Physical Assessment (Mother)

Vital Signs: Part I

Temperature: Respiratory Rate:

Pulse Rate: Blood Pressure:

Body Part General Survey Body built, height and weight in relation to the clients age, lifestyle and health Posture, gait, standing, sitting and walking Overall hygiene and grooming Body and breath odor

Actual Finding Not proportionate

Norms & Standards Proportionate, varies with lifestyle

Analysis Not normal

the client is relaxed, erect posture; movements are coordinated She is clean and neat. No body odor or minor body odor relative to work or exercise; no breath odor No signs of distress healthy. The client is cooperative The clients moods is appropriate to situation Clients quality of speech is understandable, moderate pace; exhibits thought association Logical sequence; makes sense; has sense of reality Her skin is light brown

Relaxed, erect posture; coordinated movement Clean, neat No body odor or minor body odor relative to work or exercise; no breath odor No distress noted Healthy appearance Cooperative Appropriate to situation Understandable, moderate pace; exhibits thought association

Normal

Normal Normal

Signs of distress, in posture of facial expression Obvious signs of health or illness Attitude Affect/mood: appropriateness of response Quantity and quality of speech

Normal Normal Normal Normal Normal

Relevance and organization of thoughts Intergumentary A. Skin Color: uniformity of color

Logical sequence; makes sense; has sense of reality

Normal

Varies from light to deep brown; from ruddy pink to light; from yellow overtones

Normal

Presence of edema Lesions according to location, distribution, color, configuration, size, shape, type or structure Skin moisture Skin temperature Skin turgor

No edema There are no lesions or abrasions .

to olive. Generally uniform except in areas exposed to the sun; areas of lighter pigmentation in dark- skinned people No edema Normal Freckles, some birthmarks, Normal some flat and raised nevi; no abrasions or other lesions

She has moisturized skin she has uniform skin temperature within normal range. The clients skin springs back to previous state when pinched. The clients nails are convex curvature The clients nail is highly vascular and pink. Smooth texture Intact epidermis

Moisture in skin folds and the Not Normal axillae Uniform; within normal Normal range When pinched, skin springs back to previous state Normal

B. Nails Fingernail plate shape, curvature and angle Fingernail and toenail bed color

Convex curvature; angle of nail plate about 160 degrees Highly vascular and pink in light-skinned clients; darkskinned clients may have brown or black pigmentation in longitudinal streaks Smooth texture Intact epidermis

Normal Normal

Fingernail and toenail texture Tissues surrounding nails Blanch test of capillary refill Head A. Skull Size, shape and symmetry

Normal Normal Normal

Prompt return of pink Prompt return of pink or or usual color(pink) usual color (generally less than four seconds)

The clients skull is normocephalic and symmetrical; smooth skull contour. Smooth, uniform consistency; absence of nodules and

Nodules, masses, depressions

Rounded normocephalic and Normal symmetrical, with frontal, parietal, and occipital prominences); smooth skull contour Smooth, uniform consistency; Normal absence of nodules and masses

masses B. Scalp Color and appearance Areas of tenderness C. Hair Evenness of growth, thickness or thinness Texture and oiliness over the scalp D. Face Facial features, symmetry of facial movements White and no lesions, abrasions and other foreign substance. No areas of tenderness. Evenly distributed hair; thick hair Silk, resilient hair Symmetric facial features; symmetric nasolabial folds White and no lesions, abrasions and other foreign substance. No areas of tenderness Evenly distributed hair; thick hair Silky, resilient hair Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial folds Normal Normal Normal Normal Normal

Eyes A. Eyebrows Hair distribution, alignment, skin and quality of movement B. Eyelashes Hair distribution and direction of curl C. Eyelids Surface characteristics, position and relation to the cornea, ability to blink, and frequency of blinking

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement Equally distributed; curled slightly outward Skin intact; no discharge; no discoloration; lids close symmetrically; approximately 15-20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement

Normal

Equally distributed; curled slightly outward

Normal

Skin intact; no discharge; no Normal discoloration; lids close symmetrically; approximately 15 to 20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

D. Conjunctiva

Color, texture and presence of lesions of the bulbar conjunctiva Color, texture and presence of lesions of the palpebral conjunctiva E. Sclera Color and clarity F. Cornea Clarity and texture G. Iris Shape and color H. Pupils Color, shape, symmetry of size

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in darkskinned clients) Shiny, smooth, and pink or red

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in dark- skinned clients) Shiny, smooth, and pink or red

Normal

Normal

Clients sclera is white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round Able to read Not performed Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose

Sclera appears white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round

normal Normal

Normal Normal

I. Visual Acuity Near vision Distance vision J. Pupils Light reaction and accommodation

Able to read newsprint 20/20 vision on Snellen chart Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose Normal

K. Lacrimal gland, lacrimal sac, and nasolacrimal duct Inspection and palpation of the lacrimal gland L. Extraocular Muscles Alignment and

