Basic Head to Toe Assessment Part 2 Including: Neural assessment, cont. General overview of patient Cardiac assessment PerfusionPulses

PRONATOR DRIFT Also known as Pyramidal drift Test identifies the patient’s spatial awareness What is a Pronator Drift?

Positive Drift = 1 arm slowly lowers itself  Positive Pronation = 1 hand pronating  In both cases patient does not control the movement  Positive Pronator Drift = both occur  Arm drifts and hand pronates  Good result = Negative Pronator Drift  Which means that arms do not move  EYES MUST BE CLOSED DURING TESTING What does Positive Pronation mean?

What does PERRLA stand for? Pupils equal, round,reactive to light, and accommodation This testing is better done with lights slightly lowered

Direct Constriction A light is shone into the left eye and the pupil constricts to 2 millimeters in diameter Where is a light shone during Direct Constriction? How large is the constricted pupil during Direct Constriction?

Consensual Constriction A light is shone into the left eye and the pupil in the right eye constricts What does Consensual Constriction mean? WHEN PROBLEMS OCCUR WITH CONSTRICTION ACCOMMODATION MUST BE CHECKED

ACCOMMODATION - procedure  A pen-light is held 10 cm. from the patient’s nose  Patient is staring in one spot away from the light  Patient looks at the pen-light  Eyes should converge and pupils should restrict Explain the Accommodation Procedure?

Accommodation =  Eyes are able to focus from a far away distance to a close distance Accommodation checks for...?

General Overview of Patient The Health Provider assesses the face and looks for:  Sclera is white (white part of eye)  and not bloodshot (red) nor  Yellow (jaundice)  Clean hair  Healthy ear cartilage  Nose is not runny How must the eyes appear during the assessment of the face?

Oral membrane (mouth)  Is a good detector of fluid balance problems  In case of dehydration → mouth looks very dry  A patient’s mouth tells you a lot about his/her general health condition How does the mouth look like in case of dehydration? What does a patient's mouth tell you?

Neck  Look for big jugular veins which are distended What should be checked in the neck area? What are jugular veins?

Assessing Cardiac  PROFUSION → how the heart beats to profuse organs  Assessing Profusion → the patient should be warm and pink and the skin should be dry What is profusion? In assessing Profusion, how should the patient look like?

CAUTION  The entire body must be pink, warm and dry – both the upper and the lower part of the body Good Blood Pressure = Good Profusion Does good blood pressure indicate good profusion?

RADIAL PULSE to access profusion Radial Pulse scale: Grading Force  4+ = strong and bounding  3+ = full pulse, increased  2+ = normal, easily palpable  1+ = weak, barely palpable Can Radial pulse be used to assess profusion?

Where is the Radial Pulse taken?  Straight down from the thumb - lightly place forefinger/index finger and middle finger in the groove near the wrist bone  If difficult to find – reposition  Positive signs to look for:  strenght and regularity/rythm Name the positive signs when taking Radial Pulse?

When Radial Pulse is abnormally irregular or irregular an Apical Pulse must be done When must an Apical Pulse be done?