Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

General Physical Assessment


Published on

Published in: Health & Medicine
  • Acne No More! Cure your acne, end the breakouts and regain your natural inner balance.. Guaranteed! -- Discover how Mike Walden has taught thousands of people to achieve acne freedom faster than they ever thought possible.. Even if you've never succeeded at curing your acne before.. Right here you've found the clear skin success system you've been looking for! ♣♣♣
    Are you sure you want to  Yes  No
    Your message goes here
  • Who Else Wants To Cure Their Acne, Regain Their Natural Inner Balance and Achieve LASTING Clear Skin? Click Here 
    Are you sure you want to  Yes  No
    Your message goes here
  • why is it 3 slides only appeared?
    Are you sure you want to  Yes  No
    Your message goes here

General Physical Assessment

  1. 1. General Physical Assessment C. Richard Finley, Ed.D, PA-C Associate Professor Acting Department Chair Assistant Academic Director Physician Assistant Department College of Allied Health & Nursing
  2. 2. Examination of the Skin
  3. 3. Exam of the Skin <ul><li>Examine the patient in good lighting </li></ul><ul><li>Inspect and palpate skin for the following: </li></ul><ul><ul><li>Color </li></ul></ul><ul><ul><li>Texture </li></ul></ul><ul><ul><li>Turgor </li></ul></ul><ul><ul><li>Moisture </li></ul></ul><ul><ul><li>Pigmentation </li></ul></ul><ul><ul><li>Lesions </li></ul></ul><ul><ul><li>Hair distribution </li></ul></ul><ul><ul><li>Warmth: use back of hand </li></ul></ul>
  4. 4. Abnormal Findings <ul><li>Color </li></ul><ul><ul><li>Pallor: </li></ul></ul><ul><ul><ul><li>Iron def. anemia </li></ul></ul></ul><ul><ul><li>Yellow: </li></ul></ul><ul><ul><ul><li>Jaundice </li></ul></ul></ul><ul><ul><ul><li>Carotenemia </li></ul></ul></ul><ul><ul><ul><li>Hemolysis </li></ul></ul></ul><ul><ul><li>Red: </li></ul></ul><ul><ul><ul><li>Erythroderma </li></ul></ul></ul><ul><li>Pigmentation </li></ul><ul><ul><li>Hyper pigmentation </li></ul></ul><ul><ul><li>Localized : </li></ul></ul><ul><ul><ul><li>Pregnancy </li></ul></ul></ul><ul><ul><ul><li>BCP ingestion </li></ul></ul></ul><ul><ul><li>Generalized : </li></ul></ul><ul><ul><ul><li>Thyrotoxicosis </li></ul></ul></ul><ul><ul><ul><li>Liver disease </li></ul></ul></ul><ul><ul><ul><li>Renal disease </li></ul></ul></ul><ul><ul><li>De-pigmentation: </li></ul></ul><ul><ul><ul><li>Vitiligo </li></ul></ul></ul><ul><ul><ul><li>Injury </li></ul></ul></ul>
  5. 5. Abnormal Findings <ul><li>Texture </li></ul><ul><ul><li>Soft: (Thyrotoxicosis) </li></ul></ul><ul><ul><li>Tight: (Scleroderma) </li></ul></ul><ul><ul><li>Rough : (Hypothyroidism) </li></ul></ul><ul><li>Moisture </li></ul><ul><ul><li>Dry: (Vitamin A def, Myxedema) </li></ul></ul><ul><ul><li>Oily: (Acne) </li></ul></ul><ul><li>Turgor </li></ul><ul><ul><li>Decreased: (Dehydration) </li></ul></ul><ul><li>Warmth: </li></ul><ul><ul><li>Generalized warmth : (Fever, Hyperthyroidism) </li></ul></ul><ul><ul><li>Localized warmth : (Inflammation) </li></ul></ul><ul><ul><li>Coolness: (Hypothyroidism, Frostbite, Hypothermia, Shock, Low cardiac output) </li></ul></ul>
  6. 6. MOLE WARNING SIGNS The &quot;ABCD&quot; rule & Melanoma Danger Signs
  7. 7. <ul><li>A symmetry </li></ul><ul><ul><li>Unequal or asymmetric moles are suspicious. </li></ul></ul>
  8. 8. <ul><li>B order </li></ul><ul><ul><li>If the border is irregular or indistinct, it is more likely to be cancerous (or precancerous) </li></ul></ul>
  9. 9. <ul><li>C olor </li></ul><ul><ul><li>Variation of color (e.g., more than one color or shade) within a mole is a suspicious finding </li></ul></ul>
  10. 10. <ul><li>D iameter </li></ul><ul><ul><li>Any mole that has a diameter larger than a pencil's eraser in size (> 6 mm) should be considered suspicious. </li></ul></ul>
  11. 11. <ul><li>E levation </li></ul><ul><ul><li>If a mole is elevated, or raised from of the skin, it should be considered suspicious </li></ul></ul>
  12. 12. Examination of the Lymph Nodes
