Hospital Corpsman Sickcall Screeners Handbook
Hospital CorpsmanSickcall Screeners HandbookBUMEDINST 6550:9ANaval Hospital Great LakesApril, 1999This Edition Produced by the Brookside Associates LtdMedical Education Division542 Lincoln AvenueWinnetka IL60093www.brooksidepress.orgC. 2006, Brookside Associates Ltd. All rights Reserved.Page 1 of 215
Hospital CorpsmanSickcall Screeners HandbookBUMEDINST 6550:9AContentsContents. 2Introduction .3Course Description .4Utilization of Military Sick Call Screeners .5SOAP Note.6Orthopedics .12The Eye .22Dermatology .27Ear, Nose, and Throat .37Respiratory System.42The Heart and Blood Vessels .44Neurologic System .48Gastrointestinal System .57Genitourinary System .62Sexually Transmitted Disease .68Endocrine System .72Pharmacology - Medical Therapeutics .75Lesson Training Guides (LTGs). 84Examination of the Abdominal Region .84Cardiovascular Disorder and Exam Techniques .91Dermatology Disorders and Examination .99GI, GU, STD Disorders .114HEENT Disorders and Exam .125Immunizations .141Your Command: Student Handout, Laboratory .149Male Genitalia .156Examination of the Musculoskeletal System .160Mental Status and Neurological Exam .179Your Command: Student Handout, Pharmacy .191SOAP Note.194Taking a Medical History .200Thorax, Lungs, and Respiratory Disorders .205Page 2 of 215
Hospital CorpsmanSickcall Screeners HandbookIntroduction"Desert Storm" demonstrated once again that Navy Hospital Corpsmen are vital membersof the Health Care Delivery Team. Their responsibilities and roles are expanding as arethe demands placed on them to provide quality health care. In order to meet thesedemands and better prepare Hospital Corpsmen, training is a necessity. The Sick CallScreeners Course is such a program and is directed at the junior Hospital Corpsmen (E-2to E-4). Here the Corpsmen are exposed to clinical subjects taught by a staff of highlyskilled personnel (Physicians, Nurses, Physician Assistants, and Independent DutyCorpsmen). The goals and objectives of this course are:1. To give the Corpsmen a better understanding of the clinical aspects of medicine ina Military Sick Call setting.2. To expose corpsmen to the techniques of obtaining a history, performing aphysical exam and recording their findings in an outpatient record.3. To learn the signs, symptoms and therapy for medical problems that are commonto military sickcall.Page 3 of 215
Hospital CorpsmanSickcall Screeners HandbookCourse DescriptionThe Military Sick Call Screeners Course is divided into modules that cover specific areasof medicine. The topics include: Dermatology, Eye, ENT, Neurology, Cardiology,Pulmonary, Gastrointestinal, Orthopedics, Sexually Transmitted Diseases, InfectiousDiseases, Endocrinology, and Pharmacology. Each module contains sections on anatomyand physical examination and a number of common medical problems presented in aSOAP format.The course is designed to be presented over a period of eighty hours. Written test andquizzes, a mid-term and a comprehensive final exam will be given. A practicalexamination will also be used to evaluate the student’s ability to perform a physicalexamination.Instructors will draw upon personal knowledge and experience and demonstrate thephysical examination techniques required for each section.Page 4 of 215
Hospital CorpsmanSickcall Screeners HandbookUtilization of Military Sick Call ScreenersPolicy and guidance for the Military Sick Call Screener Program is contained inBUMEDINST 6550.9BThe primary goal of the Military Sick Call Screener Program is to provide timely, qualitycare for active duty personnel with minor medical conditions. Screeners are not tofunction as independent providers. They must work under the direct supervision of amedical officer who is responsible for the care they provide.The following guidelines must be followed:1. The SOAP format must be used when evaluating a patient. This will include thehistory, physical examination, assessment, and treatment.2. The Military