What is the proper method to assess a patient from head to toe?

Head-to-Toe Physical Assessment

Begin with vital signs including blood pressure measurements in both arms (difference >15-20 mmHg suggests subclavian stenosis), followed by systematic examination of each body region from head to feet, with particular attention to cardiopulmonary, vascular, neurological, and skin assessments. 1, 2

Initial Preparation and Vital Signs

• Measure blood pressure in both arms to identify potential subclavian artery stenosis (difference >15-20 mmHg is significant) 1, 2, 3
• Record temperature, pulse rate and regularity, respiratory rate, and oxygen saturation 3
• Calculate BMI from height and weight measurements 2, 3
• Assess orthostatic blood pressure when evaluating falls, dizziness, or autonomic dysfunction 4, 2, 3

General Appearance Assessment

• Evaluate overall body habitus for wasting, obesity, or lipodystrophy 1, 2
• Assess level of consciousness and signs of acute distress 2, 3
• Note gait and mobility if patient ambulates 2

Head and Neck Examination

• Inspect head for deformities, lesions, and symmetry 1, 2
• Palpate skull for tenderness or masses 2
• Examine eyes including visual acuity, pupillary response, extraocular movements, and fundoscopic examination 2, 3
• Inspect ears, nose, and throat 3
• Auscultate carotid arteries for bruits 4, 1
• Palpate thyroid gland and cervical lymph nodes for enlargement or tenderness 1, 3

Cardiopulmonary Assessment

• Inspect chest wall for symmetry of movement and use of accessory muscles 4, 1
• Palpate for tactile fremitus and chest wall tenderness 1
• Auscultate lungs for breath sounds, crackles, wheezes, or rubs in all lung fields 4, 1
• Inspect chest for visible pulsations or deformities 2
• Auscultate heart in all four valve areas for rate, rhythm, murmurs, gallops, or rubs 4, 1, 2

Abdominal Assessment

• Inspect for distension, visible peristalsis, or pulsations 1
• Auscultate for bowel sounds and bruits 1
• Palpate for tenderness, masses, organomegaly (hepatomegaly/splenomegaly), or pulsatile masses 1, 3

Musculoskeletal Assessment

• Assess range of motion of major joints 1
• Evaluate for joint deformities, swelling, or tenderness 1
• Test muscle strength in all extremities 1
• Assess for foot deformities (bunions, hammertoes, prominent metatarsals) that increase ulceration risk 1

Neurological Assessment

• Evaluate mental status and cognitive function including orientation to person, place, time, and situation 1, 2, 3
• Assess memory, attention, and executive function 2
• Test sensory function using the 10-g (5.07 Semmes-Weinstein) monofilament on plantar surfaces of both feet at three sites 4, 1, 2, 3
• Perform vibration testing with a 128-Hz tuning fork on the dorsal distal phalanx of the first toe 4, 1, 3
• Test pinprick or temperature perception 1, 3
• Assess deep tendon reflexes, including ankle reflexes 1
• Evaluate coordination and gait 1

Vascular Assessment

• Palpate all peripheral pulses bilaterally: femoral, popliteal, dorsalis pedis, and posterior tibial 4, 1, 2, 3
• Grade pulse intensity and note any absent or diminished pulses 2
• Assess capillary refill time 1, 2
• Evaluate for rubor on dependency, pallor on elevation, and venous filling time 1, 3
• Auscultate femoral arteries for bruits 4
• Note signs of peripheral arterial disease including decreased walking speed, leg fatigue, or claudication 1

Comprehensive Skin and Foot Examination

• Perform systematic inspection of entire skin surface for integrity, color, moisture, temperature, and turgor 1, 3
• Identify any lesions, ulcerations, rashes, calluses, corns, fissures, or suspicious changes 1, 2, 3
• Remove shoes and socks to thoroughly examine legs and feet 4
• Inspect for foot deformities, wound sites, and pressure points 4, 1, 2
• Pay particular attention to feet in patients at risk for skin breakdown 1, 3

Special Considerations for High-Risk Patients

For Diabetic or Neuropathic Patients:

• Perform comprehensive foot examination at least annually including skin integrity, foot deformity evaluation, neurological assessment with 10-g monofilament plus at least one other test, and vascular assessment 1, 3
• Obtain history of ulceration, amputation, Charcot foot, vascular surgery, smoking, retinopathy, and renal disease 1
• Inspect feet at every visit for patients with sensory loss or prior ulceration/amputation 1

For Geriatric Patients After Falls:

• Complete head-to-toe evaluation for ALL patients, including those with seemingly isolated injuries 4
• Perform "get up and go test" - patients unable to rise from bed, turn, and steadily ambulate should be reassessed 4
• Assess gait and balance before discharge 4

Documentation and Follow-Up

• Document all findings systematically to guide treatment planning 4, 3
• Develop patient treatment plan prioritizing goals and intervention strategies 4
• Create discharge/follow-up plan reflecting progress toward goals 4
• Provide patient education on relevant self-examination techniques (daily foot inspection, skin checks for suspicious lesions) 2, 3