THERE ARE 4 TYPES OF PROFESSORS

TYPE 1 IS THERE BECAUSE THE WANT TO MAKE A DIFFERENCE AND WILL HELP YOU THROUGH THICK AND THIN.

TYPE 2 IS THE TEACHER WHO COULD NOT DO THE JOB SO THEY DECIDED TO TEACH IT.

TYPE 3 IS THE TEACHER WHO IS JUST THERE TO DRAW A CHECK. (NOT EARN ONE)

THEN THERE IS TYPE 4 I PUT THEM AT THE BOTTOM BECAUSE THEY ARE SCUM.
THESE PEOPLE SET THEMSELVES UP TO BE THE GATE KEEPER OF THEIR PROFESSION.
THIS INDIVIDUAL TAKES IT UPON THEMSELVES TO TRY AND FAIL ANYONE THEY PERCEIVE AS THE WEAK STUDENT.
IN NURSING YOU HAVE TO KEEP IN MIND, THERE ARE NO WEAK STUDENTS.
I MAKE THIS STATEMENT WITH CONFIDENCE BECAUSE OF THE GPA FACTOR AND ADMITTING REQUIREMENTS.
IF YOU GOT INTO THE PROGRAM
YOU HAVE WHAT IT TAKES UNLESS YOU JUST FIND YOU DO NOT LIKE THE WORK.
THIS CHAPTER IS NOT JUST MINDLESS CHATTER I MENTION THIS PERSONALITY TYPE TO GIVE YOU A HEADS UP.

YOU WILL MEET ONE OF THESE INDIVIDUALS IN NURSING SCHOOL.
DO NOT TAKE THEM ON!
YOU HAVE TO UNDERSTAND PROFESSORS EAT DINNER WITH PROFESSORS
THEY ARE FRIENDS WITH PROFESSORS, THE LIST COULD GO ON.
IF YOU PISS ONE OF THEM OFF THE WORD WILL GET OUT ABOUT YOU.
THEY HAVE THE POWER TO MAKE SURE YOU DO NOT MAKE IT THROUGH THE PROGRAM.
THIS POWER COMES FROM ALL OF THE CHECK OFFS YOU ENCOUNTER THROUGHOUT YOUR NURSING SCHOOL CARRIER.
EVERY MOVE YOU MAKE ON A CHECKOFF IS JUDGED BY SOMEONES OPINION.
AND AN OPINION CAN FAIL YOU.
SO BE WISE
AND CHOOSE YOUR BATTLES WISELY.

Health Assessment Skit (Respiratory)

Hi my name is a nursing student at USA. I will be conducting your respiratory exam today.

Respiratory rate of 15 breaths per minute. Within normal range of 10-20.

Breathing pattern is regular, automatic and relaxed indicating diaphragm and intercostal muscles are being used. No use of accessory muscles noted. Posture is relaxed, no retraction or bulging of the interspaces.

Now I will exam your chest expansion. Take a beep breath. Symmetric expansion noted. Breaths are smooth and moderately deep. I will repeat for the posterior. Deep breath. Symmetrical expansion noted.

Skin-tone is tan and consistent. No cyanosis or pallor. No visible lesions. Open mouth. Keep head back. Lips and mucous membranes of the mouth, as well as the nose are pink and moist. No visible lesions.

Nails are pink, normally shaped with a 160 degree angle, no indication of clubbing. Nail base is firmly attached to the nail bed and the nail bed is firm. Capillary refill time is prompt, less than 2 seconds indicating good peripheral vascular perfusion and cardiac output.

Inspection of thorax indicates spinous processes are straight. Symmetric thorax with downward ribs at 45 degree angle. The anteroposterior to transverse diameter is 1:2, within the normal range.

No lesions, scars are present. No excessive hair present. Fine vellus hair is normally distributed.

Now I will palpate, please indicate if there is any tenderness of pain. Skin is warm, moist and firm. Temperature consistent with the rest of the body. No lumps, lesions, or crepitus noted. No tenderness noted.

To check tactile fremitus, I will need to have you say “blue moon” each time I touch you. Both anterior and posterior fremitus is equal bilaterally.

Now I will percuss the posterior lungs fields. Resounance noted at the apices, indicationg normal adult lung tissue. Dullness would be heard over organs and flat sounds would be heard over bone.

Hyperresonance will be heard if the lungs are over-inflated, as in emphysema or a pneumothorax. Dull sound indicates abnormal lung tissue, indicating possible pneumonia, atelectasis or a tumor.

Now I will check for diaphragmatic excursion. Please exhale and hold your breath. I will percuss down until the sound changes from resonant to dull. I will mark this measurement. Now take a deep breath and hold it. I will continue to percuss down until sound changes to dullness. I will measure the difference. Normal range is 3 to 5 cm. An abnormally high level of resonance or absence of excursion would indicate pleural effusion or atelectasis of the lower lobes. A well conditioned person may have a larger range of 7 to 8 cm.

Now I will have you breathe deeply through your mouth as I auscultate the breath sounds on both the anterior and posterior.

Normal bronchial sounds over the trachea and larynx are loud and high pitched. Inspiration is shorter than expiration.

Brochiovesicular sounds are over the major brochi along the upper sternum and vertebrae. Normal sounds are moderate in pitch and amplitude. Inspiration equals expiration.

Normal vesicular sounds over the peripheral lung fields are low pitched and soft. Inspiration is longer than expiration.

No adventitious sounds such as crackles indicating possible pneumonia or wheezes with asthma or emphysema are present. No decreased lung sounds indicating possible obstruction or increased lung sounds indicating dense tissue indicative of pneumonia.

