Hello my name is grace and about to perform a health assessment of my own work I have my supplies setup over here and normally I would wash my hands before a patient comes in at this point like to invite my patient in hello my name is nurse Grace and I'll do be doing your health assessment today go ahead and take a seat you could go ahead and tell us your your name your age and your.
Occupation my name is Grant Fox I'm 21 and I'm a student okay and could you also tell me the date the location and your reason for visiting today there for Thanksgiving Marilyn's location and I'm just getting a checkup okay thank you so much and is English your native language yes okay so right here we have a 21 year old Caucasian male alert and oriented.
Times three his hearing appears to be grossly intact due to his answering the questions articulately and appropriately without hesitation his skin appears overall more dry intact with no apparent lesions but we'll go ahead and do a more thorough skin assessment later on he is well nourished and well developed his gait when he came in was smooth and steady.
Had no assistive devices and his range of motion seemed to be intact but we will go ahead and assess the musculoskeletal system later on he is exhibits good hygiene and he's dressed appropriately for the occasion his mood and effect is complex which is congruent and appropriate for the situation and his posture is erect so at this point normally what I would do is I would take.
His vital signs but for this for the sake of this video we're going to go ahead and just skip that what we're going to do is go ahead and actually take his pulses so I'm going to move over here um grant I'm going to first assess is temporal artery up here and check for just circulation and overall pulsing here it's a good plus two and I normally do both sides bilaterally but.
I'm just going to go ahead and do one side here I'm going to assess the carotid I would never do both sides at once I wouldn't want to occlude the blood flow to the brain okay the plus two go ahead and do the brachial here break you pulse that's one nice and strong plus two there okay when do the radial pulses here good plus two here here as well.
Normally I would assess the femoral for the sake of privacy I'll just I'm not going to go ahead and assess it but it would be right in between here you assess right in the groove by the groin um you can usually teach your patient to assess it on themselves and if they have good blood flow further on you can just assume that he's getting proper blood flow the popliteal um here behind the.
Knee sometimes is not accessible in a normal adult and I'm not really finding it on him but I'm gonna go ahead and move on to the the pedal pulses dorsalis pedis as well can take off your sock I have to assess that you take two fingers and lightly touch over on the top of the foot here and sometimes it can be difficult to find but there it is and also here behind the behind the ankle.
You got a good plus two pulses all around grant all right so I put your sock back on for you okay grant so at this point one Wendy now is go ahead and just knock out the cranial nerves I do it in this way just because it makes sense to me to just knock them all in the beginning so first one the first cranial nerve the olfactory nerve for the nose cranial.
Nerve one is not routinely assessed in the skypes it's in this type of scenario but what I would do if I were to assess is to have him occlude each nostril independently and then bring um common smells like coffee or peppermint and see if you were able to identify them one nostril a time for cranial nerve to this is going to assess the acuity so what we're going to do mooom this way go.
Ahead scoot over I get my little Jagger card here so we're going to do is going to take this about twelve inches away from your face or okay great and what you're going to do is going to tell me if you can read this last line here okay four to eight seven three nine very good and that's about 20/20 vision so that's good next we're going to do what's called the confrontation test so.
We need to sit facing each other and you're going to take this card and I'm gonna take a card I'm going to put it on the side of our eye okay you're going to do you're gonna tell me when I move this pen at what point you can no longer see the pen testing your peripheral vision what is the purpose of that it's a screening for glaucoma um which a decrease in peripheral vision can.
Sometimes be a screening for that alright so go ahead and block the vision here and just tell me when you can no longer see the object going good it's about the same time as me so assuming that I have normal peripheral vision his would also be normal as well go ahead and move to this side same thing tell me when you can no longer see this black tip okay come on alright good awesome.
Okay so that's good news good visual acuity a good confrontation test next one we're going to go ahead and assess cranial nerve three four and six by doing um doing the the Cardinal gaze and the perla to test his pupils to see if they are equal around reactive to light and one thing I wanted to say with them with the the confrontation test is one what you're looking for when you move.
The object out of the way is typically people have 50 degrees superior view and what was it 70 inferior 90 temporally and sixty nasally and I don't have any way to measure that right now but that's what normal findings would be so with the test the pupils I'm gonna shine a light into them this is testing for cranial nerve three four and six and see if his light if these people react to.
