mcgraw hill guide sherman alexie
LINK 1 ENTER SITE >>> Download PDF
LINK 2 ENTER SITE >>> Download PDF
File Name:mcgraw hill guide sherman alexie.pdf
Size: 4015 KB
Type: PDF, ePub, eBook
Category: Book
Uploaded: 8 May 2019, 18:57 PM
Rating: 4.6/5 from 733 votes.
Status: AVAILABLE
Last checked: 11 Minutes ago!
In order to read or download mcgraw hill guide sherman alexie ebook, you need to create a FREE account.
eBook includes PDF, ePub and Kindle version
✔ Register a free 1 month Trial Account.
✔ Download as many books as you like (Personal use)
✔ Cancel the membership at any time if not satisfied.
✔ Join Over 80000 Happy Readers
mcgraw hill guide sherman alexieYou may experience issues with this site. Please upgrade your browser. You may have followed a broken link, or typed in the Web address incorrectly.Dayton, OH 45435 USA 937-775-1000. We'll bring you back here when you are done. Please select the correct language below. Find out how you can intelligently organize your Flashcards. Please upgrade to Cram Premium to create hundreds of folders! To find the time, I compared the chart time with the admission time on” patient summary” page. Step 3: If t. Before touching a patient. To protect the patient against colonization and, in some cases, against exogenous infection, by harmful. Note presenting signs and symptoms, lab values, medical history, and the ED physician’s impression, as well as the re. A viral infection commonly known as cold sores; not confined to the mouth, can spread over the face and to other parts of the body also. Appea. In order for the patient to better understand the risks of infection due to improper. A person may know that they have conjunctivitis when symptoms arrive (Durning, 2. THis would give yo a baseline to go by and future measurements would indicate if and how fast more fluid is accumulating Also a normal variant in the third trimester of pregnancy If the pulse is faint or irregular it would be important to what. Observe for odors from skin, breath, wound5. Develop and use nursing instincts6. Inspection is done alone and in combination with other assessment techniquesB. Back of hand (dorsal aspect) to assess skin temperature2. Fingers to assess texture, moisture, areas of tenderness3. Assess size, shape, and consistency of lesions and organs4. Produces different notes depending on underlying mass (dull, resonant, flat, tympanic)2. Used to determine size and shape of underlying structures by establishing their borders andindicates if tissue is air-filled, fluid-filled, or solid3.Thank you, for helping us keep this platform clean. The editors will have a look at it as soon as possible.http://www.szp45.pl/wsg/userfiles/campbell-instruction-manual.xml
- Tags:
- mcgraw hill guide sherman alexie, mcgraw hill guide sherman alexie books, mcgraw hill guide sherman alexie book, mcgraw hill guide sherman alexie online, mcgraw hill guide sherman alexie library.
Books You don't have any books yet. Studylists You don't have any Studylists yet. Recent Documents You haven't viewed any documents yet. Students also viewed Chapter 3 - notes related to the book. Quiz 1 Tutoring - pediatrics lecture notes Quiz 3 Notes Cardiac Scanned Documents - lecture pediatrics Chapter 5 2014 Review Problems Assigment 1 - Other related documents Chapter 6 - notes related to the book. Chapter 5 Planning INstruction on Content Literacy Notes for Ch. 4 in class Ch. 2 Class Notes RED3393 Ch. 2 Book Notes RED3393 Ch. 1 Literacy Matters Preview text PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE. Nursing AssessmentGathering Data. Subjective data - Said by the client (S). Objective data - Observed by the nurse (O). Document: SOAPIER. Assessment Techniques:Page 1 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andA general survey is an overall review or first impression a nurse has of a person’s well being. This isAppearance. BehaviorDeviations from what would generally be considered to be normal or expected should be documented. Standardized and routine screening such as audiometric screening, scoliosis and vision screeningHealth History. A patient history should be done as indicated by the age specific prevention guidelines, usually set forthAssociation of Pediatrics, and National Association of Pediatric Nurse Practitioners. The Healthy. People website (www.healthypeople.gov) provides an excellent source to determine benchmarks forA comprehensive history, including chief complaint or reason for the visit, a complete review ofThe history should be age and sexUsually, completing a provider based Health History and Physical Examination Form will assist in theCertain health problems,Page 2 of 35.http://fixmyhelicopter.com/project-new/christianbook/upload_images/campbell-hausfeld-tl1102-manual.xml Adapted from the Kentucky Public Health Practice Reference, 2008 andA measuring board with a stationaryThe head should be held against