nursing

1. PHYSICAL EXAMINATION

2. THE ABDOMEN
Techniques
Inspection
Palpation
Percussion
Auscultation
Equipments
Examining light
Stethoscope
Tape measure
Water soluble skin marking pencil

3. Four abdominal quadrants

4. Nine abdominal regions

5. Abdomen
• Inspect the abdomen for
– skin integrity
– Contour and symmetry and measure the abdominal girth
– Observe abdominal movements
– Observe vascular pattern
• Auscultate the abdomen for
– Bowel sounds
– Vascular sounds
– Peritoneal friction rub

6. Auscultation of the abdomen

7. Abdomen
• Percussion of the abdomen
– Use indirect percussion
– Start from the RLQ
– Normally there is generalized
tympany over the bowels.
• Percuss the liver to determine
its size.
– 6-12 cm in the midclavicular
line

8. Abdomen
• Palpation of the abdomen
– Perform light palpation to
detect areas of tenderness.
– Perform deep palpation to
asses masses and underlying
structures
• Palpate the liver to detect
enlargement and tenderness
• Palpation of the bladder

9. THE MUSCULOSKELETAL
SYSTEM
•Muscles
•Bones and
•Joints

10. MUSCLES
• Inspect the muscle for
– Size
– Contractures
– Tremors
• Palpate for muscles at rest to determine muscle tonicity
• Palpate muscles while the client is active for
– Flaccidity
– Spasticity and smoothness of movements
• Test muscle strength (compare the right side with the left side)

11. Grading of muscle strength

12. Bones and joints
BONES
• Inspect the skeleton for structure
• Palpate the bones to locate any areas of edema or tenderness
JOINTS
 Inspect the joint for swelling
 Palpate each joint for tenderness, smoothness of movement,
swelling, crepitation and nodules
 Assess joint Range of motion

13. THE NEUROLOGIC
SYSTEM

14. The neurological system
• Mental status
– Language
– Orientation (time, place and person)
– Memory (immediate, recent and remote memory)
– Attention span and calculation
• Level of consciousness (GCS scale )
• Cranial nerves
• Reflexes
• Motor and sensory function

16. Cranial nerves
I. Olfactory nerve
II. Optic nerve
III. Oculomotor nerve
IV. Trochlear nerve
V. Trigeminal nerve
VI. Abducens nerve
VII. Facial nerve
VIII.Vestibulocochlear nerve
IX. Glossopharyngeal nerve
X. Vagus nerve
XI. Accessory nerve
XII. Hypoglossal nerve

17. Cranial nerves

18. REFLEXES
Reflexes Spinal cord level
Biceps reflex C5C6
Triceps reflex C7C8
Brachioradialis reflex C5C6
Pattellar reflex L2 L3 L4
Achillis reflex S1s2
Plantar reflex Superficial reflex

19. REFLEXES
Biceps Triceps Brachioradialis
Pattellar Achillis Babinski

20. Motor function
• Walking gait
• Romberg test
• Standing on one foot with eye closed
• Heel toe walking
• Toe or heel walking
• Finger to nose test
• Alternating supination and pronation of hands on knees
• Finger to nose to the nurse’s finger
• Finger to fingers

21. Motor function
• Finger to thumb (same hand)
• Heel down opposite shin
• Toe or ball of foot to the nurse’s finger
• Light touch sensation
• Pain sensation
• Temperature sensation
• Position or kinesthetic sensation
• Tactile discrimination
• Extinction phenomenon

22. Genital and inguinal area
• Male
– Inspect the distribution ,amount and characteristics of pubic
hair
– Penis :
• Inspect the penile shaft & glands penis for lesions , nodules
swelling and inflammation
• Inspect the urethral meatus for swelling ,inflammation and
discharge
• Palpate the penis for tenderness ,thickening and nodules

23. • Male
– Scrotum:
• Inspect scrotum for appearance ,general size, and symmetry
• Palpate the scrotum to assess status of underlying testes, epidydimis
and spermatic cord.
– Inguinal area:
• Inspect both inguinal area for bulges
Genital and inguinal area

24. Genital and inguinal area
• Female
– Inspect the distribution , amount and characteristics of pubic
hair
– Insects parasites, inflammation, swelling and lesions .
– Inspect clitoris
– Palpate the inguinal lymph nodes

25. THE RECTUM AND ANUS
Techniques
Inspection
Palpation
Digital examination
Positions
Lithotomy
Left sims lithotomy
Dorsal recumbent

26. The rectum and anus
• Inspect the anus and surrounding tissue for color ,integrity
and skin lesions.
• Palpate the rectum for anal sphincter tonicity ,nodules,
masses and tenderness