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cartilage. Swallow water feel for isthmus rise. Displace to one side,
Wash hands and stethoscope swallow water feel right lobe. Displace to other side, swallow
water feel left lobe. No nodules or irregularities
DRAPE
LUNGS
VITAL SIGNS
Blood pressure Inspect and palpate trachea trachea above sternal notch, midline
o Fit cuff around arm with finger space Tactile fremitus patient cross arms, you place hands at upper, mid,
o Radial pulse, pump till you dont feel pulse, release, pump +30 lower thorax back,bilateral, pt says 99 no inc/dec/absent fremitus
o Rest their arm on your shoulder, use bell side Percuss post lung fields 3 levels, bilat
Pulse Percuss lat lung fields 2 levels, bilat
o Radial, measure bilaterally - Both equal, strong and regular
Auscult lung fields 3 levels, bilat, post slow deep breaths viamouth
o Measure 1 side only, count pulse for 30 sec
Auscult lung fields 3 levels, bilat, lat slow deep breaths via mouth
Respiration
Whispered pectoriloquy auscult 3 levels, bilat, pt whisper 99
o Count resp while taking second half 30 sec of pulse
Egophony auscult 3 levels, bilat, pt says ee
HEENT Percuss ant lung fields 2 levels, bilat
Auscult ant lung fields 2 levels bilat
Palpate scalp front to back, note lumps or tenderness
Inspect hair separate strands at roots texture fine, no signs of HEART
alopecia
Wrinkle forehead, show teeth, smile Raise bed to 30-45*
Inspect Neck veins(R side only) noticing neck for any jugular
Inspect conjunctive, sclera of both eyes together move eyelids venous distention
down/up no conjunctival pallor/discharge, no scleral icterus Auscult carotid (bell) pt deep breath in, hold it, note bruits
Visual acuity pt holds 14 away, cover eye, read low line possible Palpate carotid (1 side at a time) pulse is strong/regular/2+
Visual field by confrontation move fingers inwards diagonally (2) Inspect Precordium I dont notice any heaves
and horizontally (1), switch eyes tell me when you see 0, 1, or 2 Palpate precordium Use palm of hands at upper L sternal border
fingers. feel for impulses, thrills, or lift
Exraocular eye mvmts CN 3, 4, 6 - Draw H Palpate point of max intensity (PMI) 5th intercostal, midclavic line,
Convergence finger towards nose pupils also constricted PMI is nickel coin sized, strong in quality
Pupil 4 mm, symmetric and round Auscult Aortic area (diaphragm)
Pupillary light reflex Dim lights, direct and consensual, both eyes Auscult Pulmonic area (diaphragm)
Opthalmoscope exam At 15*, see red reflex, follow vessels to optic Auscult Tricuspid area (diaphragm) from bottom if female
disc, look at me, I see the macula Auscult Mitral area (diaphragm)
Auscult Mitral area (bell) no gallops, murmurs or rubs
Palpate external ear and mastoid pull on auricle, push on tragus, Palpate femoral pulse one at a time, bilat
palpate mastoid process. Any tenderness at any of those? Palpate popliteal pulse one at a time, bilat, bent knee
Auditory acuity cover 1 ear at a time, both eyes, rub fingers tell Palpate dorsalid pedis pulse both at same time, bilat equal/strong
me when you hear something and what you hear Pitting edema test press for 5 sec on ant/med tibia
Weber test 512 hz place fork on mid skull hear sound better in
one ear or both ears equally? ABDOMEN
Rine test 512 hz- place on mastoid process tell me when hearing
Bed is flat, expose abdomen abd is flat, no veins, rashes, masses
goes away. Place in front of ear tell if you still hear it
Auscult 4 quads bowel sounds present, no bruits
Otoscope exam - brace hand against head, pull auricle see
tympanic membrane, its not erythematous or bugling, no exudate Percuss 4 quads
Palpate 4 quads 1st superficially, then deeply watching the patients
Palpate sinuses frontal and maxillary face to see if in any pain
Inspect lips, gums, tongue, teeth, buccal mucosa, floor of mouth- use Percuss liver span - Start at or below umbil level and move upwards
tongue blade and light no fissures or lesions until percussion note changes from tympany to dullness, note that
level. Start nipple line and move downwards until note changes from
Uvula CN 10 say ahh, uvula was midline
resonance to dullness. Liver span Normal length is 6 to 12 cm
Palpate liver edge Hooking technique, inspire feel liver edge
CN 11 pt shrug shoulder against your resistance
Palpate spleen Pt in R lat decub, inspire, feel spleen
Lymph nodes (6) - Preauricular in front of ears/on cheeks , post
auricular behind ears, occipital at behind mastoid process, tonsillar is Peritoneal inflamm ask if pt is feeling any pain in abd, palpate
under jaw near the back, submandibular is under jaw near chin, towards that area, check rebound tenderness
submental is right under chin, superficial cervical is down the neck Appendicitis 2/3 way from umb to ASIS is McBurneys point, ask
on the outside of thyroids, posterior cervical is behind scm muscle, pt if any pain or tenderness
deep cervical is same as posterior cervical except that you pinch the Costo-vertebral angle tenderness palm on mid back, L and then R
skin slightly instead of just palpating them. Ask pt to raise shoulders, pound on palm, any tenderness?
and supraclavicular is right behind clavicle.
Neck ROM flex/ext, r/l lat rot, r/l lat bending
NEUROLOGIC/EXTREMITIES MEDICAL HISTORY
Romberg test pt standing, close eyes, feet together, arms side for
15 sec
Gait
o Normal
o On toes
o On heels
o Heel to toe