ANTERIOR CHEST Inspect for obvious deformities and symmetry Now, I am going to inspect your anterior chest, for any obvious deformities in symmetry, and I do not see any. Auscultate 8 lung sounds in anterior lung fields 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. POSTERIOR CHEST (BACK)
6 Auscultate 8 posterior lung fields: Start above scapula alternating side-to-side in intercostal spaces. Go down into bases of lungs. Assess lateral lung fields (get right middle lobe). 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 gonna get the lateral. Middle right, middle low. UPPER EXTREMITIES *All ROM & DTR examination only needs to be performed unilaterally for purposes of the 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. 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. Assess passive unilateral ROM of the shoulders (flexion, extension, internal rotation, external rotation, abduction, adduction). 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.
- Fall '15