Scribd Upload a Document

Search Documents

Explore Sign Up | Log In

/ 6

Download this Document for Free

Palpation Angle approx.160 Firm nail base

Angle approx.16 0 Firm nail baseE y e s I n s pection Symmetricalw i t h n o droopin

g,infection, tumor so r o t h e r a bnormalities Visual Acuity:20/20 Sclera:White in li ght-

s k i n n e d w / o ex udates, lesionso r f o r e i g n bodie s. In darkskinned, may h a v e b r o w n patc hes

Pupils: equallyrou nd, reactive tol i g h t a n d ac commodation;2-6 mm No tearing, s w e l l i n g o r disch arge

Eyessymmetrical Visual acuity of 2 0/20 Sclera appearsw hite

Pupils equallyro und, reactive tol i g h t a n d acc ommodation;appro x. 4 mm No tearing,s w e l l i n g o r de scharge

No significantfin dings(pp.350362,HealthAssess ment &PhysicalE xamination Zator Estes)E a r s I n

s p e c t i o n Pa lpation Match fleshcolo r of the restof the skin. Central position. Proportional.

No redness,lesi ons, swelling,tendernes s S h o u l d n o t com plain of painor tenderness

Same color asfa ce Central position Proportional No redness,s w e l l i n g , o r te nderness

No pain assessed No significantfin dings(pp.386389,HealthAssess ment &PhysicalE xamination Zator

Estes) N o s e I nspection Symmetrical,midl ine of theface. Symmetrical andin midline

No significantfin dings

Palpation Withoutswelling, b leeding, lesions,or masses. Each nostril pate nt.

N o p a i n o r dis comfortduring palpation No swelling, b leeding, lesions,o r masses Patent nostrils

No pain or d iscomfort noted(pp.394397,HealthAssess ment &PhysicalE xamination Zator Estes)M o u t h I nspection

Breath smellsfres h. L i p s a n d mem branes pink and moist withn o le sions or inflamm ation.

T o n g u e i s midl ine. Pink,m o i s t , r o u g h without le sions. Symmetrical;move s freely.

G u m s h a v e pale -red strippledsurface. No swelling or bleeding. L i p s a n d me mbranes aremoi

st, dark fleshcolo red; no lesionsor inflammation T o n g u e i n mi dline and movesfreely

No swelling or bleeding No significantfin dings(pp.398405,HealthAssess ment &PhysicalE xamination Zator

Estes) N e c k I nspectionP alpation Symmetricalw i t h h e a d i n central position.

Able to movehe ad without disc omfort or notice able limits Muscless h o u l d b e symmetricalw ithout palpablema sses or spasm

Symmetricalw i t h h e a d i n central position Able to move h e a d w / o disc omfort

No palpablem asses No significantfin dings(p.331, Hea lthAssessment &PhysicalExamin ation Zator

Estes)C h e s t I nspection Withoutlesions; skin intact. Quiet, Without lesions

Quiet rhythmica nd effortless No significantfin dings

PalpationAuscultat ionrhythmic an deffortless breathi ng No pulsations,ma sses, thoracictende rness present.

Normal lungtiss ue producesreson ant sound,diaphr agm hasdull sounds. Bronchial, bronch ovesicular o r v e s

i c u l a r breath sounds breathing No masses or t enderness Bronchovesicular breath sounds(pp.451-

469,HealthAssess ment &PhysicalE xamination Zator Estes)A b d o m e nInspection AuscultationPercu ssionPalpation

Abdominalcontou r flat or rounded. Symmetrical. Uniform inc o l o r o r pigm entation.

No abdominalsca rs. No striae Intermittentgurgli ng soundsthrough outabdominalquad rants.

Tympany, predomi nantsound heard N o o r g a n enla rgement palpable, or anymasses, bu lges,or swelling

Abdominalcontour rounded. Symmetrical. U n i f o r m i n col or. No scars; striae

Gurgling soundsin abdomen No friction rubs/audible bruits No significantfin dings(pp.552562,HealthAssess

ment &PhysicalE xamination Zator Estes)S u p r a p u b i c AreaInspection Palpation Withoutlesions

Urinary b l a d d e r not Without Lesions Urinary bladder n ot palpable

No significantfin dings(p.638,

palpable and nottender Fundam entals of N u r s i ng Kozier)G e n i t a l iaInspectio n Palpation

P u b i c h a i r dis tributed intriang ular form. More coarsethan scalp hair. No nits or lice.

Penis skin freeof lesions an dinflammation. Pubic hair evenlydistributed No nits or lice

No lesions or i nflammation No significantfin dings(pp.746753,HealthAssess ment &PhysicalE xamination Zator

Estes)R e c t u m Inspection Palpation No lesions,redn ess Sphincter intact Non-tender

In midline Redundant massn oted, reddish A dilated veinsee n as swollen,reddishbluemass signifie

shemorrhoids( p p . 5 5 - 5 6 , Medical Surgical Nursing, Harkness andDi ncher)Upper Extre mitiesInspection

Withoutlesions, sc ars or inflammatio n Without lesions,s c a r s o r inf lammation

No significantfin dings(p.579,Funda mentals of Nursin g, Kozier)Lower Extr emitiesInspectionP alpation

Withoutlesions, scars No edema Without lesions,sc ars No edema

No significantfin dings(p.579,Funda mentals of Nursin g, Kozier)

Physical Assessment Sample

Download this Document for FreePrintMobileCollectionsReport Document
Info and Rating
Follow carlylove

Share & Embed Related Documents

PreviousNext
1.
p.

p.

p.

2.
p.

p.

p.

3.
p.

p.

p.

4.
p.

p.

p.

5.
p.

p.

p.

6.
p.

p.

p.

More from this user

PreviousNext
1.
6 p.

Recent Readcasters

Add a Comment

Upload a Document
Search Documents

Follow Us!
scribd.com/scribd twitter.com/scribd facebook.com/scribd

About Press Blog Partners Scribd 101 Web Stuff Scribd Store Support

FAQ Developers / API Jobs Terms Copyright Privacy

Copyright 2011 Scribd Inc. Language: English