No edema or tenderness over lacrimal gland Both eyes

No edema or tenderness over lacrimal gland

Normal

Both eyes coordinated, move

Normal

coordination M. Visual fields Peripheral fields

coordinated, move in unison, with parallel alignment

in unison, with parallel alignment Normal

When looking When looking straight ahead, straight ahead, client client can see objects on the can see objects on the periphery periphery

Ears A. Auricles Color, symmetry and position

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye Mobile, firm and not tender; pinna recoils after it is folded Distal third contains hair follicles and glands

Texture, elasticity and areas for tenderness B. External ear canal Inspection of ear canal for cerumen, skin lesions, pus and blood C. Hearing acuity test Response to normal voice tones Watch tick test Webers test Rinnes test Nose Shape, size, or color and flaring or discharge from nares Presence of redness, swelling, growths and discharge of nasal cavities Nasal septum between nasal chambers Patency of both

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye, about 10 degrees from vertical Mobile, firm and not tender; pinna recoils after it is folded

Normal

Normal

Distal third contains hair follicles and glands; dry cerumen, grayish-tan color; or sticky, wet cerumen in various shades of brown Normal voice tones audible Able to hear ticking sound on both ears

Normal

Normal voice tones audible Able to hear ticking sound in both ears Not performed Not performed Symmetric and straight; No discharge; uniform color Symmetric and straight; No discharge or; uniform color Nasal septum intact and on midline Air moves freely as

Normal Normal

Symmetric and straight; No discharge or flaring; uniform color Symmetric and straight; No discharge or flaring; uniform color Nasal septum intact and on the midline Air moves freely as the client

Normal

Normal

Normal Normal

nasal cavities Tenderness, masses displacements of bone and cartilage Sinuses Tenderness Mouth A. Lips Symmetry of contour, color and texture B. Buccal Mucosa Color, moisture, texture, and presence of lesions C. Teeth Color, number and condition and presence of dentures D. Gums Color and condition E. Tongue/floor of the mouth Color and texture of the mouth floor and frenulum Position, color and texture, movement and base of the tongue Nodules, lumps or excoriated areas F. Palpates and uvula Color, shape, texture and the presence of the

the client breathes through the nares Not tender; no lesions

breathes through the nares Not tender; no lesions Normal

No tenderness

No tenderness

Normal

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips.

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips. Normal

Uniform pink color; Uniform pink color; moist, moist, smooth, soft, smooth, soft, glistening, and glistening, and elastic elastic texture texture 32 adult teeth 32 adult teeth; smooth, white shiny tooth enamel; smooth, intact dentures Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base with prominent veins Smooth with no palpable nodules; no lesions; no tenderness

Normal

Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base Smooth with no palpable nodules; no lesions; no tenderness Light pink, smooth, soft palate; lighter pink hard palate,

Normal

Normal Normal

Normal

Light pink, smooth, soft palate; lighter pink hard palate, more irregular texture

Normal

bony prominences Position of the uvula and mobility while examining the palates G. Oropharynx and tonsils Color and texture Size of tonsils, color and discharge Neck and Lymph nodes A. Lymph nodes Location of lymph nodes and tenderness B. Trachea Placement C. Thyroid gland Symmetry and visible masses Smoothness and areas of enlargement, masses or nodules

more irregular texture Positioned on midline of soft palate

Positioned is on midline of soft palate

Normal

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Normal Normal

Not palpable

Not palpable

Normal

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Normal

Normal Normal

A. Posterior Thorax 75. size, shape, symmetry and diameter of anteroposterior thorax to transverse diameter

Anteroposterior to transverse diameter in ratio is about1:2; chest symmetric

Anteroposterior to Normal transverse diameter in ratio 1:2; chest symmetric Spine vertically aligned Uniform temperature; no tenderness; no masses Normal Normal

Spine vertically 76. spinal alignment aligned 77. temperature, Uniform tenderness and temperature; no masses tenderness; no

78. respiratory excursion

79. vocal fremitus

80. percussion of posterior thorax

81. auscultation of posterior thorax B. Anterior Thorax 82. breathing patterns 83. temperature, tenderness and masses 84. respiratory excursion 85. vocal fremitus

masses Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Normal

Normal

Normal

Normal

Normal Normal

Normal

Normal

86. percussion of anterior thorax

Normal

over the heart and the liver, and tympanic over the underline stomach 87. auscultation of trachea 88. auscultation of anterior thorax Cardiovascular 89. aortic and pulmonic areas 90. tricuspid areas 91. apical area (local point of maximal impulse) Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations No pulsations; no lift or heave

over the heart and the liver, and tympanic over the underline stomach Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations Normal

Normal

No pulsations; no lift Normal or heave Pulsations visible in Normal 50% of adults and palpable in most PMI in 5th LICS at or medial to MCL; diameter of 1 to 2 cm; no lift or heave S1; Usualy heard at all sites; usually louder at apical area S2; Usualy heard at all sites; usually louder at the base of the heart. Systole: silent interval; slightly shorter duration than diastole at normal heart rate(60 to 90 bpm) Diastole; Silent interval; slightly longer duration than systole at normal heart rates S3 in children and young adults S4 in many older adults Symmetric pulse Normal

