Preface
The purpose of this Laboratory Manual is to provide structure for students as they practice with classmates acting as patients to obtain health histories and perform physical examinations.
• The History contains questions about the patient’s Present health state, Past health history, Family history, Personal and psychosocial history, and Review of Systems with space to document findings. In addition to learning how to obtain a health history, students learn medical terminology, such as documenting “edema” when patients report “swelling.”
A table is provided at the end of Chapter 2 to help students learn this terminology. Also, the Review of Systems in chapters containing a health history uses lay terminology followed by medical terminology in parentheses to help students learn these terms.
• The Examination section in Chapters 6–17, and 19–22 provides techniques performed in the left column with space for documenting findings in the right column. Techniques for Special Circumstances have been integrated within the Routine Techniques. Each examination technique is numbered to facilitate discussion of the skills by number rather than naming the entire skill. These skills are written to direct the student; thus, the verbs are second person with an implied “you,” e.g., (You) PERFORM hand hygiene.
• The Clinical Judgment that follows the history and examination sections uses the first two layers of the Clinical Judgment Measurement Model to help students analyze data. These include: 1) Recognize cues for this patient. Identify relevant findings from the history and examination and 2) Analyze cues. Organize and link the recognized cues to the patient’s clinical presentation.
• A Performance Check List for examination skills has been added following each examination section in Chapters 7–17 and 22 as a structure to evaluate students. There are four descriptors of performance: Correct (C), Incomplete (Inc), Incorrect (I), and Not performed (NP). Skills in the Check List are numbered the same as those in the examination section. These skills are written to direct the evaluator; thus, the verbs are present tense, third person with an implied “he or she”, e.g., (He/She) PERFORMS hand hygiene.
• Following the Skills Performance Check List is an Implementation checklist that allows an appraisal of the student’s implementation of the examination including assembly and use of equipment, the organization of the examination, the confidence demonstrated by the student, and the student’s interaction with the “patient.” These skills are written to direct the evaluator who assesses the implementation of the examination; thus, the verbs are past tense, third person with an implied “he or she”, e.g., (He/She) Assembled needed equipment.
• At the end of the Check List there is space to tally the number from each category of descriptors in each of the categories in Examination and Implementation.
• There are no laboratory activities for Chapters 1, 18, 23, and 24.
Chapter 2 Obtaining a Health History
Chapter 3 Techniques and Equipment for Physical Assessment
Chapter 4 General Inspection and Measurement of Vital Signs
Chapter 5 Cultural Competence
Chapter 6 Pain Assessment
Chapter 7 Mental Health Assessment
Chapter 8 Nutritional Assessment
Chapter 9 Skin, Hair, and Nails
Chapter 10 Head, Eyes, Ears, Nose, and Throat
Chapter 11 Lungs and Respiratory System
Chapter 12 Heart and Peripheral Vascular System
Chapter 13 Abdomen and Gastrointestinal System
Chapter 14 Musculoskeletal System
Chapter 15 Neurologic System
Chapter 16 Breasts and Axillae
Chapter 17 Reproductive System and the Perineum
Chapter 19 Assessment of the Infant, Child, and Adolescent
Chapter 20 Assessment of the Pregnant Patient
Chapter 21 Assessment of the Older Adult
Chapter 22 Conducting a Head-to-Toe Examination
Obtaining a Health History
With your lab partner assuming the role of a patient, conduct a comprehensive history. Your “student patient” may role-play a person with particular related symptoms and history.
HISTORY
BIOGRAPHIC DATA
Date Name
Date of birth Age Race/Ethnicity Religion Language(s)
Marital status S M D W Occupation
REASON FOR SEEKING CARE (Presenting problem)
HISTORY OF PRESENT ILLNESS
Symptom Analysis of Presenting Problem (Onset, Location, Duration, Characteristics, Aggravating factors, Related symptoms, Treatment, Severity)
PRESENT HEALTH STATUS
• Describe your current health conditions.
