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PHYSICAL ASSESSMENT PROCEDURE 1 SKIN 1. WASH HANDS 2. Take TPR, BP, height and weight 3.

Skin: color, pigmentation, lesions, jaundice, cyanosis, scars, vascularity, moisture, edema, color of mucous membrane, hair distribution, nails 4. Palpate skin for temperature, texture, elasticity, turgor 5. Head: inspect the symmetry, configuration of skull, hair scalp. 6. Palpate hair Texture, Masses, swelling tenderness of scalp, configuration of skull. EYES AND VISION 7. Inspect globes, palpebral fissures, lid margins, conjunctiva, sclera, pupils, eye movement, visual acuity(use Snellen’s Chart) 8. Palpate upper lids and globes 9. Fundoscopic examination. PERRLA EAR AND HEARING 10. Use Otoscope, Hold helix, gently pull pinna upward and backward toward the occiput 11.Gently insert otoscope, examine the ear 12.Inspect Pinna, External canal, tympanic membrane, landmarks 13.Palpate pinna for tenderness, consistency of cartilage, swelling 14.Mechanical test PRN: Weber and Rinne Test NOSE AND SINUSES 15. Insect for general deformity 16.With nasal speculum examine: nasal septum, discharge, obstructions, mucus membrane color, turbinate for color and swelling. 17.Palpate sinuses for tenderness MOUTH 18. Inspect the lips for color and moisture, pigment, masses, ulceration and fissures. 19.Using tongue depressor and penlight, examine, teeth, gums, buccal mucosa, pharynx, tongue, salivary gland, uvula, tonsils, odor for breath and voice. 20.Record. NECK 21. Inspect for symmetry, masses and unusual swelling, pulsation’s, ROM 22.Thyroid: ask the patient to swallow. 23.Muscular strength of cervical muscles and 2 3 4 5

trapezius muscle. 24.Examine external jugular veins 25.Palpet cervical nodes, salivary glands, trachea, thyroid, and carotid arteries. LYMPH NODES 26. Inspect for size, shape, mobility, consistency, tenderness, and inflammation 27.Palpate cervical supra and infraclavicular node, axillary nodes, inguinal nodes, epithochlear nodes BREAST 28. Inspect for Areola and nipples for position, pigmentation, inversion, discharge, crusting and masses. 29.Examine breast tissue for size, shape color, symmetry, surface, contour, skin characteristic, level, retraction or dimpling. * start with asymptomatic side 30.Palpate with pillows under scapulae at arms raised. 31.Palpate one breast at a time using the palmar surface in rotating motion, compressing tissue against chest wall. 32.Note skin texture, moisture, temperature and masses 33.Gently squeeze the nipple and note discharge 34.Repeat examination of opposite breast and compare findings. THORAX AND LUNGS 35. Have the patient seated; examine posterior chest and lungs. 36.Inspect spine for mobility, deformities 37.Observe for symmetry, posture and mobility of thorax upon respiration 38.Palpate posterior chest with patient sitting; identify area of tenderness masses, inflammation 39.Palpate the rib, costal margins for symmetry, mobility and tenderness and the spine for tenderness. 40.To assess respiratory excursion, place the thumb at the levels of the 10th vertebrae with the hand parallel to the 10th rib, then ask patient to inhale deeply. Observe movement. 41.To vocal and tactile/fremitus: ask the patient to say “99” and use ball of one hand. ABDOMEN 42.Let patient empty bladder. 43.Observe general contour of abdomen,

symmetry, visible peristalsis and aortic pulsation 44.Check umbilicus for conour and hernia and the skin for rashes, striae, and scars 45.Auscultate and note the frequency and characters of bowel sounds(pitch, Duration) 46.Listen over the aorta an renal arteries for bruits MALE GENETALIA 47. Inspect the pubic hair distribution and the skin of the penis 48.Retract or have the patient retract the foreskin, if present 49.Observe the glans penis and the urethral meatus. Note any ulcers, masses and scars. 50.Note the location of the urethral meatus and any discharge 51.Observe the skin of the scrotum for ulcers, masses, redness, or swelling. Note the size, contour and symmetry. Palpate for presence of masses. 52.Inspect the inguinal areas and the groin for bulges. Palpate for inguinal hernias. FEMALE GENITALIA 53. Let the patient empty their bladder. Place in lithotomy position 54.Inspect the pubic hair distribution, the labia majora, the monspubis and the perineum 55.With gloved hand, separet e the labia majora and inspect the clitoris , urethral meatus and vaginal opening. Note the skin color, ulcerations, nodules, discharge and swelling. RECTUM 56. Have the patient stand and bend over the edge of the table 57.Spread buttocks and inspect the anus, perianal region, and sacral region for inflammation, nodules, scars, lesions, ulcerations and rashes. 58.Palpate any abnormal area noted on inspection LOWER EXTREMITIES 59.Observe skin over extremities for color, pallor, rubor, and hair distribution 60.Inspect for any superficial vessels 61.Note temperature of the skin over extremities, comparing one side to the other. 62.Palpate pulses(radial, femoral, posterior tibial, dorsalis pedis) comparing symmetry for side to side

63.Palpate the skin over the tibia for edema and note for indention TOTAL ABILITY TO ANSWER QUESTIONS: