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Head
- General Appearance: size, shape, skin color, distribution of hair
- Face: expression, rash, lesion, symetry, Cranial Nerve 7 (smile, raise eyebrows, puff out cheeks, close eyes tight), Cranial Nerve 5 (close eyes,- pt name location of touch)
- Palpate: temporal artery (between top of ear and eye) normal finding-> nontender (ask) and elastic
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Eyes
- General Appearance: external eye, eye lash, eyelid, position of eye
- PERRLA: pupil equal, round, reactive to light and accomodation (shine light pupil should constrict), (accomodate- focus object at distance bring close to face, pupil should constrict)
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Ears
- General Appearance: lumps, smooth skin, color as face, lesion
- Palpate: external ear, mastoid process for tender, ask if hearing change
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Nose
- General Appearance: color, shape, consistancy
- Palpate: for tenderness (nose/sinus), check patency of nostril (hold one nostril then other), ask if any smell change
- Internal nose: transluminate PRN (shine light look for fld/secretions
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Mouth/ Throat
- (use gloves, tongue depress, pen light),
- General Appearance: lips (color, consistancy, lesion), teeth( note #, condition), gums ( color, consistency, lesion), uvula (say "ah" use light is there a rise?) any taste change?
- cranial nerve 9/10: test gag reflex, (use tongue depress/pt open mouth)
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Neck
- General Appearance: swell, tender, lesion, symetry, mass, harness
- ROM: head turn L/R, chin to shoulder, ear to shoulder, chin to chest, look up (smooth/controlled?)
- Palpate: lymph nodes in front/behind ear(hard, tender, swell)
- trachea: finger in sternal notch
- thyroid gland: index finger/thumb around throat (not palpable)
- Carotid artery: 1 at a time, (auscultate with bell) pt hold breath each side. normal-> no swish/blow
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Arms
- general appearance: skin color, lesion, texture, moisture, mass, swell
- ROM: arms together, up, behind head, elbow to head, arms out, palm up/down
- palpate: brachial, radial, ulnar pulse
- ROM wrist: hand up/down
- muscle strength: pt push against hands
- palpate palm: temp
- capillary refill: <3 sec/note color of nail bed
- ROM finger: finger out/fist, up/down
- Movement of hands: palm up/down start slow then fast (control vs uncontrol?)
- sensation of hand: pt close eyes, where are you touching?
- sensitive of postion: pt close eyes, direction you are moving fingers
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Thorax (posterior/lateral)
- general inspection: tender, mass, leasion, shape, spine abnormal, ask if SOB/diff cough?
- crepitis: palpate for air in tissue (crackles)
- fremitis: "99" as move hands down
- chest expansion: (T9/T10) hand around chest thumbs move 5-10 CM as breathes
- percuss: for tone-tap finger across top and down in zig zag
- auscultate: breath sound/adventicious (wheeze, crackle, pleural friction rub)
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Thorax (Anterior)
- general appearance: diameter of chest, slope of rib, skin color, barrel chest, intercostal space (bulge, retraction, use of accessory muscle)
- quality/pattern of breath: note rate, depth, rythem
- palpate: tender, sensation, lesion, mass, fremitis ("99")
- percuss: for tone, start at clavicle
- auscultate: chest sound/adventicious (5 places bilateral)
- skin turgor: under scapula
- breast exam: palpate breast tissue/axilla
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Heart
- Appearance: visual pulsation, palpate pulsations, apical pulse (palm of hand find pulse use 1-2 finger pad)
- Auscultate:
- aortic:
R side, 2nd intercostal/R sternal border - pulmonic: (S2 Dub)-L side, 2nd intercostal/L sternal border
- Erbs: L side, 3rd intercostal/ L sternal border
- Tricuspid: L side, 5th intercostal/L sternal border
- Mitral: (S1 Lub)-L side, 5th intercostal/Medial to clavical midline
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Abdomen:
- appearance: visual pulsation, skin color, straia, lesion, mass, vascularity, rash, scar, mole, distention, umbilicus(location, contour, color)
- symmetry/contour: flat/evenly round, parastalsys waves or aortic pulsation visible? )
- auscultate bowel sounds : 4 quadrants (5-30/min) frequency, intensity, pitch
- vascular sound:
- aorta: above umbilicus
- renal artery: bilateral umbilicus
- iliac artery: bilateral below umbilicus
- femoral artery: bilateral groin/leg
- percuss: tone (4 quadrant) tympany over stomach/dull over other organs
- palpate: mass, large organ, tender
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Leg / feet / toes
- appearance: skin color, texture, moisture, edema, hair distribute
- ROM: hips, (leg up and bring to chest)
- Palpate:
femoral pulse, - popliteal pulse (bend knee, thumb on top, fingers deep in bend of knee)
- dorsalis pedis (ankle, inside big toe/top of foot)
- Posterial tibial (in groove between ankle and achiles tendon)
- ROM: feet up/down, out, in, toes up/down
- capillary refill: <3 sec
- sensitive to position: eye closed, which direction move toes
- sensation to touch: close eyes, where are you touching?
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Musculoskeletal / Neuro
- Heel shin Test: L heel move down R shin, R heel move down L shin
- Petella reflex: Knee hit/kick
- spinal curvature: stand, lean forward and look at spine
- walk around room:
- rhomberg test:
- feet together, arms at side, close eyesopen eyes, arms out to side, take R index finger touch nose/L index finger touch nose
- repeat with eyes shut
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mixing insulin
- roll cloudy
- draw up amt of air for cloudy insulin
- inject air into cloudy
- draw up amt of air for clear insulin
- inject air in clear insulin and withdrawl insulin from clear
- insert needle into cloudy insulin and withdrawl amount per order
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