M a r y v i l l e
6 1 2
E x a m
1
Claudication
-
ANS
a
condition
in
which
cramping
pain
in
the
leg
is
induced
by
exercise,
typically
caused
by
obstruction
of
the
arteries.
May
be
characterized
as
a
dull
ache
with
accompanying
muscle
fatigue
and
cramps.
Usually
appears
with
sustained
exercise.
Site
of
pain
is
distant
to
narrowing.
How
do
you
test
EOM?
-
ANS
Eye
movement
is
controlled
by
6
extraocular
muscles
and
3
cranial
nerves,
III,
IV,
and
VI.
To
evaluate
eye
movement,
use
4
techniques.
●
First
have
the
patient
watch
your
finger
move
through
the
6
cardinal
fields
of
gaze.
Jerking
or
sustained
nystagmus
is
abnormal.
A
few
beats
of
horizontal
nystagmus
may
occur.
●
Second
have
the
patient
follow
your
finger
vertically
from
the
ceiling
to
the
floor.The
globes
and
the
upper
eyelids
should
move
smoothly
without
eyelid
lag
or
exposure
of
the
sclera.
●
Third,
test
extraocular
muscle
balance
using
the
corneal
light
reflex.
WIth
the
patient
looking
at
a
nearby
object,
shine
a
light
on
the
nasal
bridge.
The
eyes
should
converge
and
reflect
the
light
symmetrically .
●
Fourth,
if
the
corneal
light
reflex
is
imbalanced,
perform
the
cover-uncover
test.
As
the
patient
stares
at
a
fixed
point
nearby,
cover
one
eye
and
observe
the
uncovered
eye.
Then
remove
the
cover
and
observe
that
eye
as
it
focuses
on
the
object.
Note
any
eye
movement.
Your
patient
should
be
able
to
follow
your
finger
with
full,
smooth
extraocular
movements
and
without
nystagmus,
or
"shaky"
eye
motion.
Normal
extraocular
movements
indicate
intact
cranial
nerves
III,
IV,
and
VI.
*******What
is
the
difference
between
objective
and
subjective
data?
What
components
of
the
health
history
are
objective
and
subjective?
***********
-
ANS
Seidel
pg
618:
objective:
"direct
observation,
what
you
see,
hear,
and
touch".
This
includes
vital
signs
and
actual
assessment.
Subjective:
"information
patients
offer
about
their
condition
or
feelings."
This
includes
chief
complaint,
past
medical
history,
history
or
present
illness,
family
history,
and
review
of
symptoms.
Erb's
point
-
ANS
Erb's
point
is
the
auscultation
location
for
heart
sounds
and
heart
murmurs
located
at
the
third
intercostal
space
and
the
left
lower
sternal
border.
Erb's
point,
found
two
interspaces
below
the
pulmonic
area,
does
not
reflect
sound
from
one
particular
heart
valve,
but
is
a
common
listening
post,
lying
halfway
between
the
base
and
the
apex
of
the
heart. Tonsil
assessment
-
ANS
•
Enlargement;
Acute
infection,
2+,
3+,
or
4+
o
1+
-
visible
o
2+
halfway
between
tonsillar
pillars
o
3+
touching
uvula
o
4+
touching
each
other
Order
physical
assessment
is
done
-
ANS
Inspection,
Palpation,
Percussion,
Auscultation
Proper
use
of
Otoscope
on
adult
or
child
-
ANS
Adult-
straighten
the
external
auditory
canal
by
pulling
auricle
up
and
back
Child-
face
child
sideways
with
one
arm
around
parents
waist.
Pull
auricle
either
downward
and
back
or
upward
and
back
to
gain
best
view
of
tympanic
membrane.
How
do
you
assess
for
sensoineural
hearing
loss
-
ANS
air
conduction
heard
longer
than
bone
conduction
with
Rinne
Test;
lateralization
to
unaffected
ear;
loss
of
high-frequency
sounds
How
do
you
assess
for
conductive
hearing
loss
-
ANS
bone
conduction
heard
longer
than
air
conduction
with
Rinne
Test;
lateralization
to
affected
ear
with
Weber
Test;
loss
of
low
frequency
sounds;
loss
of
11-30
decibels
on
audiometry
with
cerumen
impaction.