ο How long have you had these conditions?
ο How have these health conditions affected your daily activities?
• What medications or supplements do you take? (Include prescription, over-the-counter, herbs, and vitamins) (Document if no medications or supplements are taken)
Name of Drug/Supplement Dosage/Frequency Last Dose Taken Reason for Taking
• Describe any medical treatments you are receiving (e.g., breathing treatments, dialysis, wound dressing): (Document if no medical treatments are received)
• Describe any allergies to medications, foods, medical products (e.g., latex, contrast, tape), or things in the environment. Describe your symptoms and their frequency. (Document if there are no allergies)
Allergic To Reaction and frequency
PAST HEALTH HISTORY
Childhood Illnesses (Check all that apply):
Measles ❏ Mumps ❏ Rubella ❏ Chickenpox ❏
Pertussis ❏ Influenza ❏ Ear infections ❏ Throat infections ❏
Other (describe) ❏
List previous medical conditions, surgeries, hospitalizations, or injuries. (Document if none apply)
Name and Type
Immunization
Diphtheria, tetanus, acellular pertussis (DTaP)
Hepatitis A (HepA)
Human papillomavirus (HPV)
Inactivated poliomyelitis (IPV)
Meningococcal serogroups A, C, W, Y (MenACWY)
Measles, mumps, rubella (MMR)
Pneumococcal polysaccharide vaccine (PPS23)
Rotavirus (RV)
Tetanus, diphtheria, acellular pertussis (Tdap)
Zoster live (ZVL)
Date Residual Problems
Date/s Immunization
Haemophilus influenzae type b (Hib)
Hepatitis B (HepB)
Influenza (IIV)
Influenza live attenuate vaccine (LAIV)
Meningococcal serogroup B (MenB)
Pneumococcal conjugate vaccine (PCV13)
Zoster recombinant (RZV)
Tetanus toxoid (Td)
Varicella (VAR)
Other www.cdc.gov/vaccines/schedules. Accessed 1/27/20.
Last Examination Date Outcome
Last Physical
Last Vision
Last Dental
Other (describe)
Women Only
Last Pap Test
Last Mammogram
Men Only
Prostate Exam
Date/s
Obstetric history
Last menstrual period (LMP) Date Outcome
Pregnancies Dates Gravida (number of pregnancies) ________
Para (number of births) ________
Abortion/miscarriage ________
FAMILY HISTORY
(Document age and current health of family members. If deceased, indicate age and cause of death.)
Person
Mother Father
Sister Brother
Sister Brother
Daughter Son
Daughter Son
Draw a genogram for your lab partner’s family history.
PERSONAL AND PSYCHOSOCIAL HISTORY
Personal
Status
• How would you describe yourself? or How do you feel about yourself?
• Describe your cultural/religious affiliations and practices.
• Describe your education, occupational history, and work satisfaction.
• Describe your perception of adequate time for leisure and rest, hobbies and interests.
Family and Social Relationships
• Describe your satisfaction with interpersonal relationships including significant others, individuals in home, and your role within family.
• Describe the state of health of these individuals. Describe social interactions with friends, social organizations, or religious groups.
Diet/Nutrition
• Describe your appetite, typical food and fluid intake, and caffeine intake.
• Do you have any dietary restrictions or food intolerances?
• Have you had any changes in appetite or weight; changes in taste of food; problems while eating, e.g., indigestion, pain, difficulty chewing or swallowing? If yes, describe.
• Have you had experiences with overeating, sporadic eating, or intentional fasting? If yes, describe.
Functional Ability
Do you need any assistance performing any of the following activities?†
Dressing ❏ Toileting ❏ Bathing ❏ Eating ❏ Ambulating ❏
Shopping ❏ Cooking ❏ Housekeeping ❏ Managing finances ❏
†If unable to perform independently, describe.
Mental Health
• Describe your sources of stress. How do you cope with these stresses?