92. auscultation of aortic, pulmonic, tricuspid and apical valves

S1 and S2

A. Carotid arteries 93. carotid artery

Symmetric pulse

Normal

94. auscultation of carotid arteries B. Jugular veins 95. jugular veins C. Breast and Axillae 96. size, symmetry, contour, or shape 97. localized discoloration or hyperpigmentation, retraction, dimpling, localized hypervascular areas, swelling, or edema 98. size, shape, symmetry, color surface characteristics, mass or lesions of areola 99. size, shape, position, color, discharge, and lesions of nipple

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible Rounded shape, slightly unequal in size; generally symmetric Skin uniform in color ( same in appearance as skin of abdomen or back)

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible

Normal Normal Normal

Rounded shape, Normal slightly unequal in size; generally symmetric Skin uniform in color Normal ( same in appearance as skin of abdomen or back)

100. axillary, subclavicular and supraclavicular

Round or oval and bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breast- feeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes

Round or oval and Normal bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and Normal equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breastfeeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes Normal

lymph nodes 101. masses, tenderness 102. tenderness and discharges of nipples Abdomen 103. skin integrity

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

Normal Normal

Normal

104. abdominal contour 105. enlarge spleen or liver 106. symmetry of contour 107. abdominal movements associated with respirations, peristalsis, or aortic pulsations 108. vascular patterns 109. bowel sounds, vascular sounds, and peritoneal friction rubs 110. percussion of areas in four quadrants

Normal Normal Normal Normal

Normal Normal

Normal

111. light and deep palpation of four quadrants

Normal

and over sigmoid colon Musculoskeletal System A. Muscles 112. size, comparison on both sides (arm, thigh, calf) 113. muscles and tendons for contractures (shortening) 114. fasciculations and tremors 115. muscle tonicity B. Bones 119. structure and deformities 120. locate areas of edema or tenderness C. Joints 121. swelling 122. tenderness, smoothness of movement, swelling, erepitation, and presence of nodule

and over sigmoid colon

Equal size on both sides of the body No contractures

Equal size on both sides of the body No contractures

Normal

Normal

No fasciculations or tremors Normally firm No deformities No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

No fasciculation and tremors Normally firm No deformities No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

Normal Normal Normal Normal Normal Normal

Physical Assessment (Father)

Vital Signs: Part I

Temperature: Respiratory Rate:

Pulse Rate: Blood Pressure:

Body Part General Survey Body built, height and weight in relation to the clients age, lifestyle and health Posture, gait, standing, sitting and walking Overall hygiene and grooming Body and breath odor

Actual Finding Proportionate

Norms & Standards Proportionate, varies with lifestyle

Analysis normal

the client is relaxed, erect posture; movements are coordinated She is clean and neat. No body odor or minor body odor relative to work or exercise; no breath odor No signs of distress healthy. The client is cooperative The clients moods is appropriate to situation Clients quality of speech is understandable, moderate pace; exhibits thought association Logical sequence; makes sense; has sense of reality Her skin is light brown

Relaxed, erect posture; coordinated movement Clean, neat No body odor or minor body odor relative to work or exercise; no breath odor No distress noted Healthy appearance Cooperative Appropriate to situation Understandable, moderate pace; exhibits thought association

Normal

Normal Normal

Signs of distress, in posture of facial expression Obvious signs of health or illness Attitude Affect/mood: appropriateness of response Quantity and quality of speech

Normal Normal Normal Normal Normal

Relevance and organization of thoughts Intergumentary A. Skin Color: uniformity of color

Logical sequence; makes sense; has sense of reality

Normal

Varies from light to deep brown; from ruddy pink to light; from yellow overtones

Normal

Presence of edema Lesions according to location, distribution, color, configuration, size, shape, type or structure Skin moisture Skin temperature Skin turgor

No edema There are no lesions or abrasions .

to olive. Generally uniform except in areas exposed to the sun; areas of lighter pigmentation in dark- skinned people No edema Normal Freckles, some birthmarks, Normal some flat and raised nevi; no abrasions or other lesions

She has moisturized skin she has uniform skin temperature within normal range. The clients skin springs back to previous state when pinched. The clients nails are convex curvature The clients nail is highly vascular and pink. Smooth texture Intact epidermis

Moisture in skin folds and the Not Normal axillae Uniform; within normal Normal range When pinched, skin springs back to previous state Normal

B. Nails Fingernail plate shape, curvature and angle Fingernail and toenail bed color

Convex curvature; angle of nail plate about 160 degrees Highly vascular and pink in light-skinned clients; darkskinned clients may have brown or black pigmentation in longitudinal streaks Smooth texture Intact epidermis

Normal Normal

Fingernail and toenail texture Tissues surrounding nails Blanch test of capillary refill Head A. Skull Size, shape and symmetry

