PHYSICAL ASSESSMENT General Appearance Present weight: Height:

BODY MASS INDEX

Body Mass Index (BMI) is used to determine the normal weight of a person in relation to height using formula for Adults, weight in kilograms divided by height in meter square. Weight in kilograms (Height in meters)2 Appearance: WEIGHT FOR AGE <18.5 =18.5 to 24.9 =25.0 to 29.9 >30.0 INTERPRETATION Underweight Normal Weight Overweight Obese =BMI

Table 1 Body Mass Index (BMI) and its interpretation

Vital Signs Blood Pressure (B/P): 100/80 mmHg Temperature: 36.3 oC Pulse Rate (PR): 116 bpm Respiratory Rate (RR):

Integumentary Color varies from light brown Generally uniform Normal distribution of hair No edema No abrasions or other lesions Uniform skin temperature When pinched, skin springs back to previous state Nails: convex curvature, smooth in texture, highly vascular and pinkish in color, intact epidermis, prompt return of pink or usual color Hair: brownish in color, evenly distributed, thick hair, silky and resilient, with infection (+) lice Head: Normocephalic and symmetric Smooth skull contour Smooth, uniform consistency; absence of nodules or masses Symmetrical facial features; palpebral fissures equal in size; symmetric nasolabial folds Symmetric facial movements

Eyes Eyebrows: hair evenly distributed, skin intact, symmetrically aligned, equal movement Eyelashes: equally distributed, curled slightly outward Eyelids: skin intact, no discharge, no discoloration, lids close symmetrically approximately 15 to 20 involuntary blinks per minute, bilateral blinking, no visible sclera above cornea Bulbar conjunctiva: transparent, sclera appears white Palpebral conjunctiva: shiny, smooth, pink Lacrimal gland: no edema or tenderness Lacrimal sac: no edema or tearing Cornea: transparent, shiny and smooth, visible iris details Corneal sensitivity reflex: blinks when the cornea is touched Anterior chamber: transparent, no shadows of light on iris, depth of about 3mm Pupils: black in color, equal in size, 4mm in diameter, round, smooth border, iris flat and round PERRLA Visual fields: can see objects in the periphery when looking straight ahead Six ocular movements: both eyes coordinated, move in unison, with parallel alignment Visual acuity: able to read newsprint

Ears Auricles: color same as facial skin, symmetrical, aligned with outer canthus of eye, mobile, firm and not tender, pinna recoils after it is folded Normal voice tones audible (-) Weber (+) Rinne Nose and Sinuses Symmetrical, proportional to the face, nasal septum is aligned

Patent nostrils Facial sinuses: not tender

Mouth and Oropharynx Lips: symmetrical and moist Teeth: complete misaligned and discoloration in some of the teeth Gums: pinkish, moist, firm texture and no retraction Tongue: pinkish, smooth, symmetrical, raised papillae

Neck Proportional to gross body structure Coordinated, smooth movements with no discomfort Equal muscle strength Thyroid not enlarged upon palpation

Thorax and Lungs: Posterior Thorax: Chest symmetric Spine column vertically aligned, straight Right and left shoulders and hips are at same height Skin intact, uniform temperature Chest wall intact, no tenderness, no masses Full and symmetric chest expansion Bilateral symmetry of vocal fremitus Percussion notes resonate, except over scapula

Lowest point of resonance is over the diaphragm Excursion is 3cm bilaterally Vesicular and bronchovesicular breath sounds Anterior Thorax: Quiet, rhythmic, and effortless respirations Costal angle is less than 90o and the ribs insert to the spine at approximately a 45o angle Full symmetric excursion; thumbs normally separate 3cm Percussion notes resonated down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas over the heart and the liver, tympanic over the underlying stomach Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds

Heart and Central Vessels No pulsations No lift or heave

Peripheral Vascular System Symmetric pulse volumes Full pulsations Presence of distention and nodular bulges at claves in dependent position Limbs not tender, symmetric in size Skin color pink Skin temperature not excessively warm or cold No edema Skin texture resilient and moist

(+) Buergers test (+) Capillary refill test

Breast and Axillae Skin uniform in color Generally symmetric; rounded shape; slightly unequal in size Recent change in breast size Rounded, dark brown areola Inversion of (L) nipple With bilateral tenderness

Abdomen Unblemished skin Uniform color Brownish striae marks on the lower (L) and (R) quadrants