Study Guideline Physical Examination NUR 224: Dr. Mohammed H. Moreljwab

Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬
Ministry Of Education
‫وزارة التعــــليم‬
University of Bisha
Faculty of Applied Medical ‫جامعـــة بيشـــة‬
science ‫كلية العلوم الطبية التطبيقية‬
Nursing department
‫قسم التمريض‬
Study Guideline
Physical Examination
NUR 224
Prepared by:
Dr. Mohammed H. Moreljwab
mhassan@ub.edu.sa
1
According to curriculum and course specification, the following topics will be covered:
First Topic
Course Orientation& Introduction to Health Assessment
Learning Outcomes:
1. Distinguish various definitions of health.
2. Explain the steps of the nursing process.
3. Identify the key components of health assessment in nursing.
4. Explain the role of the professional nurse in health assessment.
5. Apply the critical thinking process to health assessment in nursing.
6. Outline the key elements of an effective teaching plan.
Contents:
 Health Assessment.
 Cultural Considerations.
 Psychosocial Assessment.
 Health Assessment Across the Life Span
 Assessment of Vulnerable Populations
 Interviewing and Communication Techniques
 The Health History and effective teaching.
 Techniques and Equipment
 General Survey
 Pain Assessment
 Nutritional Assessment
Teaching Methods:
☼ Lecture, group discussion .…
2
Second topic
Assessment of Skin, Hair, and Nails (Ch: 13)
Learning Outcomes
Upon completion of this chapter, you will be able to:
1. Identify the anatomy and physiology of the skin, hair, and nails.
2. Develop questions to be used when completing the focused interview.
3. Outline the techniques used for assessment of the skin, hair, and nails.
4. Explain patient preparation for assessment of the skin, hair, and nails.
5. Differentiate normal from abnormal findings in physical assessment of the skin, hair, and nails.
6. Describe developmental, psychosocial, cultural, and environmental variations in assessment
techniques and findings.
7. Relate integumentary health to Healthy People 2020 objectives.
8. Apply critical thinking to the physical assessment of the skin, hair, and nails.
Contents:
 Anatomy and Physiology Review

