Patient Assessment Check Off 1

Front 1

Steps of General Survey

Back 1

1. Washes hands with sanitizer upon entering the room
2. Introduces self to patient; first and last name. States reason for being there
Assesses Patient's:
3. mental status - determines orientation to person/place time
4. apparent state of health
5. level of consciousness and state of awareness
6. signs of distress
7. posture
8. dress, grooming, hygiene
9. affect, mood, manner & speech

Front 2

Vital Signs: Blood Pressure

Back 2

10. places cuff properly
11. palpates brachial/radial artery
12. determines BP upper limit by palpation
13. places stethoscope properly
14. determines BP accurately with bell

Front 3

Vital Signs: Pulses

Back 3

15. determines rate and rhythm or 15 or 60"
16. compares radial pulses bilaterally

Front 4

Vital Signs: Respiration

Back 4

17. counts respiration for 15 or 60"
18. interprets rate & pattern (i.e., regualr, tachy/ shallow, deep)

Front 5

Cerebellar Functions: Gait

Back 5

19. normal
20. heel-to-toe
21. toe
22. heel
23. Romberg test (pt's. arms to side, eyes open/closed, 20 to 30 sec)
24. pronator drift test (pt's. arms exteded, palms up, eyes closed, tap down on hands)

Front 6

Cerebellar Functions: Rapid alternating movements bilaterally

Back 6

25. arms rapid alternating movements (hands-to-thighs)
26. thumbs to fingers
27. fingers to nose with eyes pen and closed (finger still and moving)
28. legs rapid alternating movements (foot tap bilaterally)
29. heel to shin (bilaterally)

Front 7

Spine

Back 7

30. inpescts posture and curvature; properly drapes patient
31. palpates spine
*students serving as patinets will provide theiir own drapes (large shirt and towel) for use by student examiner

Front 8

Determines ROM on

Back 8

32. flexion
33. extension
34. lateral bending
35. rotation

Front 9

Skin: inspects

Back 9

36. inspects entirey of skin (note - for lab and taping, inspect only exposed skin)

Front 10

Skin: palpates entirety of skin, noting:

Back 10

37. color and any lesions
38. temp and moisture
39. texture, turgor, and mobility
40. nail beds - both hands and feet
41. dons gloves for examination of lesions if present (states)

Front 11

Upper Extremities (UEs)

Back 11

42. inpects bilateral upper extremities

Front 12

UEs: Palpates bilateral UEs

Back 12

43. digit joints
44. wrists
45. elbows
46. shoulders
47. muscles

Front 13

UEs: Determines ROM of bilateral UEs fingers

Back 13

48. flexion
49. extension
50. spreading

Front 14

UEs: determines ROM of bilateral UEs wrists on

Back 14

51. flexion
52. extension
53. radial & ulnar deviation

Front 15

UEs: Determines ROM of bilateral UEs elbows on

Back 15

54. flexion
55. extension
56. pronationn
57. supination

Front 16

UEs: Determines ROM of bilateral UEs shoulders on

Back 16

58. flexion
59. extension
60. abduction
61. adduction
62. internal rotation
63. external rotation

Front 17

UEs: determines muscle strength on bilateral UEs (neuro)

Back 17

64. handgrip
65. wrist flexion
66. wrist extension
67. elbow flexion
68. elbow extension
69. shoulder flexion
70. shoulder extension
71. shoulder adduction
72. shoulder abduction
73. shoulder shrugging (CN XI)