• Have you had feelings of anxiety, depression, irritability, or anger? If yes, describe.
Tobacco, Alcohol, and Illicit Drug Use
Tobacco use: Y ❏ N ❏ Type: Daily use:
Alcohol intake: Y ❏ N ❏ Type: Drinks per day: Illicit drug use: Y ❏ N ❏ Describe: Frequency:
Health Promotion Practices
• What activities do you perform regularly to maintain your health?
Exercise (type/frequency):
Stress management:
Sleep habits:
Use of seat belts:
Other:
Environment (Include living and work environments)
• Describe actions do you take to main your environmental safety? (Circle hazards below and add others as warranted.)
Potential hazards within home e.g., lack of fire or smoke detectors, poor lighting, steep stairs, inadequate heat, open gas heaters, inadequate pest control, violent behaviors, firearms
Potential hazards within neighborhood e.g., noise, water or air pollution, heavy traffic, overcrowding, violence, firearms, sale/use of street drugs
Potential hazards within work environment e.g., inhalants, noise, heaving lifting, machinery, psychological stress
Any travel outside the United States
REVIEW OF SYSTEMS
Describe locations and dates
• Remember to ask questions using lay terms the patient understands, but document using medical terminology. For example, ask the patient if he has shortness of breath; if he says “yes,” perform and document a symptom analysis and document that the patient “reports dyspnea.” (See the Learning Activity at the end of this chapter for a listing of lay and medical terms.)
• Check all boxes that apply and add additional data below each section.
• Document if no symptoms are reported.
General Symptoms
Pain ❏ Fatigue ❏ Weakness ❏ Fever ❏
Problems sleeping ❏ Unexplained changes in weight ❏
Additional data:
Integumentary System
Skin lesions (wounds, sores, growths) ❏ Excessive dryness ❏ Excessive sweating or odors ❏
Changes in skin temperature, texture, color ❏
Change in a mole ❏ Sore that does not heal ❏ Rashes ❏ Itching (pruritus) ❏
Frequent bruising ❏ Changes in amount, texture, distribution of hair ❏ Hair loss (alopecia) ❏ Itching scalp ❏
Changes in texture, color, or shape of nails ❏ Use of sunscreen ❏ Skin self-examination ❏ Types and frequency of nail care ❏
Additional data:
Head
Headaches ❏ Significant trauma ❏ Dizziness ❏ Fainting (syncope) ❏
Use of protective head gear ❏
Additional data:
Eyes
Discharge ❏ Redness ❏ Itching (Pruritis) ❏ Excessive tearing ❏
Eye pain (Ophthalmalgia) ❏ Change in vision ❏ Difficulty reading ❏ Blurred vision ❏
Sensitivity to bright lights (Photophobia) ❏ Blind spots ❏ Floaters ❏ Halo around lights ❏
Double vision (Diplopia) ❏ Do you wear eyeglasses? ❏ Do you wear contact lenses? ❏ Use protective eyewear? ❏
Additional data:
Ears
Ear pain (otalgia) ❏ Excessive earwax ❏ Discharge ❏ Recurrent infections ❏
Decreased hearing ❏ Sensitivity to noises ❏ Ringing in the ears (tinnitus) ❏ Use of hearing device ❏
Protect ears from excessively loud noises ❏
Additional data:
Nose, Nasopharynx, Sinuses
Nasal discharge ❏ Nose bleeds (epistaxis) ❏ Sneezing ❏ Nasal obstruction ❏
Sinus pain ❏ Postnasal drip ❏ Change in ability to smell ❏ Snoring ❏
Additional data:
Mouth/Oropharynx
Sore throat ❏ Tongue or mouth lesions (abscess, sore, ulcer) ❏
Altered taste ❏ Difficulty swallowing (dysphagia) ❏
