Manual of Clinical Skills

References (97)

1. Cranial Nerves Exam
2. Motor System Exam
3. Sensory System Exam
4. Neurological Exam of Lower Limb 5 Elshama 2015
5. -Tricepes jerk :- 1-Patient is in the sitting position. (or supine position) 2-Flex the elbow of the patient.
6. -Allow the forearm of patient to rest across his chest. 4-Tap the triceps tendon just above the olecranon. 5-Observe the contraction of triceps muscle.
7. -Biceps jerk :- 1-Patient is in the sitting position. (or supine position) 2-Flex the elbow of the patient at the right angle.
8. -Place the forearm of patient in the semipronated position. 4-Place your index finger on the biceps tendon and strike it by the hammer 5-Observe contraction of biceps muscle.
9. -Supinator jerk :- 1-Patient is in the sitting position. (or supine position) 2-Flex the elbow of the patient slightly.
10. -Place the forearm of the patient in the slight pronation po- sition.
11. -Strike the styloid process of the radius by the hammer. 5-Observe the supination of the elbow. B-Superficial reflexes :- 1-Plantar reflex :- 1-Hold the foot of the patient by your left hand. Scratch the outer edge of the sole of the foot firmly by the key. (from the heel towards the little toe)
12. -Observe the flexion of all toes. (The normal response is the plantar flexion of the big toe with the flexion and adduction of the other toes "The flexor plantar reflex")
13. -Romberg test :- 1-Ask the patient to stand with feet close together. 2-Ask the patient to close the eyes.
14. -Observe the posture of the patient after the closure of eyes. 5-Walking test :- 1-Ask the patient to walk along a straight line. 2-Observe the patient during the walking. Picture (124) : Walking test.
15. Locomotor Exam
16. Lower Limb Joints Exam
17. Spine Exam
18. Elshama 2015 Picture (143) : Subtalar movements .
19. Picture (144) : Knee joint . (normal anatomy and abnormal disorders) Eye Examination
20. Visual Acuity
21. Eye Movement
22. Pupil Reaction
23. Fundus Exam 7 -Keep the chin lifted and the head tilted. -Give two breaths. Each breath takes about a second and makes the chest rise. Picture (162) : Mouth to mouth breathing . Chest Compressions:- 1. Check for the carotid pulse. (for 5-10 seconds)
24. Expose the victim's chest.
25. Place the heel of your other hand on the top of the first hand.
26. Position your body directly over your hands with the extended elbows.
27. Press down about two inches into the chest.
28. Let the chest rise completely.
29. Give 30 chest compressions. (These compressions are fast and hard)
30. Continue until the victim recovers. • 30 chest compressions followed by two breaths and then repeat. Elshama 2015 Picture (163) : Chest compressions .
31. Assess the victim every five cycles for 10 seconds by assessment of:- A-Breathing.
32. B-Carotid pulse. Picture (164) : Assessment of carotid pulse .
33. Use AED for the adult if it is indicated . Note :- -Five cycles of CPR should be indicated before the using of AED. -No breathing plus the arrest mean that an immediate AED is the treatment of choice . Elshama 2015
34. Picture (169) The suitable site is one from veins of upper limb . Picture (170) The suitable site is one from veins of hand .
35. -Applies the tourniquet above the injection site.
36. -Massages the injection site by the fingers of his hand. 11-Cleans the site of injection with an antiseptic swab. -Apply the swab at the center of the site and rotate outward in a circular direction for about 5 cm.
37. -Grasps the lower end of the syringe by non-dominant hand, while his dominant hand moves to the end of the plunger.
38. -Blood aspiration by the needle means the correct site of intra venous injection.
39. -Loosens the tourniquet . 18-Injects the medication very slowly .
40. -Checks the patient for the pain, swelling and hematoma . -If in doubt whether you are still in the vein aspirate again .
41. -Observes the condition of the patient during the injection of the medication .
42. -Withdraws the needle while placing cotton ball or a sterile gauze gently over the injection site . (apply a gentle pressure) 22-Discards the needle in an appropriate method . 23-Removes the disposable gloves . Elshama 2015 3-For the infant :- -Infant is in a supine position .
43. -Grasps the ankles of the infant by the left hand and elevates the legs.
44. -For the old child :- -Child is on the side with the flexed knee joints .
45. -Separates the buttocks by the left hand to expose the anal opening .
46. -Inserts gently the thermometer and instructs the older child to take a deep breath :- -Insert ¼ to ½ inch for the infant . -Insert 1 to 1½ inch for the older child .
47. -Leaves the thermometer in the rectum for three minutes .
48. -Removes the thermometer gently in a straight line .
49. -Reads the temperature degree at the eye level :- -Rotate thermometer slowly until the mercury level is visualized. (The degree of temperature is the reading degree minus 0.5 Ċ) 9-Cleans and stores the thermometer.
50. -Removes the gloves and washes his hands . D-Axillary temperature (Child):- Physician :- 1-Exposes the axillary area of the patient . 2-Makes sure that the axillary skin is dry . 3-Places the tip of thermometer under the child s arm .
51. -Brings the child s arm down close to the body and holds it in the place.
52. -Leaves the thermometer in the place for three minutes . Elshama 2015 11-Holds the square steady. 12-Orders the patient to move out from under the square. 13-Reads the measurement at the eye level where the lower edge of the square intersects the measuring tape. Note :- -Do not use the height bar on a balance scale … It is not accurate. 3-Waist Girth Physician :- 1-Introduces himself to the patient . 2-Explains the procedure to the patient .
53. -Stands the patient upright in a relaxed manner, weight balanced on both feet and with his arms hanging by his side.
54. -Holds the casing of the tape in his right hand and gives the pa- tient the stub end of the tape by his left hand.
55. -Asks the patient to pass the tap around his back(back of the pa- tient) and gives it back to him .
56. -Takes the hold of the stub with his right hand which then holds both the stub and the casing, leaving his left hand free to ma- nipulate the tape at the correct level.
57. -Uses enough tension on the tape with the right hand to hold it where he positions it.
58. -Asks the patient to put the tape at his waist level. -At the narrowest point between the lower costal (10th rib) bor- der and the top of the iliac crest, perpendicular to the long axis of the trunk.
59. -Takes the hold of the stub again and pulls it across to his left into the cross-hand position, keeping enough tension on the tape to prevent it slipping out of position.
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