The light by constricting go ahead and stare straight ahead over here okay this one good reacts this will reach constricts as well and then go ahead and block this side from seeing and see if we have if this side constricts as well while the side does a good they both constrict at the same time go ahead and shut this one as well so even.
Though this one isn't receiving any light this one is constricting the same time as this one they're doing at the same time to test accommodation go ahead stare straight ahead my finger bring it in his eye should go in together and constrict and that's exactly what they do so that's good um so those pupils are perla turn this off all right all right if you're gonna do.
The Cardinal Vision Cardinal gaze would I put my pen I'll hear this all right so we're going to do is just gonna have you follow this pen in all the directions at a point okay so I'm gonna start here and go up this way and I'm looking to see if there's any nystagmus which is a shaking of the eyes I'm not seeing any sometimes it's normal to have brief periods of establish on the far lateral but I'm not.
Seeing any of that both of his eyes are following no hesitation altogether some people like to do it this way people like to do the H pattern and that's assessing in the cranial nerves three four and six next is cranial nerve 5 which is trigeminal so what you're going to do grants clench your jaw together and I'm gonna try and separate your jaw but.
Don't allow me to do that okay okay guys you've got very strong jaw okay for cranial nerve three to five um seven is the facial nerve so he's going to do them and ask him to make some faces um go ahead puff your cheeks out okay good you can relax raise your eyebrows smile and give me a frown so good he's got good motor function of facial nerve I'm gonna go ahead and test sensation so go.
Ahead and close your eyes and do light touch and you just say now when you feel a touch on your face okay no no okay no good no good I'm doing three different sections no okay no no okay and I waited a little bit longer just to make sure he wasn't just getting used to my rhythm all right you go ahead open open your eyes I'm also going to go.
Ahead and test your extremities I would normally do the feet as well but for the time sake just going to do the hands here so I have a dull side of this paperclip and a point is out of this paperclip and when I you're gonna close your eyes I'm gonna touch which either side and you tell me if it's point to your dull or sharp or dull okay so go ahead and close your eyes don't don't.
Don't sure sure sure sharp sure okay go ahead and open the reason why we do this is um when we're testing the neurological function which is of the cranial nerves um this isn't a part of the facial nerve but I just want to go ahead and do this while we're at it and it's testing for any diseases that affect the neurological status.
Which like diabetes and the reason why I started with the fingers I moved up is because usually those diseases affect distally to proximally so that's why it's better practice to start distally at the fingers and move your way up towards the extremity or towards that proximally so now i'm going to go ahead and do the light touch and you just say now when you feel it so go ahead and.
Have your eyes closed I don't have a cotton ball so I'm using this little piece of gauze no no no all right good he has good neurological sensation I just wanted to kind of knock that one out as I'm hitting the facial nerve as well next um the next cranial nerve is cranial nerve eight which is the hearing some what I'm going to do is in a step about two feet away I'm going to whisper.
Three letters and numbers and you're going to repeat what he hears so I'm gonna say three things and you repeat them after okay so go ahead and close that one ear on the other side you ready 12:7 w good and I said twelve seven and w which is what he repeated and only I would do both sides as well um but just for the sake of this video you can do one side um all right.
So eight and never not to assess cranial nerve nine and ten what I'm gonna do um is going to take this some tongue depressor and he's going to say ah and when he says ah his uvula and his palate raises mid lines that's um some good function and also I'm gonna go ahead and open up again open up put your tongue out okay good I just assessed his gag reflex which is assessing the vagal.
Nerve cranial nerve 10 soon as good gag reflex intact for cranial nerve 11 we're going to go ahead and set the the accessory muscles here so what you want to ask you to do I'm gonna put pressure and try to shrug against resistance hey very strong muscles there now I'll try to turn towards me good turn you get very strong accessory muscles and for cranial nerve 12 it's um the tongue.
Movement so go ahead and stick your tongue out and we sticks it out notice it is straight it's not curved to one side its midline to put your tongue to left to the right up and down okay so that's all good next um we're going to move from the cranial nerves and now we're going to do um a broad skin assessment so we did a little bit with the initial general overlook but I'm.
Gonna go ahead and just assess the rest of his skin looking at his arms all of his arms are warm dry no evidence of cyanosis or diaphoresis no lesions no bruising bleeding anything like that it's got good skin turgor here no evidence of dehydration go ahead and look at your nails they're smooth round flat no evidence of clubbing his his angle of his nails.
