DPR Practical #1

Blood Pressure

Palpate radial artery, add 30, take BP

Orthos

Lay supine for 3 min, get HR and BP, stand, HR and BP within 1 minute

Heart rate

30 seconds, radial artery

Respiratory rate

Don’t tell them, observe rise and fall, 60 seconds

Auscultation of Carotid a.

Turn head, hold breath, 15 seconds, both sides

Palpation of carotid a.

Palpate if nothing is wrong, bilateral, one side at a time

Inspect chest

Inferior border of right ventricle, junction of sternum and xiphoid, right ventricle, behind sternum, apex, 4th or 5th intercostal, midclavicular, point of maximal impulse is in same place

Palpation of chest

Right and left second intercostal for aortic and pulmonic areas, 3rd, 4th, and 5th intercostals for right ventricle, point of maximal impulse, leaning forward, 4th or fifth interspace, midclavicular

Auscultation of heart

Aortic at 2nd intercostal right, pulmonic at 2nd intercostal left, tricuspid at 4th intercostal left, mitral at 5th midclavicular left

Peripheral abdomen

Auscultate, aorta, above and to the patient’s slight left, renal, above and to both sides, iliac, below and to both sides

Abdomen palpatation

Aorta, move closer until pulsation barely palpable

Upper extremity pulses

Brachial, flex elbow, medial to biceps, radial, lateral, ulnar, medial, probably not palpable, do each bilaterally

Lower extremity

Popliteal, supine, leg flexed, fingers into popliteal, press in, posterior tibial, behind medial malleolus, dorsalis pedis, lateral of extensor tendon to big toe, do bilateral

Allen test

Tight fist, block both, pump, release one, should flush within 3-5 seconds, do both, then do other hand

Palpate for edema

Dorsum, behind medial malleolus, over shins, at least two, bilateral, two seconds

Examine jugular v.

Turn head away, examine, bilateral

Nose

Inspect, palpate, test each nostril for openness, inspect inside with otoscope, inferior and middle turbinates, nasal septum, nasal passage

Throat, exam pharynx

Open mouth, inspect soft palate, anterior and posterior pillars, tonsils, posterior wall, have them say ahh, look at movement of palate, uvula

Inspection and palpation of neck

Inspect, place finger on either side of trachea, should be one finger space on either side

Palpation of posterior thorax

Palpate over lung fields, palpate for chest expansion, thumbs at 10th ribs, inhale deeply

Tactile fremitus of posterior thorax

Place hands bilaterally, have patient say 99, do at least 2 of 4

Percussion of posterior thorax

Percuss in at least 4 of 7, ladder like, 2-3 taps each

Auscultation of posterior thorax

Cough, inhale and exhale through mouth, ladder like, full breath cycle, at least 4 of 7

Special test Auscultation of posterior and anterior, Bronchophony

Say 99, do at least 4 levels

Special test Auscultation of posterior and anterior, Egophony

Say E, do at least 4 levels

Special test Auscultation of posterior and anterior, Whispered Pectoriloquy

Whisper 99, do at least 4 levels

Inspection of Anterior thorax

Observe effort, sounds of breathing

Palpation of anterior thorax

Palpate lungs, test for expansion, thumbs along costal margin, press thumbs a little together, breathe deeply

Tactile fremitus of anterior thorax

Bilateral, at least 2 of 3, patient says 99, ask patient to move breasts out of the way for last two

Percussion of anterior thorax

At intercostal spaces, 2 or 3 taps, ladder like movement, have patient displace breast for certain ones, at least four levels

Auscultation of anterior thorax

Cough, breath through mouth, deep breaths, ladder like, entire breath, move breast tissue

Auscultation of lateral thorax

Lift arm, breathe in and out through mouth, deep breaths, full cycle, left side two lobes, right side three

Inspection of hands

Have them hold out their hands, look for cyanosis, clubbing, edema