LESSION PLAN ON PHYSICAL EXAMINATION

Subject Medical-Surgical Nursing

TOPIC Demonstration On Physical Examination
Group B.Sc. Nursing Ist Year Students
Date &Time
Teaching Method Lecture and Discussion
A.V. Aids Black/ White board, chalk, Duster, OHP, Chart
Student Pre requisite

General objective At the end of the class the students will be able
to gain knowledge about Physical Examination
Specific Objective  Discuss about Preparation of the Client
for physical Examination
 Discuss about step by step Physical
Examination
 To Take Height and Weight
 To Measure the Skull Circumference
 Examination of the Eyes
 Examination of the Ears
 Examination of the Ears
 Examination of the Nose, Throat and
Mouth
 Examination of the Chest
 Examination of the Abdomen
 Examination of the Extremities (Arm
and Legs)
 Examination of the Spine
 Examination of the Genitalia
 Examination of the Rectum
 Neurological Assessment
 Reflexes-
 Coordination Tests
 Equilibrium Tests
 Tests for Sensations
 Muscle Strength
1. Discuss about Positions and
Drapings Used for Physical
Examination
S.no. Time Specific Content Teaching Evaluation
Objective learnig activity

1 2min Discuss Wash hands Discussion Evaluate

Hand wash with alcohol based or hand
technique 15 seconds with soap washing
and water, before technique.
touching the patient,

2. 2 min. Discussion Which Type

Preparation of the
Discuss of
Client-
about preparation
Positions and Drapings
Preparation done before
Used for Physical
of the Client Procedure?
Examination
for physical
Physical preparation
Examinatio
Mental preparation
n

2. 50 Lecture &
min. Evaluate the
Take Vital Signs Discussion
Discuss step of
• Measured pulse rate physical
about
by palpating radial examination.
Procedure
of Physical pulse or auscultated at
Examinatio apex of heart at least
n 30 sec. OSCEMPPC
• Measured blood
pressure in one arm, 2
step for initial
measurement (not
baseline record)
1) used appropriate
size cuff,
2) placed on inch (2cm)
above antecubital
space,
3) inflated cuff
30mmHg above pulse
disappearance (palpate
or auscultate),
4) deflated cuff at 2-
3mm Hg per sec, until
20-30 below last sound.
Measured Respiratory
Rate- at least 30 sec .

To Take Height and

Weight-
To measure the length
of the baby who cannot
stand, place the baby on
a hard surface, with the
soles of the feet
supported in an upright
position. The knees are
extended and the
measurement is taken
from the soles of the
feet to the vertex of the
head. The head should
be in such a position
that the eyes are facing
the ceiling

After a child can stand,

the height can be
measured, if the child
stands with the heels,
back and head against a
wall. A small flat board
held from the top of the
head to the wall will
give an accurate
measures of the height,
that is the distance from
the floor to the board.

To Measure the Skull

Circumference

The skull is measured at

its greatest diameter
from above the eyes to
the occipital
protuberance.
Head, nose throat
• Examined head/hair
OSCE-
• Performed
inspection of nasal
vaults
• Performed
inspection of oral
cavity, Eyes
• Inspected
conjunctiva OSCE-
• Checked pupillary
response to light

Examined External
Ears and neck OSCE-
• Correctly held and
used otoscope to
examine ears HD Neck
• Palpated for lymph
nodes,
• Palpated carotids - at
level of thyroid
cartilage - right and left
(not same time) OSCE
• Auscultates Carotids
-with bell -bilaterally -
with patient breath
held
• Inspected thyroid
from front or side of
patient OSCE Palpated
thyroid RE

Chest and Pulmonary

Exam -
• Inspects- chest wall
for shape and
symmetry OSCECP
• Performed
percussion of posterior
lung fields - top to
bottom bilaterally - at
least three areas (upper
lobe to lower lobe)
• Inspects - precordium
-neck veins, carotid
pulse .
• Auscultates with both
bell and diaphragm .

Abdominal
Examination-
• Demonstrated
appropriate draping
OSCE
• Inspected abdomen
GR
• Auscultated
abdomen for bowel
sounds
• Percussed Abdomen
in 4 quadrants • Deep
palpation
• Palpated liver edge
• Palpated spleen.

• Spine Examination-
Palpated or percussed
costovertebral angles
for tenderness -
Palpated spinous
processes of thoracic
and lumbar spine -
Palpated paraspinal
muscles of lumbar
spine OSCE
• Assesses spine range
of motion -flexion -
extension -lateral
bending.

Extremity
Examination-
• Inspects and Palpates
for deformities OSCE –
• Palpates legs for
edema with moderate
pressure for 5 seconds
RE
 • Inspected feet for
ulcers or deformities
Peripheral Vascular
Exam
• Palpates radial pulses,
bilaterally OSCE -CP
• Palpates brachial
pulses, bilaterally
• Palpates posterior
tibial pulses
• Palpates dorsalis
pedis pulses.

Neurological Exam
• Motor strength, uses
appropriate technique
-clearly instructs
patient on desired
movement -provides
moderate resistance to
movement
• Motor strength of
arms -shoulder
abductors -elbow
flexion, elbow
extension -wrist flexion,
wrist extension
• Motor strength of
legs -hip flexion - knee
extension, knee flexion
OSCE - BM, OSCE - NS -
ankle dorsiflexion,
ankle plantar flexion -
great toe dorsiflexion

Reflexes –
selects/uses
appropriate weighted
reflex hammer -uses
bouncing motion to
transmit short strike -
assesses arm DTR-
biceps, triceps,
brachioradialis -assess
leg DTR- patellar reflex,
Achilles reflex -assesses
Babinski response
OSCENS
• Gait -normal
ambulation -toe walk,
heel walk - tandem
walk OSCENS
• Sensation - light
touch in all extremities
OSCERE
• Cerebellar function -
finger to nose -heel to
shin Musculoskeletal
Exam

• Hip -Inspects Hip- -

contour of greater
trochanter,
iliac crest, -alignment
(iliac crest level on both
sides), -resting position
(assess for atrophy,
deformity, contracture)
- Palpates- -Iliac crest
and Anterior/Posterior
Superior Iliac spine, -
Sacroiliac joint, -
Greater trochanter -
Range of motion - -
active hip flexion,
extension, abduction,
adduction, internal
rotation and external
rotation; -passive hip
flexion, extension,
abduction, adduction,
internal rotation and
external rotation -
Strength -resisted hip
flexion and extension, -
resisted hip abduction
and adduction -Further
functional assessment -
gait
• Back/Spine -Inspects
Back / Spine --contours
(for lordosis, kyphosis,
scoliosis), -alignment
(general stance at
shoulder / pelvis
levels), -assess gait (as
patient walks across
room) - Palpates --
spinous processes
(cervical to lumbar), -
paraspinal muscles, -
iliac crest and sacroiliac
joint - Range of motion
--neck flexion,
extension, lateral
flexion, rotation; -
lumbar flexion,
extension, lateral
bending