Head To Toe Assessment CheckList

Revision date: 29-Jan-15

Head to Toe Assessment Check ListStudent Name: ______________________________________________Time started:______________ Time ended:_______________Tell your patient & instructor what you are doing and what assessment results you are finding (ex. state sound type for all lung auscultation) You have 25 minutes to complete your assessment.Head to Toe AssessmentSNIComments

*7 Cardinals

*Pain assessment

Nursing Assessment Questions

Medication Hx

Orientation

Inspection/Symmetry

*Pupil Size/PERRLA

*6 Cardinal Fields of Gaze

Conjunctiva/Sclera

Mouth Assessment

JVD (45 degree angle)

*Carotid pulses (RSE)

Posterior back inspection

Posterior back palpation

*Posterior Lung Auscultation

Anterior Chest Inspection

Skin Turgor

*Anterior Lung Auscultation

*Auscultation APTM (state and palpate for landmarks)

*Pulse at PMI x 1 minute

Upper Extremities Inspection

Upper Extremities Palpation

Brachial pulse

*Radial pulse x 30 seconds

*UE Capillary Refill

*UE Neuro: push/pull/squeeze

GI symptoms, LBM

Abd Inspection

*Abd Auscultation: 4 quadrants

Abd Palpation

GU symptoms/current function

Posterior Skin Check

Lower Extremities Inspection

Lower Extremities Palpation

Popliteal pulse

Posterior Tibialis

*Dorsalis Pedis

*LE Neuro: push/pulls

*LE capillary refill

Comfort: assist patient to comfortable position

*Safety: bed to low position, handrails, call light

Did Student provide for patient modesty throughout assessment?

S=Satisfactory / NI: Needs Improvement/ No check: indicates not completedPoints will be awarded for completion: 42 points are possible. If a recheck is needed the score for the first attempt will be recorded in the grade book. All *starred items MUST be completed to pass (Although may still need improvement) Student must complete 20 of the 26 non-starred items to pass Assessment must be completed within the 25 minute time frame.All *starred items completed (Y/N) (17 pts possible) _______ pts: student completed (___/26) (1 point each 25 possible) Total points: ______/42 Pass (Y/N)

Student signature: _________________________ Instructor: _________________________________ Date: _____________________________