NRNP 6550 I-Human Ken Fowler V5 Advanced Care of Adults in Acute Settings II

Neck:  Inspect neck: no visible scars, deformities, or other relations; trachea is in the midline and fully mobile; No asymmetry or access respiratory muscle used with quiet breathing.  Palpate neck:  Ask patient to swallow:  Evaluate neck range of motion:  Measure JVP (jugular venous pressure): flat, nodular venous tension.  Auscultate carotid arteries: no bruits auscultated Breast:  Breast exam: Lymphatic:  Palpate all lymph nodes: Chest Wall/lungs:  Visual Inspection – anterior and posterior chest: normal respiratory efforts and his question; no gynecomastia.  Palpate – anterior and posterior chest: normal tactile fremitus; thorax non tender to palpation throughout; no maxillary, supraclavicular, or infraclavicular adenopathy.  Percuss – anterior and posterior chest:  Auscultate lungs: (remember to do the back): left lung and right lung normal breath sounds Heart:  Palpate for PMI (Point of Maximum Impulse): slight lateral (left ward) and downward displacement of the PMI  Measure JVP (Jugular Venous Pressure): flat, no jugular venous distention  Auscultate heart: cardiac auscultation – murmur (systolic/diastolic) loudest heard over the aortic and pulmonic area, also overheard at the tricuspid area. ==NORMAL==  Dynamic auscultation: no significant change while standing, squatting, during the Valsalva maneuver or with sustained handgrip. Abdomen:  Visual Inspection of abdomen: abdomen lean, non-distended, symmetrical; RLQ incisional scar consistent with surgical history  Auscultate abdomen: hyperactive bowel sounds  Auscultate abdominal/femoral arteries: normal  Auscultate fetal heart:  Palpate abdomen: Adam and soft, non-distended, mild tenderness in periumbilical region-more superficial; no HSM, mass, or herniation; no abnormal abdominalaortic pulsation; no abdominal, renal, or femoral bruits.  Percuss abdomen: abdomen normal to percussion: no tympany, shifting dullness, or because if evidence of hepatosplenomegaly.  Measure girth: Extremities:  Visual Inspection of extremities: well perfused; No edema; no inflammatory joint signs.  Palpate extremities: Musculoskeletal:  Inspect muscle bulk and tone:  Inspect/palpate back and spine:  Percuss back and spine: non-tender to percussion  Knee drawer test:  Test stability:  Test strength: Vascular:  Auscultate carotid arteries: no bruits auscultated  Auscultate abdominal/femoral arteries: normal  Ankle branchial pressure index (ABI): Neurological:  Mini mental state exam (MMSE):  assess cranial nerves: cranial nerves I-XII intact  Assess gait and stance: normal gates and posture  inspect for muscle bulk and tone:  look for involuntary movements: none of the following involuntary movements found: revelations, fasciculations, asterixis, tics, dystonia’s, chorea, athetosis, hemiballismus, nor seizure. ,  point to point test arms (fingers to nose)