  13. 13. Lymph Node Palpation <ul><li>Palpate with pads of all four fingertips </li></ul><ul><li>Examine both sides simultaneously </li></ul><ul><li>Use steady gentle pressure </li></ul><ul><li>The major lymph node groups are located along the anterior and posterior aspects of the neck and on the underside of the jaw </li></ul>
  14. 14. Cervical Nodes
  15. 17. Exam of Lymph Nodes <ul><li>Lymph nodes are part of immune system </li></ul><ul><li>Lymphadenitis </li></ul><ul><ul><li>Firm </li></ul></ul><ul><ul><li>Tender </li></ul></ul><ul><ul><li>Enlarged </li></ul></ul><ul><ul><li>Warm </li></ul></ul><ul><li>May remain enlarged after infection </li></ul><ul><ul><li>Less than 1 cm </li></ul></ul><ul><ul><li>Nontender </li></ul></ul>
  16. 18. Malignancies <ul><li>Firm </li></ul><ul><li>Non-tender </li></ul><ul><li>Matted (i.e. stuck to each other) </li></ul><ul><li>Fixed (i.e. stuck to underlying tissue </li></ul><ul><li>Increase in size over time </li></ul>
  17. 19. Common Causes of Lymphadenitis <ul><li>Pharyngitis or dental infections </li></ul><ul><li>Diffuse upper airway infections </li></ul><ul><ul><li>Mononucleosis </li></ul></ul><ul><li>Systemic infections </li></ul><ul><ul><li>Tuberculosis </li></ul></ul><ul><li>Inflammatory processes </li></ul><ul><ul><li>Sarcoidosis </li></ul></ul>
  18. 20. Examination of the Thyroid
  19. 21. Inspection <ul><li>Gland lies approximately 2-3 cm below the thyroid cartilage </li></ul><ul><ul><li>Either side of the tracheal rings, which may or may not be apparent on visual inspection. </li></ul></ul>
  20. 22. Palpation <ul><li>Stand behind the patient and place the middle three fingers of both hands along the mid-line of the neck, just below the chin </li></ul><ul><ul><li>identify and feel the structures from the front before performing the exam from behind </li></ul></ul><ul><li>Slide the three fingers of both hands to either side of the rings </li></ul><ul><li>Have the patient drink water as you palpate </li></ul>
  21. 23. <ul><li>If enlarged, is it symmetrical </li></ul><ul><ul><li>Unilateral vs. bilateral </li></ul></ul><ul><li>Discrete nodules within either lobe? </li></ul><ul><li>Gland feels firm </li></ul><ul><ul><li>is it attached to the adjacent structures? </li></ul></ul><ul><ul><ul><li>(i.e. fixed to underlying tissue.. consistent with malignancy) </li></ul></ul></ul><ul><ul><li>freely mobile? </li></ul></ul><ul><ul><ul><li>(i.e. moves up and down with swallowing) </li></ul></ul></ul>
  22. 24. Findings of Exam of Thyroid <ul><li>Consistency of gland </li></ul><ul><ul><li>Consistency of muscle tissue </li></ul></ul><ul><ul><li>Unusual hardness </li></ul></ul><ul><ul><ul><li>Cancer or scarring </li></ul></ul></ul><ul><ul><li>Softness, or sponginess </li></ul></ul><ul><ul><ul><li>Toxic goiter </li></ul></ul></ul><ul><ul><li>Tenderness </li></ul></ul><ul><ul><ul><li>Acute infections </li></ul></ul></ul><ul><ul><ul><li>Hemorrhage into the gland </li></ul></ul></ul>
  23. 25. Examination of the Abdomen
  24. 26. General Considerations <ul><li>Patient should have an empty bladder . </li></ul><ul><li>Supine on the exam table and appropriately draped. </li></ul><ul><li>Examination room must be quiet to perform adequate auscultation and percussion. </li></ul><ul><li>Watch the patient's face for signs of discomfort during the examination </li></ul>
  25. 27. <ul><li>Disorders in the chest will often manifest with abdominal symptoms </li></ul><ul><li>It is always wise to examine the chest when evaluating an abdominal complaint </li></ul><ul><li>Inguinal/rectal examination in males </li></ul><ul><li>Pelvic/rectal examination in females </li></ul>
  26. 28. Anatomical Locations
  27. 30. Inspection <ul><li>Scars, striae, hernias, vascular changes, lesions, or rashes </li></ul><ul><li>Movement associated with peristalsis or pulsations </li></ul><ul><ul><li>Abdominal contour </li></ul></ul><ul><ul><ul><li>Flat, scaphoid, or protuberant? </li></ul></ul></ul>
