HEAD TO TOE

Question 1

ASSESSMENT OF THORAX AND LUNGS

Answer 1

Hello My name is Kelvin Dodzi, a student nurse, I’ll be perforning a head to toe assessment on you today. Im going to start by washing my hands. Now im going to provide you with proper draping to ensure privacy. Can you confirm your name and DOB with me. do you know where you at right now? (GOOD, PATIENT IS ALERT AND ORIENTATED). Mr gulam do you have any question before i proceed.

• Im goin to start by inspecting the shape and configuration fo the chest wall. (NO SIGN OF BARREL CHEST WHICH COULD INDICATE A SIGN OF COPD, PATIENT HAS A 1:2 TRANSVERSE DIAMETER RATIO)
• Now im going to take a look at the skin. (SKIN IS INTACT AND MOSTURIZED, EQUAL HAIR DISTRIBUTION, NO SIGN OF CYANOSIS WHICH COULD BE INDICATED BY A BLUE DISCOLORIZATION OF THE SKIN.
• NOW I’LL ASSESS THE RESPIRATORY RATE AND PATTERN for 60 seconds (PATIENTS BREATHS ARE SYMMETRIC AND UNLABORED
• Now im going to palpate both the anterior and posterior thorax for CHEST EXPANSION…(TELL PATIENT TO TAKE DEEP BREATHE IN..AND OUT)….DO SAME AT THE POSTERIOR AT T10 * BREATHES ARE DEEP AND EQUAL AND CHEST EXPANDS SYMMETRICALLY*
• Now i’m going to palpate for TACTILE FREMITUS. Say 99 anytime i move my hand) (FRONT: on the chest under the clavicle..POSTERIOR: start from shoulder going to neck down LATERAL SIDE TOO!!) ** PATIENT HAS NORMAL FREMITUS WITH SYMMETRIC VIBRATIONS. abnormal vibrations could be a sign of emphysema**
• Now i’m going to percuss over the anterior and posterior lung fields. LITTLE OVER THE CLAVICLE, I EXPECT TO HEAR RESONANCE, ON THE CLAVICLE I EXPECT TO HEAR FLATNESS BECAUSE ITS A BONE. AS I MOVE DOWN TO WARDS THE LUNG AREA, THE EXPECTED SOUND IS RESONACNCE (indicating healthy lung tissues). AS I MOVE DOWN FROM THE LUNG TOWARDS THE LIVER AREA, I EXPECT TO HEAR DULLNESS OVER THE ORGANS.
• **DO AND SAY SAME FOR THE POSTERIOR**
• now im going to auscultate the thorax USING THE DIPHRAGM OF MY STETHOS (ASK PATIENT TO BREATHE THROUGH MOUTH ANYTIME I MOVE MY STETH. (breathing through nose can alter PITCH SOUND).
  ++AROUND THE TRACHEA, I HEAR BROCNHIOL SOUNDS. AS I MOVE DOWN AROUND THE STERNUM, I HEAR BRONCHIOLVESICULAR SOUNDS. AND AS I MOVE DOWN I HEAR VESICULAR SOUNDS OVER THE LUNG TISSUES (((((((DO SAME FOR POSTERIOR)))))) 5 FOR FRONT. 9 FOR BACK CUS OF LATERAL(8,
• WHILES AUSCULATATING, I DID NOT HEAR ANY ADVENTITIOUS SOUNDS, CRACKCLES OR WHEEZES.
  CRACLINGS COULD INDICATE a sign of ASTHMA or HEART FAILURE

Question 2

ASSESSMENT OF HEART AND NECK VESSELS

Answer 2

Patient appears alert and oriented. No sign of difficulty breathing.