About 106 degrees who's good oxygenation um lack of oxygenation chronically could lead to clubbing and see his cap refill is brisk and immediate less than two seconds I'd also checked the feet normally um let's see go ahead and check this other arm here okay check your legs hair is equally distributed no patchiness or anything that and you feel any pain or tenderness.
Or itchiness or anything like that any rashes you're worried about no I just go ahead and do a general skin assessment don't have to worry about it later I'll go ahead and check here we turn this check this back here back is clean dry smooth good turgor here pink tones no dry skin or anything go ahead and check your chest as well look at this all more further in depth.
When we do all the regional assessments okay pink good musculature hair evenly distributed go ahead put your shirt down okay next what we're going to go ahead and do is um look at his head on his face so I'm go ahead you want me know if you feel any tenderness or anything when I'm feeling your scalp okay your scalp nice no receding hairline full thick hair um no protrusions or lumps or.
Anything in the head any tenderness no protrusions cuz it is normal cephalic I'm gonna go ahead and feel your sinuses okay this is your frontal sinus I'm going to feel any tenderness know you've been having any problems with the sinus pressure holes or anything okay this is the maxillary sinus he's got other sinuses but they're not really palpable um good facial hair um I'm gonna go.
Ahead and look at his his trachea is midline here there's no deviation which could indicate um pneumothorax but he doesn't seem to have that I'm gonna go ahead and I'm going to do now is gonna go ahead and look at his lymph nodes so if you could turn just a little bit this way okay here you would feel submental I'm not feeling anything they should all be non tender and mobile this one is.
Submandibular preauricular in front of the ears right here posterior auricular behind the ear here occipital jugular Dagget digastric underneath the ear superior cervical up here on the neck posterior cervical just behind the muscle here the deep cervical chain or all the ones on the neck here and then supraclavicular would be up here and did you feel any tenderness on these any of.
These lymph nodes and I didn't feel any hardened ones or any overly large ones or anything so didn't have any lymph problems I'm gonna go ahead and check your thigh right now King grant so just back up this way okay so for this one I'm going to do I'm going to put my hands around his neck like this just around the muscle displace the the thyroid to my right and ask him to.
Swallow it so go ahead and swallow again I felt it rub against the side I didn't feel any lumps turn I'm gonna do the other side squeezing in turn this way so the camera can see a little bit give it a wrap around the sternomastoid here and I'm gonna displace it now to the left pushing it now go ahead swallow and it's hard to swallow I again I felt it passed down when he swallowed I didn't feel any.
Lumps or any nodules if I did I might be worried about um thyroid tumor or anything like that I didn't feel anything so that's good alright go ahead and I'm going to um going to go ahead and assess your nose okay grant external nose it's midline the skin is intact no excess puffiness or redness oh no sneezing or anything like that lately.
Okay I'm gonna go ahead and um use my speculum here turn it on okay so I'm gonna go ahead and lift up his nose like this and look inside and I'm not seeing any edema or anything like that no bleeding no discharge no swelling no foreign body but superior termini is not visible but the inferior in the middle are are visible they're pink.
Vascular look at the side as well okay the septum is not deviated I'm gonna go ahead and include this nostril can you breathe in you can't include this in Austral that's just assessing the patency of his nose he's not having any trouble breathing okay I'm going to go ahead and move on to now the the mouth so go ahead and move to this side get my glove on over here all.
Right grant no it's a little stuck all right go ahead and open up your mouth well first I noticed that his lips are they're not dry or cracked or anything like that look at his teeth they're white evenly spaced very clean no evidence of debris and I'd also give some patient teaching here about how often brushed teeth and flossing when open lift down his gums.
Are pink no swelling no redness no inflammation no evidence of any gingivitis or anything down here is also pink so that is good I'm going lift your tongue up very smooth and shiny and vascular with the blue veins you can put your tongue down stick your tongue out it's pink a little bit rough a little bit of white patches well that's that can be normal okay go ahead and open up.
Again there's no lumps or anything inside of his mouth the buccal mucosa is pink and warm and moist no evidence of any lesions or bleeding I'm gonna go ahead and get my tongue depressor go ahead and say ahh I'm gonna go ahead and get my light also if I can look at the tonsils okay the tonsils are visible but they're not protruding very far so I put.
Classify them as a plus one I'm gonna go ahead and see if I can see the Stenson's duct the sencence duct is opposite the second upper molar and is the opening of the parotid salivary gland I can see it right there that's good go ahead and close your mouth right and put this down so cops up good all right next thing I'm going to go ahead and um let's sit under your ears and I'm gonna do your ears.
