Nursing health assessment, Eye assessment, ear assessment, GIT assessment, casdiovascular assessment, respiratory assessment, genatourinary system, and others

2. Anatomical ReviewAnatomical Review
2

3. Visual pathwayVisual pathway
light (object)→cornea→aqueous humor→lens→vitreous
body→ retina → optic nerve( CNII )→occipital lobe cortex

4. A nursing assessment of the Eye:
•Obtaining the patient’s health
history and performing a physical
examination.
•A complete nursing assessment is
conducted on admission.
•Provide privacy and comfortablity.

5. • As a nurse practitioner, it is vital that
you can take a history in a structured
format.
• As nurses we are used to assess,
plan, implement, evaluate approach
to health care especially of eye
problems.

6. • Patient's name; age, race, sex.
List the patient’s significant
medical problems.
• Name of informant (patient,
relative).

7. • Reason given by patient for
seeking medical care and the
duration of the symptom.
• List all of the patients medical
problems, concerning eye
problems.

8. oVision, last eye exam
oDifficulty with vision

9. Trauma; surgery; infections; DM; HTN

10. • Refractive errors; Cancers;
Color blindness; Cataracts;
Glaucoma; DM; HTN

11. •Alcohol, smoking, drug
usage, Marital status,
employment situation,
Level of education, vision,
and walking.

12. Examination of the EyesExamination of the Eyes
Assessment of External OcularAssessment of External Ocular
StructuresStructures
Assessment of Ocular MovementAssessment of Ocular Movement
Assessment of Visual AcuityAssessment of Visual Acuity
Assessment of Visual FieldAssessment of Visual Field

13. Assessment of External Ocular StructuresAssessment of External Ocular Structures
13
*Eyeballs:*Eyeballs: Position & alignment of
the eyes (e.g Exophthalmos)
*Eyebrows*Eyebrows: Hair distribution; skin;
alignment & movement

14. 14
*Eyelashes:*Eyelashes: symmetry; direction
of curl
*Eyelids:*Eyelids: surface; position in
relation to the cornea; blinking;
Edema (e.g; Periorbital edema)
Assessment of External Ocular StructuresAssessment of External Ocular Structures

15. 15
**Sclera (Bulbar Conjunctiva):Sclera (Bulbar Conjunctiva):
color; texture; lesions
*Palpebral conjunctiva :*Palpebral conjunctiva : color;
texture; lesions (e.g. Conjunctivitis)
Evert the upper lids if neededEvert the upper lids if needed
*Lacrimal sac & nasolacrimal*Lacrimal sac & nasolacrimal
ductduct (e.g tearing; edema, dryness)
Assessment of External Ocular StructuresAssessment of External Ocular Structures

16. 16
*Cornea:*Cornea: clarity; texture; corneal
sensitivity (Reflex) “5th
C.N”
*Pupils:*Pupils: color; shape; symmetry;
direct & consensual reaction to
light (3rd & 4th C.N)
Assessment of External Ocular StructuresAssessment of External Ocular Structures

17. Assessment of Ocular MovementAssessment of Ocular Movement
17
By assessing the six ocular movement

18. Assessment of Visual AcuityAssessment of Visual Acuity
18
Snellen Eye ChartSnellen Eye Chart
1. Keep area well lit.1. Keep area well lit.
2. Client stands 6 m2. Client stands 6 m (20 feet)(20 feet) fromfrom
chart.chart.
3. Test one eye at a time & then both3. Test one eye at a time & then both
eyes.eyes.
4. Read smallest line of print4. Read smallest line of print
possible.possible.

