IAN VAN V. SUMAGAYSAY, RN, MAN PHYSICAL ASSESSMENT IAN VAN V. SUMAGAYSAY, RN, MAN

Skin, Hair and Nails Assessment Inspect and palpate the skin Expose area and clean if needed Note general color Note temperature Note Moisture and texture Note mobility and turgor Note lesions Check for edema

Skin, Hair and Nails Assessment Inspect and palpate the hair, noting quantity, distribution, color and texture Inspect scalp Inspect and palpate fingernails and toenails, noting color, shape, contour, surface smoothness, uniformity of thickness, and lesions

Inspect the head, face, scalp Assessment of the Head Inspect the head, face, scalp Palpate the skull, noting shape, symmetry and inconsistencies Check function of the temporomandibular joint Check cranial nerve V and VII Normal Findings: Head Symmetrical, Upright, Still Face Symmetrical, Freely movable

Temporomandibular Joint Assessment of the Head Scalp Smooth, intact, moves freely Skull Hard and Smooth Temporal Artery Non-tender Temporomandibular Joint 3 to 6 cm vertical range with mouth open 1 to 2cm lateral motion Snapping or popping common

Assessment of the Head Cranial Nerve V Cranial Nerve VII Sensory Function Sensation of Light touch Eyelids blink when cornea is touched by cotton Motor Function Symmetrical Jaw Movement Equal muscle strength Cranial Nerve VII Symmetrical Strength and movement of facial muscles

Assessment of the Eye Materials: Snellen’s chart, newsprint, cover card, penlight, opthalmoscope Test visual acuity Snellen’s chart Examine outer eye structures Inspect eye lids Inspect lashes

Assessment of the Eye Observe the globe Inspect the sclera and conjunctiva Test visual acuity Snellen’s chart Examine outer eye structures Inspect eye lids Inspect lashes Check for clarity of the cornea Inspect each iris Inspect each pupil Test for Accommodation

Assessment of the Eye Check for parallel gaze Assess for coordinated movement of two eyes Check for convergence Normal findings: 20/20 vision Intact skin Sclera smooth, white, glossy, moist Eyelashes evenly distributed with an outward curve Pupils equally round at 3 to 5mm

Assessment of the Ears Materials: Tuning Fork, Otoscope Inspect external ear Placement, size, shape, symmetry and skin color Observe for drainage, swelling, lumps and skin lesions Palpate external ear Feel for nodules or other irregularities

Assessment of the Ears Inspect the external auditory meatus Note size of opening, swelling, redness, swelling, discharge, foreign body Examine the external auditory canal and ear drum with an otoscope Test for Hearing Acuity Gross acuity Weber and Rinne test

Assessment of the Nose and Sinuses Materials: Otoscope, Nasal Speculum, Penlight, Scents Inspect external nose Symmetry, lesions, deformity Check for patency of nares Inspect inside of nose Mucosa, nasal septum Palpate the sinuses for tenderness Test Cranial nerve I Scents

Assessment of the Nose and Sinuses Normal findings: External nose: symmetrical Nasal mucosa: intact, moist, smooth, pink Nasal septum: straight Sinuses: nontender Able to distinguish scents

Assessment of the Mouth and Throat Materials: Tongue depressor, Clean gloves, square gauze Inspect lips Inspect buccal mucosa Inspect gums and teeth Inspect roof of mouth Inspect all surfaces of the tongue Inspect Throat Test Cranial nerve X, vagus nerve Test Cranial nerve XII, hypoglossal nerve

Assessment of the Mouth and Throat Normal findings: Lips: moist, pink, intact Buccal mucosa: smooth, pink, moist, intact Gums: pink, moist, intact, clearly defined margins Teeth: 32 pearl white and shiny Palate: pale, moist, intact Tongue: pink, moist, intact, smooth Throat: mucosa pink, moist and intact

Assessment of the Neck Materials: Stethoscope Inspect the neck Appearance, posture and symmetry Check neck movement Flexion, extension, lateral abduction and rotation Inspect the carotid artery and jugular vein Jugular distention, carotid pulsation

Assessment of the Neck Inspect and palpate the trachea for deviation from the midline Inspect the neck for the thyroid gland Palpate the thyroid size, shape and consistency Auscultate any enlarged thyroid for vascular sounds Palpate for cervical lymph nodes