Take this off all right grant I'm usually would do both sides but again I'm just going to do one side for the sake of time so on him I'm gonna look at the UM the exterior of the ear the color is congruent the rest of his face no lesions of bleeding everything is there any tenderness when I press down the tragus no tenderness here any history of ear infections lately no like.
I'm gonna when I look inside the ear I'm going to use the biggest speculum that fits I'm going to pull up and back for an adult and I would pull down for a child and pull up like this and look inside and I'm looking for the tympanic membrane and there's no evidence of any cerumen or foreign body and I see the tympanic membrane in there it is pearly gray no evidence of any.
Distension or anything no scar tissue and the the light reflex is about five o'clock so that's good okay this way we're going to go ahead and assess his eyes okay grants what we're going to do is check your corneal light reflex what this is going to do I'm just going to take this light here and shine it in your eyes to make sure that the light is reflected equally okay turn this light.
On here just stare straight ahead I need okay so what I'm seeing here is that the the light is shining equally on the same spot the cornea which is showing that there's parallel eye axes and that the cornea is smooth and rounded with no abrasions or anything like that on there um it says your eyebrows his eyebrows err on the hair is equally distributed they're symmetrical they're even his.
Eyelids um let's open it open them up they slightly overlap the superior part of the Irish which is a normal finding his palpable fret fissure between his two eyes they're equal and they're horizontal his lashes the hair is equally distributed um let's see the the balls of his eyes there's no swelling or edema they're not any they're not protruding it also that.
Shows that absence of exophthalmos which is can be a common disorder with them the thyroid the sclera and his eyes are are white there's a little bit of a little bit of redness that I know that public from staying up late helping me with this video so his iris is a nice green color and his pupils are I would say about three or four milliliter millimeters which is normal finding no.
I'm going to do now is get at my up down the scope check your um to look at your right now okay so all you have to do is just look straight ahead and I'm gonna go ahead and look in your eye make sure that it's calibrated here so I'm looking for um as I go across just look for the red reflex first just stay looking across I'm starting up this far away okay I've captured the red reflex I'm.
Moving closer until I find a vessel all right uh and I found one moving a little bit closer here alright so his disc is an orange II pinkish color the vessels are no there's no AV nicking um so that looks great I would at this point normally I would go ahead and assess the other eye I'm just going to had one for the sake of this video we already assessed his pupils and acuity the.
Cranial nerves test we don't need to do that at this point now we go ahead and assess your heart okay grant so um go ahead and lie down go ahead put your head over here everyone do is stand on the right of him I'm gonna go ahead and feel for the the PMI here all right I'm go ahead and feel for the pulse okay I found that when I'll try and localize it down to one finger all.
Right I go ahead and found it it's about the at the fifth intercostal space about the midclavicular line was just expected finding I don't feel any pulsations or extra or excessive heave I don't feel any thrills which is good um I'm not gonna notice I didn't have him turn because if I turn him that might shift the PMI which could be indicative of LVH or left ventricular hypertrophy so okay.
Um grant you can go ahead and sit back up Michael and listen listen to your heart sounds okay you've got a nice strong heartbeat I'm just going to ahead listen to all the hearts faces he's got a nice even rhythm I don't hear any gallops already were any murmurs no adventitious sounds I hear a nice steady s1 s2 and no other sounds I'm unable to say that he is.
Almost sinus unless he was hooked up to a pill monitor but he does have an even rate and rhythm so that's good um at this point grant went ahead and assess your lungs okay if you could just turn this way and if you don't mind you'd mind taking off your shirt I'm going to assess the posterior side first okay first I'm gonna go ahead and look at his thoracic cage configuration his um his.
Back is very symmetrical there's it's an elliptical shape his ribs are in a downward sloping angle here um first my test is symmetric expansion so I'm going to do you could turn slightly this way so the the camera can see your back just a little bit right there sorry all right so I'm going to do is put my hands evenly like this my thumb's are be about t9 or t10 now we're trying.
To do grant is just inhale as deep as you can and exhale I notice that my hands go up together that one side didn't go up or an other side stay down which is indicative of both lungs expanding normally there's no collapse too long or anything like that no go ahead do it one more time breathe in and breathe out all right good thank you um excellent we're gonna do is the.