19. Snellen Eye ChartSnellen Eye Chart

20. Alterations on Visual AcuityAlterations on Visual Acuity
MyopiaMyopia (Nearsightedness): can’t see
objects far away
HyperopiaHyperopia (Farsightedness): can’t
see objects nearby
Presbyopia:Presbyopia: become farsighted as
age(with age, the eye exhibits a progressively diminished ability to focus on near
objects. )
Astigmatism:Astigmatism: uneven curvature of
the cornea blurred vision 20

21. Assessment of Visual FieldAssessment of Visual Field
21
The visual field is the entire
area seen by an eye when its gaze
is fixed on a central point. Visual
fields are limited by the eyebrows,
the cheeks & by the nose.
 To test visual fields by
confrontationconfrontation you need to face
the client directly

22. Assessment of Visual FieldAssessment of Visual Field
22
Face at about 60 cm with eyes
at the same level.
Test one eye at a time.
Slowly bring a pencil in from the
periphery into the field of vision.
Do this in eight different
directions.

23. Ophthalmoscope ExamOphthalmoscope Exam
Ophthalmoscope examination ofOphthalmoscope examination of
the eye isthe eye is notnot routinely requiredroutinely required
by nurses. Nevertheless; basicby nurses. Nevertheless; basic
information will be mentionedinformation will be mentioned
here.here.
23

24. Ophthalmoscope examOphthalmoscope exam
24
a. Red reflex
b. Optic fundus
c. Optic disk: Size; Shape; Color; Margins
d. Blood vessels
Arterioles Veins
Color Light red Dark purple
Size Small Large
Light reflex Bright Absent
Pulsations None Present

25. Ophthalmoscope examOphthalmoscope exam
25
e. Macula
f. Periphery
g. Vitreous/Lens
# Abnormalities:# Abnormalities: e.g. Papilledema;
Optic atrophy; Glaucoma;
Hypertension; Diabetic retinopathy;
Retinal hemorrhage…………..

28. Anatomical ReviewAnatomical Review
28

30. A nursing assessment of the Ear:
•Obtaining the patient’s health
history and performing a physical
examination.
•A complete nursing assessment is
conducted on admission.
•Provide privacy and comfortablity.

31. • As a nurse practitioner, it is vital that
you can take a history in a structured
format.
• As nurses we are used to assess,
plan, implement, evaluate approach
to health care especially of ear
problems.

32. • Patient's name; age, race, sex.
List the patient’s significant
medical problems.
• Name of informant (patient,
relative).

33. • Reason given by patient for
seeking medical care and the
duration of the symptom. List
all of the patients medical
problems, concerning ear
problems.

34. • Describe the course of the patient's
illness, including when it began,
character of the symptoms, location
where the symptoms began; aggravating
or alleviating factors; pertinent positives
and negatives.

35. • Past diseases, surgeries, hospitalizations;
medical problems; history of diabetes,
hypertension, asthma, myocardial
infarction, cancer, otitis media, trauma,
sinusitis.
• In children include birth history, prenatal
history, immunizations, and type of
feedings.

36. • Medical problems in family,
including the patient's
disorder; coronary artery
diseases, tuberculosis, allergic
rhinitis, asthma, ear infections.

37. •Alcohol, smoking, drug
usage, Marital status,
employment situation,
Level of education,
communication, hearing,
and talking.

38. • This should be targeted to the presenting
symptom and associated systems with ear
problems.
• Examination of the ear, is always necessary.
• This should be supplemented with
examination of the central nervous system if
vertigo or facial weakness is the presenting
symptom.

39. Diagram of the ear

40. Assessment of the External EarAssessment of the External Ear
InspectionInspection
Size & shape:Size & shape: symmetry, swelling ,
thickening
Skin condition:Skin condition: intact , lumps or
lesions
Tenderness:Tenderness: move the pinna & push
the tragus
The external auditory meatus:The external auditory meatus: size; 40

41. Common Disorders/External EarCommon Disorders/External Ear
Trauma:Trauma: Blows to the ear can cause
inflammation, hematoma &
conductive hearing loss.
Otitis Externa:Otitis Externa: inflamation of the
epithelium of the auricle & ear canal
(might be caused by bacteria or fungi)
Impacted wax & foreign bodiesImpacted wax & foreign bodies:
decrease hearing.. How to remove? 41

