Recording-1(44 MB) https://purdueglobal.zoom.us/rec/play/AmRsVaGV0ihl-_COPoqCCit6Nr0uaC3iXQoVC98Jm5y

Recording-1(44 MB) https://purdueglobal.zoom.us/rec/play/AmRsVaGV0ihl-_COPoqCCit6Nr0uaC3iXQoVC98Jm5yBl20IUBkeZB9yX2OcSlPjnk-nwE8Imxm56aP6.1taCqdVT24FRZOZb listen and write short summary Welcome to Unit Three with PowerpointRenee Shell posted on Oct 1, 2024 10:39 PM•Edited Patient Assessment: General Survey, HEENT, Skin The objective component of the patient encounter begins with the general survey. As you move through the patient assessment you will be quickly and methodically observing and assessing the below components in addition to using various tools and specialty techniques of assessment. Move through the assessment process in a methodical fashion to limit patient position changes. Be sure to practice these to gain finesse and acumen. Additionally in a focused exam more attention may be given to an area of concern for more in depth investigation and guided by diagnostic reasoning. Key Components of the General Survey, Vital Signs, and Pain Assessment Perform a general survey (appearance, apparent state of health, discomfort or distress, skin color, dress, grooming and personal hygiene, facial expression, odors, posture, and gait and motor activity). Measure height and weight and calculate BMI. Measure blood pressure using a sphygmomanometer. Select the appropriate device for measuring blood pressure. Prepare the patient and setting. Select the correct size blood pressure cuff. Position the arm and cuff appropriately. Use the palpated radial pulse obliteration pressure to estimate systolic blood pressure. Position the stethoscope diaphragm or bell over the brachial artery. Inflate the cuff rapidly to target level followed by gradual deflation. Identify systolic and diastolic blood pressures. Average two or more readings. Measure blood pressure in both arms at least once. Measure orthostatic blood pressure (if indicated). Examine arterial pulses, heart rate, and rhythm. Observe rate, rhythm, depth, and effort of breathing. Measure core body temperature (oral, tympanic, rectal, or temporal). Assess acute and chronic pain (if indicated). Key Components of the Full-Body Skin Examination Patient Position — Seated Inspect the hair and scalp (distribution, texture, and quantity). Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard. Inspect the upper back. Inspect the shoulders, arms, and hands including palpation of fingernails. Inspect the chest and abdomen. Inspect the anterior thighs and legs. Inspect the feet and toes including soles, interdigital areas, and toenails. Patient Position — Standing Inspect the lower back. Inspect the posterior thighs and legs. Inspect the breasts, axillae, and genitalia including axillary and pubic hair (as appropriate in exam sequence). Alternative positioning is having the patient supine then prone. The systematic flow of examination from head to foot, anteriorly to posteriorly remains. Key Components of the Head and Neck Examination Examine the hair (quantity, distribution, texture, any pattern of loss). Examine the scalp (scaliness, lumps, nevi, lesions). Examine the skull (size, contour, deformities, depressions, lumps, tenderness). Inspect the skin in the head and face (expression, contours, asymmetry, involuntary movements, edema, and masses). Palpate the cervical lymph nodes (size, shape, delimitation, mobility, consistency, tenderness). Examine the trachea (deviation, breath sounds over it). Examine thyroid gland (size, shape, and consistency). Key Components of the Ophthalmologic Examination Test visual acuity using a Snellen eye chart. Test visual fields by confrontation. Test color vision and contrast sensitivity. Assess position and alignment of the eyes (protrusion, deviation). Inspect eyebrows (fullness, distribution, scaliness). Inspect eyelids and eyelashes (width, edema, color, lesions, eyelid closure). Assess the lacrimal apparatus (lumps, swelling, tearing, dryness). Inspect the conjunctivae and sclerae (vascular pattern, color, nodules, swelling). Inspect the cornea, iris, and lens (opacity, anterior chamber depth). Inspect the pupils (size, shape, symmetry). Test for pupillary reaction to light (direct and consensual light reactions). Inspect the light reflection in the corneas. Test the extraocular muscle movements. Perform ophthalmoscopic (funduscopic) examination including optic disc and cup, retina, and retinal vessels. Key Components of the Ear Examination Inspect the auricle and surrounding tissue (deformities, lumps, pits, or skin lesions). Move the auricle and palpate the auricle, tragus and mastoid (tenderness). Examine ear canals and tympanic membranes with an otoscope. Inspect the ear canal (cerumen, discharge, foreign bodies, redness of the skin, or swelling). Inspect the tympanic membrane and malleus (color, contour, perforations, and mobility). Test auditory acuity or gross hearing with the whispered voice test. If hearing loss or difficulty is present, determine sensorineural versus conductive hearing loss with tuning fork tests. Test lateralization if unilateral hearing loss or difficulty (Weber) is present. Compare air conduction versus bone conduction (Rinne). Key Components of the Nose and Paranasal Sinus Examination Inspect the anterior and inferior surfaces of the nose (asymmetry, deformities, tenderness). Test for nasal obstruction on each nare (if indicated). Inspect the nasal mucosa, nasal septum, inferior and middle turbinates, and corresponding meatuses with a light source or otoscope with large speculum (deviation, marked asymmetry, polyps, ulcers). Palpate the frontal sinuses (tenderness, pressure, fullness). Palpate the maxillary sinuses (tenderness, pressure, fullness). Key Components of the Mouth and Pharynx Examination Inspect the lips (color, moisture, lumps, ulcers, cracking, or scaliness). Inspect the oral mucosa (discoloration, ulcers, white patches, nodules). Palpate the oral mucosa (if indicated for any lesions, thickening). Inspect the gingiva (erythema, discoloration, ulceration, and swelling). Inspect the gum margins and interdental papillae (swelling, ulceration). Inspect the teeth (missing, discolored, misshapen, or abnormally positioned). Inspect the roof (hard palate) and floor of the mouth (erythema, discoloration, nodules, ulcerations, or deformities). Some HEENT exams will overlap systems based on natural anatomy. Test the hypoglossal nerve, or CN XII (symmetry of tongue protrusion). Inspect the tongue (color, texture, lesions). Palpate the tongue (if indicated for any lesions, thickening). Inspect the soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx (color, symmetry, exudate, swelling, ulceration, or tonsillar enlargement). Test the vagus nerve, or CN X (symmetry of uvula). After completing this unit, you should be able to: Apply effective communication techniques during a physical examination. Apply critical thinking and diagnostic reasoning parameters to a HEENT clinical condition. Appraise normal and abnormal vision and hearing assessments. Develop advanced physical assessment techniques for the HEENT examination across the lifespan. Explore normal and abnormal physical assessment differentiation in the HEENT assessment. Use compassion to improve outcomes in patient assessment. Course Outcome practiced in this unit: NU552-2: Explore the process of assessment skills, diagnostic reasoning, and appropriate techniques necessary for a focused patient physical examination of the head, ears, eyes, nose, throat (HEENT), and chest across the lifespan.

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