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Tongue has full range of motion and protrudes midline when patient asked to stick out tongue and move.NeckSymmetry, lumps, and pulsationsHead is centered on neck. No bulges, lesions, or lumps evident. Neck is symmetrical in structure. No 9
pulsations notedCervical lymph nodesCervical lymph nodes nonpalpable with no enlargement or tenderness noted.Carotid pulse (bruits if indicated)Carotid pulses present bilaterally with no bruitsTracheaTrachea is midline on palpation with no lumps or masses. Adam’s apple midlineROM (cranial nerve XI)Movement of the neck is smooth and nonpainful. Neck and shoulder move against slight resistance with no difficultyThyroid glandThyroid gland palpable when patient swallows, not enlarged or visible on inspection; no nodules palpatedChest and Lungs: Posterior and LateralThoracic cage configurationSkin characteristicsSymmetric expansionTactile fremitusLumps or tendernessSkin of posterior thoracic cage is warm, pink, and dry with some small pimples evident. Pt has somefine body hair on back. Thoracic expansion symmetrical. Mild vibration noted on verbalization, which is appropriate for tactile fremitus. No lumps or lesions noted. No tenderness or painSpinous processSpinous process grossly midline with not evidence of kyphosis or scoliosisPercussion over lung fieldsPercussion over all lung fields are resonantCVA tendernessNo CVA tenderness reported on palpationBreath soundsLung sounds unlaboredAdventitious soundsInspiratory and expiratory wheezing in lower lung fields bilaterallyChest and Lungs: AnteriorRespirations and skin characteristicsSkin on anterior chest is warm, dry and pink. Some fine hair noted on chest. Nipples midline.Tactile fremitus, lumps, andTendernessTactile Fremitus: Mild vibration with vocalization. No lumps or lesions noted. No tenderness with palpationPercuss lung fieldsResonant lung fields on percussionBreath soundsLung sounds unlabored; Inspiratory and expiratory wheezing in lower lung fields bilaterally; cleared with coughUpper ExtremitiesROM and muscle strengthMoves all joints of upper extremities through ROM 10
smoothly and without pain. No tremor noted with extended arms. Muscle strength equal and consistent.Epitrochlear nodesEpitrochlear nodes nonpalpableDiscuss the process for assessing breasts and axillaFor female pts, have patient lay down and raise arm. Uncover one breast at a time. Observe for puckering, asymmetry, pulled skin, obvious lesions, nipple discharge. Methodically palpate breast using vertical, wheel spoke, or spiral patterns to assess the full breast. Palpate tail of breast tissue in axilla and axillary lymph nodesNeck VesselsJugular venous pulseJugular venous pulse present bilaterally on palpationPresence of jugular venousdistensionNo jugular venous distention observed, but pt was upright for examination rather than at 45 degrees, so cannot rule out JVDHeartPrecordium: pulsations andheaveNo pulsations or heave noted with palpation of precordium and left sternal borderApical impulse and PMI