Physical assessmentPhysical assessmentHIPPIRONEL can be usedto find most diagnosis.
history--OPQRSTinspection---scars, redness,symetry,gait
palpation--nodule, pain, spasmpercussion--heart/abdomen
instrumentation--stethoscope,tuning forkrange of motion---spine and extremities
orthopedic test--many testsneurologic test---dermatomes, reflex,motor
related test---xray, MRI,ectlab tests----CBC,ect
HIPPIRONEL can be usedto find most diagnosis.
history--OPQRSTinspection---scars, redness,symetry,gait
palpation--nodule, pain, spasmpercussion--heart/abdomen
instrumentation--stethoscope,tuning forkrange of motion---spine and extremities
orthopedic test--many testsneurologic test---dermatomes, reflex,motor
related test---xray, MRI,ectlab tests----CBC,ect
History--OPQRSTHistory--OPQRST
• Onset--when?• Palliative--makes it better?• Provacative--irritates?• Quality--stab,burn,numb?• Radiation/Referral--shoot down
arm/leg?• Severity---0-10 or mild/moderate/severe• Timing--after dinner, 2am?
• Onset--when?• Palliative--makes it better?• Provacative--irritates?• Quality--stab,burn,numb?• Radiation/Referral--shoot down
arm/leg?• Severity---0-10 or mild/moderate/severe• Timing--after dinner, 2am?
HistoryHistory• Past history---happened before?• Family history--stroke,MI, cancer• medications/vitamins• other clinics?• Medical history--surgeries• Social history---alcohol,drugs,STD• Occupational history--hard job,work
comp
• Past history---happened before?• Family history--stroke,MI, cancer• medications/vitamins• other clinics?• Medical history--surgeries• Social history---alcohol,drugs,STD• Occupational history--hard job,work
comp
Vital signsVital signs
• BP• pulse• resp• temp• height/weight• pain rating
• BP• pulse• resp• temp• height/weight• pain rating
ROM--range of motionROM--range of motion
• neck--flexion,extension, lateral flexion, rotation
• lumbar--flexion,extension, lateral flexion, rotation
• elbow--flexion,extension• forearm--supination,pronation• wrist--flexion, extension, radial deviation ulnar deviation
• fingers--flexion, extension• shoulder--flexion,extension, abduction, adduction, internal rotation, external rotation, circumduction
• neck--flexion,extension, lateral flexion, rotation
• lumbar--flexion,extension, lateral flexion, rotation
• elbow--flexion,extension• forearm--supination,pronation• wrist--flexion, extension, radial deviation ulnar deviation
• fingers--flexion, extension• shoulder--flexion,extension, abduction, adduction, internal rotation, external rotation, circumduction
IntegumentaryIntegumentary
skin---dehydrated(tugor),color, temp,ulcer
nails--clubbing,spooning, cap refill less 2 sec
skin---dehydrated(tugor),color, temp,ulcer
nails--clubbing,spooning, cap refill less 2 sec
ROM--range of motionROM--range of motion• knee--flexion, extension• hip-flexion,extension,int rotation, ext rotation, abduction, adduction
• ankle--inversion,eversion,• plantar flexion,dorsiflexion• toes-flexion,extension
• knee--flexion, extension• hip-flexion,extension,int rotation, ext rotation, abduction, adduction
• ankle--inversion,eversion,• plantar flexion,dorsiflexion• toes-flexion,extension
eye exameye exam
•http://www.youtube.com/watch?v=wPzCA9k8GRQ
•ear exam •http://www.youtube.com/watch?v=iIbaq15t1L0
•http://www.youtube.com/watch?v=wPzCA9k8GRQ
•ear exam •http://www.youtube.com/watch?v=iIbaq15t1L0
MusculoskeletalMusculoskeletal
• motor stength--0 to 5• 5--Full ROM with gravity & full resistance• 4--Full ROM with gravity & some
resistance• 3--Full ROM with gravity & No resistance• 2-Full ROM with gravity eliminated• 1--slight contractility; no joint motion• 0--No evidence of contractility
• motor stength--0 to 5• 5--Full ROM with gravity & full resistance• 4--Full ROM with gravity & some
resistance• 3--Full ROM with gravity & No resistance• 2-Full ROM with gravity eliminated• 1--slight contractility; no joint motion• 0--No evidence of contractility
NeurologyNeurology
• oriented?---time, place, name• cranial nerves--I to XII these can be seen on the bottom of brain
• ‘On old Olympus towering top, a Fin and German viewed some hops’
• oriented?---time, place, name• cranial nerves--I to XII these can be seen on the bottom of brain
• ‘On old Olympus towering top, a Fin and German viewed some hops’
Cranial nervesCranial nervesI Olfactory - olfaction (smell) s IIOptic - vision (Contain 38% of all the axons connecting to the brain.)
sIII Oculomotor - eyelid and eyeball muscles mIV Trochlear - eyeball muscles mV Trigeminal - facial and mouth sensation , chewing bVI Abducens - eyeball movement mVII Facial - taste, facial muscles and salivary glands bVIII Auditory - hearing and balance sIX Glossopharyngeal - taste, swallowing bX Vagus - long nerve goes to heart, GI, lungs bXI Accessory - moving head and shoulder mXII Hypoglossal - tongue muscles mSome cranial nerves give sensation, some give muscle control, some
do both.
