Expansion
The patient, the bedside and the surroundings
Expansion
The patient
- Comfortable or distressed, and at rest or in pain
- Position: sitting forward in respiratory distress, still in peritonitis, restless in colic
- Colour: pallor, jaundice, cyanosis, plethora, pigmentation
- Nutritional state: cachexia, obesity, temporal wasting
- Breathing: rate, pattern, accessory muscles, audible wheeze or stridor
- Consciousness and orientation
- Scars, deformity, obvious swelling, rash, tremor or abnormal movement
The bedside
- Oxygen, and the delivery device and flow rate
- Inhalers, nebulisers and a peak flow meter
- Sputum pot and its contents
- Monitoring, infusion pumps, syringe drivers
- Catheter and the urine appearance, drains, stoma bags
- Feeding tubes, dietary supplements, thickened fluids
- Walking aids, wheelchair, hoist
- Vomit bowl, glucose meter, insulin
- Charts: observations, fluid balance, drug chart
The surroundings
- Bed rails, pressure relieving mattress, sensor mat
- Cards, visitors, glasses and hearing aids, which speak to social support and to whether the patient can engage with the consultation at all
Introduce yourself, gain consent and position the patient at 45 degrees before starting. This is not ceremony; it is where marks are lost and where rapport is built.