42. The Otoscopic ExaminationThe Otoscopic Examination
Otoscopic examination of theOtoscopic examination of the
ear isear is notnot routinely required byroutinely required by
nurses. Nevertheless; basicnurses. Nevertheless; basic
information will be mentionedinformation will be mentioned
here.here.
42

43. The Otoscopic ExaminationThe Otoscopic Examination
Using the Otoscope :
a. choose a suitable speculum
b. head toward the opposite shoulder
c. pull adult ear : pinna upper and back
 Pull infant & child ( <3 age ) pinna down
d. hold the otoscope : upside down
43

44. * Inspect the External Canal for:
redness; swelling; lesion; foreign
body ; discharge
* Inspect The Tympanic Membrane
for: color; character; perforation;
shiny ; translucent; pearl-gray
color
44
The Otoscopic ExaminationThe Otoscopic Examination

46. Tympanic MembraneTympanic Membrane
A normal tympanic membrane on the
left & a bulging red membrane with
amber bubbles above the fluid line as
seen in otitis media.
46

47. Assessment of Hearing AcuityAssessment of Hearing Acuity
I. Voice TestI. Voice Test (Whisper test)
Stand 30 ~ 60 cm to one side of the client
& has him occlude the opposite ear
Softly whisper numbers or words & ask the
client to repeat them
The sounds increase in volume until the
client is able to accurately hear them
 The opposite ear is then tested
If unable to hear whisper ⇒ high tone loss 47

48. II. Tuning fork testsII. Tuning fork tests
Tuning fork tests can differentiate
between conductive & sensorineural
hearing loses
A conductive hearing loss is due to
a problem in the outer or middle ear.
A sensorineural hearing loss is due to
disease of the inner ear or nerve
pathways. 48
Assessment of Hearing AcuityAssessment of Hearing Acuity

49. The most commonly used tests are the
Rinne test & the Weber’s test.
Both involve use of a metal instrument
that conducts sound.
In the Rinne test, the activated tuning
fork is held against the mastoid bone &
then outside of the ear canal. Normally,
the client reports hearing sound longer
through the ear canal (by air conduction).49
Assessment of Hearing Acuity/Assessment of Hearing Acuity/ II. Tuning fork testsII. Tuning fork tests

50. Assessment of Hearing Acuity/Assessment of Hearing Acuity/ II. Tuning fork testsII. Tuning fork tests
In the Weber’s test the activated
tuning fork is placed on the forehead
or midline of the skull. Normally,
sounds should be heard equally in
both ears.
Using these tests requires skill &
experience & they are not always
accurate. 50

53. Assessment of Hearing Acuity,Assessment of Hearing Acuity,
III. AudiometryIII. Audiometry
AudiometryAudiometry is a measurement of
hearing which helps determine the
type & degree of hearing loss. This
test is conducted by an audioloogist
who is also trained to fit hearing aids.
53

56. Health Assessment of the
Respiratory System

57. Anatomical ReviewAnatomical ReviewAnatomyoftheChestCavity
Left Lung
Pericardium
Intrapleural
space
Intrapleural
space
Right Lung
Trachea
Diaphragm
Mediastinum

58. History TakingHistory Taking
Chief Complaint:Chief Complaint:
■ What resulted in the patient seeking medical
attention?
■ What are the symptoms that caused the patient
to seek medical attention?
■ Are there any associated symptoms
(sweats/chills, fever, cough, etc.)?
■ Onset, duration, severity?

59. The respiratory symptoms

60. Present historyPresent history
 Detailed description of each symptom described in
the chief complaint.
 Farm exposure, homelessness, residence in a
nursing home, immigration from a foreign country.
 Smoking, leg pain or swelling (pulmonary
embolism), bronchitis, aspiration of food or foreign
body.

61. Past medical historyPast medical history
 COPD, heart failure, HIV risk factors
(pulmonary Kaposi’s sarcoma). Prior chest
Xrays, CT scans, tuberculin testing
 Medications: Anticoagulants, NSAIDs.