Oral hygiene practice (frequency of brushing/flossing) ❏
Additional data:
Bleeding gums ❏ Dental prosthesis (dentures, bridges) ❏
Trouble chewing ❏ Change in voice ❏
Neck
Lymph node enlargement ❏ Edema or mass in neck ❏ Neck pain ❏ Neck stiffness/limitation in movement ❏
Additional data:
Breasts
Pain ❏
Swelling (edema) ❏ Lumps or masses ❏ Breast dimpling ❏
Nipple discharge ❏ Change in nipples ❏
Additional data:
Respiratory System
Cough, nonproductive or productive ❏
Coughing up blood (hemoptysis) ❏
Frequent colds ❏
Night sweats ❏ Wheezing ❏ High pitched, musical sound when breathing (stridor) ❏
Handwashing frequency ❏ Tuberculosis screening ❏
Additional data:
Cardiovascular System
Sensation of heart fluttering or racing (palpitations) ❏ Chest pain ❏
Periodic shortness of breath during sleep (paroxysmal nocturnal dyspnea) ❏
Varicose veins ❏
Changes in color of extremities ❏
Additional data:
Smoking cessation ❏
Shortness of breaths (dyspnea) ❏
Pain with breathing (inspiration/ expiration) ❏
Reducing secondhand smoke ❏
Shortness of breath (dyspnea) ❏ Difficulty breathing unless sitting up (orthopnea) ❏
Coldness in extremities ❏ Numbness ❏ Swelling (edema) of hands or feet ❏
Leg pain with activity relieved by rest (intermittent claudication) ❏
Leg pain with activity not relieved by rest (rest pain) ❏
Limit salt and fat intake ❏ Blood pressure screening ❏
Abnormal sensation in extremities (paresthesia) ❏
Gastrointestinal System
Pain ❏ Heartburn ❏
Yellowing of sclera/skin (jaundice) ❏ Increased abdominal size due to fluid accumulation (ascites) ❏
Passing gas (flatus) excessively ❏
Nausea/vomiting ❏ Vomiting blood (hematemesis) ❏
Changes in usual bowel habits ❏
Painful defecation ❏
Change in color or consistency of stools ❏ Constipation ❏ Diarrhea ❏
Blood in stools (hematochezia) ❏ Hemorrhoids ❏ Dietary analysis ❏ Colon cancer screening ❏
Additional data:
Urinary System
Changes in color, contents, or odor of urine ❏
Change in urine stream ❏
Blood in urine (hematuria) ❏
Difficulty initiating urine flow (hesitancy) ❏
Excessive urination during the night (nocturia) ❏
Inability to control urination (incontinence) ❏
Plan to prevent urinary tract infections ❏ Performing Kegel exercises ❏
Additional data:
Reproductive System
Repeated need to urinate (frequency) ❏
Pain with urination (dysuria) ❏
Excretion of abnormally large volumes of urine (polyuria) ❏
Male: Lesions ❏ Pain in penis or testicles ❏
Hernia ❏
Female: Lesions ❏ Pain ❏
Excessive menstruation (menorrhagia) ❏
Sexual Activity
Are you currently involved in a sexual relationship(s)?
What is the type and frequency of sexual activity?
Number of sexual partners in last 3 months?
Do you protect yourself from sexually transmitted infections (STIs)?
❏ No
Sudden, almost uncontrollable need to urinate (urgency) ❏
Pain in back between ribs and ilium (flank pain) ❏
Decreased urine output (oliguria) ❏
Masses in penis or testicles ❏
Vaginal discharge/ odor ❏
Painful menstruation (dysmenorrhea) ❏ Irregular menstruation (metrorrhagia) ❏
Penile discharge ❏
Absent menstruation (amenorrhea) ❏
Pelvic pain ❏
❏ Yes Is the nature of the relationship heterosexual, homosexual, or bisexual?
Type: ❏Vaginal ❏Anal ❏Oral ❏Oher _____________________________ Frequency:
❏ No
❏ Yes, what method is used?