• I START BY TAKING A LOOK AT THE SYMMETRY OF THE TRACHEA. TRACHEA IS POSITIONED MIDLINE. NO SIGN OF PORTRUDING JUGULAR VEINS. I SEE NO VISIBILE PULSATIONS.
• now im going to palpate the carotid (((SAY ONE SIDE AT A TIME TO PRVENT REDUCED CEREBRAL BLOOD BLOW ))) == PULSES ARE 2+ INDICATING NORMAL
• Now im going to auscultate the carotid alteries FOR BRUITS USING THE BELL OF MY STETHOS. ILL ASK PATIENT TO HOLD THEIR BREATHE. ===((( I DID NOT HEAR ANY BRUITS)))) 3 times each side
• NOW IM GOING TO INSPECT THE PRECORDIUM AND I DO NOT SEE ANY SIGN OF HEAVES, LIFTS OR PULSATIONS
• NOW IM GOING TO AUSCULTATE THE HEART USING THE DIAPHRAGM OF THE STETHOS.
• at the right sternal border 2nd intercostatl space, im listening for AORTIC sounds (S2 IS LOUD HERE)
• moving across to the left sternal 2nd intercostal space, im listening for PULMONIC SOUNDS (S2 is also loud here)
• as i move down to the 3rd intercostal space where the erbs point is located, S1 AND S2 SOUNDS ARE THE SAME
• as i move down to the 4th intercostal space 4, im listening for tricuspid sounds. S1 sound will be loudest at this point.
• as i move to the 5th intercostal. mid claviculr, right below the nipple, im listening for mitral sounds. HERE IS THE APEX OF THE HEART ABD S1 SOUND IS THE LOUDEST HERE

VERBALIZE NORMAL S1 AND S2 SOUNDS HEARD ACROSS THE PRECORDIUM. I DID NOT HEAR ANY MUMORS OR CLICKING SOUNDS.

I CAN REPEAT THIS STEP USING BOTH THE BELL AND DIAPHRAGM OF MY STETHOSCOPE AND HAVE MY PATIENT SITTING, LYING SUPINE OR LEFT LATERAL ((((i expect to hear normal similar sounds as before). NO MURMURS OR CLICKINGS))*

FINALLY VERBALIZE THAT S1 COINCIDES WITH THE CAROTID PULSE

Question 3

ASSESSMENT OF MUSCULOSKELETAL SYSTEM

Answer 3

Ill start by insoecting and palpating the cervical spine and spinous process fro scoliosos, kyphosis or lordosis.

• ill alsO take a look a the PLUMB LINE (stand at the ear side. (PATIENT HAS A STRAIGHT UPRIGHT POSTURE). NO TILTED WAIST AT THE LOWER EXTREMEITIS AS WELL
• Now im going to inspect, palpate the SIZE AND CONTOUR of all joints. starting from SHOULDER, ELBOWS, WRIST, HAND , HIP, KNEE, ANKLE AND FOOT) WHILES PALPATING, IM ALSO FEELING FOR TEMPERATURE.
  ( ASK PATIENT TO VOICE IF THEY FEEL ANY PAIN WHILES PALPATING)

**JOINTS ARE SYMMETRIC BILATERALLY WITH NO SIGN OF SWELLING, TENDERNESS, MASSES, SWELLING, TENDERNESS, TEMPERATURE IS IN THE NORMAL RANGE.
MASSES COULD BE AN INDICATION OF CALCIFICATION

• NOW IM GOING TO INSPECT AND PALPATE THE TEMPOROMANDIBULAR JOINT CN5 FOR CREPITUS (((((PLACE MY INDEX FINDERS AT THE RIGHT POSITION AND ASK PATIENT TO OPEN MOUTH)))
• —I DID NOT HEAR ANY CLENCHING OR CLICKING SOUND AND PATIENT DID NOT REPORT ANY PAIN.
• NOW WE WILL TEST FOR 4 PAIRS OF RANGE OF MOTIONS. ((((((FIRST WE WILL START BY THE ACTIVE ROM. ASK THEM TO DO WHAT I DOING)
  1. ABDUCTION/ADDUCTION
  2. PRONATION/SUPINATION
  3. FLEXION/ EXTENTION LOWER EXTRE
  4. EVERSION/INVERSION

PATIENT IS ABLE TO PERFORM UPPER AND LOWER EXTREMITIES WITHOUT ANY DIFFICULTIES

• Now im going to access muscle strengths in the upper extremeity by holidn patient FOREARM AND AND TELLING THEM TO FLEX HANDS. ((patient has ROM in the upper extremeties, repeat for lower extremities)
  ((((DO SAME ON SHIN)))

PATIENT HAS RANGE OF MOTION AGAINST RESITENCE

FINALLY IM GONNA TEST FOR THE PHALLEN AND TINEAL TEST FOR CARPAL TUNNEL. START HAVE patient perform inverted hands for 60 SECONDS. ask patinet to tell me if theyre felling any pain. NO PAIN INDICTATES A POSITIVE PHALLEN TEST.

