Physical Assessment

5604 WordsOct 14, 201123 Pages
mentPHYSICAL ASSESSMENT Last September 16, 2011 at exactly 9 o’clock in the morning, we conducted a physical assessment to Patient X who is 12 years old. He was admitted last September 15, 2011 at 12:30 am due to edema on the right ankle. He is under Dr. Uy. Patient X was admitted per wheelchair with watcher. General Survey Patient X was lying on bed. He was awake and coherent and responsive to any kind of stimulus. He had an IVF of PNSS 1 liter at KVO rate infusing well at his left metacarpal vein. Elastic bandage was well attached at his right ankle. Vital Signs | 12:00 nn | Normal Range | Blood Pressure | 90/60 mmHg | 110/70- 130/90 mmHg | Cardiac Rate | 95 bpm | 70-80 bpm | Pulse Rate | 93 bpm | 70-80 bpm |…show more content…
He was able to guess the smell of soup and meal served. | II | Optic | He was able to read the readings from the students jot down notebook. | III | Oculomotor | In this test, we ask the patient to look straight and follow the direction of the finger were it was heading. Patient X was able to move his eyes in six ocular directions. | IV | Trochlear | In this test, we ask him to look straight and follow the direction of the finger were it was heading. Patient X was able to move his eyes in six ocular directions. | V | Trigeminal a. Opthalmic b. Maxillary c. Mandibular | When we lightly touched the lateral sclera of the eye, the patient blinked. As the he closed his eyes, we wiped a wisp of cotton over his forehead and paranasal sinuses and when asked, he was able to feel it. We used the blunt and sharp ends of a pin to test for deep sensation over the same area and the patient was still able to feel it, as verbalized. | VI |
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