Have Patient Turn and Sit with Legs Dangling off Side of Bed Vital Signs

1. Palpate radial pulse for rate and regularity (see Chapter 15, The Peripheral Vascular System).

2. Determine respiratory rate and pattern (see Chapter 13, The Chest).

Head (Chapter 9, The Head and Neck)

1. Inspect cranium.

2. Inspect scalp.

3. Palpate cranium.

Face (Chapters 8, The Skin, and 9, The Head and Neck)

1. Inspect face.

2. Inspect skin on face.

Eyes (Chapter 10, The Eye)

1. Assess visual acuity, both eyes.

2. Check visual fields, both eyes.

3. Determine eye alignment, both eyes.

4. Test extraocular muscle function, both eyes.

5. Check pupillary response to light, both eyes.

6. Test for convergence.

7. Inspect external eye structures, both eyes.

8. Perform ophthalmoscopic examination, both eyes.

Nose (Chapter 11, The Ear and Nose)

1. Inspect nose.

2. Palpate nasal skeleton.

*If the blood pressure is elevated in the upper extremity, blood pressure in the lower extremity must be assessed to exclude coarctation of the aorta. The patient is asked to lie prone, and blood pressure by auscultation is determined (see Chapter 14, The Heart).

3. Palpate sinuses (frontal, maxillary), both sides.

4. Inspect nasal septum, both sides.

5. Inspect turbinates, both sides.

Ears (Chapter 11, The Ear and Nose)

1. Inspect external ear structures, both sides.

2. Palpate external ear structures, both sides.

3. Evaluate auditory acuity, both sides.

4. Perform Rinne test, both sides.

5. Perform Weber test.

6. Perform otoscopic examination, both sides.

7. Inspect external canal, both sides.

8. Inspect tympanic membrane, both sides.

Mouth (Chapter 12, The Oral Cavity and Pharynx)

1. Inspect outer and inner surfaces of lips.

2. Inspect buccal mucosa.

3. Inspect gingivae.

4. Inspect teeth.

5. Observe Stensen's and Wharton's ducts, both sides.

6. Inspect hard palate.

7. Inspect soft palate.

8. Inspect tongue.

9. Test hypoglossal nerve function (see Chapter 21, The Nervous System).

10. Palpate tongue.

11. Inspect floor of mouth.

12. Palpate floor of mouth.

13. Inspect tonsils, both sides.

14. Inspect posterior pharyngeal wall.

15. Observe uvula as patient says ''Ah'' (see Chapter 21, The Nervous System).

16. Test gag reflex (see Chapter 21, The Nervous System).

Neck (Chapter 9, The Head and Neck)

1. Inspect neck, both sides.

2. Palpate neck, both sides.

3. Palpate lymph nodes of head and neck, both sides.

4. Palpate thyroid gland by anterior approach.

5. Evaluate position of trachea (see Chapter 13, The Chest).

Neck Vessels (Chapter 14, The Heart)

Inspect height of jugular venous pulsation, right side.

Neck* (Chapter 9, The Head and Neck)

1. Palpate thyroid gland by posterior approach.

2. Palpate for supraclavicular lymph nodes, both sides.

Posterior Chest (Chapter 13, The Chest)

1. Inspect back, both sides.

2. Palpate back for tenderness, both sides.

3. Evaluate chest excursion, both sides.

4. Palpate for tactile fremitus, both sides.

5. Percuss back, both sides.

6. Evaluate diaphragmatic excursion, right side.

7. Auscultate back, both sides.

8. Palpate for costovertebral angle tenderness, both sides (see Chapter 17, The Abdomen).

*The examiner should now go to the back of the patient while the patient remains seated with legs dangling off the side of the bed.

Sacrum (Chapter 14, The Heart)

Test for edema.

Anterior Chest* (Chapter 13, The Chest)

1. Inspect patient's posture.

2. Inspect configuration of chest.

3. Inspect chest, both sides.

4. Palpate chest for tactile fremitus, both sides.

Female Breast (Chapter 16, The Breast)

1. Inspect breast, both sides.

2. Inspect breast during maneuvers to tense pectoral muscles, both sides.

Heart (Chapter 14, The Heart)

1. Inspect for abnormal chest movements.

2. Palpate for point of maximum impulse.

3. Auscultate for heart sounds, all four positions.

Axilla (Chapter 16, The Breast)

1. Inspect axilla, both sides.

2. Palpate axilla, both sides.

3. Palpate for epitrochlear nodes, both sides (see Chapter 15, The Peripheral Vascular System).

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