D116 Comprehensive Advanced Health Assessment Techniques Checklist

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Western Governors University

D116 Advanced Pharmacology for the Advanced Practice Nurse

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Date

Advanced Health Assessment for the Advanced Practice Nurse

The Comprehensive Advanced Health Assessment Techniques Checklist outlines critical assessment areas and individual items for advanced practice nurses to evaluate accurately. This tool ensures that candidates demonstrate proficiency in various examination techniques, contributing to holistic patient care.

Health History

When obtaining a health history, it is essential to gather detailed and relevant information systematically. The assessment should include:

Chief complaint
History of present illness with a focused orthopedic review
Current medications
Allergies and any associated reactions
Past medical history
Vaccination status
Family medical history
Social history
Review of symptoms

These components allow the practitioner to build a thorough patient profile, which is foundational for diagnosis and treatment planning. The health history section accounts for 9 points.

Measurement and Vital Signs

Assessing basic measurements and vital signs includes asking the patient about their weight and accurately measuring pulse, respiration rate, and blood pressure. These vital signs offer essential baseline data on the patient’s physiological status. This section has 2 points available.

Skin Assessment

Skin examination is comprehensive, focusing on the following characteristics:

Hands and nails
Skin color and pigmentation
Temperature
Moisture
Texture
Turgor
Presence of any lesions

Such detailed inspection aids in identifying dermatological conditions or systemic illnesses manifesting through skin changes. This portion carries 7 points.

Head and Face Examination

Assessment of the head and face requires inspection and palpation of:

Scalp, hair, and cranium
Facial symmetry and function, including cranial nerve VII
Temporal artery and temporomandibular joint
Maxillary and frontal sinuses

These evaluations help detect abnormalities such as infections, vascular issues, or neurological impairments. This section is worth 6 points.

Eye Examination

Evaluating the eyes involves several tests to assess cranial nerves II, III, IV, and VI, including:

Visual fields
Extraocular muscle function
Corneal light reflex
Cardinal positions of gaze
External structures and conjunctivae
Pupillary response

Proper eye examination is vital in detecting neurological and ocular diseases. This segment offers 7 points.

Ear Examination

Examination includes:

External ear inspection
Palpation for tenderness
Conducting the voice test to assess cranial nerve VIII

Ear assessment helps diagnose infections or hearing impairments. This section is allocated 3 points.

Nose Assessment

The nose is evaluated for:

External structure
Patency of the nostrils

This brief but essential assessment ensures nasal airway function, contributing 2 points.

Mouth and Throat Examination

Examination of the oral cavity covers:

Lips and buccal mucosa
Teeth and gums
Tongue
Hard and soft palate
Tonsils
Uvula, related to cranial nerves IX and X
Tongue motor function (cranial nerve XII)

Oral assessment is crucial for detecting infections, lesions, and neurological deficits. This area is valued at 7 points.

Neck Assessment

Key aspects include:

Symmetry, presence of lumps or pulsations
Cervical lymph node palpation
Carotid pulse and auscultation for bruits
Tracheal position
Range of motion and muscle strength (cranial nerve XI)
Thyroid gland palpation

This examination identifies vascular, lymphatic, and musculoskeletal disorders. It carries 6 points.

Chest and Lung Examination

Posterior and lateral chest and lungs involve assessing:

Item	Description	Points
Thoracic cage configuration	Includes skin characteristics, symmetric expansion, tactile fremitus, lumps, or tenderness	5
Spinous processes	Inspection and palpation
Percussion	Over lung fields
Costovertebral angle (CVA) tenderness	Checking for kidney-related pain
Breath sounds	Auscultation

Anterior chest and lungs assessment focuses on:

Item	Description	Points
Respirations and skin characteristics	Observing breathing pattern and skin	4
Tactile fremitus, lumps, tenderness	Palpation for abnormalities
Percussion	Assessing lung resonance
Breath sounds	Auscultation

Heart Examination

A thorough cardiac assessment includes:

Precordium inspection for pulsations and heaves
Apical impulse palpation
Thrills over the precordium
Apical rate and rhythm evaluation
Auscultation of heart sounds

This detailed examination is crucial for detecting cardiac abnormalities, and it accounts for 5 points.

