Advance Health Assessment Nurse Practitioner

Front 1

skin hair nailes
SKIN- inspection: good lighting, whole body, palpation: temp, moisture, texture, turgor, mobility.
HAIR- palpate - texture,
inspect- color, distribution,quanity
NAILS- inspect- color, length, configuration, symmetry, clean
palpate- hard with uniform thickness

Back 1

SKIN- changes ( dry, itch, sore, rash, bump, color , texture, sweat, lesion, non healing wound), sequence of events, symptoms ( itch, pain, exudate, bleed, color change, seasonal, climate), location, associated sympt. ( systemic disease, fever, stress) recent exposures, pt perception of cause, travel hx. , how pt adjusting, medications
HAIR- changes in loss, growth, distribution, texture, color, occurence/ reoccurence, associated symptoms ( pain, itch, lesion, systemic disease,stress) exposures, nutrition change, how pt is treating/ adjusting, medications
NAILS- changes ( split, break, discoloration, ridge, thick, marks, seperation) recent ( ill, fever, trauma, psychologic) associated symptoms ( pain, swelling exudate) sequence of events, exposures, treatment, medications

Front 2

lymphatic
Palpate:
HEAD AND NECK: preauricular, parotid, tonsilar,submental, submaxilary, anterior cervial,posterior cervical, postauricular, occiptal, supraclavicular,
AXILLAE: anterior and posterior
epitrochlear: underside of elbow
INGUINAL: femoral

Back 2

Bleeding- site( nose, mouth, gum, skin petechiae, brusing, vomit) character ( onset, freq., duration, amount , color), associated symptoms ( pallor, dizzy, headache, sob)
Enlarged NOdes ( bumps, kernals, swollen glands) character ( onset, location, duration, number, tenderness), associated symptoms ( pain , fever, redness, warmth, red streaks, itch) predisposing factors ( infection, surgy, trauma)
Swelling of Extrmity ( uni/bilat, intermittentm, constant, duration) predisposing factors ( cardiac, renal, surg, infection, trauma, venous insuff.) associated symptoms ( warmth, red, discoloration,ulceration) treatment/ effect ( teds, elevation) Meds/ alternative thr.

Front 3

head and neck
HEAD INSPECT; head position and facial features ( eyelid, eyebrow, palpebral fissures nasolabial folds, mouth) skull ( size , shape, symmetry)
Palpate: front to back, hair
Auscultate: if diplopia , bruit heard over orbit ( temporal)
NECK
Inspection: anatomic positon, movement ( turn head against resistance, shrug shoulders against resistance) passive rom
Palpation: trachea for midline( thumb on each side at sternoclad. )identify hyoid and cricoid ( smooth nontender,move with swallow)
Lymph Nodes - see card on lymphatics
Thyroid Gland
Inspection: slight extension of neck and swallow water
Palpation-flex slight forward,thumb 3 cm below prominece of cartlidge, press trachea to side, first 3 fingers in thyroid bend, ask to swallow.

Back 3

HEAD INJURY-( event discription, loss of consciousness- immediate/5 min later,duration, combative) predisposing factors ( seizure, hypoglycemia, vision, syncope) associated symptoms ( pain, laceration, level of consciouness, tenderness, breathing pattern, vision, ear d/c, n/v, urinary/ fecal incont. ability to move extremities, medications
HEADACHE; onset (time of day), duraton, location, character, sevarity ( pain scale), visual prodromal , pattern, episodes ( closer together lasting longer), change in level consc. as pain increases, associated symptoms ( n/v, diarrhea, photophobia, visual, nasal dc, tinnitus, parathesias, mobility impaired) precipitating factors ( fever, fatigue, stress, food additives, fasting, etoh, allergies, menustral) medications
Stiff Neck- injury, fever (viral/bac. illnesss), character, predisposing factors ( vision/ hearing loss) effort to treat ( heat, pain, med, pt)
THYROID PROBLEM changs ( temp, prefernce, selling in neck, texture of hair, nails, incrased pigmentation at pressure points) change in emotional stability, increase energy, irritablity, nervousness, lethary, disinterest, increase prominence in eyes, puffy, tachycardia, palpatations, change in menstural flow, change in bowel habits, medication