theMove child and measureRead and record the measurementAfter plotting measurements for children on age and genderThe patient is to be wearing only socks or be bare foot. HaveMeasuring weight:Spring typeCDC recommends that all scales should be zero balanced andWeigh children after removingWeigh adolescents and adults with the patient wearing minimalRead the measurement and record resultsMeasuring Body Mass Index.Measuring Head and Chest Circumference.For greatest accuracy, the tape is placed three times, with a reading taken at the right side, atPage 4 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andVital signs, generally described as the measurement of temperature, pulse, respirations and bloodEquipment NeededBlood Pressure Cuff. Watch Displaying Seconds. Thermometer. General ConsiderationsA. TemperatureB. RespirationDo not announce that you are measuringIs it normal orThere is no reason for the patient's arm to be in an awkwardNote whether the pulse is regular or irregular. Regular - evenly spaced beats, may vary slightly with respiration. Irregularly Irregular - chaotic, no real pattern, very difficult to measure rate accurately. Page 5 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andThe following table should serve as a roughAverage Pulse and Blood Pressure in Normal Children. Age. BirthPulseCategory. Systolic. Diastolic. Normal. High NormalPage 7 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andHead and Neck Exam; Lymphatic Exam. Eye Exam. Chest and Lung Exam. Cardiovascular Exam and Peripheral vascular System. Abdominal Exam. Musculoskeletal Exam. Neurologic Exam. Genito-Urinary. A. Examination of SkinPalpate: temperature, turgor, lesions, edema, texture. Percussion and auscultation: rarely used on skin.https://labroclub.ru/blog/excell-pressure-washer-exha2425-manual Terminology: pallor, cyanosis, edema, ecchymosis, macule, papule, cyanosis, jaundice, typesB. Examination of the Head and Neck. Equipment NeededTongue blades. Cotton tipped applicators. Non-latex exam gloves. General Considerations. The head and neck exam is not a single, fixed sequence. The assessment varies depending on theHeadFontanels in a newborn - toddler. Page 8 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andInform the patient that this procedureThyroid GlandNote whether it is visible and symmetrical. AHave the patient tilt head slightly to right.Special Tests. A. Facial TendernessPress upward under both eyebrows with your thumbs. (frontal sinus). Press upward under both maxilla with your thumbs. (maxillary sinus). Excessive discomfort on one side or significant pain suggests sinusitis. B. Sinus TransilluminationPage 10 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andC. Examination of the Eye - see also Cranial Nerve II, III, IV, V. Equipment Needed. Snellen Eye Chart or Rosenbaum Pocket Vision Card. Ophthalmoscope. Visual Acuity. In cases of eye pain, injury, or visual loss, always check visual acuity before proceeding with the rest ofYou are interested in theInspectionAsk the patient to look to eachNote any deformity of the iris or lesionVisual Fields - Screen Visual Fields by ConfrontationHold your hands to the side half way between you and the patient. Wiggle the fingers on one hand. Ask the patient to indicate which side they see your fingers move. Repeat two or three times to test both temporal fields. If an abnormality is suspected, test the four quadrants of each eye while asking the patient toExtraocular Muscles. A. Corneal ReflectionsPage 11 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andTo test for neglect, onThe patient should see movementThe ophthalmoscope actually has a series ofD. Examination of the Chest and Lungs. Stethoscope. Peak Flow Meter. General ConsiderationsIdeally the patient should be sitting on the end of an exam table. The examination room must be quiet to perform adequate percussion and auscultation. Observe the patient for general signs of respiratory disease (finger clubbing, cyanosis, airInspectionNote whether the expiratory phase isPalpationPage 13 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andProper TechniqueDiaphragmatic ExcursionPosterior Chest. Anterior Chest. Anterior ChestPosterior ChestInterpretation. Percussion Notes and Their Meaning. Flat or Dull. Pleural Effusion or Lobar Pneumonia. Healthy Lung or Bronchitis. Hyperresonant Emphysema or Pneumothorax. Page 14 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andThese tests are only used in special situations. This part of the physical exam has largely beenAll these tests become abnormal when the lungs become filled withC. Tactile FremitusYou should feel the vibrations transmitted through the airways to the lung. Increased tactile fremitus suggests consolidation of the underlying lung tissues. D. BronchophonyLouder, clearer sounds are calledE. Whispered PectoriloquyIf you hear the sounds clearly this is