 Skin and Glands
 Hair
 Nails
 Special Considerations
 Lifespan Considerations
 The Pregnant Female
 The Older Adult
 Psychosocial Considerations
 Cultural and Environmental Considerations
 Focused Interview
 Patient Education
 Physical Assessment
 Abnormal Findings
 Primary lesions
 Secondary lesions
 Vascular lesions
 Configuration and Shapes of Lesions
 Overview of Skin Lesions
 Infectious skin lesions
 Allergic or inflammatory skin lesions
 Malignant skin lesions
 Overview of Hair and Scalp Abnormalities
 Overview of Nail Abnormalities
Teaching Methods:
☼Lecture, group discussion, seminars. PBL….
3
Third topic
Head, Neck, and Related Lymphatics (Ch: 14)
Learning Outcomes
On completion of this chapter, the learner will be able to:
1. Describe the anatomy and physiology of the structures of the head, neck, and related lymphatics.
3. Outline the techniques used for assessment of the head, neck, and related lymphatics.
4. Explain patient preparation for assessment of the head, neck, and related lymphatics.
5. Differentiate normal from abnormal findings in the physical assessment of the head, neck, and
related lymphatics.
7. Relate overall health of the head, neck, and related lymphatics to Healthy People 2020 objectives.
8. Apply critical thinking to the physical assessment of the head, neck, and related lymphatics.
Contents:
 Head
 Neck
 Lymphatics
 Special Considerations
 Lifespan Considerations
 Psychosocial Considerations
 Cultural and Environmental Considerations
 Physical Assessment
 The Head
 The Neck
 Areas of the Lymphatics
 Headaches
 Thyroid Abnormalities
Teaching Methods:
☼Lecture, group discussion, PBL….
4
Forth Topic:
Eye, Ears, Nose, Mouth, and Throat. (Ch: 15&16)
Learning Outcome
1. Describe the anatomy and physiology of the eye.
3. Outline the techniques used for assessment of the eye.
4. Explain patient preparation for assessment of the eye.
5. Explain the use of the ophthalmoscope.
6. Differentiate normal from abnormal findings in physical assessment of the eye.
7. Describe developmental, psychosocial, cultural, and environmental variations in
assessment techniques and findings of the eye.
8. Apply critical thinking to the physical assessment of the eye.
9. Describe the anatomy and physiology of the ear, nose, mouth, and throat.
11. Outline the techniques used for assessment of the structures of the ear, nose, mouth, and
throat.
12. Demonstrate correct use of the otoscope.
13. Differentiate normal from abnormal findings in the physical assessment of the ear, nose,
mouth, and throat.
14. Describe the developmental, psychosocial, cultural, and environmental variations in
assessment techniques and findings.
15. Relate ear, nose, and throat health to Healthy People 2020 objectives.
16. Apply critical thinking to the physical assessment of the structures of the ear, nose, mouth,
and throat.
Contents:
 The Eye
 Refraction of the Eye
 Visual Pathways
 Accessory Structures of the Eye
 Health Promotion Considerations
 Assessment of the Eye
 Ear
 Nose and Sinuses
 Mouth
 Throat
 Assessment Techniques
5
Teaching Methods:
☼Lecture, group discussion, seminars and PBL…. .
6
Fifth Topic:
Assessment of respiratory system ( Ch: 17)
Learning Outcomes
1. Describe the anatomy and physiology of the respiratory system.
2. Identify landmarks that guide assessment of the respiratory system.
4. Explain patient preparation for assessment of the respiratory system.
5. Describe the techniques required for assessment of the respiratory system.
6. Differentiate normal from abnormal findings in physical assessment of the respiratory system.
techniques and findings related to the respiratory system.
8. Discuss the objectives related to the overall health of the respiratory system as presented in
Healthy People 2020.
9. Apply critical thinking to the physical assessment of the respiratory system.
Contents:
 Introduction
 Anatomy and physiology review
 Upper respiratory tract
 Lower respiratory tract
 Lower respiratory tract
 Respiratory Process
 Landmarks
 Bony structures
 Sternum
 Angle of Louis
 Clavicles
 Ribs
 Vertebral column
 Horizontal and vertical lines
 Anterior, posterior, and lateral sections
 Division of the thorax
 Anterior: Imaginary vertical lines, Sternal, Midclavicular, Anterior axillary lines
 Posterior: Imaginary vertical lines, Vertebral, Scapular, Posterior axillary.
 Lateral: Imaginary vertical lines, Anterior, Posterior, Midaxillary.
 Inspection
 Palpation
 Percussion
 Auscultation
 Respiratory disorders
 Asthma
 Atelectasis
7
 Bronchitis
 Emphysema
 Pneumonia
 Pleural effusion
 Pneumothorax
 Congestive heart failure
 Valley fever
Teaching Methods:
8
Sixth Topic:
Assessment of Breasts, Axillae ( Ch: 18)
Learning Outcomes
1. Describe the anatomy and physiology of the breasts and axillae.
3. Explain patient preparation for examination of the breasts and axillae.
4. Outline the techniques for assessment of the breasts and axillae.
5. Differentiate normal from abnormal findings in the physical assessment of the breasts and
axillae.
6. Identify the anatomic, physiologic, developmental, psychosocial, and cultural variations that
guide assessment.
7. Relate Healthy People 2020 objectives to issues of the female breasts and axillae.
8. Apply critical thinking to assessment of the breasts and axillae.
Contents:
 Breasts
 Axillae and Lymph Nodes
 Muscles of the Chest Wall
 Inspection
 palpation
Teaching Methods:
9
Seventh topic:
Assessment of Abdomen (Ch 19)
Learning Outcomes
1. Describe the anatomy and physiology of the abdomen.
2. Identify landmarks that guide assessment of the abdomen.
4. Explain patient preparation for assessment of the abdomen.
5. Differentiate normal from abnormal findings in the physical assessment of the abdomen.
techniques and findings related to the abdomen.
7. Describe the variation in techniques required for assessment of the abdomen.
8. Relate Healthy People 2020 objectives to issues of the abdomen and gastrointestinal system.
9. Apply critical thinking to the physical assessment of the abdomen.
Contents:
 Introduction
 Abdomen
 Alimentary Canal
 Accessory Digestive Organs
 Other Related Structures
 Landmarks
 Mapping
 4 Quadrants
 9 Regions
 Lifespan
 Inspection
 Auscultation
 Percussion
 Palpation
 Abnormal Abdominal Findings
 Abnormal sounds
 Pain
 Distention
 Hernias
 Alterations of the Gastrointestinal Tract
 Cancers
 Inflammatory processes
Teaching Methods:
10
Eights Topic:
Assessment of cardiovascular system (Ch 20)

