Vis/Pulse
Name three components of the General Survey
family members/significant others
skin color
facial expression, mood, affect, eye contact
orientation and mental alertness
mobility
dress and posture
speech pattern, language fluency, speech disorders
difficulties with hearing or vision; assistive devices
stature and build, nutritional state
musculoskeletal deformities
respiratory problems/evidence of acute distress
What are the four heart areas we auscultate?
aortic, pulmonic, tricuspid, and mitral
Auscultation is always done on...
skin
What is the name of the special maneuver that produces abrupt cessation of inspiration with pressure over the gallbladder?
Murphy's Sign
What do we inspect joints for?
color, swelling (skinfolds), masses
Where should the lower edge of the blood pressure cuff sit?
lower edge of cuff one inch above antecubital fossa
What do we palpate during the supine cardiac examination?
thrills, lifts, PMI
Demonstrate palpation of bilateral expansion
Hand on lower posterior thorax- watch hands/fingers move as patient takes deep breath
What does deep palpation assess?
bulges, masses, tenderness
What bony landmarks of elbow do we verbalize as we palpate?
ulna, olecranon process, epicondyles
What are lymph nodes inspected for?
size, position, erythema, red streaks
Why do we auscultate the apex in the lateral decubitus position?
Name three things we verbalize during Chest/Thorax inspection
rate, rhytm, depth of breathing
size, shape and symmetry of thorax (deformity? barrel chest?
skin color and nail beds: cyanosis?
symmetry of chest expansion
accessory muscle use or presence of retractions
position and alignment of trachea
audible sounds with respiraton (stridor/wheezing)
Name four things we inspect the abdomen for
skin characteristics, venous return patterns, symmetry, masses, hernia, speparation of muscles, evidence of trauma.
movement- peristalsis or pulsations
abdominal contour
What is the name of the special maneuver that involves percussing the median nerve of the wrist?
Tinel test
Which pulses are auscultated during the Vis/Puls exam?
carotid, temporal, abdominal aorta, renal, femoral
What should you verbalize that you are listening for during cariac auscultation?
rate and rhythm, identify S1 and S2, splitting of heart sounds, presence of S3 or S4, extra sounds (snaps, clicks, rubs, murmurs), murmur characteristics (timing, pitch, intensity, location, radiation)
Demonstrate how to properly measure diaphragmatic excursion
*patient holds deep breath, percuss diaphragm down, patient holds exhale, percuss diaphragm up, excursion 3-5 cm
BILATERAL
What skill is performed during the seated exam of the Abdominal Exam?
percussion of costovertebral angles with fist
(can auscultate renal artery bruits- optional)
What do we do to chest muscle strength of the shoulders?
shoulder shrug, forward flexion, abduction, adduction
Name all lymph nodes palpated in the head and neck (9)
occipital, postauricular, preauricular, tonsillar (parotid/retropharyngeal), submandibular, submental, anterior cervical, posterior cervical, supraclavicular
Which two skills are performed after extremity inspection and before palpating pulses?
palpation for peripheral edema on tibia and check capillary refill
How many pairs and in what position do we auscultate during the pulmonary exam?
4 pairs posteriorly
2-3 pairs laterally- 2 on right, 3 on left
2-3 pairs on anterior chest including supraclavicular
What four things (generally) are percussed during the abdominal exam
gastric air bubble, tone in all four quadrants, liver span, splenic dullness
What 8 motions do we have the patient perform to assess hip ROM?
flexion with knee bent
flexion with knee extended
extension
abduction
adduction
internal rotation with knee bent
external rotation with knee bent
hyperextension