referredF. EgophonyE. Cardiovascular Examination and Peripheral Vascular System. General ConsiderationsIf the radial pulse is absent or weak, check the brachialIf these pulses are absent orRequires light touch. Page 16 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andPulse pressure: difference between the systolic and diastolic blood pressure reading. Amplitude and Contour (Carotid)Press firmly but not to the point ofAuscultation for Bruits (Carotids). If the patient is late middle aged or older, you should auscultate for bruits. A bruit is often, but notYou may use the diaphragm ifDo not be confused by heart sounds or murmursJugular Venous PressureUse light pressure justUsing a horizontal line from this point, measure verticallyPrecordial MovementAlways examine from the patient's right side. Inspect for precordial movement. Tangential lighting will make movements more visible. Palpate for precordial activity in general.It is normally located in the 4th orPage 17 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andAuscultate for blowing, swishing sound. GradeDescription. Barely audible. Heard only if room silent and then still hard to hear. Clearly audible, but faint. Moderately loud, easy to hear. Loud, associated with thrill on chest wall. Very loud, can hear with edge of stethoscope off chest. Loudest, can hear with entire stethoscope off chest wall. Edema, Cyanosis, and ClubbingPitting edema. Scale. Level of pitting. MildDeep. Very deep. Indentation. Slight. Subsides rapidly. Remains for short time. Remains for long time. Swelling of leg. Not noticeable. Leg looks swollen. Grossly swollen and misshapen. LymphaticsCheck for the presence of axillary lymph nodes. (breast and arm). Check for the presence of inguinal lymph nodes. (groin). PEDIATRICS: to assess lymph nodes in younger children, tilt head slightly to check neck nodes. Page 19 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andEquipment NeededGeneral ConsiderationsNotesInspectionLook for movement associated with peristalsis or pulsations. Note the abdominal contour. Is it flat, scaphoid, or protuberant? Contour in newborn is normally protuberant and soft. Contour in child is normally symmetric and slightly rounded. AuscultationAre they normal, increased, decreased, orPercussionTympany is normally present over most of theUnusual dullness may be a clue to an underlying abdominalPage 20 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 and. Students also viewed Fundamentals of Nursing Lecture Notes Medications for Psych Clinical 10 Nclexbundle - PDF Pain Management - PDF Loraxepam medication template Captopril medication template Related Studylists Health Assessment BETTY Preview text Page 1 of 35. Adapted from the Kentucky Public Health Practice Reference, 2008 andObjective data - Observed by the nurse (O). Document: SOAPIER Adapted from the Kentucky Public Health Practice Reference, 2008 andBehavior maintains eye contact with appropriate expressions;Association of Pediatrics, and National Association of Pediatric Nurse Practitioners. People website ( www.healthypeople.gov ) provides an excellent source to determine benchmarks forThe history should be age and sexUsually, completing a provider based Health History and Physical Examination Form will assist in theCertain health problems,Adapted from the Kentucky Public Health Practice Reference, 2008 andA measuring board with a stationaryThe head should be held against the headboard by the parent or an assistant and the knees held so that the hips and knees areMove child and measureRead and record the measurementWhen a standing height is obtained for a two year old, plot the finding onAfter plotting measurements for children on age and genderThe patient is to be wearing only socks or be bare foot. HaveSpring typeCDC recommends that all scales should be zero balanced andWeigh children after removingWeigh adolescents and adults with the patient wearing minimalRead the measurement and record resultsAdapted from the Kentucky Public Health Practice Reference, 2008 andDo not announce that you are measuringIs it normal orThere is no reason for the patient's arm to be in an awkwardNote whether the pulse is regular or irregular:Adapted from the Kentucky Public Health Practice Reference, 2008 andThe following table should serve as a roughAge Birth 6mo 1yr 2yr 6yr 8yr 10yr. Pulse 140 130 115 110 103 100. Systolic BP 70 90 90 92 95 100 105 Category Systolic Diastolic. High Normal 130 -139 85-. Mild Hypertension 140 -159 90-. Moderate Hypertension 160 -179 100 -. Severe Hypertension 180 -209 110 -. Adapted from the Kentucky Public Health Practice Reference, 2008 andB. Head and Neck Exam; Lymphatic Exam. C. Eye Exam. D. Chest and Lung Exam. E. Cardiovascular Exam and Peripheral vascular System. F. Abdominal Exam. G. Musculoskeletal Exam. H. Neurologic Exam. I. Genito-Urinary The assessment varies depending on theAdapted