Front 4

EYE
Visual test: ( optic nerve 2) for central vision. Snellen chart at 20 ft. each eye with other covered, without then with corrective lenses. if < 20/20 test with pinhole occulder, test near vision with Rosenbaum pocket vision screener, check peripheral vision by confrontation - stand opposite at eye level, pt cover rt eye examiner cover left test to see when pt views moving fingers in nasal, temporal , superior and inferior fields
EXTERNAL : eyebrows: size, extension,texture. orbital area, puffy, edema, sagging, lesions,
eyelids: with eyes closed for fasiculations , falkiness, redness, swelling, eyelashese for presence, ptosis, inversion, eversion, blepharitism, ability to cover globe completely
Palpation; for nodules
CONJUNCTIVA: look up while pulling down lower lid, only flip top lid if you suspect a foreign body ( erythema , exudate, cobblestone)
Cornea: shine light tangentially , conreal sensitivity ( cranial nerve 5) touch whisp of coton to cornea
IRIS AND PUPIL: visible pattern, same color, shape of ppupils. response to light - dim light in room , shine light in pupil for constricition, test optic nerver by shining light in one eye then rapidly swing to other ( should see slight dilation as light moves across nose then constrict). test for constriction to accomidation - ask to look at far away object then at a close object held at bridge of nose. estimate pupillary sizes and compare.
LENS: inspect for transparancy
SCLERA: inspect for white
LACRIMAL APPARATUS: palpate lower orbital rim near inner canthus
EXTRAOCULAR MUSCLES: (CN 3,4,6,)- hold chin and ask to look through six carnial gazes each eye. Convergence- direct light at bridge of nose ask to look at nearby object, light should be reflected symmetrically in both eyes, if problem, do cover/ uncover- stare straight ahead at fixed point, cover one observe uncovered for movement during focusing, remove the cover and watch for movement of newly uncovered eye - repeat
Opthalmic eval: optic disc, arteries , veins, retina, red reflux, macula

Back 4

EYELIDS: recurrent stye, ptosisi, growth , mass , itching
Vision: poor/ good, one/ both, glasses, cataracts, floaters, diplopia,
Pain: w/o loss of vision, in / around eye, superficia/ deep, insidious/ abrupt, burn, itch, gritty, nonspecific
Secretions: color, consistency, duration, tearing, ( increase/ decrease) redness
Medications- drop, ointment, atbx, artificial tears, glaucome, vitamins( antioxident), steroids, scripts,

Front 5

ear/ nose/ throat
EARS AND HEARING;
External: Inspect: auricles , external auditory canal. Palpate-auricle and mastoid area
Otoscope exam: tympanic membrane
Hearing eval: (CN7)
whispered voice- pt places finger in opposite ear moving it up and down stand 1-2 ft away ear being tested
Weber/Rinne
weber- tap fork place on head ask if hear in both ears, or better in one ear.
rhinne- place at mastoid, count till no longer heard, positon in front of canal - count seconds heard- air 2x bone.
NOSE/ SINUS : inspect for shape, size , color, d/c , flaring, narrow. Palpate bridge and soft tissue, evaluate patency.
NASAL CAVITY; speculum head back , smell sense (CN1) for different odors.
SINUSES; Inspect: frontal and maxillary sinus for selling. Palpate frontal with thumbs up and under the bony brow on each side of nose, up and under zygomatic processes, maxillary sinuses
LIPS: inspect ; symmetry color , edema, abnomalityes
BUCCAL MOCOSA, TEETH, GUMS: clench teeth and smile (cn 7) for occlusion. remove any dental appliances and inspect mucosa, gums, teeth ( tongue blade and light) locate stensen duct. Palpate for lesions induration , thicening, masses . inspect and count teeth.
ORAL CAVITY; inspect dorsum of tongue, selling, size, color , coating, ulcerations, ask to extend tonuge (CN12), touch to palate look at floor of mouth, and ventral tonguewharton ducts, wrap with gauze and pull to sides , tilt head back and inspect palate and uvula, ahh observe rise and remain midline (CN 9-10)
OROPHARYNX; inspect ( tongue blade) tonsiliar pillars , posterior wall , gag response (cn 9-10)