  28. 31. Auscultation <ul><li>Place the diaphragm of stethoscope lightly on the abdomen </li></ul><ul><li>Listen for bowel sounds </li></ul><ul><ul><li>normal </li></ul></ul><ul><ul><li>increased </li></ul></ul><ul><ul><li>decreased </li></ul></ul><ul><ul><li>absent </li></ul></ul>
  29. 32. Listen for bruits over the renal arteries, iliac arteries, and aorta
  30. 33. Percussion <ul><li>Percuss in all four quadrants </li></ul><ul><li>Categorize what you hear as tympanic or dull. </li></ul><ul><ul><li>Tympany is normally present over most of the abdomen in the supine position. </li></ul></ul><ul><ul><li>Unusual dullness may be a clue to an underlying abdominal mass </li></ul></ul>
  31. 34. Liver Span <ul><li>Percuss downward from the chest in the right midclavicular line to detect the top edge of liver dullness. </li></ul><ul><li>Percuss upward from the abdomen in the same line to detect the bottom edge of liver dullness. </li></ul><ul><li>Measure the liver span between these two points. This measurement should be 6-12 cm in a normal adult. </li></ul>
  32. 35. Splenic Dullness <ul><li>Percuss the lowest costal interspace in the left anterior axillary line </li></ul><ul><ul><li>This area is normally tympanic. </li></ul></ul><ul><li>Ask the patient to take a deep breath and percuss this area again </li></ul><ul><ul><li>Dullness in this area is a sign of splenic enlargement. </li></ul></ul>
  33. 36. General Palpation <ul><li>Light palpation </li></ul><ul><ul><li>Areas of tenderness </li></ul></ul><ul><ul><li>Most sensitive indicator is patient’s facial expression </li></ul></ul><ul><ul><ul><li>Watch the patient’s face, not your hands </li></ul></ul></ul><ul><ul><li>Voluntary or involuntary guarding may be present </li></ul></ul><ul><li>Deep Palpation </li></ul><ul><ul><li>Identify abdominal masses or areas of deep tenderness </li></ul></ul>
  34. 37. Palpation of the Liver <ul><li>Place the fingers just below the right costal margin and press firmly. </li></ul><ul><li>Ask the patient to take a deep breath. </li></ul><ul><li>You may feel the edge of the liver press against your fingers </li></ul><ul><ul><li>Or it may slide under your hand as the patient exhales. </li></ul></ul><ul><li>A normal liver is not tender </li></ul>
  35. 38. <ul><li>Palpation of the Aorta </li></ul><ul><ul><li>Press down deeply in the midline above the umbilicus </li></ul></ul><ul><ul><li>The aortic pulsation is easily felt on most individuals </li></ul></ul><ul><ul><li>A well defined, pulsatile mass, greater than 3 cm across, suggests an aortic aneurysm. </li></ul></ul>
  36. 39. <ul><li>Palpation of the Spleen </li></ul><ul><ul><li>Use the left hand (posteriorly) to lift the lower rib cage and flank </li></ul></ul><ul><ul><li>Press down just below the left costal margin with the right hand </li></ul></ul><ul><ul><li>Ask the patient to take a deep breath </li></ul></ul><ul><ul><ul><li>The spleen is not normally palpable on most individual </li></ul></ul></ul>
  37. 40. Special Tests
  38. 41. Rebound Tenderness <ul><ul><li>Test for peritoneal irritation </li></ul></ul><ul><ul><li>Warn the patient </li></ul></ul><ul><ul><li>Press deeply on the abdomen </li></ul></ul><ul><ul><ul><ul><ul><li>After a moment, quickly release pressure </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>If it hurts more upon release, the patient has rebound tenderness </li></ul></ul></ul></ul></ul>
  39. 42. <ul><ul><li>+CVA is associated with renal disease </li></ul></ul><ul><ul><li>Warn the patient what you are about to do </li></ul></ul><ul><ul><li>Have the patient sit up on the exam table </li></ul></ul><ul><ul><li>Use heel of your closed fist to strike the patient firmly over costovertebral angles </li></ul></ul><ul><ul><li>Compare the left and right sides </li></ul></ul>Costovertebral Tenderness
  40. 43. <ul><ul><li>Test for peritoneal fluid (ascites) </li></ul></ul><ul><ul><li>Percuss the abdomen to outline areas of dullness and tympany </li></ul></ul><ul><ul><li>Have the patient roll away from you </li></ul></ul><ul><ul><ul><ul><li>Percuss again </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If dullness has shifted to areas of prior tympany, patient may have excess peritoneal fluid </li></ul></ul></ul></ul>Shifting Dullness
