Question

Discuss the purpose and at the same time demonstrate how you perform physical examination of head, face, eyes, ears, nose, mouth, throat, neck vessel, breast, regional lymphatics, thorax and lungs, heart, abdomen, and peripheral vascular system in order. Your discussion should includes the reason why we perform physical exam in each system or what abnormalities do we have to assess during physical examination of those systems.

Answer 1

answer

Normal findings of physical examination:

Assessment	Findings
Integumentary
· Skin	When skin is pinched it goes to previous state immediately (2 seconds). With fair complexion. With dry skin
· Hair	Evenly distributed hair. With short, black and shiny hair. With presence of pediculosis Capitis.
· Nails	Smooth and has intact epidermis With short and clean fingernails and toenails. Convex and with good capillary refill time of 2 seconds.
Skull	Rounded, normocephalic and symmetrical, smooth and has uniform consistency.Absence of nodules or masses.
Face	Symmetrical facial movement, palpebral fissures equal in size, symmetric nasolabial folds.
Eyes and Vision
· Eyebrows	Hair evenly distributed with skin intact. Eyebrows are symmetrically aligned and have equal movement.
· Eyelashes	Equally distributed and curled slightly outward.
· Eyelids	Skin intact with no discharges and no discoloration. Lids close symmetrically and blinks involuntary.
· Bulbar conjunctiva	Transparent with capillaries slightly visible
· Palpebral Conjunctiva	Shiny, smooth, pink
· Sclera	Appears white.
· Lacrimal gland, Lacrimal sac, Nasolacrimal duct	No edema or tenderness over the lacrimal gland and no tearing.
Cornea
· Clarity and texture	Transparent, smooth and shiny upon inspection by the use of a penlight which is held in an oblique angle of the eye and moving the light slowly across the eye. Has [brown] eyes.
· Corneal sensitivity	Blinks when the cornea is touched through a cotton wisp from the back of the client.
Pupils	Black, equal in size with consensual and direct reaction, pupils equally rounded and reactive to light and accommodation, pupils constrict when looking at near objects, dilates at far objects, converge when object is moved toward the nose at four inches distance and by using penlight.
Visual Fields	When looking straight ahead, the client can see objects at the periphery which is done by having the client sit directly facing the nurse at a distance of 2-3 feet. The right eye is covered with a card and asked to look directly at the student nurse’s nose. Hold penlight in the periphery and ask the client when the moving object is spotted.
Visual Acuity	Able to identify letter/read in the newsprints at a distance of fourteen inches. Patient was able to read the newsprint at a distance of 8 inches.
Ear and Hearing
· Auricles	Color of the auricles is same as facial skin, symmetrical, auricle is aligned with the outer canthus of the eye, mobile, firm, non-tender, and pinna recoils after it is being folded.
· External Ear Canal	Without impacted cerumen.
· Hearing Acuity Test	Voice sound audible.
· Watch Tick Test	Able to hear ticking on right ear at a distance of one inch and was able to hear the ticking on the left ear at the same distance
Nose and sinuses
· External Nose	Symmetric and straight, no flaring, uniform in color, air moves freely as the clients breathes through the nares.
· Nasal Cavity	Mucosa is pink, no lesions and nasal septum intact and in middle with no tenderness.
Mouth and Oropharynx	Symmetrical, pale lips, brown gums and able to purse lips.
· Teeth	With dental caries and decayed lower molars
· Tongue and floor of the mouth	Central position, pink but with whitish coating which is normal, with veins prominent in the floor of the mouth.
· Tongue movement	Moves when asked to move without difficulty and without tenderness upon palpation.
Uvula	Positioned midline of soft palate.
Gag Reflex	Present which is elicited through the use of a tongue depressor.
Neck	Positioned at the midline without tenderness and flexes easily. No masses palpated.
Head movement	Coordinated, smooth movement with no discomfort, head laterally flexes, head laterally rotates and hyperextends.
Muscle strength	With equal strength
Lymph Nodes	Non-palpable, non tender
· Thyroid Gland	Not visible on inspection, glands ascend but not visible in female during swallowing and visible in males.
Thorax and lungs
Posterior thorax	Chest symmetrical
· Spinal alignment	Spine vertically aligned, spinal column is straight, left and right shoulders and hips are at the same height.
Breath Sounds	With normal breath sounds without dyspnea.
· Anterior Thorax	Quiet, rhythmic and effortless respiration
Abdomen	Unblemished skin, uniform in color, symmetric contour, not distended.
Abdominal movements	Symmetrical movements cause by respirations.
· Auscultation of bowel sounds	With audible sounds of 23 bowel sounds/minute.
Upper Extremities	Without scars and lesions on both extremities.
Lower Extremities	With minimal scars on lower extremities
Muscles	Equal in size both sides of the body, smooth coordinated movements, 100% of normal full movement against gravity and full resistance.
Bones and Joints	No deformities or swelling, joints move smoothly.
Mental Status
Language	Can express oneself by speech or sign.
Orientation	Oriented to a person, place, date or time.
Attention span	Able to concentrate as evidence by answering the questions appropriately.
Level of Consciousness	A total of 15 points indicative of complete orientation and alertness.
Motor Function
Gross Motor and Balance
· Walking gait	Has upright posture and steady gait with opposing arm swing unaided and maintaining balance.
Standing on one foot with eyes closed	Maintained stance for at least five (5) seconds.
Heel toe walking	Maintains a heel toe walking along a straight line
Toe or heel walking	Able to walk several steps in toes/heels.
Fine motor test for Upper Extremities
Finger to nose test	Repeatedly and rhythmically touches the nose.
Alternating supination and pronation of hands on knees	Can alternately supinate and pronate hands at rapid pace.
Finger to nose and to the nurse’s finger	Perform with coordinating and rapidity.
Fingers to fingers	Perform with accuracy and rapidity.
Fingers to thumb	Rapidly touches each finger to thumb with each hand.
Fine motor test for the Lower Extremities
Pain sensation	Able to discriminate between sharp and dull sensation when touched with needle and cotton.

