Head, shoulders, knees, and toes. It is a familiar song that was part of our childhoods that taught us the basics of anatomy. Little did we know that it would relate to our lives ten years later. Dr. Richard McElhaney visited us this week to teach us the nursing head-to-toe survey. It is a typical survey that many medical professionals perform to test a patient for any health problems. Many tools are needed to complete this assessment, such as a stethoscope, penlight, tongue depressor, gloves, thermometer, reflex hammer, blood pressure cuff, pulse oximeter, and something that gives off a strong scent. This survey usually takes an hour to finish and is used very often, so it is important to know how to do it. The four stages of the assessment are inspecting, palpating, percussing, and auscultating.
The head-to-toe assessment starts when you introduce yourself to the patient. You begin to observe and inspect the patient. What condition are they in? Do they look neat and clean or distressed and ill? You ask them a couple of random questions, such as what their name is or what school they go to. This will help you get a sense of understanding of if they are okay or are a bit confused. After, you do orientation, where you will check their temperature, which should be 98.6 F. There are three different places to check temperature: oral, axillary, and rectal. Blood pressure is measured for abnormality. The pulse is checked with a pulse oximeter. Check their armband for general information, such as name, age, or allergies. Respiratory rate, oxygen saturation, height, and weight are charted.
Next is the head and face. Check the distribution of the face tissue and muscles, hair condition, and scalp. The lips should be checked for any discoloration or dehydration. Discoloration is a sign of illness in the patient, so it is important not to skip this step. The face is also assessed for problems, such as droopiness or lacerations. The eyes are checked for symmetry and state of the conjunctiva. Eyebrows and eyelashes are checked for the distribution of hair follicles. The sclera is checked for infection and parasites. To check eye health, doctors use the acronym PERRLA, which stands for pupils, equal, round, reactive to, light, and accommodation. They make sure your pupils are in the right place, the same size, perfectly round, sensitivity to light, and ability to change focus. They check the six cardinal positions of the gaze. Next, the ears are checked. Medical professionals inspect and palpate the auricle for lesions and tenderness. They look inside the ear and assess it for discharge and tympanic membrane. They also do a whisper test to check how well the patient can hear. The nose is palpated and assessed for symmetry. A medical professional will then check the septum, inside the nostrils, and verify the patient's breathing ability. They then inspect gums and teeth, assess buccal mucosa and palate, examine the tongue, uvula, and tonsils, and palpate the jaw point. The mouth can help doctors predict and discover diseases before they get serious.
Next is the neck and shoulders. Do not palpate both carotid arteries at the same time because it could stop blood flow to the brain. Check the neck range of motion, shoulder shrug with resistance, and palpate lymph nodes of the head, face, neck, and underarms. Lungs are auscultated for sounds of abnormality front and back. The thorax is palpated, and the respiratory exclusion level is assessed. Next, the circulatory system is checked. The carotid and temporal artery are bilaterally palpated. Medical professionals auscultate the heart in five places: the aortic valve, pulmonic valve, Erbs point, tricuspid valve, and mitral valve. They listen for any swooshing or weird noises of the heart, in case of a heart murmur or cardiac arrhythmia, which is an abnormal heartbeat.
The abdomen is assessed next. First, you inspect it and auscultate the four quadrants for bowel sounds. Then, you percuss and palpate for any pain or tenderness. Medical professionals always do it in this order to avoid altering bowel sounds. They ask about problems with the bowels and bladder.
The limbs are assessed next. The arms and hands are checked for a range of motion and strength, checked for brachial and radial pulses, skin turgor, and capillary refill on fingernails. The legs and feet are assessed for the same things.
Overall, head to assessments are an easy and thorough way to check patients. It was a fun unit to be able to learn the basics of healthcare. I hope I get to dig deeper into the world of medicine and its variants in health.
Comments