Upper Extremities

Assessment includes:

Range of motion and muscle strength
Palpation of epitrochlear lymph nodes

This ensures musculoskeletal and lymphatic health, contributing 2 points.

Neck Vessels

Evaluation focuses on:

Jugular venous pulse
Jugular venous distension

These findings assist in diagnosing cardiovascular conditions such as heart failure and venous congestion. This section is worth 2 points.

Abdominal Examination

The abdomen is assessed systematically for:

Component	Description	Points
Contour, symmetry, skin, umbilicus, pulsations	Inspection and palpation	7
Bowel sounds	Auscultation
Vascular sounds	Listening for bruits
Percussion	Liver span measurement along right midclavicular line
Spleen	Palpation for enlargement
Light and deep palpation	Liver, spleen, kidneys, and aorta

Inguinal Area

Focused on:

Femoral pulse palpation
Inguinal lymph node palpation

This helps detect vascular and lymphatic pathologies, contributing 2 points.

Lower Extremities

Assessment includes:

Feature	Description	Points
Symmetry, skin, hair distribution	Visual and tactile examination	4
Pulses	Popliteal, posterior tibial, dorsalis pedis
Temperature, pretibial edema	Palpation
Toes	Inspection and function

Musculoskeletal and Neurological Examination

This complex evaluation covers:

Ankles and feet inspection
Sensory testing of the face, arms, hands, legs, and feet
Position sense and stereognosis
Cerebellar function tests (finger-to-nose, heel-to-shin)
Deep tendon reflexes: biceps, triceps, brachioradialis, patellar, Achilles
Babinski reflex
Meningeal signs including nuchal rigidity, Kernig sign, Brudzinski sign, and jolt accentuation headache
Cranial nerves I and V
Romberg test

This comprehensive neurological exam ensures integrity of sensory, motor, and cerebellar functions. It holds 12 points.

Hips and Knees: Range of Motion and Muscle Strength

Functional assessment involves:

Walking across the room heel-to-toe
Walking on tiptoes, then on heels
Performing shallow knee bends
Touching toes
Assessing spine range of motion

These tests help identify musculoskeletal weaknesses or neurological impairments and account for 5 points.

Presentation Skills

Effective communication is assessed by observing if the candidate:

Engages with the patient respectfully
Explains each procedure clearly
Advises appropriate follow-up
Thanks the patient and leaves the room politely

This professional conduct is valued at 3 points.

Focused Orthopedic Examination

This section includes evaluations of:

Scoliosis
Low-back pain
Shoulder function
Wrist function
Knee joint stability

Each part must be performed successfully to pass, though it is not included in the total 100-point score. Passing requires achieving at least 85 points in scored areas and successful completion of all orthopedic components.

Scoring and Competency

The assessment uses a points system with a maximum of 100 points plus bonus points. Candidates must score a minimum of 85 points on the scored sections and pass the focused orthopedic exam to achieve an overall passing grade.

Summary Table of Assessment Areas and Points

Assessment Area	Points Possible
Health History	9
Measurement and Vital Signs	2
Skin	7
Head and Face	6
Eyes	7
Ears	3
Nose	2
Mouth and Throat	7
Neck	6
Posterior and Lateral Chest and Lungs	5
Anterior Chest and Lungs	4
Heart	5
Upper Extremities	2
Neck Vessels	2
Abdomen	7
Inguinal Area	2
Lower Extremities	4
Musculoskeletal and Neurological	12
Hips and Knees (ROM and Strength)	5
Presentation	3
Total Points	100 (+ bonus)

References

Jarvis, C. (2020). Physical Examination and Health Assessment (8th ed.). Elsevier.
Bickley, L. S., & Szilagyi, P. G. (2021). Bates’ Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer.