You are on page 1of 17

Head to Toe Assessment Hand Hygiene Assemble All Equipment Prior to Exam Wear Gloves Communicate with Patient

(any pain, etc.) Provide Privacy Vital Signs and Skin Assessment
Blood pressure: Two-step; elbow flexed at heart level. Oral temperature Respirations: Count for minimum of 30 seconds Pulse: Count for minimum of 30 seconds

Inspection/Palpation of Skin
Color/Pigmentation o Color is pinkish-tan to ruddy dark tan o Note any freckles, moles or birthmarks o If any freckles, moles, or birthmarks noted, they are normal if they are symmetric, with regular borders, no color variation, no elevation or enlargement, and a diameter of less than 6 mm (pencil eraser). Moisture/Dryness o No diaphoresis, skin warm, dry and intact o Warm to touch, dry, smooth and even Skin Growths/Masses/Lesions o No skin growths/masses/lesions Texture o Skin feels smooth and firm, with an even surface. Turgor o Pinch a large fold of skin an note ability to return to place promptly when released. o Turgor good, no tenting Shape of nails/Nail bed color o Nail base firm to palpation o Nail surface slightly curved and smooth; thickness is uniform o Surface smooth and regular, not brittle or splitting o No clubbing or deformities o Nail bed is pink and even colored; no cyanosis o Capillary refill less than 2 seconds

General Palpation
Temperature changes o Use backs of hands to palpate; check bilaterally o Skin should be warm and temperature equal bilaterally o Skin should be cool or warm Edema o Imprint thumbs against ankle or tibia o Skin surface should stay smooth, with no denting or edema o Look for edema in lower extremities, sacrum

Head/Face Cranial Nerve 7Facial Nerve Pt smiles, frowns, wiggles eyebrows, shows teeth, puffs cheeks
Inspect and palpate the skull o Note contour and shape/size Normocephalic skull, denotes a round symmetric skill that is appropriately related to body size. Inspect and palpate scalp and hair To assess shape, place fingers in the persons hair and palpate the scalp. Skull feels symmetric and smooth. No tenderness to palpation. Palpate temporal artery above the zygomatic (cheek) bone between the eye and the top of the ear. Inspect and palpate the face for: o Color o Pinkish red, even toned. o TMJ joint mobility as Pt opens and closes mouth TMJ just below the temporal artery and anterior to the tragus. Palpate the joint as the person opens the mouth, and note normally smooth movement with no limitation or tenderness. o Expressions, frowns, smile, puff out cheeks, raise eyebrows Facial expression is appropriate to behavior or reported mood. Facial structures should be symmetric. Symmetry of eyebrows, nasolabial folds, sides of mouth. CN VII: Facial Function -- Facial Expression/Sense of Taste Test: Have Pt smile, wrinkle face, puff cheeks, wiggle eyebrows o Movements/Symmetry Head is positioned centered in the midline, and the accessory neck muscles are also symmetric. Ask Pt to touch chin to chest, turn head to the right and left, and try to touch ear to the shoulder without elevating shoulders, and to extend the head backwards. Motion should be smooth and controlled. Test CN XI by trying to resist the persons movements with our hands as the person shrugs the shoulders. o Sensory Touch cotton ball to Pts face

Nose Cranial Nerve 1Olfactory Nerve ID odor on each side of the nose
Inspect and palpate the nose: o Contour Nose is symmetric, in he midline and in proportion to other facial features. No defornities, inflammation or skin lesions. o Nares patency Push each nare shut while asking the person to sniff through the other open nare. o Olfactory (CN1) Ask Pt to close eyes and ID two different smells, one in each nostril. Inspect the nose with the otoscope and view each nasal cavity with the persons head slightly tilted back. Inspect the nasal mucosa, noting its normal red

color and smooth moist surface. No swelling, discharge, bleeding or foreign bodies. Turbinates intact with no swelling or lesions. No deviation of the septum.

