Head to Toe

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Head to Toe
2011-04-06 19:19:29
Head Toe Checkoff

Head to Toe Checkoff
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  1. Skin
    • Pt removes shirt.
    • Inspect: Skin color/integrity
    • (head, trunk, limbs – tan, intact, no cyanosis/jaundice. No lesions, moles, scars, tattoos, piercings, no venous distention).

    • Palpate: Skin temperature (dorsal surface of hand), moisture, texture, turgor.
    • (smooth, warm, dry with good turgor)
  2. Hair
    • Inspect & Palpate: Hair
    • Shaved, shadow of new growth terminal hair.
    • Scalp - no hair loss, scars, inflammation, redness.

    Body - vellus hair (arms, legs, back, shoulders; more coarse on chest and abdomen)
  3. Nails
    • Inspect: Nails (hands & feet)
    • Short, well-groomed, smooth, light pink, flat w/round edges, no ridging/pitting, adhered to nail bed.
    • Base/angle = no clubbing.

    Palpate: Cap refill (fingers/toes) < 3 seconds
  4. Head
    • Inspect:
    • Head = erect, midline, oval.
    • Facial features = symmetrical, appropriately sized
  5. Cranial Nerve V: Trigeminal. Sensory/Motor
    • Inspect for muscle atrophy, tremors.
    • Palpate jaw muscles for tone/strength when pt clenches teeth.
    • Use cotton ball/paper clip to test superficial pain & touch.
  6. Cranial Nerve VII: Facial. Sensory/Motor
    • Symmetry of facial features with expression.
    • Pt smile, frown, puff cheeks, wrinkle forehead.
    • Able to taste salty & sweet. Are you able to taste salty and sweet?
  7. Neck
    • Inspect/Palpate:
    • Neck - fullness
    • Trachea - midline
    • Thyroid - swallow (smooth, no nodules)
    • Carotid pulse - 2+ bilaterally

    • Auscultation:
    • Carotid arteries - bruits (bell, light pressure)
  8. Lymph - Head & Neck
    • Inspect/Palpate:
    • Preauricular
    • Post-auricular
    • Tonsillar
    • Submandibular
    • Submental
    • Anterior cervical
    • Posterior cervical
    • Supraclavicular
    • (nonpalpable, no redness, tenderness, or inflammation)
  9. Lymph - Axilla, epitrochlear, inguinal & popliteal
    • Inspect/Palpate:
    • Axillary nodes - Are you aware of any lumps?
    • Epitrochlear
    • (nonpalpable, no redness, tenderness, or inflammation)

    • Verbalize:
    • Palpate inguinal nodes (femoral areas) and popliteal nodes (behind the knees) bilaterally
    • For palpable nodes, tenderness, redness, or inflammation
  10. Eyes
    • Inspect: Eyelid, eyeball, conjunctiva, iris, pupil, lens, sclera, & lacrimal apparatus (bilateral)
    • Test: Direct/consensual light response (pupil response)
    • Test: EOMs (move eyes in 6 cardinal fields without nystagmus)
    • Test: Corneal light reflex (light reflected symmetricially in both eyes)
    • Verbalize: Snellen chart = distance vision, Rosenbaum chart = near vision
    • Ophthalmoscope exam: Red reflex, macula (yellow dot surrounded by deep pink background)
  11. Cranial Nerve II: Optic. Sensory.
    • Vision tested with Snellen
    • Ophthalmoscope exam of fundi
  12. Cranial Nerve III, IV, & VI: Oculomotor, Trochlear, Abducens. Motor.
    • EOMs in 6 cardinal fields of vision
    • Inspection of eyelids for drooping
    • Pupil size for equality and direct/consensual response to light and accommodation
  13. Ears, Nose, & Throat:
    • Inspect & Palpate: Auricles, mastoid, auditory meatus, alignment (equal size, appearance, alignment with inner canthus of eyes, smooth skin without tags/lesions, no discharge/odor, tenderness, or pain on palpation of tragus/mastoid)
    • Otoscope exam: auditory canal/TM for color/landmarks (minimal cerumen, hair along outer 1/3, canal pink; TM & malleus pearly gray/translucent)
    • Test: auditory acuity - whisper test
  14. Cranial Nerve VIII: Acoustic. Sensory
    • Hearing and equilibrium
    • Whisper test
    • Weber and Rinne tests
  15. Ears, Nose, & Throat:
    • Inspect & Palpate: Nose bilaterally.
    • Nares - size, discharge (nares symmetrical, no discharge)
    • Nasal cavity, septum, middle meatus, turbinates (nasal cavity mucosa, meatus, and turbinates deep pink and moist)
  16. Cranial Nerve I: Olfactory. Sensory
    • Sense of smell
    • Are you able to smell coffee?
  17. Ears, Nose, & Throat:
    • Inspect & Palpate:
    • Frontal, ethmoid, maxillary sinuses bilaterally
    • (no swelling or tenderness on palpation)
  18. Ears, Nose, & Throat:
    • Inspect & Palpate: Lips
    • Color, symmetry, characteristics
    • (pink, symmetrical, smooth)
  19. Ears, Nose, & Throat:
    • Inspect:
    • Mouth, mucosa, gums, teeth, oral cavity, tongue, hard palate, uvula (say "ah"), oropharynx
    • Mucosa/oral cavity = pink, moist
    • Gums = pink, tight margins at teeth
    • Teeth = ivory, 30 teeth, firmly anchored
    • Tongue = midline, no fasciculations, dull red color, moist, without masses, lesions, scars, swelling, or discoloration
    • Uvula = midline w/elevation of soft palate
    • Tonsils = 1+ bilaterally
    • Oropharynx/hard palate = without redness, swelling, or lesions
  20. Cranial Nerve IX & X: Glossopharyngeal & Vagus. Sensory/Motor.
    • Ability to taste sour/bitter
    • Swallow
    • Symmetry of uvula
    • Gutteral speech sounds
  21. Cranial Nerve XII: Hypoglossal. Motor.
    • Stick out tongue
    • Say "light, tight, dynamite" to test lingual speech
  22. Chest
    • Inspect:
    • Chest landmarks - Anterior, lateral, posterior chest
    • Respiratory pattern and movement
    • (ratio of AP to transverse diameter = 1:2, chest movement symmetrical, respirations = regular, even, unlabored, and symmetrical)
  23. Chest
    • Percuss: Anterior, posterior, lateral chest
    • Auscultate: Breath sounds, verbalizing sounds heard
    • (bronchovesicular medially, vesicular laterally, no adventitious breath sounds)
    • Verbalize: Difference between bell & diaphragm
    • (bell transmits low frequency sounds; diaphragm transmits higher frequency sounds)
  24. Heart
    • Pt supine
    • Inspect: Chest wall - pulsations, heaves, thrusts
    • Palpate: Precordium, apical impulse (Left 5th ICS, MCL)
  25. Heart
    • Auscultate:
    • Aortic - Right 2nd ICS, Right sternal border, S2>S1
    • Pulmonic - Left 2nd ICS, Left sternal border, S2>S1
    • Erb's Point - Left 3rd ICS, Left sternal border, S2=S1
    • Tricuspid - Left 4th ICS, Left sternal border, S1>S2
    • Mitral - Left 5th ICS, MCL, S1>S2 at the apex

