620 - Unintentional ASMR - Assessment / Exam / Head to Toe

[00:00:01]Hi, my name is Caitlyn O'Neal. I'm a nurse practitioner student at St. Thomas University. And today we'll be doing a physical assessment on Emily. Emily, do you consent to be in this presentation?

[00:00:12]>> Yes, I do.

[00:00:13]>> Okay, mighty.

[00:00:18]Okay. So, first I'm going to do the head and face assessment. So, I'm going to look at Emily's scalp, hair, and head.

[00:00:30]Okay, everything is intact.

[00:00:34]Can you wrinkle your forehead for me?

[00:00:37]Can you squeeze your eyes tight? Can you puff out your cheeks?

[00:00:43]And can you clench your teeth? Okay, perfect. Now, I'm going to palpate your tempor palpate your temporal artery.

[00:00:54]All righty, perfect.

[00:01:00]Okay, now I'm going to palpate for TMJ.

[00:01:04]Clench your teeth for me. Open and close your mouth. You move your jaw side to side.

[00:01:11]Perfect.

[00:01:14]Now, I'm going to palpate your sinuses.

[00:01:18]I'm going to palpate your maxillary right here above your cheekbones.

[00:01:23]I'm going to go under your eyebrows.

[00:01:27]Perfect. Now I'm going to take a look at your vision. Now we did the smell and test and the patient has 2020 vision in both eyes.

[00:01:36]Okay. Now I'm going to assess your eyes.

[00:01:46]Click the All right.

[00:01:55]Pearla is equal round reactive to light.

[00:01:58]Conjunctiva is white. No floaters. Everything seems normal. Now I'm going to assess the six cardinal fields of gaze.

[00:02:16]Now, keep your head straight. And then you're just going to be looking at my finger.

[00:02:31]All righty. Everything seems normal.

[00:02:35]Now, I'm going to have you cover one eye, and I'm going to have you see how many fingers am I holding here?

[00:02:41]>> One.

[00:02:45]two four.

[00:02:48]>> Okay, now I'm going to have you do the other eye.

[00:02:52]One, four, three.

[00:02:58]>> Okay, now we're going to I'm going to assess for the corial light reflex.

[00:03:16]Perfect. They're two plus.

[00:03:19]They're 3 mm round regular reactive to light and they do accommodate the changes.

[00:03:29]Now I'm going to assess the external ear. If I I would be you doing this exam with an autoscope.

[00:03:36]All right.

[00:03:38]Ears are symmetrical.

[00:03:42]Everything seems to be intact.

[00:03:46]Now I'm going to palpate the oracle entragus of both ears.

[00:04:00]Non- tender. There's no masses. Now I'm going to be doing the whisp test.

[00:04:04][clears throat] Whisper test. So, I'm going to have you cover one ear.

[00:04:12]>> 3B9 3B9.

[00:04:21]>> Okay, both are both ears are normal and have passed the whisper test. Now, again with an autoscope, I would be assessing the tempanic membrane. Um, normal Normally they'd be pearly gray. Um neutral in position and intact. Cone of light is present and everything is uh visible.

[00:04:47]Now I'm going to assess her nose.

[00:04:52]Her nose is symmetric and midline patent.

[00:05:01]Now um mucosa also in the nose is pink and intact. There's no septal deviation and the um turbineates are smooth and there is no drainage.

[00:05:14]Now I'm going to be inspecting her mouth and her throat.

[00:05:18]Open your mouth for me.

[00:05:20]Uvula is midline. Mucosal membranes are pink and red. Patient has good dentition. All teeth are intact. Tongue is midline. Move your tongue side to side for me. Perfect.

[00:05:36]Patients tonsils are also two plus. Um, now we're going to do the gag reflex.

[00:05:42]I'm going to have you stick out your tongue.

[00:05:45]I would stick a tongue blade in there.

[00:05:49]And gag reflex is intact. Okay. Now, I'm going to be looking at the neck.

[00:05:56]Neck is symmetric. I'm going to see if there's any lumps, no swelling or masses. I'm going to be looking at the lymph nodes as well.