Inspect and palpate the paranasal sinuses: o Frontal sinuses Using thumbs, press over the frontal sinuses below the eyebrows. Pt should feel pressure but no pain. o Maxillary sinuses Using thumbs, press over the maxillary sinuses below the cheekbones. Pt should feel pressure but no pain.

Hand Hygiene Put on Gloves Mouth/Oropharynx Cranial Nerve 5Trigeminal Nerve Pt clenches teeth, try to separate jaws by pushing chin, normal if you cant Cotton ball to the face, with pt eyes closed, say now when they feel cotton Cranial Nerves 9 and 10Glossopharyngeal and Vagus Depress tongue with tongue blade, note pharyngeal movement as person says AAH. Uvula and soft palate rise in midline. Watch person swallow. Cranial Nerve 12Hypoglossal Nerve Inspect tongue, ask person to protrude tongue
Inspect and palpate mouth and oropharynx: Use a tongue blade Skin color, no lesions, etc. o Lips Inspect lips for color, moisture, cracking or lesions. Retract the lips and note inner surface. o Buccal mucosa characteristics Hold cheek open with tongue blace and check buccal muscosa for color, nodules or lesions Pink, smooth and moist o Gums/teeth Normal teeth look white, straight, evenly spaced, clean and free of debris or decay. Gums look pink and gum margins at teeth are tight and well defined. No swelling, no bleeding. o Tongue characteristics Use 4x4 gauze to move tongue for this Color is pink and even; examine under the tongue for lesions.

o o o o o

Hold tongue with a cotton gauze pad for traction and swing the tongue out and to each side. Inspect for any white patches or lesions. Inspect floor of mouth Hard and soft palate Shine light up to roof of mouth. Anterior hard palate is white with rugae. Posterior soft palate is pinker, smooth, upwardly moveable. Gag reflex (do not initiate) Uvula say Ah (CNIX, CNX) Tongue Protrusion (CN XII) Swallowing (can be integrated into thyroid check) (CNIX, CNX)

Hand Hygiene Neck Cranial Nerve 11Spinal Accessory Nerve Ask person to rotate head forcibly against resistance applied to side of cin Ask person to shrug shoulders against resistance
Skin color, no lesions, etc. Inspect the neck for: o Symmetry Neck muscles symmetric, head held straight and still o Enlargement or masses No enlargement or masses o Thyroid placement No thyroid gland enlargement. o Tracheal deviation Trache is midline, no tracheal shift (upon palpation). Place index finger on sternal notch and slip it off to each side. Space is symmetric on both sides. No deviation from the midline. Musculoskeletal: Head and Neck TMJ: crepitation, asymmetry Neck ROM and strength Flexion/extension Lateral motion Rotation Palpate the neck for: o Thyroid enlargement To palpate, move behind the person. Ask the person to sit up very straight and then bend the head slightly forward and to the right. Use fingers of your left hand and right hand to curve around the trachea. Ask the Pt to take a sip of water. The thyroud moves up under your fingers with the trachea and larynx as the person swallows. Do this again for the left side. o Lymph nodes/characteristics of lymph nodes Using a gentle circular motion with fingerpads, palpate the lymph nodes. Begin with the lymph nodes in the front, under the jaw and then move along the jawline to in front of the tragus. Then inspect the lymph nodes down the side of the neck, and behind the ears. Normal nodes feel movable, discrete, soft and nontender.

Shrug shoulders, turn head against resistance (CNXI) Neck ROM: Touch chin to chest; lift chin to ceiling; touch ear to the other shoulder, turn ear toward each shoulder (CN IX) Shoulders: a. Inspect Compare both shoulders posteriorly and anteriorly. No redness, atrophy, deformity, or swelling present.

