Physical Assessment

PHYSICAL ASSESSMENT
Prof. Jason Garcia, RN, RM, MPA

Professor, College of Midwifery
Purpose:
Physical Assessment is a component of the first step of the nursing process. The
purpose is to identify normal and deviations from normal. It is the key means of collecting
baseline data and establishing a need for continued focused assessment.
Equipment:
1. Stethoscope 2. Ophthalmoscope/ otoscope 3. Tuning fork 4. Percussion hammer 5.
Snellen’s chart 6. Tongue depressor 7. Safety pins and cottons swabs 8. Pen light 9.
Sphygmomanometer 10. Watch with second hand 11. Tape measure 12. Special marking pen.
Techniques:
A systematic approach to physical assessment is important to prevent omission. This

usual sequence of assessment activities are 1. Look (inspect) 2. Feel (palpate) 3. Tap or
thump (percus) and 4. Listen (auscultate).
1. Inspection- it is an assessment technique in which the examiner observes the body surface.
The nurse notes the general body contour, posture, and color of the skin, presence of rashes,
scars, and any external visible pathology.
2. Palpation- is an assessment technique in which the examiner feels with his or her fingers and
one or both hands. The degree of pressure applied during palpation varies, depending on the
tenderness of the area and the depth of palpation required. Some organs are always palpable
and changes in size, shape and location may be felt. Others are palpable only when enlarge or
disposed.
3. Percussion- is an assessment technique in which the examiner “thumps “ or “taps” a body
surface with a percussion hammer or the hand or fingers, percussion assesses density of a
cavity or organ.
4. Auscultation- is an assessment technique in which the examiner listens and assesses the
sound produced by various body organs and tissues such as heart, lung or bowel with use of
a stethoscope.
Essential Condition for a good physical examination
1. Good lighting
2. Full exposure of the area to be examined
3. Patient relaxation
CONTENTS OF A PHYSICAL EXAMINATION

General Survey
Observe for:
 Race, sex, age
 General physical development
 Nutritional state
 Mental state (oriented, disoriented, confused, responsive, unresponsive, incoherent.
Somnolent, unconscious)
 Evidence of pain restless.
 Body position, stature, gait
 Clothes, hygiene, grooming
 Emotional status, including attitudes and mood
 Apparent state of health, in acute distress or chronically ill.
Vital sign and clinical Measurement

