Ch 31- Physical Examinations

Ch 31- Physical Examinations

1. Vitals signs

   • Bp/ Height/Weight/RR/HR

2. Lymph nodes

   • Raise patients chin, head tilted palpate both sides of the neck. use pads of middle three fingers to palpate in circular motion over each node. check for masses or tenderness 

3. Skin

   • Looking for color, moisture, temperature, texture, edema(swollen), Turgor(elasticity), vascularity and lesions 

4. Ears

   • Ear canal
     • Obverse with otoscope.. slightly tip head to opposite site examining by patient 

5. Hair and Scalp

   • Hair: Check color, distribution, quantity, thickness, texture and lubrication  Scalp: Inspect for lesions or growths, lumps, bruises, lice

6. Mouth

   • Use penlight and tongue depressor and gloves  Lips: inspect for color texture and hydration level Teeth: review all teeth and molars Gums= retract lower lip. look for color and mucus color 
   • Tongue
     • Inspect on all sides have patient stick tongue out ask to raise up and move side to side look for color, texture and lesions. look under tongue carefully
   • Pharynx
     • Ask oatient to tilt head back and say "ah"  look with penlight depress tongue with drepresser look for lesions, swelling and color

7. Trachea

   • Locate trachea slipping thumb and index finger to each side

8. Thorax

   • Patient must be undressed to the waist 
   • Anterior
     • Do as you would with posterior.
   • Laternal
     • Patient lifts arms. do as you would with posterior throax
   • Posterior
     • Observe the shape and symmetry with the back and front.  Look for position of spine, slope of ribs, bulging of intercostal spaces.  rate and rhythm of breathing.(12-20 Respirations/min) Place stepthoscope over posterior shest between ribs. take deep breaths. check for abnoral signs 

9. Head/Neck

   • Note position, size  Note eyebrows, facial features(symmetry)  Examine size shape and contour of skull 

10. Nose/Sinus

    • Nose
      • -Check for color, size and deformity or inflammation. -Palpate gently, check for tenderness.  Check internal by tilting patient had back and apply light, checking for bleeding or allignment of septum. Abnormal mucus color
    • SInus
      • Exert pressure with thumb up and under eyebrows if complaint of pressure=the sinuses are irritated. DO NOT apply pressure to the eyes. 

11. Eyes

    • Acuity(able to see small objects. Read something) Read larger objects (numbers on chart) Count fingers 
    • External eye structure
      • Position of eye relative to each other. Eyebrows eyelids-color, condition of surface, ability to open and close and blink To inspect eye lid, have patient close eyes-obvi  Cornea Sclerae-Should be white
    • Visual Field
      • Have patient cover one eye. You close opposite eye of patient.  move one finger outside of field of vision and slowly bring it back. Have patient report when they can see the finger  if you see it before patient, their field is reduced
    • Extracular movement
      • patient sit/stand, stand in front.  hold one finger in front of patient. have patient follow finger left right up and down without moving head. check parallel eye movement, abnormal eye movements. position of upper eyelid to iris(should be cover iris slightly)

12. Nails

    • Inspect nail bed for color and length symmetry cleanliness and configuration. Texture  Palpate= grasp finger and observe color of nail bed