immersion evaluation. Strength testing should be performed bilaterally. Inspect the joints of the hands – redness, swelling, deformities Palpate for capillary refill Assess radial pulses Assess hand grips (bilateral) – 5/5 strength Assess passive unilateral ROM of the elbows (flexion, extension) Assess strength of biceps, triceps (bilateral) – flex/extend elbow against resistance – 5/5 strength Assess passive unilateral ROM of the shoulders (flexion, extension, internal rotation, external rotation, abduction, adduction) Assess cerebellar coordination with rapid alternating movement: Serial finger opposition, hand flip-flop Assess unilateral DTRs: Biceps, patellar, achilles Have patient lie down ABDOMEN Inspect abdominal contours and symmetry. Auscultate for bowel sounds in all 4 quadrants Auscultate for bruits (verbalize) – aorta, renal arteries, iliac arteries Percuss in all 4 quadrants for tympany, dullness, flatness Palpate in all 4 quadrants for tenderness and masses Palpate liver and spleen (verbalize) Perform Blumberg’s sign (verbalize) LOWER EXTREMITIES Inspect the skin integrity of lower extremities and assess for edema. Assess passive unilateral ROM of hips (flexion, abduction, adduction, internal rotation, external rotation) *extension not tested for this exam Assess passive unilateral ROM of the knees (flexion, extension) Assess strength at the knees (bilateral) – flex/extend against resistance – 5/5 strength Assess passive unilateral ROM of the ankles (dorsiflexion, plantar flexion, rotation) Assess strength at ankles (bilateral) – dorsi/plantar flex against resistance – 5/5 strength Assess dorsalis pedis pulse Have patient stand up Inspect and palpate the spine – expected curvatures, alignment, tenderness Assess active ROM of the spine (flexion, extension, lateral flexion, and rotation) Assess Romberg Assess gait (just several steps)
Example script: ___________, my name is ____________, I will be doing your exam today. I’ll begin with inspecting your face. I’ll note that I don't see any discolorations or lesions & the head is midline & symmetrical. LYMPH NODES Next, I’ll palpate the lymph nodes. I’ll begin with the preauricular lymph nodes, right in front of the ear, and postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the back of the head. And then I'm going to move forward and palpate the tonsillar lymph nodes. Come under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior cervical lymph nodes, and the posterior cervical lymph nodes. And I will end with the supraclavicular lymph nodes right about the clavicles. I do not feel any enlargement, and they are equal bilaterally. FACE I’m testing trigeminal nerve , which is cranial nerve # 5 . Palpating over the masseter muscle as the pt clenches the jaw. I don't feel any distortions & my pt has great strength.
- Fall '15
- buccal mucosa, trigeminal nerve, TMJ, throat, Pulmonic Erb