Comprehensive Adult Assessment
Initial Preparation and Vital Signs
- The American College of Cardiology recommends measuring vital signs, including blood pressure in both arms, temperature, pulse rate, respiratory rate, and oxygen saturation, to identify potential subclavian artery stenosis 1
- Calculate body mass index (BMI) by measuring height and weight, as recommended by the Mayo Clinic 2
- Assess orthostatic blood pressure changes when indicated, according to Circulation guidelines 3
General Assessment
- Evaluate overall appearance, level of consciousness, and apparent distress, as suggested by Praxis Medical Insights 1
- Assess body habitus for evidence of wasting, obesity, or lipodystrophy, as recommended by Praxis Medical Insights 1
Head and Neck Assessment
- Inspect head for deformities, lesions, and symmetry, as suggested by Praxis Medical Insights 1
- Examine eyes, including visual acuity, pupillary response, extraocular movements, and fundoscopic examination, as recommended by the Mayo Clinic 2
- Palpate thyroid gland and lymph nodes in the neck, according to the Mayo Clinic 2
Abdominal Assessment
- Assess for hepatomegaly or splenomegaly, as recommended by the Mayo Clinic 2
Neurological Assessment
- Evaluate mental status and cognitive function, as suggested by the Mayo Clinic and Praxis Medical Insights 1, 2
- Test sensory function using the 10-g monofilament test, pinprick or temperature perception, and vibration testing with a 128-Hz tuning fork, as recommended by Diabetes Care and Praxis Medical Insights 1, 4
Vascular Assessment
- Palpate peripheral pulses, including femoral, popliteal, dorsalis pedis, and posterior tibial, as recommended by Diabetes Care and Praxis Medical Insights 1, 4
- Assess for capillary refill time, rubor on dependency, pallor on elevation, and venous filling time, according to Diabetes Care and Praxis Medical Insights 1, 4
Skin Assessment
- Perform comprehensive skin examination, noting any lesions, ulcerations, calluses, or wounds, as suggested by Praxis Medical Insights 1
- Pay particular attention to feet and pressure points in patients at risk for skin breakdown, as recommended by Diabetes Care and Praxis Medical Insights 1, 4
Laboratory and Diagnostic Evaluation
- Initial laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, fasting blood glucose or glycohemoglobin, lipid profile, liver function tests, and thyroid-stimulating hormone, as recommended by Circulation and the Mayo Clinic 2, 3
- Consider 12-lead electrocardiogram and chest radiograph when indicated, according to Circulation guidelines 3
Special Considerations for Specific Populations
- For diabetic patients, perform comprehensive foot examination at least annually, as recommended by Diabetes Care 4
- For older adults, apply the "Geriatric 5Ms" framework, including Mind, Mobility, Medications, what Matters most, and Multicomplexity, as suggested by the Mayo Clinic 2