1. Diagnostic Procedures & Pharmacology
Chapter 15

2. Basic exam procedures are performed during the assessment of the patients. Condition. As used in medicine, assessment means the evaluation or appraisal of a condition. This info is used in reaching a diagnosis and in formulating a patient care plan.

3. Basic Examination Procedures

4. Vital Signs Pulse Respirations Blood pressure (BP) Temperature
Rate, Regularity, & Quality
Normal rate ranges from beats per minute (bpm) for adults
Can be checked at multiple sites on the body (Figure 15.2 on page in textbook)
Respirations
A single respiration is one inhalation & one exhalation
Normal rate ranges from breaths per minute for an adult
Blood pressure (BP)
Uses a sphygmomanometer (BP cuff) and stethoscope to measure
“Textbook normal” is 120/80 for an adult
Temperature
Average normal adult temp is 98.6˚F or 37.0˚C

5. Auscultation Sounds Auscultation means to listen
Auscultation using a stethoscope is used on many body parts; lungs, pleura, heart, and abdomen
Common auscultation sounds
A bruit is an abnormal sound or murmur
A rale is an abnormal rattle or crackle-like respiratory sound heard during inspiration
Rhonchus or Rhonchi a harsh “wet” respiratory sound indicating fluid in the large airways
Wheezing is a whistling sound heard in the airways due to constriction of the airways
Stridor is an abnormal, high-pitched, harsh or crowing sound heard during inspiration that results from a partial blockage of the pharynx, larynx, and trachea

6. Palpation & Percussion
Palpation is an examination technique in which the examiner’s hands are used to feel the texture, size, consistency, and location of certain body parts.
Percussion is a diagnostic procedure to determine the density of a body area by the sound produced by tapping the surface with the finger or instrument. Is used to evaluate air content in the lungs and over the abdomen to detect air in the loops of intestine.

7. Additional Examination Procedures
An ophthalmoscope is used to examine the interior of the eye
The abbreviation PERRLA means “pupils are equal, round, responsive to light and accommodation. Sometime PEARL is used which mean “pupils are equally active and responsive to light”
An otoscope is used to visually examine the external ear canal and tympanic membrane

8. Additional Exam Procedures Continued
A speculum is used to enlarge the opening of any canal or cavity to facilitate inspection of its interior.

9. Basic Exam Positions

10. Recumbent may be used to describe any position in which the patient is lying down either on the back, front, or side
Decubitus also means the act of lying down or the position assumed in lying down.
In radiography, the term decubitus is used to describe the position of the patient when lying in a recumbent position
Decubitus is most commonly used to describe a decubitus ulcer, which is also known as a bedsore

11. Prone Position
This is a recumbent patient is lying facedown on the belly. The arms may be placed under the head for comfort. This position is used for the examination and treatment of the back and buttock.

12. Supine Position
Also known as the horizontal recumbent position, is the patient lying on the back with the face up. This position is used for exam and treatment of the anterior surface of the body and for x-rays.

13. Dorsal Recumbent Position
In this position the patient is supine with knees bent. This position is used for the exam and treatment of the abdominal area and for vaginal or rectal exams.

14. Sims’ Position
In this position the patient is lying on the left side with the right knee and thigh drawn up with the left arm placed along the back. This position is used in the exam and treatment of the rectal area.

15. Knee-Chest Position
The patient is lying face down with the hips flexed (bent) so the knees and chest rest on the table. This position is used for rectal exams.

16. Lithotomy Position
In this position the patient is supine with the feet and legs raised and supported in stirrups. This position is used for vaginal and rectal exams.

17. Trendelenburg Position
In this position the patient is lying on the back with the pelvis higher than the head; the knees are slightly bent, and the legs are hanging off the end of the table. This position is used for pelvic surgery and for some radiographic exams.
The modified Trendelenburg position is
where the patient is lying flat on the back with
the legs elevated inches above the head
in an effort to improve the blood flow to the
brain. This position is often used in the
treatment of shock.