How it went

Just wanted to update about how my head-to-toe went. In the morning, I was SOO NERVOUS with stomach flips and heart palpitations. Mirza came over and we practiced twice before we finally left.
About 3 minutes into the exam, I consciously said to my self, "Hey, I'm not even nervous!?" It was weird--all my nervousness went away. I wasn't red and blotchy and my heart wasn't beating fast like I had anticipated. I think it is because my instructor is so awesome.
Anyway, the only things I forgot were CVA tenderness and aorta width, but I guess almost everyone left those out. Also, I think I left out the babinski reflex, but she thought I did it. Another funny thing is when I was examining the ear, I was about to move onto the mouth area and my instructor, without even looking up, quietly and calmly handed me the tuning fork. I was like "ooooh yes, now I will do the Rinne and Weber tests!" ahhaha.

Head-to-Toe

Well, tomorrow is the "big day"--my full head-to-toe motor exam. It has to be done in a half hour. I practiced on Mirza last night and I did it in 27 minutes. However, I really want to practice it one more time tonight because I know it'll be a lot more scary when someone else is watching and grading and I might easily forget something under pressure. I'm feeling pretty good about it at this point though because when I practice, the most I ever miss is 1 or 2 and I realize it before the exam is done and I do it, so they can't take away points, except for not in logical order. We need an 85%.

This is the exam (I rewrote it so it was in "logical sequence"):
Head-to-Toe Motor Exam


Sitting

· Introduce yourself and explain exam.

-Ask them to remember 3 words: Apple, Book, Cat (Cognitive ability-memory (0.5))

-Inspect skin 0.5

-Palpate skin (turgor, texture, temperature) 0.5

-Hair—Inspect 0.5

-Nails- Inspect and palpate (clubbing, capillary refill) 1.0

-Observe facial features for symmetry 0.5

-Assess CN V—Trigeminal (Motor and Sensory) 1.0
Ask them to clench their teeth
Rub cotton on face for them to feel

-Assess CN VII –Facial (Motor only) 0.5
Ask to smile, frown, squeeze eyes, raise eyebrows)

-Palpate head and scalp, including sinuses and TMJ 2.0

-Palpate and auscultate temporal arteries. Inspect neck and neck veins. 2.0

-Palpate neck: 1.5
-Trachea
-Thyroid
-Lymph nodes (state which ones)

-Assess CN XI-Spinal Accessory 0.5
-Ask them to shrug their shoulders

Before each ROM say inspecting joints/muscles 1.0

-Neck 2.0
-Flexion
-Extension
-Lateral bending
-Rotation

-Neck Strength 2.0

-Shoulder 2.0
-Adduction
-Abduction
-Internal rotation
-External rotation

-Shoulder strength 2.0

-Elbow 2.0
-Flexion
-Extension
-Supination
-Pronation

-Elbow Strength 2.0
-Reflexes –Upper 2.5
-Biceps
-Triceps
-Brachioradialis

-Wrist 2.0
-Flexion
-Extension
-Ulnar deviation
-Radial deviation

-Hand strength 2.0

-Fingers 2.0
-Flexion
-Extension
-Adduction
-Abduction

-Inspection of eyebrows, eyelids, orbital area, eyelashes, lacrimal gland 2.5

-Palpation of orbital area (sclera, conjunctiva) 0.5

-Pupil condition and response to light and accommodation 1.0
CN III (Oculomotor), CN IV (Trochlear), and CN VI (Abducens)

-Direct and consensual response 0.5

-Extraocular movement (six cardinal fields) CN III, IV, VI 0.5

-Fields of peripheral vision CN II Optic 0.5

-Functional vision (Rosenbaum) CN II Optic 0.5

-Ophthalmoscope examination (red reflex using RRR, LLL) 2.0
-Proper use of instrument=1 point

-Inspection and palpation of the ear 1.0

-Otoscope: ear canal and tympanic membrane 2.0
-Proper use of instrument=1 point

-Functional hearing (whisper test) CN VIII Acoustic 0.5

-Assess Rinne (side of head) and Weber (top of head) 1.0

-Inspect external nose 0.5

-Inspect internal nares with otoscope (use diff. Speculum cover) 0.5

-Inspect lips, teeth, buccal mucosa, tongue, floor of mouth 2.5

-Inspect tongue for movement CN XII Hypoglossal 0.5

-Observe movements of soft palate CN IX Glossopharyngeal and X Vagus 0.5

-Inspect anterior, posterior, lateral, chest wall. 0.5

-Respiratory rate, rhythm, and effort (retractions, use of a accessory muscles) 0.5

-Palpate for chest wall (for tenderness, lesions) 0.5

-Thoracic expansion (anterior/posterior) 1.0

-Percussion (anterior, posterior, lateral) from apex to base (note resonance, hyper resonance, dullness 1.5

-Tactile (or voice) fremitus 0.5

-Auscultation of breath sounds from apex to bases (posterior, anterior, lateral) 1.5
Voice sounds: egophony, whispered pectoriloquy, bronchophony

-CVA tenderness (ie-hit kidneys) 0.5

-Inspection of precordium. Describe 6 areas of assessment (aortic, pulmonic, Erb’s point, Tricuspid, Mitral, Epigastric) 3.5

