Physical Assessment Comprehensive

8/10/2019 Physical Assessment Comprehensive

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Health

examination

Ms christine

Mn prev


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DEFINITION

Health examination

Health examination is the systematic

assessment of human body which involves the

use of ones senses to determine the general

physical and mental conditions of the body


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Indication of health examination

On admission

On discharge

On follow up

Health camps

Before and after diagnostic and therapeutic

procedure.


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TECHNIQUE OF PHYSICAL

ASSESSMENT


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INSPECTION


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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


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PALPATION


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PRINCIPLES OF PALPATION

You should have short fingernails.

You should warm your hands prior to placing themon 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 thetouch will occur, especially when the patient cannot

see what you are doing.


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LIGHT PALPATION


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DEEP PALPATION


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PERCUSSION


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TYPE OF PERCUSSION

DIRECT PERCUSSION


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INDIRECT PERCUSSION


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AUSCULTATION


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FOUR CHARACTERISTICS OF SOUND

1.Pitch (ranging from high and low):frequency ornumber 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)


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OLFACTION


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EQUIPMENT USED FOR PE


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STETHOSCOPE


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OPHTHALMOSCOPE


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OTOSCOPE


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SNELLEN CHART


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NASAL SPECULUM


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VAGINAL SPECULUM


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TUNING FORK


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PERCUSSION HARMER


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SPHYGMOMANOMETER

POSITIONING


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POSITIONING

Sitting/fowlers


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STANDING


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SUPINE AND PRONE


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DORSAL RECUMBENT


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Sims


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LITHOTOMY


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KNEE-CHEST


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PREPARING THE ENVIRONMENT


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PREPARING THE PATIENT PSYCHOLOGICAL PREPERATION


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PHYSICAL PREPERATION


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ARTICLES REQUIRED

Screen to provide privacy

Bowl for antiseptic lotion

Kidney tray and paper bag

Weighing machine and height scale

Patient gown


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ARTICLES REQUIRED

Bath blanket to cover the patient

Pair of leggings

Draw sheet to cover patients chest

Square drum containing test tube, gauze

piece, cotton swab, specimen bottle,

swabsticks

Gloves

lubricant


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ARTICLES REQUIRED

Torch

Ophthalmoscope

Snellenschart

Book for colour blindness Pen

Flash card

Autoscope with speculum of different sizes

Percussion Hammer

Tuning fork


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ARTICLES REQUIRED

Nasal speculum

Mouth gag

Laryngeal mirror

Tongue depressor

Stethoscope

Inch tape


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ARTICLES REQUIRED

Sterile tray for vaginal examination

Proctoscope

VITALS TRAY


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EXAMINATION

Powder, soap

Snellans chart

Pencil or pen

Cotton wicks

Torch

Tuning fork

Salt, sugar


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EXAMINATION

Tongue depressor

2 test tubes one with hot water and other withcold water

Safety pins

Some thing solid for grasping

Sharp object like key

Reading material to assess eyes and language of

person Knee harmer


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GENERAL SURVEY Identification data

Gender and race

Age

Signs of distress

Body type

Posture

Gait


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GENERAL SURVEY

Body movements

Hygiene and grooming

Body odour

Affect and mood

Speech

Substance abuse:


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VITALS SIGNS

HEIGHT AND WEIGHT


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HEIGHT AND WEIGHT:

ASSESSING INTEGUMENT SYSTEM


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ASSESSING INTEGUMENT SYSTEM Assessing skin

Skin colorErythema


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CYANOSIS


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Jaundice


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Pallor


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Vitiligo


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Inspect skin vascularity

Ecchymosis


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Petechiae

C Inspect skin lesion


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C Inspect skin lesion

Palpate skin temperature texture


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Palpate skin temperature, texture,

moisture and turgor


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EDEMA

PITTING EDEMA


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PITTING EDEMA

PITTING EDEMA


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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

ASSESSING NAILS


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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 whitetips

Capillary refill

ABNORMALITIES OF NAIL


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ABNORMALITIES OF NAIL Koilonychias (spoon nail)

clubbing Paranychia

indentations called (beaus line)

ASSESSING HAIR AND SCALP


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ASSESSING HAIR AND SCALP color,

texture and distribution. Thickness and lubrication of hair

INSPECT THE SCALP


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INSPECT THE SCALP

Cleanliness, color, dryness,

Lump, lesions,

Lice (pediculus humanus capitus)

Dandruff etc

HEAD AND NECK


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HEAD AND NECK ASSESSING THE SKULL

for size, symmetry any nodules or masses

INSPECT THE FACE


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INSPECT THE FACE

ASSESS THE EYE


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ASSESS THE EYE Inspect external eye structure

Position and alignment Exophthalmoses

strabismus

ASSESS THE EYE


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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

ASSESS THE EYE


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ASSESS THE EYE Eye lashes: sty.