Including actual body weight, height, temperature, blood pressure (BP), Pulse Rate
(PR)
Respiratory rate (RR) and heart rate/ cardiac rate (HR/CR).
Skin:
1. Color – Cyanosis, pallor, jaundice, flushing, pigmentation.
2. Lesion- macule, papule, etc. (distribution, type, configuration, size).
3. Vascularity- Evidence of brushing, bleeding, edema, vascular and purpuric lesions ( angioma,
purpuras, petechiae)
4. Moisture- Dryness, Sweating, oiliness
5. Texture- rough, Smooth, Scaly
6. Temperature- warm, Hot , cold
7. Mobility- and turgor- firm, loose, wrinkled, edematous, turgid, skin rapidly resumes its original
shape: loss of turgor is indicated bye persistence of the skin fold for a time pinching.
8. Hair and nails
Head: normally, the skull and face is systematical, with distribution of hair varying from person
to person.
Hair- quantity and distribution texture- dry brittle: luster, color
Scalp- lice, dandruff, lesions, lacerations, tenderness or swelling.
Skull- size, contour, configuration, depression
face- portrays emotions, pain, intelligence and understanding
 Observe for expression- flat, expressionless, wide-eyed, confused or quizzical expression,
anger, excited.
 Symmetry
 Edema
 Masses
 Involuntary movement- tics, spasmodic conditions
 Shape- round, oval triangular
 Skin- color and pigmentation
Forehead- smooth, furrowed with wrinkles
Eyes- general expression use of supportive aid such as contact lens, eyeglasses
 Eyebrow- quality of hair: presence of flakes, scars, lesions, etc.
 Eyelids- lid margins are normal clear, the lacrimal duct opening( puncta) are evident at the
nasal side of the upper and lower lids.
*Observes for:
 Height of palpebral fissure (longitudinal opening between the eyelids which appears equal in
size when the eyes are open)
 Blinking reflex
 Presence of edema, hemorrhage, hematoma
 Color- redness, cynosis
 Direction of lashes (outward, inward)
 Lid eversion or inversion
Visual acuity ( use snellen’s chart)
normal vision 20/20
myopia- near sightedness
hyperropia- far sightedness
Ear: Symmetry
inspect external and internal surface of the ear.
Response to mechanical test
Weber test- test to liberalization of vibration
Rinne’s test- Compares air and bone conduction
Nose: inspect surface of the nose for symmetry color, shape and size.
Mouth:
 Lips- color, moisture, masses, ulceration, fissures, lesions, edema, congenital defect.
 Teeth- number (32 in adult): arrangement; general condition; caries discoloration; fillings,
absence of one tooth or more; abnormal dental shape and use of artificial teeth.
 Gum- color, texture; discharge; swelling; retraction; bleeding; lesions.
 Buccal mucosa- normally the mucosa should b pink, smooth and fine lesions.
 Tongue- is normally midline and covered with papillae which vary in size from the tip to the
back. Observe for the size; color; thickness; lesion; moisture; symmetry; deviation from
midline.
 Hard palate and soft palate: uvula- observe for ulcerations congenital defects and symmetry
when the patient say “AH”
 Tonsils- Size, ulcerations; exudates; inflammation
 Odor of breath- ability to masticate and swallow. Odor- use of tabaco or alcohol. Poor dental
hygiene; gingivitis, acetone breath for diabetic coma, musty odor for severe liver disease;
urinary odor for uremic status.
Pharynx: for inflammation; exudates and masses
larynx: voice (hoarseness) and disorder of speech
Neck:
Inspect all the areas of the neck anteriorly and posterioly for muscular symmetry, masses,
unusual swelling or pulsations and range of motion- which includes right and left lateral, right
and left rotation, flexion, extension and hyperextension. The neck should move easily without
any discomfort.
Thyroid- inspect enlargement; is not visible, especially in extremely thin person. If palpable, it
is not normally smooth, without nodules, masses or irregularities, or bruits ( gushing sound)
produced by blood moving through a narrow vessel.
Trachea- palpate for deviation
Lymph nodes and salivary glands- cervical nodes-not normally palpable unless the patient is
very thin.
Carotid arteries lying at 30 to 40 degrees angle; neck should not be flexed.
Observe for any limitation (e.g. torticollis)
Breast:
Nipple and areola- position, pigmentation, inversion, discharges, crusting and masses.
breast tissues- size, shape, color, symmetry, surface, contour, skin characteristics, level of
breast; note for any retraction of dimpling.
axilla- rashes, infection, lymph nodes.
Chest and lungs

Inspection
Observe for Normal findings
Symmetry of the posterior chest and the Thorax is symmetry, it moves easily and
Posture and mobility of the thorax upon Without impairment upon registration.
Respiration, retraction or intercostals There are no bulges nor retraction of
spaces. the Intercostals spaces
Note the anteroposterior diameter in the AP diameter of the thorax in relation
Relation to the lateral diameter of the to the lateral is approximately 1:2
Chest.
Examine for skin lesions, masses,
cyanosis.
Respiration rate and rhythm regular,
Irregular, noisy, deep, fast and slow.
Present of:
Dyspnea- exertional, paroxysmal, nocturnal, orthopnea
Cough- single or paroxysmal
Palpation: Palpate the posterior wall over areas.(✽ To distinguish between normal and
abnormal structures: tender, masses, swelling or painful area )
Normal findings:
1. No tenderness, superficial lumps or masses, normal skin mobility and turgor.
Abnormal Findings:
1. Tender pectoral muscles or costal cartilage
2. Pain · Masses
Inspection: Stand behind the client and observe the posterior chest for shape and movement.
(✽To identify shape or movement; assess respiratory movement)
Normal Findings:
1. Shoulders are even; scapulae are at the same level; spine is midline and straight.
2. Posterior chest slightly rises and falls on respiration.
Abnormal:
1. Structural deformities or asymmetry are present:
2. Scoliosis (: lateral curvature)
3. Lordosis (: pronounced lumbar curvature)
4. Kyphosis (: abnormal spinal curvature and vertebral rotation deform the chest)
Inspection and palpation:

