Health Assessment

(NUR 241)

General Examination

1
Learning objectives
At the end of this module, the learner should be
able to:
1.Define the Key terms.
2.Understand the concept of physical examination
in terms of its requirements.
3.Discuss the concept of general survey in terms
of its purpose, skills, and components.
4.Discuss the four basic physical examination
techniques.
5.Identify commonly needed physical examination
equipments and their functions.
Physical Examination

 Physical examination is a systematic approach

of collecting objective data about clients’
health status.
 It employs through detailed evaluation of
clients’ all body structures, organs, or systems.
 It requires the nurse to apply special
techniques, use equipments and knowledge
base, to physically expose each region of
clients’ body and examine it by looking,
listening, touching, or smelling.
Purpose of physical Examination

 Physical examination is performed in all

health care settings, covering healthy
and sick clients.
 It serves for screening, detection, and
prevention of disease.
 It also provides an opportunity for health
promotion (education & counseling) as
well as the evaluation of disease process
or treatment results.
:Component of Physical Examination

 General survey (the nurses’ initial observation

for the clients’ general appearance and

behavior).

 Vital signs measurement

 Height and weight measurement

 Body systems examination

 Physical Appearance -1
Normal Range of Findings
1- Age – the person appears his or her
stated age.
2- Sex – Sexual development is
appropriate for gender and age
3- Level of consciousness – the person is
alert and oriented, attends to your
questions and responds appropriately.
Alert. Follow commands and responds
completely and appropriately to stimuli
Abnormal Findings
Appears older, smaller, or younger, as with
chronic disease or retardation.
Delayed or early puberty, or inappropriate to
gender.
Lethargic. The patient is sleepy or drowsy
and will awaken and respond appropriately
to command.
Stupor. require vigorous stimulation for a
response .
Semi coma. The patient is not awake but
will respond purposefully to deep pain
Coma. The patient is completely
unresponsive.
 Physical Appearance -1
Normal Range of Findings
4- Skin color – color tone is even, skin
is intact with no obvious lesions
5- Facial features – symmetric with
movement.
6- No signs of acute distress are
present
Abnormal Findings
• Pallor, (loss of color)
• cyanosis, (bluish discoloration)
• jaundice Yellowish discoloration)
• lesions.
• Immobile, masklike, asymmetric,
drooping.
• shortness of breath, wheezing.
• facial grimace, holding body part.
(Pain)
 II- Body STRUCTURE
1- Stature – the height • Excessively short or tall
appears within normal
range for age.

2- Nutritional status – the • Underweight

weight appears within normal • Obese
range for height and body
build.
 II- Body STRUCTURE
3- Symmetry – body parts look
equal bilaterally
4- Posture – the person stands
comfortably erect as appropriate
for age.
• Unilateral atrophy
• hypertrophy
(enlargement of muscles.)
• Rigid spine and neck (moves
as one unit) e.g., arthritis.
Stiff and tense.
5- Position – the person sits
comfortably in a chair or on
the bed or examination table,
arms relaxed at sides, head
turned to examiner.
•Leaning forward with arms
braced on chair arms (chronic
pulmonary disease).
•Sitting straight up and resists
lying down, (left-sided
congestive heart failure).

7- Physical deformities–
Absence of any congenital or Presence of deformities or
acquired defects. congenital defect
 III- Mobility
1-Gait: the walk is smooth, even,
and well-balanced; and
Limping with injury.
associated movements,
(symmetric arm swing), are Difficulty stopping
present.

2-Range of motion – the person Limited joint range of motion.

has full mobility for each joint. Paralysis – absent movement.

3- Involuntary movement: Movement jerky,

absent uncoordinated
Tics, tremors, seizers
IV- Behavior

1- Facial expression – the Flat, depressed, angry, sad

person maintains eye contact anxious. However, note that
expressions are appropriate to anxiety is common in ill
the situation. people.