Normal Normal Normal

Prompt return of pink Prompt return of pink or or usual color(pink) usual color (generally less than four seconds)

The clients skull is normocephalic and symmetrical; smooth skull contour. Smooth, uniform consistency; absence of nodules and

Nodules, masses, depressions

Rounded normocephalic and Normal symmetrical, with frontal, parietal, and occipital prominences); smooth skull contour Smooth, uniform consistency; Normal absence of nodules and masses

masses B. Scalp Color and appearance Areas of tenderness C. Hair Evenness of growth, thickness or thinness Texture and oiliness over the scalp D. Face Facial features, symmetry of facial movements White and no lesions, abrasions and other foreign substance. No areas of tenderness. Evenly distributed hair; thick hair Silk, resilient hair Symmetric facial features; symmetric nasolabial folds White and no lesions, abrasions and other foreign substance. No areas of tenderness Evenly distributed hair; thick hair Silky, resilient hair Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial folds Normal Normal Normal Normal Normal

Eyes A. Eyebrows Hair distribution, alignment, skin and quality of movement B. Eyelashes Hair distribution and direction of curl C. Eyelids Surface characteristics, position and relation to the cornea, ability to blink, and frequency of blinking

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement Equally distributed; curled slightly outward Skin intact; no discharge; no discoloration; lids close symmetrically; approximately 15-20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement

Normal

Equally distributed; curled slightly outward

Normal

Skin intact; no discharge; no Normal discoloration; lids close symmetrically; approximately 15 to 20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

D. Conjunctiva

Color, texture and presence of lesions of the bulbar conjunctiva Color, texture and presence of lesions of the palpebral conjunctiva E. Sclera Color and clarity F. Cornea Clarity and texture G. Iris Shape and color H. Pupils Color, shape, symmetry of size

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in darkskinned clients) Shiny, smooth, and pink or red

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in dark- skinned clients) Shiny, smooth, and pink or red

Normal

Normal

Clients sclera is white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round Able to read Not performed Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose

Sclera appears white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round

normal Normal

Normal Normal

I. Visual Acuity Near vision Distance vision J. Pupils Light reaction and accommodation

Able to read newsprint 20/20 vision on Snellen chart Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose Normal

K. Lacrimal gland, lacrimal sac, and nasolacrimal duct Inspection and palpation of the lacrimal gland L. Extraocular Muscles Alignment and

No edema or tenderness over lacrimal gland Both eyes

No edema or tenderness over lacrimal gland

Normal

Both eyes coordinated, move

Normal

coordination M. Visual fields Peripheral fields

coordinated, move in unison, with parallel alignment

in unison, with parallel alignment Normal

When looking When looking straight ahead, straight ahead, client client can see objects on the can see objects on the periphery periphery

Ears A. Auricles Color, symmetry and position

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye Mobile, firm and not tender; pinna recoils after it is folded Distal third contains hair follicles and glands

Texture, elasticity and areas for tenderness B. External ear canal Inspection of ear canal for cerumen, skin lesions, pus and blood C. Hearing acuity test Response to normal voice tones Watch tick test Webers test Rinnes test Nose Shape, size, or color and flaring or discharge from nares Presence of redness, swelling, growths and discharge of nasal cavities Nasal septum between nasal chambers Patency of both

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye, about 10 degrees from vertical Mobile, firm and not tender; pinna recoils after it is folded

Normal

Normal

Distal third contains hair follicles and glands; dry cerumen, grayish-tan color; or sticky, wet cerumen in various shades of brown Normal voice tones audible Able to hear ticking sound on both ears

Normal

Normal voice tones audible Able to hear ticking sound in both ears Not performed Not performed Symmetric and straight; No discharge; uniform color Symmetric and straight; No discharge or; uniform color Nasal septum intact and on midline Air moves freely as

Normal Normal

Symmetric and straight; No discharge or flaring; uniform color Symmetric and straight; No discharge or flaring; uniform color Nasal septum intact and on the midline Air moves freely as the client

Normal

Normal

Normal Normal

nasal cavities Tenderness, masses displacements of bone and cartilage Sinuses Tenderness Mouth A. Lips Symmetry of contour, color and texture B. Buccal Mucosa Color, moisture, texture, and presence of lesions C. Teeth Color, number and condition and presence of dentures D. Gums Color and condition E. Tongue/floor of the mouth Color and texture of the mouth floor and frenulum Position, color and texture, movement and base of the tongue Nodules, lumps or excoriated areas F. Palpates and uvula Color, shape, texture and the presence of the

the client breathes through the nares Not tender; no lesions

breathes through the nares Not tender; no lesions Normal

No tenderness

No tenderness

Normal

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips.