    • Verbalize: Rate, rhythm, splitting, murmurs
    • (rate=64, rhythm=regular, no splitting or murmurs)
  26. Blood Vessels
    Palpate: Temporal, brachial, radial, posterior tibial, dorsalis pedis pulses bilaterally

    (pulses are 2+ bilaterally for temporal, brachial, radial, posterior tibial, and dorsalis pedis pulses)
  27. Abdomen
    Inspect: Contour, color, symmetry, surface motion, venous patterns

    (flat, tan, symmetrical, surface motion smooth & even with respirations, venous return toward head above umbilicus and toward feet below umbilicus)
  28. Abdomen
    • Auscultate: Bowel sounds in all 4 quadrants, verbalize
    • (audible & active in all 4 quadrants)
    • Percuss: Liver, spleen, gastric bubble
    • (dullness to percussion over liver & spleen; tympany over stomach)
  29. Abdomen
    • Palpate: Epigastrum for aortic pulsation
    • (aortic pulsation palpable in epigastrum)
    • Palpate: Liver, spleen, kidneys
    • (liver, spleen, & kidneys nonpalpable)
    • Pt in sitting position
    • Percuss: CVA tenderness
    • (no CVA tenderness on percussion)
  30. MSK
    • Verbalize: Inspection of gait (upon pt entering room)
    • Inspect: Posture (erect)
  31. MSK:
    Active ROM of upper body:
    • Hands: thumb opposition, finger abduction/adduction, wrist extension, hyperextension
    • Elbows: flexion/extension
    • Shoulders: shrug against resistance, forward flexion (forward then up over head), hyperextension (extend & stretch behind back), abduction (laterally over head)
    • Neck: forward flexion (chin to chest), hyperextension (back looking at ceiling), lateral bending (ear to shoulder), rotation (side to side, chin to shoulder against resistance
    • T&L Spine: forward flexion (touch toes), hyperextension (bend back at waist), lateral bending (side to side), rotation (turning at waist)
  32. Cranial Nerve XI: Spinal Accessory: Motor.
    • Turning head and shrugging shoulders against resistance.
  33. MSK:
    Active ROM of Lower body
    • Pt supine
    • Hips & Knees: flexion, knee extended (raise leg over body); flexion, knee flexed (raise one knee to chest, while keeping other leg straight; abduction/adduction
    • Feet: dorsiflexion (point toward ceiling), plantar flexion (point toward floor), flexion/extension (bend & straighten toes)
  34. Neuro
    • Cranial nerves - covered in appropriate body sections
    • Evaluate coordination:
    • Rapid alternating rhythmic movement: Finger-to-nose test
    • Sensory:
    • Superficial touch (cotton ball to various bilateral areas of body)
    • Vibration (vibrating tuning fork to areas of body on bony prominences)
  35. Neuro
    • Deep Tendon Reflexes: (name and elicit reflex correctly)
    • Brachial
    • Brachioradial
    • Triceps
    • Patellar
    • Achilles