Health Assessment Skit (Musculoskeletal)

“Hello my name is , a nursing student at USA. Let’s start your musculoskeletal system exam.”

A. Inspect & palpate 2 joints selected by the Faculty for: Color, Swelling, Masses, Deformity, Temp.

1. Temporomandibular Joint (TMJ)

“Please sit on the exam table.” Inspect area in front of ear. “The temporomandibular joint area is a tan-pink color with no swelling, masses, or deformities.”

Palpate. “Please open and close your mouth and tell me if you feel any pain or tenderness. The TMJ is nontender and moves smoothly without pain, or crepitation. No heat, swelling or masses are noted.”

“Please clench your teeth. The temporalis and masseter muscles are firm and bilaterally symmetrical.”

2. Neck

Inspect alignment of head and neck. “The cervical spine is a uniform tan-pink color with no swelling, masses, or deformities. Head and spine are aligned. The spine is straight, and the head is erect.”

Palpate. “Tell me if you feel any pain or tenderness. The spinous processes, sternomastoid and paravertebral muscles are firm and non tender. No heat, swelling or masses are noted.”

3. Shoulder

Inspect and compare both shoulders front and back. “The shoulder is a uniform tan-pink color with no swelling masses, or deformities. There is no muscular atrophy.”

Palpate. “Tell me if you feel any pain or tenderness. The shoulder area is non tender. No heat, swelling or masses are noted.”

4. Elbow

Inspect the size and contour of the elbow in flexed and extended positions. “The elbow is a uniform tan-pink color with no swelling, masses or deformities.”

Palpate. “Tell me if you feel any pain or tenderness.” Palpate with elbow flexed about 70 degrees and relaxed. “The elbow joint is non tender. No heat swelling or masses are noted.”

5. Wrist and Hand

Inspect hands and wrists on dorsal and palmar sides. “The wrists and hands are tan-pink in color with no swelling, masses or deformities.”

“Tell me if you feel any pain or tenderness.” Palpate. “The hands and fingers are nontender. No heat, swelling or masses are noted.”

6. Hip

Inspect. “The iliac crests are level and symmetric, gluteal folds and buttocks are symmetric. The smooth even gait reflects equal leg lengths and functional hip motion. No deformities are noted.”

Palpate. Lie supine. “Tell me if you feel any pain or tenderness. The hip is non tender. No heat, swelling, masses or are noted. There is no crepitance.”

7. Knee

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Inspect. The patient should be supine with legs extended. “The lower leg is aligned with the thigh.”

Ask patient to sit up and dangle legs over edge of table. “The knee area is a uniform tan-pink in color with no swelling, masses or deformities noted.”

Palpate. “Please tell me if you feel any pain or tenderness. The knee is non tender. No heat, swelling, or masses are noted.”

8. Ankle and Foot

Inspect ankles and feet while person is sitting, standing and walking. “Feet and ankles are a uniform tan-pink in color with no swelling, masses, or deformities noted. The foot has a longitudinal arch, the toes point forward and lie flat, and the ankles have smooth bony prominences.”

Palpate. “Please tell me if you feel any pain or tenderness.” Support ankle. “The feet and ankles are nontender. No heat, swelling, masses or calluses are noted.”

“Now we’re going to test your range of motion and muscle strength. Please tell me if you feel any pain or tenderness. Please open and close your mouth as wide as you can. Now open your mouth and move it side to side. Please stick out your lower jaw. Please open your mouth. Temporomandibular Joint has full range of motion with smooth movement, no crepitance or tenderness noted.”

“Now we’ll test your cervical spine. Tell me if you feel any pain. Touch your chin to your chest. Full flexion ROM. Lift your chin towards the ceiling. Full extension ROM. Touch each ear towards your shoulder. Full lateral bending ROM. Turn the chin towards each shoulder. Full rotation ROM.”

Patient should be standing. “Please raise your arms with your elbows extended. Full forward flexion ROM. Now lower your arms as far back as possible. Full hyperextension ROM. Now please raise your arms to the sides and above your head until your palms touch. Full abduction ROM. Now lower your arms, crossing in front of your body. Full adduction ROM. Put your hands behind your head. Full external rotation ROM. Now put your hands behind your back. Full internal rotation ROM.”

Test muscle strength. Place both your hands on the patient’s shoulders as resistance. “Please shrug your shoulders, flex your shoulders forward and up. “Patient’s shoulder muscles are graded as 5 for full ROM against full resistance.”

“Please bend and straighten your elbow, and tell me if you feel any pain. Full flexion and extension ROM. To test muscle strength, place your hands just below the wrist as resistance. “Please flex your elbows against my resistance. Now extend your elbows against my resistance. Muscle strength in both arms is graded as 5.”

Patient sits on table. “Please bend your hands up at the wrist. Full extension ROM. Bend your hands down at the wrist. Full flexion ROM. Bend your fingers up and down at the joints. Full flexion and hyperextension ROM. With your palms flat on the table, turn your wrists out and in. Full radial and ulnar deviation ROM. Spread your fingers apart, and make a fist. Full abduction ROM, and bilaterally tight fists. Now touch your thumb to each finger and the base of your pinky. Full ROM noted.”

Place elbow on table. Now please hold your hand midway, and touch the front and back of your hand to the table. Full pronation and supination ROM.”

For muscle testing, place patient’s forearms on the table with palm side up. “Please try to flex your wrist against my resistance. Muscle strength in both wrists is a 5.”

