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THE PHYSICAL EXAMINATION HEAD TO TOE ADULT ASSESSMENT.

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Presentation on theme: "THE PHYSICAL EXAMINATION HEAD TO TOE ADULT ASSESSMENT."— Presentation transcript:

1 THE PHYSICAL EXAMINATION HEAD TO TOE ADULT ASSESSMENT

2 GENERAL SURVEY (OBSERVATION) APPARENT SIGNS OF RESPIRATORY OR OTHER DISTRESS? APPARENT SIGNS OF RESPIRATORY OR OTHER DISTRESS? LEVEL OF CONSCIOUSNESS, AWARENESS LEVEL OF CONSCIOUSNESS, AWARENESS MOOD & BEHAVIOR MOOD & BEHAVIOR SPEECH CLARITY SPEECH CLARITY ASSESS SKIN (COLOR, TEMP., MOISTURE ASSESS SKIN (COLOR, TEMP., MOISTURE ODORS (ALCOHOL, KETONE, URINE, ETC) ODORS (ALCOHOL, KETONE, URINE, ETC)

3 EXAMINING THE HEAD AND NECK (INSPECTION, PALPATION, AUSCULTATION) INSPECT: INSPECT: FOR OBVIOUS INJURY/DEFORMITY FOR OBVIOUS INJURY/DEFORMITY CHECK PUPILS CHECK PUPILS OBSERVE FOR DISCHARGE (FROM EYES, EARS, NOSE, MOUTH) OBSERVE FOR DISCHARGE (FROM EYES, EARS, NOSE, MOUTH) OBSERVE ORAL, PHARYNGEAL CAVITIES,TEETH OBSERVE ORAL, PHARYNGEAL CAVITIES,TEETH INSPECT NECK (VEIN DISTENTION, ENLARGED NODES, SYMMETRY) INSPECT NECK (VEIN DISTENTION, ENLARGED NODES, SYMMETRY)

4 Examining the head & neck (cont.) PALPATE: PALPATE: SCALP SCALP FACIAL BONES FACIAL BONES LYMPH NODE LOCATIONS (SUBMANDIBULAR, SUBMENTAL, PRE AND POST AURICULAR, CERVICAL) LYMPH NODE LOCATIONS (SUBMANDIBULAR, SUBMENTAL, PRE AND POST AURICULAR, CERVICAL)

5 Examining the head & neck (cont.) AUSCULTATE: AUSCULTATE: CAROTID ARTERIES FOR BRUITS CAROTID ARTERIES FOR BRUITS

6 EXAMINING THE CHEST AND BACK INSPECT: INSPECT: FOR OBVIOUS INJURY, DEFORMITY,SKIN ABNORMALITIES (SUCH AS DECUBITI) FOR OBVIOUS INJURY, DEFORMITY,SKIN ABNORMALITIES (SUCH AS DECUBITI) OBSERVE RESPIRATIONS, CHECK FOR EQUAL CHEST EXPANSION BILATERALLY OBSERVE RESPIRATIONS, CHECK FOR EQUAL CHEST EXPANSION BILATERALLY OBSERVE FOR CONTOUR AND SYMMETRY OBSERVE FOR CONTOUR AND SYMMETRY

7 Examining the chest & back (cont.) Palpate: Palpate: Clavicles, supra and sub clavicular lymph node areas Clavicles, supra and sub clavicular lymph node areas Axillae Axillae Ribs, spine, check for sacral edema Ribs, spine, check for sacral edema

8 Examining the chest & back (cont.) Auscultate: Auscultate: Breath sounds in all five lung lobes, resp- Breath sounds in all five lung lobes, resp- iratory rate, depth,rhythm.Wheezing? On inspiration or expiration or both? Cough? Productive or nonproductive? iratory rate, depth,rhythm.Wheezing? On inspiration or expiration or both? Cough? Productive or nonproductive? Heart sounds (aortic, pulmonic, Erb’s, tricuspid, mitral areas), S1 and S2. Check heart rate: regular? Regularly irregular? Irregularly irregular? Heart sounds (aortic, pulmonic, Erb’s, tricuspid, mitral areas), S1 and S2. Check heart rate: regular? Regularly irregular? Irregularly irregular?

9 Examining the chest & back (cont.) Percuss: Percuss: Chest periphery Chest periphery Costoverterbral angles Costoverterbral angles

10 EXAMINING THE ABDOMEN INSPECT: INSPECT: FOR OBVIOUS INJURY, SCARS, RASH FOR OBVIOUS INJURY, SCARS, RASH FOR DISTENTION FOR DISTENTION FOR ASYMMETRY, MASSES, HERNIAS FOR ASYMMETRY, MASSES, HERNIAS OBSERVE FOR PULSATIONS, VISIBLE PERISTALSIS OBSERVE FOR PULSATIONS, VISIBLE PERISTALSIS INSPECT EXTERNAL GENITALIA INSPECT EXTERNAL GENITALIA

11 Examining the Abdomen (cont.) Auscultate: Auscultate: All four quadrants for bowel sounds All four quadrants for bowel sounds For bruit over the abdominal aorta For bruit over the abdominal aorta

12 Examining the Abdomen (cont.) Palpate (gently!) Palpate (gently!) For pain, rebound tenderness, guarding For pain, rebound tenderness, guarding Liver margin, spleen Liver margin, spleen Carefully palpate any hernias Carefully palpate any hernias Check femoral pulses Check femoral pulses

13 Examining the Abdomen (cont.) Percuss: Percuss: For fluid, motion For fluid, motion All four quadrants, noting sounds All four quadrants, noting sounds

14 EXAMINING THE EXTREMITIES INSPECT: INSPECT: OBSERVE FOR SYMMETRY, OBVIOUS DEFORMITY OBSERVE FOR SYMMETRY, OBVIOUS DEFORMITY FOR GAIT, RANGE OF MOTION FOR GAIT, RANGE OF MOTION OBSERVE SKIN FOR COLOR, CONDITION OBSERVE SKIN FOR COLOR, CONDITION OBSERVE NAILS FOR COLOR, CONDITION OBSERVE NAILS FOR COLOR, CONDITION OBSERVE FOR INVOLUNTARY MOVEMENTS OBSERVE FOR INVOLUNTARY MOVEMENTS OBSERVE FOR EDEMA OBSERVE FOR EDEMA

15 EXAMINING THE EXTREMITIES PALPATE: PALPATE: UPPER EXTREMITIES: RADIAL, BRACHIAL PULSES, COMPARE UPPER EXTREMITIES: RADIAL, BRACHIAL PULSES, COMPARE CHECK GRIP, STRENGTH BILATERALLY CHECK GRIP, STRENGTH BILATERALLY LOWER EXTEMITIES: PERIPHERAL PULSES:POPLITEAL, DORSALIS PEDIS, POSTERIOR TIBIAL; COMPARE BILATERALLY LOWER EXTEMITIES: PERIPHERAL PULSES:POPLITEAL, DORSALIS PEDIS, POSTERIOR TIBIAL; COMPARE BILATERALLY EVALUATE SENSATION IN ALL EXTREMITIES EVALUATE SENSATION IN ALL EXTREMITIES ASSESS FOR PITTING EDEMA ASSESS FOR PITTING EDEMA PERFORM HOMAN’S SIGN EXAM; CHECK FOR CALF TENDERNESS, PAIN, HEAT PERFORM HOMAN’S SIGN EXAM; CHECK FOR CALF TENDERNESS, PAIN, HEAT

16 EXAMINING THE EXTREMITIES PERCUSS: PERCUSS: DEEP TENDON REFLEXES DEEP TENDON REFLEXES


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