Sick Call Screener will consult with the supervising medical officerprior to the patient leaving the treatment facility. Military Sick Call Screeners willhave 100% of their records reviewed by the supervising medical officer andcountersigned.3. A screener may order a CBC and urinalysis. Any other studies must be ordered bythe supervising MO/PA/IDC.4. Screeners must realize their limitations and immediately refer to an MO/PA/IDCany patient with one of the following conditions:a. Febrile illness with temp. exceeding 101 F.b. Acute distress such as, breathing difficulties, chest pain, acute abdominalpain, suspected fractures, lacerations, etc.c. Altered mental statesd. Unexplained pulse above 120 per minutee. Unexplained respiratory rate above 28 or less then 12 per minutef. Diastolic blood pressure over 100 mm HgIf any uncertainty or doubt in the assessment of the patient's medical conditionexists, refer to your medical officer. Also, if any patient presents with the samecomplaint twice in a single episode of care, he must be referred to a medicalofficer for evaluation and treatment. The only exception is patients returning forroutine follow up of a resolving acute minor illness or injury.5. All prescriptions written will be signed by the supervising MO/PA/IDC.Page 5 of 215
Hospital CorpsmanSickcall Screeners HandbookSOAP NoteLTG #Allotted Lesson Time:References: Nursing Procedures ManualHM 3&2Terminal Learning Objective: Given a simulated patient with a simulated complaint, thestudent will be able to obtain the needed information for proper treatment of the patient.Enabling Learning Objective: Given a list of components of a SOAP note, select byshading the correct response.a. The information charted for each component.b. The proper way of obtaining the information for each component.Problem oriented medical record approach (POMR)The S.O.A.P.(E. R.) method is the only accepted method of medical record entries for themilitary.a.b.c.d.S: (subjective) - What the patient tells you.O: (objective) - Physical findings of the exam.A: (assessment) - Your interpretation of the patients condition.P: (plan) - Includes the following:1. Therapeutic treatment: includes use of meds, use of bandages, etc.2. Additional diagnostic procedures: any test which still might be needed.e. E: (patient education) - special instructions, handouts, use of medications, sideeffects, etc.f. R: (return to clinic) - when and under what circumstances to return.Components of the SOAP note.1. Medical History - Gives you an idea of the patients problem before you startphysical exam.a. biographic datab. chief complaint1. This is the reason for the patients visit.2. Use direct quotes from patient.3. Avoid diagnostic terms.c. Observation: begins as soon as the patient walks through the door.Page 6 of 215
Hospital CorpsmanSickcall Screeners Handbookd. Listening: listen carefully. This will help you get an accurate diagnosis ofthe problem.e. Open ended questions: help you to get more complete and accurateinformation.f. Provider obstacles: your attitude or predeterminations may prevent youfrom making an accurate judgment.g. Patient obstacles: the patient has many obstacles to overcome. Patientsmust have confidence in you.2. History of present illness/injury (HPI)a. Duration: when the illness/injury started.b. Character: use the patients words to note character of pain.c. Location: have the patient explain, then have them point it out.d. Exacerbation or remission: what makes it better or worse and is it constantor does it vary in intensity.e. Positional pain: does the pain vary with the change of the patientsposition.f. Medications/allergies: note any medications whether over the counter ornot. Do the medications relate to the problem? Take note of the patientsallergies. Do not rely on the patients health record or SF 600.g. Pertinent facts: facts which lead you to your diagnosis. Usually consist ofclassical signs and/or symptoms.ANOTHER FASTER WAY TO TAKE A MEDICAL HISTORY IS BYUSING THE KEY WORD "SAMPLE PQRST"S: SymptomsA: AllergiesM: Medicine takenP: Past history of similar eventsL: Last mealE: Events leading up to illness or injuryP: Provocation/Position - what brought symptoms on, where is painlocated.Q: Quality - sharp, dull, crushing etc.R: Radiation - does pain travelS: Severity/Symptoms Associated with - on scale of 1 to 10, what othersymptoms occurT: Timing/Triggers - occasional, constant, intermittent, only when I dothis. (activities, food)Page 7 of 215