from the Kentucky Public Health Practice Reference, 2008 andInform the patient that this procedureNote whether it is visible and symmetrical. AHave the patient tilt head slightly to right. Adapted from the Kentucky Public Health Practice Reference, 2008 andYou are interested in theAsk the patient to look to eachNote any deformity of the iris or lesionAdapted from the Kentucky Public Health Practice Reference, 2008 andTo test for neglect, onThe patient should see movementThe ophthalmoscope actually has a series ofNote whether the expiratory phase isAdapted from the Kentucky Public Health Practice Reference, 2008 andFlat or Dull Pleural Effusion or Lobar Pneumonia. Normal Healthy Lung or Bronchitis. Hyperresonant Emphysema or Pneumothorax Adapted from the Kentucky Public Health Practice Reference, 2008 andThis part of the physical exam has largely beenAll these tests become abnormal when the lungs become filled withLouder, clearer sounds are calledIf you hear the sounds clearly this is referredIf the radial pulse is absent or weak, check the brachialIf these pulses are absent orRequires light touch Adapted from the Kentucky Public Health Practice Reference, 2008 andPress firmly but not to the point ofA bruit is often, but notYou may use the diaphragm ifDo not be confused by heart sounds or murmursUse light pressure justUsing a horizontal line from this point, measure verticallyTangential lighting will make movements more visible. It is normally located in the 4th orAdapted from the Kentucky Public Health Practice Reference, 2008 andStethoscope Is it flat, scaphoid, or protuberant? Are they normal, increased, decreased, orTympany is normally present over most of theUnusual dullness may be a clue to an underlying abdominal. Inspection - critical observation 1. Take time to ?observe? with eyes, ears, nose (all senses) 2. Use good lighting 3. Look at color, shape, symmetry, position 4. Odors from skin, breath, wound 5. Develop and use nursing instincts 6. Inspection is done alone and in combination with other assessment techniquesB. Palpation - light and deep touch 1. Back of hand (dorsal aspect) to assess skin temperature 2. Fingers to assess texture, moisture, areas of tenderness 3. Assess size, shape, and consistency of lesionsC. Percussion - sounds produced by striking body surface 1. Produces different notes depending on underlying mass (dull, resonant, flat, tympani) 2. Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solidD. Describe sound characteristics (frequency, pitch intensity, duration, quality) (practice)6. Flat diaphragm picks up high-pitched respiratory sounds best7. Bell picks up low pitched sounds such as heart murmurs8. Practice using BOTH diaphragmsGeneral AssessmentA general survey is an overall review or first impression a nurse has of a person’s well being. This is done head to toe, or cephalo-caudal, lateral to lateral, proximalto distal, and front to back. Usually familyhealth histories are completed across three generations looking specifically for patterns in genetic issues that negatively impact quality of life.The health history gives picture of the patient’s current health and behavior risk status. Additional information than what is on a form may be required depending onthe specialized service(s) to be provided or if the person presents with special needs or conditions. So a health history maybe may be problem focused, expandedproblem focused, detailed, or comprehensive. American Medical Association clinical practiceguidelines recognize the following body areas and organ systems for purpose of the examination: Body Areas: Head (including the face); Neck; Chest (including breasts and axillae); Abdomen; genitalia, groin, buttocks; Back (including spine); and each extremity. Integument includes skin, hair and nails. Inspect: skin color and uniformity of color, moisture, hair pattern, rashes, lesions, pallor, edema Palpate: temperature, turgor, lesions, edema Percussion and auscultation: rarely used on skin Terminology: pallor, cyanosis, edema, ecchymosis, macule, papule, cyanosis, jaundice, types of edema, vitiligo, hirsutism, alopecia, etc.Normal and abnormal findings should be recorded on a health history and physical examination form. Page 3 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Thereafter, body measurements includeheight and weight. The assessment of hearing, speech and vision are also measurements of an individual’s function in these areas. The Denver DevelopmentScreening Test measures an infant’s and young child’s gross motor, language, fine motor-adaptive and personal-social development milestones. Deviation from standards helps identifysignificant conditions requiring close monitoring or referral to a physician or pediatric nurse practitioner.The significance of measurements and actions to take when they deviate from normal expectations are age-specific.Procedures for Measuring