I Olfactory - olfaction (smell) s IIOptic - vision (Contain 38% of all the axons connecting to the brain.)
sIII Oculomotor - eyelid and eyeball muscles mIV Trochlear - eyeball muscles mV Trigeminal - facial and mouth sensation , chewing bVI Abducens - eyeball movement mVII Facial - taste, facial muscles and salivary glands bVIII Auditory - hearing and balance sIX Glossopharyngeal - taste, swallowing bX Vagus - long nerve goes to heart, GI, lungs bXI Accessory - moving head and shoulder mXII Hypoglossal - tongue muscles mSome cranial nerves give sensation, some give muscle control, some
do both.
test your nervestest your nerves
I Olfactory - olfaction (smell) s
IIOptic - vision (Contain 38% of all the axons connecting to the brain.) s
III Oculomotor - eyelid and eyeball muscles m
IV Trochlear - eyeball muscles m
V Trigeminal - facial and mouth sensation , chewing b
VI Abducens - eyeball movement m
VII Facial - taste, facial muscles and salivary glands b
VIII Auditory - hearing and balance s
IX Glossopharyngeal - taste, swallowing b
X Vagus - long nerve goes to heart, GI, lungs---gag b
XI Accessory - moving head and shoulder m
XII Hypoglossal - tongue muscles m
I Olfactory - olfaction (smell) s
IIOptic - vision (Contain 38% of all the axons connecting to the brain.) s
III Oculomotor - eyelid and eyeball muscles m
IV Trochlear - eyeball muscles m
V Trigeminal - facial and mouth sensation , chewing b
VI Abducens - eyeball movement m
VII Facial - taste, facial muscles and salivary glands b
VIII Auditory - hearing and balance s
IX Glossopharyngeal - taste, swallowing b
X Vagus - long nerve goes to heart, GI, lungs---gag b
XI Accessory - moving head and shoulder m
XII Hypoglossal - tongue muscles m
DermatomesDermatomes
homunculus
neuro levelsneuro levels
AbdomenAbdomen
• RUQ LUQ RLQ LLQ--any bruises, bulges, discoloration
• sounds of borborygmus-normal 3-30? sound/minute• no sounds after 5 minutes----severe GI problem• McBurneys point---for appendix. between navel
and ASIS• Murphy sign--------press under liver then
release. severe pain=cholecystitis• murphys punch-----fist tap over kidneys
• RUQ LUQ RLQ LLQ--any bruises, bulges, discoloration
• sounds of borborygmus-normal 3-30? sound/minute• no sounds after 5 minutes----severe GI problem• McBurneys point---for appendix. between navel
and ASIS• Murphy sign--------press under liver then
release. severe pain=cholecystitis• murphys punch-----fist tap over kidneys
Orthopedic testsOrthopedic tests
stressing a body part to determine cause of pain
• neck• lumbar• elbow• knee• ankle• hip• shoulder
stressing a body part to determine cause of pain
• neck• lumbar• elbow• knee• ankle• hip• shoulder
dermatome, motor, reflexdermatome, motor, reflex• http://www.youtube.com/watch?v=esEWwFq940g
• http://www.youtube.com/watch?v=esEWwFq940g
check your own borborygmuscheck your own borborygmus
• normal, hyperactive, hypoactive
• normal, hyperactive, hypoactive
CardiacCardiac
• percussion to find heart size• systole (S1 sound)--ventricles contract and aortic/pulmunary valves open.mitral/tricuspid close.= lub
• diastole (S2 sound)--ventricles relax, mitral/tricuspid open to let in blood, aortic/pulmunary valves close.= dub
• percussion to find heart size• systole (S1 sound)--ventricles contract and aortic/pulmunary valves open.mitral/tricuspid close.= lub
• diastole (S2 sound)--ventricles relax, mitral/tricuspid open to let in blood, aortic/pulmunary valves close.= dub
CardiacCardiac
• pulses---• 0 absent• 1 weak/thready• 2 palpable• 3 strong• 4 bounding
• pulses---• 0 absent• 1 weak/thready• 2 palpable• 3 strong• 4 bounding
PulsesPulses
• radial• brachial• popliteal• dorsalis pedis• carotid• femoral• http://www.youtube.com/watch?v=74v4mEWhOao
• radial• brachial• popliteal• dorsalis pedis• carotid• femoral• http://www.youtube.com/watch?v=74v4mEWhOao
check your pulsescheck your pulses
LungsLungs14-20 bpmlabored breathing?scalene muscles used?finger,lips color, coughing, sputumchest shape--barrel, excavatus palpation--hands on back,symetric movement with breathing
‘99’ hand on back---fremitis vibrationauscultation---crackles, rales, wheezes
14-20 bpmlabored breathing?scalene muscles used?finger,lips color, coughing, sputumchest shape--barrel, excavatus palpation--hands on back,symetric movement with breathing
‘99’ hand on back---fremitis vibrationauscultation---crackles, rales, wheezes