NUR 634 HEENT and Respiratory Examination — Transcript

Full transcript

1. 0:00hello my name is Daryl I'm a nursing
2. 0:02student nurse practitioner so I'm going
3. 0:04to be examining your head in chest today
4. 0:05okay can you just verify your name and
5. 0:07date of birth for me alignment hell 10
6. 0:0912 1995 okay very good so patient is
7. 0:12well nourished no keyless First full
8. 0:14groom it's going to start with the head
9. 0:16some more cephalic a traumatic
10. 0:18symmetrical the face is also symmetrical
11. 0:20no redness no rashes no lesions no
12. 0:22swelling I'm gonna look at the scalp
13. 0:24the hair is finally smooth to shoot it
14. 0:26evenly no redness no rashes no lesions
15. 0:28gonna palpate it
16. 0:30you know mass is palpated any tenderness
17. 0:32no very good kind of palpate that
18. 0:34temporal arteries now any tenderness no
19. 0:37no pulsation two plus okay moving on to
20. 0:39your eyes gonna test your vision
21. 0:41the rosenbottom chart to use glasses yes
22. 0:43okay
23. 0:4514 inches from your face cover the right
24. 0:46eye
25. 0:48let me just redesign for me
26. 0:50ltfdh okay cover the left eye now
27. 0:53backwards hpftm okay visual Acuity is 20
28. 0:5720 bilaterally next I'm going to check
29. 0:59the eyes
30. 1:00take them off for a bit gonna check the
31. 1:02eyebrows it's symmetrical no redness no
32. 1:04rashes and the lesions the eyelids are
33. 1:06also symmetrical papillom fissures are
34. 1:08symmetrical no redness no swelling no
35. 1:11lesions eyebrows are present symmetrical
36. 1:13point in the right direction position
37. 1:15the eyes is also symmetrical no
38. 1:17protrusion and I'm going to take the
39. 1:18medial lateral canvases symmetrical no
40. 1:21redness no rashes I'm going to check
41. 1:23inside the eye lactosec and gland no
42. 1:24redness no discharge no obstruction I
43. 1:29discharge this letter is white no
44. 1:32redness no jaundice and the cornea no
45. 1:35opacities and the irises are well
46. 1:36defined now I'm going to check the
47. 1:38pupils
48. 1:40now I'm gonna try and enter these people
49. 1:43into the black people into the right
50. 1:45people so that people's aren't equal and
51. 1:48round
52. 1:49to my accommodation and they're about
53. 1:52three millimeters in size and they're
54. 1:54symmetrical now I'm going to test for
55. 1:55direct and consensual
56. 1:57light reflex pupillary reflex and I'm
57. 2:00going to shine a light into the left
58. 2:02pupil
59. 2:03language like the scene in the left
60. 2:05pupil not for consensual going to shine
61. 2:07light into the black people like reflect
62. 2:10the scene in the right people
63. 2:11moving on to the right people
64. 2:14language like the scene in the right
65. 2:17pupil not on the test for consensual
66. 2:21like reflexes seen in the left people so
67. 2:25very good as normal finding assessment
68. 2:26Foundation convergence so it just
69. 2:28fixating on the wall in the distance and
70. 2:30when I tell you to fixate your gaze onto
71. 2:31the pattern okay
72. 2:33okay the wall pupils are dilated now
73. 2:35look at the pen eyes converge if he was
74. 2:38constrict which is normal very good not
75. 2:40going to test for
76. 2:41feels a vision to confrontation so now
77. 2:43it fixing it on my nose
78. 2:45cover the left eye for me
79. 2:48okay now you can tell me how many
80. 2:50fingers I'm holding each hand okay
81. 2:52one
82. 2:53one very good covering it right now
83. 2:56one
84. 2:58one very good visual fields are intact
85. 3:00now I'm going to test for your
86. 3:02extraocular movements so just keep your
87. 3:05head still use your eyes and follow my
88. 3:06pen okay
89. 3:10in each motion
90. 3:12very good astronomical movements are
91. 3:13intact non-establishing the little thing
92. 3:15cranial nerves three four and six are
93. 3:17inside now I'm gonna be checking inside
94. 3:18your eye using the thermoscope I'm going
95. 3:21to turn off the lights
96. 3:22so during the exam just fix it on the
97. 3:24wall in the distance okay
98. 3:34okay
99. 3:35hold your face Redline visual reflex is
100. 3:38seen gonna go in