Height. Obtain height by measuring the recumbent length of children less than 2 years of age and children between 2 and 3 who cannot stand unassisted. A measuring board with a stationary headboard and a sliding vertical foot piece is ideal, but a tape measure can also be used. Lay the child flat against the center of the board. The head should be held against the headboard by the parent or an assistant and the knees held so that the hips and knees are extended. The foot piece is moved until it is firmly against the child’s heels. A modified technique in home settings is to lay the child flat and straight where the head should be held by the parent and the knees held so that the hips and knees are extended, mark the flat surface at the top of the head and tip of the heels. Move child and measure the distance between the marks with a tape measure. Obtain a standing height on children greater than 2 to 3 years of age, adolescents, and adults, using a portable stadiometer. The patient is to be wearing only socks or be bare foot. Have the patient stand with head, shoulder blades, buttocks, and heels touching the wall. The knees are to be straight and feet flat on the floor, and the patient is asked to look straight ahead. The flat surface of the stadiometer is lowered until it touches the crown of the head, compress the hair. A measuring rod attached to a weight scale should not be used. Under some conditions a recumbent length can be obtained for a two year old. If so it should be plotted on the birth to 36 months growth chart. In other situations a standing height may be obtained for a two year old. Under this condition, plot the finding on the CDC for BMI for age and gender, 2 to 18 year growth chart. After plotting measurements for children on age and gender specific growth charts, evaluate, educate and refer according to findings. Weight. Balance beam or digital scales should be used to weigh patients of all ages. Spring type scales are not acceptable. CDC recommends that all scales should be zero balanced and calibrated. Scales must be checked for accuracy on an annual basis and calibrated in accordance with manufacturer’s instructions. Prior to obtaining weight measurements, make sure the scale is ?zeroed?. Weigh infants wearing only a dry diaper or light undergarments. Weigh children after removing outer clothing and shoes. Weigh adolescents and adults with the patient wearing minimal clothing. Place the patient in the middle of the scale. Read the measurement and record results immediately. Scales should be calibrated annually. Plot measurements on age and gender specific growth charts and evaluate accordingly Page 4 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). The Body Mass Index (BMI) is a measure that can help determine if a person is at risk for a weight-related illness. Instructions forobtaining the BMI are included within the chart in this section for adults. To calculate BMI for children, see BMI Tables for Children and Adolescents forguidance.Head Circumference. Obtain head circumference measurement on children from birth to 36 months of age by extending a non-stretchable measuring tapearound the broadest part of the child’s head. For greatest accuracy, the tape is placed three times, with a reading taken at the right side, at the left side, and atthe mid-forehead, and the greatest circumference is plotted. The tape should be pulled to adequately compress the hair.Vital Signs. Vital signs, generally described as the measurement of temperature, pulse, respirations and blood pressure, give an immediate picture of a person’scurrent state of health and well being. Do not announce that you are measuring respirations2. Without letting go of the patients wrist begin to observe the patient's breathing. Rapid respiration is called tachypnea. Page 5 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Sit or stand facing your patient.2. Grasp the patient's wrist with your free (non-watch bearing) hand (patient's right with your right or patient's left with your left). Tachycardia and bradycardiaare not necessarily abnormal. Athletes tend to be bradycardic at rest (superior conditioning). Tachycardia is a normal response to stress or exercise.Blood Pressure. Blood pressure (BP) is the pressure by circulating blood on the walls of blood vessels. Arterial refers systemic circulation. During eachheartbeat, blood pressure varies between a maximum systolic and a minimum diastolic pressure. The blood pressure in the circulation is principally due to thepumping action of the heart. Differences in mean blood pressure are responsible for blood flow from one location to another during circulation. The rate of meanblood flow depends on the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heartthrough arteries, capillaries and veins due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occursalong the small arteries and