Examine this patients Upper and Lower limb neurologically. Skills: physical examination (A), identifying physical signs (B), differential diagnosis (D), clinical judgement (E), Maintaining patient welfare (G) Physical Examination- Hello, Would you mind If I examine your limbs Is that ok Thank You Inspection - I am going to look at you from the end of the bed first Upper Limb- Do you have any pain in your arms at all I am going to examine those first Tone - I am going to examine tone of your arms first If you stay nice and floppy Power- I am going to test strength of your arms At Elbow- Could you put arms on your side like this Dont let me push you away Dont let me pull you away At Shoulder- Could you put arms on your side like this Dont let me push them down At Wrist- Push up your wrist toward the ceiling for me Again Push up toward the ceiling Can you spread your fingers for me Finger Nose Test - Can you touch your index finger of left hand with my index finger and then touch your nose Yes, after touching my finger Power - I am going to check your reflexes now If you just really relax this arm let it go nice and loose Biceps- This arm go nice and loose and same on the other side Nice and relax Triceps- I am going to tap on back of you elbow Same on this side Supinator - And on the wrist and onto your other wrist as well Lower Limb- I am going to examine your legs Do you have any pain at all Inspection - I am going to have quick look first Tone - you let your legs go nice and floppy Keep your legs relax I am going to examine tone I am going to Roll your leg ok Nice and relax Power- I am going to check strength of your leg At Hip- Raise your leg off of the bed for me Dont let me push you down Dont let me push them up At Knees- Can you pull your heel toward your bottom I am going to pull your leg at the bottom Dont let me pull me away Dont let me push me away If you could bend this knee If you can bend your knee Push me away At Ankle- If you could now push your foot up toward the ceiling Dont let me push it down Could you do it on the left side as well At toes- Big toe up toward your face Dont let me push them down Reflexes- Knee jerk- If you could let go your leg nice and floppy Ankle Jerk- If you Could please just bend you knee out for me - I will tap back of your ankle I will hold your ankle here - tap ankle jerk Planter response- I am just going to tickle inner side of your foot is that ok Heel shin test- I wonder if you could take your left heel on your right knee and slide it down over your shin for me please if you could take your right heel on your left knee and slide it down over your shin for me please Gait - One last thing I would like you to do it for me Could you please walk for me Thank You Very Much
Posted on: Sun, 29 Jun 2014 23:12:28 +0000
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