101. 3:39after this is pink brown well defined
102. 3:42after this cut ratio is 0.3 no type of
103. 3:45Edema no random lesions let me be making
104. 3:47no agency around the macula very good
105. 3:50moving on to the right eye
106. 3:53I'm gonna use my right eye
107. 3:55well I refits a scene visualize going to
108. 3:58go in
109. 3:59after this cup ratio is 0.3
110. 4:03now Apple edema normal lesions no
111. 4:06lesion scene around the macula
112. 4:09you're good I'm gonna turn the lights
113. 4:12all right moving on to the nose
114. 4:14fantastic
115. 4:15breathe in out
116. 4:19breathe in out pancake is normal
117. 4:21bilaterally now I'm going to test your
118. 4:23sense of smell let's close your eyes for
119. 4:25me I'm gonna cover one nostril breathe
120. 4:27in
121. 4:28out what's wrong with that coffee very
122. 4:30good I'm gonna cover this much we'll
123. 4:33keep your eyes closed breathe in out
124. 4:36what small is that cinnamon very good
125. 4:40I'm gonna populate the nose
126. 4:42pretty tenderness no very good not even
127. 4:45going to be expecting nostrils and I'm
128. 4:48going to start with the left nostril
129. 4:50okay
130. 4:51okay push the tip to the nose forward
131. 4:53so that's nostril
132. 4:55very good nasal because it's pink moist
133. 4:58sat on this midline no deviation no
134. 5:00redness no discharge no lesions no nasal
135. 5:01polyps and check the outer nostril
136. 5:06Hazel mucosa is pink moist
137. 5:09that Centum is midline no deviation no
138. 5:11redness no distract no lesions no nasal
139. 5:13polyps very good
140. 5:15now we're going to copy the mascular and
141. 5:17frontal sinuses
142. 5:19the maxillary tenderness no I'm gonna
143. 5:21copy the frontal
144. 5:23any tenderness no very good moving on to
145. 5:26the mouth the outside of the mouth the
146. 5:29redness no lesions no swelling
147. 5:33lifts our pink moistural cracks now I'm
148. 5:36going to check the inside of your mouth
149. 5:37so say after me uh
150. 5:41mitosis pink moist no reddish monsters
151. 5:44no lesions good dentation the gums are
152. 5:47pink
153. 5:48no redness ulcers no lesions tongue is
154. 5:50midline the white patches and ulcers no
155. 5:52lesions you can live underneath the
156. 5:53tongue mucosa is also pink moist and
157. 5:56redness ulcers and the lesions the soft
158. 5:58and hard palettes are pink moist no
159. 6:00redness also the lesions so
160. 6:07okay very good now I'm going to move on
161. 6:09to the ears going to test your hearing
162. 6:12so cover the left ear for me
163. 6:13I'm gonna whisper some words behind you
164. 6:15and you repeat it back to me okay
165. 6:18one two three very good moving on to the
166. 6:20other here
167. 6:21cover this here
168. 6:25ABC very good hearing is intact
169. 6:27bilaterally
170. 6:28you're going to strike this and put it
171. 6:30on your head it's only here in one ear
172. 6:32or both ears
173. 6:34both very good normal Weber test I'm
174. 6:37going to do brine test I'm going to put
175. 6:39it behind your master process on your
176. 6:40master process tell you when the sound
177. 6:42stops
178. 6:44it's done okay tell me when the sound
179. 6:46stops Again by your ear
180. 6:50they stop okay I'm gonna do it again on
181. 6:52the other here
182. 6:54when the time stops
183. 6:57it stopped not talking when it sounds
184. 6:59soft again
185. 7:03okay air conduction is great ball
186. 7:05conduction by laterally oracles
187. 7:08they're symmetrical no renders no rashes
188. 7:10no lesions gonna palpate the tragus in
189. 7:12the ear are you tenderness no I'm gonna
190. 7:15probably the master process is a
191. 7:16tenderness no very good now I'm going to
192. 7:18look at inside here
193. 7:19now I'm gonna look into the left ear
194. 7:21playing Oracle upwards and backwards
195. 7:23inside the ear canal
196. 7:26cerumen is present but no redness will
197. 7:28discharge no lesions from scarring
198. 7:30the coronary reflexes in the center of
199. 7:32acquisition probably a great tympanic
200. 7:34membrane no redness no discharge no
201. 7:36perforation of membrane and the malleus
