HAPE Integrative Physical Exam Part 1

General Survey

Assessing apparent state of health, level of consciousness, distress or discomfort, facial expression, grooming and hygiene, odors, posture, gait, motor activity, stature, build

Vital Signs

Would obtain height, weight, temperature, pulse, respirations, BP, calculate BMI

Skin/Hair Inspection & Palpation

Inspecting skin of head and face (part hair), palpate face and skull

Head Inspection and Palpation

Inspect and palpate TMJ, palpate ROM when palpating TMJ

Trigeminal Motor Exam

Palpate temporalis and masseters, state assessing cranial nerve five

Trigeminal Sensory Exam

Sharp and dull, light touch, state assessing cranial nerve five

Facial Motor Exam

raise eyebrows, close eyes against resistance, smile, puff out cheeks, state assessing cranial nerve seven

Visual Acuity

Right eye only with Snellen chart, state assessing CN II

VF Confrontation

State assessing visual field deficits

Eye Inspection

Lids and lacrimal apparatus, conjunctiva and sclera, pupils (state each)

Eye Inspection with Light

Cornea, lenses, and irides with oblique lighting, pupillary reaction assessing CN II and III

Eye Exams

EOMS (assessing CN III, IV, VI), convergence, fundal reflex, Fundoscopic exam

Fundoscopic Exam Statement

Inspecting optic disc, vessels and retina, look into light, inspect fovea and macula

Ear Inspection and Palpation

State inspecting auricles, earlobes, tragi, mastoids, palpation needs no statement

Whispered Word Test

State assessing CN VIII, only right ear

Otoscopic Exam

State inspecting ear canals and tympanic membrane

Nose Inspection and Palpation

State inspecting nose, palpate nose and frontal/maxillary sinuses

Nare Patency

Ask patient to occlude one nare at a time and take a breath through nonoccluded nare

Internal Nasal Exam

State inspecting nasal mucosa, turbinates, septum

Inspection of Lips

State inspecting lips

CN XII Assessment

Ask patient to stick out tongue and move side to side, state assessing CN XII

Inspect Mouth and Pharynx

Use light and tongue blade, state inspecting oral mucosa, gums, teeth, hard and soft palate, tonsils and uvula, ask patient to say ah, state inspecting posterior pharynx and CN IX and X

Inspection of Neck and Thyroid

Have patient swallow while visualizing thyroid, states assessing neck and thyroid

Palpation of Neck and Thyroid

Palpate trachea centrally, thyroid from side and behind while swallowing

Carotids

Auscultate with bell while patient holds breath, palpate while feeling for thrills

Palpate Lymph Nodes

Postauricular, preauricular, parotid, tonsillar, submandibular, submental, anterior cervical, posterior cervical, supraclavicular, verbalize each

Cervical Spine ROM

Active flexion, extension, rotation, lateral bending

Assessment of CN XI

Shoulder shrug, head turn, state assessing CN XI

Inspect UE

State inspecting upper extremity

Actions of UE

Assess for turgor on dorsum of hand, palpate radial pulses, assess capillary refill

Shoulder Palpation

State each as palpating: sternoclavicular joint, clavicle, AC join, acromion, coracoid, greater tubercle, bicipital groove, scapula

Shoulder ROM

Forward flexion, extension, internal rotation, external rotation, abduction, adduction

Shoulder Strength Testing

Abduction, I/E rotation against resistance

Elbow Palpation

M/L epicondyles and olecranon, state as palpating

Elbow ROM

Flexion, extension, pronation, supination

Elbow Strength Testing

Elbow flexion and extension against resistance

Palpate Wrist

Distal ulna, radius, radial styloid, distal radioulnar joint, snuffbox, verbalize as palpating

Hand/Finger Palpation

Carpals, metacarpals, MCP joints, fingers, thumbs, verbalize as palpating

Wrist and Hand ROM

Active wrist flexion, extension, ulnar/radial deviation, finger flexion, extension, abduction, adduction, thumb flexion, extension, abduction, adduction, opposition