NOW IM GOING TO PERFORM TINEAL TEST for carpal tunnel syndrome also. TAP ON THE TMEDIAN NERVE. PATIENT IS NOT SUPPOSE TO FEEL ANY TINGLING SENSATION. FEELING SUCH WOULD INDICATE POSITIVE TINEAL TEST FOR CARPAL TUNNER SYNDROME

Question 4

ASSESSMENT OF THE NEUROLOGICAL ASSESSMENT

Answer 4

• ill start by inspecting the gait and balance of my patient by having them take a few steps.
• Now ill inspect patient for tandem test by having them walk (DO IT AND LET THEM DO IT AFTER ME. (tandem test = four poles measurement). INSPECT FOR ROMBER TEST BY MAKING THEM CLOSE EYES AND STANDINg. **MAKE SURE TO STAND WITH ARMS EXTENDED (pateint in the middle) INCASE PATIENT FALLS* whiles doing these tets, im looking for swingings

(patient is able to MAINTAIN HIS POSTURE WHILES performING these test withought falling or swinginf movements)

• Now im going to inspect muscles for SYMETERY STREGNTH, TONE AND INVOLUNTARY MOVEMENTS BY HAVING PATIENT PERFORM SOME ACTIONS SUCH AS FRLEXING WRIST AND KNEES.
• PATEINT DEMONSRTAE MUSCLE GRADE OF 5 BY SHOWING NO SIGN OF FLACCID OR RIGID MUSCLES AND ALSO HAS NO INVOLUNTARY MOVEMENTS**
• now im going to assess patients cranial nerves

= Im gonna assess for CN1 (OLFACTORY 1) - assess for smell. BY HAVING PATIENT CLOSE EYES AND BLOCK ONE NOSTRIL TO SMELL (do for both nostrils) CN 1 IS INTACT!!

= Im gonna test for CN 2 OPTIC by using snellen chart or HAVING THEM READ SOMTHING. snellen = 20 feet. Jaeger 14 feet. TO TEST FOR VISUAL ACUITY.

= im gonna test for CN 3,4,6. Olfactory, trochlear, Abducens BY PERFORMING THE 6 CARDINAL GUAZE. (tell patient to follow up with my finger movements)
SAY I SEE THAT THE EYELID COVERS EYE AT 2MM OF THE IRIS
—–(((((( move penlight close to the face )))))
PATIENTS CN 3,4,6 ARE INTACT!

= now im going to test for CN 5 trigerminal / Jaw movements. HAVE PATIENT OPEN AND CLOSE MOUTH (clench teeth) and palpate the MASETER and TEMPORAL MUSCLES. ((ask if they feel any pain)) PATIENT CAN OPEN AND CLOSE MOUTH WITHOUT ANY PAIN INDICATING CN 5 TRIGERMINAL IS INTACT.

= now im going to test for CN 7 facial symmetry. HAVE PATIENT SMILE, FROWN AND PUFF CHEEKS. patient is able to perform these actions. CN 7 is intact

= now im going to test for CN8 ACOUSTIC BY PERFORMING A WHISPER TEST. close one ear by PRESSING ON THE TRAGUS. STAND AT PATIENT BACK AND WHISPER LETTER AND NUMBER. (((((DO FOR BOTH EARS)))))). PATIENT IS ABLE TO REPEAT WORDS. CN8 IS INTACT

= now im going to test for CN9 and 10 GLOSSOPHARYNGEAL (GAG REFLEX) and VAGUS by using TONGUE DEPRESSOR ON TONGUE AND having patient say AHH.
*SAY ULVA RISES WITH RISES

• now im going to access for cranial nerve 11 (ASSESSORY NERVE) by putting slight pressure on SHOULDER SHRUG. PATIENT IS ABLE TO SHRUG. CN 11 IS INTACT
• lastly im gonna assess for CN 12 HYPOGLOSSAL BY HAVING PATEINT PERFORM ACTIONS WITH TONGUE LEFT RIGHT. PATIENT IS ABLE TO PERFORM THIS ACTION. CN 12 IS INTACT

= now im going to access RAPID ALTERNATING MOVEMENT by HAVING PATIENT TAP ON THINGS WITH INSIDE AND OUTSIDE OF PAL.

= NOW IM GOING TO PERFORM DEEP TENDON REFLEXES ON BOTH UPPER AND LOWER EXTREMETIS.

(((((((PUT THRUMB ON BRACHIAL ARTERY, HIT THE NAIL BED OF MY THUMB))))))
- THE BICEPS FLEXES AND CONTRACTS INIDCATING NORMAL

• FOR THE LOWER EXTREMEITY, ILL PERFORM A PATELLER REFLEX TEST. **USING DISTRACTION METHOD**

===SAY((((((THE KNEES EXTEND AND QUADRICEPS CONTRACTS)))) WHIHC IS A NORMAL REFLEX AND A GRADE OF 2

Question 5

ASSESSMENT OF THE ABDOMEN

Answer 5

= ill start by inspecting the color and CONTOUR of the abdomne. NO sign of lesions of moles abdomen is round with NO SIGN OS ASCITIES

= Next im gonna AUSCULTATE THE ADBODEM AND IM GOING TO DO THIS PEFORE I PERCUS AND PALPATE TO PREVENT ALTERING OF BOWERL SOUNDS. !!TENDER AREA IS AUSCULTATED LAST!!

= USING THE DIAGPHRAM OF MY STETH ILL START THE AUSCUATING FROM THE RLQ AND MOVE CLOCKWISE. ILL AUSCULATE FOR 60 SECODNS IN EACH QUADRANT

* SAY NORMAL GURGLES ARE HEARD ACROSS THE ADBDOMEN. NO BRUITS WERE HEARD*

= now im going to AUSCULATET FOR VASCULAR SOUNDS WITH THE BELL OF STETHOSCOPE
1= AORTA
2= BILATERAL RENAL ARTERIES
3= BILATERAL ILIAC
4= FEMORAL
(((((((( NO BRUITS WERE HEARD))))))

=now ill percuss the abdomen in the 4 quadrants starting from the RUQ AND MAKE MY WAY TO THE RLQ. AT THE RUQ, I HEAR DULLNESS OVER THE LIVER.

• AS I MOVE TO THE LUQ, I EXPECT TO HEAR OVER DULLNESS OVER THE SPLEEN
• AND AS I MAKE IT DOWN TO THE LEFT LOWER QUADRANT I EXPECT TO HEAR TYMPANY OVER THE SIGMOID COLON AND SAME WHEN I GET TO RLQ

= NOW IM GOING TO PERCUSS OVER THE COSTOVERTEBRAL ANGLE FOR ASSESSMENT OF KIDNEY FOR PYEOLONEPHRITIS. (((((((( PALM FLAT AT BACK AND HIT WITH BLOW))) NO TENDERNESS OR PAIN REPORTED BY PATIENT

= NOW IM GOING TO PERFORM LIGHT AND DEEP PALPATIONS IN ALL 4 QUADRANTS.
- Light palation is PERFORMED PRESSING THE ABDOMEN 1-2 CM
now do
- Deep palpation IN ALL 4 QUADRANT 3 CM. (((((TELL ME IF YOU FEEL ANY PAIN)))) ADBOMEN IS SOFT, NO TENDERNESS OR MASSES FELT.

= NOW IM GOING FOR MURPHY SIGN ASSESSMENT OF THE GALLBLADDER. BY PALPATING THE RUQ (((((( TAKE A DEEP BREATHE IN AND TELL ME IF YOU FEEL ANY PAIN)))
THERE IS NO PAIN == MURPHY TEST IS NEGATIVE

= LASTLY ILL ASSESS FOR REBOUND TENDERNESS (DEEP PALPATION) FOR THE ASSESSMENT OF THE APPENDIX. even thought the appendis is located at the RLQ, this test is performed at the opposite side LLQ. LEMME KNOW IF YOU FEEL ANY PAIN.
- IF PATIENT HAS APPENDICITIS, THEY WOULD EXPERIENCE REBOUND PAIN IN THE RLQ

