Head-to-Toe Assessment

Question 1

EYES

Answer 1

inspect cornea, iris, lens
color of conjunctiva, sclera
test visual acuity
determine if gaze is conjugate, symmetrical
corneal light reflex test
cover/uncover test
visual fields

Question 2

EARS

Answer 2

whisper test

Question 3

NOSE

Answer 3

check for nasal deviation and polyps

note color and condition of nasal mucous membranes

Question 4

MOUTH

Answer 4

say "aah" to view posterior pharynx
upper/lower lips
tongue, including underside
note size, position, symmetry of tonsils
lift upper lip to examine upper teeth
note quality of voice

Question 5

NECK

Answer 5

check mobility, lymph

check for nuchal rigidity

Question 6

RESPIRATORY

Answer 6

don’t rush to use the stethoscope
note breathing when child is distracted
note effort/work of breathing (flaring, grunting)