Physical Assessment Flashcards
Inspect
Palpitation
Percussion
Auscultation
Unless GI auscultation first
Head, neck and lymph
Inspect head and facial features for size, shape and symmetry
Inspect for thyroidmegaly
Evaluate thyroid and palpate and auscultation
Assess carotid pulses
Say- head is normocephalic, round, midline upright and still, facial features are symmetrical, bilaterally no tics or tremors. Fine blond vellus hair over face. Skin tanned without lesions or masses no neck fullness trachea midline thyroid and cartilage moves with swallowing thyroid smooth without masses
Palpate- Pre auricular, parotid, tonsillar, submanidbular, submental, anterior cervical, posterior cervical, post auricular, occipital, supraclavucular, axillary, and epitroclear are non tender and non palpable bilaterally
Carotid pulses are regular rare and rhythm 2/4, bilaterally no bruits noted
Eyes
Inspect eyelids, eyeball, conjunctiva, iris, pupil, lens, sclera, lacrimal apparatus
Say- eyelids are symmetric eyebrows and eye lashes evenly distributed, eyeballs firm, conjunctiva clear, iris green, lens clear, sclera white, lactimal apparatus soft free of redness or exudate bilaterally
PERRLA pupils 3mm
Opthalmascope evaluation
Direct and consensual
Corneal light-direct light at nasal bridge 12 inches have pt look at nearby object
Cover and uncover- patient stare ahead at near and fixed object cover one eye and observe the other then remove the cover, observer uncovered and repeat on other eye
Six cardinal fields
Eye chart and how to use
Ears
Inspect position
Palpate external ears and mastoid process
Otoscope eval for canal and TM whisper test
Say- pinna in alignment with eye canthus bilaterally, pinna and lobes non tender bilateral, no nodules or erythema, mastoids non tender without inflammation or masses bilaterally canals without erythema or cerumen, TM pearly gray, bony landmarks intact no bulging or retraction right cone of light at 5 o clock left cone of light at 7 o clock, no perforations bilaterally
Whisper test
Nose, mouth, throat sinuses
Nose- external nose, midline, and Patent bilaterally nasal mucosa pink and moist without lesions, edema, polyps, or redness. Septum intact, maxillary and frontal sinuses nontender bilaterally, maxillary trans illumination without occlusion.
Mouth and throat -lips, pink and moist gums and buccal pink without masses lesions or fissures. 32 pearly white teeth no dental carry is no appliances, tongue, dull, red, moist appropriate size for mouth and was symmetric movement. Mucosa, pink and moist posterior cobblestone. Uvula midline and moves up when patient says ah tonsils plus one bilaterally no redness or exudate
Chest
Skin on chest is smooth, warm and dry, without lesions or swelling chest elliptical without deviations AP to transverse diameter one to two ratio even chest movements equal bilaterally, respirations 12 per minute, even and unlabored all breast sounds clear to occultation without adventagious breathe sounds bilaterally
Inspect chest landmarks and symmetry respiration rate and pattern and movement
Tactile fremitus- great variability
Percuss anterior posterior and lateral chest space resonance expected
Auscultate breath sounds and verbalized findings
Cardiac
No pulsation, heaves, thrust or thrills
Ape to man
Apical right 2nd intercostal space right sternal border, note S1S2
Pulmonic left in intercostal space let sternal border, S2 greater than S1
Erbs point- third intercostal space on the left sternal border S two equals S1
Tricuspid - 4th intercostal space on the left lower sternal border, S one is greater than S2
Mitral -5th intercostal space left midclavicular S1 greater than S2
Note apical pulse of normal heart rate regular rate and rhythm without splitting murmurous gallop or rubs
Verbalized difference between ball and diaphragm-bell is for low pitch sounds diagram is for high pitch
Verbalize heart sounds that should be assessed in three position, sitting laying and left recumbent
Blood vessel
Temporal brachial radial Potier posterior tibia dorsalis pedis
+2 bilaterally regular rate and rhythm
Skin
Inspect skin surface thoroughly during exam for color and integrity
Describe lesions according to characteristics
Palpate skin for turgor on forearm
Inspect nails for base angle, and for color, length, symmetry, and cyanosis
Palpate nails for capillary refill
Hair
Inspect hair color, distribution, and quality of hair, hair loss, scarring or inflammation, palpate scale and hair
Neurological
Cranial nerves 1-12
1-ability to identify smells
2-near and distance vision (also done in eye)
3, 4,6 extra ocular movement (also done in eye)
5-trigeminal inspect for facial atrophy, tremors, palpate jaw for tone, clench teeth, pain sensation on face
7-smile, frown, puff cheeks, wrinkle forehead
8-hearing (done with ears)
9-sour and butter on tongue; gag reflux, swallowing
10-say ah
11-spinal accessory shrug shoulders against pressure
12-inspect tongue protrude, L, T, D, N
Coordination
rapid alternating rhythmic movement- flip hands in knee
finger to nose sensory
upper and lower superficial touch and vibration
DTR in biceps, triceps, brachioradialis, patellar, Achilles, plantar
Abdomen
Inspect abdomen for contour, color, symmetry, surface motion and venous pattern
Auscultate bowel sounds in all four quadrants
Percuss all four quadrants and epigastric, liver, spleen
CVA tenderness
Palpate and verbalize light and deep all four quadrants
MSK
inspect gait and posture
Perform scoliosis screen
Evaluate active and passive ROM on ankle, cervical spine, shoulders and wrist
