1.

Head To Toe Assessment Checklist Client Initials

Vital Signs Time T P R B/P Manual/Electric Location Body Position

Upper Extremities Skin Color Skin Temp Turgor(Chest) Radial Pulses Capillary refill Handgrip Movement ROM

Lower Extremities Skin Color Skin Temp

Pedal Pulses Capillary refill

Movement ROM Hohmans Sign

Oxygen Oximetry Liters/Minute Room Air

Nasal Cannula Mask

IV/Saline Loc Solution Rate Site Redness Irritation Edema

Pain Pain Location Duration Scale (1 10) Intervention Evaluation (within 30 minutes)

Mental Status Alert Person Place Time

Apical Pulse Rate Regular Regular Irregularity Irregular Irregularity

Elimination Voiding freely Continent/incontinent Foley Patent

Color Clarity

BM Continent/incontinent Color Consistency Amount

Pupils Left Right P E R R L A

Breath Sounds Anterior/Posterior L Upper Middle Lower Inspiratory/Expiratory

Dressing Location Clean Dry Intact Drainage Color Amount Odor Consistency

Mucous Membranes Moist Pink

Abdomen Soft Round Non Tender LUQ RUQ LLQ RLQ

Miscellaneous Pt in bed Low position Siderails up Call light within reach Special equipment