62. Family historyFamily history
 A family history of asthma, cystic fibrosis or
emphysema should be sought.
 A family history of infection with tuberculosis
is also important.
 DM, Hypertension, Renal Diseases, Cancer.

63. Social historySocial history
A smoking history should be routine,
Many respiratory conditions are chronic
and may interfere with the ability to
work.
Housing conditions
An inquiry about the patient's alcohol
consumption is important.

64. Occupational historyOccupational history
 The previous occupations of more
importance.
 It is most important to find out what the
patient actually does when at work, the
duration of any exposure, use of protective
devices and whether other workers have
become ill.

65. The respiratory examination
Positioning the patient
The patient should be undressed to the waist.
If he or she is not acutely ill, the examination is
easiest to perform with the patient sitting over
the edge of the bed or even on a chair.

66. General appearance
 It is important to look for the signs before
beginning the detailed examination.

67. The Four Parts of the Chest Exam
 Inspection
 Palpation
 Percussion
 Auscultation

68. Inspection
 Cyanotic?
 Finger clubbing?
– Caused by certain
lung disorders

69. Inspection
 How is the patient breathing?
– Rate, Rhythm, Effort
– Any abnormal sounds?
– What muscles are being used?
– Is there any chest deformity or asymmetry?

70. Tracheal Deviation

71. Palpation
 Palpate the ribs and
sternum for pain or
deformity
 Check for symmetry by
palpating lung
expansion

72. Palpation
 Tactile fremitus
– Have the patient say “ninety-nine” while palpating
the base of their lungs
– Use the ball of your hand
– Increased vibration indicates increased mucus
production

73. Percussion
 A technique for determining tissue density

75. Percussion
Posterior Anterior

76. Percussion
 Percussion Notes and Their Meaning
 Flat or Dull Pneumonia (dense)
 Normal Healthy Lung
 Hyperresonant Emphysema (trapped air)

78. Auscultation - Lungs
 Use the diaphragm of the stethoscope
 Compare one side to the other
Posterior Anterior

79. Auscultation - Lungs
 Abnormal Findings
– Decreased sounds – presence of air, as in
emphysema
– Crackles – sounds like rubbing hair between your
fingers – pneumonia
– Wheezes – such as in asthma
– Rhonchi – snoring or gurgling sound

80. Respiratory Investigations

82. Health Assessment of the
Cardiovascular System

83. Anatomical ReviewAnatomical Review

84. Assessment of CVS
Introduce yourself to the
patient and let them know
what you are about to do
…

85. History TakingHistory Taking
Chief Complaint:Chief Complaint:
■ Chest pain
The mention of chest pain by a patient tends to
take more urgent attention than other symptoms.
■ Onset, duration, severity?

86. The major symptoms
 Chest pain or heaviness
 Dyspnea
 Ankle swelling
 Palpitations
 Syncope
 Intermittent claudication
 Fatigue

87. Present historyPresent history
 Detailed description of each symptom
described in the chief complaint.
 Coronary artery disease risk factors:
1. Previous coronary disease
2. Smoking
3. Hypertension
4. Hyperlipidaemia
5. Family history of coronary artery disease
6. Diabetes mellitus
7. Obesity and physical inactivity
8. Male sex and advanced age

88. Past medical historyPast medical history
History of ischemic heart disease:
myocardial infarction, coronary artery
bypass grafting.
 Rheumatic fever, sexually transmitted
disease, recent dental work, thyroid
diseases.
 Prior medical examination revealing heart
disease (e.g. military, school, insurance)


89. Family historyFamily history
 Myocardial infarcts, cardiomyopathy, congenital
heart disease, mitral valve prolapse.
 Family history of coronary artery disease
 Diabetes mellitus
 Hypertension

