TAGUM DOCTORS COLLEGE, INC.

Mahogany St., Rabe Subd., Tagum City

Telefax: (084) 655 – 6971 E-Mail: tdci_007@yahoo.com
Website: TagumDocollege.com

PERFORMANCE ASSESSMENT

Name:_____________________________ Grade___________
Year & section:______________________ Date____________

PHYSICAL ASSESSMENT 3

RATING
5 4 3 2 1
Assessing the Musculoskeletal System
1. Inspect the muscle for size. Measure the muscle with a tape.
2. Compare each muscle on one side of the body to the same muscle
on the other side for any apparent discrepancies.
3. Inspect the muscle and tendons for contractures and fasciculation.
4. Inspect any tremors of the hands and arms by having the client
hold the arms out in front of the body.
5. Palpate muscles at rest to determine muscle tonicity.
6. Palpate muscle while client is doing active range of motion. Check
flaccidity, spasticity, and smoothness of movement. Flexion and
extension movement)
7. Palpate muscle while the client is doing passive range of motion.
8. Test muscle strength. Compare the right side with left side.
Grade Description
0 No muscular contraction detected
1 A barely detectable trace of
Contraction
2 Active movement with gravity
eliminated.
3 Active movement against gravity
4 Active movement against gravity
and some resistance
5 Active movement against full
resistance.

Bones
1. Inspect the skeleton for normal structure and deformities.
2. Palpate the bone to locate any areas of edema or tenderness.
Joints
1. Inspect the joint for swelling.
2. Palpate each joint for tenderness, swelling, crepitation, and
presence of nodules.
3. Assess joint for ranger of motion, smoothness of movement.
4. Document pertinent findings in the client’s record.
Neurologic Assessment
1. Determine the client orientation to time, place and person by tactful
questioning.
2. Determine client’s Level of Consciousness (RLS/GCS). Make use
of the Neuro Assessment Graphic Sheet.
3. Assess the Cranial Nerves
a. Cranial Nerve I- Olfactory
Ask the client to close eyes and identify different mild aromas,
such as coffee, alcohol, vanilla, alcohol.
b. Cranial Nerve II-Optic
Ask client to read Snellen’s chart and check visual fields by
confrontation.

c. Cranial Nerve III- Oculomotor

Assess six ocular movements ad pupil reaction.
d. Cranial Nerve IV- Trochlear, 6-Abducens
Assess six ocular movements. CN 6 assess ability to gaze laterally.
e. Cranial Nerve V- Trigeminal
While the client looks upward, lightly touch lateral sclera of eye to
elicit BLINK reflex. To test light sensation, have client close eyes,
and wipe a wisp of cotton over the client’s forehead and paranasal
sinuses. Use blunt and sharp ends of safety pin for deep sensation
over the same area.
f. Cranial Nerve VII-Facial
Ask client to smile, raise the eyebrows, frown, puff out his cheeks,
close his eyes tightly (against attempt to open them).
 TAGUM DOCTORS COLLEGE, INC.
Mahogany St., Rabe Subd., Tagum City
Telefax: (084) 655 – 6971 E-Mail: tdci_007@yahoo.com
Website: TagumDocollege.com

g. Cranial Nerve VIII- Acoustic (Vestibulocochlear)

Assess client’s ability to hear spoken words, and vibrations from
tuning fork (Apply Weber and Rinne Test)

h. Cranial Nerve IX- Glossopharyngeal

Depress the tongue with a tongue blade,and note pharyngeal
movement as the person says “ahhh” or yawns. Touch the
posterior pharyngeal wall with tongue blade and note the gag
reflex. Apply tastes on posterior tongue for identification.
i. Cranial Nerve X- Vagus
Assess with CN IX; assess client’s speech for hoarseness.
j. Cranial Nerve-XI-Spinal Accessory
Ask the client to shrug shoulder against resistance from your hands
and turn his head to side against resistance from your hand.
Repeat for the other side.
k. Cranial Nerve X- Hypoglossal
Ask client to protrude his tongue at midline, then move it’s side to
side.
Reflex
1 Biceps Reflex- test the spinal cord level C5-C6
Partially flex the client’s arm at the elbow, and rest the forearm
over the thighs, placing the palm of the hand down. Pace the
thumb of your nondominant hand horizontally over the biceps
tendon.
Deliver a blow (slight downward thrust) with the percussion
hammer to your thumb. Observe the normal slight flexion of the
elbow,and feel the bicep’s contraction through your thumb.
2. Triceps Reflex- test the spinal cord level C7, C8
Flex the client’s arm at the elbow level, and support it in the palm of
your nondominant hand. Palpate the triceps tendon about 2-5 cm
(1-2in) above the elbow.
Deliver blow with the percussion hammer directly to the tendon.
Observe for the normal slight extension of the elbow
3. Brachioradialis Reflex- tests the spinal cord level C3, C6
Rest the client’s arm in a relaxed position on your forearm or on the
client’s own leg.
Deliver a blow with the percussion hammer directly on the radius 2-
5 cm (1-2in) above the bony prominence on the thumb side of the
wrist. Observe the normal flexion and supination of the forearm.
The fingers of the hand may also extend slightly.
4. Patellar Reflex- test the spinal cord level L2, L3, L4
Ask the client to sit on the edge of examining table so that his legs
hang freely.
Locate the patellar tendon directly below the patella.
Deliver a blow with the percussion hammer directly to the tendon.
Observe the normal extension or kicking out of legs as the
quadriceps muscle contracts.
5. Achilles Reflex- tests the spinal cord level S1;S2.
With the client in the same position as for the patellar reflex, slightly
dorsiflex the client’s ankle by supporting the foot lightly in the hand.
Deliver a blow with the percussion hammer directly to the Achilles
tendon just above the heel. Observe and feel the normal plantar
flexion (downward jerk) of the foot.
6. Plantar (Babinski’s) Reflex-
Use moderately sharp object, such as the handle of percussion
hammer.
Stroke the lateral border of the sole of the client’s foot, starting at
the heel, continuing to the ball of the foot, and then proceeding
cross the ball of the foot toward the big toe. Observe for the
response. Normally, in adult all five toes bend downward.
Motor Function
1. Gross Motor and Balance Test
a. Walking Gait
Ask the client to walk across the room and back and assess the
client’s gait.
b. Romberg’s test
Ask the client to stand with feet together and arms resting at the

