Physical Assessment

Neck:
The neck muscles are equal in size. The client showed coordinated, smooth head
movement with no discomfort.
The lymph nodes of the client are not palpable.
The trachea is placed in the midline of the neck.
The thyroid gland is not visible on inspection and the glands ascend during
swallowing but are not visible.
Thorax, Lungs, and Abdomen

Chest:
The chest wall is intact with no tenderness and masses. Appearance of the
chest/shape
Shape of the chest:
Kyphosis- forward bending of spine
Scoliosis- lateral curvature of spine
Flattening
Over inflation

Normal chest wall: Symmetrical

Abormalities:
Barrel Chest- persistenly round
Palpation:

Interostal tenderness may be due to inflamed pleura

Determine nature of any mass or swelling:

Site
Temperature
Tenderness
Size
Consistency
Surface

Percussion:

Flat or Dull- pleural effusion or Lobar pneumonia

Resonant- Normal Healthy lung or bronchitis
Hyperresonant- emphysema or pneumothorax
Auscultation:

Normal breath sounds:

Over the lung tissue – vesicular breath sound
over the lung trachea – bronchial breath sound
between the two over main bronch is vesiculobroncheal breath sound

Abdomen:

The abdomen of the client has an unblemished skin and is uniform in color. The
abdomen has a symmetric contour. There were symmetric movements caused
associated with client’s respiration.
The jugular veins are not visible.
When nails pressed between the fingers (Blanch Test), the nails return to usual
color in less than 4 seconds.

Inspection
Scars – midline scars (laparotomy) / RIF (appendectomy) / right subcostal
(cholecystectomy)
Masses – assess (size/position/consistency/mobility) – organomegaly / malignancy
Pulsation – a central pulsatile and expansile mass may indicate an abdominal aortic
aneurysm (AAA)
Cullen’s sign – bruising surrounding umbilicus – retroperitoneal bleed
(pancreatitis/ruptured AAA)
Grey-Turner’s sign – bruising in the flanks – retroperitoneal bleed
(pancreatitis/ruptured AAA)
Abdominal distension – fluid (ascites) / fat (obesity) / faeces (constipation) /
flatus / fetus (pregnancy)
Striae – reddish/pink (new) or white/silverish (chronic) – abdominal distension
Caput medusae – engorged paraumbilical veins – portal hypertension
Stomas – colostomy (LIF) / ileostomy (RIF) / urostomy (RIF and contains urine)

Palpation

Light palpation

Palpate each of the 9 abdominal regions, assessing for any of the below.

Tenderness – note the areas involved and the severity of the pain

Rebound tenderness – pain is worsened on releasing the pressure – peritonitis

Guarding – involuntary tension in the abdominal muscles – localised or generalised?

Masses – large/superficial masses may be noted on light palpation

Deep palpation

Assess each of the 9 regions again, but with greater pressure applied during
palpation.

If any masses are identified then assess:

Location – which region

Size
Shape
Consistency – smooth / soft / hard / irregular
Mobility – is it attached to superficial/underlying tissues?
Pulsatility – a pulsatile mass suggests vascular aetiology

Percussion

Abdominal organs
Liver – percuss up from RIF then down from right side of chest to determine the size
of the liver
Spleen – percuss up from RIF moving towards the left hypochondrium to assess for
splenomegaly

Bladder – percuss suprapubic region – differentiating suprapubic masses (bladder

(dull) / bowel (resonant))

Auscultation

Bowel sounds
Normal – gurgling

Abnormal – e.g. “tinkling” (bowel obstruction)

Absent – ileus / peritonitis

Bruits
Aortic bruits – auscultate just above the umbilicus – AAA
Renal bruits – auscultate just above the umbilicus, slightly lateral to the midline