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Comprehensive Physical Exam

Terms in this set (16)

Components
General Survey
Head
Face
Eyes
Ears
Nose
Mouth/Throat
Neck
Lungs/Thorax
Heart
Abdomen
Upper Extremities
Lower Extremities
Spine
Cerebellar
General Survey
Wash Hands
Apparent State of Health (breathing, resp distress)
LOC (Alert and Oriented x3)
Skin color, temp, moisture (lesions, rashes, etc)
Grooming/Hygiene (disheveled, odorous)
Facial expressions, mood, posture (eye contact, upright)
Head
-Examine the scalp, hair, bones of skull (normocephalic, lesions, flaky scaly skin, hair loss, texture)
-Facial skin & muscles for symmetry of movement (CN 7)
-Palpate scalp thoroughly
Face
-Symmetry (drooping, lid lags)
-Test CN 5 (sensory: light tough on face; motor: jaw clench and lateral jar movement)
-Test CN VII (motor fxn in mimetic musculature of face; raise eyebrows; show teeth, puff out cheeks or smile)
Eyes
-Test CN II (acuity w/snellen; fields with confrontation)
-Inspect eyelids (retracted, lowered), sclera (jaundice), conjunctiva w/light source
-Examine EO movements in 6 directions of gaze (CN 3, 4)
-Pupils PERRLA (CN 2)
-Check for convergence and accomodation
-Examine the retina w/opthalmoscope (anterior structures w/red reflex, optic nerve, trace vessels in 4 quadrants, observe macula)
Ears
-Inspect pinnae, Helix, and tragus
-Observe auricles and post-auricular regions bilaterally
-Assess hearing w/whisper or fork (CN 8)
-Palpate auricles bilaterally
-Performs otoscope exam of both ears (no pain, stabilize, external canal noting cerumen/blood, identify bony landmarks--incus, pars flacida, para tensa, hand of malleus, short process of malleus-- on TM, identify cone of light, verbalize assessing for redness, bulging TM, air/fluid levels)
Nose
-Test CN 1: smell --> ask if changes, if yes would check w/ alcohol swab
-Use light source to inspect septum and turbinates
-Inspect nasal vaults with speculum
-Insert speculum w/o causing pain
-Test for patency of both nasal passages
-Palpate for frontal sinus tenderness
-Palpate for maxillary sinus tenderness
Mouth/Throat
-Inspect w/ light: mucous membranes, tonsils (size, exudate), teeth (missing?), gums (abscesses, bleeding, red), the pharynx/hypopharynx using depressor (cobblestoning, red)
-Test for symmetry of movement of soft palate and uvula with phonation --> CN 9, 10 (say ahh, midline)
-Test CN 12: observe midline protrusion of tongue
-Look for deviation on tongue protrusion
Neck
-Identify the internal (visible) and external (not visible, deep to sternomastoid muscle) jugular and assess for neck vein distention
-Palpate lymph nodes (anterior cervical, posterior cervical, tonsillar, submandibular, submental, post auricular, occipital, supraclavicular)
-Palpate the carotid pulses
-Note position of trachea (midline and supple)
-Palpate for size and movement of thyroid (from behind)
-Test CN 11: rotation of head against resistance, shoulder shrug against resistance
Lungs/Thorax
-Inspect skin (sweat/diaphoresis, cyanosis, rashes, scars)
-Assess resp effort and WOB (able to speak in full sentences, no retractions, no paradoxical chest wall movements)
-Examine chest expansion for symmetry
-Auscultate the anterior chest in at least 6 places
-Auscultate the right middle lobe/left lateral chest
-Auscultate the posterior chest in 8 places
-Percuss anterior lung fields bilaterally (should be hearing hyperresonance, if not would worry about pneumonia, etc)
-Percuss posterior lung fields bilaterally
Heart
-Inspect the neck veins (carotid, jugular)
-Inspect and palpate precordium and apical impulse (5th ICS)
-Palpate apical area
-Auscultate the heart w/ bell and diaphragm (apex/mitral, tricuspid, left sternal border/Erbs, Pulmonic, aortic)
Abdomen
Watch patient's face during exam
-Inspect for bulges, masses, hernias, and skin lesions
-Auscultate over epigastrium for bowel sounds and bruits
-Auscultate over 4 quads to assess sounds in all quads
-Auscultate for abdominal bruits (aortic and renal)
-Finger-percuss over the 4 quads
-Palpate gently (all quads)
-Palpate deeply (tenderness, enlarged organs, would do branching if any positives)
-On inspiration, palpate superficially, then deeply for liver and spleen
-Palpate aorta
-Palpate femoral pulses
-Auscultate for femoral bruits
-Palpate the inguinal area for lymph nodes
Watch patient's face during exam
Upper Extremities
-Inspect and palpate both arms and forearms with clothing removed
-Palpate axillary nodes (armpit)
-Assess circulation Brachial and Radial arteries (grade out of 4)
-Assess for edema in bilateral upper extremities
-Assess for cap refill and sensation in fingers
-Assess DTRs : triceps, brachial, brachial radialis
-Assess muscle strenth and grade out of 5: triceps, biceps, deltoid, dorsiflexed wrists, hand grips
-Assess find rapid movements (finger pinch) --> cerebellar
-Assess for Pronator drift with outstretched arms (feet together, eyes closed, "don't let me move your arm", push on arm, should come back up)
Lower Extremities
-Inspect bilaterally with outer clothes removed (rashes, lesions, swelling)
-Inspect feet including toes (circ, color, etc)
-Palpate pulses bilaterally (posterior tibial, dorsalis pedis)
-Assess cap refill bilaterally
-Check for peripheral pitting edema bilaterally
-Assess muscle strength and grade out of 5: quads, hamstring, hip adduction, hip abduction
-Assess DTRs: patellar, achilles
Spine
-Observe posture and curvatures
-Perform screening test for scoliosis
-Palpate spinous processes of thoracic and lumbar vertebrae
-Test flexion by having bend at waist to touch toes
-Test extension by having patient bend backwards
-Have patient bend sideways
-Test flexion, extension, and rotation of neck
-Skipping fist percussion
Cerebellar
-Romberg test (feet together, hands out, eyes closed, look for sway)
-Test rapid alternating movements (hands palms then backs on thighs)
-Test finger-to-nose bilaterally
-Test heel-to-shin bilaterally
-Observe tandem gait - heel-to-toe
-Have patient walk on toes
-Have patient walk on heels
-Have patient hop on each foot
THIS SET IS OFTEN IN FOLDERS WITH...