Midterm Physical Assessment

introduction

Hi my name is Caitlin I will be your nurse.
- hand hygeine

• patient identification

• explain what you are doing

inspect

symmetry, skin color appropriate

patient is awake and alert and relaxed, making eye contact

scalp and hair

even hair distribution and volume

scalp is mobile

tempromandibular joint

palpate

frontal and maxillary sinuses + facial bones

lacrimal glands

on forehead and below eyes

below eyebrows

inspect eyes, brows, sclerae

mouth

inspect oral mucosa (cheeks, teeth, gums)

tonsils : +1 normal, describe palate and pillars

check bite

mouth cranial nerves

smile and puff out cheeks (CNVII - facial)

stick out tongue, move side to side (CNXII - hypoglossal)

say Ah (CNIX and CNX - glossopharyngeal and vagus)

neck

ROM - 4 directions, 2 directions with resistance

shoulder shrug with resistance (CNXI - accessory)

lymph nodes

preauricular (front ear), postauricular (behind ear), occipital (below ear in back), tonsillar, submandibular (jaw), submental (chin), superficial cervical (right under jaw in front of jugular), posterior (neck spinal chain) and deep cervical (below jugular), supraclavicular (deep spot above collarbone), infraclavicular (under clavicle, next to armpit)

trachea + thyroid

trachea is midline

thyroid:

• Stand directly behind the sitting patient.

• Ask them to tilt their head slightly forward and down to relax the neck muscles (sternocleidomastoid muscles).

• Place the finger pads of both your hands on the front of the patient's neck.

• Locate the cricoid cartilage (the firm ring of cartilage just below the thyroid cartilage / Adam's apple). The thyroid gland sits just beneath this ring.

• To check the right lobe: Use your left hand fingers to gently push the trachea (windpipe) slightly to the patient's right. This pushes the right thyroid lobe out so it is easier to feel. Place your right hand fingers just out from the windpipe and feel for the tissue.

• To check the left lobe: Do the opposite. Use your right hand fingers to gently push the trachea to the patient's left, and use your left hand fingers to feel the left lobe.

• ask patient to swallow

face sensation

CNV - trigeminal

Test light touch sensation- forehead, cheeks, chin

ears

Inspect and palpate the auricles (tragus, mastoid and pull helix forward)

Inspect the external auditory canals and tympanic membranes with otoscope (describe)

• pearly gray, cone of light R 5o’clock L 7o’clock

evaluate hearing

whisper test

rinne - side of ear (normal air > bone)

• abnormal: sensorineual is air > bone. conductive is bone > air

weber - top of head (same in both ears)

• abnormal: hear more in affected ear conductive. hear more in normal ear sensorineural

takes care of CNVIII - vestibulococlear (auditory)

nose

look in nostril with light

findings: striaght septum, pink moist mucosa, intact turbinate tissue

sense of smell with coffee or whatever (CN1 - olfactory)

eyes

start with snellen

penlight : accomodation and light reflex

corneal light reflex - the sparkle in your eye

eyes cranial nerves

EOM - CNIII, CNIV, CNVI - oculomotor, trochlear, abducens

peripheral vision and retina inspection with the red reflex - CNII - optic