Physical Examination Part 2 PDF

CHAPTER 16 Physical Examination Part 2 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Reminders   Read: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearn...

CHAPTER 16 Physical Examination Part 2 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Reminders   Read: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Nancy Caroline Chapter 16  BLS-PCS  Paramedic Conduct Standard  Patient Assessment Standard  General Measures Standard Head, Ears, Eyes, Nose, and Throat (1 of 2)  HEENT examination Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Comprehensive evaluation of the head and related structures Head: contains the brain, numerous important sensory organs, and all of the upper airway anatomy Eyes: nervous system structure that involves both motor pathways and sensory pathways  Head, Ears, Eyes, Nose, and Throat (2 of 2)  HEENT examination (continued) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Ears: provide for both hearing and balance control Nose: sensory organ; plays an important role in breathing Throat: mouth and posterior pharynx; simultaneously coordinates many motor and sensory functions as well as the initial activities of both the respiratory and digestive systems Head (1 of 3)  Cranium Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Foramen magnum  The most posterior portion of the cranium is the occiput.  Lateral portions are called the temporal regions.  Parietal regions lie between the temporal region and the occiput.  Forehead is called the frontal region. Head (2 of 3)  Cranium (continued) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Layer of muscle fascia covers the skull.  Scalp  Meninges  Dura Mater  Arachnoid Mater  Pia Mater  Cerebrospinal fluid Head (3 of 3) Head/Face DCAP-BLS-TIC: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Deformities Contusions Abrasions Punctures/Penetrations Burns Lacerations Swelling Tenderness Instability Crepitus Skill Drill 16-2: Assessing the Head Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Step 1 Step 2 Step 3 Step 4 © Jones & Bartlett Learning. Courtesy of MIEMSS. Eyes (1 of 6)  Tremendously complex sensory organs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Critical link to the CNS  Anterior chamber and posterior chamber © Germán Ariel Berra/Shutterstock.  Eyes (2 of 6) Pupil Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Pupil size is regulated by continuous motor commands. Check in millimeters  Size,  Shape  Symmetry of pupils Courtesy of AAOS Typically expressed as “PERRL”  “Pupils equal, round, and reactive to light.”  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Eyes (3 of 6) Eyes (4 of 6) General issues: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Pain or redness Loss of vision Diplopia Photophobia Blurring Discharge Corrective lens use  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com © Jones & Bartlett Learning. Eyes (5 of 6) Eyes (6 of 6) Pen light examination Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Check the lids, lashes, and tear ducts. Look for foreign bodies, evidence of wounds and trauma, and discharge. Turn up the lids and inspect the conjunctivae and sclera. Examine the anterior chamber and iris for clarity. Examine the posterior chamber and retina. Skill Drill 16-3: Examining the Eye (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Step 1 Step 2 Step 3 © Jones & Bartlett Learning. Courtesy of MIEMSS. Skill Drill 16-3: Examining the Eye (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Step 4 Step 5 © Jones & Bartlett Learning. Courtesy of MIEMSS.  Ears (1 of 3)  Sensory organs chiefly involved with hearing and sound perception Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Involved with balance control  External ear  Pinna and the external auditory canal Ears (2 of 3) Middle ear Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Hammer, anvil, and stirrup  Move in response to sound waves  Eustachian tube Inner ear  Consists of bony chambers filled with fluid  Fine nerve endings within the fluid send impulses to the brain. Ears (3 of 3)  Assessment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Involves checking for new aberrations in hearing perception  Plus inspecting and palpating for wounds, swelling, or drainage.  Mastoid Bruising  Fluid Drainage (CSF?) Nose (1 of 3)  Sensory organ involved with smell and taste Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Also, part of the respiratory system  Each nasal chamber contains three layers of bone covered with a moist lining.  During nasal breathing, air moves through the nasal chambers and is humidified as it passes over the turbinates.  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com © Jones & Bartlett Learning. Nose (2 of 3) Nose (3 of 3)  Assessment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Both anteriorly and inferiorly  Look for evidence of asymmetry, deformity, wounds, foreign bodies, discharge or bleeding, and tenderness.  Inspect the exterior of the nose, looking for colour changes, symmetry, and structural abnormalities.  Inspect the septum for any deviation from midline.  Note any drainage or discharge. Throat (1 of 3)  Conduit for both respiration and Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com digestion  Assessment:  Evaluation of the mouth, the pharynx, and sometimes the neck  Overall hydration status  Presence of a foreign body or aspiration  Examination of the mouth begins with the lips. Throat (2 of 3)  Assessment (continued) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Gums should be pink.  Visualize the tongue, noting its colour, size, and moistness.  Examine the oropharynx.  Note any unusual odors on the breath.  Inspect the uvula for edema and redness. Throat (3 of 3)  Neck (Extraordinarily Muscular Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Region)  External anatomy  Jaw, cricothyroid membrane, external jugular veins, thyroid cartilage, suprasternal notch, and cervical spinous processes  Palpate the suprasternal notch in an effort to identify any tracheal deviation. Cervical Spine (1 of 5) Pathway Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Spinal cord makes its way out of the brain and into the torso.  Enables the spinal nerves to emanate to and innervate the rest of the body  Point at which the head connects to the body  Spine is supported by a large mass of muscle.  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com © Jones & Bartlett Learning. Cervical Spine (2 of 5)  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Altered mental status? Cervical Spine (3 of 5) Presence of pain First for the MOI Evaluation Cervical Spine (4 of 5)  Examining the cervical spine Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Inspect and palpate  Look for evidence of tenderness and deformity.  Midline posterior tenderness should raise concerns.  Palpable discomfort over the lateral aspects of the neck  Any pain, tenderness, or tingling should prompt you to stop the examination. Cervical Spine (5 of 5) Ranging the neck Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com First, conduct the examination passively. Then, conduct the examination actively. Slowly rotate the head from shoulder to shoulder. Extend the head back. Flex the head and neck, touching the chin to chest. Reminders   Read: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Nancy Caroline Chapter 16  BLS-PCS  Paramedic Conduct Standard  Patient Assessment Standard  General Measures Standard