Denise Plevier Final Practicum Script (Introduce self and wash hands) The patients posture is normal and

she is comfortably sitting erect. Her dress is appropriate for the setting and season, and her hygiene and grooming are good. I am checking the patients nutritional status. (Check skin turgor) The skin is elastic and shows no signs of dehydration. (Check oral mucous membranes and conjunctiva). The mucosa and conjunctiva are pink, moist, and free of lesions. (Palpate lymph nodes: Preauricular, posterior auricular, occipital, submental, submandibular, posterior cervical, anterior cervical, deep cervical chain, supraclavicular) The lymph nodes are not palpable. The patients facial expression is appropriate for the situation. The mood and affect are pleasant and she is conscious. (Ask name, where we are, and date). The patient is oriented to person, place and time. (Shine light in each eye twice, checking first for pupil constriction and second for accommodation). Patient is PERRLA- Pupils are equal, round, and reactive to light with accommodation. Please grasp my fingers with your hands. Hand grasps are strong bilaterally. Please push my hands down like a gas pedal with your feet. Please pull your feet up towards the ceiling against my hands. Plantar flexion and dorsiflexion are equal and strong bilaterally. (Test patellar and biceps reflexes). Patellar and biceps reflexes present bilaterally. I am inspecting the posterior chest. The skin is smooth and dry and the configuration is symmetrical with no barreling of the chest. I am palpating for symmetrical expansion. Please take a deep breath. Expansion is symmetrical. (Place hands on upper back) Please say the word Ninety-nine. (Move to points down the back). Fremitus is present over all lung fields. No lumps are present. Spinal processes are normal. Did you feel any pain or tenderness on your back? No tenderness present. I am auscultating posterior breath sounds. Please take a large breath in and out through your mouth. Breath sounds are clear in all fields (6 places). Assess respirations secretly. Respiratory rate is ___ breaths per minute. Rhythm and depth are normal and there is no dyspnea. (Auscultate the apical heart rate for one full minute). Apical HR is ____. (Auscultate and name 5 cardiac landmarks with diaphragm). Aortic, Pulmonic, Erbs, Tricuspid, Mitral. (Auscultate using bell).

I am palpating the peripheral pulses. (Palpate radial, dorsalis pedis, and posterior pulses bilaterally). Pulses are strong, symmetrical and present bilaterally. Skin color is appropriate for ethnicity, skin is warm and dry over upper and lower extremities. (Check lower legs for edema) There is no edema in the lower legs. Please lay down on the table. The abdomen is flat and symmetrical. (Auscultate BS x4 quadrants) Bowel sounds are normoactive in all 4 quadrants. (Percuss x4 quadrants). Tympany is present in all 4 quadrants. (Light and deep palpation x4 quadrants). Do you have any pain in your abdomen? No masses or tenderness in the abdomen. Take blood pressure. Blood pressure is ___/___.