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Hi Julia,

my name is august Rose and I'm a nurse and I'm a

student with Arkansas State University and I'll be doing your exam today.

So I'm gonna greet my patient and then I'm

gonna have good hand hygiene and then I'm gonna take

note of her overall general appearance which from what

I see she looks like a fit young female.

Um She's alert and oriented and able to speak with me.

She has animated expressions,

she doesn't appear to be in any kind of distress of no labored breathing, no pain.

Um

And she's like I said alert and oriented to me um

after we get her general appearance then we

would get her weight without her shoes on.

And I would see at that time her stature is a slender and tall build.

We would also get her blood pressure and her

left arm at heart level with the legs uncrossed,

we would get an oral temperature and be sure

to denote that we took her temperature orally.

And then I would get her respirations and her

um

Pulse. So I'm gonna take her radial pulse for 15 seconds.

If it was irregular I would do it for a full minute

And I have a clock here that I'm going to watch so that

I can count for the 15 seconds and multiply it by four.

Her pulse is 78. It's regular.

It's not bounding or threading now I'm gonna

get your respirations and what I'm gonna do is

I'm just gonna lay my hand on your back

I'm gonna count her respirations for 30 seconds.

If they were irregular I would count for a full minute.

Right?

Her respirations are easy and unlabeled at 18 per minute.

Once we have her vitals and her general appearance.

Um and also with her general appearance um I don't

smell any foul odors of the body or breath.

We will then move into the inspection of the skin.

So let's see. I'm gonna kind of move around

so we're gonna look at, let me get you to turn towards me. There we go.

Let's see

three shadows. I think we're okay. Okay so I'm gonna look at your face first.

I don't see any hyper or hypo pigmentation. Her lips are pink and moist.

We open your mouth real quick.

Ah And it looks like her mucus membranes are nice and pink. Let me check your eyes.

I'm gonna come in from a lateral view of the

eye and it looks like there are no okay cities.

Um

There's no lesions, no masses that I see.

Now I'm gonna look at her scalp

and I'm just gonna park the hairs that I can

see and I don't see any lesions or masses noted.

Known it's anything like that.

It looks like her hair is of average texture. It's not not coarse or dry.

I'm looking at the neck, looking at chest, looking at upper extremities.

I don't see any hyper or hypo pigmentation.

She does have a few small brown navy that are about six millimeters or less.

None that look suspicious.

If we did see one that looks suspicious, we would use the A. B. C. D. E.

Rule which is a symmetry borders um um symmetry borders, color,

um elevation and diameter.

And I'm gonna check your upper extremities.

And she's got a small nearby here that's a light brown.

And these are just very scattered throughout. Their not arranged in any kind of way.

The temperature of her arm is warm. I do not feel any moisture.

Her hands are dry. I don't feel any moisture. They're warm.

There's no clubbing of the nails.

There's no cyanotic features on this upper extremity.

We know we're going to look at this one.

Same thing. A few small brown. Um Never I just scattered randomly throughout.

No dryness, no lesions, no redness. Um Upper extremity is warm to the dorsal hand.

To my dorsal hand, there is no moisture on her palms.

Her there's no clubbing of her nails, no cyanotic colors.

Now, if you don't mind, I'm gonna get you to stand up so I can look at your lower body

um legs. I see like a little brown, probably eight millimeter.

Is this a birthmark, birthmark?

Um doesn't look suspicious or anything lower extremities to the touch or warm.

And if you put your right leg up here

and I'm gonna palpate her toes. There's no clubbing.

Her feet are actually cool to the touch, they are moist.

I'm just gonna peek under here at the bottom of your feet. No

no redness, no swelling, no edema. And now we'll do the same thing on this one.

I see a few small navy that are light brown

in color are located on the back of her thigh,

in the lateral part of her thigh.

Her lower extremity is warm,

no moisture noted. Her foot is cool to the touch but it's not cyanotic.

And there are no clubbing when I'm and

I'm palpitating her toes and they're not cyanotic.

Okay. And you can sit back down

and I'm just gonna look if you'll turn opposite of me.

I'm just gonna look at your back.

You fixed system

mm hmm.

And same thing on the back.

I see a a few scattered small brown molds, but nothing looks suspicious.

We would use the abc V rule. Um if we thought that they were suspicious for melanoma.

Okay. Turn back around.

So that was the skin on me. Um

played up here for your texture of your hair is nice and thick,

it's an average texture.

Um And it and it appears like there's no hair loss anywhere.

It's distributed evenly.

Now we're gonna do the head

so there's no um

facial movements that there shouldn't be. Everything is symmetrical. Your eyes.

Let me have you turned more towards me. Eyes are symmetrical eyebrows.

Ears are set bilaterally. Um

No hyper hyper pigmentation no masses. Now I'm just gonna palpate

feeling for any masses or anything like that.

And I don't feel anything and just looking at her head

it looks enormous a phallic.

Um Now let's do your eyes.

Mhm.

Yes We're gonna do the eyes and we have the snail in short.

And what we're gonna do is just hold this about 14" in front of you

and then we're gonna cover your right eye so that

we can test the visual acuity in your left eye.

And you want to read the smallest line that you can

L. T. F. P. H. And I forgot to ask you do you wear contacts or glasses

and you have them in?

