FAR

EASTERN UNIVERSITY
Institute of Nursing

PERFORMANCE EVALUATION TOOL

HEALTH ASSESSMENT OF CHEST, BREAST, HEART, & ABDOMEN

Name : __________________________________________ Score: ___________________

Sec/Grp: ___________________________ Date: ___________________

DIRECTION: Rate the Learner based on the competencies listed below.

RATING DESCRIPTION
3 Performs expected competencies in a very consistent manner.
2 Performs expected competencies in a moderately consistent manner.
1 Performs expected competencies in a rarely consistent manner.
0 Does not perform expected competencies.

ASSESSMENT PROCEDURES RATING REMARKS

PREPARATION
1. Introduce yourself and verify the client’s identity. Explain to
the client what you are going to do, why it is necessary, and 0 1 2 3
how the client can cooperate.
2. Perform hand hygiene and observe other appropriate
0 1 2 3
infection control procedures.
3. Assemble equipment 0 1 2 3
4. Provide for client privacy. 0 1 2 3
POSTERIOR THORAX
5. Inspect Configuration 0 1 2 3
6. Observe use of accessory muscles 0 1 2 3
7. Inspect the client’s positioning 0 1 2 3
8. Palpate for tenderness, sensation and crepitus 0 1 2 3
9. Palpate surface characteristics 0 1 2 3
10. Palpate for fremitus 0 1 2 3
11. Assess chest expansion 0 1 2 3
12. Observe use of accessory muscles 0 1 2 3
13. Percuss the tone 0 1 2 3
14. Percuss for diaphragmatic excursion 0 1 2 3
15. Auscultate for breath sounds 0 1 2 3
16. Auscultate for voice sounds 0 1 2 3
ANTERIOR THORAX
17. Inspect for shape and configuration 0 1 2 3
18. Inspect position of the sternum 0 1 2 3
19. Watch for sternal retractions 0 1 2 3
20. Inspect slope of the ribs 0 1 2 3

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21. Observe quality and pattern of respirations 0 1 2 3
22. Inspect intercostal spaces 0 1 2 3
23. Observe for use of accessory muscles 0 1 2 3
24. Palpate for tenderness, sensation and surface masses 0 1 2 3
25. Palpate for tendernaess at costochondral junctions of ribs 0 1 2 3
26. Palpate for crepitus 0 1 2 3
27. Palpate for fremitus 0 1 2 3
28. Palpate anterior chest expansion 0 1 2 3
29. Percuss the tone 0 1 2 3
30. Auscultate for breath sounds 0 1 2 3
BREASTS & LYMPHATIC SYSTEM
31. Inspect size and symmetry. 0 1 2 3
32. Inspect color and texture. 0 1 2 3
33. Inspect superficial venous pattern. 0 1 2 3
34. Inspect the areolas. 0 1 2 3
35. Inspect the nipples. 0 1 2 3
36. Inspect for retraction and dimpling. 0 1 2 3
37. Palpate texture and elasticity 0 1 2 3
38. Palpate for tenderness and temperature. 0 1 2 3
39. Palpate for masses. 0 1 2 3
40. Palpate the nipples. 0 1 2 3
41. Inspect and palpate the axillae. 0 1 2 3
42. Demonstrate how to perform Breast Self-Exam 0 1 2 3
HEART & NECK VESSELS
43. Observe the jugular venous pulse. 0 1 2 3
44. Evaluate jugular venous pressure. 0 1 2 3
45. Auscultate the carotid arteries 0 1 2 3
46. Palpate the carotid arteries. 0 1 2 3
47. Inspect pulsations. 0 1 2 3
48. Palpate the apical impulse. 0 1 2 3
49. Palpate for abnormal pulsations. 0 1 2 3
50. Auscultate heart rate and rhythm. 0 1 2 3
51. Auscultate to identify S1 and S2. 0 1 2 3
52. Auscultate for extra heart sounds. 0 1 2 3
53. Auscultate for murmurs. 0 1 2 3
ABDOMEN
54. Observe the coloration of the skin. 0 1 2 3
55. Note the vascularity of the abdominal skin. 0 1 2 3
56. Inspect for scars. 0 1 2 3
57. Assess for lesions and rashes. 0 1 2 3
58. Inspect the umbilicus. 0 1 2 3
59. Inspect abdominal contour and symmetry 0 1 2 3
60. Inspect abdominal movement when the client breathes 0 1 2 3
61. Observe aortic pulsations. 0 1 2 3
62. Observe for peristaltic waves. 0 1 2 3
63. Auscultate for bowel sounds. 0 1 2 3
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64. Auscultate for vascular sounds. 0 1 2 3
65. Auscultate for a friction rub over the liver and spleen. 0 1 2 3
66. Percuss for tone. 0 1 2 3
67. Percuss the span or height of the liver by determining its
0 1 2 3
lower and upper borders.
68. Perform blunt percussion on the liver and the kidneys. 0 1 2 3
69. Perform light palpation. 0 1 2 3
70. Deeply palpate all quadrants to delineate abdominal organs
0 1 2 3
and detect subtle masses.
71. Palpate the liver. 0 1 2 3
72. Palpate the urinary bladder. 0 1 2 3
73. Assess for rebound tenderness. 0 1 2 3
74. Document findings 0 1 2 3
TOTAL

_________________________________ ____________________________________
Signature of Student Name & Signature of Faculty