Learning Outcomes
1. Recognize the anatomy and physiology of the cardiovascular system.
2. Recognize landmarks that guide assessment of the cardiovascular system.
4. Explain patient preparation for assessment of the cardiovascular system.
5. Outline the techniques required for assessment of the cardiovascular system.
6. Differentiate normal from abnormal findings in the physical assessment of the cardiovascular system.
7. Describe the developmental, psychosocial, cultural, and environmental variations in assessment
8. Relate Healthy People 2020 objectives to the cardiovascular system.
9. Apply critical thinking to the physical assessment of the cardiovascular system.
Content
 Pericardium
 Heart
 Valves
 Heart Sounds
 Additional Heart Sounds
 Coronary Arteries
 Cardiac Veins
 Cardiac Conduction System
 Pulmonary Circulation
 Systemic Circulation
 Landmarks for Cardiac Assessment
 Sternum
 Clavicles
 Ribs
 Second through fifth intercostal spaces
 Cardiac Cycle
 Measurements of Cardiac Function
 Stroke volume
 Cardiac output
 Cardiac index
 Influences on pumping action
 Preload
 Afterload
 Inspection
 Palpation
 Percussion
 Auscultation
Teaching Methods:
11
Ninth Topic:
Assessment of Peripheral Vascular (Ch 21)
Learning Outcomes
1. Identify the anatomy and physiology of the peripheral vascular and lymphatic systems.
2. Develop questions that guide the focused interview.
3. Explain patient preparation for assessment of the peripheral vascular system.
4. Outline the techniques used for assessment of the peripheral vascular system.
5. Differentiate normal from abnormal findings in the physical assessment of the peripheral vascular
system.
6. Describe the developmental, psychosocial, cultural, and environmental variations in assessment
techniques and findings of the peripheral vascular system.
7. Relate peripheral vascular health to Healthy People 2020 objectives.
8. Apply critical thinking to the physical assessment of the peripheral vascular system.
Content
 Arteries
 Veins
 Lymphatics
 Capillaries
 Inspection
 Palpation
 Auscultation
 Assessment of blood pressure
Teaching Methods:
12
Tenth Topic:
Assessment of Urinary System (Ch 22)

Learning Outcomes
1. Describe the anatomy and physiology of the urinary system.
2. Identify landmarks that guide assessment of the urinary system.
4. Explain patient preparation for assessment of the urinary system.
5. Outline the techniques required for assessment of the urinary system.
6. Differentiate normal from abnormal findings in the physical assessment of the urinary system.
7. Identify the developmental, psychosocial, cultural, and environmental variations in
assessment techniques and findings.
8. Relate Healthy People 2020 objectives to issues of the urinary system.
9. Apply critical thinking to the physical assessment of the urinary system.
Content
 Kidneys
 Renal Arteries
 Ureters
 Urinary Bladder
 Urethra
 Landmarks
 Costovertebral angle (CVA)
 Rectus abdominis muscles
 Symphysis pubis
 Inspection
 Palpation
 Auscultation
 Bladder cancer
 Glomerulonephritis
 Renal calculi
 Renal tumor
 Renal failure
 Urinary tract infection
 Changes in urinary elimination
Teaching Methods:
13
Eleventh Topic:
Assessment of Male Reproductive System (Ch 23)

Learning Outcomes
1. Describe the anatomy and physiology of the male reproductive system.
3. Describe techniques required for assessment of the male reproductive system.
4. Differentiate normal from abnormal findings in the physical assessment of the male
reproductive system.
techniques and findings of the male reproductive system.
6. Discuss the objectives for the male reproductive system as presented in Healthy People 2020.
7. Apply critical thinking to the physical assessment of the male reproductive system.
Content
 External
 Penis
 Scrotum
 Internal
 Testes
 Spermatic cord
 Duct system
 Accessory glands
 Inguinal and perianal areas
 Inguinal Areas
 Perianal Area
 Inspection
 Palpation
 Inguinal hernias
 Abnormalities of the penis
 Abnormalities of the scrotum
 Abnormalities of the perianal area
Teaching Methods:
14
Twelfth Topic:
Assessment of Female Reproductive System (Ch 24)

Learning Outcomes
1. Describe the anatomy and physiology of the female reproductive system.

2. Explain patient preparation for the assessment of the female reproductive system.
3. Develop questions to be used when conducting the focused interview.
4. Describe techniques required for assessment of the female reproductive system.
5. Differentiate normal from abnormal findings in the physical assessment of the female
reproductive system.
6. Describe developmental, cultural, psychosocial, and environmental variations in assessment
and findings of the female reproductive system.
7. Discuss the objectives related to women's health as stated in Healthy People 2020.
8. Apply critical thinking to the physical assessment of the female reproductive system.
Content
 Cyclical changes
 Ovarian cycle
 Menstrual cycle
 Functions
 External Genitalia
 Internal Reproductive Organs
 Vagina
 Uterus
 Uterine (fallopian) tubes
 Ovaries
 Inspection
 Palpation
 External genitalia
 Pediculosis pubis
 Herpes simplex
 Syphilitic lesion
 Human papillomavirus
 Abscess of Bartholin's gland
 Cervix
 Hypoxia
 Carcinomas
 Erosions
 Polyps
15
 Diethylstilbestrol (DES) syndrome
 Inflammatory processes
 Internal reproductive organs
 Myomas
 Ovarian cancer
 Ovarian cysts
Teaching Methods:
16
Thirteenth Topic:
Assessment of musculoskeletal System (Ch 25)