Assessment of the Neck Normal findings: Neck: symmetrical, proportional, coordinated movement Carotid artery: mild pulsation Trachea: midline, nontender, distinct rings Thyroid: non-visible, smooth, symmetrical and rubbery on palpation Cervical lymph nodes: non-palpable less than 1 cm, smooth, firm, mobile, non-tender with definite margins

Assessment of the Breast and Axillae Materials: Small pillow, sheets, towel or gown Inspect breast for size, color, venous pattern, skin appearance, vascularity, contour and symmetry Inspect areola size, shape and color Observe nipple size, shape, symmetry and direction Inspect axillae for hair distribution, cleanliness, uniformity and skin condition Palpate each breast for masses, consistency, tenderness and lymph nodes

Assessment of the Breast and Axillae Check for nipple discharge Palpate the axillae Normal Findings: Symmetrical, one breast may be larger than the other Contour: conical to pendulous Color: similar to normal skin Venous pattern: faint, symmetrical Appearance: smooth, soft Consistency: uniformly loose to dense, feels firm to soft, smooth, elastic

Assessment of the Breast and Axillae Tenderness: tender if premenstrual Masses: none Nipples and Areolae: symmetrical, no discharges Axillae: nontender central nodes; not usually palpable

Assessment of the Chest and Lungs Materials: Stethoscope, Tape Measure Prepare the patient for examination Inspect and palpate the skin and nails for color, lesions, turgor and abnormalities Inspect and palpate the thorax, clavicle, scapula, ribs and spine for contour and abnormalities Inspect breathing pattern: rate and rhythm Inspect breast and axillae Inspect for tactile fremitus

Assessment of the Chest and Lungs Palpate for respiratory excursion Percuss the posterior and anterior thorax Percuss the diaphragmatic excursion Auscultate the posterior, lateral and anterior thorax

Assessment of the Chest and Lungs Normal Findings: Thorax: normal contour Ribs: normal sloping of the ribs Spine: straight Breathing: regular; 16-20 breaths per minute Muscles: normal, non-tender Tactile fremitus: symmetrical Respiratory excursion: normal excursion of 1 ¼ to 2 inches

Assessment of the Chest and Lungs Normal Findings: Diaphragm descends 3 to 6 cm Breath sounds: normal, symmetrical Percussion Resonance: over air filled areas Dullness: over fluid-filled or solid areas and organs Tympany: over stomach

Assessment of the Heart Materials: Stethoscope, Tape measure Prepare the patient for the exam Inspect and palpate the anterior chest, including all anatomical landmarks - aortic, pulmonic, erb’s point, apical, tricuspid, epigastric and sternoclavicular Palpate the point of maximum impulse (PMI) Palpate carotid pulse Auscultate the heart for rate and rhythm Palpate and compare the apical and radial pulse

Assessment of the Heart Normal Findings: - Inspection and palpation of the anterior chest: no lesions noted - Heart rate and rhythm: 60 to 100 beats per minute - Apical and Radial should be equal - No systolic and diastolic murmurs present

Assessment of the Peripheral Vascular System Materials: Stethoscope, BP apparatus Assess the patient’s BP Inspect and palpate the carotid arteries Assess jugular venous pulsations Assess the peripheral venous circulation Skin changes, temperature, edema, varicosities, phlebitis, DVT, Phlebitis, Trendelenburg

Assessment of the Peripheral Vascular System Assess the peripheral arterial circulation Skin and nail changes, temperature, sensation, pulses Allen’s Test

Assessment of the Peripheral Vascular System Assess the peripheral arterial circulation Skin and nail changes, temperature, sensation, pulses Allen’s Test Normal findings: BP: systole 90-140 mmHg; diastole 60-90 mmHg Carotid pulse: 60-90bpm Skin: warm to touch Pain: negative

Assessment of the Peripheral Vascular System Sensation: positive perception of sharp, soft and vibratory sensations Vessels: appear bluish, feel elastic and nontender Edema: No Edema

Assessment of the Abdomen Materials: Stethoscope, tape measure Observe patient’s posture Inspect the skin, abdomen Auscultate for bowel sounds Auscultate for abdominal bruits Percuss the abdomen Percuss and span the liver Percuss gastic air bubbles Percuss kidney and spleen

Assessment of the Abdomen Do light palpation on all quadrants of the abdomen Do deep palpation on all quadrants of the abdomen Palpate the umbilicus Palpate the liver Palpate the gallbladder Palpate the spleen Palpate the aorta Palpate for ascites Perform ballottement for suspected masses

