Physical Assessment
HEAD TO TOE ASSESSMENT
Objectives
 Review previous lecture content(any questions?)
 Head to Toe Assessment to a Spanish speaking
patient
Signos Vitales

I am going to measure your blood
pressure.
Voy a medir su presión arterial.

I’m going to take your pulse.
Voy a tomar su pulso



Your blood pressure is___
Su presión arterial es_____

Your pulse is___
Su pulso es__________
I’m going to take your temperature. Put
thermometor under your tounge
Voy a tomar su temperatura.
Ponga el termometro debajo su
lengua

Your temperature is___
Su temperatura es_______

Your oxygen level is_____
Su nivel de oxígeno es____
I’m going to measure your oxygen level.
Voy a medir su nivel de oxígeno
Responses
 Es normal/ No es normal
 Está un poco alta/baja
 Está muy alta/ muy baja
Review
 “I’m going to take your
 BP 130/85  HR 121
vital signs”
 “I’ m going to____”
 “your___is”
 Is it normal, high, low?
 HR 76
 Temp
 Temp






36.0°C
99%
115/80
HR 59
39.0°C
94%
85/60





35.9°C
100%
145/90
HR 88
Temp
38.2°C
88%
Head to Toe Assessment
 Neuro
 Eyes
 Heart
 Lungs
 Abdomen
 Lower Extremities
AAO X 3
 “What is your full name”
 “Cual es su nombre
completo”
“Do you know what__it is?”
 day
 month
 year
“Sabe que__es?”
 Dia
 Mes
 Año
 “Do you know where you
 “Sabe donde está?”
are”
Ojos/Eyes
Checking pupil
response
 “Look directly at the
light”
 “Mire directamente a la
luz”
Corazon/Heart
Heart Sounds
 “I’m going to listen to
your heart”
 “Voy a escuchar a su
Arm Strenght
 “Squeeze my hands”
 “Relax your grip”
 “Apriete mis manos”
corazon”
 “Relaje su agarre”
Pulmones/Lungs
Lungs Sounds
 “I’m going to listen to
your lungs”
 “Breath deeply and
exhale”
 “again…”
 “Voy a escuchar a sus
pulmones”
 “Respire profundo y
exale”
 “otra vez…”
Abdomen
Abdomen
 “I’m going to listen to
your stomach”
 “ I’m going to press on
your abdomen”
 “Tell me if it hurts”
 “Voy a escuchar a su
estomago”
 “Voy a presionar en su
abdomen”
 “Digame si le causa
dolor”
Piernas/Legs
Lower extremeties
 “I’m going to examine your
legs for swelling”
Muscle Strength
 Push your feet forward
 Pull your feet back
 Push your hands forward
 Pull your hands back
 “Voy a examinar sus
piernas para ver si estan
hinchadas”
 “ Empuje sus pies hacia el
frente”
 “Tire sus pies hacia atras”
 “Empuje sus manos hacia
el frente”
 “Tire sus manos hacia
atras”
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Physical Assessment