[00:06:09]Looking at the posterior cervical, the super ventricular, the clavicles.

[00:06:15]Now I'm going to do her corateed pulses.

[00:06:22]There are two plus bilaterally.

[00:06:24]I'm going to palpate her midline trachea.

[00:06:30]Shift it to the left side. Can you swallow?

[00:06:36]Perfect. Now I'm going to oscultate to see if there's any breeds in the corateed artery.

[00:06:57]Perfect. No bruises are present.

[00:07:02]Now I'm going to see her next range of motion.

[00:07:08]Can you look down for me? Look up.

[00:07:13]Look side to side.

[00:07:16]Can you move put tilt your head side to side ear to shoulder?

[00:07:19]Perfect. It's full symmetric any pain when you're doing that. No. All right.

[00:07:23]Perfect. Now I'm going to have you shrug your shoulders. Now I'm going to have you push against resistance.

[00:07:34]Perfect. Side to side.

[00:07:39]Your neck. Side to side.

[00:07:41]No pain. No. Perfect. Everything is symmetric and there's no spasms present.

[00:07:47]Now I'm going to be examining her heart.

[00:07:54]No chest pain or anything today? No.

[00:07:57]Okay. I'm going to assess the apical and the um fifth intercostal space, the left midclavicular.

[00:08:22]Now I'm at the PMI, the mitro site, the fifth intercostal space.

[00:08:30]Now I'm going to be assessing her apical rate for about 60 seconds.

[00:08:48]Patient has a regular rhythm. S1 and S2 are present. There's no murmurss, no thrills. Um, patient does not seem to be exhibiting any shortness of breath or anything as well.

[00:09:04]All righty. And I just um oscultated her heart sound. So we had the aortic, pulmonic, the herb, tricuspid and mitral. And now we're going to repeat it with the bell of the stethoscope.

[00:09:37]again for about 60 seconds.

[00:09:45]Okay, everything seems normal there as well.

[00:09:51]Now, I'm going to be palpating your thyroid gland.

[00:09:59]Everything seems fine. There's no masses, no lumps. Now I'm going to palpate your thorax and spine.

[00:10:10]There's no tenderness.

[00:10:12]Patient's skin is intact.

[00:10:15]Her spine is midline.

[00:10:18]Now I'm going to perform tactile femus.

[00:10:20]So, I'm going to have you repeat um 99 >> 99 99.

[00:10:28]Okay. Everything is equal.

[00:10:34]Now, I'm going to be [laughter] looking at your back. I'm going to have you turn around for me.

[00:10:43]Okay.

[00:10:47]Everything is equal bilaterally. Now, I'm going to also take for her breath sounds.

[00:10:59]Going to have you breathe in and out.

[00:11:24]All lung fields are clear. Now I'm going to percuss at her coastal vertebral angle.

[00:11:32]Any pain? No.

[00:11:36]Any pain? No. Okay.

[00:11:40]Now I'm going to have you turn around.

[00:11:43]I'm going to inspect her chest.

[00:11:48]Everything seems equal. No difficulty breathing. No. Um, everything is symmetrical. There's no deformities.

[00:11:56]Now, I'm going to listen to the front portion as well.

[00:12:03]I'm going to have you breathe in and out.

[00:12:20]Everything is clear. There's no adventitious sounds noted.

[00:12:25]Now I'm going to take a look at her upper and lower extremities.

[00:12:30]I'm going to take a look at your nails.

[00:12:32]Perfect. No clubbing. Patient is well groomed. Have you flip your hands over for me?

[00:12:40]Cap refill is normal.

[00:12:48]Skin is warm. There's no signs of bruising. Now, I'm going to be palpating the wrists. Um, palpating the joints in the wrists and the hands.

[00:13:08]No pain? No. Okay. Um everything's equal bilaterally. There's no tenderness, no swelling, no deformities.

[00:13:16]Now, we're going to do um range of motion in the upper extremity. So, I'm going to have you I'm going to do we're going to be doing abduction, abduction, flexion, hyperextension, um external rotation, internal rotation. So, I'm going to have you lift your right arm up.