Okay so this is not this is not this is non correct vision

in the left eye and it's 2020 according to the snail and chart.

Okay now we're gonna do the same thing on the other eye.

This is the right eye.

L. T. F. P. H. Alright. And uncorrected vision using the snelling chart.

And the right eye is 2020 as well.

And now you can hold it and just leave both eyes uncovered.

L. T. F. P. A good deal. And that was 2020 as well. Now if you'll turn towards me

we're gonna do a visual field test.

So what I'm gonna do is put my hands out to the side and bring them in.

I'm gonna wiggle my fingers and I want you to tell me when you see my fingers wiggling.

Okay

I can see you okay

you can see it. Okay so her um the visual field test was good in all four quadrants.

Now I want you to look at my finger and then maybe look at the light switch

and then back at my finger

and back at the light switch.

Alright so that was good because her pupils constricted when they looked at my

finger and they dilated whenever they looked at the light switch making my pin light

I'm gonna check her people's

for. Um

And then come on on your

left eye first.

All right.

And that was her direct vision.

Her people is constricting and it looks like it's about

um a four on the people gauge and it constricts to about it three.

And I'm gonna do this side coming in laterally.

Same thing on this side. People get size is about four and constricted to a three.

Mhm.

And now I'm gonna check her that was direct and I'm gonna check her consensual.

So I'm gonna just bring it across really quick.

And when I brought it across her right eye, her when I brought it across her left eye,

her right eye constricted

and the same thing on this side when I brought it across her opposite,

I constricted so her consensual um gaze is good

now um So that her pupils are equally

reactive and responsive to light and they accommodated.

Um Let's do um

The six Cardinal Gaze Division. So you're gonna follow my finger

and we're going to go up

down

collateral.

Uh huh.

Damn

five middle.

And that was good. I saw no lid lag or anything like that.

She was able to follow in the entire age. Now what I'm gonna do is take my fund a scope.

I have it set to zero

And if you will face in towards the middle again,

what I'm gonna do for safety is I'm going to come to her left eye with my left eye.

I am holding my

telescope in a way that protects her and I'm gonna

use my opposite hand to hold her eyebrow up.

I'm gonna come in at a 15° angle. Find her red reflex and zoom in from there.

Okay

so I found the red reflex. And when I come in I see that her arteries are smaller

and lighter color than her veins which are larger and darker.

Her optic disc is a yellow orange color.

The margins are sharp and the physiological cup is abnormal, ratio 1 to 3.

I do not see any hemorrhaging

or foreign bodies. And I'm gonna come around you and do the other

the other eye.

And I'm gonna use my right eye on her right eye.

I'm gonna hold your eyebrows up for safety.

We're gonna come in and a lateral angle find the red reflex and zoom in.

And for her right eye uh the arteries are smaller and

lighter color than the veins which are larger and darker.

Her optic disc is yellow orange with sharp borders there.

Her physiological cup is 123 S. C.

No hemorrhaging or foreign bodies or papillae adama's

all right. Make him back on this side of you.

And after the eyes we're gonna do the ears.

So we're gonna inspect both ears and I don't see

any deformities and I'm going to look behind the ear,

I don't see any cracking, no redness, no swelling.

And if you'll turn and face me, I'm gonna do the same thing on this here.

Just look look behind

the oracle and I see nothing back there and then I'm gonna peel paint

before I copy it. Let's do your visual here um hearing.

So what I want you to do is look at me and put a

finger over your trays which is that part right there and I just want

to kind of wiggle your finger finger and I'm gonna say a couple of

two syllable words and I want you to repeat them back to me.

Okay baby

baseball. Alright And we're gonna do the same thing in the other ear

apple.

Alright so she that was the whisper test and she

was able to repeat the words back to me.

Um Let's um yeah I'm gonna palpate her ears.

The field turns, yep. There you go.

And what I'm gonna do is I'm just gonna palpate the oracle. And kind of pull it up?

I'm gonna palpate her lobe and um asteroid, do you have any pain?

There is no right now, if you'll face me, I'm gonna do the same thing on this side.

So I'm gonna pull that oracle up.

I'm just gonna palpate all down, push on the Travis the lobe and the master.

Why do you have any pain there? Okay, and then I'm going to examine her ears.

So I have my own telescope.

And what I'm going to do is using my left hand,

I'm gonna hold her article up and kind of pull it back to straighten out her ear canal.

And I'm gonna hold my OTA scope in a way that keeps her safe. Should she move her jerk.

So

I'm gonna gently place this

into her ear canal

and her ear canal is smooth. I see light little hairs,

a little bit of sermon that's kind of an orange color.

But her tim panic membrane is pearly gray. I see the cone of light.

It's not perforated or bulging. And I see no redness or a Dema

I'm going to come on the other side of use that. I can get your other ear.

Mhm.

And we're going to do the same thing on this side where I hold her ear up and kind of

pull it back to straighten out the canal and hold my older scope in a way that is safe.

Should she move

gently inserted

and her ear canal is there's no swelling? It's smooth. A few little here,

a few little hairs,

and her tim panic membrane is a pearly gray color, non perforated, non bulging.

I do see the cone of white

and I also see the army.

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