arterioles. Gravity affects blood pressure via hydrostatic forces (e.g., during standing) and valves in veins, breathing, and pumpingfrom contraction of skeletal muscles also influence blood pressure in veins.The measurement blood pressure without further specification usually refers to the systemic arterial pressure measured at a person's upper arm and is a measureof the pressure in the brachial artery, major artery in the upper arm. A person’s blood pressure is usually expressed in terms of the systolic pressure overdiastolic pressure and is measured in millimetres of mercury (mmHg). Interpretation? Higher blood pressures are normal during exertion or other stress. Systolic blood pressures below 80 may be a sign of serious illness or shock.? Blood pressure should be taken in both arms on the first encounter. If there is more than 10 mmHg difference between the two arms, use the arm with the higher reading for subsequent measurements. It is frequently helpful to retake the blood pressure near the end of the visit. Page 6 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). The following table should serve as a rough guide: Average Pulse and Blood Pressure in Normal Children Age Birth 6mo 1yr 2yr 6yr 8yr 10yr 100 95 Pulse 140 130 115 110 103 100 105 Systolic BP 70 90 90 92 95 The Physical Exam1. Head and Neck Exam2. Eye Exam3. Chest and Lung Exam4. Cardiovascular Exam5. Abdominal Exam6. Back and Extremity Exam7. Different portions are included depending on the examiner and the situation.Head 1. Look for scars, lumps, rashes, hair loss, or other lesions. 2. Look for facial asymmetry, involuntary movements, or edema. 3. Palpate to identify any areas of tenderness or deformity.Ears Inspect the auricles and move them around gently. Ask the patient if this is painful. 1. Palpate the mastoid process for tenderness or deformity. 2. Hold the otoscope with your thumb and fingers so that the ulnar aspect of your hand makes contact with the patient. 3. Page 7 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Ask them to hold their breath for the next few seconds. 2. Insert the otoscope into the nostril, avoiding contact with the septum. 3. Inspect the visible nasal structures and note any swelling, redness, drainage, or deformity. 4. Repeat for the other side. 5. Turbinates should be pink and moist 6. Frontal sinuses are below eyebrows 7. Maxillary sinuses are below zygomatic archThroatIt is often convenient to examine the throat using the otoscope with the speculum removed. 1. Ask the patient to open their mouth. 2. Using a wooden tongue blade and a good light source, inspect the inside of the patients mouth including the buccal folds and under the tongue. The deep cervical chain of lymph nodes lies below the sternomastoid and cannot be palpated without getting underneath the muscle: Inform the patient that this procedure will cause some discomfort. 11. Hook your fingers under the anterior edge of the sternomastoid muscle. 12. Ask the patient to bend their neck toward the side you are examining. 13. Move the muscle backward and palpate for the deep nodes underneath. 14. Note the size and location of any palpable nodes and whether they were soft or hard, non-tender or tender, and mobile or fixedThyroid Gland 1. Inspect the neck looking for the thyroid gland. Note whether it is visible and symmetrical. A visibly enlarged thyroid gland is called a goiter. 2. Move to a position behind the patient. 3. Identify the cricoid cartilage with the fingers of both hands. 4. Move downward two or three tracheal rings while palpating for the isthmus. 5. Move laterally from the midline while palpating for the lobes of the thyroid. 6. Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.Special TestsA. Facial Tenderness 1. Ask the patient to tell you if these maneuvers causes excessive discomfort or pain. 2. Press upward under both eyebrows with your thumbs. 3. Press upward under both maxilla with your thumbs. 4. Excessive discomfort on one side or significant pain suggests sinusitis.B. Sinus Transillumination 1. Darken the room as much as possible. 2. Place a bright otoscope or other point light source on the maxilla. 3. Ask the patient to open their mouth and look for an orange glow on the hard palate.4. A decreased or absent glow suggests that the sinus is filled with something other than air.C. Temporomandibular Joint 1. Place the tips of your index fingers directly in front of the tragus of each ear. Page 9 of 39 Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Ask the patient to look to each side and downward to expose the entire bulbar surface. 4. Note any discoloration, redness, discharge, or lesions. Note any deformity of the iris or lesion cornea. 5. If you suspect the patient has conjunctivitis, be sure to wash your hands immediately. Viral conjunctivitis is very contagious, so protect your self!Visual FieldsScreen Visual Fields by Confrontation 1.