Physical Assment Return Demo 1

Front 1

What is the first thing we do after we check vitals?

Back 1

examin neck

Front 2

What is the first thing we do when examining the neck?

Back 2

We intro our selves then we wash our hands and begin to inspect and palpate the neck for deformities.

Front 3

After we check for deformites what do we inspect next with the neck?

Back 3

Inspect ROM of neck
Chin to chest (extension)

Extend head back (hyperextension)

Ear to shoulder(lateral bending)

Chin to shoulder (rotation)

Front 4

After we check for ROM of neck what do we do?

Back 4

We check for stregth of the neck (testing CNXI).
We do all the steps for ROM but against resistence.

Chin to chest (extension against resitence)

Extend head back(hyperextension againt resitence)

Ear to shoulder (lateral bending against resistance)

Chin to shoulder (rotation against resistance)

Front 5

What is the last step we do with the neck?

Back 5

Palpate and grade one cartorid at a time.

Front 6

In summary what are all the steps we must do with the neck after vitals are taken?

Back 6

Inspect and palpate neck for deormities
ROM OF NECK
a) Chin to chest - flexion (.25)
b) Extend head back - hyperextension (.25)
c) Ear to shoulder - lateral bending (.25)
d) Chin to shoulder - rotation (.25)
3. STRENGTH OF NECK (CNXI)
a) Chin to chest, against resistance - flexion (.25)
b) Extend head back against resistance - hyperextension (.25)
c) Ear to shoulder against resistance - lateral bending (.25)
d) Chin to shoulder against resistance - rotation (.25)
4. Palpate carotid pulses - one side at a time (1)

Front 7

After inspecting the neck what is the next field that we inspect?

Back 7

The lungs/ thorax

Front 8

What is the first step we do with the lungs?

Back 8

We step behind Pt. tell them we are going to examine their back and open the back of the gown carful not to expose to much.

Front 9

After we open the gown what do we do?

Back 9

We inspect the postier chest and NOTE: Shape, configuration, and skin.

Front 10

After inspection of the postier back what step is next?

Back 10

We palapate the back for
Tenderness
Masses on ribs
Soft tissue

Front 11

After palpating the postier back what is next?

Back 11

We Palpate for respitory expansion at the CVA.
1. Tell patient that your going to place your hands on her postier chest wall so you dont startle her.
2. Place your hands wher the bottom of the chest wall is the CVA and make sure to have applied enough preasure to fold her skin on her back.
3. When she inhals the folds should straighten equally and NOTE: equal bi lateral expansion.

Front 12

Befor taking vitals what is the first thing we do?

Back 12

Introduce your self and wash your hands.

Front 13

After palpating for respitory expansion of the postier chest what is next?

Back 13

We chec for tactile frematis
1. Have pt. hands on shoulders to increase the area of lung field.
2. Using the Karte chop place your hands on back laterally and have pt. repeat 99. Do not go straight down, follow the lung fields. Make sure you know where the lungs are best to inspect on postier and anterior.

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Front 14

After Tactile fremits what is next?

Back 14

We percuss the appropriate lung fields comparing each side as we go down.

Front 15

After Percussion what step is next?

Back 15

Auscultation
We ausculate the lungs in the appropriate lungs fields on the back. We have them take a deep breath in every spot. We switch off between left and right to compare the lung sounds.

Front 16

After percussion of the postier back what step is next?

Back 16

Auscultation,
Use the diaphram of the stethescome, do not place finger on bell.
Auscultate all the appropriate lug fields (know them).
Note: they are symetrical

Front 17

After assesing the postier ches what is next?

Back 17

We have ly down in supine position and reveal there chest to begin antior chest exam. Make sure you ask the a proffessor how exactly they want to us to expose the antior chest. Do we leave the posterior open ext?

Front 18

What is the first step when inspecting the Anterior chest?

Back 18

Inspection
Ispect and NOTE: shape, configuration, and skin.

Front 19

AFter initial insection what is next?

Back 19

inspect for use of accessory muscles, they should not be using them.

Front 20

what do we do after inspection of antior chest?