Eye Examination Cranial Nerve 2Optic Nerve Visual acuity and visual fields Cranial Nerves 3, 4 and 6Oculomotor, Trochlear and Abducens PERRLA Cardinal positions of gaze
Skin color, no lesions, etc. Inspect external eye structures: o Eyebrows, eyelids and lashes Eyebrows present bilaterally, move symmetrically as the facial expression changes Eyelid skin intact without redness, swelling, discharge, or lesions o Lacrimal apparatus Ask the person to look down. With thumbs, slide the outer part of the upper lid. Inspect for any redness or swelling. Press index finger against the lacrimal sac, just inside the lower orbital rim, not against the side of the nose. Should be no excessive tearing, which may indicate blockage of the nasolacrimal duct. o Sclera/Conjunctiva Ask Pt to look up. Using thumbs, slide the lower lids down along the bony orbital rim. Dont push against the eyeball. Inspect the exposed area. Eyeball should look moist and glossy. Eyeballs are aligned in their sockets normally with no protrusion or sunken appearance. Cunjuntivae are clear and white with no color changes, swelling or lesions. o Cornea/Lens Shine a light on the cornea and check for smoothness and clarity. No opacities in the cornea, the anterior chamber or the lens behind the pupil. o Iris Iris appears flat with a round regular shape and even coloration. Size and shape of iris equal bilaterally. Evaluate visual acuity and function: o Peripheral visual fields (CNII) CNII: Optic Function Visual acuity; Visual field Test: Assess visual acuity using an eye chart from 14 inches away from Pt Assess peripheral vision

o EOMs CN III: Oculomotor function -Pupillary reaction CN IV: Trochlear function -Eye movement CN VI: Abducens function -Abduction of the eye Tests: III: Assess pupils for equality and reactivity to light IV/VI: Have Pt follow your finger without moving his or her head in the six directions. Accommodation test Ask Pt to focus on a distant object, which will dilate the Pupils. Then have the Pt shift the gaze to a near object, such as a finger help about 3 inches from their nose. The normal response includes papillary constriction and convergence of the axes of the eyes. Pupil response - direct and consensual, accommodation (PERRLA)

Test confrontation: Bring hand from side of Pts head and ask when they can see it in the periphery. Do one side at a time.

Ear Examination Cranial Nerve 8Acoustic Nerve Weber and Rinne tuning fork tests
Skin color, no lesions, etc. Inspect and palpate ears: Pinna, tragus Position and alignment Ears are of equal size bilaterally with no swelling. Skin condition Skin color consistent with the persons facial color. Skin is intact with no lumps or lesions. Auditory meatus Move auricle and push tragus for tenderness Pinna and tragus feel firm, and movement produces no pain. Mastoid process tenderness Palate mastoid process and Pt should not report pain. Use otoscope to examine External auditory canal No redness, swelling, lesions, foreign bodies, discharge Tympanic membrane and landmarks, integrity Eardrum is shiny an translucent with a pearly gray color Use of otoscope Pull pinna up and back and do not release until you have finished the examination and the otoscope is removed. Hold otoscope upside-down along your fingers. Insert speculum slowly & carefully along axis of the canal. Avoid touching inner bony section of the canal wall. Perform screening evaluation of auditory function (CN VIII) CN VIII: Acoustic Function: Hearing/Balance Test: Weber & Rinne Tests Weber test

Place a vibrating tuning fork in the midline of the persons skull and ask whether the tone sounds the same in both ears or better in one. Should sounds equally loud and vibrations felt the same on both sides. Rinne test Compares air conduction and bone conduction sound. Place stem of the vibrating tuning fork on the persons mastoid process and ask them to signal when the sound goes away. Quickly invert the fork so the vibrating end is near the ear canal; the person should still hear a sound. The sound should be hearf twice as long by air conduction (next to the ear canal) as by bone conduction (through the mastoid process). Normal result is a positive Rinne test: AC > BC

Peripheral Vascular System

Skin color, no lesions, no masses Inspect upper extremities bilaterally for: Symmetry Color / discoloration Edema Ulcers, lesions Condition of nails Hair distribution Palpate all pulses for rate and rhythm. Compare side to side. Classify on 0-4+ scale for amplitude (0 absent, 1+ weak, 2+ normal, 4+ bounding). RADIAL PULSE