“Please lay on your back, raise your right leg as high as you can, keeping your knees straight, and tell me if you feel any pain. Now do the same with your left leg. Full ROM for hip flexion with knee straight. Bend each knee to your chest while keeping the other leg straight. Full ROM for hip flexion with bent knee. Bend your knee and swing your leg outward and inward. Full ROM for internal and external rotation. Swing your leg out and in, keeping your knees straight. Full ROM for abduction and adduction. All hip movements were smooth and without crepitance.”

“While you are lying down, we can go ahead and assess for sciatic pain and herniated nucleus polposus. Please tell me if you feel any pain.” Raise the patient’s leg 30 degrees while keeping the knee extended. Then dorsiflex the foot upward. “Test is negative.” Repeat with other leg. “No pain noted.”

“Please sit up. Point the toes of both feet down to the floor, and tell me if you feel any pain.” Observe. “Full plantar flexion ROM.” “Point your toes up toward your nose.” Observe. “Full dorsiflexion ROM.” Stabilize the ankle with one hand and hold heel with other hand. “Turn the soles of your feet in and out.” Observe. “Full inversion and eversion ROM.”

Test muscle strength by asking person to maintain dorsiflexion and plantar flexion of both feet against your resistance. “Please point the toes of both feet down to the floor against my resistance. Now point your toes up.” “Muscle strength is graded as 5 for full ROM against resistance.”

Check muscle strength. “Please remain seated, and bend both your knees against my resistance.” Place your hands below each knee and pull patient’s legs forward. “Now please rise from the chair without using your hands for support Muscle strength in both knees is graded as 5.”

“Remain standing. Please bend your knee, and tell me if you feel any pain. Full flexion ROM. Now extend your knee. Full extension ROM.

Inspect alignment of spine. “Spine is straight with equal horizontal positions for shoulders, scapulae, iliac crests and gluteal folds. There is equal space between arm and lateral thorax on both sides. Knees and feet are aligned with the trunk.”

Inspect the side profile. “Normal spine curvatures are noted with concave at cervical, convex at thoracic and concave in the lumbar regions. There is no kyphosis or lordosis.”

“Please bend forward and touch your toes, and tell me if you feel any pain.” Look for flexion of 75 to 90 degrees and smoothness and symmetry of movement. “There is full flexion ROM, and the back has a single convex C-shaped curve.”

Stabilize the pelvis with your hands. “Please bend sideways in each direction. Full ROM with lateral bending.” “Now bend backward. Full ROM with hyperextension. Please twist your shoulders to one side and then the other. Full ROM with bilateral rotation.”

Seat yourself behind the standing patient. “Please stand with your feet shoulder width apart and bend forward slowly to touch your toes.” Observe. “There is no sign of scoliosis Spine is straight while standing and bending. Posterior ribs are symmetric with equal elevation of shoulders, scapulae and iliac crests.”

Health Assessment Skit (Cardio)

Hi. My Name is , a nursing student at USA. Please lay down and we will get started with the cardio exam.

The apical pulse is found in the 5^th ICS at the midclavicular line. It is not visible on this patient. No lifts or heaves noted. The apex is the tip of the heart and is located at the 5^th ICS, left midclavicular line. The base is the top of the heart, located at the 3^rd ICS from the right border of the sternum to the left midclavicular line.

PALPATE The apical pulse is at the 5^th ICS at about the midclavicular line. Apical pulses are palpable in about half adults. It is present in this patient.

Now I am palpating the apex, left sternal border and base for thrills, lifts, or heaves. None are noted.

Now I will percuss the borders of the heart. Over the lungs I will hear resonance and dullness over the heart. Left border is at midclavicular line at the 5^th ICS. The right border matches the sternal border. Heart is of normal size and there appears to be no enlargement.

Now I will ascultate the five majors areas: aortic, pulmonic, Erb’s point, tricuspic, and mitral valves with both the diaphragm and the bell.

Normal S1 and S2 sounds noted in the aortic valve area, 2nd ICS, right sternal border.

Pulmonic valve area is in the 2^nd ICS left sternal border.

Erb’s point is at the 3^rd left ICS at the left sternal border.

Tricuspid valve area is at the 5^th ICS at the left sternal border.

Mirtal valve area is at the 5^th ICS left midclavicular line. Normal rate and rhythm noted with an S1 and S2. No splitting, extra sounds or murmurs noted.

S 1 is created by the closing of the AV valves at the start of systole and is heard loudest at the apex. S 1 coincides with the carotid artery pulse. S2 is created by the closing of the SL valves at the end of systole. S2 is loudest at the base.

I have pre-assessed Miss Davis’ heartbeat as 70 beats per minute. The rhythm is regular. Normal adult range is 60 to 100 BPM.

Apical pulse and carotid pulse re identical. No pulse deficit.

Radial pulse has regular rhythm and is a 2+ on a 4 point scale for both sides.

Bracial pulse is the same.

Femoral pulse is found in the groin area, below the inguinal ligament between the pubis and illiac spine.

Popliteal pulse is also a 2+.

The posterior tibial pulses are regular and is a 2+.

Dorsalis pedis pulses are regular and also a 2+.

With the carotid pulses, I am going to use the bell and listen for bruits. No swooshing sounds of bruits are present.

Lastly I am going to examine your nails. Nails are pink, smooth, slightly curved. Nail base is firmly attached to nail bed. Angle is 160 degrees, no indication of clubbing. Capillary refill time is prompt, less than 2 seconds indicating good peripheral fusion and cardiac output.

