Medical Skills -- Hematology

Name of student:
0 -- Not performed:
1 -- Initial:
2 -- Developing:
3 -- Developed:
4 -- Proficient:

Date:
Did not perform the task.
Glaring omissions or predominantly incorrect technique. Near total re-training required.
Performed some of the task properly but also some omissions or incorrect technique. Major improvement is required.
Performed most of the task properly. Some minor improvement is needed.
Completed the task and used proper technique no improvement or additional training is needed
Exam of the Lymphatic System & Introductory Abdominal Exam Checklist

Setting the stage of the physical exam

Asks permission to enter the room

Greeting and introduction
Disinfects hands prior to shaking hands with patient
Shakes hands with patient
Identifying data
Establishes patient's comfort & needs
Sets the agenda
Asks permission to proceed with examination
Physical Exam: General Considerations
Ensures patient modesty during the exam (uses drapes as appropriate)
Is sensitive to patients anatomy
Performs an honest exam (performs exam elements on bare skin as
appropriate)
Lymphatic System
Inspection: Student inspects t h e p a t i e n t p r i o r t o p a l p a t i o n
Palpation (Neck): Student palpates preauricular, posterior auricular, occipital,
tonsillar, submandibular, submental, superficial/deep cervical, posterior
cervical, and supraclavicular lymph nodes.
Palpation (Axilla): Student palpates lateral (along the upper humerus), central
(deep within the axilla), subscapular (posterior and deep in the posterior axillary
fold), and pectoral (anterior and along the lower border of the pectoralis major
inside the anterior axillary fold) lymph nodes of the axilla.
Palpation (inguinal region): Student palpates the horizontal group only (to
avoid exposure of the pubic/genital region).
Abdomen/Spleen
Position: Stays to the right side of the patient. Patient supine with hands at
sides. Abdomen draped appropriately. May ask the patient to bend the knees
to relax abdominal muscles.
Auscultation: Auscultates the abdomen using the diaphragm of the
stethoscope.
Inspection: Inspects the abdomen for lesions, scars, hernia, peristalsis, and
general surface contour.
Percussion: Percusses at least the 4 quadrants of the abdomen to assess for
tympany and dullness.
Palpation: Palpates all 4 quadrants of the abdomen superficial first and then
deep. Uses palmar surface of fingers of one hand (with other hand on top to
guide). Assess for presence of masses.

Spleen:
Student percusses Traubes space: the left lower anterior chest wall
from the 6th rib to the anterior axillary line and down to the costal
margin.
Assesses for splenic percussion sign by percussing the lowest
interspace in the left anterior axillary line before percussing again
after patient takes a deep breath (observes for change in tympany).
Student palpates the spleen with the right hand below the left costal
margin and with the left hand behind the patient at the lower left rib
cage.
Asks the patient to take a deep breath in to palpate the spleen in an
attempt to feel the spleen move down with inspiration.
Ending the encounter

Summarized findings
Came to appropriate closure of the encounter
Shook patients hand prior to leaving
Disinfected hands before leaving
Verbal Communication
Talked to the patient with respect
Used appropriate language & avoided or explained medical jargon
Explained the exam to the patient (sufficiently but without excess)
Other (Professionalism)
Dressed appropriately with white coat and name tag
Demonstrates professional behavior
Comments from faculty:

Signature/Date