Rinne
Test*****
-
ANS
helps
distinguish
whether
patient
hears
better
by
air
or
bone
conduction.
Place
the
tuning
fork
at
base
of
vibrating
tuning
fork
against
the
patient's
mastoid
bone
and
ask
patient
to
tell
you
when
the
sound
is
no
longer
heard.
Time
this
interval
of
bone
conduction
noting
number
of
seconds.
Continue
timing
the
interval
of
sound
due
to
by
air
conduction
heard
by
the
patient.
Compare
#
of
seconds
air
vs.
bone.
Air
conducted
should
be
heard
twice
as
long
as
bone
conducted
sounds.
(If
bone
conducted
heard
for
15
seconds,
air
conducted
should
be
heard
for
additional
15
seconds).
Weber
Test
-
ANS
helps
assess
unilateral
hearing
loss.
Place
base
of
fork
on
mid-line
of
patient's
head.
Ask
patient
if
sound
heard
equally
in
both
ears
or
in
one
ear
(lateralization
of
sound).
Should
hear
sound
equally.
Presbyopia
-
ANS
Progressive
weakening
of
accommodation
(focusing
power).
The
major
physiologic
change
that
occurs
after
the
age
of
45
years;
the
lens
becomes
more
rigid,
and
the
ciliary
muscle
becomes
weaker. Strabismus
-
ANS
a
condition
in
which
both
eyes
do
not
focus
on
the
object
simultaneously ,
although
either
eye
can
focus
independently;
may
be
paralytic
or
non-paralytic.
Photopsia
-
ANS
presence
of
perceived
flashes
of
light.
(Most
commonly
associated
with
posterior
vitreous
detachment,
migraine
with
aura,
retinal
break,
or
detachment).
Amblyopia
-
ANS
also
called
lazy
eye;
is
disorder
of
sight
d/t
eye
and
brain
not
working
well
together.
Results
in
decreased
vision
in
an
eye
that
otherwise
typically
appears
normal.
Most
common
cause
of
decreased
vision
in
a
single
eye
among
children
and
younger
adults.
Macular
Degeneration
-
ANS
is
caused
when
part
of
the
retina
deteriorates;
dry
(atrophic)
from
gradual
breakdown
of
cells
in
macula
resulting
in
gradual
blurring
of
central
vision
and
wet
(exudative
or
neovascular)-
new
abnormal
vessels
grow
under
the
center
of
the
retina;
the
blood
vessels
leak,
bleed,
and
scar
the
retina,
distorting
or
destroying
central
vision.
In
contrast
to
dry,
vision
loss
may
be
rapid.
Is
leading
cause
of
blindness
in
older
than
55
years
of
age
in
U.S.
Xanthelasma
-
ANS
condition
characterized
by
elevated
plaque
of
cholesterol;
commonly
found
on
the
nasal
portion
of
the
eyelid.
Snellen
Test*****
-
ANS
The
optic
nerve
is
assessed
by
testing
for
visual
acuity
and
peripheral
vision.
Visual
acuity
is
tested
using
a
snellen
chart,
for
those
who
are
illiterate
and
unfamiliar
with
the
western
alphabet,
the
illiterate
E
chart,
in
which
the
letter
E
faces
in
different
directions,
maybe
used.
The
chart
has
a
standardized
number
at
the
end
of
each
line
of
letters;
these
numbers
indicates
the
degree
of
visual
acuity
when
measured
at
a
distance
of
20
feet.
The
numerator
20
is
the
distance
in
feet
between
the
chart
and
the
client,
or
the
standard
testing
distance.
The
denominator
20
is
the
distance
from
which
the
normal
eye
can
read
the
lettering,
which
correspond
to
the
number
at
the
end
of
each
letter
line;
therefore
the
larger
the
denominator
the
poorer
the
version.
Measurement
of
20/20
vision
is
an
indication
of
either
refractive
error
or
some
other
optic
disorder.