Health Assessment Skit (Neurological)

“Hello my name is , a nursing student at USA Let’s start your neurological system exam.”

Inspect. “This is a pleasant year old . Posture is erect and position is relaxed. Body movements are voluntary, coordinated, and smooth. Dress is appropriate, and the patient is well groomed with good hygiene. Hair and nails are neat and clean.”

“How are you feeling today?” “The patient is awake, alert and responds to stimuli. Facial expression is appropriate to the situation and there is comfortable eye contact. Speech is moderate and effortless. Mood and affect are appropriate.”

“Now I’m going to ask you some questions. What day of the week is it? What city are we in? What is your name?” “Patient is oriented to time, place and person.”

“What time did you arrive here today?” “Recent memory is intact.”

“What date is your birthday?” “Remote memory intact.”

“What do you think it means when I say ‘The grass is greener on the other side of the fence’?” “Patient exhibits ability to think abstractly.”

“Now we will test your 12 cranial nerves.” Close one nostril. “Please sniff.” Close other nostril. “And sniff again. Now close your eyes and tell me what you smell. Cranial Nerve I, the Olfactory Nerve is intact.”

“To test Cranial Nerve II, the Optic Nerve I would use the Snellen chart. The patient would stand 20 feet away from the eye chart, cover one eye and read the smallest line possible. I would record the results, noting any errors. Repeat with other eye. Normal vision is 20/20, and 20/100 means a person can see at 20 feet what a person with normal vision can see at 100 feet.”

“Now we will test your eyes using the Rosenbaum card. Hold the card 14" from your eyes. Now cover your left eye and read the smallest line you can see.” Report numeric fraction at last line read. Indicate how many letters patient missed. “Now cover your right eye and do the same.” Report fraction.

“Now I’m going to look inside your eye. The red reflex is present. Arterioles and venules are present. A creamy yellow, round optic disc with sharp margins is present. A brownish macula with even color is present. Cranial Nerve II, the Optic Nerve is intact.”

“Please hold your head steady and follow the movement of my finger. There is parallel tracking with both eyes. The extraocular muscles of Cranial Nerves III, IV, and VI, the Oculomotor, Trochlear and Abducens Nerves are intact. There is no nystagmus.”

“The left pupil is 3mm. Right pupil is 3mm. Pupils are round and equal in size. There is no anisocoria.”

“Please look at the wall. Simultaneous pupil constriction noted.”

“Please continue to look at the wall. Now look at my finger. There is pupillary accommodation and convergence. Thus, pupils are equal, round, reactive to light. They have accommodation and convergence.”

TMJ “Please open and close your mouth. Now clench your teeth, and try not to let me open your mouth. Please close your eyes and say “Now” when you feel the touch of the cotton ball. Sensory and motor functions of Cranial Nerve V, the Trigeminal Nerve are intact.”

“Please smile, and frown. Close your eyes and try not to let me open them. Please raise your eyebrows, show your teeth. Now puff your cheeks. The motor functions of Cranial Nerve VII, the facial nerve are intact. To test sensory functions I would apply a cotton ball with a sweet salty or sour solution to the tongue and ask the person to identify it.”

“Now we will test your high frequency hearing. I’d like you to repeat the word I’m going to whisper. Please cover your left ear.” “Baseball.” The whisper test results are normal.”

“Now I’d like you to tell me when you can no longer hear the sound. The Rinne test compares bone conduction vs. air conduction. The sound was heard twice as long through air conduction. This is a normal result.”

“For the Weber test, please tell me if the sound seems equally loud in both ears. Tone heard midline with no lateralization. Cranial Nerve VIII, the Acoustic Nerve is intact.”

“I’d like you to open your mouth.” Depress the tongue with a tongue blade. “Now please say ‘ahh’. The uvula is midline and rises with phonation. I am not going to elicit the gag reflex today. Cranial Nerves IX and X, the Glossopharyngeal and Vagus Nerves are intact.”

“Please try to resist my hand. Now shrug your shoulders. Cranial Nerve XI, the Spinal Accessory Nerve is intact.

“Please stick out your tongue Now please say ‘light, tight, dynamite.’ The tongue is midline with no tremor, loss of movement or deviation. Cranial Nerve XII the Hypoglossal Nerve is intact.”

“Please walk toward the wall, and turn around. The gate is smooth, rhythmic and coordinated with good arm swing.”

“Now please walk in a straight line with one foot in front of the other -- heel-to-toe. The patient is able to Tandem walk in a straight line and maintain balance.”

“Now I’d like you to stand with your feet together and arms at your sides. Close your eyes, and hold this position for 20 seconds.” Stand close to patient in case she falls. “Romberg test is negative, patient maintained balance.”

“Please close your eyes and stretch out your arms. Now please touch the tip of your nose with each index finger, alternating your hands and increasing your speed. The finger-to-nose test shows smooth and accurate movement.”

“Now I’d like you to pat your knees with your hands, alternating from the palms to the backs of your hands. Now do this faster. The RAM (rapid alternating movement) test shows coordinated movement with a quick and rhythmic pace.

“Now I’d like you to hop in place, first on one leg, then the other. The patient displayed normal position sense, muscle strength, and cerebellar function.”

“Now I’d like you to close your eyes and tell me whether you feel a sharp or dull sensation. Patient correctly identifies sensations. Spinothalamic sensory nerves and parietal lobe are intact.”

“Please close your eyes. Now I’m going to move your finger up or down. Tell me the direction I’ve moved it. Patient exhibits normal position sense or kinesthesia. Posterior column tract is intact.”