Eye balls Conjunctiva and sclera{Paleness, rednessor

purulent,jaundice}


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ASSESS THE EYE

Cornea and iris:arcus senilis

Pupil: PEERLA.


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ACCOMMODATION


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PUPILLARY REFLEX TO LIGHT


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VISUAL ACUITY

INSPECT INTERNAL EYE STRUCTURES


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INSPECT INTERNAL EYE STRUCTURES


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EXTRA OCULAR MOVEMENTS


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PERIPHERAL VISION

EARS


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EARS

AURICLES

EAR CANAL AND TYMPANIC MEMBRANE


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HEARING WEBERS TEST:

RINNE, S TEST:

NOSE AND SINUSES


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NOSE AND SINUSES


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ABNORMAL FINDINGS


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pallor, cyanosis or redness

lesions, swollen lips red tonsils,swollen red

bleeding gums,

white coating of tonguefissured tongue from

dehydration.

bright red tongueseen in deficiency of iron b12

or niacin,

black tongue

ASSESS THE NECK


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ASSESS THE NECK

PALPATE TRACHEA AND LYMPH


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PALPATE TRACHEA AND LYMPH

NODES

PALPATE THE THYROID GLAND


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PALPATE THE THYROID GLAND

ASSESS THE THORAX AND LUNGS


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INSPECT THE THORAX

Abnormal findings :increase in chest size andcontour , abnormal breathing pattern with the

use of accessory muscles, unequal chest

expansion, and abnormal breath sounds, barrelchest, pigeon chest

PALPATE THE THORAX


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PALPATE THE THORAX

PERCUSS THE THORAX


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PERCUSS THE THORAX

AUSCULATE BREATH SOUND


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Bronchial soundsheard 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 soundsare soft , low pitched and heard

best in base of lungs during inspiration longer than

expiration.

ABNORMAL BREATH SOUNDS


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WHEEZE

RHONCHI

CRAKLES

FRICTION RUB

CARDIO VASCULAR SYSTEM


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CARDIO VASCULAR SYSTEM

INSPECT NECK AND PRECORDIUM

PALPATE THE PRECORDIUM

AUSCULATATE HEART SOUND

AUSCULATATION


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AUSCULATATION

ASSESSING THE BREAST AND AXILLA


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ASSESSING THE BREAST AND AXILLA

INSPECT BREAST AND AXILLA

PALPATION OF BREAST AND AXILLA

ASSESSING THE ABDOMEN


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QUATRANTS OF ABDOMEN


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INSPECT THE ABDOMEM


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AUSCULTATE BOWEL SOUNDS


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AUSCULTATE BOWEL SOUNDS

PERCUSS THE ABDOMEN


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PALPATE THE ABDOMEN


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ASSESS MUSCULO SKELTAL SYSTEM


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INSPECT AND PALPATE MUSCLE

MUSCULO SKELTAL SYSTEM


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PALPATE THE BONES

INSPECT AND PALPATE THE JOINTS

INSPECT SPINAL CURVES

kyphosis

Lordosis

Scoliosis

ASSESSING MALE AND FEMALEGENITALIA


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GENITALIA

INSPECT AND PALPATE FEMALE GENITALIA

INSPECT AND PALPATE RECTUM AND


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ANUS

NEUROLOGICAL SYSTEM


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MENTAL AND EMOTIONAL STATUS:


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BEHAVIOR AND APPEARANCE


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BEHAVIOR AND APPEARANCE

LANGUAGE


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LANGUAGE

INTELLECTUAL FUNCTION


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Memory

Knowledge

Abstract thinking

Association

Judgment

CRANIAL NERVE FUNCTION


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Olfactory nerve(1):

Optic nerve(2)

Occulomotor(3)

Trochlear(4)

Trigeminal(5)

Abducens(6)



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Facial(7)

Auditory(8).

Glossopharyngeal(9)

Vagus(10)

Spinal accessory(11

Hypoglossal(12)

MOTOR FUNCTION


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Balance and gait

Rombergs test

Motor function and coordination

SENSORY FUNCTION


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SENSORY FUNCTION

REFLEX FUNCTION


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REFLEX FUNCTION

Biceps reflex

Triceps reflex

Knee and patellar reflex

Ankle/ Achilles tendon reflex

Babinski reflex

Abdominal reflex

PERIPHERAL VASCULAR SYSTEM

ASSESSMENT


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ASSESSMENT

ALLENS TEST BUERGERS TEST

CAPILLARY REFILL

HOMANS SIGN PALPATE PERIPHERAL PULSES

DOCUMENTATION OF DATA


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AFTER CARE OF THE PATIENT


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AFTER CARE OF ARTICLES


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Physical Assessment Comprehensive

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