What structures are we evaluating in the oral cavity

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Head and Face

Anatomy review (lymph nodes, sinuses, salivary glands, thyroid gland)

What is the anterior and posterior fontanel? Where are they located? What should they look like? What age do they close?

Normal changes in skin & muscle as one ages.

How does head size change from newborn to adult. What age should we be measuring head circumference and why?

Eyes

Do you know the external and internal anatomy of the eye? Do you understand the visual pathways and visual fields? Do you know what the 4 most common causes of decreased visual function in older adults are? We will discuss the details of each of this causes in Advanced diagnostics but you should know what often causes a decline in visual function in this course.

Do you understand how to test for accommodation, visual acuity, pupillary light reflex (direct and consensual), corneal light reflex, the 6 cardinal fields of gaze (CN III, IV, and VI), & peripheral vision?

Why do you turn the light off when examining the internal structures of the eye?

What are you looking for during your physical exam?

How do you test visual acuity? (be familiar with the Allen test & Snellen E chart that is used to asses vision. What ages are these 2 visual acuity tests used? What is considered normal vision and when should you be concerned (note: review the National Society for Prevention of Blindness criteria for referral).

How would you assess visual acuity in a newborn?

Can you explain what the Snellen Results mean? When documenting be sure to document the words (with or without correction). It is important to know if the person being examined was wearing contact lens or glasses during Snellen exam.

What is color blindness, who is more likely to suffer from color blindness, and what percentage of the Caucasian and Black population does it affect?

What does palpebral fissure mean? What does a normal palpebral fissure look like?

What does the term strabismus mean? When should you be evaluating for possible strabismus?

What does the term nystagmus mean and is ever normal?

What does the term amblyopia mean?

What does the term diplopia mean?

What do the terms myopia and hyperopia mean?

What is the function of the lacrimal ducts?

What is the cover test?

Why is it important to screen for glaucoma? What part of the eye exam would lead an Advanced Practice Nurse to worry about the possibility of glaucoma? In Health Assessment you just need to know what the signs are that would suggest possible glaucoma so you can refer to eye specialist. In advanced diagnostics you will discuss the difference between open and closed glaucoma? acute vs chronic glaucoma? Start learning early... acute closed angle glaucoma is a serious concern... it can develop within a few hours and cause blindness if not treated promptly.

What does a normal optic disc look like? How do you assess the optic disc?

Is vision loss normal with age? If it is, what changes?

Chapter 13 - Ears and Nose

EARS:

Be able to identify the structures of the external and middle ear.

Ears are not easy because there are so many variations of normal.

How would you describe a normal ear exam (objective findings)?

How would you describe a normal tympanic membrane (objective findings)?

Are the right and left tympanic membranes exactly the same? If not what differences is/are there?

Describe all of the landmarks.

What normal findings of the tympanic membrane may be mistaken as abnormal? (hint - easy to figure out if you take a good history!

Be able to describe best technique for examining the ear (hint - young children, adults, elderly, developmentally disabled, etc).

Air and bone conduction-What is it? What are we assessing?

Be able to describe normal age-related changes in hearing acuity.

Does ear anatomy change with age? If yes, how?

Do know what is meant by the startle reflex and the acoustic blink reflex? What age are these reflexes normal, when do they go away?

What do the following terms mean: otalagia, otorrhea, presbycusis, tinnitus, vertigo? What is the difference between subjective and objective vertigo?

Is hearing loss normal with age? If it is, what changes?

NOSE:

Be able to recognize and name the anatomy pictured.

What part of the nose do most nose bleeds occur?

Name the paranasal sinuses. Where are they located? What is the normal maturation of sinuses (timeline from birth to adulthood).

What is best technique for examining the nose? Which sinuses can you palpate/percuss?

What cranial nerve is associated with smell and how do you test this?

How would you describe a normal exam (objective findings) of the nose?

Chapter 14 - Throat and Oral Cavity

What structures are we evaluating in the oral cavity?

How many pairs of salivary glands are in the mouth and where are they located?

Cranial nerve IX & X? What are they and how do we assess?

What are deciduous teeth? How many do we have? At what ages do you expect them to erupt?

How would you describe a normal posterior pharynx?

How are tonsils sizes graded and the meaning of each grade?

What are normal age-related findings in the mouth of (infants/newborns, pregnant women, elderly persons)

Understand all of the things you are asking your patient about and educating your patient about in the check-off.

Chapter 23 - Musculoskeletal

Do you know Range of Motion - Abduction, Adduction, Flexion, Extension, Lateral Bending, Internal Rotation, External Rotation, Dorsiflexion, Plantar Flexion, Circumduction, Inversion, and Eversion?

How many vertebrae make up the spinal column?

Landmarks of the spine?

C7/T1

T12

Know the types of joints

What are burse, ligaments, and tendons?

How do you document strength, reflexes and pulses?

Review developmental milestones (hold up head, sit, crawl, walk)

Know normal aging changes for the musculoskeletal system and osteoporosis and risk factors

Do you know your musculoskeletal anatomy that was referenced on your check off rubric?

Chapter 24 - Nervous System

Do you understand your 12 cranial nerves - name, test, and if sensory/motor or both?

Do you understand how to test all of the specialty tests on your check off rubric - (i.e., two point discrimination, extinction, Romberg, etc.)?

What are the 3 tests for motor function? Strength, coordination and balance. How do you test for each of these?

What are the 4 tests for sensory function? Stereognosis, graphesthesia, spinothalamic tract, posterior column tract. How do you test for each of these?

Reflexes involve what dermatomes...........

How do you test DTRs, grade DTRs, and what nerve(s) is involved with each?

Biceps reflex - C5-C6

Brachioradialis - C5-C6

Triceps reflex - C6-C7

Quadriceps - L2-L4

Achilles - S1

SUPERFICIAL REFLEXES

Abdominal reflexes - upper (T8-T10) lower (T10-T12)

Cremasteric - L1-L2

Anal reflex - S2-S3-S4

Plantar reflex L4-S2

Dermatome Segments involve what part of the body --------------

Axilla T1

Nipple T4

Umbilicus T10

Groin/Inguinal L1

Knee L4

Review newborn reflexes. Do you know what is considered normal and at what age? For instance, what is the tonic neck reflex and when does it go away?

Understand all of the things you are asking your patient about and educating your patient about in the check-off.

Reference no: EM133847934

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