2- Mood and affect – the

person is comfortable and Hostile, distrustful,
cooperative with the suspicious, crying
examiner and interacts
pleasantly.
General Examination
Pallor

Cyanosis

Clubbing

Edema
 Pallor (Anemia)

Pallor is a pale color of the skin.

page 15
Cyanosis

page 16
 Clubbing

 Clubbing is painless soft-tissue swelling of the terminal

phalanges.

congenital cyanotic heart disease

Infective endocarditis

page 17
 Edema
 Edema is tissue swelling due to an increase in interstitial fluid
 Pressure should be applied over a bony prominence (tibia, lateral
malleoli, sacrum)
 Cardinal feature of congestive heart failure.
 Edema is most prominent around the ankles in the ambulant patient and
over the sacrum in the bedridden patient.
 In advanced heart failure, edema may involve the legs, genitalia and
trunk.
 Transudation into the peritoneal cavity (ascites), the pleural and
pericardial spaces may also occur.

page 18
Vital
signs are the key physiologic measures of the person’s
general health state. The nurse obtains vital signs to:
a.Establish baseline measurement.
b.Identify physiologic problems.
c.Monitor clients’ response to therapy.

Signs range
Pulse rate 60 - 100 beats/min
Respiratory rate 12 - 20 breath/min
Blood pressure 100/70 to 140/90 mmHg
Temperature 36.5 - 37.5 C
Pain
 Measuring Height and weight
 Body mass index _Weight_(kg)____
(Height) 2
 Where
 Weight is measured in kilograms.
 Height is measured in meters
 BODY MASS INDEX FINDING
 < 20 PERSON IS UNDER WEIGHT
 =20-25 PERSON IS NORMAL WEIGHT
 =25-30 PERSON IS OVERWEIGHT
 >30 PERSON IS OBESE
 EXAMPLE:-

 Calculate body mass index of person, his

weight is 98kg, his height is172 cm .
 Answer steps:
 Transfer height from cm to meter
=172/100=1.72m
 Body mass index (BMI) = 98/(1.72)2
=33
 BMI = 33 SO the person is obese.
Body systems examination
Body systems examination is the systematic
objective evaluation of client’s body structures,
parts, and organs, using the examiners’ sense
 Review client health history
 Prepare equipment
 Examine client in a warm quiet room
 Examine client in well- lighted room
 Consider patients’ privacy and comfort
 Practice and adhere to standard precaution of Infection
control
 Explain procedure to client, reassure client along the
examination. Begin examination with the patient in
sitting position( if possible). This facilitates front and
back examination
 Use appropriate Draping, such that only body part
being examined is exposed
:Physical examination equipments

Ophthalmoscope
Otoscope
Tuning fork

Nasal speculum 

Percussion hammer
Snellen chart 
Basic Physical examination techniques
Physical examination utilizes four techniques
Inspection

Palpation

Percussion

Auscultation
1. Inspection
 means Observing the client in a close, focused manner
using vision, and smell senses.
*It begins during the first contact with client and
continues throughout the assessment

*It provides information about body parts’: color, size,

location, movement, texture, symmetry, odor, and
sound
 2. Palpation
 Palpation is the use of hands and fingers to
feel different body parts for data collection.

 The nurse uses pads of the fingers and palms

to touch and feel the patient’s body parts
with his hands to examine:
size texture
location
tenderness
body temperature
lumps or masses
 Types of palpation
1. Light palpation

 Using the flat part of the right hand or the

pads of the fingers, not the fingertips

 The fingers should be together

 Depress the skin 1 to 2 cm with your finger
pads, usually the lightest touch possible.
Light palpation
2. Deep palpation

 Used to determine organ size as well as the presence

of abdominal masses

 The flat portion of the right hand is placed on the

abdomen

 Depress the skin 4 to 5 cm with firm, deep pressure.

Pressure should be applied to the abdomen gently but
steadily

 The patient should be instructed to breathe quietly

through the mouth and to keep arms at the sides
 3. Percussion
 A methods of “ striking” of body parts
during physical examination with fingers to
evaluate the size, consistency, borders and
presence of fluid in body organs

 Percussion of a body part produces a sound

that indicates the type of tissue within the
organ

 It is particularly important in examining the

chest and abdomen
 Methods of Percussion
1. Direct percussion:
 Using one or two fingers, tap directly on the
body part. Ask the patient to tell you which
areas are painful and watch his/her face for
signs of discomfort.
 Direct percussion is commonly used to assess
an adult patient's sinuses for tenderness.
2. Indirect Percussion

 Press the distal part of the middle finger (pleximeter) of your

nondominant hand firmly on the body part(left hand).