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips. Normal

Uniform pink color; Uniform pink color; moist, moist, smooth, soft, smooth, soft, glistening, and glistening, and elastic elastic texture texture 32 adult teeth 32 adult teeth; smooth, white shiny tooth enamel; smooth, intact dentures Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base with prominent veins Smooth with no palpable nodules; no lesions; no tenderness

Normal

Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base Smooth with no palpable nodules; no lesions; no tenderness Light pink, smooth, soft palate; lighter pink hard palate,

Normal

Normal Normal

Normal

Light pink, smooth, soft palate; lighter pink hard palate, more irregular texture

Normal

bony prominences Position of the uvula and mobility while examining the palates G. Oropharynx and tonsils Color and texture Size of tonsils, color and discharge Neck and Lymph nodes A. Lymph nodes Location of lymph nodes and tenderness B. Trachea Placement C. Thyroid gland Symmetry and visible masses Smoothness and areas of enlargement, masses or nodules

more irregular texture Positioned on midline of soft palate

Positioned is on midline of soft palate

Normal

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Normal Normal

Not palpable

Not palpable

Normal

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Normal

Normal Normal

A. Posterior Thorax 75. size, shape, symmetry and diameter of anteroposterior thorax to transverse diameter

Anteroposterior to transverse diameter in ratio is about1:2; chest symmetric

Anteroposterior to Normal transverse diameter in ratio 1:2; chest symmetric Spine vertically aligned Uniform temperature; no tenderness; no masses Normal Normal

Spine vertically 76. spinal alignment aligned 77. temperature, Uniform tenderness and temperature; no masses tenderness; no

78. respiratory excursion

79. vocal fremitus

80. percussion of posterior thorax

81. auscultation of posterior thorax B. Anterior Thorax 82. breathing patterns 83. temperature, tenderness and masses 84. respiratory excursion 85. vocal fremitus

masses Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Normal

Normal

Normal

Normal

Normal Normal

Normal

Normal

86. percussion of anterior thorax

Normal

over the heart and the liver, and tympanic over the underline stomach 87. auscultation of trachea 88. auscultation of anterior thorax Cardiovascular 89. aortic and pulmonic areas 90. tricuspid areas 91. apical area (local point of maximal impulse) Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations No pulsations; no lift or heave

over the heart and the liver, and tympanic over the underline stomach Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations Normal

Normal

No pulsations; no lift Normal or heave Pulsations visible in Normal 50% of adults and palpable in most PMI in 5th LICS at or medial to MCL; diameter of 1 to 2 cm; no lift or heave S1; Usualy heard at all sites; usually louder at apical area S2; Usualy heard at all sites; usually louder at the base of the heart. Systole: silent interval; slightly shorter duration than diastole at normal heart rate(60 to 90 bpm) Diastole; Silent interval; slightly longer duration than systole at normal heart rates S3 in children and young adults S4 in many older adults Symmetric pulse Normal

92. auscultation of aortic, pulmonic, tricuspid and apical valves

S1 and S2

A. Carotid arteries 93. carotid artery

Symmetric pulse

Normal

94. auscultation of carotid arteries B. Jugular veins 95. jugular veins C. Breast and Axillae 96. size, symmetry, contour, or shape 97. localized discoloration or hyperpigmentation, retraction, dimpling, localized hypervascular areas, swelling, or edema 98. size, shape, symmetry, color surface characteristics, mass or lesions of areola 99. size, shape, position, color, discharge, and lesions of nipple

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible Rounded shape, slightly unequal in size; generally symmetric Skin uniform in color ( same in appearance as skin of abdomen or back)

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible

Normal Normal Normal

Rounded shape, Normal slightly unequal in size; generally symmetric Skin uniform in color Normal ( same in appearance as skin of abdomen or back)

100. axillary, subclavicular and supraclavicular

Round or oval and bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breast- feeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes

Round or oval and Normal bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and Normal equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breastfeeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes Normal

lymph nodes 101. masses, tenderness 102. tenderness and discharges of nipples Abdomen 103. skin integrity

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

Normal Normal

Normal

104. abdominal contour 105. enlarge spleen or liver 106. symmetry of contour 107. abdominal movements associated with respirations, peristalsis, or aortic pulsations 108. vascular patterns 109. bowel sounds, vascular sounds, and peritoneal friction rubs 110. percussion of areas in four quadrants

Normal Normal Normal Normal

Normal Normal

Normal

111. light and deep palpation of four quadrants

Normal

and over sigmoid colon Musculoskeletal System A. Muscles 112. size, comparison on both sides (arm, thigh, calf) 113. muscles and tendons for contractures (shortening) 114. fasciculations and tremors 115. muscle tonicity B. Bones 119. structure and deformities 120. locate areas of edema or tenderness C. Joints 121. swelling 122. tenderness, smoothness of movement, swelling, erepitation, and presence of nodule

and over sigmoid colon

Equal size on both sides of the body No contractures

Equal size on both sides of the body No contractures

Normal

Normal

No fasciculations or tremors Normally firm with deformities, cannot be flexed No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

No fasciculation and tremors Normally firm No deformities No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