Question 6

ASSESSMENT OF PERIPHERAL VASCULAR SYSTEM AND LYMPHATIC SYSTEM

Answer 6

• I’ll start by inspecting the skin color. Skin is mosturized, equal distribution of hair, no lesions or moles on both arms. Symmetric skin color
  NO SIGN OF EDEMA

= whiles doing this, I’M ALSO GONNA PALPATE FOR SKIN TEMPERATURE USING THE DORSAL SURFACE OF MY HAND
*SAY SMOOTH SKIN TEXTURE AND ASK FOR PAIN

• NOW IM GOING TO INSPECT THE NAILS FOR ANY SIGN OF CLUBBIN. (have them do how to test for clubbing) (((((NAILS APPEAR NORMAL AND WELL TRIMMED)))))
  CAPILLARY REFIL IS LESS THAN 3 SECONDS INDICATING NORMAL. ANYTHING OVER 3 SECONDS CAN INDICATE POSSIBLE HEART PROBLEMS

= PALPATE FOR EPITROCHLEAR LYMP NODE (((before i forget))) hold patient elbow in hand and other hand up
NO TENDERNESS OF EPITROCHLEAR NODE FELT, NO SWELLING OR TENDERNESS

= now im going to PALPATE BRACIAL AND RADIAL PULSES BILATERALLY FOR RATE, RHYTYTM AND STRENGTH. ((((((( do both hand at the same time)))))

• VERBALIZE **BRACHIAL PULSES ARE 2+. RATE AND RHYTHM ARE SYMMETRIC

= DO SAME FOR RADIAL PULSES. RADIAL PULSES ARE 2+. RATE AND RHYTHM ARE SYMMETRIC

= NOW IM GOING TO GO TO THE LOWER EXTREMITIES. ((((have them lay down)))) **NO SING OF ULCERS, NO SIGN OF VARICOSITIES.

= IM GOING TO TEST FOR EDEMA BY PUSHING THE SKIN OVER THE SHIN. NO SIGN OF PITTING WITH A GRADE IF 0

= FINALLY IM GOING TO PALPATE THE POPLITEAL FOR RATE RHYTHM AND STRENTG ((( pulses are 2+ with equal rate and rhtym)

• DO SAME FOR POSTERIOR TIBIAL
• DO SAME FOR DORSALIS PEDIS

FOR ALL SAY = PULSES ARE 2+ WITH EQUAL RATE AND RHYTHYM

Question 7

ASSESSMENT OF HEAD, FACE, NECK, REGIONAL LYMPHATICS

Answer 7

Inspecting the shape of the head. HEAD IS SYMMETRIC AND SIZE OF HEAD IS PROPORTIONAL TO THE BODY SIZE

• NOW ILL INSPECT THE HAIR OF THE HEAD, EQUAL DISTRIBUTION OF HAIR. NO SIGNS OF LICES OR DANDRUFFS
• • NOW I’LL PALPATE THE TEMPORAL ARTERY. ((((((PAULSE IS 2+)))).
    NOW ILL PALPATE THE TEMPOROMANDIBULAR JOINT FOR CREPITATION FOR TENDERNESS. ((((have patient close open and close mouth)))
    NO CREPITATION OR TENDERNESS WITH MOVEMENT
• NOW ILL INSPECT THE FACE. FACE IS SYMMETRIC. NO SIGN OF TIC MOVEMENTS.
• PALPATE THE TRACHEA. TRACHEAL IS MIDLINE FROM STENOMASTOID MUSCLES (SAME DISTANCE)
• PALPATE THE THYROID GLAND FROM THE BACK. I DO NOT FEEL ANY ENLARGEMNT OF NODULES
• NOW IM GOING TO AUSCULATE THE THYROID GLAND WITH THE BELL OF MY STETH AND ASK PATIENT TO HOLD BREATH FOR ANY BRUITS.
  ((((((( NO BRUITS ARE HEARD)
• HAVE PATIENT PERFORM ROM OF NECK BY TURNING IN VARIOUS DIRECTIONS. UP DOWN LEFT AND RIGHT.
• NOW ILL PALPATE REGIONAL LYMPH NODES
• pre AND POSE AURICULAR
• OCCIPITAL
• SUB MENTAL
• SUB MANDIBULAR (tonsiler close)
• SUPERFICIAL CERVICAL
• DEEP CERVICAL
• POSTERIOR CERVICAL
• SUPRACLAVICLE

