What are teh 4 techniques of exam in the right order of how you would perform them?
- INSPECTION= assess age, posture, mobility, asymmetry, color change
- AUSULTATION= listen to lung, heart, GI vascular sounds
- PERCUSSION= flatten fingers of thorax/abdomen, strike knuckle with 3rd finger to elicit sound, note sound difference when percussing over hollow organs vs bone (dull, flat, tympanic)
- PALPATION= superficial adn deep touching
What are the sounds you look for with percussion?
- sound difference over hollow organ vs bone
- dull= fluid
- flat= solid
- tympanic= air
What do you do with the ophthalmoscope
- part of eye exam
- examine fundus/retina/posterior chamber an pupillary reflex (direct and consensual) and red reflex which is the normal reflection off the retina
How would you give a good eye exam?
- have patient look over shoulder
- hold ophthalmoscope in right hand and use right eye to examin the patients right eye (and opposite with left)
- move light lateral to medial until over the iris then move toward the patient
- bilaterally
Pupillary light reflex
- direct= when light shined in eye, pupil constricts
- consensual= when light shined in eye pupil of other eye also constricts
Snellen eye chart
-assess visual acuity (20/20 normal)
Ex) 20/40 means test subject sees at 20 ft what a normal person sees at 40 ft
- held 14 inches from eyes
- test with both eyes open then covering one at a time
What is the otoscope used for?
- part of ear and oropharyngeal exam
- grasp auricle and pull up and back (or down adn back for kids)
- insert 1/2 length of speculum
- identify canal and tympanic membrane
What si the turning fork used for?
- air conduction= lasts longer, hold fork at external auditory meatus
- bone conduction= shorter, hold handle at occipital condyle behind ear
- vibratory sense= place handle on patella and compare left and right for duration
What is the reflex hammer used for?
- elicit a deep tendon reflex (DTR)
- identify patellar, achilles, bicep, brachioradialis, triceps
- string bilaterally and compare
What is the diaphragm of the stethescope used for?
- larger circle for higher frequency sounds
- breath sounds and heart sounds and bowel sounds
What is the bell on the stethescope used for?
- smaller circle
- lower frequency sounds
- bruits
What is a sphygmomanometer
- BP cuff
- choose cuff in which width of bladder is 40% of upper arm circumference, 80% length
- arrow aligned with brachial artery
- arm at heart level
- using diaphragm of stethescope
- listen for 1st Korotkoff sound (systolic) and LAST korotkoff sound (diastolic)
- deflate
How do you obtain pulse?
- index finger to chekc peripheral pulse
- radial, pedal, carotid
- pulse rate is reported “per minute”
- can count for 10 seconds multiple by 6 or 15 sec and multiple by 4
How do you take a respiratory rate?
- observe patients respiratory rate by looking for chest rise and counting
- listening while examining lungs
What are universal precautions
- standards set by CDC
- protect patient adn provider from spread of infectious disease
- gloves worn if obvious blood/body fluid
- wash hands before and after wearing gloves
What is the proper way to apply and remove gloves?
- wash hands
- apply gloves
- revmove one glove and hold onto it
- pull the cuff over the hand and encase the gloves
- dispose in proper container–> red bags are supplies contaminated with body fluids or potentially infectious debris
What are teh 6 positions for exam?
- Sitting
- Standing
- Supine
- Prone
- Right lateral recumbent
- Left lateral recumbent
Why is an OSE important?
- body is a unit and possesses self regulatory mechanisms
- structure adn function are reciprocally interrelated (rational therapy is based upon understanding of that)
- OSE integrates info about MSK