Hospital CorpsmanSickcall Screeners HandbookEXAMPLE:S) 21 y/o male c/o sore throat. No known allergies. Taking no meds. Haveapprox (2) ST per year. Eating and drinking normally. Was fine untilyesterday morning when woke up with ST. Denies fevers, chills, sweats, SOB,& HA.3. Past History (PH)a. Other significant illnessesb. Prior admissionsc. History of major traumad. Surgerye. Childhood illnessesf. Neurological history4. Family Historya. This is the pertinent history of diseases of the family within the patientsbloodline.b. Any disease traced through the family is important. If no history found,note it on SF600.5. Social History (SH)a. Drugsb. ETOHc. Tobaccod. Over the counter medications6. Marital Historya. Assist by assessing patients current condition.b. May help diagnose an underlying physical or psychological problem.7. Occupational History (OH)a. This is a brief description of the patients job.b. This is of importance if the patient works around hazardous materials andchemicals.8. Systems Review (ROS)a. A comprehensive account of complaints, both past and present.b. Double check: Recheck your work to prevent omission of significant data.c. Diagnosis: a systems review will allow the examiner to group thesymptoms and arrive at a logical diagnosis.Review of Systemsd. General1. usual weight2. weight change3. weakness, fatigue, feverPage 8 of 215
Hospital CorpsmanSickcall Screeners Handbooke. Skin1. rashes2. lumps3. itching4. dryness5. color changes6. hair and nailsf. Head1. headache2. head injuryg. Eyes1. vision2. corrective lens use; type3. last eye exam4. pain5. redness6. tearing7. double visionh. Ears1. hearing2. tinnitus3. vertigo4. pain, earache5. infection6. dischargei. Nose & Sinuses1. frequent colds, nasal stuffiness2. hay fever, atopy3. nosebleeds4. sinus troublej. Mouth & Throat1. teeth and gums2. last dental exam3. sore tongue4. frequent sore throat5. hoarsenessk. Neck1. lumps in neck2. painl. Breasts1. lumps2. nipple discharge3. pain4. self-examPage 9 of 215
Hospital CorpsmanSickcall Screeners Handbookm. Respiratory1. cough2. sputum (color, quantity)3. hemoptysis4. wheezing5. asthma6. bronchitis7. pneumonia8. TB, last PPD9. pleurisy10. last CXRn. Cardiac1. heart trouble2. HTN3. rheumatic fever4. heart murmurs5. dyspnea/orthopnea6. edema7. chest pain/palpitations8. last EKGo. Gastrointestinal1. trouble swallowing2. heartburn3. appetite4. nausea5. vomiting6. vomiting blood7. indigestion8. frequency of BM’s, last BM, change in habit9. rectal bleeding or tarry stools10. constipation11. diarrhea12. abdominal pain13. food intolerance14. excessive belching or farting15. hemorrhoids16. jaundice, liver or gall bladder trouble, hepatitisp. Urinary1. frequency of urination2. polyuria3. nocturia4. dysuria5. hematuria6. urgency, hesitancy, incontinencePage 10 of 215
Hospital CorpsmanSickcall Screeners Handbookq.r.s.t.u.v.7. urinary infections and STD’s8. stones (renal calculi)Genito-reproductive1. MALEa. discharge from or sores on penisb. STD hx and treatment, Last HIV testc. herniasd. testicular pain or massese. frequency of intercourse, libido, difficulties2. FEMALEa. 1st menarche, regularity, frequencyb. flow duration, amountc. bleeding between periods or after intercoursed. last PAP, resultse. number of pregnancies, deliveries, abortions (spontaneous& induced)f. STD’s hx and treatments, Last HIV testMusculoskeletal1. joint pain/stiffness, arthritis, bachache.(describe location and swelling, redness, pain, weakness, ROM)2. past injuries, treatmentsNeurologic1. fainting, blackouts, seizures, paralysis, weakness, numbness,tingling, tremors, memoryPsychiatric1. mood, affect2. nervousness, tension, depression3. past careEndocrine1. thyroid trouble2. heat or cold intolerance3. excessive sweating, thirst, hunger, urination4. diabetesHematologic1. anemia2. ease of bruising, bleeding3. past transfusions and any reactionsPage 11 of 215