90. Social historySocial history
Tobacco and alcohol use
 Occupation

91. Physical Examination
Suggested CVS Exam routine
General Inspection
Hands
Pulse
BP
Head & Neck
• JVP, Carotids, Anaeimia, Cyanosis
Praecordium
Auscultation

92. General Appearance
- Marfanoid features

93. - Central cyanosis

94. - Look at the neck for a goiter

95. Examine the radial pulse
- rhythm
- character
- volume
Pulse

96. Start with the nails and look
for clubbing
Increased Curvature
Loss of nail bed angle
Fluctuant nail Beds
Examine BOTH hands at
eye level
HandsHands

97. Feel for the carotid pulse for
character e.g., a slow rising pulse
in AS
Head & Neck: Carotid pulse

98.  Examine the eyes for : -
- Anaemia
- Thyroid eye disease
Exam: Face

99.  Examine the tongue for central cyanosis
Exam: Tongue

100. Exam: Praecordium
Look
For
Obvious
Deformity
Pigeon Chest Funnel Chest

101. Bell
Exam: Auscultation
Low pitched murmurs eg. Mitral Stenosis

102. Exam: Auscultation
Diaphragm
Normal / High pitched murmurs.
Use for general purpose auscultation

103. Exam: Auscultation

104. Investigations: CXR
Name Marker

105. Investigations: CXR
Cardiac
Silhouette
Lung
Fields

106. Investigations
Echocardiography

107. Investigations: ECG

108. Investigations: ECG
Normal ECG

109. Investigations
- Cardiac Enzyme
- Lipid profile

110. Health Assessment of the Abdomen

111. Anatomical review

112. History TakingHistory Taking
Chief Complaint:Chief Complaint:
■ Abdominal pain
■ Onset, duration, severity?

113. The major symptoms
 Pain.
 Indigestion.
 Intestinal gas.
 Nausea and vomiting.
 Hematemesis.
 Changes in bowel habits.

114. Present historyPresent history
 Duration of symptom, pattern of progression; exact
location at onset and at present.
 Effect of eating, vomiting, defecation, flatus,
urination, inspiration, movement, position on the
pain. Timing and characteristics of last bowel
movement.

115. Past medical historyPast medical history
History of abdominal surgery
(appendectomy, cholecystectomy), hernias,
gallstones; coronary disease, kidney stones;
alcoholism, cirrhosis, peptic ulcer,
dyspepsia. Endoscopies, X-rays, upper GI
series.

116. Family historyFamily history
 Does anyone in your family have liver,
gallbladder, or pancreatic disease or alcoholism
cancer, heart disease, or bleeding tendencies.?
 Some GI problems such as colon cancer are
thought to be hereditary.

117. Diet historyDiet history
Has your appetite or weight changed?
Have you experienced nausea and
vomiting?
Ask the patient about any abnormal
weight loss or unexpected weight.

118. The Abdominal Exam
 Inspection
 Auscultation
 Percussion
 Palpation

119. The Quadrants of the Abdomen
Right
Upper
Quadrant
Right
Lower
Quadrant
Left
Upper
Quadrant
Left
Lower
Quadrant

120. Inspection
 Are there any:
– Scars
– Rashes/lesions
– Pulsations
 What is the contour?
– Flat/protruding

121. Auscultation
 Use the diaphragm to listen to:
– Bowel sounds (increased, decreased, absent?)
– Arterial pulses

122. Percussion
 Percuss for areas of unusual dullness
 This may be a sign of an abdominal mass
 Percuss the area over the liver to check for
enlargement

123. Palpation
 Light and deep palpation of the abdomen
 Check for:
– Tenderness
– Abdominal masses

124. Liver Palpation

125. Special Tests
 Rebound tenderness
– Press deeply into the abdomen and release
quickly
– A painful response is a sign of peritoneal
inflammation

126. Special Tests
 Shifting Dullness
– Percuss for areas of dullness
– Have the patient roll to one side
– If the dullness shifts this is a sign of excess fluid

