Nursing Physical Assessment

Physical Assessment Lab 120-103 1. General Survey ! Level?! Awake & Alert a. Orientation to person, place, time? b. Ability to Communicate in full sentences with clear speech? c. Posture: upright and erect, shoulders level and symmetrical? d. Personal Hygiene: Clean & neat, no odor, dresses appropriately for the weather. 2. Integumentary System: a. Color: Uniform color – pink, tan, brown, olive. Slightly darker on exposed areas. There are normally no areas of bleeding, ecchymosis, or increased vascularity. No skin lesions should be present except for freckles, birthmarks, or moles, which may be flat or elevated. . Temperature: Warm and dry bilaterally. Hands and feet may be slightly cooler than the rest of the body. Skin surfaces should be non tender. (use back of both hands on patient’s forearms) c. Textures: Skin should feel soft/fine or coarse/thick. d. Turgor: When the skin is released, it should instantly recoil, no tenting. Best place to assess: Ant. ?Chest or abd omen. **Verbalize: I will integrate the integumentary system throughout the rest of the exam through checking and observing. 3. Head, Face, Neck a. Cranium: The head should be normocephalic, midline, and symmetrical.? . Scalp: The scalp should be white to light brown, shiny, intact, and without lesions or masses, flaking, or pidiculi (lice)? c. Hair: Pale blonde to black, thick or thin, curly or straight, coarse or fine, shiny or dull.? d. Frontal Maxillary Sinuses: Should be non palpable and non tender (must ask â€Å"did that hurt? †) e. Cervical Lymph Nodes: Should be non palpable and non tender, non visible or inflamed. (Preauricular, postauricular, occipital, submental, submandibular, tonsillar, anterior cervical chain, posterior cervical chain, supraclavicular. e. Best place to assess: Ant. Chest or abdomen. **Verbalize: I will integrate the integumentary system throughout the rest of the exam through checking and observing. Physical Assessment Lab 120-103 f. Carotid Ar tery: Has visible pulsation (should be in front of the sternocleidomastoid muscle), palpable bilaterally (not at the same time!!! ), no bruits (soft blowing or wooshing sound from constriction of plaque) g. Temporal Artery: Should be palpable and equal bilaterally h. TMJ: Glides smoothly, no clicking or crepitus. i. Trachea: Midline, Thyroid: non palpable, non tender (ask) j.Neck: ROM & Muscle Strength: Stand behind the patient, touch the chin to the chest, look up at the ? ceiling, move each ear to shoulder (without elevating the shoulder), turn head to each side to look at the shoulder. The Cervical spine’s alignment is straight, the head is held erect. Normal muscle strength allows for full, complete, voluntary joint ROM against both gravity and moderate to full resistance. Muscle strength is equal bilaterally. There is no observed involuntary muscle movement. Say: â€Å"full active ROM with no restrictions† k.Thyroid: Palpation: have the patient lower the chin slig htly in order to relax neck muscles. Place your thumbs on the back of the patient’s neck and bring the other fingers around the neck anteriorly to rest their tips over the trachea on the lower portion of the neck. Move the finger pads over the tracheal rings. Gently move trachea over to the side, then have patient swallow. Feel for any consistency, nodularity, or tenderness. 4. Eyes? a. Eyelids: Palpebral Fissure are symmetrical, no ptosis or lid lag.? b. Lacrimal Glands: Pale pink, patent, no excessive tearing, dryness, drainage, or edema.? . Eyelashes: Evenly distributed no ectropion no entropion.? d. Eyebrows: Even and equally bilateral? e. Conjunctiva: clear, pink, moist, without lesions? f. Sclera: white & intact? g. Cornea: Surface should be moist and shiny and without discharge, cloudiness, opacity, and irregularity.? h. Iris: round, symmetrical, and colored: green, blue, brown, hazel, violet, honey, etc.? i. Pupils: PERRLA (Pupils are Equal, Round, Reactive to Light a nd Accommodation) Check pupil reflexes. check twice each eye, direct/consensual, then bring penlight toward nose to assess for accommodation. . Ears? a. Pinna: Non tender, symmetrical bilaterally, without lesions or masses, (top of pinna should always be equal to outer canthus) – palpate simultaneously? b. Tragus: non tender, without lesions? c. Mastoid Process (piece of bone inferior posterior ear): non tender, no swelling, equal bilaterally (if one is different, ask for how long)? d. Tympanic Membrane: Pearly gray, shiny, intact (sometimes will see some white-cottage cheese looking bumps = scarring) MAKE SURE TO CHANGE SPECULUM BTWN EARS FOR PRACTICUM Adult: pull back and up, look anterior.Child pull down) **know how to use equiptment!! Instructors/proctors look for this!!! *** e. Umbo: (Part of the Stapes) Make sure this is present, Protruding = dehydrated, Not present = fluid behind eardrum. f. Cone of Light: Tiny triangle anterior inferior on tympanic membrane = healthy. 5:00 on the right ear, 7:00 on the left ear. Physical Assessment Lab 120-103 6. Nose? a. Nares: patent, have patient occlude one nostril and gently blow out air on back of hand to test patency. Mucosa: pink, moist, without lesions, edema, drainage? b. Septum: without deviation.Best was to assess is to push tip of nose up – shows if deviation is present. ! ***If nares are pink = allergies. If nares are bright red = cold. Saline shortens cold as it washes it ! down to stomach, where stomach kills the virus. 7. Mouth/Lips? a. Lips: pink, moist, intact, without lesions? b. Teeth: 32 including 4 wisdom. White with good repair, without caries? c. Tongue: pink, moist, papillae intact, midline, full mobility (ask pt to stick tongue out move left, right, up, down), without lesions? d. Oral Mucosa: pink, moist, without lesions (use tongue depressor & penlight) no red, no swelling? . Gingiva: pink, moist, intact, no bleeding? f. Uvula: Midline, rises symmetrically with soft palate when patient says â€Å"Ahhh† If absent patient will be sensitive to gagging. If long may be a sign of sleep apnea? g. Tonsils: Pink, symmetrical. They are graded from â€Å"absent – +4) +1 = peeking, +4 = kissing h. Hard/Soft Palate: pink, intact. Soft palate is pinker than hard Write: â€Å"What you would expect to see† If not, must state what you see. Are the eyelids covering the top of the iris? Always compare OD to OS. First begin assessment with visual acuity.?Corneal Light Reflex: Shine penlight 12-15† away toward eyes (at midline) Should get right reflex in same position in each eye. If asymmetric they have strabismus (weak eye muscle) Ears: Use tuning fork? Weber Test: Hit on palm Hold at tip head (hairline) Should be able to hear equally in each ear. Rinne Test: hearing acuity. Hit prongs on palmar, put it on mastoid process until can’t hear it any longer, then move it to holding it in front of the ear canal. ***Air conduction should be twice as long as bone conduction*** Semicircular Canals: control balance and equilibriumVertigo can be caused by a foreign body which has been dislodged and landed in semicircular canals. Native Americans and Asians can have â€Å"Torus Palantitis† looks like mountain ranges on palate this is a benign condition. 8. Sensory Neuro (answer to most cranial nerve testing is â€Å"intact†) *verbage: Physical Assessment Lab 120-103 a. Sensation – light touch, sharp/dull, intact? a. Upper Extremities – use cotton ball, & sharp & dull sides of broken tongue depressor use 3 spots: finger, back of hand, arm. * ! b. Abdominal Reflex * ! ! Positive or not present * ! . Lower Extremities – use cotton ball & sharp & dull sides of broken tongue depressor use 3 spots: toe, top of ! foot, and shin.? b. Deep Tendon Reflexes – (smack deep tendons using flat side of hammer) *These are graded 0-4 â€Å"What you would expect to find +2/4†) ? a. Biceps – p lace thumb at patient’s elbow (antecubital) to hold their arm. Hit own thumb with the hammer. ?b. Triceps – hold patient’s muscle so patient’s arm can swing freely. Hit hammer above funny bone. ?c. Brachial Radialis – Hold pt’s hand then hit hammer midway btwn wrist & antecubital. d.Patellar – Find tendon right above patellar bone, hit hammer on tendon? e. Achilles – About 2† above heel, support foot, relax leg. Will have plantar flexion.? f. Plantar or Babinski = severe brain damage â€Å"abduction†. So we say â€Å"Positive plantar ? flexion, no abduction† we only expect to find in babies. How to test: use metal side of hammer and trace the outer margin of the foot and across top, under toes. ?babinski or f. Best place to assess: Ant. ?Chest or abdomen. **Verbalize: I will integrate the integumentary system throughout the rest of the exam through checking and observing.