Back 5

VERTIGO/ DIZZINESS: time of onset, druation, circumstances, past attacks, description ( to and fro/ spinning), change of sensation with turning ove or head turning,best position associated symptom ( n/v,tinnitus, hearing loss, dble vision, fullness), unsteady, loss of ballance, falling , medications ( ototoxic - aminoglycosides, gentamiycin, strep, asa, lasix, steroids,
EARACHE; onset, duration, pain, fever, d/c, recent diving/ flying, URI, swimming, trauma, rt c/o with mouth , teeth, sinus, throat, tmj. associated symptoms ( decreased hearing, ringing, vertigo) method of ear cleaning, impacted crenumen, medications
HEARING LOSS ;
onset ( slow/gradual), repeated crenumen impactions, enviroment hears best in, speech ( soft/loud), adaption ( hearing aid, lip read, sign) ototoxic meds.
NASAL DRAINAGE; character,odor, amount, duration uni/bilat. assocated symptoms-sneexe, consgestion ,itch, nasal mucosa, sniffiling, obstruction, mouth breath, halitosis, burn, itch ,tenderness over sinuses, pst nasal drip, cough, face pain, headache, seasonality of symptoms, medications
SNORING; change in pattern, loudness, apnea, daytime sleepy, medications
NOSEBLEED- frequency, amount, obstruction, treatment , predisposing factors, uri, dry heat picking, blowing, trauma,allergies, site ( uni/bi) medication
DENTAL PROBLEMS; pain with chew, localto tooth or entire jaw, sevarity, interfer with eating, grinding, tmj, swollen / bleeding gums, ulcers masses , tooth loss, dentures / appliances, orthodonic work, medications
MOUTH LESIONS; inermitten or constant, duration, painful/less, dryness, halitosis, associ with stress, food, season, fatigue, tobacco, etoh, dentures, variation in tongue character, swelling, size change, color , coating, ulceration, difficulty moving, lesion, medications
SINUS PAIN; fever, malise, cough, headache, maillary toothache, eye pain, nasal congestion, colored d/c pain- tenderness over sinuses, increase with bending forward, medications
SORE THROAT; pain with swallowing, uri, exposure, post nasal drip mouth breath, fever, hoarseness ( voice overuse, infection , gerd, clear throat frequent) medications.
DIFFICULTY SWALLOWING;
solds, liqids, tightness, catching fullness, regurg., drooling, aspriation, swallowed lliqids coming out of nose.

Front 6

chest and lung : INSPECT; sit upright naked to waist ( shape, symmetry back and front, costal angle, intercostal spaces, skin, nails, lips, nipples, breath, supperficial vein patterns) ,RR, pattern, expansion PALPATION; thoracic muscles and skeleton, expansion from behind ( thumbs at spine), tactile fremitus ( back at second intercostal space,say 99) TRACHEA ; thumb on each side at suprasternal notch PERCUSSION;1) back with head bent forward arms folded in front 2) arms over head for lateral and anterior
DIAPHRAGMATIC EXCURSION: 1) deep breath and hold 2) percuss along scapular line until reach dullness 3) exhale to rv 4) percuss up from mark to resonance 5) measure distance
AUSCULTATION: 1) head bent forward arm folded in front 2) arms overhead for lateral 3) erect with shoulders back for anterior