Hospital CorpsmanSickcall Screeners HandbookOrthopedicsBack Problems: Affects 85% of the population at some time.Anatomy: The spine is composed of 7 cervical, 12 thoracic, 5 lumbar vertebrae, and thesacrum. They are separated from each other by a disc that cushions the vertebrae. Tounderstand the back you have to understand the anatomy and know how the vertebrae disc - vertebrae unit work.Looking from the side you can see a hole (foramen) that serves as a window throughwhich a nerve root from the spinal cord exists. This nerve can be pinched if the discherniates into the intervertebral foramen. This disturbs the muscular function and effectsthe deep tendon reflexes the nerve controls. Each nerve serves a different part of thebody. Disc problems most often affect the L4, L5, and 51 nerve roots. Evaluating thefunction of these nerve roots is part of examining a person with back painMost back problems are due to muscle stain and involve the paravertebral (para - around)muscles, which include the latissimus dorsi and trapezious muscles.Physical Examination:With the patient standing: Check symmetry, curvatures, ROM (range of motion) includeextension, flexion and side to side; gait, heel - toe walking (heel walk L-5, and tiptoe SI), and look for paravertebral muscle spasm.Note: A malingerer will complain of pain when pressing down on the head; andmay have an abnormal gait or limp. Have patient walk backwards - it isimpossible to limp backwards unless it is genuine.With the Patient sitting: Check deep tendon reflexes (DTRs) - patellar (L4) and achilles(S-I). Check extension strength of the great toe (ability to pull it up against resistance L5).With the patient supine: Straight leg raising test - Raise the patients relaxed andstraightened leg until pain occurs This places a stretch on nerve roots normally L-5. Thendorsiflex the foot, this will increase the pain if the nerve root is being compressed.Increased - in the affected leg when the opposite leg is raised (crossed straight leg raisingsign) strongly confirms nerve root involvement.Lower Back Strain / Pain:A painful condition involving the lower back, related to physical activity and may berecurrent.Page 12 of 215
Hospital CorpsmanSickcall Screeners HandbookS: Moderate pain in the lumbar area made worse by movement such as bending.O: Tenderness and spasm of paravertebral muscle in the lumbar area with limitedROM.Remainder of exam is normal - no nerve root involvement.A: Lower Back PainP: Bed rest may be needed, heat to area, Motrin 800 mg TID, and a musclerelaxant like Flexeril 10 mg TID.Herniated Disc: A syndrome of severe back pain as a result of impingement of a nerveroot by a bulging intervertebral disc.S: Backache, worse with coughing, sneezing and movement. Pain may radiate into leg.May have numbness tingling or weakness in the lower leg.O: Positive straight leg raise, decreased ROM, with altered strength and deep tendonreflexes (DTR).A: Herniated DiscP: Bed rest, Motrin, Flexeril, and referral to Ortho if not improved in 48 to 72 hours, mayrequire surgeryKNEE PROBLEMSA careful history makes the diagnosis!!!1. Is there direct trauma or injury? If no go to #2. If so. What was the precisemechanism of injury -what happened?2. Is it mechanical pain that is related directly to use of the knee? Worse "withbending, walking, climbing stairs, or running"3. Is there a history of effusion?4. Does it:a. lock -fixed in one position ? (Miniscal tear)b. click - usually normal with deep knee bends.c. buckle - does knee give out? (ligament instability, miniscal tear, or patellardislocation)d. Pseudo buckle - gives out due to pain usually due to patellar - Femoralsyndrome. No ligament instability.5. What factors cause, worsen, or relieve pain?ANATOMY1. Bones: Femur with distal medial and lateral epicondyles, Patella, Tibia withmedial and lateral condyles, Tibial tubical - attachment of the quads and theFibula2. Muscles:Page 13 of 215