202. 7:38and particles intact and visualized
203. 7:40okay moving on to the right here
204. 7:43playing upwards and backwards and
205. 7:45looking at ear canal it's a room is
206. 7:46present but no rent is no discharge no
207. 7:48lesions no scarring chronological scene
208. 7:51in a five o'clock position
209. 7:52for the greater Panic membrane the
210. 7:54redness no discharge on perforation and
211. 7:57the malleus and prophecy it is
212. 7:58visualized and intact very good I'm
213. 8:00going to move on to the neck don't look
214. 8:02at the neck now
215. 8:04like a symmetrical positive symmetrical
216. 8:05no swelling
217. 8:07and the puppy the lymph nodes could
218. 8:09probably the preauricular postericular
219. 8:11occipital tonsillar submandibular
220. 8:14submental kind of calculate the
221. 8:17superficial cervical chain deep cervical
222. 8:19chain posterior cervical chain and
223. 8:21superclavicular chain any tenderness no
224. 8:23no massive palpated not no palpate the
225. 8:25trachea
226. 8:26use one finger
227. 8:28tracheus midline no masses palpate or
228. 8:31any tenderness no very good you're going
229. 8:33to calculate the thyroid gland between
230. 8:34cricular cartilage and super sternal
231. 8:36nuts or thyroid
232. 8:37ism is midline lateral lobes are felt no
233. 8:41masses no nodules felt any tenderness no
234. 8:43very good moving on to the chest
235. 8:46recruit gonna test the AP
236. 8:51to know one to two ratio and then
237. 8:54inspect the interior chest and the
238. 8:55redness no rashes no lesions
239. 8:58and symmetrical the retraction seam now
240. 9:01I'm going to palpate the interior chest
241. 9:03any tenderness no no mass is palpated
242. 9:05now breathe in out which has expansion
243. 9:09symmetrical
244. 9:16okay all areas resonant meltdown is hurt
245. 9:19and I'm going to oscillate each lung
246. 9:21field
247. 9:24okay breathe in out and out and out and
248. 9:30out and out and up and up and out and
249. 9:36out and out so it's clear occupation
250. 9:38bilaterally no weasels no weasels rails
251. 9:40around face crackles the rubs move this
252. 9:43way I'm going to push through your chest
253. 9:45I'm going to cover you
254. 9:48okay I'm going out to posterior chest so
255. 9:50no rashes no lesions no nodules it's
256. 9:53symmetrical respiratory rate is normal
257. 9:57and now I'm gonna palpate the posterior
258. 9:59chest
259. 10:01any tenderness No No Mess is palpated
260. 10:05assessor taxonomous but you feel my
261. 10:07hands say 99 for me okay 99 99 99 99 99
262. 10:13is equal bilaterally and
263. 10:15in for me
264. 10:17uh test expansion symmetrical calcium
265. 10:27okay all errors are resonant no don't is
266. 10:30hurt per customer diaphragmatic
267. 10:32Excursion so I want you to breathe in
268. 10:35exhale so breathe in exhale and hold the
269. 10:37exhalation okay
270. 10:39for customers capture really
271. 10:43okay I'm gonna Mark the area of dullness
272. 10:46right here so you can breathe normally
273. 10:47now
274. 10:48okay I want you to breathe in again and
275. 10:51inhale holding inhalation so breathe in
276. 10:53inhale hold it
277. 10:58[Music]
278. 10:59marking breathe normally now distance is
279. 11:02four centimeters which is known for
280. 11:03diaphragmatic Excursion now I'm going to
281. 11:05oscillate each lung field
282. 11:08okay so once you breathe in
283. 11:12out in up and out and out and out and
284. 11:18out in and out and up clear loss
285. 11:22location but laterally no ways as whales
286. 11:25bronchitis crackles or ropes now when
287. 11:27you feel my stethoscope I want to say
288. 11:28eat from me okay and perform your coffee
289. 11:31e e e e e e e
290. 11:36e e
291. 11:39okay e is for an OS notation no a sound
292. 11:43on consolidation now I'm gonna be
293. 11:44foreign
294. 11:58one two three okay one two three is
295. 12:00muffled barely audible on Lost location
296. 12:02which is normal no consolidation
297. 12:05okay everything sounds very good right
298. 12:07because examination thank you very much
299. 12:09I'll give you some prize for the dress
300. 12:10okay okay