Back 6

COUGH; onset ( sudden, grad, duration), nature ( dry , moist, wet , ect) sputum production ( duration, freq. time of day , activity), pattern ( occ. reg, paroxysmal, time of day, weather, activities, talk, deep breath, changs) sevarity ( tires, distrupt sleep, cause chest pain) associated symptoms ( sob, chest pain, tightness, fever, runy nose, noisy respiration, hoarseness, gagging, chocking, stress , Treatment ( script, otc, vaporizor)
SHORTNESS OF BREATH; onset ( sudden/ grad. duraton, gagg, chocking ) patter, positon most comfortable, number of pilows used, r/t ( exercise, time of day, eat), harder to inhale/exhale, sevarity ( extent of activity, limitation, fatigue, anxiety,) associated symptoms ( pain, discomfort, cough, diaphoresis, ankle edema) effort to treat
CHEST PAIN; onset duration, associated with trauma, cough, lower resp. infection, recent anesthesia, hx . thrombophlebitis, Associated symptoms ( shallow breathing, fever, cough, anxiety, radition of pain to neck or arms) Effort to treat ( splint, pain med) other meds, ( script/ otc/ street)

Front 7

Heart: Inspection: impulse at 5th midclavicular ( sit up lean formward), skin, venous distention, nails ( cap refill). Palpation lie flat : Apex ( below nipple), Left sternal border, ( right of sternum) Apical impulse( sit lean forward below nipple)( also feel for carotid pulse at same time)
Percussion: little value ( anterior axilary line toward sternal boarder change to dull is boarders) Auscultation: 1) aortic ( 2nd right intercostal) 2) pulmonic (2nd left intercostal) 3) second pulmonic ( third left intercostal 4) tricuspic ( 4th left intercostal 5) mitral ( 5th left intercostal at midclavicular )
all SITTING LEANING FROWARD, LYING, LEFT LATERAL LYING

Back 7

CHEST PAIN: Onset and duration (sudden, gradul, vague, length, nature, r/t exertion.rest, emotion,eating, cough,cold, trauma,awakens from sleep. character (aching , sharp, tingling, burning, pressure, stabbing, curshing, clenched fist ) Location ( radiating to arms, neck, jaws, teeth, scapula, relied with rest or positon change), Sevarity ( activity, disrupt sleep, pain scale) associated symptoms ( anxiety, dyspnea, diaphoresis, dizzy, n/v, faint, cold clammy skin, cyanosis, pallor, swelling, edema
Treatment:( rest, position,exercise, nitrogly. dig, diuretic, bb, ace, cal channel block, nsaids, antihtn. other meds
FATIGUE; unusual/ persistant, unable to keep up, bedtime earlier. Associated symptoms ( dyspnea on exertion, chest pain, palpatations,orthopmnea,parox.nocturnal dyspnea, anorexia, n/v) Meds
COUGH: onset and duration, character( wet /dry, nighttime, when lying)
DIFFICULT BREATHING; aggravated by exercise (much?) on level ground/ stairs worsening ? lying? eased with pillows ( many?)parox. nocturnal dyspnea
LOSS OF CONSCIOUSNESS: assoc. with palpatations,dyshrthimia, unusal exertion, sudden turn of neck, looking up,change in posture

Front 8

Blood Vessels
Palpation: carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibal
Ausculation: temporal, carotid, subclavian, abdomina aorta, reanl iliac, femoral. ( hold breath druing)
Blood pressure: both arms

Back 8

LEG PAIN/CRAMPS- onset/duration, activity/rest, elevation, recent injury, immobilization. character ( cont burn intoe, pain with point toe, pain in thigh, but, any other spec location) skin change (cold, pallor, hair loss, sores, red, warmth, visible veins,darkening) Dizziness (fatigue/ limping )wake up at night. Severe headaches ( onset, duration, location, character, known hx htn.
SWOLLEN ANKLES; onset/duration, r/t circumstances, associated symptoms (nocturia, increase in frequency, increased sob) treatment attempted: rest massage heat, elevation, medication.

