Physical Assessment Wash hands Provide for privacy Explain procedure to client Gather equipment Obtain relevant history

General Survey 1) Observe appearance Posture and position Related to stated age Physical deformity 2) Mobility Gait Assistive devices ROM Involuntary movements 3) Personal hygiene Clothing Appropriate for season Clean, neat disheveled 4) Skin color noted throughout the exam Exam both hands Inspect nails 5) Facial expression and symmetry Affect Mood Eyes

6) Speech Articulation Pattern Content appropriate Native language 7) Vital Signs Radial pulse Respiration Blood pressure Temperature Nutritional status Head and Face 1) Observe for Eye contact Level consciousness Orientation 2) Inspect and palpate Scalp, cranium Hair Face: symmetry Temporal artery TM Join Sinuses: Maxillary/Frontal

1) Inspect external eye structures Eyelids & lashes

Eyeballs Conjunctiva Sclera Cornea & lens Iris 2) Test central visual acuity Snellen eye chart Near vision 3) Test visual fields Confrontation test Extraocular muscle function Six positions of gaze Corneal reflex 4) Pupil Size Response to light Response to accommodation Nose

Rinne test Weber test

1) External Inspect symmetry deformities lesions Palpate external nose 2) Internal Nasal cavity (use speculum) Septum Turbinates Mouth and Throat 1) Inspect Lips Teeth Gums Tongue

EARS 1) External Inspect external ear 2) Otoscopic examination External canal Tympanic membrane 3) Hearing acuity Voice test

Buccal mucosa Uvula and mobility (CN X) Grade tonsils (1, 2, 3, 4) 2) Test CN XII (stick out tongue) Neck 1) Inspect for symmetry Masses Pulsations

*Jugular venous pulsation *Jugular venous pressure 2) Palpate Cervical lymph nodes (T, 261) Carotid pulses Trachea Thyroid 3) Test ROM (f,b,l,r) Muscle strength Chest 1) Inspect Symmetry shoulders & muscles Config. Thoracic cage Skin 2) Palpate Masses Tenderness Spinous process (knobs) Symmetry of expansion Tactile fremitus (ninety nine) 3) Percuss lung fields 4) Auscultate breath sounds Heart 1) Inspect precordium Pulsations

2) Palpate Apical pulse Precordium 2) Auscultate Base for murmurs Heart sounds (bell &diaphragm) Apical rate & rhythm Apex with bell Abdomen 1) Inspect Contour Symmetry Skin Umbilicus Pulsation (Aorta) 2) Auscultate Bowel sounds (start RLQ) Vascular sounds (for bruits) 3) Palpate 4 quadrants Inguinal Area 1) Palpate Femoral pulse Inguinal nodes Upper Extremities 1) Test ROM & Muscle strength (Hands, Arm, Shoulders) 3

2) Palpate epitrochlear node Lower Extremities 1) Inspect for Symmetry Skin Hair Varicose veins Toes 2) Palpate Popliteal pulse Posterior tibial Dorsalis pedis Temperature Edema 3) Test ROM & Muscle strength (Hips, Knees, Ankles, Feet, Spine) Musculoskeletal 1) Gait Normal On toes On Heels 2) Perform Romberg test Neurologic 1) Test Position sense of finger 4

Sterogenosis Cerebellar function Finger to nose Rapid alternating movements Heel down shin 2) Sensation Face Hands Legs Feet Superficial pain Light touch Vibration 3) Elicit deep tendon reflexes Biceps Triceps Plantar Patellar Achilles