Thorax and Respiratory System POSTERIOR CHEST

Inspection of Posterior Chest: Skin color, no lesions, etc. (no cyanosis or pallor; no lesions) Symmetry and chest wall configuration Posterior chest: Note shape and configuration of the chest wall Thorax is symmetric Spinous processes in a straight line Diameter of Chest (measure if indicated) Anteroposterior diameter less than transverse diameter Any use of accessory muscles Palpation of Posterior Chest: Palpate skin and thorax of posterior chest using palmar surface of hands Evaluate: Skin texture and temperature No tenderness, skin warm/cool; no lumps or masses Assess tactile fremitus (fremitus is a palpable vibration) Use palm of hand and touch pts back while they say 99 Start over lung apices and palpate from one side to the other Vibrations should be symmetric bilaterally Palpate respiratory excursion Confirm symmetric chest expansion by placing hands on back with thumbs at the level of T9 or T10. Ask pt to take a deep breath. Palpate the spinous processes; they should be evenly spaced Percussion of Posterior Chest: Percuss posterior chest, identifying characteristics of percussion sounds Start at apices and percuss across tops of both shoulders Percuss the interspaces, making side-to-side comparisons down the lung field Resonance is heard (low-pitched, clear, hollow) Dullness at the bottom, below the lungs Flatness over the bones Diaphragmatic Excursion Ask pt to exhale and hold it briefly and percuss down the scapular line until the sound changes from resonant to dull on either side. Mark spot. Ask pt to take a deep breath and hold it and continue percussing down from the first mark and mark the level where the sound changes to dull on this deep inspiration. Measure the difference. Should be equal bilaterally and measure about 3-5 cm in adults. Auscultation of Posterior Chest: Auscultate posterior chest identifying: (2) Apices (6) Lobes plus L mid-area lung field (2) Lateral aspects of lung fields Pt is sitting, leaning forward slightly. Instruct pt to breathe through mouth deeper than usual and stop if they feel dizzy from that. Normal is lung sounds are automatic and effortless, regular and even, with no adventitious sounds, and the chest expands symmetrically with each inspiration. Check for costovertebral angle tenderness

Anterior Thorax Inspection of anterior chest: Skin is pink-tan with no cyanosis, no lesions. Thorax is symmetric and in a straight line. Respiratory rate and rhythm Pt is in a relaxed position when breathing Any use of accessory muscles No use of accessory muscles when breathing Palpation of Anterior Chest Assess tactile fremitus Begin palpating over lung apices in the supraclavicular areas Compare vibrations from one side to the other as the person repeats 99 Avoid palpating over female breast tissue bc it usually damps the sound. Normal pt does not have any tenderness (communicate to make sure they tell you if they have tenderness) and no lumps or masses are noted. Note skin mobility and turgor, and note skin temperature and moisture. Percussion of Anterior Chest Percuss comparing one side with the other Begin percussing the apices in the supraclavicular areas Then percuss the interspaces and compare one side to another Move down the anterior chest Auscultation of Anterior Chest Auscultate anterior chest from apex to base following 5 point method Auscultate the lung fields over the ant. Chest from the apices in the supraclavicular down to the sixth rib. Progress from side to side as you move downward Listen to one full respiration in each location Do not place steth directly over female breast, displace the breast Note no adventitious breath sounds, breathing even and chest symmetric with each breath Auscultate lateral chest wall

Cardiovascular System While patient is seated:

Skin color, no lesions, no masses. Inspect anterior chest wall Precordium Note no thoracic deformities Note no heave or lift present Note the visible apical pulse (when visible, it occupies the fourth or fifth intercostal space, at or inside the midclavicular line) Palpate anterior chest wall Precordium (using ball of hand) Palpate the apex, the left sternal border and the base, searching for any other pulsations Thrills using ball of hand Note that there are no thrills, which signify turbulent blood flow and accompany a loud murmur Carotid arteries Palpate one at a time Contour is smooth with a rapid upstroke and normal strength is 2+ Findings the same bilaterally Palpate the apical pulse (used to be called the point of maximal impulse) Count for one full minute Locate by using one finger pad, asking the person to exhale and hold it until it is found Auscultate in each of these four areas (Auscultate 30-60 seconds per area) Alert the pt: Just bc I am listening a long time, it doesnt mean there is something wrong. Aortic area 2nd ICS, R-SB Use both diaphragm and bell Identify S2 Note there are no murmurs, rubs, or clicks Evaluate regularity of rate and rhythm Pulmonary area 2nd ICS, L-SB Use both diaphragm and bell Note there are no murmurs, rubs, or clicks Evaluate regularity of rate and rhythm Tricuspid area 4-5th ICS, L-SB Use both diaphragm and bell Note there are no murmurs, rubs, or clicks Evaluate regularity of rate and rhythm Mitral area 5th ICS, L-MCL Use both diaphragm and bell Note there are no murmurs, rubs, or clicks Evaluate regularity of rate and rhythm Apical pulse: Auscultate and note this is where S1 is heard.

Abdomen and GI System Inspect, Auscultate, Percuss, PALPATE

Skin color, no lesions, etc. Position of the patient is supine, abdomen exposed, and knees flexed.

While patient is supine:

Inspection: Note jugulars for venous distension (JVD) Pt should be supine at 30-45 degree angle Turn pts head slightly away from examined side and note that there is no distention. Note carotid pulsations (+2 is normal) Contour Stand on persons right side and look down on abdomen Then stoop or gaze across abdomen Contour of pt will be FLAT Symmetry No bulging, masses, or lesions. Abdomen is symmetric and smooth. Umbilicus Umbilicus is midline with no sign of discoloration, inflammation or hernia. Skin Inspection Smooth and even. Pink-tan. No striae or scars. No moles or lesions. No visible venous networks. Turgor Good skin turgor, no tenting. Aortic Pulsation No aortic pulsation visible beneath the skin in the epigastric area. No peristalsis visible. Hair Distribution Normal and even. Observe and note general behavior and appearance of client. Benign facial expression, with slow and even respirations. Auscultate: All 4 abdominal quadrants and gastric bubble Begin in the RLQ bc bowel sounds normally present here Bowel sounds occur irregularly from 5-30 times per minute Note that bowel sounds present in all 4 quadrants, every 5 seconds Sounds = gurgling Vascular Sounds Note the presence of any vascular sounds or BRUITS Check over aorta; renal arteries; iliac; femoral arteries Normal = no sound present

Percuss systematically to assess: GENERAL TYMPANY All 4 quadrants plus gastric bubble Percuss lightly in all 4 quadrants and move clockwise Tympany should predominate Liver Span Percuss to map out liver span. Normal = 7 cm for females

Palpate abdomen in all 4 quadrants Use light palpation technique(one hand) Keep palpating hand low and parallel to abdomen Depress skin about 1 cm; make a rotary motion, sliding the fingers and skin together. Then lift the fingers and move clockwise to the next location around the abdomen. Ask if any areas are tender and same the examination of those parts until last. a. Note no tenderness b. Note no masses c. Muscle wall no tenderness or inflammation d. Note no enlarged organs (liver, kidneys, spleen) Palpate inguinal nodes and femoral pulse

Peripheral Vascular System

Skin color, no lesions, etc. Inspect lower extremities bilaterally for: Symmetry Color / discoloration Edema Ulcers, lesions Condition of nails Hair distribution Palpate all pulses for rate and rhythm. Compare side to side. Classify on 0-4+ scale for amplitude (2+ normal). 1. Femoral pulses 2. Popliteal pulses 3. Dorsalis pedis pulses 4. Posterior tibial pulses

Musculoskeletal System
Skin color, no lesions, etc. Edema General Inspection: 1. Gait: normal, tandem (motor coordination) 2. Muscles 3. Size, symmetry, tone 4. During ROM of each joint, note strength against resistance (0-5 scale) Follow sequence of MSK exam skills: Inspect Note the size and contour of the joint Color is pink-tan No swelling, no masses or deformities No scars, no erythema No edema Palpate Palpate each joint, including its skin, for temperature, muscles. Note no tenderness or crepitus Note no heat, swelling, or masses No tenderness or crepitus