Front 9

ABDOMEN: seated at pts right side ( color / surface char), flow of blood in superficial vein, Contour ( symmetry, visible peristalsis) ( also stand behind patient) ask to take deep breath and hold, then raise head and hold it.
Movement- with head on table, Auscultation- all 4 quads bowel sounds , vascular sounds 1) epigastric 2) aortic 3) renal 4) iliac 5) femoral , liver and spleen for friction rubs.
Percussion: 1) all quads( 3 spots each). 2) liver span- right midclavicular ( tympany to dull , lower up) then reasonance down to dull. measure span 3 ) lier descent - deep breath hold , percuss upward abd to right midclaviclar 4) Spleen-posterior midaxilllary line on left ( lie on back) several directions then lowest intercostal space before and after deep breath. 5) Gastric bubble-left lower anterior rib cage, 6) Kidneys-sitting position palm over costovetebral and strike with fist.
PALPATION; right side with pt flatm knees bent,light all four quads, moderate, deep, umbilicale ring 1) Liver- left hand under patient at 11- 12 ribs press upward, right hand on abdomen fingers points at head tips resting below dullnes, press gently in and up ask to take deep breath, 2) gallbladder- palpate below liver margin at lateral border of rectus abd . take deep breath if abrupt halt ( positive murphy) 3) spleen - stand at right reach arcross to left place left hand beneath costovertebral angle, palm surface on right below costal margin press fingertips in as take deep breath, repeat again with pt lying on right side. 4) Kidney LEFT- ie supine, stand on right, left hand arcrss and under flank, right hand on left costal margin, deep breath and elevate left hand palpate deeply with right hand. RIGHT- change sides repeat 5) AORTA- supine , palpate deeply slighty left.6) URINARY BLADDER- usualy not palpable 7) abdominal reflexes- supine stroke each quad with tongue blade

Back 9

discomfort, discomfort, excessive belch, flatulence, loss of appetite, severe pain) location ( localized/general,radiate) association with ( food, menses) onset of symptoms, relieved by ( rest, antacid, activity) medications
NAUSEA: associated with vomiting ( orders, activities, time of day, food intake ) date of last menstrual , meds
VOMITING; character (nature, quanity, duration, frequency, ability to keep liqid and food in), r/t (prev meal, change in appetite, diarrhea, constipation, fever, wt loss, abd pain , meds, headache, nause, period.) meds
DIARRHEA; character ( watery, copius, explosive, color, blood mucus, oil fat odor, times duration change in pattern) associated symptoms ( chills fever thirst wt loss abd pain cramping incontinence) r/t ( timing and nature of food intake, stress ) travel , meds,
CONSTIPATION: character ( bright blood, black, tarry, appearance, diarrhea alternating, pain, discomfort), pattern ( last bm, pain with passage, size), diet ( recent change, incusion of fiber) meds,
FECAL INCONTINANCE: character( stool char, timing it meals , number of episodes, with or without warning) assocated with ( laxatives, underlying disease) r/t ( fluid and dietary intake)meds
JAUNDICE: onset and duration, color of stool/ urin, associated with abd pain, chils, fever, exposure to hepatitis, meds, club/rec drugs
DYSURIA; character ( location, pain, burn, frequency, volume) exposure to tb, fungal viral, parasitic, bacterial, increased frequency of sexua intercourse, amount of fluid intake, meds/ therapies
URINARY FREQUENCY; change in usual patter/volume, associate with (dysuria.urgency, hematuria,incontence, nocturia) change in stream, meds
URINARY INCONTINENCE: character( amount ,frequency,constant/ intermittent ,dribbiling v/s frank) associated with ( urgency, previous surg, cough, sneeze, walk up stairs,nocturia, menopause) Meds
HEMATURIA; character ( color, present at begining, end,throught void) alternate possibilites( red food, red dye) laxatives containing phenolphthalein, meds
CHYLURIA (MILKY URIN);exposure to parasite, tb, meds

