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Listening

Activeperception of listening, paying attention

Non-verbalvalidation

Distance:

Public: 12+ ft

Social: 4-14

Personal : 1.5-4ft

Intimate: 1.5 ft

Asking right types of question:

Open ended

Close ended

Communication techniques

Making observations:

Pointing symptoms

Restating the answer to question

Reflecting

Clarifying

Interpreting

Sequencing

Summarizing

M-A-K-I-N-G I-To Use these Skills. In this order

Inspection

o Palpationo Percussion

o Auscultationo Inspectionusing sense of sight

o You are always inspecting

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o Good lightingo Expose the body part

o Compare findings to opposite sideo Dont hurry

o Palpationusing sense of touchDirectskin to skin

Indirectuse of an objectInvolves

Lightused moreDeep4-5 cm (abdomen

Flatness, Dullness, resonance, hyper resonance, tymphanyo Warm hands!

o Short fingernailso Gentle approach

o Temperature best with dorsum of hando Texture, size and pulsation with finger pads

o Palm for vibrationso Percussionstriking an object to another for sound

Intensity, duration, pitch, quality, location*the more solid the structure the higher its pitch the softer its intensity and shorter its duration*the more air filled the structure the lower the pitch the harder the intensity and longer the duration

DirectfingerIndirectbody partDirect fistbottom of fist

Indirect fistbody to bottom of fisto Turgorby grasping skin

o Percussiontapping the body (using the sense of hearing)o Involves striking body with fingertipso Used to evaluate size, borders, discover fluid in cavities

o Evaluate density of underlying structures

o Auscultationlistening to soundsIntensiry, pitch, duration, quality, location

Directlistens wit hunaided earIndirect- use of instrument

*low pitch- bell*high pitch - diaphram

o (using the sense of hearing)o Done last with the exception of the abdominal examo First learn normal

o Need good hearingo Quiet environment

o Good stethoscope

o Always listen to naked skin - not on top of clotheso You may close your eyes

Head and face

Inspect head Palpate the head Inspect face

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Palpate the temporal artery Palpate the temporomandibular

Neck

Inspect neck Inspect movement of the neck structures Inspect the cervical vertebrae Inspect range of motion Palpate the trachea Palpate the thyroid gland (posterior approach) Auscultate the thyroid only if you find an enlargement thyroid gland during inspection

Lymph nodes of head and neck

Palpateo Preauricular nodes (in front of ear)o Postauricular nodes (behind the ear)o Occipital nodes (posterior base of the skull)o Tonsillar nodes (angle of the mandible)o Submandibular nodes (medial border of mandible)o Submental nodes (behind tip of mandible)o Superficial cervical nodes (sternomastoid musclue)o Posterior cervical nodes (behind ^)o Deep cervical chain nodes (within and around sternomastoid muscle)o Superclavicular nodes (hook on to the clavical)

Eye

Test distant visual acuitysnellen E chart Test near visual acuity Test visual fields for gross peripheral vision

Extraocular muscle functioning

Perform corneal light reflex test Perform Cover test The positions test assesses eye muscle strength and cranial nerve function

External Eye structures

Inspect eyelids and eye lashes Observe the position and alignment of the eyeball in the eye socket Inspect the bulbar conjunctiva Inspect the palpebral conjunctiva Inspect the lacrimal apparatus Palpate the lacrimal apparatus Inspect the cornea and lens Inspect the iris and pupil Test papillary reaction to light

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Test accommodation of pupilsInternal Eye structures

Inspect the optic disk Inspect the retinal vessels Inspect the retinal background Inspect fovea (sharpest are of vision) and macula Inspect anterior chamber

Ear

Inspect the auricle, tragus and lobule Palpate the auricle and mastoid process Inspect the tympanic membrane Perform Webers test if the client reports diminishing or lost hearing in one ear (TOP of head) Perform Rhinnes test (tip touches back of ear) Perform Rombergs test (beside the ear)

Mouth

Inspect lips Inspect teeth and gums Inspect buccal mucosa Inspect and palpate the tongue Assess the ventral surface of the tongue Inspect for Whartons ducts Observe the side of tongue Check strength of tongue Check the anterior tongues ability to taste Inspect the hard (anterior) and the soft(posterior) palates and uvula Assess uvula Inspect tonsils Inspect the posterior pharyngeal

Nose

Inspect and palpate the ecternal nose Check patency of air flow through nostrils Inspect the internal nose

Sinuses

Palpate the sinuses Percuss the sinucess Transilluminate the sinuses

Posterior Thorax

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Inspect configuration Observe use of accessory muscles Inspect the clients positioning Palpate for tenderness and sensation Palpate for crepitus (crackling sensation) Palpate surface characteristics Palpate for fremitus Assess chest expansion Percuss for tone Percuss for diaphragmatic excursion Auscultate for breathe soundsAuscultate voice souns

o Bronchophonyninty nineo Egophonyrepeat Eo Whispered pectoriloquywhisper a phrase while auscultating

Anterior Thorax

Inspect for shape and configuration Inspect position of the sternum Inspect slope of the ribs Observe quality and pattern of respiration Inspect intercostals spaces Observe for use of accessory muscles Palpate for tenderness, sensation and surface masses Palpate for fremitus Palpate anterior chest expansion Percuss for tone Aucultate for anterior breath sounds, adventitious sounds and voice counds