Comprehensive Skills Exam Flashcards
(44 cards)
What needs to be verbalized when measuring the JVP?
That a normal range is 4-9cm and abnormal findings would indicate RA overload
How do you measure the JVP
Raise bed to 30 degrees, use tangential lighting, use ruler to measure from sternal angle, identify highest point of pulsations (meniscus) and make an attempt to determine A and V waves
What needs to be verbalized when inspecting the abdomen? (8 things)
Skin: scars, striae, dilated veins/capid Medusa, rashes/lesions
Umbilicus: contour, bulges, location, inflammation, bleeding, or discharge
Contour: scaphoid, flat, rounded, protuberant, obese
Assess for bulging of flank, pulsations and symmetry of visible organs
How do you assess for aortic insufficiency?
Have pt sit upright, places diaphragm of stethoscope over either 3rd or 4th interspace, instruct patient to lean forward and exhale
What needs to be verbalized when assessing for aortic insufficiency?
That it is a high-pitched diastolic murmur
How do you do generalized splenic percussion?
Position patient supine with knees flexed, arms at side. Identify left hypochondriac region and percuss
What needs to be verbalized when doing generalized splenic percussion?
Splenomegaly is when percussion goes from dullness to tympani, can indicated pleural effusion as well
What is the left hypochondriac region?
Traube’s space
What is the 3rd or 4th interspace called?
Erbs point
How do you palpate the musculoskeletal system?
Elbow or Knee: Comment on: landmarks, tenderness, crepitus, warmth, spasm, or bogginess
How do you test for Kusmault’s sign?
Set bed at 30 degrees, direct patient to breath in and use tangential lighting, observe for paradoxical rise of JVP with inspiration
What needs to be verbalized when testing for Kusmault’s sign?
When it is present, this finding suggests impaired filling of the RV
How do you assess for abdominal bruits?
Position patient supine, knees flexed and arms at side. Place stethoscope bell over: aorta, renal arteries, iliac arteries, femoral arteries. Listen for systolic or diastolic bruits
What part of the stethoscope can be used over clothes to listen for abdominal bruits?
Diaphragm
How do you assess the TMJ?
Verbalize general inspection, look at pts face, palpate for clicking and popping. Effective if pt is moving jaw. Have pt open and close mouth, protrude and retract mandible, slide from side to side
What needs to be verbalized when assessing the TMJ?
Name atleast 2/3 of the muscles of mastication: Masseter, Temporalis, and Ptyergoid
How do you assess for splitting of S2 heart sounds?
Can listen over 2nd and 3rd interspace, auscultate with diaphragm, listen while pt inhales and exhales quietly
What needs to be verbalized when assessing for splitting of S2 heart sound?
Normal or physiologic splitting of S2 is accentuated by inspiration and usually disappears with expiration
How do you assess the shoulder for active ROM?
Have pt flex to 180 degrees, extend to 50 degrees, ABduct to 180 degrees, and ADduct to 50 degrees, internal rotation can be limited or full, external rotation can be limited or full, also assess shoulder shrug
How do you assess the carotid pulse?
Patient supine, listen for bruits, palpate for the pulse on the upper 1/3 of neck, do this on both sides
What needs to be verbalized when assessing the carotid pulse?
The upstroke of carotid pulse follows S1
How do you assess for hepatojugular reflex?
Set bed at 30 degrees, use tangential gifting, apply firm pressure over RUQ of abdomen while observing JVP in neck
What needs to be verbalized when assessing for the hepatojugular reflex?
Used in pts with subacute right-sided HF or passive hepatic congestion. When the finding is present: an increased JVP waveform is noted
How do you palpate the abdomen?
Position patient supine knees flexed and arms at side, perform light palpation, assess with one hand, assess for superficial lesions, assess for guarding. Deep palpation: asses with two hands, assess abdominal organs, deep lesions
