NSG 121 Unit 5 head to toe rehearsal log example

One Repositioning, Two Repeats, Three Things Left Undone: A Head-to-Toe Rehearsal Log From the Skills Lab

Student Name

Department of Nursing, Herzing University

NSG 121: Health Assessment

Instructor Name

February 12, 2026

One Repositioning, Two Repeats, Three Things Left Undone: A Head-to-Toe Rehearsal Log From the Skills Lab

Before Approaching

The rehearsal was performed in the skills lab on a composite partner, a 24-year-old male classmate with no health concerns, over 38 minutes. Before starting, the equipment was laid out on the bedside table in the order it would be used: blood pressure cuff and stethoscope, penlight, otoscope and ophthalmoscope, tongue blade, Snellen card, tuning fork (512 Hz), reflex hammer, cotton wisp, and paper clip for sharp and dull testing. The bed was raised to my hip height, the head of the bed flat, a drape and gown ready, and the room warmed. I explained that the examination would go from head to feet, that he would sit for the first half and lie down once, and that he could ask me to stop at any point. Hands were washed in front of him.

Seated Sequence

General survey and vital signs, seated on the edge of the bed. Done first because they need rest before, and because the general survey starts the moment the person is seen.

Head and face: inspection, then palpation of the scalp and temporal arteries. Eyes: visual acuity with the Snellen card, then extraocular movements, then pupils with the penlight, then the ophthalmoscope. The ophthalmoscope was the one departure from the taught order in this region: it was moved to the end of the head examination because the room lights had to be dimmed for it, and dimming them once rather than twice saved time.

Ears: otoscope, then whispered voice, then the Weber and Rinne tests with the tuning fork. Nose and mouth: penlight and tongue blade. Neck: inspection, lymph nodes palpated in a fixed order from the preauricular nodes around to the supraclavicular, thyroid palpated from behind, trachea checked for position.

Transition: I moved behind him to examine the posterior chest while he was still sitting, since the thyroid had just been palpated from that position. He crossed his arms to move his shoulder blades apart. Posterior chest: inspection, palpation for expansion, percussion, then auscultation, comparing side to side at each level.

Anterior chest and heart, still seated: auscultation of the lungs, then the five cardiac listening sites with the diaphragm and then the bell. Upper extremities and cranial nerves were completed while seated, including grip strength and arm reflexes, so that he would not need to sit up again later. This is the second departure from the taught sequence, which places the neurologic examination last; doing the upper-body neurologic parts now saved a repositioning.

The One Repositioning, and the Supine Sequence

Transition: he lay back with the bed tilted up 30 degrees so the neck veins could be judged, and the bed was then lowered flat. This was the only change of position for the rest of the examination.

Heart, supine: the point of maximal impulse could not be felt with him flat. He was turned partly onto his left side and it was felt in the fifth intercostal space just inside the midclavicular line, about 2 cm across. This is recorded as a repeat, with the position in which it was found.

Abdomen: inspection, then auscultation before percussion and palpation, since touching the abdomen can change bowel sounds. Knees bent on a pillow to relax the abdominal wall. Liver span percussed at the right midclavicular line; light and then deep palpation in all four quadrants.

Lower extremities: inspection of skin and hair, pulses from the femoral down to the dorsalis pedis and posterior tibial, capillary refill, and a check for edema at the shins and ankles. Lower extremity neurologic examination: strength, sensation with the wisp and the paper clip, vibration at the big toe with the tuning fork, knee and ankle reflexes, and plantar responses.

Repeats

Two parts were repeated because the first attempt was not good enough. The point of maximal impulse, as described above. And the Rinne test on the left ear: on the first attempt the tuning fork had been struck too hard and was still ringing loudly when moved to the ear, which made the comparison unreliable. It was struck gently and repeated. Both are recorded as repeats rather than written as if they worked the first time, because the course text notes that technique problems of this kind are a common source of misleading findings (Bickley et al., 2021).

Left Undone, and Why

Three parts of a complete examination were not performed. The breast, genital, and rectal examinations are not done on classmates in this lab; they are practiced on models and would be recorded as deferred in a real record. Gait and balance were not tested because the lab floor was being cleaned in the walking area; this is the omission most likely to be forgotten in practice, since it requires the person to stand again after lying down. The ophthalmoscope examination was attempted but the optic disc was not seen in either eye; it is recorded as attempted and not visualized, not as normal.

The partner is a composite for this assignment. The sequence taught in the course, and the departures from it, follow Jarvis (2020); the advice on minimizing repositioning follows McGee (2018).

References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Jarvis, C. (2020). Physical examination & health assessment (8th ed.). Elsevier.

McGee, S. (2018). Evidence-based physical diagnosis (4th ed.). Elsevier.