Do you use birth control? ❏ No
❏ Yes, what method is used?
Problems with sexual activity
Change in sex drive ❏ Infertility ❏ Exposure to sexually transmitted infections ❏
Males: Inability to achieve erection (impotence) ❏
Additional data:
Males: Premature ejaculation ❏
Females: Pain intercourse (dyspareunia) ❏
Females: Bleeding after intercourse (postcoital bleeding) ❏
Musculoskeletal System
Muscle twitching ❏ Muscle cramping/pain ❏ Muscle weakness ❏ Joint swelling (edema) or redness (erythema) ❏
Joint pain ❏ Joint stiffness/ deformity ❏
Back pain ❏
Additional data:
Neurologic System
Headache ❏ Seizures ❏
Inability to coordinate muscle movement (ataxia) ❏ Change in sensation ❏
Additional data:
Noise with joint movement (crepitus) ❏
Amount and kind of weekly exercise ❏
Fainting/loss of consciousness (syncope) ❏
Difficulty swallowing (dysphagia) ❏
Limitations in range of motion ❏
Osteoporosis screening ❏
Changes in movement ❏
Difficulty communicating (dysphasia) ❏
Use seat belts in a vehicle ❏ Wear helmet ❏
CLINICAL JUDGMENT
1. Recognize cues for this patient. Identify relevant and important data from the history. (Which information is relevant/irrelevant? Which information is most important? What is of immediate concern?)
2. Analyze cues. Organize and link the recognized cues to the patient’s clinical presentation. (Why is a particular cue or subset of cues of concern? What other information would help establish the significance of a cue or subset of cues?)
3 Using the analysis above, develop a problem list for this patient.
LEARNING ACTIVITY: With your lab partner, quiz each other on the lay terms and medical terms used to document a health history. For example, ask your partner (from the left side of the table), “What is the medical term for swelling?” or work from the other side by asking, “If you want to know if the patient has had syncope, what term do you use with the patient?”
When the patient reports these symptoms: → You document symptoms using these terms:
Skin, Hair, and Nails
Itching
Pruritus
Tiny red or purple spots on the skin surface formed by minute hemorrhages Petechiae
Swelling Edema
Hair loss
Head, Eyes, Ears, Nose, Throat
Brief loss of consciousness, fainting
Eye pain
Double vision
Increased sensitivity to light
Alopecia
Syncope
Ophthalmalgia
Diplopia
Photophobia
Ear pain Otalgia
Ear wax Cerumen
Ringing in the ears
Nose bleed
Difficulty swallowing
Respiratory system
Coughing up blood
Short of breath
High-pitched, musical sound when breathing
Cardiovascular system
Sensation that the heart is racing or fluttering
Difficulty breathing unless sitting up
Periodic shortness of breath during sleep
Leg pain during activity relieved with rest
Leg pain during activity not relieved with rest
Abnormal sensations in extremities
Gastrointestinal system
Vomiting blood
Yellowish color of skin or sclera
Increased abdominal size due to fluid accumulation
Tinnitus
Epistaxis
Dysphagia
Hemoptysis
Dyspnea
Stridor
Palpitations
Orthopnea
Paroxysmal nocturnal dyspnea
Intermittent claudication
Rest pain
Paresthesia
Hematemesis
Jaundice
Ascites
When the patient reports these symptoms: → You document symptoms using these terms:
Passing gas
Blood in the feces/stool
Urinary system
Difficulty initiating urine flow
Repeated need to urinate
Sudden, almost uncontrollable need to urinate
Painful urination
Pain in the back between ribs and ilium
Blood in the urine
Inability to control urination
Excretion of abnormally large volumes of urine
Excessive urination during the night
Decreased urine output
Reproductive system – Female
Absent menstruation
Excessive menstruation
Painful menstruation
Irregular menstruation
Painful intercourse
Bleeding after intercourse
Reproductive system – Male
Inability to achieve an erection
Musculoskeletal system
Noise with joint movement
Redness (e.g., of joints)
Neurologic system
Inability to coordinate muscle movement
Difficulty communicating
Flatus
Hematochezia
Urinary hesitancy
Urinary frequency