“I’d like you to close your eyes and tell me the object I’ve placed in your hand. Now let’s test your other hand. Patient correctly identifies object. Problems with stereognosis occur with lesions of the parietal lobe or posterior column.”

“Please close your eyes and tell me the number I’m writing on your hand. Patient correctly identified number. Inability to distinguish number occurs with lesions of the parietal lobe or posterior column.”

“Biceps reflex is +2 which is an average or normal response. Note the biceps muscle contracts and the forearm flexes.”

“Now let your arm go dead. Triceps reflex is +2. Note the forearm extends.”

“Brachioradialis is +2. Note flexion and supination of the forearm.”

“Patellar reflex is +2. Note extension of lower leg and contraction of the quadriceps muscle.”

“Achilles reflex is +2. Note plantar flexion of foot.”

“Negative Babinski sign. Note plantar flexion of toes and inversion and flexion of forefoot.”

Health Assessment Skit (Head and Neck)

Head and Neck

“Hi, my name is . I am a nursing student at USA and I am going to conduct an assessment of your head and neck.”

“The head is normocephalic with no visible lumps or lesions. The facial features are symmetric and proportional. Expression is appropriate. The eyebrows, palpebral fissures, nasolabial folds and sides of the mouth are symmetric. No noted changes in skin color or pigmentation. No swelling or involuntary movements.”

“The hair is shiny and evenly distributed. No pest inhabitants. No lumps or lesions noted.”

“Open and close your mouth. Now, clench your jaw and try to keep it closed.”

Instruct patient on cotton ball test.

“Sensory and motor function of CN V (Trigeminal) are intact.”

“External nose is symmetric, midline and proportional. No deformities or lesions. Tilt your head back please. Muscosa are pink and moist. Septum is midline and intact. No bleeding or deviation noted. Middle and inferior turbinates are pink. No polyps present.”

“Occlude one nostril and sniff. And the other. Close your eyes and tell me what you smell.”

“CN I (Olfactory) is intact.”

“Now smile, frown. Close your eyes and resist my pressure to open them. Raise your eyebrows, show your teeth and puff out your cheeks.”

“Motor portion of CN VII (facial) is intact. To test sensory function, I would apply a sweet, salty, or sour solution to the tongue for identification.”

“Tell me if you feel any tenderness as I check your lymph nodes. Pre-auricular, Post-auricular, occipital, submental, submandibular, jugulodigastic (tonsillar), superficial cervical, deep cervical, posterior cervical, and supraclavicular. All lymph nodes are non-palpable. No tenderness or masses noted.”

“Now I will examine your thyroid. Trachea is midline. Thyroid is non-palpable with no masses or nodules.”

“Now I will assess CN XI (spinal accessory). Try to push against my hand. And shrug your shoulders. CN XI intact.”

“Now I will assess your eyes. Eyeballs are smooth and glossy, normally aligned in their sockets, no protrusion or sunken appearance. The palpebral conjunctiva are pink and moist. The bulbar conjunctiva are clear. The sclera is white. Cornea and lens are clear. No opacities noted. Iris is round and symmetrical. Pupils are equal in size. No aniscoria noted.”

“Close your eyes. Palpebral fissures are horizontal. No lid lag or drooping. Brow hair and lashes present and intact. Lacrimal gland and puncta are intact, no redness, swelling, or discharge noted.”

“I will use the 6 Cardinal Positions to test the extraocular muscles. Follow my finger with only your eyes. Keep your head still. Parallel tracking with both eyes. CN III(Oculomotor), CN IV(Trochlear), and CN VI(Abducens) are intact. No nystagmus present.”

“Now for the Corneal Light reflex test. Please stare straight ahead. Reflection is the same position in each eye, indicating symmetry.”

“And the Cover test… Please stare straight ahead, I will cover one of your eyes. And now the other. No eye muscle weakness noted. Stare was fixed and steady.”

“For the confrontation test, I need you to cover one eye and let me know when you see my finger. Assuming I have normal peripheral vision, the patient has a superior angle of 90 degrees, inferior 70 degrees, nasal 60 degrees, and temporal 90 degrees.”

“For the Snellen eye chart, the patient would stand 20 feet from the chart and read the smallest visible line while covering each eye. Normal vision is 20/20. If the patient saw 20/100, then they can see at 100 feet what one with normal sight can see at 20 feet.”

“Please hold the Rosenbaum card 14 inches from your eye. Cover one eye and read the smallest line you can see. Now do the other eye. Patient has 20/20 in both eyes.”

“Let’s take a look at your pupils. Left is 3 mm and right is 3mm. They are round, equal in size. Now look at the clock on the wall. Simultaneous pupil constriction noted. Still look at the clock on the wall, now look at my finger. Convergence and accommodation noted. Thus, pupils equal, round, reactive to light, there is accommodation and convergence.”

“Now I will look into your eye with the opthalmoscope. Remain focused on the clock. Red reflex noted on retina. Arterioles and venules present. Optic disc is round, creamy yellow with sharp margins. Macula is brownish, and even in color.”

“Now for the external ear. Helix and antihelix are firm. No nodules or tenderness noted. EAM has no swelling, redness or discharge. The tragus is firm and non-tender. Antitragus is intact. No swelling or tenderness noted in the lobule.”

“Now for the inside of the LEFT ear. Tympanic membrane is intact, it is flat, pearly gray and translucent. Cone of light present at 7 o’clock. The bony landmarks of the short process are present.”

“Now for the inside of the RIGHT ear. Tympanic membrane is intact, it is flat, pearly gray and translucent. Cone of light present at 5 o’clock. The bony landmarks of the short process are also present.”