Assessment of the Abdomen Normal findings: Posture: may sit or lie freely Skin: normal, warm, no lesions noted Abdomen: soft, smooth, convex for thin persons, concave for distention due to full bladder, tympany over the stomach Bowel sounds: High-pitched gurgling sound, occuring normally in only one quadrant

Assessment of the Female Genitalia Materials: Gyne table, gooseneck lamp, gown, drapes, gloves, speculum Inspect and palpate vulva for lesions, masses and abnormalities Inspect pubic hair Inspect and palpate the labia majora for lesions, masses, inflammation, swelling and abnormalities Inspect the labia minora for position, lesion, masses or abnormalities

Assessment of the Female Genitalia Inspect the clitoris for position, size, lesions, masses and abnormalities Inspect the urethral meatus and Skene’s glands for lesions, masses, inflammation, discharge or abnormalities Inspect the hymen Inspect vaginal opening for lesions, masses, inflammation, tears, discharge Inspect Bartholin’s gland for pain, swelling, masses or discharge

Assessment of the Female Genitalia Inspect the cervix and cervical os for position, shape, size, color, inflammation, erythema, lesions, masses and discharge Palpate cervix Inspect the vaginal outlet for lesions, masses, inflammation, discharge and abnormalities Palpate vaginal wall Palpate ovaries Palpate the uterus for position, size, shape and consistency

Assessment of the Female Genitalia Normal findings: Vulva: smooth, warm, pink to brown Pubic hair: quantity and distribution according to age Infestations: none Labia majora: smooth, moist skin, symmetrical, lie together except for sexually active women Clitoris: pink, usually not more than 2cm in length, 0.5cm in width

Assessment of the Female Genitalia Urethral meatus: midline, anterior to vaginal opening Hymen: Intact in virgins Vaginal opening: Open and unobstructed Bartholin’s gland: nontender and non-palpable Vaginal wall: ruggerated, thin clear or cloudy secretions Cervix: pink, smooth, moist, glistening, rounded, firm, approx. 1 inch in diameter

Assessment of the Male Genitalia Materials: Gloves, Lubricant, Drapes, Gown Inspect the external genitalia. Assess maturity. Inspect and palpate the skin for color, temperature, lesions, masses, excoriation, lacerations, abnormalities, infestations or lack of hygiene Inspect and palpate the prepuce or foreskin in uncircumcised males

Assessment of the Male Genitalia Inspect and palpate the glans Inspect the urethral meatus Inspect and palpate the shaft of the penis Inspect and palpate the scrotum and testes for size, shape, color, temperature, tenderness, lesions, abnormalities Inspect and palpate for hernia Palpate the prostate gland

Assessment of the Male Genitalia Normal findings: Skin: warm, smooth without lesions Pubic hair: growth and distribution according to age Prepuce: normally without lesions, smegma present, easily retractable Glans: pink, moist in uncircumcised males; dry and reddish in circumcised males Shaft: no lesions

Assessment of the Male Genitalia Scrotum and testes: coarse, loose, slightly darker than the rest of the body, no lesions, not more than 1 inch in diameter, left testis is lower than the right Vas deferens and spermatic cord: no masses, thickening, tenderness Hernias: none

Assessment of the Anus, Rectum, and Prostate Materials: gloves and lubricant Inspect and palpate the perianal tissue and perineum Inspect for the appearance of protrusions or masses with straining Perform a digital exam to palpate the anus, rectum and prostate Assess the muscle tone of the anal ring and rectum Palpate or high masses Examine fecal material

Assessment of the Anus, Rectum, and Prostate Normal findings: Perianal tissue: no lesions, masses, erythema Anus: slightly reddened and closed; no lesions, masses, protusion, hemorrhoids Rectum: smooth without masses, lesions, tenderness Prostate: palpable after puberty, rubbery and smooth to palpate Uterus and cervix: rubbery, smooth, nontender -Fecal material: well-formed; brown

Assessment of the Musculoskeletal System Materials: Tape measure , Goniometer Assess the patient’s posture, stance and gait Inspect for any gross abnormality Inspect and palpate the skin and surrounding tissue of all bones, joints and muscle groups to be examined Inspect and palpate the temporomandibular joint and jaw Inspect and palpate the neck and spine Assess ROM of the neck

Assessment of the Musculoskeletal System Assess ROM of the spine Inspect and palpate the upper and lower extremities, assessing each joint and associated muscle groups Shoulders, Elbows, Wrists, Fingers, Hips, Knees, Ankles, Toes

Assessment of the Nervous System

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