Front 10

Female Genitalia

Back 10

ABMORMAL BLEEDING- character ( short interval between periods,long interval, amorrhea, prlonged menses, bleeding between , postmenopausal) , change in flow , clots, sequence( onset, duration, precipitating factors, associated symptoms ( pain, cramp, abd, distention, pelvic fullness, change in bowel habits, wt loss/gain. meds
PAIN" temporal sequence ( date/ time, sudden/gradule,course, duration , recurrence, character ( location , type, intensity , pain scale) associated symptoms (d/c, bleeding, gi, abd distention,tenderness, pelvic fullness.) association with menstural cycle ( time , location, duration, changes)r/t body functions activities ( void, eat , deficate, flatus, exercis, walking up stairs, bending, streach, sex, ) aggrivate / relieve, previous med care, effort to treat, med
VAGINAL D/C; character( amount, color, odor, consistncey, change in char. ) occurance ( acute / chronic) douch, choting habits, sexual hx, d/c in sexual partner, condoms, associatd symptoms ( itch, tender, inflamed, bleeding external tissues, dysuria, burning on urination, abd pain, cramp , pelvic fullness, effort to treat, meds,
PREMENSTURAL SYMPTOMS COMPLAINT; symptpms: headaches, wt gain, edema, breast tender, irritabiity mood change, fequency, interference with adls, relief measures, aggrivating factors, med
MENOPAUSAL SYMPTOMS OCMPLAINT; age at menopause, or current, symptoms ( menstural changes , mood change, tension, hot flash, postmen. bleeding, generl feeling ( self image, relationships) birth control measures, mothers experience, medications
INFERTILITY; lenght of time attemptin, sexual activity patter, knowledge of fertil period, cycle length, abnormalities of vagina, cervis, uterus, tubes, ovaries, contributing factors ( stress, nutrition, chemical subs) partner factors, diag evals
URNINARY SYMPTOMS ; dysuriam, buring, frequency, urgency, character ( acute/chronic) frequency of occurence, last episode, onset, course, feeling ( bladder empty or not) pain with urination, discription of urin ( coor , blood , particles, clear, cloudy, associated symptoms ( vag d/c, bleeding ,abd pain ,cramp, distention, pelvic fullness, flank pain) meds

Front 11

MUSCLE / SKELETAL Inspection: anterior, posterir, later aspect of posture. skin and subq tissues,muscles, PALPATION; all bones, joints, surrounding muscles.
active and passive rom: muscle strength push / pull against force
TMJ- fingertips anteriro to tragus, slip into joint as pt opens mouth. rom ( open close) laterally move lower jaw to each side , protrude and retract chin,
CERVICAL SPINE: INSPECT anterior and posterior.alignment with shoulders, symmetryof skinforld and mucles, Palpate posterir neck, cervical spine, paravertebra, trapexius, sternocleidomastoid , ROM - bend head forward chin to chest, backward , chin to ceiling, to each side (ear to shoulder) turn to each side ( chin to shoulder) THORACIC AND LUMBAR SPINE; head directlyover fluteal cleft , vertebrae straight,knee and feet align with trunk, Palpate- along spinal process, percuss with fist along spine, Ask to bend forward and touch toes, hyperextend ( backwards) bend to each side, swing upper trunk side to side
SHOULDERS; Inspect: contour, girdle, clavicles, Palpate, sternoclavicular joint, clavicle, acromioclavicular joint, scapula, coracoid process, greater tubercle of humerus, biceps groove ( rotate arm and forarm externally, locate bicep near elbow and follow to tendon , then lift elbow andposteriorly to extend shoulder ROM: shrug shoulders, raise both arms forward, up over head, hyperextend arms behind back, lift laterally and straight overhead, swing each arm in front, arms behind hips elbows out, arms behind head elbows out . shrug should against force
ELBOWS; inspect contour in flexed and extended palpate in both positions, with elbow flexed rotate palm up and down
HAND AND WRIST: inspect dorsal and palmer, palapte each oint in hand and wrist ROM: flex and hyperextend fingers , touch thumb to each fingertip, spread apart, bend hand at wrist up and down, palm side down , turn left to right, make fist
HIPS; inspect anteriorly and posterily while standing, palpate : hips and pelvis with pt supine ROM: supine , raise leg with knee exteded above body, standing or prone swing leg back, while supine raise one knee to chest other straight, supie swing leg latterly and medially with knee straight wihle supine,flex knee toward ohter leg , lwhle supine place lateral aspect of foot on knee of other leg moved flexed knee towards table
LEGS AND KNEES: inspect knees and popliteal spaces flexed and exteded. palpate popliteal space and tibiofemoral joint space,
ROM: bend knee, straighten leg and stretch
FEET AND ANKLE: INSPECT with bearing wt, stand and walk, and sitting. Palpate chilles tendon, anterior surface of ankle, medical and lateral malleoli, metoltarsal joint ROM: pint toward celing, pint toward floor, bend at ankle, rotate ankle bend and straighten toes