“To test the hearing we will first start with the Whisper test to evaluate high tone hearing loss. Please cover your left ear. Tell me what I say… football. Now cover your right ear.”

“Now for the Rinne test. Tell me when you cannot hear the sound any longer. And again. Air conduction should be twice as long as bone conduction in a normal result. In this case it was.”

“The Weber test is for conductive or sensorineural hearing loss. Please tell me if you can hear the sound better in one ear than the other or if it is the same.”

“Finally we will look at your mouth. Lips are pink and moist with no lesions. Buccal mucosa is pink, smooth and moist. No lesions noted. Gums are pink with no swelling or bleeding noted. Thirty-two teeth present, bite down… no malocclusion. Jaws aligned. Please stick out your tongue. Touch the roof of your mouth. Tongue is pink and moist, no lesions on or under tongue. Tongue is midline, no deviation. CN XII (Hypoglossal) intact. Hard palate is white, soft palate is pink. No lesions present. Say ‘ah’… uvula is pink and rises with phonation. Stick out your tongue… Tonsils visible, 1+.”

Health Assessment (Abdomen)

“Hello my name is , a nursing student at USA. Let’s start your abdomen exam.”

“Please lie down on the exam table with your arms at your sides. I’ll place one pillow under the head and a second pillow under the knees.”

Inspect. “The skin is a uniform tan-pink color. It is smooth with no scars, striae or other lesions. There is an even distribution of fine, vellus hair and a few small moles. No veins are visible. The umbilicus is midline and inverted with no sign of inflammation.”

Inspect. Stand on the patient’s right side, and bend down to determine the abdomen’s profile. “The abdominal profile is flat (or scaphoid, rounded or protruberant).” Stand and continue inspecting. “The abdomen is bilaterally symmetric with no visible hernias, masses or distention. A slight aortic pulsation is noted. Peristalsis waves are not visible.”

Auscultate. “Now we will auscultate for bowel sounds. We do this before palpating and percussing the abdomen so we do not artificially increase peristalsis. I will warm the stethoscope with my hands. Hold the stethoscope using the diaphragm to listen for a few seconds in each of four quadrants. I will start at the RLQ because bowel sounds are normally always present.” Listen at the RLQ, RUQ, LUQ, LLQ. “Audible bowel sounds are noted in all four quadrants. A lack of bowel sounds would be abnormal. I would listen for 5 minutes in each quadrant to determine if the bowel sounds are completely absent.”

Auscultate. “Now I will use the bell of the stethoscope and firmer pressure to detect the presence of bruits over the aorta, renal arteries, and iliac arteries.” Auscultate. “No bruits present. A bruit is a whoosing sound that indicates turbulent blood flow. It occurs with stenosis or occlusion of an artery.”

Percuss lightly in all four quadrants (in a zig-zag, upside-down U pattern using hands or hammer) to determine the relative amount of tympany and dullness. “There is tympany in all four quadrants. This is expected because air in the intestines rises to the surface when the patient is supine.”

Percuss to measure the height of the liver in the right midclavicular line. Begin in the area of lung resonance and percuss down the interspaces until the sound changes to dullness in the 5^th intercostal space. “Resonance, resonance, dullness.” Mark the spot with a pen. Then find abdominal tympany and percuss upwards until the sound changes to dullness at the right costal margin. “Tympany, tympany, dullness.” Mark the spot and measure the distance. “The liver measures 7cm, which is within the normal range for an adult female. In males, normal is about 10.5 cm. An enlarged liver or hepatomegaly occurs with diseases such as hepatitis or cirrhosis.”

Percuss for a dull note from the 9^th to 11^th intercostal space just behind the left midaxillary line.“Splenic dullness can sometimes be percussed from the 9^th to 11^th intercostal space just below the left midaxillary line. The area is normally not wider than 7cm.” “Tympany, tympany, tympany. Splenic dullness was not detected. A dull note before the midaxillary line indicates enlargement of the spleen. Please take a deep breath.” Percuss in the lowest interspace in the left anterior axillary line. You should hear tympany. “Tympany is noted. This is a normal result. A change in percussion from tympany to a dull sound would indicate mild to moderate splenomegaly before the spleen becomes palpable. This can occur with mononucleosis or trauma.”

Percuss.“Now I’d like you to please sit up for me, keeping your arms at your sides so we can examine your kidneys. Please let me know if you feel any pain or tenderness.” Place your left hand over the 12^th rib at the costovertebral angle on the back. Thump that hand with the ulnar edge of your right fist. “No pain or tenderness noted at the costavertebral angle. Sharp pain would occurof there was inflammation.”

Palpate. “Now I’d like you to lie down again, and bend your knees and keep your arms at your sides. Touch the patient’s abdomen and forehead with the back of your hand. “The temperature of the abdomen is normal and consistent with the rest of the body.”

Palpate. “Breathe deeply, relax, and tell me if you feel any tenderness.” Keep your four fingers close together, and depress the skin 1cm with a gentle rotary motion. Start at 12 o’clock and move around the abdomen in a clockwise direction. “The abdomen is not tender. There is normal muscle tone and rigidity. There may normally be some tenderness around the cecum and sigmoid colon.”

Palpate. “Keep breathing deeply, and tell me if you feel any tenderness.” Push down 2-3" (5-8 cm), using the same circular motion to explore the entire abdomen, moving clockwise starting at 12 o’clock. “No enlargements, tenderness or masses noted.”