Back 20

Palpate for tenderness and masses on ribs, also for soft tissue.

Front 21

After palpating for tenderness ofthe antirior chest what do we do?

Back 21

We palapter for respiratory expansion of the anterior chest.
1. First palpate for lateral respiratory expansion, place hands on upper abdominal area and ask pt. to take a deep breath and NOTE: that the lungs expand bi lateraly.
2. We Palpate for Antro posterior expansion lay both hands on the left and right of the stirnum and ask pt. to take a deep breath and note if the each side goes up equally.

Front 22

After Respiratory expansion of of the chest what do we do?

Back 22

We check for tactile frematis in generally the same areas we check for purcussion and ausculation.

Front 23

After tactile fremitis of the anterior chest what do we do?

Back 23

We perform percusion in the the percussable lung fields.

Front 24

After performing percussion of anterior chest what do we do?

Back 24

We Auscultate in appropriate fields.

Front 25

In summray what is everything we do for the anterior and posterior chest?

Back 25

. Step behind person - open back of the gown and expose back (3.5 points)
1. Inspect posterior chest. Note shape, configuration, skin (.5)
2. Palpate for tenderness, masses on ribs, soft tissue (.5)
3. Palpate for respiratory expansion (.5)
4. Palpate for tactile fremitus (.5)
5 Percuss lung fields at ICS (.5)
6. Auscultate breath sounds and compare symmetrical areas (1)
D. Move around to face person and expose the anterior chest (6.0 points)
1. Inspect anterior chest. Note shape, configuration, skin (.5)
2. Use of accessory muscles (.5)
3. Palpate for tenderness and masses on ribs and soft tissue (.5)
4. Palpate for respiratory expansion (.5)
5. Palpate for tactile fremitus (.5)
6. Percuss lung fields at ICS (.5)
7. Auscultate breath sounds and compare symmetrical areas (1)

Front 26

After accessing the Neck and Lungs what do we access next?

Back 26

We access the Shoulders, Arms, and Hands.

Front 27

What is the first thing we do when accessing the shoulders?

Back 27

Inspect the shoulders, arms, and hands for symmetry, contour, redness, and clubbing.

Front 28

After inspecting Shoulders, arms, and Hands what do we do next?

Back 28

We palpate them for tenderness, swelling, heat, and capillary refill.

Front 29

After the brief inspection and plapation of shoulders, arms, and hands what comes next?

Back 29

Checking the ROM of the shoulders.

Front 30

What is involved in checking the ROM of the shoulders?

Back 30

Forward flextion against RESISTANCE, (both arms forward and up.

Front 31

After shoulder flexion what is next?

Back 31

Shoulder hyperextension with no resistance. Bring arms as far back as you can.

Front 32

After hyperextension of the shoulder what is next?

Back 32

Internal rotation. This is when you try to reach your hands up your back. Kinda like your your in handcuffs.

Front 33

After internal rotation of the shoulder what is next?

Back 33

External rotation, When you put your hands behind your head, like your being arrested.

Front 34

What is next after internal and external rotation?

Back 34

Abduction and adduction. Abduction is when you reach your hands up over your head and have your palms overlap. Adduction is when you bring your arms back down in the same motion. Look for any lagging or pain.

Front 35

After adduction and abduction what is next?

Back 35

The shoulder shrug against resistance.

Front 36

What is a quick overview of what we do with the shoulders?

Back 36

Inspect shoulders, elbows, wrists hands ,fingers for symmetry of
size, contour, redness ,clubbing (1)

Palpate shoulders, elbows, wrists, hands ,fingers for tenderness,
swelling, heat and capillary refill (1)

ROM AND STRENGTH OF SHOULDER (2.75 points)

Forward flexion against resistance (extend both arms forward and up)

Hyperextension (extend both arms backward) (.5)

internal rotation (reach hands up behind back (.5)
External rotation (hands behind head) (.5)

Abduction against resistance (hands over head, palms touching) (.25)
Adduction (swing arm across front of body) (.25)

Shrug shoulders against resistance (.25)

Front 37

After accessing the shoulders what do we access?

Back 37

We access the elbows and the wrist