 Keep the rest of your hand off the body surface.

 Flex the wrist of your dominant hand.
 Using the middle finger (plexor or striking finger) of your
dominant hand, tap quickly and directly over the point where
your other middle finger touches the patient's skin. The
motion of the striking finger should come from the wrist and
not from the elbow
 Deliver 2 - 3 quick taps and listen carefully.
 Types of sounds
Sound Quality of Where it is Source
sound heard

Tympany Drumlike sound Over enclosed Puffed-out

air cheek, air in
bowel
Resonance Hollow sound Over areas of Normal lung
part air and solid
Hyper Booming sound Over air (child’s lungs) N
resonance (adult) Lung with
emphysema
Dullness Thudlike sound Over solid area Liver, spleen

Flatness Flat sound Over dense Thigh Muscle,

tissue bone, over
tumor
 4. Auscultation

 A method used to “listen” to the body sounds.

 Various body systems like heart, lungs, and

abdominal organs have characterized sounds
 Bowel, breath, heart, and blood movement
sound are heard using a stethoscope

 It is important to know the normal sound to

distinguish from abnormal sound
 Types of auscultation
1. Direct auscultation:
* Uses the ear alone to listen, such as when
listening to the grating of a moving joint.
* Sounds are audible without stethoscope

2. Indirect auscultation:
sounds are audible with stethoscope

3. Bell for low pitched sound and diaphragm

for high pitched sound
Question?

37
Positions of physical
examination
Fowler's position

It is used for examinations and treatments of the head, neck, and chest or for patients who .
find it difficult to breathe lying down. The patient sits on the examination table with the head
of the table elevated 90 degrees or simply sits at the edge of the table. The drape will vary
according to the exposure of the patient
Semi-Fowler's position

It is used for postsurgical examinations, with patients with breathing disorders, or

elevated temperatures or head trauma or pain. It is a modification of Fowler's position,
the head of the table is at 45-degree angle. The drape and/or gown should cover the entire
patient from the nipple line down.
Supine (Horizontal Recumbent)
This position is used for the examination of the frontal portion of the body, including the
heart, breasts, and abdominal organs. The patient's gown should be open down the front,
and the drape placed over any exposed area that is not being examined. The patient lies
flat, with the face upward and the lower legs supported by the table extension .
Dorsal Recumbent

It is used for digital examination and/or inspection of the rectal, vaginal, and perineal areas.
The drape should cover the patient in a diamond shape until the physician is present. The
patient lies face upward, with the weight distributed primarily to the surface of the back by
flexing the knees so that the feet are flat on the table .
 .
Lithotomy position
It is used for vaginal examinations that requires the use of a speculum and for Pap Smears.
Place the patient on the back, with the knees sharply flexed, the arms placed at the sides or
folded over the chest, and the buttocks at the bottom edge of the table. Support the feet in
stirrups placed wide apart and away from the table. The patient should not be placed into this
position until the physician is in the examination room and is ready for the examination. The
drape should be diagonally over the patient's abdomen and knees, the drape should be large
enough to cover the breasts and long enough to cover the knees and touch the ankles and wide
enough to prevent the sides of the thighs from being exposed.
Sim's position (called lateral position)

It is used for rectal examinations, instillation of rectal medications, and perineal and
some pelvic examinations. Patient is on left side with right knee flexed against abdomen
and left knee slightly flexed and the buttocks are pulled to the edge of the table. Left arm
is behind body; right arm is placed comfortably. The drape extends diagonally from the
arms to below the knees.
Prone position

It is used for examinations of the back and spine and for certain surgical procedures. The
patient lies face down on the abdomen, Arms may be above head or alongside body. The
drape should cover from the middle of the back to below the knees, with the gown open
to the back.
Knee-Chest position

It is used for rectal examination. Patient is on knees with chest and elbows resting on bed
or arms above head. Head is turned to one side. Thighs are straight and slightly separated,
the buttocks extends up to the air and lower legs are flat on bed. The gown should open in
the back, with a fenestrated opening drape or a single sheet draped diagonally over the
patient's back at the sacral area.
 ANY
QUESTIONS ?????