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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