INSPECT

Hand Hygiene

Washes or sanitizes hands prior to patient exam

Personal Protective Equipment (PPE)

Utilizes appropriate PPE for patients with isolation precautions

Patient Privacy

Draws curtains, maintains patient's privacy at all times

Self-Introduction

Introduces self and explains the purpose of the exam prior to performing the exam

Verbal Consent

Asks and obtains verbal consent prior to exam if patient is alert and oriented

Hair Changes

Asks about any recent hair changes, too much hair falling out on the pillow or in the shower?

Dry, Brittle Hair/Easily Pluckable Hair

Inspects for dry hair and gently palpates strands of hair to test for brittleness and pluckability

Face & Nasolabial Areas for Flakiness

Inspects nasolabial folds, around nose and corners of the mouth for erythema with scaling

Temporal Muscles

Inspects temporalis muscle directly from the front or as feasible for hollowing/scooping, palpates bilaterally using fingers with patient clenching teeth if able

Buccal Fat Pads

Inspects cheeks bilaterally standing directly from the front or as feasible, palpates fat pads under the cheekbones

Eye Conjunctivae for Pale Color

Gently retracts lower eyelids and inspects color using penlight bilaterally

Bitot's Spots

Using penlight, inspects conjunctiva bilaterally for small, foamy, dry, oval or triangular spots

Orbital Fat Pads

Inspects orbital fat pads bilaterally, using pointer & middle fingers, gently palpates around eye sockets

Dentures

Asks if patient wears dentures and if yes, asks patient if dentures are ill-fitting

Exam of Perioral Areas for Angular Stomatitis/Cheilosis

Using penlight, inspects around mouth, corners of the mouth and lips for red cracks/blisters

Oral Ulcer & Lesions

Using penlight, inspects for shallow ulcers inside mouth, base of gums and under the tongue, retracts buccal mucosa to inspect inside of cheeks and to visualize back of the throat

Gums & Teeth

Using penlight and tongue blade, inspects gums and teeth

Tongue Inspection for Filiform Papillary Atrophy, Magenta/Beefy-Red Tongue, Glossitis

Using penlight and tongue blade, inspects tongue for filiform papillae height, smooth appearance, swelling, or beefy red color

Pectoralis Major

Asks patient to sit up if able with arms at sides, inspects directly from the front or as feasible, palpates muscles right below clavicles

Deltoids

Inspects rounded vs squared shoulders, palpates deltoids around shoulders, may ask the patient to raise the arms out to the side to engage the muscle

Acromion Process Protrusion

Inspects for prominent protrusion of acromion process

Intercostal Muscles

Inspects for concave shape and palpates between ribs for depression

Muscles Around Midaxillary Line

Inspects and palpates muscles around midaxillary line

Iliac Crest Prominence & Iliac Crest Skinfolds

Inspects tip of the hip bone for prominent iliac crest, gently pinches and rolls skin folds between the iliac crest and last rib to determine the spacing between fingers to assess fat loss

Posterior Trapezius Muscles

Inspects & palpates trapezius on the back bilaterally

Scapular Muscles (Supraspinatus & Infraspinatus)

Inspects scapula, asks the patient to push against examiner's hand, palpates over and around scapula bilaterally

Skin Exam of Upper & Lower Arm for Follicular Hyperkeratosis, Corkscrew Hair, Lanugo

Inspects skin of upper and lower arm (penlight optional) for papules at tips of hair follicles (rough, goose bump-like appearance), coiled corkscrew or swan-neck shaped hair or fine, soft hair on arms

Biceps/Triceps

Asks patient to bend the arm at a 90-degree angle, gently grabs biceps/triceps between thumb and pointer finger and rolls to determine the amount of fat

Nail Exam for Color, Koilonychia, Beau's Lines, Splinter Hemorrhage, Clubbing

Inspects nails for nail color, thin, concave, spoon-shaped nails, transverse, deep grooved lines, small splinter like dark hemorrhages, and/or convex clubbed nails with a downward curve

Interosseous Muscles

Asks patient to press the pads of thumb and rest of four fingers together, inspects & palpates muscles near the metacarpal bone

Thenar Eminence

Asks patient to press the pads of thumb and rest of four fingers together, inspects and palpates base of the thumb

Leg Exam for Petechiae and/or Purpura

Inspects skin for small, pinpoint round hemorrhages and/or reddish-purple rash on knees, thighs or legs

Quadriceps Muscles

With patient's leg propped up and slightly bent at the knee, inspects for concave depression around the thighs, palpates quads bilaterally, may ask patient to lift leg for muscle engagement

Gastrocnemius Muscles

With the patient's leg propped up, gently grasps calf muscle, and assesses for bulk or thinning, may ask the patient to flex toes to engage muscle

Pitting Edema

Inspects & palpates by pressing down on skin over the pretibial area, ankles, and/or foot for 5 seconds and releases to assess size and depth of the pit

Handgrip using Dynamometer When Available (objective measure)

Using standard dynamometer techniques, assesses patient's handgrip strength

Handshake and/or Grip/Squeeze Fingers (subjective measure, not part of Academy/ASPEN diagnostic criteria)

Assesses handgrip strength through handshake and/or asking patient to squeeze examiner's pointer and middle fingers bilaterally

Bilateral Inspection & Palpation

Examines patient bilaterally where applicable

Patient Dignity

Maintains patient dignity by uncovering patient only as needed, examines all necessary areas when uncovering to minimize exposing patient repeatedly

Patient Position

Assures patient comfort, safety and is gentle when moving patient during examination, returns patient's arms/legs to original position after completing the exam

Patient Interview

Asks patient appropriate questions that helps with examination