Active ROM Ask for active ROM while stabilizing the body area proximal to that being moved. Note no limitations in active ROM Muscle Testing/Strength Test strength for the mover muscles of each joint Repeat the motions used for active ROM Ask person to flex and hold as you apply opposing force Grade muscle strength 5: full ROM against gravity, full resistance

Spine 1. Inspect curvature Spine should be straight and the head erect Note normal convex thoracic curve and concave lumbar curve; no lateral tilting or forward bending Palpate: Spinous processes straight and non-tender 2. Range of motion (ROM) 1. Flexion/extension 2. Bend forward and touch the toes: black has single convex C-shaped curve 3. Bend sideways 4. Bend backwards 5. Twist shoulders to one side, then the other 6. Ask pt to walk on toes a few steps and then return walking on heels Shoulders ROM and strength Cup one hand over the shoulder during ROM to note any crepitation, normally none is present. 1) With arms at sides and elbows extended, move both arms forward and up in wide vertical arcs, then move them back 2) Rotate arms internally behind back, place back of hands as high as possible toward the scapulae 3) With arms at sides and elbows extended, raise both arms in wide arcs in the coronal place. Touch palms together above head. 4) Touch both hands behind the head with elbows flexed and rotated posteriorly Elbows a. Inspect Size and contour; no deformities, redness or swelling. b. ROM and strength 1) Bend and straighten elbow 2) Movement of 90 degrees in pronation and supination While testing muscle strength, stabilize the pts arm with one hand; have the person flex against resistance applied just proximal to the wrist. Ask the pt to extend the elbow against resistance. Wrists a. Inspect Inspect on dorsal and palmar sides, noting position, contour, and shape. No redness, swelling, deformities or nodules present Skin looks smooth

Palpate: support the hand with my fingers under it and palpate with thumbs. Surfaces feel smooth with no swelling, nodules or tenderness. Palpate fingers. b. ROM and Strength Radial, ulnar deviation (abduction, adduction) 1) Bend hand up at the wrist 2) Bend hand down at the wrist 3) Bend fingers up and down at the metacarpophalangeal joints 4) With palms flat on table, turn them outward and in 5) Spread fingers apart, make a fist 6) Touch thumb to each finger For muscle testing, position the persons forearm palm up and rest on a table. Stabilize by holding my hand at the persons midforearm. Ask person to flex the wrist against resistance at the palm. Phalens Test: Ask person to bold both hands back to back while flexing the wrists 90 degrees. Hands and fingers a. Inspect carpal & phalangeal joints (nodules) b. ROM and strength Grip strength Hips a. Inspect symmetry Symmetric iliac crests b. ROM and strength Flexion/extension External/internal rotation 1) Raise each leg with knee extended 2) Bend leg up at knee 3) Swing leg laterally, then medially, with knee straight 4) Swing leg back behind the body 5) Bend over at waist Knee a. Inspect joint alignment (varus/valgus deformities) No bowleggedness, no knock knees Skin smooth with even coloring and no lesions Lower leg alignment: legs extend in same axis as thighs (not bowlegged) Knees shape: no fullness or swelling, no atrophy in quadriceps muscle in anterior thigh b. ROM and strength 1) Bend each knee 2) Extend each knee 3) Check ROM during ambulation Check muscle strength by asking the person to maintain knee flexion while I oppose by trying to pull the leg forward. c. Flexion/extension Ankles and Foot 1. Inspect Note position of feet and toes, contour of joints, skin characteristics Foot should align with the axis of lower leg Toes point forward and lie flat; anskles are smooth; skin on ankles is smooth No hallux valgus, no hammertoes, no swelling or inflammation, no calluses/blisters, no corns, warts.