NO SIGN OF TENDERNESS OF THE REGIONAL LYMPH NODES

Question 8

ASSESSMENT OF THE NOSE MOUTH AND THROAT

Answer 8

ill start by taking a look at the external nose. NASOLABIAL FOLD POINTS TO THE CORRECT LOCATION

NOW IL GONNA ASSESS FOR THE PATENCY OF THE NOSE BY MAKING CLIENT OCCLUDE ON NOSTRIL AND BLOW OUT THE OTHER FOR BOTH.

= NOW WITH THE PENLIGHT, IM GOING TO INPECT INSIDE THE NASAL CAVITY. THE MUCOUS MEMRBRAE, NO SWELLING OF TURBINATES, NO DRAINIAGE OR PERFORTAION

= NOW IM GOING TO PALPATE THE MAXILLARY AND FRONTAL SINUSES. TO TENDERNESS FELT UPON PALPATION. PATIENT DOES NOT REPORT ANY PAIN

= NOW MOVING TO THE LIPS. LIPS ARE MOSTURIZED NO SIGN OF CYANOSIS OR LESIONS

= ILL ASK PATIENT TO OPEN MOUTH

• teeth are intact
• no gum bleeds. gums looks healthy no swollen
• tongue is pink and moist (CN3)

= NOW ILL TAKE A LOOK AT THE STENSEN DUCT DOES NOT APPEAR INFLAMMED

= THE PATIENTS THROAT APPEARS PINK AND MOIST, NO SWOLLEN TONSILS INDICATING A GRADE OF 0

= NOW ILL INSPECT THE UVULA UISNG A TONGUE DEPRESSOR TO PRESS DOWN ON TONGUE AND STICK OUT TONGUE ( CN 9 AND 10

((((PATIENT DOES NOT ELICIT GAG REFLEX, UVULA RISES AND IS SYMMETRIC AND CENTERED IN THE MIDDLE)))))
- NOT DEVIATED.

THE PALATE ALSO APPEARS WHITIS AND MOIST

Question 9

ASSESSMENT OF THE EYES

Answer 9

• ill begin by expecting the external eye. NO SIGN OF PTOSIS. EYES ARE SYMMETRIC AND IN LINE
• PALPEBRAL FISSURE LOOKS INTACT, EYE LID COVERS THE EDGE OF THE IRIS
• INSPECT THE CONJUCTIVA AND SCKERA (((( pulling down the eyes)))) CONJUCTIVA IS CLEAR AND PINK SCLERA IS WHITE AND SHINY
• NOW IM GOING TO INSPECT EXTRAOCULOMOTOR PERFORM THE 6 CARDINAL TEST TO TEST FOR THE CN 3 4 6.
• EYE MOVEMENT ARE SYMMETRIC THROUH ALL 6 DIRECTIONS**

= NOW IM GOING TO ASSESS PERIPHERAL VISION BY CONDUCTING A CONFRONTATION TEST. **COVER ONE EYE AND MAKE PATIENT DO SAME* TELL ME WHEN NUMBER 1 GOT UP. CN 2

====PATIENTS HAS NORMAL PERIPHERAL VISION=====

= NOW ILL DO THE SNELLE CHART TEST BY STANDING 20 FEET AND HAVING PATIENT READ OF A CHART. 20/20 IS THE NORMAL WOULD INDICATING THE PATIENT IS ABLE TO READ AT 20 FEET WHAT THE HEALTHY EYES CAN SEE AT 20 FEET.