What's called tactile fremitus okay so come back and face this way now what I'm going to do is put the ulnar surface of my hands against um his back like this you can sit up a little bit and I want you to say um we either say blue moon or ninety nine which is a very vibratory sound Cohen sess assess the vibrations so go ahead and say blue moon and a deep voice.
All right grab your damn blue moon grandeur again blue moon again blue moon and one more deep blue moon okay so what I'm feeling is equal vibrations bilaterally one side is and stronger than the other an increase in vibrations what could indicate consolidation which could show which could be indicative of having a disease process like pneumonia if there was a decrease in the amount of.
Vibrations it could be indicative of a an obstruction of the bronchus such as a pleural effusion or emphysema which is why we do this this monitoring okay so what we're gonna do now is something called diaphragmatic excursion okay grant so just turn a little bit this way so the camera can see you all right so I'm going to do is you're going to go ahead and breathe in and then you're.
Going to breathe out and then take a deep breath in and hold it okay so what I'm gonna do in the tap to hear those sounds I learned this trick actually for my professor and it's easier to tap with this and just with your finger if you're still learning so um go ahead and take breathe in breathe out and then take a deep breath and hold all right hold it I.
Mean listening to all the resonant sounds okay breathe out and this about right here is where I hear the dullness which is hitting the diaphragm I'm gonna go ahead and mark that all right so go ahead and breathe normally catch your breath um then I want you to breathe out breathe in and then breathe out all of your air and hold it you breathe out dull dull dull though and that's where I.
Hear the resonance okay you can breathe normally mark it there and I'm gonna measure the distance here with my little ruler awesome so he has seven and a half centimetres from his diaphragmatic excursion which is really good three to five is typically normal but you can have up to seven to eight four really well conditioned people it's a good job.
You're well conditioned grant okay um so next what we're going to do is I'm just going to perk us the rest of your back to see if it's all symmetrical and even we already did a little bit I would normally do both sides for the DICOM attic excursion but for the sake of the VA rule I do one today resonant all right so everything is good and resonant you can feel any pain or tenderness on.
Your back anywhere okay next last thing I'm gonna do is listen to his his breath sounds yeah go ahead and sit up and then just um every time I move my stethoscope just go ahead and take a deep breath in and deep breath out okay alright breathing yeah I'm sure you get the side all right so good Oh his breath stones.
Seem to be clear and even hear any crackles or any rails or any adventitious sounds good long expansion okay and now for the anterior side of the chest we would do the same as assessing the posterior side just to name what we did we checked the thoracic cage configuration that's an asymmetry the equal we would also do a tactile fremitus again on the front on the.
Anterior side we do the percussion and the auscultation listen to the breath sounds as well one thing I wanted to note is that his breathing is even in regular it son labored and he's not using any of his accessory muscles in order to breathe so very good now we're going to go ahead and move on to the neurological system we already assessed the cranial nerves earlier on in the.
Beginning of the videos we don't have to reassess that now but first thing what I'm going to do is um we're going to look at your cerebellar function okay grant what that means is when I have you do some different tests just to check that your Salamone cerebellum is working properly so first thing is I'm just taking your fingers finger to nose repeatedly okay good.
Also the next thing to do is heel to shin so taking your heel dragging it down to your shin on both sides she's very balanced and coordinated with no hesitations or awkwardness there um next time we're in ters was called rapid alternating movements what you're going to do is slap your hands flipping over like this on your knees as fast as you can okay guys so he doesn't seem to have.
Many hesitancies does it with ease no problems there is good okay so next thing we're going to do is something called stereognosis what's their diagnosis is he's going to have his eyes closed I'm going to bring some common household objects so you can identify them with the absence of any visual information so go ahead and close your eyes and pull out your hand I'm gonna.
Give you one object and tell me if you can identify what it is go ahead and feel it you tell what it is the key it's a key good make sure you can see that it is a key all right close your eyes again and have one more go ahead and feel it paperclip yeah it's a paperclip it's an open paperclip but it is a paperclip nonetheless so his their gnosis seems to be doing well all.
Right next thing grant we're gonna do go ahead and assess your reflexes okay we have a couple of them to do first we're gonna start with the patellar so go ahead and relax um sometimes people get it anxious so go ahead and focus on squeezing your arms really really tight and go ahead and text your test your patellar reflexes here squeeze harder okay there we go we got it I I would.
