assess peripheral vascular status when examining the lower extremities.
When you assess the legs you will be assessing the parts of the skin (color and condition of skin on legs), peripheral vascular system (pulses, color, edema, lesions of legs), musculoskeletal system (movement, strength, and tone of legs), and neurologic system (ankle and patellar reflexes, clonus).
Normal Findings:
- Empties bladder independently (or urinary catheter patent)
- No urgency, frequency, incontinence or dysuria
- Urine clear and yellow to amber in color.
If patient's condition warrants, examine the external genitalia and anus Inspect for:
- abnormal color
- pain, tenderness or trauma
- presence of obvious lesions or masses
- odor or unusual discharge
- any swelling or inflammation
-presence of itching
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Comprehensive health assessment: involves an in depth assessment of the whole person, including the physical mental emotional cultural and spiritual aspects of the patients health. Collected through physical eximination and interview. May take as long as 2 hours to complete. Is generally performed when patient is admitted.
Focused assessment: less encompassing and involves and eximination and an interview regarding a specific body system. Provides a cluster of data about just one body system being assessed.
Initial head to toe shift assessment: quick overall assessment of the patients condition to establish a baseline against which you can compare later assessments. This baseline is necessary for you to be able to identify changes in the patients condition. Consists of performing a focused assessment of the following systems, neurological, cardiovascular, respiratory, integumentary, gastrointestinal, genitourinary, muscular, skeletal. Also includes vitals, appearance, speech, safety risk factors, tubes and equipment, comfort or complaints, needs.
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