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Taitum Shared "NUR 216 Exam 2" - 6 Picmonics

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NUR 216 Exam 2

Airway and Lungs Assessment
Inspection
Examine Back of Chest
Determine Respiratory Rate for 1 Minute
Assess for Abnormalities with Uneven Movement or Use of Accessory Muscles
Inspect Skin, Nails and Mucous Membrane
Palpation
Palpate for Crepitus, Tenderness, Alignment, Masses or Retraction
Palpate for Tactile Fremitus
Check Chest-Wall Symmetry and Expansion
Note Resonance, Hyperresonance, Dullness and Tympany
AUSCULTATION
Use Diaphragm of Stethoscope to Listen to Full Inspiration and Full Expiration
Ask Patient to Breathe Through Mouth
Normal Breath Sounds
Abnormal Breath Sounds
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5 mins
Head, Face and Neck Assessment
Head
Inspect Size and Shape of Skull
Palpate Temporal Artery
Face
Observe Facial Expression
Inspect Facial Structures and Symmetry
Neck
Look for Symmetry
Check Range of Motion
Inspect Lymph Nodes and Thyroid Gland
Confirm Trachea is Midline
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2 mins
Nose Assessment
External Nose
Inspect for Deformity or Asymmetry
Inspect for Inflammation and Skin Lesions
Nasal Cavity
Check for Nasal Obstruction
Inspect Nasal Mucosa
Note Discharge, Bleeding or Foreign Body
Sinus Area
Palpate the Sinus Areas
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2 mins
Ear Assessment
EXTERNAL EAR
Inspect Position and Symmetry
Inspect for Lesions, Drainage, Nodules or Redness
Inspect Opening of Ear Canal
OTOSCOPIC EXAMINATION
Insert Speculum
Position Scope
View Structures
Light Reflect
HEARING ACUITY TESTS
Whisper Test
Weber’s Test
Rinne Test
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4 mins
Eye Assessment
Inspect External Structures
Eye and Eyebrow Symmetry
Eyeball Alignment
Inspect Eyeball Structures
Examine Cornea and Lens for Cloudiness
Iris and Pupil Shape and Size
Pupillary Light Reflex and Accommodation
P.E.R.R.L.A
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2 mins
Pressure Ulcers
Risk Factors
Prolonged Immobilization
Neurologic Disease
Decreased Level of Consciousness
Classification
Stage 1: Intact Skin with Non-blanchable Erythema
Stage 2: Partial Thickness Skin Loss
Stage 3: Full-thickness Skin Loss without Fascial Involvement
Stage 4: Full-thickness Skin Loss with Fascial Involvement
Management
Wound Care
Surgery
Considerations
Septicemia
Osteomyelitis
Prevention
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3 mins

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