Arizona State University
SKILL: Hair, Skin, and Nails, HEENT & Neuro
Exam: Hair Client sitting
|Scoring |Normal client: |
|1. Inspect hair on scalp for color, distribution |Even distribution; (state color) |
|2. Separate hair with blunt end of Q-tip to visualize the scalp. |No dandruff, lesions or pest inhabitants |
|Inspect for dandruff, lesions or pest inhabitants | |
|3. Palpate hair and scalp for lesions and hair texture |Hair texture smooth; no palpable lesions |
Exam: Skin and Nails
|Scoring |Normal client: |
|1. Inspect skin head to toe, APL for color, lesions, visible |Skin pale pink/flesh colored with even |
|edema, erythema, varicosity, hair distribution |pigmentation; no visible lesions, edema, erythema, |
| |varicosity; body hair distribution even |
|2. Inspect all fingernails and toenails for color, shape, contour|Fingernails smooth rounded, cuticles intact, nail |
|bilaterally |beds pink |
|3. Inspect at least one fingernail on each hand for clubbing |No clubbing bilaterally |
|4. Palpate at least one fingernail on each hand for capillary |Capillary refill < 3 seconds bilaterally |
|refill | |
|5. Check skin turgor/mobility on neck/upper chest in one location |Turgor: instant recoil no tenting |
|6. Palpate skin with back of the hand for temperature: Include |Temperature warm bilaterally |
|face, arms, and legs bilaterally | |
|7. Palpate skin with palm of the hand for moisture and texture: |Skin dry, texture smooth bilaterally |
|Include arms, legs, bilaterally | |
|8. Palpate pretibial edema bilaterally, depress for 5 seconds |No pretibial edema bilaterally |
|9. Palpate feet bilaterally for temperature, moisture, texture. |Temperature warm, dry bilaterally |
|Separate toes and note skin condition | |
|10. Palpate at least one toenail on each foot for capillary refill|Capillary refill < 3 seconds bilaterally |
Exam: HEAD AND FACE Client sitting
|Scoring |Normal client: |
|1. Inspect face for expression and symmetry |Face symmetrical |
|2. Instruct client to smile, frown and close eyes tightly, and |Face symmetrical with smile, frown; eye muscle |
|resist your attempts to open them bilaterally. Observe for equal |strength 5/5 bilaterally |
|strength and symmetry (CN VII) | |
|3. Instruct client to lift eyebrows, show teeth, puff out cheeks.|Face symmetrical with lifting eyebrows, frown, |
|With cheeks puffed press cheeks in and note air escape equally on |smile, puff cheeks, show teeth; air escapes equally|
|both sides. Observe for symmetry of movement (CN VII) |bilaterally |
|4. Palpate skull for size, shape, symmetry |Head normocephalic |
|5. Palpate temporal artery bilaterally |Temporal artery pulses present and equal |
| |bilaterally |
|6. Instruct client to clench teeth. Palpate temporal and masseter |TMJ muscle strength 5/5, equal bilaterally |
|muscles (TMJ). Attempt to separate the jaws by pushing down on the| |
|chin. (CN V) | |
|7. Palpate frontal & maxillary sinuses for pain and edema, |Frontal & maxillary sinuses non-tender, no edema |
|bilaterally |bilaterally |
Exam: EYES
|Scoring |Normal client: |
|1. Inspect external eye structures – eyebrows, eyelids, |Even distribution of eyebrows, eyelashes; no ptosis|
|eyelashes bilaterally |bilaterally |
|2. Inspect conjunctiva, sclera, cornea, iris bilaterally |Conjunctiva pink, sclera white, cornea smooth, iris|
| |(state color) bilaterally |
|3. Inspect extraocular muscle (EOM) function: corneal light |Corneal light reflex symmetrical |
|reflex bilaterally using pen light | |
|4. PERRLA (CN III, IV, VI) |Pupils equal, round, react to light, accommodation |
|5. Inspect 6 cardinal positions of gaze (CN III, IV, VI) |Pupils move parallel in 6 cardinal fields of gaze |
|6 Inspect extaocular muscle (EOM) function: cover/uncover test |Cover/uncover reveals fixed, steady gaze |
|bilaterally | |
|7. Fundoscopic exam - red reflex |Red reflex present bilaterally |
|bilaterally. | |
|8. Inspect visual fields: Confrontation test bilaterally (CN II) |Bilateral peripheral vision matches examiners by |
| |gross confrontation |
Exam: EARS
|Scoring |Normal client: |
|1. Inspect external ear for size, shape, and skin condition |External ear equal size, shape, height bilaterally |
|bilaterally | |
|2. Palpate pinna, tragus, and mastoid process for tenderness |Pinna, tragus and mastoid process non-tender |
|bilaterally |bilaterally |
|3. Otoscopic exam — inspect external, internal ear canal and |External ear canal skin intact; tympanic membrane |
|tympanic membrane bilaterally |pearly grey, cone of light bright bilaterally |
|5. Test hearing: Whisper test bilaterally (CNVIII) |Able to repeat whispered words bilaterally |
|6 Test hearing: Weber test with unmuffed tuning fork (CNVIII) |No lateralization |
|7. Test hearing: Rinne bilaterally with unmuffed tuning fork |AC ................
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