127. Special Tests
 Psoas Sign
– Have patient flex their hip against resistance
 Obturator Sign
– Rotated leg internally at the hip
 Pain in either case denotes appendicitis

128. Special measurements
 Height,
 Weight,
 Body Mass Index

129. Investigations
 Abdominal Ultrasound
 CT- Abdomen or MRI
 X-rays of abdomen
 Upper GI Endoscopy
 Lower GI Endoscopy
 Gastric Analysis
 Stool Analysis
 Stool Culture

130. Neurological Assessment

131. Anatomical ReviewAnatomical Review

132. Anatomical ReviewAnatomical Review

133. History TakingHistory Taking
Chief Complaint:Chief Complaint:
■ The patient should be allowed to describe the
symptoms in his or her own words to begin with

134. Present historyPresent history
 The neurological history begins in detail with the
presenting problem

135. Past medical historyPast medical history
 History of meningitis or encephalitis, head or
spinal injuries, a history of epilepsy or
convulsions and any previous operations.
 Any past history of sexually transmitted
disease (e.g. risk factors for HIV infection or
syphilis) should be obtained.
 Treatment with anticonvulsants, the
contraceptive pill, antihypertensive agents,
steroids, anticoagulants,

136. Family historyFamily history
 Any history of neurological or mental disease
among his or her family should be
documented.

137. Social historySocial history
As smoking predisposes to
cerebrovascular disease, the smoking
history is relevant.
It is useful to ask about occupation and
exposure to toxins (e.g. heavy metals).
Alcohol can also result in a number of
neurological diseases

138. Neurologic Examination
1.Mental Status
2.Cranial Nerves
3.Motor
4.Reflexes
5.Sensory

139. 1- Mental Status
 AVPU
 Alert
 Verbal – respond to voice?
 Pain – respond to pain?
 Unconscious – no response

140. Glasgow Coma Scale
• The total possible score on the GCS ranges from 3 to 15.
• A score of less than 7 indicates a comatose patient
• A score of 15 indicates the patient is fully alert and oriented.
• A score of 13 or 14 indicates mild head injury
• A score of 9 to 12 indicates moderate injury,

141. 2- Cranial Nerves
 12 Cranial Nerves

142. Cranial Nerves

143. I - Olfactory Nerve
 Not normally tested

144. II - Optic Nerve
 Acuity
 Visual Fields
 Pupillary Reactions

145. III, IV, & VI – Oculomotor, Trochlear &
Abducens Nerve
 Test eye movements

146. V - Trigeminal Nerve
 Three Divisions – Test
Each For:
– Muscle Strength
 Jaw & Temple
– Pain Sensation
 Test Corneal Reflex
– Use a cotton wisp
– Normal = blinking

147. VII – Facial Nerve
 Facial asymmetry?
 Test the following
movements
– Raising eyebrows
– Smiling
– Showing your teeth
– Puffing your cheeks

148. VIII – Auditory Nerve
 Hearing test

149. X – Vagus (IX – Glossopharyngeal)
 Ask Pt. to Swallow
 Say “Ah”
 Test Gag Reflex

150. XI – Accessory
 Have pt. turn their head
 Have pt. shrug their
shoulders

151. XII - Hypoglossal
 Ask pt. to protrude
tongue
 Move tongue from side
to side

152. 3- Motor Exam
 Check for:
– Symmetry
– Atrophy
– Strength
– Tone

153. 4- Deep Tendon Reflexes
 Biceps
 Triceps
 Brachioradialis
 Abdominal
 Knee
 Ankle
Diminished reflexes can indicate the presence of a lesion

154. Babinski Reflex
Indicator of severe central nervous system damage

155. 5- Sensory
 By dermatomes test:
– Pain
– Temperature
– Light touch
– Vibration
 Test each side with pt’s eyes closed

156. Neurological investigations
 X-Ray
 Computed Tomography (CT) Scan
 Magnetic Resonance Imaging (MRI)
 Lumbar Puncture
 Angiogram
 Electroencephalogram (EEG)

157. Health Assessment of the
Genitourinary System

158. Anatomical ReviewAnatomical Review

159. Anatomical ReviewAnatomical Review

160. Anatomical ReviewAnatomical Review

161. History TakingHistory Taking
Chief Complaint (Chief Complaint (subjective)
■ The nature, onset, extent, and duration of the
problem and associated complaints.

