THE PHYSICAL THE PHYSICAL EXAMINATIONEXAMINATION

HEAD TO TOE ADULT HEAD TO TOE ADULT ASSESSMENT ASSESSMENT

GENERAL SURVEY GENERAL SURVEY (OBSERVATION)(OBSERVATION)

• APPARENT SIGNS OF RESPIRATORY OR APPARENT SIGNS OF RESPIRATORY OR OTHER DISTRESS?OTHER DISTRESS?

• LEVEL OF CONSCIOUSNESS, LEVEL OF CONSCIOUSNESS, AWARENESSAWARENESS

• MOOD & BEHAVIORMOOD & BEHAVIOR

• SPEECH CLARITY SPEECH CLARITY

• ASSESS SKIN (COLOR, TEMP. , MOISTUREASSESS SKIN (COLOR, TEMP. , MOISTURE

• ODORS (ALCOHOL, KETONE, URINE, ETC)ODORS (ALCOHOL, KETONE, URINE, ETC)

EXAMINING THE HEAD AND EXAMINING THE HEAD AND NECKNECK(INSPECTION, PALPATION, (INSPECTION, PALPATION, AUSCULTATION)AUSCULTATION) INSPECTINSPECT ::• FOR OBVIOUS INJURY/DEFORMITYFOR OBVIOUS INJURY/DEFORMITY• CHECK PUPILSCHECK PUPILS• OBSERVE FOR DISCHARGE (FROM EYES, OBSERVE FOR DISCHARGE (FROM EYES,

EARS, NOSE, MOUTH)EARS, NOSE, MOUTH)• OBSERVE ORAL, PHARYNGEAL OBSERVE ORAL, PHARYNGEAL

CAVITIES,TEETHCAVITIES,TEETH• INSPECT NECK (VEIN DISTENTION, INSPECT NECK (VEIN DISTENTION,

ENLARGED NODES, SYMMETRY)ENLARGED NODES, SYMMETRY)

Examining the head & neck Examining the head & neck (cont.)(cont.)

• PALPATE:PALPATE:

• SCALPSCALP

• FACIAL BONESFACIAL BONES

• LYMPH NODE LOCATIONS LYMPH NODE LOCATIONS (SUBMANDIBULAR, SUBMENTAL, PRE (SUBMANDIBULAR, SUBMENTAL, PRE AND POST AURICULAR, CERVICAL)AND POST AURICULAR, CERVICAL)

Examining the head & neck Examining the head & neck (cont.)(cont.)

• AUSCULTATE:AUSCULTATE:

• CAROTID ARTERIES FOR BRUITSCAROTID ARTERIES FOR BRUITS

EXAMINING THE CHEST AND EXAMINING THE CHEST AND BACKBACK

• INSPECT:INSPECT:

• FOR OBVIOUS INJURY, DEFORMITY,SKIN FOR OBVIOUS INJURY, DEFORMITY,SKIN ABNORMALITIES (SUCH AS DECUBITI)ABNORMALITIES (SUCH AS DECUBITI)

• OBSERVE RESPIRATIONS, CHECK FOR OBSERVE RESPIRATIONS, CHECK FOR EQUAL CHEST EXPANSION BILATERALLYEQUAL CHEST EXPANSION BILATERALLY

• OBSERVE FOR CONTOUR AND OBSERVE FOR CONTOUR AND SYMMETRYSYMMETRY

Examining the chest & back Examining the chest & back (cont.)(cont.)

• Palpate:Palpate:

• Clavicles, supra and sub clavicular Clavicles, supra and sub clavicular lymph node areaslymph node areas

• AxillaeAxillae

• Ribs, spine, check for sacral edemaRibs, spine, check for sacral edema

Examining the chest & back Examining the chest & back (cont.)(cont.)

• Auscultate:Auscultate:• Breath sounds in all five lung lobes, resp-Breath sounds in all five lung lobes, resp- iratory rate, depth,rhythm.Wheezing? On iratory rate, depth,rhythm.Wheezing? On

inspiration or expiration or both? Cough? inspiration or expiration or both? Cough? Productive or nonproductive?Productive or nonproductive?

