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PHYSICAL ASSESSMENT
BODY PARTS       TECH-NIQUE    NORMAL             ACTUAL FINDINGS   ANALYSIS
                               FINDINGS

Skin             Inspection,   -light to dark     -
                 Palpation     brown & feels
                               warm

                               -no swelling,




                               -smooth and soft
                 Inspection,
Hair and Scalp
                               -color black

                               -properly
                 Inspection
Nails                          distributed

                               -no presence of
                               parasites (lice)

                               -fine texture
-no masses

                                 -round nail with
                                 160degrees nail
                                 base

                                 -pink nail bed

Head                Inspection   -face is
                                 symmetrical,
                                 centered-head
                                 position

                                  -smooth and
                                 controlled
Neck                Inspection
                                 movements

Eyes                Inspection   -blinking
                                 symmetrical,
                                 involuntary &
                                 approximately 15
                                 blinks/min
•      Eye brows
                                 -evenly
                                 distributed
•      Eye lashes
                                 -eye lashes are
                                 short

•      Eye lids                  -eye lid margins
                                 moist & pink
-pupil is equally
                        round and
Pupil •
                        reactivated to
                        light
                        accommodation



                        -uniform in color




Iris •
                        -transparent,
                        smooth, moist




Ears      Palpation ,   -Ears of equal size
          Inspection    & similar
                        appearance
-Skin in the
                         external ear is
                         smooth and color
                         pink

Nose        Inspection   -color is same as
                         face

                         -symmetrical
                         appearance

                         -no redness in
                         the nasal mucosa



Mouth       Inspection
            Palpation
                         -pink in color

Lips •                   -dry

                         -smooth, moist
                         with no lesions
•  Buccal
mucosa                   -moist with no
                         lesions
Tongue •
                         -pink and moist

                          -no dental
Gums •                   carries
-32 complete no.
                               of teeth
                Inspection

Teeth




Thoracic & Lungs Inspection    -position of
                               sternum is level
                Palpation,
                               with ribs
                Auscultation
                               -no masses

                               -lungs clear upon
                               auscultation

Breast          Inspection     -smooth skin
                               surface
                Palpation
                               -flat areola

                               -no masses

Heart           Palpation,     -PMI is felt upon
                Inspection     pulsation

                               -Rhythm: regular

Upper           Palpation,     -bilateral pulses
Extremities (right Inspection    strong & equal
and left)                        (radial pulse)

                                 -mobile

                                 -intact condition
                                 of the skin in
                                 arms

                                 -no lesions, no
                                 swelling

Abdomen           Inspection,    -no rashes or
                                 lesions
                  Auscultation
                                 -umbilicus is
                  Percussion
                                 centrally located
                  Palpation
                                 -rounded
                                 abdomen

                                 -symmetrical

                                 -high pitched,
                                 irregular gurgles
                                 5-35times/min

                                 -abdomen rises
                                 with inspiration
                                 in synchrony with
                                 chest
Genitourinary                   (The patient
                                refused to assess
                                his genitourinary
                                organs.)



Lower              Inspection   -bilaterally
Extremities                     symmetrical and
                                equal
(right and left)
                                -right foot has no
                                lesions, no swelling

                                -left foot has no
                                lesions, no swelling

                                -skin color is the
                                same as the other
                                part of the body
Physical assessment

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Physical assessment

  • 1. PHYSICAL ASSESSMENT BODY PARTS TECH-NIQUE NORMAL ACTUAL FINDINGS ANALYSIS FINDINGS Skin Inspection, -light to dark - Palpation brown & feels warm -no swelling, -smooth and soft Inspection, Hair and Scalp -color black -properly Inspection Nails distributed -no presence of parasites (lice) -fine texture
  • 2. -no masses -round nail with 160degrees nail base -pink nail bed Head Inspection -face is symmetrical, centered-head position -smooth and controlled Neck Inspection movements Eyes Inspection -blinking symmetrical, involuntary & approximately 15 blinks/min • Eye brows -evenly distributed • Eye lashes -eye lashes are short • Eye lids -eye lid margins moist & pink
  • 3. -pupil is equally round and Pupil • reactivated to light accommodation -uniform in color Iris • -transparent, smooth, moist Ears Palpation , -Ears of equal size Inspection & similar appearance
  • 4. -Skin in the external ear is smooth and color pink Nose Inspection -color is same as face -symmetrical appearance -no redness in the nasal mucosa Mouth Inspection Palpation -pink in color Lips • -dry -smooth, moist with no lesions • Buccal mucosa -moist with no lesions Tongue • -pink and moist -no dental Gums • carries
  • 5. -32 complete no. of teeth Inspection Teeth Thoracic & Lungs Inspection -position of sternum is level Palpation, with ribs Auscultation -no masses -lungs clear upon auscultation Breast Inspection -smooth skin surface Palpation -flat areola -no masses Heart Palpation, -PMI is felt upon Inspection pulsation -Rhythm: regular Upper Palpation, -bilateral pulses
  • 6. Extremities (right Inspection strong & equal and left) (radial pulse) -mobile -intact condition of the skin in arms -no lesions, no swelling Abdomen Inspection, -no rashes or lesions Auscultation -umbilicus is Percussion centrally located Palpation -rounded abdomen -symmetrical -high pitched, irregular gurgles 5-35times/min -abdomen rises with inspiration in synchrony with chest
  • 7. Genitourinary (The patient refused to assess his genitourinary organs.) Lower Inspection -bilaterally Extremities symmetrical and equal (right and left) -right foot has no lesions, no swelling -left foot has no lesions, no swelling -skin color is the same as the other part of the body