  41. 44. <ul><ul><li>Have patient lie on left side </li></ul></ul><ul><ul><li>Place your left hand on patient’s right hip </li></ul></ul><ul><ul><li>Extend the right thigh while applying counter resistance </li></ul></ul><ul><ul><li>Increased abdominal pain indicates a positive psoas sign </li></ul></ul>Psoas Sign                                                 
  42. 45. <ul><ul><li>Raise the patient's right leg with the knee flexed </li></ul></ul><ul><ul><li>Rotate the leg internally at the hip </li></ul></ul><ul><ul><li>Increased abdominal pain indicates a positive obturator sign </li></ul></ul>Obturator Sign                  
  43. 46. Evaluation of Stool and Urine
  44. 47. Discolored Urine <ul><li>Colorless </li></ul><ul><ul><li>Low concentration from excessive fluid intake </li></ul></ul><ul><ul><ul><li>Chronic glomerulonephritis </li></ul></ul></ul><ul><ul><ul><li>Diabetes mellitus </li></ul></ul></ul><ul><ul><ul><li>Diabetes insipidus </li></ul></ul></ul>
  45. 48. <ul><li>Cloudy White : Phosphates in an alkaline urine </li></ul><ul><ul><li>Epithelial cells from the lower GU tract </li></ul></ul><ul><ul><li>Bacteria </li></ul></ul><ul><ul><li>Pus </li></ul></ul><ul><li>Yellow : Highly concentrated normal urine </li></ul><ul><ul><li>Tetracycline </li></ul></ul><ul><ul><li>Pyridine </li></ul></ul><ul><li>Orange : Urobilinogen </li></ul><ul><ul><li>Santonin (anthelminthic) </li></ul></ul><ul><ul><li>Phenindione (anticoagulant) </li></ul></ul>
  46. 49. <ul><li>Orange in Acid/ Red in Alkaline: </li></ul><ul><ul><li>Rhubarb (food and purgative) </li></ul></ul><ul><ul><li>Senna (cathartic) </li></ul></ul><ul><ul><li>Aloes (cathartic) </li></ul></ul><ul><li>Red : </li></ul><ul><ul><li>Beets, blackberries, aniline dyes from candy </li></ul></ul><ul><li>Brown-Black : </li></ul><ul><ul><li>Highly concentrated normal urine </li></ul></ul><ul><ul><ul><li>Bilirubin (with yellow froth) </li></ul></ul></ul>
  47. 50. Hematuria <ul><li>Gross vs. Microscopic </li></ul><ul><li>Kidney </li></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Neoplasms </li></ul></ul><ul><ul><li>Infections </li></ul></ul>
  48. 51. Stool Evaluation <ul><li>Acute Diarrhea </li></ul><ul><ul><li>Defecation of watery or loose stools </li></ul></ul><ul><ul><li>Consistency not frequency </li></ul></ul>
  49. 52. <ul><li>Acute Nonbloody Diarrhea </li></ul><ul><ul><li>Viral gastroenteritis </li></ul></ul><ul><ul><li>Food intolerance </li></ul></ul><ul><ul><li>Fecal impaction </li></ul></ul><ul><li>Acute Bloody Diarrhea </li></ul><ul><ul><li>Posterior penetrating duodenal ulcer </li></ul></ul><ul><ul><li>Staph food poisoning </li></ul></ul><ul><ul><li>Heavy metal poisoning </li></ul></ul><ul><ul><li>Ulcerative colitis </li></ul></ul>
  50. 53. <ul><li>Chronic Intermittent Diarrhea </li></ul><ul><ul><li>Chronic pancreatitis </li></ul></ul><ul><ul><li>Irritable colon </li></ul></ul><ul><ul><li>Fibrocystic disease </li></ul></ul><ul><li>Chronic Constant Diarrhea </li></ul><ul><ul><li>Ulcerative colitis </li></ul></ul><ul><ul><li>Regional enteritis </li></ul></ul>
  51. 54. Constipation <ul><li>Acute Constipation </li></ul><ul><ul><li>Intestinal obstruction </li></ul></ul><ul><ul><li>Fecal impaction </li></ul></ul><ul><li>Chronic Constipation </li></ul><ul><ul><li>Irritable colon </li></ul></ul><ul><ul><li>Atonic colon </li></ul></ul><ul><ul><li>Megacolon </li></ul></ul><ul><ul><ul><li>Congenital or acquired defects in innervation </li></ul></ul></ul><ul><ul><li>Carcinoma of descending colon </li></ul></ul>
  52. 55. Blood in the Feces <ul><li>Black or Tarry Stools (digestive enzymes convert Hgb to black pigment) </li></ul><ul><li>Bloody Red Stools </li></ul><ul><ul><li>Site of hemorrhage is in the colon or below </li></ul></ul><ul><ul><li>Copious hemorrhage higher may pass through undigested </li></ul></ul><ul><li>Occult Blood </li></ul><ul><ul><li>Small volume from any site in the alimentary tract </li></ul></ul>