-Palpation of precordium for any heave, thrill, PMI, pulsations 0.5

-**Auscultation of heart in the 6 areas of assessment (sitting) 1.5

-Inspection, palpation, and auscultation of carotids 1.5

- **Location of palpable pulses (2.5)
-Radial
-Brachial

Laying Down

-Inspection of abdomen (supine position, pillow under head, arms at side, empty bladder 0.5

-**Auscultation of heart while laying down (1.5)

-Auscultation of all quadrants: 3.0
-Bowel sounds
-Aortic
-Iliac
-Femoral
-Renal arteries

-Percussion of abdomen in 4 quadrants 0.5

-Percussion of liver span at MCL 0.5

-Percussion of splenic dullness 0.5

-Light palpation of 4 quadrants 0.5

-Deep palpation of 4 quadrants 0.5

-Palpate aortic pulsation/width 1.0

-Palpate abdominal organs :liver, spleen, kidneys 1.5


-Hip: 3.0
-Internal rotation
-External rotation
-Flexion
-Extension
-Adduction
-Abduction

-Hip Strength 2.0

-Knee 2.0
-Flexion
-Extension

-Knee strength 2.0

-Popliteal pulse (2.5)

Sit back up

-Patellar reflex (2.0)

-Ankle 1.0
-Plantarflexion
-Dorsiflexion
-Ankle strength 2.0

-Foot 2.0
-Invert
-Evert
(of both subtalar joint and transverse tarsal joint)

-Achilles reflex (2.0)

-Babinski reflex

-Clonus

-Dorsalis pulse

-Posterior tibia pulse

-Ask them to repeat the 3 words from the beginning of the exam (0.5)

-Ask them: 1.0
-What would you do if your house was on fire? (judgement)
-What does it mean to say, “Don’t put eggs all in one basket”? (abstraction)

-Sensation 1.5
-Touch
-Pain
-Vibration
(lower and upper extremities)

-Discrimination 1.5
-Stereognosis (key in hand)
-Graphesthesia ( Draw 8 in hand)
-Proprioception (Done along with romberg)

-Coordination (finger to nose, nose to finger, alternating, rapid hand patting) 1.0

-Sitting balance (sternal nudge) 0.5

Standing up

-Vertebral column 2.0
-Flexion
-Extension
-Rotation
-Lateral bending

-Standing balance (Romberg sign) 0.5

-Gait 2.0
-Regular
-Tandem
-Walk on heels
-Walk on toes

The end!!!

If I lay here

Last week I was so unproductive. It was my first week with no clinicals, so I had Tuesday and Wednesday off to *cough* study, but I had a real cough and a tickle in my throat, so I pretty much just sat around and watched tv, I can't even lie! It was okay. I was feeling a bit depressed for awhile, but now I am feeling more positive again. Still, I haven't been getting much productive studying in because of the excitement of holidays coming, but today is a new day! I have today off, so my plan is to knock out two chapters of Fundamentals for hardcore studying. Tomorrow the lab is open from 8-12 to practice head to toe, so I will do that and then study the other two chapters of Fund. because our last test (minus the HESI) is on Monday. It rocks that it only covers 4 chapters, but I also have my head-to-toe next Wednesday and I am FREAKING THE HELL OUT!!!! It is so much to remember and we have to do it all in a half hour.
Over Christmas break we have to do almost this entire Drug calculation book, which we will be tested on when we return from our "break." I guess they will have this thing called Med Pour in the lab, which is like a huge test. Every semester from here on out, we will have a drug calculations test and we have to pass with a 95%, but we get 4 chances, so I am not scared. The cool thing is that I already finished the first 6 chapters of the book because I thought questions from it would be on this test, but I guess not. woohoo for being ahead!

Things I am currently shitting my pants over:
-Head-to-Toe exam
-Fundamentals exam
-HESI-Fundamentals...how the HELL do we study for this?!
-Money

Goals for today:
-Activity/sleep ch. 36--KNOW accomplishment! I needed something to keep me focused, but I didn't want to do notecards, so instead I made a chart with two columns and wrote questions and answers for the chapter--108 to be exact.
-Wound care ch. 47--KNOW
-Review for Patho
-Begin notecards for physical exam/assessment
-Look over stuff for HESI?

Two Group photos of our team, which will probably be deleted soon after I post this...
*deleted*

LAST TIME WAKING UP AT 4AM UNTIL 2007!!!!!! WOOOHOO!!

Last clinical day

Tomorrow is my LAST clinical day!
I got my nurse preceptor a little hallmark ornament of a set of scrubs wearing a stethoscope, along with a nice thank you card. I also got a thank you card for the nurse I had last week because I feel like she taught me a lot.
Finally, I bought a box of Whitman's sampler for the entire floor. I hope that isn't tacky, but I figure they eat enough donuts, cookies, and cupcakes as it is. Time for some chocolates!
I feel uneasy about tomorrow though because I have to do TWO Soapies! argh.
Gotta remind myself to bring my camera so we can take a group picture.

I got skillz....

That is me at Daytona.

woohoo, so today I inserted a foley into a female!!!!
I had practiced in the lab on dummies, but never on a real human. Well, today I GOT THE CHANCE!
My nurse donned sterile gloves as well though and helped with holding the labia back, but I did everything else--it rocked.
Oh, and she said I did a really good job, which was awesome to hear.