IV.

PHYSICAL ASSESSMENT

Assessment Method Findings Interpretation

Integumentary
Skin Inspection With minimal Uremic frost is due to
amount of deposition of urea beneath the
uremic frost in skin which is seen in patient
the lower with chronic kidney disease.
extremities. Our patient has BUN level of
45.0 mg/dl indicating impaired
ability of kidney to excrete
urea.
Reference: Brunner and
Suddarth’s Medical-Surgical
Nursing 13th Edition Volume 2
page 1529

Pale in Paleness may be the result of

appearnce decreased
blood supply. It can also be
due to
decreased number of red blood
cells
(anemia).
Retrieved from
https://medlineplus.go

With good skin

Palpation turgor Characterized as normal
Hair Inspection With well- Characterized as normal
trimmed and
evenly
distributed black
hair. No
infection or
infestations.

Palpation With smooth Characterized as normal

and resilient
haiR

12
 IV. PHYSICAL ASSESSMENT

Nails Inspection Pale in Pale nail beds is due to

appearance. decrease circulating RBC in
patient with CKD. This is
because the function of kidney
to release erythropoietin, a
hormone that is known to
stimulate bone marrow to
produce RBC is impaired.
Patient E has 3.72x 10^23/L
level of RBC.
Reference: Brunner and
Suddarth’s Medical-Surgical
Palpation Delayed Nursing 13th Edition Volume 2
capillary refill page 1512.

Capillary refilling time is

prolonged in congestive heart
failure because the cardiac
output is reduce so there
occurs reduction in the
perfusion to tissues.
Reference: Brunner and
Suddarth’s Medical-Surgical
Nursing 13th Edition Volume 2
Skull Inspection Rounded Characterized as normal.
(normocephalic
and
symmetrical,
with frontal,
parietal, and
occipital
prominence),
smooth skull
contour.

Palpation Without
enlarged
nodules or
masses
Eyes and Vision

Eyebrows Inspection Even hair Characterized as normal

distribution,
even alignment,
equal movement
as facial
expression

13
 IV. PHYSICAL ASSESSMENT

changes.
Eyelashes Inspection Hair is present Characterized as normal.
and evenly
distributed along
the eyelid
margins and
curled slightly
outward.
Eyelids Inspection Skin intact, Characterized as normal.
similar in color
to the face, no
discoloration,
smooth and
uniform.

Meets
completely
when eyes
closed.
Lacrimal Inspection Absence of the Characterized as normal.
gland and bulge.
nasolacrimal
gland

Palpation No tenderness
on palpation
Lacrimal sac Inspection Absence of Characterized as normal.
and discharge,
nasolacrimal absence of
sac tearing, absence
of swelling
between the
nose and lower
eyelids.
Conjunctiva Inspection Pale to look at. Paleness may be the result of
and sclera decreased blood supply. It can
also be due to decreased
number of red blood cells
(anemia).
Retrieved from
https://medlineplus.gov/ency/article/
003
244.htm
Cornea, lens Inspection Cornea is Characterized as normal.
and pupil transparent,
smooth and
shiny.

There is a

14
 IV. PHYSICAL ASSESSMENT

positive corneal
reflex.

Black, equal in
size.
Constrict when
looking at near
object; pupils
dilate when
looking at far
objects.
Ears
Auricles Inspection Color of the Characterized as normal.
auricles is same
as facial skin,
symmetrical,
auricle is
aligned
with the outer
canthus of the
eye.

Palpation Mobile, firm,

non-tender, and
pinna recoils
after
it is being folded
External ear Inspection Without Characterized as normal.
canal impacted
cerumen
Nose and sinuses
External Inspection Color is same as Characterized as normal.
nose face,
symmetrical
appearance.
Nostrils Inspection With nasal Nasal flaring is when the
Flaring nostrils widen
while a person is breathing. It
is a sign
that the person is having
difficulty of
breathing.It is most commonly
seen in
children and infants; in those
cases nasal flaring can
indicate respiratory distress.
Retrieved from
http://healthtools.aarp.org/

Difficulty of breathing is one

15
 IV. PHYSICAL ASSESSMENT

of the symptoms of CKD.

Since Patient E’s kidneys are
impaired, retention of water
was induced. These fluids
which may have also
accumulated in the patient’s
lungs have caused respiratory
distress and thus, nasal flaring
is present.
Mouth and Oropharynx
Mouth and Inspection Movements of Characterized as normal.
Oropharynx lips when
smiling and
pursed are
symmetrical.

With pale lips. Paleness may be the result of

decreased
blood supply. It can also be
due to
decreased number of red blood
cells
(anemia).
Retrieved from
https://medlineplus.gov/ency/article/
003
244.htm
Tongue Inspection Moist with no Characterized as normal.
lesions and
aligned at the
midline.
Uvula Inspection Positioned in Characterized as normal.
midline of soft
palate.
Neck
Neck Inspection Position at the Characterized as normal.
midline

Without Characterized as normal.

presence of
lymph nodes

Palpation Thyroid gland Characterized as normal.

palpated at the
midline
Chest and Inspection Skin is intact Characterized as normal.
lungs and with
symmetric chest
expansion.

16
 IV. PHYSICAL ASSESSMENT

Palpation No masses
present and
warm to touch.

Auscultate With Crackles Indicates accumulation of

fluids due to fluid retention
and pulmonary edema.
Heart Auscultate S3 sound was S3 heart sounds results from
heard upon the impact of inflowing blood
auscultation. against a distended or in
compliant ventricle in mid
diastole since our patient has
left ventricular hypertrophy,
S3 heart sounds are common
in this condition.
Reference: Brunner and
Suddarth’s Medical-Surgical
Nursing 13th Edition Volume 2
page 689
Abdomen Inspection Symmetric, no Characterized as normal.
bumps and
bulges, or
masses, skin
intact, uniform
in color.

Auscultation With
normoactive
bowel sounds.
RUQ 5
LUQ 8
LLQ 8
RLQ 3

Palpation No abdominal Characterized as normal.

mass with
tenderness on
right upper
quadrant.
Upper Inspection Without scars, Characterized as normal.
extremities lesions
Lower Inspection With minimal After protein metabolism,
extremeties amount of some nutrients are absorbed by
uremic frost our body, while some become
waste products, such as urea.
When kidneys are healthy,
they can remove those waste
products from the blood, but

17
 IV. PHYSICAL ASSESSMENT

when kidneys fail to work,

they build up in the blood.
When their concentration is
very high in the blood, part
urea may be discharged out
with sweat. When sweat
evaporates, urea dissolves out
and deposits in the skin,
leading to uremic frost.
Retrieved from http://www.kidney-
cares.org/kidney-failure-symptoms-
complications/4727

Uremic frost is a pale frostlike

deposit of white crystals on the
skin caused by kidney failure
and uremia. Urea compounds
and other waste products of
metabolism that cannot be
excreted by the kidneys into
the urine are excreted through
Palpation With pitting
the small superficial capillaries
edema grade of
into the skin, where they
+ 2 on both
collect on the surface.
ankles noted. Retrieved from: Mosby's Medical
Dictionary, 9th edition

Kidney disease can cause foot

and ankle swelling. When
kidneys are not functioning
properly, fluid can build up in
the body.

Retrieved from
https://www.webmd.com/a-to-z-
guides/swollen-ankles-and-feet#2
Mental status Oriented and Characterized as Normal.
(Neurologic aware of his
assessment) environment.

18