Head to Toe Assessment

• Wash hands
• Introduce self and review role for visit
• BP, PTR
• Cranium for size, contour, color, lesions
• Inspect eyebrows, eyelids, and eyelashes
• Palpate sinuses and TMJ
• CN VII (facial expression)
• CN II (confrontation test - peripheral vision)
• CN III, IV, & VI (positions of gaze)
• PERRLA
• Inspect and palpate external ear
• CN VIII (whisper test)
• Inspect and palpate external nose
• Nostril patency and CN I (fragrance test) 
• Inspect lips, buccal mucosa, gums, tongue, and palates
• CN V (clench teeth, palpate face)
• Tap teeth
• CN XII (protrude tongue - "light, tight, dynamite")
• CN IX and X (depress tongue and say "ah")
• Neck ROM
• Auscultate carotid pulses
• CN XI (shrug shoulders against resistance)
• Inspect and palpate chest and lungs - back then front
• Palpate spinous processes for paraverbal muscles for tenderness and symmetry
• Auscultate over all lung fields and verbalize normal vs abnormal breath sounds
• Percuss over all lung fields
• Palpate pericardium for pulsations, thrills, and/or heaves
• Auscultate five heart fields, sitting then lying (diaphragm & bell) 
• Auscultate heart at apex in lt. lateral position
• Inspect abdomen skin, contour, symmetry, & umbilicus
• Auscultate abdomen with diaphragm, all four quadrants
• Auscultate abdominal aorta with bell for bruit
• Percuss all four quadrants of abdomen
• Palpate abdomen; light then deep
• Inspect skin and nails; capillary refill
• Palpate skin for temperature; skin turgor
• Compare symmetrical parts
• Palpate radial, brachial, & pedal pulses, bilaterally
• Test sensations of extremities w/ cotton ball - tell pt to close eyes
• Test upper & lower extremity ROM and muscle tone using resistance
• Elicit reflexes for biceps, triceps, patellar, and achilles
• Observe gait and balance; heel-toe walk
• Romberg's sign & rapid alternating movements

Giving Thanks

The first semester of nursing school is winding down, and I couldn't be more ready for Thanksgiving break.  In fact, this year I'll be giving thanks for making it through the boring abyss that is this first semester. I'm not sure if my mid-semester slump just came late, or the effects of burnout from the previous degree took awhile to kick back in, but I am bored with the material and reluctant to study it.  

I am really looking forward to next semester, because I will study Maternal and Child Health.  I have wanted to work in obstetrics and/or neonatology ever since I can remember.   A little birdie told me that I'll be working Saturday clinicals for OB.  This is very good news because I will be placed at a "city" hospital, with higher birth rates and a NICU.  Knowing that I will work in Labor & Delivery and the NICU in just over two months is what's carrying me through the rest of this semester.

I Hate Med-Surg.

It has come to my attention that I would rather not be a nurse at all than be a med-surg nurse.  


Watching the RN's in action, I see an endless cycle of: vitals, meds, vitals, meds, procedure (if you're lucky), vitals, documentation, more meds.  It would be enough to make me puke.  No excitement, no stretching your brain, and rarely anything innovative or medically fascinating.  
Just meds, pee, poop, wounds, and moving people [who are probably obese...], all the live long day. 


I have all the respect in the world for med-surg nurses.  I don't know how they do it.