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 TAGUM DOCTORS COLLEGE, INC.
Mahogany St., Rabe Subd., Tagum City
Telefax: (084) 655 – 6971 E-Mail: tdci_007@yahoo.com
Website: TagumDocollege.com

sides, first with eyes open, then closed or 20-30 second without
support.
c. Standing with one foot with eyes closed.
Ask the client to close his eyes and stand on one foot, then the
other. Stand close to the client during the test.
d. Heel-Toe Walking
Ask the client to walk a straight line, placing the heel of one foot
directly in front of the toes and then on the heels.
2. Fine motor Test for Upper Extremities
a. Finger to Nose Test
Ask the client to abduct and extend the arms at shoulder height
and rapidly touch the nose alternately with one index finger and
then the other. Have the client repeat the test with the eyes closed
if the test is performed easily.
b. Alternating Supination and pronation of hands and Knees
Ask the client to pat both knees with the palms of both hands and
then with the backs of the hands alternately at an ever-increasing
rate.
c. Finger to Nose and to the Nurse’s finger
Ask the client to touch the nose and then your index finger held at
a distance at about 4cm (18in) at a rapid and increasing rate.
d. Fingers to Fingers
Ask the client to spread the arms broadly at shoulder height and
then bring the fingers together at the midline, first with the eyes
open and then closed, first slowly and then rapidly.
e. Finger to thumb
Ask the client to touch each finger of one hand to the thumb of the
same hand as rapidly as possible.
3. Fine Motor test for the lower extremities
Ask the client to lie supine and to perform these test:
a. Heel Down opposite Shin
Ask the client to place the heel of one foot just below the opposite
knee and run the heel down the shin to the foot. Repeat with the
other foot. The client may also use a sitting position for this test.
b. Toe or Ball of Foot to the Nurse’s finger
Ask the client to touch your finger with the larger toe of each foot.
4. Light-touch Sensation
a. Compare the light touch sensation of symmetric areas of the
body.
b. Ask the client to close the eyes and to respond by saying “yes”
or “now” whenever the client feels the cotton wisp touches his skin.
c. With a wisp of cotton, lightly touch specific spot and then the
same spot on the other side of the body.
d. Test areas on the forehead, cheek, hand, lower arm, abdomen,
foot, and lower leg. Check a specific area of the limb first.
e. Ask the client to point to the pot where the touch was felt.
f. If areas of sensory dysfunction are found, determine the
boundaries of sensation by testing responses about every 2.5cm
(1in) in the area. Make a sketch of the sensory loss area for
recording purposes.
5. Pain Sensation
Equipment: Broken tongue depressor
a. Assess pain sensation as follows:
b. Ask the client to close his eyes and to say “sharp”, “dull”, “don’t
know” when the sharp or dull end of the broken tongue depressor
is felt/
Alternately, use the sharp and dull end of the sterile pin or needle
to lightly prick designated anatomic areas at random. The face is
not tested in this manner. Allow at least 2 seconds between each
test.
6. Temperature Sensation
Touch skin areas with test tubes filled with hot or cold water.
Have the client respond saying “hot”, “cold” or “don’t know”.
7. Position or kinesthetic Sensation
Commonly, the middle fingers and the large toes are tested for the
kinesthetic sensation.
To test the fingers, support the client’s arm with one hand and hold

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 TAGUM DOCTORS COLLEGE, INC.
Mahogany St., Rabe Subd., Tagum City
Telefax: (084) 655 – 6971 E-Mail: tdci_007@yahoo.com
Website: TagumDocollege.com

the client’s palm in the other. To test the toes, place the client’s
heels on the examining table.
Ask the client to close his eyes.
Grasp a middle finger or a bigtoes firmly between your thumb and
index finger and exert the same pressure on both sides of the
finger or toe while moving it.
Use a series of brisk up-and-down movement before bringing the
finger or toe suddenly to rest in one of the three positions.
Moving the finger of toe until it is up, down, or straight out, and ask
the client to identify the position.
8. Tactile Sensation
For the entire test, the client’s eyes need to be closed.
a. One-and-Twopoint Discrimination
Alternatively stimulate the skin with two pins simultaneously and
then one pin. Ask whether the client feels one or two pinpricks.
b. Stereognosis
Place familiar objects-such as key, paper clip, or coin-in the
client’s hand, and ask the client to identify them.

If the client has a motor impairment of the hand and is unable to

manipulate an object, write a number or letter on the client’s palm,
using a blunt instrument, and ask the client to identify it.
c. Extinction Phenomenon
Simultaneously stimulate two symmetric areas of the body, such
as the thighs, the cheeks, or the hands.
9. Document findings in the client’s chart.

Comments

Student’s Signature:______________________________________ Date signed: _____________

Clinical Instructor’s Signature: ______________________________ Date Signed: ______________