Normal Normal Not normal Normal Normal Normal

Physical Assessment (Baby)

Vital Signs: Part I

Temperature: Respiratory Rate:

Pulse Rate: Blood Pressure:

Body Part General Survey Body built, height and weight in relation to the clients age, lifestyle and health Posture, gait, standing, sitting and walking Overall hygiene and grooming Body and breath odor

Actual Finding Proportionate

Norms & Standards Proportionate, varies with lifestyle

Analysis normal

the client is relaxed, erect posture; movements are coordinated She is clean and neat. No body odor or minor body odor relative to work or exercise; no breath odor No signs of distress healthy. The client is cooperative The clients moods is appropriate to situation Clients quality of speech is understandable, moderate pace; exhibits thought association Logical sequence; makes sense; has sense of reality Her skin is light brown, with scars of mosquito bites

Relaxed, erect posture; coordinated movement Clean, neat No body odor or minor body odor relative to work or exercise; no breath odor No distress noted Healthy appearance Cooperative Appropriate to situation Understandable, moderate pace; exhibits thought association

Normal

Normal Normal

Signs of distress, in posture of facial expression Obvious signs of health or illness Attitude Affect/mood: appropriateness of response Quantity and quality of speech

Normal Normal Normal Normal Normal

Relevance and organization of thoughts Intergumentary A. Skin Color: uniformity of color

Logical sequence; makes sense; has sense of reality

Normal

Varies from light to deep brown; from ruddy pink to light; from yellow overtones

Not Normal

Presence of edema Lesions according to location, distribution, color, configuration, size, shape, type or structure Skin moisture Skin temperature Skin turgor

No edema There are no lesions or abrasions .

to olive. Generally uniform except in areas exposed to the sun; areas of lighter pigmentation in dark- skinned people No edema Normal Freckles, some birthmarks, Normal some flat and raised nevi; no abrasions or other lesions

She has moisturized skin she has uniform skin temperature within normal range. The clients skin springs back to previous state when pinched. The clients nails are convex curvature The clients nail is highly vascular and pink. Smooth texture Intact epidermis

Moisture in skin folds and the Not Normal axillae Uniform; within normal Normal range When pinched, skin springs back to previous state Normal

B. Nails Fingernail plate shape, curvature and angle Fingernail and toenail bed color

Convex curvature; angle of nail plate about 160 degrees Highly vascular and pink in light-skinned clients; darkskinned clients may have brown or black pigmentation in longitudinal streaks Smooth texture Intact epidermis

Normal Normal

Fingernail and toenail texture Tissues surrounding nails Blanch test of capillary refill Head A. Skull Size, shape and symmetry

Normal Normal Normal

Prompt return of pink Prompt return of pink or or usual color(pink) usual color (generally less than four seconds)

The clients skull is normocephalic and symmetrical; smooth skull contour. Smooth, uniform consistency; absence of nodules and

Nodules, masses, depressions

Rounded normocephalic and Normal symmetrical, with frontal, parietal, and occipital prominences); smooth skull contour Smooth, uniform consistency; Normal absence of nodules and masses

masses B. Scalp Color and appearance Areas of tenderness C. Hair Evenness of growth, thickness or thinness Texture and oiliness over the scalp D. Face Facial features, symmetry of facial movements White and no lesions, abrasions and other foreign substance. No areas of tenderness. Evenly distributed hair; thick hair Silk, resilient hair Symmetric facial features; symmetric nasolabial folds White and no lesions, abrasions and other foreign substance. No areas of tenderness Evenly distributed hair; thick hair Silky, resilient hair Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial folds Normal Normal Normal Normal Normal

Eyes A. Eyebrows Hair distribution, alignment, skin and quality of movement B. Eyelashes Hair distribution and direction of curl C. Eyelids Surface characteristics, position and relation to the cornea, ability to blink, and frequency of blinking

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement Equally distributed; curled slightly outward Skin intact; no discharge; no discoloration; lids close symmetrically; approximately 15-20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement

Normal

Equally distributed; curled slightly outward

Normal

Skin intact; no discharge; no Normal discoloration; lids close symmetrically; approximately 15 to 20 involuntary blinks per minute; bilateral blinking; when lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered

D. Conjunctiva

Color, texture and presence of lesions of the bulbar conjunctiva Color, texture and presence of lesions of the palpebral conjunctiva E. Sclera Color and clarity F. Cornea Clarity and texture G. Iris Shape and color H. Pupils Color, shape, symmetry of size

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in darkskinned clients) Shiny, smooth, and pink or red

Transparent; capillaries sometimes evident; sclera appears white ( yellowish in dark- skinned clients) Shiny, smooth, and pink or red

Normal

Normal

Clients sclera is white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round Able to read Not performed Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose

Sclera appears white. Transparent, shiny, and smooth; details of the iris are visible Flat and round Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round

normal Normal

Normal Normal

I. Visual Acuity Near vision Distance vision J. Pupils Light reaction and accommodation

Able to read newsprint 20/20 vision on Snellen chart Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is move toward nose Normal

