UNIVERSITY OF CEBU BANILAD

College of Nursing
PHYSICAL ASSESSMENT FINDINGS

Date of Interview: _____________________

Information given by: _____________________
Interviewer: _____________________
I.

PATIENT PROFILE
Patients Name: __________________________________
Age: _________________________
Nationality: _____________________________________
Occupation: ____________________
Date of Birth: ___________________________________
Place of Birth: __________________
Hospital: _______________________________________
Room No. : ____________________
Date of Admission: _______________________________
Physician: _____________________
Medical/Surgical Diagnosis:
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II.
VITAL SIGNS
Temperature
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Pulse
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Blood Pressure
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Respiration
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Height
_______ cm.
Weight
_______ kg.

/ / oral
/ / axilla
/ / rectal
/ / regular / / irregular
/ / lying
/ / sitting
/ / standing
/ / regular / / irregular
BMI __________
Waist to hip ratio _________

III.
GENERAL OBSERVATION
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IV.
CHIEF COMPLAINTS/REASON FOR HOSPITALIZATION
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A.

HISTORY OF PRESENT ILLNESS

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B.

PAST MEDICAL AND SURGICAL HISTORY

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C.

PHYSIOLOGICAL HISTORY
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D. NUTRITION AND METABOLIC PATTERNS

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E.

ELIMINATION PATTERN
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F.

ACTIVITY AND TOLERANCE

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G. COGNITIVE AND PRECEPTUAL PATTERN

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H. SLEEP AND REST PATTERN
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I.

SELF PERCEPTION AND SELF CONCEPT PATTERN

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J.

ROLE RELATIONSHIP PATTERN

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K. COPING STRESS TOLERANCE PATTERN

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L.

VALUE AND BELIEF PATTERN

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V. SUMMARY

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