Head to Toe Assessment Patient: ____________________________________ Neurological State full name & DOB?

Where are you right now? Date or president?

Correct Correct Correct Incorrect Incorrect Incorrect

Review of Systems Are you having any pain right now? Yes No *If yes: 1 2 3 4 5 6 7 8 9 10 *If yes, where? ______________________________ How is your appetite? Good Fair Poor Any trouble going to the bathroom? Yes No *If yes Do you need assistance? Yes No Are you having any shortness of breath? Yes No Vitals Blood Pressure: ____________________ Pulse Rate: ________________________ Pulse Force: 3-bounding 2-normal 1-weak Respirations: ______________________ Temperature: ______________________

Abdomen- inspect shape, symmetry, visible pulse/peristalsis -Bowel Sounds-all four quadrants? Yes No * If no, then which quadrant is absent? 1 2 3 4 -Light Palpation Does this hurt anywhere? Yes No * If yes, where?____________________________________ -Deep Palpation Does this hurt anywhere? Yes No * If yes, where?____________________________________ BMs: when, consistency, color, normal for you? ________________________________________________ Extremities/pulses- inspect color, temp, appearance Carotids Yes No Brachials Yes No Radials- equal Yes No Capillary refill ____________________________________ Squeeze my fingers? (Equal?) Yes No Posterior tibial-equal Yes No 3-bounding 2-normal 1-weak 0-absent Dorsal pedis-equal Yes No 3-bounding 2-normal 1-weak 0-absent Push feet down on my hands? Yes No Pull toes up? Yes No Skin Breakdown or bruising? Yes No Skin color? Normal Abnormal Edema? Yes No * If yes, indicate: 1-mild 2-moderate 3-deep 4-very deep Notes:

0-absent

Head/scalp Hair distribution even? Yes No Lesions Yes No Eyes (Pupils) Equal? Yes No Round? Yes No React to Light? Yes No Accommodation? Yes No Size (in mm) ________ Mouth Dentures Yes No *If yes, any problems? _____________________________ Lesions, sores? Yes No Anterior/Posterior Chest- symmetry, pulsations, shape Spinous processes straight? Yes No Lungs Take a deep breath for me, in & out please? (mouth open) Normal Abnormal -Breath Sounds- __________________________________ Cough- _________________________________________ Carotids-bruits present Yes No Heart Exam -Aortic Normal Abnormal -Pulmonic Normal Abnormal -Erbs Point Normal Abnormal -Tricuspid Normal Abnormal -Mitral Normal Abnormal *Apical pulse 1 min ______________________________