= ILL ASSESS ALLIGNMENT BY PERFORMING THE CORNEAL LIGHT REFLEX. ((((((ask them to stare straight AND SHINE STRAIGHT)))))
I SEE THE REFLECTION OF THE LIGHT AT THE SAME SPOT ON THE CORNEAL IN BOTH EYES* CN 346

= NOW ILL ASESS FOR PUPILLARY LIGHT REFLEX BY SHINING LIGHT FROM THE SIDE. SIZE 2MM TO 3MM
=== ILL ALSO ASSES FOR ACCODATION BY TELLING PATIENT TO LOOK STRAIGHT AS I MOVE PENLIGHT CLOSE TO FACE

PERRLA
PUPILS ARE EQUAL, ROUND, REACTIVE TO LIGHT BY CONSTRICTION AND ACCOMODATION

= NOW I’LL USE THE PENLIGHT, TO VIEW THE RED LIGHT REFLEX. IT SHOULD APPEAR ROUND AND REGULAR. WITH THE OPTHALMOSCOPE I THE OPTIC DISK WOULD BE VISUALIZED BY THE NASAL SIDE

Question 10

ASSESSMENT OF SKIN, HAIR AND NAILS

Answer 10

Inpsect skin for lesions. Inspect hair of head. NO LSEIONS MOLES, BIRTHMARK NOTICED

• WHILES INSPECTING THE SKIN, ILL ALSO USE THE DORSAL OF MY FINGER TO PALPATE FOR TEMPERATURE. TEMPERATURE IS WITHIN THE NORMAL RANGE
• NOW IM GOING TO PALPATE BELOW THE CLAVICLE FOR SKIN SKIN TURGOR. WHEN I PULL THE SKIN, ITS SUPPSOE TO RETURN
  (((((((((TENTING WOULD INDICATE DEHYDRATION!!!!!!!)))))

- AS I STATED PREVIOUSLY, NO LESIONS AND MOLES WERE NOTICED. IF MOLES WERE PRSENT, ID USE THE ABCDE assesement to look for
ASSYMETRY
BORDERS
COLOR
DIAMETER
EVOLUTION, ELEVATION OR EXUDATE PRESENT.

NOW ILL INSPECT THE NAIRLS FOR COLOR SHAPE, NAIL LOOKS WELL GROOMED AND CLEAN NO SIGN OF CLUBBING OF NAILS.
CAPILLARY REFIL IS LESS THAN 3 INDICATING NORMAL AND GOOD PERFUSION.

ILL INPSECT AND PALPATE HAIR FOR ANY DANDRUFFS LICES, TENDERNESS.
NO DANDRUFFS OR LICES SEEN. PATIENT DOES NOT REPORT ANY PAIN AS WEKK

Question 11

ASSESSMENT OF EARS

Answer 11

I’ll start by inspecting both ears. EARS ARE SYMMETRIC , COLOR OF EARS MACTHES WITH THE COLOR OF THE FACE.

= THE EAR ALLIGNS WITH THE THE EYE

= IM GOING TO PALPATE THE PINNA TRAGUS AND MASTOID PROCESS FOR ANY PAIN AND TENDERNESS. (((((PATIENT DOES NOT REPORT ANY PAIN. NO TENDERNESS)))

= NOW ILL TAKE A LOOK INSIDE THE EARS FOR ANY DRAININAGE, LEAKAGE, CERUMEN IS INTACT.

NOW IM GOING TO PERFORM THE WHISPER TEST. CN8 ACOUSTIC NERVE.
(((((stand at the back of patient and have them occlude one 1 ear by pressing on the tragus. WHISPER 2 SYLLABLE WORDS!! DO SAME FOR OTHER EAR CN 8 IS INTACT

WHEN ASSESSING THE EAR, IT IS IMPORTANT TO ASSESS THE WELL EAR FIRST #####

• NOW IM GOING TO INPSECT FOR THE TYMPANIC MEMBRANE. SINCE MY PATIENT IS AN ADULT, IM GOING TO PULL THE PINNA UP AND BACK. (((((FOR A CHILD, THE EAR IS HELD DOWN AND BACK WITH HEAD SUPPORTED AGAINST SURFACE
• THE TYMPANIC MEMNRANE APPEARS SHINY, TRANSLUCENT PEARLY GRAY COLOR.

!!! THE CONE LIGHT REFLEX OF THE OTOSCOPE WOULD BE FOUND AT 5 OCLOCK IN THE RIGHT EAR AND 7 OCLCOK IN THE LEFT EAR

LASTLY ILL GUIDE MY CLINET THROUGH PERFORMING A ROMBER TEST BY HAVING THEM PUT FEETS TOTHER AND CLOSE EYES FOR 20 SECS. PATIENT DOES NOT SWING OR SWAY INDICATING A NEGATIVE ROMBERG TEST