Health

examination

Ms christine
Mn prev
 DEFINITION
• Health examination
• Health examination is the systematic
assessment of human body which involves the
use of one’s senses to determine the general
physical and mental conditions of the body
 Physical examination
• Physical examination is defined as a complete
assessment of a patient’s physical and mental
status.
• A physical assessment is the systematic
collection of objective information that is
directly observed or is elicited through
examination techniques
 Indication of health examination
• On admission
• On discharge
• On follow up
• Health camps
• Before and after diagnostic and therapeutic
procedure.
TECHNIQUE OF PHYSICAL
ASSESSMENT
INSPECTION
 GENERAL INSPECTION OF A CLIENT
FOCUSES ON
• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene
PALPATION
 PRINCIPLES OF PALPATION
• You should have short fingernails.
• You should warm your hands prior to placing them
on the patient.
• Encourage the patient to continue to breathe
normally throughout the palpation.
• If pain is experienced during the palpation.
discontinue the palpation immediately.
• Inform the patient where, when, and how the
touch will occur, especially when the patient cannot
see what you are doing.
LIGHT PALPATION
DEEP PALPATION
PERCUSSION
 TYPE OF PERCUSSION
• DIRECT PERCUSSION
INDIRECT PERCUSSION
AUSCULTATION
 FOUR CHARACTERISTICS OF SOUND
• 1.Pitch (ranging from high and low):frequency or
number of oscillations generated per second by
vibrating object
• 2. Loudness (ranging from soft to loud): amplitude
of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)
OLFACTION
 EQUIPMENTS
• STETHOSCOPE
OPHTHALMOSCOPE
OTOSCOPE
SNELLEN CHART
NASAL SPECULUM
VAGINAL SPECULUM
TUNING FORK
PERCUSSION HARMER
SPHYGMOMANOMETER
 POSITIONING
• Sitting/fowler’s
STANDING
SUPINE AND PRONE
DORSAL RECUMBENT
Sim’s
LITHOTOMY
KNEE-CHEST
PREPARING THE ENVIRONMENT
 PREPARING THE PATIENT
• PSYCHOLOGICAL PREPERATION
PHYSICAL PREPERATION
 ARTICLES REQUIRED

