Approach to Identifying
Priorities
• Airway
• Breathing
• Circulation
• Vitals Signs
1. Immediate Priorities (ABCs)
• Mental status change
• Acute pain
• Urinary elimination problems
• Untreated medical problem (diabetic without insulin)
• Risk of infection, safety, security
2. Second-level Priorities
• Lack of knowledge
• Activity, rest, sleep

Approach to Identifying
Priorities
• STUDENTS WILL DEMONSTRATE DURING FHTA Comments 1 point
1. Hand Hygiene before or as entering room
2. Acknowledge and Introduce self and address client
respectfully
3. Confirm identity (2 points)
_____ Ask client their name and date of birth
_____ Verify with wristband
4. Explain exam, Duration and offer opportunity for
questions
5. Code Status Educate client if necessary
Full Code vs. DNR
6. Physical Appearance
7. Body Structure
8. Mobility
9. Behavior
Introduction & General Survey

Dwarfism
Hypopituitary
dwarfism
Achondroplastic
dwarfism
Gigantism versus acromegaly
(hyperpituitarism)
Anorexia nervosa
Endogenous obesity—
Cushing’s syndrome
Marfan syndrome
CRIES Neonatal Scale and FLACC (Infants and Toddlers) referenced in Jarvis

-- Provoking
• Q – Quality/Quantity
• R – Region/Radiation
• S – Severity/symptoms
• T – Timing (Onset)/triggers
• Location
• Duration
• Relieving Factors
PQRST
• O - Onset
• L - Location
• D - Duration
• C – Clarification
• A – Aggravating/Alarming Factors
• R – Related to/Radiating/Relieving
• T – Timing/Triggers/Treatment
• S- Severity
OLDCART
10 TRAPS OF INTERVIEWING
1. Providing False Assurance
2. Giving Unwanted Advice
3. Using Authority
4. Using Avoidance Language
5. Engaging in Distancing
6. Using Professional Jargon
7. Using Leading or Biased Questions
8. Talking Too Much
9. Interrupting
10. Using “Why” Questions

Critical characteristics

1.Location—be specific and precise
2. Character or quality—provide descriptive terms
3. Quantity or severity—use scales to identify intensity
4. Timing—onset, duration, and frequency
5. Setting—location and/or associated activity
6. Aggravating or relieving factors—what makes it worse or better
7. Associated factors—is the concern r/t any other symptom?
8. Patient’s perception—how does it affect you?

Central Vision. CN II
◦ Snellen chart at ___ feet.
◦ Test each eye individually.
◦ Test with and without corrective lenses.
◦ Tests distance vision:
◦ Nearsighted (myopia): can see objects clearly
that are close, difficult seeing far away.
9
◦ To Test near vision:
◦ Have client read small print approx. __ inches
from face (Rosenbaum pocket screener)
◦ Farsighted (hyperopia): can see things clearly
far away, difficult seeing close objects such as
print.
◦ Eyes tested individually, then together

Peripheral Vision
Confrontation Test
◦ Face the client at eye level, 2 ft away
◦ Cover eye directly opposite each other
◦ You and client look directly at each other
◦ Hold a wiggling finger as a target midline
between you and the client and slowly advance
it in from the periphery in several directions
◦ Client says "now" when they see 1 or 2 fingers
◦ Assuming your peripheral vision is normal, you
should see fingers when client does
Note to
Examiner
 During history, notice clues from normal
conversation indicating possible hearing loss.
 Lip reading or watching your face and lips
rather than your eyes
 Frowning or straining forward to hear
 Posturing of head to catch sounds with better
ear
 Misunderstands questions; frequently asks
you to repeat
 Irritable or shows startle reflex when you
raise your voice
 The person’s speech sounds garbled; vowel
sounds distorted
 Inappropriately loud voice
 Flat, monotonous tone of voice
Copyright © 2020 by Elsevier Inc. All rights reserved.

Aging Adult Considerations
 May be dry and less resilient due to loss of connective tissue
 Increased hair that is coarse and wiry
 Pinna increases in width and length, earlobe elongates
 Eardrum normally may be whiter in color and more opaque, duller
and thicker than in younger adult.
 Presbycusis = age-related hearing loss
 Cerumen is dryer, may accumulate and become impacted
 Generalized hearing loss in all frequencies, high pitched usually first

WHAT SHOULD A LYMPH NODE FEEL LIKE???
Normally, lymph nodes are:
Movable
Discrete
Soft
Non tender

LYMPHADENOPATHY (NODE
ENLARGEMENT > 1CM)
Acute Infection vs.
 enlarged
 bilateral
 firm
 tender
 freely movable
 acute onset, warm
Cancerous nodes
 > 3 cm
 unilateral
 hard like a rock
 non-tender
 fixed to adjacent structures
 * Hodgkin lymphoma is painless,
rubbery with gradual onset