side in Weber test = lateralization
To _ side in conductive loss To _ in sensorineural loss |
Affected
Unaffected |
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What do you need to do prior to inserting an otoscope
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Palpate targus and pinna for pain - differentiates otitis externa from otitis media
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Position of canal for ear exam in adults
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up, out and back
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Position of canal for ear exam in kids
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Down out and back
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Parotid gland opening location
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Adjacent to 2nd upper molar
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Opening of submandibular gland is called _
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Wharton duct
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