2. ROM and strength Rotation of ankles Plantar flexion/dorsiflexion of ankles 1) Point toes toward floor 2) Point toes at nose 3) Turn soles of feet in then out 4) Flex and straighten toes Feet 1. Inspect: deformities (bunions, hammertoes), lumps (neuroma), blisters, ulcers, callouses, corns, warts, skin disorders (tinea pedis, ingrown nails), compression by footwear 2. Palpate MTP joint 3. ROM and strength

Deep Tendon Reflexes (DTRs) 2+ Rating is NORMAL Brachioradialis Hold persons thumbs to suspend the forearms in relaxation Strike forearm directly Biceps Support persons forearm on mine Place thumb on he biceps tendon and strike blow to my thumb Triceps Tell pt to let arm go dead and suspend by holding it Strike triceps directly above elbow; normal response is extension of forearm Patellar Let lower legs dangle freely to flex knee Strike tendon directly just below patella Achilles Hold foot in dorsiflexion and strike Achilles tendon directly Sensory Pain (sharp to dull) Compare sides Using the sharp side of an object and the soft side, instruct the Pt to distinguish between sharp and dull sensations. Compare left to right, with the Pts eyes closed. Choose one : Stereognosis Graphesthesia

No tics, tremors, fasciculations, myoclonus 1. Gait: usual walk, tandem gait (heel-toe), tip-toe, heel walk o Observe gait while Pt walks across the room 10-20 feet and comes back Gait should be smooth, rhythmic and effortless o Have Pt walk on heels for a few steps and then toes for a few steps o Have Pt hop in place on each foot o Note a smooth, equal gait 2. Balance: Romberg and gait above CN VIII Acoustic

o Request that Pt stands with feet together and arms at their sides o Support them in case they fall o Have their eyes closed for 20 seconds. o Pt is normal if they can maintain posture and balance o Negative Romberg is normal Pronator or lateral drift (position sense) o Ask pt to hold out arms and close eyes, then turn palms up and down 3. Rapid alternating movements (fingers to thumb or hands on knees) o Instruct Pt to touch their thumb to each finger on the same hand, starting with the index finger, then in reverse o Finger to finger test: with pts eyes open, ask that they use their index finger to touch mine, then their own nose. Ask person to close eyes and touch nose and then my finger. Coordination (finger to nose or finger to nose to assessors finger) o Instruct Pt to touch his/her nose and your index finger alternately several times o Continually change the position of your finger during the test Vibration: tuning form over bony prominences, foot.

Neurological Systems
Mental Status LOC only (defer rest for checkout demo) Pt should be alert, not lethargic or stuporous Cranial Nerves bilaterally CN I: Olfactory Function Smell Test: Ask Pt to identify familiar odors, using a different one for each nare CNII: Optic Function Visual acuity; Visual field Test: Assess visual acuity using an eye chart from 14 inches away from Pt Assess peripheral vision CN III: Oculomotor/CN IV: Trochlear/CN VI:Abducens CN III: Oculomotor function -Pupillary reaction CN IV: Trochlear function -Eye movement CN VI: Abducens function -Abduction of the eye Tests: III: Assess pupils for equality and reactivity to light IV/VI: Have Pt follow your finger without moving his or her head in the six directions. CN IV: Trochlear Down and inward movement of eye CN V: Trigeminal Function -- Facial Sensation/Muscles of Mastication Test: Touch the face and assess for sharp and dull sensation Have Pt hold mouth open CN VII: Facial Function -- Facial Expression/Sense of Taste Test: Have Pt smile, wrinkle face, puff cheeks, wiggle eyebrows CN VIII: Acoustic Function: Hearing/Balance Test: Weber & Rinne Tests

Have Pt stand with feet together, arms at side with eyes closed for 10 seconds CN IX: Glossopharyngeal/CN X: Vagus CN IX Glossopharyngeal function -Swallowing/Voice CN X Vagus function -Gag reflex Test: Have Pt swallow and then say AH Use tongue depressor to see if the uvula moves up when they say AH CN XI: Spinal Accessory Function: Neck motion Test: Have Pt shrug shoulders or turn head against resistance CN XII: Hypoglossal Function: Tongue movement and strength Test: Have Pt stick out tongue and move it from side to side.