Urinary urgency
Dysuria
Flank pain
Hematuria
Incontinence
Polyuria
Nocturia
Oliguria
Amenorrhea
Menorrhagia
Dysmenorrhea
Metrorrhagia
Dyspareunia
Postcoital bleeding
Impotence
Crepitus
Erythema
Ataxia
Dysphasia
Techniques and Equipment for Physical Assessment
Equipment Provided by Student
• Penlight
• Stethoscope
• Ruler
Equipment Provided by School Lab
• Empty cardboard box and fluid-filled bag for percussion
• Sphygmomanometer
• Thermometer(s)
• Pulse oximeter
• Scale to measure weight and height
• Skin-fold calipers
• Ruler or tape measure
• Visual acuity charts
• Ophthalmoscope
• Otoscope with specula
• Audioscope with specula
• Tuning fork
• Nasal speculum
• Doppler
• Goniometer
• Percussion hammer or neurologic hammer
• Monofilament
• Vaginal speculum
After performing hand hygiene, perform these examination techniques with a lab partner.
Examination Techniques
Inspection
Inspect the skin on the forearm of your lab partner.
What is the overall color? Do you see any variations in color?
Notice the hair on the arm—amount, color, patterns.
Do you see a lesion (scar, mole) on the forearm? If so, where is it located, what color is it, and what size is it?
Does using a pen light to create tangential lighting improve the inspection?
Using a penlight, inspect our lab partner’s pupillary constriction and equality.
Document Findings
Color:
Hair color/distribution:
Lesions:
Pupil reactivity and equality
Examination Techniques
Palpation
With your lab partner, practice light palpation with your fingertips and deep palpation with your hands. In the column to the right, indicate the type of palpation appropriate for the example given.
Document Findings
Palpate a radial pulse.
deep light
Palpate the texture of skin. deep light
Palpate the abdomen. deep light
Palpate tenderness over a muscle. deep light
Touch the skin of your lab partner. Notice the temperature, moisture, and skin texture.
Percussion
Practice indirect finger percussion using the surface of the following three objects: an empty cardboard box, a table surface, and a liquid-filled plastic container.
Can you hear percussion tones?
Can you hear differences in the tones of the various objects?
Practice indirect finger percussion with your lab partner. Percuss over the following places: abdomen over the stomach; abdomen over the liver; chest over the lung field; and chest over the sternum.
Can you hear percussion tones?
Can you hear differences in tones as you percuss the different areas?
Auscultation
Identify the following parts of your stethoscope: earpiece, tubing, head (bell and diaphragm) (See Fig. 3.8A.) If your stethoscope has a two-sided head, turn it to the bell and then to the diaphragm. How can you tell which side is engaged?
Place the earpieces in your ears, pointing forward. Gently rub or tap the head of the stethoscope to sound.
With your lab partner, listen with your stethoscope for sounds at the following locations:
abdomen
carotid artery
lungs
heart
brachial artery
Indicate “Y” or “N” whether you can hear sounds.
Skin Palpation
Temperature:
Moisture:
Texture:
Empty cardboard box:
Table surface:
Liquid-filled plastic container:
Abdomen-stomach:
Abdomen-liver:
Chest-lung:
Chest-sternum:
USING EQUIPMENT
With a lab partner, complete the following activities using the equipment available in your lab.
Thermometers
Electronic thermometer:
• Put a disposable sheath over the probe. See Fig. 3.7A for an example. What is the temperature?
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏
Tympanic thermometer:
• Put a disposable sheath over the probe. See Fig. 3.7B for an example. What is the temperature?
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏
Temporal artery thermometer:
• Depress the scan button on the thermometer and slide across one side of the lab partner’s forehead to behind the ear. See Fig. 3.7C for an example. What is the temperature? _______________________
• What temperature unit is the electronic thermometer calibrated in?