K. Lacrimal gland, lacrimal sac, and nasolacrimal duct Inspection and palpation of the lacrimal gland L. Extraocular Muscles Alignment and

No edema or tenderness over lacrimal gland Both eyes

No edema or tenderness over lacrimal gland

Normal

Both eyes coordinated, move

Normal

coordination M. Visual fields Peripheral fields

coordinated, move in unison, with parallel alignment

in unison, with parallel alignment Normal

When looking When looking straight ahead, straight ahead, client client can see objects on the can see objects on the periphery periphery

Ears A. Auricles Color, symmetry and position

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye Mobile, firm and not tender; pinna recoils after it is folded Distal third contains hair follicles and glands

Texture, elasticity and areas for tenderness B. External ear canal Inspection of ear canal for cerumen, skin lesions, pus and blood C. Hearing acuity test Response to normal voice tones Watch tick test Webers test Rinnes test Nose Shape, size, or color and flaring or discharge from nares Presence of redness, swelling, growths and discharge of nasal cavities Nasal septum between nasal chambers Patency of both

Color same as facial skin; symmetrical; auricle aligned with outer canthus of eye, about 10 degrees from vertical Mobile, firm and not tender; pinna recoils after it is folded

Normal

Normal

Distal third contains hair follicles and glands; dry cerumen, grayish-tan color; or sticky, wet cerumen in various shades of brown Normal voice tones audible Able to hear ticking sound on both ears

Normal

Normal voice tones audible Able to hear ticking sound in both ears Not performed Not performed Symmetric and straight; No discharge; uniform color Symmetric and straight; No discharge or; uniform color Nasal septum intact and on midline Air moves freely as

Normal Normal

Symmetric and straight; No discharge or flaring; uniform color Symmetric and straight; No discharge or flaring; uniform color Nasal septum intact and on the midline Air moves freely as the client

Normal

Normal

Normal Normal

nasal cavities Tenderness, masses displacements of bone and cartilage Sinuses Tenderness Mouth A. Lips Symmetry of contour, color and texture B. Buccal Mucosa Color, moisture, texture, and presence of lesions C. Teeth Color, number and condition and presence of dentures D. Gums Color and condition E. Tongue/floor of the mouth Color and texture of the mouth floor and frenulum Position, color and texture, movement and base of the tongue Nodules, lumps or excoriated areas F. Palpates and uvula Color, shape, texture and the presence of the

the client breathes through the nares Not tender; no lesions

breathes through the nares Not tender; no lesions Normal

No tenderness

No tenderness

Normal

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips.

Uniform pink color; soft, moist, smooth texture; symmetry of contour; ability to purse lips. Normal

Uniform pink color; Uniform pink color; moist, moist, smooth, soft, smooth, soft, glistening, and glistening, and elastic elastic texture texture 32 adult teeth 32 adult teeth; smooth, white shiny tooth enamel; smooth, intact dentures Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base with prominent veins Smooth with no palpable nodules; no lesions; no tenderness

Normal

Pink gums; moist, firm texture to gums; no retraction of gums Pink color; smooth Central position; smooth tongue base Smooth with no palpable nodules; no lesions; no tenderness Light pink, smooth, soft palate; lighter pink hard palate,

Normal

Normal Normal

Normal

Light pink, smooth, soft palate; lighter pink hard palate, more irregular texture

Normal

bony prominences Position of the uvula and mobility while examining the palates G. Oropharynx and tonsils Color and texture Size of tonsils, color and discharge Neck and Lymph nodes A. Lymph nodes Location of lymph nodes and tenderness B. Trachea Placement C. Thyroid gland Symmetry and visible masses Smoothness and areas of enlargement, masses or nodules

more irregular texture Positioned on midline of soft palate

Positioned is on midline of soft palate

Normal

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Pink and smooth posterior wall Pink and smooth; no discharge; of normal size

Normal Normal

Not palpable

Not palpable

Normal

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Central placement on midline of neck; spaces are equal No visible on inspection Lobes may not be palpated; if palpated, lobes are small, smooth, centrally located, painless and the rise are freely with swallowing

Normal

Normal Normal

A. Posterior Thorax 75. size, shape, symmetry and diameter of anteroposterior thorax to transverse diameter

Anteroposterior to transverse diameter in ratio is about1:2; chest symmetric

Anteroposterior to Normal transverse diameter in ratio 1:2; chest symmetric Spine vertically aligned Uniform temperature; no tenderness; no masses Normal Normal

Spine vertically 76. spinal alignment aligned 77. temperature, Uniform tenderness and temperature; no masses tenderness; no

