Thank you, and those are all intact equally. I will test the cranial nerve number 11, which is the spinal accessory nerve. I will put resistance on your shoulders and ask you to shrug your shoulders. They are equal and intact. 3
Now I'm going to evaluate your heart sounds. I begin with the auscultation in all five areas, with the bell and the diaphragm, with the patient sitting. I begin with the aortic valve which, is the 2nd intercostal space on the right sternal border. Next, the pulmonic valve, is the 2nd intercostal space to your left sternal border. Moving down to Erb's point, which is the 3rd intercostal space, left sternal border. Further down is the tricuspid, which is the 4th intercostal space, left sternal border. Lastly, the mitral area, which is the midclavicular line, 5th intercostal space. Now I will repeat the 5 areas with the bell of my stethoscope. Now, I am going to inspect your anterior chest, for any obvious deformities in symmetry, and I do not see any. Now, I will auscultate your lung sounds in the anterior lung fields, beginning at the intercostal spaces. Please take some normal breaths in and out through your mouth. And your breath sounds are nice and clear. Now, I will proceed to the posterior chest. And listen to your lungs. Please turn around. I'm going to auscultate eight areas, beginning above the scapula. Take some normal breaths, in and out through your mouth And I'm going to get the lateral right middle lobe. Now I will check your upper extremities. I will begin with inspecting the hand joints. If you'll extend your hands out. I don’t note any redness or swelling or any deformities of the finger joints. Next, I will palpate for capillary refill on one finger of each hand by pressing on a finger nail until it turns white and releasing. It turns pink in under 3 seconds. I repeat it on the other side; it turns white, release, and it turns pink in less than 3 seconds. That is a normal capillary refill. Now I will check your radial pulses bilaterally, and if you will just face your palms inward and I will palpate the radial pulses. And they are 2+ equal bilaterally. Next, I will assess your hand grips. Please grip my hands tightly. Very good; your hand strength is five out of five. I'm going to assess your range of motion. Normally ROM is examined bilaterally. However, for Immersion evaluation, I will only perform a range of motion unilaterally. I'm going to assess your relaxed or passive range of motion of the elbow. Flexion and extension. I would do so on the other side. And now, I would like to check the strength of your biceps and triceps. So if you will, flex your elbows and push against my hands. And now, pull back towards you. Your biceps and triceps strength was five out of five. Now I will assess the passive range of motion of the shoulder. Flexion, extension, internal rotation, external rotation. Then you have abduction and adduction.
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- Fall '15
- trigeminal nerve