(Sarah knocking)
- Come in.
- Hi. - Hi.
- How are you doing? - All right.
- All right? - Yeah.
- My name is Sarah.
I'm a student nurse at UVM and I'll be caring for you
this morning. - All right.
- I'm just gonna sanitize my hands real quick.
All right, I'm just gonna check your name band.
Can you tell me your name
and date of birth? - John Smith,
it's August 17th, 1965.
- And can you tell me your allergies?
- I'm allergic to penicillin. - Okay,
and then do you like to be called John?
- Yes. - Okay.
And what are your pronouns?
- Oh, he or him. - Okay, great.
So I'm here to take care of you this morning.
I hear that you're gonna be discharged
and they just wanted me to come in
to make sure that you're stable.
So I'm gonna assess your pain
your vital signs and that head to toe assessment.
- All right. - Looks like the bed
is nice and locked and your side rails are up.
So that's what I'm going to do.
- All right. - Do you have any concerns?
- No, they said I'd probably go home today.
I hope that's the case. - Yeah.
Well, so far what I'm hearing
is that you'll be able to go home.
We just need to do a final,
you know, vital sign check pain assessment
and head to toe. - All right, that's fine.
- And once that's done,
I'll report the findings to the doctor
and then we'll go from there. - Okay, good.
- Do you have any questions
before I start? - No, thanks.
I feel a lot better.
I'm not having too much pain.
- Yeah. - No I'll be fine.
- So no concerns.
You feel good? - Yeah.
- I think you're ready to go. Perfect.
So the thing I'm gonna do
is I'm going to do a pulse ox
and you've probably had this done to you oxygen.
While that's cooking, I'm gonna check your pulse.
Sorry, my hands are cold.
I apologize. - That's fine.
- Okay, a little bit longer.
So, your heart rate was 68
and respiratory rate was 12.
Okay, so that looks good. Let's see what your oxygen is.
Looks like it's 96.
I'm gonna take the temperature of your forehead.
You don't have to do anything.
Oh, this here 98.
98, so that's perfect.
The normal limits,
I'm gonna check your,
do you prefer one arm versus the other?
- It doesn't really matter if you're over here.
- That's fine. - Yeah.
I just wanna raise you up
just 'cause I feel like you're gonna be bending down.
(bed whirring)
Your arm.
You are so nice and warm and my hands,
(John laughing)
they're like really cold.
I'm like, oh my goodness.
Something is off (indistinct) okay, one more time.
Your time's a (indistinct). - That's right.
- They're all different,
aren't they? - They are.
I gonna make sure I'm taking this correctly.
All right, just relax your arm.
I'm gonna fill your break heel pulse.
There you go.
So the first thing I'm gonna do
is I'm gonna feel your radio pulse as I pump it up.
I said radio (indistinct). - Right.
- I'm gonna feel your break.
Radio, wow, Sarah.
Radio pulse.
Where does your blood pressure normally run?
- It can surprise anyone.
It goes from 120 to 140. - Yeah, sure.
Okay, 120 to 140 is so strong.
- Depending on the time of day
if I have had coffee whatever. - Yeah, that makes sense.
While I'm waiting for this to kinda your arm to settle,
I'll ask you for your pain.
So you said you had pain.
Where is that pain? - It's in my knee.
When I fell on my knee, I don't actually hurt it
but it hurts on this side. - Okay.
On the left knee. - On the left knee.
- On the side right here? - On the outside.
- Okay, and that started when you
fell down, you think? - Well, it started,
well, I don't know how else.
- Yeah. - Yeah.
- And it's been
pretty constant? - It has.
- What's, on a scale of one to 10,
10 being the worst. - Oh, it's hard.
Anything it's maybe true.
- Okay. Is it sharp stabbing?
- No, it's kinda achy. - Kinda achy.
- Yeah. - Okay.
- And it, you know, it's helped (indistinct).
Ice- - Ice helps elevation.
Does that help at all? - Elevation helps.
