nursing procedure of physical examination

1. Health
examination
Ms christine
Mn prev

3. DEFINITION
• Health examination
• Health examination is the systematic
assessment of human body which involves the
use of one’s senses to determine the general
physical and mental conditions of the body

4. Physical examination
• Physical examination is defined as a complete
assessment of a patient’s physical and mental
status.
• A physical assessment is the systematic
collection of objective information that is
directly observed or is elicited through
examination techniques

5. Indication of health examination
• On admission
• On discharge
• On follow up
• Health camps
• Before and after diagnostic and therapeutic
procedure.

6. TECHNIQUE OF PHYSICAL
ASSESSMENT

7. INSPECTION

8. GENERAL INSPECTION OF A CLIENT
FOCUSES ON
• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene

9. PALPATION

10. PRINCIPLES OF PALPATION
• You should have short fingernails.
• You should warm your hands prior to placing them
on the patient.
• Encourage the patient to continue to breathe
normally throughout the palpation.
• If pain is experienced during the palpation.
discontinue the palpation immediately.
• Inform the patient where, when, and how the
touch will occur, especially when the patient cannot
see what you are doing.

11. LIGHT PALPATION

12. DEEP PALPATION

13. PERCUSSION

14. TYPE OF PERCUSSION
• DIRECT PERCUSSION

15. INDIRECT PERCUSSION

16. AUSCULTATION

17. FOUR CHARACTERISTICS OF SOUND
• 1.Pitch (ranging from high and low):frequency or
number of oscillations generated per second by
vibrating object
• 2. Loudness (ranging from soft to loud): amplitude
of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)

18. OLFACTION

19. EQUIPMENTS
• STETHOSCOPE

20. OPHTHALMOSCOPE

21. OTOSCOPE

22. SNELLEN CHART

23. NASAL SPECULUM

24. VAGINAL SPECULUM

25. TUNING FORK

26. PERCUSSION HARMER

27. SPHYGMOMANOMETER

28. POSITIONING
• Sitting/fowler’s

29. STANDING

30. SUPINE AND PRONE

31. DORSAL RECUMBENT

32. Sim’s

33. LITHOTOMY

34. KNEE-CHEST

35. PREPARING THE ENVIRONMENT

36. PREPARING THE PATIENT
• PSYCHOLOGICAL PREPERATION

37. PHYSICAL PREPERATION

38. ARTICLES REQUIRED
• Screen to provide privacy
• Bowl for antiseptic lotion
• Kidney tray and paper bag
• Weighing machine and height scale
• Patient gown

39. ARTICLES REQUIRED
• Bath blanket to cover the patient
• Pair of leggings
• Draw sheet to cover patient’s chest
• Square drum containing test tube, gauze
piece, cotton swab, specimen bottle,
swabsticks
• Gloves
• lubricant

40. ARTICLES REQUIRED
• Torch
• Ophthalmoscope
• Snellen’s chart
• Book for colour blindness
• Pen
• Flash card
• Autoscope with speculum of different sizes
• Percussion Hammer
• Tuning fork

41. ARTICLES REQUIRED
• Nasal speculum
• Mouth gag
• Laryngeal mirror
• Tongue depressor
• Stethoscope
• Inch tape

42. ARTICLES REQUIRED
• Sterile tray for vaginal examination
• Proctoscope
• VITALS TRAY

43. ARTICLES FOR NEUROLOGICAL
• Powder, soap
EXAMINATION
• Snellan’s chart
• Pencil or pen
• Cotton wicks
• Torch
• Tuning fork
• Salt, sugar

44. ARTICLES FOR NEUROLOGICAL
EXAMINATION
• Tongue depressor
• 2 test tubes one with hot water and other with
cold water
• Safety pins
• Some thing solid for grasping
• Sharp object like key
• Reading material to assess eyes and language of
person
• Knee harmer

45. GENERAL SURVEY
• Identification data
• Gender and race
• Age
• Signs of distress
• Body type
• Posture
• Gait

46. GENERAL SURVEY
• Body movements
• Hygiene and grooming
• Body odour
• Affect and mood
• Speech
• Substance abuse:

47. VITALS SIGNS

48. HEIGHT AND WEIGHT:

49. ASSESSING INTEGUMENT SYSTEM
• Assessing skin
• Skin color
 Erythema

50. CYANOSIS

51. Jaundice

52. Pallor

53. Vitiligo

54. Inspect skin vascularity
• Ecchymosis

55. Petechiae

56. C Inspect skin lesion

57. Palpate skin temperature, texture,
moisture and turgor

58. EDEMA

59. PITTING EDEMA

60. PITTING EDEMA
• Grades of pitting edema
• Grade 0 : (none)
• Grade +1 :( trace , 2 mm)
• Disappear rapidly
• Grade +2 ( moderate , 4 mm)
• 10-15 sec
• Grade +3 (deep, 6 mm)
• ≥ 1min
• Grade +4 (very deep, 8 mm)
• 2-5min

61. ASSESSING NAILS
• Shape; convex
• Angle : between nail and its base is 160 degrees
• Texture: smooth, nail base should be firm and
non tender
• Color: pinkish nail bed with translucent white
tips
• Capillary refill

