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22 Cards in this Set

  • Front
  • Back
What is the physical examination general survey?
- One of the most important portions of exam
- Begins when you walk into room
Key things to observe about a patient during the physical examination.
- general appearance
- demeanor
- emotion
- dress
- degree to which they are kept
- posture/gait
- level of discomfort
- respiration/pattern
- skin color/nature
- height/weight
- level of consciousness (LOC)
- odor
- hearing level
- speech/pattern
Steps of general survey
1. Apparent state of health
2. Level of consciousness
3. Skin
4. Dress and the degree at which they are kept
5. Facial expression and emotion
6. Posture and motor activity
4 basic techniques of physical exam
1. inspection
2. palpation
3. percussion
4. auscultation
Inspection
A close observation of the details of the patient’s general appearance. This builds on the general survey and is used for both general and local examinations.
Palpation
Tactile pressure from the palmar fingers or finger pads to assess areas of skin elevation, depression, warmth, contour, and tenderness. Always lay hands on the patient.
Percussion
Technique of striking or taping over a body area to evoke a sound wave such as resonance, dullness, or vibration. Usually using the distal third finger of the left had laid against the surface and striking it with the tip of the second finger of the other hand.
Auscultation
Using a stethoscope to detect the characteristics of heart, lung, bowel sounds, and other. It includes location, timing, duration, pitch and intensity.
ALWAYS LISTEN TO HEART AND LUNGS.
What are universal precautions?
A set of guidelines designed to prevent transmission of HIV, hepatitis B virus, and other blood-borne pathogens when providing care to an individual.

Formal Universal precautions were developed in 1987 by the CDC due to the new HIV epidemic.
Infectious agents may include:
1. All blood and body fluids containing visible blood
2. Semen
3. Vaginal secretions
4. Cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.
What protective barriers should be used?
- gloves
- gowns
- aprons
- masks
- protective eyewear
What are standard precautions?
1. Hand washing
2. Personal Protective Equipment– gloves, gown, masks, and other protective barriers.
3. Droplet precautions
4. Contact precautions
5. Airborne precautions
What should be included in hand hygiene?
Alcohol-based hand rub - recommended by CDC and WHO because of its activity against a broad spectrum of epidemiologically important pathogens

Soap and water - recommended when hands are visibly soiled (dirt, blood, body fluids) or after caring for patients with known or suspected infectious diarrhea
What is sterile technique?
The method by which asepsis is maintained throughout the duration of an invasive procedure thereby minimizing the introduction of microorganisms into a sterile field.
Sterile field
An area created in aseptic manner to exclude all living microbes.
What are the components of a hand scrub?
- Remove the dirt and debris and reduce the existing viable bacterial flora.
- Immediate reduction in the surface microbial count that is sustained, cumulative, and persistent.
- 2-6 minute scrub time pending scrub chemical used
Hand washing/scrubbing steps
A. prewash hands with soap and water then rinse
B. using surgical scrub brush begin with fingernails, then move to each surface of each finger, then palmar and dorsal hand/wrists, then up arms to elbows. Repeat for the other hand.
C. rinse starting at the fingertips and moving proximally always allowing water to drip off elbows
Site preparation steps
A. use clippers to trim hair not razor
B. scrub the skin with antiseptic solution from procedure site working out in a circular fashion, this must be vigorous for both mechanical and chemical cleaning
C. Never return to a previous site
Draping standards
A. to maintain a sterile field the surrounding the procedure site the areas around and the patient must be barred
B. hold drapes high to avoid touching unsterile areas
C. walk around tables to drape, never reach over
D. any part of the drape below the waist or table must be considered unsterile.
E. never adjust drapes after placed, either remove and discard or cover with another drape
Sterile fields standards
A. a minimum of 2 individuals is typically required
B. open sterile packages without contaminating
C. contamination of supplies or personnel must be removed from sterile field
D. unsterile personnel must avoid contact with sterile field by remaining at a safe distance ( at least 12 inches)
Gowns, masks, caps, and gloves standards
A. snugly fit mask crimped at the nose and fully covering the mouth (put on prior to scrubbing)
B. appropriate sized caps (put on prior to scrubbing)
C. gowns are required for lengthy procedures or when the forearms will enter the sterile field. These are typically held for you to insert your arms most of the way. Then using pull tab from the from handed to assistant to tie in the back. (the back of the body in unsterile)
D. gloves are typically held open for your insertion or opened for you to place on you own
Using and removing PPE
Remove PPE at doorway, before leaving room or in anteroom.
Respirators remove outside of room after door has been closed and sealed