- Yeah. - Yeah.
- I noticed you weren't really taking medicine for it.
Do you feel like
you need medicine or? - I feel like
it doesn't hurt enough really?
- To really- - If it hurt a little more
I might take something like Tylenol.
- Yeah, any muscle spasms associated with that?
Anything else associated? No. Okay. Perfect.
I'm gonna listen to your blood pressure.
So I'd say 140/90. - All right.
- You all excited about talking about
your injury and pain- - I'm sure.
- All right.
So, so far you look calm.
You know, if you're in distress
you're in a semi fowler's position.
You're direct in bed.
You're alert and oriented times three.
Your speech is clear
as much as it can be with a mask on your face, right?
And I'm noticing your neck on a 45 degree angle.
'Cause I'm pretty sure this is a 45 degree angle
or 25 degree angle but close.
When you have a little bit doesn't appear
the jugular veins don't appear distended.
I am gonna look into your eyes.
If you could look straight ahead, that would be great.
Keep your eyes open and create blue eyes.
So your pupils are about three millimeters on both sides.
They're equal, they're reactive to light, they're round.
The next thing I wanna have you do is
look at the tip here, focus on that.
Bring it up.
And your pupil's accommodated.
They constrict and converge when I bring it close
and then they dilate when I bring it away.
So just thinking through my assessment,
all of that looks good (indistinct) your face.
Because of mask, I can't assess your smile.
I can have you puff out your cheeks or show me your teeth.
But what I would like you to do
is raise your eyebrows
and then fur your eyebrows, like perfect.
So that's equal.
The other thing I would normally have you do
is stick out your tongue.
But again, with the mask, we can't do that.
So, but that so far looks symmetrical.
The next thing I'm gonna do is I'm gonna move to your chest
I should've put my glove on when I first started
but we're pretty close to the beginning anyways.
All right, so I'm just gonna bring that down
a little bit down.
Are you comfortable? - Sure.
- I'm just gonna look at your chest.
All the tie down ones, right?
So your chest looks even, it looks symmetrical.
It expands symmetrically.
When you breathe, it looks regular.
I don't see any variations in the skin color or the sheath,
that looks good.
I am going to listen to your heart first.
So you can just relax as I do that.
You can breathe normally as well.
So listening to the four locations, I'm hearing S1, S2.
I don't hear any murmurs or extra hard sounds.
You don't feel any palpitations
or anything like that? - No.
- Okay, so next I'm gonna listen to your long sounds.
I will sit you up a little bit more for that.
Okay, let me know if you're not comfortable
I can adjust it there.
All right, so I am gonna listen
to the front of your chest, the sides.
Oh, thank you.
Are you okay like that? - Yeah.
- You don't mind? - I don't mind.
- Okay, as I put my stethoscope down on your chest
just take a deep breath.
Don't feel like you have to force your breath though.
Just nice deep breath.
If I'm going too fast, let me know.
Okay? - Yeah.
- Okay, (indistinct).
Okay, lung sounds in the front sound clear.
I'm just gonna have you bring your left arm to your side.
Just relax it here like so.
You okay? - Yeah.
- Oh, nice. Another deep breath.
A deep breadth.
Perfect, you can bring that arm down
and I'll do the opposite.
Same to the opposite side. - Okay.
- All right, so your lung sounds clear in the front.
Let me help you with that. - Yeah, I got it.
- Do you wanna lean forward? - Sure.
- Feel like you can.
Okay, I'm gonna listen to eight spots in the back.
Nice, deep breaths. Good job.
Take your time.
Two more times.
Okay lung sounds are clear.
Both anteriorly, laterally and posteriorly.
We wanna lay back down
if you feel like
you can tolerate that. - Oh yes.
- We'll look at your belly next.
(bed whirring)
All right, now moving to your belly.
Are you feeling nauseous
at all? - No.
- You passing gas. Okay.
All right, so your belly looks symmetrical and color
symmetrical and shape looks round and no extra.