62. ABNORMALITIES OF NAIL
• Koilonychias (spoon nail)
• clubbing
• Paranychia
• indentations called (beau’s line)

63. ASSESSING HAIR AND SCALP
• color,
• texture and distribution.
• Thickness and lubrication of hair

64. INSPECT THE SCALP
• Cleanliness, color, dryness,
• Lump, lesions,
• Lice (pediculus humanus capitus)
• Dandruff etc

65. HEAD AND NECK
• ASSESSING THE SKULL
• for size, symmetry
• any nodules or masses

66. INSPECT THE FACE

67. ASSESS THE EYE
• Inspect external eye structure
• Position and alignment
• Exophthalmoses
• strabismus

68. ASSESS THE EYE
• Eye brows
• Eye lid :
• ectropion(eversion ,lid margin turn out)
• entropion(inversion, lid margin turns inwards)
• ptosis( abnormal drooping of lid over pupil

69. ASSESS THE EYE
• Eye lashes : sty.
• Eye balls
• Conjunctiva and sclera{ Paleness, redness or
purulent,jaundice}

70. ASSESS THE EYE
• Cornea and iris :arcus senilis
• Pupil : PEERLA.

71. ACCOMMODATION

72. PUPILLARY REFLEX TO LIGHT

73. VISUAL ACUITY

74. INSPECT INTERNAL EYE STRUCTURES

75. EXTRA OCULAR MOVEMENTS

76. PERIPHERAL VISION

77. EARS
• AURICLES
• EAR CANAL AND TYMPANIC MEMBRANE

78. HEARING
• WEBER’S TEST:
• RINNE, S TEST:

79. NOSE AND SINUSES

80. INSPECT THE MOUTH PHARYNX
AND NECK
• LIPS: lesions ,pallor (anemia),
cyanosis(respiratory cardiovascular problems),
cherry colored
• BUCCAL MUCOSA , GUMS AND TEETH: teeth look
for alignment , dental caries.buccal mucosa is a
good site to visualize jaundice and
pallor.leukoplakia (thick white patches ) is a
precancerous lesion.
• TONGUE
• FLOOR OF MOUTH
• PHARYNX:

81. ABNORMAL FINDINGS
• pallor, cyanosis or redness
• lesions, swollen lips red tonsils, swollen red
bleeding gums,
• white coating of tongue fissured tongue from
dehydration.
• bright red tongue seen in deficiency of iron b12
or niacin,
• black tongue

82. ASSESS THE NECK

83. PALPATE TRACHEA AND LYMPH
NODES

84. PALPATE THE THYROID GLAND

85. ASSESS THE THORAX AND LUNGS
• INSPECT THE THORAX
• Abnormal findings :increase in chest size and
contour , abnormal breathing pattern with the
use of accessory muscles, unequal chest
expansion, and abnormal breath sounds, barrel
chest, pigeon chest

86. PALPATE THE THORAX

87. PERCUSS THE THORAX

88. AUSCULATE BREATH SOUND
• Bronchial sounds heard over the trachea are high –
pitched, harsh sounds with expiration longer than
inspiration .
• Bronchovesicular sounds: heard over the main
stem bronchus and is moderate (blowing) sound
with inspiration equal to expiration.
• Vesicular sounds are soft , low pitched and heard
best in base of lungs during inspiration longer than
expiration.

89. ABNORMAL BREATH SOUNDS
• WHEEZE
• RHONCHI
• CRAKLES
• FRICTION RUB

90. CARDIO VASCULAR SYSTEM
• INSPECT NECK AND PRECORDIUM
• PALPATE THE PRECORDIUM
• AUSCULATATE HEART SOUND

91. AUSCULATATION

92. ASSESSING THE BREAST AND AXILLA
• INSPECT BREAST AND AXILLA
• PALPATION OF BREAST AND AXILLA

93. ASSESSING THE ABDOMEN

94. QUATRANTS OF ABDOMEN

95. INSPECT THE ABDOMEM

96. AUSCULTATE BOWEL SOUNDS

97. PERCUSS THE ABDOMEN

98. PALPATE THE ABDOMEN

99. ASSESS MUSCULO SKELTAL SYSTEM
• INSPECT AND PALPATE MUSCLE

100. MUSCULO SKELTAL SYSTEM
• PALPATE THE BONES
• INSPECT AND PALPATE THE JOINTS
• INSPECT SPINAL CURVES
• kyphosis
• Lordosis
• Scoliosis

101. ASSESSING MALE AND FEMALE
GENITALIA
• INSPECT AND PALPATE FEMALE GENITALIA

102. INSPECT AND PALPATE RECTUM AND
ANUS

103. NEUROLOGICAL SYSTEM

104. MENTAL AND EMOTIONAL STATUS:

105. BEHAVIOR AND APPEARANCE

106. LANGUAGE

107. INTELLECTUAL FUNCTION
• Memory
• Knowledge
• Abstract thinking
• Association
• Judgment

108. CRANIAL NERVE FUNCTION
• Olfactory nerve(1):
• Optic nerve(2)
• Occulomotor(3)
• Trochlear(4)
• Trigeminal(5)
• Abducens(6)

109. CRANIAL NERVE FUNCTION
• Facial(7)
• Auditory(8).
• Glossopharyngeal(9)
• Vagus(10)
• Spinal accessory(11
• Hypoglossal(12)

110. MOTOR FUNCTION
• Balance and gait
• Romberg’s test
• Motor function and coordination

111. SENSORY FUNCTION

112. REFLEX FUNCTION
• Biceps reflex
• Triceps reflex
• Knee and patellar reflex
• Ankle/ Achilles tendon reflex
• Babinski reflex
• Abdominal reflex

113. PERIPHERAL VASCULAR SYSTEM
ASSESSMENT
• ALLEN’S TEST
• BUERGER’S TEST
• CAPILLARY REFILL
• HOMAN’S SIGN
• PALPATE PERIPHERAL PULSES

114. DOCUMENTATION OF DATA

115. AFTER CARE OF THE PATIENT

116. AFTER CARE OF ARTICLES