Normally check bilaterally but we're just go ahead and do one side for now you can relax here next one we're gonna do is the biceps so I'm gonna go ahead and have his arm Bend a little bit like this and a squeeze right here I'm gonna hit my own thumb oh that was good huh pull about plus to his patellar reactions about plus two as well next what I'm going to do is the the triceps.
So go ahead and let his hot arm hang like this I'm gonna go ahead and strike in between this little notch right there so go ahead and relax get a little bit there you go ahead a little bit of twitch plus one foot plus two okay next one is the brachioradialis so I'm gonna come over move this way you give me both of your thumbs this way like this we're going to do no strike above this little.
Radial notch okay I could hit a little bit of a twitch there so that's a good good reaction plus two as well um last one or next to last one is the Achilles is this me a little hard to see um I'll try to raise it up a little bit so I'm going to hold his foot in a in a Dorsey flex position while striking his Achilles tendon here okay so what we saw and if you could see in the videos that.
He his foot reacted by doing a plantar flexion which is a normal expected finding last one um grant we're going to do is the Babinski reflex which is normally assessed on babies what we're going to go ahead and do this anyway and take off your sock you don't mind I'm going to take the edge of my reflex thing and move upwards like this I'm good he had a plantar flexion.
Reaction which is a normal expected finding go ahead put your sock back on it's a little chilly in here all right thank you as your reflexes um next we're going to just move on to the musculoskeletal system okay so grant what we're going to do is actually to come up off the table um you could just I'm gonna get out of your way here just walk a little bit.
Back and forth walk this way turn around go that way okay go so his his gait is normal steady smooth and even he doesn't need any assistive devices who seems to have full range of motion with that um now grant if you could go ahead and do the same thing but walk from heel to toe okay good his balance is in tact and coordination no excess of swaying or loss of balance there okay grant what.
We're going to do now I'm going to ask you to do what's called a Romberg test the Romberg test is where you stand with feet together going face the camera hands at your sides back up a little bit you can you're too tall now we're going to do to close your eyes and try to stay standing upright I understand close enough to him just in case he starts to sway and fall but if.
His you know neuromuscular functions intact you shouldn't have any excess of swaying I shouldn't need to catch him usually test it for about 20 seconds he seems to be doing good no excessive swaying or X excessive motion alright looks like you're good you can go ahead and um sit down and I'm going to test his hand grips make sure that they're um strong bilaterally all right someone.
Give me my fingers just go ahead and squeeze them okay his grips are strong and equal bilaterally with the both equal and strength you can let go go ahead and scoot back a little bit um I'm gonna ask you to just to press your feet against my hands as hard you can okay good his both of his feet are pressing equally as strong bilaterally as well and um are one more thing if you go.
Ahead and stand up again we're going to ask you to do if you can reach down touch your toes as far as you can okay if you can't reach all the way oh wow okay he can reach all the way I said his spine here is midline there's no curvature both his muscles seem to be equal in size you can go ahead and stand up alright last thing we're going to do is.
Just has some range of motion okay so you can what we call abduction is when moving away from the body can take your arms and move away from the body abduction adduction moving back and then what we call circumduction going in a circle all right everything things do good so you go ahead take a seat okay now we're going to begin with doing the assessment of the abdominal system we.
Want to make sure that we assess with our eyes first then we auscultate before we palpate because any palpations could could stimulate peristalsis which could be a false indicator of bowel sounds so first I'm just going to assess you could go ahead and lay flat on the table alright first I'm going to look at the contour of his abdomen and if we look here we.
See that his abdomen is flat and flat here no distension or um any roundedness or anything like that flat abdomen that's good um his abdomen symmetrical with the musculature and um the skin there's doesn't appear to be any lumps or lesions his skin is pink and everything um so that looks good in his humble Lycus is in midline it is inverted there's no discoloration no.
Swelling or anything like that next I'm going to do is listen to his bowel sounds okay so I'm gonna start in the right lower quadrant which is the ileocecal valve because that's typically the most common place for hearing bowel sounds if I ended in fact not here bowel sounds I would have to listen for a good like five to ten minutes before being able to say that there was hypo AK.
Hypoactive bowel sounds just to make sure I'm gonna go ahead and listen you're wrecking Tori the last time you mate oh now we're at a half ago about a half ago okay so I'm gonna move to this side so that the camera can see we start in the right lower quadrant here and I can tell that you just ate recently they got nice gurgling going on some high-pitched.