I know. Sorry. - Very nice of you.
- Slightly round- - To put it that way.
- Rounded, it doesn't look distended to me,
but I'll assess more when I feel your belly.
So I'm gonna listen into the right lower quadrant.
Let me know if you feel uncomfortable.
Soft sounds are active in all four quadrants.
I am gonna feel around your belly
and then I'm gonna end up in your bellybutton area.
Okay? - Okay.
- Let me know if you're uncomfortable
as I'm doing this. - Okay.
- So it feels nice and soft not distended
even throughout no nodules, masses or anything like that.
No, nothing that I would be concerned about.
So all of that looks great.
Now I'm just gonna assess your arms and your legs.
(bed whirring)
So just looking at your arms,
sorry I'm just gonna lift the sleeves
just as I mentioned I can see them.
They look symmetrical in shape, in size,
color and hair distribution are also even.
I'm gonna feel your arms and your hands
and they're nice and warm bilaterally.
Nice and dry.
No pinning edema noted.
I'm gonna feel your bra heel pulses.
And you're plus two bilaterally.
And then I'm gonna feel your radial pulses.
And then plus two bilaterally.
So just looking at your hands
you're nails looking intact and they're pink.
I'm gonna feel the cat refill on both sides.
You're less than three seconds.
I'm gonna have you grasp my hands.
Nice and strong.
Nice, so bilateral strong hand grasp.
And then I'm gonna have you raise your arms like so
so you're able to lift up your arms against gravity.
But I'm gonna push down to know
if you can do it against resistance.
So plus five arm strength looks great there.
Don't think I forgot something, but maybe I did.
Now I'm gonna move down to your legs, same thing
and keep you covered.
So, again size looks symmetrical,
hair distribution and color also looks symmetrical.
I'm gonna feel again.
I don't feel any hitting edema, warm and dry.
Looks good.
And I'm gonna try to feel your patella tails.
I do feel this one.
I don't feel this one, but I would go grab a dog afterwards
if I really wanted to feel it.
I'm gonna break this down.
Just a smidge so you don't get cold.
I'm gonna feel your posterior pulses.
Here plus two.
I'm gonna feel your pitea posture too.
All these are nice and strong.
I can feel these really well.
Good, there's also plus two and regular.
Your toes. - My toes are little mess.
- Well, I'm checking,
(both laughing)
I'm looking at the cap refill.
So cap refill is less than three seconds on both sides.
I'm gonna have you push down
like you're pushing down on the pedal
so that's your planter reflection.
Nice and strong bilaterally.
And then door inflection.
So push back.
Good, you're nice and strong, John.
And then same thing with your arms,
except it's hard to raise your arms, your legs equally.
So one leg at a time I'm gonna have you raise it up.
I'm gonna push perfect.
Plus five strength.
Perfect. Plus five strength.
Okay, so that all looks good.
The last thing that we're gonna do,
(bed whirring)
'cause I'm gonna have you walk,
I'm gonna sit up and you walk to the door and back
if you feel comfortable
with that. - I do.
- I know that knee might be hurting you.
- I can do it. - Okay.
- Nothing hooked to me,
right? - No, not in the ICU.
So- - All right.
So I'm just walking. - Literally
you're just walking to the door
and then back to sitting position.
So your gate is even, your stride is also even,
you look erect in your posture
and there's no swaying to one side or the other.
So my impression is that you're stable.
Everything looks stable
despite that mild pain that you have in the,
I don't know would you consider it
mild pain- - Yes.
- In your knee? - Yes.
- So I'll note all of those things in the chart
along with the vital signs
and see what the doctor says. - Okay.
- And then I'll be back probably in like half an hour.
But if you need me before then feel free
to use your call bell. - Right.
- That's right.
And do you have any questions before I step out?
- No, you've been very nice
and very helpful out there. - All right.
Well thank you so much
and I'll be back, okay? - Okay, great.
Thank you. - All right, we're good.