In
testing
for
visual
acuity
you
may
refer
to
the
following:
6 1 2
E x a m
1
Claudication
-
ANS
a
condition
in
which
cramping
pain
in
the
leg
is
induced
by
exercise,
typically
caused
by
obstruction
of
the
arteries.
May
be
characterized
as
a
dull
ache
with
accompanying
muscle
fatigue
and
cramps.
Usually
appears
with
sustained
exercise.
Site
of
pain
is
distant
to
narrowing.
How
do
you
test
EOM?
-
ANS
Eye
movement
is
controlled
by
6
extraocular
muscles
and
3
cranial
nerves,
III,
IV,
and
VI.
To
evaluate
eye
movement,
use
4
techniques.
●
First
have
the
patient
watch
your
finger
move
through
the
6
cardinal
fields
of
gaze.
Jerking
or
sustained
nystagmus
is
abnormal.
A
few
beats
of
horizontal
nystagmus
may
occur.
●
Second
have
the
patient
follow
your
finger
vertically
from
the
ceiling
to
the
floor.The
globes
and
the
upper
eyelids
should
move
smoothly
without
eyelid
lag
or
exposure
of
the
sclera.
●
Third,
test
extraocular
muscle
balance
using
the
corneal
light
reflex.
WIth
the
patient
looking
at
a
nearby
object,
shine
a
light
on
the
nasal
bridge.
The
eyes
should
converge
and
reflect
the
light
symmetrically .
●
Fourth,
if
the
corneal
light
reflex
is
imbalanced,
perform
the
cover-uncover
test.
As
the
patient
stares
at
a
fixed
point
nearby,
cover
one
eye
and
observe
the
uncovered
eye.
Then
remove
the
cover
and
observe
that
eye
as
it
focuses
on
the
object.
Note
any
eye
movement.
Your
patient
should
be
able
to
follow
your
finger
with
full,
smooth
extraocular
movements
and
without
nystagmus,
or
"shaky"
eye
motion.
Normal
extraocular
movements
indicate
intact
cranial
nerves
III,
IV,
and
VI.
*******What
is
the
difference
between
objective
and
subjective
data?
What
components
of
the
health
history
are
objective
and
subjective?
***********
-
ANS
Seidel
pg
618:
objective:
"direct
observation,
what
you
see,
hear,
and
touch".
This
includes
vital
signs
and
actual
assessment.
Subjective:
"information
patients
offer
about
their
condition
or
feelings."
This
includes
chief
complaint,
past
medical
history,
history
or
present
illness,
family
history,
and
review
of
symptoms.
Erb's
point
-
ANS
Erb's
point
is
the
auscultation
location
for
heart
sounds
and
heart
murmurs
located
at
the
third
intercostal
space
and
the
left
lower
sternal
border.
Erb's
point,
found
two
interspaces
below
the
pulmonic
area,
does
not
reflect
sound
from
one
particular
heart
valve,
but
is
a
common
listening
post,
lying
halfway
between
the
base
and
the
apex
of
the
heart. Tonsil
assessment
-
ANS
•
Enlargement;
Acute
infection,
2+,
3+,
or
4+
o
1+
-
visible
o
2+
halfway
between
tonsillar
pillars
o
3+
touching
uvula
o
4+
touching
each
other
Order
physical
assessment
is
done
-
ANS
Inspection,
Palpation,
Percussion,
Auscultation
Proper
use
of
Otoscope
on
adult
or
child
-
ANS
Adult-
straighten
the
external
auditory
canal
by
pulling
auricle
up
and
back
Child-
face
child
sideways
with
one
arm
around
parents
waist.
Pull
auricle
either
downward
and
back
or
upward
and
back
to
gain
best
view
of
tympanic
membrane.
How
do
you
assess
for
sensoineural
hearing
loss
-
ANS
air
conduction
heard
longer
than
bone
conduction
with
Rinne
Test;
lateralization
to
unaffected
ear;
loss
of
high-frequency
sounds
How
do
you
assess
for
conductive
hearing
loss
-
ANS
bone
conduction
heard
longer
than
air
conduction
with
Rinne
Test;
lateralization
to
affected
ear
with
Weber
Test;
loss
of
low
frequency
sounds;
loss
of
11-30
decibels
on
audiometry
with
cerumen
impaction.
