Intro to PE and Instruments + Competency Flashcards
Who sets the standards for universal health precautions to protect patient and provider from spread of infectious disease?
CDC
When does the CDC specify gloves must be worn during physical exam?
Whenever there is obvious blood or body fluid present
[must wash hands before and after wearing gloves]
The CDC requires that a face shield be worn for what type of injection?
Lumbar puncture
What are some standard precautions for all patient care set forth by the CDC?
Perform hand hygiene
Use PPE for possible exposure
Follow cough etiquette
Ensure proper patient placement/isolation
Properly handle/disinfect patient care equipment
Follow safe injection practices
Proper handling of sharps
Describe proper handwashing according to the world health organization. Include water temp and timing
Wet hands with clean running water (can be warm or cold), turn off tap and apply soap. Lather hands by rubbing together, getting backs of hands, between fingers, under nails. Scrub for at least 20 seconds. Rinse under running water. Dry with towel or air dry
What is the gold standard technique for hand hygiene in most situations for day to day decontamination of hands?
Hand rubbing with an alcohol based sanitizer
Hand sanitizer is the gold standard for day to day hand hygiene/decontamination. When must handwashing with soap and water be done?
When hands are visibly dirty or visibly soiled with blood or other body fluids
After using the toilet
When exposure to potential spore forming pathogens like C diff is suspected or proven
Handwashing with soap and water is required when exposure to spore forming pathogens are suspected or proven. What are some spore forming pathogens?
Bacillus anthracis (anthrax)
Bacillus cereus (food poisoning)
Clostridium botulinum (botulism)
Clostridium tetani (tetanus)
What physical exam technique involves tapping over an area to differentiate air, fluid, or solid underneath the surface of area to be examined?
Percussion
What are some things to include in your survey of someone’s general appearance for PE?
Apparent state of health Level of consciousness Signs of distress Skin color + obvious lesions Dress, grooming, personal hygiene Posture, gait, motor activity Height and weight Waist circumference BMI
What are some odors of the body and breath indicative of someone’s health?
Diabetes - sweet and fruity odor (acetone)
Fetor hepaticus “breath of the dead” - sweet musty aroma (dimethyl sulfide)
Uremic fetor - “fishy” urine like odor due to ammonia
What might you notice about someone’s posture if they have CHF?
Leaning forward
What are some causes for pathologic weight loss?
Malignancy Diabetes Hyperthyroidism Chronic infection Depression Diuresis
How is BMI calculated?
Weight (lbs)/height^2 (inches) x 703
OR:
Weight (kg)/height^2 (meters)
What is the difference between BMI measurements in adults vs. children?
The BMI for children is based on percentile
Describe use of ophthalmoscope during your PE
Used to visualize inner aspect of eye - retina, vascular supply, optic nerve, etc.
Identify the lens selector and select 0
Turn on the light, have patient look over your shoulder
Look through aperture, hand on patient forehead, use your right eye to examine patient right eye and vice versa
Start 15 degrees from center laterally
Identify red reflex
What part of the ophthalmoscope adjusts to your own and patient’s eyesight?
Refraction adjustment wheel
What part of the ophthalmoscope allows you to change the color and shape of the light source for different diagnostic purposes?
Aperture adjustment
Opthalmoscopes usually have 2 or 3 sizes of light to use depending on the level of _______ ________.
When would you use the small light vs. large light?
What setting is most commonly used?
Pupil dilation
Small light for constricted pupil in well lit room (no pupil dilators used); large light if using mydriatic eyedrops to dilate
Most common is dark room, non-dilated pupil, medium-sized light
When would you use the half-light aperture setting on your ophthalmoscope?
If pupil is partially obstructed by a lens with cataracts, half circle can be used to pass light through only the clear portion of the pupil to avoid light reflecting back
When would you use the red free light aperture setting on your ophthalmoscope? What appearance will this give the retina?
Used to visualize the vessels and hemorrhages in better detail by improving contrast; will make retina appear black and white
When would you use the slit-beam aperture setting on your ophthalmoscope?
To see contour abnormalities of cornea, lens, and retina
When would you use the blue light aperture setting on your ophthalmoscope?
Observation of corneal abrasions and ulcers after fluorescein staining
(Only some opthalmoscopes have)
When would you use the grid aperture setting on your ophthalmoscope?
Used to make rough approximations of relative distance between retinal lesions