Learning Outcomes
1. Describe the anatomy and physiology of the bones, muscles, and joints.
2. Discuss the directional movements of the joints.
4. Outline techniques used for assessment of the musculoskeletal system.
5. Differentiate normal from abnormal findings of the musculoskeletal system.
6. Describe the developmental, cultural, psychosocial, and environmental variations in
assessment and findings of the musculoskeletal system.
7. Relate musculoskeletal health to Healthy People 2020 objectives.
8. Apply critical thinking to the physical assessment of the musculoskeletal system.
Content
 Introduction
 Bones
 Classification
 Composition
 Major functions
 Skeletal muscles
 Most under voluntary, conscious control
 Elongated muscle cells or fibers arranged in striated bands that attach to skeletal
bones
 Functions
 Joints
 Also articulation
 Point where two or more bones in the body meet
 Fibrous
 Cartilaginous
 Synovial
 Tendons
 Temporomandibular joint
 Elbow
 Shoulder
 Wrist and hand
 Hip
 Knee
 Ankle and foot
 Spine
 Inspection
 Palpation
17
 Inflammatory disorders
 Trauma-induced disorders
 Abnormalities of the spine
 Joint disorders
 Joint Disorders
 Temporomandibular joint syndrome
 Rotator cuff tear
 Olecranon bursitis
 Effusion
 Rheumatoid modules
 Carpal tunnel syndrome
 Dupuytren's contracture
 Ulnar deviation
Teaching Methods:
18
Forteenth Topic:
Assessment of Neurologic System (Ch 26)

Learning Outcomes
1. Describe the anatomy and physiology of the neurologic system.
3. Describe the techniques required for assessment of the neurologic system.
4. Differentiate normal from abnormal findings in the physical assessment of the neurologic
system.
5. Describe developmental, cultural, psychosocial, and environmental variations in assessment
techniques and findings of the neurologic system.
6. Discuss the objectives regarding neurologic health as stated in Healthy People 2020.
7. Apply critical thinking to the physical assessment of the neurologic system.
Content
 Introduction
 Central Nervous System (CNS)
 Brain
 Spinal Cord
 Reflexes
 Peripheral Nervous System
 Cranial nerves
 Spinal nerves
 Inspection
 Palpation
 Auscultation of the carotid arteries
 Sensory and motor function
 Reflexes
 Testing of cranial nerves
 Motor Function
 Sensory Function
 Additional Assessments: Meningeal assessment
 Glasgow Coma Scale
 Problems with motor function, gait, and movement
 Problems with dysfunction of cranial nerves
 Seizures
 Spinal cord injuries
 Traumatic brain injury
 Infections of the neurologic system
 Meningitis
19
 Myelitis
 Brain abscess
 Lyme disease
 Degenerative neurologic disorders
 Alzheimer disease
 Amyotrophic lateral disease
 Huntington disease
 Multiple sclerosis
 Myasthenia gravis
 Parkinson disease
Teaching Methods:
Assessment guideline
Schedule of Assessment Tasks for Students During the Semester
1. Continuous Assessment:
30%
Quizzes, group project, oral presentation, Seminars, etc.)
2. Midterm activity 20%
Final clinical exam 20%
3.
Final written exam 30%
4. Total mark 100%
Identification of assessment contents

Practical evaluation Theory evaluation
Assessment Marks Types Assessment Marks Types

Oral presentations 10 1 Quiz 5 2 quiz
Quiz 10 4Q seminars 5 Seminar for students groups from

one units or more)
Midterm 10 OSCE exam Midterm 10 20 MCQs each one = 0.5 marks
Final 20 OSCE exam Final 30 60 MCQS each one = 0.5
Total 50 Total 50
Course coordinator
Dr. Mohammed H. Moreljwab
20

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Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬

Course Orientation& Introduction to Health Assessment

Assessment of Skin, Hair, and Nails (Ch: 13)

 Anatomy and Physiology Review

Head, Neck, and Related Lymphatics (Ch: 14)

Eye, Ears, Nose, Mouth, and Throat. (Ch: 15&16)

Assessment of respiratory system ( Ch: 17)

Assessment of Breasts, Axillae ( Ch: 18)

Assessment of Abdomen (Ch 19)

Assessment of cardiovascular system (Ch 20)

Assessment of Peripheral Vascular (Ch 21)

Assessment of Urinary System (Ch 22)

Assessment of Male Reproductive System (Ch 23)

Assessment of Female Reproductive System (Ch 24)

1. Describe the anatomy and physiology of the female reproductive system.

Assessment of musculoskeletal System (Ch 25)

Assessment of Neurologic System (Ch 26)

Identification of assessment contents

Assessment Marks Types Assessment Marks Types

Quiz 10 4Q seminars 5 Seminar for students groups from

Final 20 OSCE exam Final 30 60 MCQS each one = 0.5

Dr. Mohammed H. Moreljwab

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