162. The major symptoms
Associated symptoms: fever, chills,
weight loss, nausea, vomiting.
Lower Urinary Tract Symptoms (LUTS):
frequency, dysuria, oliguria, anuria,
urgency, intermittency, decreased force or
caliber of stream, prolonged voiding, post-
void dribble, incomplete emptying.

163. The major GU problems
 Incontinence
 Dysmenorrhea
 Infection: urethral discharge (colour, amount,
smell), sexual history, UTIs, external genital skin
lesions, lymphadenopathy.
 Others: renal calculi, infertility, erectile
dysfunction, congenital disorders,
hematospermia, trauma.

164. Present historyPresent history
 Detailed description of each symptom described in
the chief complaint.
 For instance; Pain: location, onset, quality (colicky,
burning), severity, radiation,

165. Past medical historyPast medical history
 (Overflow), history of neurological problems, past
pregnancies and method of delivery, past
abdominal-pelvic operations
 Is there a history of urinary tract infections (UTIs)?
 DM, HTN, Allergies, hospitalized for a UTI?
 What diagnostic tests were performed before?
Cystoscopy?

166. Family historyFamily history
 Family history of urological disease,
 Family history of pelvic/perineal diseases
 Is there any family history of renal disease?

167. Occupational historyOccupational history
 What are the patient's present and past
occupations?
 Look for occupational hazards related to the
urinary tract contact with chemicals, plastics,
rubber.

168. Social historySocial history
A smoking history
Environmental Sanitation
Housing conditions

169. Sexual History:Sexual History:
 Is patiet sexually active?
 Does he or she use protection against
infection?
 Method of birth control?
 Any concern with or history of STDs?

170. The Physical Examination (Objective)

171. General appearance
 It is important to look for the signs before
beginning the detailed examination.
 Signs of dehydration, septic appearance.
Note whether the patient appears ill or well.

172. Vital Signs
 Blood pressure
 Respiratory rate
 Heart rate
 Body temperature

173. Parts of the GU Examination
 Inspection
 Palpation
 Percussion

174. Inspection
 Abdomen: masses, scars from previous
operations, suprapubic distension,
 Edema of skin, hair distribution
 Penis: circumcision (if not circumcised retract
foreskin).
 Epispadias, hypospadias, urethral discharge
(colour, Consistency), superficial ulcers or
vesicles, genital warts.

175. Inspection
 Scrotum: testicular atrophy, testicular
asymmetry, dilated veins (varicocele) on
standing, scrotal erythema, edema, cysts.
 Assessment of color, clarity, and specific
gravity of the urine

176. Palpation
 Abdomen: masses, suprapubic tenderness,
auscultate upper abdominal quadrants for
systolic bruits (renal artery stenosis/aneurysm),
 Inguinal lymphadenopathy
 Penis: penile masses, penile tenderness.

177. Palpation
 Scrotum: tenderness, masses (size,
consistency, location, mobility, shape),
 Hernia, hydrocele, spermatocele, spermatic
cord (varicocele, fusiform enlargement,
thickening of the cord), absence of vas
deferens.

178. Percussion
 Percussion of the flanks for costovertebral
angle tenderness

179. Investigations
 Renal Function Test (RFT): S. Creatinine, Blood Urea
 Radiological: KUP X-ray, CT, MRI
 Ultrasound
 Intravenous Urogram (IVU)
 Prostate-Specific Antigen (PSA)
 Urine analysis
 Urine culture
 S. Electrolytes (S.Na, S.K, S.ca,….)
 Cystoscopy

180. Thanks