Back 11

JOINT COMPLAINTS: Character ( stiff, limitatin, change in size or contour, swelling, redness, constant pain , pain with motion, uni/ bilat , interfer with adl, locking , give away) Associated events ( time of day, activity, specific movemoent, injury , strnous activity, weather), Temporal factors ( change in freq. char of episoeds, better/ worse into day, progess, natrue of onset) effort to treat ( exercise, rest, wt red, pt, heat, ice brace, splint ) meds
MUSCULAR COMPLAINTS; CHARACTER ( limit of movement, weak or fatigue, paralysis, tremor, tic, spasms, climsiness, wating, aching pain,Precipitating fortors ( injury, strenous activity, sudden movement, stress) effort to treat( heat , ice, splints, rest, massage,) Medications
SKELETAL COMPLAINTS character ( diff with gait, limping, numbness, tingleing, pressure sensation, pain with movement, crepitus, deformity, change in contour) asociated event ( injury, recent fx, strenuous activity, sudden movemnt , stress, postmenopause ) effort to treat ( reast, splints , chiropractic, acupuncture ) meds
INJURY: sensation at time of injury ( click, pop, tear, mubmness, tingling, catching , locking, grating, snapping ,warmth, coldness, ability to bear wt) mechanism of injury ( direct trauma, overuse, sudden change of direction, forceful contraction overstreach),pain: location , type ,onset ( sudden/gradule) aggravating or alleviating factors, position for comfort. Swelling ( location, timing , with or without activity ) effort to treat ( rest, ice, heat ,splints)
BACK PAIN: abrupt or gradual onset, characterofpain and sensation ( tearing, buring, steady ache, tingling, numbness, location distribution ( unilater/bilateral),radiation to but, groin or legs, trigged by cough, sneezing, sudden movements . Associated with ( trauma, occupation, nonoccupational lifting , long distance driving, sports change in posture or deformity, Effort to treat ( rest, avoid,stand, suden movement, chiro) meds

Front 12

NEUROLOGICAL
Crainal Nerves
cn1 olfactory - odors one nare at time , eyes closed
cn2 optic - vision with snellen chart and rosenbaum
cn3- oculomoter/cn 4 trocheler/cn6 abducens- visual fields by confrontation and extinction, eyelids for drooping, pupil size equality , direct and consensual response to light and accomondation, extraocular eye movements
cn5 trigeminal - face muscle for atrophy and tremor, palpate jaw muscle for tone, and strencht with clench teeth test superficial pain and touch sensations ( cotton, broke tongue blade) corneal reflex
cn 7 facial - symmetry of facial features with varous expressions ( smile, frown, puff cheek, wrinkle forehead) identify seeet and salty tastes on each side of tongue
cn 8 acoustic - hearing wht whisper , bone and ir conduction, lateralization of sound
cn 9 glossopharyngeal - sour and bitter tastes, gag reflex, ability to swallow
cn 10 vagus- inspect palate and uvual for symmetry with speech and sounds and gag, observe for swallowing difficulty eval qualit of guttural speech sounds ( nasal for hoarse voice quality 0
cn 11 spinl accessory ( shurg should strenght, sternocleidomastoid ( head turn against hand resistance)
cn 12 hypoglossal - instpect tongue in mouth, while protruced for symmetry tremor and atrophy, tongue movement toward nose and chin, strenth wit index finger when tongue is pressed against cheek, quality of lingual speech sounds ( l,t,d,nz)
COORDINATION AND FINE MOTOR SKILLS. pat knees with both hands alt turn palm up and down increasing rate, touch nose to moving index finger, heel to shin ( stand sit and supine ) index finger to nose eyes open and closed
BALANCE; eyes open and closed - stand with feet together and arms at sides, feet apart push shoulders to knock off balance, stand on one foot eyes open and closed
GAIT - heel toe walking
SENSORY FX; eyes closed hands, lower arms abd, feet lower legs
1) superficial ( cotton wisp)
2) superficial pain( broken tongue blade)
3) temp / deep pressure if superficial is not intact
4) vibrating tuning fork against several bony prominences
5) position of joints
CORTICAL SENSORY FX.
eyes closed, hand familiar object, identicy
2) touch 2 points at same time with sharp object
3) touch cheek and hand on opposits ask how many areas are being touched
4) draw letter or number in hand , ask what it is
5) point location, touch area, removed, ask to identify
REFLEXES
1) abdominal
2) inner thigh of male ( testes on same side rise)
3) planter heel to ball each side
DEEP TENDON REFLEX
1) bicep- flex elbow palm up ( rest on your arm) palpate tendon in ac , place thumb on tendon fingers under elbow. strike thumb
2) brachioradial - flex arm to 45, rest forearm on your arm, hand pronated, strike tendon 2 inches above wrist
3) triceps - flex elbow at 90 support under upper arm with hand, palpate tricep tendon just above elbow, strike with hammer
4) patellar - flex knee 90, support upper leg with hand( under edge of examin table) strike tendon below patella
5) achilles - flex ankle in hand 90 , strike at level o f ankle malleoli
6) clonus, test if other is hyperactive, support knee in partially flexed position, briskly dorsiflex foot with other hand

