PHYSICAL ASSESSMENT

Lecture notes

Usual Sequence of Physical Assessment Sequence1. Vital signs2. Appearance and behaviour3. Skin4. Head5. Eyes6. Ears7. Nose8. Mouth

9. Neck10. Breaks11. Chest and Lungs12. Heart13. Abdomen14. Extremities15. Back and Spine16. Mental Status17. Genitalia and rectum

Usual Sequence of Physical Assessment Sequence

PERCUSSION

Percussion notes

1. Resonant- hollow sound2. Dull- “healthy liver”3. Tympanic- “drum like sound” (stomach)4. Flat- “large muscle” (thigh)

PERCUSSION

PALPATION

PALPATION

Types of palpation

1. Superficial palpation-- assess point of maximal Impulse2. Deep palpation-- lower edge of liver and spleen tip

AUSCULTATION

EQUIPMENTS1. Flashlight2. Opthalmoscope3. Otoscope4. Tongue depressor5. Watch with 2nd hand6. Thermometer7. Stethoscope8. Sphygmomanometer9. Reflex hammer10. Tuning Fork

EQUIPMENTS

EQUIPMENTS

Height and Body weight

Body mass Index (BMI)= Weight in kg_____________ Height in Meters2

Hypertension, incr LDL, incr triglycerides, elevate blood glucose, Cardiac disease

Body mass Index classification

Classification BMIUnderweight < 18.5Normal weight 18.5- 24.9Overweight 25- 29.9Class I obesity 30-34.9Class II obesity 35-39.9Class III obesity >40

SKIN

• Evaluated thru inspection and palpationInspection---skin color (pallor, cyanosis, redness,

yellowness) lesions, trauma, abnormalities

Palpation--turgor (hydration status) moistness,

temperature, texture, thickness, mobility and edema

Head and neck

• Evaluated thru inspection and palpationHead, neck, nose, ears, mouth and pharynx

--- Visual acuity, hearing and facial and ophthalmic reflexes

Hearing (ears)

Rinne Test--compares sensitivity with bone and air

conduction.

Weber’s test---place the tip of a vibrating tuning fork on

the center of the patient’s forehead.

Chest and Lungs

• Techniques used: Inspection, palpation, percussion and auscultation

• Changes in respiratory status can happen very slowly, or very quickly, so respiratory status is assessed carefully, and frequently

• Percussion over intercoastal spaces• Palpate chest for massesand tactile

fremitus

• Ausculate using stethoscope---- BREATH SOUND

Chest and Lungs

Breath Sounds• Auscultate using diaphragm, use a

systematic approach, compare each side to the other, document when and where sounds are heard

• Normal breath sounds: bronchovesicular, bronchial, and vesicular– Abnormal breath sounds are called

adventitious sounds

Breath Sounds• Stridor - may be heard without stethoscope, shrill

harsh sound on inspiration d/t laryngeal obstruction

• Wheeze - may be heard with or without stethoscope (document which), high-pitched squeaky musical sound; usually not changed by coughing; Document if heard on inspiration, expiration, or both; May clear with cough– Noise is caused by air moving through narrowed or

partially obstructed airway– Heard in asthma or FBA

Breath Sounds• Crackles - heard only with stethoscope (formerly called

rales): fine, medium, coarse short crackling sounds (think hair); May clear with cough– Most commonly heard in bases; easier to hear on inspiration

(but occurs in both inspiration and expiration)• Gurgles - heard only with stethoscope (formerly called

rhonchi): Low pitched, coarse wheezy or whistling sound - usually more pronounced during expiration when air moves through thick secretions or narrowed airways – sounds like a moan or snore; best heard on expiration (but occur both in and out)

Breath sound

• Friction rub – Grating, creaking, or rubbing sound heard on both inspiration and expiration; not relieved by coughing; due to pleural inflammation

• Document breath sounds as clear, decreased or absent, compare right to left, and describe type and location of any adventitious sounds– CTAB or BBS cl + =

Cardiovascular system• Inspection, auscultation, palpation to

examine the heart.Inspect chest for visible cardiac motions,

Palpate for pulses. ( radial, carotid, brachial, femoral, popliteal, posterior tibial, dorsalis pedis, Ausculatate with a stethoscope.