Gurgles cascading sounds move it all the quadrants here okay so that's good go ahead and finishing up with that I'm now I'm gonna move on to percussion of the absent okay grant so I'm going to just go ahead and tap around make sure that I can hear timpani so I'm expecting to hear because normally when the patient lies lying flat like this air is going to be rising.
To the surface I should hear the air I'm just going to percuss here good symphony sound if I were to hear like excessive dullness I might suspect an obstruction or something like that that's a nice sound right there good okay grant next I'm going to go ahead and palpate the abdomen I'm feeling for any lumps or masses I might be able to feel an obstruction if he had.
One do you feel any pain or tenderness when I'm doing this no okay I'm not feeling any masses or anything I'm moving in a circular motion with the pads of my fingers in order not to poke in too badly okay so that seems about good all right if you go ahead and sit up for me to test your CVA tenderness or that that stands for cost over tigre angle normally um what this is testing.
For us as kidneys if he were to have a kidney infection or something like that he would probably jump off the table out in pain so we're going to go ahead and test him okay so just let me know if you have any any pain when I do this okay anything good and again if he were to have pain that could be indicative of a kidney infection that's good okay he'll go ahead and lay back down I'm gonna.
Feel for you ready order okay so normally the aorta you can feel it right above the humble life is here and it's usually about two and a half to four centimeters so I'm gonna go ahead and measure after I find it here it's right there okay it's about three centers that's normal that's good alright now if you'll go ahead and um lift your knees up and put your feet flat we do this.
When we assess the liver and spleen so I'm going to do first grant and I'm going to check your liver border okay so what that entails is I'm gonna get my wax pencil and my handy dandy tool here and I'm going to start in the resonance of the of the lungs and move my way down until I hear the shift to dull which will be the liver and then I'm going to mark that spot then I'm going to start.
Down with the tympani of the abdomen and work my way up until again I have a shift adult with the delivery I'm going to mark that spot and measure the liver border two justices screening for hepatomegaly and typically the distance is about six to 12 centimeters so I'm going to go ahead and see what his is I'm gonna move to this size you can see what I'm doing I'm gonna start here.
Resonance resonance all right here to shift adult right there and go ahead and Mark that and I'm gonna start down here with the timpani of the abdomen and move up until I hear that shift to dullness again it's a good timpani thing right there and that's right where I hear a shift to Dolph I'm going to go ahead and Mark that I'm going to measure it okay and he has about a little just over.
Seven centimeters which is in a normal range which is six to twelve centimeters so that's good alright next grant where I'm going to go ahead and do is I'm in a cow pate your liver which means to feel it what if I can feel what it feels like okay make my hands in the V all right over here and as he breathes in I'm gonna go in and as you breathe out and breathe in again and go in deeper and.
See if I can feel the border the edge of that liver okay so go ahead and breathe breathe in going in deeper okay I can just barely feel the edge of it they're smooth regular I don't feel any irregularities on it just firm okay good and again I am standing on the patient's right side and I'm going to go ahead and now um assess the spleen so to do that I'm going to move our to this side you.
Can just put your arm there what I'm going to do is going to take my finger I'm going to find the lowest rib on the on the ribcage then I'm going to slide my finger into that intercostal space and then I'm going to percuss as he's breathing in and out and there should be no shift too dull if there is a ship's at all that could be indicative of splenomegaly so I'm going to go ahead.
And find that last rib here okay put my finger in that intercostal space then go ahead and breathe in and out okay I'm doing it I'm not hearing any too dull so that's good um that should be no indication of splenomegaly and I'm not able to really palpate it which is a good sign because normally you're not usually able to unless there's um splenomegaly so that's good.
Okay grant can go ahead and sit up all right you can come around turn around this way all right now we're going to go ahead and assess the reproductive system for the sake of this video we're just going to go over what I would normally do in a reproductive assessment what we would do is I would feel for the inguinal nodes which are right here near the femoral where the pulses are so.
Would feel right in there if you like feel for any swelling or any pain or enlargement and also teaching himself how to assess for that as well next I would go over the importance of testifed testicular self exam or TSE we have a good acronym you can remember how to assess yourself using the TSE acronym t for time which is about once a month you want to go ahead and assess yourself.
S for shower because the warmth of the shower helps the testicles to relax and what your East and for is examining what you're examining for is any any changes any like lumps that weren't there before and to make sure to report any changes promptly to get screened for those so that's how we will check the reproductive system and that is all for the reproductive system.