• Heart sounds (aortic, pulmonic, Erb’s, Heart sounds (aortic, pulmonic, Erb’s, tricuspid, mitral areas), S1 and S2. Check tricuspid, mitral areas), S1 and S2. Check heart rate: regular? Regularly irregular? heart rate: regular? Regularly irregular? Irregularly irregular?Irregularly irregular?

Examining the chest & back Examining the chest & back (cont.)(cont.)

• Percuss:Percuss:

• Chest peripheryChest periphery

• Costoverterbral anglesCostoverterbral angles

EXAMINING THE ABDOMEN EXAMINING THE ABDOMEN

• INSPECT:INSPECT:

• FOR OBVIOUS INJURY, SCARS, RASHFOR OBVIOUS INJURY, SCARS, RASH

• FOR DISTENTIONFOR DISTENTION

• FOR ASYMMETRY, MASSES, HERNIASFOR ASYMMETRY, MASSES, HERNIAS

• OBSERVE FOR PULSATIONS, VISIBLE OBSERVE FOR PULSATIONS, VISIBLE PERISTALSISPERISTALSIS

• INSPECT EXTERNAL GENITALIAINSPECT EXTERNAL GENITALIA

Examining the Abdomen Examining the Abdomen (cont.)(cont.)

• Auscultate:Auscultate:

• All four quadrants for bowel soundsAll four quadrants for bowel sounds

• For bruit over the abdominal aortaFor bruit over the abdominal aorta

Examining the Abdomen Examining the Abdomen (cont.)(cont.)

• Palpate (gently!)Palpate (gently!)

• For pain, rebound tenderness, For pain, rebound tenderness, guardingguarding

• Liver margin, spleenLiver margin, spleen

• Carefully palpate any herniasCarefully palpate any hernias

• Check femoral pulsesCheck femoral pulses

Examining the Abdomen Examining the Abdomen (cont.)(cont.)

• Percuss:Percuss:

• For fluid, motionFor fluid, motion

• All four quadrants, noting soundsAll four quadrants, noting sounds

EXAMINING THE EXAMINING THE EXTREMITIESEXTREMITIES• INSPECT:INSPECT:

• OBSERVE FOR SYMMETRY, OBVIOUS OBSERVE FOR SYMMETRY, OBVIOUS DEFORMITYDEFORMITY

• FOR GAIT, RANGE OF MOTIONFOR GAIT, RANGE OF MOTION

• OBSERVE SKIN FOR COLOR, CONDITIONOBSERVE SKIN FOR COLOR, CONDITION

• OBSERVE NAILS FOR COLOR, CONDITIONOBSERVE NAILS FOR COLOR, CONDITION

• OBSERVE FOR INVOLUNTARY MOVEMENTSOBSERVE FOR INVOLUNTARY MOVEMENTS

• OBSERVE FOR EDEMAOBSERVE FOR EDEMA

EXAMINING THE EXAMINING THE EXTREMITIESEXTREMITIES• PALPATE:PALPATE:• UPPER EXTREMITIES: RADIAL, BRACHIAL PULSES, UPPER EXTREMITIES: RADIAL, BRACHIAL PULSES,

COMPARECOMPARE• CHECK GRIP, STRENGTH BILATERALLYCHECK GRIP, STRENGTH BILATERALLY• LOWER EXTEMITIES: PERIPHERAL LOWER EXTEMITIES: PERIPHERAL

PULSES:POPLITEAL, DORSALIS PEDIS, POSTERIOR PULSES:POPLITEAL, DORSALIS PEDIS, POSTERIOR TIBIAL; COMPARE BILATERALLYTIBIAL; COMPARE BILATERALLY

• EVALUATE SENSATION IN ALL EXTREMITIESEVALUATE SENSATION IN ALL EXTREMITIES• ASSESS FOR PITTING EDEMAASSESS FOR PITTING EDEMA• PERFORM HOMAN’S SIGN EXAM; CHECK FOR CALF PERFORM HOMAN’S SIGN EXAM; CHECK FOR CALF

TENDERNESS, PAIN, HEATTENDERNESS, PAIN, HEAT

EXAMINING THE EXAMINING THE EXTREMITIESEXTREMITIES

• PERCUSS:PERCUSS:

• DEEP TENDON REFLEXESDEEP TENDON REFLEXES