[00:13:35]All right. And then I'm going to have you raise that same arm to the front as high as possible.

[00:13:42]All right. Can you put your arm out to the right at a 90° angle and rotate it up and down?

[00:13:49]Perfect. Everything is normal on that side. There's full range of motion. Now, I'm going to have you do it to the left.

[00:13:58]Right. To the front. Now, perfect. Now, I'm going to have you 90° and bend.

[00:14:07]Perfect. Everything is normal and symmetrical on both sides. And patient is reporting no pain.

[00:14:14]Okay. Now, we're going to be doing um pronation um supenation, flexion, and extension.

[00:14:20]So, I'm going to have you flex your arms.

[00:14:23]Perfect. Extend.

[00:14:25]Perfect. Now, I'm going to have you turn them in and out. No pain?

[00:14:30]>> Nope. All right. Perfect.

[00:14:34]Now, we're going to be doing um flexion and extension towards the front, but I'm going to be doing it with resistance.

[00:14:41]All right.

[00:14:43]Perfect. Patient is not verbalizing any resistance.

[00:14:48]No resistance there either. No pain.

[00:14:51]All right. Now, I'm going to be doing the range of motions for the hands and the wrist. So, I'm going to have you put your hands up and down.

[00:14:58]No pain?

[00:14:59]>> Nope.

[00:15:00]>> All right. Can you flip your palms for me? No pain. Bend your fingers.

[00:15:07]Perfect. I'm going to have Can you touch your fingers to each? Perfect. All right. Make a fist. Spread your fingers for me. All right. Everything is full active range of motion. Um, no pain and symmetrical.

[00:15:23]Okay. Now, going to have you do. We're going to see the um muscle strength of the wrists and the hands.

[00:15:31]No, I believe I just did this, but I'm going to do it again.

[00:15:37]Wrists and everything is fine and no pain.

[00:15:40]>> Yeah.

[00:15:40]>> Okay. I'm going to have you grasp my hand.

[00:15:46]Perfect. Everything is equal and no pain and symmetrical. Now, I'm going to have you um Lay down.

[00:15:59]Patient's laying down now. I'm going to inspect her abdomen.

[00:16:08]Everything is soft. No pain when I press on your abdomen? No. Okay, perfect. Now, I'm going to be oscultating her bowel sounds. So, also the patient's abdomen is flat, symmetric. It's non-distended, rounded, soft.

[00:16:24]All right. So, I'm going to be oscultating from the um patient's right lower quadrant all the way to the left lower quadrant, assessing for bowel sounds.

[00:16:50]Everything is normal, active.

[00:16:55]Now I'm going to oscultate the aortic sounds of the bowels with the bell of my stethoscope.

[00:17:11]>> [snorts] >> There's no brewies over the abdominal aorta. Now I'm going to be percussing her abdomen.

[00:17:36]Any pain? No.

[00:17:38]No. No. No. No.

[00:17:44]No.

[00:17:45]Everything seems normal. It's tempanic and dullness is heard of course of over the um right upper quadrant where the liver is located. Now I'm going to lightly palpate and then I'll be doing deep palpation as well.

[00:18:00]Lightly palpate first.

[00:18:03]No abnormalities are noted. Now I will deeply palpate.

[00:18:13]No abnormalities are noted as well. No swelling, masses, or pain.

[00:18:18][snorts] Now, I'm going to be assessing range of motion of the hips. This patient would be lying down. I'm going to have you turn that way.

[00:18:31]Okay.

[00:18:34]Now, I'm going to do straight leg flexion.

[00:18:40]All right. Now, the other leg.

[00:18:44]Now, we'll I'm going to have you bend your leg. We'll do abduction. Adduction.

[00:18:51]All right.

[00:18:53][snorts] Okay. Internal rotation is fine.

[00:18:58]Everything is smooth and symmetrical. No pain or anything?

[00:19:00]>> No. All right. Perfect.