• Screen to provide privacy

• Bowl for antiseptic lotion
• Kidney tray and paper bag
• Weighing machine and height scale
• Patient gown
 ARTICLES REQUIRED
• Bath blanket to cover the patient
• Pair of leggings
• Draw sheet to cover patient’s chest
• Square drum containing test tube, gauze
piece, cotton swab, specimen bottle,
swabsticks
• Gloves
• lubricant
 ARTICLES REQUIRED
• Torch
• Ophthalmoscope
• Snellen’s chart
• Book for colour blindness
• Pen
• Flash card
• Autoscope with speculum of different sizes
• Percussion Hammer
• Tuning fork
 ARTICLES REQUIRED
• Nasal speculum
• Mouth gag
• Laryngeal mirror
• Tongue depressor
• Stethoscope
• Inch tape
 ARTICLES REQUIRED
• Sterile tray for vaginal examination
• Proctoscope
• VITALS TRAY
 ARTICLES FOR NEUROLOGICAL
• Powder, soap
EXAMINATION
• Snellan’s chart
• Pencil or pen
• Cotton wicks
• Torch
• Tuning fork
• Salt, sugar
 ARTICLES FOR NEUROLOGICAL
EXAMINATION
• Tongue depressor
• 2 test tubes one with hot water and other with
cold water
• Safety pins
• Some thing solid for grasping
• Sharp object like key
• Reading material to assess eyes and language of
person
• Knee harmer
 GENERAL SURVEY
• Identification data
• Gender and race
• Age
• Signs of distress
• Body type
• Posture
• Gait
 GENERAL SURVEY
• Body movements
• Hygiene and grooming
• Body odour
• Affect and mood
• Speech
• Substance abuse:
VITALS SIGNS
HEIGHT AND WEIGHT:
 ASSESSING INTEGUMENT SYSTEM
• Assessing skin
• Skin color
 Erythema
CYANOSIS
Jaundice
Pallor
Vitiligo
 Inspect skin vascularity
• Ecchymosis
Petechiae
C Inspect skin lesion
Palpate skin temperature, texture,
moisture and turgor
EDEMA
PITTING EDEMA
 PITTING EDEMA
• Grades of pitting edema
• Grade 0 : (none)
• Grade +1 :( trace , 2 mm)
• Disappear rapidly
• Grade +2 ( moderate , 4 mm)
• 10-15 sec
• Grade +3 (deep, 6 mm)
• ≥ 1min
• Grade +4 (very deep, 8 mm)
• 2-5min
 ASSESSING NAILS
• Shape; convex
• Angle : between nail and its base is 160 degrees
• Texture: smooth, nail base should be firm and
non tender
• Color: pinkish nail bed with translucent white
tips
• Capillary refill
 ABNORMALITIES OF NAIL
• Koilonychias (spoon nail)
• clubbing
• Paranychia
• indentations called (beau’s line)
 ASSESSING HAIR AND SCALP
• color,
• texture and distribution.
• Thickness and lubrication of hair
 INSPECT THE SCALP
• Cleanliness, color, dryness,
• Lump, lesions,
• Lice (pediculus humanus capitus)
• Dandruff etc
 HEAD AND NECK
• ASSESSING THE SKULL
• for size, symmetry
• any nodules or masses
INSPECT THE FACE
 ASSESS THE EYE
• Inspect external eye structure
• Position and alignment
• Exophthalmoses
• strabismus
 ASSESS THE EYE
• Eye brows
• Eye lid :
• ectropion(eversion ,lid margin turn out)
• entropion(inversion, lid margin turns inwards)
• ptosis( abnormal drooping of lid over pupil
 ASSESS THE EYE
• Eye lashes : sty.
• Eye balls
• Conjunctiva and sclera{ Paleness, redness or
purulent,jaundice}
 ASSESS THE EYE
• Cornea and iris :arcus senilis
• Pupil : PEERLA.
ACCOMMODATION
PUPILLARY REFLEX TO LIGHT
VISUAL ACUITY
INSPECT INTERNAL EYE STRUCTURES
EXTRA OCULAR MOVEMENTS
PERIPHERAL VISION
 EARS
• AURICLES
• EAR CANAL AND TYMPANIC MEMBRANE
 HEARING
• WEBER’S TEST:
• RINNE, S TEST:
NOSE AND SINUSES
 INSPECT THE MOUTH PHARYNX
AND NECK
• LIPS: lesions ,pallor (anemia),
cyanosis(respiratory cardiovascular problems),
cherry colored
• BUCCAL MUCOSA , GUMS AND TEETH: teeth look
for alignment , dental caries.buccal mucosa is a
good site to visualize jaundice and
pallor.leukoplakia (thick white patches ) is a
precancerous lesion.
• TONGUE
• FLOOR OF MOUTH
• PHARYNX:
 ABNORMAL FINDINGS
• pallor, cyanosis or redness
• lesions, swollen lips red tonsils, swollen red
bleeding gums,
• white coating of tongue fissured tongue from
dehydration.
• bright red tongue seen in deficiency of iron b12
or niacin,
• black tongue
ASSESS THE NECK
PALPATE TRACHEA AND LYMPH
NODES
PALPATE THE THYROID GLAND
 ASSESS THE THORAX AND LUNGS
• INSPECT THE THORAX
• Abnormal findings :increase in chest size and
contour , abnormal breathing pattern with the
use of accessory muscles, unequal chest
expansion, and abnormal breath sounds, barrel
chest, pigeon chest
PALPATE THE THORAX
PERCUSS THE THORAX
 AUSCULATE BREATH SOUND
• Bronchial sounds heard over the trachea are high –
pitched, harsh sounds with expiration longer than
inspiration .
• Bronchovesicular sounds: heard over the main
stem bronchus and is moderate (blowing) sound
with inspiration equal to expiration.
• Vesicular sounds are soft , low pitched and heard
best in base of lungs during inspiration longer than
expiration.
 ABNORMAL BREATH SOUNDS
• WHEEZE
• RHONCHI
• CRAKLES
• FRICTION RUB
 CARDIO VASCULAR SYSTEM
• INSPECT NECK AND PRECORDIUM
• PALPATE THE PRECORDIUM
• AUSCULATATE HEART SOUND
AUSCULATATION
 ASSESSING THE BREAST AND AXILLA
• INSPECT BREAST AND AXILLA
• PALPATION OF BREAST AND AXILLA
ASSESSING THE ABDOMEN
QUATRANTS OF ABDOMEN
INSPECT THE ABDOMEM
AUSCULTATE BOWEL SOUNDS
PERCUSS THE ABDOMEN
PALPATE THE ABDOMEN
 ASSESS MUSCULO SKELTAL SYSTEM
• INSPECT AND PALPATE MUSCLE
 MUSCULO SKELTAL SYSTEM
• PALPATE THE BONES
• INSPECT AND PALPATE THE JOINTS
• INSPECT SPINAL CURVES
• kyphosis
• Lordosis
• Scoliosis
 ASSESSING MALE AND FEMALE
GENITALIA
• INSPECT AND PALPATE FEMALE GENITALIA
INSPECT AND PALPATE RECTUM AND
ANUS
NEUROLOGICAL SYSTEM
MENTAL AND EMOTIONAL STATUS:
BEHAVIOR AND APPEARANCE
LANGUAGE
 INTELLECTUAL FUNCTION
• Memory
• Knowledge
• Abstract thinking
• Association
• Judgment
 CRANIAL NERVE FUNCTION
• Olfactory nerve(1):
• Optic nerve(2)
• Occulomotor(3)
• Trochlear(4)
• Trigeminal(5)
• Abducens(6)
 CRANIAL NERVE FUNCTION
• Facial(7)
• Auditory(8).
• Glossopharyngeal(9)
• Vagus(10)
• Spinal accessory(11
• Hypoglossal(12)
 MOTOR FUNCTION
• Balance and gait
• Romberg’s test
• Motor function and coordination
SENSORY FUNCTION
 REFLEX FUNCTION
• Biceps reflex
• Triceps reflex
• Knee and patellar reflex
• Ankle/ Achilles tendon reflex
• Babinski reflex
• Abdominal reflex
 PERIPHERAL VASCULAR SYSTEM
ASSESSMENT
• ALLEN’S TEST
• BUERGER’S TEST
• CAPILLARY REFILL
• HOMAN’S SIGN
• PALPATE PERIPHERAL PULSES
DOCUMENTATION OF DATA
AFTER CARE OF THE PATIENT
AFTER CARE OF ARTICLES