umbilicus (Then) Left Iliac, left and below the umbilicus (Then) Right Iliac, right and below the umbilicus. 59. Percuss in all four quadrants (Percuss for tympany, dullness, flatness, and is it normal) 60. Palpate in all four quadrants (Note any tenderness, masses, does it feel normal) 61. Palpate the liver and spleen: Begin with the Liver (Place left hand underneath. With the right hand at the midclavicular line, place palm upward right at the edge of the costovertebral angle, and ask the pt take a deep breath) When the pt breaths in, press deeper and upward, then feel for the lower edge of the liver. 62. Next, the spleen. Have the pt come towards you laterally. (Place left hand on the back and the right hand below the costovertebral angle) Ask the pt to breath in and push upward and downward. (Do you feel the edge of the spleen? Not feeling the edge is normal) Then Assess the Blumberg sign (Put your hand vertically 90 degrees and press down into the abdomen, when you release, if pt feels any pain on the rebound, that would be a positive Blumberg sign) (Ask if the pt felt any pain) 63. Lower extremities examination: First inspect the skin for any lesions or any edema (Next) Assess ROM of the hip by flexing the pt knee, then abduct the leg, then adduct the leg crossing the midline, then internal rotation, and then external rotation. [For purposes of this exam, we will not test extension] 64. Assess ROM of the knee: Flexion and extension 65. Assess strength of the knee: (Have pt flex knees) Place your hands on the shin and ask the pt to push up towards them, Now place your hands on the cal and have the pt push back. (Rate strength 0-5, and equality bilaterally) Have pt extend legs
66. Assess ROM of ankles: Supporting the ankle, dorsiflexion, plantar flexion, and rotation 67. Assess the strength of ankles: (Have the pt dorsiflex against resistance that you apply and then plantar flex against resistance that you apply) Rate 0-5 and are they equal bilaterally 68. Assess the dorsalis pedis pulses: (are they 2+ and equal) Next, Have the pt stand up 69. Spinal examination: Inspect and palpate along both sides of the spine for any expected curvatures, alignment, and tenderness. (Next) ROM of the spine (Ask pt to bend over and touch toes, then straighten back up, and extend backwards, then straighten back up, and do lateral flexion to one side and then the other. (Next) have the pt rotate to the left and then to the right. (Is the pt good, and is there active ROM) 70. Assess the Romberg: Have pt stand with arms down by their side and close their eyes for 20 seconds (Look for any swaying, if there is none, they can open their eyes, that would be a negative Romberg) 71. Assess her gait: Ask the pt to take a few steps forward, turn around, and a few steps more.
- Summer '17
- Left-handedness, pulse