[00:19:04]Now, I'm going to be taking a look at her lower extremities, looking at the skin and everything like that. All right. Skin is intact. patient does have freckles. Everything is warm and dry.

[00:19:19]No edema is present. I'm going to be taking a look at her pedal pulses.

[00:19:28]Patient has two plus pedal pulses. And now I'm also going to be assessing her popl posterior tibia tibia pulses as well.

[00:19:48]Everything is normal there as well. Two plus. Now I'm going to be looking at the range of motion of her lower extremities. So we're going to do dorsif flexion, planter f planter flexion as well. All right.

[00:20:00]Now dorsif flex. Planter flex.

[00:20:04]Perfect.

[00:20:10]Perfect.

[00:20:12]All righty. Can you The camera was more pointed down. Can you curl your toes for me? Okay. Extend them. Perfect.

[00:20:23]Now I'm going to be assessing her toes.

[00:20:25]Looking at cap refill and everything like that.

[00:20:30]Cap refill in the toes is fine.

[00:20:35]Everything is three plus.

[00:20:37]If this was a child, we would be doing the Babinsky reflex where I would stroke my finger up against the outer side of the foot and it it would be negative.

[00:20:48]Um, now I'm going to have you run your heel downwards.

[00:20:54]All right, perfect. Everything is symmetric there as well.

[00:21:00]Now, I'm going to have you come to the edge of the chair, and I'm going to have you bend your knees.

[00:21:09]Perfect.

[00:21:13]Perfect. Everything is equal bilaterally. Now, I'm going to have you sit back in the chair and I'll be assessing the reflexes.

[00:21:29]Okay.

[00:21:32]All right. Reflexes are perfect. Now, I'm going to be doing the light sensation test. I'm going to have you close your eyes. And now, I'm going to be stroking a cotton ball. And you just let me know if you feel it and where you feel it.

[00:21:50]Left cheek.

[00:21:55]Right cheek.

[00:21:58]Right forearm.

[00:22:02]Left forearm.

[00:22:06]Left shin.

[00:22:08]Right chin.

[00:22:10]Left foot. Right foot. Okay. Patients light sensation is intact.

[00:22:20]Now I want to I'm going to touch the combo and you're going to say when you feel it. So, I'm going to have you close your eyes and have you flip your hands for me.

[00:22:32]Left palm, right palm. Okay.

[00:22:45]Close your eyes one more time. Now, I'm going to be using a Q-tip for sharp and dull sensation.

[00:22:52]Dull.

[00:22:55]Dull, dull, sharp. Okay, everything is intact as well. Now, I'm going to be doing stereogenesis. I'm going to put a paper clip in your hand and I want you to tell me which hand it's in. Now, have you flip your hands for me?

[00:23:20]Left palm. It's a paper clip.

[00:23:26]This is a paper clip.

[00:23:29]Perfect. Everything is intact.

[00:23:33]Now, I'm going to have you open your eyes and I want to have you flip your hands and your palms.

[00:23:43]Okay, perfect. Patient rapid alternating moodles is movement is normal and intact. Now, I'm going to have you stand up.

[00:23:54]Okay. Now, I'm going to have you walk up and down.

[00:24:07]Patient gate is normal. Now, I'm going to have you walk back heel to toe.

[00:24:15]Normal. Walk on your tippy toes.

[00:24:21]Perfect. Now, I'm going to have you walk on your heels.

[00:24:27]Everything is perfect. Now, I'm going to be doing the romance. So, I'm going to have you stand with your feet close together. Close your eyes. We'll see if you can stay balanced for about 20 seconds.

[00:24:41]20 seconds have passed. Now, I'm going to be examining the range of motion of your spine. So, I'm going to have you bend forward.

[00:24:50]Patient can almost touch the floor. Now I'm going to have you bend side to side.

[00:24:56]And then I'm going to have you twist.

[00:24:59]All right. Everything seems normal there. Now [snorts] I'm going to have you do this one again.

[00:25:06]We're going to see your knee bend.

[00:25:13]All right. Everything seems normal as well.

[00:25:18]Thank you, Emily, for coming to your physical assessment. Thank you.