Physical Examination Flashcards
(23 cards)
When do you do a physical examination?
All the time, on every patient.
What is the introduction for the exam?
7Cs
What are the 7 Cs?
Confirm ID (yours and patient’s)
What to Call the patient
Chaperone
Consent
Clean hands, surfaces, equipment
Comfort and dignity
Concerns
How do you open a physical examination?
Introduce yourself - hello my name is … and I am a …
Ask for the patient’s name and DOB
Ask the patient what they would like to be called
Inform the patient of the exam - today I will be conducting a physical examination, if you feel any pain or discomfort please don’t hesitate to let me know
Ask the patient if they want a chaperone
Ask the patient if they consent
Clean hands
Ask the patient to lay on the bed (if not lead) and check if they are comfortable
Ask the patient if they have any concerns
What is the next step after the introduction?
Move towards to the bottom of the bed and begin to observe -
I am just going to just observe you from the end of the bed to just assess from this appearance
What are you looking for when assessing patient’s appearance from the end of the bed?
If the patient is fully alert and conscious
Patient’s colour
Patient’s level of comfort (pain, breathlessness, sweating posture)
Patient’s habitus
Any genetic features
Bruises / rashes
How they are moving, functioning, behaving
Listen for respiratory noises
Any smells
Look around bed for any clues - oxygen, medicines, drips, walking aids etc.
What are different colours that can be seen in patients?
Blueness = cyanosis
Paleness = pallor
Yellowness = jaundice
Redness = erythema
Where do you go to next after bed obseravtion?
Hands
What do you assess at the patient’s hands?
Nails - colour and for any clubbing
Colour
Temperature
Skin turgor
Arthritic change
Fine tremor
Flapping tremor
How do you test for fine tremor?
Ask patient to stretch their arms out and spread out their fingers.
What do you do after assessing hands and what do you start with?
Inform the patient you would like to check for some further observations for example pulse, breathing rate, blood pressure, temperature and oxygen levels.
Pulse
What do you do after checking the pulse?
Assess the rhythm and measure the rate (number of beats per minute)
How do you check the pulse?
Palpate radial pulse at patient’s wrist (over flexor surface of right distal radius), support the limb horizontally so that it is relaxed and tendons do not twitch - use 3 fingers not thumb.
After assessing the rhythm what is next?
Assess patient’s respiratory rate.
How do you assess the respiratory rate?
Count the rise or fall of their chest wall over 60secs - maybe not tell the patient to make them not conscious.
What are the further observations after the respiratory rate?
Temperature,
Oxygen saturation,
Peak flow rate,
Blood pressure
What do you do after the other observations?
Brachial pulse
How do you test for brachial pulse?
Ask patient to flex their elbow to identify the biceps tendon, patient can then relax.
Place your index just medial to this tendon. You may need to press more firmly to locate pulse.
What is the next step after observing the arm?
Face
What is observed at the face?
Eyes, mouth and neck.
What is tested at the eyes?
Inferior tarsal conjuctiva (inner, bottom eyelid) for pallor - if not pink suggests anaemia.
Check sclera (white of eye) for jaundice
How do you assess the mouth?
Check tongue for central cyanosis.
Check for dryness (dehydration)
Look for ulcers & poor dentition.
Angular stomatitis