physical examination to rule out any abnormalities

In a physical examination, there are many things that your healthcare provider can find out by using their hands to feel (palpate), stethoscope and ears to listen, and eyes to see.

Findings that are present on the physical examination may by themselves diagnose, or be helpful to diagnose, many diseases. The components of a physical examination include:

Inspection

Certain findings on "inspection" may alert the healthcare provider to focus other parts of the physical examination on certain areas of your body. For example, the legs may be swollen. the healthcare provider will then pay special attention to the common things that cause leg swelling, such as extra fluid caused by your heart, and use this information to help them make a diagnosis. Common areas that are inspected may include:

• skin - to look for bruising, cuts, moles or lumps
• face and eyes - to see if they are even and "normal"
• neck veins - to see if these are bulging, distended (swollen)
• chest and abdomen (stomach area)- to see if there are any masses, or bulges
• legs - to see if there are any swelling
• muscles- to check for good muscle tone
• elbows and joints - check for swelling and inflammation, if any deformities are present

Palpation

The examiner uses their hands to feel for abnormalities during a health assessment.

Things that are commonly palpated during an examination include your lymph nodes, chest wall (to see if your heart is beating harder than normal), and your abdomen.

He or she will use palpation to see if there are any masses or lumps, anywhere in your body.

Percussion

This is when the examiner uses their hands to "tap" on an area of your body. The "tapping" produces different sounds. Depending on the kind of sounds that are produced over your abdomen, on your back or chest wall, your healthcare provider may determine anything from fluid in your lungs, or a mass in your stomach. This will provide further clues to a possible diagnosis.

Auscultation

This is an important physical examination technique used by your healthcare provider, where he or she will listen to your heart, lungs, neck or abdomen, to identify if any problems are present. Auscultation is often performed by using a stethoscope. The stethoscope will amplify sounds heard in the area that is being listened to. If there is an abnormal finding on your examination, further testing may be suggested.

• The neck: When your doctor or healthcare provider is listening to your neck, they are often listening for a "swishing" sound in your arteries. This may suggest that there is a narrowing of the arteries, which would increase the sound of blood flow.
• The Heart: Normally, your heart produces a "lub-dub" sound, when the heart valves are opening and closing during the flow of blood. Your healthcare provider will listen to see if your heart is beating regularly, or if there are any murmurs (extra sounds with every heart beat). Heart murmurs may be "innocent", meaning they are normal, and non-life threatening, or they may signify a problem may be present. To diagnose this, your healthcare provider may listen with their stethoscope to many areas around the heart, instead of just one area, and suggest further testing, if necessary.
• The Lungs: Your doctor or healthcare provider may listen to your lungs with their stethoscope, anywhere on your back (posterior), or on the front of your chest wall (anterior). He or she may be able to tell if air is moving to the bottom of your lungs, by listening to the airflow in and out of your lungs with each breath. These are called normal lung sounds. If there is a blockage, constriction or narrowing of your lung tubes, or fluid in your lungs, this can be heard by the examiner.
• The Abdomen: The abdomen will be examined using a stethoscope, to listen for any "swishing" sounds of blood through the arteries near your stomach (such as the aorta), or abnormal bowel sounds.
• Other locations: Auscultation may be used anywhere your healthcare provider wants to listen

The Neurologic Examination:

• During a physical examination by the health care professional, a neurologic examination may be performed. This can be very brief or more detailed depending on concerns and findings.   In general the physical examination is divided into 4 parts; cranial nerve assessment, motor function assessment, sensory function assessment, and assessment of reflexes.
• Cranial nerve assessment: There are 12 cranial nerves and these arise from the brain. Each nerve has its own function and the assessment of the nerves is done by evaluating each function. For example, testing the gag reflex with the tongue depressor is testing the 9th and 10th cranial nerves.
• Motor function assessment is checking a person's gait, muscle strength and coordination. The test where a person is asked to touch their nose then the finger of the examiner, with eyes open then with eyes closed is an example of how coordination may be evaluated.
• Sensory function assessment is checking sensations such as pain, temperature, position sense, crude and fine touch along certain pathways. A test that may used to evaluate this is asking the person to close their eyes and then using a wisp of cotton, ask the person if they can feel the cotton brushed on the skin.
• During a physical examination, testing reflexes helps to assess the status of the central nervous system, this indicates whether the pathway from the spinal cord to the area stimulated and back is intact. The briskness of response is evaluated.