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