Comparing bluetooth technology and infrared Essay

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Border control for imigration Essay Example | Topics and Well Written Essays - 750 words

Border control for imigration - Essay Example Strict border control laws are a need for today’s American society as such laws will provide protection to current workforce of America and to protect taxpayers right to access welfare. Body During the period of 1814, Francis Scott Key stated that the land of America is free and houses the bravest of all and today American society comprises of people belonging from different ethnic background (Hart 36). To a certain extend this has proven to be quite advantageous for the American society and its members, but now it is proving to hurt the already existing citizens of America. One of the reasons due to which the notion promoted by Francis Scott Key and poor border control policies has hurt the Americans is that due to increase in illegal immigration, the existing nationals of America face a higher fear of remaining unemployed. When illegal immigrants make to the American nation, they tend to take up jobs that do not require much skill set and the current citizens of US who are l ack skills to work in high paying jobs end up being jobless. According the census bureau of the nation under discussion, during the period of 2009, there were a total of more than 61k high school graduates belonging to different races and both male as well as female gender (United States Census Bureau 1). These fresh high school graduates lack skills and abilities as compared to the skills and abilities of college and bachelor level students and they are more likely to pursue careers in low paying jobs. If border control laws are not tightened then these high school students would fail to secure a careers and will fail to meet the needs of their own and their family members. Those who believe that strict border control is not essential defend their stance by stating that illegal immigration does not decrease employment opportunities for natives of US as the immigrants are not capable of speaking good English. For example: Peri states that although increase in immigrant population cr eate competition in areas of work where physical skills are required, but they cannot compete in areas where both physical and communication skills are required, thus native Americans have a competitive advantage over immigrants as they are well rehearsed with English speaking skills (Peri 165). Another issue with relaxed border control laws is that, these laws make the American taxpayers vulnerable and threatens their welfare. The United States have created a system through which it reimburses individuals for staying idle or they help those who are unemployed. This and several other benefits provided by the US for its citizens seem quite lucrative to people living in those nations where government does not contribute to the wellbeing of their citizens. In order to capitalize on such benefits, immigrants tend to move to United States from the host nations. Due to this, the tax payers who have tremendously added to the treasury of the United States for so many years end up being limi ted from their right of attaining welfare receipts as the welfare system even aids those who are not legally living in US. Those who contradict strict border laws state that the illegal immigrants add instead of eating the subsidy provided by the government. For example:

