Leveled Physical Assessment Tool (LPAT)

Date:___________ patient initials:______ room #:______ diet: ______ Height: ______ weight: ______ BMI: ______

Vital Temperature: _____ Pulse: _____ Respirations: _____ Blood Pressure: _____ Pain (0-10/10): _____ O2 sats:_____
Signs: Temperature: _____ Pulse: _____ Respirations: _____ Blood Pressure: _____ Pain (0-10/10): _____ O2 sats:_____
NEUROLOGIC
Level of consciousness: alert lethargic / obtunded / stuporous / comatose
Level of orientation: person / place / time / purpose = oriented X ____
Babinski: negative positive, clonus ( R / L )
Tremors: none resting / intention / fasciculation / tics / athetoid / chorea
SKIN
Color/Quality: robust pale / jaundice / cyanotic / other:______________________
Temp ./ texture / moisture: warm / smooth / dry cool / rough / moist / sweating / oily / itching
Turgor / mobility: good / mobile poor (tenting) / stiff
Rashes: absent present (location):__________________________________
Ecchymosis: absent present / hematoma (location & appearance):_____________
HEAD, EYES, NOSE, & THROAT (HEENT)
Eyes: vision normal (20/20) cataracts / glaucoma / blind / glasses / contacts / prosthesis
pupils PERRLA / consensual unequal/non-reactive to light/ accmomadation/ consensual
sclera / conjunctiva white / moist red / yellow / dry / discharge: OD / OS / OU (color)____
Ears: hearing normal (+ whisper test) HOH / Aids / Deaf: AD / AS / AU
Nose: patent non patent / deviated septum / polyps / epistaxis / rhinorrhea
Mouth: lips/mucous membranes intact / moist cracked / dry / cyanotic / swollen / cheilitus / asymmetrical
tongue slightly rough smooth / cracked / swollen / bright red / white patches / nodule
dentition good poor / caries / dentures or partial plate: upper / lower
Speech / swallowing clear / smooth aphasia / dysphagia / odynophagia
Neck: lymph glands not enlarged enlarged / tender / non tender (location):_________________
RESPIRATORY
Rhythm / effort: regular irregular / shallow / deep / retractions / unilateral lag
Chest shape: normal (AP<transverse) barrel / pigeon / funnel / flail
Expansion: normal (3-5cm) asymmetrical
Lung sounds: A/P clear crackles (fine / coarse) / wheeze (insp. / exp.) rhonchi /
stridor / rub / crunch / absent (lobe):_____________________
CARDIOVASCULAR
Heart: rhythm / quality regular / strong irregular / regularly irregular / irregularly irregular
weak / thready / bounding / paradoxical / alternans
murmur / rub absent present (Grade I-VI/VI & location):________friction rub
Bruit (listen if>45y.o.): none carotid ( R / L ) / abdominal / femoral ( R / L )
Peripheral Pulses: present / equal / strong absent / unequal / weak / Doppler used: (location): _________
Cap. Refill: finger / toenails normal (<3 seconds) delayed (site):_______________________________________
Peripheral Vascular (legs): good color / hair pallor / rubor / brawny / hairless / ulcers ( R / L )
Edema: none slight / marked / lymph / pitting (+1-4/4 & location):________
Homans’ sign: absent present R / L (location on leg):_________________________
GASTROINTESTINAL
Abdomen: size / shape round / flat protuberant / scaphoid
scars/striae/pulsations absent present (location):___________________________________
Bowel sounds X 4 quadrants active / borborygmi hypoactive / hyperactive / absent (which quadrant):_________
Percussion / Palpation tympanic / non-tender dull / flat (quad):____ tender: superficial / deep (quad): _____
Bowel Movement yes / regular (formed, soft) no / date of last BM: ______ usual pattern: ______________
GENITOURINARY
Bladder non-distended / non-tender distended / tender
Kidney no CVA pain positive CVA pain ( R / L )
Urine clear / color:______ cloudy / blood / burning / diminished stream / incontinent
MUSCULOSKELETAL
Muscle tone good hypotonic (flaccid) / increased resistance / atrophy
Strength: hand / foot strong / equal unequal / paresis (weak) / plegia (paralysis) R / L
Range of Motion (ROM) full limited (location):_________________________________
Gait steady unsteady / propelling / staggering / other:_______________
PSYCHOSOCIAL
Behavior cooperative / pleasant uncooperative / withdrawn / combative / depressed / manic
Other:

©jgrichards 1997, revised 2004 (use with permission only)