Dull - Soft to moderate, moderate to high pitch, moderate duration, thudlike quality, ex.
Over liver
Flat - Soft, high pitch, short duration, very dull quality, ex. Over muscle
Immediate percussion - Strike finger/hand directly against body
Indirect/mediate percussion - Strike distal phalanx of middle finger against finger placed
on body, originate strike from wrist
Percussion with fist - used to elicit tenderness from liver, gallbladder, kidneys; uses
ulnar aspect of fist
Palpation - Gathering information through hands and fingers (touch)
Fine discrimination - Palmar surfaces of fingers and finger pads, sensitive, use for
discriminatory touch to determine position, texture, size, consistency, masses, fluid,
crepitus.
, Vibration - Ulnar surface of hand and fingers
Dorsal surface of hand - Use for temperature
How to palpate - Be gentle, warm hands
Pneumatic otoscope - Illuminates external auditory canal and tympanic membrane
Reflex hammer - Tests deep tendon reflexes; use brisk, wrist snap
Opthalmoscope - For inner structures of eye
Large aperture - Large round beam, used most often
Small aperture - To examine small pupils
Red-free filter - Green beam to examine optic disc for pallor and minute vessel changes,
permits recognition of retinal hemorrhage, blood appears black
Slit aperture - For anterior eye; determines elevation of lesions on retina
Grid aperture - For size of fundal lesions
Wood's lamp - Black light (wavelength 360 nm); causes substances to fluoresce; used
to see fungi on skin lesions
Cognitive impairment indications - LOC, response to question, reasoning or judgment,
arithmetic ability, memory, attention span, specific mental test scores
Complex mental processes - learning, perceiving, decision making, and memory
Older adults complex mental processes - Montreal Cognitive Assessment and miniCog
Signs of possible cognitive impairment - significant memory loss, confusion (impaired
cognitive function with disorientation, attention and memory deficits, and difficulty
answering questions or following multiple-step directions), impaired communication,
inappropriate affect, personal care difficulties, hazardous behavior, agitation, and
suspiciousness
Cognitive impairment - Ask patient to complete analogy (analogies), tell the meaning of
a fable, proverb, etc. (abstract reasoning), do arithmetic calc, ask to write down a
phrase (writing ability), ask to button shirt or comb hair (execution of motor skills),
memory tests
Immediate recall or new learning - Listen and repeat a sentence or series of numbers
(5-8 forward, 4-6 backward)
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