1) Assess chest expansion on the posterior
chest: Symmetric expansion 1 Place your hands in the posterolateral chest wall with thumbs at
the level of T9 or T10 2 Slide your hands medially to pinch up a small fold of skin between your
thumbs 3Ask the client to take a deep breath. 4Watch your thumbs’ move apart symmetrically
and not smooth chest expansion with your finger
Normal findings:
1. Chest expansion is symmetric.
Abnormal findings:
1. An abnormally wide costal angle with little inspiratory variation occurs with emphysema.
2. A lag in expansion occurs with atelectasis and pneumonia
3. Pain accompanied deep breathing when the pleurae are inflamed
Assess tactile (vocal) fremitus
1. Begin palpating by using the ball or ulnar surface of your hand from the lung apices 2. Touch
the client’s chest while he/she repeats the words “ninety-nine” or “ blue moon”
3. Compare vibration from one side to the other
Normal findings:
1. Vibrations should feel the same in the corresponding area on each side
Abnormal:
1. A palpable grating sensation with breathing indicates pleural friction fremitus.
2. Decreased fremitus occurs when anything obstructs transmission of vibration, e.g.,
obstructed bronchus, pleural effusion, pneumothorax emphysema.
3. Increased fremitus occurs with compression or consolidation of lung tissue e.g., lobar
pneumonia.
4. Rhonchal fremitus is palpable with thick bronchia secretions.
5. Pleural friction fremitus palpable with inflammation of the pleura.
Percussion: Lung Fields Percuss the posterior chest comparing both sides.
(✽ To identify and locate any area with an abnormal percussion)
(✽ To enhance percussion)
1) Percuss the posterior chest from the apices and then to interspaces with a -5 cm intervals.
2) Note any abnormal findings
Normal Findings:
Resonance is normal lung sound: except heart area because heart normally produces dullness
bound, liver produces dullness stomach produces tympany, muscles and bone produces flat
Abnormal:
1. Dullness replaces resonance when fluid or solid tissue replaces air containing lung or
occupies the pleural space, i.g., pneumonia, pleural effusion, atelectasis, or tumor.
2. Hyper resonance is found in COPD and asthma
3. Hyper resonant or tympanic in pneumothorax
Auscultation:
1)Listen to the breath posteriorly with mouth open and more deeply than the normal
(✽ To note intensity, identify any variation and any adventitious sounds)
2) Repeat auscultation in the posterior chest.
Normal findings:
1. Breath sounds are usually louder in upper anterior lung fields.
2. Bronchial, Broncho vesicular, vesicular sounds are normal breath sounds.
3. None adventitious sounds
Abnormal findings:
1. Decreased or absent breath sounds occur i.g., atelectasis, pleural effusion,
pneumothorax, chronic obstructed pulmonary disease(; COPD)
2. Increased breath sounds occur when consolidation or compression yields a dense lung
area, i.g., pneumonia, fluid in the intrapleural space.

Physical Assessment

Uploaded by

Copyright:

Available Formats

Physical Assessment

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Physical Assessment

Uploaded by

Copyright:

Available Formats

PHYSICAL ASSESSMENT

Prof. Jason Garcia, RN, RM, MPA

A systematic approach to physical assessment is important to prevent omission. This

CONTENTS OF A PHYSICAL EXAMINATION

Vital sign and clinical Measurement

Chest and lungs

Inspection and palpation:

2) Repeat auscultation in the posterior chest.

You might also like