PA- Module 10 Peripheral Vascular

Student Name: ______________________________________

Date: _________________

Points Possible

Points Earned

Comments

Knocks

Washes hands

Identifies the client with 2 identifiers

Provides privacy

Explains procedure

0.

5

General Survey (Appearance & Mental Status)

Assess level of consciousness and orientation to person, place and time

Assess quality and appropriateness of speech

Inspect posture & general hygiene

HEENT (Head, Ears, Eyes, Nose, Throat) and Neck

Inspect head for bumps, lesions, hair distribution ,and parasites

Inspect face for sensation (CN V [trigeminal]) and movement (VII [facial])

Inspect external eyes for redness & discharge. Inspect pupil size and PERRLA (CN III [oculomotor])

3

Inspect extraocular muscle movements (CN III [oculomotor] IV [trochlear, VI [abducens)

Perform confrontation test (CN II [optic])

Inspect mouth – mucous membranes & general dentition condition, tongue midline, say “ah”-uvula midline, observe swallow (CN lX [glossopharyngeal], X [vagus], & XII [hypoglossal])

4

Inspect nose for discharge, nasal patency, & deviations in shape

Inspect ears for cerumen or other discharge in external canal, lesions & gross hearing (rub fingers together by ear – CN VIII [acoustic])

Assess CN XI (shoulder shrug & turn head against resistance)

Palpate the following lymph nodes: submental, submandibular, tonsillar, preauricular, postauricular, anterior cervical, posterior cervical, occipital, and supraclavicular

4.5

Thorax, Lung, and Back Assessment

Inspect shape of thorax with comparison of anteroposterior to transverse diameters

Assess respiratory rate, rhythm, depth, presence of accessory muscle use or cough

Inspect spinal alignment

Percuss for costovertebral angle tenderness

Palpate for thoracic expansion

Palpate for tactile fremitus

Auscultate breath sounds anterior and posterior at least 8 places on each side and 2 places in the axillary region on each side (stethoscope on skin). Total of 20 places.

10

Heart and Central Vessels Assessment

Palpate carotid pulses (ONE AT A TIME)

Points Possible

Auscultate each carotid artery for bruits

Auscultate heart sounds in the aortic, pulmonic, Erb’s point, tricuspid, & mitral areas (stethoscope on skin)

Gastrointestinal & Genitourinary Assessment

Inspect shape of abdomen

Auscultate bowel sounds in all 4 quadrants (stethoscope on skin)

Lightly palpate all 4 abdominal quadrants for distension or tenderness

Assess bowel & urinary habits, problems & last BM

Musculoskeletal, Neurologic, & Peripheral Vascular Assessment

Inspect and palpate extremities for edema, tenderness, temperature, deformities & lesions

Check capillary refill of fingers and toes

Inspect gait and balance (Romberg test)

Assess range of motion of neck, arms, & legs (at least 3 directions for each)

Assess strength in all extremities

Assess the following deep tendon reflexes: patellar, plantar, triceps, Achilles, biceps, & brachioradialis.

6

Locate and palpate radial, brachial, popliteal, posterior tibial, and dorsalis pedis pulses, assessing for symmetry and strength.

Post-Procedure Steps

Inquires if the client is comfortable

Student is professional and courteous with their communication

Ensures the client has their call light

Ensures client’s personal items are within reach (glasses, phone, etc.)

Washes hands

Total Points Earned

of 100 possible

The above named student has:

Passed this skill evaluation

Failed this skill evaluation and must remediate. Plan for remediation:

Student signature and date indicating agreement with remediation plan: _____________________________________

Instructor signature and date indicating agreement with remediation plan: ___________________________________