Palpate. “Now we will palpate the aortic pulsation.” Using your thumb and fingers pinch a small amount of skin just above the umbilicus slightly to the left of midline. Pinch a small amount of skin about an inch above the umbilicus to feel the aortic pulsation. “The aortic pulsation is noted.”

Palpate. “Now we will palpate the border of the liver.” Stand at the patient’s right side. Place your left hand under the patient’s back parallel to the 11^th and 12^th ribs and lift up to support the abdominal contents. Place your right hand on the RUQ with fingers parallel to the midline. Push down deeply and under the right costal margin. “Please take a deep breath. Now let the air out and relax” Feel under the rib. The edge of the liver bumps your finger tips as the diaphragm pushes it down during inhalation. But often the liver is not palpable and nothing firm is felt. “The liver is non palpable.”

Palpate. “Now we will palpate the spleen. Normally the spleen is not palpable and must be enlarged to three times it’s normal size to be felt. An enlarged spleen can rupture if overpalpated.” Reach your left hand over the abdomen and behind the left side at the 11^th and 12^th ribs. Lift up for support. Place your right hand obliquely on the LUQ with the fingers pointing toward the left axilla and just inferior to the rib margin. Push your hand deeply down and under the left costal margin. “Please take a deep breath. The spleen is not palpable.”

Health Assessments

Health Assessments is a Pass or Fail Class.
If you do not make a 90 on your assessment you will fail the class.
No stress there.
There are 6 assessments you must be able to conduct while verbalizing.
When you go to check off on this assessment you will draw a card on
One Major system
And One Minor system.
I have 6 skits to help you memorize the information.
If you would like them E-Mail me at rn2012@yahoo.com

Nursing Math Study Questions E-mail me

If you would like to see sample problems on a Nursing Math Study Guide
E-mail me rn2012@yahoo.com
I will send them to you

Quote by Mother Teresa

Have you ever noticed there is an Evil Person no matter where you go.
It is evident even as we watch Disney movies.
It is a fact that you must learn to live with as an adult.
I consider myself a very nice people loving person.
It is obvious by this web site that I desire to make the road easier for the next person.
But it never fails in my life, there is always that one person who just seems to want to stand in the way of your progression.
In Nursing school there are plenty that want you to succeed and there are those that are down right evil.
These individuals want to act as the gate keeper.
We have a teacher who has from the very beginning made the statement This Class is Way too large.
( The school accepts the same number of students each semester) You would think this woman would be used to the size of classes by now.
Well this dear lady has took it upon herself to go around to most all of the students and suggest they drop out of nursing school, or at minimum go down to part time.
In nursing school you can only drop or fail 2 classes over a 2 year period.
If you drop 2 classes in the beginning you are setting your self up for heart ache.
This dear lady had me quite angry and a friend brought this quote to me by Mother Teresa.
What an example of true wisdom.

" People are often unreasonable,illogical, and self-centered; Forgive them anyway. If you are kind, people may accuse you of selfish, ulterior motives; Be kind anyway. If you are successful, you will win some false friends and some true enemies; Succeed anyway. If you are honest and frank people may cheat you; Be honest and frank anyway. What you spend years building, someone could destroy overnight; Build anyway. If you find serenity and happiness they may be jealous; Be happy anyway. The good you do today people will often forget tomorrow; Do good anyway. Give the world the best you have and it may never be enough; Give the world the best you've got anyway. You see, in the final analysis it is between you and God; It was never between you and them anyway." --Mother Teresa

TROUBLE FOCUSING ON SCHOOL WORK??

I have added a link to help

This Doctor is awesome
He is on the cutting edge of his field.

On the side bar Click on the Focus link www.amenclinic.com
when you get to the site
click on
Amen Clinics
then click on
Online Self-Test


On this site you can take a test.
After you complete 2 test you can get your results.

The results give you an idea of what supplements you can take
RIGHT NOW
to help with your school work.

You can also take these test results to your Doctor to aid in prescribing the medication you need.
Most Family Doctors are just shooting in the dark when it comes to brain medications.
With these test results in their hand there is a focus point for their plan of attack.
This can help you to avoid a long list of frustrating medication changes.

JUST REMEMBER
DO NOT BE IN DENIAL if the results are positive
It took me 5 YEARS to admit I had add.
SO TAKE THE TEST
AND FOLLOW UP IF YOU HAVE A DIAGNOSIS ON THIS TEST
YOU WILL BE HAPPY THAT YOU DID. ( I AM)

University of South Alabama BSN program Helps

So you are planning to come to USA. (GOOD FOR YOU)

I want to share a story with you real quick.

One day a young boy was walking along the Gulf Shores beach in Alabama, with his father. He was about eight years old at the time. Just then he noticed a man with a bucket of crabs. The crab bucket did not have a top on it. The little boy asked his father why the crabs were not able to escape. His father gave him a simple explanation that taught a valuable lesson.

The father said, “If there was only one crab in the bucket it would certainly escape. However, when there is more than one crab in the bucket, if one tries to crawl out, the other crabs would grab hold and pull it back down so that it would share the same fate as the rest of them.”

This is true with people. If one person attempts to better himself, other people will attempt to drag him back down to share their fate. The little boys father said, “ You must ignore the crabs if you want to be a success in life.

Throughout my life I have been around tons of buckets but I bite real hard when someone tries to place me in one of them.

If you want to soar with the eagles

you can not be on the ground scratching with the chickens.

If you are to be successful you must hang around people who are successful

If you have ever doubted your self go and check out a book called

Gifted hands.

It is about a young black ghetto child who grew up to become a world renowned Brain surgeon.

