Weber ch 28 Head to Toe

• •Systems approach v. head-to-toe
• •No “right” way
• •Comfortable routine / systematic
• •Takes time/practice
• •Basic Assessment Techniques:
• –Inspection
• –Palpation
• –Percussion
• –Auscultation

• •Gather equipment
• •Wash hands/Universal standard precautions
• –Gloves for bodily fluids, mucous membranes & nonintact skin
• •Introduce self
• •Explain procedure & throughout

• •General Appearance
• –Apparent v. actual age
• –Physical & sexual development plus behavior
• –Overall skin color & A-F warning signs
• –Dress, grooming & hygiene
• –Body build/muscle mass

• •Vital Signs
• –T, P, R, BP & 5th VS/Pain

• •Body Measurements
• –Ht, Wt., waist & mid-arm circumference
• –BMI

Young adult: intimacy v. isolation (affiliation & love)

Middlescent: generativity v. stagnation (production & care)

Older adult: ego integrity v. despair (renunciation & wisdom)

• Ectomorph = slight body build
• Mesomorph = medium/well-proportioned bod
• Endomorph = large body build (McDonald’s supersized)

• •Observe level of consciousness (LOC)
• –Assess posture & body movements
• –Assess facial expressions & mood
• –Assess speech & thought processes/ perceptions

• •Assess cognitive abilities -
• –Oriented x3 to person, place & time
• –Concentration
• –Recent vs. remote memory
• –Recall unrelated information
• –Abstract reasoning
• –Judgment
• –Visual perception/copy figures

• •Inspect & palpate head for size, shape & configuration
• Normocephalic = appropriately proportioned
• Microcephalic = abnormally small head
• Macrocephalic = abnormally large head, listen to temporal arteries with bell of stethoscope for
• bruits (normally none)
• Acromegaly = enlarged bony structure due to increased growth hormones (esp. hands, feet, nose & ears)

•Inspect hair consistency, distribution & color

•Inspect facial features for symmetry & skin color

•Palpate temporal arteries

•Palpate temporomandibular joint for tenderness, swelling or crepitus


•Assess CN VII/facial by smiling showing teeth, blowing out cheeks, raising eyebrows & closing eyes

•Assess CN V/trigeminal for acial sensation (dull vs. sharp)

•Assess eye alignment

•Inspect conjunctiva, sclera & lacrimal apparatus

• •Test vision
• –Snellen distant vision or near vision (reading) (CN II/Optic)
• –Visual fields for peripheral vision

•Test corneal light reflex & PERRLA

•Perform cover – uncover test

•Test corneal reflex (CN V & VII)

•Inspect auricle (helix to lobule) for shape, position, lesions, discoloration or discharge

•Palpate auricle for tenderness or masses

• •Perform hearing tests:
• –Whisper test
• –Finger rubbing
• –Weber test for hearing
• –Rinne test for air v. bone conduction

•Inspect external nose for color, shape & consistency

•Palpate nose & sinuses for tenderness

•Assess patency of nares

•Identify smells with eyes closed (CN I)

•Transilluminate sinuses with penlight

•Inspect lips for color, consistency & lesions

•Inspect & count teeth

•Inspect gums, oral mucosa for color & lesions

•Inspect tonsils for color, size, lesions or exudate

•Check that uvula rises & + gag reflex (CN IX)

•Inspect & palpate tongue for color, moisture & resistance against tongue blade (CN IX & XII)

• •Identify tastes on tongue with eyes closed (CN VII & IX)
• CN VII taste anterior 2/3 tongue (sweet & salty)
• CN IX taste posterior 1/3 tongue (bitter & sour

•Inspect neck for lesions, masses, swelling & symmetry

•Assess JVD Assess for JVD/jugular venous distention by laying flat to see (shine penlight) then raise to 45 degrees (should disappear)

•Palpate trachea

•Palpate carotid arteries & auscultate for bruits

•Test neck ROM

•Palpate lymph nodes (pre & post auricular, occipital, tonsillar, submandibular, sub-mental, cervical & supraclavicular)

•Inspect chest shape, color, use of accessory muscles, bulges or retractions

•Palpate for tenderness, crepitus, masses, lesions or fremitus


•Evaluate chest expansion (T9-10)

•Percuss for tone bilaterally

•Ausculate for breath sounds

•Check respiratory rate, rhythm & pattern

•Check skin turgor over sternum/clavicle area

• Talk about rate, rhythem, and pattern
• #, unlabored,

If crepitus or fremitis know what you would do next if you detected it

• •Inspect & palpate chest for lifts, heaves & thrills
• Lift = sustained thrust felt during systole due to L
• ventricular hypertrophy
• Heave = more prominent thrust felt during systole due to
• L ventricular hypertrophy
• Thrill = palpable fine vibration over precordium due to
• aortic stenosis

•Inspect & palpate PMI/apical impulse

•Auscultate heart sounds

•Check heart rate, rhythm & pattern

•Auscultate with bell for extra heart sounds (S3, S4) or murmurs

•Inspect arms for skin color, texture, masses & lesions

•Shrug shoulders against resistance (CN XI)

•Palpate extremities for tenderness, swelling & temperature

•Palpate epitrochlear lymph nodes

•Palpate pulses 0 to 3+/4+ (brachial, radial & ulnar)

•Assess capillary refill & clubbing

•Test ROM elbows & fingers

•Test reflexes (biceps, triceps & brachioradialis)

•Test rapid alternating hand movement

• •Sensation testing with eyes closed:
• –Touch, pain, temperature
• –Position of fingers
• –Stereognosis/objects
• –Graphesthesia

–2-point discrimination

• •Inspect skin color, vascularity, striae, lesions , & rashes
• •Inspect location & contour of umbilicus
• •Inspect abd. contour & symmetry
• •Look for aortic pulsations or peristalsis
• •Auscultate bowel sounds
• •Auscultate vascular sounds
• •Percuss for tone
• •Palpate lightly before deeply with pain last
• •Abd. reflex

•Inspect legs for skin color, texture, temperature, masses, lesions & varicosities

•Observe muscles & palpate tone

•Note hair distribution - reduced circulation

•Palpate pulses (femoral, popliteal, dorsalis-pedis & posterior tibial)

•Palpate for edema

•Assess capillary refill

•Test sensation, vibration & 2-point discrimination

•Test ROM & Homan’s sign (pain when examiner dorsiflexes the foot when knee is at 90 degrees)

•Perform heel to shin test - laying down

•Inspect & palpate spine (touch toes)

•Observe gait for stability, arm swing & posture

•Walk heel-to-toe/tandem

•Hop on 1 leg

•Perform Romberg test

•Perform finger-to-nose