Hospital CorpsmanSickcall Screeners Handbooka. Quadriceps (made up of 4 muscles). They form a tendon that envelops thepatella. Below the patella it is call the patellar tendon and it inserts into thetibial tubical, anchoring the quads to the tibia. The quadriceps cause kneeextensionb. Hamstring muscles Found in the back of the thigh, they cause flexion ofthe knee.3. Parts of the Knee Joint:a. Ligaments: (hold bones together)Collateral Ligaments - lateral and medialCruciate Ligaments - Anterior and posteriorb. Menisci: Distributes weight over the surface of the joint and functions asshock absorbers or cushions.c. Patella: Our kneecap rides in the groove between the femoral condyles.d. Bursa: fibrous sacs of fluid that reduce friction between bones, ligamentsand tendons.PHYSICAL EXAMINATION1. With patient standing: Check - active ROM - The patient uses his own muscles tocomplete ROM.Note: Passive ROM involves the examiner moving the patient's limbs through theROM. This is useful when the patient can not perform active ROM. Bend (flex) each knee (130 degrees of flexion) Straighten (extend) each knee2. With patient seated:a. inspect knee - swelling, tenderness, deformityb. palpate - check patellar tendon, tibial tubical, and joint line.3. With patient sitting down:. Compare knees - loss of "hollows" swelling superior to the patella isusually caused by an effusiona. Patella movement, tendernessb. Check extension (passive ROM)c. Test medial and lateral collateral ligaments; Valgus (knock knees). Varus(bowed legs)d. Examine with McMurray or Apley tests to detect a torn meniscus.COMMON KNEE PROBLEMSOsgood Schlatters Patellar Tendinitis Pain over the tibial tubercle and into the patellartendon. Actual injury occurs in early teens with the pulling of the patellar tendon out ofits attachment at the tibial tubical. This heals with a large calcium deposit below the knee.The tendinitis is a re-inflammation of this old injury. Pain with extension of lower leg.Treated with rest and anti-inflammatoriesPage 14 of 215
Hospital CorpsmanSickcall Screeners Handbook1. Patellar - Femoral Syndrome: Pain resulting from overuse of the joint. Themechanical movement of the patella between the femoral condyles on flexi
Hospital Corpsman Sickcall Screeners Handbook SOAP Note LTG # Allotted Lesson Time: References: Nursing Procedures Manual HM 3&2 Terminal Learning Objective: Given a simulated patient with a simulated complaint, the student will be able to obtain the needed information for proper treatment of the patient.
Hospital Corpsman Sickcall Screeners Handbook EXAMPLE: S) 21 y/o male c/o sore throat. No known allergies. Taking no meds. Have approx (2) ST per year. Eating and drinking normally. Was fine until yesterday morning when woke up with ST. Denies fevers, chills, sweats, SOB, & HA. 3. Past History (PH) a. Other significant illnesses b. Prior admissions
The purpose of the Advancement Handbook is to assist Hospital Corpsman in studying for Navywide advancement-in-rating examinations. The bibliographies (BIBs) together with this handbook form a comprehensive examination study package. Since this handbook provides skill and knowledge components for each
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ACCOUNTING 0452/22 Paper 2 October/November 2018 1 hour 45 minutes Candidates answer on the Question Paper. No Additional Materials are required. READ THESE INSTRUCTIONS FIRST Write your Centre number, candidate number and name on all the work you hand in. Write in dark blue or black pen. You may use an HB pencil for any diagrams or graphs. Do not use staples, paper clips, glue or correction .