78. respiratory excursion

79. vocal fremitus

80. percussion of posterior thorax

81. auscultation of posterior thorax B. Anterior Thorax 82. breathing patterns 83. temperature, tenderness and masses 84. respiratory excursion 85. vocal fremitus

masses Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Full and symmetric when client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separates 3 to 5 cm during deep inspiration Bilateral symmetry of vocal fremitus; fremitus is heard most clearly at the apex of the lungs Percussion notes resonate, except over scapula; lowest point of resonance is at the diaphragm Vesicular and bronchovesicular breath sounds Quiet, rhythmic, and effortless respirations Uniform temperature; no tenderness; no masses Full symmetric excursion; thumbs normally separate 3 to 5 cm Same as posterior vocal fremitus; fremitus is normally decreased over heart and breast tissue Percussion notes resonates down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas

Normal

Normal

Normal

Normal

Normal Normal

Normal

Normal

86. percussion of anterior thorax

Normal

over the heart and the liver, and tympanic over the underline stomach 87. auscultation of trachea 88. auscultation of anterior thorax Cardiovascular 89. aortic and pulmonic areas 90. tricuspid areas 91. apical area (local point of maximal impulse) Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations No pulsations; no lift or heave

over the heart and the liver, and tympanic over the underline stomach Bronchial and tubular breath sounds Bronchovesicular and vesicular breath sounds No pulsations Normal

Normal

No pulsations; no lift Normal or heave Pulsations visible in Normal 50% of adults and palpable in most PMI in 5th LICS at or medial to MCL; diameter of 1 to 2 cm; no lift or heave S1; Usualy heard at all sites; usually louder at apical area S2; Usualy heard at all sites; usually louder at the base of the heart. Systole: silent interval; slightly shorter duration than diastole at normal heart rate(60 to 90 bpm) Diastole; Silent interval; slightly longer duration than systole at normal heart rates S3 in children and young adults S4 in many older adults Symmetric pulse Normal

92. auscultation of aortic, pulmonic, tricuspid and apical valves

S1 and S2

A. Carotid arteries 93. carotid artery

Symmetric pulse

Normal

94. auscultation of carotid arteries B. Jugular veins 95. jugular veins C. Breast and Axillae 96. size, symmetry, contour, or shape 97. localized discoloration or hyperpigmentation, retraction, dimpling, localized hypervascular areas, swelling, or edema 98. size, shape, symmetry, color surface characteristics, mass or lesions of areola 99. size, shape, position, color, discharge, and lesions of nipple

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible Rounded shape, slightly unequal in size; generally symmetric Skin uniform in color ( same in appearance as skin of abdomen or back)

volumes; full pulsations, thrusting quality; Quality remains same when client breathes, turns heads, and changes from sitting to supine position; elastic arterial wall No sound heard on auscultation Veins not visible

Normal Normal Normal

Rounded shape, Normal slightly unequal in size; generally symmetric Skin uniform in color Normal ( same in appearance as skin of abdomen or back)

100. axillary, subclavicular and supraclavicular

Round or oval and bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breast- feeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes

Round or oval and Normal bilaterally the same; Irregular placement of sebaceous glands on the surface of the areola Round, everted, and Normal equal in size; similar in color; soft and smooth; both nipples point in the same direction; no discharge except from pregnant or breastfeeding females; inversion of one or both nipples that is present from puberty No palpable lymph nodes Normal

lymph nodes 101. masses, tenderness 102. tenderness and discharges of nipples Abdomen 103. skin integrity

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

No tenderness, masses or nodules No tenderness, masses, nodules or nipple discharge Unblemished skin; uniform color; silverwhite striae or surgical scars Flat, rounded (convex), or scaphoid (concave) No evidence of enlargement of liver or spleen Symmetric contour Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area No visible vascular pattern Audible bowel sounds; absence of arterial bruits, absence of friction rub Tympany over the stomach and gasfiled bowel; dullness, especially over the liver and spleen, or a full bladder No tenderness; relaxed abdomen with smooth, consistent tension Tenderness maybe present near xiphoid process, over cecum,

Normal Normal

Normal

104. abdominal contour 105. enlarge spleen or liver 106. symmetry of contour 107. abdominal movements associated with respirations, peristalsis, or aortic pulsations 108. vascular patterns 109. bowel sounds, vascular sounds, and peritoneal friction rubs 110. percussion of areas in four quadrants

Normal Normal Normal Normal

Normal Normal

Normal

111. light and deep palpation of four quadrants

Normal

and over sigmoid colon Musculoskeletal System A. Muscles 112. size, comparison on both sides (arm, thigh, calf) 113. muscles and tendons for contractures (shortening) 114. fasciculations and tremors 115. muscle tonicity B. Bones 119. structure and deformities 120. locate areas of edema or tenderness C. Joints 121. swelling 122. tenderness, smoothness of movement, swelling, erepitation, and presence of nodule

and over sigmoid colon

Equal size on both sides of the body No contractures

Equal size on both sides of the body No contractures

Normal

Normal

No fasciculations or tremors Normally firm No deformities No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

No fasciculation and tremors Normally firm No deformities No tenderness or swelling No swelling No tenderness, swelling, crepitation or nodules Joints move smoothly

Normal Normal Normal Normal Normal Normal