Fahrenheit ❏ Celsius ❏ Both ❏
Sphygmomanometer/Cuffs
• Practice placing and removing a cuff on your lab partner’s arm. See Fig. 3.9A for an example.
• Compare various sizes of cuffs. See Fig. 3.10 for an example. Practice steps involved in determining a correct fit on your lab partner.
• Holding the cuff tightly wrapped in your hand, practice inflating the cuff with the inflation bulb, then slowly deflate the cuff using the control knob next to the inflation bulb.
• If your lab has one, examine an automated blood pressure device. (See Fig 3.9B for an example.) How does the procedure for placing a cuff differ compared with the manual BP cuffs?
• Determine how to turn the device on and off. Identify the display for blood pressure measurement. What other information is displayed?
Pulse Oximeter
• Turn on the device, place the probe on the finger of your lab partner, and record the oxygen saturation of arterial blood (SaO2). See Fig. 3.11 for an example.
Level = ______%
• What does this mean?
Scale to measure body weight and height
• Calibrate the weight on a standing platform scale to 0 (zero) before weighing your lab partner. See Fig. 3.12A for an example.
• Determine the weight of your lab partner by balancing the weights. ______________lb.
• Determine the height of your lab partner ________ft, ______In.
Skin-Fold Calipers
• What are the calibrations of the calipers? See Fig. 3.13 for an example.
• Manipulate the calipers. Measure the thickness of your lab partners triceps skin fold. See Fig. 8.11 for an example of the technique.
• Use Table 8.6 to determine the percentile. Document your findings,
Average of measurements: mm.
Percentile:
Ruler and Tape Measure
• Notice the units of measurement on your ruler: Tape measure:
• Measure the following spots with your ruler. Write your measurements in the space provided.
a. in./cm.
b. in./cm.
c. in./cm.
• Measure the circumference of your lab partner’s left wrist and his or her left forearm, 4 inches below the elbow.
Record your measurements. Left wrist __________ Left forearm __________
Visual Acuity Charts
• Distance vision. Using a Snellen visual acuity chart at a distance of 20 feet from your lab partner, test distance vision and screen for color and field perceptions of each eye with glasses off and on. (See Figs. 3.15A-D for examples.) Document your findings.
Eye glasses off glasses on Left eye /20 /20
Right eye /20 /20
_________ Correctly Identified red and green lines.
_________ Identified green line as longer.
• Near vision. While your lab partner holds a Rosenbaum or similar tool 14 Inches from the face, test near vision of each eye. See Fig. 3.16 for an example. Document your findings.
Eye glasses off glasses on Left eye /20 /20
Right eye /20 /20
Ophthalmoscope
• Practice attaching and removing the head of the ophthalmoscope. See Fig. 3.17A for an example.
• Turn on the power switch to your instrument. Shine the light from the instrument against your hand. Turn the aperture dial and observe the various settings: large light, small light, red-free filter, slit light, and grid light. As you shine these on your hand, identify each setting.
• Locate the lens selector dial. Turn the lens and observe the red and black numbers.
• Look through the eyepiece at your hand (or another object) and slowly turn the lens selector dial. Become familiar with adjusting the magnification while looking through the eyepiece.
Otoscope
• Practice attaching and removing the head of the otoscope. See Fig. 3.18A for an example.
• Compare adult and pediatric speculums (black, cone-shaped pieces).
• Place a speculum on the head of the otoscope.
• Turn on the power switch to your instrument. Shine the light from the instrument against your hand.
• Look through the lens at your hand or another small object.
Audioscope
• Select a speculum that snuggly fits the ear canal of your lab partner and attach the speculum to the audioscope. See Fig. 3.19 for an example.
• Instruct your lab partner: After the speculum is placed in the external auditory canal, he or she should raise an index when a tone is heard.