Awesome book.

Just remember those who say it cannot be done

are being passed up by those who are doing it.

It does not matter how hard and far you fall

what matters is how high you bounce

Because you will come out on top.

This post will be continually updated as I live it.

SO ON WITH THE SOUTH ADVISE.

First of all!!!!!!!!!
When you fill out your application follow up on every thing.
They misplace crap
Don't think just because you have been accepted you are in the clear.
Follow up on every thing.
They sent me an e-mail and said they did not get my paper work
and would kick me out of the program if I did not respond immediately.
The lost paper work was
CPR certification
TB skin test
nor my Hep b conversion
I called and reminded them that I sent on this date in with a 15 page fax.
Needless to say they found it
This happened to more than just me so be aware.


YOU NEED A NEW COMPUTER
YOU NEED DSL minimum cable better. (I have DSL works fine)
You have to watch tons of media web videos.
For Souths videos you need to use Internet explorer to be compatible

YOU NEED A
CANNON IP4200 PRINTER and a case of paper.(NO KIDDING)
THE INK IS CHEAP AND IF YOU TRY YOU CAN BUY A KIT FROM SAMS FOR 35.00 AND REFILL IT (IT IS A CAKE WALK.) I own 2 one for a backup in case my old one dies at 2:00 in the morning before a paper is due.

When you get your books look them over for websites that go along with the book like
(E companion) they have alot of study guide helps (Chapter Reviews).

At Books a million
or Barnes and Nobel
purchase
Saunders Comprehensive Review
Nclex RN 3rd ed or higher
This book is how South's Test look

Throughout nursing school this is how they test because every test is designed to help you take the big nursing boards
They are teaching you how to think.
Like I said
IT IS NURSING BOOT CAMP!!!

In your Text books study the boxes and the End of chapter reviews.

Remember in your studies
You turn into a pumpkin at midnight.
You can not go 2 years without sleep.
If you don't take care of your body
your body will not take care of you.
YOU WILL GET SICK
YOU WILL MISS CLASS
AND YOU WILL FAIL
along with that statement

THE MUSCLE YOU ARE USING TO PASS SCHOOL
WILL NOT WORK VERY WELL WHEN YOU ARE TIRED
ALL OF THESE QUESTIONS HAVE 2 RIGHT ANSWERS
YOU HAVE TO BE ON YOUR TOES TO FIGURE OUT THE CORRECT ONE FROM CONTEXT CLUES IN THE QUESTION.
(Just a thought from experience)
Your first 2 weeks in nursing school you will see people try to not sleep
because they keep you in class 40 hours
they assign you 30 chapters to read
and 20 hours of media sites to watch
It is humanly impossible to get it all done without loosing your mind.

It has helped me to TAKE A GOOD MULTI VITAMIN

Disabilities
If you have any kind of learning disability (adhd/add)
Handle this before you get into the program.
If handled you may be able to get much needed extra time on test.
If you do not have ADD consider your self lucky because for those who do
it is not that the information is not there
It just take them longer to recall the information.

Introduction "So You Want To Be a NURSE??"

It does not matter if you are 16 or 60 if you have decided to go to college to better your life
I am behind you all the way.

There is one thing you must know as you begin your journey.

College is a game.
When I make that statement This is what I mean.
All of the Prerequisites are designed to frustrate you to make you quit school.
And a large majority of the students fall to the wayside.
(YOU MAY BE THINKING THATS CRAP THEY WOULD GO BANKRUPT)
You are replaced the next year by a ton of High school seniors and people coming back to school after they dropped out 10 years ago, so the system works.

This weed out process has a purpose.
Usually lets only the serious individuals into a professional program thus eliminating a high drop out rate from a professional component no matter what the field of study.

If you are beginning your college career I would suggest starting with a 2 year state funded college to insure that your credits will transfer. In Alabama by law all credits must transfer.
This varies from state to state so do your home work.
The reason you want to choose a small 2 year college is for a number of reasons

• usually a lower cost
• smaller classes (the professors tend to care more about you)
• You will feel the weed out factor less at a community college than a large University. They want you to pass.
• In other words it primes you to take on the big University and minimizes the shock which in turn lessens the weed out factor.

There have been studies that have proven the college freshman whom start at a two year tend to go on to earn a Bachelors degree.
The freshman who begin at a large University tend to fall by the way side far more frequently.

I write this Assuming that everyone reading this wants to be an RN so I will write from that prospective.
As you begin your quest through college you need to plot out your road map.
IF YOU START AT A 2YEAR COLLEGE YOU MUST GO BY THE PREREQUISITES FOR THE COLLEGE YOU HOPE TO TRANSFER TO.
So go to that Colleges Professional Program and get a copy of their Prerequisite list and plot your course from there.

As you attend school working on your prerequisites remember many professional components look at grades first.
So keep your GPA Up
Keep the Drinking to a Minimum you are trying to build your brain power not kill brain cells.
Search out your God
how ever you believe
Attend church because it will make you feel better.
I mention this because I am very religious and also to say this.

When you get into a Professional component you will cry more than you have ever cried
you will laugh more than you have ever laughed
you will study more than you have ever studied so remember this.

STUDY AS IF IT WERE ALL UP TO YOU
AND PRAY AS IF IT WERE ALL UP TO GOD
YOU WILL BE MET IN THE MIDDLE
AND HE
WILL SEE YOU THROUGH.

With that being said
Pray before you begin to study and ask for help to understand and remember.
And don't forget the thank you
when you pass that test.

Well lets move on.