Ethics Essay Example | Topics and Well Written Essays - 500 words - 3

Ethics - Essay Example Since infant walkers have hit the market, parents ran out and purchased the product. In 1992 30,000 injuries were related to the product and eventually the product was banned in 1994. Upon being banned makers were aware that the market for the product was out there because of the freedom it allowed infants and the way parents responded according to sales. What this meant for manufactures was that the product still had potential to make a nice amount of profit. Just because a product is banned in the United States does not mean that the product could not be sold in other countries. Most manufactures that see a potential market that will allow for large profit will pursue targeting the market. This happens every day and requires that certain individuals make either ethical or unethical business decisions. The infant walker case has many ethical and unethical business decisions behind exporting the product. An agent assigned to the case could be making ethical business decisions by expo rting the product if the agent was unaware of the ban in the United States. The company however would be making the unethical decisions by purposely hiring someone new or someone unaware of the previous injuries resulting from the product. An agent would be acting unethically if they were aware of the previous injuries and how the product has become banned.

Proposal Design Essay Example | Topics and Well Written Essays - 750 words - 1

Proposal Design - Essay Example You may give, for those outside of your particular range of ability, an official rundown written in non-specialized dialect. Either you may incorporate a glossary of terms that clarifies specialized dialect use in the group of the proposition and append addendums that explain specialized data in by and large comprehended dialect. A statistical hypothesis is a logical hypothesis that is testable on the premise of observing a process that is being displayed through a situated of irregular variables. A factual theory test is a strategy for accurate deduction utilized for testing a reasonable speculation. A hypothesis contrasts with research question; it is more particular and makes an expectation. It is a conditional proclamation two or more variables are being related to each other. The significant distinction between an examination inquiry and a speculation is that a research predicts an exploratory result. A test outcome is called statistically significant on the off chance that it has been anticipated as unrealistic to have happened through sampling error only, as indicated by edge likelihood the criticalness level. Speculation tests are being utilized as a part of figuring out what results of a study would prompt a dismissal of the null theory for a pre-specified level of centrality. In the Neyman-Pearson structure (see beneath), the procedure of recognizing the invalid theory and the alternative hypothesis is helped by distinguishing two calculated sorts of blunders (sort 1 & sort 2). And by indicating parametric points of confinement on e.g. the amount of kind one lap will be allowed (Lai & Calandra, 2007). An option structure for factual theory testing is to indicate a situated of measurable models, one for every applicant speculation, and afterward utilize design choice procedures to pick the most suitable model. The most widely recognized determination strategies

Surveillance Soceity (pro and cons) Essay Example | Topics and Well Written Essays - 750 words - 1

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Multiculturalism Essay Example | Topics and Well Written Essays - 1250 words - 1

Multiculturalism - Essay Example We have to get rid of the stereotypes and learn to embrace the strengths that everyone brings to the table. Instead of ridiculing someone because they are different we are to seek the commonalities so that everyone is included in whatever we are doing. When you are in a classroom it is very important to take into consideration the diversity of cultures that are represented. In many school districts Americans struggle with the idea that they have to teach English as a second language to those children who come from Mexico. It is important to make sure that all children are included in the classroom by encouraging them to explore their differences. Some teachers bring in readings about different cultures and create activities around them. Children today do not only have racial differences because of the extended families that raise them. Today a teacher my have children who are disabled, who come from single parent homes and those who come from gay or lesbian homes. These are all a part of the multicultural arena in the class room and all should be made to feel comfortable in their learning. Gender bias in the classroom is not new. There have been several studies done to show that boys and girls receive different educations in most classrooms. In elementary schools many girls are looked over when they raise their hand to answer a question in favor of a boy to answer. In other classrooms it is the boys who are getting the lower grades and who are being referred to special education classrooms. Sometimes this bias comes because of the way the teacher perceives the individual learners in each category. Some teachers seem to socialize young girls towards what they expect a feminine individual to do. They also pressure the boys to accept the role that someone masculine would assume. Chapman (2008) suggests that education teaches girls that they are not equal to boys and there are behaviors that