Back 12

SEIZURE AND CONVULSIONS sequence of event , aura, fall to groung, shrill, cry, motor activity, transition phase, change in color of face, lips, pupil changes, eye deviation, loss of consciousness, ostictal phase, total linght of seizure , Character or symptoms, Aura 9 irritability, tension,confusion, blurr vision, mood changes, focal motor seizure, activity, gi distress, Level of consciousness ( loss ,impairment, duration) automatism ( eyelid fluttering, chewing , lip smacking, swallowing, Muscle tone ( flaccid, stiff, tense, twitching, where began and where moved throughout body, change in char of motor activity during seizure, postical behavior ( weakness, paralysis, confusion, drowsiness, headaches, muscle aching, time sleeping after seizure, andlateralization of signs.r/t of seizure to (time of day, meals, fatigue, emotionale stress, excitement, menses, d/c meds, poor compliance with meds, activity before attack) frequency of seizures , age at first, meds
PAIN; onset ( sudden/ progressive , associated with fever, injury) quality and intensity ( deep/ superficial, ach,,,boring, throb, sharp, stab, burn, pres, sting, cramp, gnaw, prick, shoot, duration,constancy) Loaction ( along distribution of one or more nerves, or more general , radiating) associated manifestations ( crying, decreased activites, seat, muscle rigidity, tremor, impairment medtal process, or concentration, wakness) Effort to treat, Meds
GAIT COORDINATION; BALANCE ( sensation of listing when walkin , unsteay) falling ( directions, associated with looking up) Legs give way, stiffness, associated problems ( ra, ataxia, stroke ,seizures, arthritis in knee, arrhythmia, sensory changes ) Meds
WEAKNESS OR PARESTHESIA : onset ( sudden for with initiation of or followin sustained activity , time before began, rapid or slow) character ( generalized or specific body part) progressively ascending for transient , proximal or distal extremities, uni/bilat or asymmetrical, difficulty walking, loss of balance or coordination, hypersensitvity to touch or burning sensation. associatd symptoms: tingeling, numbness, confussion, trbouble speaking, or understanding speech, severe headache, impaired vision in one or both eyes, limb feels encased, pain, sob, stiff of joints, spasms, muscle tension ,sensory deficits ,loss of urinary or bowel control. concurrent chronic illness ( hiv, nutrition or vitamin deficiency, recent acute illnes, Meds
TREMOR: onset (sudden/gradual) character : worse with rest, intentional movement, anxiety, uni/bilat body location,interfer with adls associated problems : hyperhyroid, familiar tremor, liver or kidney disorder, consumption of ethoh, ms. relived by ( rest , activity, etho) Meds