Rinne
Test*****
-
ANS
helps
distinguish
whether
patient
hears
better
by
air
or
bone
conduction.
Place
the
tuning
fork
at
base
of
vibrating
tuning
fork
against
the
patient's
mastoid
bone
and
ask
patient
to
tell
you
when
the
sound
is
no
longer
heard.
Time
this
interval
of
bone
conduction
noting
number
of
seconds.
Continue
timing
the
interval
of
sound
due
to
by
air
conduction
heard
by
the
patient.
Compare
#
of
seconds
air
vs.
bone.
Air
conducted
should
be
heard
twice
as
long
as
bone
conducted
sounds.
(If
bone
conducted
heard
for
15
seconds,
air
conducted
should
be
heard
for
additional
15
seconds).
Weber
Test
-
ANS
helps
assess
unilateral
hearing
loss.
Place
base
of
fork
on
mid-line
of
patient's
head.
Ask
patient
if
sound
heard
equally
in
both
ears
or
in
one
ear
(lateralization
of
sound).
Should
hear
sound
equally.
Presbyopia
-
ANS
Progressive
weakening
of
accommodation
(focusing
power).
The
major
physiologic
change
that
occurs
after
the
age
of
45
years;
the
lens
becomes
more
rigid,
and
the
ciliary
muscle
becomes
weaker. Strabismus
-
ANS
a
condition
in
which
both
eyes
do
not
focus
on
the
object
simultaneously ,
although
either
eye
can
focus
independently;
may
be
paralytic
or
non-paralytic.
Photopsia
-
ANS
presence
of
perceived
flashes
of
light.
(Most
commonly
associated
with
posterior
vitreous
detachment,
migraine
with
aura,
retinal
break,
or
detachment).
Amblyopia
-
ANS
also
called
lazy
eye;
is
disorder
of
sight
d/t
eye
and
brain
not
working
well
together.
Results
in
decreased
vision
in
an
eye
that
otherwise
typically
appears
normal.
Most
common
cause
of
decreased
vision
in
a
single
eye
among
children
and
younger
adults.
Macular
Degeneration
-
ANS
is
caused
when
part
of
the
retina
deteriorates;
dry
(atrophic)
from
gradual
breakdown
of
cells
in
macula
resulting
in
gradual
blurring
of
central
vision
and
wet
(exudative
or
neovascular)-
new
abnormal
vessels
grow
under
the
center
of
the
retina;
the
blood
vessels
leak,
bleed,
and
scar
the
retina,
distorting
or
destroying
central
vision.
In
contrast
to
dry,
vision
loss
may
be
rapid.
Is
leading
cause
of
blindness
in
older
than
55
years
of
age
in
U.S.
Xanthelasma
-
ANS
condition
characterized
by
elevated
plaque
of
cholesterol;
commonly
found
on
the
nasal
portion
of
the
eyelid.
Snellen
Test*****
-
ANS
The
optic
nerve
is
assessed
by
testing
for
visual
acuity
and
peripheral
vision.
Visual
acuity
is
tested
using
a
snellen
chart,
for
those
who
are
illiterate
and
unfamiliar
with
the
western
alphabet,
the
illiterate
E
chart,
in
which
the
letter
E
faces
in
different
directions,
maybe
used.
The
chart
has
a
standardized
number
at
the
end
of
each
line
of
letters;
these
numbers
indicates
the
degree
of
visual
acuity
when
measured
at
a
distance
of
20
feet.
The
numerator
20
is
the
distance
in
feet
between
the
chart
and
the
client,
or
the
standard
testing
distance.
The
denominator
20
is
the
distance
from
which
the
normal
eye
can
read
the
lettering,
which
correspond
to
the
number
at
the
end
of
each
letter
line;
therefore
the
larger
the
denominator
the
poorer
the
version.
Measurement
of
20/20
vision
is
an
indication
of
either
refractive
error
or
some
other
optic
disorder.
In
testing
for
visual
acuity
you
may
refer
to
the
following:
